Recurrent Respiratory Infections In Children Research Articles

Supply of vitamins (A, E, D, C, B6, B12) and mineral substances (ZN, FE, MG, CA, P) for children with recurrent respiratory infections and deficiency correction of their deficiency as a possibility to prevent frequent respiratory infections

Introduction. Recurrent respiratory infections in children are a pressing problem in pediatrics. To maintain and function the immune system in children, their provision of vitamins and minerals is important.Purpose. To assess the provision of children with recurrent respiratory infections with vitamins (A, E, D, C, B6, B12, folic acid) and minerals (Zn, Fe, Mg, Ca, P) and to correct their deficiency with a vitamin-mineral complex.Materials and methods. The study was conducted on 65 children aged 3 to 8 years in 2 groups of children: group 1, children with RID, n = 50; group 2 – control, n = 15). An outpatient examination, a parent survey and a blood test for vitamins (A, E, D, C, B6, B12, folic acid) and minerals (Zn, Fe, Mg, total Ca, Ca++, P) were carried out. 30 children with RID were prescribed the vitamin and mineral complex, 1 tablet 2 times a day, with an assessment of vitamin and mineral sufficiency and the frequency of respiratory infections after the end of the dose.Results. In all examined children, both in the main and control groups, the most common were deficiencies of fat-soluble vitamins D (69%), A (40%), E (35%) and the minerals Zn (70%) and Fe (44%). In children with RID, deficiency of vitamins D, A and Zn was more common than in the control group (p < 0.05), in 96% of cases it was combined, more often in the form of a combined deficiency of fat-soluble vitamins D, A, E and minerals Zn, Fe (66% of cases). Taking vitamin-mineral complex in the 2nd prophylactic dose for 1 month contributed to an improvement in vitamin and mineral sufficiency and a decrease in respiratory morbidity in the next 2 months after stopping the drug.Conclusion. Vitamin-mineral complex can be successfully used to maintain vitamin and mineral levels and reduce respiratory morbidity in children with recurrent respiratory infections.

Recurrent Respiratory Infections in Children with Down Syndrome: A Review.

Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent Respiratory tract Infections (RRIs), leading to an increased rate of hospitalisation, a higher need for intensive care and fatality. With a literature review, we summarise here the main etiological factors for RRI in this category of patients, particularly focusing on airway malformations such as tracheomalacia, tracheal bronchus and bronchomalacia, comorbidities associated with the syndrome, like congenital heart diseases, dysphagia, gastroesophageal reflux, musculoskeletal involvement and obesity, and immunologic impairments, involving both innate and adaptive immunity. For these patients, a multidisciplinary approach is imperative as well as some preventive strategies, in particular vaccinations in accordance with their national schedule for immunization.

Recurrent respiratory infections in young school-age children and psychological maternal predictors

Recurrent respiratory infections (RRIs) in children remain a pertinent issue in modern medicine. According to literary data, the prevalence of this phenomenon can reach up to a quarter of the child population. RRIs adversely affect a child’s physical development, social adaptation, and give rise to intra-family conflicts. Purpose - to investigate the contribution of psychological predictors from the mother’s perspective in the development of recurrent courses of respiratory infections in their young school-age children. Materials and methods. The study included surveys of mothers (Spielberger-Hanin State-Trait Anxiety Inventory, the Varga-Stolin Parenting Attitudes Test) and their children (R. Temple, M. Dorki, E. Amen “Choose a face” projective test). The main group comprised children aged 5-7 years with RRIs according to the criteria of the 2021 Inter-Society Consensus. The control group consisted of children aged 5-7 years who experienced occasional acute respiratory infections. Results. In our study, 40 families (mothers and children) participated. We found that mothers of children with RRIs had significantly higher levels of state and trait anxiety, as well as a higher score in the “Cooperation” parenting attitude model compared to the control group. In the structure of the anxiety phenomenon in mothers of children from the main group, 43% of cases exhibited high anxiety levels. Additionally, a high score in maternal personal anxiety correlated with a predominant choice of ineffective parenting models. Conclusions. Mothers of children with a RRI have significantly higher levels of situational and personal anxiety (p<0.01). 43% of mothers of children with RRIs exhibit excessively high levels of personal anxiety. Furthermore, more anxious mothers tend to adopt the following parenting models towards their own children: “Little looser”, “Authoritarian hypersocialization” and “Rejection”. The predictive value in the development of RRIs in children is associated with the level of maternal trait anxiety and the psychological portrait of the mother-child relationship, namely the score for by the “Cooperation” model. Data collection and processing were conducted in accordance with the Helsinki Declaration of the World Medical Association regarding ethical principles in medical research involving human subjects. The informed consent of patients was obtained for the studies. No conflict of interests was declared by the authors.

