Paediatric Respiratory Reviews最新文献

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.

Consolidated nighttime sleep is a critical milestone in infant development, underpinning physical, cognitive, and socioemotional growth. Despite being a normative maturational process, fragmented sleep and difficulties initiating/maintaining sleep are common parental concerns. This review synthesizes developmental and behavioral science to elucidate mechanisms and evidence-based strategies that foster healthy sleep consolidation in infants and toddlers. First, we describe the evolution of sleep architecture and the interaction between circadian and homeostatic processes that regulate sleep-wake cycles. Then, we highlight how environmental and caregiving factors support these biological systems. Lastly, we describe behavioral strategies and the influence of environmental elements on circadian entrainment and independent sleep initiation. Across approaches, we emphasize the importance of family-centered implementation, where caregivers can both promote and benefit from optimal infant sleep. This review provides clinicians, researchers, and caregivers with a comprehensive framework to promote sleep consolidation and well-being during early childhood.

Preterm birth, affecting approximately 10 % of live births worldwide, is the most common cause of altered lung development and can have lasting respiratory consequences, including the occurrence of bronchopulmonary dysplasia (BPD). This review summarizes prenatal and postnatal strategies to promote pulmonary growth and reduce morbidity in preterm infants. Prenatal interventions such as optimizing maternal health and antenatal corticosteroids improve foetal lung maturity. Postnatally, non-invasive respiratory support-particularly continuous positive airway pressure (CPAP)-both prevents injury and promotes alveolar and vascular growth. Lung-protective ventilation strategies, adequate nutrition, and pharmacologic agents like caffeine enhance outcomes. Experimental therapies, including mesenchymal stem cells, insulin-like growth factor-1 (IGF-1), and artificial placenta technology, show promise in restoring pulmonary growth and function. Despite advances, many preterm survivors exhibit persistent lung deficits into adulthood, underscoring the need for longitudinal monitoring and continued innovation to support lung growth and lifelong respiratory health.

Pressurised metered-dose inhalers (pMDIs) are widely used in the treatment of paediatric respiratory diseases. Despite their widespread use, knowledge about effective inhaler technique amongst patients and clinicians is poor. Even amongst well-trained specialists, knowledge about how these devices function is limited. This short review outlines what it is critical to understand about how pMDIs work. This allows advanced troubleshooting of problems for patients and can decrease non-intentional non-adherence from a variety of causes.

Non-invasive ventilation (NIV) has become an essential component of pediatric respiratory support, offering effective alternatives to invasive mechanical ventilation in both acute and chronic conditions. Advances in technology and a growing understanding of pediatric respiratory physiology have expanded the application of NIV across a range of clinical scenarios, from acute respiratory failure in the intensive care unit to long-term management of neuromuscular and sleep-related breathing disorders in outpatient settings. As part of a review series, in this part 1 we provide an overview of conventional NIV modes in children, highlighting the history of mechanical ventilation, indications, interfaces, conventional modes of NIV and considerations unique to the pediatric population in both acute and chronic care contexts.