Paediatric Respiratory Reviews最新文献

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A systematic review of the clinical effectiveness of dry powder inhalers in maintenance treatment and in treatment of acute exacerbations of asthma in children. 干粉吸入器在维持治疗和治疗儿童哮喘急性加重中的临床效果的系统评价。

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-04-16 DOI: 10.1016/j.prrv.2025.04.005

Helen Twohig, Lauren Franklin, Will Carroll, Nadia Corp, Emma Jackson, Christian Mallen, Bernice Ruan, Louisa Yapp, Danielle Van Der Windt, James Smith

Background: Dry powder inhalers (DPIs) are a lower-carbon option than pressurised metered dose inhalers (pMDIs). However, DPIs require a forceful inhalation to achieve good lung deposition and there is uncertainty as to whether younger children can effectively use DPIs for maintenance treatment or rely upon them during exacerbations.

Methods: We searched electronic databases to identify randomised trials of children with asthma receiving treatment delivered via DPI, either for maintenance treatment (children ≤ 12 years) or for an acute exacerbation (participants up to age 18). Screening and data extraction were carried out by two reviewers. Risk of bias (RoB) assessment was made using the Cochrane RoB2 tool. Findings were narratively synthesised and a modified GRADE approach was taken to summarise the strength of evidence.

Results: 27 studies were included. 20 addressed maintenance treatment in children ≤ 12 years although only 4 compared the same treatment delivered via pMDI to DPI. All found no difference in efficacy between the device types (high certainty evidence). Other studies provided weaker, indirect evidence supporting this finding. 7 studies considered acute asthma in hospital/emergency settings. All reported no difference in efficacy between device types but certainty of evidence was low due to high RoB and clinical and methodological heterogeneity.

Conclusion: There are few studies directly comparing treatment via DPI/pMDI for asthma in children. Comparative studies suggest that for children who can use both DPI/pMDI, the devices are equal in efficacy for maintenance treatment in children ≤ 12 years but high-quality evidence is lacking regarding their use during acute exacerbations. This review did not find sufficient evidence to identify a lower age at which DPIs can start being used.

背景：干粉吸入器（dpi）是一种比加压计量吸入器（pmdi）更低碳的选择。然而，dpi需要强力吸入才能获得良好的肺沉积，对于低龄儿童是否可以有效地使用dpi进行维持治疗或在恶化期间依赖dpi，还存在不确定性。方法：我们检索了电子数据库，以确定接受DPI治疗的哮喘儿童的随机试验，无论是维持治疗（≤12岁的儿童）还是急性加重（18岁以下的参与者）。筛选和数据提取由两名审稿人进行。使用Cochrane RoB2工具进行偏倚风险（RoB）评估。对研究结果进行叙述性综合，并采用改进的GRADE方法来总结证据的强度。结果：纳入27项研究。20项研究涉及≤12岁儿童的维持治疗，尽管只有4项研究比较了通过pMDI和DPI提供的相同治疗。所有研究均发现不同器械类型的疗效无差异（高确定性证据）。其他研究提供了较弱的间接证据来支持这一发现。7项研究考虑了医院/急诊环境中的急性哮喘。所有研究均报告不同器械类型之间的疗效无差异，但由于高RoB以及临床和方法学的异质性，证据的确定性较低。结论：直接比较DPI/pMDI治疗儿童哮喘的研究较少。比较研究表明，对于同时使用DPI/pMDI的儿童，在≤12岁的儿童中，这两种装置在维持治疗方面的疗效相同，但在急性发作期间缺乏高质量的证据。本综述没有发现足够的证据来确定dpi可以开始使用的较低年龄。

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引用次数: 0

Editorial: Thinking community acquired pneumonia (CAP) and its impact on lung health 社论：思考社区获得性肺炎（CAP）及其对肺部健康的影响。

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-29 DOI: 10.1016/j.prrv.2025.03.003

Dominic A. Fitzgerald

引用次数: 0

Efficacy of intratracheal budesonide plus surfactant vs. Surfactant alone on bronchopulmonary dysplasia in preterm Infants: A meta-analysis of randomized controlled trials 气管内布地奈德加表面活性剂与单独表面活性剂治疗早产儿支气管肺发育不良的疗效：随机对照试验的荟萃分析。