Risk factors of recurrent respiratory infections in early school-age children

Acute respiratory infections (ARIs) annually rank first in the structure of infectious diseases both in Ukraine and worldwide. ARIs are the leading cause of disability and death in preschool children, and with recurrent episodes, they can impact the physical and psychological aspects of children's health, imposing a significant medical burden on families, healthcare systems, and society as a whole. Preventing recurrent respiratory infections (RRIs) can only be achieved through timely intervention in risk factors.Aim: to determine the influence of risk factors on the development of recurrent episodes of acute respiratory infections in children aged 5 to 7 years and to develop preventive measures for their control in primary healthcare settings.Materials and Methods. The authors retrospectively analyzed medical records of 342 children aged 5 to 7 years. The main group included children with RRIs (264), and the control group consisted of children with sporadic illness episodes (78). Results: the incidence of RRIs in children has two peaks at ages 3 and 6, which is likely associated with the commencement of attendance in childcare settings (kindergarten and school). Key prenatal and postnatal, clinical-anamnestic, and social risk factors that increase the likelihood of recurrent respiratory infections in younger school-age children were identified.Conclusions. factors significantly increasing the likelihood of developing RRIs in a child include: ARI episode within the first 6 months of life (OR = 22, 95% CI 11.6 - 41.7), previous pneumonia (OR = 12, 95% CI 3.7 - 40), and the presence of chronic infection foci in the form of tonsillitis (OR = 8.2, 95% CI 4.3 - 15.6), p=0.0001. Primary healthcare practitioners should follow strategies to modify these risk factors and not wait for further depletion of the child's adaptive potential (sanitation of chronic infection foci, promotion of breastfeeding, and tobacco cessation).

Рецидивирующие респираторные заболевания и активные герпесвирусные инфекции у детей: проблемы и варианты их решения

Background: recurrent respiratory infections (RRI) in children are a relevant medical and social issue. Reactivation of latent herpes simplex virus (HSV) infections is recognized as one of the leading causes of recurrent respiratory infections. Its rate in children is up to 40%. Therapeutic options for recurrent respiratory infections in children are discussed given the activity of HSV infections and immune disorder treatment. Aim: to assess the efficacy of inosine pranobex (Normomed®) for recurrent respiratory infections and active HSV infection in children. Patients and Methods: we examined 96 children aged 1–17 years who requested medical care in an outpatient department with complaints typical of recurrent respiratory infections and laboratory-confirmed active HSV infection. Children received inosine pranobex (50–75 mg/kg/day) in three 10-day courses (10-day breaks). 5±1 weeks after finishing therapy, control clinical and laboratory tests and virology were performed. The nature of ARI episodes during the follow-up period and HSV infection activity over time were evaluated. Results: during treatment, a reduction in the rate and severity of respiratory diseases was reported in 94% of children. Fever severity decreased twice (p=0.035), oropharynx condition improved in 66.7% (p<0.01), and the severity of lymphoproliferative syndrome reduced in 62.5% (tonsil hypertrophy in 52.1%, lymphadenopathy in 50.6%, hepatomegaly in 55.3%, splenomegaly in 66.7%). During treatment with inosine pranobex, a decrease in HSV infection activity was reported in 88.6% of children. The active HSV count also decreased. A significant (p<0.01) reduction in the percentage of patients with active HHV 6A/B (from 78.1% to 12.5%), Epstein– Barr virus (from 45.8% to 7.3%), and HSV type 1 (from 14.6% to 1.0%) was reported. Conclusion: significant improvement in the somatic and virological status of children with recurrent respiratory infections and HSV infection after a course of inosine pranobex, which is characterized by antiviral and immunomodulatory effects, was established. KEYWORDS: monthly respiratory infections, recurrent respiratory infections, Epstein–Barr virus, human herpes virus 6A/B, children, inosine pranobex, Normomed. FOR CITATION: Melekhina E.V., Preobrazhenskaia D.V., Muzyka A.D., Soldatova E.Yu., Gorelov A.V. Recurrent respiratory infections and active herpesvirus infections in children: problems and solutions. Russian Medical Inquiry. 2023;7(11):704–712 (in Russ.). DOI: 10.32364/2587- 6821-2023-7-11-2.

