key: cord-0041894-gqltd6u0
authors: nan
title: Poster Sessions
date: 2019-06-27
journal: Pediatr Pulmonol
DOI: 10.1002/ppul.24373
sha: ad2e3ed0f9808a4328254f16461c9f82bde76294
doc_id: 41894
cord_uid: gqltd6u0

nan

in this study. The near-fatal group accounted for 19%. The 12 months to 5 years age group accounted for 58%. Female/male ≈ 1.2/1. Sixtyone percent of children were from Hồ Chí Minh City. Admission to ICU increased recently. Dyspnea was the chief complaint, accounting for 88%. Cough, wheezing, dyspnea were essential symptoms. Fiftly-one percent had a history of asthma. Preventer medication ownership was recorded in 34% of cases. The rate of impaired consciousness was 59.4%. 27% had a pH < 7.3% and 33% had a PaCO2 > 40 mm Hg.

Chest X-rays showed hyperinflation, infiltrates and atelectasis. Time of treatment was 7 days (6,11), days in ICU was 2 days (2, 4). Ten children were intubated, 43.5% received NCPAP; 72.6% of children older than 1 year were given MgSO4, 65% children were given diaphyllin, 20% children were given salbutamol and 6% children were given adrenaline subcutaneously. All intubated patients received pressure control ventilation. Inspiratory pressure was 14 to 16 cmH2O to achieve tidal volume of approximately 6ml/kg, mean PEEP was 7 cmH2O, FiO2 was approximately 80% and I/E was 1/2 -1/3.

Conclusions: Appropriate treatment at first is crucial to lower the number of children to be intubated. Mechanical ventilation still remains the last recourse in the treatment of near fatal exacerbations of asthma after MgSO4, diaphyllin and salbutamol.

A-132 | Peanut and Brazil Nut Sensitization Profile among Asthmatic Patients in Southern Taiwan data on its importance in Asian populations. The relevance of CDHR3 to childhood lung functions is also unknown. This cross-sectional study investigated the associations between CDHR3 and wheezing illnesses and lung function of preschool children in Hong Kong.

Methods: Chinese children younger than 6 years of age were recruited from randomly selected nurseries and kindergartens throughout Hong Kong. The demographic, early-life exposures and allergy phenotypes of these preschool children were recorded by validated and modified ISAAC questionnaire. These children underwent incentive spirometry to measure their forced expiratory indices. Their buccal swabs were collected for DNA extraction and tagging single-nucleotide polymorphisms (SNPs) of CDHR3 were determined by TaqMan genotyping assays. Genotypic and haplotypic associations between these SNPs and wheezing and lung function traits were analyzed by multivariable regression and R-package haplo.stats 1.7.7, respectively.

Results: The mean (SD) age of a total of 1341 children was 4.7 (1.0) years. Forty-one percent of them had domestic exposure to cigarette smoking, whereas 17% and 11% had wheeze ever and current wheeze respectively. Current wheeze was associated with rs6967330 and rs140154310 of CDHR3, with the respective odds ratios (ORs) being 1.63 and 2.20. These two SNPs were also associated with frequency of wheezing illnesses over the past 12 months, with ORs being 1.57 (P = 0.034) for rs6967330 and 2.14 (P = 0.024) for rs140154310. Current wheeze was also associated with the 3-locus GAC haplotype of CDHR3 (OR, 1.54 and P = 0.048). Two CDHR3, SNPs rs408223 and rs140154310 were associated with FEV0.5, FVC and FEV0.5/FVC, and the GGG haplotype was associated with FEV0.5. A-174 | Development and Validation of an Adherence Questionnaire for Adolescents with Asthma on Controller Inhaled Corticosteroids with asthma on ICS at multiple hospitals and clinics in Japan.

Adherence to ICS medication was separately evaluated by "confidential" questions to ask frequency of "forgetting to take medicine" by nonmedical study staff. The best model to predict adherence was formed by multivariate logistic analysis. Validation of the model was performed using answers to the questions from a separate group of ICS-treated asthma patients of the same age.

Results: Responses from 445 adolescents were used as development data set and those from separate 275 adolescents were used as validation data set. A 6-item logistic model was selected from the development data set. It showed good statistical fit and well discriminated poor adherence with AUC at 0.814 and 0.759 in development and validation datasets, respectively. Probability of adherence was calculated as propensity score in the logistic regression model and named as the Pediatric Asthma Adherence Questionnaire (PAAQ) score. The PAAQ scores for the physicians' ratings of adherence differed significantly in the hypothetical direction.

The PAAQ may be a useful tool to evaluate adherence in adolescents with ICS-treated asthma.

A-208 | Effect of Long-term Inhaled Corticosteroid Therapy on Adrenal Suppression Growth and Bone Health in Children with Asthma years diagnosed as having asthma on inhaled corticosteroid therapy for more than 6 months were included as cases. Children who were on oral steroids for exacerbations a week Before the study, asthma with other chronic illnesses and children over 9 years old to avoid the confounding effects of pubertal growth acceleration seen at this age, were excluded. Comparison group consisted of 70 age-matched children with asthma who were not on ICS.

Heights were assessed according to their Mid Parental Heights (MPH). Serum calcium, alkaline phosphatase and vitamin D levels were assayed in both groups. Low dose short Synacthen test was performed on cases and serum cortisol at 0, 30, 60 minutes of the test was performed to assess HPA axis function. Peak cortisol level > 500nmol/l at 30 minutes was considered to have passed the test and exclude adrenal suppression. The average daily dose of ICS was categorized as low, medium and high according to published literature.

Results: Both the associations between long-term ICS and growth (chi square value = 0.785, P = 0.376) and calcium levels (P = 0.88)

were not statistically significant. A significant association was found between long-term inhaled corticosteroid therapy and ALP level (P < 0.01) although the interquartile ranges of serum ALP in both groups were within the normal range for the age.

There was no statistically significant difference in vitamin D levels in both groups (P = 0.886), although Vitamin D levels were deficient in 34% of cases and 41% of controls (< 50 nmol/l). Interestingly suppressed cortisol levels were seen in 24% of cases. Cumulative doses of ICS in 70 cases were low, medium and high in 41%, 41% and 17% of children respectively. Results: Total antibiotic use appeared to have decreased 1 year after follow-up in a specialized asthma clinic. Both the overall use (p 0.08) and the use of amoxycillin / clavulanate (p 0.01) were statistically significant. The use of amoxycillin, cephalosporins and macrolides was also found to be reduced. A statistically significant reduction was also found in the use of antihistamines (p 0.048). In terms of quality of life, a statistically significant improvement was found in the worry domain of asthma both in children (p 0.012) and their parents (p 0.013) as well as in the impact domain for parents (p 0.05). Methods: In this prospective cross sectional study, we enrolled consecutive children between 5 to 15 years of age with poorly controlled asthma (partly controlled and uncontrolled as per GINA guidelines) between July 2016 to March 2018. We excluded children with cystic fibrosis. The enrolled children were investigated for ABPA that included total IgE, Aspergillus-specific IgE, Aspergillus-specific IgG, skin prick test for Aspergillus, serum precipitins, absolute eosinophil count (AEC), chest X-ray, and chest CT (in selected patients). ABPA was diagnosed as per recent criteria: if both of the following criteria were fulfilled: (1) total IgE > 1000 IU/ml and positive skin prick test (SPT) to Aspergillus or Aspergillus-specific IgE > 0.35 kUA/L; (2) at least of two of following three: presence of precipitating antibody or Aspergillus-specific IgG > 27 mg/L; chest radiology suggestive of ABPA; and total eosinophil count > 500 cells/mm3. Data were analyzed using STATA 12.0. We used the receiver operating characteristic (ROC) curve along with area under the curve (AUC) to determine the utility of various parameters to differentiate children with ABPA from those without. To determine best cut-offs, Youden's index was used (sensitivity + specificity -1).

Results: We included 106 asthmatic children (male: female 72:34) with mean (SD) age of 10.2±2.6 years. The prevalence of ABPA was 12/106 (11.3%; 95% CI, 5.2%, 17.5%). Among baseline characteristics including spirometry of included children, only the presence of brownish sputum S88 | ABSTRACTS was greater in ABPA children. Among diagnostic criteria, all were significantly different between children with ABPA and without ABPA except Aspergillus-specific IgG and positive SPT. The AUC (95% CI) of ROCs are shown in Figure 1 . The difference between AUC of total IgE and Aspergillus-specific IgE vs. Aspergillus-specific IgG was significant. The sensitivity and specificity of total IgE (>1000 IU/ml), Aspergillus-specific IgE (> 0.35 kUA/L), AEC (> 500/ mm3) and Aspergillus-specific IgG (> 27 mg/L) cut-offs as defined by diagnostic criteria was 100% and 65.9%, 75.0% and 79.8%, 91.7% and 57.0%, and 27.3% and 87.5% respectively.

The best cut-off values as per Youde's index of total IgE, Aspergillus-specific IgE, AEC, and Aspergillus-specific IgG were 1806 IU/ml, 0.63 kUA/L, 786/mm3, and 16.8 mg/L, respectively with corresponding sensitivities and specificities of 75% and 76.6%; 75.0% and 88.3%; 83.3% and 74.2%; and 63.4% and 71.5%, respectively.

Conclusions: Aspergillus-specific IgE levels had the best discriminative value followed by total IgE, AEC, and Aspergillus-specific IgG for ABPA in asthmatic children. The currently proposed cut-off values may not be appropriate for children.

Reflections and concrete proposals for action: There is need to develop childhood-specific diagnostic criteria for ABPA. Methods: This is a one-year retrospective study that was conducted in our pediatric intensive care unit (PICU) comparing the intervention failure rate of three different Noninvasive respiratory support modalities (bi-level positive airway pressure (BIPAP), continuous positive airway pressure (CPAP) and HFNC) for infants and young children between the ages of 1 month and 2 years admitted with the diagnosis of bronchiolitis.

A sample size of 137 patients was collected with a median age of 2 months. Children who required HFNC were older (mean 4.5 months) than children who required BIPAP (2.7 months) while the mean age for children who required CPAP was (2.8 months).

