Pediatric Pulmonology最新文献

Background: Poor indoor air quality (IAQ) contributes to asthma morbidity, particularly affecting children and young people (CYP) from socioeconomically deprived backgrounds. Air purification devices may improve IAQ and asthma symptoms, but real-world evidence remains limited.

Aim: To assess the feasibility, acceptability, and potential clinical impact of installing an air purifier in the homes of CYP with severe asthma.

Methods: An unblinded feasibility study recruiting children ≤ 15 years with a confirmed diagnosis of asthma attending a regional severe asthma service. Participants selected by computer-generated random allocation. An air purifier (manufactured by Rensair Ltd.) was installed in each home, with instructions to operate continuously on "quiet mode" for 1-year, and operating costs covered. Data on asthma management and symptoms, quality of life, and qualitative feedback were collected and analysed using thematic analysis.

Results: Twenty CYP were recruited (mean age: 11.2 (SD: 2.68), 60% boys). Thematic analysis of feedback from CYP and families indicated high acceptability and perceived improvements in night-time symptoms and IAQ. Over this 12-month study period, the mean annual number of systemic corticosteroid courses decreased from 4.2 to 2.15 (p = 0.006) from the previous year, and unscheduled primary care visits fell from 4.0 to 1.8 (p = 0.02). Trends towards marginal improvements in asthma control test mean scores (13.3 to.14.2 for < 12 years (p = 0.2), 15.5 to 16.8 for ≥12 years (p = 0.6) and quality of life scores were observed (54.6 to 62.4 for total score (p = 0.08), 17.2 to 19.8 for emotional domain (p = 0.07) and 13.6 to 13.9 for activity domain (p = 0.7)), with a statistically significant increase in the symptom domain of the Mini-PAQLQ (23.8 to 28.8 p = 0.04).

Conclusions: Air purifiers may offer a feasible, acceptable, and potentially beneficial intervention for children with severe asthma, particularly in settings with poor IAQ. Larger controlled trials are warranted to confirm these findings and inform implementation.

Trial registration: NCT05817357.

Background: Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators revolutionized the care of people with Cystic fibrosis (pwCF) by addressing the underlying genetic defect rather than merely managing symptoms. Elexacaftor/Tezacaftor/Ivacaftor (ETI) has shown significant clinical benefits in pwCF carrying specific CFTR mutations; however, data on its safety and efficacy in young children with CF (ycwCF), aged 2-6 years, remain sparse.

Methods: We conducted a real-world, retrospective study that included all Israeli ycwCF who were genetically eligible for and treated with ETI. Body mass index (BMI) z-score, forced expiratory volume in one second (FEV₁) percent predicted, rate of pulmonary exacerbations (PEx), sweat conductivity levels, bacterial sputum isolates, clinic visits frequency, and sputum samples collected before and after ETI initiation were evaluated. Additionally, adverse effects were assessed.

Results: Sixteen ycwCF, aged 2-6 years, received ETI therapy for a mean duration of 13 months (range 4-25 months), including three pancreatic-sufficient patients. Following ETI initiation, significant improvements were observed. BMI z-scores increased from -0.37 ± 1.32 to -0.01 ± 1.14 (p = 0.005), and in the subset of patients tested (7/16), FEV₁ improved from 91 ± 12 to 113 ± 18 percent predicted (p = 0.018). The rate of PEx decreased from 0.7  ±  1.1 to 0.2  ±  0.4 (p = 0.058) and sweat conductivity levels dropped significantly from 112  ±  38 to 48  ±  30 mmol/L (p = 0.002). There was a marked reduction in bacterial colonization in sputum: Pseudomonas aeruginosa declined from 9/16 to 2/14 (p = 0.04), and Staphylococcus aureus from 12/16 to 2/14 (p = 0.01). Notably, the total number of sputum cultures sent also decreased by 35%, from 116 before ETI to 75 after treatment initiation. This reduction paralleled decreased CF clinic visits, from 7.3  ±  3 per year to 4.7  ±  3 (p = 0.001). Reported adverse effects were minimal, and no treatment discontinuations were required.

Conclusions: These real-world findings support the safety and effectiveness of ETI in ycwCF. Robust, long-term studies involving larger populations are essential to confirm these results.

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.

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.

Background: Acute bronchiolitis is a frequent cause of hospitalization in early childhood and has been associated with subsequent respiratory morbidity. However, its long-term impact on mental health has not been extensively studied.