IF 4 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-03 DOI: 10.1016/j.prrv.2025.02.003

Aluisio D’lucas Alves Gomes , Elísio Bulhões , Danielle Costa do Amaral , Luis Felipe Matos de Sousa , Ely Cavalcante Lima Júnior , José Airton Alves Ferreira , Hilderlania Alves de Oliveira , Maria LR Defante , Jafar Aljazeeri

Background

Bronchopulmonary dysplasia (BPD) is a chronic pulmonary disease commonly affecting preterm infants. The potential benefits of combining budesonide with surfactant for preterms with early BPD remain uncertain and warrant further exploration.

Objective

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of intratracheal budesonide plus surfactant compared with surfactant alone in preterm infants.

Methods

We searched PubMed, Embase and Cochrane Central databases from inception to November 2024. We conducted a meta-analysis following the PRISMA guidelines. We calculated the risk ratios (RRs) of endpoints of interest with 95% confidence intervals using a random effects model. R software (version 4.3.2) was used for statistical analyses. Heterogeneity was assessed with I² statistics.

Results

Eight RCTs including 2029 preterm infants were included. Compared with surfactant alone, a combined intratracheal budesonide plus surfactant significantly reduced the risk of bronchopulmonary dysplasia (RR: 0.70; 95 % CI: 0.54–0.91; p = 0.007; I² = 71.4 %), mortality (RR: 0.81; 95 % CI: 0.66–0.98; p = 0.029; I² = 14.6 %), pulmonary hemorrhage (RR: 0.58; 95 % CI: 0.37–0.90; p = 0.015; I² = 0 %) and patent ductus arteriosus (RR: 0.84; 95 % CI: 0.75–0.94; p = 0.004; I² = 0 %).

Conclusion

This meta-analysis found that intratracheal budesonide plus surfactant reduces the risk of bronchopulmonary dysplasia, mortality, pulmonary hemorrhage and patent ductus arteriosus compared with surfactant alone. Given its potential to reduce pulmonary complications associated with prematurity, clinicians may consider this combination therapy.

背景：支气管肺发育不良（BPD）是一种常见于早产儿的慢性肺部疾病。布地奈德联合表面活性剂治疗早期BPD的潜在益处尚不确定，值得进一步探索。目的：我们对随机对照试验（RCTs）进行系统回顾和荟萃分析，评价气管内布地奈德联合表面活性剂与单独表面活性剂治疗早产儿的疗效。方法：检索PubMed、Embase和Cochrane Central数据库，检索时间为成立至2024年11月。我们按照PRISMA指南进行了荟萃分析。我们使用随机效应模型以95%的置信区间计算感兴趣终点的风险比（rr）。采用R软件（4.3.2版）进行统计分析。采用I2统计量评估异质性。结果：共纳入8项随机对照试验，共纳入早产儿2029例。与单用表面活性剂相比，气管内布地奈德联合表面活性剂可显著降低支气管肺发育不良的风险(RR: 0.70；95 % ci: 0.54-0.91；p = 0.007;I2 = 71.4 %)，死亡率(RR: 0.81；95 % ci: 0.66-0.98；p = 0.029;I2 = 14.6 %)，肺出血(RR: 0.58；95 % ci: 0.37-0.90；p = 0.015;I2 = 0 %)和动脉导管未闭(RR: 0.84；95 % ci: 0.75-0.94；p = 0.004;I2 = 0 %)。结论：本荟萃分析发现，与单用表面活性剂相比，气管内布地奈德联合表面活性剂可降低支气管肺发育不良、死亡率、肺出血和动脉导管未闭的风险。鉴于其减少早产相关肺部并发症的潜力，临床医生可能会考虑这种联合治疗。

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Post COVID-19 pandemic consequences for children 小型专题讨论会：COVID-19大流行后对儿童的影响。

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-01 DOI: 10.1016/j.prrv.2025.01.003

Dominic A. Fitzgerald

引用次数: 0

Climate change and children’s respiratory health 气候变化与儿童呼吸道健康。

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-01 DOI: 10.1016/j.prrv.2024.07.002