Results: HFNC carried a higher failure rate in comparison with the other two respiratory support modalities (50.6% for HFNC n39/77 vs.

Zero % for CPAP n0/10% and 8% for BIPAP n4/50, P < 0.01). Among the 39 patients who failed HFNC, (90%) were successfully shifted to BIPAP and weaned off later, while the other 4 were intubated and needed mechanical ventilation. On the other hand, all 4 patients who failed BIPAP were intubated and mechanically ventilated. No difference was found between the three groups in terms of gender or the causative virus. No respiratory complications or mortality was reported in the three groups. In the BIPAP group, oxygen requirement was significantly reduced at 24 hours from the start of the intervention and afterward in comparison with the HFNC group (P < 0.01 -0.02),

although not statistically significant with the CPAP group. No difference was observed in length of PICU stay or hospital stay between the three groups. We did not observe any association between causative virus(es) and the number of ER or pulmonology clinic visits for wheezing or recurrent bronchodilator use after discharge from the hospital. In the BA group, we found virus infection only in 25%, predominantly adenovirus, followed by RV and RSV. In 56% of the cases, Streptococcus pneumoniae was confirmed in the throat swabs vs. only 33% for isolated Moraxella catarrhalis. There were no other bacteria isolated in the BA group. In the CWC group, we found only in 10% of viral infections mainly hMPV, followed by adenovirus and RV. Results: 105 children had been taking antibiotics Before hospitalization while the remaining 180 patients were antibiotic naïve. In 44.9% of the cases, we could not prove etiological agent, while bacteria were confirmed in 41.6% and viruses in 16.2% (in 4.6%, we found combined virus and bacteria), and fungi were found in 2.5%. When dividing the cases according to prior antibiotic use, the distribution was: 38.8%, 48.3%, 15% and 2.2% for antibiotic naïve vs. 55.23%, 28.5%, 18.9% and 2.8% for the others respectively (P = 0.002). When looking at the bacterial isolates and prior antibiotic use, we did not find any significant difference regarding Mycoplasma pneumoniae isolation (P = 0.36) although there was one for Streptococcus pneumoniae (P = 0.015), mainly due to the standard guidelines to GPs to start with penicillin antibiotic for pneumonia. As expected Mycoplasma was isolated in older children, while Streptococcus was mainly isolated in younger patients. Mean age for children with bacterial pneumonia was 6.54 years, for those with viral pneumonia 4.34 years., for combined (viral+bacterial) 3.08 years. and for fungal pneumonia 10.42 years (P = 0.000). The values for CRP were lower in cases with Mycoplasma and in cases with non-compact infiltrate changes on X-rays (P = 0.002 and P = 0.000). Almost 2/3 of the children have been immunized with pneumococcal vaccine (66%).

The immunized patients had higher numbers of viral and lower numbers of bacterial isolates − 25.7% and 37.23% vs. non-immunized patients − 4.12% and 48.45%, respectively (P = 0.002). There was no difference in Streptococcus pneumoniae isolation and vaccination status, but there was a major drop in Mycoplasma isolates in vaccinated patients (6.9% vs. 32.98%, P = 0.000). For the patients with asthma only, we could not identify the microorganism in 14%, while in 48.5% and 51.2%, we found viruses and bacteria, respectively (co-infection was found in 23.26%). In 50% of children without asthma, we did not isolate the etiological agent and there was co-infection only in one case, while viral pneumonia and bacterial pneumonia was confirmed in 10.6% and 39.3% respectively (P = 0.008). All children but 3 were discharged healthy for mean 6.54 days in hospital stay. The mentioned 3 patients had severe complications and required surgical intervention.

Conclusion: In the future, we could expect more viral pneumonia with increasing vaccination coverage and maybe we should reevaluate our treatment guidelines. Objective: To compare the need for pediatric critical care in a tertiary children's hospital with a diagnosis of community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). Furthermore, we conducted a pilot study to evaluate the possible medical biomarkers which are associated with longer pediatric intensive care unit stay.

Methods: An observational, retrospective cohort analysis was conducted in children who were admitted to our tertiary children's hospital with a diagnosis of CAP or HAP. Patient demographics, clinical characteristics, and comorbidity were collected between January 2012 and December 2013. The following prospective pilot study was conducted in children who were admitted to our pediatric intensive care unit (PICU) due to pneumonia progression. We evaluated the clinical profiles and medical biomarkers. The primary endpoint was the duration of PICU stay with associated predicting factors.

Results: A total of 548 patients with 598 episodes of pneumonia (310 males; 288 females) requiring admission to our children's hospital were included. The mean age at admission was 59.6 ± 1.95 months and the average length of stay was 11.4 ± 0.70 days. 530 episodes were identified as CAP and the other 68 episodes were HAP.

Patients with CAP had significantly shorter lengths of hospital stay and duration of ICU stay than those with HAP (8.2±10.5 vs. 36.5±31.5 days, P < 0.001; 2±6.9 vs. 10±18 days, P < 0.001). The most common co-morbidities in CAP were neurological diseases and atopy history. Among the CAP patients, 90 episodes (17%) led to ICU admission during treatment course with the most common comorbidities being neurological diseases. However, in HAP patients, cardiovascular diseases were the most common co-morbidities as well as those (38.2 %) who required PICU care. The overall mortality rate was 3.8%, with the mortality rate being significantly higher in the HAP group (P < 0.001).

The pilot study included 8 children with the diagnosis of pneumonia in PICU from Jan 2015 to Dec 2015. Neither progressive ARDS mobility nor mortality occurred. The mean age at diagnosis was 37.5 ± 30.4 months. The average number of days of PICU stay was 6.9 ± 4.7 days.

The median duration of hospital stay was 14 days. Patients were divided into two groups: PICU stay more than 7 days and less than 7days. The values of pro-BNP, AaDO2, platelets, CRP and CI in patients with PICU stay more than 7 days showed a significant difference with those less than 7 days in the initial PICU admission (P < 0.05). However, the values of thoracic fluid content (TFC) or even TFC corrected by cardiac output were not significantly different between the two groups. The levels of sputum 8-isoprostane and urinary 8OHdG revealed a trend of decreasing level after disease relief.

Conclusions: In this study, we found that (1) HAP resulted in significantly longer lengths of hospital stay and PICU stay than CAP.

The possible risk factors for the need of critical care are associated neurological disease in CAP and heart disease in HAP; (2) the possible biomarkers of pro-BNP, platelet, CRP, CI, 8-isoprostane and 8OHdG may predict the duration of PICU stay in our pilot study.

These results not only help further our understanding of the risk of pneumonia in children who require critical care but also provide chances for better intensive respiratory care. Background: Pneumonia is a leading cause of respiratory morbidity and mortality in children younger than 5 years of age. 1 The incidence of severe cases of Community-Acquired Pneumonia (CAP) in low-and middle-income countries is still high. 2 Although severe CAP can be diagnosed by clinical features and chest X-ray, it could be useful to measure biomarkers to predict the outcome.

The aim of the study was to determine the association between Methods: Ninety children aged between > 28 days to < 5 years hospitalized with diagnosis of severe CAP in the Pediatric Department of West Nusa Tenggara Province General Hospital from January to October 2018 were enrolled. Data on demographic and clinical characteristics, and laboratory examination were recorded.

All subjects were treated in accordance with the hospital CAP protocol and prospectively monitored until discharged.

Results: Out of 90 subjects, 68% were ages < 1 year, 59% male, 87% passive smoke exposure, 56% lived in crowded environment, 62% came from low family income, 97% showed infiltrate on chest X-ray 81% with comorbidity and Fe deficiency anemia was the most common (64%). C-reactive Protein, ESR, LC, and NLR were not significantly associated with hospital length of stay and duration of oxygen consumption (P > 0.05). After adjustment for CRP, LC, NLR, and age, ESR was found associated with mortality, with every increase in one log of ESR decreasing the log odds of death about 3.3 (P = 0.043).

Conclusion: Higher ESR was associated with lower risk of death.

However, none of the biomarkers were associated with hospital length of stay or duration of oxygen consumption.

Keywords: Community-Acquired Pneumonia, outcome, children, biomarker. recurrent episode of bronchial obstruction were enrolled in this study.

Detailed history, physical examination, blood sample and nasopharyngeal aspirate (NPA) collection were performed. The viral etiology of the respiratory tract infections was determined using polymerase chain reaction (PCR) and the concentration of IFN-γ in NPA by ELISA kits.

Results: The mean NPA levels of IFN-γ in RSV (+) infants -4.3 (0-30.1) pg/ml was lower than RSV (-) infants -14.43(0-49) pg/ml, (P = 0.12). A gender difference in IFN-γ was detected with significant higher values in girls (OR, 1.95; [CI] 0.85-4.26; P = 0.05). The cytokine ratio did not differ between infants with or without atopic status and family history of asthma. Moderate-to-severe bronchiolitis in 7 cases (20%) was associated with lower IFN-γ level (OR, 0.8; [CI] 0.64-1.13; P = 0.06), none of them required mechanical ventilation. Decreased IFN-γ production correlated with the recurrent episodes of wheezing (P = 0.05). Objectives: To test the hypothesis that high amplitude BCPAP support after acute lung injury may have different effects on gas exchange efficiency and lung injury protection compared to high flow CPAP (mimicking HFNC) support in rats with ALI.

Methods: After normal saline lavage lung injury, all rats initially received high tidal volume mechanical ventilation (9 ml/kg) for 30 minutes, then were randomly divided into three groups: high amplitude BCPAP group using the bubble technique with 135 degrees of expiratory limb (n = 8); standard BCPAP group using the bubble technique with 0 degree of expiratory limb (n = 4); and high flow CPAP (mimicking HFNC) group using the high flow technique (2 L/min, n = 8). All groups were killed 2.5 hours after BCPAP or high flow CPAP (mimicking HFNC) support. Arterial blood gases, respiratory rate, peak inspiratory pressure (PIP) and mean airway pressure (MAP) of rat lung during respiratory support, wetto-dry lung weight ratio, lung homogenate and/or bronchoalveolar lavage fluid tumor necrosis factor-α, macrophage inflammatory protein-2, interleukin-6 and total protein levels were measured and compared among groups after study completion.

