1.                  Alpern ER, Stanley RM, Gorelick MH, Donaldson A, Knight S, Teach SJ, Singh T, Mahajan P, Goepp JG, Kuppermann N, Dean JM, Chamberlain JM; Pediatric Emergency Care Applied Research Network. Epidemiology of a pediatric emergency medicine research network: the PECARN Core Data Project. Pediatr Emerg Care. 2006 Oct;22(10):689-99.

Department of Pediatrics, Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. alpern@email.chop.edu.

OBJECTIVE: To examine the epidemiology of pediatric patient visits to emergency departments (ED). METHODS: We conducted a cross-sectional study of pediatric ED visits at the participating Pediatric Emergency Care Applied Research Network (PECARN) hospitals in 2002. We provide descriptive characteristics of pediatric ED visits and a comparison of the study database to the National Hospital Ambulatory Medical Care Survey (NHAMCS). Bivariate analyses were calculated to assess characteristics associated with hospital admission, death in the ED, and length of ED visit. We also performed multivariate regression to model the likelihood of admission to the hospital. RESULTS: Mean patient age was 6.2 years; 53.5% were boys; 47.5% black; and 43.2% had Medicaid insurance. The most common ED diagnoses were fever, upper respiratory infection, asthma, otitis media, and viral syndromes. The inpatient admission rate was 11.6%. The most common diagnoses requiring hospitalization were asthma, dehydration, fever, bronchiolitis, and pneumonia. In multivariate analysis, patients who were black or Hispanic, had Medicaid insurance or were uninsured, or were older than 1 year were less likely to be hospitalized. Demographics of the PECARN population were similar to NHAMCS, with notable exceptions of a larger proportion of black patients and of admitted patients from the PECARN EDs. CONCLUSION: We describe previously unavailable epidemiological information about childhood illnesses and injuries that can inform development of future studies on the effectiveness, outcomes, and quality of emergency medical services for children. Most pediatric ED patients in our study sought care for infectious causes or asthma and were discharged from the ED. Hospital admission rate differed according to age, payer type, race/ethnicity, and diagnosis.

2.                  Aslan S, Kandis H, Akgun M, Cakir Z, Inandi T, Gorguner M.  The effect of nebulized NaHCO3 treatment on "RADS" due to chlorine gas inhalation. Inhal Toxicol. 2006 Oct;18(11):895-900.  Department of Emergency Medicine, School of Medicine, Ataturk University, Erzurum, Turkey.

Chlorine is one of the most common substances involved in toxic inhalation. As with all irritant gases, the airway injuries caused by chlorine gas may result in clinical manifestations similar to those of asthma. In this study, we investigated the effect of nebulized sodium bicarbonate (NSB) on the treatment and quality of life (QoL) of victims exposed to chlorine gas. Forty-four consecutive patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation (40 females and 4 males, age range 17-56 yr) were included in this study. Patients were placed in control and treatment groups in a sequential odd-even fashion based on their order of presentation. Treatment of all patients included corticosteroids and nebulized short-acting beta2-agonists. Then the control group (n = 22) received nebulized placebo (NP), and the NSB group (n = 22) received NSB treatment (4 cm3 of 4.20% sodium bicarbonate solution). A quality of life (QoL) questionnaire and pulmonary function tests (PFTs) were performed before and after treatments in both groups. The most common symptoms were dyspnea (82%) and chest tightness (82%). Baseline characteristics of both groups were similar. Compared to the placebo group, the NSB group had significantly higher FEV1 values at 120 and 240 min (p < .05). Significantly more improvement in QoL questionnaire scores occurred in the NSB group compared to the NP group (p < .001). Thus, NSB is a clinically useful treatment, as tested by PFTs and QoL questionnaire, for patients with RADS caused by exposure to chlorine gas.

3.                  Birnkrant DJ, Picone C, Markowitz W, El Khwad M, Shen WH, Tafari N.  Association of transient tachypnea of the newborn and childhood asthma. Pediatr Pulmonol. 2006 Oct;41(10):978-84. 

Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio 44109, USA. dbirnkrant@metrohealth.org

OBJECTIVE: To determine if transient tachypnea of the newborn (TTN) is independently associated with childhood asthma. METHODS: The sampling frame was a computerized database on 18,379 term infants born between January 1, 2024 and December 31, 2023 in an urban tertiary care hospital. This was a case-control study nested in a cohort of all term newborns who were subsequently diagnosed with asthma (n = 2137) and a similar number of birthday-matched controls. The International Classification of Diseases, Ninth Revision code was used to identify the infants with TTN and those who developed asthma. Logistic regression was used to adjust for potentially confounding variables. Stratified multivariate analysis was undertaken on subgroups to assess possible effect modification by factors known to influence the incidence of asthma: race, gender, domicile, and maternal asthma. RESULTS: After adjustment for potential confounding, TTN was significantly associated with the diagnosis of childhood asthma (adjusted OR = 1.50, 95% CI: 1.13-1.99; P = 0.0052). The association of TTN and asthma was statistically strongest among male infants, especially among males whose mothers lived at an urban address, males of non-white race, and males whose mothers did not have asthma. The pattern of association of TTN and asthma was similar for infants diagnosed with asthma once compared with those diagnosed with asthma recurrently. CONCLUSION: TTN was independently and significantly associated with the subsequent diagnosis of childhood asthma, especially among male infants. TTN may be a marker of deficient pulmonary function reflecting inherited susceptibility to asthma. (c) 2006 Wiley-Liss, Inc.

