Pediatric Pulmonology最新文献

Background: Previous studies that discussed risk factors associated with extubation failure among preterm infants may have underestimated extubation failures because they used short observation windows for detecting reintubations.

Aims: To explore risk factors associated with reintubations among extremely preterm infants during hospitalization.

Study design: A single-center, retrospective cohort study.

Subjects: Infants born < 28 weeks gestational age between January 1, 2018, and December 31, 2022.

Outcome measures: We focused only on extubation failures associated with respiratory problems. We assessed risk factors by conducting multivariable logistic regression analyses using variables previously reported as risk factors associated with extubation failure among preterm infants.

Results: Ninety-five infants with a median gestational age of 25.6 weeks were eligible, and of those, 33 infants (34.7%) experienced extubation failure. Reintubations within 7 days after extubation accounted for approximately three-quarters of whole reintubations (24 infants, 72.7%). Risk factors associated with extubation failure were partial pressure of carbon dioxide (PCO₂) before extubation (adjusted odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.14; p = 0.023), fraction of inspired oxygen (F_IO₂) before extubation (adjusted OR, 2.97; 95% CI, 1.10-8.04; p = 0.032), and postmenstrual age (PMA) at extubation (adjusted OR, 0.90; 95% CI, 0.84-0.97; p = 0.004). The predictive model submitting these variables demonstrated an area under the curve of 0.802.

Conclusions: When evaluating extubation failures more precisely by adopting the longer period, we might need to consider not only respiratory status before extubation but also maturity at extubation to assess extubation readiness.

Introduction: Pneumomediastinum is an uncommon condition in pediatrics with a peak incidence in adolescence. The most common symptom of spontaneous pneumomediastinum (SPM) is chest pain; however, most patients are asymptomatic. Hamman's sign is a rare but pathognomonic sign of pneumomediastinum. This clinical sign is characterized by a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium. Hamman's syndrome is a SPM associated with subcutaneous emphysema.

Case description: We report the case of a previously healthy 15-year-old adolescent male, an elite athlete, who was admitted to hospital with a 3-day history of chest pain. There was no history of previous respiratory infections, invasive procedures, or trauma. On physical examination, he had a palpable subcutaneous neck edema and a crackle on cardiac auscultation. Chest and neck radiographs confirmed ectopic air in the mediastinum and subcutaneous neck emphysema. Given the identification of Hamman's sign and the presence of emphysema, the diagnosis of Hamman's syndrome was made and symptomatic treatment was given with complete resolution.

Conclusion: This case highlights the value of physical examination and medical semiology in the diagnosis of Hamman's syndrome, especially in the presence of the pathognomonic Hamman's sign.

Introduction: Lung ultrasound score (LUS) is used to predict the need for surfactant in preterm neonates. Its performance is lower in neonates with a gestational age (GA) ≥ 34 weeks. We developed a score, thoracic ultrasound score (TUS), to overcome the shortcomings of LUS.

Objectives: To assess the feasibility and diagnostic accuracy of TUS to evaluate oxygenation and predict the need for surfactant administration, compared to LUS.

Materials and methods: This was a prospective, multicenter, observational study. Preterm neonates in noninvasive ventilation with GA between 24 + 0 and 36 + 6 weeks were assessed for eligibility. Lung ultrasound were performed within 3 h of life, and TUS and LUS were calculated.

Results: Fifty-eight neonates who received surfactant were compared with 112 neonates who did not receive surfactant: GA 30.2 ± 3.1 weeks versus 32.6 ± 2.3 weeks, (p < 0.001), and birth weight 1466 ± 674 g versus 1725 ± 519 g, (p = 0.006), respectively. TUS and LUS showed a similar association with S/F ratio (r = -0.670 and r = 0.615) and OSI (r = 0.524 and r = 0.423), all p < 0.001. In neonates with GA < 34 weeks, the AUC (95% CI) was similar: 0.956 (0.923-0.989) versus 0.952 (0.921-0.984). In neonates with GA ≥ 34 weeks, the AUC (95% CI) of TUS was superior to LUS: 0.971 (0.914-1.000) versus 0.797 (0.639-0.980), p = 0.02.

Conclusion: Compared to LUS, TUS showed a similar association with the oxygenation status and a superior ability to predict the need for surfactant in neonates with GA ≥ 34 weeks. The latter was similar in neonates with GA < 34 weeks.

Background: Point of care lung ultrasound (POC-LUS) is a rapid and simple method to evaluate infants with respiratory distress after birth.

