In a retrospective study of 22 neonates with congenital diaphragmatic hernia, fetal lung volume (FLV) measured by magnetic resonance imaging was associated with survival; the best FLV ratio cut-off to predict mortality was 30% of expected FLV. This study supports a correlation between FLV and the chances of survival. Despite advances in postnatal care, the death rate in patients with congenital diaphragmatic hernia (CDH) remains as high as 40-60%.1 Reliable outcome predictors are needed to provide families with accurate prognostic information, to optimise postnatal care, and to detect patients who may be candidates for future prenatal treatments.1 However, prenatal prediction of prognosis in patients with isolated CDH remains a challenge. 1Lung hypoplasia is a key prognostic factor.1 This can be estimated by fetal lung volume (FLV) measured by magnetic resonance imaging.2 However, the predictive value of FLV remains controversial. [3][4][5] We evaluated the potential for FLV to predict survival in neonates with CDH. STUDY DESIGN PatientsWe conducted a retrospective study of neonates with prenatal diagnosis of CDH between January 1996 and August 2004 and FLV measurement by magnetic resonance imaging. We excluded voluntarily terminated pregnancies and neonates without FLV measurement. Neonates were inborn and managed according to the same protocol through the years. Measurement of FLVMagnetic resonance imaging was performed at 30-32 weeks gestation, using a 1.5 T system. Lung boundaries were manually outlined on axial T2 weighted sequences. The lung surface area was multiplied by section thickness and corrected for gap to yield a partial FLV. The sum of partial FLV yielded the FLV. Predicted FLVs were estimated as FLV = 0.0033 6 g 2.86 , where g is gestational age.2 We then computed the ratio of observed over predicted FLV (hereafter designated ''FLV ratio'').The primary evaluation criterion was the association between postnatal mortality and FLV ratio. We also compared the prognostic value of FLV with that of gestational age at birth, gestational age at diagnosis of CDH, fetal sex, side of CDH, and liver herniation. Data are reported as mean (SD) unless specified otherwise. RESULTSTwenty two neonates were studied, and 10 survived. The FLV ratio was lower in non-survivors than in survivors (25.1 (12.8)% v 46.9 (11.6)% respectively; p,0.01). The area under the receiver operator characteristic curve of sensitivity and specificity of various ratio cut-offs for predicting postnatal death was 0. 92 (fig 1). The best cut-off was 30%, with a sensitivity of 0.83 (0.55-0.95) and a specificity of 1.00 (0.72-1.00). In our study, the FLV ratio was the only variable significantly associated with mortality (p,0.01) (table 1). DISCUSSIONIn this retrospective study of 22 neonates with CDH, the FLV ratio correlated with neonatal survival. The receiver operator characteristic curve identified 30% as the best FLV ratio cutoff for predicting survival.Prognostic interest of FLV in CDH has previously been evaluated in three studies.3-5...

Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-α2 alone (five patients) or with IFN-ω (eight patients) from a cohort of 279 patients (4.7%) aged 6–73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-α2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-ω. The patients’ autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients <70 yr of age (5.7 vs. 1.1%, P = 2.2 × 10−5), but not >70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-α2 and IFN-ω (OR = 11.7, P = 1.3 × 10−5), especially those <70 yr old (OR = 139.9, P = 3.1 × 10−10). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for ∼5% of cases of life-threatening influenza pneumonia in patients <70 yr old.

Secondary AI is frequent during the acute phase of pediatric TBI, particularly when intracranial hypertension is present. Systematic assessment of pituitary function after TBI appears to be essential. A randomized clinical trial is warranted to evaluate the benefits of hormonal replacement therapy in TBI patients with AI.

Background: The present study explores the frequency, diagnostic approach, and therapeutic management of cerebral vasospasm in a cohort of children with moderate-to-severe traumatic and nontraumatic subarachnoid hemorrhage (SAH). Methods:This was a single-center retrospective study performed over a 10-year period, from January 2010 to December 2019. Children aged from one month to 18 years who were admitted to the pediatric or adult intensive care unit with a diagnosis of SAH were eligible. Cerebral vasospasm could be suspected by clinical signs or transcranial Doppler (TCD) criteria (mean blood flow velocity > 120 cm/s or an increase in mean blood flow velocity by > 50 cm/s within 24 h) and then confirmed on cerebral imaging (with a reduction to less than 50% of the caliber of the cerebral artery).Results: Eighty patients aged 8.6 years (3.3-14.8 years, 25-75th centiles) were admitted with an initial Glasgow Coma Scale score of 8 (4-12). SAH was nontraumatic in 21 (26%) patients. A total of 14/80 patients (18%) developed cerebral vasospasm on brain imaging on day 6 (5-10) after admission, with a predominance of nontraumatic SAH (12/14). The diagnosis of cerebral vasospasm was suspected on clinical signs and/or significant temporal changes in TCD monitoring (7 patients) and then confirmed on cerebral imaging. Thirteen of 14 patients with vasospasm were successfully treated using a continuous intravenous infusion of milrinone. The Pediatric Cerebral Performance Category score at discharge from the intensive care unit was comparable between children with vasospasm (score of 2 [1-4]) vs. children without vasospasm (score of 4 [2-4]) (p = 0.09). Conclusions:These findings indicate that cerebral vasospasm exists in pediatrics, particularly after nontraumatic SAH. The use of TCD and milrinone may help in the diagnostic and therapeutic management of cerebral vasospasm.