Paediatric Respiratory Reviews最新文献

{"title":"Current approaches to the patent ductus arteriosus: Implications for pulmonary morbidities.","authors":"Sarah Spenard, Carl Backes, Dominic A Fitzgerald, Guilherme Sant'Anna, Gabriel Altit","doi":"10.1016/j.prrv.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.05.001","url":null,"abstract":"<p><p>The natural closure of the ductus arteriosus is often delayed in premature newborns, especially in the most immature ones, and a significant left-to-right shunt volume raises concerns about pulmonary overcirculation, steal of systemic blood flow, and its potential contribution to neonatal respiratory morbidities such as bronchopulmonary dysplasia (BPD). Extremely low gestational age and long duration of mechanical ventilation may influence the relationship between the patent ductus arteriosus (PDA) and BPD. Decades of research has employed various pharmacologic approaches including NSAIDs and acetaminophen administered based on diverse criteria and using various timing, dose, and route combinations. Unfortunately, none of these interventions has consistently demonstrated meaningful improvements in clinical outcomes. Instead, these treatments inconsistently achieve PDA closure or restriction of flow through the ductus and are often associated with adverse effects. Thus, the lack of clear benefit from available treatments, coupled with the potential for harm, has prompted many centers to adopt conservative or expectant management of the PDA while awaiting novel strategies that could offer improved efficacy and safety. This review explores the associations between PDA and pulmonary outcomes of prematurity, reflecting on past research and outlining potential future directions.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226097","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-acting muscarinic antagonists as add-on treatment for asthma in children under age 12: a systematic review and meta-analysis.","authors":"Gabriel Bolner, Yohanna Idsabella Rossi, Jonathan Costa Dall'Acqua, Artur Vestena Rossato, Fabiana Dolovitsch de Oliveira, Kauê Bolner, Gilberto Bueno Fischer, Janice Luisa Lukrafka, Helena Teresinha Mocelin","doi":"10.1016/j.prrv.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.003","url":null,"abstract":"<p><strong>Introduction: </strong>Children under 12 have fewer treatment options for uncontrolled asthma than adolescents and adults. Long-acting muscarinic antagonists (LAMA) can be used as an add-on therapy for asthma in adults, but the evidence in children is unclear.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies that evaluated LAMA as an add-on therapy to inhaled corticosteroids in asthmatic children younger than 12. We performed a random-effects meta-analysis for lung function, asthma control, and adverse events. Subgroup analyses were performed for different LAMA dosages.</p><p><strong>Results: </strong>Four RCTs and two observational studies (n = 1210) were included in our systematic review. The pulmonary function tests indicated that LAMA at any dose significantly improved peak FEV1 (MD 86.16 mL; 95 %CI 18.62-153.71; p < 0.01) and FEF25-75 % (MD 0.2518L; 95 %CI 0.1971-0.3064; p < 0.01), while FVC (MD 9.69 mL; 95 %CI -34.57 to 53.95; p = 0.67) remained unchanged. Asthma control measured by the Asthma Control Questionnaire (MD -0.07; 95 %CI -0.08 to -0.06; p < 0.01) also favoured LAMA treatments. Nighttime awakenings and rescue treatment usage showed no significant differences between groups. Using LAMA was also associated with fewer adverse events (RR 0.88; 95 %CI 0.79-0.98; p = 0.021).</p><p><strong>Conclusion: </strong>LAMA are safe and effective for moderate/severe asthma for children aged 6-11. Evidence is still slowly evolving for children younger than 6 years.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182389","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":"Glue ear: an ongoing global program - closing the audiology gap among First Nations children.","authors":"Isabella Ludbrook, Georgia Tongs Wiradjuri, Kelvin Kong Worimi, Hasantha Gunasekera","doi":"10.1016/j.prrv.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.011","url":null,"abstract":"<p><p>Most children globally (∼80 %) are affected by Otitis Media with Effusion (OME; 'serous otitis media' or 'glue ear') by four years of age. Most episodes are brief and uncomplicated. Chronic, recurrent and complicated OME has been linked to social disadvantage, with poorer educational and employment outcomes and increased criminal justice system contact. Specific populations are particularly at risk, even in High Income Countries, including children with craniofacial abnormalities, immunocompromise and First Nations children in colonised regions (e.g., Australia, New Zealand, and the Arctic Circle). OME is a significant cause of childhood morbidity, particularly during infancy. Mortality should not occur in