Mary Ellen Peters

Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates

All neonates (n = 581) with birth weights less than 1501 gm admitted to seven neonatal intensive care units in Wisconsin and Iowa were candidates for a study aimed at the multivariate assessment of risk factors for chronic lung disease while controlling for baseline severity of respiratory disease. Data from 361 neonates were analyzed for all risk factors except fluids; only neonates weighing less than 1200 gm were included (n = 220). Information on traditional risk factors for chronic lung disease was abstracted. A total of 110 (30%) of the analyzed neonates were oxygen dependent on day 30 of life. The following baseline factors were associated with increased risk of oxygen dependence in a joint multivariate model: lower birth weight (odds ratio 1.4/100 gm), higher baseline severity score (odds ratio 2.7/doubling at 32 weeks gestational age), lower gestational age (odds ratio 2.4/week at severity 0), Apgar score at 1 minute (odds ratio 1.6/2 points), male gender (odds ratio 1.9), and nonblack race (odds ratio 2.2). After adjustment for all baseline factors, patent ductus arteriosus, ventilator pressure at 96 hours, oxygen at 96 hours, and fluid intake were associated with oxygen dependence. Neonates with a low baseline severity score who remained oxygen dependent had a higher intake of fluid relative to output, whereas neonates with a higher baseline severity score had higher fluid intake and output. Lack of weight loss was associated with increased severity but not with oxygen dependence. The results of this study generally confirm the significance of previously reported risk factors for chronic lung disease in a multivariate setting but show that risk factors may not have the same impact in neonates with different baseline severity.

Wisconsin cystic fibrosis chest radiograph scoring system: Validation and standardization for application to longitudinal studies †

This study was designed to achieve a final modeling, validation, and standardization plan for the Wisconsin cystic fibrosis (CF) chest radiographic scoring system. Sixty chest radiographs were selected to reflect a range of severity of lung pathology in children with CF. Seven experienced volunteer raters (three radiologists and four pediatric pulmonologists) from five institutions were recruited to evaluate and score the films. Analysis of scores revealed that the subcomponents of the Wisconsin system showed considerable variation from rater to rater, but reliability assessment indicated satisfactory Cronbachs alpha coefficients (0.83–0.90) among the seven raters. It was found that an additive method of total score computation is significantly more reliable (P < 0.05) than either the original multiplicative model or the traditional Brasfield scoring system. Comparison of radiologists and pulmonologists revealed a marked, systematic difference in scoring with the former group being more conservative in interpretation of abnormalities than the pulmonologists, and some of the raters showing very limited sensitivity.

Narrow trachea in mucopolysaccharidoses

Nine of 56 patients with mucopolysaccharidoses (MPS) showed small tracheal diameters on their frontal chest radiographs. Autopsy of an MPS I-H (Hurler disease) patient demonstrated that the small calibre was secondary to deposition of glycosaminoglycan (mucopolysaccharide). Autopsies of two patients with other storage diseases, one with geleophysic dysplasia and one with mucolipidosis II, also exhibited compromise of their airways because of storage material accumulation.

Esophageal stricture and web secondary to Stevens-Johnson syndrome

Esophageal stricture and web are described in a 14-year-old girl who presented with a history of progressive dysphagia subsequent to an episode of Stevens-Johnson syndrome at the age of 4.

Swyer-James-Macleod syndrome: a case with a baseline normal chest radiograph.

Development of Swyer-James-Macleod syndrome in a child which can be directly attributed to an adenoviral pneumonia is presented. The case is remarkable as there is a baseline normal chest x-ray immediately prior to the pneumonia and subsequent development of the hyperlucent, hypoplastic lung.

Intramural esophageal pseudodiverticulosis: A report in a child with a 16-year follow up

A case of intramural esophageal pseudodiverticulosis in a five-year-old with a 16-year follow up is presented.

Identification of a bronchopleural fistula by computerized tomographya—A case report

A case report is presented of a bronchopleural fistula demonstrated on computed tomography (CT) scan but not identifiable on plain radiographs. The case illustrates the importance of CT in evaluating the pleural space.

Short-course amphotericin B therapy for isolated candiduria in children.

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Intramural esophageal pseudodiverticulosis

A case of intramural esophageal pseudodiverticulosis in a five-year-old with a 16-year follow up is presented.