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Efficacy of nebulized hypertonic saline and albuterol combination for the management of acute bronchiolitis: a randomized, double-blind controlled trial
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Posters / Paediatric Respiratory Reviews 13S1 (2012) S51–S85
RD et al. [1]. The questionnaire also collected demographic data and information on family history, medical history, sleep habits and symptoms of non-pulmonary sleep disorders. Children with chronic medical problems, severe learning difficulties, known syndromes or craniofacial/neuromuscular abnormalities were excluded from the study. Results: 559 subjects (males 52.8%) took part in the study. The mean(SD) age was 8.3(2.3) years. Snoring was more common in males compared to females (p = 0.018) and habitual snoring (defined as snoring ≥3 nights per week) was reported in 15.7% children. 16.3% children had a SRBD scale cut-off value >0.33 and there was no significant age or sex difference in this group. Excessive day time sleepiness (EDS), defined as sleepiness occurring at least once per week was reported in 20.1%, but no significant age or sex difference was observed. Parent reported problem behaviours were common (hyperactivity in 50.4% and attention deficit in 55.5%) and were significantly higher in boys (p < 0.01). Children with SRBD scale cut-off value >0.33 were significantly more likely to have parentreported EDS (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 2.4–6.5), and problem behaviours, including hyperactivity (OR: 16.4; CI: 7.4–36.3) and attention deficit (OR: 49.7, CI: 12.1–204). Conclusions: Symptoms of SRBDs are common in South Indian school children. These symptoms are associated with excessive day time sleepiness and problem behaviours such as attention deficit and hyperactivity. Our findings emphasise the need for heightened awareness of SRBDs in children among parents and paediatricians, so that appropriate management may be provided to affected children. References [1] Chervin RD et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000; 1(1):21–32.
N09-217 Persistent and recurrent pneumonia in children: a clinico-investigative profile from North India A. Parakh1 , V. Singh1 , R. Kumar Meena1 , M.K. Narula2 , P. Kumar1 , J. Chandra1 . 1 Lady Hardinge Medical College and Kalawati Saran Children’s Hospital Pediatrics, New Delhi, India; 2 Lady Hardinge Medical College and assoc Hospitals Radiology, N Delhi, India Objective: To identify the various etiological causes of persistent and recurrent pneumonia among children (0–16 year) and to assess the yield of different investigations required for reaching the final diagnosis. Design: Prospective observational study. Methods: Children (<16 years) presenting between November 2008 to March 2010 with a persistent or recurrent pneumonia but not diagnosed as tuberculosis or with a known co-existent congenital heart disease, asthma or immunodeficiency were included. Demographic and clinical details, previous investigations were recorded. Patients were investigated using a detailed battery of tests as required on the individual case basis. The special investigations included: CT chest; flexible bronchoscopy with bronchial washings and lavage; Immunoglobulin levels and others tests for immunodeficiency; Sweat chloride test; tests for gastroesophageal reflux disease (GERD) and Lung biopsy to find out the underlying cause. Results: Out of 44 included patients, 86% (6/44) had persistent pneumonia while the rest had recurrent pneumonia. Median age of the study group was 3.5 years (range 2 mo. to 14 years) with 59% males. Children <1 year accounted for 36% cases, while those between >1–5 years, 5–10 years and >10 years accounted for 27%, 20% and 20% respectively. In cases of persistent pneumonia, the commonest etiology found was infections (19%, 7/38) including 4 cases of tuberculosis (not diagnosed previously on routine tests), followed by slowly resolving pneumonia (16%; 6/38), GERD (14%; 5/38), bronchiectasis (13%; 5/38), structural anomalies
(11%; 4/38), interstitial lung disease (8%; 3/38), and cystic fibrosis (6%; 2/38). In children with recurrent pneumonia GERD was the commonest cause (67%; 4/6), followed by immunodeficiency and asthma (one each). Conclusions: In cases of Persistent and recurrent pneumonia detailed history and a battery of tests can help in making the diagnosis and decide treatment. On the basis of our study, we conclude that CECT chest, bronchoscopy with washings/lavage, GER studies (scintiscan/24h PH) are the special investigations that provided the maximum yield to final diagnosis. N10-224 Efficacy of nebulized hypertonic saline and albuterol combination for the management of acute bronchiolitis: a randomized, double-blind controlled trial S.I. Bagus, S.P. Putu. Sanglah Hospital, Child Health, Denpasar, Indonesia Keywords: hypertonic saline, acute bronchiolitis, efficacy