Перспективные иммуномодулирующие эффекты бактериальных лизатов в профилактике и лечении острых и реккурентных респираторных инфекций у детей

The incidence of influenza and acute respiratory infections (ARI) continues to grow, including due to limited opportunities for immunoprophylaxis of the most common respiratory infections, in particular, acute respiratory viral infections (ARVI). Attempts are being made to reduce the children susceptibility to respiratory pathogens through the rational use of nonspecific immunoprophylactic agents, among which bacterial lysates (BL) occupy a special place. BL key patterns, contributing to the prevention of viral infections, are innate immune response activation, excessive inflammatory response prevention, adaptive immune response stimulation. BL contain fragments of inactivated various pathogenic bacteria strains that are important in the ARI etiology. Obtaining lysates of bacterial strains is possible by mechanical or chemical lysis. The article discusses the results of preclinical and clinical studies on BL, as well as suggests the expediency of further study concerning the BL pharmacodynamic effects within the modern concept of trained immunity. The authors conclude that BL as a trained immunity inducer according to the rationally selected regimen can contribute to the respiratory infections' prevention both during COVID-19 pandemic and post-pandemic period. KEYWORDS: acute respiratory infections, acute respiratory viral infections, influenza, trained immunity, immunoprophylaxis, bacterial lysate. FOR CITATION: Zaplatnikov A.L., Kanner E.V., Kanner I.D., Girina A.A., Farber I.M., Maximov M.L. Promising immunomodulatory effects of bacterial lysates in the prevention and treatment of acute and recurrent respiratory infections in children. Russian Journal of Woman and Child Health. 2023;6(3):290–297 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-12.

Prediction of recurrent course of respiratory infections in premature infants

The problem of prevention of frequent respiratory diseases for children remains relevant. Among premature infants, the most vulnerable group are children with very low and extremely low birth weight. Therefore, the development of a clinical prognostic model for the development of respiratory recurrent infections in premature infants may be the basis for creating a preventive program of early intervention. Purpose - to determine the clinical and genetic determinants of the development of recurrent respiratory infections for children born with a body weight less than 1500 g and to develop an algorithm for early prediction of adverse effects. Materials and methods. A cohort prospective study was conducted, which involved 155 children with very low and extremely low body weight. Prediction of the development of recurrent respiratory diseases was performed using simple and step-by-step multiple logistic regression analysis. Genetic methods included polymorphism studies of the GSTP1, GSTT1, GSTM1, ACE, AGT2R1 and eNOS genes. Results. Important predictors of increased morbidity of the examined children in a simple logistic regression analysis were: body weight at 12 months <10 percentile, rickets in the first year of life and artificial feeding at discharge from the neonatal hospital. The study showed no effect of genes polymorphism of the glutathione-S-transferase family and genes of the renin-angiotensin system on the development of recurrent respiratory infections in children with born weight less than 1500 g. Conclusions. The developed model for predicting the recurrent course of respiratory infections for children born with a body weight less than 1500 g has a high specificity (95.35%) and moderate sensitivity (76.90%), which indicates the possibility of its use for a personalized approach to prevention adverse effects. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Primary care experience on Stimunex® gocce in children with recurrent respiratory infections: a real-world study during the COVID-19 pandemic era.

