[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:
Elevated serum Mead acid as a proportion of total fatty acids is an indirect marker of a deficiency of essential fatty acids (EFA). The aim of the study was to evaluate the symptoms and nutrition of food-allergic children with elevated or normal serum Mead acid.
Serum fatty acid compositions from 400 children were studied by clinical indications, mostly by suspicion of deficiency of EFA due to inadequate nutrition. A Mead acid level exceeding 0.21% (percentage of total fatty acids) was considered to be a specific sign of an insufficient EFA supply. From a total of 31 children with elevated Mead acid (MEADplus group), 23 (74%) had food allergy. The symptoms and dietary restrictions of this MEADplus group of food allergic children were compared to 54 age-and sex-matched controls with food allergy but normal Mead acid proportions (MEADminus group) before and 6 months after the serum fatty acid determination.
At the beginning of the 6-month follow-up, 44% of the food allergic children in both MEADplus and MEADminus groups were on an elimination diet. These diets did not differ between the two groups and we were not able to document an association between the severity of elimination diet and elevated Mead acid proportion. However, the MEADplus children were on average more symptomatic than MEADminus children. In the MEADplus group, food allergy presented with skin symptoms in 100% (vs. 70% in the MEADminus group, p < 0.001) and with vomiting or diarrhea in 70% (vs. 44% in the MEADminus group, p < 0.05). Clinical suspicion of malnutrition resulted in increase in the use of vegetable oil and milk-free margarine in both groups from <50% to 65-74% during the follow-up. After 6 months, 64% of the MEADplus children with food allergy had been sent to a control serum fatty acid analysis. Of these children, Mead acid had declined to normal level in 69%, and remained elevated in 31%.
Severe symptoms of food allergy combined with elimination diets in children may lead to insufficient nutrition presenting with elevated serum Mead acid. Adding of supplementary polyunsaturated fat to the diet should be considered in these children.
Lipids in Health and Disease 12/2014; 13:180. · 2.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimThe role of inflammation in the bronchopulmonary dysplasia (BPD) survivors is indistinct. We evaluated lung function in relation to inflammatory markers in plasma, exhaled breath condensate and exhaled air in school-aged very low birth weight (VLBW) survivors with and without radiographic BPD.Methods
Pre- and post-bronchodilator impulse oscillometry were performed by 21 six to 14-years-old VLBW children with radiographic BPD, 19 VLBW children without radiographic BPD and 19 age-matched non-asthmatic term controls. Eosinophilic cationic protein, interleukins 6 and 8, adiponectin, adipsin, leptin and resistin in plasma, leukotriene B4 and 8-isoprostane in exhaled breath condensate, andbronchial andalveolar nitric oxideoutput were measured.ResultsAbnormal lung function was found in 12.5% of the former VLBW children. Airway resistance at 5Hzwashighest in the radiographicBPD, but bronchodilator responses were most prominent in the nonBPD group.Plasma adiponectinhad a modest positive correlation with obstructionand with bronchodilatorresponses, and alveolar nitric oxideand plasma interleukin 6 withbronchodilator responses.ConclusionVLBW children with radiographic BPD had poorestlung function. The most pronounced bronchodilator responses were found in VLBW children without radiographic BPD. Current detected inflammatorymarkers had only a minor association with lung function in school-aged BPD survivorsThis article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: AimThe Finnish national allergy programme was introduced in 2008 to decrease the burden of allergy in the population. This study, carried out in 2013, evaluated the prevalence of parent-reported food allergies, treated with an avoidance diet until early school age, and discussed the rates in relation to those found in an identical study in 2009.Methods
School health nurses used a structured questionnaire to interview the parents of 1,653 children aged of six or seven in the first year of elementary school. The criterion for a parent-reported food allergy was that the parents considered it necessary for their child to follow an avoidance diet at school.ResultsIn 2013, 6.1% of the children were allergic to at least one food and 2.5% of the children were allergic to basic foods, such as cows’ milk, eggs and wheat, compared to 2.7% in 2009. A significant decrease was seen in allergies to nuts, fruits and vegetables.Conclusion
Parent-reported allergies to basic foods, such as cow's milk, eggs and wheat, remained rather stable in first-graders of elementary schools during the first five years of the Finnish national allergy programme, but allergies to nuts, fruits and vegetables decreased.This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Bronchiolitis is a viral lower respiratory tract infection characterised by inflammation and obstruction of the small airways. Respiratory syncytial virus (RSV) is the most common causative agent, followed by parainfluenza viruses, adenoviruses and the recently discovered metapneumovirus. Birth cohort studies have reported that the incidence of bronchiolitis is 18–32% during the first year of life, and 1–3% of infants need hospitalisation for bronchiolitis, with the majority being admitted before six-months-of-age (1).This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: All respiratory viruses are capable of causing lower respiratory tract infections. Active testing of influenza viruses during influenza epidemics is recommended. Antitussive medications are ineffective and should not be used. Croup presenting with inspiratory stridor is recommended to be treated with oral corticosteroids and inhaled racemic adrenalin. Corticosteroids and inhaled racemic adrenalin are ineffective for the treatment of bronchiolitis. Inhaled salbutamol administered by a spacer (with a mask) is recommended for wheezy bronchitis. Amoxicillin is recommended for treating pneumonia at home and intravenous penicillin in hospital (combined with macrolide if mycoplasma is suspected). Pertussis is treated with azithromycin or clarithromycin.
