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February 2012

Breastfeeding and Lung Function at School-Age: Does Maternal Asthma Modify the Effect?

Breastfeeding is associated with improved lung function at school age, particularly in children of asthmatic mothers, according to a new study from researchers in Switzerland and the UK.

“In our cohort of school age children, breastfeeding was associated with modest improvement in forced mid-expiratory flow (FEF50) in our whole group and with improvements in forced vital capacity (FVC) and forced expiratory volume at 1 second (FEV1) only in the children of asthmatic mothers,” said Claudia E. Kuehni, MD, MSc, professor at the Institute of Social and Preventive Medicine at the University of Bern. “In contrast, some earlier studies have suggested that breastfeeding might be harmful in the offspring of mothers with asthma.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The researchers analyzed data from a nested sample of 1458 children from the Leicestershire cohort studies, born between 1993 and 1997 in the UK. They assessed duration of breastfeeding, other exposures and respiratorysymptoms by repeated questionnaires. Post-bronchodilator FVC, FEV1, peak expiratory flow rates (PEF), FEF50 and skinprick tests were measured at age 12.

In the entire sample of children, FEF50was significantly higher in breastfed children compared with those who were not breastfed, increasing by 0.130 L/sec (P=.048) in those breastfed for 4-6 months and 0.164 L/sec (P=.041) in those breastfed for more than six months. These effects were larger among children of mothers with asthma, with increases of 0.375 L/sec (P=.015) in those breastfed for 4-6 months and 0.468 L/sec (P=.009) in those breastfed for more than six months. Significant improvements in FVC and FEV1with breastfeeding were seen only in the children of asthmatic mothers. Adjustments for respiratory infections in infancy and asthma and atopy in childhood did not change the results of these analyses.

The study had several limitations, including a modest response rate of the original cohort for laboratory examinations and the use of self-report for determining duration of breastfeeding, maternal asthma and infections during infancy.

“We observed modest improvements in lung function in breastfed children in our cohort, including the children of mothers with asthma. Furthermore, our data suggest that rather than acting by reducing respiratory infections, asthma or allergy, breastfeeding might have a direct effect on lung growth,” said Dr. Kuehni. “This study supports a strong recommendation for breastfeeding in all children, including those with asthmatic mothers.”

To read the article in full, please visit http://www.thoracic.org/media/press-releases/dogaru.pdf.

Contact for article:Claudia E. Kuehni, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11 - 3012 Bern, Switzerland
Phone: +41 (0)31 631 35 07
Email: kuehni@ispm.unibe.ch

Positive Airway Pressure Therapy Improves Neurobehavioral Outcomes in Children with Obstructive Sleep Apnea

Treatment of childhood obstructive sleep apnea syndrome (OSAS) with positive airway pressure (PAP) therapy improves a number of important neurobehavioral outcomes, according to a new study from the The Children’s Hospital of Philadelphia.

“In our study of 52 children and adolescents with OSAS, we observed significant improvements in neurobehavioral function after three months of PAP therapy,” said lead author Carole L. Marcus, professor of pediatrics at the Children's Hospital of Philadelphia. “These improvements were seen despite suboptimal adherence with treatment and were observed in a heterogeneous group of children, many with underlying medical conditions and/or developmental delays.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

In the prospective study, 52 children (mean age 12 ±4 years) with OSAS, 10 of whom had significant developmental delays, underwent neurobehavioral assessments of sleepiness, behavioral problems, attention and quality of life at baseline and after three months of PAP treatment. Adherence with PAP treatment varied widely, with an average use of 170+145 minutes per night.

PAP treatment was associated with significant improvements in attention deficits, behavior, sleepiness and caregiver- and child-reported quality of life. Improvements in sleepiness scores, but not in other outcomes, were significantly correlated with adherence. Similar improvements in behavioral scores were seen in the subset of children with developmental delays. Among subjects younger than seven (mean age 4.5 ±1.7 years), significant improvements were seen in sleepiness and OSAS-specific quality of life.

“OSAS in children is known to be associated with behavioral disturbances and learning deficits, but the effects of PAP therapy on these deficits have not been studied,” said Dr. Marcus. “Our study is the first to demonstrate that PAP therapy results in significant improvements in a range of neurobehavioral domains in these patients, including those with developmental delays.”

The study had several limitations, including the lack of a placebo group, the use of reports from subjects and caregivers only, and the lack of blinding.

“The improvements we observed in daytime sleepiness, attention, internalizing behaviors and quality of life occurred despite a mean use of PAP of only three hours a night,” said Dr. Marcus. “This suggests that PAP use should be encouraged in children with OSAS, even in those with suboptimal adherence, as it can lead to improvements in function that can in turn affect family, social and school function.”

To read the article in full, please visit: http://www.thoracic.org/about/newsroom/press-releases/resources/marcus.pdf

Contact for article: Carole L. Marcus, MBBCh, Children's Hospital of Philadelphia
Main Building, 9NW50, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104
Phone: 267-426-5842
Email: marcus@email.chop.edu

Fever Control Using External Cooling Reduces Early Mortality in Septic Shock Patients

Fever control using external cooling in sedated patients with septic shock is safe and decreases vasopressor requirements and early mortality, according to a new study from researchers in France.

“The benefits and risks of fever control in patients with severe sepsis remains a matter of controversy,” said lead author Frédérique Schortgen, MD, PhD, of the Henri Mondor Hospital in Créteil, France. “In our study, external cooling to achieve normothermia in patients with septic shock was safe, accelerated hemodynamic stabilization, decreased vasopressor requirements, increased the rate of shock reversal, and decreased early mortality.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

In the multicenter trial, 200 febrile adults with septic shock from seven participating ICUs, all of whom were receiving vasopressor treatment, mechanical ventilation and sedation, were randomized to external cooling (n = 101) or no external cooling (n = 99). Patients underwent cooling for 48 hours to maintain a core body temperature between 36.5°C and 37°C. Vasopressors were tapered to maintain a mean arterial pressure target of 65 mmHg or more in both groups.

After two hours of treatment, body temperature was significantly lower in the cooling group. The percentage of patients with a 50 percent vasopressor dose decrease vs. baseline was significantly higher in the cooling group from 12 hours of treatment; this difference was not significant at 48 hours. Shock reversal during the ICU stay was significantly more common in the cooling group, as was day-14 mortality. All comparisons remained significant after adjustment for baseline vasopressor dose and sepsis severity scores.

The study had several limitations. Patients in the cooling group had a lower baseline dose of vasopressors, perhaps indicating lower illness severity, although all other variables associated with outcomes in sepsis were well balanced between the two treatment groups. In addition, the study was not blinded, and life-supporting treatments given before inclusion during the early stage of sepsis were not recorded.

“Although cooling prevented early deaths in our patients, mortality reduction was not significant at ICU or hospital discharge, and we cannot make definitive conclusions on the effects of cooling on mortality from our data” said Dr. Schortgen. “Larger studies are needed to confirm the positive effects of cooling on mortality we observed and to examine whether fever control provides any additional benefits in patients with severe sepsis.”

To read the article in full, please visit: http://www.thoracic.org/about/newsroom/press-releases/resources/Schortgen.pdf.

Contact for article: Dr Frédérique Schortgen, Service de réanimation médicale, CHU Henri Mondor, 94000 Créteil, France
Phone: +33 1 49 81 23 89
Email: frederique.schortgen@hmn.aphp.fr