Severity In Infants Research Articles

Safety of levetiracetam among infants younger than 12 months--Results from a European multicenter observational study.

There are limited data on the use of the antiepileptic drug (AED) levetiracetam for the treatment of infants. To prospectively evaluate the safety of levetiracetam oral solution and its impact on epilepsy severity in infants with different seizure types. This noninterventional post-authorization safety study included patients 1-11 months of age. Patients' treatment - levetiracetam dose, and addition, withdrawal or changes in the doses of concomitant medications and AEDs - was at the discretion of the physician. The primary variable was treatment-emergent adverse events (TEAEs). Of 101 infants, 75 completed and 26 discontinued the study. Mean age was 6.0 months, 50 were male, most (80%) took 1 ≥ concomitant AED and had cryptogenic or symptomatic epilepsy that was focal (38.6%) or generalized (20.8%), particularly frontal lobe epilepsy (20.0%) or West syndrome/infantile spasms (20.0%). Among known aetiologies, congenital factors (22.8%) such as dysplastic lesions or perinatal events (17.8%) were predominant. Overall, 54.5% of patients had ≥ 1 TEAE. Five patients experienced drug-related TEAEs - convulsion, irritability, somnolence and hypotonia, all listed in the product label, with the exception of hypotonia, which was reported for one patient and resolved without any change in study medication. Seven patients discontinued due to TEAEs, mainly due to infantile spasms and respiratory disorders. At study end, 71.8% of patients showed improvement in epilepsy severity, 18.8% remained stable and 9.4% showed worsening. Levetiracetam did not appear to have a negative effect on growth parameters. In this prospective study, which included the largest number of patients in this age range so far, levetiracetam was found to be well tolerated and efficacious for the treatment of infants with epilepsy.

Severity quantification of pediatric viral respiratory illnesses in chest X-ray images.

Accurate assessment of severity of viral respiratory illnesses (VRIs) allows early interventions to prevent morbidity and mortality in young children. This paper proposes a novel imaging biomarker framework with chest X-ray image for assessing VRI's severity in infants, developed specifically to meet the distinct challenges for pediatric population. The proposed framework integrates three novel technical contributions: a) lung segmentation using weighted partitioned active shape model, b) obtrusive object removal using graph cut segmentation with asymmetry constraint, and c) severity quantification using information-theoretic heterogeneity measures. This paper presents our pilot experimental results with a dataset of 148 images and the ground-truth severity scores given by a board-certified pediatric pulmonologist, demonstrating the effectiveness and clinical relevance of the presented framework.

Nasopharyngeal bacterial burden and antibiotics: Influence on inflammatory markers and disease severity in infants with respiratory syncytial virus bronchiolitis

Animal studies suggest that RSV increases nasopharyngeal (NP) bacterial colonization facilitating bacterial infections. We investigated the influence of antibiotic treatment and colonization with potentially pathogenic bacteria on inflammatory markers and disease severity in RSV-infected in infants. Healthy young infants hospitalized with RSV bronchiolitis (n=136) and age-matched healthy controls (n=23) were enrolled and NP samples cultured for potentially pathogenic bacteria including: Gram-positive bacteria (GPB): Staphylococcus aureus, Streptococcus pneumoniae, β-hemolytic Streptococcus; and Gram-negative bacteria (GNB): Moraxella catarrhalis and Haemophilus influenzae. Clinical parameters and plasma IL-8, IL-6 and TNF-α concentrations were compared according to the bacterial class and antibiotic treatment. Antibiotic treatment decreased by 10-fold NP bacterial recovery. Eighty-one percent of RSV infants who did not receive antibiotics before sample collection were colonized with pathogenic bacteria. Overall, GNB were identified in 21% of patients versus 4% of controls who were mostly colonized with GPB. Additionally, in RSV patients NP white blood cell counts (p=0.026), and blood neutrophils (p=0.02) were higher in those colonized with potentially pathogenic bacteria versus respiratory flora. RSV patients colonized with GNB had higher plasma IL-8 (p=0.01) and IL-6 (p<0.01) concentrations than controls, and required longer duration of oxygen (p=0.049). Infants with RSV bronchiolitis colonized with potentially pathogenic bacteria had increased numbers of mucosal and systemic inflammatory cells. Specifically, colonization with GNB was associated with higher concentrations of proinflammatory cytokines and a trend towards increased disease severity.

