Paediatric Respiratory Reviews最新文献

Pseudomonas aeruginosa remains a major cause of morbidity in people with cystic fibrosis (pwCF). The advent of elexacaftor/tezacaftor/ivacaftor (ETI) has transformed clinical outcomes, but its impact on airway microbiology and diagnostic surveillance remains uncertain. We conducted a systematic review of PubMed and Embase (2019-2025) according to PRISMA guidelines, including studies comparing culture with molecular methods for P. aeruginosa detection in pwCF treated with ETI. Fourteen observational studies (n=2525 subjects) were identified. Chronic P. aeruginosa detection declined from 51.4% at baseline to 24.8% after ETI, with nearly half of colonized subjects achieving apparent clearance. Several studies applying molecular techniques reported persistent P. aeruginosa detection despite negative cultures. These findings indicate that ETI markedly reduces bacterial burden and sputum availability, which may limit the sensitivity of culture-based surveillance. However, the clinical and inflammatory significance of PCR+/culture- results remains uncertain. Combining molecular and culture-based surveillance may help guide infection monitoring in the modulator era.

Behavioural sleep problems are common in children. The challenges with establishing and maintaining good sleep hygiene may prove challenging to overcome based on environmental issues such as the liberal availability of electronic media from a young age, permissive parenting, difficult family dynamics and limited parental/carer understanding of a child's sleep needs as they progress through childhood and adolescence. Melatonin is inexpensive, easily accessible, in high demand from the community and, at its simplest, may be perceived as a harmless "silver bullet" for "sleep problems". Clinicians are encountering children already using melatonin, sometimes with minimal behavioural support and misconceptions about its safety. This article provides frontline clinicians with an evidence-based overview of melatonin's role in paediatric care, emphasising its approved indications, the dangers of unregulated products and the risks of unsupervised use.

Paediatric lung transplantation is a rare but increasingly successful therapeutic option for children with end-stage respiratory failure. Over the past decade, its epidemiology has shifted, with cystic fibrosis becoming an uncommon indication and a growing proportion of candidates presenting with interstitial lung disease or pulmonary arterial hypertension. In parallel, advances in donor allocation, the development of size-reduction surgical techniques and the reconditioning of marginal lungs have expanded the donor pool and reduced waiting-list mortality, including in small children. Peri-operative improvements-including broader use of extracorporeal life support as a bridge to transplantation-have further strengthened early and long-term outcomes. At the same time, progress in infectious disease prophylaxis and antiviral therapy, coupled with a more refined understanding of rejection mechanisms, is reshaping post-transplant care. Together, these developments underscore the importance of early referral to specialised paediatric transplant centres to ensure timely assessment and optimal access to advanced supportive strategies.

Lung ultrasound (LUS) is increasingly used in the delivery room to assess respiratory transition and guide early respiratory management. The objective of this systematic review was to evaluate current evidence on the diagnostic applications of neonatologist-performed LUS during neonatal resuscitation and immediate postnatal stabilization in late preterm and term neonates. Twelve studies were included in this qualitative systematic review, addressing physiological LUS patterns after birth, the use of LUS scoring systems to predict the requirement of respiratory support, and applications of LUS during neonatal resuscitation and immediate postnatal stabilization. Normal postnatal adaptation was characterized by rapid progression from fluid-rich to aerated lung patterns, whereas persistent high-risk LUS patterns were associated with respiratory morbidity. Several LUS scoring systems demonstrated good discriminative ability for predicting the need for respiratory support shortly after birth. In addition, characteristic ultrasound patterns supported early identification of late preterm and term neonates at risk for surfactant requirement and mechanical ventilation. Despite substantial heterogeneity in study design, timing of imaging, and analytic methods, the evidence supports the feasibility and clinical value of LUS in the delivery room. Neonatologist-performed LUS represents a promising bedside tool that may complement clinical assessment during early postnatal transition in late preterm and term neonates.

Bubble continuous positive airway pressure (CPAP) is a widely used non-invasive respiratory support strategy for neonates and is commonly employed in the management of preterm infants with respiratory distress. Bubble CPAP generates continuous distending pressure by submerging the distal expiratory limb in water, producing low-amplitude, high-frequency pressure oscillations as airflow escapes and bubbles into the water canister. These oscillations, which are transmitted back to the neonate, vary dynamically with airway and lung mechanics and may contribute to the physiological benefits observed with bubble CPAP. This review summarizes the historical context, physiological rationale, clinical evidence supporting bubble CPAP, and areas for future optimization.

Background: Obstructive sleep apnoea (OSA) is prevalent among children with obesity and is associated with long-term morbidity.

