Pediatric Pulmonology最新文献

Background: Disparities in asthma persist despite advances in interventions. Adherence and self-management behaviors are critical yet challenging during adolescence. Treatment barriers include individual factors as well as structural and social determinants of health.

Objective: To determine differences in controller medication adherence, asthma control, and treatment barriers by race, income, and insurance and whether racial disparities persist when controlling for income and insurance. Associations between adherence, barriers, and control were also examined.

Methods: Adolescents completed measures of treatment barriers and asthma control. Controller medication adherence was measured electronically. Descriptive statistics, means comparisons, and analyses of covariance were conducted.

Results: One hundred twenty-five adolescents participated (M_age = 14.55, SD = 2.01, 37.6% Black or African American, 55.2% White). Black or African American adolescents had significantly lower adherence than White adolescents, t(105) = 2.79, p = .006, Cohen's d = .55. This difference was not significant when controlling for income and insurance (p > .05). There was a significant difference in asthma control, F(1,86) = 4.07, p = .047, η_p ² = .045, where Black or African American adolescents had better asthma control scores than White adolescents. Feeling tired of living with asthma was the most common barrier among all adolescents (62.4%). More Black or African American adolescents endorsed difficulty getting to the pharmacy than White adolescents, X² (1, N = 116) = 4.86, p = .027.

Conclusions: Racial disparities in asthma may be partially driven by income, insurance, and pharmacy access. Asthma burnout may be important to address for all adolescents with asthma.

Background: Asthma is a common chronic condition in children, with parental and child health literacy affecting health outcomes and asthma control. This study examined pediatric asthma knowledge at a Portuguese central hospital and its determinants.

Methods: We conducted a comparative cross-sectional study, applying the Asthma Knowledge Questionnaire (QCSA), answered by adolescents and/or caregivers. The sample was categorized into two groups based on the presence or absence of respiratory conditions, such as asthma or recurrent wheezing, in children. Those with such conditions (Group A) were further divided into two subgroups: those receiving general pediatric care (Group A2) and those receiving specialized care, followed in pulmonology or allergology consultations (Group A1).

Results: The study involved 154 participants, predominantly female (74%) with an average age of 31.2 years ( ± 13.4). The average QCSA score was 14.8 ( ± 3.2), and Group A exhibited a statistically higher score, 15.5 points ±3.2 versus Group B, 14.2 points ± 3.2, p = .034. Group A1 achieved significantly better scores (16 points: range 4-21) than Group A2 (14 points: range 9-21) (p = .029). Scores were correlated positively with the duration of specialized follow-up (ρ = .326; p = .027). Asthma knowledge was correlated with the level of education (r = .468; p < .001). The number of wheezing episodes (r = -.466; p < .001) within the past year were associated to QCSA scores.

Conclusion: In summary, the presence of respiratory condition, the follow-up in specialized appointments and higher levels of education were associated with greater asthma knowledge.

We depict an uncommon presentation of rubber toy ingestion which remained impacted in the esophagus for months, gradually eroding the mucosa, and ultimately causing a traumatic acquired tracheoesophageal fistula.

Background: The respiratory microbiota plays a crucial role in the development of tuberculosis (TB). While existing research has underscored imbalances in the respiratory microbiota of adult patients with TB, information regarding the lower respiratory tract (LRT) microbiota in pediatric patients with TB remains scarce.

Methods: We employed 16S rRNA gene sequencing technology to investigate the LRT microbial communities of 85 children of different ages with active TB of different severities, 33 children with infectious diseases other than TB, and 48 sex- and age-matched healthy children.

Results: A marked imbalance in the respiratory microbiota was observed in children with TB, highlighted by reduced alpha diversity and a distinct microbial community structure. Comparative analysis indicated that patients with severe TB exhibited lower Neisseria levels than those with non-severe TB (1.01% vs. 3.93%, respectively; p = .02). Streptococcus and Gemella levels were lower in bacteriologically confirmed TB cases compared with clinically diagnosed cases, and higher in healthy children younger than 10 years old than in the older group. Spearman correlation analysis demonstrated significant associations between the microbiota of the LRT and cytokine concentrations in the sputum of children with TB (e.g., an inverse correlation between Veillonella and interleukin-17A).

Conclusions: TB induced significant dysbiosis in the LRT microbiota of children that was associated with disease severity and the immunological response in the respiratory tract. Our findings may offer a deeper understanding of the role of the respiratory microbiome in TB pathogenesis and progression.

