Biomarkers in Pediatric ARDS: Future Directions

Orwoll, Benjamin; Sapru, Anil

doi:10.3389/fped.2016.00055

Cited by 29 publications

(19 citation statements)

References 193 publications

(199 reference statements)

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“…A rapidly progressive area of research is in understanding the role of biomarkers not only in the diagnosis and prognosis of ARDS, but also in potential therapeutic options to alter such biomarkers (91). Inflammatory proteins in the matrix metalloproteinase (MMP) family have been shown to be elevated in pediatric ALI (92) with a specific increase in MMP-9 production in RSV infection.…”

Section: Pathophysiology and Histology Of Rsv And Influenza A (H1n1) mentioning

confidence: 99%

Viral Infection in the Development and Progression of Pediatric Acute Respiratory Distress Syndrome

2016

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Viral infections are an important cause of pediatric acute respiratory distress syndrome (ARDS). Numerous viruses, including respiratory syncytial virus (RSV) and influenza A (H1N1) virus, have been implicated in the progression of pneumonia to ARDS; yet the incidence of progression is unknown. Despite acute and chronic morbidity associated with respiratory viral infections, particularly in “at risk” populations, treatment options are limited. Thus, with few exceptions, care is symptomatic. In addition, mortality rates for viral-related ARDS have yet to be determined. This review outlines what is known about ARDS secondary to viral infections including the epidemiology, the pathophysiology, and diagnosis. In addition, emerging treatment options to prevent infection, and to decrease disease burden will be outlined. We focused on RSV and influenza A (H1N1) viral-induced ARDS, as these are the most common viruses leading to pediatric ARDS, and have specific prophylactic and definitive treatment options.

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Section: Pathophysiology and Histology Of Rsv And Influenza A (H1n1) mentioning

confidence: 99%

Viral Infection in the Development and Progression of Pediatric Acute Respiratory Distress Syndrome

2016

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“…Several studies have shown that altered innate responses and hypercytokinemia in patients with ARDS developed from H5N1, H7N9, and SARS‐CoV infection . Several inflammatory mediators were reported to be biomarkers of ARDS and potential predictors of poor outcome . However, few studies have examined the inflammatory response, specifically in severe ARDS of pulmonary origin in children with respiratory virus infections.…”

Section: Introductionmentioning

confidence: 99%

Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin

Phung

Suzuki

Phan

et al. 2017

Pediatric Pulmonology

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BackgroundAcute respiratory distress syndrome (ARDS) is one of the most lethal diseases encountered in the pediatric intensive care unit (PICU). The etiological pathogens and prognostic factors of severe ARDS of pulmonary origin in children with respiratory virus infections were prospectively investigated.MethodsEnrolled children fulfilled the following criteria: (1) PICU admission; (2) age of 1 month to 16 years; (3) diagnosis of infectious pneumonia and respiratory virus infection; and (4) development of severe ARDS within 72 h after PICU admission. Pathogens were detected in the blood and tracheal lavage fluid using molecular techniques and a conventional culture system. The serum levels of inflammatory mediators on the day of PICU admission were examined.ResultsFifty‐seven patients (32 boys; median age, 9 months) were enrolled. Multiple virus infections, co‐infection with bacteria/fungus, and bacteremia/fungemia were observed in 60%, 49%, and 32% of children, respectively. Adenovirus‐B, measles virus, and cytomegalovirus were detected predominantly in tracheal lavage fluid. There were no statistically significant differences between non‐survivors and survivors regarding the types of pathogen, incidence of multiple virus infection, gender, age, clinical features, and treatment. The serum levels of interferon (IFN)‐γ and the IFN‐γ/interleukin (IL)‐10 ratio were higher in non‐survivors.ConclusionsIFN‐γ upregulation as detected on the day of PICU admission was found to be one of the possible prognostic factors affecting a fatal outcome. These results suggest that modulation of inflammatory responses is critical for the clinical management of children with ARDS.

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“… 31 Sepsis generally initiates a systemic inflammatory response, and proinflammatory cytokines, such as tumor necrosis factor alpha, interleukin 1 beta (IL-1β), IL-6, and IL-8, 32 , 33 are released. These cytokines activate neutrophils to produce toxic mediators and damage the endothelium and alveolar epithelium, 34 – 36 eventually leading to alveolar–capillary barrier injury. 30 , 37 Then, the protein-rich fluid induces acute pulmonary edema and inactivates PS.…”

Section: Discussionmentioning

confidence: 99%

Differences in clinical characteristics of early- and late-onset neonatal sepsis caused by Klebsiella pneumoniae

You

Zhang

Ling

et al. 2020

Int J Immunopathol Pharmacol

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To identify differences in the clinical characteristics of early- and late-onset sepsis (EOS and LOS) caused by Klebsiella pneumoniae ( K. pneumoniae) and to describe the risk factors for multidrug-resistant K. pneumoniae (MDR-KP) infection. Infants with K. pneumoniae-induced sepsis who were admitted to a children’s Hospital between Jan 2000 and Dec 2019 were included. All infants were divided into EOS and LOS groups, as well as MDR-KP and non-MDR-KP groups. Demographics, clinical characteristics, and risk factors were compared between the two groups. One hundred eighty infants (66 with EOS and 114 with LOS) were further analyzed, accounting for 36.8% of sepsis cases caused by MDR-KP. The frequency of respiratory failure, bronchopulmonary dysplasia, and intraventricular hemorrhage were more common in the LOS group and a higher rate of acute respiratory distress syndrome was more common in infants in the EOS group ( P < 0.05). K. pneumoniae showed a low sensitivity to penicillin, beta-lactams and cephalosporins, and it showed a high sensitivity to levofloxacin, ciprofloxacin, and amikacin. Prematurity, low birth weight, longer antibiotic exposure time, long duration of peripheral catheter insertion, long mechanical ventilation time, and long parenteral nutrition time were associated with an increased rate of MDR-KP infection by univariate analysis ( P < 0.05). The regression analysis identified a long antibiotic exposure time (OR = 1.37, 95% CI: 1.01–1.89) and long parenteral nutrition time (OR = 1.39, 95% CI: 1.01–1.89) as independent risk factors for a MDR-KP infection, and a greater gestational age and birth weight were associated with a lower risk of MDR-KP infection (OR = 0.57, 95% CI: 0.40–0.79). LOS caused by K. pneumoniae may lead to a higher frequency of complications. The risk factors for MDR-KP infection were longer duration of antibiotic exposure and parenteral nutrition. A greater gestational age and larger birth weight may decrease the risk of MDR-KP infection.

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Biomarkers in Pediatric ARDS: Future Directions

Cited by 29 publications

References 193 publications

Viral Infection in the Development and Progression of Pediatric Acute Respiratory Distress Syndrome

Viral Infection in the Development and Progression of Pediatric Acute Respiratory Distress Syndrome

Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin

Differences in clinical characteristics of early- and late-onset neonatal sepsis caused by Klebsiella pneumoniae

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