Results: The high amplitude BCPAP group exhibited a significantly higher PaO2, lower PaCO2 and significantly lower alveolar protein, PIP, MAP, wet-to-dry lung weight ratio and cytokine level compared to high flow CPAP (mimicking HFNC) group. High amplitude BCPAP group also exhibited a lower cytokine level compared to the standard BCPAP group. No difference in gas exchange efficiency was observed between the two BCPAP groups.

Conclusion: High amplitude BCPAP support decreases lung inflammation, increases gas exchange efficiency and lung compliance compared to high flow CPAP (mimicking HFNC) support in rats with ALI, and may have a better lung protective effect than standard BCPAP.

Keywords: bubble continuous positive airway pressure, high-flow nasal cannula, respiratory support, acute lung injury. Nontraumatic chylothorax in children is rare and more difficult to treat than traumatic chylothorax. In some cases, they are refractory to conventional treatment, leading to severe morbidity and mortality.

Thus, the purpose of this study is to analyze the clinical features of chylothorax in pediatric patients in our hospital and seek appropriate therapeutic management.

Methods: A retrospective review was performed in 63 patients with chylothorax from January 2000 to December 2018 in the Children's Hospital of Seoul National University. Traumatic or postoperative chylothorax was excluded. A total of20 patients with nontraumatic chylothorax were included in our study. Etiology, treatment, and outcome of chylothorax were analyzed.

Results: Nontraumatic chylothorax was diagnosed in 20 patients. Male patients (14/20 = 70%) were more frequently affected than female (6/ 20 = 30%) patients. Eighteen patients were diagnosed before 1 year of age (90%), only two patients were diagnosed after 1 year of age (6 years old, 12 years old respectively). The most common cause of spontaneous chylothorax was idiopathic factors, constituting 45.5% (13), three cases were related to high central venous pressure due to venous thrombosis and recurrent sepsis, 2 cases were related to Down syndrome, 1 case was Noonan syndrome, and the remaining case was Gorham stout syndrome. Seventeen patients needed a respiratory support device, 6 of the latter received low flow oxygen supplementation, 11 patients received ventilator support. Dietary modification (NPO or MCT base feeding), conventional medication (somatostatin or octreotide), sirolimus, surgical management were administrated to our patients. In the neonate and infant group, three patients who were related to venous thrombosis died because of recurrent septic shock before chylothorax management was administered. Fifteen patients received a dietary modification (NPO or MCT base feeding) and nine patients improved by conservative management. One patient died due to heart failure before medical treatment. Somatostatin or octreotide was used in 5 patients who failed dietary modification, but only one patient improved with octreotide.

Among the somatostatin or octreotide failure group, 4 patients received surgical management (pleurodesis or thoracic duct ligation). Three of these patients improved, although one patient died after thoracic duct ligation operation because of post-op ARDS. Two patients who were diagnosed after 1-year of age were refractory to nutritional modification and conventional medication such as somatostatin or octreotide.

However, lymphatic intervention and surgical treatment were not suitable for these two patients. Considering that their underlying disorder consisted of Noonan syndrome and Gorham stout syndrome, we used sirolimus to treat the refractory chylothorax. After administration of sirolimus, their chylothorax improved compared to before.

Conclusions: Most of the nontraumatic spontaneous chylothorax in pediatric patients occur in newborns and the most common cause of chylothorax in the neonatal and infantile period is idiopathic. On the other hand, nontraumatic chylothorax in childhood is rare and tends more to be accompanied by the underlying syndrome. Moreover, the treatment failure rate is higher in the childhood group. In such cases, sirolimus which is an mTOR inhibitor, can be beneficial to patients who tend to be refractory and cannot be treated with lymphatic intervention or operation. Purpose: Specific genetic causes for childhood interstitial lung disease (chILD) in immunocompetent patients have been identified within the past decade. However, little is known about the pathogenesis of many forms of chILD, and treatment approach has not been standardized. A national survey was carried out by the Japanese Society of Pediatric Pulmonology (JSPP) To identify the histopathology and response to current treatment, especially hydroxychloroquine, which is contraindicated for children younger than 6 years old in Japan.

Methods: A questionnaire was sent to pediatricians who registered a chILD patient to the JSPP. We conducted the survey over a period of 9 years, between 2010 and 2018. Children (0-15 years) were included in the survey with persistent hypoxemia (PaO2 less than 60 torr or SpO2 less than 90%) for more than 2 weeks, diffuse infiltrates on CT scanning, and elevated serum markers such as KL-6, Sp-A, or Sp-D. Immunodeficiency and other diseases which present with similar symptoms to chILD were excluded. The questionnaire included information on the patients' clinical symptoms, family history, pathological histology, clinical genetic findings, treatments and clinical outcomes. Informed consent was obtained by all patients' guardians before participating in the survey.

Results: Twenty-six cases were identified, including 15 males and 11 females. Age of onset was between 0 months and 8 years. Fourteen (53%) cases presented in the first year of life. Lung biopsy was performed in 11 (42%) cases. Five cases showed changes of nonspecific interstitial pneumonia (NSIP), 1 case with desquamative interstitial pneumonia (DIP), 1 case with cryptogenic organizing pneumonia (COP), 1 case with usual interstitial pneumonia (UIP), 1 case with acute lung injury (ALI), and 2 cases untagged. Genetic testing was performed in 21 (80%) cases. Mutation in Sp-C gene (SFTPC) was detected in 8 cases, ATP binding cassette subfamily A member 3 (ABCA3) in 1 case, NK2 homeobox 1 (NKX2-1) in 1 case, coatomer associated protein subunit alpha (COPα) in 1 case, and no mutation was detected in 10 cases. In the first half of the study period, only 5 out of 16 (31%) cases were diagnosed with genetic testing without lung biopsy, which increased to 8 out of 10 (80%) cases in the latter half. Prednisolone was used in 24 (92%) cases and hydroxychloroquine in 20 (76%) cases with no onset of retinopathy.

Conventional treatment with prednisolone or hydroxychloroquine, monotherapy or in combination, resulted in a good response in 17 (65%) cases. Three (11%) children died despite all therapies. In addition, it turned out that 1 case was diagnosed as juvenile idiopathic arthritis 4 years after registration.

Conclusions: This is the first nationwide prospective study regarding chILD in Japan. The histopathology in this study is similar to that reported previously. There is increasing emphasis on genetic studies in the diagnosis of chILD as it can help avoid unnecessary lung biopsy.

Corticosteroid and hydroxychloroquine were the main therapeutic agents in our study. Hydroxychloroquine therapy was tolerated in many cases, with no significant side effects. Methods: Twenty three children aged 11.8±4.9 years with BOS after allogeneic hematopoietic cell transplantation were enrolled, and their clinical data were reviewed retrospectively. All subjects repeated the pulmonary function test at an interval of 1 month after occurrence of

Results: Among 23 subjects with BOS, 6 (25.0%) subjects expired due to respiratory failure, 4 (17.4%) subjects underwent lung transplantation, and 16 (69.6%) subjects needed O2 therapy. The mean value of FEV1% predicted at the diagnosis of BOS was 37.0±13.0%, and it rose after 12 months (47.0±24.9%). FEV1 % predicted at diagnosis of BOS tended to be lower in subjects with oxygen therapy (34.7±12.2) than in subjects without oxygen therapy (45.8±11.1), [YJ1] although there was no statistical significance. The changes in FEV1 % predicted at 3 months after BOS diagnosis were significantly lower in the subjects with oxygen therapy (-19.4±24.3%) than in subjects without oxygen therapy (8.6±21.9%). However, there was no significant difference in the change over 3 months of FEV1% predicted values between the two groups at 6, 9, and 12 months.

In addition, the group with a negative slope of FEV1% predicted change during the first 3 months had a higher likelihood of O2 therapy, compared to the group with a positive slope of FEV1 change during the period (HR of 3.57, P = 0.059).

The change in FEV1 during the first 3 months after BOS was significantly different between the subjects with and without oxygen therapy. These results suggest active intervention strategy is needed during the first 3 months after BOS To improve the prognosis. This study is aimed to assess the effectiveness of HS nebulizations Before physiotherapy over conventional physiotherapy in children with non-CF bronchiectasis.

Objectives: Primarily to compare the change in FEV1 from pretreatment phase to posttreatment phase between the two groups. Method: We performed a retrospective cohort study of extremely preterm infants born before 28 weeks of gestational age in our NICU.

Study subjects were divided into two groups: AUTO group who underwent the automated control of inspired oxygen concentration (AUTO) with CPAP, and MANUAL group who underwent manual control of inspired oxygen concentration (MANUAL) with CPAP before introduction of AUTO in our NICU. We retrospectively investigated the patient characteristics and short-term outcome related to the respiratory system (reintubation rate, duration of CPAP, introduction rate of home oxygen therapy) and retinopathy of prematurity (incidence, stage, and therapy rate). the Mann-Whitney U test and Chi-squared test were used for statistical analysis, and logistic regression was used for multivariable analysis.

Result: A total of 47 infants were eligible for this study. There were 25 and 22 infants in the AUTO group and MANUAL groups, respectively. In the AUTO and MANUAL groups, the median (range) of their gestational age in weeks was 25.1 (23.3-27.9) and 25.5 (23.7-27.9, P = 0.25), birth weight in grams was 690 (461-990) and 789 (442-1178, P = 0.02), the rate of maternal steroid administration was 73% and 36% (P = 0.01), age at study entry in days was 2 (54-48) and 31 (2-67, P = 0.31). Reintubation rate was 56% and 50% (P = 0.68), duration of CPAP (day) was 28 (6-62) and 26 (3-38, P = 0.29), and introduction rate of home oxygen therapy was 20% and 27% (P = 0.56). The incidence of total retinopathy of prematurity (ROP) was 64% and 77% (P = 0.32), the incidence of ROP over stage Ⅱ was 24% and 59% (P = 0.02), and therapy rate for ROP was 8% and 14% (P = 0.53) in each group. There was a statistically significant association between the decreasing risk of ROP over stage Ⅱ and use of AUTO by multivariable analysis adjusted for confounding factors (odds ratio: 0.22 [95% CI: 0.06-0.76], P = 0.02).

