Pediatric Respirology and Critical Care Medicine

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Background: Cystic fibrosis (CF) is the most common inherited life-limiting illness in the Caucasian population. It is considered to be rare in Asia, but recent reports suggest that CF does occur in Asia. Methods: We carried out a questionnaire-based survey to determine the prevalence of CF across Asian countries and the diagnostic and therapeutic capabilities available in member countries. A questionnaire was sent to member countries of the Asian Pediatric Pulmonology Society. The questionnaire included the total number of children diagnosed with CF seen in the country and the available resources. available resources for diagnosis and management. Results: Fifteen countries responded to the questionnaire. Three countries/regions (Myanmar, Vietnam, and Macau) have not recorded any case of CF. The remaining 12 countries have recorded a variable number of cases which have also been reported in the literature. Sweat chloride testing facilities were available in all the countries except Taiwan that reported cases of CF. Some countries such as India and Bangladesh have developed their own indigenous method for sweat testing. Some countries have facilities for mutation testing. Basic medications such as pancreatic enzyme supplementation and antibiotics were available in all the countries where children with CF have been diagnosed. Inhaled antibiotics and dornase alfa were available only in a few countries. Some other countries reported using the injectable preparation of gentamicin and amikacin for inhalation therapy. Testing for genetic mutation wherever available showed a low frequency of the Delta F 508 mutation which is the most common mutation found in the Caucasian population. Only two countries (India and Japan) have formal CF associations for the affected community. Two countries Japan and China maintain a CF registry, whereas India already started the process of developing it. Conclusion: CF is increasingly being diagnosed over the past two decades in Asian countries. There is a need to create awareness among pediatricians and to develop regional or country-specific protocols and tools for the diagnosis and treatment of children with CF.

Background: Tissue damaging effects of free radicals generated during the acute inflammation processes of childhood pneumonia may be ameliorated by antioxidants. This study aimed to determine the serum non-enzymatic antioxidants {Total Phenols, Carotenoids, Flavoids, Ascorbic acid, Tocopherols and Total Antioxidant Contents (TAC)} of Nigerian children with or without severe pneumonia (SP) and relate these to the presence of parapneumonic effusions (PPE) and length of hospitalisation (LOH). Methods: Consecutive children two months to 14 years admitted with severe pneumonia and their age and sex matched controls were recruited over a 12-month period at a Nigerian Health facility. Serum antioxidants were assayed using chromatography method and related to PPE and LOH. Results: The majority (86.1%) of the 144 children (72 each with SP and controls) were under-fives and eight (11.1%) of SP group had PPE. Median (IQR) LOH was 5.0 (4.0 – 7.0) days and 45 (62.5%) had prolonged (≥5 days) hospital stay with 3 (4.2%) mortality. Serum Tocopherols, 10.1 (4.7) vs. 13.2 (7.6) µg/dl; total flavoids 1.0 (0.6) vs. 1.3 (0.8) µg/dl and TAC 6.1 (4.4-8.9) vs. 7.4 (5.0 – 13.3) ng/dl were significantly lower in children with SP (p < 0.05). Serum antioxidants levels were not related to the PPE, however children with prolonged LOH had lower TAC (p<0.05), which also correlated negatively with LOH (r =- 0.418; p < 0.001) Conclusion: Lower serum antioxidants observed in children with severe pneumonia may connote increased demand or increased predisposition to the infection. Antioxidant supplementation may aid recovery of Nigerian children with SP.

Objectives: The aims of this study are to determine the accuracy of serum procalcitonin (PCT) in the early detection of severe bacterial infections among critically ill children and to establish the correlation between PCT changes and clinical outcomes. Design: This was a prospective, observational study at Queen Sirikit National Institute of Child Health, Bangkok, Thailand, between March 2014 and December 2014. Materials and Methods: Children aged between 1 month and 15 years with acute severe life-threatening conditions were included. Microbiologic specimens were sent for multiplex polymerase chain reaction and bacterial culture on day 1 of hospitalization. PCT was obtained on days 1, 2, 3, and 5. Measurement and Main Results: A total of 61 patients with a mean age of 21.2 months were enrolled. Microbiologic specimens were sent for multiplex polymerase chain reaction and bacterial culture on day 1 of hospitalization. PCT was obtained on days 1, 2, 3, and 5. The medians of PCT levels on days 1 and 2 from the bacterial infections group were significantly higher than those from the viral infections group and the mixed infections group. The sensitivity, specificity, and area under the PCT curve (cutoff value ≥1.1 ng/ml) employed to predict bacterial infections were 67.7%, 73.7%, and 0.72, respectively. The percentage changes of PCT levels on days 2–5 correlated with those of pediatric logistic organ dysfunction (PELOD) scores on days 1–5 but did not correlate significantly with the lengths of PICU stay. Conclusions: PCT is a moderately accurate option for the early detection of bacterial infections among children with acute severe life-threatening conditions since there is a correlation between the percentage changes of PCT levels and PELOD scores but no significant correlation between the percentage changes of PCT levels and the length of PICU stay.W

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