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Transcutaneous carboxyhemoglobin assessment of allergic respiratory activity
Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
the patient received decreasing doses of oral propranolol. During this process and even after the discontinuation of the drugs, the symptoms did not aggravate. The symptoms have not recurred 2 months after the discontinuation of the drugs. Conclusion: We report that subglottic haemangioma accompanied by respiratory distress and failure in an infant was successfully treated by oral prednisolone followed by treatment with inhalation of nebulised budesonide and oral propranolol. P47D Transcutaneous carboxyhemoglobin assessment of allergic respiratory activity L.E. Kurlandsky. Upstate Medical University Department of Pediatrics – Syracuse, New York, USA Background: Endogenous production of carbon monoxide (CO) as a byproduct of the breakdown of heme by heme oxygenase (HO) is increased in patients with asthma and allergic rhinitis and is found in increased concentrations in the exhaled breath of these patients. Because exhaled CO correlates with serum carboxyhemoglobin (HbCO), the clinical usefulness of measuring HbCO in pediatric patients with allergic respiratory disorders with a recently available, non-invasive instrument that measures serum HbCO transcutaneously. Methods: A transcutaneous CO-Oximeter (Rad-57, Masimo Corp., Irvine, CA) measures differences in light absorption between HbCO (SpCO), methemoglobin, and oxygenated and unoxygenated hemoglobin. This instrument is available in our Pediatric Pulmonary and Allergy Center to evaluate HbCO resulting from tobacco smoke or other environmental CO exposure. Asthma was defined by significant reversible airway obstruction by spirometry; allergic rhinitis by exam of nasal mucosa or positive allergy skin tests or serum IgE RAST testing; and GERD by positive pH probe study or dramatic response to H2 antagonist or proton pump inhibitor treatment. Results: Measurements of SpCO% from pediatric patients with clinically active or controlled asthma, allergic rhinitis, and gastroesophageal reflux (GERD)causing respiratory symptoms were collated and compared to 23 controls composed of pediatric residents and clinic staff who did not smoke. Results were as follows where (+) denotes disease activity and (−) denotes good control.
Patient No. SpCO% Avg. Stand. Dev.
Normal
Rhinitis +
Rhinitis −
Asthma +
Asthma −
GERD
23 0.08 0.28
88 6.15 4.07
26 0.77 1.53
51 4.78 3.56
86 0.3 0.85
44 0.64 1.97
Conclusions: This preliminary series of observations supports reports of increased CO in patients with asthma, allergic rhinitis, and GERD. In addition, elevated levels were seen in active asthma and allergic rhinitis compared to asymptomatic patients providing a simple, noninvasive measurement of disease activity.
S95
5. Fetal and neonatal respiratory disorders P48E Abnormal lung features on prenatal ultrasound and postnatal outcome A.E. Dereymaeker1 , A. Debeer2 , L. De Catte3 , R. Devlieger3 , L. Breysem4 , J. Breckpot5 , E. Verbeken6 , P. Moerman6 , A. Lerut7 , D. Van Raemdonck7 , K. De Boeck1 . 1 University Hospitals Leuven Department of Pediatric Pulmonology – Leuven, Belgium; 2 University Hospitals Leuven Neonatal Intensive Care Unit – Leuven, Belgium; 3 University Hospitals Leuven Department of Obstetrics and Gynaecology – Leuven, Belgium; 4 University Hospitals Leuven Department of Radiology – Leuven, Belgium; 5 University Hospitals Leuven Centre for Human Genetics – Leuven, Belgium; 6 University Hospitals Leuven Department of Pathology – Leuven, Belgium; 7 University Hospitals Leuven Department of Thoracic Surgery and Esophageal Surgery – Leuven, Belgium Background: With widespread use of prenatal ultrasound many major congenital lung malformations are detected antenatally. Congenital pulmonary adenomatoid malformations (CPAM), bronchopulmonary sequestration (BPS) and congenital lobar emphysema (CLE) are the most common prenatal diagnoses. However, the correlation between antenatal findings and postnatal diagnosis, management and outcome is still unclear. Aim of the study: To describe the correlation between prenatal sonographic findings, postnatal imaging and histopathological features of congenital lung malformations and to determine the significance of these findings in postnatal outcome. Patients and Methods: In this retrospective study