Discussion: In this study, the incidence of ROP over stage Ⅱ was significantly decreased in extremely preterm infants who underwent AUTO with CPAP. It is suggested that exposure to the excessive oxygen levels and the fluctuation of oxygenation are related to the incidence of ROP. Large studies indicate the strict SpO2 target range.

But in fact, the manual control of inspired oxygen concentration during respiratory support is not sufficient for the maintenance of SpO2 within the latter. AUTO can maintain SpO2 within the target range compared to the manual control of inspired oxygen concentration. AUTO has the potential to prevent ROP by decreasing the exposure to excessive oxygen levels and the fluctuation of oxygenation. Several limitations should be considered in our study. This was a retrospective, single-centered, non-randomized study; a further multi-centered prospective study is needed. Since their pulmonary function is decreased, lower respiratory tract infections in this population may have a more severe clinical course.

In our study, in addition to lung function measurement, we also wanted to see whether there is a connection between mental abilities and pulmonary function.

Methods: Before the examination, a license was obtained from the ethical committee of the University of Szeged. Conclusions: We could also detect in our smaller population that VLBW patients at the age of 6 to 8 years have lung function test values in the lower normal region of the reference range. This may raise the presumption of the higher susceptibility of these children to respiratory tract diseases also in the later decades of life. BPD patients have lower pulmonary function test results than non-BPD patients. On the other hand, we could not find any connection between low Raven test performance and lung function results.

Background: Esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) is one of the rare congenital anomalies occurring in 1 out of 3,000-5,000 births. There has been improvement in the survival of these infants during recent decades. The diagnosis of TEF with EA is commonly made during the first 24 hours after birth.

Preoperative flexible endoscopy (FE) is not yet routinely included in the diagnostic and postoperative assessment. This study aimed to evaluate the predictive factors that affected patients' prognosis and the role of flexible endoscopy application in managing infants with EA and/or TEF in a tertiary medical center.

Methods: We enrolled patients who were admitted into our hospital due to suspected EA and/or TEF and accepted an FE examination for one or more times between Jan. 2000 and Dec. 2017. All associated medical and surgical records were retrospectively reviewed. The analyzed data included basic characteristics, diagnosis, age of surgical repair, associated anomaly, timing of FE before and after surgical repair, and mortality. Factors related to patient's mortality were analyzed.

Results: A total of 33 patients were enrolled, including 28 (84.8 %) cases referred from other hospitals. Their mean birth weight was 2448 ± 603 gm, including 19 (57.6%) low-birth-weight infants, 17 (51.5%) cases with cardiac anomalies, 12 (36.4%) cases aged > 90 days, and 12 (36.4%) cases underwent FE before reconstruction. The most common classification of enrolled cases was type C (84.8%). Additional other airway anomalies were found in 23 (69.7%) cases, including tracheomalacia, bronchostenosis, lung hypoplasia, and laryngeal cleft. One case underwent nasaltracheo-fistula-gastric catheter insertion before surgery. The mean age of receiving surgical reconstruction was 5 ± 7 days. The most common postsurgical complication was anastomotic stenosis (25, 75.8%) that required laser therapy (9, 27.3%), balloon dilatation (17, 51.5%), or stent implantation (2, 6.1%). Gastroesophageal reflux was also commonly found in 21 (63.6%) cases. The overall 2-year survival rate was 72.7% (27/33).

Significant factors related to 1-year mortality were post-reconstruction referral (P = 0.004), age of reconstruction > 7 days (P < 0.001), and cardiovascular surgery requirement (P = 0.032).

Conclusions: In infants with EA and/or TEF, FE is feasible for the early identification of associated airway and esophageal anomaly, as well as postoperative diagnosis and therapeutic interventions. Postreconstruction referral, age of reconstruction > 7 days, and cardiovascular surgery requirement were significantly related to 1-year mortality of infants with EA and/or TEF. Background: Patent ductus arteriosus (PDA) is a common cardiovascular complication among premature infants and may be responsible for prematurity-related complications. Surgical ligation is considered when medical treatment has either failed or was contraindicated. Transcatheter occlusion, which was established in term infants, has recently been applied to premature population. Previous reports stated that the complication and success rates were not statistically different between the transcatheter technique and surgical ligation. In this study, our aim was to compare the oxygenation status and oxygen dependence between these two techniques. The basic demographic data, FiO2 change, pulmonary score, intubation days, ventilator-dependent days, oxygen-dependent days and mortality within 1 year were evaluated.

Results: The birth body weight, gestational age, post-menstrual age on procedure day, body weight on procedure day, pulmonary score and FiO2 before procedure were not different between these two groups.

The range of body weight on procedure day was from 478 to 1602gm in group A and from 551 to 1646gm in group B. The overall mortality within 1 year was similar (P = 0.360). The overall incidence of chronic lung disease was not significantly different (2/10 vs. 8/16, P = 0.218).

When comparing the FiO2 change before and 5 days after the procedure, the transcatheter closure group had a significant improve- are rare disorders of which the incidence is not precisely known. This malformation might threaten the fetus, but it can also disappear spontaneously, or neonates can be asymptomatic with the malformation. According to previous studies, CPAM may increase the risk for lung infections and lung malignancies, which is also the argument used when treating asymptomatic CPAM-patients with surgery.

Purpose of the study: The purpose of the present study was to investigate whether there are differences between the treatment protocols between Nordic countries.

Material and methods: A questionnaire was sent to 16 Nordic centers dealing with pre-and postnatal management of patients with congenital lung malformation. This questionnaire was aimed to collect information on pre-and postnatal treatment protocols in the centers involved.

Results: The treatment protocols of this malformation vary largely in Nordic centers. Prenatal ultrasound was the primary examination in all centers. Magnetic Resonance Imaging (MRI) was used routinely as next prenatal examination in four centers for every CPAM-patient with persistent finding in ultrasound during whole pregnancy (4 of 11). Five centers (5 of 11) used MRI if needed for differential diagnosis. Various prenatal interventions were used in cases of fetal hydrops caused by CPAM. Shunting macrocystic lesion was used in 4 out of 11 centers, maternal cortisone in 9 out of 11. Over half of the centers (7/11) consulted and co-operated with centers that performed fetal surgery and 3 out of 11 did consider ex utero intrapartum (EXIT) surgery.

Postnatally surgery was performed in every center (100%) for symptomatic CPAM-patients. One center (14%) did not remove CPAM but instead performed follow-up on asymptomatic patients. Four infants used Precision flow: three used single prong cannula (tip OD1.9 mm), and the remaining infant used double prong, infant cannula (tip OD1.9 mm). Pharyngeal pressure tended to rise to flow rate dependence with any type of cannula. In patients managed with the Optiflow junior, the mean pharyngeal pressure at the flow rates of 1, 2, 3, and 4 L/kg/min for premature size cannula were 2.3, 3.0, 3.1, and 3.6 cmH2O, respectively, and for neonatal size cannula were 0.5, 1.9, 3.0, and 3.7 cmH2O, respectively. In patients managed with Precision flow, the mean pharyngeal pressure for each cannula at flow rates of 1, 2, 3, and 4 L/kg/min for single prong cannula were 1.8, 3.9, 4.7, and 5.0 cmH2O, respectively, and for double prong, infant size cannula were 2.6, 5.7, 6.0, and 7.0 cmH2O, respectively. Background: Even though it is considered as a screening test, sweat conductivity (SC) analysis seems to be an alternative diagnostic method to the coulometric quantitative test (CQT) for the diagnosis of Cystic Fibrosis (CF). It is widely accepted that coulometry requires specialized technicians, in addition to being performed only in referral centers. On the other hand, SC sweat analysis is a semiautomated procedure, simpler and faster than the conventional CQT.

Specially in poor-resource settings, it allows the decentralization of the diagnostic network and, consequently, a wider accessibility to CF diagnosis. To date, there are no studies comparing two concomitant conductivity tests performed in the same patient.

Objective: to assess the agreement between two sweat conductivity results performed concomitantly in young infants.

Methods: This was a prospective, cross-sectional study in which two sweat samples were obtained from the two arms among 100 consecutive patients, using the Wescor Macroduct collection system Conclusion: Since the strength of agreement was perfect, it reveals a high reliability of SC. Apart from its role as a screening test, it seems that it has a place as a diagnostic tool in CF. Background: Because of frequent exacerbations and pulmonary deterioration in cystic fibrosis (CF), the radiological exposure to chest X-ray and CT scan is frequent in patients with CF, with subsequent potential secondary effect, although also required. Lung ultrasound is, ABSTRACTS | S103 currently, a useful method of evaluation in multiples diseases such as: pneumonia, pleural effusion, interstitial syndrome or pulmonary fibrosis; therefore, the use of LUS in CF would be of interest Aim of the study:

Evaluation of thoracic ultrasound utility in CF exacerbations.

Methods: Fifty CF patients were included in the study and monitored for 2 years of age. Lung ultrasound was performed every 3 months, at clinical and biological evaluation. CT scan was performed during exacerbations and for stable patients, every 2 years timetable (aged over 8 years). Ultrasound was performed using a linear high frequency 8 to 12 MHz probe, using a score based on specific artifacts which quantified the presence of consolidation, interstitial syndrome, saccular bronchiectasis and pleural effusion. CT was interpreted using the Bhalla scoring system, independently of the LUS score. Pearson's correlation was used for the evaluation of the relationship between LUS score and CT.

Results: Median CT Bhalla score was 14.3 + -4.5, and the average LUS score = 5.13 + -2, consistent for moderate morphological lung injury. A good correlation was found in patients with increased LUS (> 4) and

CT score, R= 0.75, P < 0.001. There was no reliable correlation between the lung ultrasound score and CT, therefore, validation of the LUS-CF score (R= 0.37, P = 0.26) was impossible with the currently identified artifacts. For patients in acute exacerbations, alveolarinterstitial syndrome described by multiple B-line artifacts and the presence of lake signs quantifying cystic bronchiectasis were accurately identified by LUS and confirmed by CT. Methods: We conducted a retrospective descriptive study at the University Hospital of Montpellier between 30/08/2000 and 30/08/2018. We collected the various respiratory disorders presented during the follow-up of these children.

