Research at the Breathing Institute

Creating a clinical practice guideline for home oxygen therapy for children

Although home oxygen therapy is commonly required to care for children with respiratory conditions, there is a striking lack of empirical evidence regarding implementation, monitoring and discontinuation of supplemental oxygen therapy. In some cases, insurance companies and durable medical equipment suppliers apply adult standards for oxygen use that are unsafe for kids. Children and infants have specialized needs for their growing brains and bodies, and their respiratory care should be treated differently than adults.

Robin Deterding, MD, senior author and co-chair of the subcommittee that authored this research, and Don Hayes Jr., MD at Nationwide Children’s and co-chair of the committee, worked together to identify the challenges with home oxygen therapy specific to both pediatric lung disease and pulmonary vascular disease. Joyce Baker, clinical coordinator for Respiratory Therapy, Steven H. Abman, MD, and Stephen Hawkins, MD, from the Breathing Institute at Children’s Colorado participated as members of a multidisciplinary panel and conducted systematic reviews of relevant literature to set a new standard of care for oxygen use in children. Based on this review, the panel developed an official clinical practice guideline featuring recommendations for or against the use of home oxygen therapy based on each condition.

Read the article “Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline.”

Early pulmonary vascular disease in preterm infants Is associated with late respiratory outcomes in childhood

Despite marked advances in perinatal care, preterm infants remain at high risk for chronic lung disease, known as bronchopulmonary dysplasia (BPD). BPD is often associated with poor outcomes, such as prolonged ventilator support, lengthy NICU stays, persistent respiratory failure and late respiratory disease during early childhood. Past experimental work from the Pediatric Heart Lung Center (PHLC) showed that the development of pulmonary vascular disease (PVD) during the perinatal period causes high risk for BPD and for pulmonary hypertension (PH) in rodents. This prospective study, featuring several providers from Children’s Colorado, confirmed this concept in human infants. Researchers determined that early signs of PVD in preterm neonates on day 7 of life increased the susceptibility for BPD as well as late breathing problems, such as frequent ER visits, rehospitalizations and the need for respiratory medications throughout the first 2 years of life. These data further suggest that identifying PVD in preterm infants at day 7 may allow future interventions to prevent late lung disease after preterm birth.

Read the article “Early Pulmonary Vascular Disease in Preterm Infants Is Associated with Late Respiratory Outcomes in Childhood.”

Using aptamer-based proteomics to analyze cystic fibrosis bronchoalveolar lavage fluid

Biomarkers are essential in treating cystic fibrosis because they allow providers to understand disease progression, evaluate therapy’s effectiveness and improve enrollment for clinical trials. Aptamer-based proteomics, the study of particular oligonucleotide or peptide molecules, has been useful in identifying biomarkers in blood samples. This study aimed to apply this same method of study to bronchoalveolar lavage fluid (BALF), which is fluid gently sprayed into the lungs via a bronchoscope and then collected for analysis.

The study compared BALF in children with cystic fibrosis to disease control groups to identify endotypes (clinical subtypes of cystic fibrosis) during cystic fibrosis exacerbations. The researchers identified increased concentrations of proteins associated with inflammation and decreased concentrations of protein folding and host defense proteins in the cystic fibrosis group compared to disease controls. Based on this, they also identified two distinct endotypes within the cystic fibrosis group of the study. This research suggests that aptamer-based proteomics can differentiate between groups and determine endotypes within cystic fibrosis.

Read the full article, “Novel Application of Aptamer Proteomic Analysis in Cystic Fibrosis Bronchoalveolar Lavage Fluid.”

Oxygen saturations and neurodevelopmental outcomes in single ventricle heart disease

In this study, researchers evaluated whether the degree of hypoxemia following stage-I and stage-II palliative surgeries predicts neurodevelopmental outcomes at 14 months of age in children with single ventricle congenital heart disease (SVCHD). Researchers measured oxygen saturation via pulse oximetry at discharge from stage-I and stage-II palliative surgeries and developmental scores at 14 months old. This study showed that oxygen saturation levels following these surgeries did not relate to neurodevelopment scores. Neither oxygen saturation measurements below 80% nor changes in oxygen saturation levels were associated with neurodevelopment scores. Researchers concluded that the relationship between oxygen saturation levels and neurodevelopment in patients with SVCHD is complex. Pulse oximetry readings following these palliative surgeries is not a reliable predictor of future neurodevelopmental risk and may be an insufficient proxy for cerebral oxygen delivery.

Read the full article “Oxygen saturations and neurodevelopmental outcomes in single ventricle heart disease.”

Inpatient provider survey on steroid preferences for children with asthma

The Children’s Colorado pediatric emergency department began using dexamethasone for treating asthma exacerbations after studies showed it was as effective as prednisone. However, providers have not reached consensus on using prednisone or dexamethasone for inpatients. This study evaluated provider preference for inpatient steroid treatment. Researchers found that inpatient provider preference varied, with most providers reporting that it depends on the scenario. Researchers concluded that use of dexamethasone in the emergency department has led to uncertainty in inpatient steroid prescribing practices. Providers often revert to prednisone, especially in severe asthma exacerbations, possibly due to experience with prednisone and limited research on dexamethasone in the inpatient setting.

Read the article “Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.”