Respiratory infections (RI) significantly burden society, mainly when there are recurrent respiratory infections (RRI). Thus, there is a need to prevent RI in clinical practice. In this regard, the modulation of the immune system and resolution of the inflammatory cascade could represent an ideal way to prevent RI. Stimunex® gocce, a multicomponent food supplement, contains Sambucus nigra extract, β-glucan, Zinc, and Vitamin D3. This study investigated its ability to prevent RRI in children using a real-world setting: the pediatric primary care. Two hundred and ninety-eight children with RRI were enrolled in the current study. The food supplement was randomly prescribed to 160 children with RRI daily for 4 months (Active group); the remaining 138 children with RRI were treated only with standard therapy for RI (Control group). The number and duration of RI, parental perception of symptom severity and treatment efficacy, use of medications, and school and working absence were evaluated. Children treated with Stimunex® gocce had significantly less RI than the Control group, both concerning upper and lower RI (p˂0.001 and 0.003, respectively) during the follow-up period. Moreover, children in the Active group experienced shorter RI duration during the treatment and follow-up phases (p˂0.001 for both). In addition, parents of treated children perceived less severe symptoms and better treatment efficacy during the first and follow-up phases (p˂0.001 for all). The food supplement was well tolerated and there was no adverse event. The current real-world study demonstrated that Stimunex® gocce supplementation in children with RRI might safely prevent RI episodes and reduce RI duration. These outcomes should be highlighted as obtained during the COVID-19 pandemic era, characterized by a dramatic reduction of RI.

Immunoprophylaxis of influenza, acute and recurrent respiratory infections during the COVID-19 pandemic

The article notes features of the last epidemic season (2020-2021) in the form of extremely low activity of influenza viruses with SARS-CoV-2 remaining dominant in the etiological structure of acute respiratory viral infections. Presented own data indicating the heterogeneity of SARS-CoV-2 (Alpha, Delta, B.1.1.317, B.1.1.397, B.1.1.523) isolated from hospitalized patients was noted. An increase in the etiological role of bocavirus, alpha-coronavirus and metapneumovirus with a decrease in the frequency of parainfluenza viruses, adenoviruses, rhinoviruses and respiratory syncytial virus was established. An unusual shift of the period of maximum activity of respiratory syncytial virus to the 20th week was noted. Attention is paid to the need during the ongoing pandemic COVID-19 to fully immunize children as part of the National Immunization Calendar, also emphasized the role of mandatory annual vaccination against influenza. It is noted that the maximum protective effect of immunoprophylaxis of influenza acute and recurrent respiratory infections can be achieved with a combination of vaccination with bacterial lysates. The article presents a review of the literature and our data demonstrating the safety, good tolerability, and high clinical and immunological efficiency of polyvalent mechanical bacterial lysate for the prevention of acute and recurrent respiratory infections in children. It is shown that the use of polyvalent mechanical bacterial lysate during the prevaccination period makes it possible to substantially reduce the frequency of intercurrent infections, which reduces the number of temporary medical withdrawals and increases the coverage of vaccinations against influenza in organized groups to 85.1%. The role of trained immunity as one of the possible mechanisms providing nonspecific immunoprophylaxis during influenza vaccination and the use of bacterial lysates is discussed.

Рекурентні респіраторні інфекції в педіатричній практиці: ефективність застосування інозину пранобексу

В огляді літератури наведені сучасні дані щодо термінології та причини рекурентних респіраторних інфекцій у дітей, імунологічних основ рецидивування інфекцій респіраторного тракту в дитячому віці. Представлена схема стандартного обстеження дитини з рекурентними респіраторними інфекціями. Дана характеристика препарату інозин пранобекс із противірусною та імуномодулюючою дією. Узагальнено результати досліджень клінічної ефективності інозину пранобексу при рекурентних респіраторних інфекціях у дітей. Показані дозування і схеми застосування препарату інозин пранобекс при рекурентних респіраторних захворюваннях у дітей.