Objectives: The primary objective was to determine whether the POC-LUS score is a good predictor of NICU admission in late preterm and term infants born with respiratory distress when performed within the first 2 h of life. The secondary objective was to find a correlation between the LUS score and the clinical respiratory distress severity score.

Methods: A prospective observational study was carried out in a tertiary care neonatal unit (Level III) over 1 year on 97 late preterm and term infants having respiratory distress at birth. POC-LUS was performed in a transition nursery area within 2 h of birth, and LUS score was recorded as per a pre-validated LUS scoring system. The decision for NICU admission was independently taken by the medical team based on clinical criteria and blinded to the LUS findings. A receiver operating characteristic (ROC) curve was generated to predict NICU admission based on the LUS score. LUS score was also analyzed for correlation with clinical respiratory distress severity scoring, that is, Silverman-Anderson score (SA score).

Results: The mean gestational age of the infants in the study was 37.45 ± 1.88 weeks. Fourty-three percent of infants needed NICU admission. LUS score > 5/18 performed within 2 h after birth was an excellent predictor of NICU admission in late preterm and term infants with respiratory distress after birth (area under ROC curve 0.903, sensitivity 64%, specificity 98%, positive likelihood ratio 35, and p < 0.001). LUS score also had a weak positive correlation with the SA score (Pearson's correlation, r = 0.325; p = 0.001).

Conclusion: A LUS score of > 5/18 is an excellent predictor of NICU admission in term and late-preterm infants with respiratory distress after birth.

Introduction: Prolonged or recurrent cough is a common reason for referral to pediatric pulmonologists, yet few studies have assessed its causes. We examined records of children visiting respiratory outpatient clinics in Switzerland and assessed how diagnoses vary by age.

Methods: We analyzed data from the multicenter Swiss Paediatric Airway Cohort study. We included 363 children (median age 6 years, range 0-16) referred for prolonged or recurrent cough. From outpatient records, we extracted information on diagnostic investigations, final diagnoses proposed by pediatric pulmonologists, and treatments prescribed.

Results: Asthma and asthma-like conditions (cough variant asthma, episodic viral wheeze, and recurrent obstructive bronchitis) were diagnosed in 132 (36%) of 363 children, respiratory tract infections (RTI) including protracted bacterial bronchitis (PBB) in 51 (14%), upper airway cough syndrome (UACS) in 48 (13%), and postinfectious cough in 36 (10%); other diagnoses including gastroesophageal reflux disease (GERD) and somatic cough syndrome or tic cough were found in 23 (6%). No etiology was found in 73 children (20%). Asthma was diagnosed 3.5 times more often in schoolchildren while RTI including PBB was diagnosed three times more often in preschoolers. Inhaled corticosteroids were prescribed for 84% of children diagnosed with asthma and asthma-like conditions, antibiotics for 43% of children with RTI, and nasal corticosteroids for 83% of those with UACS.

Conclusion: Coughing children received a wide spectrum of diagnoses that differed between preschool and schoolchildren. Asthma accounted for 36% of diagnoses, which emphasizes the importance of comprehensive investigation beyond asthma in children with prolonged or recurrent cough.

Background: People with CF (pwCF) are often treated with prolonged courses of aminoglycosides (AGs), for which known adverse effects include ototoxicity as a subset of hearing impairment (HI).

Methods: The PIANO-CF trial was a single-center study conducted at The Royal Children's Hospital where 28 pediatric patients aged < 7 years underwent sequential hearing tests at increased range up to 12,500 Hz in relation to receiving intravenous (IV) AGs. More than 85% of the cohort (n = 24) participated in the follow-up hearing testing up to 1 year.

Results: HI was defined by degree (dB) and frequency (Hz) on the audiogram. This was further reviewed to determine if the type of HI was consistent with ototoxicity as there are frequently other causes of HI in this age group. At baseline the prevalence of HI and ototoxicity were 11% and 7%, respectively. Over a period of 1 year, HI was identified in 12.5% and that of ototoxicity in 6%. No correlation was found between degree of IV AG exposure and HI or ototoxicity.

Discussion: The finding of HI in young children with CF, including in those with minimal IV AG exposure, has implications for CF services to proactively screen for HI. Undetected HI may compromise learning outcomes and given the age of children studied, this is not insignificant during the acquisition and development of language skills.

Conclusion: Routine audiometric testing for pwCF up to 12,500 Hz or beyond may increase sensitivity in detection of ototoxicity and should be considered for use in screening, monitoring, and future research.