Pediatric Respirology and Critical Care Medicine

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Introduction: Neonatal sepsis is a clinical syndrome described as any systemic bacterial infection in neonates documented by positive blood culture. However, blood culture is positive in only 5.0%–10.0% of suspected cases. Serum concentration of many acute-phase reactants rises in response to infection, which can be used as a non-specific indicator of bacterial sepsis. Aim and Objectives: The aim of this study was to correlate the levels of serum markers C-reactive protein (CRP), serum ferritin, and thrombocytopenia with neonatal sepsis. Materials and Methods: This was a prospective cross-sectional study conducted in the Neonatal Intensive Care Unit, Department of Paediatrics and Pathology, Jawaharlal Nehru Medical College (JNMC), Aligarh from 2019 to 2021 on 172 babies (cases =142; controls = 30). Neonates with sepsis who presented with clinical signs or symptoms of sepsis were taken as case group and healthy neonates served as control. Result: Blood culture was positive in 58 (40.8%) neonates in the case group and Klebsiella was present in maximum number of cases. Blood culture was positive in only 8 (13.8%) cases out of 31 cases of mild thrombocytopenia. The total culture-positive organism was 58 (40.8%), with 09 (15.5%) gram-positive, 46 (79.3%) gram-negative organisms, and 03(5.2%) fungus. Positive CRP was seen in 88 (61.9%) neonates in the case group, out of which, positive culture was noted in 38 (65.5%) neonates and negative in 50 (59.5%) neonates. Serum ferritin values >400 µgm/L was seen in 97 (68.3%) neonates in the case group and 6 (20.0%) neonates in control group. The mean serum ferritin in culture positive neonates was 1024 ± 309 µgm/L and in culture-negative neonates was 999 ± 301 µgm/L. Conclusions: The signs and symptoms of neonatal sepsis are non-specific, leading to difficulty in diagnosis and treatment. Biomarkers such as hematological indices, blood culture, and acute-phase reactants could be more reliable in rapid evaluation and early diagnosis of sepsis and may provide a new diagnostic strategy for the neonates with sepsis.

Background and Aims: Exercise-induced bronchoconstriction (EIB) is associated with eosinophilic inflammation of the airway in asthmatic children and studies showed fractional exhaled nitric oxide (FeNO) is associated with it. The aim of this study was to explore the relationship between FeNO and EIB and find a cutoff reference of FeNO for EIB based on existing normative data from healthy Asian children by Yao et al. in 2012. Materials and Methods: Asian asthmatic children who had undergone FeNO and exercise challenge test from January 1, 2016 to December 31, 2019 in a local respiratory centre were reviewed retrospectively. The FeNO values of the individuals were converted to z-score with reference to the predicted value of FeNO in Asian children by Yao et al. in 2012. A receiver-operating characteristic (ROC) curve is plotted to identify a cutoff representing EIB. Results: Data of 88 Asian asthmatic children aged 5–18 were retrieved. There is a significant overlapping of the FeNO z-scores of normal and mild EIB groups. The cutoff value determined by the Youden index (0.724) to predict moderate or severe EIB in asthmatic patients is 3.276 with sensitivity of 88.9% and specificity of 83.5%Conclusion: High FeNO value of z-score 3.276 has high sensitivity and specificity to moderate to severe EIB in Asian asthmatic children. FeNO could be used as a simple test in clinic setting before exercise challenge test is available.

Background/Purpose: Dengue fever (DF) may cause severe morbidity and mortality. Asthma has been proposed as a protective factor for DF. Asthma, allergic rhinitis, and atopic dermatitis are atopic diseases with a common background. Herein, we aimed to determine whether allergic rhinitis and atopic dermatitis are also protective factors for DF, as this aspect remained unknown. Materials and Methods: A resampled nationwide population-based retrospective case-control study was conducted. Multivariate logistic regression was used to identify independent protective factors of these atopic diseases for DF. The Kaplan–Meier method was used to compare dengue-free proportions between patients with or without atopic diseases. Result: This case-control cohort study included a total of 1119 patients with DF and 4476 age- and sex-matched patients without DF. At least one of these atopic diseases was observed in 1322 patients. Compared to patients with DF, the non-DF group had a high prevalence rate of atopic diseases (16.2% vs 25.5%, P <0.001). Both asthma and allergic rhinitis were protective factors for DF with an odds ratio (OR) of 0.40 (95% confidence interval (CI) 0.25–0.65, P<0.001) and 0.48 (95%CI, 0.38–0.61; P<0.001), respectively. Atopic dermatitis was not a protective factor for DF (OR, 0.96; 95%CI, 0.58–1.58; P=0.873). Conclusion: Asthma and allergic rhinitis, rather than atopic dermatitis, can be independent protective factors against DF. Our finding provides insights into the association between allergy and DF.

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