Pub Date : 2025-10-04DOI: 10.1016/j.prrv.2025.10.001
Adam Lawton, Dominic Hughes
Proponents of artificial intelligence (AI) believe that it will revolutionise the modern world, affecting how healthcare is delivered and improve both the clinical care we provide and the ease with which we perform our work. In this paper we explain what is meant by 'artificial intelligence' and explore how this technology has been implemented, or might be implemented, with respect to paediatric respiratory medicine. We review the current literature on how AI has been used to improve diagnostics - including examples in radiology, primary ciliary dyskinesia (PCD) diagnostics, sleep medicine, and pulmonary function tests. We also review how AI has been applied to therapeutics and drug discovery, how it will impact evidence-based medicine and literature review, and how clinician support tools will assist us in our work.
{"title":"Artificial intelligence in paediatric respiratory medicine.","authors":"Adam Lawton, Dominic Hughes","doi":"10.1016/j.prrv.2025.10.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.10.001","url":null,"abstract":"<p><p>Proponents of artificial intelligence (AI) believe that it will revolutionise the modern world, affecting how healthcare is delivered and improve both the clinical care we provide and the ease with which we perform our work. In this paper we explain what is meant by 'artificial intelligence' and explore how this technology has been implemented, or might be implemented, with respect to paediatric respiratory medicine. We review the current literature on how AI has been used to improve diagnostics - including examples in radiology, primary ciliary dyskinesia (PCD) diagnostics, sleep medicine, and pulmonary function tests. We also review how AI has been applied to therapeutics and drug discovery, how it will impact evidence-based medicine and literature review, and how clinician support tools will assist us in our work.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313300","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}
Pub Date : 2025-09-20DOI: 10.1016/j.prrv.2025.09.001
Jose A Castro-Rodriguez, Gustavo Nino, Asher Tal, Erick Forno
Asthma is an umbrella term for several phenotypes and endotypes. It most frequently begins before the age of 6, with significant morbidity and decline in lung function occurring among all pediatric age groups. A delay in the diagnosis of asthma in preschoolers is associated with more severe exacerbations. One problem clinicians face is how to diagnose asthma early in its course; epidemiological phenotypes (i.e., transient, persistent, late-onset, and mid-childhood remitting wheeze) can only be ascertained retrospectively, and clinical phenotypes (e.g., episodic viral and multi-trigger wheeze) suffer from high variability and no relation with underlying pathological airway markers. International guidelines recommend that lung function tests and biomarkers be performed before diagnosing asthma in children under 5 years old. However, spirometry and airway resistance measures are typically normal in most preschoolers with asthma, and blood eosinophil counts, the most reliable biomarker for inhaled corticosteroid therapy, vary widely over time. Clinical predictive indices can help in predicting and diagnosing asthma in preschoolers. At least eight clinical predictive indices have been published, and four have been validated (API, PIAMA, APT, and PARS). Here, we will review the challenges of diagnosing asthma in the preschool age, the utility of several clinical indices, and the usefulness of incorporating biomarkers such as volatile organic components, exhaled breath condensate, and gene expression. Finally, we will discuss existing gaps and future directions for research in the field.
{"title":"Precision medicine to diagnose asthma in preschool children: comparison of clinical scores, lung function, biomarkers, and genetic tests.","authors":"Jose A Castro-Rodriguez, Gustavo Nino, Asher Tal, Erick Forno","doi":"10.1016/j.prrv.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.09.001","url":null,"abstract":"<p><p>Asthma is an umbrella term for several phenotypes and endotypes. It most frequently begins before the age of 6, with significant morbidity and decline in lung function occurring among all pediatric age groups. A delay in the diagnosis of asthma in preschoolers is associated with more severe exacerbations. One problem clinicians face is how to diagnose asthma early in its course; epidemiological phenotypes (i.e., transient, persistent, late-onset, and mid-childhood remitting wheeze) can only be ascertained retrospectively, and clinical phenotypes (e.g., episodic viral and multi-trigger wheeze) suffer from high variability and no relation with underlying pathological airway markers. International guidelines recommend that lung function tests and biomarkers be performed before diagnosing asthma in children under 5 years old. However, spirometry and airway resistance measures are typically normal in most preschoolers with asthma, and blood eosinophil counts, the most reliable biomarker for inhaled corticosteroid therapy, vary widely over time. Clinical predictive indices can help in predicting and diagnosing asthma in preschoolers. At least eight clinical predictive indices have been published, and four have been validated (API, PIAMA, APT, and PARS). Here, we will review the challenges of diagnosing asthma in the preschool age, the utility of several clinical indices, and the usefulness of incorporating biomarkers such as volatile organic components, exhaled breath condensate, and gene expression. Finally, we will discuss existing gaps and future directions for research in the field.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233073","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}
Pub Date : 2025-09-15DOI: 10.1016/j.prrv.2025.07.002
David Drummond, Job F M van Boven, Boudewijn J H Dierick, Ireti Adejumo, William Carroll, Heather De Keyser, Erol A Gaillard, Amy Chan
Smart inhaler systems represent a major opportunity to transform paediatric asthma care by potentially addressing three fundamental problems affecting paediatric asthma outcomes: medication adherence, inhalation technique and reliever overuse. The data generated across these domains opens up multiple applications - from supporting patient self-management to enabling early detection of asthma deterioration. In this review, we outline the main categories of smart inhalers - including digital dose counters, smart spacers, and smart nebulisers - and summarise the current evidence surrounding their use in children. We discuss key obstacles to implementation, including technical limitations, behavioural factors, and health system-level challenges. Establishing clear smart inhaler systems quality standards, defining appropriate indications resulting in better asthma outcomes, achieving better integration of smart inhaler data into electronic health care records, and generating robust cost-effectiveness data will be essential to support the widespread clinical adoption of these technologies.
