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Currently, there is a lack of studies addressing the post-discharge care of children with chronic lung disease of immaturity. The unique European Respiratory Society clinical guidelines of 2020 represents the first large-scale work on this topic and makes several suggestions. However, they are based on a low or very low quality of the available scientific papers. Based on our experience, we provide basic information on how to follow up children with chronic respiratory problems after discharge. We list the most common causes of acute and chronic respiratory symptoms in children born prematurely, treatment options and prevention of progression of respiratory difficulties. Long-term follow-up of these children in specialist outpatient clinics is recommended. [ABSTRACT FROM AUTHOR]

Preterm birth is associated with increased respiratory morbidity and mortality. The severity of long-term structural and functional changes is usually inversely related to gestational age and birth weight category. Chronic lung disease of immaturity is mainly developed in very preterm (28–31 week of gestation) and extremely preterm infants (bellow 28 week of gestation) and its development is not necessarily associated with the diagnosis of bronchopulmonary dysplasia. Despite the impact of immaturity on the vulnerable developing respiratory tract is moderated by huge progress in the development of modern medical equipment for respiratory support and pharmacotherapy; however, these advances lead to the general total increment of infants with the immature respiratory tract. The whole number of children with severe CLDI remain stable. Immaturity, together with other additional compounding factors, may lead to persistent respiratory tract pathology with improving clinical manifestation during childhood but lifelong functional and structural abnormality with uncertain prognosis till adulthood. [ABSTRACT FROM AUTHOR]

Acute cough is one of the most common symptoms presented by children. Causal therapy may resolve coughing in a minority of cases, in practice treatment of cough usually tends to be symptomatic. The evidence on effectiveness of antitussives is limited and these medications are responsible for serious adverse events, especially among children younger than six years. Most of mucolytics are considered to be effective for acute cough, nevertheless their application in children younger than two years should be avoided because of possible paradoxically increased bronchorrhoea observed in infants. The list of recommendations presented in this article is limited owing to the lack of scientific data from studies in children with cough during acute respiratory infection. [ABSTRACT FROM AUTHOR]

Léky volně prodejné i vázané na recept určené pro terapii kašle u dětí (antitusika, mukoaktivní substance) patří mezi nejčastěji užívaná léčiva. Cílem naší studie bylo zhodnotit, zda je účinnost a bezpečnost těchto léčiv vědecky doložena. Metody: V dubnu 2012 jsme provedli rozsáhlou rešerši české i zahraniční vědecké literatury (učebnice, elektronické databáze PubMed, MEDLINE, EMBASE, Cochrane Library). Dále jsme použili ruční vyhledávání prací v citacích uváděných v zobrazených článcích. Vzhledem k významnému placebo efektu u léčby kašle jsme vyhledávali a hodnotili pouze metaanalýzy a randomizované placebem kontrolované klinické studie (RCT). Zadávali jsme klíčová slova česky a anglicky („antitussive”, „mucolytic”, „cough” a „children“). Výsledky: Nalezli jsme jen omezené množství RCT studií zabývajících se léčbou kašle u dětí. Metaanalýzy z databáze Cochrane neprokázaly účinnost antitusik u dětí s akutním respiračním infektem, efekt většiny léčiv nebylo možno hodnotit pro absenci RCT studií. Výsledky RCT studií mukolytik svědčily pro mírný efekt některých látek. Závěr: Antitusika při akutním respiračním infektu u dětí obvykle nejsou indikována, terapie je spojena s rizikem závažných nežádoucích účinků a její účinnost není doložena. Mukolytika v indikovaných případech u dětí nad 2 roky mohou přinést částečný efekt. [ABSTRACT FROM AUTHOR]

