Pediatric Pulmonology最新文献

Background: Bronchopulmonary dysplasia, a sequela of preterm birth, is the most common chronic respiratory disorder in infancy, and the second most common in children. Despite this, clinical care remains highly variable with guidelines supported by limited evidence, and do not provide specific guidance for timing of clinical follow-up, echocardiography, modalities of pulmonary function testing, etc. OBJECTIVE/METHODS: To further our understanding of care delivery for BPD, we sought to describe outpatient care patterns at tertiary care centers through survey data from 27 well-established BPD programs.

Results: We observed variability in referral patterns to outpatient BPD clinics, ancillary services provided, indications for follow-up echocardiograms, availability of lung function testing, and criteria for discharge from care.

Conclusion: More comprehensive and detailed clinical guidelines similar to other pulmonary diseases such as asthma and cystic fibrosis should be developed to help standardize care and may improve long term outcomes.

Purpose: Our aim was to explore the applicability of the definition of "large" primary spontaneous pneumothorax (PSP) of adult guidelines to pediatric patients.

Methods: We performed a retrospective monocentric analysis of first-episodes of PSP (Period: January 2010-January 2023). We defined large PSP according to French SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines.

Inclusion criteria: age 1-18 years-old, follow-up ≥ 1 year. We performed a comparative analysis between large and nonlarge PSP. We reported the categorical variables as frequencies, and continuous as median and range. We compared categorical variables using Chi-Square or Fisher test, and continuous using U Mann-Whitney test. p < 0.05 was considered significant.

Results: The population consisted of 49 patients, 15 (30%) with large PSP. We found no significant differences at presentation between large and nonlarge PSP regarding age, sex, side, BMI, oxygen saturation, respiratory rate and hearth rate. Conservative first-line management was used significantly less for large PSP (26% vs. 82%, p = 0.0003), while drain more (46% vs. 8%, p = 0.005). The groups were similar regarding surgery. Large PSP had a significantly longer hospitalization (7 days vs. 4 days, p = 0.003). The incidence of first-line management failure was similar between the groups. During the follow-up, we found no significant differences regarding ipsilateral recurrence (33% vs. 17%, p = 0.275), and contralateral occurrence (0% vs. 5%, p = 1.000), need for drain (6% vs. 5%, p = 1.000), or surgery (33% vs. 14%, p = 0.246).

Conclusions: In the first-line, large PSP were treated significantly less conservatively and more drained. Radiographic size of the pneumothorax does not seem to have an impact on first-line treatment failure and follow-up outcomes.

Background: There is a scarcity of high-quality research on the efficient delivery of inhaled corticosteroids using valved holding chambers (VHCs) in children.

Methods: The delivered dose (DD) of fluticasone from a metered dose inhaler (pMDI) was tested using four VHCs: AeroChamber plus Flow-Vu (AC), Babyhaler (BH), EasyChamber (EC), and Optichamber Diamond (OD). The in vitro setup included an anatomical child throat model, Next Generation Impactor, and a breathing simulator to generate tidal breathing of a four and a 6-year-old child, and adult type single inhalation.

Results: OD showed the lowest proportion of fluticasone trapped in the throat with all breathing patterns. AC showed similar fine particle dose (FPD) in the respirable range (1-5 µm) irrespective of the breathing pattern. For BH, the median FPD 1-5 µm was highest during adult breathing. OD and EC showed higher overall DD and higher doses in the 1-5 µm range with paediatric breathing profiles compared to adult inhalation. The median DD and FPD 1-5 µm were significantly lower with BH compared to any other VHCs during tidal breathing. Compared to EC, the FPD of the other VHCs were skewed towards <2 µm particles.

Conclusion: Fluticasone delivery is markedly affected by breathing pattern and VHC model. The observed differences in throat deposition and FPD delivered may have significant clinical implications for side effects and controlling airway inflammation. All VHCs intended for paediatric use should undergo testing using internationally recognised standardised methods incorporating clinically relevant paediatric breathing patterns.

Objective: Although studies have examined changes in C-reactive protein (CRP) during pulmonary exacerbations (PEX) in people with cystic fibrosis (PwCF), few have evaluated CRP profiles across age groups. Here, we characterize age-related CRP responses to PEX treatment.

Methods: We measured CRP concentrations at the beginning and end of intravenous (IV) antibiotic therapy for PEX in 100 pediatric and 147 adult PwCF at 10 US CF Centers. We examined relationships between CRP and age, lung function, severity of PEX symptoms, and time to next PEX.

Results: CRP measured at initiation of IV antibiotic treatment for PEX was higher in adults than children, median 8 mg/L (IQR 4, 32) versus 5 mg/L (IQR 2, 10), respectively (p < 0.001). There was a significant correlation between the initial CRP and drop in lung from baseline to the beginning of IV antibiotics in adults and children. Adjusted CRP dropped in response to PEX treatment more commonly in adults than in children (70% vs. 48%, respectively). The range of treatment responses was greater in adults, in those with higher symptom scores, and in those with more advanced lung disease. In adults elevated CRP at the end of treatment was also associated with incomplete recovery of lung function. CRP at the start of IV antibiotics was inversely related to time until the next PEX.

Conclusion: In children and adults with CF, CRP is increased at the initiation of IV antibiotic therapy for PEX and declines with treatment. The response is more pronounced in highly symptomatic adults with advanced lung disease.

Objective: To investigate the effect of viral co-infections on treatment length and treatment failure in children with lower respiratory tract infections (LRTI) supported with continuous positive airway pressure (CPAP) or high-flow nasal cannula oxygenation therapy (HFNC).

