Paediatric Respiratory Reviews最新文献

{"title":"Intravenous magnesium sulfate for asthma exacerbations in children: Systematic review with meta-analysis","authors":"Dominika Ambrożej ,&nbsp;Aleksander Adamiec ,&nbsp;Erick Forno ,&nbsp;Izabela Orzołek ,&nbsp;Wojciech Feleszko ,&nbsp;Jose A. Castro-Rodriguez","doi":"10.1016/j.prrv.2024.01.003","DOIUrl":"10.1016/j.prrv.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Asthma is the most prevalent chronic disease<span> in children and constitutes a significant healthcare burden. First-line therapy for acute asthma exacerbations is well established. However, secondary treatments, including intravenous magnesium sulfate (IV-MgSO4), remain variable due to scarcity of data on its efficacy and safety.</span></div></div><div><h3>Objective</h3><div>To assess the effectiveness and safety of IV-MgSO4 as a second line of treatment in managing children with asthma exacerbations.</div></div><div><h3>Methods</h3><div><span>We searched five databases from inception until April 2023 on randomized clinical trials of IV-MgSO4 in children with acute asthma exacerbations. The primary outcomes were hospitalization rate and length, and change in the severity score. Secondary outcomes included percentage increase in </span>peak expiratory flow rate<span><span> (PEFR), hospital re-admission rate, need and length for pediatric intensive care unit (PICU) treatment, and </span>adverse effects. Meta-analysis was performed for three outcomes with estimated odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs).</span></div></div><div><h3>Results</h3><div>Eleven studies met the final criteria. In comparison to control, administration of IV-MgSO4 was associated with a reduced hospitalization risk (OR 0.15; 95%CI: 0.03, 0.73) in four studies, and improvement of lung function (MD 26.77% PEFR; 95%CI: 18.41, 54.79) in two studies. There were no significant differences in the length of stay between groups. Due to heterogeneity, a narrative synthesis of other outcomes was performed.</div></div><div><h3>Conclusion</h3><div>The use of IV-MgSO4 demonstrated a reduction in the hospitalization rate and PEFR improvement in children with asthma exacerbations. Adverse effects were rare. Further well-designed studies are needed to better determine the efficacy and safety profile of IV-MgSO4.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"52 ","pages":"Pages 23-30"},"PeriodicalIF":4.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139875941","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":"High flow, low results: The limits of high flow nasal cannula in the treatment of bronchiolitis","authors":"Jennifer E. Lane ,&nbsp;Taylor Ford ,&nbsp;Michelle Noelck ,&nbsp;Courtney Byrd","doi":"10.1016/j.prrv.2024.06.003","DOIUrl":"10.1016/j.prrv.2024.06.003","url":null,"abstract":"<div><div><span>Bronchiolitis continues to be the most common cause of hospitalization in the first year of life. We continue to search for the remedy that will improve symptoms, shorten hospitalization and prevent worsening of disease. Although initially thought to be a promising therapy, large </span>randomized controlled trials<span> show us that high flow nasal cannula<span><span> (HFNC) use is not that remedy. These trials show no major differences in duration of hospital stay, intensive care unit (ICU) admission rates, duration of stay in the ICU, duration of oxygen therapy, </span>intubation rates, heart rate, respiratory rate or comfort scores. Additionally, practices regarding initiation, flow rates and weaning continue to vary from institution to institution and there are currently no agreed upon indications for its use. This reveals the need for evidence based guidelines on HFNC use in bronchiolitis.</span></span></div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"52 ","pages":"Pages 9-13"},"PeriodicalIF":4.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141392324","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":"Addressing high flow overuse in bronchiolitis − Successes and future directions","authors":"Taylor Ford ,&nbsp;Jennifer Lane ,&nbsp;Michelle Noelck ,&nbsp;Courtney Byrd","doi":"10.1016/j.prrv.2024.06.002","DOIUrl":"10.1016/j.prrv.2024.06.002","url":null,"abstract":"<div><div><span><span>The use of high flow nasal cannula (HFNC) in the treatment of </span>bronchiolitis has markedly increased in the last decade, yet </span>randomized controlled trials have reported little clinical benefit with early, routine use. This article provides a concise overview of the current status of HFNC therapy, discusses successful de-implementation strategies to curtail HFNC overuse, and explores future bronchiolitis and HFNC quality improvement and research considerations.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"52 ","pages":"Pages 14-17"},"PeriodicalIF":4.