Pediatric Pulmonology最新文献

{"title":"Evaluating Clinically Directed Continuous Positive Airway Pressure to High Flow Nasal Cannula Transitions in Stable Preterm Infants Using Electrical Impedance Tomography: A Prospective, Observational Study.","authors":"David M Rub, Natalie Napolitano, Francis Simmons, Rachel Mackenzie, Kelle Matthews, Elizabeth E Foglia, Howard B Panitch","doi":"10.1002/ppul.71328","DOIUrl":"10.1002/ppul.71328","url":null,"abstract":"<p><strong>Objective: </strong>To assess lung aeration changes during clinically directed transitions from CPAP to HFNC in preterm infants using Electrical Impedance Tomography (EIT).</p><p><strong>Design: </strong>Prospective, observational study.</p><p><strong>Setting: </strong>Single-center, Level IV Neonatal Intensive Care Unit.</p><p><strong>Patients: </strong>Infants born < 32 weeks gestational age (GA) undergoing a clinically indicated transition from CPAP to HFNC following ≥ 2 weeks of respiratory support.</p><p><strong>Interventions: </strong>EIT data were recorded for 30-60 min before and after transition.</p><p><strong>Main outcome measures: </strong>The primary outcome was change in end-expiratory lung impedance (ΔEELI). Infants were followed for 7 days following transition to assess for transition failure.</p><p><strong>Results: </strong>From 15 subjects, 4257 total breaths were analyzed. No significant difference in %∆EELI was found between HFNC and CPAP (Median ∆: -1.0%; IQR -3.6% to 6.0%; p = 0.78). The largest %∆EELI decrease (-9.8%) occurred in the subject who failed transition.</p><p><strong>Conclusions: </strong>Transitioning from CPAP to HFNC did not consistently decrease lung aeration in stable preterm infants. In the infant who failed transition, a distinct respiratory pattern was observed using EIT, characterized by a decrease in EELI and frequent recruitment breaths. These findings suggest better methods are needed to individualize and titrate respiratory support at the bedside for preterm infants.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71328"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiparametric Analysis of Nasal Inspiratory Pressure (SNIP) in Duchenne Muscular Dystrophy: A Case-Control Study With Healthy Subjects.","authors":"Ilsa P Santos, Layana Marques, Jessica D M da Fonseca, Mario E Dourado, Matías Otto-Yáñez, Rodrigo Torres-Castro, Francesca Pennati, Andrea Aliverti, Guilherme A F Fregonezi, Vanessa R Resqueti","doi":"10.1002/ppul.71344","DOIUrl":"https://doi.org/10.1002/ppul.71344","url":null,"abstract":"<p><strong>Background: </strong>Individuals with Duchenne Muscular Dystrophy (DMD) exhibit respiratory muscle changes leading to fatigue and weakness, and assessing relaxation rates and contractile properties may help detect early fatigue.</p><p><strong>Aim: </strong>To non-invasively assess inspiratory muscle relaxation and contractile rates using sniff nasal inspiratory pressure (SNIP) parameters in DMD subjects and compare them with matched healthy controls.</p><p><strong>Methods: </strong>A case-control study of 32 DMD male subjects and 32 age-matched healthy controls (12.7 ± 5.1 years). All subjects underwent spirometry, maximal respiratory pressures, and SNIP test. We calculated the maximum relaxation rate (MRR), decay constant (τ), and maximum rate of pressure development (MRPD) from the SNIP curve.</p><p><strong>Results: </strong>The DMD group had significantly lower MRR (5.9 [5.1-6.9] vs. 8 [6.9-10.3] %/ms, p = 0.001), lower MRPD (-0.38 [-0.47 to -0.26] vs. -0.62 [-0.52 to -0.80] cmH₂O/ms-1, p = 0.001), and higher τ (65.7 [50.7-78.1] vs. 40.5 [30.2-48.7] ms, p = 0.001). ROC curves showed that SNIP parameters effectively distinguish DMD from healthy subjects (SNIP [AUC 0.94, p < 0.001], MRR [AUC 0.86, p < 0.001], τ [AUC 0.92, p < 0.001], and MRPD [AUC 0.89, p < 0.001]).</p><p><strong>Conclusions: </strong>DMD subjects show impaired inspiratory muscle contraction and relaxation, indicating early muscle weakness or fatigue. SNIP-derived parameters may help in the early identification of inspiratory muscle dysfunction in DMD, potentially contributing to clinical detection and intervention.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71344"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345839","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":"Response to Commentary on Evaluation of Intestinal Permeability in Children Diagnosed With Bronchiolitis in Pediatric Emergency Department: A Cross Sectional Study.","authors":"Abdullah Akkuş, Ahmet Osman Kiliç, Fatih Ercan, Mehtap Yücel, Abdullah Yazar, Fatih Akin, Sevgi Pekcan, Hasan Çetin, Hanife Tuğçe Çağlar","doi":"10.1002/ppul.71350","DOIUrl":"https://doi.org/10.1002/ppul.71350","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71350"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293207","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":"Regional Pulmonary Involvement in Bronchiolitis: Insights From Lung Ultrasound.","authors":"Seyfeddine Zayani, Farah Thabet, Abir Daya, Olfa Betbout, Chokri Chouchane, Slaheddine Chouchane","doi":"10.1002/ppul.71337","DOIUrl":"10.1002/ppul.71337","url":null,"abstract":"<p><strong>Background: </strong>Acute bronchiolitis is a leading cause of pediatric hospitalization, with severe cases necessitating ventilatory support. Lung ultrasound (LUS) is emerging as a valuable tool for assessing respiratory conditions, yet its utility in evaluating regional heterogeneity in bronchiolitis remains underexplored.