Methods: Patients aged 0-5 years hospitalized with viral LRTI and in need of respiratory support between August 1 and December 31, 2021, were retrospectively evaluated by patient chart audits.

Results: A total of 148 children (median age 10.1 [IQR 2.2-17.6] months) were included. Of this, 98 children were treated with HFNC and 50 with CPAP. Five children were transferred to the pediatric intensive care unit. In 17 children, HFNC treatment failed, leading to a shift to CPAP. The median treatment length was 90.6 (IQR 61-136) h. A total of 93 children were mono-infected: 66 with respiratory syncytial virus (RSV), 14 with rhino/enterovirus (REV), 11 with metapneumovirus (MPV), 1 with adenovirus (AV), and 1 with coronavirus. Fourteen children were co-infected with either RSV, REV or MPV and AV or parainfluenza virus (PIV). A total of 41 children were infected with both RSV and REV, RSV and MPV, MPV and REV, or all three viruses. Co-infections with RSV, MPV, and/or REV were independent predictors of treatment failure with HFNC (p < 0.05) and length of treatment (p < 0.01), whereas co-infections with AV or PIV had no effect.

Conclusion: In children with viral LRTI, the combination of RSV/REV/MPV had an impact on treatment length and failure with HFNC, whereas co-infections with either RSV, REV or MPV, and AV or PIV had not.

Objective: This study aimed to evaluate the predictive value of combining nucleated red blood cells (NRBC) with the pediatric critical illness score (PCIS) in infants with severe pneumonia at 28 days.

Methods: This retrospective study was conducted at the Pediatric Intensive Care Unit (PICU) of the First People's Hospital of Bijie and included infants with severe pneumonia from September 1, 2021, to August 31, 2022. Demographic, clinical, and laboratory data were extracted from electronic medical records, and the differences between the groups were compared. Variables showing significant differences were included in binary multivariable logistic regression analysis to explore independent risk factors for mortality in infants with severe pneumonia. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of patient outcomes at 28 days.

Results: The study included 128 patients; at 28 days, 96 survived (survivor group), and 32 had died (nonsurvivor group). Compared with the survivor group, the nonsurvivor group had lower levels of platelets [348 (239-496) versus 431 (324-540) ×10⁹/L; p = 0.023], albumin [35.7 ± 5.2 vs. 37.9 ± 4.4 g/L; p = 0.022], CD3 [36.9 ± 1.7 vs. 47.6 ± 1.8%; p ＜ 0.001], CD4 [20.4 ± 1.2 vs. 23.6 ± 1.9%; p ＜ 0.001], IgG [4.9 ± 1.0 vs. 6.4 ± 0.7 g/L; p ＜ 0.001], IgA [0.5 ± 0.1 vs. 0.8 ± 0.1 g/L; p ＜ 0.001], 25-hydroxyvitamin D(25(OH)D) [21.1 ± 1.0 vs. 30.7 ± 1.36 ng/mL; p ＜ 0.001], PCIS [72.8 ± 7.8 vs. 87.5 ± 6.2; P＜0.001], and a greater NRBC level [0.450 (0.162-0.832) vs. 0.185 (0.100-0.500) ×10⁹/L; p = 0.005]. Binary multivariable logistic regression analysis revealed that the NRBC count (odds ratio (OR) = 2.46, 95% confidence interval [CI] 1.427-4.239; p = 0.001) and PCIS (OR = 0.775, 95% CI: 0.644-0.934; p = 0.008) were independent predictors of 28-day survival in infants with severe pneumonia. The PCIS had an area under the curve (AUC) of 0.782 (95% CI: 0.680-0.884), NRBC had an AUC of 0.719 (95% CI: 0.622-0.816), and when the NRBC and PCIS were combined, the AUC was 0.929 (95% CI: 0.880-0.978).

Conclusion: The NRBC count and PCIS are risk factors for the prognosis of infants with severe pneumonia, and their combination can increase the predictive value of patient outcomes at 28 days.

Introduction: The diagnosis of cystic fibrosis (CF) can impact the mental health of caregivers. This study aimed to explore prevalence of postpartum depression (PPD) symptoms in caregivers of infants with CF or CFTR-related metabolic syndrome (CRMS).

Methods: This prospective, observational study was conducted in a CF clinic at a tertiary hospital over 4 years. Caregivers of infants with CF/CRMS completed serial surveys over the first year of life. Surveys included the Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). A control group of healthy infant caregivers was used for comparative analysis of EPDS scores.

Results: Analyses were conducted on 55 caregivers of 42 infants with CF/CRMS and 915 caregivers of healthy infants. Caregivers of infants with CF/CRMS had a significantly higher prevalence of elevated EPDS scores and higher mean EPDS scores for visit 1 (age 1-2mo) and visit 3 (age 6-9mo) compared to healthy controls (p < 0.001 for both). There was a higher prevalence of caregivers identifying thoughts of self-harm in the CF/CRMS cohort (8.3%) compared to caregivers of healthy controls (1.2%) at visit 1 (p = 0.015) and at visit 3 (CF/CRMS 8.8%; control 1.7%; p = 0.030). EPDS scores correlated with PHQ-9 and GAD-7 scores, particularly earlier in the infant's life.

Conclusions: Caregivers of infants with CF/CRMS may be at higher risk of PPD and thoughts of self-harm when compared to healthy controls. Given what is known about the impact of PPD on mental and physical health of children, early identification is vital for this population.