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141395405","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":"Necrotizing Pneumonia In Children: A Review","authors":"Helena Teresinha Mocelin ,&nbsp;Gilberto Bueno Fischer ,&nbsp;Júlia Danezi Piccini ,&nbsp;Júlio de Oliveira Espinel ,&nbsp;Cristiano Feijó Andrade ,&nbsp;Andrew Bush","doi":"10.1016/j.prrv.2024.02.003","DOIUrl":"10.1016/j.prrv.2024.02.003","url":null,"abstract":"<div><div>The objective of the review was to determine the long-term outcomes of necrotising pneumonia (NP). Studies published since 1990 in English, Portuguese, or Spanish, published on PubMed and Scielo were evaluated. Our findings showed ultrasound scanning is the diagnostic modality of choice. Despite prolonged hospitalisation (median 13–27 days) and fever (median 9–16 days), most patients recover completely. Empyema and bronchopleural fistulae are frequent in bacterial NP. <em>Streptococcus pneumoniae</em> is the most prevalent cause. Seventeen studies with 497 patients followed for 30 days to 8.75 years showed that most patients were clinically asymptomatic and had normal lung function. X-ray or CT chest imaging demonstrated that almost all lung lesions recovered within 4–6 months. We suggest that it is not necessary to request frequent chest X-rays during the treatment and recovery process. Chest CT scans should be reserved for specific cases not following the expected clinical course.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"52 ","pages":"Pages 51-57"},"PeriodicalIF":4.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139927153","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":"New paradigms in acute viral bronchiolitis: Is it time to change our approach?","authors":"Jose A Castro-Rodriguez, Patricio Astudillo, Sandeep Puranik, Mark A Brown, Adnan Custovic, Erick Forno","doi":"10.1016/j.prrv.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.prrv.2024.10.004","url":null,"abstract":"<p><p>Viral bronchiolitis is the most common pediatric acute respiratory infection leading to hospitalization, and it causes a significant healthcare burden worldwide. Current guidelines recommend supportive management after many clinical trials on specific therapies failed to demonstrate benefits. However, several studies in the past decade have revealed that bronchiolitis may not be a homogeneous disease, but instead may constitute an umbrella comprised of different \"endotypes\" and \"phenotypes\" based on patient characteristics, etiology, pathophysiological mechanisms, and clinical presentation. In this extensive review, we summarize the current evidence that several different types of bronchiolitis (\"bronchiolitides\") coexist, with different short- and long-term consequences on respiratory health and the risk of asthma development. Disease pathobiology, immune response, and clinical characteristics may differ between the two most prevalent viral agents, respiratory syncytial virus and rhinovirus. Recent randomized trials have shown that some subgroups of children may benefit from the use of systemic corticosteroids and/or bronchodilators. These findings also suggest that some children may benefit from individualized therapeutical approaches for viral bronchiolitis rather than following broad recommendations for treating all patients uniformly using only supportive management.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142730969","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":"Addition of long-acting beta-agonists to inhaled corticosteroids for asthma in preschool children: A systematic review.","authors":"Dominika Ambrożej, Maja Cieślik, Wojciech Feleszko, Carlos E Rodriguez-Martinez, Jose A Castro-Rodriguez","doi":"10.1016/j.prrv.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.prrv.2024.09.002","url":null,"abstract":"<p><p>Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are essential in asthma management, but the guidelines for treatment in preschool children remain heterogeneous worldwide. This systematic review evaluates the efficacy and safety of LABA + ICS therapy in asthmatic children under six years. We searched four databases, identifying six eligible studies (n = 1415 preschoolers), and in all the LABA used was salmeterol. Due to high heterogeneity, quantitative analysis was not feasible. Three before-and-after studies demonstrated significant reductions in unscheduled visits and hospitalizations due to asthma exacerbations with LABA + ICS. One RCT showed fewer exacerbations in the LABA + ICS group compared to ICS alone. Night-time awakenings decreased significantly in two studies but not in one RCT. Improvements in lung function using impulse oscillometry and FeNO levels were noted with LABA+ICS in one RCT. No significant adverse effects were reported. Despite positive findings, high-quality trials are needed to confirm these results, particularly using formoterol as LABA, aligning with the recommendations. Further research is imperative to optimize asthma management in preschool children.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605116","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 potential effects of climate change on non-cystic fibrosis bronchiectasis in children.","authors":"Grigorios Chatziparasidis, Ahmad Kantar, Maria Rafailia Chatziparasidi, Sotirios Fouzas, Andrew Bush, Anne Chang","doi":"10.1016/j.prrv.