Pediatric Pulmonology最新文献

Background: Treprostinil for the treatment of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) has previously been described in small cohort studies, often used later in the course after failure to improve on other therapies.

Objective/methods: We retrospectively describe the clinical course and outcomes of 18 infants (gestational age 26.3 ± 2.6 weeks) from 2012 to 2025 who received parenteral treprostinil to treat BPD-PH, including changes in echocardiographic and cardiac catheterization parameters.

Results: All patients had moderate-to-severe BPD and PH, with a mean pulmonary arterial pressure of 45.6 ± 12.7 mmHg at cardiac catheterization prior to treprostinil. Treprostinil was initiated at a median postmenstrual age of 53.5 (IQR: 45.7, 62.6) weeks. Echocardiograms after 3 months of treatment showed improvement of PH severity. At repeat catheterization, mean pulmonary arterial pressure (delta -16.4 ± 12.2, p < 0.01) and indexed pulmonary vascular resistance (delta -4.2 ± 3.3, p < 0.01) significantly improved. Ten of 18 infants (55.6%) survived to discharge; BNP ≥ 35 pg/mL prior to treprostinil initiation demonstrates potential utility for mortality prediction with area under the receiver operator characteristic curve 0.87 ± 0.10 (95% CI: 0.67-1.00).

Conclusion: Our study shows a potential benefit of treprostinil use in moderate-to-severe BPD-PH; larger studies are needed to validate our findings and guide decision-making around treprostinil initiation and duration.

Objective: Infants hospitalized with bronchiolitis may experience persistent symptoms linked to future chronic lung diseases like bronchiectasis. Identifying phenotypes during hospitalization could guide targeted interventions. As traditional clustering requires large datasets, this study explores whether Unsupervised Feature Extraction Algorithms (UFEAs) and clustering can identify high-risk profiles in a small dataset of Indigenous infants.

Methods: We included 128 Indigenous infants hospitalized with bronchiolitis at the Royal Darwin Hospital, Northern Territory, Australia. Eight UEFAs were applied to reduce the dimensionality of 22 variables across 2-17 dimensions. A support vector machine classifier assessed the effectiveness of each UFEA in classifying bronchiectasis. Kernel Principal Component Analysis with nine dimensions performed best, and these dimensions were used for clustering.

Results: Six clinical profiles were identified. Profile C, the highest-risk group with the most infants with bronchiectasis (45%), preterm birth (95%), low birth weight (86%), weight-for-length z-score < -2 (62%), household smoke exposure (90%), and antibiotics prescribed before hospitalization (100%). Profile D, the second-highest risk, had bronchiectasis (30%), the highest wet/productive cough (45%), crackles/crepitations (36%), and wheeze (18%). Profile F infants included bronchiectasis (22%), oxygen supplementation (91%), and lobar collapse/consolidation on chest X-rays (65%). Profile A included bronchiectasis (5%) and household smoke exposure (30%), and Profile E showed bronchiectasis (9%) and household smoke exposure (36%). Profile B, the lowest-risk group, with no bronchiectasis (0%), preterm birth (15%), low birth weight (10%), and any bacteria (5%).

Conclusion: Using UFEAs and clustering, we reduced dataset dimensionality, effectively identifying six unique, clinically significant risk profiles in Indigenous infants.

Introduction: Respiratory syncytial virus (RSV) bronchiolitis during infancy has the potential to progress to recurrent wheezing and asthma. However, studies evaluating lung function using tidal breath analysis in this age group are limited.

Objective: This study aimed to assess lung function in infants hospitalized during their first episode of acute RSV bronchiolitis using tidal breath analysis, to compare tidal breathing parameters between the acute phase and 2 months after clinical recovery, and to evaluate the impact of bronchiolitis severity on lung function.

Subjects and methods: A total of 78 infants aged 1-12 months were enrolled in this prospective study; 39 diagnosed with RSV bronchiolitis and 39 age-and sex-matched healthy controls. Lung function was measured using tidal breath analysis during hospitalization for the acute episode and re-evaluated 2 months after recovery.

Results: The ratio of time to peak tidal expiratory flow to expiratory time (tPTEF/tE) was significantly lower in the RSV bronchiolitis group than in healthy controls, and remained significantly reduced at the 2-month follow-up [19.2% (14.9-24.2) vs. 31.4% (28.7-35.3), p < 0.01]. No significant changes in tidal breath analysis parameters were observed between the acute phase and two- months after recovery. In the severe subgroup, both tPTEF and tPTEF/tE values were lower than in the mild and moderate subgroups.