Scoring system for periventricular leukomalacia in infants with congenital heart disease.

Currently two magnetic resonance imaging (MRI) methods have been used to assess periventricular leukomalacia (PVL) severity in infants with congenital heart disease: manual volumetric lesion segmentation and an observational categorical scale. Volumetric classification is labor intensive and the categorical scale is quick but unreliable. We propose the quartered point system (QPS) as a novel, intuitive, time-efficient metric with high interrater agreement. QPS is an observational scale that asks the rater to score MRIs on the basis of lesion size, number, and distribution. Pre- and postoperative brain MRIs were obtained on term congenital heart disease infants. Three independent observers scored PVL severity using all three methods: volumetric segmentation, categorical scale, and QPS. One-hundred and thirty-five MRIs were obtained from 72 infants; PVL was seen in 48 MRIs. Volumetric measurements among the three raters were highly concordant (ρc = 0.94-0.96). Categorical scale severity scores were in poor agreement between observers (κ = 0.17) and fair agreement with volumetrically determined severity (κ = 0.26). QPS scores were in very good agreement between observers (κ = 0.82) and with volumetric severity (κ = 0.81). QPS minimizes training and sophisticated radiologic analysis and increases interrater reliability. QPS offers greater sensitivity to stratify PVL severity and has the potential to more accurately correlate with neurodevelopmental outcomes.

Relationship of Secondhand Smoke and Infant Lower Respiratory Tract Infection Severity by Familial Atopy Status

M Lemke, TV Hartert, T Gebretsadik, KN Carroll. Ann Allergy Asthma Immunol. 2013;110(6):433–437 The goal of this study was to establish atopic predisposition as a predictive factor to lower respiratory tract infection severity in infants with secondhand smoke (SHS) exposure. Study patients were 451 mother–infant pairs enrolled in TCRI (Tennessee Children’s Respiratory Initiative). This longitudinal prospective study assessed familial atopic predisposition and severity of viral respiratory infections in infants with SHS exposure. Term infants with a birth weight ≥2275 g were enrolled from September to May of 2004 to 2008 when they presented with lower respiratory tract infection …

PO-1029 Diagnostic Value Of Apoptotic Activity And Oxidative Stress In Community-acquired Pneumonia In Infants

Background Community-acquired pneumonia is one of the most studied pathologies of childhood, while the problem of diagnostics the disease severity still remains. Aim To increase the effectiveness of diagnostics the severity of community-acquired pneumonia in infants by studying the processes of neutrophils’ apoptotic activity and oxidative stress. Methods The study involved 73 infants with community-acquired pneumonia (moderate severity of disease was diagnosed in 44 children (I group); severe pneumonia – in 29 (II group)) and 23 healthy children of the control group. The intensity of neutrophils’ apoptosis and necrosis was determined by flow cytometry, the generation of superoxide anion (O 2 - ) – by spectrophotometric method, reactive oxygen species (ROS) – by fluorometric method. Results The intensive growth of neutrophils’ apoptosis was revealed in infants with community-acquired pneumonia of moderate severity (p c-1 c-2 The oxidative stress indicators correlated with disease severity. ROS generation indices in infants of I group – 17.23 (16.29; 18.73) RFU·ml -1 , II group – 24.11 (21.23; 25.75) RFU·ml -1 , p c-1 c-2 2 - – 1.13 (1.06; 1.14) nmol·(min·mL) -1 and 1.41 (1.33; 1.49) nmol·(min·mL) -1 accordingly, p c-1 c-2 The method of multiple regression analysis showed, that lowering of saturation in infants with severe pneumonia for 33.8% is interrelated with the changes of neutrophils’ apoptosis and necrosis, determined by the determination index, and confirm the diagnostic value of apoptotic activity. Conclusion The oxidative stress indicators allow to determine the community-acquired pneumonia severity in infants, and intensification of neutrophils’ necrosis with simultaneous inhibition of apoptotic activity is an accurate criterion of severe pneumonia.

