Stijn Verhulst

University of Antwerp | UA · Faculty of Medicine

Objectives To improve adult height in pubertal girls with a poor height prediction, treatment with growth hormone (GH) can be used in combination with a gonadotropin releasing hormone agonist (GnRHa), to delay closure of the growth plates. However, there are few studies to support this practice, and they show conflicting results. The objective of t...

Background: Respiratory sounds are induced by turbulence of airflow at the level of lobar and segmental bronchi. Although this physiological principle is widely accepted, generation of these sounds has never been demonstrated in human subjects. Aim: To investigate a new approach relating lung sounds to airflow turbulence intensity using computatio...

Objectives The aim of this study is to investigate the efficacy of equimolar mixture of 50% nitrous oxide and oxygen (EMONO) to obtain conscious sedation for otolaryngologic examinations and minor Ear-Nose-Throat (ENT) procedures in children with or without comorbidities. Methods Retrospective analysis of patient records from all children who were...

Recently, it was reported that heterozygous PCSK1 variants, causing partial PC1/3 deficiency, result in a significant increased risk for obesity. This effect was almost exclusively generated by the rare p.Y181H (rs145592525, GRCh38.p13 NM_000439.5:c.541T>C) variant, which affects PC1/3 maturation but not enzymatic capacity. As most of the identifie...

Background Inpatient pediatric obesity treatments are highly effective, although dropouts and weight regain threaten long-term results. Preliminary data indicate that leptin, adiponectin, and cardiometabolic comorbidities might predict treatment outcomes. Previous studies have mainly focused on the individual role of adipokines and comorbidities, w...

Objective Laryngomalacia can be an important cause of obstructive sleep apnea (OSA) in infants. Nocturnal oximetry is a cheap and safe method in comparison to polysomnography for the detection of sleep-disordered breathing. The aim of this study is to evaluate the validity of nocturnal oximetry as a diagnostic tool for OSA in infants with laryngoma...

Long term noninvasive respiratory support, comprising continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), in children is expanding worldwide, with increasing complexities of children being considered for this type of ventilator support and expanding indications such as palliative care. There have been improvements in equip...

Background: Currently available treatment programs for children with obesity only have modest long-term results, which is (at least partially) due to the poorer self-control observed within this population. The present trial aimed to determine whether an online self-control training, training inhibition, and redirecting attentional bias, can improv...

Background Elexacaftor plus tezacaftor plus ivacaftor is a triple-combination cystic fibrosis transmembrane conductance regulator (CFTR) modulator regimen shown to be generally safe and efficacious in people with cystic fibrosis aged 12 years or older with at least one F508del-CFTR allele. We aimed to assess the magnitude and durability of the clin...

Digital auscultation is a well-known method for assessing lung sounds, but remains a subjective process in typical practice, relying on the human interpretation. Several methods have been presented for detecting or analyzing crackles but are limited in their real-world application because few have been integrated into comprehensive systems or valid...

Background Childhood obesity is an increasing problem with substantial comorbidities such as obstructive sleep apnea (OSA) and increased cardiovascular morbidity. Endothelial dysfunction is an underlying mechanism related to both obesity and OSA. Research question To investigate the effect of weight loss on endothelial function and OSA in obese ch...

Background Lumacaftor/ivacaftor (LUM/IVA) has shown modest benefits in previous research, but the exact effects in the cystic fibrosis (CF) lung remain unclear. This study aims to offer novel information on the mode of action of the cystic fibrosis transmembrane conductance regulator (CFTR)-modulating drug by assessing lung structure and function u...

(1) Background: Obstructive sleep apnea (OSA) and lower airway anomalies are both highly prevalent in children with Down syndrome (DS). However, little is known on the interaction between both. We aim to investigate the co-occurrence of OSA (defined as obstructive apnea/hypopnea index (oAHI) ≥ 2/h) and lower airway anomalies in children with DS and...

Background: Functional Respiratory Imaging (FRI) combines HRCT scans with computational fluid dynamics to provide objective and quantitative information about lung structure and function. FRI has proven its value in pulmonary diseases such as COPD and asthma, but limited studies have focused on cystic fibrosis (CF). This study aims to investigate...

