Paediatric Respiratory Reviews最新文献

英文中文

Surfactant administration and cerebral oxygenation and perfusion in preterm neonates - A systematic review of literature. 早产新生儿使用表面活性物质与脑氧合和灌注--文献系统回顾。

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-11 DOI: 10.1016/j.prrv.2024.11.001

Christina H Wolfsberger, Marlies Bruckner, Christoph Schlatzer, Bernhard Schwaberger, Nariae Baik-Schneditz, Berndt Urlesberger, Gerhard Pichler

Background: Surfactant replacement is standard for preterm neonates with respiratory distress syndrome, improving survival and outcomes. Less invasive surfactant administration (LISA) and intubation-surfactant-extubation (INSURE) are preferred methods for surfactant replacement in spontaneously breathing preterm neonates. Despite the undeniable benefits of surfactant implementation in neonatal care, surfactant administration can affect vital parameters and cerebral oxygenation and perfusion, assessed by near-infrared spectroscopy (NIRS).

Objective: This review systematically examined the literature on surfactant administration in preterm neonates and its impact on NIRS-measured cerebral oxygenation.

Methods: A systematic search of PubMed, Embase, CINAHL, Clinical Trials, and Ovid Medline was conducted using following terms: newborn, infant, neonate, preterm, premature, prematurity, surfactant, LISA, less-invasive surfactant administration, INSURE, near-infrared-spectroscopy, NIRS, oximetry, spectroscopy, cerebral oxygenation, cerebral tissue oxygen saturation (crSO₂), crSO₂, cerebral perfusion. Only studies in human preterm neonates were included.

Results: Sixteen studies were identified that described cerebral oxygenation measured by NIRS in the context of surfactant administration demonstrating a decrease in crSO₂ during surfactant administration, followed by a subsequent increase. Three studies specifically described the course of crSO₂ in neonates while receiving LISA, whereby in two of these LISA was compared to INSURE describing differences in crSO₂ behaviour. Two additional studies described surfactant administration using the INSURE procedure and the influence on cerebral oxygenation. Ten studies investigated surfactant administration in intubated neonates receiving mechanical ventilation. One study described crSO₂ in neonates receiving aerosolised surfactant.

Conclusion: This systematic review indicates that surfactant administration is associated with a transient decrease in crSO₂ followed by a return to baseline levels, whereby differences between the LISA and INSURE methods were observed.

背景：表面活性剂替代是治疗呼吸窘迫综合征早产儿的标准方法，可改善生存率和预后。微创表面活性剂给药（LISA）和插管-表面活性剂-拔管（INSURE）是自主呼吸早产儿表面活性剂替代的首选方法。尽管表面活性剂在新生儿护理中的应用有不可否认的好处，但表面活性剂的使用可以影响重要参数和脑氧合和灌注，近红外光谱（NIRS）评估。目的：系统回顾了有关表面活性剂在早产儿中的应用及其对nirs测定的脑氧合的影响。方法：系统检索PubMed、Embase、CINAHL、临床试验和Ovid Medline，使用以下术语：新生儿、婴儿、新生儿、早产儿、早产、早产儿、表面活性剂、LISA、低创表面活性剂给药、INSURE、近红外光谱、近红外光谱、血氧仪、光谱学、脑氧合、脑组织氧饱和度（crSO2）、crSO2、脑灌注。仅包括对人类早产儿的研究。结果：16项研究发现，在表面活性剂施用的背景下，用近红外光谱测量脑氧合，表明表面活性剂施用期间crSO2减少，随后增加。三项研究专门描述了接受LISA治疗的新生儿的crSO2过程，其中两项研究将LISA与INSURE进行了比较，以描述crSO2行为的差异。另外两项研究描述了使用INSURE程序给药表面活性剂及其对脑氧合的影响。10项研究探讨了表面活性剂在接受机械通气的插管新生儿中的应用。一项研究描述了接受雾化表面活性剂的新生儿的crSO2。结论：本系统综述表明，表面活性剂的施用与crSO2的短暂下降有关，随后恢复到基线水平，因此观察到LISA和INSURE方法之间的差异。

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引用次数: 0

The lower airway microbiome in paediatric health and chronic disease 儿童健康和慢性疾病中的下呼吸道微生物组

