<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_116"
                     title="SCCM: Toddler Found Frozen in Creek Revives (CME/CE)"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/SCCM/tb/17927?impressionId=1265766752369"
                     
      &lt;p&gt;MIAMI BEACH  --  When Scott Magley, MD, of Conemaugh Memorial Medical Center in Johnstown, Pa., arrived at the scene in December 2008, the 23-month old toddler was literally a block of ice.&lt;/p&gt;
&lt;p&gt;After going missing for at least three hours, she had been found face down in a creek. She had no heartbeat, no response. Her initial core temperature was below the reading limits of Magley&apos;s field thermometer. Ice crystals had formed in her mouth.&lt;/p&gt;
&lt;p&gt;&quot;We have learned that we can&apos;t just give up on these patients,&quot; said Ricardo Patton Po, MD, chief trauma and surgical resident at Conemaugh, who presented the girl&apos;s remarkable case study at the annual meeting of the Society of Critical Care Medicine here. &quot;We believe this was the youngest child to be revived without extracorporeal warming.&quot;&lt;/p&gt;
&lt;p&gt;Magley, another critical care specialist who lives in the countryside near the spot where the Amish child was found, managed to perform endotracheal intubation. He began advanced life support and transported her to the hospital, with multiple doses of epinephrine and atropine administered en route.&lt;/p&gt;
&lt;p&gt;&quot;On arrival the girl was unresponsive, with fixed and dilated pupils, no palpable pulse and no appreciable cardiac wall movement on ultrasound,&quot; Po recalled. &quot;Cardiac rhythm showed asystole.&quot;&lt;/p&gt;
&lt;p&gt;Over the course of the next two hours, the cardiopulmonary resuscitation Magley had begun in the field continued at the hospital. Passive warming was initiated, but the staff could not do an extracorporeal bypass because the appropriate-sized catheters weren&apos;t available. Active warming was performed using the Arctic Sun Management System.&lt;/p&gt;
&lt;p&gt;&quot;We continued working because we were encouraged that her body temperature appeared to be rising  --  from a low of 19 degrees Celsius (66.8 degrees F),&quot; Po said.&lt;/p&gt;
&lt;p&gt;The girl occasionally opened her eyes and made nonpurposeful arm movements during cardiac compressions.&lt;/p&gt;
&lt;p&gt;When her core temperature rose to 26 degrees C (79 degrees F), doctors detected ventricular fibrillation. They administered one electric shock, and regular sinus rhythm returned. That resulted in a palpable pulse and eventually a discernible blood pressure.&lt;/p&gt;
&lt;p&gt;&quot;She then began to exhibit purposeful movements and appeared to recognize her parents, who had since arrived at the hospital,&quot; Po told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;She was transferred to Children&apos;s Hospital of Pittsburgh when her internal temperature rose to 31-33 degrees C (88-91 degrees F).&lt;/p&gt;
&lt;p&gt;Po said the transfer created a problem because her parents insisted that she not be transported by powered vehicles  --  and most certainly not by an aircraft, as doctors first proposed.&lt;/p&gt;
&lt;p&gt;He said they finally compromised on an ambulance transfer.&lt;/p&gt;
&lt;p&gt;She was extubated on day one at the hospital and was discharged home on day five, with apparently normal neurological status.&lt;/p&gt;
&lt;p&gt;Po said that on follow-up, her parents thought she was having some difficulty in picking up items with either hand, but otherwise did not appear to have any lasting ill-effects.&lt;/p&gt;
&lt;p&gt;&quot;This case serves as an opportunity to review important concepts in the resuscitation of the profoundly hypothermic patient and to emphasize the resiliency of quickly cooled tissue, deprived of perfusion but before hypoxia damages cellular mechanisms involved in recovery,&quot; Po said.&lt;/p&gt;
&lt;p&gt;&quot;The abundant case reports in the literature, both children and adults, speak to the ability of prolonged and vigorous resuscitation to achieve favorable outcomes,&quot; he said.&lt;/p&gt;
&lt;p&gt;Dominic Cave, MD, a fellow in pediatric intensive care at Stollery Children&apos;s Hospital/University of Alberta in Edmonton, said he&apos;s seen similar episodes.&lt;/p&gt;