Camille Bignier , Lucile Havet , Margot Brisoux , Céline Omeiche , Swati Misra , Apolline Gonsard , David Drummond

Climate change has significant consequences for children’s respiratory health. Rising temperatures and extreme weather events increase children’s exposure to allergens, mould, and air pollutants. Children are particularly vulnerable to these airborne particles due to their higher ventilation per unit of body weight, more frequent mouth breathing, and outdoor activities. Children with asthma and cystic fibrosis are at particularly high risk, with increased risks of exacerbation, but the effects of climate change could also be observed in the general population, with a risk of impaired lung development and growth. Mitigation measures, including reducing greenhouse gas emissions by healthcare professionals and healthcare systems, and adaptation measures, such as limiting outdoor activities during pollution peaks, are essential to preserve children’s respiratory health. The mobilisation of society as a whole, including paediatricians, is crucial to limit the impact of climate change on children’s respiratory health.

气候变化对儿童的呼吸系统健康有重大影响。气温升高和极端天气事件增加了儿童接触过敏原、霉菌和空气污染物的机会。由于儿童的单位体重通气量较高、口呼吸较频繁以及户外活动较多，他们特别容易受到这些空气微粒的影响。患有哮喘和囊性纤维化的儿童面临的风险尤其高，病情恶化的风险也会增加，但气候变化的影响也可能出现在普通人群中，他们的肺部发育和成长可能会受损。减缓措施（包括医疗保健专业人员和医疗保健系统减少温室气体排放）和适应措施（如在污染高峰期限制户外活动）对于保护儿童的呼吸系统健康至关重要。动员包括儿科医生在内的全社会，对于限制气候变化对儿童呼吸健康的影响至关重要。

引用次数: 0

Longer term psychological trauma following the COVID-19 pandemic for children and families COVID-19大流行给儿童和家庭带来的长期心理创伤。

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-01 DOI: 10.1016/j.prrv.2024.12.002

Kenneth Nunn , Dominic A. Fitzgerald

The psychological trauma following COVID-19 has been lengthy and fraught for some children and their families. The specific problems encountered by children rendered helpless and hopeless by watching others suffer, vicarious traumatisation, is explained in brief as it represents a central motif in clinical work in psychology. This paper will focus on what is known of the nature of psychological trauma in children and families with a focus on the individual clinical manifestations of personal significance. As a backdrop, consideration will be given to the epidemiological trends of psychological morbidity in and around the COVID-19 pandemic. Finally, the article seeks to provide readers with an appreciation of the dimensions of the neural legacy of COVID-19, a form of neurodisability developing in vulnerable children at a point in time, that is likely to emerge in children suffering an enduring trauma response.

对一些儿童及其家人来说，2019冠状病毒病后的心理创伤是漫长而痛苦的。孩子们看到别人受苦而变得无助和绝望时所遇到的具体问题，即替代性创伤，简要地解释，因为它代表了心理学临床工作的中心主题。本文将重点关注儿童和家庭心理创伤的本质，重点关注个人意义的个体临床表现。在此背景下，将考虑2019冠状病毒病大流行期间及其前后心理发病率的流行病学趋势。最后，本文试图让读者了解COVID-19的神经遗产的各个方面，这是一种在某个时间点上在弱势儿童中发展起来的神经残疾形式，很可能出现在遭受持久创伤反应的儿童身上。

引用次数: 0

A review of post COVID syndrome pathophysiology, clinical presentation and management in children and young people 儿童和青少年科维德后综合征病理生理学、临床表现和管理综述

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-01 DOI: 10.1016/j.prrv.2024.01.002

Rebecca Johnston , Samatha Sonnappa , Anne-Lise Goddings , Elizabeth Whittaker , Terry Y Segal

Post Covid Syndrome (PCS) is a complex multi-system disorder with a spectrum of presentations. Severity ranges from mild to very severe with variable duration of illness and recovery. This paper discusses the difficulties defining and describing PCS. We review the current understanding of PCS, epidemiology, and predisposing factors. We consider potential mechanisms including viral persistence, clotting dysfunction and immunity. We review presentation and diagnosis and finally consider management strategies including addressing symptom burden, rehabilitation, and novel therapies.