Evaluation of IgG antibodies against Respiratory Syncytial Virus (RSV), and associated risk factors for severe respiratory tract infections in pre- school children in North-central, Nigeria

Childhood mortality and morbidity due to RSV is increasing. Our current study was aimed at determining the sero-prevalence rate of RSV IgG antibodies and investigates certain known risk factors for RSV disease severity in infants and pre-school children presenting with various forms of respiratory tract infections in Ilorin, Nigeria. About 280, children and 30, aged matched controls were enrolled into the study at the specialist hospital Ilorin. Blood testing for anti RSV IgG was done using a commercial ELISA kit by IVD Research Inc® Carlsbad. California U.S.A. Information regarding Nutritional status, socio-economic status and other demographic variables were collected. A prevalence rate of 85.7% was recorded among tested children and 23.3%, in controls, across age groups and gender. A statistically significant difference in age groups were recorded among patients with LRTI, (p <0.05), age <1 41%, age 1 <5, 27.6%. This was also the case for children with SRTI (Pneumonia and Bronchiolitis), with age < 1yr, 9%, and 1 <5yr, 19.8%. Analysed risk factors for disease severity showed thatnutritional status of children were statistically significant for disease severity, p-value, 0.039 (Chi square test). We report a high level of exposure to RSV in infancy and early childhood among children from a representative population in a major central Nigerian City, further studies into neutralising antibody levels and subtype distribution of RSV are advocated.

Importance of plasma endothelin-1 level in the evaluation of heart failure severity in infants with ventricular septal defect

Haemodynamic disturbances due to ventricular septal defect (VSD) can lead to heart failure (HF) and cause neurohormonal activation. Endothelin-1 (ET-1) clearance takes place mainly in the pulmonary circulation. We hypothesized that increased pulmonary blood flow in children with VSD could influence ET-1 level and reflect haemodynamic disturbances in these patients. To analyse usefulness of plasma ET-1 level in the evaluation of HF severity in infants with VSD without pulmonary hypertension. The study group included 34 children (aged 38-338 days, mean 130 ± 81 days) with VSD. Evaluation included history, physical examination, ET-1 level measurement, standard 12-lead electrocardiogram, chest X-ray, and transthoracic echocardiography in all children. The control group consisted of 31 healthy children. Mean plasma ET-1 level was significantly (p < 0.01) higher in the study group compared to the control group. We found no significant difference (p > 0.05) in mean plasma ET-1 level between children with or without HF. No significant correlation was found between plasma ET-1 level and the severity of HF. Infants with VSD show higher ET-1 level compared to healthy children. Plasma ET-1 level does not reflect the severity of HF in infants with VSD.

FiO2 predicts outcome in infants with respiratory syncytial virus-induced acute respiratory distress syndrome

Respiratory syncytial virus (RSV) infection can progress to acute respiratory distress syndrome (ARDS) in infants. ARDS is a life-threatening condition that is characterized by severe hypoxemia, defined as PaO(2)/FiO(2) ratio <300 mmHg. This ratio is used in many trials as the sole oxygenation criterion for ARDS. Recently, however, it has been shown in adults with ARDS that FiO(2), independently of the PaO(2)/FiO(2) ratio predicts mortality. Because epidemiology and outcome of ARDS differ strongly between children and adults, we determined if FiO(2) on admission (baseline FiO(2)) independently predicted the duration of mechanical ventilation (MV) and length of stay (LOS) in the pediatric intensive care unit (PICU) in infants with RSV-induced ARDS. Retrospective observational study. A 14-bed pediatric intensive care unit. One hundred twenty-nine mechanically ventilated infants with RSV-induced ARDS. None. Independent predictors for outcome, including baseline FiO(2) and PEEP, were analyzed using the cox regression model. Endpoints were duration of MV and LOS in the PICU. A higher baseline FiO(2) was independently associated with a longer duration of MV (HR 0.12, CI 0.02-0.87, P = 0.036) and increased LOS in the PICU (HR 0.09, CI 0.01-0.57, P = 0.023). Neither baseline PEEP nor PaO(2)/FiO(2) ratio correlated with outcome. FiO(2) level independently predicted outcome in infants with RSV-induced ARDS, whereas both PEEP and the PaO(2)/FiO(2) ratio did not. This suggests that FiO(2) should be taken into account in defining disease severity in infants with RSV-induced ARDS.