&lt;p&gt;&quot;This is another one of those amazing cases that seem to follow the rule that a person isn&apos;t dead until he or she is warm and dead,&quot; he told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The survival of this child without apparent brain damage is also gratifying,&quot; he added. &quot;You never know if the person you are reviving is going to make such an amazing recovery.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;None of the doctors disclosed any relevant financial relationships.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2650"
                     title="Hypoxia Risk Cited for Infant Car Seats and Beds (CME/CE)"
                     score="-0.007"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/15652?impressionId=1265766752369"
                     
      Healthy, full-term infants may face an increased risk of oxygen deprivation when placed in conventional car seats and car beds, a study of 200 newborns suggested.&lt;br&gt;
&lt;br&gt;As a result, researchers warned parents to use car seats and beds only for transportation, and not as substitutes for a real crib or other furniture.&lt;br&gt;
&lt;br&gt;According to the study, reported online in &lt;em&gt;Pediatrics&lt;/em&gt;, mean oxygen saturation declined significantly following 60 minutes in a car bed (96.3%) and 60 minutes in a car seat (95.7%), compared with 30 minutes in a hospital crib (97.9%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;br&gt;
&lt;br&gt;The average minimal oxygen saturation and total time spent with an oxygen saturation below 95% also differed significantly in car seats or car beds, versus a hospital crib.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Similar results came from a study of 50 infants who stayed in each position for 120 minutes.&lt;/p&gt;
&lt;p&gt;The study &quot;supports the notion that car beds and car seats need to be redesigned to limit respiratory compromise,&quot; T. Bernard Kinane, MD, of Massachusetts General Hospital and Harvard Medical School, and colleagues concluded.&lt;/p&gt;
&lt;p&gt;&quot;These safety devices should only be used for protection during travel and not as replacements for cribs,&quot; they added.&lt;/p&gt;
&lt;p&gt;While they did not disagree with that recommendation, several pediatricians and neonatologists not connected with the study said they weren&apos;t particularly surprised by the finding  --  or concerned.&lt;/p&gt;
&lt;p&gt;&quot;Frankly, it doesn&apos;t surprise me that some degree of airway obstruction and alteration of pulmonary dynamics occurs when young infants are placed in the sitting position,&quot; said Ian R. Holzman, MD, chief of the Division of Newborn Medicine at Mount Sinai School of Medicine in New York.&lt;/p&gt;
&lt;p&gt;&quot;Those of us who deal with premature infants are especially aware of this and do explain to parents that the infants need to be watched when placed in a car seat because of this very concern.&quot;&lt;/p&gt;
&lt;p&gt;But he called the instances of desaturation &quot;relatively mild,&quot; and most likely without long-term consequences. He said the findings of this study don&apos;t outweigh the benefits of safety seats in general.&lt;/p&gt;
&lt;p&gt;In their report, the authors of the study noted that previous research has shown that healthy infants may develop respiratory compromise while in car seats and beds.&lt;/p&gt;
&lt;p&gt;In one investigation, the authors evaluated use of a car bed, as opposed to a car seat, to alleviate the potential for respiratory compromise in infants. However, infants spent a substantial proportion of study time with oxygen saturation levels below 95%, whether in a seat or bed.&lt;/p&gt;
&lt;p&gt;In follow-up to their previous work, the authors conducted the current study to test the hypothesis that respiratory compromise occurs more often with a car seat or bed compared with a hospital crib.&lt;/p&gt;
&lt;p&gt;The study involved 200 healthy, full-term infants, whose oxygen saturation parameters were assessed when placed in a hospital crib for 30 minutes, a car seat for 60 minutes, and a car bed for 60 minutes.&lt;/p&gt;
&lt;p&gt;The infants were assessed in each position and served as their own controls. The primary outcome was the proportion of time with an oxygen saturation level below 95%.&lt;/p&gt;
&lt;p&gt;To ensure that the time in each position was adequate, the authors performed a second study involving 50 healthy infants, who were placed sequentially in a crib, car seat, and car bed for 120 minutes in each position.&lt;/p&gt;
&lt;p&gt;The results confirmed the hypothesis and showed significant differences in prespecified outcomes.&lt;/p&gt;
