الفهرس 
Premature rupture of the membranes (PROM)
The Thymus and Microdeletion (22Q 11)Only 14 pages are availabe for public view
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Abstract
Bronchiolitis is one of the most common reasons for hospitalization
of children worldwide and assessment of infants with bronchiolitis may
require serial observations over time, also this assessment is based on
subjective clinical findings, which can vary between different physicians.
Diaphragmatic ultrasound has been proven to be a non-invasive,
easily performed, learned and reliable tool in assessing diaphragmatic
function.
Brain natriuretic peptide (BNP) is a 32-amino acid polypeptide
secreted by the ventricles of the heart in response to excessive stretching of
cardio-myocytes and this peptide has a diuretic, natriuretic, and hypotensive
effects.
Recent studies detected that plasma BNP level induced by hypoxia
may indicate the clinical severity in children with bronchiolitis.
The aim of the study was
To study the correlation between diaphragmatic ultrasound parameters,
serum brain natriuretic peptide with clinical scoring of acute bronchiolitis
to evaluate their role in assessment of disease severity.
This study was carried out on sixty infant from the Emergency
department, inpatient of Chest and Allergy unit and Pediatric intensive care
unit (PICU) Pediatric department, Tanta University Hospital with clinical
diagnosis of acute bronchiolitis according to American Academy of
Pediatrics (AAP) (AAP, 2018) and thirty apparently healthy infants of
matched age and sex were included as a control groupThe study included Infants with clinical diagnosis of acute
bronchiolitis according to American Academy of Pediatrics.
- Infants with life threatening disease, preterm infant, patients with
chronic disease ,recent history of surgery, major trauma or burn,
recurrent wheezing ,positive family history of asthma, finding
concomitant with other lung pathology in chest x-ray and patient with
evident of gastro-esophageal reflux disease were excluded from the
study.
Every studied infant was subjected to
History and clinical examination in the form of general examination and
local chest examination.
Chest X-ray and laboratory assessment
Clinical Score:
Grading of severity of bronchiolitis was assessed according to Wood-
Downes Clinical Score and cases were divided in to three groups (mild,
moderate and severe bronchiolitis)
Lung ultrasonography
Diaphragm ultrasound
Brain natriuretic peptide assessment
Results of study were:
1) Cases were classified according to wood downes clinical score into three
groups, group (I) mild bronchiolitis 30 cases (50%), group (II) moderate
bronchiolitis 20 cases (33%) and group III severe bronchiolitis 10cases
(16, 7%)
2) Assessment of cases with lung ultrasound showed that pleural line
irregularities were found in 75% of cases, sub pleural consolidationswere found in 61% of cases with focal B lines in 52%, confluent B lines
in 8%.
3) Pleural line irregularities were present in 16(53.3%) patient with mild
bronchiolitis, 19(95.0%) patient with moderate bronchiolitis and in all
patients with severe bronchiolitis.
Consolidations were found in 7(23.3%) patients with mild bronchiolitis
and all patients with moderate and severe bronchiolitis.
B-lines were found in all patients with mild bronchiolitis with focal Blines
constitute 100 % and no confluent B-Lines, in patients with
moderate bronchiolitis with focal B-lines constitute 75% and confluent
B- lines constitute 15% and in patients with severe bronchiolitis all BLines
were in confluent pattern.
4) Assessment of patients with bronchiolitis ultrasound score divide them
into three groups with 22 cases (36.7%) in mild group, 23cases (38.3%)
in moderate group and 15 cases in severe group (25%).
5) Comparison between cases and control as regard to M-mode
diaphragmatic ultrasound parameters showed that mean TF was
significantly lower in patient than in control , mean thickness was
significantly higher in control than in patient, mean excursion was higher
in control than in patient and mean inspiratory slope (IS) was
significantly higher in patient than in control.
6) Relation between clinical score with different diaphragmatic ultrasound
parameters showed that mean value for diaphragmatic thickness in
inspiration (TEI) was significantly higher in mild group than moderate
and severe group, mean value for diaphragmatic thickness in expiration
(TEE) was higher in mild group than moderate and severe group, Infants
with severe bronchiolitis had lower TF (Thickening Fraction) than those
with moderate and mild clinical score ,Inspiratory slope increase withincrease in clinical score with mean IS significantly higher in severe
group, and diaphragmatic excursion was higher in severe group than
mild and moderate group with statistically significance difference
between groups.
7) A statistically significance was found between patient and control with
increase BNP levels in patient than control.
8) Comparison between BNP level in mild, moderate and severe
bronchiolitis showed that a statistically significance between three
groups with BNP levels in group I lower than group II and highest value
for BNP in group III with severe bronchiolitis.
9) A positive significant correlation between clinical score and brain
natriuretic peptide level.