from 1998 to 2008 we identified 36 fetuses with abnormal prenatal lung sonographic features, diagnosed at 17 to 34 weeks of gestation. In all cases we gathered prenatal sonographic findings, postnatal imaging and/or histopathological features if available. Subjects with a clear-cut diagnosis of isolated congenital diaphragmatic hernia were not included. Results: CPAM was suspected on prenatal ultrasonography in 25 out of 36 cases. The presence of CPAM was confirmed by postnatal Computed Tomography (CT) in 19 of them, but could not be differentiated from BPS in the remaining 6 cases. Histopathologic information was available on 20 resected lesions and confirmed the CPAM diagnosis in 17 cases, including 3 cases with an unclear diagnosis on postnatal CT. In the 3 remaining cases the histopathologic diagnosis of congenital bronchiectasis was retained. In 9 out of 36 cases the type of lung malformation could not be distinguished on prenatal ultrasound. One case presented with a combination of congenital diaphragmatic hernia (CDH) and BPS requiring urgent surgical intervention at birth due to respiratory distress. Postnatal CT was performed in all other cases and suggested the diagnosis of CPAM in one case, BPS in one case, CLE in 3 cases and remained unclear in 3 cases (BPS and/or CPAM). Histopathologic data were available in 5 of these 8 cases, confirming the tomographic diagnosis in all of them (1 CPAM, 1 BPS 2 CLE and 1 combination of BPS and CPAM). The 3 remaining cases (1 CLE and 2 cases with BPS and/or CPAM on postnatal CT) are still in clinical follow-up and did not undergo surgical resection yet. In 2 out of 36 cases the prenatal diagnosis was a congenital high airway obstruction syndrome (CHAOS). Histopathologic data of the first case revealed a combination of CPAM and BPS, which was not suspected on prenatal ultrasound. No histopathologic data on the other case were available. Ten out of 25 patients prenatally diagnosed as CPAM presented with respiratory problems, either acute respiratory distress at birth (6 cases) or recurrent infections (4 cases). In the non-CPAM group there was 1 mors in utero and 7 symptomatic cases with acute respiratory distress.
the patient received decreasing doses of oral propranolol. During this process and even after the discontinuation of the drugs, the symptoms did not aggravate. The symptoms have not recurred 2 months after the discontinuation of the drugs. Conclusion: We report that subglottic haemangioma accompanied by respiratory distress and failure in an infant was successfully treated by oral prednisolone followed by treatment with inhalation of nebulised budesonide and oral propranolol. P47D Transcutaneous carboxyhemoglobin assessment of allergic respiratory activity L.E. Kurlandsky. Upstate Medical University Department of Pediatrics – Syracuse, New York, USA Background: Endogenous production of carbon monoxide (CO) as a byproduct of the breakdown of heme by heme oxygenase (HO) is increased in patients with asthma and allergic rhinitis and is found in increased concentrations in the exhaled breath of these patients. Because exhaled CO correlates with serum carboxyhemoglobin (HbCO), the clinical usefulness of measuring HbCO in pediatric patients with allergic respiratory disorders with a recently available, non-invasive instrument that measures serum HbCO transcutaneously. Methods: A transcutaneous CO-Oximeter (Rad-57, Masimo Corp., Irvine, CA) measures differences in light absorption between HbCO (SpCO), methemoglobin, and oxygenated and unoxygenated hemoglobin. This instrument is available in our Pediatric Pulmonary and Allergy Center to evaluate HbCO resulting from tobacco smoke or other environmental CO exposure. Asthma was defined by significant reversible airway obstruction by spirometry; allergic rhinitis by exam of nasal mucosa or positive allergy skin tests or serum IgE RAST testing; and GERD by positive pH probe study or dramatic response to H2 antagonist or proton pump inhibitor treatment. Results: Measurements of SpCO% from pediatric patients with clinically active or controlled asthma, allergic rhinitis, and gastroesophageal reflux (GERD)causing respiratory symptoms were collated and compared to 23 controls composed of pediatric residents and clinic staff who did not smoke. Results were as follows where (+) denotes disease activity and (−) denotes good control.
Patient No. SpCO% Avg. Stand. Dev.
