Asthma, Eczema, and Food Allergy in Children Following Liver Transplantation.

OBJECTIVES: To describe the prevalence and the relationship between asthma, eczema, food allergy, and rhinitis in children after liver transplantation. STUDY DESIGN: Children who were liver transplant recipients were investigated to assess whether the high prevalence of food allergies was accompanied by eczema, rhinitis, and asthma. Furthermore, we included 56 children with chronic liver disease to explore the risk of allergy, eczema, and asthma in this group. RESULTS: After liver transplantation, children had higher prevalence of allergic reactions to food as compared with children with chronic liver disease (P < .001). Current asthma (P = .04) and eczema (P < .02) were observed more frequently in transplanted children as compared with children with chronic liver disease. For transplanted children who had ever received tacrolimus the relative risk (RR) of asthma was 1.7 (95% CI, 1.2-2.4; P = .02) as compared with children with chronic liver disease. Transplanted children with asthma had higher rates of sensitization to food allergens than those without asthma (RR, 3.6; 95% CI, 1.3-10.3; P = .01). The most frequent food allergens associated with asthma in transplanted children were milk (RR for asthma, 3.9; 95% CI, 1.6-9.4; P < .01), eggs (RR, 2.9; 95% CI, 1.2-7.0; P = .03), and peanuts (RR, 3.7; 95% CI, 1.6-8.3; P < .01). Food allergies occurred earlier than asthma, at 1.5 years after transplantation (IQR, 0.5-3.0 years) vs 2.5 years after transplantation (IQR, 1.0-4.5 years; P < .05). Food allergies were also associated with eczema, but not with sensitization to aero-allergens or rhinitis. CONCLUSIONS: The high risk of food allergies in children who were liver transplant recipients was associated with eczema and asthma, but not rhinitis. The most frequent food allergens associated with asthma were milk, eggs, and peanuts.

Differing lung function development in infants with univentricular hearts compared with healthy infants.

AIM: To compare the difference in lung function development of healthy controls and patients with univentricular hearts from birth prior to surgery and during the first year of life when cardiac shunt procedures and the cavopulmonary connection are required. METHODS: Tidal flow-volume measurements and single-occlusion tests were performed from birth serially up to 18 months of age on 28 unsedated spontaneously breathing infants with univentricular hearts and 58 healthy control infants. RESULTS: Infants with univentricular heart physiology had low tidal volumes, low compliance of the respiratory system and high respiratory rate at birth, which over time normalized, whereas the peak expiratory flow increased during the study period. The lung function measured at birth was predictive of later lung function measurements. CONCLUSION: The pattern of lung function development is different in the patients with univentricular hearts compared to healthy controls. Lung function measured at birth is predictive of later lung function.

Preoperative lung function in newborn infants with univentricular hearts compared with healthy controls.

AIM: To measure the difference in lung function between newborns with univentricular hearts and healthy controls and study associations between lung function and pulmonary blood flow and pulmonary vasculature markings. METHOD: Tidal flow-volume measurements and single occlusion tests were performed before surgery on 25 unsedated spontaneously breathing newborns with univentricular hearts recruited over a 3-year period. Seventy-five healthy control infants were measured. Pulmonary blood flow was graded according to the haemodynamic effect of the echocardiographically defined anatomy of the heart defect. Pulmonary vasculature was graded according to radiological markings. RESULTS: The infants with univentricular hearts had a lower mean tidal volume of 4.7 ml (CI 2.3, 7.2, p < 0.001) (n = 24) and a lower mean compliance of the respiratory system of 12.7 ml/kPa (CI 4.6, 20.8, p = 0.004) (n = 14). Pulmonary blood flow grading was associated with respiratory rate (r = 0.53, p < 0.001), tidal volume (r =-0.48, p < 0.001), compliance (r =-0.55, p < 0.001) and resistance (r =-0.31, p = 0.043). Pulmonary vasculature grading was associated with compliance (r =-0.68, p = 0.006), resistance (r =-0.69, p = 0.007) and the time constant (r =-0.62, p = 0.042). CONCLUSION: Newborns with univentricular hearts have reduced tidal volumes and reduced compliance of the respiratory system. The lung function abnormalities are associated with the degree of pulmonary blood flow and pulmonary vasculature markings.

[Screening for congenital hearing loss--a pilot project]. / Screening for medfødt hørselstap--en pilotstudie.

BACKGROUND: Until recently in Norway, congenital hearing loss has on average been diagnosed at 2.8 years of age. Delayed diagnosis is associated with loss of valuable opportunities for auditory habilitation and speech development. MATERIAL AND METHODS: Since September 1999 we have carried out universal screening for congenital hearing loss in both healthy and sick newborns. During the first screening period, all newborns were screened with automated auditory brainstem response audiometry. In the second period all healthy infants were screened primarily with otoacoustic emission audiometry, with automated auditory brainstem response audiometry as a second stage screening for those who failed the otoacoustic emission test. 3,996 infants were screened from start-up until December 2001. RESULTS: Hearing loss was confirmed in 25 patients (11 unilateral and 14 bilateral). A further two patients were referred but found to have normal hearing. The incidence of congenital hearing loss was 0.16% in presumed healthy infants and 2.2% in infants admitted to the intensive care nursery. INTERPRETATION: Screening for congenital hearing loss can be carried out with a very low rate of referrals and a low rate of false positive tests, particularly if there is access to otoacoustic emission as well as automated auditory brainstem response testing. In our opinion, Norway now needs to legislate for universal screening for congenital hearing loss in the neonatal period. Our departments of audiology should be given the opportunity and resources to upgrade their skills in relation to this new group of patients.