High-Income-Countries. However, in Low-Middle-Income Countries, lack of access to health programs can lead to devastating, preventable complications, including death from meningitis, brain abscesses, and sepsis. This emphasises the importance of equitable access to medical resources globally, a universal and ongoing problem for First Nations people. Upper respiratory tract infections (including OME), are the most common reason for children to present to healthcare services, be prescribed antibiotics, and undergo surgery. Although OME is often managed with antibiotics, guidelines recommend observation for uncomplicated cases, given potential harms for the child (e.g., rash and diarrhoea), and for healthcare (e.g., cost and antibiotic resistance). OME is also the most common reason for hearing impairment among children, and peaks at the time that auditory processing neural pathways, the foundations of cognitive development, are being laid down. Causative effect between OME and impaired cognitive function is hard to prove because of the challenges of designing and analysing rigorous observational studies to emulate clinical trials. Recurrent OME cannot be left untreated due to the potential for both severe physical harm and significant long-term social consequences. Clinicians should be aware that children's behavioural and developmental outcomes and balance disturbance may indicate middle ear disease or its sequelae and remain vigilant. Children's ears should be checked and findings documented at every healthcare visit to ensure close surveillance for this insidious condition, particularly for those most at-risk.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187554","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":"The wicked problem of otitis media: summary of recent systematic reviews on otitis media with effusion.","authors":"Hasantha Gunasekera","doi":"10.1016/j.prrv.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.008","url":null,"abstract":"<p><p>Otitis media (OM) is a wicked problem. Millennia ago, middle ear disease was described in the ancient Egyptian Ebers Papyrus and Indian Sushruta Samhit ('Compendium'). Centuries ago, Italian anatomists (Bartholomaeus Eustachius ∼ 1563; and Antonio Valsalva ∼ 1704) described the structures and technique for draining middle ear pus that still bear their names. Recently, immunological studies have broadened our understanding of the important inflammatory and immune responses in middle ear disease. Despite all of this knowledge, we have made no real progress eliminating this disease that nearly every child will still experience, although the severe life threatening forms are much less common. Colonised High Income Countries have recorded evidence of middle ear disease among the indigenous populations for centuries and the massive disparities in disease burden persist. We have made little progress, indeed may have gone backwards, managing OM with priority populations, such as First Nations children. More broadly, OM is one of the commonest reasons for children to attend healthcare, be prescribed antibiotics and undergo surgery. Therefore, it has a significant impact on health-spending and antibiotic resistance as well as morbidity for children, including hearing impairment, balance disturbance, behavioural disruption, speech and language and other delays with all the consequent life-course impacts, including justice system contact. Perhaps OM is not eradicable, but we must do better to contain the recurrent, persistent and severe forms.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180587","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":"Sleep problems and sleep disordered breathing in children with cerebral palsy.","authors":"R Dhandayuthapani, C M McDougall, F Gahleitner, S Cunningham, D S Urquhart","doi":"10.1016/j.prrv.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.007","url":null,"abstract":"<p><p>Cerebral palsy refers to a group of disorders affecting movement and posture, caused by an impact to the developing brain. Children and young people (CYP) with cerebral palsy (CP) may have multiple associated co-morbidities, including sleep disorders. Sleep disorders, including sleep disordered breathing, are more prevalent among CYP with CP compared to typically developing children due to several contributory factors. Sleep-disordered breathing (SDB) collectively represents several different pathologies, namely obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and hypoventilation. Multiple intrinsic and extrinsic factors contribute to each of these pathologies. Sleep studies (either as polysomnography or cardiorespiratory polygraphy) allow the detection of effort and apnoea, with contemporaneous measurement of oxygen saturations (SpO₂) and transcutaneous carbon dioxide (tcpCO₂). Together these enable the diagnosis of SDB, and the delineation of OSA, CSA and/or hypoventilation. The multifactorial