Bronchopulmonální dysplazie (BPD) je chronické plicní onemocnění popsané u dětí v souvislosti s předčasným porodem již před 45 lety. V průběhu dalších let došlo k zásadním změnám prenatální i perinatální péče (antenatální kortikosteroidy, surfaktant, oxygenoterapie, umělá plicní ventilace a jiné). Přesto incidence dětí s BPD dále narůstá s klesající mortalitou novorozenců velmi nízkých porodních hmotností. Klinický i radiologický obraz nemoci se tak výrazně mění. Současná definice byla přizpůsobena této „nové“ formě BPD, nekoreluje však s následnou prognózou těchto dětí a dosud platná diagnostická kritéria jsou revidována. Širší pojem chronické plicní nemoci (CLD, chronic lung disease) byl dosud používán pro plicní postižení nesplňující kritéria BPD. Výsledky dřívějších studií klinických projevů BPD u prvních pacientů po dosažení dospělosti pravděpodobně nelze aplikovat na děti narozené v pozdějších letech a recentní studie to potvrzují. Účinky dosud užívaných léčiv v časném i pozdním průběhu BPD jsou podrobovány metaanalýzám, které odhalují omezený či přechodný efekt některých běžně doporučovaných farmak a závažné nežádoucí účinky. Nové terapeutické terapeutické možnosti zaměřené na prevenci BPD i omezení progrese onemocnění jsou intenzivně zkoumány. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to address the critical need for more accurate growth reference charts for preterm infants, with a particular focus on low- and very low-birth-weight infants., Methods: The subjects were recruited at a single tertiary centre. The cohort comprised singleton and twin infants born before 37 weeks of gestation, with data collected from 2000 to 2016. Standardised measurements of body parameters were recorded in this mixed longitudinal survey. LMS method was utilised for data analysis. Statistical analysis was performed using SPSS Statistics Version 21. The validation with another new cohort was executed., Results: A total of 1781 infants (52.5% boys) met the inclusion criteria. The median gestational age at birth was 30 weeks, with a median birth weight of 1350 grams. The main findings included the construction of ImaGrow charts for low- and very low-birth-weight infants and significant differences in growth trajectories compared to Fenton+WHO charts., Conclusion: Our comprehensive growth references, ImaGrow, are based on a long-term auxological assessment of preterm infants and differ from charts derived from size-at-birth standards or charts for term babies. These charts have significant implications for clinical practice in monitoring and assessing the growth of preterm infants., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background: The long-term respiratory consequences for children with bronchopulmonary dysplasia (BPD) are well known. However, there is little emphasis on monitoring preterm infants without BPD. Few studies have explored the lung function status of infants with the symptoms of chronic lung disease of prematurity (CLD)., Objective: To evaluate functional lung deficits in preterm infants with CLD, and to assess the perinatal determinants of diminished lung function., Methods: In our cross-sectional study, 132 preterm infants with symptomatic CLD underwent infant pulmonary function testing (iPFT) at a median post-term age of 0.9 years. The iPFT included bodypletysmography, compliance measurement, tidal breath analysis, and rapid thoracoabdominal compression. The relationships between the respective z scores of the iPFT parameters and perinatal characteristics, postnatal treatment, and BPD status were investigated., Results: Seventy-three patients (55.3%) were born before the 28 th week of gestation, and 92 (69.7%) met the BPD criteria. Functional deficits were detected in 85.8%. The obstructive ventilatory pattern was more prevalent than restrictive (36.3 vs. 12.4%, p < 0.001). Infants with restriction had lower birth weight (BW) and required a longer duration of oxygenotherapy. In a univariate model, the lung function correlated with the duration of invasive mechanical ventilation, gestational week, and BW. In a general linear model, BPD status was not an additional determinant of the iPFT results., Conclusion: IPFT may reveal significant functional deficits in preterm infants with CLD even without BPD. The current symptoms and perinatal factors may be more important determinants of functional deficits than the BPD status itself., (© 2022 Wiley Periodicals LLC.)

