Summary Speculation MATERIALS AND METHODSSevere neonatal lung injury, with persistent oxygen dependency throughout infancy might result in inhibition or marked slowing of lung growth. Because development of conducting airways is completed early during intrauterine life and because most alveolar development takes place postnatally, one might expect disturbances in alveolar growth to overshadow residual airway injury in survivors of bronchopulmonary dysplasia.Morphometric analysis of the lungs and heart of a male infant who died at 33 months of age of bronchopulmonary dysplasia after prematurity and respiratory distress syndrome and its treatment is presented. Alveolar internal surface area was 8.4 m 2 compared to 15.3-27.8 for age-matched controls. The number of alveoli was 19 X 10 6 (123.3-172.5 X 10 6 for controls); however, the mean small airway diameter, 0.44 mm was normal, and small airway abnormalities were minimal. There was marked muscular hypertrophy of the right ventricle.The growth and development of the lungs follow a continuous course, beginning with conception and finishing when somatic growth ceases. Conducting airways are fully formed by the sixteenth wk of gestational age, whereas multiplication of alveoli continues throughout gestation, infancy, and early childhood (21).In the premature infants with mild hyaline membrane disease, pulmonary function tests after the first year of life seem to indicate that such infants subsequently progress toward normal lung development (4, II,19,23). On the other hand, little is known of the nature and degree of "catch-Up" lung growth during early childhood in premature infants who are survivors of severe respiratory distress syndrome and its sequel, bronchopulmonary dysplasia (BPO). In this group of older infants with BPO, pulmonary function studies during the first year of life (4, 19) have shown marked abnormalities, including hypoxemia, increased lung volume, maldistribution of ventilation, and increased airway resistance. These findings have been attributed mostly to the presence of interstitial edema (13, 22) and/or increased bronchiolar secretions (3, 18). Obliterative airway disease and simplified alveoli with interstitial fibrosis have been described in infants with BPO,(3,16,18), but, to our knowledge, quantitative anatomic studies have not been done. required continuous positive airway pressure (CPAP) with 100% oxygen mask-bag because of bradycardia and cyanosis. He was admitted to the intensive care nursery and had a gestational age of 31 wk by Oubowitz criteria (weight, 1500 g; length, 41 cm; and head circumference, 27.5 cm). Despite CPAP and 100% inspired oxygen the child developed immediate and severe respiratory distress with apneic spells. At 35 min of age he was intubated and mechanically ventilated with an inspired oxygen concentration (FI02) of 80% and positive end-expiratory pressure (PEEP) of 8 cm H20. The peak pressure remained between 40-50 cm of H 2 0 during the first wk; the oxygen requirement diminished rapidly to 60% at 12 hand 40% at...
Pulmonary function tests (PFT) were obtained during the course of a self-controlled study of six children aged 5 to 43 months who had moderate to severe bronchopulmonary dysplasia (BPD). Changes after the administration of intravenous (IV) furosemide (2 mg/kg), inhaled isoproterenol (0.2 cc, 1:200), inhaled atropine sulfate (0.05 mg/kg), and a placebo were assessed. The study indicated the furosemide and atropine significantly (P less than 0.05) increased dynamic compliance (CL) for the group. A decrease in total pulmonary resistance (RL) and work of breathing (W) was observed after isoproterenol, although the responses were not significant (P = 0.08 and P = 0.09, respectively). It was speculated that pulmonary edema and increased vagal tone may contribute to small airway dysfunction in children who have BPD.
Spine deformity and chronic pulmonary disease are commonly seen in patients with cystic fibrosis (CF). In order to assess the prevalence of kyphosis, a retrospective evaluation of all initial standing chest radiographs of our CF patients matched with our "reference" population was undertaken. We also studied the possible correlation between the degree of kyphosis and the pulmonary function tests ( PFTs ), consisting of thoracic gas volume and maximal expiratory flows. In our population, the study confirmed an increased prevalence of kyphosis in CF patients (p less than .01), which occurred mostly in girls after 12 years of age (p less than .018). The kyphosis appeared to be, in most instances, of mild degree and was not related to any of the PFTs . No measurable increase of kyphosis was observed over a 3-year period in the group. Longer prospective study and the relationship of kyphosis to endocrine function in CF at puberty should be undertaken.
The static lung compliance was studied in 57 healthy children, 6 to 14 years old. A new method called ‘end-expiratory-compliance’ (C1EE) has been developed and the results were compared to the data obtained from Zapletal et al. with the ‘static pressure-volume’ curves technique. The advantages of the method are discussed. The static lung compliance of children increases with height. Static lung compliance value is greater than dynamic lung compliance. This difference is discussed. Static recoil pressure of the lung was measured by the oesophageal balloon technique at so-called ‘zero-volume’ of air in the balloon. At functional residual capacity (FRC), i.e. 41-44 % total lung capacity (TLC), static recoil pressure is negative in all children, according to this technique. The taller the child, the more negative is the intrathoracic pressure at the same lung volume in percent of TLC, the slopes of the P/V curve being significantly different in younger and in older children. These data are compared to those observed in adults. The elastic properties of the lungs in younger children seem to be similar to those in older adults as a result of lung growth and aging, which successively influence the elastic behaviour of the lung tissue. The influence of the experimental conditions (intra-oesophageal balloon) on the data collected in children is emphasized.
42 children with asthma who had been taking aerosol medication from canister nebulizers for longer than 6 months were evaluated for aerosol inhalation technique. Proper inhalation technique is a simple procedure. Patient should close lips around the mouthpiece of the nebulizer and exhale first. As the canister is actuated he should inhale deeply by mouth and breathhold for a few seconds before exhaling. The mouthpiece of a canister nebulizer was modified so that actuation of the canister and inhalation through the mouthpiece could be recorded on paper. The age range of the patients was 7 to 15. They were either on bronchodilator or steroid aerosols or a combination of both. Of the 42 tested, 24 had correct technique and 18 (43%) did not. 11 simply squirted the aerosol into the mouth without inhaling. 6 lnhaled first, then actuated the aerosol. One inhaled only a whiff of air (501111) with the actuation. Those who inhaled incorrectly were taught the correct technique. 11 learned it within 5 minutes of instructions and demonstrations. 7 required a teaching aid. When retested 1-2 weeks later, 15 out of 18 had retained UPPER AIRWAY OBSTRUCTION (UAO) DURING SLEEP:A CLINICAL
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