The Prevalence of Odontogenic Inflammatory Diseases in Frequently ILL Children

Many questions of etiology, pathogenesis, prevention and treatment of purulent-inflammatory processes of the maxillofacial region remain unresolved to this day, which explains the constant interest and attention of researchers to them (Roginsky V. V., Korinskaya N. N., 1996; Ushakov R. V. 1995; Kawai T. etal., 1998, etc.). Meanwhile, it is known that acute inflammatory processes of the maxillofacial region in children often develop with reduced immunological reactivity of the body, and the course of the disease and the likelihood of complications are largely determined by the initial indicators of immunity. In the structure of this pathology, a special place is occupied by odontogenic inflammatory diseases and their complications against the background of reduced immunity due to recurrent respiratory infections in children (Zuev V. P. 1994; Kazimirsky V. A. ssoavt, 1996, Henderson, 1995; Henderson, Wilson, 1995, 1996, etc.). The course of odontogenic infection in children has a number of features due to the relative immaturity of the child's organs and tissues, imperfection of immunity, abundance of lymphatic tissue, the presence of anatomical and physiological features of the structure of teeth and jaws, ease of damage and increased permeability to microbes of natural protective barriers, etc.

MAXILLOFACIAL AREA AND SOFT TISSUES OF ODONTOGENIC INFLAMMATORY DISEASES IN FREQUENTLY ILL CHILDREN

In the structure of this pathology, a special place is occupied by odontogenic inflammatory diseases and their complications against the background of reduced immunity due to recurrent respiratory infections in children (Zuev V. P. 1994; Kazimirsky V. A. ssoavt, 1996, Henderson, 1995; Henderson, Wilson, 1995, 1996, etc.).

Interactions of genetic variants and prenatal stress in relation to the risk for recurrent respiratory infections in children

Genetic variants may predispose children to recurrent respiratory infections (RRIs) but studies on genotype-environment interaction are rare. We hypothesized that the risk for RRIs is elevated in children with innate immune gene variants, and that prenatal exposure to maternal psychological distress further increases the risk. In a birth cohort, children with RRIs (n = 96) were identified by the age of 24 months and compared with the remaining cohort children (n = 894). The risk for RRIs in children with preselected genetic variants and the interaction between maternal distress during pregnancy and child genotype were assessed with logistic regression. The IL6 minor allele G was associated with elevated risk for RRIs (OR 1.55; 95% CI 1.14–2.12). Overall, there was no interaction between maternal psychological distress and child genotype. Exploratory analyses showed that, the association between the variant type of IL6 and the risk for RRIs was dependent on prenatal exposure to maternal psychological distress in males (OR 1.96; 95% CI 1.04–3.67). Our study didn’t find genotype-environment interaction between prenatal maternal distress and child genotype. Exploratory analyses suggest sex differences in gene-environment interaction related to susceptibility to RRIs.

COVID-19 and recurrent respiratory infections in children of Kazakhstan

The study goal was to investigate the COVID-19 clinical course in children with recurrent respiratory infections (RRI) in Nur-Sultan, Kazakhstan. Material and Methods — we conducted the retrospective analysis of 94 children with RRI, diagnosed with COVID-19, in Nur-Sultan, Kazakhstan. The study involved 53 males and 41 females. The inclusion criterion for the study was the frequency of RRI at least six times per year. In the course of our study, we split the patients among three groups and identified two phenotypes. These groups included children with RRI and atopic phenotype (Group 1), with D-deficiency phenotype (Group 2), and control group (Group 3) encompassing children with RRI lacking these phenotypes. Results — The most common symptoms of 94 pediatric patients were dry cough (94.7%), fever (81.9%), along with a loss of appetite and fatigue (76.6%). Malaise was observed in 74.5% cases, rhinorrhea was noted in 71.2% of patients, sore throat was detected in 64.9 % of children, and dyspnea was established in 45.7% of cases. We observed no statistical differences in clinical manifestations of COVID-19 among three groups of children. However, duration of hospitalization period, of fever, and of the catarrhal period differed significantly among the groups (р<0.001). Conclusion — In children with RRI and vitamin D deficiency, who were diagnosed with COVID-19, the course of the infection was unfavorable (which was confirmed by a longer hospital stay and catarrhal period), and a more severe intoxication syndrome was observed. In the group of children with atopic phenotype, a prolonged residual cough was detected.

