Correlates of acute lower respiratory tract infections in children under 5 years of age in India.

BACKGROUND: In developing countries, acute lower respiratory tract infections (ALRTI) cause considerable morbidity, hospitalisation and mortality in children aged <5 years. METHODS: A prospective case-control study was conducted to identify potential socio-demographic, nutritional and environmental risk factors for ALRTI. The World Health Organization definition for ALRTI was used for cases. Healthy children attending child immunisation services were enrolled as controls. RESULTS: A total of 214 children, 107 cases and 107 controls, were enrolled. Among the cases, pneumonia, severe pneumonia and very severe disease constituted respectively 23.3%, 47.7% and 29%. Among cases and controls, the male-to-female ratio (1.3:1 vs. 0.9:1) and the proportion of infants (64.5% vs. 70.1%) were identical. Parents' literacy level was negatively associated with ALRTI. On multivariate logistic regression analysis, low socio-economic status (OR 4.89, 95%CI 1.93-12.36), upper respiratory infections in family members (OR 5.32, 95%CI 2.11-13.45), inappropriate weaning period (OR 3.01, 95%CI 1.12-8.07), malnutrition (OR 1.75, 95%CI 1.84-3.67), pallor (OR 7.18, 95%CI 2.08-24.82) and cooking fuel other than liquid petroleum gas (OR 3.58, 95%CI 1.23-10.45) were found to be significant risk factors (P < 0.05). CONCLUSIONS: The present study identified various risk factors for ALRTI, some of which are modifiable by effective community education and public health measures.

Meconium-stained amniotic fluid and meconium aspiration syndrome: a prospective study.

BACKGROUND: The incidence of meconium aspiration syndrome (MAS), associated perinatal factors, morbidity and deaths varies widely. This study aimed to assess the perinatal attributes and morbidity associated with MAS. METHODS: Over a 2-year period, all neonates born through meconium-stained amniotic fluid (MSAF) were observed for respiratory distress (RD). Birth details, chest radiograph (CXR) and clinical course were documented. Neonates with consistent CXR findings whose RD could not otherwise be explained were defined as MAS. RESULTS: Of 409 neonates born through MSAF, meconium was thick in 196 (47.9%). Fifty-five (13.4%) had RD and 45 (11.3%) were consistent with MAS. Six (1.5%) neonates died. Mean (SD) birthweight and gestation of MAS infants were 2721.9 (510.2) g and 38.67 (1.09) weeks, respectively. About one-third were of low birthweight and 28 were born by caesarean section. On univariate analysis, caesarean delivery, meconium in the trachea and thick meconium were the significant perinatal factors for the development of MAS. On multiple regression analysis, thick meconium was the only independent factor for MAS (OR 7.08, 95% CI 3.08-16.27, p<0.001). An Apgar score of

Cantrell syndrome in one of a set of monozygotic twins.

Cantrell syndrome is a rare syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium and the heart. The spectrum of anomalies varies widely. A full syndrome, probable syndrome and incomplete expression have been described. Less than 160 cases have been described in the world literature. Only one set of monozygotic twins concordant with the syndrome has been reported. To our knowledge, the syndrome affecting only one of a set of twins has not been reported. We report a premature infant, the first-born twin, with the syndrome. The omphalocoele was large, and heart abnormalities included dextrocardia with atrial septal defect. The co-twin is normal.

Dampened ventilatory response to added dead space in newborns of smoking mothers.

BACKGROUND: Term newborns can compensate fully for an imposed dead space (tube breathing) by increasing their minute ventilation. OBJECTIVE: To test the hypothesis that infants of smoking mothers would have an impaired response to tube breathing. DESIGN: Prospective study. SETTING: Perinatal service. PATIENTS: Fourteen infants of smoking and 24 infants of non-smoking mothers (median postnatal age 37 (11-85) hours and 26 (10-120) hours respectively) were studied. INTERVENTIONS: Breath by breath minute volume was measured at baseline and when a dead space of 4.4 ml/kg was incorporated into the breathing circuit. MAIN OUTCOME MEASURES: The maximum minute ventilation during tube breathing was determined and the time constant of the response calculated. RESULTS: The time constant of the infants of smoking mothers was longer than that of the infants of non-smoking mothers (median (range) 37.3 (22.2-70.2) v 26.2 (13.8-51.0) seconds, p = 0.016). Regression analysis showed that maternal smoking status was related to the time constant independently of birth weight, gestational or postnatal age, or sex (p = 0.018). CONCLUSIONS: Intrauterine exposure to smoking is associated with a dampened response to tube breathing.

Exhaled nitric oxide in chronically ventilated preterm infants.

Exhaled nitric oxide (eNO) levels were measured in eight ventilated infants, mean gestational age 25.8 (SD 1.7) weeks and postnatal age 55 (SD 39) days, before and after three days of dexamethasone treatment. The eNO levels fell from a mean of 6.5 (SD 3.4) to 4.2 (SD 2.6) parts per billion (p = 0.031) and the mean supplementary oxygen levels from 62% to 45% (p = 0.0078).

Effect of posture on respiratory function and drive in preterm infants prior to discharge.

Our objective was to determine the effect of posture on respiratory function and drive in prematurely born infants immediately prior to discharge. Twenty infants (6 oxygen-dependent), median gestational age 29 weeks (range, 25-32), were studied at a median postconceptional age (PCA) of 36 weeks (range, 33-39). On 2 successive days, infants were studied both supine and prone; each posture was maintained for 3 hr. The order on each day in which postures were studied was randomized between infants. At the end of each 3-hr period, tidal volume (Vt), inspiratory (Ti) and expiratory (Te) time, respiratory rate, and minute ventilation were measured. In addition, respiratory drive was assessed by measuring the pressure generated in the first 100 msec of an imposed airway occlusion (P(0.1)), and respiratory muscle strength was assessed by recording the maximum inspiratory pressure (Pimax) generated against an occlusion which was maintained for at least five breaths. Overall, tidal volume was higher (P < 0.05), but respiratory rate (P < 0.05), P(0.1) (P < 0.05), and Pimax (P < 0.05) were lower in the prone compared to the supine position. There were no significant differences in Ti or Te between the two postures. In oxygen-dependent infants only, minute volume was higher in the prone position (P < 0.05). In conclusion, posture-related differences in respiratory function are present in prematurely born infants studied prior to neonatal unit discharge.