Background: The dominant abnormality of acute bronchiolitis are bronchiolar edema and mucous bronchiolar obstruction. Based on the mechanism of action reduce airway edema and increase mucociliary clearance, hypertonic saline (HS) has been used for management of acute bronchiolitis but the results still inconsistent. Objective: To know the efficacy combination of nebulized HS and albuterol for management of acute bronchiolitis. Methods: A randomized, double-blind controlled trial was conducted. Sample were bronchiolitis patients who met the eligibility criteria. Samples were divided into 2 groups (HSA group: HS and albuterol vs NSA group: normal saline and albuterol). The primary outcome was length of hospital stay (LOS) and secondary outcome was Wang respiratoric score at day 3 of admission. Data was analyzed using t test, Kaplan–Meier, and Cox regression. A P value of <0.05 was considered statistically significant. Results: There were 92 subjects who met the inclusion criteria, 12 subjects were excluded. There were similar in characteristics of subjects except history of atopy. Mean of LOS was shorter in HSA compared to NSA groups [mean 4.1 (SD 0.71) days vs 4.9 (SD 1.90) days, mean difference −0.8 (95% CI −1.52 to −0.18) days, P = 0.014]; mean Wang respiratoric score at day 3 of admission was no different between groups [mean 3.0 (SD 1.10) vs 3.5 (SD 1.36), mean difference −0.5 (95% CI −1.10 to 0.10), P = 0.146]. Kaplan–Meier showed shorter LOS in HSA compared to NSA groups (Log rank, P = 0.009). Cox regression showed slight shorter LOS in HSA compared to NSA groups with nearly statistically significant [HR 1.611 (95% CI 0.996 to 2.634), P = 0.051]. There were no differences in side effects. Conclusion: Combination of nebulized HSA slight reduce the LOS of acute bronchiolitis compared to NSA. N11-225 Clinical features of community acquired pneumonia with different hemoglobin status I. Andarini. Sebelas Maret University Child Health, Surakarta, Indonesia Background: Pneumonia is a serious illness associate with significant morbidity and mortality. Anemia is one of the risk factors for pneumonia, a leading cause of death in children under five. It is a well-established fact that anemic children are prone to severe infection and may have longer duration of illness. Objectives: To identify the incidence of anemia in community acquired pneumonia (CAP) and to compare clinical features of community acquired pneumonia patients with different hemoglobin status. Methods: A cross-sectional study was based on medical records of community acquired pneumonia patients, ages two months until ten years old who are hospitalized in Dr. Moewardi Hospital, Surakarta from January 2009 to December 2010. Diagnosis of CAP was confirmed by clinical findings and chest x-ray features. Data on symptoms, nutritional status, laboratory test, and chest x-ray
Posters / Paediatric Respiratory Reviews 13S1 (2012) S51–S85
RD et al. [1]. The questionnaire also collected demographic data and information on family history, medical history, sleep habits and symptoms of non-pulmonary sleep disorders. Children with chronic medical problems, severe learning difficulties, known syndromes or craniofacial/neuromuscular abnormalities were excluded from the study. Results: 559 subjects (males 52.8%) took part in the study. The mean(SD) age was 8.3(2.3) years. Snoring was more common in males compared to females (p = 0.018) and habitual snoring (defined as snoring ≥3 nights per week) was reported in 15.7% children. 16.3% children had a SRBD scale cut-off value >0.33 and there was no significant age or sex difference in this group. Excessive day time sleepiness (EDS), defined as sleepiness occurring at least once per week was reported in 20.1%, but no significant age or sex difference was observed. Parent reported problem behaviours were common (hyperactivity in 50.4% and attention deficit in 55.5%) and were significantly higher in boys (p < 0.01). Children with SRBD scale cut-off value >0.33 were significantly more likely to have parentreported EDS (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 2.4–6.5), and problem behaviours, including hyperactivity (OR: 16.4; CI: 7.4–36.3) and attention deficit (OR: 49.7, CI: 12.1–204). Conclusions: Symptoms of SRBDs are common in South Indian school children. These symptoms are associated with excessive day time sleepiness and problem behaviours such as attention deficit and hyperactivity. Our findings emphasise the need for heightened awareness of SRBDs in children among parents and paediatricians, so that appropriate management may be provided to affected children. References [1] Chervin RD et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000; 1(1):21–32.
