Bronchiolitis obliterans is a rare form of chronic obstructive lung disease that follows a severe insult to the lower respiratory tract, resulting in fibrosis of the small airways. In the nontransplant pediatric population, adenovirus infection is the most common cause. Treatment is largely supportive and prognosis is mainly related to the underlying cause and to the severity of the initial insult.

Lung transplantation is as successful for patients with end stage diffuse lung disease as compared to other lung transplant candidates.

Histopathology has been considered the gold standard for diagnosis of bronchiolitis obliterans (BO). Although chest computed tomography (CT) has gained acceptance as an alternative tool for diagnosis, no systematic studies validating the diagnostic accuracy of chest CT have been performed in children with BO unrelated to transplantation. A study was undertaken to provide estimates of the strength of association between CT findings and the presence or absence of BO, and to determine if chest CT is predictive of lung biopsy results. In a singlecenter, retrospective, case-control study, 120 children who had both a chest CT and lung biopsy and no history of lung, heart-lung, or bone marrow transplant were included in this study. Chest CTs were scored for the presence or absence of 24 individual CT findings by a blinded subspecialty-trained pediatric radiologist. Lung biopsies were reviewed by a pediatric lung pathologist for the presence of airway fibrosis, which was classified as mild, moderate, or severe. Ten children had moderate-to-severe BO by lung biopsy. The presence of parenchymal hypoattenuation (P ¼ 0.003) and bronchiectasis (P ¼ 0.001) distinguished these patients from the remaining 110 patients who formed the control group. Combinations of findings improved specificity, and the combination of parenchymal hypoattenuation and vascular attenuation was highly specific (specificity 99.1%; positive likelihood ratio 22.2 and 44.4 for moderate and severe disease, respectively). However, the sensitivity of individual and combination findings was modest. In children with moderate or severe BO, a confident diagnosis can be made with a chest CT that has characteristic radiographic findings, thus avoiding the need for open lung biopsy. However, CT is not an effective screening tool for excluding BO.

The presence of methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) patients' sputa is associated with a decline in pulmonary function and increased mortality. Vancomycin is the preferred treatment for MRSA pneumonia in children. No published studies have evaluated the vancomycin dose needed to achieve goal vancomycin trough concentrations (VTCs; 15-20 mg/L) in pediatric patients with CF. The primary objective is to determine whether a vancomycin dosage of 60 mg/kg/day achieves a goal VTC in pediatric CF patients. Secondary objectives include determining the average dosage required to reach a goal VTC and the impact of achieving a goal VTC on estimated glomerular filtration rate (eGFR) and pulmonary function. METHODS: A retrospective review of pediatric patients with CF who received vancomycin was conducted. RESULTS: A total of 90 vancomycin treatment courses were analyzed. Standard vancomycin dosing (60 mg/ kg/day) achieved goal VTC in 11 courses (12.2%). The mean dosage required to achieve a goal VTC for all courses was 70.6 ± 16.7 mg/kg/day. Patients who achieved goal VTCs were more often older, weighed more, and had higher serum creatinine concentrations at therapy initiation. On average, a dosage of 70.6 mg/kg/ day was required to achieve a goal VTC. Despite dosages up to 120 mg/kg/day, no significant changes in renal function occurred. Achieving a goal VTC had no significant impact on eGFR or pulmonary function during therapy. CONCLUSIONS: Vancomycin dosing of 60 mg/kg/day does not reliably achieve a VTC of 15 to 20 mg/L in pediatric CF patients. Younger CF patients may require higher vancomycin doses.

The c.2988+1616_c.3367+356del3796ins62 complex rearrangement is a recurrent mutation from patients of different ethnic backgrounds. This mutation can be detected through a simple PCR based analysis.

Objectives (1) To highlight the important causes of chronic and recurrent cough in children. (2) To discuss multidisciplinary approach to management of chronic/recurrent pediatric cough. Methods Review of scholarly articles, guidelines, expert panels via PubMed and Google Scholar. Conclusion Chronic cough (CC) in children is mainly attributed to persistent bacterial bronchitis, asthma, nonspecific cough, and gastroesophageal reflux disease (GERD) symptoms. A multi‐disciplinary approach is cost‐effective and aids with earlier diagnosis and appropriate treatment. Congenital or acquired narrowing of the subglottis is the leading ENT cause for recurrent croup (RC) in children. Laryngeal cleft‐type 1 is commonly seen in children with recurrent aspiration and CC. Children are usually referred to pulmonologists for wet cough not responding to treatment. Eosinophilic esophagitis (EoE) and GERD should be considered in the differential diagnosis of CC in children with both respiratory symptoms and failure to thrive. Level of Evidence: 2a

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