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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_116"
                     title="SCCM: Toddler Found Frozen in Creek Revives (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/SCCM/tb/17927?impressionId=1265782440659"
                     
      &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_1030"
                     title="Hemofiltration Improves Outcomes from ECMO for Sickest Babies"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/13575?impressionId=1265782440659"
                     
      LITTLE FALLS, N.J., April 2 -- In the neonatal intensive care unit, adding hemofiltration to extracorporeal membrane oxygenation (ECMO) improves short-term outcomes and cuts costs, a case-control study showed.
              &lt;br&gt; 
              &lt;br&gt;Newborns who received hemofiltration had a significantly shorter duration of ECMO (&lt;em&gt;P&lt;/em&gt;=0.02) and spent less time on mechanical ventilation after stopping ECMO (&lt;em&gt;P&lt;/em&gt;=0.04) than those who did not receive hemofiltration, according to Dick Tibboel, M.D., Ph.D., of the Erasmus Medical Center Sophia Children&apos;s Hospital in Rotterdam, The Netherlands.
              &lt;br&gt; 
              &lt;br&gt;In addition, there was less need for blood transfusions (&lt;em&gt;P&lt;/em&gt;&lt;0.001).
              &lt;br&gt; 
              &lt;br&gt;Dr. Tibboel and colleagues reported their findings online in &lt;em&gt;Critical Care&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;In real life, the advantages they found translated into savings of about &amp;euro;5,000 ($6,600) per ECMO run, the researchers said.
              &lt;p&gt; 
              &lt;p&gt;ECMO is a supportive cardiopulmonary bypass technique used in patients with acute reversible cardiovascular or respiratory failure, according to the researchers.
              &lt;p&gt; 
              &lt;p&gt;Previous studies have shown hemofiltration to be beneficial during cardiopulmonary bypass, so the researchers set out to see whether it could also improve outcomes from ECMO.
              &lt;p&gt; 
              &lt;p&gt;They compared outcomes from 15 patients who received continuous veno-venous hemofiltration during ECMO and 46 controls who received ECMO only.
              &lt;p&gt; 
              &lt;p&gt;All patients were younger than 28 days (median about 2 days). Those who received hemofiltration started the treatment within three hours of initiating ECMO.
              &lt;p&gt; 
              &lt;p&gt;The two groups were generally well matched for baseline illness severity. The most common reasons for treatment in the NICU were congenital diaphragmatic hernia, which was more frequent in the controls, and meconium aspiration syndrome.
              &lt;p&gt; 
              &lt;p&gt;Other reasons included respiratory distress syndrome, viral or bacterial pneumonia, congenital cystic adenomatoid malformation of the lung, persistent pulmonary hypertension, postcardiac surgery, and sepsis.
              &lt;p&gt; 
              &lt;p&gt;The researchers identified several outcomes that were improved by adding hemofiltration. They included:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;Shorter time on ECMO (98 versus 126 hours, &lt;em&gt;P&lt;/em&gt;=0.02)
                &lt;li&gt;Shorter time on mechanical ventilation after ECMO (2.5 versus 4.8 days, &lt;em&gt;P&lt;/em&gt;=0.04)
                 &lt;li&gt;Fewer blood transfusions (0.9 versus 1.8 mL/kg/day, &lt;em&gt;P&lt;/em&gt;&lt;0.001)
                  &lt;li&gt;Lower fluid balance per day (?29 versus +40 mL/kg/day, &lt;em&gt;P&lt;/em&gt;&lt;0.001)
                   &lt;li&gt;Lower maximum serum urea (4 versus 6 mmol/L, &lt;em&gt;P&lt;/em&gt;=0.01)
                                &lt;/ul&gt;
                                  &lt;p&gt; 
                                  &lt;p&gt;Researchers speculated that hemofiltration alleviated some of the systemic inflammatory effects and complications of ECMO, including capillary leakage syndrome.
                                  &lt;p&gt; 
                                  &lt;p&gt;There was no significant difference in the mortality rate (16% in the controls versus 21% in the cases, &lt;em&gt;P&lt;/em&gt;=0.61), but the researchers said the numbers of patients were too small to draw any definitive conclusions.
                                  &lt;p&gt; 
                                  &lt;p&gt;Because the personnel who run ECMO are also trained to run hemofiltration, there were no additional staffing costs associated with adding the treatment.
                                  &lt;p&gt; 
                                  &lt;p&gt;Taking into consideration the need for fewer blood transfusions and shorter duration of ECMO, a facility that has 30 patients who require ECMO per year could save about &amp;euro;150,000 ($198,000) a year by adding hemofiltration, the researchers said.
                                  &lt;p&gt; 
                                  &lt;p&gt;The findings are being confirmed in an ongoing randomized controlled trial, they said.
                                  &lt;p&gt; 
                                  &lt;p&gt;The team acknowledged some limitations of the study, including the small sample size, inability to perfectly match the cases and controls on illness severity, the fact that the cases and controls were treated during two different two-year periods, and the lack of information on inflammatory mediators.
                                  &lt;p&gt; 
                                  &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The authors reported no conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
                              
    </recommendedItem>
    <recommendedItem id="20090101_19_4193"
                     title="Gene Linked to Asthma in Children (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Pediatrics/Asthma/tb/17676?impressionId=1265782440659"
                     
      &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="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/17680?impressionId=1265782440659"
                     
      &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="-0.005"
                     href="http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/tb/17800?impressionId=1265782440659"
                     
      &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>