Paediatric Respiratory Reviews最新文献

Background: Lung ultrasound (LUS) is an established bedside tool for assessing neonatal respiratory distress. However, conventional semi-quantitative LUS scoring relies on subjective interpretation and may miss subtle but clinically relevant differences in lung aeration. We hypothesized that a novel quantitative grayscale-based Heterogeneity Index (HI) derived from LUS video loops could objectively quantify lung aeration and be associated with respiratory severity and clinical outcomes.

Methods: In this prospective single-centre observational study, neonates with respiratory distress underwent LUS within 15-30 min after birth. LUS scoring was performed bilaterally across anterior, lateral, and posterior lung fields. Quantitative analysis used manually selected regions of interest from 2-second raw LUS video loops acquired from lateral lung fields. Grayscale- (Gray_mean, Gray_SD_time) and heterogeneity-based metrics (HI, HI_SD_time) were calculated using a custom MATLAB algorithm and correlated with oxygenation parameters, blood gas and acid-base parameters, diagnoses, and duration of respiratory support.

Results: Of 47 neonates (gestational age 37.2 ± 1.8 weeks), 24 had transient tachypnoea of the newborn (TTN), 6 had respiratory distress syndrome (RDS), and 17 had delayed neonatal transition. ROC analysis demonstrated that grayscale- and HI-based metrics enabled early discrimination between respiratory diagnoses. Gray_mean and HI differentiated delayed transition from TTN (Gray_mean: AUC 0.85, 95% CI 0.72-0.96, HI: AUC 0.84, 95% CI 0.69-0.95), Gray_SD_time differentiated TTN from RDS (AUC 0.75, 95% CI 0.56-0.91), and HI_SD_time differentiated delayed transition from RDS (AUC 0.89, 95% CI 0.72-1.00). In TTN neonates, HI showed moderate discrimination for disease severity (AUC 0.72, 95% CI 0.49-0.91). Gray_SD_time correlated with FiO₂, lower pH, and longer respiratory support. TTN neonates requiring prolonged respiratory support showed higher LUS scores, higher FiO₂ requirements, and worse acid-base status compared to neonates with rapid resolution of symptoms. In RDS neonates, higher HI was associated with higher pCO₂ and lower pH, whereas LUS scores showed no significant correlations.

Conclusion: Quantitative grayscale analysis of LUS video loops provides an objective measure of lung aeration. HI correlates with respiratory severity and may detect subtle changes not captured by conventional LUS scoring.

With an ever increasing number of excellent publications in the field of pediatic pulmonary and sleep medicine each year, it is a challenge to identify those with the greatest impact and interest for readers of this journal. The challenge was made both more exciting and more difficult when a group of leaders in the field recommend nearly 100 papers that they loved and asked us to consider. We have read each of these recommendations and agonized over which to include here. We hope that you enjoy reading this collection as much as we have enjoyed preparing it.

In this article the curmudgeonly authors take a broad strokes reflection upon the misuse of language in the medical literature through the lens of paediatric pulmonology. The paper addresses the cult of conciseness as reflected in the explosion of ambiguous acronyms, the dismantling of the Latin and Greek origins of medical terminology, and the insatiable desire to change taxonomy seemingly for change sake. The paper serves as a call to arms for those seasoned clinicians of a certain age to push back against the tic-toc approach to learning in the literature and at the bedside in modern paediatric respiratory medicine.

Bronchiectasis in children is a heterogeneous, chronic respiratory condition for which standardised, evidence-based management is essential. While international guidelines have improved diagnostic and therapeutic consistency, the treatable traits (TT) approach offers a complementary precision-medicine framework aimed at identifying all clinically relevant, measurable, and modifiable factors in individual patients. Through a comprehensive literature review, we identified 40 potential TT in paediatric bronchiectasis, spanning aetiological, pulmonary, extrapulmonary, and behavioural/environmental domains. However, the level of evidence supporting many TT remains limited in children, with most data extrapolated from adults or other respiratory diseases. This framework should therefore be considered dynamic, guiding systematic assessment while emphasising the urgent need for paediatric-specific clinical trials.

Background: Long-term non-invasive ventilation (LT-NIV) is commonly used to treat sleep-related breathing disorders (SRBD) in children. Children with central nervous system (CNS) disorders experience a high rate of SRBDs. However, the outcomes of LT-NIV use for children with CNS disorders remains unclear.

Methods: This systematic review is a sub-study of a scoping review on LT-NIV use in children. The scoping review search strategy identified studies of children using LT-NIV from January 1990 to March 2024. These results were searched for studies of children with CNS disorders. To identify studies for meta-analysis, studies were grouped as: 1) studies of children with CNS disorders as part of broader a broader group of children using LT-NIV; 2) studies exclusively of children with CNS disorders using LT-NIV; and 3) studies of children with congenital central hypoventilation syndrome using LT-NIV. The Non-Randomized Studies of Interventions tool was used to assessed risk of bias.

Results: A total of 55 studies met inclusion criteria and included 2,015 children with CNS disorders using LT-NIV. Nineteen studies reported outcomes specific to children with CNS disorders. Meta-analysis of four studies showed no difference in mortality between children with and without CNS disorders(1.23, 95% CI: 0.40-3.79). Hospitalization rates across four studies suggested a higher rate of hospitalization in children with CNS disorders compared to children without CNS disorders. Meta-analysis of three studies showed reductions in the apnoea-hypopnoea index following LT-NIV use; the response to LT-NIV, however, varied across individual studies.

Conclusion: LT-NIV use may benefit some children with CNS disorders, particularly through improvements in sleep-related breathing disorders. However, data remain limited, and uncertainty persists regarding the impact on mortality, hospitalization, and other important outcomes.

Background: This scoping review examines the recommendations for short-acting beta-agonists (SABA) in discharge and weaning plans following acute asthma exacerbations in children. It focuses on SABA overprescription in discharge/weaning plans after acute asthma exacerbations and explores strategies to promote protocol-directed care.

Methods: National and institutional protocols from the USA, UK, Australia, Canada, and Singapore between 2000 and 2025 were reviewed. Data on SABA weaning plan recommendations, initial dosage, frequency, duration, and caregiver instructions were extracted and analysed using descriptive statistics. Searches were conducted from December 2024 to August 2025.

Results: Significant variability in protocols was found, with no randomised controlled trials or systematic reviews supporting current SABA discharge/weaning practices, highlighting a lack of evidence-based recommendations.

Conclusions: There is an urgent need for RCTs to guide safe SABA use. Improved patient education, access to inhaled corticosteroids, and evidence-based discharge plans are key to reducing SABA overuse and improving paediatric asthma outcomes.

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.