Paediatric Respiratory Reviews最新文献

Robin sequence (RS) is diagnosed by the clinical triad of micrognathia, glossoptosis, and airway obstruction. The reported occurrence is variable and noted in 1:8,500 to 1:20,000 live births. Although advances in perinatal imaging, neonatal resuscitation, non-invasive respiratory support and surgical techniques can mitigate against adverse outcomes, there remains much debate as to the best treatment for children born with RS. This review will outline surgical treatment of cleft palate and speech outcomes for children with RS.

Severe asthma affects about 6.7% of adolescents worldwide, posing a substantial burden on their physical and psychosocial well-being. The impact of severe asthma on adolescents is multifaceted, with several factors that contribute to this burden, such as comorbidities including obesity, dysfunctional breathing, sleep-disordered breathing and mental health issues. Moreover, daily therapy management is often complex and may require lifestyle modification that could lead to a failure in treatment adherence and to peer-related stressors such as feelings of exclusion. Furthermore, adolescents with severe asthma are prone to risk-taking behaviours, including vaping and substance misuse. While current management strategies often fail to account for their developmental stage, digital technologies offer novel solutions to improve disease management. This narrative review aims to provide a comprehensive overview of the multifaceted impact of severe asthma on adolescents, addressing the main clinical management issues and exploring the role of innovative digital tools to enhance asthma management in this critical population.

Objectives: To investigate the role of both diagnostic and interventional paediatric bronchoscopy in the management of respiratory diseases in children in low- and middle-income countries (LMICs).

Design: A review of published English literature from January 2014 to February 2024.

Results: Indications for bronchoscopy in LMICs will vary depending on the burden of infectious diseases like tuberculosis (TB) and HIV, and the expertise and equipment available. TB diagnosis in children remains challenging due to the paucibacillary nature of the disease and its overlap with other infectious diseases like actinomycosis and echinococcosis. Acquired conditions, such as foreign body (FB) inhalation, present late with a high complication rate, making them challenging to manage. Paediatric bronchoscopy has an important role in the diagnoses, management and follow-up of many of these conditions. Interventional procedures like endobronchial ultrasound (EBUS), radial EBUS and cryotherapy enhance diagnostic and management capabilities.

Conclusion: Children in LMICs are affected by both infectious and acquired conditions. Bronchoscopy remains expensive with limited training offered in LMICs but is increasingly recognised for its important diagnostic and therapeutic role.

Assessing obstructive sleep apnoea (OSA) in children involves various methodologies, including sleep studies, nocturnal oximetry, and clinical evaluations. Previous literature has extensively discussed these traditional methods. Despite this, there is no consensus on the optimal screening method for childhood OSA, further complicated by the complexity and limited availability of diagnostic polysomnography (PSG). Recent advancements, such as the integration of artificial intelligence, biomarkers, 3D facial photography, and wearable technology, offer promising alternatives for early detection and more accurate diagnosis of OSA in children. This article provides a comprehensive review of these innovative techniques, highlighting their potential to enhance diagnostic accuracy and overcome the limitations of current methods. With an emphasis on cutting-edge technologies and emerging biomarkers, we discuss the future directions for paediatric OSA assessments and their potential to revolutionise clinical practice.

Community acquired pneumonia (CAP) is a disease experienced by children the world over, though CAP-related morbidity and mortality differ markedly between low- and middle-income countries (LMICs) and high-income countries (HICs). Thus, setting-specific clinical prediction models are needed to identify children at risk for CAP-related morbidity and mortality. Here, we outline published clinical prediction models from LMICs and HICs for pediatric CAP-related outcomes. To date, there have been four clinical prediction models to predict treatment failure, two to predict a composite outcome of poor outcomes, and eight models for mortality prediction for CAP in LMICs. No prediction models developed in LMICs had publications that described their impact on clinical care through implementation. In HICs, to date there are three published clinical prediction models evaluating disease severity and one examining the need for major medical interventions. While clinical prediction models described in this review provide a strong foundation for risk stratification for children with CAP in HICs, there is a need for widespread external validation and implementation of optimally performing models.