Vallecular cysts (VCs) are a rare clinical entity in infants. In this report, we discuss 4 infants presenting with respiratory and feeding problems caused by VCs. The diagnosis was established by awake flexible endoscopy and was confirmed and treated using direct laryngoscopy. Marsupialization, with cold steel microsurgical instruments, was perform...

Background: Children with Down syndrome (DS) often present with chronic or recurrent respiratory symptoms and generally have a more severe and prolonged disease course in case of infection. This can be caused by anatomical and/or immunological predisposition. With this study, we aim to compare microbial composition in the lower airways of patients...

Introduction Severe asthma is a rare disease in children, for which three biologicals –anti-IgE, anti-IL-5 and anti-IL-4RA antibodies– are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the fiel...

Context: Down syndrome (DS) is a prevalent chromosomal disorder associated with a wide range of congenital anomalies and other health problems. Objectives To give a scoping overview of encountered lower airway problems (both infectious and non-infectious) in DS children. Data sources: We systematically searched the MEDLINE and PubMed databases for...

Aims Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint. Data synthesis A literature search was pe...

This chapter focuses on the role of upper airway (UA) evaluation by imaging modalities in pediatric obstructive sleep apnea (OSA). This chapter emphasizes upon studies using imaging techniques that may further enhance our understanding about the mechanisms of UA obstruction leading to pediatric OSA and could assist in treatment selection.

Stay-at-home orders, physical distancing, face masks and other non-pharmaceutical interventions (NPIs) do not only impact COVID-19, but also the dynamics of various other infectious diseases. Bronchiolitis is a clinically diagnosed viral infection of the lower respiratory tract, and causes a yearly seasonal wave of admissions in paediatric wards wo...

Background: Obesity and age influence the reliability of dual energy X-ray absorptiometry scanning (DEXA) and bioimpedance spectroscopy (BIS). Both are used in clinical settings, but have not been compared for measurements in obese children. We compared DEXA and BIS for evaluating body composition and inherent changes in obese children before and...

Rationale: Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Lung function and imaging are classically used to assess BPD. Functional Respiratory Imaging (FRI) combines a structural and functional assessment of the airways and their vasculature. We aimed to assess BPD with FRI and to correlate these findings with the clini...

Rationale: Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Lung function and imaging are classically used to assess BPD. Functional Respiratory Imaging (FRI) combines a structural and functional assessment of the airways and their vasculature. We aimed to assess BPD with FRI and to correlate these findings with the clin...

Genome-wide copy number surveys associated chromosome 11q11 with obesity. As this is an olfactory receptor-rich region, we hypothesize that genetic variation in olfactory receptor genes might be implicated in the pathogenesis of obesity. Multiplex Amplicon Quantification analysis was applied to screen for copy number variants at chromosome 11q11 in...

Objective/background Surgical interventions for obstructive sleep apnea (OSA) are less effective in obese than in normal-weight children. However, the mechanisms that underpin this relationship are not fully understood. Therefore, this study aimed to explore how body weight influences upper airway collapse and treatment outcome in children with OSA...

Background Airway clearance techniques (ACTs) are an important aspect of the treatment of children with chronic obstructive lung diseases. Unfortunately, a sound evidence base is lacking and airway clearance strategies are largely based on clinical expertise. One of the reasons for the limited evidence is the lack of appropriate outcome measures sp...

Slaapstoornissen komen geregeld voor bij kinderen en jongeren. De gevolgen zijn wisselend en ze kunnen invloed hebben op medische, psychische en ontwikkelingsaspecten van het opgroeiende kind. Het is belangrijk om slaapstoornissen te herkennen en correct te behandelen. We bespreken verscheidene slaapstoornissen met behulp van de derde editie van de...

Background Bronchopulmonary dysplasia (BPD) remains a common complication of preterm birth. Both historically and in current practice, radiologic evaluation of the lungs has an important role in assessing disease severity and complications. Aim To provide an overview of imaging techniques for detecting lung abnormalities in patients with BPD in al...

There is limited knowledge on the occurrence of respiratory manifestations and sleep‐disordered breathing in particular in children with the MECP2 duplication syndrome. Although sleep‐disordered breathing and nocturnal hypoventilation are currently not cited as an important symptom in these children, we present three cases who all had an abnormal b...

