Pediatric Pulmonology最新文献

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.

Introduction: This national study aimed to assess the incidence and respiratory morbidity in children with esophageal atresia (EA).

Methods: We conducted a national population-based cohort study from 1998 to 2018 using the National Patient Registry to identify children with EA and calculated the annual incidence. Respiratory morbidity was evaluated through healthcare utilization and prescribed therapy. A case-control analysis linked to the Prescription Registry compared lung disease management in EA patients to age-matched children with asthma, and a control group from the background population.

Results: The incidence of EA remained stable at 2.5 cases per 10,000 births, with a 20-year mortality rate of 4%. Children with EA exhibited higher antibiotic use, with an average of 3.2 prescriptions per year, compared to 2.1 in the asthma group (p < 0.01) and 1.75 in the control group (p < 0.01). Use of beta-2 agonists was similar between the EA and asthma group, with 2.7 and 2.3 prescriptions per year, respectively. Compared to the controls inhaled corticosteroid use was also elevated in children with EA (p < 0.01), averaging 3.5 prescriptions per year, and approaching 3.1 prescriptions per year observed in children with asthma (p < 0.01). Children with EA had more healthcare contacts averaging 4.8 per year, more than both asthma 2.2 and controls 1.7 (p < 0.01), which were not solely related to esophageal complications.

Conclusion: The incidence of EA has remained stable and children with EA experience higher respiratory morbidity in early life compared to peers with asthma or those without chronic illness. This disparity diminishes with age, particularly during adolescence.

Background: Flexible bronchoscopy (FB) is widely used in the management of children with Cystic Fibrosis (CF) to visualize airway abnormalities, assess inflammation and detect infection. While previous scoring systems have been proposed to quantify visual airway findings in general pediatric populations, no standardized tool exists for assessing airway inflammation specific to CF.

Methods: We modified the previously proposed pediatric bronchoscopy scoring tool by adding four features relevant to CF pathology: mucus plugging, secretion viscosity, bleeding, and vascular drawing (abnormal or enhanced visualization of airway mucosal vessels, reflecting neovascular remodeling associated with inflammation). Eighty bronchoscopy recordings (50 CF, 30 non-CF) were retrospectively scored by four raters blinded to the clinical information, and ten visual features were assessed: six from the previously proposed score (secretion amount and color, mucosal edema, erythema, ridging, and pallor) and the four CF-specific additions. Inter-rater reliability was assessed using Gwet's AC2 coefficient.

Results: Agreement between raters varied across features. Mucus plugging (AC2 = 0.94) and bleeding (0.80), both CF-specific, were among the most reliably scored features, while secretion viscosity (0.47) and vascular drawing (0.50) showed the lowest agreement. The expanded score demonstrated comparable or improved reliability for overlapping features from earlier scoring systems.

Conclusion: The modified bronchoscopy score demonstrated moderate to excellent inter-rater reliability and added clinically relevant features specific to CF. It may serve as a standardized method to assess bronchoscopy for pediatric CF lung disease, although further validation is needed for features with lower inter-rater reliability.

Objectives: CFTR modulators have revolutionized cystic fibrosis (CF) management by targeting the defective protein rather than its consequences. Their impact on quality of life (QoL) have been studied in numerous trials, but few data are available on QoL in patients receiving Elexacaftor-Tezacaftor-Ivacaftor (ETI), notably in children given its recent authorization for this age group. We aimed to assess the impact of ETI on children's QoL.

Methods: This prospective observational study included children with CF (6-17 years), assessing QoL using the CF Questionnaire Revised (CFQ-R) before (baseline) and 3 months after (M3) starting ETI treatment for children and their caregivers.

Results: We included 23 children (median [range]) age 10.2 [6-17.2] years, 13 (57%) with homozygous F508del genotype. The total QoL score at baseline ([mean (SD)] children: 74.07 [10.86]; caregivers: 73.21 [10.38]) reflected severe disease impact, particularly regarding treatment burden in the children's perspective (63.28 [21.04]) and digestive domains in the caregivers' perspective (digestive symptoms: 66.67 [17.37]; eating disorder: 67.54 [32.14]; weight: 61.40 [33.82]). At M3, there was a significant increase in reported QoL (p = 0.0001), particularly regarding physical domains. Emotional/social/school domains barely showed improvement. Although QoL mean scores were comparable between children and caregivers' groups, they were poorly correlated within the same family. Homozygous F508del genotype was associated with better QoL improvement at M3 compared to composite heterozygous genotypes (p < 0.001).

Conclusion: ETI treatment has a significant impact on children's QoL, particularly in physical health domains. Other QoL domains that are not improved by ETI need to be addressed, in particular, psycho-social components. Both children's and caregivers' perspectives must be considered for a holistic picture of children's QoL.

Background: While adult patients with interstitial lung disease (ILD) commonly experience poor sleep quality characterized by abnormal sleep architecture, increased fragmentation, and sleep-disordered breathing (SDB), children's interstitial lung disease (chILD)-a heterogeneous group of diffuse parenchymal lung diseases-remains less studied in terms of its impact on sleep.

Objective: We aimed to assess sleep quality and the prevalence of SDB, and to investigate potential associations between SDB and clinical, functional, and radiological parameters.

Materials and methods: This prospective cross-sectional study included children diagnosed with ILD. Sleep questionnaire scores, polysomnography (PSG) parameters, and SDB outcomes were recorded and compared between patients with and without lung fibrosis.

Results: Of 30 patients (36.7% female, mean age 115 ± 59.3 months), 77% were diagnosed with OSAS (63.3% mild, 13.3% moderate). Sleep efficiency was below 85% in 20% of cases, and REM sleep was reduced in 90%. Median AHI was 1.8. According to sleep questionnaires, 80% of patients had impaired sleep quality, and 60% showed an increased risk for SDB. No significant association was found between pulmonary fibrosis and SDB.

Conclusion: Contrary to common belief, SDB is not rare in chILD, and PSG alongside sleep questionnaires should be used in follow-up to improve screening and detection.

Background: Spirometry (FEV₁) is often measured as part of ongoing asthma management, but little is understood about what merits a clinically meaningful change in FEV₁.

Metholology: Data were collated from five clinical trials where FEV₁ was measured at 3-month intervals. Change in FEV₁ over 3-months was expressed as: FEV₁ change score (Zc), absolute change in %FEV₁ (∆FEV₁%) and absolute change in FEV₁ z score (∆FEV₁z). The association between change in FEV₁ over 3 months and asthma outcomes in the following 3 months was estimated using logistic regression.

Results: Data from 1264 children were analysed. Declines in in Zc between 1.1 and 2.9, in ∆FEV₁% between 12% and 23% and in ∆FEV₁z between 0.9 and 2.0, were associated with increased odds ratio (OR) for later asthma exacerbation of between 1.3 and 2.3. Unexpectedly, rises in Zc of 1.7-1.9 and in ∆FEV₁% of 14 and 18 were also associated with increased OR for a future exacerbation of between 1.3 and 1.6. Among children with controlled asthma symptoms, declines in Zc of 1.7, in ∆FEV₁% of 11 and 14 and in ∆FEV₁z of 0.8-1.1 were associated with increases in OR for future loss of control of between 1.5 and 1.7. Rises in all three indices of change in FEV₁ were associated with reduced OR between 0.4 and 0.7 for future loss of control. A lower initial FEV₁ z score was associated with higher variability in longitudinal FEV₁ z-score measurements.

Conclusions: FEV₁ variability, and not simply a fall in FEV₁, identifies children at increased risk for future asthma exacerbations. The clinical relevance of a single FEV₁ may be uncertain.