&lt;p&gt;In addition to the primary outcome, the mean minimal oxygen saturation level was 83.7% for the car bed and 83.6% for the car seat, compared with 87.4% with the hospital crib (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Total time with oxygen saturation level below 95% averaged 23.9% with the car seat, 17.2% with the car bed, and 6.5% with the hospital crib (&lt;em&gt;P&lt;/em&gt;=0.003).&lt;/p&gt;
&lt;p&gt;In the study involving 50 infants placed in each position for approximately two hours, results were similar to those of the larger study.&lt;/p&gt;
&lt;p&gt;Mean oxygen saturation was 95.6% with the car bed and 95.1% with the car seat compared with 97.2% with the hospital crib (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;The proportion of time with oxygen saturation below 95% averaged 22.4% with the car bed, 31.6% with the car seat, and 9.9% with the hospital crib (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Mean minimal oxygen saturation ranged between 78.7% and 80.7% and did not differ significantly among the three positions.&lt;/p&gt;
&lt;p&gt;The results give pause for concern because &quot;even mild airway obstruction has been associated with behavioral problems and IQ deficits,&quot; the authors said.&lt;/p&gt;
&lt;p&gt;Car beds and seats &quot;are often used for many hours at a time for reasons other than travel,&quot; they added. &quot;Infants placed in these devices for prolonged periods of time are, thus, at increased risk for recurrent hypoxic events.&quot;&lt;/p&gt;
&lt;p&gt;Other physicians were not so concerned.&lt;/p&gt;
&lt;p&gt;&quot;It frankly doesn&apos;t surprise me that in certain positions, the head of the infant might flop forward and occlude the airway. Of course, we also don&apos;t know about what saturations are like in any number of other routine circumstances,&quot; commented Elliot J. Krane, MD, Professor of Anesthesia &amp;amp; Pediatrics at Stanford University School of Medicine.&lt;/p&gt;
&lt;p&gt;&quot;As far as implications, there would not be any adverse outcomes associated with saturations in the mid-80s. The importance is that the child would be on the steep part of the oxygen hemoglobin saturation curve, so any further perturbation might result in a precipitous desaturation, but being in the 80s is no big deal. Finally, I know of no children who came to harm from this phenomenon.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no financial disclosures relevant to the article.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News.   &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/5/14/14212.jpg&quot;&gt;
              &lt;p&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_4193"
                     title="Gene Linked to Asthma in Children (CME/CE)"
                     score="-0.007"
                     href="http://www.medpagetoday.com/Pediatrics/Asthma/tb/17676?impressionId=1265766752369"
                     
      &lt;p&gt;A gene on chromosome one appears to be linked to moderate to severe persistent asthma in children  --  the second such genetic locus associated with the disease, researchers found.&lt;/p&gt;
&lt;p&gt;The gene, dubbed &lt;em&gt;DENND1B&lt;/em&gt;, is one of two in a region of the chromosome that has significant associations with asthma, according to Hakon Hakonarson, MD, PhD, of the Children&apos;s Hospital of Philadelphia, and colleagues.&lt;/p&gt;
&lt;p&gt;The other gene in the location, &lt;em&gt;CRB1&lt;/em&gt;, is only expressed in the retina and brain and seems unlikely to be involved in asthma, the investigators reported online in the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The &lt;em&gt;DENND1B&lt;/em&gt; gene, on the other hand, is expressed in dendritic cells, which play a role in regulating the innate and adaptive immune responses, the researchers said.&lt;/p&gt;
&lt;p&gt;&quot;In asthma, patients have an inappropriate immune response in which they develop airway inflammation and overreaction of the airway muscle cells, referred to as airway hyper-responsiveness,&quot; Hakonarson said in a statement. &quot;The gene mutations in &lt;em&gt;DENND1B&lt;/em&gt; appear to lead to overproduction of cytokines that subsequently drive this oversensitive response in asthma patients.&quot;&lt;/p&gt;
&lt;p&gt;Hakonarson said the research may have pinpointed a therapeutic target. &quot;Because this gene seems to regulate many different cytokines, intervening in this pathway has great potential for treating asthma,&quot; he said.&lt;/p&gt;
&lt;p&gt;The finding comes from a genome-wide association study, starting with a cohort of 793 North American children of European ancestry who had persistent asthma and who needed daily inhaled glucocorticoids. They were matched with 1,988 controls.&lt;/p&gt;