Results: One hundred and two files were examined and 76 patients were included in our study. Asthma concerned 26 patients in our cohort (34%) which is more frequent than in our general population (9% in Occitania region, France). It was significantly related with atopy (P < 0.01). Respiratory tract disorders were identified in 10 patients (13%). The most common were: tracheomalacia and laryngomalacia. Lower respiratory infections were found in 18 patients (24%) and were significantly related to lymphopenia (P < 0.05) and swallowing disorders (P < 0.05). Infants were tested for HIV using PCR and antibody testing. The association between HIV and ARV exposure and lung function during 2 years was assessed using linear regression, adjusted for BMI for age Z-score, sex, ethnicity, socioeconomic status (SES) ABSTRACTS | S105 quartile at enrolment and pre-and postnatal smoke exposure (based on urine cotinine).

Results: A total of 1036 infants had at least one lung function measurement and were followed over 2 years, 226 (22%) were HEU; 535 (52%) male, 560 (54%) black African ancestry, 330 (33%) mothers smoked during pregnancy, 775 (71%) household tobacco smoke exposure. Nine hundred and ten (88%) infants had lung function tested at 6 weeks and 743 (72%) children at 2 years. The majority of HEU infants were black African (93% vs. 43% HU, P < 0.001), HEU infants had less household smoke exposure (69% vs. 81%, P = 0.01), lower SES (P = 0.001) and had higher BMI zscore at 2 years (P = 0.001) compared to HU; other demographics were similar.

At 6 weeks, HEU infants had higher tidal volume compared to HU (1.1mL, CI, 0.02; 2.2, P = 0.045). Amongst the HEU infants, those whose mothers had triple therapy ARVs had lower expiratory flow ratios, tPTEF/tE, compared to those whose mothers had zidovudine (AZT) only (-0.26, CI -0.4; -0.1, P < 0.001). At 2 years, tidal volume differences were no longer seen, but HEU infants had a higher lung clearance index compared to HU (0.12, CI, 0.02; 0.23, P = 0.019). Low antenatal maternal CD4 count was associated with an average 6.5mL lower tidal volume at 2 years compared to infants whose mothers had CD4 counts> 500 cells/ mm3 (CI, 1.0, 12.1; P = 0.02). Background: Chronic wet cough, which is prevalent in Indigenous children, is the most common symptom of bronchiectasis and its precursors. Early recognition of chronic wet cough leading to prompt and appropriate treatment may potentially prevent progression to bronchiectasis. Therefore, timely health seeking for chronic wet cough by families, and its effective management by health practitioners is potentially important to prevent development of bronchiectasis.

Purpose: To identify the barriers to and enablers for timely health seeking for chronic wet cough by families, and optimal management by health practitioners, for chronic wet cough in Aboriginal children.

Method: A qualitative study was conducted in two communities (one remote town and one very remote community) in the Kimberley region of northern, Western Australia, of which 43% of the population is Aboriginal. Data were gathered through individual semi-structured in-depth interviews and focus groups to ascertain: The key enabler described was the provision of culturally appropriate health literacy information. All participants reported that they would seek help for chronic wet cough once they were informed that it could signify underlying disease. Furthermore, families suggested that improved health practitioner knowledge of chronic wet cough Database. Complete monitoring data for the air pollutants (SO2, NO2, O3, CO, PM2.5 and PM10) and meteorological factors (relative humidity, rainfall, and daily average temperature) were collected from 74

Environmental Protection Agency monitoring stations of the Taiwanese government. In the present study, each ER visit for asthma AE was defined as case day. In bidirectional control samplings, the same weekdays 1, 2 or 3 weeks before and after ER visit for asthma were defined as the control days. Multiple correlation coefficients (R) (multiple regression analysis) were used to explain how much of the variance in the ED visits could be explained by a given set of air pollutants.

Result: As the study cases were divided as male and female, a 1 ug/m3 increase in the 48-h averages of PM2.5 and a 1℃ increase in temperature were associated with asthma ER visit [OR= Conclusion: In Taiwan, asthma AE is closely related to low temperature and indicated air pollution. There is an obvious bias if only a single air pollutant is being considered and neglects the influence of meteorological factors in studying the effects of the environment on asthma.

With the result of this study, we can predict asthma exacerbation precisely according to individual age, gender and local air pollution/ meteorological conditions. In days with high risk for asthma exacerbation, patients with asthma should avoid/decrease outdoor activity, dress warmly and maintain inhaled corticosteroid therapy. However, while the path length of the right dorsum manus was not statistically significant, there was a significant difference in completion time between the two groups. The reason considered was that their left hand was their nondominant hand, while their dominant hand needed to be kept clean to touch an asepstic suction catheter. Therefore, novice participants were unfamiliar with manipulating suctioning equipment with their left hand, which appeared as a difference in their proficiency. benefits of 3D CG were reported that the function of a virtual camera improved the accessibility to AOIs by screen transition, whereas operation was difficult, so they could not realize the effect of learning. Advantages of 2D video was described that it is easy to concentrate because the device was familiar, while there was a negative impression that it was hard to observe AOIs compared to 3D CG. There was no significant difference between the groups who watched 2D video or 3D CG animation in the frequency distribution of fixation point movement speed analysis.

However, considering the unignorable potential of 3D CG animation as a training tool, we concluded that defining visual criteria for assessing learning outcome of digital contents requires more research in the future. Graduate School of Nursing, The Jikei University School of Medicine -Tokyo, Japan

The aim of this study is to compare the level of endotracheal suctioning proficiency between experts and novices, using an eyemark recorder.

A head-mounted eye-tracking device (Pupil, Pupil Lab, USA) was used to capture eye movement of the participants. Twelve experienced nurses from three healthcare facilities who had more than 3 years of experiences of suctioning, and twelve nursing students from a university who had no experience of providing suctioning for real patients, participated in a simulation scenario of a patient with endotracheal intubation. We utilized cephalothorax realia with a simulated upper respiratory tract from mouth, nose, to a tracheal bifurcation, which did not represent any biological/patholo- showed that 57.3% of students are exposed to environmental tobacco smoke, which causes inflammation of respiratory tracts and a decrease in lung function. Urinary cotinine can be used as a biomarker for cigarette smoke exposure.

Objectives: To examine the effects of environmental tobacco smoke exposure on urinary cotinine level and lung function test in children.

Methods: Subjects were students aged 11 to 16 years-old in Jakarta.

Data were obtained from questionnaire, spirometry and urinary cotinine test using ELISA method.

Results: There were 92 subjects, consisting of 46 in the case group and 46 in the control group. Urinary cotinine level > 10 ng/ml was found in 37.0% of the case group and 4.3% of the control group; P = 0.000; OR= 8.50 (CI, 95% 2.08-34.71). There were significant differences between urinary cotinine level with number of smokers (P = 0.027) and number of cigarettes per day (P = 0.037). No association was found between cigarette smoke exposure and lung function test. There was a significant difference in school absenteeism between the case group and control group; P = 0.004; OR= 6.00 (CI, 95% 1.42-25.33).

Conclusions: Children exposed to environmental tobacco smoke There are relatively little data in healthy children and no data that compared these techniques. In 100 children without respiratory disease, we described (i) the BAL differential cellular count and its correlation with age, and (ii) compared the differential cytology versus B-BAL (10%, IQR 4-13%)). However, when adjusted for age using regression statistics, these differences were not significant.

There was no significant difference in the total cell count (NB-BAL 9.3x104/mL, IQR 4.5-15.3x104/mL versus B-BAL 11.8x104/mL, IQR 8-22.1x104/mL) and neutrophil percentage (NB-BAL 4.5%, IQR 2.8%-7% versus B-BAL 3.5%, IQR 1.8-8%) between the two groups. There was no significant difference in the differential cytology with age in both B-BAL and NB-BAL.

Conclusion: NB-BAL provides comparable information on the cellularity components of BAL when compared to B-BAL and should be considered an alternative. As age influences cellular differential count, age-matched data are required for comparative studies on BAL in children.

J-99 | Spirometry Assessment in Children with Congenital Heart Disease after Open Heart Surgery In these spirometry assessments, obstructive type was more common than restrictive type (31.5% vs. 20.7%). However, in TOF patients, restrictive type was slightly more common than obstructive type. J-115 | To Squeeze or Not to Squeeze? Can the Raised -Volume Passive Expiration Flow-Volume Curve Be Used to Estimate Pulmonary Functions in Infants?

Background: Spirometry is an essential tool for assessing patients with lung disease. However, it necessitates cooperation and thus, it cannot be performed in infants. One of the established alternative techniques in infants is the raised-volume rapid thoraco-abdominal compression technique (RVTCT) which uses a compression vest to squeeze the chest forcedly after inflating the lungs to near total lung capacity (TLC). Although it is an acceptable method, it is far from being perfect since it is not easy to perform. Obtaining the raisedvolume passive expiration curve (RVPE) from passive deflation of the lungs from TLC is an easier technique (Figure 1) . However, to our knowledge, data obtained from the RVPE curve were not assessed for their ability to estimate expiratory airway function in infants. TST was considered positive if induration > 10 mm and QFT-GIT However, anesthetic choice as a risk factor for fever has not yet been reported.

Objectives: The aim of our study was to explore the role of sedative agents as a risk factor for fever during the 24 hours after the procedure. Additional risk factors were investigated as well. Multivariate analysis of the data (comorbidities, sedation choice, age, indication for performing the procedure, BAL performed and its findings, post-prematurity, FTT, and medications) suggested that only Sevoflurane and young age were statistically significant risk factors for fever. Chronic treatment with Montelukast was found to be a protective factor against fever.