{"title":"Smart inhalers in paediatric asthma: bridging the gap between innovation and clinical practice.","authors":"David Drummond, Job F M van Boven, Boudewijn J H Dierick, Ireti Adejumo, William Carroll, Heather De Keyser, Erol A Gaillard, Amy Chan","doi":"10.1016/j.prrv.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.07.002","url":null,"abstract":"<p><p>Smart inhaler systems represent a major opportunity to transform paediatric asthma care by potentially addressing three fundamental problems affecting paediatric asthma outcomes: medication adherence, inhalation technique and reliever overuse. The data generated across these domains opens up multiple applications - from supporting patient self-management to enabling early detection of asthma deterioration. In this review, we outline the main categories of smart inhalers - including digital dose counters, smart spacers, and smart nebulisers - and summarise the current evidence surrounding their use in children. We discuss key obstacles to implementation, including technical limitations, behavioural factors, and health system-level challenges. Establishing clear smart inhaler systems quality standards, defining appropriate indications resulting in better asthma outcomes, achieving better integration of smart inhaler data into electronic health care records, and generating robust cost-effectiveness data will be essential to support the widespread clinical adoption of these technologies.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233065","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}
Pub Date : 2025-09-01DOI: 10.1016/j.prrv.2024.09.002
Dominika Ambrożej , Maja Cieślik , Wojciech Feleszko , Carlos E. Rodriguez-Martinez , Jose A. Castro-Rodriguez
Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are essential in asthma management, but the guidelines for treatment in preschool children remain heterogeneous worldwide. This systematic review evaluates the efficacy and safety of LABA + ICS therapy in asthmatic children under six years. We searched four databases, identifying six eligible studies (n = 1415 preschoolers), and in all the LABA used was salmeterol. Due to high heterogeneity, quantitative analysis was not feasible. Three before-and-after studies demonstrated significant reductions in unscheduled visits and hospitalizations due to asthma exacerbations with LABA + ICS. One RCT showed fewer exacerbations in the LABA + ICS group compared to ICS alone. Night-time awakenings decreased significantly in two studies but not in one RCT. Improvements in lung function using impulse oscillometry and FeNO levels were noted with LABA+ICS in one RCT. No significant adverse effects were reported. Despite positive findings, high-quality trials are needed to confirm these results, particularly using formoterol as LABA, aligning with the recommendations. Further research is imperative to optimize asthma management in preschool children.