Normal
Rhinitis +
Rhinitis −
Asthma +
Asthma −
GERD
23 0.08 0.28
88 6.15 4.07
26 0.77 1.53
51 4.78 3.56
86 0.3 0.85
44 0.64 1.97
Conclusions: This preliminary series of observations supports reports of increased CO in patients with asthma, allergic rhinitis, and GERD. In addition, elevated levels were seen in active asthma and allergic rhinitis compared to asymptomatic patients providing a simple, noninvasive measurement of disease activity.
S95
5. Fetal and neonatal respiratory disorders P48E Abnormal lung features on prenatal ultrasound and postnatal outcome A.E. Dereymaeker1 , A. Debeer2 , L. De Catte3 , R. Devlieger3 , L. Breysem4 , J. Breckpot5 , E. Verbeken6 , P. Moerman6 , A. Lerut7 , D. Van Raemdonck7 , K. De Boeck1 . 1 University Hospitals Leuven Department of Pediatric Pulmonology – Leuven, Belgium; 2 University Hospitals Leuven Neonatal Intensive Care Unit – Leuven, Belgium; 3 University Hospitals Leuven Department of Obstetrics and Gynaecology – Leuven, Belgium; 4 University Hospitals Leuven Department of Radiology – Leuven, Belgium; 5 University Hospitals Leuven Centre for Human Genetics – Leuven, Belgium; 6 University Hospitals Leuven Department of Pathology – Leuven, Belgium; 7 University Hospitals Leuven Department of Thoracic Surgery and Esophageal Surgery – Leuven, Belgium Background: With widespread use of prenatal ultrasound many major congenital lung malformations are detected antenatally. Congenital pulmonary adenomatoid malformations (CPAM), bronchopulmonary sequestration (BPS) and congenital lobar emphysema (CLE) are the most common prenatal diagnoses. However, the correlation between antenatal findings and postnatal diagnosis, management and outcome is still unclear. Aim of the study: To describe the correlation between prenatal sonographic findings, postnatal imaging and histopathological features of congenital lung malformations and to determine the significance of these findings in postnatal outcome. Patients and Methods: In this retrospective study from 1998 to 2008 we identified 36 fetuses with abnormal prenatal lung sonographic features, diagnosed at 17 to 34 weeks of gestation. In all cases we gathered prenatal sonographic findings, postnatal imaging and/or histopathological features if available. Subjects with a clear-cut diagnosis of isolated congenital diaphragmatic hernia were not included. Results: CPAM was suspected on prenatal ultrasonography in 25 out of 36 cases. The presence of CPAM was confirmed by postnatal Computed Tomography (CT) in 19 of them, but could not be differentiated from BPS in the remaining 6 cases. Histopathologic information was available on 20 resected lesions and confirmed the CPAM diagnosis in 17 cases, including 3 cases with an unclear diagnosis on postnatal CT. In the 3 remaining cases the histopathologic diagnosis of congenital bronchiectasis was retained. In 9 out of 36 cases the type of lung malformation could not be distinguished on prenatal ultrasound. One case presented with a combination of congenital diaphragmatic hernia (CDH) and BPS requiring urgent surgical intervention at birth due to respiratory distress. Postnatal CT was performed in all other cases and suggested the diagnosis of CPAM in one case, BPS in one case, CLE in 3 cases and remained unclear in 3 cases (BPS and/or CPAM). Histopathologic data were available in 5 of these 8 cases, confirming the tomographic diagnosis in all of them (1 CPAM, 1 BPS 2 CLE and 1 combination of BPS and CPAM). The 3 remaining cases (1 CLE and 2 cases with BPS and/or CPAM on postnatal CT) are still in clinical follow-up and did not undergo surgical resection yet. In 2 out of 36 cases the prenatal diagnosis was a congenital high airway obstruction syndrome (CHAOS). Histopathologic data of the first case revealed a combination of CPAM and BPS, which was not suspected on prenatal ultrasound. No histopathologic data on the other case were available. Ten out of 25 patients prenatally diagnosed as CPAM presented with respiratory problems, either acute respiratory distress at birth (6 cases) or recurrent infections (4 cases). In the non-CPAM group there was 1 mors in utero and 7 symptomatic cases with acute respiratory distress.