Pub Date : 2025-06-01Epub Date: 2024-10-16DOI: 10.1016/j.prrv.2024.10.003
S. Haggie , I.M. Balfour-Lynn
Community acquired pneumonia is among the most common causes of hospitalisation in children, despite most cases being successfully managed in ambulatory care. Empyema is the most common complication of hospitalised pneumonia, and although associated with considerable morbidity, death is rare, even in severe disease.
Beyond the acute infection, there is a recognised association of paediatric lower respiratory tract infection and impaired lung function over the whole life span. Longitudinal birth cohorts highlight the deleterious effect of paediatric pneumonia on lung function and the development of chronic obstructive pulmonary disease and a near doubling of respiratory associated mortality in adults. Less clear is how to reconcile this worrisome data with most children only having mild abnormalities on spirometry in paediatric follow up. Recurrent or severe pneumonia is infrequently associated with irreversible lung injury such as bronchiectasis or bronchiolitis obliterans.
{"title":"Outcomes of paediatric community acquired pneumonia","authors":"S. Haggie , I.M. Balfour-Lynn","doi":"10.1016/j.prrv.2024.10.003","DOIUrl":"10.1016/j.prrv.2024.10.003","url":null,"abstract":"<div><div>Community acquired pneumonia is among the most common causes of hospitalisation in children, despite most cases being successfully managed in ambulatory care. Empyema is the most common complication of hospitalised pneumonia, and although associated with considerable morbidity, death is rare, even in severe disease.</div><div>Beyond the acute infection, there is a recognised association of paediatric lower respiratory tract infection and impaired lung function over the whole life span. Longitudinal birth cohorts highlight the deleterious effect of paediatric pneumonia on lung function and the development of chronic obstructive pulmonary disease and a near doubling of respiratory associated mortality in adults. Less clear is how to reconcile this worrisome data with most children only having mild abnormalities on spirometry in paediatric follow up. Recurrent or severe pneumonia is infrequently associated with irreversible lung injury such as bronchiectasis or bronchiolitis obliterans.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 3-11"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605198","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 : 2025-06-01Epub Date: 2024-09-02DOI: 10.1016/j.prrv.2024.08.002
Lisa Frigati , Leonore Greybe , Savvas Andronikou , Ernst Eber , Shyam Sunder B. Venkatakrishna , Pierre Goussard
Objectives
To investigate the epidemiology, aetiology, diagnostics and management of childhood pneumonia in low and middle income countries (LMICs).
Design
Review of published english literature from 2019 to February 2024.
Results
Lower respiratory tract infections (LRTIs) still result in significant mortality in children under 5 years of age in LMICs. Important studies have reported a change in the pathogenesis of LRTIs over the last 5 years with respiratory syncytial virus (RSV) resulting in a large burden of disease. SARS-CoV-2 had a significant direct and indirect impact in children in LMICs. Mycobacterium tuberculosis (MTB) remains a priority pathogen in all children. Nucleic acid amplification and rapid antigen tests have improved diagnostic accuracy for MTB and other bacterial pathogens. Point of care diagnostics may overcome some limitations, but there is a need for better cost-effective diagnostics. Access to shorter courses of TB treatment are now recommended for some children, but child friendly formulations are lacking. The role of chest X-ray in TB has been recognized and included in guidelines, and lung ultrasound to diagnose LRTI is showing promise as a lower cost and accessible option.
Conclusion
Advances in diagnostics and large multi-centre studies have provided increased understanding of the causative pathogens of LRTIs in LMICs. Increased access to preventive strategies such as vaccines, treatment modalities including antivirals, and addressing upstream factors such as poverty are essential if further declines in LRTIs in LMICs are to be realised.
