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  • 1
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    Online Resource
    Heliox Therapy in Infants With Acute Bronchiolitis
    American Academy of Pediatrics (AAP) ; 2002
    In:  Pediatrics Vol. 109, No. 1 ( 2002-01-01), p. 68-73
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 109, No. 1 ( 2002-01-01), p. 68-73
    Abstract: Objective. To assess the therapeutic effects of breathing a low-density gas mixture (heliox: 70% helium and 30% oxygen) in infants with bronchiolitis. Design. Prospective, interventional, comparative study. Setting. A pediatric intensive care unit (PICU) in a tertiary care, teaching hospital. Patients. Thirty-eight infants, 1 month to 2 years old, consecutively admitted to the PICU for treatment of moderate-to-severe acute respiratory syncytial virus bronchiolitis. Interventions. The first 19 patients were enrolled as the control group and received supportive care and nebulized epinephrine. In the next 19 patients, heliox therapy was added through a nonrebreather reservoir face mask. Measurements and Outcomes. Respiratory distress score, respiratory rate, heart rate, end-tidal CO2 (etCO2), and pulse oximetry oxygen saturation (satO2) values were recorded at baseline and at regular intervals. Data obtained during the first 4 hours were analyzed for comparison purposes. Demographic data, age, time elapsed from the start of the symptoms to the admission to PICU, length of stay in PICU (PICU-LOS), and duration of heliox therapy were also collected for each patient. Reductions in clinical scores and PICU-LOS were considered primary outcomes. Main Results. At baseline, the heliox and control groups had similar age (5.5 ± 3.1 vs 5.9 ± 3 months), previous length of course (47.3 ± 19.3 vs 45.4 ± 18.6 hours), clinical score (6.7 ± 1.1 vs 6.6 ± 1), heart rate (160 ± 24 vs 165 ± 20 beats per minute), respiratory rate (64 ± 7 vs 61 ± 7 respirations per minute), satO2 (91 ± 2.3 vs 91 ± 2.5%), and etCO2 (34 ± 7 vs 33 ± 6 mm Hg). Clinical score, heart rate, respiratory rate, and satO2 improved during the study in both groups. After 1 hour, the improvement in clinical score was significantly higher in the heliox group than in the control group (3.6 ± 1.16 vs 5.5 ± 0.89), and these differences continued to be significant at the end of the observation period (2.39 ± 0.69 and 4.07 ± 0.96, respectively), with a total average decrease in the score of 4.2 points in the heliox group versus 2.5 points in the control group. Heart and respiratory rates were also significantly lower in the heliox group compared with the control group after 1 hour and stayed lower throughout the rest of the study period. No changes were noted either in satO2 between groups or in etCO2 within or between groups throughout the study. Mean duration of heliox administration was 53 ± 24 hours (range: 24–112 hours) and no adverse effects were detected. PICU-LOS was significantly shorter in the heliox group (3.5 ± 1.1 days) than in the control group (5.4 ± 1.6 days). Conclusions. In infants with moderate-to-severe respiratory syncytial virus bronchiolitis, heliox therapy enhanced their clinical respiratory status, according to the marked improvement in their clinical scores and the reduction of the accompanying tachycardia and tachypnea. This beneficial response occurred within the first hour of its administration and was maintained as long as heliox therapy continued. In addition, PICU-LOS was reduced in heliox-treated patients. Long-term prospective studies are required to corroborate these findings and to establish the proper place of heliox in the therapeutic schedule of bronchiolitis.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.109.1.68
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2002
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  • 2
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    Online Resource
    Heliox Questions
    American Academy of Pediatrics (AAP) ; 2003
    In:  Pediatrics Vol. 111, No. 2 ( 2003-02-01), p. 441-443
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 111, No. 2 ( 2003-02-01), p. 441-443
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.111.2.441
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2003
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  • 3
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    Online Resource
    Nasal Continuous Positive Airway Pressure With Heliox Versus Air Oxygen in Infants With Acute Bronchiolitis: A Crossover Study
    American Academy of Pediatrics (AAP) ; 2008
    In:  Pediatrics Vol. 121, No. 5 ( 2008-05-01), p. e1190-e1195
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 121, No. 5 ( 2008-05-01), p. e1190-e1195
    Abstract: OBJECTIVE. The purpose of this work was to evaluate the effects of administering either heliox or air oxygen in combination with nasal continuous positive airway pressure in infants with refractory bronchiolitis. PATIENT AND METHODS. We conducted a prospective, interventional, single-center, crossover study in a teaching hospital including infants 1 month to 2 years of age, consecutively admitted to the PICU from February 2004 to February 2005 for treatment of severe acute bronchiolitis unresponsive to therapy. Patients with a clinical score (Modified Wood's Clinical Asthma Score) of & gt;5, arterial oxygen saturation of & lt;92%, or transcutaneous CO2 pressure of & gt;50 mmHg despite supportive therapy, nebulized L-epinephrine, and heliox therapy through a nonrebreathing reservoir face mask were eligible. During the study period, 40 infants with bronchiolitis were admitted to the PICU; 12 fulfilled inclusion criteria. A predetermined balanced sequential allocation to either 30 minutes of treatment with nasal continuous positive airway pressure with heliox or to air-oxygen nasal continuous positive airway pressure was performed. Measurements were taken at baseline and after 30 minutes of each treatment. RESULTS. Baseline mean values were as follows: nasal continuous positive airway pressure of 7.2 cmH2O; clinical score of 7.7 points; transcutaneous CO2 pressure of 61.6 mmHg; and arterial oxygen saturation of 88.6%, with the fraction of inspired oxygen at 35.4%. Clinical score, transcutaneous CO2 pressure, and