Currently, a rise in incidence of polyethological inflammation of the upper respiratory tract mucosa paralleled by altered resident and transient microbiota displaying in many cases increased antibiotic resistance has been noted. Opportunistic microbes play a major role in developing inflammatory process in Pirogov–Waldeyer’s ring. An inflammatory process occurring in the tonsillar lymphatic tissue results in host systemic complications. Fighting against acute and chronic infections of the upper respiratory tract holds the main task in pediatric otorhinolaryngology, as they can consequently elicit the cardiovascular, genitourinary and musculoskeletal complications. The results of studies examining this issue remain very contradictory, which accounted for a need to conduct our study on the territory of Moldova featured with mixed climatic conditions. Here, we wanted to study a role of microbial factor in etiopathogenesis of chronic tonsillitis in children. Bacteriological microbiota data for superficial palatine tonsils were obtained form 608 children subdivided into 5 groups: group I — 333 children with compensated chronic tonsillitis; group II — 87 children with decompensated chronic tonsillitis; group III — 91 children with acute upper respiratory tract infections (comparison group); group IV — 48 children with acute upper respiratory tract infections treated with antibiotic therapy; group V — 49 apparently healthy children (control group). It was found that β-hemolytic streptococcus exerting high sensitivity to virtually all antibiotics groups was detected in 17.4% of children with acute tonsilar inflammatory processes and decompensated defense in the lymphatic pharyngeal ring compared to 3.5% in control group. Streptococcus pneumoniae was isolated in all study groups ranging within 4.8–21.7%, including 14% in apparently healthy children characterized by reduced antibiotics sensitivity. The data obtained suggest that sickly children with acute and chronic upper respiratory tract infections constitute a risk group for developing somatic diseases. The high incidence of Streptococcus pneumoniae indicates a need for performing immunoprophylaxis, use of therapeutic vaccination as a up-to-date, combined approach in treatment of such pediatric cohort.
Background and aims Tracheostomy is performed in infants with airway anomalies or requiring prolonged mechanical ventilation (MV). Risks and outcomes are described only in small studies. We report risk factors for mortality following tracheostomy in a large cohort of infants. Methods We identified all infants discharged from 348 NICUs managed by Pediatrix Medical Group who underwent tracheostomy between 1997 and 2012. We only included infants cared for at a single site. We performed multivariable logistic regression with random effects for site to evaluate association between death after tracheostomy and risk factors: diagnosis, gestational age, small for gestational age (SGA), age at tracheostomy, and days exposed to fraction of inspired oxygen >40%, inotropes and MV prior to tracheostomy. Results 532 infants required tracheostomy (0.06% of infants). Median gestational age and birth weight were 26 weeks (IQR; 25, 30) and 780 g (610, 1400). The most common diagnoses were bronchopulmonary dysplasia, 465/532 (85%), airway anomalies, 237/532 (45%) and pulmonary anomalies, 88/532 (17%). Tracheostomy was performed on median postnatal age of 87 days (36,128). Of the 532 infants, 344 (65%) were weaned off MV prior to discharge at a median of 6 days (3, 12) after tracheostomy. Mortality was 14%. On multivariable regression, the following were associated with mortality: days of oxygen exposure, OR = 1.01 (95% CI; 1.00, 1.02); inotrope exposure, OR = 1.04 (1.00, 1.09); SGA, OR = 2.40 (1.32, 4.35). Conclusion While tracheostomy is rarely performed, mortality after the procedure is high and is associated with increased by pre-tracheostomy oxygen and inotrope exposures and SGA status.
Background Otitis media (OM) is a common problem for primary care, pediatricians and otorhinolaryngologists. The Aim of our work is to analyze the evolution of OM in children of the first 7 years of life after respiratory tract (RT) pathology. Subjects Children from 1 to 7 years of life (2785) without evident OM after standard treatment of RT pathology -bronchitis, pneumonia; RT infection-prone children; chronic nasal breathing difficulties. Healthy children of the same age were included in the control group. Outcome measures Screening tympanometry, otoscopy; audiology assessment and otomicroscopy for children who failed the screening tests, paranasal sinuses evaluation, otological follow up for children with middle ear pathology during 2 years. Results We diagnosed OM in 68% of cases from RT pathology group and in 6% of cases from control group (p less than 0.001). Acute middle ear effusion was presented in 53%, chronic OM with effusion in 38%, recurrent OM in 9%. Chronic and recurrent OM was related with RT infection-prone children (p less than 0.01), age younger than 5 years of life (p less than 0.01) and sinusitis (p less than 0.01). Adhesive and chronic OM was recorded during otomicroscopy and surgery in 12% of cases. Conclusions Screening for OM is important for children with recurrent and chronic RT pathology. These groups of patients need comprehensive diagnostic management and intensive treatment, including surgical one. In healthy children OM is a relative rare and temporary condition.
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