Pediatric Pulmonology最新文献

Background and aim: Flexible bronchoscopy (FB) poses a risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission due to aerosol generation. This study aimed to assess the utilization, indications, outcomes, and safety of FB in pediatric patients for noncoronavirus disease of 2019 (COVID-19) reasons during the pandemic.

Materials and methods: We retrospectively analyzed pediatric patients who underwent FB for non-COVID-19 indications at a tertiary children's hospital's pulmonary clinic during the COVID-19 pandemic. Patients showed no COVID-19 symptoms and tested negative for SARS-CoV-2 by real-time polymerase chain reaction (PCR) of nasopharyngeal and throat swabs within 24 h before the procedure. FBs were conducted in the operating room, with healthcare professionals (HCPs) wearing personal protective equipment, including medical N95 masks, gloves, gowns, and eye protection.

Results: Between March 2020 and April 2022, 167 pediatric patients underwent FB for non-COVID-19 indications. Common indications included foreign body aspiration (22.7%), stridor (10.1%), and atelectasis (8.9%). No COVID-19 symptoms were observed in patients on the 1st and 10th days post-FB. During the 1-month follow-up, 52 patients underwent SARSCoV-2 PCR testing, and one patient tested positive in the third week after the procedure. None of the HCPs in the FB team experienced COVID-19 symptoms or tested positive for SARS-CoV-2.

Conclusion: A bronchoscopy protocol with safety precautions minimized the risk of COVID-19 transmission, allowing safe FB performance for non-COVID-19 indications in pediatric patients during the pandemic. The experience gained in FB during COVID-19 is valuable for similar situations in the future.

Background & objectives: Despite the availability of biologics for severe pediatric asthma, real-life studies reporting on drivers behind initiating biologics and their alignment with the Global Initiative for Asthma (GINA) recommendations are lacking.

Methods: We performed analysis within the pediatric asthma noninvasive diagnostic approaches study, a prospective cohort of 6- to 17-year-old children with severe asthma. Information was collected on demographic factors, symptom control, treatment, comorbidities, and diagnostic tests from medical records and questionnaires. We divided patients into "starters" or "nonstarters" based on the clinical decision to initiate biologics and performed multivariate logistic regression analysis to identify drivers behind initiating therapy. Additionally, we assessed patient suitability for biologics according to key factors in the GINA recommendations: Type 2 inflammation, frequency of exacerbations, and optimization of treatment adherence.

Results: In total, 72 children (mean age 11.5 ± 3.0 years, 65.3% male) were included (13 starters). Initiation of biologics was associated with a higher GINA treatment step (adjusted odds ratio's [aOR] = 5.0, 95%CI 1.33-18.76), steroid toxicity (aOR = 21.1, 95%CI 3.73-119.91), frequency of exacerbations (aOR = 1.6, 95%CI 1.10-2.39), improved therapy adherence (aOR = 1.7, 95%CI 1.10-2.46), Caucasian ethnicity (aOR = 0.20, 95%CI 0.05-0.80), ≥1 allergic sensitization (aOR = 0.06, 95%CI 0.004-0.97), and allergic rhinitis (aOR = 0.13, 95%CI 0.03-0.65). Furthermore, steroid toxicity was identified as an important factor for deviation from the current recommendations on biologic prescription.

Conclusions: We identified multiple drivers and inhibitors for initiating biologics, and showed the clinical need for biologics in severe pediatric asthmatics suffering from steroid toxicity. These findings may help refine asthma management guidelines.

Tomographic imaging via MRI can capture structural abnormalities at high resolution and reveal functional abnormalities if acquired during respiration. In infants and children with chronic lung diseases, MRI can serve as a safe and effective tool to characterize cardiorespiratory disease where PFTs are not feasible. Functional lung imaging via hyperpolarized Xe MRI has been shown to have very high sensitivity to regional airway obstruction, changes in alveolar-airspace size/structure, and gas-exchange due to abnormalities in the interstitium or blood-flow; the technique is routinely used in ages 5 and up. This summary outlines each of the functional measures currently available using Xe MRI.

