Lower respiratory infection children

In an analysis of data from the Mother and Child Cohort study in Norway, where foods are not fortified, wheezing and lower respiratory tract infections during the first 18 months of life were examined in 32 077 children born between 2000 and 2005 in relation to maternal reported intake of folic acid 400 mg/day and cod liver oil 5 ml/day [29 , 30" ]. The relative risks in the infants of mothers who took folate supplements during the first trimester were 1.06 (95% Cl = 1.03, 1.10) for wheezing, 1.09 (95% Cl = 1.02, 1.15) for lower respiratory tract infections, and 1.24 (95% Cl = 1.09, 1.41) for hospitalization associated with lower respiratory tract infections. Although small, these relative risks were statistically significant. 

Because of the difficulty in accurately establishing the diagnosis of a hospital-acquired pneumonia or tracheitis in a critically ill child, a standardized approach for defining these infections offers the best opportunity for interhospital comparisons. The Centers for Disease Control and Prevention (CDC) definitions for lower respiratory tract infections in children are included in Tables 2 and 3 (27). However, pneumonia and tracheitis may still be diagnosed and treated in children who do not satisfy these criteria. Also, children who fulfill these criteria may not truly have a nosocomial LRI. This occurs most commonly when the child exhibits a deterioration in his or her underlying pulmonary condition. 

Most bacterial nosocomial lower respiratory tract infections occur by aspiration of bacteria that colonize the oropharynx or upper gastrointestinal tract of the child. Both intubation and mechanical ventilation alter or circumvent some of the patient s natural barrier defenses against infection. These interventions allow organisms from the oropharyngeal or upper gastrointestinal tract greater access to the lower respiratory tract. The aspiration of contaminated materials may be obvious or, more commonly, it is subclinical. The normal respiratory flora of children admitted to a hospital consists of both gram-positive and... 

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