Methods: This population-based cohort study used data from the National Health Insurance Service (NHIS) in South Korea, including 985,957 children born between 2002 and 2003, followed until December 2021. Children hospitalized for acute bronchiolitis (n = 25,550) were compared to a matched unexposed cohort (n = 102,220). The primary outcomes were 24 predefined mental health disorders, categorized into early-onset (before 10 years) and late-onset (after 10 years) conditions. Hazard ratios (HRs) were estimated using proportional hazards models, adjusting for potential confounders. The modifying effects of asthma and atopic dermatitis were also evaluated.

Results: The median age at hospitalization for bronchiolitis was 8 months (IQR, 3-20 months). Over a mean follow-up of 15 years, the incidence rate of any mental health disorder was 187.9 and 153.9 per 10,000 person-years in the bronchiolitis and unexposed cohorts, respectively. The adjusted hazard ratio (aHR) for any mental health disorder in the bronchiolitis cohort was 1.20 (95% CI, 1.16-1.23). Early-onset developmental disorders showed aHR of 1.34 (95% CI, 1.26-1.43), and late-onset psychiatric disorders had aHR of 1.18 (95% CI, 1.15-1.22). There was a progressive increase in risk for multiple mental health disorders (p < 0.01). Asthma (p = 0.77) and atopic dermatitis (p = 0.48) did not significantly modify this risk.

Conclusions: Children hospitalized for acute bronchiolitis showed an increased risk of developing mental health disorders. These findings provide epidemiologic evidence supporting the need for long-term mental health surveillance and supportive care in this population.

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.

Background: Tracheostomies are increasingly performed in children. The treatment of infections in tracheostomized patients is challenging because of the distinction between chronic colonization and acute infection. Next-generation sequencing (NGS) is a promising alternative for identifying and quantifying pathogens in a short period. This study investigated the utility of NGS of tracheal aspirates from healthy and tracheostomized children (TC).

Methods: This monocentric prospective case-control study recruited children with long-term TC and compared the colonization of the lower airways with a control group of children who had undergone elective general surgery. Tracheal aspirates were analyzed using three methods: bacterial culture, polymerase chain reaction (PCR), and NGS.

Results: In total, 107 children were recruited for this study. Sixty-two samples were excluded due to acute exacerbation, lack of tracheal secretion, or insufficient cfDNA concentration (< 0.3 ng/µl). Consequently, 45 samples (17 controls and 28 tracheotomized samples) were analyzed. Tracheal aspirates analyzed using NGS revealed a significantly higher prevalence of Pseudomonas aeruginosa (p = 0.0001), Staphylococcus aureus (p = 0.002), Stenotrophomonas maltophilia (p = 0.004), and Moraxella catarrhalis (p = 0.03) in TC. Through NGS, we were able to demonstrate that Pseudomonas aeruginosa was the dominant bacterium in 44% of the samples in which it was detected.

Conclusions: NGS can effectively identify a wide spectrum of DNA-based pathogens (bacteria, viruses, and fungi) in the tracheal aspirates of children. Tracheostomized children were significantly more likely to be colonized by difficult-to-treat bacteria. Future research is required to evaluate the clinical benefits of NGS compared with standard microbiological procedures.

Background and objective: Early-life insults affect lung function trajectories throughout life. In Nepal there is a high burden of disease from lower respiratory tract infections, and high levels of exposure to household and environmental pollution. To enable assessment of these factors on lung development we aimed to assess the feasibility of establishing a pulmonary function laboratory for tidal breath flow-volume loops (TBFVL) in infants and children in Dhulikhel, Nepal.

Methods: A pulmonary function laboratory was established and TBFVL testing, meeting international quality standards, were performed on healthy children 1-24 months of age, between October 2024 and May 2025, in Dhulikhel, Nepal. Results were interpreted by local staff after initial training and ongoing oversight by international experts. TBFVL indices with coefficient of variation (CoV) were reported and inter-interpreter level of agreement evaluated using Bland-Altman plots.

Results: Eighty-six children were included, of which 80 (93%) had successful tests. Fifty-five (69%) 0- <4 months, 12 (15%) 4- < 12 months and 13 (16%) 12-24 months of age. The CoV ranged from 4.7 (4.4, 5.2) for tidal volume to 19.5 (15.8, 24.1) for the ratio of the proportion of time to reach peak tidal expiratory flow to total expiratory time (T_PTEF/TE), with CoV being similar across age groups. Agreement between local and expert international assessors was good, with the largest mean inter-interpreter difference observed for T_PTEF/TE.

Conclusion: Establishing a pulmonary function laboratory and achieving high-quality TBFVL measurements with expert-level interpretation is feasible in Nepal and contributes to the knowledge of normal pulmonary function values in Nepali children.