Pulmonary arteriovenous malformations (PAVMs) are rare abnormalities observed mainly in children with hereditary haemorrhagic telangiectasia (HHT). A majority of patients are asymptomatic at the time of detection. However, complications such as hypoxemia, stroke, cerebral abscess and massive hemoptysis can arise if larger PAVMs remain untreated. Larger PAVMs are usually managed successfully with embolization, although reperfusion of PAVMs have been reported post procedure. Early screening for PAVMs is recommended in asymptomatic children with HHT or those at risk for HHT. Longer term surveillance is also essential, to enable timely identification and management of PAVMs.

Objectives: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects premature babies and contributes to their morbidity. French BPD guidelines suggest the use of intravenous methylprednisolone pulses (IVMP) for those who require respiratory support (RS) following 36 weeks postmenstrual age (PMA). However, there is scant data on the efficacy and tolerance for this indication. Our objectives were to assess the efficacy and tolerance of IVMP in patients with severe BPD requiring RS.

Study and design: This retrospective observational study included preterm infants (<32 weeks gestational age) treated by IVMP between January 2016 and March 2021, in a single tertiary care hospital. The primary endpoint was signified by changes in the Pulmonary Severity Score (PSS). Our secondary endpoints were changes in RS and the tolerance of IVMP.

Results: Data of 14 children with BPD under RS were reviewed. Their median [IQR] gestational age at birth was (26[26-29.5] weeks). After IVMP administration, the PSS did not improve significantly from baseline day 0 (D0) (0.85[0.55-1.15]) to D7 (0.74 [0.48-1.00]) or Month 1 (1.02 [0.57-1.48]). Three children (21%) experienced a decrease in RS in the following month of IVMP. There was no negative short-term impact on growth. Five infants presented infectious complications. The development quotient was measured in 5 children at 2 years of age.

Conclusion: In our study, IVMP did not improve PSS and it was associated with a high number of infections. Other studies are needed to better define the place of IVMP in these infants.

Oxygen therapy has been one of the main challenges in neonatal intensive care units (NICU). The guidelines currently in use try to balance the burden of hypoxia and hyperoxia such as retinopathy of prematurity, bronchopulmonary dysplasia, and death. The goal of this paper is to review neonatal oxygenation and the impact of hyperoxia and hypoxia in neonatal outcomes as well as review the available literature concerning the use of Oxygen Reserve Index (ORi^TM) in clinical practice and its potential in Neonatology, particularly in NICU. Pulse oximetry has been used to monitor oxygenation in newborns with the advantage of being a noninvasive and continuous parameter, however it has limitations in detecting hyperoxemic states due to the flattening of the hemoglobin dissociation curve. The ORi^TM is a new parameter that has been used to detect moderate hyperoxia and, when used in addiction to spO₂, could be helpful in both hypoxia and hyperoxia. Studies using this tool are mainly in the adult population, during anesthetic procedures with only a small number of studies being performed in pediatric context. Oxygen targets remain a major problem for neonatal population and regardless of the efforts made to establish a safe oxygenation range, a more individualized approach seems to be the more appropriate pathway. ORi^TM monitoring could help defining how much oxygen is too much for each newborn. Despite its promising potential, ORi^TM is still a recent technology that requires more studies to determine its true potential in clinical practice.

Pediatric obstructive sleep apnea (OSA) is a common syndrome in children. While an adenotonsillectomy is effective for most, it may not be the treatment of choice for all, and possible alternative treatment options are briefly discussed herein. In obese children, in whom OSA is more prevalent, and has high rates of persistence after surgery, weight loss interventions may be recommended. Anti-inflammatory therapies, such as nasal steroids and montelukast, reduce the size of the adenoids and tonsils and are considered part of the stepwise treatment approach. Functional orthodontic therapies may improve OSA as well as orthopedic interventions in children in whom orthodontic indications exist. Positive airway pressure and high flow nasal cannula, stent the airway open and alleviate the obstruction, but adherence may be challenging. Tongue surgery, as well as several additional interventions are further discussed. In conclusion, multiple therapeutic options are available for pediatric OSA. Further studies are required to better identify the children most likely to benefit from these therapies.