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2024.02.001

S Campbell , K Gerasimidis , S Milling , AJ Dicker , R Hansen , RJ Langley

The advent of next generation sequencing has rapidly challenged the paediatric respiratory physician’s understanding of lung microbiology and the role of the lung microbiome in host health and disease. In particular, the role of “microbial key players” in paediatric respiratory disease is yet to be fully explained. Accurate profiling of the lung microbiome in children is challenging since the ability to obtain lower airway samples coupled with processing “low-biomass specimens” are both technically difficult. Many studies provide conflicting results. Early microbiota-host relationships may be predictive of the development of chronic respiratory disease but attempts to correlate lower airway microbiota in premature infants and risk of developing bronchopulmonary dysplasia (BPD) have produced mixed results. There are differences in lung microbiota in asthma and cystic fibrosis (CF). The increased abundance of oral taxa in the lungs may (or may not) promote disease processes in asthma and CF. In CF, correlation between microbiota diversity and respiratory decline is commonly observed. When one considers other pathogens beyond the bacterial kingdom, the contribution and interplay of fungi and viruses within the lung microbiome further increase complexity. Similarly, the interaction between microbial communities in different body sites, such as the gut-lung axis, and the influence of environmental factors, including diet, make the co-existence of host and microbes ever more complicated. Future, multi-omics approaches may help uncover novel microbiome-based biomarkers and therapeutic targets in respiratory disease and explain how we can live in harmony with our microbial companions.

新一代测序技术的出现迅速挑战了儿科呼吸科医生对肺部微生物学以及肺部微生物组在宿主健康和疾病中作用的认识。特别是，"微生物关键角色 "在儿科呼吸系统疾病中的作用尚未得到充分解释。由于获取下气道样本和处理 "低生物量样本 "在技术上都存在困难，因此对儿童肺部微生物组进行精确分析具有挑战性。许多研究提供了相互矛盾的结果。

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引用次数: 0

Pulmonary fibrosis treatment in children – What have we learnt from studies in adults? 儿童肺纤维化治疗--我们从成人研究中学到了什么？

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2023.12.001

Michael B. Jia , Dominic A. Fitzgerald

Pulmonary fibrosis (PF) in children is a rare complication of specific forms of childhood interstitial lung diseases (chILD) with extremely limited scientific evidence to guide optimal management. Whilst there continues to be significant progress in PF management for adult populations, paediatric guidelines have stagnated. New anti-fibrotic medications (nintedanib and pirfenidone) are finding regular use amongst adult PF patients but remain largely unstudied and untested in children. Although there are major differences between the two age-group populations, it is useful to learn from the evolution of adult PF management, especially in the absence of dedicated paediatric studies. Whilst there have been recent trials aimed at assessing the safety and efficacy of drugs such as nintedanib and hydroxychloroquine, there is still a dire need for more research aimed at further assessing current treatment practices and evaluating the safety and efficacy of new emerging treatments in the paediatric population.

儿童肺纤维化（PF）是儿童间质性肺病（chILD）的一种罕见并发症，用于指导最佳治疗的科学证据极其有限。虽然成人肺纤维化治疗取得了重大进展，但儿科指南却停滞不前。新的抗纤维化药物（nintedanib 和 pirfenidone）在成人 PF 患者中得到了常规使用，但在儿童患者中基本上仍未进行研究和测试。虽然这两个年龄组的人群之间存在很大差异，但从成人 PF 管理的演变中汲取经验是有益的，尤其是在缺乏专门的儿科研究的情况下。虽然最近有一些试验旨在评估宁替达尼（nintedanib）和羟氯喹等药物的安全性和有效性，但仍然迫切需要更多的研究来进一步评估当前的治疗方法，并评估新出现的治疗方法在儿科人群中的安全性和有效性。

引用次数: 0

Effectiveness of high flow nasal Cannula (HFNC) therapy compared to standard oxygen therapy (SOT) and continuous positive airway pressure (CPAP) in bronchiolitis 高流量鼻导管（HFNC）疗法与标准氧疗（SOT）和持续气道正压（CPAP）对支气管炎的疗效比较

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2024.05.004

Emma C Alexander , Toranj Wadia , Padmanabhan Ramnarayan

High Flow Nasal Cannula therapy (HFNC) is a form of respiratory support for bronchiolitis. Recent evidence confirms HFNC reduces the risk of treatment escalation by nearly half (45%) compared to standard oxygen therapy (SOT), although most patients (75%) with mild-moderate respiratory distress manage well on SOT. The majority of children (60%) failing SOT respond well to HFNC making rescue use of HFNC a more cost-effective approach compared to its first-line use. HFNC is compared to CPAP in the setting of moderate to severe bronchiolitis. Patients on HFNC have a slightly elevated risk of treatment failure especially in severe bronchiolitis, but this does not translate to a significant difference in patient or healthcare centred outcomes. HFNC has improved tolerance, a lower complication rate and is more easily available in peripheral hospitals. It is therefore the preferred first line option followed by rescue CPAP. HFNC is clinically effective and safe to use in bronchiolitis of all severities.