component of SDB among CYP with CP may require intervention ranging from conservative measures (e.g. nasopharyngeal airway, soft collar), surgical options (e.g. adenotonsillectomy), or the initiation of respiratory support. Respiratory support, delivered as Continuous Positive Airway Pressure (CPAP) or Non-Invasive Ventilation (NIV), has a key role in the management of SDB in children with CP though the journey can often be turbulent with a high failure rate. Nonetheless, CYP with CP are being increasingly commenced on respiratory support, often for reasons others than SDB, for example aiding airway clearance in order to reduce the frequency of lower respiratory tract infections. Open discussions between the parents and healthcare professionals are important in setting shared goals for CYP with CP, guided by the primary aim of improving quality of life.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013373","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":"Management of acute rhinosinusitis in children.","authors":"Yanisa Wannasuphoprasit, Mahmood F Bhutta","doi":"10.1016/j.prrv.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.004","url":null,"abstract":"<p><p>Acute rhinosinusitis (ARS) is a common condition in children, usually preceded by a viral upper respiratory tract infection (URTI). Diagnosing ARS can be challenging, relying primarily on clinical history and examination. Differentiating between viral URTI, post-viral ARS and acute bacterial rhinosinusitis (ABRS) is crucial for guiding appropriate antibiotic treatment. Antibiotics have been showed to be effective in improving symptom scores and cure rates in ABRS. Adjunct therapies, including corticosteroids, nasal saline irrigation and analgesics, may provide symptomatic relief. While viral ARS is self-limiting, bacterial ARS can lead to severe complications, including orbital and intracranial involvement, necessitating timely diagnosis and treatment. This review highlights current evidence on the diagnosis and management of ARS in children, emphasising best practices to optimise patient outcomes and prevent complications.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079388","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":"A systematic review of the clinical effectiveness of dry powder inhalers in maintenance treatment and in treatment of acute exacerbations of asthma in children.","authors":"Helen Twohig, Lauren Franklin, Will Carroll, Nadia Corp, Emma Jackson, Christian Mallen, Bernice Ruan, Louisa Yapp, Danielle Van Der Windt, James Smith","doi":"10.1016/j.prrv.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.005","url":null,"abstract":"<p><strong>Background: </strong>Dry powder inhalers (DPIs) are a lower-carbon option than pressurised metered dose inhalers (pMDIs). However, DPIs require a forceful inhalation to achieve good lung deposition and there is uncertainty as to whether younger children can effectively use DPIs for maintenance treatment or rely upon them during exacerbations.</p><p><strong>Methods: </strong>We searched electronic databases to identify randomised trials of children with asthma receiving treatment delivered via DPI, either for maintenance treatment (children ≤ 12 years) or for an acute exacerbation (participants up to age 18). Screening and data extraction were carried out by two reviewers. Risk of bias (RoB) assessment was made using the Cochrane RoB2 tool. Findings were narratively synthesised and a modified GRADE approach was taken to summarise the strength of evidence.</p><p><strong>Results: </strong>27 studies were included. 20 addressed maintenance treatment in children ≤ 12 years although only 4 compared the same treatment delivered via pMDI to DPI. All found no difference in efficacy between the device types (high certainty evidence). Other studies provided weaker, indirect evidence supporting this finding. 7 studies considered acute asthma in hospital/emergency settings. All reported no difference in efficacy between device types but certainty of evidence was low due to high RoB and clinical and methodological heterogeneity.</p><p><strong>Conclusion: </strong>There are few studies directly comparing treatment via DPI/pMDI for asthma in children. Comparative studies suggest that for children who can use both DPI/pMDI, the devices are equal in efficacy for maintenance treatment in children ≤ 12 years but high-quality evidence is lacking regarding their use during acute exacerbations. This review did not find sufficient evidence to identify a lower age at which DPIs can start being used.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975124","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":"What a paediatric pulmonologist needs to know about vaping.","authors":"M Horgan, D W Cox","doi":"10.1016/j.prrv.