N09-217 Persistent and recurrent pneumonia in children: a clinico-investigative profile from North India A. Parakh1 , V. Singh1 , R. Kumar Meena1 , M.K. Narula2 , P. Kumar1 , J. Chandra1 . 1 Lady Hardinge Medical College and Kalawati Saran Children’s Hospital Pediatrics, New Delhi, India; 2 Lady Hardinge Medical College and assoc Hospitals Radiology, N Delhi, India Objective: To identify the various etiological causes of persistent and recurrent pneumonia among children (0–16 year) and to assess the yield of different investigations required for reaching the final diagnosis. Design: Prospective observational study. Methods: Children (<16 years) presenting between November 2008 to March 2010 with a persistent or recurrent pneumonia but not diagnosed as tuberculosis or with a known co-existent congenital heart disease, asthma or immunodeficiency were included. Demographic and clinical details, previous investigations were recorded. Patients were investigated using a detailed battery of tests as required on the individual case basis. The special investigations included: CT chest; flexible bronchoscopy with bronchial washings and lavage; Immunoglobulin levels and others tests for immunodeficiency; Sweat chloride test; tests for gastroesophageal reflux disease (GERD) and Lung biopsy to find out the underlying cause. Results: Out of 44 included patients, 86% (6/44) had persistent pneumonia while the rest had recurrent pneumonia. Median age of the study group was 3.5 years (range 2 mo. to 14 years) with 59% males. Children <1 year accounted for 36% cases, while those between >1–5 years, 5–10 years and >10 years accounted for 27%, 20% and 20% respectively. In cases of persistent pneumonia, the commonest etiology found was infections (19%, 7/38) including 4 cases of tuberculosis (not diagnosed previously on routine tests), followed by slowly resolving pneumonia (16%; 6/38), GERD (14%; 5/38), bronchiectasis (13%; 5/38), structural anomalies
(11%; 4/38), interstitial lung disease (8%; 3/38), and cystic fibrosis (6%; 2/38). In children with recurrent pneumonia GERD was the commonest cause (67%; 4/6), followed by immunodeficiency and asthma (one each). Conclusions: In cases of Persistent and recurrent pneumonia detailed history and a battery of tests can help in making the diagnosis and decide treatment. On the basis of our study, we conclude that CECT chest, bronchoscopy with washings/lavage, GER studies (scintiscan/24h PH) are the special investigations that provided the maximum yield to final diagnosis. N10-224 Efficacy of nebulized hypertonic saline and albuterol combination for the management of acute bronchiolitis: a randomized, double-blind controlled trial S.I. Bagus, S.P. Putu. Sanglah Hospital, Child Health, Denpasar, Indonesia Keywords: hypertonic saline, acute bronchiolitis, efficacy
Background: The dominant abnormality of acute bronchiolitis are bronchiolar edema and mucous bronchiolar obstruction. Based on the mechanism of action reduce airway edema and increase mucociliary clearance, hypertonic saline (HS) has been used for management of acute bronchiolitis but the results still inconsistent. Objective: To know the efficacy combination of nebulized HS and albuterol for management of acute bronchiolitis. Methods: A randomized, double-blind controlled trial was conducted. Sample were bronchiolitis patients who met the eligibility criteria. Samples were divided into 2 groups (HSA group: HS and albuterol vs NSA group: normal saline and albuterol). The primary outcome was length of hospital stay (LOS) and secondary outcome was Wang respiratoric score at day 3 of admission. Data was analyzed using t test, Kaplan–Meier, and Cox regression. A P value of <0.05 was considered statistically significant. Results: There were 92 subjects who met the inclusion criteria, 12 subjects were excluded. There were similar in characteristics of subjects except history of atopy. Mean of LOS was shorter in HSA compared to NSA groups [mean 4.1 (SD 0.71) days vs 4.9 (SD 1.90) days, mean difference −0.8 (95% CI −1.52 to −0.18) days, P = 0.014]; mean Wang respiratoric score at day 3 of admission was no different between groups [mean 3.0 (SD 1.10) vs 3.5 (SD 1.36), mean difference −0.5 (95% CI −1.10 to 0.10), P = 0.146]. Kaplan–Meier showed shorter LOS in HSA compared to NSA groups (Log rank, P = 0.009). Cox regression showed slight shorter LOS in HSA compared to NSA groups with nearly statistically significant [HR 1.611 (95% CI 0.996 to 2.634), P = 0.051]. There were no differences in side effects. Conclusion: Combination of nebulized HSA slight reduce the LOS of acute bronchiolitis compared to NSA. N11-225 Clinical features of community acquired pneumonia with different hemoglobin status I. Andarini. Sebelas Maret University Child Health, Surakarta, Indonesia Background: Pneumonia is a serious illness associate with significant morbidity and mortality. Anemia is one of the risk factors for pneumonia, a leading cause of death in children under five. It is a well-established fact that anemic children are prone to severe infection and may have longer duration of illness. Objectives: To identify the incidence of anemia in community acquired pneumonia (CAP) and to compare clinical features of community acquired pneumonia patients with different hemoglobin status. Methods: A cross-sectional study was based on medical records of community acquired pneumonia patients, ages two months until ten years old who are hospitalized in Dr. Moewardi Hospital, Surakarta from January 2009 to December 2010. Diagnosis of CAP was confirmed by clinical findings and chest x-ray features. Data on symptoms, nutritional status, laboratory test, and chest x-ray