{"title":"Respiratory infections in low and middle-income countries","authors":"Lisa Frigati , Leonore Greybe , Savvas Andronikou , Ernst Eber , Shyam Sunder B. Venkatakrishna , Pierre Goussard","doi":"10.1016/j.prrv.2024.08.002","DOIUrl":"10.1016/j.prrv.2024.08.002","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the epidemiology, aetiology, diagnostics and management of childhood pneumonia in low and middle income countries (LMICs).</div></div><div><h3>Design</h3><div>Review of published english literature from 2019 to February 2024.</div></div><div><h3>Results</h3><div>Lower respiratory tract infections (LRTIs) still result in significant mortality in children under 5 years of age in LMICs. Important studies have reported a change in the pathogenesis of LRTIs over the last 5 years with respiratory syncytial virus (RSV) resulting in a large burden of disease. SARS-CoV-2 had a significant direct and indirect impact in children in LMICs. <em>Mycobacterium tuberculosis</em> (MTB) remains a priority pathogen in all children. Nucleic acid amplification and rapid antigen tests have improved diagnostic accuracy for MTB and other bacterial pathogens. Point of care diagnostics may overcome some limitations, but there is a need for better cost-effective diagnostics. Access to shorter courses of TB treatment are now recommended for some children, but child friendly formulations are lacking. The role of chest X-ray in TB has been recognized and included in guidelines, and lung ultrasound to diagnose LRTI is showing promise as a lower cost and accessible option.</div></div><div><h3>Conclusion</h3><div>Advances in diagnostics and large multi-centre studies have provided increased understanding of the causative pathogens of LRTIs in LMICs. Increased access to preventive strategies such as vaccines, treatment modalities including antivirals, and addressing upstream factors such as poverty are essential if further declines in LRTIs in LMICs are to be realised.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 43-51"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292825","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 : 2025-06-01Epub Date: 2024-09-06DOI: 10.1016/j.prrv.2024.08.003
Johanna Sandlund , Ram Duriseti , Shamez N. Ladhani , Kelly Stuart , Jeanne Noble , Tracy Beth Høeg
Mask mandates for children were implemented at schools and childcare centers during the COVID-19 pandemic, and the US continues to recommend masking down to the age of two in certain settings. Medical interventions should be informed by high-quality evidence and consider the possibility of harm (i.e., include harm-benefit analyses). In this review, we weigh the existing evidence for the effectiveness of mask mandates to protect against COVID-19 and other viral respiratory infections and the harms associated with face mask wearing in children.
There is a lack of robust evidence of benefit from masking children to reduce transmission of SARS-CoV-2 or other respiratory viruses. The highest quality evidence available for masking children for COVID-19 or other viral respiratory infections has failed to find a beneficial impact against transmission. Mechanistic studies showing reduced viral transmission from use of face masks and respirators have not translated to real world effectiveness. Identified harms of masking include negative effects on communication and components of speech and language, ability to learn and comprehend, emotional and trust development, physical discomfort, and reduction in time and intensity of exercise.
Effectiveness of child masking has not been demonstrated, while documented harms of masking in children are diverse and non-negligible and should prompt careful reflection. Recommendations for masking children fail basic harm-benefit analyses.
{"title":"Face masks and protection against COVID-19 and other viral respiratory infections: Assessment of benefits and harms in children","authors":"Johanna Sandlund , Ram Duriseti , Shamez N. Ladhani , Kelly Stuart , Jeanne Noble , Tracy Beth Høeg","doi":"10.1016/j.prrv.2024.08.003","DOIUrl":"10.1016/j.prrv.2024.08.003","url":null,"abstract":"<div><div>Mask mandates for children were implemented at schools and childcare centers during the COVID-19 pandemic, and the US continues to recommend masking down to the age of two in certain settings. Medical interventions should be informed by high-quality evidence and consider the possibility of harm (i.e., include harm-benefit analyses). In this review, we weigh the existing evidence for the effectiveness of mask mandates to protect against COVID-19 and other viral respiratory infections and the harms associated with face mask wearing in children.</div><div>There is a lack of robust evidence of benefit from masking children to reduce transmission of SARS-CoV-2 or other respiratory viruses. The highest quality evidence available for masking children for COVID-19 or other viral respiratory infections has failed to find a beneficial impact against transmission. Mechanistic studies showing reduced viral transmission from use of face masks and respirators have not translated to real world effectiveness. Identified harms of masking include negative effects on communication and components of speech and language, ability to learn and comprehend, emotional and trust development, physical discomfort, and reduction in time and intensity of exercise.</div><div>Effectiveness of child masking has not been demonstrated, while documented harms of masking in children are diverse and non-negligible and should prompt careful reflection. Recommendations for masking children fail basic harm-benefit analyses.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 62-69"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292824","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 : 2025-06-01Epub Date: 2025-01-16DOI: 10.1016/j.prrv.2025.01.002
Chris A. Rees , Stuart Haggie , Todd A. Florin
Community acquired pneumonia (CAP) is a disease experienced by children the world over, though CAP-related morbidity and mortality differ markedly between low- and middle-income countries (LMICs) and high-income countries (HICs). Thus, setting-specific clinical prediction models are needed to identify children at risk for CAP-related morbidity and mortality. Here, we outline published clinical prediction models from LMICs and HICs for pediatric CAP-related outcomes. To date, there have been four clinical prediction models to predict treatment failure, two to predict a composite outcome of poor outcomes, and eight models for mortality prediction for CAP in LMICs. No prediction models developed in LMICs had publications that described their impact on clinical care through implementation. In HICs, to date there are three published clinical prediction models evaluating disease severity and one examining the need for major medical interventions. While clinical prediction models described in this review provide a strong foundation for risk stratification for children with CAP in HICs, there is a need for widespread external validation and implementation of optimally performing models.