教育目的：读者将了解：我们目前对科维德后综合征（PCS）含义的理解；患有 PCS 的儿童和青少年（CYP）的表现和评估；解决症状及其对功能影响的管理策略；未来的研究方向：确定 PCS 症状的关键病理生理机制和可能的针对性药物治疗；了解 PCS 与其他疾病（包括神经发育疾病、过度运动和自主神经功能障碍）的关联。研究 PCS 与肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）之间的联系，以及 PCS 患者的研究是否为肌痛性脑脊髓炎/慢性疲劳综合征和其他病毒后病症提供了启示。其严重程度从轻微到非常严重不等，病程和恢复情况也各不相同。本文讨论了定义和描述 PCS 的困难。我们回顾了目前对 PCS、流行病学和易感因素的认识。我们考虑了包括病毒持续存在、凝血功能障碍和免疫在内的潜在机制。我们回顾了疾病的表现和诊断，最后考虑了包括解决症状负担、康复和新型疗法在内的管理策略。

引用次数: 0

Unintended impacts of COVID-19 on the epidemiology and burden of paediatric respiratory infections COVID-19对儿科呼吸道感染流行病学和负担的意外影响

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-01 DOI: 10.1016/j.prrv.2023.07.004

Rebecca Burrell , Gemma Saravanos , Philip N. Britton

Acute respiratory infections (ARI), especially lower respiratory infections (LRI), are a leading cause of childhood morbidity and mortality globally. Non-pharmaceutical interventions (NPI) employed during the COVID-19 pandemic have impacted on the epidemiology and burden of paediatric ARI, although accurately describing the full nature of the impact is challenging. For most ARI pathogens, a reduction was observed in the early phase of the pandemic, correlating with the most stringent NPI. In later phases of the pandemic resurgence of disease was observed as NPI eased. This pattern was most striking for seasonal viruses, such as influenza and respiratory syncytial virus. The impact on ARI-associated bacterial disease varied; marked reductions in invasive Streptococcus pneumoniae and Streptococcus pyogenes were observed, followed by a resurgence that correlated with increases in respiratory viral infections. For Corynebacterium diphtheriae, Bordetella pertussis, and Mycoplasma pneumoniae, a sustained reduction of disease was observed well into 2022 in most regions. Proposed mechanisms for the varied epidemiological disruption amongst ARI pathogens include differential effects of NPI on specific pathogens, population-level immunological effects, and ecological and genetic pathogen adaptations. Additionally, important indirect effects of pandemic restrictions on paediatric respiratory infections have been identified. These occurred as a result of disruptions to routine health services, reductions in vaccination coverage, and disruptions to respiratory infection research and surveillance activities. Impacts have been disproportionately borne by those in low resource settings. We discuss opportunities to leverage pandemic learnings to support improved understanding of the epidemiology of paediatric respiratory infections to inform future prevention and health system strengthening.

急性呼吸道感染（ARI），特别是下呼吸道感染（LRI），是全球儿童发病和死亡的主要原因。在2019冠状病毒病大流行期间采用的非药物干预措施（NPI）对儿科急性呼吸道感染的流行病学和负担产生了影响，尽管准确描述这种影响的全部性质具有挑战性。对于大多数急性呼吸道感染病原体，在大流行的早期阶段观察到减少，这与最严格的国家预防措施有关。在大流行的后期阶段，随着新感染的缓解，观察到疾病再次出现。这种模式对季节性病毒最为显著，如流感病毒和呼吸道合胞病毒。对ari相关细菌性疾病的影响各不相同；观察到侵袭性肺炎链球菌和化脓性链球菌的显著减少，随后与呼吸道病毒感染增加相关的复苏。在大多数地区，白喉棒状杆菌、百日咳博德泰拉和肺炎支原体的发病率持续下降，直至2022年。ARI病原体之间不同的流行病学破坏机制包括NPI对特定病原体的不同影响、群体水平的免疫效应以及生态和遗传病原体适应。此外，已经确定了大流行限制对儿童呼吸道感染的重要间接影响。这是由于常规卫生服务中断、疫苗接种覆盖率下降以及呼吸道感染研究和监测活动中断造成的。资源匮乏地区的人承受的影响不成比例。我们讨论了利用大流行的学习来支持提高对儿科呼吸道感染流行病学的理解的机会，为未来的预防和卫生系统加强提供信息。