We conclude that post-bronchoscopy fever is probably an inflammatory noninfectious process. Sevoflurane is a significant risk factor for developing post-bronchoscopy fever by generating such inflammation. The same mechanism may also explain why Montelukst has a protective role. conditions were mostly present in young children less than 5 years old while obesity was more common in adolescents. Of the treated patients, 75.6% had allergic rhinitis. Comparing symptoms before and within 6 months after PAP trial, there were significantly less patients with complaints of habitual snoring (95.6% vs. 8.9%, P < 0.01) and excessive daytime sleepiness (42.2% vs. 11.1%, P < 0.01). There was significant improvement in PSG parameters with mean OAHI decreasing from 21.5±18.5/hour TST to 1.6±1.9/hour TST (P < 0.05) and mean SpO2 (oxygen saturation) nadir increasing from 80.6% ±10.4% to 90.9%±5.7% (P < 0.05) after PAP therapy. Within 6 months of follow up, 57.8% of the patients adhered to PAP satisfactorily while the adherence dropped to 37.8% at the time of the latest follow-up. Satisfactory usage established before 6 months was associated with favorable long-term outcomes of satisfactory usage or cessation of therapy due to improvement at the latest follow-up (chi square test P = 0.008). The commonest reported reason for non-adherence was due to nasal obstruction. Results: Forty-three BEMSs were placed in 26 infants. The mean BW and mean age were 4.0 ± 0.8 kg and 4.9 ± 2.7 months, respectively.

There were 21, 9 and 13 stents located in trachea, carina and mainstem bronchi, respectively. Seven infants with 13 stents died without obvious stent-related mortality. Among them, 12 stents in 8 children were successfully retrieved by rigid endoscopy. At placement, the diameters of 30 tracheal and 22 bronchial stents were 7.5 ± 1.1 (4-10) and 5.4 ± 0.9 (4-8) mm, respectively. These implanted BEMSs could be gradually and significantly (P < 0.01) expanded. At the end of this study, all the remaining 18 stents in 12 infants could be kept functional. The diameters of the 11 remaining tracheal and 11 remaining bronchial stents were 9.7 ± 2.0 (8-14) and 7.0 ± 1.4 (4-10) mm, respectively. Results: Eithty -three children were included. Males represented 48.5%, average age was 31.7 ± 4 months. The rate of ARDS was 39.8%. The mortality rate in children with this syndrome was 78.8%. Septic shock with ARDS had a higher mortality rate than septic shock without this syndrome (26%). Most children with this syndrome were in the moderate and severity range (78.8%); 81.8% were ventilated.

The tidal volume was 8.3 ± 1.6 ml/kg and average PEEP was 8.6 ± 2.2 cmH2O, the medium FiO2 was 90.7 ± 16.4 %; 36.4% of cases had a tidal volume of 8 to 10 ml/kg. There were no differences in tidal volume, PEEP and FiO2 between survivor and non-survivor cases.

Conclusions: ARDS had a high prevalence in pediatric septic shock and the mortality rate among septic shock cases with this syndrome is still very high. According to the unit policy to transfer to ICU which is based on IDSA guidelines, 2% of the patients needed intensive care. HDU care was given for 38% of patients who required supplemental oxygen to maintain pulse oximetry above 92%.

Analysis of length of hospital stay indicated that 25% of the patients were discharged by the 4th day and 61% were hospitalized for 5 to 9 days. There was no mortality among the patients evaluated.

Conclusions: This retrospective analysis revealed that childhood community-acquired pneumonia is associated with significant morbidity and is an economic burden. The majority (65%) needed therapy beyond first line antibiotics which may indicate significant antibiotic resistance. Central sleep apnea (CSA) and periodic breathing are unusual findings described in pediatric patients with congestive heart failure. However, CSA has not been reported in children with pulmonary hypertension. We hereby report on a 10-year-old girl with idiopathic pulmonary arterial hypertension (IPAH) who had frequent central events in a periodic breathing fashion seen in her polysomnography, which was normalized following medical treatment leading to improvement of the pulmonary pressures.

This case supports the importance of PSG in pediatric patients with IPAH, not only to exclude OSA as a potential cause but also to assess for the presence of PB. We also show that the presence of PB might be a sign of disease severity and can be a marker of response to We present two children from a TB endemic region, with microbiologically confirmed TB presenting with parapneumonic effusion containing chyle, that were misdiagnosed initially as pleural empyema. Tuberculous pleural effusion occurring with chylothorax is uncommon. The first case is a 12-year-old girl who presented with localized left-sided chest pain and parapneumonic effusion and a previous liver transplant and long-term intravenous catheter, who was on chronic immunosuppressive therapy. The second case was a 10-year-old boy who was HIV-exposed but uninfected and presented reports, to our knowledge, on using gastric lavage PCR to diagnose PJP. We report two cases in which P. jirovecii was identified by gastric lavage PCR and was treated appropriately.

Case 1 was a 1-year-old preterm, low-birth-weight male infant with Down syndrome who had undergone operation for necrotizing enterocolitis and was being administered central venous nutrition. He was started on prednisolone for pericardial effusion because of postpericardiotomy syndrome when he was 7 months old and had been in an NICU for a year. On the day of onset of PJP, he required increased oxygen levels, and infiltrative shadows were observed in both lung fields on chest radiography. Further, his (1→3)-D glucan (BDG) levels were elevated. P. jirovecii was detected on gastric lavage polymerase chain reaction (PCR), and trimethoprim-sulfamethoxazole was administered for 3 weeks, following which his condition improved.

Case 2 was an 8-month-old preterm, very-low-birth-weight male infant who was under central venous nutrition because of digestive tract disease. He was under treatment with hydrocortisone for 5 months because of refractory hypoglycemia and had been in an NICU. On the day of PJP onset, he showed increased oxygen demand, and chest radiography showed infiltration in both lung fields. Further, his BDG level was elevated. P. jirovecii was detected on gastric lavage PCR, and trimethoprim-sulfamethoxazole was administered for 3 weeks, following which his condition improved.

Discussion: About 10%-30% of immunocompetent children carry P. jirovecii in their respiratory tract, and this percentage, depending on the underlying disease, is 60%-70% in immunosuppressed patients. Therefore, when P. jirovecii is detected, it is important to distinguish infection from colonization. In these two cases, we suspected PJP on the basis of the clinical symptoms, backgrounds, BDG levels, and observations from image examination, and P. jirovecii was detected on gastric lavage PCR analysis.

The patients' condition improved after definitive therapy. To our knowledge, there has been no report of PJP diagnosis by gastric lavage PCR to date, and this diagnostic technique may be useful if it is difficult to collect lower respiratory tract specimens. Both patients had cellular immunodeficiency because of long-term steroid administration, although prophylactic treatment with trimethoprim-sulfamethoxazole for PJP had not been administered. This suggests the necessity of prophylaxis. We are reporting a 7-month-old boy, who was previously hospitalized with recurrent monthly pneumonia since birth until presentation to a regional tertiary center with pediatric respira- Tracheal agenesis (TA) is extremely rare and usually fatal. Complete or partial absence of the trachea below the larynx can be found, and a tracheoesophageal fistula may exist. There is usually no prenatal symptom, but other congenital anomalies are commonly found.

We present a low-birth-weight male infant (gestational age 36 weeks; birth weight 2100g) born with respiratory distress. Physical and radiological examination disclosed single umbilical artery, bilateral malalignment of thumbs, sacral dimple, and hemi vertebra. Difficult intubation was noted soon after birth. After being transferred to our center with an intubated endotracheal tube, flexible bronchoscopy was performed and found it was an esophageal intubation. A blind pouch at the subglottic level of the trachea without a fistula was observed. Diagnosis by computed tomography (CT) with 3D-reconstruction revealed TA (Floyd type II) with a small esophago-bronchial (EB) fistula at the lower esophagus and linked to the right upper bronchus. At the age of 3 days, esophageal ligation and gastrostomy were performed. At the age of 21 days, with the assistance of 3Dprinting simulation and veno-venous extracorporeal membrane oxygenation (ECMO) support, cervical esophagostomy and tracheoplasty were executed. The cervical esophagus was end-to-end anastomosed to the larynx. After dividing and excision of the EB fistula, the proximal end of the lower thoracic esophagus just above the fistula was end-to-side anastomosed to the right main bronchus.

The distal end of the lower thoracic esophagus was ligated. However, pneumothorax, anastomosis dehiscence and repair, narrowing of anastomosis, collapse of esophageal-consisted airway, and bilateral pulmonary atelectasis developed in the following 2 weeks. Flexible bronchoscopy aid balloon dilatation and stent implantation were planned. However, massive air-leak to mediastinum and peritoneum, shock and disseminated intravascular coagulation (DIC) occurred. Initially, nasal CPAP (continuous positive airway pressure) was provided for respiratory support; however, intubation was finally performed with high-frequency oscillation use due to fluctuating respiratory condition. Series of chest plain film showed progressive diffused infiltration, while high-resolution computed tomography showed bilateral ground glass appearance. In combination of her clinical features and image presentation, lung biopsy was performed due to the high suspicion of diffuse lung disease. Oral steroid and azithromycin was administered but her improvement was poor. We did not administer Hydroxychloroquine because of her G6PD (glucose-6-phosphate dehydrogenase) deficiency.

Recurrent ventilator-associated pneumonia was noted which needed several types of antibiotics. At 3 months of age, a tracheostomy was performed. Lung transplantation was offered to the family but they decided to proceed with mechanical ventilation use. Due to worsening of clinical condition and resistance to medication treatment, she received palliative extubation after full discussion with her family at the 5th month.

A blood sample was collected for genetic testing before the patient passed away. revolutionized imaging of the "forgotten third circulation", improving our understanding of lymphatic diseases and paving the way for a new treatment modality, lymphatic embolization. We present a 7-year-old girl with KLA whose pleural effusion stabilized following two lymphatic embolization procedures.

Case Report: Our patient presented at 2 years with recurrent severe non pulmonary infections. Chest radiographs showed prominent diffuse reticular opacities despite the absence of respiratory symptoms or signs.

Comprehensive immunology and rheumatology investigations were normal, as were exhaled and nasal nitric oxide, ciliary biopsy, bronchoscopy and lavage, echocardiography and oxygen saturation at rest, on exertion and overnight. A chest CT showed thickening of interlobular septae with preservation of parenchymal architecture. A bone scan showed reduced uptake at L4, as well as T10 and the left clavicle in keeping with "vanishing bone disease". AT has no effect on OSA caused by CA, although rapid maxillary expansion (RME) is reported to be useful for it.

