Paediatric Respiratory Reviews最新文献

{"title":"Incidence of ventilator-associated pneumonia in neonatal intensive care units: a systematic review and meta-analysis.","authors":"Feifei Wu, Jie Wang, Zhonghua Li, Siwen Tang","doi":"10.1016/j.prrv.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.09.007","url":null,"abstract":"<p><strong>Objective: </strong>This paper systematically evaluated the infection rate and 1000-day infection rate of ventilator-associated pneumonia (VAP) in neonatal intensive care units (NICUs) worldwide, to provide evidence-based support for hospital infection control.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from database establishment to November 2025 for studies that reported the infection rate and 1000-day infection rate of VAP among infants in the NICU. We conducted a meta-analysis using a random-effects model in R software to estimate the pooled infection rate and its 95% CI. Sources of heterogeneity were explored through subgroup analyses (by gestational age, birth weight, and underlying medical conditions) and meta-regression. Sensitivity analyses were performed using a leave-one-out approach to assess result's robustness, and publication bias was examined using funnel plots and the trim-and-fill method. This study has been registered in PROSPERO (CRD420251235255).</p><p><strong>Results: </strong>In total, 75 studies were included (of which 72 provided data on the overall VAP incidence, and 38 provided data on the 1000-day VAP incidence rate). Among infants in the NICU who were confirmed to have received invasive mechanical ventilation (53 studies, 16,724 patients), the combined incidence of VAP was 22.75% (95% CI: 18.02%-28.30%, I² = 95.9%); the pooled incidence per 1000 ventilator days based on 38 studies (984,209 ventilator days) was 7.3‰ (95% CI: 5.2‰-10.2‰, I² = 98.8%). Among all NICU infants not restricted to mechanical ventilation (19 studies, 45,280 cases), the infection rate of VAP was 2.72% (95% CI: 1.31%-5.56%, I² = 97.4%). Subgroup analysis revealed that among mechanically ventilated infants, the infection rate was substantially higher among preterm infants (34.45%), very low birth weight infants (36.45%), and those with respiratory distress syndrome (33.38%). Meta-regression further identified preterm status as a significant positive moderator for VAP infection rates and publication year for the per 1000 ventilator-day rate (both p < 0.05). Sensitivity analysis indicated robust results; although publication bias may exist, the effect size did not change significantly after correction using the trim-and-fill method.</p><p><strong>Conclusion: </strong>VAP incidence in the NICU was 22.75%. This finding underscores high VAP incidence among mechanically ventilated neonates, which poses a significant challenge to clinical management. Preterm birth, very low birth weight, and respiratory distress syndrome are identified as the primary risk factors. Further exploration of effective prevention and control strategies is needed to improve neonatal outcomes.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azithromycin for acute wheezing and bronchiolitis in children younger than six years: A systematic review and meta-analysis.","authors":"Douglas Amaral da Silva Menegazzo Miotto, Isabela Ovídio Ramos, Caroline Molina Grassi","doi":"10.1016/j.prrv.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.09.002","url":null,"abstract":"<p><strong>Background: </strong>Azithromycin is often prescribed off-label for acute wheezing and bronchiolitis in young children, despite guideline advice against routine antibiotics. We synthesised the randomised evidence and tested whether benefit depends on care setting.</p><p><strong>Methods: </strong>We searched four databases and two registries to June 2026 for double-blind, placebo-controlled trials of azithromycin versus placebo in children younger than six years with acute wheezing or bronchiolitis. The acute episode was pooled as the ratio of means and binary outcomes as risk ratios (random-effects models).</p><p><strong>Results: </strong>Ten trials (2,071 children) were included. In emergency-department and ward patients, azithromycin had no effect on the acute episode (ratio of means 0.99, 95 % CI 0.96-1.04; I²=0 %) and did not reduce hospitalisation or recurrent wheeze. Apparent benefit was confined to intensive-care and home-treated recurrent episodes (between-subgroup p<0.0001).</p><p><strong>Conclusions: </strong>Azithromycin does not help children with acute wheezing or bronchiolitis where it is used; routine use is not supported.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and type of respiratory issues following Tracheo-Oesophageal fistula repair in children and young people: A systematic review.","authors":"Ava Machesney, Kieren Lock, Colin Hamilton, Veronica Phillips, Louise Selby, Jessica Bewick","doi":"10.1016/j.prrv.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.09.008","url":null,"abstract":"<p><strong>Background: </strong>Tracheo-oesophageal fistula (TOF) is a rare congenital anomaly requiring early surgical correction. Despite improved survival, long-term respiratory morbidity remains significant and under-characterised. This review aimed to evaluate the prevalence and nature of respiratory complications following TOF repair in paediatrics.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. Six databases were searched (2004-2025). Eligible studies reported respiratory outcomes following complete TOF repair in paediatric populations. Screening, data extraction, and quality appraisal were performed independently by two reviewers. Pooled prevalence estimates were calculated.</p><p><strong>Results: </strong>Twenty studies (n = 2,214) were included, predominantly retrospective observational studies with heterogeneous outcome definitions. Respiratory morbidity was consistently reported. The highest pooled prevalence estimates were recurrent cough (57.2%), pneumonia/LRTI (50.08%), and airway malacia (40.62%). Bronchiectasis (11.96%) and atelectasis (20.78%) were less frequent.