RESUMO
UNLABELLED: Croup syndrome is an urgent and frequent reason for hospitalization of children. MATERIAL AND METHODS: 632 children with croup syndrome (422 boys and 210 girls aged 2 months-17 years) admitted to 15 pediatric departments in Lower Silesia were prospectively observed for 12 months (from April 2001 to March 2002). We conducted prospective survey of clinical and laboratory data from all study centers. RESULTS: Following diagnoses were accepted as the croup syndrome: subglottic laryngitis in 482 patients (75.4%), laryngotracheobronchitis in 75 (11.8%), laryngitis in 50 (7.8%) and epiglottitis in 20 children (3%). The most severe course was observed in children with epiglottitis. Four of them required airway intervention and had endotracheal intubation. H. influenzae b was cultured from blood of one patient. The most cases of epiglottitis occurred in the 3rd year of life (45%). CONCLUSIONS: 1. The most common reason of croup was subglottic laryngitis. 2. Epiglottitis was rare with serious course of disease; frequency was comparable with the frequency seen in European countries before the implementation of Hib vaccine. The routine use of Hib vaccine in Poland may prevent from children life threatening epiglottis cases.
Assuntos
Crupe/etiologia , Crupe/terapia , Adolescente , Bronquite/complicações , Bronquite/terapia , Criança , Pré-Escolar , Crupe/microbiologia , Crupe/prevenção & controle , Epiglotite/complicações , Epiglotite/terapia , Feminino , Infecções por Haemophilus/sangue , Infecções por Haemophilus/terapia , Vacinas Anti-Haemophilus/uso terapêutico , Humanos , Lactente , Laringite/complicações , Laringite/terapia , Masculino , Polônia , Estudos Prospectivos , Fatores de TempoRESUMO
UNLABELLED: The aim of the study was to estimate treatment practice in hospital management of croup syndrome (laryngitis subglottica) in children in Poland. MATERIAL AND METHODS: During the period of 12 months, we have prospectively observed 482 children with croup syndrome admitted to 15 pediatric departments in Lower Silesia (south-west region of Poland). Data concerning epidemiology, clinical course and treatment were collected from uniform observation cards. There were 326 boys and 156 girls aged between 2 and 174 months in our study. RESULTS: Among 482 observed children, received glucocorticoids 424 (88%) mainly parenteral, L-epinephrine--211 (43.8%), mist therapy--241 (50%), antihistamines--308 (63.9%), antibiotics--280 (58.1%). Children treated with antibiotics were younger (p=0.0316), their temperature, amount of leukocytes and value of C-reactive protein was higher when compared with those not treated (p=0.0002; p=0.0081, p=0.0172 respectively). CONCLUSIONS: Children in Lower Silesia with croup syndrome were treated in agreement with recent standards with glucocorticoids and/or epinephrine. There was an excessive usage of antihistamines which have no established treatment role. It seems that in many cases antibiotic treatment could have been avoided.
Assuntos
Antibacterianos/uso terapêutico , Crupe/tratamento farmacológico , Epinefrina/uso terapêutico , Glucocorticoides/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Polônia , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Neutrophil elastase is a proteolytic enzyme which can have a destructive effect on respiratory tract structures. Interleukin-8 (IL-8), a proinflammatory cytokine, is an important chemoattractant for neutrophils. The aim of our study was to assess inflammatory states by determining elastase in complex with alpha1-proteinase inhibitor (E-alpha1PI) and IL-8 in children requiring mechanical ventilation. MATERIAL/METHODS: Plasma and respiratory tract lavage fluid (RTLF) levels of E-a1PI and IL-8 were measured (ELISA) in 31 children with (group I) and 22 without (group II) respiratory tract infection. Plasma results were compared with a group of healthy controls. Results are given as medians and ranges. Additionally, the percentage content of neutrophils in RTLF was determined. RESULTS: Significantly higher (p<0.00004) plasma levels of E-alpha1PI were found in group I than in group II. In group II, there were significantly higher (p<0.002) RTLF levels of E-alpha1PI and IL-8 than in group I. In both groups, the percentage content of neutrophils in RTLF exceeded 60%. A negative correlation was found between the plasma and RTLF levels of E-alpha1PI (r=-0.69; p<0.0004), between E-alpha1PI and percentage neutrophil content (r=-0.6; p<0.006), and between IL-8 and percentage neutrophil content (r=-0.5; p<0.04) in RTLF in group II. CONCLUSIONS: The determination of E-alpha1PI and IL-8 may be useful in the assessment of the inflammatory state in children requiring mechanical ventilation.