{"title":"Narrative review of clinical prediction models for paediatric community acquired pneumonia","authors":"Chris A. Rees , Stuart Haggie , Todd A. Florin","doi":"10.1016/j.prrv.2025.01.002","DOIUrl":"10.1016/j.prrv.2025.01.002","url":null,"abstract":"<div><div>Community acquired pneumonia (CAP) is a disease experienced by children the world over, though CAP-related morbidity and mortality differ markedly between low- and middle-income countries (LMICs) and high-income countries (HICs). Thus, setting-specific clinical prediction models are needed to identify children at risk for CAP-related morbidity and mortality. Here, we outline published clinical prediction models from LMICs and HICs for pediatric CAP-related outcomes. To date, there have been four clinical prediction models to predict treatment failure, two to predict a composite outcome of poor outcomes, and eight models for mortality prediction for CAP in LMICs. No prediction models developed in LMICs had publications that described their impact on clinical care through implementation. In HICs, to date there are three published clinical prediction models evaluating disease severity and one examining the need for major medical interventions. While clinical prediction models described in this review provide a strong foundation for risk stratification for children with CAP in HICs, there is a need for widespread external validation and implementation of optimally performing models.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 19-27"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449713","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 : 2025-06-01Epub Date: 2025-03-29DOI: 10.1016/j.prrv.2025.03.003
Dominic A. Fitzgerald
{"title":"Editorial: Thinking community acquired pneumonia (CAP) and its impact on lung health","authors":"Dominic A. Fitzgerald","doi":"10.1016/j.prrv.2025.03.003","DOIUrl":"10.1016/j.prrv.2025.03.003","url":null,"abstract":"","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 1-2"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992236","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 : 2025-06-01Epub Date: 2024-09-12DOI: 10.1016/j.prrv.2024.09.001
Anastasios-Panagiotis Chantzaras , Panagiota Panagiotou , Georgia Koltsida , Angeliki Moudaki , Christina Kanaka-Gantenbein , Athanasios G. Kaditis
Introduction
Pseudohypoaldosteronism type 1b (PHA1B) is a rare autosomal recessive disease caused by dysfunction of amiloride-sensitive epithelial sodium channels (ENaC), that might present with a wide variety of pulmonary symptoms.
Methods
We provide a systematic review of published cases with PHA1B and respiratory symptoms, adding a relevant case from our clinic.
Results
Thirty-seven publications presenting 61 cases were identified apart from our case. Parental consanguinity was reported in 24/62 patients. In 39 patients the onset of pulmonary manifestations was early in infancy. Lower respiratory tract infections caused by Pseudomonas aeruginosa and Staphylococcus aureus were reported in 3 cases each, while 2 patients developed bronchiectasis. Pathological sweat test results were recorded in all 34 patients with available data. In 36/47 patients the underlying pathogenic variant was identified in SCNN1A gene.
Conclusion
High clinical suspicion is required when treating patients with PHA1B for the potential need for early treatment of respiratory symptoms to avert any permanent pulmonary damage.