arterial oxygen saturation improved during the study time with both heliox-nasal continuous positive airway pressure and air-oxygen-nasal continuous positive airway pressure: after 1 hour, the clinical score fell 1.7 points, transcutaneous CO2 pressure decreased 8.2 mmHg, and arterial oxygen saturation increased by 7.7%. Improvement in clinical score was double with heliox-nasal continuous positive airway pressure compared with the air-oxygen-nasal continuous positive airway pressure (2.12 vs 1.08 points), and the fall in the transcutaneous CO2 pressure was greater with heliox-nasal continuous positive airway pressure compared with air-oxygen-nasal continuous positive airway pressure (9.7 vs 5.4 mm Hg). There was no difference in arterial oxygen saturation between groups. No patients required endotracheal intubation. No adverse effects attributable to either of the study interventions were detected. CONCLUSIONS. Nasal continuous positive airway pressure improves the clinical score and the CO2 elimination of infants with refractory bronchiolitis. These positive effects are significantly enhanced when nasal continuous positive airway pressure is combined with heliox instead of air oxygen. Both techniques are noninvasive, seem safe, and may reduce the need for endotracheal intubation.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2007-1840
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2008
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  • 4
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    Online Resource
    Meningococcal B Vaccine Immunogenicity in Children With Defects in Complement and Splenic Function
    American Academy of Pediatrics (AAP) ; 2018
    In:  Pediatrics Vol. 142, No. 3 ( 2018-09-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 142, No. 3 ( 2018-09-01)
    Abstract: The capsular group B meningococcal vaccine (4CMenB) is recommended for children with complement deficiencies, asplenia, and splenic dysfunction; however, data on the immunogenicity of 4CMenB in these “at-risk” children are missing. METHODS: Participants aged 2 to 17 years in Italy, Spain, Poland, the United Kingdom, and Russia with complement deficiencies, asplenia, or splenic dysfunction received 2 doses of 4CMenB 2 months apart, as did healthy children in the control group. Exogenous and endogenous human complement serum bactericidal activity (SBA) was determined at baseline and 1 month after the second immunization against 4 test strains: H44/76 (assessing vaccine antigen factor H binding protein), 5/99 (Neisserial adhesion A), NZ98/254 (Porin A), and M10713 (Neisserial heparin binding antigen). RESULTS: Of 239 participants (mean age 10.3 years, 45% female), 40 children were complement deficient (9 eculizumab therapy, 4 terminal-chain deficiencies, 27 “other”), 112 children had asplenia or splenic dysfunction (8 congenital asplenia, 8 functional asplenia, 96 splenectomy), and 87 children were in the control group. After immunization, the proportions of complement-deficient participants with exogenous complement SBA titers ≥1:5 were 87% (H44/76), 95% (5/99), 68% (NZ98/254), and 73% (M10713), compared with 97%, 100%, 86%, and 94%, respectively, for asplenic children and 98%, 99%, 83%, and 99% for children in the control group. When testing with endogenous complement, strain-specific bactericidal activity was evident in only 1 eculizumab-treated participant and 1 terminal chain complement-deficient participant. CONCLUSIONS: 4CMenB administration is similarly immunogenic in healthy children and those with asplenia or splenic dysfunction. The significance of the trend to lower responses of SBA titers in complement-deficient children (especially those with terminal chain complement deficiency or those on eculizumab therapy) must be determined by ongoing surveillance for vaccine failures.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2017-4250
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2018
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  • 5
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    Online Resource
    13-Valent Pneumococcal Conjugate Vaccine (PCV13) in Preterm Versus Term Infants
    American Academy of Pediatrics (AAP) ; 2015
    In:  Pediatrics Vol. 135, No. 4 ( 2015-04-01), p. e876-e886
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 135, No. 4 ( 2015-04-01), p. e876-e886
    Abstract: This study evaluated the immune response and safety profile of 13-valent pneumococcal conjugate vaccine (PCV13) in preterm infants compared with term infants. METHODS: This Phase IV, open-label, 2-arm, multicenter, parallel-group study enrolled 200 healthy infants (preterm, n = 100; term, n = 100) aged 42 to 98 days. All subjects received PCV13 at ages 2, 3, 4 (infant series), and 12 (toddler dose [TD]) months, together with routine vaccines (diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b vaccine and meningococcal group C conjugate vaccine). RESULTS: Most subjects achieved an anticapsular immunoglobulin G (IgG) antibody concentration ≥0.35 μg/mL for all serotypes: & gt;85% after the infant series (except preterm infants for serotypes 5, 6A, and 6B) and & gt;97% after TD (except for serotype 3). Preterm infants had overall lower IgG geometric mean concentrations compared with term infants; however, geometric mean fold increases after TD were similar for all serotypes. Opsonophagocytic activity results were consistent with IgG results and titers increased after TD in both groups for all serotypes, including serotype 3. PCV13 was generally well tolerated, with similar safety profiles in all preterm subgroups. CONCLUSIONS: Immune responses were lower in preterm infants than in term infants. However, the majority of subjects in both groups achieved both pneumococcal serotype-specific IgG antibody levels after the infant series that exceeded the World Health Organization–established threshold of protection and functional antibody responses. Responses were uniformly higher after TD, reinforcing the importance of a timely booster dose. PCV13 was well tolerated regardless of gestational age.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2014-2941
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2015
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