Association of lipid-laden alveolar macrophages and gastroesophageal reflux in children.

The association of lipid-laden alveolar macrophages (LLAM) and gastroesophageal reflux (GER) was investigated prospectively in 115 patients in two groups. Group 1 included 74 children with chronic respiratory tract disorders and documented GER by prolonged esophageal pH monitoring, barium esophagram, and esophagoscopy; group 2 included 41 children with chronic respiratory tract disorders without GER. LLAM were present in 63 (85%) and eight (19%) children from groups 1 and 2, respectively (P less than 0.0001). Thus a strong association between the presence of LLAM and GER in children with chronic respiratory tract disorders was established. We suggest that LLAM from bronchial lavage may be a useful marker for tracheal aspiration in children with GER in whom chronic lung disease may subsequently develop.

Intracranial pressure monitoring as a guide to prognosis in the nearly drowned, severely comatose child.

During a 34-month-period, 55 nearly drowned, comatose children who were admitted to our pediatric intensive care unit were divided into C1 (decorticate), C2 (decerebrate), and C3 (flaccid) subgroups. Patients in subgroup C3 were selected for intracranial pressure (ICP) measurements by the subarachnoid bolt, and were reclassified according to clinical outcome into recovered (group A), fatality (group B), and brain damaged (group C) categories. Six children (29%) had complete recovery, 10 died (48%), and five (23%) demonstrated residual brain damage. There was a highly significant difference between the ICP in group A and group B (P less than 0.001), and between group B and group C (P less than 0.001). Both group A and group C had highly significant differences in mean cerebral perfusion pressure (CPP) values compared with group B (P less than 0.001). There were no significant differences in ICP or CPP between groups A and C. Finally, using a combination of ICP and CPP, we found that ICP less than or equal to 20 mm Hg and CPP greater than or equal to 50 mm Hg were associated with survival in 11 of 12 patients (92%), whereas ICP greater than 20 mm Hg and CPP less than 50 mm Hg were associated with death in seven patients cases (100%). The two other patients who died had either CPP less than 50 mm Hg or ICP greater than 20 mm Hg, but not both. We find that intracranial pressure monitoring is a safe, useful tool in predicting death or survival, but not residual brain damage, in the nearly drowned, severely comatose child.

Nonimmune rosette formation: a measure of the newborn infant's cellular immune response.

Nonimmune rosette formation, an in vitro measure of cellular immunity, was evaluated in normal newborn infants. Active rosette formation in 14 specimens of cord blood was 18.9 +/- 4.8% compared to 28.1 +/- 5.2% in 15 adult control samples (p less than 0.05). Total rosette formation in 13 cord blood samples was 33.3 +/- 7.6% compared to 55.1 +/- 6.5% in 15 adult control specimens (p less than 0.05). Tritiated thymidine uptake from phytohemagglutinin stimulation was comparable in cord blood and adult control lymphocytes. The importance of these findings is discussed in light of other recent reports suggesting that cord blood thymic derived T lymphocytes may have reduced immune capability when compared to adult lymphocytes.