4.                  Boyd JH, Macklin EA, Strunk RC, DeBaun MR. Asthma is associated with acute chest syndrome and pain in children with sickle cell anemia. Blood. 2006 Nov 1;108(9):2923-7.

Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine in St Louis, Patient Oriented Research Unit, 4444 Forest Park Blvd, CB 8519, St Louis, MO 63108, USA.

Pain and acute chest syndrome (ACS) episodes are 2 of the most common causes of hospitalization in children with sickle cell anemia (SCA). However, very few potentially modifiable risk factors for either condition have been identified. In this prospective infant cohort study, we tested the hypothesis that asthma is associated with an increased incidence rate of pain and ACS episodes. An infant cohort was composed of 291 African American children with hemoglobin SS enrolled in the Cooperative Study for Sickle Cell Disease before age 6 months and followed beyond age 5 years. Asthma was defined by a physician diagnosis, an acute asthma event, or use of prescription asthma medications. The incidence rates of ACS and painful episodes were compared for children with and without asthma. A clinical diagnosis of asthma was made in 17% of the cohort. Asthma was associated with more frequent ACS episodes (0.39 vs 0.20 events per patient year, P < .001) and painful episodes (1.39 vs 0.47 events per patient year, P < .001). In conclusion, in children with SCA, asthma is associated with an increased incidence of sickle cell disease-related morbidity, including ACS and painful episodes.

5.                  Kubota A, Kawahara H, Okuyama H, Shimizu Y, Nakacho M, Ida S, Nakayama M, Okada A.  Cow's milk protein allergy presenting with Hirschsprung's disease-mimicking symptoms. J Pediatr Surg. 2006 Dec;41(12):2056-8.

Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka 594-1101, Japan. kubota@mch.pref.osaka.jp

BACKGROUND: Pediatric surgeons often encounter neonates who present with Hirschsprung's disease (HD)-like symptoms and plain x-ray findings, but respond well to conservative treatment. During our investigation of the etiology of this condition, which we named "benign transient nonorganic ileus of neonates" (BTNIN), we noticed that BTNIN included cases of cow's milk allergy (CMA). Therefore, a prospective study of the identity of BTNIN and CMA was conducted. METHODS: Cow's milk allergy was diagnosed when a baby showed HD-like symptoms after oral feeding, and a drug-induced lymphocyte stimulation test was positive for cow's milk with a titer of more than 300%. MATERIALS: Of 38 neonates with suspected HD, a surgical disorder was excluded by plain x-ray in 9, intestinal atresia was diagnosed in 3, and the remaining 26 were enrolled in this study. RESULTS: Of 26 cases, 9 were diagnosed as HD by manometric studies and 17 as CMA. Thirteen of 17 CMA cases had been fed with breast milk and 4 with formula milk. CONCLUSION: The proportion of CMA in the cases presenting with HD-like symptoms in the neonatal period is much higher than what we expected, and most cases of BTNIN are caused by CMA. If HD is ruled out, CMA should be considered.

6.                  Mallia P, Johnston SL.  How viral infections cause exacerbation of airway diseases. Chest. 2006 Oct;130(4):1203-10. Review.

Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, Norfolk Pl, London W2 1PG, UK.

Exacerbations of asthma and COPD are major causes of morbidity, mortality, and health-care costs. Over the last decade, studies using new molecular diagnostic techniques have established that respiratory viruses are a major cause of exacerbations of both asthma and COPD. The most prevalent viruses detected during exacerbations are the rhinoviruses. Despite the burden of disease associated with exacerbations, little is known about the mechanisms of virus-induced exacerbations of airway diseases. Exacerbations are associated with increased airway inflammation in patients with both asthma and COPD, but many questions remain unanswered regarding the key inflammatory cells and mediators involved. Identifying the key inflammatory mediators involved in exacerbations holds the promise of developing diagnostic and prognostic markers of exacerbation. In addition, such studies can identify new therapeutic targets for the development of novel drugs for the prevention and treatment of exacerbations.

7.                  Wagelie-Steffen A, Aceves SS.  Eosinophilic disorders in children. Curr Allergy Asthma Rep. 2006 Nov;6(6):475-82. Review. 

Division of Allergy, Immunology, Children's Hospital of San Diego, 3020 Children's Way MC-5114, San Diego, CA 92123, USA.

Many pediatric diseases demonstrate blood or tissue eosinophilia. Included among these disorders are common atopic diatheses such as asthma as well as the rarer conditions of hypereosinophilic syndrome and eosinophilic gastrointestinal disorders. Eosinophil trafficking and activation in target organs leads to tissue damage and ongoing reparative attempts that can ultimately result in changes in organ structure and function. Recent treatment with biologic agents such as tyrosine kinase inhibitors and anti-interleukin-5 has offered new therapeutic options in certain eosinophilic disorders. Eosinophilic disorders such as eosinophilic esophagitis are increasingly being diagnosed in children, but many lessons in disease pathogenesis, diagnosis, optimal treatment, and natural history continue to be learned.