</p><p><strong>Objectives: </strong>This study aimed to assess the regional distribution of pulmonary lesions in infants with bronchiolitis using LUS and explore their association with the need for ventilatory support.</p><p><strong>Methods: </strong>A prospective study of 160 infants with bronchiolitis was conducted at a tertiary care center. LUS was performed within the first 12 h of admission, with pulmonary regions scored based on the Brat scoring system. Patients were categorized into a favorable outcome group and a ventilatory support group, and the severity of regional lung lesions was analyzed.</p><p><strong>Results: </strong>Median age was 65.5 days (IQR 38-118.5; range 11-314). Infants requiring ventilatory support exhibited higher regional LUS scores-particularly in lateral-superior, lateral-inferior, posterior-superior, and posterior-inferior zones (p = 0.001); posterior regions showed the highest prevalence of severe lesions. In multivariable analysis, involvement of specific zones independently predicted ventilatory support, notably right lateral-superior (OR 4.6, 95% CI 2.12-9.86), left lateral-superior (OR 3.7, 95% CI 1.78-7.86), left posterior-superior (OR 2.0, 95% CI 1.23-3.51), and left posterior-inferior (OR 2.1, 95% CI 1.20-3.71).</p><p><strong>Conclusions: </strong>Our findings highlight the heterogeneous distribution of pulmonary involvement in bronchiolitis and underscore the potential role of LUS in severity stratification. However, the study's single-center design necessitates cautious interpretation, with further research needed to validate these results and expand the clinical application of LUS in bronchiolitis management.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71337"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic Fibrosis Care in South Africa: Facing the Challenge of Diversity and Inequality.","authors":"Marco Zampoli, Cathy Baird, Brenda Morrow, Janine Verstraete, Greg Calligaro, Mark Seale","doi":"10.1002/ppul.71338","DOIUrl":"10.1002/ppul.71338","url":null,"abstract":"<p><p>Low-and-middle-income countries (LMIC) like South Africa (SA) were left behind with advancements in cystic fibrosis (CF) care that followed re-imbursement agreements in high-income countries of CF transmembrane regulator protein modulators (CFTRm) for the treatment of CF. A combination of global monopoly, patent protection by international trade agreements and delays in regulatory approvals are factors keeping these transformative drugs out of reach for many LMIC due to their high cost. Unequal and delayed access to CFTRm is amplifying existing disparities in CF care and outcomes worldwide, including SA where currently only 200 (50%) of the 400 eligible people have access to CFTRm. However, the SA experience demonstrated how health professionals, legal experts and global CF community activists can collaborate to mobilize local and international resources to advocate for affordable and equal access to CFTRm In this paper we describe the journey followed in SA to overcome some of these inequalities and challenges and highlight the current and future impact on CF care in SA that may have much in common with other LMIC.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71338"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracotomies in Children in Low to Middle Income Countries: The Indications for Surgery.","authors":"Jacobus Botha, Pierre Goussard, Jacques Janson, Zane Ismail, Jin Kim, Francois Retief, Jonathan Burke, André Gie, Delano Rhode, Pawel Schubert, Savvas Andronikou","doi":"10.1002/ppul.71353","DOIUrl":"https://doi.org/10.1002/ppul.71353","url":null,"abstract":"<p><strong>Introduction: </strong>There is a scarcity of data on the utilization of thoracotomy for lung pathology in children in low- and middle-income countries (LMICs). These countries have high burdens of infectious diseases, especially tuberculosis, hydatic disease and Human immunodeficiency virus (HIV).</p><p><strong>Methods: </strong>This is a retrospective descriptive study reviewing the indications for thoracotomy in a single center in a LMIC country. The study included all children under the age of 13 who underwent thoracotomy for pulmonary disease or vascular conditions affecting the airways at Tygerberg Hospital between January 2018 and December 2022. The indications for thoracotomy were classified into five groups: infectious, congenital, diagnostic, traumatic or neoplastic. Data collected included age, sex, HIV status, indication for the thoracotomy, procedures performed, complications of surgery and the final diagnosis after surgery.</p><p><strong>Results: </strong>One hundred seventy-two children who had undergone thoracotomy were studied with 182 thoracotomies performed. Infectious diseases (54.9%) were the most common indication for thoracotomy followed by congenital (35.2%), diagnostic (4.9%), traumatic (3.3%) and neoplastic (1.6%). The most common indication for thoracotomy was airway compression due to tuberculosis (TB) lymph nodes (21.4%), followed by hydatic cysts (20.9%) and vascular malformations (11.5%).