Pediatric Pulmonology最新文献

Aim: Preeclampsia (PE) is characterized by antenatal hypoxia and inflammation, which may impair neonatal respiratory control. However, its association with apnea of prematurity (AOP) in late preterm infants remains unclear. This study aimed to test the hypothesis that maternal PE is an independent risk factor for AOP in late preterm infants.

Methods: This retrospective cohort study was conducted at Yamanashi Central Hospital between January 2017 and June 2025. Singleton pregnancies delivered between 34^ + 0 and 36^ + 6 weeks of gestation were included. Early-onset PE was defined as diagnosis before 34 weeks of gestation, and late-onset PE as diagnosis at or after 34 weeks. Multivariable logistic regression analyses were performed to evaluate the association between PE and AOP, adjusting for potential confounders. In Model 1, PE was analyzed as a binary variable. In Model 2, subjects were categorized into three groups: early-onset, late-onset, and no PE.

Results: A total of 470 mother-infant pairs were analyzed. Among them, 23 women experienced early-onset PE, and 34 experienced late-onset PE. The overall incidence of AOP was 27.9% (131/470). In Model 1, PE was associated with a higher AOP risk (adjusted odds ratio [aOR], 2.44; 95% confidence interval [CI]: 1.21-4.90). In Model 2, early-onset PE was significantly associated with AOP (aOR: 3.42; 95% CI: 1.20-9.72), whereas late-onset PE was not (aOR: 1.88; 95% CI: 0.75-4.73).

Conclusion: PE, particularly early-onset, was significantly associated with AOP. Incorporating maternal PE status into perinatal risk stratification may help identify late preterm infants at elevated AOP risk and guide timely intervention.

Introduction and objective: Physical activity (PA) is associated with improved asthma outcomes. Black girls face higher rates of asthma morbidity and are less likely to meet recommended PA than their White and Black male peers. To address these health disparities, it is essential to understand beliefs and behaviors related to PA among Black girls with asthma.

Methods: For this qualitative study, Black girls with asthma and their mothers or female caregivers were recruited through flyers and direct outreach to patients at one academic medical center. Semi-structured interviews focused on knowledge of PA recommendations, perceived risks and benefits of PA, barriers and facilitators to PA, and maternal influences on PA. Transcripts were coded iteratively through deductive thematic analysis.

Findings: Twenty girls (age: mean = 9.9 years, SD = 1.33, range = 8-12) and their caregivers participated. Most viewed asthma as a limitation to PA and could not identify a beneficial relationship between PA and asthma. Nonetheless, girls were enthusiastic about PA and shared strategies for managing asthma symptoms while exercising. Facilitators included outdoor access and social support, while barriers included program costs and safety concerns. Many girls said they would be more active with their mother/caregiver.

Conclusions: Despite personal and structural barriers to PA, Black girls with asthma view PA as important for physical and social wellbeing. Mothers/female caregivers play a major role in motivating and creating opportunities for PA. Our findings inform efforts to promote PA in a vulnerable yet understudied population, including expanding asthma management education and leveraging mother-daughter relationships to facilitate engagement in PA.

Purpose: Childhood empyema can have variable management and is associated with hospitalization and prolonged length of stay (LOS). We assessed the impact of a standard work pathway and associated electronic-health record (EHR) order set on management and outcomes.

Methods: We conducted a single-institution retrospective study of children hospitalized with empyema between 2015 and 2023. Pathway recommendations for antibiotics, consultations, MRSA screening, and pleural drainage before and after order set creation were compared using Chi-squared or non-parametric testing and over time by p-charts. We used Cox proportional hazard models to assess association of pathway recommendations and outcomes (LOS, need for repeat procedures). We compared outcomes by race, ethnicity, and language using Mann-Whitney and Kruskal-Wallis tests.

Results: Of all 141 children in our cohort, 107 (76%) underwent pleural drainage, mostly chest tube with fibrinolytic (n = 104). Pathway order set integration into the EHR was associated with a higher proportion of patients with Infectious Diseases consults and MRSA screens, but no difference in outcomes. In the whole cohort, 43 received first fibrinolytic ≥ 24 h after chest tube placement and 46.5% of these children required multiple procedures compared to those with timely fibrinolytic dose (15.6%, p = 0.0005). Median LOS was higher in children with non-English language of care (LOC) (p = 0.04). Of children needing pleural drainage, the proportion of multiple procedures differed by race/ethnicity (p < 0.01) as well as LOC (p = 0.03).

Conclusions: EHR integration of pathway-based order set led to uptake of some recommended practices for management of pediatric empyema. Across the cohort, we identified opportunities to address gaps including an association between delayed fibrinolytic administration and higher rates of repeat procedures, and differences in LOS and repeat procedures by race/ethnicity and LOC. Clinical standard pathways integrated with informatics and quality improvement can be leveraged to prioritize equitable high-quality care for children hospitalized with empyema.

Objective: To quantify associations of the community-level material deprivation index (CMDI) with asthma diagnosis by age 5 years among preterm infants with bronchopulmonary dysplasia (BPD).

Methods: We conducted a retrospective cohort study of preterm infants with BPD, born between 2010 and 2019, discharged from a single hospital system to a home address in the Philadelphia metropolitan area, with documented follow-up in the Children's Hospital of Philadelphia Care Network through 5 years of age. Patient charts were reviewed for asthma diagnoses, identified by ICD-10 codes. We geocoded each patient's address at time of neonatal intensive care unit (NICU) discharge to assign census tract CMDI values (range 0 to 1). Multivariable logistic regression models quantified associations of CMDI with asthma diagnosis by age 5 adjusting for patient-level factors.

Results: Of the 337 preterm infants with BPD and 5-year follow-up within the CHOP Care Network, 169 (50%) were diagnosed with asthma by age 5. CMDI was higher among infants diagnosed with asthma compared to those without asthma (0.43 vs 0.38, p = 0.002). Per standard deviation increment of CMDI, infants had 34% and 32% higher odds of asthma diagnosis in unadjusted (OR 1.34, 95% CI: 1.11, 1.62) and adjusted (aOR 1.32, 95%CI: 1.05-1.65) models, respectively.

Conclusions: Among an urban population of former preterm infants with BPD, high rates of asthma by school age were noted and higher neighborhood deprivation was associated with asthma diagnosis by age 5 years.

Objective: Limiting antibiotic days for treatment of tracheitis to the shortest, most effective duration is an important antimicrobial stewardship endeavor. The objective was to compare outcomes between patients who received a short course of antibiotics to those receiving a longer course.

Methods: This is a retrospective, cohort evaluation of patients admitted to the pediatric intensive care unit with an artificial airway and prescribed a course of antibiotics for at least 3 days for tracheitis. We compared the rate of re-treatment of tracheitis or development of new pneumonia requiring antibiotics within 10 days of completing therapy between patients receiving a short course (≤ 6 days) or long course (≥ 7 days) of antibiotics for tracheitis. We also compared the rate of developing a subsequent multi-drug resistant organism within 30 days of completing therapy between groups.

Results: A total of 95 patients were included; 42 (44%) patients received short (median 5 days) duration antibiotic therapy and 53 (56%) patients received long (median 9 days) duration. Duration of therapy did not statistically impact the composite of need for re-treatment of tracheitis or development of pneumonia within 10 days or all-cause mortality within 30 days of completing antibiotics.

Conclusions: Shorter courses do not have worse outcomes compared to longer courses. Pediatric providers should be encouraged to limit treatment duration for tracheitis to 5 days.