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.prrv.2024.10.002","url":null,"abstract":"<p><p>Climate change may have devastating effects on the pathogenesis of non-cystic fibrosis bronchiectasis in children since it affects the biological cycle of the respiratory pathogens and alters the human respiratory defense mechanisms. Bronchiectasis in children has been identified as an emerging global epidemic that has attracted the attention of the medical community over recent years. Pediatric pulmonologists should be aware of the consequences of climate change on children with bronchiectasis and plan strategies to ameliorate these effects.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142730974","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":"Outcomes of paediatric community acquired pneumonia","authors":"S. Haggie ,&nbsp;I.M. Balfour-Lynn","doi":"10.1016/j.prrv.2024.10.003","DOIUrl":"10.1016/j.prrv.2024.10.003","url":null,"abstract":"<div><div>Community acquired pneumonia is among the most common causes of hospitalisation in children, despite most cases being successfully managed in ambulatory care. Empyema is the most common complication of hospitalised pneumonia, and although associated with considerable morbidity, death is rare, even in severe disease.</div><div>Beyond the acute infection, there is a recognised association of paediatric lower respiratory tract infection and impaired lung function over the whole life span. Longitudinal birth cohorts highlight the deleterious effect of paediatric pneumonia on lung function and the development of chronic obstructive pulmonary disease and a near doubling of respiratory associated mortality in adults. Less clear is how to reconcile this worrisome data with most children only having mild abnormalities on spirometry in paediatric follow up. Recurrent or severe pneumonia is infrequently associated with irreversible lung injury such as bronchiectasis or bronchiolitis obliterans.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 3-11"},"PeriodicalIF":4.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605198","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":"Chest and spinal disease in patients with progressive neuromuscular disease.","authors":"Oscar Henry Mayer, Greg Redding","doi":"10.1016/j.prrv.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.prrv.2024.10.001","url":null,"abstract":"<p><p>The chest and spine deformity in neuromuscular disease (NMDz) can impact respiratory mechanics and pulmonary function by changing the orientation of the muscles and joints of the respiratory system and placing them in a mechanically unfavorable position. This increases mechanical load on weak respiratory muscles and eventually can cause respiratory failure. Therefore, chest and spine deformity in NMDz will both lead to increased respiratory \"load\" and decreased respiratory muscle \"pump\", an exceptionally bad combination. While the current pharmacotherapies used for progressive neuromuscular disease focus on slowing progression, a similar approach has been used for decades in managing chest and spine deformity in patients with NMDz. There are, however, variable approaches to doing so and a recognition that not all \"neuromuscular scoliosis\" is the same and that each patient type (i.e. hypotonic vs. hypertonic) requires a different approach. Figuring out what approach to use requires both an understanding of the underlying pathophysiology of a particular neuromuscular condition and considering available options for and timing of surgical interventions. The remaining discussion will focus on hypotonic neuromuscular scoliosis.</p>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822467","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":"Impact of highly effective modulator therapy on gastrointestinal symptoms and features in people with cystic fibrosis","authors":"Martina Cecchetti ,&nbsp;Luca Scarallo ,&nbsp;Paolo Lionetti ,&nbsp;Chee Y. Ooi ,&nbsp;Vito Terlizzi","doi":"10.1016/j.prrv.2024.07.004","DOIUrl":"10.1016/j.prrv.2024.07.004","url":null,"abstract":"<div><div>Highly effective modulator therapy (HEMT), particularly the triple combination elexacaftor-tezacaftor-ivacaftor (ETI), significantly improved clinical outcomes and quality of life in people with Cystic Fibrosis (pwCF). This review analyzes current knowledge on the impact of HEMTs on gastrointestinal (GI) symptoms and features in pwCF. A descriptive review of English literature until February 29, 2024, was conducted using medical databases. Observational studies and clinical trials addressing GI reflux disease (GERD), lower GI symptoms and pancreatic disease were considered.</div><div>Studies report positive effects of HEMTs on pH levels and bicarbonate secretion as well as improvement on intestinal inflammation. HEMTs also demonstrated positive effects on GERD and lower GI symptoms or conditions CF related such as dysbiosis. Taking ETI during pregnancy could also allow resolution of meconium ileus in fetuses with CF. The best benefits were observed in pancreatic function, potentially delaying CF-related diabetes and recovering pancreatic function in some children on ETI. Larger trials, particularly in pediatric populations, need to confirm these findings and explore long-term effects.</div></div>","PeriodicalId":19658,"journal":{"name":"Paediatric Respiratory Reviews","volume":"54 ","pages":"Pages 70-75"},"PeriodicalIF":4.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351424","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}