Pediatric Pulmonology最新文献

Introduction: A minority of asthmatic children develop persistent airflow limitation (PAL), associated with an increased risk of chronic airflow obstruction and poor prognosis. This study aimed to identify risk factors for PAL and develop a prediction model to identify high-risk asthmatic children.

Methods: This retrospective study included 2072 children (5-16 years) with asthma. After a 2-year follow-up, patients were categorized into non-PAL, reversible PAL (RPAL), and irreversible PAL (IPAL) groups. Logistic regression (LR) was used to identify independent risk factors for RPAL and IPAL. A prediction model based on multivariate LR was developed and validated to identify asthmatic children at high risk of developing PAL. A nomogram was created for visualization.

Results: Among the 2072 asthmatic patients, 14.72% (n = 305) developed PAL. Asthma exacerbation history (OR 1.80, 95% CI 1.03-3.01) and poor adherence (OR 1.83, 95% CI 1.26-2.65) were independent risk factors of RPAL. Independent risk factors for IPAL were BMI over 19.0 kg/m² (OR: 1.81, 95% CI: 1.03-3.21) and a history of pneumonia (OR: 2.40, 95% CI: 1.30-4.26). The prediction model incorporated nine variables and showed good discriminatory ability, with AUC values of 0.79 (95% CI: 0.76-0.81) for the training set, 0.76 (95% CI: 0.76-0.77) for internal validation, and 0.73 (95% CI: 0.64-0.81) for temporal validation.

Conclusion: Asthma exacerbation history and poor adherence were independent risk factors for developing RPAL. BMI over 19.0 kg/m² and a history of pneumonia were risk factors for IPAL. Our prediction model effectively identified asthmatic children at high risk of developing PAL.

Aim: Fibrinolytic therapy is commonly used in children with parapneumonic effusion, to facilitate drainage of the effusions and recovery. However, data regarding complications of this treatment in children are limited. We aimed to determine the incidence of pneumothorax (PNX) associated with intrapleural urokinase.

Methods: We analyzed retrospectively collected data of children with parapneumonic effusion who underwent chest drain insertion. The clinical course and complications, including the incidence of PNX, were compared between children who were and were not treated with urokinase.

Results: The study group included 120 children, of whom 57 were treated with urokinase. Children who were and were not treated with urokinase did not differ in markers of disease severity or in the length of hospitalization. Among the patients treated with urokinase compared to those not treated, the incidence of PNX was higher (35% vs. 6%, p < 0.001) and the median duration of chest drain treatment was longer (6 vs. 4 days, p < 0.001).

Conclusion: In our pediatric cohort, intrapleural urokinase was associated with a higher incidence of PNX and did not shorten the duration of hospitalization.

Introduction: Although noninvasive monitoring through quantifying rib cage movement has been useful in serial assessment of pulmonary function in newborns, measuring tidal volume (TV) is commonly performed invasively. As it is the most basic measure of pulmonary function, expanding its assessment to a noninvasive measure can contribute to clinical findings and interpretations in neonatal clinical practice.

Objective: (1) Create a noninvasive measurement tool for TV for neonatal clinical use; (2) Evaluate the agreement between measured TV and predicted TV.

Methods: Observational study with healthy newborns. Predicted TV was calculated based on the newborns' weight using the mid-range of the volumes usually set during mechanical ventilation of term infants (5 mL/kg). For measured TV, newborns were filmed in supine position using a digital camera, and their chest circumferences were measured with a nonelastic tape. Body markers delimited the segmentation of the area of interest, and a MATLAB software routine established their relationship with the area in cm² and generated a representative image of the thoracic and abdominal areas in a cylindrical, elliptical-based format, as well as a three-dimensional model to represent quantitative data of measured TV. Paired t-test assessed the means of measured and predicted TV, Pearson's correlation assessed level of association, and Kappa coefficient assessed the agreement between them.

Results: Newborns' gestational ages ranged from 38 to 40 weeks and weights from 2190 to 4125 g. A total of 56 respiratory cycles were validated for analysis. The mean predicted TV according to weight was 5.06 mL/kg, and measured TV was 5 ml/kg (p = 0.31), with a correlation of 0.7 (p < 0.001) and a kappa coefficient of 0.39 (p = 0.01).

Conclusions: MATLAB software routine was a practical and easy-to-use tool to monitor noninvasive TV in a neonatal setting. There was no difference between predicted and estimated TV, with fair agreement between them.

Background: The cystic fibrosis (CF) Responsibility. Independence. Self-care. Education. (R.I.S.E.) program was developed to provide assessment and education, supporting transition readiness for people with cystic fibrosis (pwCF). Lack of integration within electronic health records (EHR) was a barrier to implementation of CF R.I.S.E. University of Michigan was able to integrate CF R.I.S.E. into EHR.

Aim: To improve implementation and EHR documentation of CF R.I.S.E. module completion by pwCF across two (CF) programs from baseline (10.5%) to 75% per month in 6 months (January through June 2023).

Methods: Two CF programs utilized quality improvement (QI) methods and tools and ad hoc support by a CF Learning Network (QI) specialist. Eligibility included pwCF ≥16 years old seen in CF clinics who accepted CF R.I.S.E.

