Pediatric tracheotomies: changing indications and outcomes.

Objective/hypothesis: To study the outcomes and complications associated with pediatric tracheotomy, as well as the changing trend in indications and outcomes since 1970.

Study Design: Retrospective chart review at a major tertiary care children's hospital.

Methods: On children who underwent tracheotomy at Children's Hospital of the King's Daughters (Norfolk, VA) between 1988 and 1998, inpatient and outpatient records were reviewed.

Improved outcomes for hospitalized asthmatic children using a clinical pathway.

Background: Although asthma clinical pathways are used with increasing frequency, few controlled studies have evaluated the clinical and cost effectiveness of these pathways.

Objective: To evaluate the effect of an inpatient asthma clinical pathway on cost and quality of care for children with asthma.

Methods: One hundred forty-nine children were treated for status asthmaticus using an asthma clinical pathway in a children's hospital between September and December 1997.

Outcomes evaluation of a comprehensive intervention program for asthmatic children enrolled in medicaid.

Objectives: To evaluate health care and financial outcomes in a population of Medicaid-insured asthmatic children after a comprehensive asthma intervention program.

Design: Controlled clinical trial.

Setting: Pediatric allergy clinic in an urban, tertiary care children's hospital.

Outcomes analysis of a summer asthma camp.

Forty children with moderate to severe asthma were enrolled in an asthma camp. Changes in peak flow meter (PFM) and metered-dose inhaler (MDI) technique, health care utilization, and school absenteeism were evaluated. The mean post-PFM score at the end of camp (8.

Respiratory allergy and the relationship between early childhood lower respiratory illness and subsequent lung function.

In a study of 159 school-age children whose histories of outpatient visits for lower respiratory illness (LRI) had been documented from early infancy, we observed lower mean levels of small airway function in boys who had experienced two or more episodes of wheezing-associated LRI before 6 yr of age. To determine whether allergy was an important factor influencing this result, we examined relationships among the results of RAST tests for seven common inhalant allergens and concurrent lung function in 126 subjects who consented to venipuncture. Increasing values for the sum of scores for the seven RAST tests were associated with progressively lower mean levels of small airways function in boys with histories of recurrent wheezing LRI during the preschool years.

Lung function in school-age children who had mild lower respiratory illnesses in early childhood.

We examined the relationship between patterns of mild lower respiratory illness (LRI) experienced in early childhood and lung function in 89 boys and 70 girls 6 to 18 yr of age. The children's histories of outpatient visits for wheezing and nonwheezing LRI during the first 6 yr of life had been documented by physicians in a single pediatric practice. Most children were reported by their parents to have been free of recurrent respiratory symptoms during the 2 yr prior to lung function testing.

Noncomparability of cross-sectional and longitudinal estimates of lung growth in children.

Results from longitudinal and cross-sectional studies of pulmonary function are often compared. However, previous studies in adults suggest that results from longitudinal and cross-sectional studies are different and may not be comparable. In order to evaluate these differences further, prospectively collected data in a group of children were analyzed by both longitudinal and cross-sectional methods.

Presentation and management of postcricoid hemangiomata in infancy.

Phillips and Ruh (1912) were the first to describe a congenital hemangioma of the larynx. Sweetser subsequently classified laryngeal hemangiomata into infantile and adult types and noted differences in incidence, location, and symptoms. According to Sweetser, the infantile form is less common, is almost always subglottic, and presents with stridor which may be intermittent.

A study of spirometry in children from Mexico City.

A study was conducted in two elementary schools in Mexico City to determine values for pulmonary function tests in school-aged residents of Mexico City. The schools were located in Xalostoc, a highly industrialized area of Mexico City, and San Lorenzo, a suburban area of the city. Although data regarding atmospheric pollution were not available, there is an acknowledged higher level of macroenvironmental air pollution in Xalostoc.

Pulmonary function in children with sarcoidosis.