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引用次数: 0

Go slow with high flow initiation in bronchiolitis 支气管炎患者开始使用大流量时，速度要慢

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2024.05.005

Dominic A. Fitzgerald

引用次数: 0

Post viral bronchiolitis obliterans in children: A rare and potentially devastating disease 儿童病毒后阻塞性支气管炎：一种罕见的潜在破坏性疾病

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2024.04.003

Julie Mazenq , Jean-Christophe Dubus , Pascal Chanez , Delphine Gras

Post infectious bronchiolitis obliterans (PIBO) is a rare but severe disease in children. Several respiratory pathogens are incriminated but adenovirus is still the most represented. Risk factors are well described: the male gender, hypoxemia at diagnosis and required mechanical ventilation. No risk factor is linked to the newborn period. The clinical spectrum of PIBO is broad, ranging from asymptomatic patients with fixed airflow obstruction to severe respiratory insufficiency requiring continuous oxygen supplementation. Diagnosis includes a combination of a clinical history, absence of reversible airflow obstructions and ground glass and gas trapping on high resolution computed tomography. PIBO is primarily a neutrophilic pathology of small bronchioles characterized by high levels of pro-inflammatory cytokines leading to tissue remodeling and fibrosis of the small airways. The difficulty is to discriminate between the host’s normal response, an exaggerated inflammatory response and the potential iatrogenic consequences of the initial infection treatment, particularly prolonged mechanical ventilation. Damage to the respiratory epithelium with a possible link to viral infections are considered as potential mechanisms of PIBO. No specific management exists. Much remains to be done in this field to clarify the underlying mechanisms, identify biomarkers, and develop clear monitoring pathways and treatment protocols.

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引用次数: 0

A Review Of Host-Specific Diagnostic And Surrogate Biomarkers In Children With Pulmonary Tuberculosis 儿童肺结核宿主特异性诊断和替代生物标志物综述

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2024.01.005

Junaid Shaik , Manormoney Pillay , Prakash Jeena

Background

Tuberculosis (TB) is one of the most common causes of mortality globally with a steady rise in paediatric cases in the past decade. Laboratory methods of diagnosing TB and monitoring response to treatment have limitations. Current research focuses on interrogating host- and/or pathogen-specific biomarkers to address this problem.

Methods

We reviewed the literature on host-specific biomarkers in TB to determine their value in diagnosis and treatment response in TB infected and HIV/TB co-infected children on anti-tuberculosis treatment.

Results and Conclusion

While no single host-specific biomarker has been identified for diagnosis or treatment responses in children, several studies suggest predictive biosignatures for disease activity. Alarmingly, current data on host-specific biomarkers for diagnosing and assessing anti-tuberculosis treatment in TB/HIV co-infected children is inadequate. Various factors affecting host-specific biomarker responses should be considered in interpreting findings and designing future studies within specific clinical settings.

背景：结核病（TB）是全球最常见的死亡原因之一，在过去十年中，儿科病例稳步上升。诊断结核病和监测治疗反应的实验室方法存在局限性。目前的研究重点是通过询问宿主和/或病原体特异性生物标志物来解决这一问题：我们回顾了有关结核病宿主特异性生物标志物的文献，以确定它们在结核病感染儿童和接受抗结核治疗的 HIV/TB 合并感染儿童的诊断和治疗反应中的价值：虽然还没有发现单一的宿主特异性生物标志物可用于儿童诊断或治疗反应，但有几项研究提出了疾病活动的预测性生物特征。令人担忧的是，目前用于诊断和评估结核病/艾滋病毒合并感染儿童抗结核治疗的宿主特异性生物标志物数据不足。在解释研究结果和设计特定临床环境下的未来研究时，应考虑影响宿主特异性生物标志物反应的各种因素。

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引用次数: 0

High flow, low results: The limits of high flow nasal cannula in the treatment of bronchiolitis 高流量，低效果：高流量鼻插管在治疗支气管炎中的局限性

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2024.06.003

Jennifer E. Lane , Taylor Ford , Michelle Noelck , Courtney Byrd

Bronchiolitis continues to be the most common cause of hospitalization in the first year of life. We continue to search for the remedy that will improve symptoms, shorten hospitalization and prevent worsening of disease. Although initially thought to be a promising therapy, large randomized controlled trials show us that high flow nasal cannula (HFNC) use is not that remedy. These trials show no major differences in duration of hospital stay, intensive care unit (ICU) admission rates, duration of stay in the ICU, duration of oxygen therapy, intubation rates, heart rate, respiratory rate or comfort scores. Additionally, practices regarding initiation, flow rates and weaning continue to vary from institution to institution and there are currently no agreed upon indications for its use. This reveals the need for evidence based guidelines on HFNC use in bronchiolitis.

