Limits...
An observational study examining the relationship between respiratory symptoms, airway inflammation and bacteriology in children with severe neurodisability.

Trinick RE, Bunni L, Thorburn K, Hackett AP, Dalzell M, McNamara PS - PLoS ONE (2015)

Bottom Line: Elective patients with 16S/18S microbial rDNA positive BAL had higher neutrophil counts (positive, 33[18-70]%; negative, 8[4-38]%: p<0.05) and generally higher symptom scores (positive, 17[5-32]; negative, 5[0-9]: p = 0.097).Streptococcus mitis was commonly identified in BAL from ND children; Pseudomonas aeruginosa was not identified in any sample.Bacterial airway colonisation, particularly with oral commensals, may play a role in both symptom generation and inflammation.

View Article: PubMed Central - PubMed

Affiliation: Alder Hey Children's Hospital NHS Foundation Trust, Eaton Rd, Liverpool, United Kingdom; Institute of Translational Medicine (Child Health), University of Liverpool, Alder Hey Children's Hospital, Eaton Road, Liverpool, United Kingdom.

ABSTRACT

Background: Children with severe neurodisability (ND) commonly suffer from chronic respiratory symptoms that impact greatly on quality of life, and lead to recurrent hospital admissions. This morbidity (and its causes) is poorly described, despite being well recognised by paediatricians. In this study, we characterised respiratory symptoms in children with ND at times of stability and deterioration. We also assessed the relationship between respiratory symptoms, lower airway inflammatory markers and levels of infection/colonisation.

Methods: ND children were recruited upon admission for elective surgery (Elective-ND [n = 16]), or acutely upon admission to Intensive Care (PICU-ND [n = 19]), and compared to healthy control children [n = 12]. Parents completed a validated respiratory symptom questionnaire in which symptoms associated with activity were removed (total maximal score of 108). Bronchoalveolar lavage (BAL) was collected, and BAL neutrophil counts, IL-8 and TGFβ-1 levels measured. BAL microbial analysis was performed using a 16S/18S rRNA gene based assay and Pseudomonas aeruginosa PCR.

Results: All ND children had high levels of respiratory symptoms (median [IQR] symptom score PICU-ND, 55[38-64]; Elective-ND, 26[7-45]; Control, 4[0-7]: p<0.01), which affected their families, particularly at nighttime. Elective-ND patients with a total respiratory symptom score >20 invariably had BAL neutrophilia. Elective patients with 16S/18S microbial rDNA positive BAL had higher neutrophil counts (positive, 33[18-70]%; negative, 8[4-38]%: p<0.05) and generally higher symptom scores (positive, 17[5-32]; negative, 5[0-9]: p = 0.097). Streptococcus mitis was commonly identified in BAL from ND children; Pseudomonas aeruginosa was not identified in any sample.

Conclusions: Children with severe ND often have high levels of chronic respiratory symptoms, which may relate to lower airway inflammation. Bacterial airway colonisation, particularly with oral commensals, may play a role in both symptom generation and inflammation.

No MeSH data available.


Related in: MedlinePlus

a. BAL neutrophil levels and b. LRSQ scores in elective BAL samples that were positive and negative for microbial rDNA (m rDNA).Elective BAL samples that were m rDNA positive had significantly higher neutrophil levels than m rDNA negative samples (33%[18–70] vs. 8.5%[4–38] p<0.05). The median total LRSQ-Neuro score was generally higher in the BAL m rDNA positive group (17[5–32] vs. 5[0–9]), but not significantly so (p = 0.097).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4390362&req=5

pone.0124627.g004: a. BAL neutrophil levels and b. LRSQ scores in elective BAL samples that were positive and negative for microbial rDNA (m rDNA).Elective BAL samples that were m rDNA positive had significantly higher neutrophil levels than m rDNA negative samples (33%[18–70] vs. 8.5%[4–38] p<0.05). The median total LRSQ-Neuro score was generally higher in the BAL m rDNA positive group (17[5–32] vs. 5[0–9]), but not significantly so (p = 0.097).

Mentions: Despite P. aeruginosa being detected on culture of tracheal aspirates from multiple patients prior to this study, it was not detected in BAL samples from any patient using 16S analysis. We also examined the relationship between LRSQ-Neuro score, BAL neutrophilia, and microbial DNA detection, in Elective-ND and control patients (Fig 4). Total LRSQ score was generally higher in patients who had samples that were positive for microbial DNA, although this did not reach statistical significance (+ve, 17[5–32];-ve, 5[0–9]: p = 0.097). Median [range] BAL neutrophil levels were however significantly higher in samples that were microbial DNA positive (+ve, 33 [18–70]%;-ve 8 [4–38]%: p<0.05).