[Show abstract][Hide abstract] ABSTRACT: Early-life exposure to environmental microbial agents may be associated with the development of allergies. The aim of the study was to identify better ways to characterize microbial exposure as a predictor of respiratory symptoms and allergies.
[Show abstract][Hide abstract] ABSTRACT: Elevated white blood cells (WBC) in blood and C-reactive protein (CRP) in serum are often used as nonspecific markers for bacterial etiology of infection in children. The aim of the present study was to evaluate how rapid WBC and CRP testing influences the patient flow and costs in the pediatric emergency room (ER).
The study was a retrospective chart review. In all, 166 children who were treated during three months in the ER of a children's hospital, and in whom rapid tests for WBC and CRP were done, were included. The association between rapid testing and the length of ER stay was evaluated, and the costs of rapid tests were compared with corresponding costs if done in hospital laboratory.
The median ER stay lasted 147.5 min, if no other examinations than rapid CRP and WBC tests were taken and if no emergency treatments were given, compared with 201.5 min in those with other laboratory tests obtained or emergency treatments given (p<0.001). The respective figures were 142.5 and 179.5 min in those 96 children discharged home (p=0.003). The costs of rapid testing were only 41.5 % of the corresponding costs in laboratory.
The simultaneous rapid testing of CRP and WBC in children with presumable infection decreased the costs and shortened the length of ER stay, if no other examinations or emergency treatment were needed. The costs of rapid testing were less than half of the corresponding costs in laboratory.
Pediatrics International 04/2014; · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimThere is no widely accepted consensus on the diagnosis and treatment of bronchiolitis. This study describes current practices in Finnish and Swedish hospitals.MethodsA questionnaire on the diagnosis and treatment of bronchiolitis in children below two-years-of-age was sent to all Finnish and Swedish hospitals providing in-patient care for children. All 22 Finnish hospitals answered, covering 100% of the < 12-month-old population and 21 of the 37 Swedish hospitals responded, covering 74%.ResultsThe mean upper age limit for bronchiolitis was 12.7 months in Finnish hospitals and 12.5 months in Swedish hospitals. In both, laboured breathing, chest retractions and fine crackles were highlighted as the main clinical findings, followed by prolonged expiration. The mean value for the lowest acceptable saturation in room air was 94% in Finnish hospitals and 93% in Swedish hospitals. The most important factors influencing hospitalisation were young age, desaturation and inability to take oral fluids. Finnish doctors preferred intravenous routes and Swedish doctors preferred nasogastric tubes for supplementary feeding. The first-line drug therapy was inhaled racemic adrenaline in Finland and inhaled levo-adrenaline in Sweden.Conclusion
The diagnosis and treatment of bronchiolitis is fairly similar in Finnish and Swedish hospitals.This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: AimTo evaluate the association between hospitalisation for respiratory syncytial virus lower respiratory tract infection (RSV LRTI) in infancy and asthma, respiratory health-related quality of life and lung function at 28 to 31-years-of-age.Methods
In 2010, we carried out a 30-year follow up on 43 adults admitted to Kuopio University Hospital, Finland, for RSV LRTI, 27 for bronchiolitis and 16 for pneumonia, between 1981 and 1982. Together with 86 population-based controls, they completed the Saint George's Respiratory Questionnaire and underwent pre-bronchodilator (pre-BD) and post-BD spirometry tests to measure percentage of predicted forced vital capacity (FVC%), percentage of predicted forced expiratory volume in 1 second (FEV1%) and percentage of predicted FEV1/FVC (FEV1/FVC%).ResultsBoth the pre-BD and post-BD FEV1% and FEV1/FVC% were significantly lower in former RSV LRTI patients than in the controls. The bronchiolitis patients had more asthma in adulthood than the controls and pneumonia in infancy was associated with lower SGRQ scores.ConclusionRSV LRTI hospitalisation in infancy was associated with an increased risk of permanent obstructive lung function reduction in adulthood. The asthma risk was higher after hospitalisation for bronchiolitis, than in the controls, and respiratory health-related quality of life was lower after hospitalisation for pneumonia.This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: AimCorticosteroids have harmful dose-dependent effects on bone metabolism and growth. This study used a new method for volumetric measurements to evaluate the association between inhaled corticosteroids (ICS) for asthma and bone mineral density (BMD) in school-aged children. Methods