Whole Blood Gene Expression Profiles to Assess Pathogenesis and Disease Severity in Infants with Respiratory Syncytial Virus Infection

Respiratory syncytial virus (RSV) is the leading cause of viral lower respiratory tract infection (LRTI) and hospitalization in infants. Mostly because of the incomplete understanding of the disease pathogenesis, there is no licensed vaccine, and treatment remains symptomatic. We analyzed whole blood transcriptional profiles to characterize the global host immune response to acute RSV LRTI in infants, to characterize its specificity compared with influenza and human rhinovirus (HRV) LRTI, and to identify biomarkers that can objectively assess RSV disease severity. This was a prospective observational study over six respiratory seasons including a cohort of infants hospitalized with RSV (n = 135), HRV (n = 30), and influenza (n = 16) LRTI, and healthy age- and sex-matched controls (n = 39). A specific RSV transcriptional profile was identified in whole blood (training cohort, n = 45 infants; Dallas, Texas, US) and validated in three different cohorts (test cohort, n = 46, Dallas, Texas, US; validation cohort A, n = 16, Turku, Finland; validation cohort B, n = 28, Columbus, Ohio, US) with high sensitivity (94% [95% CI 87%-98%]) and specificity (98% [95% CI 88%-99%]). It classified infants with RSV LRTI versus HRV or influenza LRTI with 95% accuracy. The immune dysregulation induced by RSV (overexpression of neutrophil, inflammation, and interferon genes, and suppression of T and B cell genes) persisted beyond the acute disease, and immune dysregulation was greatly impaired in younger infants (<6 mo). We identified a genomic score that significantly correlated with outcomes of care including a clinical disease severity score and, more importantly, length of hospitalization and duration of supplemental O2. Blood RNA profiles of infants with RSV LRTI allow specific diagnosis, better understanding of disease pathogenesis, and assessment of disease severity. This study opens new avenues for biomarker discovery and identification of potential therapeutic or preventive targets, and demonstrates that large microarray datasets can be translated into a biologically meaningful context and applied to the clinical setting. Please see later in the article for the Editors' Summary.

Yenidoğan yoğun bakım ünitesine yatırılan yenidoğanlarda toplumda gelişen respiratuar sinsityal virüs pnömonisinin klinik seyri

Respiratory syncytial virus (RSV) is a major cause of pneumonia in infants worldwide. We aimed to evaluate the clinical course of community-acquired RSV pneumonia in newborns hospitalized in neonatal intensive care unit. All the newborns diagnosed as pneumonia were prospectively evaluated for RSV infection between November 2010 and April 2011. Fifty-four specimens of nasopharyngeal secretions were tested in parallel with the RAT and the multiplex real time polymerase chain reaction (RT- PCR). Downes' score was used to assess the disease severity in patients with pneumonia. RAT has a sensitivity of 90% and a specificity of 78.5%, as the PCR technique target assay. Four of the patients with RSV pneumonia had secundum atrial septal defect (ASD) and all of four needed mechanical ventilation support. The first day Downes' score was positively correlated with time of intravenous fluid requirement (p= 0.001, r= 0.48), total oxygen need (p= 0.000, r= 0.63), and re-enteral feeding (p= 0.001, r= 0.46). Blood pH (p= 0.031, r= 0.46) were negatively correlated with Downes' score. The second day Downes' score was higher in patients with ASD than those of without ASD (3.8 ± 2.6 vs. 2 ± 1.1, p= 0.01). The most possible risk factor for longer hospital stay was the higher second day Downes' score (p= 0.02 OR: 1.9, CI 95% (1.1-3.2). All infants were discharged from hospital in a good health. RAT is sensitive and specific in detecting RSV infections in newborns. Physicians may use Downes' score for evaluation of disease severity in infants with RSV pneumonia. In these patients, ASD has increased the disease severity.

Association between the clinical index and disease severity in infants with acute bronchiolitis

Purpose: We aimed to verify whether the formal clinical index derived from infants and toddlers have a good association with the disease severity when we confine subjects to only infants, who undergo profound changes physically and immunologically. Methods: We retrospectively reviewed the medical records of hospitalized infants with acute bronchiolitis caused by respiratory syncytial virus between January 1, 2010 and December 31, 2011 in three hospitals. The age, respiratory rate, presentation of chest retraction, and percutaneous oxygen saturation upon admission; presentation of fever, use of oxygen therapy and inhaled corticosteroid within 24 hours after admission were investigated. We then examined the effect of clinical index on severity of acute bronchiolitis; the mean length of stay, mean duration of fever and oxygen therapy. Results: A total of 172 infants were studied. The mean length of stay was longer in patients younger than 3 months (P=0.015), in those with fever (P=0.028) and chest retraction (P=0.014), and in those who needed oxygen supplement (P=0.000). In the patients with fever, the mean duration of fever was longer in those who needed the oxygen supplement than those who did not (P=0.046). Conclusion: Younger than 3 months of age, chest retraction upon admission; fever, need of oxygen supplement within 24 hours after admission may predict the severe course of infants with acute bronchiolitis.