Objectives: Herein, we report the case of a patient with OSA likely due to CA that was successfully treated with RME. nights. Respiratory event index (REI) were 24.2/h and 17.0/h on nights 1 and 2, respectively; nadir SpO2 were 70% and 76%. As a result, severe OSA was diagnosed. Since his family did not wish for AT, RME was performed. Snoring and retractive breathing during sleep disappeared 3 weeks after the start of RME, and 8 months later, OCST was performed again on two consecutive nights. REI had improved to 5.7/h and 3.7/h on nights 1 and 2, respectively, and nadir SpO2 had improved to 81% and 85%.

No evidence on the usefulness of RME for OSA in children has been established. However, RME was useful for OSA likely due to moderate ATH and CA in this patient, suggesting that tongue space expansion by RME can be a useful therapeutic method for OSA. Gorham-Stout disease is also known as vanishing bone disease. It is a rare disease of unknown etiology characterized by progressive osteolysis and proliferation of lymphatic vessels. We report 2 cases of Gorham-Stout disease presenting with recurrent chylothorax and lytic bone lesion. We present a 2-month-old female infant with fever, cough, and vomit for 4 days. She was transferred to our medical center due to rapid progression to PARDS within 1 day, and her throat swab CMV PCR test revealed positive. Her chest radiograph showed bilateral white-out, and very high ventilator settings were required to maintain oxygenation. Cardiac disease was excluded by ultrasonography. Intravenous ganciclovir, broad-spectrum antibiotics, and methylprednisolone were given, but the gas exchanges were still poor (oxygenation index= 31 at 38 hours after hospitalization). HFOV was then applied (FiO2 = 1.0, MAP= 20 cmH2O, amplitude = 30 cmH2O, frequency = 10, I time = 33%). After using HFOV, the lungs were recruited and the settings could be weaned down gradually.

Intravenous immunoglobulin was given for suspected viral sepsis. Case Report: Patient A was an 18-month-old girl with Down syndrome, congenital hypothyroidism, small patent ductus arteriosus and anorectal malformation who presented with persistent fever and cough for 2 weeks post stoma closure. On examination, she was tachypneic with a respiratory rate of 50 breaths/minute and subcostal recessions. Her breath sounds were reduced over the right lower zone with stony dullness. Chest X-ray (CXR) showed right lower lobe consolidation with a loculated parapneumonic effusion. Minimal thick stale blood-stained fluid was aspirated during an ultrasound guided thoracocentesis and an unusual mass was seen. Hence the chest drainage was aborted and a contrast-enhanced CT angiography revealed a pulmonary pseudoaneurysm within the consolidated lung, adjacent to the right pleural collection.

Blood investigations showed a drop in hemoglobin from 12g/L to 8.8g/L. Chest X-ray showed an extensive right pleural effusion and ultrasound described a right basal consolidation with a pleural effusion of 353ml. Pleural fluid sample obtained by thoracentesis was purulent with exudate characteristics and a chest tube was inserted for drainage.

Due to these findings, a thoracic CT scan was performed and revealed atelectasis of the right lung and severe loculated pleural effusion with fluid-filled cavities in the right middle and lower lobes.

Since the patient was stable, a conservative management was preferred and empiric IV antibiotics, cefotaxime and clindamycin, were started.

After 7 days of treatment, pleural fluid culture was positive for S. mitis.

S. mitis was sensitive to ampicillin, thus treatment was completed with 10 days of ampicillin and 7 days of cefotaxime and clindamycin with a satisfactory outcome.

Considering that S. mitis is an innocuous commensal organism of the oropharynx, skin, and gastrointestinal and genitourinary tracts, we looked for primary infection sites. The origin of the infection was a cavity in the third lower molar that extended to the root. The patient had a history of a dental procedure 4 weeks before diagnosis. Case Report: A nine-month-old male preterm BPD infant with maternal premature rupture of membranes delivered by emergency caesarean section at 28 + weeks gestation due to fetal distress.

Apgar score was 4 at 1-minute and 7 at 5-minutes and birth weight was 1500 g. Because of respiratory distress syndrome, endotracheal intubation was performed and the patient was transferred to the neonatal intensive care unit. After 3 months of mechanical ventilation support, the endotracheal tube was removed and the patient was treated under NIV support. After 9 months of mechanical ventilation support since birth, we decided to make an assessment of the neurodevelopment of the patient by brain MRI. Conclusion: Most of the time, preterm BPD infants with VD who are receiving NIV support will be considered as high risk and follow-up for MRI delayed because of two reasons: (1) need of oral intubation with endotracheal tube to guarantee the safety of the respiratory system; (2) The neonatal MRI-ventilator which includes NIV mode is too expensive and requires a well-trained respiratory therapist to operate the MRI-ventilator. We believed that once we well-prepared the MRI-ventilator, infants with VD who are receiving NIV support could undergo MRI more safely. By sharing this case experience, we hope the profession of neonatal respiratory therapy could receive more attention. We present two cases that were diagnosed after multiple consultations: Case 1. A 2-year-old girl presented with a history of recurrent episodes of cyanosis during her first months of life, worsening respiratory symptoms and poor exercise tolerance. She was assessed on several occasions by a general practitioner (GP) who did not consider that further investigations were necessary. She also had recurrent epistaxis and was being followed by the local ENT specialist who considered the episodes as normal. At the age of two, she was admitted to her local hospital with a LRTI, cyanosis and persistent low oxygen saturation levels (70%). She was treated with antibiotics, but given her slow improvement she was referred to our center for further workup. On examination, she presented with failure to thrive, general cyanosis, multiple telangiectasia in oral cavity and nostrils, and clubbing fingers. Initial chest X-ray showed ABSTRACTS | S139 CT Angiography revealed an arteriovenous malformation (AVM) in the middle segment of the right lower pulmonary lobe, multiple intraparenchymal small AVMs in both lungs and an aberrant artery from the descending aorta that irrigated the right upper lobe.

Embolization of the main PAVM was proposed, however, it was not possible due to its large extension since there was no embolic device according to its size. Further discussion in several international forums, a thoracotomy and pulmonary segmentectomy of the right lower lobe was suggested and then performed 7 months after presentation. Since then, the patient has been asymptomatic, despite the fact that SpO2 levels have not improved as expected. Background: Children with cystic fibrosis (CF) have frequent respiratory exacerbations, therefore the occurrence of cough and fever in a CF child raises the suspicion of an acute infectious event, while in a non-CF child this fever/cough association would suggest a pneumonia. What about the presence of tachycardia, which would suggest a different diagnosis, from myocarditis or hyperthyroidism. We herein present the case of a 3-year-old girl with cystic fibrosis with frequent acute cough, persistent fever and tachycardia attacks.

A 3-year-old girl was diagnosed with cystic fibrosis in infancy, because of a Pseudo-Barterr syndrome. The child's evolution was very good, with good clinical and biological status, normal pulmonary lung function described by a normal lung clearance index and germ-free cough swab and negative induced sputum. She was monitored according to the national Romanian guidelines every 3 months in the regional CF center and annually at the national center, by clinical and biological investigation. No CT or bronchoalveolar lavage was performed until age of 3 years.

Results: In evolution, her mother noticed episodes of tachycardia 5 months before the actual admission, supposed secondary to play or hospital anxiety, without any electrical ECG alteration. Four months before admission, she had a mild exacerbation associated with insignificant chest X-ray findings and she received intravenous cephalosporin. After 1 month, she started to productively cough and fever, with a relatively strong persistence despite AINS. Her first Sixteen emergency situations will be presented in detail using the above format. Purpose: Obstructive sleep apnea (OSA) is a common disorder estimated at 1%-5% in school-aged children. With the obesity prevalence reaching staggering rates globally, OSA in obese adolescents is estimated to be 4 to 5 fold higher than their lean peers. There is a paucity of data regarding obesity-related OSA in children 6 years and less. This is particularly relevant as OSA is associated with neurocognitive deficits. The aim of this study is to evaluate the prevalence of OSA among obese toddlers and preschool children and further to determine what other factors may be associated with the presence of OSA.

Methods: A retrospective study involving children < 6 years, identified from two Canadian pediatric tertiary care centers who had an in-lab polysomnography (PSG). Obesity was defined by a BMI of > 95th percentile for age and gender or a z-score of > 2. OSA was diagnosed if the obstructive apnea-hypopnea index (OAHI) was greater than 2 events per hour.

Results: There were 60 participants included; the mean age was 4.4 years (standard deviation [SD] + 1.7), mean BMI z-score was 3.0 (SD + 1.2). Of these, 22/60 (36.6%) had OSA. Compared with the non-OSA group, the OSA group had a higher Epworth sleepiness score (P = 0.03) and were more likely to snore (P = 0.01). The present study "Comparative study of nebulized beta 2 agonist, nebulized adrenaline and any added advantage of 3 % hypertonic saline in bronchiolitis" was undertaken to assess the efficacy. A total number of 150 patients (50 patients in each group) were examined below 24 months of age. Group A was nebulized with salbutamol, group B was nebulized with adrenaline and similarly, group C was nebulized with 3% hypertonic saline. Comparison of mean ± S.D. of RDAI score before and after nebulization was performed in all 3 groups. In each patient from all groups (ie A, B and C), RDAI scores were recorded at the time of admission (ie at 0 minutes), at 20 minutes and 40 minutes (after nebulization) and on subsequent days. The mean value of RDAI score at admission and discharge was 10.78± 1.03 and 6.58±1.54 respectively in group A. In group B, RDAI score at the time of admission and discharge was 11.20 ± 1.05 and 5.9 ± 1.61, respectively. Similarly in group C, RDAI score at the time of admission and discharge was 8.14 ± 1.80 and 3.18 ± 0.94, respectively. All the parameters before treatment had a P value > 0.05 (not significant at 0 minutes.) and at the time of discharge, the p value became < 0.0001 (extremely significant). Mean differences in HR, RR, RDAI SCORE and SpO2 were assessed after subsequent nebulization in all 3 groups. The post treatment values for group A (Salbutamol), group B (Adrenaline) and group C (3% Hypertonic Saline) were compared. All groups showed an increase in HR, but group B (mean difference of 14.80) showed a more increasing trend than group A (mean difference of 4.84) and group C (mean difference of 7.04) and had a P < 0.05. Regarding RR, all 3 groups showed decreased RR, but group B (mean difference of 15.96) was more significant than group A (mean difference of 14.80) and group C (mean difference of 12.20) and had a P < 0.05. Regarding RDAI score, all 3 groups showed improved score, but group B (mean difference of 5.3) was more significant than group A (mean difference of 4.2) and group C (mean difference of 4.96) and had a P < 0.05. Similarly, all 3 groups showed improved SpO2 %, but group B (mean difference of 10.24) showed more improvement than group A (mean difference of 9.26) and group C (mean difference of 6.38) and had a P < 0.05.

