Increasing incidence and improved survival of cancer in children and young adults in Southern Netherlands, 1973-1999.

The aim of this study was to describe time trends in incidence, treatment and survival of children (0-14 years) and young adults (15-24 years) with cancer in an area in the Netherlands with a long registration period. Between 1973 and 1999, the population-based Eindhoven Cancer Registry (ECR) recorded 852 children and 1162 young adults with a malignancy and they were actively followed up until 1 July, 2003. The world standardised incidence rates for both children and young adults showed an increasing trend until 1997 and this flattened off afterwards (estimated annual percentage change [EAPC]=3.1%, P=0.66 for children and EAPC=3.6%, P=0.06 for young adults). Lymphomas in children and testicular malignancies and melanomas in young adults seemed to increase in particular. Better detection probably led to higher completeness for gliomas. Initial treatment for leukaemias and lymphomas in children has changed, protocols prescribe more chemotherapy and less radiotherapy. For all cancers combined, the 10-year survival rate for children significantly improved from 53% (95% confidence interval [95% CI] 45-61%) in 1973-1982 to 75% (95% CI 69-81%) in 1993-1999 (P-value<0.05). The 10-year survival rate for young adults significantly improved from 57% (95% CI 49-65%) to 81% (95% CI 77-85%) (P-value<0.05). We demonstrated significantly higher five-year survival rates for children with Hodgkin's disease (HD) and young adults with HD, non-seminoma or melanoma diagnosed in 1993-1999.

Neonatal respiratory mechanics and development of bronchial hyperresponsiveness in preterm infants.

BACKGROUND: In preterm ventilated infants, irreversible damage to the airway mucosa in the neonatal period might be related to the development of bronchial hyperresponsiveness (BHR) in subsequent years. AIMS: To evaluate whether neonatal indicators of long-term respiratory morbidity, respiratory system compliance (Crs) and resistance (Rrs), were causally related to bronchial responsiveness at the age of 2 and whether these relationships were affected by other factors. STUDY DESIGN: Mean neonatal Crs and Rrs of the first 3 days of life were assessed using the single breath occlusion technique. Bronchial challenge tests were performed at 2 years of age. When wheezing occurred during chest auscultation or oxygen saturation decreased below 90%, the provocative concentration of methacholine was recorded. SUBJECTS: Forty-five preterm infants of <37 weeks gestation, being mechanically ventilated within 24 h after birth. RESULTS: Decreased neonatal Crs was related to BHR (beta per ml/kPa, 0.061; 95% confidence interval, 0.019 to 0.103; p=0.006). Correction was required for radiological gradation of respiratory distress syndrome, the maximal peak inspiratory pressure required during mechanical ventilation and postnatal corticosteroid therapy. Neonatal Rrs, gestational age and birth weight were not related to subsequent BHR development. CONCLUSION: In ventilated preterm infants, decreased neonatal Crs was related to the development of BHR at the age of 2.

Chest radiograph scores in preterm infants: interobserver agreement and relation to respiratory function.

To evaluate scoring systems for chest radiographs, we determined interobserver agreement and relation to the lung function during the 1st week of life in ventilated preterm infants. Three independent observers examined chest radiographs by applying radiological scores according to Lischka, Yuksel, Greenough, Toce, and Giedion on postnatal days 2 and 7. Kappa statistics was used to assess the interobserver agreement. By means of regression analysis, mean scores and individual radiological scores of the three observers were studied in relation to ventilation and oxygenation indices and respiratory system resistance and compliance. Forty-eight radiographs were evaluated on day 2 and 17 radiographs on day 7. All scoring systems showed kappa values equal to or <0.5. Regression analysis revealed no significant associations between radiological scores and ventilator requirements or respiratory mechanics. We conclude that in ventilated preterm infants radiological scoring systems showed a poor interobserver agreement and that they were not related to the actual respiratory function.

Respiratory outcome in preterm ventilated infants: importance of early respiratory system resistance.

UNLABELLED: Since severity of acute respiratory distress syndrome (RDS) has been decreasing, the aetiology of long-term respiratory problems may have changed in preterm infants. We investigated whether early neonatal respiratory resistance (Rrs) and compliance (Crs) were important determinants of respiratory morbidity and lung function abnormalities during the 1st year of life in ventilated preterm infants. In 70 infants of less than 37 weeks gestation, mechanically ventilated within 24 h after birth, Rrs and Crs were assessed daily during the first 3 days of life and medians were calculated subsequently (Rrsneo and Crsneo). Rrs and Crs were reassessed 1 year later in 57 of 70 infants (Rrs(1 year) and Crs(1 year)). After correction for endotracheal tube size, increased Rrsneo was significantly related to respiratory morbidity during the 1st year of life (OR 1.20, 95% CI 1.04 to 1.38; P = 0.013), increased Rrs(1 year) (multiplicative beta per kPa/l x s 1.017, 95% CI 1.000 to 1.034; P = 0.045), and decreased Crs(1 year) (multiplicative beta per kPa/l x s 0.986, 95% CI 0.974 to 0.998; P = 0.023). Associations were not adversely affected by degree of prematurity, neonatal disease and treatment. Crsneo did not show any significant associations. In the current surfactant era, increased Rrsneo, and not Crsneo was associated with poor respiratory outcome during the 1st year of life in preterm ventilated infants. Relationships were not adversely affected by measures reflecting degree of prematurity, neonatal disease, and ventilator conditions. CONCLUSION: our results indicate that inborn properties of the respiratory system have become increasingly important in relation to respiratory outcome instead of neonatal disease and treatment conditions.

Correction factors for oxygen and flow-rate effects on neonatal Fleisch and Lilly pneumotachometers.

OBJECTIVE: To assess the effects of different oxygen concentrations and flow rates on the measurement errors of neonatal pneumotachometers in heated and unheated situations and to develop correction factors to correct for these effects. DESIGN: Prospective laboratory study. SETTING: Outpatient clinic with equipment in a standardized setting. SUBJECTS: Neonatal pneumotachometers. INTERVENTIONS: In standardized conditions, the tested pneumotachometer was calibrated at a flow rate of 3 L/min with 60% oxygen and was set in series with a closed spirometer system being used as a reference. Different air-flow levels (1-9 L/min) and oxygen concentrations (21-100%) were infused into the closed system with the pneumotachometer and spirometer. MEASUREMENTS AND MAIN RESULTS: The pneumotachometers were significantly affected by changing oxygen concentrations (p < .01) and increasing flow rates (p < .01), increasing the actually measured flow rate. Correction factors, developed by multiple regression analysis, significantly reduced the overall maximum errors of the pneumotachometers from -1.1 to 0.6 L/min to -0.5 to 0.4 L/min. CONCLUSIONS: The effects of changes in oxygen concentrations and flow rates on neonatal pneumotachometers could be considerably decreased by the use of correction factors such as were calculated in this study. This will preclude frequent calibration procedures with actual flow and oxygen levels during changes in experimental settings.