Innate Immune Dysfunction is Associated with Enhanced Disease Severity In Infants with Severe Respiratory Syncytial Virus Bronchiolitis

Most patients with respiratory syncytial virus (RSV) bronchiolitis requiring admission to the pediatric intensive care unit (PICU) have no risk factors for severe disease. We sought to investigate the relationship between serum cytokine concentrations, innate immune responsiveness, and RSV disease severity. Previously healthy infants (median age, 2.6 months) with RSV bronchiolitis (PICU, n = 20; floor, n = 46) and healthy matched controls (n = 14) were enrolled, and blood samples were obtained within 24 hours of admission to measure plasma tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8), and interleukin 10 (IL-10) concentrations and, whole blood lipopolysaccharide-stimulated cytokine production capacity. Plasma IL-6, IL-8, and IL-10 concentrations were comparable between PICU and floor patients, but higher than in healthy controls (P < .05). In contrast, TNF-α, IL-6, and IL-8 production capacity was significantly decreased in PICU compared with both floor patients and healthy controls. In adjusted analyses, only impaired TNF-α and IL-8 production capacity were associated with longer length of stay (P = .035) and greater disease severity scores (P = .001). Infants with severe RSV bronchiolitis had increased plasma cytokine concentrations and yet impaired innate immunity cytokine production capacity, which predicted worse disease outcomes. Immune monitoring of otherwise healthy infants with RSV lower respiratory tract infection could help identify patients at risk for severe disease at the time of hospitalization.

Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication

To identify factors that predict the expression of neonatal abstinence syndrome (NAS) in infants exposed to methadone or buprenorphine in utero. Multi-site randomized clinical trial in which infants were observed for a minimum of 10 days following birth, and assessed for NAS symptoms by trained raters. A total of 131 infants born to opioid dependent mothers, 129 of whom were available for NAS assessment. Generalized linear modeling was performed using maternal and infant characteristics to predict: peak NAS score prior to treatment, whether an infant required NAS treatment, length of NAS treatment and total dose of morphine required for treatment of NAS symptoms. Of the sample, 53% (68 infants) required treatment for NAS. Lower maternal weight at delivery, later estimated gestational age (EGA), maternal use of selective serotonin re-uptake inhibitors (SSRIs), vaginal delivery and higher infant birthweight predicted higher peak NAS scores. Higher infant birthweight and greater maternal nicotine use at delivery predicted receipt of NAS treatment for infants. Maternal use of SSRIs, higher nicotine use and fewer days of study medication received also predicted total dose of medication required to treat NAS symptoms. No variables predicted length of treatment for NAS. Maternal weight at delivery, estimated gestational age, infant birthweight, delivery type, maternal nicotine use and days of maternal study medication received and the use of psychotropic medications in pregnancy may play a role in the expression of neonatal abstinence syndrome severity in infants exposed to either methadone or buprenorphine.

Urine viral load and correlation with disease severity in infants with congenital or postnatal cytomegalovirus infection

BackgroundA correlation between cytomegalovirus (CMV) load in urine and severity of disease in congenitally infected infants has previously been reported. CMV load in postnatally infected infants has not been studied before. ObjectiveTo investigate CMV load in urine of infants with postnatal or congenital infection and correlate this with clinical symptoms of CMV disease and cerebral abnormalities. Study designInfants admitted to our NICU between July 2000 and February 2010, and diagnosed with congenital or postnatal CMV infection were included. Clinical symptoms of CMV infection, cranial ultrasonography (cUS) and magnetic resonance imaging (MRI) findings were evaluated. CMV urine loads of postnatally infected infants were analyzed and compared with CMV urine loads of congenitally infected infants. ResultsSeventeen infants with congenital CMV infection and 45 infants with postnatal CMV infection were included. Thirteen/17 (76%) congenitally infected infants had clinical symptoms of CMV infection at birth and 11/17 (65%) had cerebral abnormalities diagnosed by neuro-imaging. None of the four asymptomatic infants had cerebral abnormalities. Of the postnatally infected infants 43/45 (96%) did not develop any clinical symptoms of CMV infection, but in 23/45 (51%) cerebral abnormalities such as lenticulostriate vasculopathy and germinolytic cysts were identified. The median CMV load in postnatally infected infants was significantly lower than in congenitally infected infants (1.0×105copies/ml versus 8.5×106copies/ml, p<0.001, respectively). ConclusionsCMV load in urine is significantly lower in infants with postnatal CMV infection than in infants with congenital CMV infection irrespective of clinical symptoms of CMV infection or cerebral abnormalities.

