Systemic arterial stiffness in infants with bronchopulmonary dysplasia: potential cause of systemic hypertension.

OBJECTIVE: Systemic hypertension is common among preterm infants with severe bronchopulmonary dysplasia (BPD); the exact cause is unknown. The objective of this preliminary hypothesis generating study was to examine systemic arterial structure and vasomotor function in a cohort of preterm infants with severe BPD, using a cohort of preterm infants without BPD and a cohort of term infants for comparison. STUDY DESIGN: After obtaining informed consent, we measured aortic wall thickness and vasomotor function by ultrasonography in 20 infants with severe BPD, 7 infants with no BPD, and compared them with 20 healthy term infants. RESULTS: Maximum aortic thickness was significantly higher in infants with BPD (827±163 µm) compared to those with no BPD (674±22 µm) and term infants (657±67 µm) (unadjusted P<0.0001). The input impedance was similarly elevated in the infants with BPD (574±127 dynes s( )cm(-5)) compared to those with no BPD (325±24 dynes s cm(-)(5)) or term infants (328±113 dynes s cm(-)(5)) (unadjusted P<0.0001). Stiffness index was significantly higher in the infants with BPD (3.4±0.6) compared to those with no BPD (2.6±0.3) or term infants (2.3±0.4) (unadjusted P<0.0001). Systemic vascular resistance was also significantly elevated in the infants with BPD. The results remained significant even after adjusting for gestational age and birth weight. Measures of vasomotor function significantly correlated with blood pressure. CONCLUSION: The aortic wall thickness and vasomotor function are significantly altered in preterm infants with severe BPD. These findings may explain the higher incidence of systemic hypertension in this population.

Imported childhood malaria: the Dublin experience, 1999-2006.

AIMS: Imported childhood malaria has never been studied in Ireland. We aimed to document the incidence and species of malaria in children presenting to paediatric hospitals in Dublin and to examine management and outcome measures. METHODS: Subjects were identified through laboratory archives from the three paediatric hospitals in Dublin. Clinical data were extracted retrospectively from clinical and laboratory records. RESULTS: As much as 67 episodes of malaria occurred in 66 children. Episodes occurred among new immigrants (n = 31) and Irish residents (n = 33) who travelled to endemic regions. The majority of those who travelled to endemic regions did not receive appropriate prophylaxis. Plasmodium falciparum was identified in 64 (95%) episodes, 26 with a parasite load above 2%. Eighteen children developed complications. All cases were treated successfully. CONCLUSIONS: Irish health-care practitioners need to encourage malaria prophylaxis among travellers to malaria-endemic regions. Management guidelines should be formulated to assist Irish clinicians treating this potentially fatal illness.