Children with cerebral palsy have increased respiratory morbidity and mortality. Infection with Pseudomonas aeruginosa (PA) is associated with poorer outcomes, yet there are no formal guidelines to inform treatment of respiratory infection in children with cerebral palsy. This review explores the existing literature regarding management of PA-infection in children with cerebral palsy, with the aim of synthesising clinical recommendations and identifying gaps in current understanding. Medline (Ovid), PubMed and Embase were searched using keywords. Full-text articles involving the paediatric population and antimicrobial therapy were included. There was no limit on date of publication. Four retrospective case series were identified. Respiratory microbiology, in samples collected from a range of sites along the respiratory tract, was reported in three studies. Patients who received PA-specific antibiotics clinically improved. Two studies suggest that the use of suppressive inhaled anti-pseudomonal therapy may improve respiratory morbidity in the chronic setting. There is minimal evidence to guide management of PA respiratory infection in children with cerebral palsy. Children with cerebral palsy are at risk of developing bronchiectasis, so in the absence of high-quality evidence, management should be informed by extrapolating from the non-cystic fibrosis bronchiectasis guidelines. Further research examining surveillance and management of PA-infection in this population is required given that early intervention may prevent irreversible lung damage.

This systematic review and meta-analysis evaluated the risk factors for bronchopulmonary dysplasia associated pulmonary hypertension (BPD-PH) in extremely premature infants (gestational age < 32 weeks) and its impact on outcomes. A computerized search of eight databases was performed, from the time of library construction to February 2024. The quality of the included studies was assessed with the Newcastle‒Ottawa scale. Statistical analyses were performed using RevMan 5.4.1 and Stata 16.0 software. Meta-analysis of 2137 extremely premature infants revealed that oligohydramnios (OR = 2.21, 95% CI 1.06-4.61), low gestational age (SMD = -0.36, 95% CI -0.47 to -0.24), low birth weight (SMD = -0.54, 95% CI -0.74 to -0.35), small for gestational age (OR = 1.61, 95% CI 1.06-2.44), neonatal respiratory distress syndrome (OR = 2.05, 95% CI 1.45-2.91), grade III bronchopulmonary dysplasia (OR = 4.67, 95% CI 1.34-16.30), and sepsis (OR = 2.25, 95% CI 1.69-4.66) were risk factors for BPD-PH, whereas antenatal steroids (OR = 0.66, 95% CI 0.49-0.88) were protective factors. BPD-PH led to the extension of oxygen therapy (SMD = 0.67, 95% CI 0.42-0.92) and hospital stay (SMD = 0.77, 95% CI 0.14-1.40), and elevated the risk of discharged on oxygen (OR = 2.77, 95% CI 1.35-5.70) and death (OR = 4.38, 95% CI 2.21-8.69). BPD-PH is a multifactorial disease. In this study, a total of seven risk factors, and one protective factor for BPD-PH were identified in extremely premature infants. By managing and mitigating these factors, it is possible to decrease the occurrence of BPD-PH. Furthermore, BPD-PH may increase the risk of a poor prognosis in extremely premature infants.

Background: Racial and ethnic disparities in pediatric lung transplantation (LTx) related to the shifting cystic fibrosis (CF) population receiving highly effective modulator therapy (HEMT) has not been well investigated.

Methods: The UNOS Registry was queried for patients age 1-25 years undergoing bilateral LTx between 1 January 2012 and 31 December 2021. Race and ethnicity were classified as non-Hispanic White, non-Hispanic Black, Hispanic, or none of the above. The primary outcome was posttransplant mortality. Trends in the association between race/ethnicity and mortality were examined using transplant year as a continuous variable and stratifying year based on introduction of HEMT (triple combination therapy) in November 2019.

Results: In the study sample (N = 941), 7% of patients were non-Hispanic Black, 15% were Hispanic, and 2% were some other racial or ethnic group. One hundred (11%) received LTx after approval of triple combination therapy, and 407 (43%) died during follow-up. We identified a statistically significant disparity in mortality hazard (hazard ratio: 1.91; 95% confidence interval: 1.31, 2.80) in non-Hispanic Black compared to non-Hispanic White patients in the pre-triple combination therapy era.

Conclusions: We found higher mortality hazard among non-Hispanic Black compared to non-Hispanic White children undergoing LTx in the United States. Further monitoring of LTx outcomes to identify and address disparities is needed in the current era of triple combination therapy for CF.