Predictors of severe chest infections in pediatric neuromuscular disorders

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Neuromuscul Disord. 2006 Apr 16

Predictors of severe chest infections in pediatric neuromuscular

disorders.

Dohna-Schwake C, Ragette R, Teschler H, Voit T, Mellies U.

Department of Pediatrics and Pediatric Neurology, University hospital

of Essen, Hufelandstr. 55, 45122 Essen, Germany.

Chest infections are serious complications in neuromuscular

disorders. The predictive values of lung and respiratory muscle

function including peak cough flow still remain unclear. We performed

retrospective analysis of 46 children and adolescents (12.7+/-3.7

years) in whom lung function, respiratory muscle function and peak

cough flows had been obtained. Data were related to: (1). number of

chest infections and days of antibiotic treatment the year prior to

the study and (2). history of severe chest infection requiring

hospital admission. The number of chest infections and the number of

days treated with antibiotics correlated with Inspiratory Vital

Capacity IVC, peak cough flow PCF and Peak Expiratory Pressure PEP.

Twenty-two patients were hospitalized at least once due to severe

chest infection. IVC (0.65 vs. 1.44l; P<0.0001) and PCF (116 vs.

211l/min; P<0.0005) in these patients were significantly lower than

in the non-hospitalized group. IVC<1.1l and PCF<160l/min were

specific and sensitive thresholds to discriminate between patients

who had already suffered severe chest infections and those who had

not. Therefore, spirometry and peak cough flow are reliable tests to

identify patients at high risk for severe chest infections. Patients

with IVC below 1.1l and/or PCF below 160l/min should be well

monitored and introduced to assisted coughing techniques.