Conclusion: Our findings suggest that expiratory airway obstruction may persist despite clinical recovery in infants following RSV bronchiolitis. The lack of improvement in tidal breathing parameters, particularly tPTEF and tPTEF/tE, highlights the need for long-term follow-up. Moreover, greater disease severity was associated with more sustained impairment in lung function. These findings emphasize the importance of early detection, long-term monitoring, and preventive strategies to reduce the long-term respiratory consequences of RSV infection.

Background: Data on the physiological impact of tracheal intubation and positive end-expiratory pressure (PEEP) on respiratory mechanics in anesthetized children are scarce. We aimed to evaluate the mechanical effects of intubation and PEEP in children without lung pathology under general anesthesia.

Methods: Prospective physiologic experimental crossover study, in children under 15 years scheduled for elective surgery. After anesthesia induction and neuromuscular blockade, volume-controlled ventilation was initiated. Respiratory mechanics were assessed before (mask ventilation) and after tracheal intubation, at PEEP 0 and 5 cmH₂O. Measured variables included peak inspiratory (PIP), plateau (P_PLAT), and total expiratory pressures (tPEEP). Calculated parameters were compliance (Crs), driving pressure (ΔP), and mechanical power (MP). A mixed linear regression model was used.

Results: 60 patients were included. Median age 58.0 (18.0-84.0) months. Intubation increased PIP-P_PLAT + 23.9% (p < 0.001), Raw +16.4% (p = 0.011), and ΔP + 20.4% (p < 0.001); and decreased Crs -14% (p = 0.001). PEEP during mask ventilation reduced ΔP 29.1% (p < 0.001) and increased Crs 46.7% (p < 0.001). Combined intubation and PEEP reduced ΔP (-7.9%, p = 0.002) and increased Crs (+19.6%, p < 0.001). PEEP raised MP both during mask ventilation (+50%) and after intubation (+83.3%, both p < 0.001). Children under 2 years showed higher Raw than older children across all conditions (p < 0.001), but similar behavior in ΔP and Crs.

Conclusion: PEEP and intubation induce changes in respiratory mechanics. While tracheal intubation increases PIP and ΔP, and decreases Crs, the addition of PEEP partially mitigates these effects on airway pressures, but not on MP. These results suggest a deterioration of both the resistive and elastic components during MV.

Trial registration: This project was registered and approved for implementation by the Pediatric Hospital Center Pereira Rossell Institutional Review Board and registered in the Ministry of Public Health (#7647719). Informed and signed consent was obtained from all the children's parents or responsible guardians. All procedures in this study were performed in accordance with the Declaration of Helsinki.

Question: Cystic fibrosis (CF) affects > 11,300 people in the UK and is characterized by thick, sticky mucus in the lungs, leading to recurrent infections, inflammation, and progressive respiratory decline. Chest physiotherapy remains a cornerstone of airway clearance; however, many people with CF (pwCF) find it burdensome and time-consuming. Exercise has been proposed as a potentially effective and more acceptable alternative. The ExACT-CF feasibility trial evaluated the use of exercise as an airway clearance technique in pwCF on modulator therapy.

Methods: This nested qualitative study explored the experiences of participants and healthcare professionals involved in the ExACT-CF trial, alongside broader perspectives on airway clearance, to inform future research and clinical practice. Purposively sampled semi-structured interviews were conducted with 32 individuals: ten pwCF, five parents, twelve healthcare professionals, four decliners, and one participant who withdrew. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using "The Framework Method."

Results: Two primary themes emerged. Theme 1 reflected experiences and lessons learned from the trial, including reported barriers and facilitators around recruitment, randomization, and daily implementation. Despite some minor difficulties, trial participation, processes, and the intervention itself were broadly acceptable. Theme 2 highlighted a preference for using ExACT alone or interchangeably with chest physiotherapy. Participants emphasized the need for robust clinical evidence to guide use.

Answer: This study highlights the acceptability of both the ExACT-CF trial processes and the use of this exercise-based airway clearance technique. Findings support progression to a definitive trial and further exzploration of patient-centered, flexible approaches to airway clearance in CF.

Trial registration: NCT02429180.