</p><p><strong>Conclusions: </strong>Respiratory morbidity post-TOF repair is common and multifactorial, highlighting the need for structured, multidisciplinary long-term follow-up and improved standardisation in future research.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances in pediatric pulmonology: Articles of interest to fellows. Azithromycin for preschool wheezing, combined maternal RSV immunization and infant nirsevimab, and oscillometric assessment of small-airway dysfunction.","authors":"Miri Dotan, Madhan Kumar, Tahani Ibrahim","doi":"10.1016/j.prrv.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.09.006","url":null,"abstract":"<p><p>Recent advances in pediatric respiratory medicine continue to refine preventive strategies, therapeutic decision-making, and physiological assessment. This review highlights three recent publications of particular interest to pediatric pulmonology fellows. First, we discuss a multicenter randomized trial demonstrating that azithromycin does not improve outcomes in preschool children presenting to the emergency department with moderate-to-severe wheezing, despite effectively eradicating respiratory bacterial colonization. Second, we review an interim randomized trial showing that combined maternal respiratory syncytial virus (RSV) vaccination and infant nirsevimab appear safe and elicit robust antibody responses, with no evidence of immune interference. Finally, we summarize evidence that impulse oscillometry can detect subclinical small-airway dysfunction in children with well-controlled asthma despite normal spirometry. Together, these studies highlight the growing importance of evidence-based prevention, antimicrobial stewardship, and precision respiratory assessment in pediatric practice.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RSV in children: an evolving story from high burden to universal prevention.","authors":"Mattia Spatuzzo, Paolo Manzoni, Raffaella Nenna, Laura Petrarca, Antonella Frassanito, Maria Giulia Conti, Enrica Mancino, Domenico Paolo La Regina, Luigi Matera, Enea Bonci, Fabio Midulla","doi":"10.1016/j.prrv.2026.09.005","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.09.005","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection and hospitalization in infants worldwide, with a substantial clinical and socioeconomic burden. For decades, preventive strategies were limited to high-risk populations, with minimal impact at the population level. Recent advances in RSV virology and immunology have transformed prevention. This review summarizes RSV epidemiology, key pathogenetic mechanisms, and current preventive strategies, with a focus on long-acting monoclonal antibodies and maternal vaccination. Evidence from randomized clinical trials, real-world studies, and international recommendations is critically appraised, with emphasis on implementation strategies and emerging preventive tools. These developments mark a shift from risk-based prophylaxis to broader, population-level prevention, with the potential to substantially reduce RSV-related morbidity and healthcare burden in early childhood.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DICER1 genetics and their impact on the diagnosis and management of lung lesions: A scoping review.","authors":"Dalia Karzoun, Puk Sandager, Anne Kirkeby Hansen, Lise Graversen, Sune Rubak","doi":"10.1016/j.prrv.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.09.004","url":null,"abstract":"<p><p>Congenital lung malformations (CLMs) are rare benign lung lesions for which no international management guidelines exist. Distinguishing CLM, especially congenital pulmonary airway malformation (CPAM), from pleuropulmonary blastoma(PPB) is clinically important for the development of future evidence-based guidelines on follow-up and treatment. PPB is strongly associated with pathogenic DICER1 variants. This suggests that genetic testing could aid in distinguishing benign from potentially malignant lung lesions. This scoping review summarises current evidence regarding DICER1 status in radiologically described lung lesions with data on follow-up and/or treatment, to inform clinical management of CLM. The scoping review was conducted following PRISMA-ScR guidelines and included 70 studies identified through PubMed, Embase and Scopus. The included studies reinforce a strong association between pathogenic DICER1 variants and PPB, whereas no such association has been reported for a true, well-described pathologically confirmed CPAM. Across studies, DICER1 status influenced decisions regarding surgical intervention, surveillance intensity and screening for additional DICER1-associated tumours. Current evidence suggests that pathogenic DICER1 variants play a central role in PPB development but not in benign CLMs. Incorporation of DICER1 testing into the diagnostic work-up of selected cystic lung lesions may improve risk stratification, support surveillance planning and facilitate genetic counselling. Prospective studies are needed to clarify the role of DICER1 testing in children with CLMs and to refine evidence-based management guidelines.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth and nutrition in early life for very preterm infants - Implications for neonatal lung health.","authors":"Laura Li Ching Ng, Marc Beltempo, Dominic A Fitzgerald","doi":"10.1016/j.prrv.