Clinical parameters (heart rate, respiratory rate, RDAI score and SpO2 %) in both groups were comparable before nebulization.

Nebulized salbutamol was given to group A, nebulized adrenaline to group B and nebulized hypertonic saline to group C.

Different clinical parameters in the groups were compared before and after subsequent nebulization. Mean respiratory rates, RDAI scores and SpO2 (%) significantly improved in all 3 groups.

However, improvement was more significant in the adrenaline group. Shorter length of hospitalization was noted in group C (Hypertonic saline).

No undesirable side effects were noted in all 3 groups.

All 3 groups showed a transient increase in heart rate, although more so in the adrenaline group. Objectives: Endothelial dysfunction (ED) is one of the initial pathological changes ultimately leading to atherosclerosis and consequent cardiovascular disease. Children with endothelial dysfunction are at higher risk of developing systemic and pulmonary hypertension, atherosclerosis and cardiac remodeling, with potential long-term adverse outcomes into adulthood. Obstructive sleep apnea syndrome (OSAS) has been found to cause impaired endothelial function in adults. However, the evidence in pediatric OSAS is limited. The aim of the study is to evaluate endothelial function in a large cohort of children clinically referred for suspected OSAS, and to identify risk factors contributing to the presence of ED.

Methods: Children aged 3 to 11 years old with habitual snoring (snoring ≥ 3 nights per week) were recruited to this study between June 1st 2015 -March 1st 2016. All subjects underwent an overnight polysomnography (PSG), as well as endothelial function testing using peripheral arterial tonometry (PAT) to derive the reactive hyperemic index (RHI). Subjects were then divided into OSAS and primary snorers (PS) groups according to their obstructive apnea-hypopnea index (OAHI).

Results: A total of 355 cases completed the study, with 248 children being diagnosed as OSAS, and 107 children assigned to the PS group.

There were no differences in age, gender and BMI Z-score between the two groups (all P > 0.05). The OSA group had lower RHI than that of PS (P < 0.05). Univariate correlation analysis showed that RHI was linearly correlated with age, gender, OAHI, oxygen desaturation index, respiratory related arousal index, and oxygen saturation nadir.

The relationship between BMI Z-sore and RHI was quadratic. RHI and BMI Z-sore were positively correlated when BMI Z-score< 1. year follow-up, we regularly performed EKG, cardiac echogram, 6 minute walk testing (SMWT) and monitoring of serum BUN, BNP and creatinine. Also, cardiac catheterization and hemodynamic studies, PET study with uptake of glucose analog 2-deoxy-2-﹝18F﹞fluoroglucose (18F-FDG) and pulmonary perfusion-ventilation scan were performed.

We enrolled six patients with ES including atrial septal defect type II (3 cases), atrial septal defect type I (1case), right atrial isomerism after total cavopulmonary connection (TCPC) (1case) and ventricular septal defect (1case); the male:female ratio was 3:3. Hemodynamic studies revealed that mean pulmonary arterial pressure was 52±7.3 mm Hg; pulmonary vascular resistance index was 26.1±7.9 WU*m2, except the case receiving TCPC. In addition, three cases of intrapulmonary thrombus in right pulmonary artery, three cases of cerebral stroke and three cases of atrial fibrillation were found. The lung scan revealed that there were nonspecific findings noted in the ES patients with or without intrapulmonary thrombus. Very interestingly, an increased uptake of 18F-FDG in the right ventricle was noted in three cases. Subsequently, there were two mortalities because of right ventricular failure. and pediatric settings which corresponds to a child of 15kg weight (tidal volume 150 ml, 25 breaths/min, ratio between inspiratory and expiratory 50/50 and PEEP 5 cm H2O). A filter was placed between the endotracheal tube and the test lung model (SmartLung Adult, IMT medical, Switzerland) to collect the drug. All components were tested for drug deposition. Deposited doses were quantified by spectrophotometry. All measurements were performed five times.

Results: The percentages of the nominal dose of salbutamol deposited on the filter with the adult model after nebulization and aerosolization, were similar when the device was located before or after the Y piece Results: Flow analysis. During inhalation, the pressure differential (y)/ flow rate (x) relationship was y = 0.1015x2 + 0.8343x (R2 = 0,9985).

During exhalation, the pressure differential (y)/flow rate (x) relationship was y = -0.0106x2 + 0.0155x (R2 = 0,9873). This indicated that the flow rate closely followed the pressure differential (n = 5). Furthermore, the AP was able to measure flow rate with great stability and reproducibility during all the experiments. Results: Valve resistance generated at low inspiratory flow rate (5 L/min) varied greatly between the different valves ranging from 9.5 to 0.27 cmH2O/L/s; however as the flow rate increased, variations were reduced (3.98 to 0.43 cmH2O/L/s at 60 L/min).

The ability to close varied strongly from one valve to another: for some valves, expiratory flow did not pass through the inspiratory valve while for others, only partial closing could be achieved (85% of expiratory flow passed through the inspiratory valve). These results were confirmed by measuring the flow through the expiratory valve, maximum (100% of the initial flow rate) when inspiratory valves were completely closed. Tilting the chamber did not seem to affect this result.

ED measured with pediatric breathing parameters in coordinated and uncoordinated use was similar for four of the custom VHCs while with the other two VHCs, ED was lower. , and a high-speed camera (HXLink64,nac) and two different shapes of membrane models were used in this study. Five catheter motions: 1) quiescent technique, 2) piston technique, 3) rolling technique, 4) twist technique, and 5) dynamic pressure technique, were performed 10 times each and the weight of secretion was measured by a digital scale. The negative pressure was set at 20kPa, suctioning time was counted 10 seconds. One-way ANOVA and Tukey test were used to analyze the obtained data.

In experiment 1, the mean amount of secretion for 1) to 5) were 0.31, 0.48, 0.32, 0.43, and 0.45, respectively. There were significant differences between 1) quiescent technique and 2) piston technique (P = 0.025), 2) piston technique and 3) rolling technique(P = 0.039) on a flat membrane model with high viscous sputum. The high-speed camera showed that absorption was started when a catheter tip aperture and two side apertures were sealed with the high viscous sputum. As dynamic pressure technique, sputum was quickly absorbed right after the researcher released her thumb which bent the suctioning catheter.

In experiment 2 with high viscous sputum on a tracheal membrane model, mean secretion weight 1) to 5) were 0.36, 0.31, 0.30, 0.42, and 0.43 respectively. There were no significant differences between these five techniques. In experiment 3 with low viscous secretion on a tracheal membrane model, mean amounts of suctioned secretion were 0.97, 0.76, 0.98, 1.01, and 1.15 respectively. There were significant differences between 2) piston technique and 4) twist technique (P = 0.042), 2) piston technique and 5) dynamic pressure technique (P = 0.000).

In conclusion, the piston technique could absorb the most amount of secretion when a catheter tip was visible on a flat membrane model, however, the catheter motion which suctioned the most secretion was the dynamic pressure technique in a tracheal model despite the viscosity of the secretion. Even though nurses had to carefully apply the level of negative pressure before their procedure, this result indicated that dynamic pressure technique is the most effective catheter motion to remove secretion on a tracheal model. Background: Respiratory syncytial virus (RSV) infection is the main cause leading to acute bronchiolitis in infants or children less than 2 years of age. Children are more susceptible to RSV infection than adults, especially those who have hemodynamic-significant congenital heart disease or heart failure. In this study, we aimed to evaluate the possible risk factors leading to prolonged stay in the pediatric intensive care unit (PICU) or hospital stay for CHD children with RSV infection.

Methods: Data were retrospectively retrieved of patients who had CHD from Jan 2011 to Dec 2013. Those patients who had concurrent RSV infections and underwent computed tomography imaging study were included as the study group. Clinical presentations were recorded and classified. Statistics used descriptive analysis and P < 0.05 was taken as significant.

Results: A total of 286 patients with associated congenital heart disease were included. The mortality rate was about 3% due to pulmonary edema, dysfunction or cyanosis. The total number of subjects whose age was below 1 year old was similar to those whose ABSTRACTS | S147 age was between 1 and 2 years old. There were 68 CHD children with airway problems, including trachea-bronchomalacia, stenosis of the trachea or bronchus. Patients aged less than 1 year old had longer hospital stay than those whose age was above 1 year old. The mean PICU stay and the intubation period had a similar trend. In the comparison of groups without airway anomalies, the hospital stay in children who had hemodynamic-significant CHD or heart failure (without associated airway anomalies) was 46.6 days compared to 11.6 days in children who did not have hemodynamic-significant CHD or heart failure(without airway anomalies) (P < 0.05). In children with airway anomalies but did not fulfill the criteria of hemodynamic-significant CHD or heart failure had longer hospital stay (22.8 days) than those without airway anomalies but with hemodynamicsignificant CHD or heart failure (10.6 days) (P < 0.05).

Conclusions: Patients with airway anomalies are not rare in children with CHD, although the severity varies. Lower airway anomalies were associated with longer hospital stay in CHD children who were not hemodynamic-significant or heart failure. We found that airway problem is a risk factor for prolonged hospital or PICU stay in CHD children with RSV bronchiolitis. To achieve successful and sustainable outcome in CHD children with RSV bronchiolitis, it is crucial to have early identification of concomitant airway anomalies in these children.

Childhood pneumonia and diarrhoea 1: Global burden of childhood pneumonia and diarrhoea