To document pulmonary function abnormalities in children with sarcoidosis, we reviewed the records of all children with this disease at the North Carolina Memorial Hospital. Spirometry was performed by 34 of 60 children at initial presentation and was repeated by 16 at least 1 yr after presentation (mean, 3.9 yr).

Serum cotinine as a measure of tobacco smoke exposure in children.

To document passive smoke exposure, we measured concentrations of serum cotinine, a major metabolite of nicotine, in 38 young children and compared the results with the smoking histories of home residents. Cotinine was detected in 26 children (68%), of which ten had no household exposure according to a questionnaire. The serum cotinine concentration was significantly elevated in blacks compared with whites after controlling for the number of smokers in the home.

Respiratory responses of vigorously exercising children to 0.12 ppm ozone exposure.

Changes in respiratory function have been suggested for children exposed to less than 0.12 ppm ozone (O3) while engaged in normal activities. Because the results of these studies have been confounded by other variables, such as temperature or the presence of other pollutants or have been questioned as to the adequacy of exposure measurements, we determined the acute response of children exposed to 0.

A longitudinal study of spirometry in young black and young white children.

Spirometry was performed longitudinally over a period of 8 yr on 72 children (29 black females, 26 black males, 9 white females, and 8 white males) starting as early as 3 yr of age. Weighted straight-line regressions of 6 maximal expiratory flow-volume parameters--forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), forced expiratory flow during the middle half of the FVC (FEF25-75), and maximal expiratory flows after 50 and 75% of the FVC had been exhaled (Vmax50 and Vmax75, respectively) - on height were computed and were found to describe adequately the data over a height range of 100 to 150 cm. Statistical comparisons of regression lines revealed significant differences for FVC and FEV1 when white females were compared with white males, white females with black females, and white males with black males, but not for black females with black males.

Risk factors associated with the development of chronic lung disease in children.

By better understanding the intrinsic and extrinsic factors that predispose children to chronic lung disease, strategies to prevent its development can be proposed. This article addresses conditions, such as bronchiolitis, croup, hyaline membrane disease, hydrocarbon ingestion, and near-drowning, that have been found to result in long-term changes in lung physiology. Also considered are the possible relationships of common respiratory infection, asthma, smoking, and air pollution to the development of chronic respiratory infection.

Postoperative pulmonary function in children. Comparison of scoliosis with peripheral surgery.

We measured lung volumes, forced expirograms, and arterial blood gases in 2 groups of elective pediatric surgical patients (mean age, 11.4 +/- SD 2.8; n = 11, 12 operations) the day prior to surgery (control) and between the first and eighth postoperative days.

Effect of allergic bronchoconstriction on airways epithelial permeability to large polar solutes in the guinea pig.

The effect of allergic bronchoconstriction on the permeability of the airway mucosa to large hydrophilic polar solutes was investigated in the guinea pig. After specific antigen (ovalbumin) challenge, there was a significant increase in the plasma levels of horseradish peroxidase (HRP) (molecular weight, approximately 40,000 daltons), 3H-dextran (approximately 10,000 daltons), and 14C-mannitol (approximately 182 daltons) compared with that in control animals aerosol-challenged with a nonspecific protein, lactoglobulin. The morphologic correlates of this enhanced transepithelial permeability after ovalbumin challenge appeared to be (1) increased HRP penetration of the epithelial tight junctions (p less than 0.

Dynamic respiratory mechanics in intact anesthetized hamsters.

A system for measuring parameters of ventilation and respiratory mechanics in intact anesthetized hamsters was developed. Means +/- SD of five weekly measurements in eight hamsters were 0.68 +/- 0.

The effects of acidosis and alkalosis on the metabolism of glutamine and glutamate in renal cortex slices.

Studies of the metabolism of glutamine and glutamate by renal cortex slices from acidotic, alkalotic, and control rats were performed. 88-95% of the glutamine and 104-115% of the glutamate taken up from the medium could be accounted for by the products found. Acidosis increased glutamine uptake and conversion to ammonia, CO(2), glucose, lactate, pyruvate, lipid, and protein.