{"title":"Pulmonary manifestations of Pseudohypoaldosteronism type 1b: A systematic review of the literature","authors":"Anastasios-Panagiotis Chantzaras , Panagiota Panagiotou , Georgia Koltsida , Angeliki Moudaki , Christina Kanaka-Gantenbein , Athanasios G. Kaditis","doi":"10.1016/j.prrv.2024.09.001","DOIUrl":"10.1016/j.prrv.2024.09.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Pseudohypoaldosteronism type 1b (PHA1B) is a rare autosomal recessive disease caused by dysfunction of amiloride-sensitive epithelial sodium channels (ENaC), that might present with a wide variety of pulmonary symptoms.</div></div><div><h3>Methods</h3><div>We provide a systematic review of published cases with PHA1B and respiratory symptoms, adding a relevant case from our clinic.</div></div><div><h3>Results</h3><div>Thirty-seven publications presenting 61 cases were identified apart from our case. Parental consanguinity was reported in 24/62 patients. In 39 patients the onset of pulmonary manifestations was early in infancy. Lower respiratory tract infections caused by <em>Pseudomonas aeruginosa</em> and <em>Staphylococcus aureus</em> were reported in 3 cases each, while 2 patients developed bronchiectasis. Pathological sweat test results were recorded in all 34 patients with available data. In 36/47 patients the underlying pathogenic variant was identified in <em>SCNN1A</em> gene.</div></div><div><h3>Conclusion</h3><div>High clinical suspicion is required when treating patients with PHA1B for the potential need for early treatment of respiratory symptoms to avert any permanent pulmonary damage.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 52-61"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471724","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 : 2025-06-01Epub Date: 2025-01-13DOI: 10.1016/j.prrv.2024.11.002
Wenhao Xu , Peng Wang , Jun Wan , Qingyu Bao , Ruixia Yu , Yuxin Zheng , Xingyu Kuang , Yulin Li , Zhicheng He , Jorge Luis Cuyubamba Dominguez , Yu Zhang
Background
Securing a stable airway is a critical component in neonatal resuscitation. Compared to direct laryngoscopy, video laryngoscopy provides improved visualization of the glottis, potentially enhancing the success rate of intubation. This systematic review and meta-analysis were conducted to assess and compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy in neonatal intubation.
Methods
A thorough search was performed across CENTRAL, Embase, and PubMed databases to identify relevant randomized controlled trials (RCTs) that evaluated the use of video laryngoscopy in comparison with direct laryngoscopy for neonatal intubation. The data extraction and analysis were conducted in alignment with Cochrane guidelines. The primary outcome of interest was the time required for intubation, while secondary outcomes included the number of intubation attempts and the success rate on the first attempt.
Results
The meta-analysis included nine RCTs, encompassing a total of 719 neonates. The findings revealed that video laryngoscopy was associated with a longer intubation time (mean difference [MD] 3.23 s, 95 % confidence interval [CI] 2.42 to 4.04; I2 = 96 %). However, it also significantly improved the first-attempt success rate (risk ratio [RR] 1.31, 95 % CI 1.20 to 1.44; I2 = 76 %) and borderline reduced the total number of intubation attempts (MD −0.08, 95 % CI −0.15 to 0.00; I2 = 53 %).
Conclusions
While video laryngoscopy is associated with a modest increase in intubation time, it provides clear benefits by enhancing the success rate of first-attempt intubations and reducing the need for multiple attempts in neonatal intubation procedures.