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.09.001","url":null,"abstract":"<p><p>Very preterm birth (< 32 weeks' gestation) disrupts a critical window of lung development, placing infants at substantial risk of bronchopulmonary dysplasia (BPD) and long-term respiratory morbidity. Nutrition is increasingly recognised as a modifiable determinant of neonatal lung health across three distinct but interconnected phases: (1) During the antenatal period, maternal macronutrient and micronutrient status, including vitamin D, omega-3 fatty acids, and folate, shapes placental function, fetal lung growth, and surfactant biosynthesis. Fetal growth restriction, a consequence of placental insufficiency, profoundly impairs pulmonary vascular and alveolar development. (2) In the neonatal intensive care unit, early aggressive parenteral nutrition followed by optimised enteral feeding with human milk reduces BPD risk, while targeted macronutrient delivery and specific micronutrient supplementation support ongoing alveolarisation. (3) After hospital discharge, catch-up growth and sustained human milk feeding are associated with improved lung function, reduced respiratory hospitalisation, and lower rates of recurrent wheeze. This review synthesises current evidence and translates it into practical guidance across all three phases, to optimise nutritional strategies for vulnerable infants.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change is coming? The concept of FEV₁ change score in predicting asthma exacerbations.","authors":"Steve Turner, Nicole Fillpow, Anne Chang, Francoise Vermeulen, Sanja Stanojevic","doi":"10.1016/j.prrv.2026.07.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.07.001","url":null,"abstract":"<p><p>Guidlines recommend that current asthma symptom control should inform asthma preventer treatment to reduce future asthma exacerbations. But current symptom control is not a reliable predictor of exacerbation. There is a need for an objective measure of lung function to support asthma preventer treatment decision-making in order to reduce risk for future asthma exacerbations in children with asthma. Historically FEV₁ was recommended as part of routine monitoring for childhood asthma, but not all current guidelines recommend regular FEV₁ measurements are made and this is, in part, due to a lack of evidence linking change in FEV₁ and future asthma outcomes. Recent work supports the use of conditional change score (Zc) as a method to express change in FEV₁ over time; Zc adjusts for age and interval between measurements and, unlike absolute change in FEV₁% or FEV₁ z score, Zc is not liable to regression to the mean. Changes in Zc are associated with future exacerbation risk and also future loss of asthma control. Rising and falling Zc are both associated with increased odds for future exacerbation whereas only falling Zc is associated with increased odds for future loss of asthma control. Randomised controlled trials are now required to determine the role of Zc in the management of childhood asthma.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Travelling with a child on ventilatory support: How to plan and avoid potential pitfalls.","authors":"R Carluke, P Davies, R J Langley","doi":"10.1016/j.prrv.2026.07.002","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.07.002","url":null,"abstract":"<p><p>Travel for families of children with complex medical needs can offer significant benefits for family wellbeing and quality of life, yet it is often perceived as complex and high risk. As the population of technology-dependent children increases, the need to support safe and feasible travel has become more prominent. Families face multiple barriers, including the need to maintain continuity of care, transport essential equipment and medications, navigate variable regulations, and coordinate extensive documentation across healthcare and travel systems. These demands, alongside financial costs and administrative burden, frequently contribute to increased anxiety and risk aversion. Experiential accounts from parents demonstrate that travel for this cohort of children is safe, achievable, and rewarding with comprehensive and anticipatory planning across key domains, including destination selection, accommodation suitability, equipment and oxygen provision, medication and nutrition management, transport arrangements, and emergency preparedness. Healthcare professionals play a crucial role in supporting families through pre-travel assessment, documentation, and risk mitigation strategies. With appropriate preparation and multidisciplinary collaboration, travel can be undertaken safely, enabling families to access important psychosocial benefits while minimising potential clinical risks.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148605887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term respiratory outcomes of infants born moderate to late preterm.","authors":"Cassidy Du Berry, Luke Howlin, Sarah J Kotecha, Sailesh Kotecha, Lex W Doyle, Jeanie L Y Cheong","doi":"10.1016/j.prrv.2026.06.007","DOIUrl":"https://doi.org/10.1016/j.prrv.2026.06.007","url":null,"abstract":"<p><p>Moderate to late preterm birth, defined as birth between 32 to <37 weeks' gestation, accounts for over 80% of all preterm births globally. Although long-term respiratory outcomes following very and extremely preterm birth are well characterised, the lifelong respiratory consequences of moderate to late preterm birth have received comparatively less attention. Infants born moderate to late preterm experience increased neonatal respiratory morbidity, greater susceptibility to early-life lower respiratory tract infection, and elevated rates of wheeze and physician-diagnosed asthma throughout childhood compared with peers born at term. Individuals born moderate to late preterm demonstrate modest decrements in expiratory airflow relative to those born at term, with emerging evidence of sex-specific trajectories, impaired gas transfer, and an increased risk of chronic obstructive pulmonary disease (COPD) in mid-adulthood. In this review, we position moderate to late preterm birth within the framework of prematurity-associated lung disease (PLD), present contemporary estimates of expiratory airflow via meta-analysis, and outline priorities for mechanistic, interventional and translational research in this large gestational group.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}