This review will focus on non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) therapy in children with obstructive sleep apnea (OSA) due to obesity and underlying syndromes. These children have a high prevalence of OSA and residual OSA after adenotonsillectomy. Therefore, a high proportion of these children are treated wit...

Objectives: The CFTRmodulatorOrkambi (lumacaftor-ivacaftor) has shown modest benefits in previous research, but the exact effects in the CF lung remain unclear. Functional Respiratory Imaging (FRI), combining highresolution CT imaging with computational fluid dynamics, provides detailed information about the lung structure and function, allowing a...

Background/Aim Children on chronic noninvasive ventilation are at risk for nonelective hospitalizations, mainly for acute infections. This study examined the prevalence of hypercapnia in children on chronic ventilatory support during an acute admission. Methods This retrospective study included children aged 0 to 18 years who regularly used bileve...

Background: Orkambi (lumacaftor-ivacaftor) is a Cystic Fibrosis Transmembrane conductance Regulator (CFTR) modulator, indicated for patients with cystic fibrosis (CF) homozygous for F508del. Previous studies have shown modest benefits of Orkambi, but the exact effects in the CF lung remain unclear. Functional Respiratory Imaging (FRI), combining hi...

Introduction High‐frequency chest wall oscillation (HFCWO) is a commonly prescribed airway clearance technique (ACT) for patients whose ability to expectorate sputum is compromised. This study aimed to assess the effectiveness of a newly developed mobile ACT device (mHFCWO—The Monarch Airway Clearance System) in patients with cystic fibrosis (CF)....

Introduction Children with Down syndrome (DS) often present with chronic respiratory symptoms. Congenital airway anomalies have been described but data about prevalence is scarce and a comparison to controls is lacking. We aim to compare the endoscopic and clinical data of children with DS to controls without significant medical history. Methods A...

Background: Patients with neuromuscular disorders (NMDs) are likely to develop respiratory failure which requires noninvasive ventilation (NIV). Ventilation via a mouthpiece (MPV) is an option to offer daytime NIV. Objectives: To determine the preferred equipment for MPV by patients with NMDs. Methods: Two MPV equipment sets were compared in 2...

Purpose Positional (supine dependent) obstructive sleep apnea (POSA) affects about 55% of adults with obstructive sleep apnea (OSA). We aimed to study the prevalence and risk factors for POSA in children. Methods Cross-sectional analysis of data obtained in 171 children with moderate to severe OSA confirmed by polysomnography (PSG) performed over...

Objective: There is still no consensus regarding the treatment of empyema in children. Intrapleural combination of tissue plasminogen activator and dornase alfa is a promising treatment for empyema in adults. The aim of this pilot study was to determine whether this combination is safe and successful in pediatric empyema. Methods: Previous well chi...

Respiratory Syncytial Virus (RSV) is a very important viral pathogen in children, immunocompromised and cardiopulmonary diseased patients and the elderly. Most of the published research with RSV was performed on RSV Long and RSV A2, isolated in 1956 and 1961, yet recent RSV isolates differ from these prototype strains. Additionally, these viruses h...

Background: Cystic fibrosis transmembrane conductance regulator (CFTR) modulators correct the basic defect caused by CFTR mutations. Improvements in health outcomes have been achieved with the combination of a CFTR corrector and potentiator in people with cystic fibrosis homozygous for the F508del mutation. The addition of elexacaftor (VX-445), a...

Retrospective chart review of 133 children who underwent bronchoscopy because of possible protracted bacterial bronchitis to compare the results of bronchial aspirates with those of bronchoalveolar lavage (BAL). When comparing BAL and bronchial aspirate in 70 patients where both samples were available, the result was comparable in 46 cases (65%). I...

Background Several treatment approaches in cystic fibrosis (CF) aim to correct CF transmembrane conductance regulator (CFTR) function; the efficacy of each approach is dependent on the mutation(s) present. A need remains for more effective treatments to correct functional deficits caused by the F508del mutation. Methods Two placebo-controlled, pha...

This article is a summary of my PhD.

Aim Bronchiolitis is one of the most common lower respiratory tract infections in young children, associated with significant morbidity, but limited therapeutic options. Nebulised hypertonic saline (HS) has been a supportive treatment until current guidelines advised against its routine use. Accordingly, the University Hospital of Antwerp recently...

Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dy...