&lt;p&gt;In this so-called discovery set, Hakonarson and colleagues found a significant association between asthma and single nucleotide polymorphisms (SNPs)  --  single-nucleotide changes in DNA  --  in a region on chromosome 17.&lt;/p&gt;
&lt;p&gt;The region, which includes the &lt;em&gt;ORMDL3&lt;/em&gt; gene, is the only genetic locus previously linked with asthma.&lt;/p&gt;
&lt;p&gt;But the researchers also found 20 SNPs in a 540-kilobase interval on chromosome one that were significantly associated with the risk of asthma, after correction for multiple testing.&lt;/p&gt;
&lt;p&gt;The most powerful association was with an SNP dubbed rs2786098. The minor-allele frequency of rs2786098 was 15.2% in patients with asthma and 22.2% in controls, leading to an odds ratio of 0.63, which was significant at &lt;em&gt;P&lt;/em&gt;=8.55x10&lt;sup&gt;-9&lt;/sup&gt;.&lt;/p&gt;
&lt;p&gt;To confirm the finding, the researchers turned to three European cohorts, including a total of 917 children with asthma and 1,546 controls, where they found that 18 of the original 20 SNPs were significantly associated with the disease.&lt;/p&gt;
&lt;p&gt;Again, the SNP rs2786098 was most strongly associated with asthma, they reported.&lt;/p&gt;
&lt;p&gt;When the two European ancestry cohorts, with a total of 1,710 cases and 3,534 controls, were combined, the researchers did not find any other SNPs that were associated with the disease.&lt;/p&gt;
&lt;p&gt;Finally, Hakonarson and colleagues looked at a cohort of African-American children, including 1,667 with physician-diagnosed asthma and 2,045 controls.&lt;/p&gt;
&lt;p&gt;Of the 20 SNPs found in the discovery set, 17 were significantly associated (including rs2786098) with the risk of asthma in the African-American children. But the associated allele in each was the opposite of that linked to asthma in the European children.&lt;/p&gt;
&lt;p&gt;Such an allele reversal has been previously reported and is attributed to &quot;differences in the underlying genomic architectures&quot; caused by loss of genetic diversity among those of European ancestry, the researchers said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from the Children&apos;s Hospital of Philadelphia, the state of Pennsylvania, the Cotswold Foundation, the Lundbeck Foundation, the National Human Genome Research Institute, and the Mary Beryl Patch Turnbull Scholar program.&lt;/p&gt;&lt;p&gt;The researchers said they had no potential conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_4195"
                     title="Kids Hit Hard by H1N1 in Argentina (CME/CE)"
                     score="-0.007"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/17680?impressionId=1265766752369"
                     
      &lt;p&gt;In the Argentine capital of Buenos Aires, the pandemic H1N1 flu was associated with a pediatric death rate that was 10 times as high as the usual winter flu season toll, researchers said.&lt;/p&gt;
&lt;p&gt;From May 1 through July 31, 251 children were admitted to six public hospitals with the pandemic flu  --  twice the rate of inpatient care seen for seasonal flu in 2008, according to Fernando Polack, MD, of Vanderbilt University in Nashville, and colleagues in Buenos Aires.&lt;/p&gt;
&lt;p&gt;Of those admitted to hospital, 13 died  --  a rate equivalent to 1.1 per 100,000 population, Polack and colleagues said online in the &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;By comparison, the pediatric death rate in the same hospitals in the 2007 flu season was 0.1 per 100,000, they said. There were no pediatric deaths from seasonal flu in 2008.&lt;/p&gt;
&lt;p&gt;The reported death rate is also five times what was seen in the U.S. during the relatively severe 2003/2004 flu season, after which the CDC reported 0.2 deaths per 100,000 children.&lt;/p&gt;
&lt;p&gt;Argentina was particularly hard hit as the pandemic flu spread across the Southern Hemisphere, with confirmed cases and deaths second only to the U.S., Polack and colleagues said.&lt;/p&gt;
&lt;p&gt;&quot;This season was unprecedented in the number of cases, disease burden, and severity,&quot; the researchers reported in the journal.&lt;/p&gt;
&lt;p&gt;Hospitals involved in the study canceled elective surgeries for infection-control purposes. Emergency rooms and wards were overwhelmed, and ICUs expanded their regular facilities, they said.&lt;/p&gt;
