Plastic Bronchitis, NICU Outcomes, Teen Drivers

The year is off to a great start, with plenty of research news to report. This biweekly installment of In the News describes a new study in the emerging field of lymphatics, shares an editorial on advancements in neonatology, and highlights research to keep teen drivers safe.

Study Suggests New Intervention Offers Adult Patients Relief From Plastic Bronchitis

In a rare condition called plastic bronchitis, patients develop a plumbing problem of sorts. Abnormal circulation of lymphatic fluid causes it to ooze backward into their airways, which hardens into caulk-like casts that form in the branching paths of their airways.  A new study suggests that most adult patients with plastic bronchitis can be safely treated with new imaging tools and a minimally invasive catheterization technique to remove these thick clogs, both of which were developed at the Center for Lymphatic Imaging and Interventions jointly operated by CHOP and Penn.

These findings build on the success of the Center’s research led by Maxim Itkin, MD, a radiologist at CHOP and Penn Medicine, and Yoav Dori, MD, PhD, a pediatric cardiologist at CHOP and Penn Medicine. They previously reported in the journal Circulation on the outcomes of 18 children who had plastic bronchitis as a complication of palliative surgery for single-ventricle heart disease and underwent the new intervention procedure. Fifteen of the 17 patients had significant improvement in symptoms nearly a year later.

Now the researchers have reported similar success in adult patients, in a study published in the Annals of the American Thoracic Society. Using a customized type of magnetic resonance imaging called dynamic contrast-enhanced MR lymphangiography (DCMRL), the study team found that six of seven patients who presented with branching bronchial casts, associated with chronic cough and/or asthma, had abnormal lymphatic flow.

The team treated the six patients with lymphatic embolization, which involves inserting a combination of glue and coils through catheters to halt the flow of lymphatic fluid. Five patients reported immediate and complete resolution of symptoms, and the sixth patient reported significant partial improvement. Four patients had minor abdominal pain, which resolved after treatment with painkillers. The average follow-up was 11 months after initial treatment.

“This was a small study, and a first report of this treatment in adults with lymphatic plastic bronchitis,” Dr. Dori said. “Longer follow-up will be needed to confirm the long-term risks and benefits of this procedure.”

Read more in the press release. Also, see the September issue of Bench to Bedside for a feature story on how CHOP’s clinical and research efforts have spearheaded these new approaches to lymphatic imaging and interventions.

CHOP Neonatologist Reflects on Rate of NICU Improvement

More research is needed to keep up the pace of improvement in neonatology, according to an editorial published online in JAMA Pediatrics by Scott A. Lorch, MD, MSCE, an attending neonatologist at CHOP and director of the Center for Perinatal and Pediatric Health Disparities Research. Dr. Lorch reflected on a study in the same issue that looked at the progress of neonatal care in the U.S. between 2005 and 2014, using the data set from the Vermont Oxford Network.

While the study highlighted many successes — overall, rates of death prior to discharge and serious morbidities decreased among the 756 U.S. neonatal intensive care units (NICU) participating in the network — it also pointed out several barriers to continuing that momentum to improve NICU outcomes.

“There is a need for further research on the underlying pathophysiology for these outcomes, but also for consideration of the patient, community, and hospital-level factors that may contribute to the variation in outcomes observed between hospitals and the variation in outcomes observed among infants,” Dr. Lorch wrote. “Such personalized approaches to the care of the very low-birth-weight infant may open additional avenues to continue the improvement in neonatal outcomes observed over the past 10 years.”

Read the full editorial here.

Teen Driver Research Steering in the Right Direction

"Do you know, we found that teens brake at half the brake pressure in an emergency situation that adults do?" Flaura K. Winston, MD, PhD, asked in an interview with Philadelphia’s 6abc Action News.

This is just one of the important insights into how teens drive that researchers at the Center for Injury Research and Prevention (CIRP) at CHOP, of which Dr. Winston is a founder and scientific director, has gained. Keeping teens safe behind the wheel is a longstanding research priority for Dr. Winston and CIRP. In the news report, Dr. Winston highlighted some of her team’s latest research, including how they use a driving simulator to assess how teens drive.

Among their recent findings, CIRP researchers reported on young intermediate drivers’ compliance with Graduated Driver Licensing (GDL) passenger and nighttime driver restrictions in New Jersey. The researchers found the number of compliant drivers was high, although GDL compliance was lower among youths from low-income areas and also among males.

"(GDL) reduces the crash rate, particularly fatal crash rate, by 40 percent in states that have adopted them," Dr. Winston told 6abc.

See an infographic about the research and tips for promoting GDL compliance on teendriversource.research.chop.edu, a website CIRP created with resources for teen drivers and their families, educators, policymakers, and researchers.

ICYMI

In case you missed it, this week on Cornerstone we explained a new imaging tool, called creatine chemical exchange saturation transfer MRI, that can detect changes in muscle creatine content before and after exercise that allow estimation of mitochondrial oxidative phosphorylation capacity, an important indicator of energy production.

Our Dec. 30 In the News post started off the new year in style with Yael Mossé, MD, a CHOP pediatric oncologist and physician-scientist specializing in neuroblastoma, who traveled on a Rose Parade float with two special patients. We also told you about new insights from an analysis of home visits with asthma patients, described an imaging tool to improve open heart surgeries, shared the story of a patient who received CTL019 therapy, and described biological pathways that come into play when CD8⁺ T cells mount an immune response.

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