Participation: Beginning January 2, 2023, programs met in biweekly, virtual meetings to discuss implementation. Deidentified data were collected monthly tracking modules completed by pwCF and number of team members engaging with CF R.I.S.E. and documenting in EHR. Data timelines were baseline (November-December 2022), project period (January-June 2023), and post-project (July-December 2023).

Results: Completion rates increased from baseline (10.5%) to 48% (range 33% to 81%) through December 2023. During the project, an average 7.7 team members completed an average 19.2 modules per month. Post-project, an average 8 team members completed an average 16.5 modules per month.

Conclusions: This collaboration demonstrated how utilization of EHR allowed for successful CF R.I.S.E. improvement at both programs. Shared software utilization and QI initiatives may be a way to facilitate timely dissemination of best practices through learning health systems.

Background: The benefits of Elexecaftor-Tezacaftor-Ivacaftor (ETI) therapy on the health and wellbeing of people with CF (pwCF) are well documented. Since approval, however, a growing number of potential side effects have emerged in reports from clinical practice. With current understanding of ETI tolerability limited to data from clinical trials, the prevalence of side effects and their impact on care decision making remains poorly categorized.

Methods: A 10-question survey was developed and distributed to patients 18 years or older who were treated at the Massachusetts General Hospital CF centers. Reports of side effects were measured across 12 distinct categories, and dose adjustments and discontinuation due to side effects were collected. If a patient reported no side effects, they did not have to complete the entire survey.

Results: Among 92 respondents initiated on ETI, 51 respondents (55.4%) reported potential side effects and 41 (44.5%) respondents reported no adverse events. The most commonly reported side effects were mental health, changes in appearance, and gastrointestinal complaints, which were reported by 22.8%, 30.4%, and 21.7% of patients, respectively. Eighteen (19.6%) respondents modified their dosing in response to side effects, and six discontinued treatment permanently (6.52%) due to persistent side effects.

Conclusions: Responses demonstrated marked heterogeneity, with most respondents reporting at least one side effect following initiation. Dose modification was commonly utilized to mitigate adverse effects, however few respondents had to discontinue treatment. These findings demonstrate the importance of monitoring for potential drug-related side effects of ETI in clinical settings.

Introduction: This study aimed to describe the epidemiology and etiologies of critical respiratory diseases of ex-premature infants (EPIs) admitted to the Pediatric Intensive Care unit (PICU).

Methods: Infants ≤2 years old with acute respiratory illnesses admitted to PICU of Vietnam National Children's Hospital from November 2019 to April 2021 were enrolled and followed up to hospital discharge. We compared respiratory pathogens, outcomes, and PICU resources utilized between EPIs and term infants. Among EPIs, we described clinical characteristics and evaluated the association between associated factors and mortality.

Results: Among 1183 patients, aged ≤2 years were admitted for critical respiratory illnesses, 202 (17.1%) were EPIs. Respiratory viruses were detected in 53.5% and 38.2% among EPIs and term infants, respectively. Compared to term infants, a higher proportion of EPIs required mechanical ventilation (MV) (85.6 vs. 66.5%, p < .005) and vasopressor support (37.6 vs. 10.7%%, p < .005). EPIs had a higher median PICU length of stay (11.0 [IQR: 7; 22] vs. 6.0 days [IQR: 3; 11], p = .09), hospital length of stay (21.5 [IQR: 13; 40] vs. 10.0 days [IQR: 5; 18], p < .005) and case fatality rate (31.3% vs. 22.6%) compared to term infants. Among EPIs, PIM-3 score (adjusted odds ratio [aOR]: 1.51; 95% confidence interval [CI]: 1.30-1.75) and PELOD-2 score at admission (aOR: 1.41; 95% CI: 1.08-1.85) were associated with mortality.

Conclusions: EPIs with critical respiratory illnesses constituted a significant population in the PICU, required more PICU support, and had worse clinical outcomes compared to term infants.

Background and aims: The long-term respiratory sequelae of COVID-19 infection in children remain poorly understood and may differ across countries. This study aims to investigate the respiratory sequelae, including residual respiratory symptoms and pulmonary function in Thai children. The secondary aim is to identify factors associated with the respiratory sequelae.

Materials and methods: This is an observational study involving 56 healthy children, aged between 7 and 18 years, who were diagnosed with COVID-19 infection from July 2021 to February 2023. Clinical data relating to COVID-19 infection and persistent symptoms after the infection were assessed after the infection up to 6 months. Spirometry was performed to assess pulmonary function.

Results: Post-COVID-19 symptoms were identified in 14 patients (25%), with fatigue, cough, and dyspnea being common symptoms (28%-35%). A significant correlation was found between post COVID-19 symptoms and pneumonia (OR = 6.00, 95%CI [1.54,23.33], p = .01). Abnormal pulmonary function was identified in 10 patients (17.8%) with obstructive impairment being the most common. However, there was no significant association between clinical factors and pulmonary function impairment.

Conclusion: Prolonged respiratory symptoms and abnormal pulmonary function following COVID-19 infection are not uncommon in children. The post-COVID-19 symptoms are possibly associated with COVID-19 pneumonia.