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引用次数: 0

OSA type-III and neurocognitive function OSA III 型与神经认知功能

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-01 DOI: 10.1016/j.prrv.2024.06.004

Brigitte Fauroux , Mathilde Cozzo , Joanna MacLean , Dominic A. Fitzgerald

Obstructive sleep apnea (OSA) due to a hypertrophy of the adenoids and/or the tonsils in otherwise healthy children is associated with neurocognitive dysfunction and behavioural disorders with various degrees of hyperactivity, aggressiveness, sometimes evolving to a label of attention-deficit hyperactivity disorder. Children with anatomical and/or functional abnormalities of the upper airways represent a very specific population which is at high risk of OSA (also called complex OSA or OSA type III). Surprisingly, the neurocognitive consequences of OSA have been poorly studied in these children, despite the fact that OSA is more common and more severe than in their healthy counterparts. This may be explained by that fact that screening for OSA and sleep-disordered breathing is not systematically performed, the performance of sleep studies and neurocognitive tests may be challenging, and the respective role of the underlining disease, OSA, but also poor sleep quality, is complex. However, the few studies that have been performed in these children, and mainly children with Down syndrome, tend to show that OSA, but even more disruption of sleep architecture and poor sleep quality, aggravate the neurocognitive impairment and abnormal behaviour in these patients, underlining the need for a systematic and early in life assessment of sleep and neurocognitive function and behaviour in children with OSA type III.

在健康儿童中，由于腺样体和/或扁桃体肥大引起的阻塞性睡眠呼吸暂停（OSA）与神经认知功能障碍和不同程度的多动、攻击性行为障碍有关，有时演变为注意缺陷多动障碍的标签。患有上呼吸道解剖和/或功能异常的儿童是OSA（也称为复合性OSA或III型OSA）高危人群。令人惊讶的是，尽管OSA比健康儿童更常见、更严重，但对这些儿童的神经认知后果的研究却很少。这可能是由于没有系统地进行OSA和睡眠呼吸障碍的筛查，睡眠研究和神经认知测试的表现可能具有挑战性，并且主要疾病OSA和睡眠质量差各自的作用是复杂的。然而，在这些儿童（主要是唐氏综合症儿童）中进行的少数研究往往表明，OSA，甚至更多的睡眠结构破坏和睡眠质量差，加重了这些患者的神经认知功能障碍和异常行为，强调需要在生命早期系统评估OSA III型儿童的睡眠、神经认知功能和行为。

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引用次数: 0

Hereditary haemorrhagic telangiectasia: A primer for the paediatrician 遗传性出血性毛细血管扩张症：儿科医生入门指南。

IF 4.7 3区医学 Q1 PEDIATRICS

Paediatric Respiratory Reviews

Pub Date : 2025-03-01 DOI: 10.1016/j.prrv.2024.07.003

Yoshua Selvadurai , Emily R. Le Fevre , Jonathan Mervis , Dominic A. Fitzgerald

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant condition characterised by small telangiectasias and larger multisystem arteriovenous malformations (AVMs). Common sites of AVMs include in the nose, lungs, brain and liver. These lesions are prone to rupture, leading to complications including recurrent epistaxis and significant haemorrhage. Pulmonary hypertension (PH) can also occur. This review presents an update on the genetics, clinical manifestations, management options, and screening recommendations for children with HHT.

遗传性出血性毛细血管扩张症（HHT）是一种常染色体显性遗传病，其特征是小的毛细血管扩张和大的多系统动静脉畸形（AVM）。动静脉畸形的常见部位包括鼻、肺、脑和肝。这些病变容易破裂，导致包括反复鼻衄和大出血在内的并发症。肺动脉高压（PH）也可能发生。本综述介绍了遗传学、临床表现、治疗方案和 HHT 儿童筛查建议的最新进展。

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