{"title":"Comparison of video laryngoscopy and direct laryngoscopy for urgent intubation in newborn infants: A meta-analysis","authors":"Wenhao Xu , Peng Wang , Jun Wan , Qingyu Bao , Ruixia Yu , Yuxin Zheng , Xingyu Kuang , Yulin Li , Zhicheng He , Jorge Luis Cuyubamba Dominguez , Yu Zhang","doi":"10.1016/j.prrv.2024.11.002","DOIUrl":"10.1016/j.prrv.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Securing a stable airway is a critical component in neonatal resuscitation. Compared to direct laryngoscopy, video laryngoscopy provides improved visualization of the glottis, potentially enhancing the success rate of intubation. This systematic review and <em>meta</em>-analysis were conducted to assess and compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy in neonatal intubation.</div></div><div><h3>Methods</h3><div>A thorough search was performed across CENTRAL, Embase, and PubMed databases to identify relevant randomized controlled trials (RCTs) that evaluated the use of video laryngoscopy in comparison with direct laryngoscopy for neonatal intubation. The data extraction and analysis were conducted in alignment with Cochrane guidelines. The primary outcome of interest was the time required for intubation, while secondary outcomes included the number of intubation attempts and the success rate on the first attempt.</div></div><div><h3>Results</h3><div>The <em>meta</em>-analysis included nine RCTs, encompassing a total of 719 neonates. The findings revealed that video laryngoscopy was associated with a longer intubation time (mean difference [MD] 3.23 s, 95 % confidence interval [CI] 2.42 to 4.04; I<sup>2</sup> = 96 %). However, it also significantly improved the first-attempt success rate (risk ratio [RR] 1.31, 95 % CI 1.20 to 1.44; I<sup>2</sup> = 76 %) and borderline reduced the total number of intubation attempts (MD −0.08, 95 % CI −0.15 to 0.00; I<sup>2</sup> = 53 %).</div></div><div><h3>Conclusions</h3><div>While video laryngoscopy is associated with a modest increase in intubation time, it provides clear benefits by enhancing the success rate of first-attempt intubations and reducing the need for multiple attempts in neonatal intubation procedures.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 28-34"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067108","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 : 2025-06-01Epub Date: 2024-12-19DOI: 10.1016/j.prrv.2024.12.001
Wendy E. Huang , Joan A. Matifoll , David Lord , Stuart Haggie
Paediatric pneumonia and its complications present substantial health and economic challenges. While chest radiographs are commonly used as the initial imaging modality for diagnosing uncomplicated pneumonia, they are less effective for complicated cases. In response, various imaging techniques, such as lung ultrasound, computed tomography (CT), and chest MRI, have been integrated into clinical practice to enhance diagnosis and guide management decisions. No definitive gold standard exists for imaging complicated paediatric pneumonia and clinicians may find it challenging to choose the best imaging technique for a given clinical scenario. In this review we describe the available imaging options relevant for the management of paediatric pneumonia and evaluate the strengths and limitations of each modality.
{"title":"A review of imaging in the diagnosis and management of complicated paediatric pneumonia","authors":"Wendy E. Huang , Joan A. Matifoll , David Lord , Stuart Haggie","doi":"10.1016/j.prrv.2024.12.001","DOIUrl":"10.1016/j.prrv.2024.12.001","url":null,"abstract":"<div><div>Paediatric pneumonia and its complications present substantial health and economic challenges. While chest radiographs are commonly used as the initial imaging modality for diagnosing uncomplicated pneumonia, they are less effective for complicated cases. In response, various imaging techniques, such as lung ultrasound, computed tomography (CT), and chest MRI, have been integrated into clinical practice to enhance diagnosis and guide management decisions. No definitive gold standard exists for imaging complicated paediatric pneumonia and clinicians may find it challenging to choose the best imaging technique for a given clinical scenario. In this review we describe the available imaging options relevant for the management of paediatric pneumonia and evaluate the strengths and limitations of each modality.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 12-18"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984564","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 : 2025-06-01Epub Date: 2024-09-20DOI: 10.1016/j.prrv.2024.07.004
Martina Cecchetti , Luca Scarallo , Paolo Lionetti , Chee Y. Ooi , Vito Terlizzi
Highly effective modulator therapy (HEMT), particularly the triple combination elexacaftor-tezacaftor-ivacaftor (ETI), significantly improved clinical outcomes and quality of life in people with Cystic Fibrosis (pwCF). This review analyzes current knowledge on the impact of HEMTs on gastrointestinal (GI) symptoms and features in pwCF. A descriptive review of English literature until February 29, 2024, was conducted using medical databases. Observational studies and clinical trials addressing GI reflux disease (GERD), lower GI symptoms and pancreatic disease were considered.
Studies report positive effects of HEMTs on pH levels and bicarbonate secretion as well as improvement on intestinal inflammation. HEMTs also demonstrated positive effects on GERD and lower GI symptoms or conditions CF related such as dysbiosis. Taking ETI during pregnancy could also allow resolution of meconium ileus in fetuses with CF. The best benefits were observed in pancreatic function, potentially delaying CF-related diabetes and recovering pancreatic function in some children on ETI. Larger trials, particularly in pediatric populations, need to confirm these findings and explore long-term effects.
