Paediatric Respiratory Reviews最新文献

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.