Pediatric Pulmonology最新文献

Background: This prospective, multicenter, randomized controlled trial aimed to determine whether the use of nasal intermittent positive pressure ventilation (NIPPV) during neonatal endotracheal intubation increased the rate of successful intubation without physiological instability during all intubation attempts.

Material and methods: In total, 150 infants were randomly assigned to either an NIPPV or standard care group (n = 75 each). The primary outcome was successful intubation without physiological instability (defined as ≥ 20% decline in the peripheral oxygen saturation [SpO₂] from preintubation value or bradycardia with a heart rate < 100 beats/min) during all intubation attempts.

Results: The mean postmenstrual age of the infants was 32.5 weeks, with a median weight of 1552 g at the time of intubation. The incidence of successful intubation without physiological instability during all intubation attempts was significantly higher in the NIPPV group (64%) than that in the standard care group (42.7%) (p = 0.009). This difference was particularly significant when inexperienced practitioners were involved. In the NIPPV group, the rates of bradycardia (18.7% vs. 41.3%) and severe desaturation (30.7% vs. 49.3%) were significantly lower, whereas the lowest SpO₂ (85% vs. 76%) and lowest heart rate (118 vs. 105 beats/min) were significantly higher.

Conclusion: NIPPV during endotracheal intubation increased the incidence of successful intubation without physiological instability during intubation attempts in neonates while reducing the rate of hypoxia and bradycardia.

Objective: This study utilizes Mendelian randomization (MR) to explore the causal relationship between immune cell phenotypes, inflammatory factors, and childhood asthma, aiming to enhance our understanding and management of the disease.

Methods: A two-sample MR approach was used to explore the causal relationships between 731 immune cell phenotypes, 91 inflammatory factors, and childhood asthma. The main analysis was performed using inverse variance weighting (IVW), with additional methods like weighted median, MR-Egger, and weighted mode. Statistical significance was further assessed using false discovery rate (FDR) correction. Sensitivity analyses assessed heterogeneity (Cochran's Q test) and pleiotropy (MR-Egger, MR-PRESSO), while reverse causality was evaluated using the Steiger test. Findings were further validated through cohort studies and meta-analyses to ensure robustness.

Results: Among 91 inflammatory factors, DNER, IL-18 R1, and Osteoprotegerin increased childhood asthma risk, while CDCP1 and VEGF-A were protective (p < 0.05). Of 731 immune cell phenotypes, 45 showed significant links to asthma, with protective effects from CD45RA+ CD8+ T cells and HLA-DR+ NK cells, and increased risk from IgD-CD38- B cells and CD8dim T cells (p < 0.05). Specific SSC-A parameters and higher MFI values for CD19, CD28, and CD3 were protective, while elevated MFI for CCR2 on monocytes and CD86 on myeloid dendritic cells increased risk. However, after further FDR correction, no statistically significant results were identified. Nonetheless, sensitivity and replication analyses, including meta-analysis, confirmed the robustness of these associations.

Conclusions: This study provides a comprehensive investigation into the complex interplay between immune system dysregulation and childhood asthma. By identifying specific inflammatory factors and immune cell phenotypes linked to asthma risk and protection, the findings offer valuable insights into disease pathogenesis. While these results highlight potential targets for precision-based therapeutic interventions, further research is needed to validate these associations and translate them into clinical applications.

Objective: To identify risk factors for late pulmonary artery hypertension (PH) at 36 weeks' postmenstrual age (PMA) in infants born before 28 weeks' gestation.

Design/methods: A retrospective cohort study included infants born < 28 weeks' gestation who underwent PH screening echocardiography at 36 weeks' PMA. We compared characteristics between infants with and without late PH to determine associations.

Results: Of 99 infants, 20 (20%) developed late PH. The FiO2% requirement at 4 weeks of age, home oxygen use, and procedural patent ductus arteriosus closure were associated with late PH. Bronchopulmonary dysplasia (BPD) severity was linearly associated with late PH, with each 1-point increase in BPD severity corresponding to a 3.5-fold increased odds of late PH diagnosis.

Conclusion(s): One in five extremely premature infants developed late PH. Markers of respiratory disease severity, including the BPD grade, were associated with the development of late PH.