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.006","url":null,"abstract":"<p><p>Electronic nicotine delivery systems (ENDS), often known as e-cigarettes or vapes, have transitioned from a smoking cessation tool to a widely used recreational product, particularly among adolescents. The prevalence of youth vaping has surged, driven by accessibility, appealing flavours, targeted marketing, and the rise of disposable vapes. Despite regulations and legislation, underage access remains widespread. Adolescents often perceive vaping as less harmful than smoking, though emerging evidence links e-cigarette use to pulmonary toxicity, increased respiratory symptoms, and potential long-term lung damage. Studies indicate associations between vaping and asthma, bronchiolitis, and chronic obstructive pulmonary disease. Additionally, harmful chemical by-products produced from e-liquid decomposition, raise future health concerns. Regulatory measures vary globally, and the effectiveness of different strategies remains unclear. Paediatric pulmonologists play a key role in addressing this epidemic through patient education and advocacy. Urgent research is needed to assess the long-term health impacts of vaping and develop the most effective vaping cessation interventions.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026715","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":"Pulmonary hemorrhage in preterm infants born <29 weeks' gestation: a population cohort study.","authors":"Pranav R Jani, Traci-Anne Goyen, James Elhindi, Rajesh Maheshwari, Daphne D'Cruz, Himanshu Popat, Mohamed Abdel-Latif, Melissa Luig, Dharmesh Shah","doi":"10.1016/j.prrv.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.001","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the incidence, clinical characteristics and outcomes of pulmonary hemorrhage (PH) in preterm infants who were born <29 weeks' gestation in relation to their small for gestational age (SGA) status.</p><p><strong>Study design: </strong>This retrospective cohort study included preterm infants born <29 weeks' gestation and admitted to one of eight tertiary perinatal hospitals in New South Wales and The Australian Capital Territory, Australia from 1 January 2007 to 31 December 2019. Data for analysis was obtained from the Neonatal Intensive Care Units' (NICUs) database. Temporal trends and changes in the outcomes were examined using multivariable logistic regression models.</p><p><strong>Results: </strong>The median gestational age was 27 weeks' (interquartile range (IR): 25-28) and the median birth weight was 928 g (IR: 756-1,106). PH occurred in 281/4,823 infants (5.8 %). PH more than doubled in SGA compared to appropriately grown infants (11.1 %: 39/353 versus 5.4 %: 242/4,470, difference 5.7; 95 % CI:2.14-9.12) and in infants born <26 weeks compared to ≥26 weeks (137/1,356: 10.1 % versus 144/3,467: 4.2 %, difference 5.9; 95 % CI:4.16-7.63). After confounder adjustments, PH was associated with a higher predischarge mortality (OR:3.97, 95 % CI:3.00-5.24) and severe intraventricular hemorrhage (OR:4.2, 95 % CI:3.10-5.67) but made no difference in levels of functional impairment at 2-3 years corrected age (OR:1.13, 95 % CI:0.77-1.66).</p><p><strong>Conclusion: </strong>PH was more common in infants born SGA and in those born <26 weeks' gestation. PH was associated with poorer predischarge clinical outcomes. Timely risk prediction is needed to improve outcomes in these infants.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026655","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":"Pediatric pulmonary and sleep medicine - Best recent articles to read in 2025.","authors":"Bruce K Rubin","doi":"10.1016/j.prrv.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.prrv.2025.04.002","url":null,"abstract":"<p><p>It is a challenge to select the \"best\" recent publications in a field. This is especially so when faced with a feast of outstanding manuscripts across a broad range of topics. I therefore reached out to a Who's Who of friends and colleagues in pediatric pulmonary and sleep medicine for suggestions, and I was delighted and overwhelmed by the response - please see the Acknowledgements for those who contributed ideas. Overwhelmed, by having to read 77 publications suggested by one or more colleagues and having to winnow the list down to a somewhat reasonable number. I chose to include all papers mentioned by two or more of my colleagues and I then selected the remainder to cover the broad range of our field, based upon my belief that a manuscript represented an important contribution to our understanding and clinical care. What follows are the chosen papers organized by topic area. Given the number of papers that made the final cut, I have briefly summarized each of these manuscripts. I hope that you will find something new and exciting in these publications and that you will have as much fun in reading them as I did.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985514","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}