Ian Mitchell

Tracheostomy in children: A population-based experience over 17 years

Tracheostomy is a lifesaving intervention with numerous complications.

Congenital tracheal stenosis in Pfeiffer syndrome

We report an infant with Pfeiffer syndrome (acrocephalosyndactyly type V) and a solid cartilaginous trachea lacking rings. This airway abnormality has been reported in a child with Crouzon syndrome but has not been described in Pfeiffer syndrome.

The risk of mortality among young children hospitalized for severe respiratory syncytial virus infection

Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) is the leading cause of childhood morbidity. Although also an important cause of childhood mortality worldwide, the impact of key risk factors has not been established. A systematic review of 34 articles reporting case fatality rates in young children hospitalized for severe RSV LRTI, according to the presence of underlying RSV risk factors, was conducted. The weighted mean case fatality rate was 1.2% (range, 0-8.3%; median, 0%; n = 10) among preterm infants; 5.2% (range, 2.0-37.0%; median, 5.9%; n = 7) among children with CHD; and 4.1% (range, 0-10.5%; median, 7.0%; n = 6) among children with BPD. Case fatality estimates among children not at high risk (n = 6) ranged from 0% to 1.5% (weighted mean, 0.2%; median, 0.0%). Fatality during hospitalization for severe RSV LRTI is rare among children not at high risk, but occurs more commonly among children at higher risk of RSV LRTI.

Screening children with asthma for psychosocial adjustment problems : A tool for health care professionals

Objective. To develop a brief questionnaire for health care professionals to use in screening children with asthma for psychosocial adjustment problems. Method. The initial version of the Childhood Asthma Resiliency Questionnaire (CARQ) listed 85 items focusing on self-esteem, medical fears, peer relationships, family relations, stress, and depression. The number of items was reduced after focus groups and pilot testing. In pilot tests, 100 children with asthma completed the CARQ. Parents completed the Child Behavior Checklist (CBCL). Another sample of 73 children with mild asthma was also obtained. Results. The total CARQ score was significantly correlated (p < 0.001) with Total Problems, Internalizing, and Externalizing Problems on the CBCL. Children with more hospitalizations and more days of school missed from asthma had significantly higher scores on the CARQ compared to children with less functional morbidity. Conclusion. The CARQ appears to be a useful brief measure to help clinicians identify children at risk for problems adjusting to asthma.

Diffuse necrotizing tracheobronchitis: An acute and chronic disease

Necrotizing tracheobronchitis (NTB) is characterized by acute episodes of airway obstruction, hypercarbia, and lack of chest movement in mechanically ventilated neonates. Emergency bronchoscopic removal of necrotic tissue is essential for survival. Although postmortem lesions extend into smaller bronchi, survivors have not demonstrated residual tracheobronchial abnormalities. Two infants were treated successfully for NTB but succumbed to diffuse tracheobronchial strictures with progressive pulmonary hyperinflation. A third neonate with esophageal atresia and left pulmonary agenesis developed NTB. Despite initial postbronchoscopic improvement, the infant died at age 6 weeks with diffuse obstructing NTB. All three infants required endotracheal intubation and mechanical ventilation. High-frequency jet ventilation was not used. Tracheal cultures for fungi, bacteria and viruses were negative. Successful treatment of NTB may be followed acutely by recurrence of NTB and chronically by diffuse tracheobronchial strictures and emphysema.

Congenital central hypoventilation syndrome; Safety of early transition to non‐invasive ventilation

Congenital central hypoventilation syndrome (CCHS) is a rare disorder of autonomic dysregulation, characterized by alveolar hypoventilation especially during sleep. As a result, lifelong ventilatory assistance is necessary in these patients. Many infants and children initially require positive pressure ventilation via tracheostomy for support. Associated complications and psychosocial pressure may prompt early transition to non‐invasive ventilation. We present the details of a patient with CCHS who successfully transitioned from tracheostomy to bilevel positive airway pressure ventilation at an early age of 3 years. Pediatr Pulmonol. 2014; 49:410–413.

Pulmonary surfactant dysfunction in pediatric cystic fibrosis: Mechanisms and reversal with a lipid-sequestering drug

BACKGROUND Airway surfactant is impaired in cystic fibrosis (CF) and associated with declines in pulmonary function. We hypothesized that surfactant dysfunction in CF is due to an excess of cholesterol with an interaction with oxidation. METHODS Surfactant was extracted from bronchial lavage fluid from children with CF and surface tension, and lipid content, inflammatory cells and microbial flora were determined. Dysfunctional surfactant samples were re-tested with a lipid-sequestering agent, methyl-β-cyclodextrin (MβCD). RESULTS CF surfactant samples were unable to sustain a normal low surface tension. MβCD restored surfactant function in a majority of samples.Mechanistic studies showed that the dysfunction was due to a combination of elevated cholesterol and an interaction with oxidized phospholipids and their pro-inflammatory hydrolysis products. CONCLUSION We confirm that CF patients have impaired airway surfactant function which could be restored with MβCD. These findings have implications for improving lung function and mitigating inflammation in patients with CF.

Analysis of sudden infant death syndrome coverage in Canadian newspapers

Sudden infant death syndrome (SIDS; also known as crib death) describes the sudden unexpected death of an infant under one year of age, which remains unexplained after a thorough investigation. SIDS is a public health concern. It is the fourth leading cause of infant death in Canada. Newspapers are a major source of health information for the public, shape public perceptions and can direct the discussion around issues. Despite the potential influence of newspapers, no study has examined the portrayal of SIDS in Canadian newspapers over time. The purpose of our study was to gain an understanding of SIDS coverage in Canadian English language newspapers using the Canadian Newsstream database from 1970 to 2015 and the historical database: The Globe and Mail from 1844 to 1977. Generating descriptive quantitative and qualitative data, we noted a decline in SIDS coverage over time. Blame and misdiagnosis were two dominant themes in the coverage of SIDS with many other aspects around SIDS missing; for example, indigenous people, who are at higher risk for SIDS, were rarely mentioned. Our findings suggest problems in the content and frequency of coverage of SIDS that have the potential to shape the public understanding of SIDS.