{"title":"Addition of long‐acting beta‐agonists to inhaled corticosteroids for asthma in preschool children: A systematic review","authors":"Dominika Ambrożej , Maja Cieślik , Wojciech Feleszko , Carlos E. Rodriguez-Martinez , Jose A. Castro-Rodriguez","doi":"10.1016/j.prrv.2024.09.002","DOIUrl":"10.1016/j.prrv.2024.09.002","url":null,"abstract":"<div><div><span><span>Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are essential in asthma management, but the guidelines for treatment in preschool children remain heterogeneous worldwide. This </span>systematic review<span><span><span> evaluates the efficacy and safety of LABA + ICS therapy in asthmatic children under six years. We searched four databases, identifying six eligible studies (n = 1415 preschoolers), and in all the LABA used was </span>salmeterol. Due to high heterogeneity, quantitative analysis was not feasible. Three before-and-after studies demonstrated significant reductions in unscheduled visits and hospitalizations due to </span>asthma exacerbations with LABA + ICS. One </span></span>RCT<span> showed fewer exacerbations in the LABA + ICS group compared to ICS alone. Night-time awakenings decreased significantly in two studies but not in one RCT<span><span>. Improvements in lung function using impulse oscillometry and </span>FeNO<span> levels were noted with LABA+ICS in one RCT. No significant adverse effects were reported. Despite positive findings, high-quality trials are needed to confirm these results, particularly using formoterol as LABA, aligning with the recommendations. Further research is imperative to optimize asthma management in preschool children.</span></span></span></div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"55 ","pages":"Pages 23-29"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605116","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}
Pub Date : 2025-09-01DOI: 10.1016/j.prrv.2024.10.001
Oscar Henry Mayer , Greg Redding
The chest and spine deformity in neuromuscular disease (NMDz) can impact respiratory mechanics and pulmonary function by changing the orientation of the muscles and joints of the respiratory system and placing them in a mechanically unfavorable position. This increases mechanical load on weak respiratory muscles and eventually can cause respiratory failure. Therefore, chest and spine deformity in NMDz will both lead to increased respiratory “load” and decreased respiratory muscle “pump”, an exceptionally bad combination.
While the current pharmacotherapies used for progressive neuromuscular disease focus on slowing progression, a similar approach has been used for decades in managing chest and spine deformity in patients with NMDz. There are, however, variable approaches to doing so and a recognition that not all “neuromuscular scoliosis” is the same and that each patient type (i.e. hypotonic vs. hypertonic) requires a different approach. Figuring out what approach to use requires both an understanding of the underlying pathophysiology of a particular neuromuscular condition and considering available options for and timing of surgical interventions. The remaining discussion will focus on hypotonic neuromuscular scoliosis.
{"title":"Chest and spinal disease in patients with progressive neuromuscular disease","authors":"Oscar Henry Mayer , Greg Redding","doi":"10.1016/j.prrv.2024.10.001","DOIUrl":"10.1016/j.prrv.2024.10.001","url":null,"abstract":"<div><div>The chest and spine deformity in neuromuscular disease (NMDz) can impact respiratory mechanics and pulmonary function by changing the orientation of the muscles and joints of the respiratory system and placing them in a mechanically unfavorable position. This increases mechanical load on weak respiratory muscles and eventually can cause respiratory failure. Therefore, chest and spine deformity in NMDz will both lead to increased respiratory “load” and decreased respiratory muscle “pump”, an exceptionally bad combination.</div><div>While the current pharmacotherapies used for progressive neuromuscular disease focus on slowing progression, a similar approach has been used for decades in managing chest and spine deformity in patients with NMDz. There are, however, variable approaches to doing so and a recognition that not all “neuromuscular scoliosis” is the same and that each patient type (i.e. hypotonic vs. hypertonic) requires a different approach. Figuring out what approach to use requires both an understanding of the underlying pathophysiology of a particular neuromuscular condition and considering available options for and timing of surgical interventions. The remaining discussion will focus on hypotonic neuromuscular scoliosis.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"55 ","pages":"Pages 30-49"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822467","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}
Pub Date : 2025-09-01DOI: 10.1016/j.prrv.2025.01.001
H.T. Fitzgerald , T. Halvorsen , M. Engan , S. Li , H. Selvadurai
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.
{"title":"Exercise capacity and the psychosocial effect in preterm born infants – Should we do more?","authors":"H.T. Fitzgerald , T. Halvorsen , M. Engan , S. Li , H. Selvadurai","doi":"10.1016/j.prrv.2025.01.001","DOIUrl":"10.1016/j.prrv.2025.01.001","url":null,"abstract":"<div><div><span><span>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 </span>cardiopulmonary function, improve </span>quality of life, and foster social interactions in childhood and beyond, thereby providing benefits that extend far beyond the physical domain.</div><div>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.</div><div>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.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"55 ","pages":"Pages 10-16"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143040689","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}
Pub Date : 2025-09-01DOI: 10.1016/j.prrv.2025.01.004
Mon Ohn , Kathleen J. Maddison , Jennifer H. Walsh , Britta S. von Ungern-Sternberg
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.