Aim: We focused on the clinical picture, severity and prognosis of children who experienced long-term respiratory issues after COVID-19., Methods: This was a national Czech multicentre study of paediatric post-COVID syndrome, which used a standard protocol to evaluate structural and functional anomalies and exclude alternative diagnoses. From 6 January to 30 June 2021, 11 paediatric pulmonologists enrolled all paediatric referrals aged 2-18 years with persistent respiratory symptoms more than 12 weeks after COVID-19, namely cough, dyspnoea and chest pain. Medical histories were taken, and physical examinations, lung function testing, chest X-ray and blood tests were performed., Results: The dominant symptoms in the 39 children (56.4% girls) were exertional dyspnoea (76.9%) and a chronic cough (48.7%), while dyspnoea at rest (30.8%) and chest pain (17.9%) were less prevalent. More than half (53.8%) reported more than 1 symptom, and 38.5% had abnormal results for 1 of the following tests: lung function, chest X-ray or D-dimers. The median age of the children was 13.5 years (interquartile range ±4.8 years), and the median recovery time was 4 months (range 1.5-8 months)., Conclusion: Our initial data suggest that the long-term respiratory impact of COVID-19 was relatively mild in our cohort, with a favourable prognosis., (© 2022 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: To investigate whether methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms and erythrocyte concentration of methotrexate (EMTX) could serve as predictors of methotrexate (MTX) efficacy and toxicity in patients with juvenile idiopathic arthritis (JIA)., Methods: Genetic analyses and EMTX and folate assessment were performed in 69 patients with JIA aged 2.5-19.6 years (30 male) treated with MTX using a dose-escalation protocol and classified as full responders (disease inactivity; n = 51) or nonresponders (< 30% improvement in pediatric American College of Rheumatology-30 criteria while receiving ≥ 15 mg/m(2)/week parenteral MTX for at least 3 months; n = 18)., Results: Nonresponders were treated with the higher median MTX dose (17.2 vs 12.6 mg/m(2)/week; p < 0.0001) and accumulated more EMTX (217 vs 106 nmol/l; p < 0.02) and erythrocyte folates (763 vs 592 nmol/l; p = 0.052) than responders. Analysis of MTHFR allele and genotype frequencies in relation to response failed to detect association. The frequency of any adverse effect was 29.4% in responders and 33.3% in nonresponders (p = 0.77). The frequency of 677T allele was elevated in patients with adverse effects (52.4% vs 20.9%; OR 3.88, 95% CI 1.8-8.6, p < 0.002). The probability of any adverse effect was significantly higher in patients with 677TT compared to the 677CC genotype (OR 55.5, 95% CI 2.9-1080, p < 0.001)., Conclusion: MTHFR genotyping may have a predictive value for the risk of MTX-associated toxicity in patients with JIA. Despite the lack of therapeutic effect, nonresponders accumulated adequate concentrations of EMTX.

Objective: To compare the bioavailability of oral and subcutaneous methotrexate (MTX) in children with juvenile idiopathic arthritis (JIA)., Methods: Seventeen JIA patients were administered oral (6.1-22.5 mg/m(2)) or subcutaneous (8.8-28.6 mg/m(2)) MTX. Blood samples were drawn pre-dose, and at 1, 2, and 4 hours after administration. Plasma MTX was determined by high-performance liquid chromatography. Non-compartmental pharmacokinetic analysis included the maximum concentration of plasma MTX (C(max)) and the area under the plasma concentration-time curve in the interval of 0-4h (AUC(0-4h))., Results: The slopes of the regression lines of the dose-corrected parameters Cmax and AUC(0-4h) plotted against the dose were negative for oral administration indicating non-linearity in pharmacokinetics, while they did not differ from zero for subcutaneous MTX. In two groups dosed orally with < or = 10 or >10 mg/m(2) (the average doses: 7.8 vs. 13.8 mg/m(2), p<0.002), the C(max) and AUC(0-4h) were comparable (p > or = 0.32). In four patients switched from oral to subcutaneous administration of the same dose, the bioavailability of oral MTX tended to be 11-15% lower when compared to subcutaneous route., Conclusion: The differences in the pharmacokinetic measures of early systemic exposure between oral and subcutaneous routes support the view that lower and saturable intestinal absorption of oral MTX limits its bioavailability and efficacy within the range of standard doses used to treat children with JIA. In light of this evidence it can be recommended to use parenteral route of administration when MTX dose around and above 10-15 mg/m(2) is needed to achieve sufficient response.

Methotrexate is used widely in the pharmacotherapy of juvenile idiopathic arthritis. Polyglutamates of methotrexate are active metabolites which accumulate in cells including erythrocytes. Their intracellular concentration may reflect methotrexate bioavailability and, at the same time, may serve as a bioindicator for optimization of methotrexate therapy and drug monitoring. Therefore, a simple and selective isocratic reversed phase chromatographic method with fluorescence detection (excitation/emission wavelengths of 370/463 nm) was developed which quantifies the sum of all methotrexate polyglutamates in erythrocytes as methotrexate after their enzymatic conversion with gamma-glutamylhydrolase. Separation was carried out on a Phenomenex GEMINI C18 column using a mobile phase flowing at a rate of 0.6 ml/min and consisting of a mixture (110:890:0.25 v/v) of acetonitrile, ammonium acetate buffer (0.05 M, pH=5.5) and hydrogen peroxide 30% (w/w). The method was found linear over the concentration range of 25-400 nmol/l. Its intra- and inter-day precision and accuracy were characterized by coefficients of variation and relative errors less than 20%. The limits of detection and quantification achieved 10.9 and 32.9 nmol/l, respectively. The method was proved suitable for monitoring the concentration of methotrexate polyglutamates in erythrocytes of patients with juvenile idiopathic arthritis.