Background: Securing a stable airway is a critical component in neonatal resuscitation. Compared to direct laryngoscopy, video laryngoscopy provides improved visualization of the glottis, potentially enhancing the success rate of intubation. This systematic review and meta-analysis were conducted to assess and compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy in neonatal intubation.

Methods: A thorough search was performed across CENTRAL, Embase, and PubMed databases to identify relevant randomized controlled trials (RCTs) that evaluated the use of video laryngoscopy in comparison with direct laryngoscopy for neonatal intubation. The data extraction and analysis were conducted in alignment with Cochrane guidelines. The primary outcome of interest was the time required for intubation, while secondary outcomes included the number of intubation attempts and the success rate on the first attempt.

Results: The meta-analysis included nine RCTs, encompassing a total of 719 neonates. The findings revealed that video laryngoscopy was associated with a longer intubation time (mean difference [MD] 3.23 s, 95 % confidence interval [CI] 2.42 to 4.04; I² = 96 %). However, it also significantly improved the first-attempt success rate (risk ratio [RR] 1.31, 95 % CI 1.20 to 1.44; I² = 76 %) and borderline reduced the total number of intubation attempts (MD -0.08, 95 % CI -0.15 to 0.00; I² = 53 %).

Conclusions: While video laryngoscopy is associated with a modest increase in intubation time, it provides clear benefits by enhancing the success rate of first-attempt intubations and reducing the need for multiple attempts in neonatal intubation procedures.

The psychological trauma following COVID-19 has been lengthy and fraught for some children and their families. The specific problems encountered by children rendered helpless and hopeless by watching others suffer, vicarious traumatisation, is explained in brief as it represents a central motif in clinical work in psychology. This paper will focus on what is known of the nature of psychological trauma in children and families with a focus on the individual clinical manifestations of personal significance. As a backdrop, consideration will be given to the epidemiological trends of psychological morbidity in and around the COVID-19 pandemic. Finally, the article seeks to provide readers with an appreciation of the dimensions of the neural legacy of COVID-19, a form of neurodisability developing in vulnerable children at a point in time, that is likely to emerge in children suffering an enduring trauma response.

Physical activity is crucial for children's physical, cognitive, and social development, reducing the risk of non-communicable diseases and improving overall well-being. A major legacy of extremely preterm delivery is respiratory limitation with reduced lung function and decreased exercise capacity which can be further exacerbated by inactivity and deconditioning. Strategies to increase incidental physical activities in early childhood and participation in sport and more formal exercise programmes in middle childhood have the potential to optimize cardiopulmonary function, improve quality of life, and foster social interactions in childhood and beyond, thereby providing benefits that extend far beyond the physical domain. Intervention strategies such as supervised aerobic and resistance training, and incorporation of physical activity into daily routines have shown promise in increasing activity levels and improving exercise capacity in this population. Engaging families and tailoring programs to individual needs are crucial for the success of these interventions. Overall, a holistic approach that promotes increased physical activity and addresses psychosocial barriers is essential for optimizing the health, well-being, and quality of life of preterm-born children. Further research and development of effective, long-term intervention programs are needed to support these vulnerable individuals throughout childhood and into adulthood.

Paediatric pneumonia and its complications present substantial health and economic challenges. While chest radiographs are commonly used as the initial imaging modality for diagnosing uncomplicated pneumonia, they are less effective for complicated cases. In response, various imaging techniques, such as lung ultrasound, computed tomography (CT), and chest MRI, have been integrated into clinical practice to enhance diagnosis and guide management decisions. No definitive gold standard exists for imaging complicated paediatric pneumonia and clinicians may find it challenging to choose the best imaging technique for a given clinical scenario. In this review we describe the available imaging options relevant for the management of paediatric pneumonia and evaluate the strengths and limitations of each modality.