&lt;p&gt;In the Northern Hemisphere, children have been hard hit by the disease, although the full effect of the second wave of the pandemic remains to be seen. (See &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/16535&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/SwineFlu/16535&quot; target=&quot;_blank&quot;&gt;CDC: H1N1 Flu Still Hits the Young Hardest&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;To help clarify what might be expected, Polack and colleagues conducted a retrospective analysis of what happened during the winter flu season in Buenos Aires  --  a season that was dominated by the H1N1 pandemic strain.&lt;/p&gt;
&lt;p&gt;As reported, the six hospitals have an estimated catchment population of 1.2 million children under 18. During the study period, 251 children were admitted with laboratory confirmed H1N1 illness, they said.&lt;/p&gt;
&lt;p&gt;Flu admissions during the study period were almost entirely due to H1N1  --  there were three cases of H3N2 influenza, two of type B, and one coinfection with both H3N2 and influenza B, the researchers said. None required intensive care.&lt;/p&gt;
&lt;p&gt;The admission rate for H1N1 was 20.9 per 100,000 children, the researchers found, compared with 10.3 per 100,000 for seasonal flu in 2008.&lt;/p&gt;
&lt;p&gt;Of the children admitted with H1N1, 47 (or 19%) were admitted to an intensive care unit, while 42 (or 17%) required mechanical ventilation, and 13 (or 5%) died.&lt;/p&gt;
&lt;p&gt;Among the 215 inpatients, 75% were under 2 and 60% were infants under the age of 1. About a third of the children had one or more preexisting conditions, the researchers reported.&lt;/p&gt;
&lt;p&gt;Twelve of the 13 children who died had only H1N1, while the remaining child was coinfected with respiratory syncytial virus, the researchers said.&lt;/p&gt;
&lt;p&gt;The most common cause of death was refractory hypoxemia, at 62%. None of the children who died had bacteremia, although three had either presumed or confirmed bacterial pneumonia.&lt;/p&gt;
&lt;p&gt;Nine patients had a preexisting condition significantly associated with increased mortality, including neurologic disorders and chronic lung diseases. Overall, the odds ratio for death among those with such a condition was 4.87 (&lt;em&gt;P&lt;/em&gt;=0.005), the researchers said.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the study may not reflect the scope and magnitude of experience elsewhere. They added that the seasonal flu in 2007/2008 was detected by a direct immunofluorescence assay, which underestimated infections, compared with the real time polymerase chain reaction test used for the pandemic strain.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from the Fundaci&amp;#243;n INFANT 2008 Fundraising Campaign, the National Institute of Environmental Health Sciences, the Argentine National Ministry of Health, the Thrasher Research Fund, and the Fogarty International Center Clinical Research Fellow Program at Vanderbilt University.&lt;/p&gt;&lt;p&gt;The researchers reported no potential conflicts of interest relevant to the study.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_31"
                     title="Factors Through Life Affect Middle Age Lung Function (CME/CE)"
                     score="-0.007"
                     href="http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/tb/17800?impressionId=1265766752369"
                     
      &lt;p&gt;Change in lung function between youth and middle age is influenced by physical, medical, and demographic factors acting throughout life, analysis of data from a nested case-control study showed.&lt;/p&gt;
&lt;p&gt;For instance, both lower height and body mass index (BMI) were significant independent predictors of lower forced expiratory volume in one second (FEV&lt;sub&gt;1&lt;/sub&gt;) at age 14 years (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both), according to Peter W.G. Tennant, MSc, of Newcastle University in England, and colleagues.&lt;/p&gt;
&lt;p&gt;And total lifetime cigarettes smoked predicted greater decline in FEV&lt;sub&gt;1&lt;/sub&gt; between ages 14 and 50 years (&lt;em&gt;P&lt;/em&gt;=0.007), the researchers reported in the January issue of &lt;em&gt;Chest&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Unfavorable influences in childhood can adversely affect later respiratory health, with childhood asthma, respiratory tract infections, and low birth weight all associated with reduced lung function in adulthood,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;However, it has been unclear whether these influences are limited to early life, or whether later factors also contribute to accelerated respiratory decline in middle age.&lt;/p&gt;