{"title":"Impact of highly effective modulator therapy on gastrointestinal symptoms and features in people with cystic fibrosis","authors":"Martina Cecchetti , Luca Scarallo , Paolo Lionetti , Chee Y. Ooi , Vito Terlizzi","doi":"10.1016/j.prrv.2024.07.004","DOIUrl":"10.1016/j.prrv.2024.07.004","url":null,"abstract":"<div><div>Highly effective modulator therapy (HEMT), particularly the triple combination elexacaftor-tezacaftor-ivacaftor (ETI), significantly improved clinical outcomes and quality of life in people with Cystic Fibrosis (pwCF). This review analyzes current knowledge on the impact of HEMTs on gastrointestinal (GI) symptoms and features in pwCF. A descriptive review of English literature until February 29, 2024, was conducted using medical databases. Observational studies and clinical trials addressing GI reflux disease (GERD), lower GI symptoms and pancreatic disease were considered.</div><div>Studies report positive effects of HEMTs on pH levels and bicarbonate secretion as well as improvement on intestinal inflammation. HEMTs also demonstrated positive effects on GERD and lower GI symptoms or conditions CF related such as dysbiosis. Taking ETI during pregnancy could also allow resolution of meconium ileus in fetuses with CF. The best benefits were observed in pancreatic function, potentially delaying CF-related diabetes and recovering pancreatic function in some children on ETI. Larger trials, particularly in pediatric populations, need to confirm these findings and explore long-term effects.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 70-75"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351424","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 : 2025-05-19DOI: 10.1016/j.prrv.2025.05.001
Sarah Spenard, Carl Backes, Dominic A Fitzgerald, Guilherme Sant'Anna, Gabriel Altit
The natural closure of the ductus arteriosus is often delayed in premature newborns, especially in the most immature ones, and a significant left-to-right shunt volume raises concerns about pulmonary overcirculation, steal of systemic blood flow, and its potential contribution to neonatal respiratory morbidities such as bronchopulmonary dysplasia (BPD). Extremely low gestational age and long duration of mechanical ventilation may influence the relationship between the patent ductus arteriosus (PDA) and BPD. Decades of research has employed various pharmacologic approaches including NSAIDs and acetaminophen administered based on diverse criteria and using various timing, dose, and route combinations. Unfortunately, none of these interventions has consistently demonstrated meaningful improvements in clinical outcomes. Instead, these treatments inconsistently achieve PDA closure or restriction of flow through the ductus and are often associated with adverse effects. Thus, the lack of clear benefit from available treatments, coupled with the potential for harm, has prompted many centers to adopt conservative or expectant management of the PDA while awaiting novel strategies that could offer improved efficacy and safety. This review explores the associations between PDA and pulmonary outcomes of prematurity, reflecting on past research and outlining potential future directions.
{"title":"Current approaches to the patent ductus arteriosus: Implications for pulmonary morbidities.","authors":"Sarah Spenard, Carl Backes, Dominic A Fitzgerald, Guilherme Sant'Anna, Gabriel Altit","doi":"10.1016/j.prrv.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.05.001","url":null,"abstract":"<p><p>The natural closure of the ductus arteriosus is often delayed in premature newborns, especially in the most immature ones, and a significant left-to-right shunt volume raises concerns about pulmonary overcirculation, steal of systemic blood flow, and its potential contribution to neonatal respiratory morbidities such as bronchopulmonary dysplasia (BPD). Extremely low gestational age and long duration of mechanical ventilation may influence the relationship between the patent ductus arteriosus (PDA) and BPD. Decades of research has employed various pharmacologic approaches including NSAIDs and acetaminophen administered based on diverse criteria and using various timing, dose, and route combinations. Unfortunately, none of these interventions has consistently demonstrated meaningful improvements in clinical outcomes. Instead, these treatments inconsistently achieve PDA closure or restriction of flow through the ductus and are often associated with adverse effects. Thus, the lack of clear benefit from available treatments, coupled with the potential for harm, has prompted many centers to adopt conservative or expectant management of the PDA while awaiting novel strategies that could offer improved efficacy and safety. This review explores the associations between PDA and pulmonary outcomes of prematurity, reflecting on past research and outlining potential future directions.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226097","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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