Methods: We conducted a systematic review and meta-analysis of risk factors for OSA among children (0-18) who are overweight/obese. Risk factors reviewed included overall adiposity, regional fat distribution, adenotonsillar hypertrophy, sex, ethnicity, and airway neuromuscular tone. PubMed and Embase were searched in July 2025. Random-effects models were applied.

Results: Forty-seven studies were included. Children with OSA had higher BMI z-scores (mean difference (MD) = 0.30), neck circumference (MD = 2.19 cm), and waist circumference (MD = 5.99 cm) compared to obese children without OSA. Adenotonsillar hypertrophy and male sex associated with higher OSA odds (adenoid odds ratio (OR) = 3.28, tonsil OR = 4.16, Male OR = 1.51). Studies also suggested airway neuromuscular tone and non-Caucasian ethnicity as risk factors, but further research is needed.

Conclusion: OSA in obese children is likely to be multifactorial. Assessment accounting for multiple factors may improve screening accuracy and guide targeted interventions in this high-risk population.

Preterm birth is increasingly recognised as a major determinant of lifelong respiratory health. Longitudinal studies consistently demonstrate that individuals born preterm have persistently worse lung function from childhood to adulthood compared with their term born peers. These adverse effects vary across gestational categories including extremely preterm, very preterm and moderate-late preterm birth, and are further exacerbated by bronchopulmonary dysplasia (BPD). Pooled analyses show that children or adults born preterm without BPD had 7.2% [95 confidence interval (CI): 5.6-8.7%] lower percent predicted FEV₁ than term-born individuals. The %FEV₁ deficit was greater in those with BPD: 18.9% [16.7-21.1%] lower for the BPD₃₆ group when compared with the term born group. Lung function deficits in pre-term born survivors persist into adult life. Preterm birth is also associated with increased risk of COPD in later life. There is evidence that male sex confers additional vulnerability in pre-term survivors, with recent literature showing poorer lung function in males compared with females. Understanding these relationships is central to developing future phenotyping frameworks, enabling early identification of those at greatest risk, and informing surveillance strategies aimed at preserving lung function and preventing early onset of chronic obstructive pulmonary disease.

This paper reviews the use of home intravenous antibiotics (IVABs) in children with cystic fibrosis (CF). We outline a program we developed during the COVID-19 pandemic for enhancing the experience for children and families by involving full multidisciplinary follow up via video for the duration of the antibiotic course. We did find though, that the majority of families were unsuitable for home IVABs. We hope that this information will be useful for other CF units considering setting up a hospital at home service.

Study objectives: Children with Down syndrome (DS) often present with craniofacial and neuromuscular features that increase the risk of sleep-disordered breathing (SDB), which may lead to cardiovascular morbidity. We conducted a scoping review to profile the current evidence base describing cardiovascular complications in children with DS and SDB. Findings from this work are expected to identify knowledge gaps that could inform future research and clinical care.

Methods: We performed a systematic scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Comprehensive searches of Embase, Scopus, and MEDLINE were conducted, and eligible studies included children aged 1-18 with DS and SDB reporting cardiovascular outcomes.

Results: Seven studies involving 1,437 participants were included. Across various study designs, children with DS and SDB showed blunted autonomic responses to apneic events, impaired nocturnal dipping of heart rate and blood pressure, increased hypoxic burden even with mild OSA severity, and early signs of left ventricular diastolic dysfunction and bi-ventricular remodeling.

Conclusions: SDB and DS are linked to a constellation of clinical signs consistent with cardiopulmonary end-organ dysfunction and elevated clinical risk. Ongoing cardiac monitoring and use of physiologic measures beyond the apnea-hypopnea index are necessary. Addressing persistent upper airway obstruction with multimodal treatments, including surgery, positive airway pressure, and new therapies like hypoglossal nerve stimulation, may be crucial to lowering long-term cardiovascular risk in this vulnerable group.

Asthma is a common complication in children and young people with sickle cell disease (CYP-SCD), contributing to increased morbidity and mortality. However, diagnosis is challenging due to overlapping SCD-related symptoms and pulmonary complications. This narrative review evaluates the utility of objective measures (spirometry, fractional exhaled nitric oxide -FeNO-, and blood eosinophil count -BEC-) in asthma diagnosis in CYP-SCD. Systematic search identified ten studies comparing asthmatic and non-asthmatic CYP-SCD and data were extracted and critically appraised. Spirometry trended towards lower values and increased obstructive patterns in asthmatic CYP-SCD. Although data interpretation was limited due to inhaled corticosteroid use, likely influencing the inability of FeNO and BEC to differentiate asthma status, alongside SCD-specific pathophysiology. Standardised diagnostic criteria, consistent use of reference ranges and further research into alternative lung function tests and asthma phenotyping are essential.