An observational study examining the relationship between respiratory symptoms, airway inflammation and bacteriology in children with severe neurodisability.

Trinick RE, Bunni L, Thorburn K, Hackett AP, Dalzell M, McNamara PS - PLoS ONE (2015)

a. BAL neutrophil levels and b. LRSQ scores in elective BAL samples that were positive and negative for microbial rDNA (m rDNA).Elective BAL samples that were m rDNA positive had significantly higher neutrophil levels than m rDNA negative samples (33%[18–70] vs. 8.5%[4–38] p<0.05). The median total LRSQ-Neuro score was generally higher in the BAL m rDNA positive group (17[5–32] vs. 5[0–9]), but not significantly so (p = 0.097).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390362&req=5

pone.0124627.g004: a. BAL neutrophil levels and b. LRSQ scores in elective BAL samples that were positive and negative for microbial rDNA (m rDNA).Elective BAL samples that were m rDNA positive had significantly higher neutrophil levels than m rDNA negative samples (33%[18–70] vs. 8.5%[4–38] p<0.05). The median total LRSQ-Neuro score was generally higher in the BAL m rDNA positive group (17[5–32] vs. 5[0–9]), but not significantly so (p = 0.097).
Mentions: Despite P. aeruginosa being detected on culture of tracheal aspirates from multiple patients prior to this study, it was not detected in BAL samples from any patient using 16S analysis. We also examined the relationship between LRSQ-Neuro score, BAL neutrophilia, and microbial DNA detection, in Elective-ND and control patients (Fig 4). Total LRSQ score was generally higher in patients who had samples that were positive for microbial DNA, although this did not reach statistical significance (+ve, 17[5–32];-ve, 5[0–9]: p = 0.097). Median [range] BAL neutrophil levels were however significantly higher in samples that were microbial DNA positive (+ve, 33 [18–70]%;-ve 8 [4–38]%: p<0.05).

Bottom Line: Elective patients with 16S/18S microbial rDNA positive BAL had higher neutrophil counts (positive, 33[18-70]%; negative, 8[4-38]%: p<0.05) and generally higher symptom scores (positive, 17[5-32]; negative, 5[0-9]: p = 0.097).Streptococcus mitis was commonly identified in BAL from ND children; Pseudomonas aeruginosa was not identified in any sample.Bacterial airway colonisation, particularly with oral commensals, may play a role in both symptom generation and inflammation.

View Article: PubMed Central - PubMed

Affiliation: Alder Hey Children's Hospital NHS Foundation Trust, Eaton Rd, Liverpool, United Kingdom; Institute of Translational Medicine (Child Health), University of Liverpool, Alder Hey Children's Hospital, Eaton Road, Liverpool, United Kingdom.

ABSTRACT

Background: Children with severe neurodisability (ND) commonly suffer from chronic respiratory symptoms that impact greatly on quality of life, and lead to recurrent hospital admissions. This morbidity (and its causes) is poorly described, despite being well recognised by paediatricians. In this study, we characterised respiratory symptoms in children with ND at times of stability and deterioration. We also assessed the relationship between respiratory symptoms, lower airway inflammatory markers and levels of infection/colonisation.

Methods: ND children were recruited upon admission for elective surgery (Elective-ND [n = 16]), or acutely upon admission to Intensive Care (PICU-ND [n = 19]), and compared to healthy control children [n = 12]. Parents completed a validated respiratory symptom questionnaire in which symptoms associated with activity were removed (total maximal score of 108). Bronchoalveolar lavage (BAL) was collected, and BAL neutrophil counts, IL-8 and TGFβ-1 levels measured. BAL microbial analysis was performed using a 16S/18S rRNA gene based assay and Pseudomonas aeruginosa PCR.

Results: All ND children had high levels of respiratory symptoms (median [IQR] symptom score PICU-ND, 55[38-64]; Elective-ND, 26[7-45]; Control, 4[0-7]: p<0.01), which affected their families, particularly at nighttime. Elective-ND patients with a total respiratory symptom score >20 invariably had BAL neutrophilia. Elective patients with 16S/18S microbial rDNA positive BAL had higher neutrophil counts (positive, 33[18-70]%; negative, 8[4-38]%: p<0.05) and generally higher symptom scores (positive, 17[5-32]; negative, 5[0-9]: p = 0.097). Streptococcus mitis was commonly identified in BAL from ND children; Pseudomonas aeruginosa was not identified in any sample.

Conclusions: Children with severe ND often have high levels of chronic respiratory symptoms, which may relate to lower airway inflammation. Bacterial airway colonisation, particularly with oral commensals, may play a role in both symptom generation and inflammation.

No MeSH data available.


Related in: MedlinePlus