Research summary – Michal Benjamin

Respiratory viral infections in infancy and school age respiratory outcomes and healthcare costs
Victoria MacBean, Simon B Drysdale, Muska N Yarzi, Janet L Peacock, Gerrard F Rafferty, Anne Greenough
Published in the journal Pediatric Pulmonology, 2018

Prematurely born infants often have lung problems such as chest infections caused by viruses, and therefore this study was set up in order to explore the impact of chest infections in infancy on lung health later in childhood. From prior research, it was thought that children who had viral chest infections during infancy would have worse breathing function when they got to school age and therefore would depend on medical services more than the average child.
A group of children who had participated in a previous study who were born before 36 weeks of pregnancy and had symptomatic chest infections during infancy were called back when aged between 5-7. During their chest infections as babies, these children had had a sample of mucus taken from the back of the nose and mouth which was tested for a variety of viruses.
When measured at 5-7 years old, various aspects of lung function of the children who had experienced viral chest infections were compared to those of the non-affected children. The results of these tests suggested that children who had had respiratory viruses had poorer lung function than healthy children.
These children also had their medical records examined in order to identify any hospital admissions, emergency department visits, hospital outpatient appointments, other contact with medical professionals, GP attendance and all medication prescriptions. Beyond the first year of life the cost of these medical treatments was recorded. The average healthcare costs of the infants who had not had chest infections were compared to those of the infants who had had respiratory viruses. The ‘virus group’ had a significantly higher respiratory health cost (an average of £431 per year) compared to the group of children who did not have chest infections in infancy (an average of £56 per year).
From these results, the researchers suggested that children who experienced chest infections caused by respiratory viruses had higher healthcare costs and poorer lung function. This study did not identify any one virus as being consistently problematic.

This summary was produced by Michal Benjamin, Year 12 student from JFS School, Harrow, as part of our departmental educational outreach programme.

Research summary – Iva Koshova

Non-volitional assessment of tibialis anterior force and architecture during critical illness
Bronwen Connolly, Matthew Maddocks, Victoria MacBean, William Bernal, Nicholas Hart, Philip Hopkins, Gerrard F Rafferty
Published in the journal Muscle and Nerve, December 2017

After being admitted into the intensive care unit (ICU) some patients experience muscle weakness and as a result they struggle to walk properly and perform other daily tasks. This weakness is not always a direct result of the condition for which the patient was admitted. The term intensive care unit-acquired weakness (ICU-AW) is the name given to functionally unfit muscles of patients who have been admitted to ICU for which there is no other reasonable explanation. ICU-AW is a serious problem as it means the quality of life of patients after their ICU stay can be impaired as their muscle weakness can be quite severe and limit what they can do.
This research was used to investigate whether admission to ICU is the cause of muscle weakness many patients experience after their stay. The researchers tested this by assessing the size and strength of a muscle at the front of the shin. This muscle is easy to access without disrupting patients’ treatment. It is also responsible for balance and walking therefore the researchers found it to be an important muscle to focus on as patients who experience weakened shin muscles can have negatively impacted lives. Moreover, researchers decided to use testing techniques that don’t involve conscious effort from the patient as it meant eliminating limitations such as patient cooperation and motivation, making the research more reliable.
The study included thirteen adults who had been admitted to ICU and who required breathing support for at least 48 hours. Patients’ shin muscle size and strength was assessed on two occasions seven days apart in order to see whether any weakness developed during their ICU stay.
If patients’ ICU stay caused their muscles to decline in ability, like the term ICU-AW suggests, then the researchers would have seen a decrease in strength of their shin muscle. What the results showed, however, was that there was weakness present at the start of their ICU admission, with no further decline in muscle strength during admission, though the muscles did decrease somewhat in size. This finding led the researchers to suggest that ‘critical illness-associated weakness’ would be a more reflective term than ICU-acquired weakness. Of course, it is important to note that due to the small number of patients studied used the data isn’t entirely conclusive as the small sample may not be representative of all patients who experience weakness after an ICU stay.
This study suggests that the ICU environment may not be the cause of the weakness patients experience. This highlights the need for further research into ICU-AW so that more about the condition can be learned; this could lead to a possible way to prevent it from developing in the first place.

This summary was produced by Iva Koshova, Year 13 student from Harris Academy, Greenwich, as part of our departmental educational outreach programme.

Research summary – Miri Frankl

Predicting healthcare outcomes in prematurely born infants using cluster analysis
Victoria MacBean , Alan C. Lunt, Simon B. Drysdale, Muska Nadia Yarzi, Gerrard F. Rafferty and Anne Greenough
Published in the journal Pediatric Pulmonology, May 2018

Children born prematurely have higher risks of chest infections caused by viruses. This is associated with poorer respiratory health in infancy and later childhood.
This study is important because it is very difficult to predict respiratory diseases, as the chances of getting the disease, and the degree of severity, will vary substantially between prematurely born children. The large differences in risks to these children means that it’s very important to be able to predict their health. This allows parents and children to have more support, and also means that expensive preventative medicine is only used when necessary.
A group of 168 prematurely born infants were assessed, and had their birth weight, how long the pregnancy was, and how long they were helped to breathe after birth recorded. Throughout the first year after birth the parents reported any symptoms of chest infections (for example, shortness of breath). These same children had follow-up measurement at 5-7 years of age.
A technique called ‘cluster analysis’ analysed the data collected from the children. This is when groups of similar individuals are identified, who share certain characteristics. The outcomes of the different groups can then be assessed. Three distinct groups were detected in the group of 168 infants.
The first and largest group of children, who needed very little help with breathing immediately after birth, had very few chest infections before their first birthday, and didn’t have chest problems later in life.
The second, smaller group of children needed help with breathing for five or more days after birth and were more likely to have mild to moderate chest problems later in life.
The third and smallest group were born weighing less than 882 grams and required a lot of breathing support after birth. These children had the highest risk of developing chest infections and had a lot of health problems later in life (both related to their chest and other health conditions).
This study suggests that prematurely born infants fall into three distinct groups. Knowing which group the baby is in may be useful to clinicians advising parents on their baby’s possible outcomes after preterm births, and researchers with their studies.

This summary was produced by Miri Frankl, Year 12 student from JFS School, Harrow, as part of our departmental educational outreach programme.