Introduction: Single maintenance and reliever therapy (SMART) uses a single inhaler for daily maintenance and as-needed relief. Despite evidence that SMART is more effective in reducing exacerbations than traditional therapy, it is not widely implemented. Successful SMART implementation requires participation from school health staff (SHS), who are a critical part of pediatric asthma management.

Methods: Using a descriptive convergent mixed methods design and grounded in the Consolidated Framework for Implementation Research, we conducted surveys and semi-structured interviews with SHS to explore their perspectives on SMART implementation in schools. We calculated descriptive statistics for survey items and used rapid qualitative analysis to synthesize interview data.

Results: A total of 11 SHS completed an interview and 22 completed a survey. Nearly all participants were familiar with SMART and 45% reported experience administering SMART. Most participants (59%) believed that SMART would be simpler for their students. In interviews, many participants highlighted that having one inhaler would also be simpler for them to manage. To support SMART implementation, communication with prescribing providers was highlighted as a primary need; 64% wanted a brief phone call with a provider, 59% wanted an email, and 82% wanted to receive a SMART-specific Asthma Action Plan.

Discussion: School health staff reported familiarity with SMART and confidence in their ability to administer it. Multilevel needs include clear communication from pediatric providers when children initiate SMART and availability of SMART inhalers. Future research should explore development and implementation of strategies to address these needs while integrating perspectives of providers and families.

Background: Asthma is a prevalent chronic condition in children, and is often not sufficiently controlled. Children and parents may have a different interpretation of the level of asthma control, which can lead to suboptimal treatment. This systematic review aims to synthesize literature regarding concordance between children and their parents in the perception of asthma control.

Methods: A systematic literature search was conducted in EMBASE, MEDLINE, Web of Science, and Google Scholar up to February 5, 2025. Studies were included if they involved children aged 4-18 with asthma and their parents, assessed asthma control using questionnaires validated for children or derived from guidelines, and compared results of children and their parents. All healthcare settings were included. Four reviewers independently screened the studies and two extracted the data. Methodological quality was assessed using the Newcastle Ottawa Scale.

Results: Nine publications were included, with a total of 1,693 children and 1,693 parents. Various questionnaires and guidelines were used to assess asthma control. The quality of the majority of the studies was rated satisfactory or good. The agreement between children and parents ranged from weak to very good. In many cases, there was a significant difference between the answers of the children and their parents: children often perceived their asthma to be less controlled compared to their parents.

Discussion: The perception of asthma control is frequently discordant between children and parents, with children often reporting lower levels of asthma control. These findings highlight the importance and potential beneficial effects of shared decision-making between children, caregivers, and healthcare providers in improving treatment outcomes.

Background: Bronchiolitis is a prevalent viral respiratory illness in infants, often caused by respiratory syncytial virus (RSV). It is the leading cause of hospitalization in children under 1 year of age. The introduction of Nirsevimab, a long-acting monoclonal antibody approved in 2022, aimed to reduce RSV-related hospitalizations and severe cases. This study assesses the impact of Nirsevimab on bronchiolitis incidence, severity, and viral etiology in Sicily from 2021 to 2025.

Methods: This observational study included all pediatric patients hospitalized for bronchiolitis at the University of Catania's Pediatric Respiratory Unit between October 2021 and March 2025. Data were collected on viral etiology, hospital stay duration, clinical severity and respiratory support requirements across four epidemic seasons. Statistical analysis was used to compare outcomes across the different years, with a focus on the 2024-2025 season, which was the first to implement Nirsevimab immunization.

Results: From 2022 to 2025, the incidence of hospitalized bronchiolitis decreased significantly, with a reduction of 84% in the 2024-2025 season compared to previous (2021-22, 2022-23, 2023-24) years (p < 0.0001). In the 2024-2025 season, a significant difference was observed in the percentage of RSV cases in 2025 compared to previous years and a significant reduction in the circulation of non-RSV viruses. The average hospital stay and clinical severity remained stable throughout the years. Only one hospitalized patient in the 2024-2025 season had received Nirsevimab, presenting with mild bronchiolitis.

Conclusion: The introduction of Nirsevimab in Sicily led to a significant reduction in bronchiolitis incidence, with a reduction of RSV and non-RSV cases. Clinical severity and hospital stay duration remained unchanged. The findings support the efficacy of Nirsevimab in preventing severe bronchiolitis requiring hospitalization.