PH-dependent entry of chikungunya virus into Aedes albopictus cells

BackgroundThe chikungunya virus (CHIKV) recently caused explosive outbreaks in Indian Ocean islands and India. During these episodes, the virus was mainly spread to humans through the bite of the mosquito Aedes albopictus. Concomitantly to the description of symptoms of an unexpected severity in infants and elderly patients, a viral genome microevolution has been highlighted, in particular consisting in the acquisition of an A226V mutation in the gene encoding envelope glycoprotein E1, which was later found to confer an increased fitness for A. albopictus. We previously decrypted the entry pathway used by CHIKV to infect human epithelial cells and showed that these mechanisms are modulated by the E1-A226V mutation. In this report we investigated the conditions for CHIKV entry into mosquito cells and we assessed the consequence of E1 gene mutation on these parameters. Principal findingsOur main findings indicate that CHIKV infection of A. albopictus cell lines is sensitive to Bafilomycin A1 and chloroquine and to membrane cholesterol depletion.The E1-226V mutated LR-OPY1 isolate collected during the 2005 outbreak in La Réunion replicated more efficiently than the 37997 African reference strain in C6/36 cells. Moreover, the LR-OPY1 strain displayed greater membrane cholesterol dependence and was more sensitive to inhibition of endosomal pH acidification. Finally, using electron microscopy, we imaged CHIKV entry into C6/36 cells. ConclusionsOur data support that CHIKV is endocyted into A. albopictus cells and requires membrane cholesterol as well as a low-pH environment for entry. These features are modulated in some extent by the A226V mutation in the E1 gene of the LR-OPY1 isolate. Altogether, our data provide information regarding the pathways used by CHIKV to infect A. albopictus cells.

Influence of host and environmental factors on wheezing severity in infants: findings from the PARIS birth cohort

Determinants of wheezing severity are poorly documented in infants. To study the determinants of wheezing severity in infants aged 18months followed-up in the PARIS («Pollution and Asthma Risk: an Infant Study») birth cohort. Data on wheezing disorders, medical visits and medications, as well as biological markers of atopy, were collected during a medical examination at age 18months. Severe wheeze was defined as wheeze that required inhaled corticosteroid and/or hospital-based care. Environmental exposures were assessed prospectively with regular questionnaires. Risk factors for wheeze in the first 18months of life were assessed by multivariate regression models. Participation in the medical examination concerned 48.2% of the original cohort. Prevalence of wheeze was 560/1879 (35.7%) and was influenced by male gender, parental history of asthma, siblings, daycare attendance, heavy parental smoking at home, and carpet covered floor in the child's bedroom. Being overweight increased the risk of wheeze by 62% (OR=1.62, 95%CI 1.13-2.32). In addition, trends towards an increased risk of wheeze were found in infants exposed to daily use of cleaning sprays and to renovation activities. Conversely, the presence of a cat reduced the risk of wheeze (OR=0.65, 95%CI 0.47-0.89), without any evidence of healthy-pet keeping effect. Severe wheeze concerned 286 of the wheezers (42.7%). The prevalence of severe wheeze was related to atopy, and risk of severe wheeze was in particular increased in infants having eosinophilia (OR=1.76, 95%CI 1.21-2.55) or being sensitized to ≥2 allergens (OR=1.88, 95%CI 1.13-3.14). Whilst risk factors for wheeze before 18months of age are factors related to infections, indoor air pollution, and being overweight, the severity of wheeze is mainly due to the atopic status of the child. We suggest that atopy should be further considered in the assessment of wheezing severity in infants.