Introduction: The Cystic Fibrosis (CF) Foundation guideline for the treatment of pulmonary exacerbations (PEx) does not address empiric antibiotic selection. The primary objective of this study is to characterize how patient-specific microbiological histories are utilized in initial antibiotic selection for CF-related PEx at a pediatric institution. The secondary outcome was to characterize why changes were made to empiric antibiotic regimens.

Methods: This single-center, retrospective study evaluated individuals aged 1-21 years hospitalized for CF-related PEx at Children's Medical Center Dallas between August 1, 2016 and July 31, 2018.

Results: Among 285 screened hospital encounters, 156 encounters met inclusion criteria. Median age was 12.9 years with a median baseline forced expiratory volume (FEV₁) of 84% predicted. Staphylococcus aureus, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia were the organisms most targeted by empiric antibiotics with median months since last growth of 1.5, 9.2, and 5.5, respectively. A difference was observed in median time since last growth for targeted organisms versus those not targeted by the initial antibiotics, but wide overlapping timeframes were noted. Organisms isolated on admission cultures were sensitive to the initial antibiotics regimen in 78.2% of encounters.

Conclusion: While variable, patient-specific microbiologic history and time since last growth of historical organisms are taken into consideration when selecting initial antibiotics for the treatment of PEx in children with CF. Expanding initial antibiotic coverage to target microbiological growth histories beyond 1 year prior to a hospital admission did not appear to increase the likelihood of providing coverage for organism(s) isolated on the admission sputum culture in children hospitalized for CF-related PEx.

Background: Residual obstructive sleep apnea (OSA) is common in childhood OSA even after upper airway obstruction removal by adenotonsillectomy. Orofacial myofunctional therapy (OMT) is becoming a popular treatment in stomatology but lacks adequate evidence of effectiveness in childhood OSA. Our study attempts to evaluate the effect of OMT on childhood OSA by subjective and objective methods.

Methods: Thirty-seven children diagnosed with postoperative residual OSA (obstructive sleep apnea) were enrolled in the study and divided into a treated group (n = 21) and a untreated group (n = 16). They were followed up at 0, 1, and 3 months. The degree of mouth opening, modified OSA-18 questionnaire responses, polysomnography (PSG) findings, and scores of the orofacial myofunctional evaluation with scores (OMES) were recorded pre- and post-therapy.

Results: Compared with pre-OMT or untreated children, the degree of mouth opening during sleep and the OSA-18 total score were significantly decreased after OMT in children with Residual OSA. Furthermore, OMT significantly decreased the apnea-hypopnea index (AHI), the longest duration of apnea and hypopnea, and the proportion of wakefulness and increased the duration of deep sleep. Moreover, the total score of OMES score and the scores of appearance and posture, mobility and functions were significantly increased after OMT.

Conclusion: OMT improves the qualities of life and sleep by repairing orofacial myofunctions in residual OSA children. OMT could be an adjuvant treatment for childhood OSA.

Trial registration: The trial was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn.).

Registration number: ChiCTR2300072252 (07/06/2023).

Tuberculosis (TB) in childhood presents a substantial global burden with nearly two million episodes of disease in children and adolescents annually. The majority of children who die from TB never receive appropriate treatment. Advancements in childhood TB treatments have been slow and there are many challenges with TB treatment in children. However, recently, there have been renewed efforts toward better options for TB treatment in children. The shortened duration of treatment (4 months) in nonsevere TB and an all-oral treatment for multidrug-resistant TB are major landmarks in childhood TB treatment. Although BCG remains the only vaccine for TB prevention, there are candidate vaccines that target infants and adolescents.

Sickle cell disease (SCD) is of global significance due to its severity and occurrence worldwide. Inheritance of the abnormal hemoglobin structure contributes to microvascular events that underlie the development of the multi-systemic complications seen in the disease pathogenesis. Pulmonary complications are common and heterogeneous including pulmonary hypertension, sleep-disordered breathing and lung function abnormalities. Lung function abnormalities commonly reported among children with SCD living in Africa are restrictive impairments. However, in high-income countries, reports suggest that obstructive lung function impairment is more predominant. The exact process that contributes to lung disease in SCD must be continuously explored and large-scale longitudinal studies employing multiple lung function methods are needed urgently. Lung disease-modifying agents need to be explored to help slow down or prevent the occurrence of pulmonary function abnormalities.