Бактериальный лизат в терапии острых и рецидивирующих инфекций дыхательных путей у детей

Study Objective: To study the clinical efficacy of adding the novel mechanical bacterial lysate to the therapy and its effect for the local immunity in children with acute and recurrent respiratory infections in children. Study Design: comparative study. Materials and Methods. The study included 97 children hospitalised with uneventful moderate bronchitis. The subjects were divided into two groups comparable on all selection parameters. Study group: 54 patients, 3 to 10 years old, who had a microbial immunomodulatory (bacterial lysate) added to the standard therapy, 1 sublingual tablet once daily: 25 children with acute bronchitis — for 10 days; 29 children with recurrent bronchitis — 3 x 10 days with 20-day intervals. Control group included 43 children of the same age (22 subjects with acute disease and 21 — with recurrent disease) who were prescribed general therapy only. Clinical examination results and local immunity were assessed using rhinocytogram and cytokine status. Study Results. The clinical effect of the bacterial lysate was 2.4-fold reduction in acute respiratory infection rate. Acute respiratory infection duration reduced by 1.3 times. Arrest of the respiratory syndrome with the help of bacterial lysate was recorded in 10.3 ± 0.2 days, while in control group it was 13.5 ± 0.4 days (р = 0.041). The study group demonstrated statistically significant reduction in the neutrophil and epithelial cell court (rhinocytogram), interleukin-8 and tumour necrosis factor α, markers of a system respiratory inflammation. Conclusion. Prescription of the product for prevention and therapy ensures reduction in morbidity rates; it is well-tolerated, easy-to-use and has no adverse drug reactions, facilitating compliance in children and their parents. Keywords: children, acute and recurrent infections, bacterial lysate.

Бактериальные лизаты: традиционные представления и новая парадигма

This paper addresses published data on therapeutic, preventive efficacy, and safety of bacterial lysates (BLs) in pediatric practice. Studies on the mechanisms of action of BLs are discussed. Experimental evidence demonstrates that the preventive effect of BLs is maintained even in the high level of bacterial lysis characterized by the presence of only small peptides or even their fragments without antigenic properties. The authors discuss the potential involvement of BLs in the development of trained immunity, whose effects last less time than a conventional epitope-specific adaptive immune memory. The article provides a pathogenic basis for BL use to prevent and manage recurrent respiratory infections and control respiratory allergic diseases as a part of complex treatment. Our data demonstrate a high efficacy of polyvalent mechanical BL to prevent acute and recurrent respiratory infections in children of organized communities, a reduced rate of bacterial complications, and the rate of antibiotic prescription when using BLs. Good tolerability and the lack of adverse and side effects of BLs are emphasized. KEYWORDS: bacterial lysates, asthma, children, immunity, immune prophylaxis, polyvalent mechanical bacterial lysate, respiratory infections, recurrent respiratory infections, trained immunity. FOR CITATION: Zaplatnikov A.L., Girina A.A., Svintsitskaya V.I. et al. Bacterial lysates: conventional views and a new paradigm. Russian Journal of Woman and Child Health. 2021;4(3):284–291 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-284-291.

Is it possible to prevent respiratory pathology?

Acute respiratory infections are the most common reason to consult a paediatrician. Children, especially during critical periods of immune response, are one of the most vulnerable groups to infections. The prevention of recurring respiratory infections is very important, especially from the beginning of attending pre-school and school facilities. Since ancient times, preventive measures such as rational daily routine, sufficient physical activity, correction of nutritional status, phytotherapy and homeopathic treatment have been used. In recent years these children have been optimising their vitamin D status and taking antioxidant vitamins, micro- and macronutrients. To date, as a result of innovative research on the human microbiome, information has emerged on its impact on the human body as a whole. The connection of the intestinal microbiota with the brain (gut-brain axis), with the respiratory tract (gut-lung axis), the cardiovascular system, kidneys and even mental health has been proved. The use of multistrain and multispecies probiotics in the prevention of recurrent infections in children opens up new opportunities to influence the child’s immune response and to form food tolerance. Today, a new multistrain multispecies probiotic (manufacturer ADM Protexin, UK) for the prevention of recurrent respiratory infections in children has appeared on the market. Studies have shown that using several strains of lactobacillus contained in this probiotic leads to more consistent results than monostrains and placebo in the prevention of respiratory diseases. Given the problem of antibiotic resistance, especially in young children, the new possibilities of preventing acute respiratory diseases in children using multistrain and multispecies probiotics make it possible not only to reduce the number and severity of episodes of acute respiratory infections, but also to reduce the frequency of antibiotic use.