Effect of Brewed Black Tea as Adjust Treatment in Severity of Infants' Conjunctivitis

Material & Methods: This was a randomized clinical trial study in the Pediatric Clinic of Amir Kabir Hospital in Arak, Iran. A total of 110 infants were randomized into 2 treatment groups who received either brewed black tea add ophthalmic erythromycin ointment 1% with sulfastamid drop 10% (group A)TDS or just antibiotics (group B) for 7 days. In group A, before used of antibiotics sticky eyelids were wiped with sterile cotton of brewed black tea and in control group just antibiotics were applied. Severity of conjunctivitis at first, 3th and 7th days during treatment and duration of disease were determined. Results: At first day of prescribing strategies, group A severity of infants' conjunctivitis were mild in12/7 %( 7), moderate 32/7 %( 18) and sever 54/5 %( 30). In just antibiotics were 18/2 %( 10), 30/9%(17), 50/9 %( 28) respectively. Difference wasn't significant. At 3rd day, in group A 74/5 %( 41) of infants were cured, in 25/5%( 14), severity were mild. In control group, 9/1 %( 5) cured, mild were 21/8 (12), moderate 47/3 %( 26) and sever 21/8 %( 12). Differences was significant (P=0/001). At 7th days, in group A 100 %( 55), in just antibiotics 34/5 %( 19) were cured. Mild severity of conjunctivitis were 45/5 %( 25) and moderate were 20 %( 11), in control group. Conclusion: Brewed black tea adds antibiotics reduced severity of infants' conjunctivitis and duration of treatment. It seems it is safe; effectiveness, accessible and cost benefit for adjust treatment of this disease.

Postoperative regional distribution of pulmonary ventilation and perfusion in infants with congenital diaphragmatic hernia

Background/Purpose Advances in management of patients with congenital diaphragmatic hernia (CDH) have improved mortality rates but with a risk of increased pulmonary morbidity. The prognosis for CDH survivors remains difficult to predict owing to the lack of adequate methods. We used single photon emission computed tomography (SPECT) to measure the regional distribution of ventilation and perfusion in CDH infants to quantify the degree of lung function impairment and relate it to neonatal clinical disease severity. Methods Single photon emission computed tomography was performed in 12 CDH infants at the mean age of six months. Ventilation and perfusion were traced with 5 MBq Technegas and technetium-labelled albumin macro-aggregates, respectively. Neonatal clinical data collected during the patient's stay in the pediatric intensive care unit was correlated with the SPECT data. Results Single photon emission computed tomography revealed varying degrees of ventilation-perfusion abnormalities which correlated with the presence of pulmonary artery hypertension, days on ventilator and days on extracorporeal membrane oxygenation. Conclusions The grade of clinical disease severity in infants following CDH repair is closely related to the ventilation-perfusion abnormality as seen using SPECT. The persistence of pulmonary artery hypertension into the postoperative neonatal period appears to be an important pathophysiological factor related to ventilation-perfusion abnormalities. Single photon emission computed tomography provides valuable clinical information for patient follow-up.

Inverse correlation between varicella severity and level of anti-Varicella Zoster Virus maternal antibodies in infants below one year of age

Varicella, a widespread disease of childhood, is usually benign but may in some instances lead to complications and eventually death. The aim of this study was to assess whether varicella severity in infants below one year of age was associated with the level of anti-varicella zoster virus (VZV) maternal antibodies. Two different data sets were used. Data on varicella-associated complications were collected through a national surveillance network involving 175 hospital-based pediatric wards. Data on levels of maternal acquired antibodies according to infants’ age were extracted from a cohort of 345 full term infants enrolled in a prospective multicenter study in seven pediatric wards and/or pediatric emergency units. Among infants hospitalized for varicella complications, the overall prevalence of complications increased regularly from 10.4% in infants below 1 month of age to over 72.4% at 5 months of age. Conversely, the mean antibody titre decreased from 536 mIU/mL in the [0–1 [month group to below the 150 mIU/mL threshold at 3–4 months [Pearson coefficient = -0.956 (p < 0.001)]. Based on large numbers of infants, our results show for the first time, a strong inverse correlation between the levels of circulating anti-VZV maternal antibodies in full term infants and occurrence of varicella complications below one year of age. Infant protection could be optimized by increasing herd immunity, reducing the susceptibility of women in childbearing age and lowering the age of routine vaccination to 9 months. Additional vaccination for unprotected persons in close contact with infants below 12 months of age could be promoted.