{"title":"The future of paediatric obstructive sleep apnoea assessment: Integrating artificial intelligence, biomarkers, and more","authors":"Mon Ohn , Kathleen J. Maddison , Jennifer H. Walsh , Britta S. von Ungern-Sternberg","doi":"10.1016/j.prrv.2025.01.004","DOIUrl":"10.1016/j.prrv.2025.01.004","url":null,"abstract":"<div><div><span>Assessing obstructive sleep apnoea (OSA) in children involves various methodologies, including sleep studies, nocturnal </span>oximetry<span><span>, 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 </span>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.</span></div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"55 ","pages":"Pages 68-74"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075278","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}
Pub Date : 2025-09-01DOI: 10.1016/j.prrv.2024.10.002
Grigorios Chatziparasidis , Ahmad Kantar , Maria Rafailia Chatziparasidi , Sotirios Fouzas , Andrew Bush , Anne Chang
Climate change may have devastating effects on the pathogenesis of non-cystic fibrosis bronchiectasis in children since it affects the biological cycle of the respiratory pathogens and alters the human respiratory defense mechanisms. Bronchiectasis in children has been identified as an emerging global epidemic that has attracted the attention of the medical community over recent years. Pediatric pulmonologists should be aware of the consequences of climate change on children with bronchiectasis and plan strategies to ameliorate these effects.
{"title":"The potential effects of climate change on non-cystic fibrosis bronchiectasis in children","authors":"Grigorios Chatziparasidis , Ahmad Kantar , Maria Rafailia Chatziparasidi , Sotirios Fouzas , Andrew Bush , Anne Chang","doi":"10.1016/j.prrv.2024.10.002","DOIUrl":"10.1016/j.prrv.2024.10.002","url":null,"abstract":"<div><div><span>Climate change may have devastating effects on the pathogenesis of non-cystic fibrosis bronchiectasis in children since it affects the biological cycle of the respiratory pathogens and alters the human respiratory defense mechanisms. Bronchiectasis in children has been identified as an emerging global epidemic that has attracted the attention of the medical community over recent years. </span>Pediatric pulmonologists should be aware of the consequences of climate change on children with bronchiectasis and plan strategies to ameliorate these effects.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"55 ","pages":"Pages 50-58"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142730974","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}
Pub Date : 2025-09-01DOI: 10.1016/j.prrv.2023.12.002
H. Fitzgerald , D.A. Fitzgerald , H. Selvadurai
With increasing competitiveness across the sporting landscape, there is a need for more research into monitoring and managing the young athlete, as the needs of a young athlete are vastly different to those of an older athlete who is already established in their respective sport. As the age of sports specialisation seems to decrease, exercise testing in the younger cohort of athletes is crucial for safety and long-term success. This article provides a comprehensive summary of available testing and monitoring methods that can be used to assist young athletes as they mature and attempt to excel in their chosen sport.
{"title":"Exercise testing for young athletes","authors":"H. Fitzgerald , D.A. Fitzgerald , H. Selvadurai","doi":"10.1016/j.prrv.2023.12.002","DOIUrl":"10.1016/j.prrv.2023.12.002","url":null,"abstract":"<div><div>With increasing competitiveness across the sporting landscape, there is a need for more research into monitoring and managing the young athlete, as the needs of a young athlete are vastly different to those of an older athlete who is already established in their respective sport. As the age of sports specialisation seems to decrease, exercise testing in the younger cohort of athletes is crucial for safety and long-term success. This article provides a comprehensive summary of available testing and monitoring methods that can be used to assist young athletes as they mature and attempt to excel in their chosen sport.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"55 ","pages":"Pages 3-9"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138818971","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}
Pub Date : 2025-09-01DOI: 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.
{"title":"Surfactant administration and cerebral oxygenation and perfusion in preterm neonates − A systematic review of literature","authors":"Christina H. Wolfsberger , Marlies Bruckner , Christoph Schlatzer , Bernhard Schwaberger , Nariae Baik-Schneditz , Berndt Urlesberger , Gerhard Pichler","doi":"10.1016/j.prrv.2024.11.001","DOIUrl":"10.1016/j.prrv.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Objective</h3><div>This review systematically examined the literature on surfactant administration in preterm neonates and its impact on NIRS-measured cerebral oxygenation.</div></div><div><h3>Methods</h3><div>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 (crSO<sub>2</sub>), crSO<sub>2</sub>, cerebral perfusion. Only studies in human preterm neonates were included.</div></div><div><h3>Results</h3><div>Sixteen studies were identified that described cerebral oxygenation measured by NIRS in the context of surfactant administration demonstrating a decrease in crSO<sub>2</sub> during surfactant administration, followed by a subsequent increase. Three studies specifically described the course of crSO<sub>2</sub> in neonates while receiving LISA, whereby in two of these LISA was compared to INSURE describing differences in crSO<sub>2</sub> 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 crSO<sub>2</sub> in neonates receiving aerosolised surfactant.</div></div><div><h3>Conclusion</h3><div>This systematic review indicates that surfactant administration is associated with a transient decrease in crSO<sub>2</sub> followed by a return to baseline levels, whereby differences between the LISA and INSURE methods were observed.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"55 ","pages":"Pages 59-67"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818889","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}
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