&lt;p&gt;Data from the prospective Newcastle Thousand Families Study, which included 1,142 children born in 1947, provided an &quot;unusual opportunity&quot; to examine pulmonary function over a period of 35 years, according to Tennant and colleagues.&lt;/p&gt;
&lt;p&gt;At the study initiation, information was collected on birth weight, gestational age, feeding, childhood infections, and social conditions for all participants.&lt;/p&gt;
&lt;p&gt;Subsequently, at age 14, some 252 of the children were recruited into a case-control study, with height, weight, and BMI recorded and FEV&lt;sub&gt;1 &lt;/sub&gt;measured with spirometry.&lt;/p&gt;
&lt;p&gt;Within this group, 167 had experienced a severe respiratory infection or disease before age 5, while 85 healthy controls lacked such a history.&lt;/p&gt;
&lt;p&gt;Analysis of this sample revealed that factors predicting lower FEV&lt;sub&gt;1&lt;/sub&gt; at age 14 included:&lt;ul&gt; &lt;li&gt;Childhood history of severe respiratory illness (&lt;em&gt;P&lt;/em&gt;=0.014)&lt;/li&gt; &lt;li&gt;Childhood asthma (&lt;em&gt;P&lt;/em&gt;=0.004)&lt;/li&gt; &lt;li&gt;Childhood tuberculosis (&lt;em&gt;P&lt;/em&gt;=0.023)&lt;/li&gt; &lt;li&gt;Being breast fed for less than four weeks (&lt;em&gt;P&lt;/em&gt;=0.028)&lt;/li&gt; &lt;li&gt;Lower social class at birth (&lt;em&gt;P&lt;/em&gt;=0.049)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Between ages 49 and 51, participants were invited to complete a questionnaire on health and lifestyle. Some 122 also underwent repeat spirometric testing.&lt;/p&gt;
&lt;p&gt;Regression analysis identified these factors as predictive of a greater decline (or a smaller increase) in FEV&lt;sub&gt;1&lt;/sub&gt; between ages 14 and 50:&lt;ul&gt; &lt;li&gt;Female sex (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)&lt;/li&gt; &lt;li&gt;Higher FEV&lt;sub&gt;1&lt;/sub&gt; at age 14 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)&lt;/li&gt; &lt;li&gt;Severe respiratory illness in childhood (&lt;em&gt;P&lt;/em&gt;=0.047)&lt;/li&gt; &lt;li&gt;Lower standardized birth weight (&lt;em&gt;P&lt;/em&gt;=0.025)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Univariate analysis had also suggested that lower social class at birth, lower height at age 14, current smoking, and occupational exposure to dust or fumes were associated with a decrease in FEV&lt;sub&gt;1&lt;/sub&gt; between 14 and 50 years, but these associations did not remain after adjustment for factors such as sex and height.&lt;/p&gt;
&lt;p&gt;The finding that severe respiratory illness during childhood is associated with later reduced lung function is consistent with most previous studies, whereas the association of birth weight and lung function in adolescence and adulthood agrees with only some other studies, according to the researchers.&lt;/p&gt;
&lt;p&gt;&quot;Our finding that birth weight influenced the progress of FEV&lt;sub&gt;1&lt;/sub&gt; between ages 14 and 49 to 51 years suggests that some of this effect may be determined by events later in life,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Mechanisms that also could help account for the association between birth weight and pulmonary function include lower maximal function and accelerated decline.&lt;/p&gt;
&lt;p&gt;&quot;Future prospective studies should include measurements [of lung function] at several time points to identify whether the observed reduction is due to attenuation of maximal lung function, more rapid decline, or both,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Another noteworthy finding was a large difference between women and men in change in FEV&lt;sub&gt;1&lt;/sub&gt; between ages 14 and 50 years, according to the authors.&lt;/p&gt;
&lt;p&gt;Compared with men, the average FEV&lt;sub&gt;1 &lt;/sub&gt;in women declined by 35.4% after age 14, which may be explained by the fact that girls typically reach their peak FEV&lt;sub&gt;1&lt;/sub&gt; at a younger age, with boys generally having a large amount of growth remaining at age 14.&lt;/p&gt;
&lt;p&gt;A strength of the study was its longitudinal data collection over a long period of time, &quot;allowing fetal and childhood data to be analyzed alongside adult information.&quot;&lt;/p&gt;
&lt;p&gt;Weaknesses included the small sample size in the longitudinal component of the study, as well as the use of self-reported or proxy variables.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Newcastle Healthcare Charity.&lt;/p&gt;&lt;p&gt;The authors reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>