Methods Population: 10 consecutive children, 1-16 years old with a diagnosis of PPE (≥ 1/4 of hemithorax (chest X-ray) or complicated effusion). Exclusion: • Tuberculosis, fungus, or noninfectious • Coagulation impairment • Preexisting chronic conditions such as immunodeficiency, congenital cardiopathy or neurologic impairment • Pregnancy, breastfe...

Background: Obesity is a widespread problem that not only leads to medical and psychological diseases in adults, but also in children and adolescents at an early stage in life. Because of its global burden on both the individual and society, it is necessary to develop effective evidence-based treatments. Current "Multidisciplinary Obesity Treatmen...

Background Intrapulmonary percussive ventilation (IPV) is frequently used in clinical practice to enhance sputum evacuation and lung recruitment. However, the evidence in different respiratory pathologies, especially in children, is still lacking. This systematic review aims to enlist the effectiveness of IPV as an airway clearance technique in ped...

Background: A potential positive effect of probiotics in cystic fibrosis (CF) on fecal calprotectin (FCP), pulmonary exacerbations and weight has been described in small controlled trials. Methods: A double-blind multicenter cross-over study (2 × 4 m) was performed looking at abdominal pain, nutritional status, pulmonary function, pulmonary exac...

Purpose: Adenotonsillectomy (AT) is the first-line treatment for obstructive sleep apnea (OSA) in children irrespective of clinical upper airway (UA) findings. We aimed to investigate whether drug-induced sedation endoscopy (DISE) changes treatment decision and outcome in otherwise healthy children and infants with OSA. Methods: Retrospective an...

Sleep disorders are a common problem during childhood. The consequences are variable, and sleep disorders can influence medical, psychological and developmental aspects of the growing child. It is important to recognize sleep disorders and to treat them correctly. We discuss common sleep disorders during childhood using the 3rd edition of the Inter...

Study objectives: The complexity of the pathogenesis of obstructive sleep apnea (OSA) in children with Down syndrome (DS) is illustrated by a prevalence of residual OSA after adenotonsillectomy. The aim of this study was to investigate whether upper airway imaging combined with computation fluid dynamics could characterize treatment outcome after...

Objective: To investigate clinical factors that could predict residual sleep-disordered breathing (SDB) after weight loss. Study design: Obese subjects between 10 and 19 years of age were recruited while entering an in-patient weight loss treatment program. All subjects underwent anthropometry and sleep screening using a portable device at basel...

The increasing prevalence of childhood obesity during the past generation has been accompanied by profound changes in daily lifestyle. Computer-related activities, video games, cell phones, and other diversions have promoted a more sedentary existence, reducing energy expenditure and facilitating weight gain. Much of the screen and cell time is spe...

Background: The vast majority of children around the world undergoing adenotonsillectomy for obstructive sleep apnea-hypopnea syndrome (OSA) are not objectively diagnosed with nocturnal polysomnography (NPSG) due to access availability and cost issues. Automated analysis of nocturnal oximetry (nSpO2), which is readily and globally available, could...

Continuous positive airway pressure (CPAP) is being increasingly used in children of all age ranges. The limited number of commercially available masks especially in infants and young children may complicate its use and compliance. In this report, we describe our experience with the use of the Optiflow™ (Fisher and Paykel Healthcare) Nasal Cannula...

The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant quest...

Background: Prader Willi Syndrome (PWS) is a syndromic form of obesity caused by a chromosomal aberration on chromosome 15q11.2-q13. Patients with a comparable phenotype to PWS not carrying the 15q11.2-q13 defect are classified as Prader Willi like (PWL). In literature, PWL patients do frequently harbor deletions at 6q16, which led to the identifi...

We have investigated the dynamics of various persistent organic pollutants (POPs) in the serum of 94 obese adolescents (34 boys and 60 girls: age range 11-19. years) before (0. M) and after 5. months (5. M) of undergoing weight loss treatment. Six groups of POPs, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane and its meta...

Neuropeptide Y (NPY) and its G protein–coupled NPY Y2 Receptor (NPY2R) are highly expressed in orexigenic NPY/Agouti‐related peptide neurons within the arcuate nucleus, a major integrator of appetite control in the hypothalamus. As NPY and NPY2R are interesting candidate genes for obesity, we hypothesized that a genetic variation in these genes mig...