The Association Between Environmental Lead Exposure and Recurrent Respiratory Infections in Children Aged 3–7 Years in Shenyang, China

To investigate the lead exposure levels, and the effect of blood lead level (BLL) on recurrent respiratory infections in children aged 3-7 years in Shenyang. A case-control study including 78 children with recurrent respiratory infections and 141 controls was performed. Venous blood was obtained for BLL, and a questionnaire was completed. The BLL was significantly higher in children with recurrent respiratory infections than that in the control group [Median (IQR): 2.56 (1.29-6.19) vs 1.99 (0.90-5.92) µg/dL, P=0.029]. Children with BLL ≥1.95 µg/dL were more likely to be suffering from recurrent respiratory infections (OR=2.328, 95%CI=1.228-4.413) than those with BLL <1.95 µg/dL. High lead level can increase the risk of respiratory infections in preschool children.

Effects of Pidotimod on recurrent respiratory infections in children with Down syndrome: a retrospective Italian study

BackgroundChildren with Down syndrome (DS) show a high susceptibility to recurrent infections (RI), caused by immune defects and abnormalities of the airways. Our goal was to investigate the effects of Pidotimod on RI prevention in children with DS, comparing immune and clinical parameters before (T0) and after (T1) the treatment with Pidotimod.MethodsThe study was conducted at the Down syndrome outpatient Center of Bambino Gesù Children’s Hospital, in Rome. We reviewed the medical records of all children with a positive history for RI and who received oral prophylaxis of Pidotimod from September 2016 to February 2017.ResultsThirty-three children met the inclusion criteria (males: 51.5%; average age: 6 years ±SD: 3). We found a significant decrease in the number of children with upper respiratory infections (82% at T0 vs 24% at T1; p = 0,0001) and with lower respiratory infections (36% at T0 vs 9% at T1; p = 0.003) after treatment with Pidotimod. We also demonstrated a significant decrease in the number of children hospitalized for respiratory infections (18% at T0 vs 3% at T1; p = 0.03). We measured T and B cells in the peripheral blood and B cell function in vitro at T0 and T1. We found that the response to CpG improved at T1. A significant increase of B cell frequency (p = 0.0009), B cell proliferation (p = 0.0278) and IgM secretion (p = 0.0478) were observed in children with DS after treatment.ConclusionsOur results provided evidence that Pidotimod may be able to prevent RI in children with Down syndrome.

Recurrent respiratory infections in children: a study in clinical practice.

Recurrent respiratory infections (RRI) are very frequent in childhood. RRI are commonly associated with some co-morbidities and typical clinical features. This study aimed to test the hypothesis whether an ENT visit could identify predicting factors for IRR. Globally, 1,002 children (550 males, mean age 5.77 years) were consecutively visited at an ENT clinic. Clinical visit, nasal endoscopy, and skin prick test were performed in all patients. RRI were present in 633 (63.5%) children. Some parameters were predicting factor for RRI: male gender (OR=1.68), tonsil and adenoid volume, even if partially for some volume grading. On the other hand, familiar atopy (OR=0.68), acute otitis media (OR=0.29), and certain tonsil and adenoid size (OR range 0.68-0-47) seemed to be protecting factor for RRI. This real-life study showed that during an ENT visit it is possible to identify some predictive factors involved in RRI: some seem to be protective, whereas other seem to be predisposing. (www.actabiomedica.it)