ORIGINAL ARTICLES
March 2014 15. Revai K, McCormick DP, Patel J, Grady JJ, Saeed K, Chonmaitree T. Effect of pneumococcal conjugate vaccine on nasopharyngeal bacterial colonization during acute otitis media. Pediatrics 2006;117: 1823-9. 16. Shea KM, Weycker D, Stevenson AE, Strutton DR, Pelton SI. Modeling the decline in pneumococcal acute otitis media following the introduction of pneumococcal conjugate vaccines in the US. Vaccine 2011;29:8042-8.
17. Somech I, Dagan R, Givon-Lavi N, Porat N, Raiz S, Leiberman A, Puterman M, Peled N, Greenberg D, Leibovitz E. Distribution, dynamics and antibiotic resistance patterns of Streptococcus pneumoniae serotypes causing acute otitis media in children in southern Israel during the 10 year-period before the introduction of the 7-valent pneumococcal conjugate vaccine. Vaccine 2011;29: 4202-9.
50 Years Ago in THE JOURNAL OF PEDIATRICS Periodic Breathing of Premature Infants Chernick V, Heldrich F, Avery ME. J Pediatr 1964;64:330-40
T
his was one of the early studies I participated in as a fellow with “Mel” Avery at Johns Hopkins University. It was very exciting because for the first time we were able to estimate arterial PCO2 using “arterialized” capillary blood (the Astrup technique). The infrared sensor for end-tidal CO2 measurements was easily misaligned and required frequent repair but provided a useful index of breathing activity. Micro techniques for the measurement of arterial PO2 were not available, nor were miniaturized sensors for the measurement of oxygen saturation. We found, perhaps not surprisingly, that infants with periodic breathing hyperventilated slightly, and speculated that this may be in response to oscillations of PaCO2 at the peripheral chemoreceptor.1 We did note that the infants were more “wakeful with twitching movements of the tongue and extremities” during periodic breathing. I also observed peculiar movements of the eyes during periodicity. Because of the observation of “wakefulness,” I took a technician’s course in electroencephalography and went on to record electroencephalograms during regular and periodic breathing in preterm infants. No one at Johns Hopkins could interpret these recordings so I took them (about 25 pounds in weight!) to an international meeting of pediatric neurophysiologists and electroencephalography experts in Houston, Texas. There I met with luminaries in the field, including Drs Peter Kellaway and Colette Dreyfus-Brisac and her protege, Dr Nicole Monod. However, I was unsuccessful in having the electroencephalograms interpreted in a meaningful sense. Of course, what we had observed was rapid eye movement (REM) sleep during periodicity as clarified in a seminal publication in 1965 by Aserinsky.2 We went on to test the ventilatory responsiveness to inhaled CO2 in infants with and without periodicity and showed no difference,3 but we completely missed the boat with regard to sleep state. Subsequent investigations would reveal how important REM sleep was during development and breathing activity, occurring in the fetus about 40% of the time and only during REM sleep.4 Victor Chernick, MD, FRCPC Professor Emeritus Department of Pediatrics and Child Health University of Manitoba, Winnipeg Manitoba, Canada
References
http://dx.doi.org/10.1016/j.jpeds.2013.09.048
1. Dutton RE, Chernick V, Moses H, Bromberger-Barnea B, Permutt S, Riley RL. Ventilatory response to intermittent inspired carbon dioxide. J Appl Physiol 1964;19:931-6. 2. Aserinsky E. Periodic respiratory pattern occurring in conjunction with eye movements during sleep. Science 1965;150:763-6. 3. Chernick V, Avery ME. Response of premature infants with periodic breathing to ventilatory stimuli. J Appl Physiol 1966;21:434-40. 4. Jansen AH, Chernick V. Development of respiratory control. Physiol Rev 1983;63:437-83.
Predicting Response to Antimicrobial Therapy in Children with Acute Sinusitis
541
March 2014 15. Revai K, McCormick DP, Patel J, Grady JJ, Saeed K, Chonmaitree T. Effect of pneumococcal conjugate vaccine on nasopharyngeal bacterial colonization during acute otitis media. Pediatrics 2006;117: 1823-9. 16. Shea KM, Weycker D, Stevenson AE, Strutton DR, Pelton SI. Modeling the decline in pneumococcal acute otitis media following the introduction of pneumococcal conjugate vaccines in the US. Vaccine 2011;29:8042-8.
17. Somech I, Dagan R, Givon-Lavi N, Porat N, Raiz S, Leiberman A, Puterman M, Peled N, Greenberg D, Leibovitz E. Distribution, dynamics and antibiotic resistance patterns of Streptococcus pneumoniae serotypes causing acute otitis media in children in southern Israel during the 10 year-period before the introduction of the 7-valent pneumococcal conjugate vaccine. Vaccine 2011;29: 4202-9.
50 Years Ago in THE JOURNAL OF PEDIATRICS Periodic Breathing of Premature Infants Chernick V, Heldrich F, Avery ME. J Pediatr 1964;64:330-40
T
his was one of the early studies I participated in as a fellow with “Mel” Avery at Johns Hopkins University. It was very exciting because for the first time we were able to estimate arterial PCO2 using “arterialized” capillary blood (the Astrup technique). The infrared sensor for end-tidal CO2 measurements was easily misaligned and required frequent repair but provided a useful index of breathing activity. Micro techniques for the measurement of arterial PO2 were not available, nor were miniaturized sensors for the measurement of oxygen saturation. We found, perhaps not surprisingly, that infants with periodic breathing hyperventilated slightly, and speculated that this may be in response to oscillations of PaCO2 at the peripheral chemoreceptor.1 We did note that the infants were more “wakeful with twitching movements of the tongue and extremities” during periodic breathing. I also observed peculiar movements of the eyes during periodicity. Because of the observation of “wakefulness,” I took a technician’s course in electroencephalography and went on to record electroencephalograms during regular and periodic breathing in preterm infants. No one at Johns Hopkins could interpret these recordings so I took them (about 25 pounds in weight!) to an international meeting of pediatric neurophysiologists and electroencephalography experts in Houston, Texas. There I met with luminaries in the field, including Drs Peter Kellaway and Colette Dreyfus-Brisac and her protege, Dr Nicole Monod. However, I was unsuccessful in having the electroencephalograms interpreted in a meaningful sense. Of course, what we had observed was rapid eye movement (REM) sleep during periodicity as clarified in a seminal publication in 1965 by Aserinsky.2 We went on to test the ventilatory responsiveness to inhaled CO2 in infants with and without periodicity and showed no difference,3 but we completely missed the boat with regard to sleep state. Subsequent investigations would reveal how important REM sleep was during development and breathing activity, occurring in the fetus about 40% of the time and only during REM sleep.4 Victor Chernick, MD, FRCPC Professor Emeritus Department of Pediatrics and Child Health University of Manitoba, Winnipeg Manitoba, Canada
References
http://dx.doi.org/10.1016/j.jpeds.2013.09.048
1. Dutton RE, Chernick V, Moses H, Bromberger-Barnea B, Permutt S, Riley RL. Ventilatory response to intermittent inspired carbon dioxide. J Appl Physiol 1964;19:931-6. 2. Aserinsky E. Periodic respiratory pattern occurring in conjunction with eye movements during sleep. Science 1965;150:763-6. 3. Chernick V, Avery ME. Response of premature infants with periodic breathing to ventilatory stimuli. J Appl Physiol 1966;21:434-40. 4. Jansen AH, Chernick V. Development of respiratory control. Physiol Rev 1983;63:437-83.
Predicting Response to Antimicrobial Therapy in Children with Acute Sinusitis
541