引用次数: 0

Intravenous magnesium sulfate for asthma exacerbations in children: Systematic review with meta-analysis 静脉注射硫酸镁治疗儿童哮喘加重：系统综述与荟萃分析

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2024.01.003

Dominika Ambrożej , Aleksander Adamiec , Erick Forno , Izabela Orzołek , Wojciech Feleszko , Jose A. Castro-Rodriguez

Background

Asthma is the most prevalent chronic disease in children and constitutes a significant healthcare burden. First-line therapy for acute asthma exacerbations is well established. However, secondary treatments, including intravenous magnesium sulfate (IV-MgSO4), remain variable due to scarcity of data on its efficacy and safety.

Objective

To assess the effectiveness and safety of IV-MgSO4 as a second line of treatment in managing children with asthma exacerbations.

Methods

We searched five databases from inception until April 2023 on randomized clinical trials of IV-MgSO4 in children with acute asthma exacerbations. The primary outcomes were hospitalization rate and length, and change in the severity score. Secondary outcomes included percentage increase in peak expiratory flow rate (PEFR), hospital re-admission rate, need and length for pediatric intensive care unit (PICU) treatment, and adverse effects. Meta-analysis was performed for three outcomes with estimated odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs).

Results

Eleven studies met the final criteria. In comparison to control, administration of IV-MgSO4 was associated with a reduced hospitalization risk (OR 0.15; 95%CI: 0.03, 0.73) in four studies, and improvement of lung function (MD 26.77% PEFR; 95%CI: 18.41, 54.79) in two studies. There were no significant differences in the length of stay between groups. Due to heterogeneity, a narrative synthesis of other outcomes was performed.

Conclusion

The use of IV-MgSO4 demonstrated a reduction in the hospitalization rate and PEFR improvement in children with asthma exacerbations. Adverse effects were rare. Further well-designed studies are needed to better determine the efficacy and safety profile of IV-MgSO4.

{"title":"Intravenous magnesium sulfate for asthma exacerbations in children: Systematic review with meta-analysis","authors":"Dominika Ambrożej , Aleksander Adamiec , Erick Forno , Izabela Orzołek , Wojciech Feleszko , Jose A. Castro-Rodriguez","doi":"10.1016/j.prrv.2024.01.003","DOIUrl":"10.1016/j.prrv.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Asthma is the most prevalent chronic disease<span> in children and constitutes a significant healthcare burden. First-line therapy for acute asthma exacerbations is well established. However, secondary treatments, including intravenous magnesium sulfate (IV-MgSO4), remain variable due to scarcity of data on its efficacy and safety.</span></div></div><div><h3>Objective</h3><div>To assess the effectiveness and safety of IV-MgSO4 as a second line of treatment in managing children with asthma exacerbations.</div></div><div><h3>Methods</h3><div><span>We searched five databases from inception until April 2023 on randomized clinical trials of IV-MgSO4 in children with acute asthma exacerbations. The primary outcomes were hospitalization rate and length, and change in the severity score. Secondary outcomes included percentage increase in </span>peak expiratory flow rate<span><span> (PEFR), hospital re-admission rate, need and length for pediatric intensive care unit (PICU) treatment, and </span>adverse effects. Meta-analysis was performed for three outcomes with estimated odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs).</span></div></div><div><h3>Results</h3><div>Eleven studies met the final criteria. In comparison to control, administration of IV-MgSO4 was associated with a reduced hospitalization risk (OR 0.15; 95%CI: 0.03, 0.73) in four studies, and improvement of lung function (MD 26.77% PEFR; 95%CI: 18.41, 54.79) in two studies. There were no significant differences in the length of stay between groups. Due to heterogeneity, a narrative synthesis of other outcomes was performed.</div></div><div><h3>Conclusion</h3><div>The use of IV-MgSO4 demonstrated a reduction in the hospitalization rate and PEFR improvement in children with asthma exacerbations. Adverse effects were rare. Further well-designed studies are needed to better determine the efficacy and safety profile of IV-MgSO4.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"52 ","pages":"Pages 23-30"},"PeriodicalIF":4.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139875941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Addressing high flow overuse in bronchiolitis − Successes and future directions 解决支气管炎大流量过度使用问题--成功经验与未来方向

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2024-12-01 DOI: 10.1016/j.prrv.2024.06.002

Taylor Ford , Jennifer Lane , Michelle Noelck , Courtney Byrd

The use of high flow nasal cannula (HFNC) in the treatment of bronchiolitis has markedly increased in the last decade, yet randomized controlled trials have reported little clinical benefit with early, routine use. This article provides a concise overview of the current status of HFNC therapy, discusses successful de-implementation strategies to curtail HFNC overuse, and explores future bronchiolitis and HFNC quality improvement and research considerations.

引用次数: 0

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