We evaluated children hospitalised for wheezing at the age of <24 months at 12.3 years (median). Volumetric BMD (vBMD) was measured using peripheral quantitative computed tomography (pQCT) from the distal tibia and radius in 82 children. Data on ICSs used were collected from hospital records and parent interviews. Cumulative doses and the duration of ICS therapy were calculated. ResultsGirls had higher total and cortical vBMD in the tibia than boys. Pubertal children had higher total and cortical vBMD in the radius than pre-pubertal children. Higher cumulative doses of ICSs were associated with lower total (r= -0.175, adjusted p= 0.016), cortical (r= -0.138, adjusted p= 0.016) and trabecular (r= -0.156, adjusted p= 0.039) vBMD in the radius, but not in the tibia. Age, weight, or the cumulative dose of systemic corticosteroids had no significant associations with vBMD. Conclusion
Although correlations between cumulative ICS doses and vBMD were weak, ICS use during childhood may reduce BMD in the radius at school age.This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Toll-like receptors (TLR´s) are a pivotal part of the innate immunity system. Variations in TLR genes have been connected to autoimmune conditions, such as allergy and asthma. The TLR2 subfamily comprises TLR1, TLR2, TLR6 and TLR 10. We hypothesized that polymorphism of the TLR2 subfamily may be associated with prevalence of post-bronchiolitic asthma and/or atopy.
TLR1rs5743618, TLR2rs5743708 and TLR6rs5743810 SNP´s of 133 children who had been hospitalized for bronchiolitis at <6months of age were analyzed. Doctor-diagnosed asthma and atopy as well as their occurrence during the first six years of life were evaluated during a follow-up visit.
At the mean age of 6.4 years, asthma was present in 17 (13%) patients, there was asthma diagnosis during the first six years of life in 39 (29%) and current doctor-diagnosed allergic rhinitis in 57 (43%) patients. Twenty four (24%) children with G/G genotype in TLR1 rs5743618 were diagnosed to have asthma between 1-6 years of age (vs. 13(38%) of those with G/T or T/T genotypes; p=0.04). In addition, 11/60 children (18%) with TLR6 rs5743810 C/T vs. 36/73(49%) of other genotypes had atopic eczema at follow-up. Only two children (8%) with wild genotype in all investigated SNP´s had asthma during the first six years of life (vs. 30% in those with variant genotype of TLR1, TLR2 and/or TLR6).
In this study we demonstrated that TLR1 rs5743618 was associated with asthma and atopic eczema during the first six years of life after early bronchiolitis. In addition, TLR6 rs5743810 was associated with present atopy at preschool age.
The Pediatric Infectious Disease Journal 01/2014; · 3.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lower respiratory infections in infancy may be associated with lung function deficits in adulthood. Our aim was to evaluate lung function, with a special focus on irreversible airway obstruction, thirty years after bronchiolitis or pneumonia in infancy.
In 1981-1982, 83 children under two years of age were hospitalized for bronchiolitis and 44 for pneumonia at Kuopio University Hospital, Finland. In 2010, 47 bronchiolitis patients, 22 pneumonia patients and 138 controls attended the study, including spirometry before (pre-BD) and after bronchodilatation (post-BD). The measured indices were forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), that were presented as % of predicted value (FVC% and FEV1%). FEV1/FVC was presented as both absolute FVC/FEV1-ratio and % of predicted (FEV1/FVC%). Irreversible airway obstruction was defined as post-BD FEV1/FVC% below 88% of predicted (FEV1/FVC% <88%) according to Finnish reference values or FEV1/FVC-ratio below fifth percentile (FEV1/FVC <5th percentile), according to Global Lung Function Initiative reference values.
All lung function indices were lower in former bronchiolitis patients and pre- and post-BD FEV1% in pneumonia patients, compared to controls. 21% of bronchiolitis (OR, 95%CI; 5.59, 1.72-18.21) and 9% of pneumonia patients (2.24, 0.34-13.56) had FEV1/FVC% <88% compared to controls (4%). Likewise 7 (15%) of bronchiolitis (7.07, 1.33-37.22) and 1 (5%) of pneumonia patients (1.73, 0.12-24.77) had FEV1/FVC <5th percentile compared to controls 2 (1%).
Evidence of reduced lung function was present 30 years after hospitalization for bronchiolitis or pneumonia in infancy. Irreversible airway obstruction after severe bronchiolitis in infancy suggests permanent, structural alterations in airways.
Respiratory medicine 12/2013; · 2.33 Impact Factor