</p><p><strong>Conclusion: </strong>LMICs still face a significant burden of infectious and congenital diseases requiring thoracotomy, as compared to higher-income countries where neoplastic indications are most common. During the study period, hydatid cysts have become more prevalent and is now the most common indication for thoracotomy in the study setting. Thoracotomy can be safely performed in an LMIC setting with low morbidity and mortality, also in HIV-positive children.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71353"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346408","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":"Lung Ultrasound Score as a Predictor for Extubation Failure in Preterm Infants.","authors":"Wegdan Mawlana, Mohamed Elhady, Attallah Alhoweiti, Asmaa Osman","doi":"10.1002/ppul.71352","DOIUrl":"https://doi.org/10.1002/ppul.71352","url":null,"abstract":"<p><strong>Background: </strong>Extubation in preterm infants is a complex decision, and clinicians need to balance the risk of respiratory failure with the potential benefits of reducing mechanical ventilation. Lung ultrasound Score (LUS) has emerged as a promising tool to assist in this decision-making process. This study aimed to evaluate the predictive value of LUS score for successful extubation in preterm infants born < 35 weeks gestation.</p><p><strong>Subjects and methods: </strong>This is a prospective, observational study that was conducted on 77 preterm infants with gestational age < 35 weeks who were supported by invasive mechanical ventilation due to respiratory distress syndrome (RDS). LUS was performed within 2 h before extubation and LUS score was calculated, receiver operating characteristic analysis (AUC) was done to get cut-off score, sensitivity, and specificity.</p><p><strong>Results: </strong>Sixty-six babies (85.7%) were successfully extubated (ES) to noninvasive respiratory support while 11 babies (14.2%) failed extubation (EF) within the 72 h period from the onset of extubation. Pre-extubation LUS score was significantly higher (7.0 ± 2.75) in EF group compared to neonates in ES group (4.89 ± 1.81) with p < 0.05 (0.028). A cut-off LUS score > 6 had a sensitivity 78.5% and a specificity 67.7% (95% confidence interval: 0.67-0.89) to predict extubation failure. Positive predictive value (PPV) was 63.3%, and negative predictive value (NPV) was 75%. The gestational age (GA) was 31.51 ± 2.9 in (ES) versus 29.90 ± 3.2 weeks in (EF) with no significant difference between both groups as well as birth weight (1661 ± 590 g vs. 1411 ± 47 g). Male sex represented 66% of the studied cohort.</p><p><strong>Conclusion: </strong>LUS score offers a modest predictive value for successful extubation in mechanically ventilated preterm infants. However, Its ease of use and real-time assessment make it a valuable addition to the clinical decision-making process in managing these fragile infants.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71352"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346550","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":"Navigating Recommendation Versus Reality: Considering Social Determinants of Health in Discharge and Outpatient Management of Children Requiring Home Mechanical Ventilation.","authors":"Annie B Friedrich, Breeanna Psaris, Cecilia Lang, Jasmine C Dowell, Jennifer Henningfeld","doi":"10.1002/ppul.71340","DOIUrl":"https://doi.org/10.1002/ppul.71340","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71340"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346385","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":"Firecracker Causing Bronchial Injury in a Child: CT Virtual Bronchoscopy as a Noninvasive Evaluation Modality.","authors":"Shubham Saini, Anmol Bhatia, Suresh K Angurana, Akshay K Saxena, Jayashree Muralidharan, Kushaljit Singh Sodhi","doi":"10.1002/ppul.71272","DOIUrl":"https://doi.org/10.1002/ppul.71272","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71272"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293119","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 Neurally Adjusted Ventilatory Assist Management on Neurodevelopmental Outcomes in Extremely Preterm Infants.","authors":"Tomoko Saito, Tomoyuki Shimokaze, Yoshinori Inagaki, Takahiro Noguchi, Jun Shibasaki, Katsuaki Toyoshima","doi":"10.1002/ppul.71327","DOIUrl":"https://doi.org/10.1002/ppul.71327","url":null,"abstract":"<p><strong>Introduction: </strong>Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator synchrony using diaphragmatic electrical activity. However, its long-term impact on neurodevelopment in extremely preterm infants remains unclear. This study examined the association between NAVA management and neurodevelopmental outcomes.</p><p><strong>Methods: </strong>We retrospectively compared infants born at ≤ 27 weeks' gestation who were admitted before (2016-2017, n = 38) and after (2019-2021, n = 44) NAVA implementation. The primary outcome was the developmental quotient (DQ) at 18 months, assessed using the Kyoto Scale of Psychological Development.</p><p><strong>Results: </strong>Comparing the pre- and post-implementation groups: median gestational age, 25.5 versus 25.9 weeks (p = 0.67); postmenstrual age at extubation, 30.6 versus 32.1 weeks (p < 0.001); NAVA use, 0% versus 91%; and high-frequency oscillatory ventilation use, 74% versus 46% (p = 0.013). No significant differences were observed between the groups in corticosteroid use, bronchopulmonary dysplasia incidence, postmenstrual age at discharge, or home oxygen therapy. At 18 months, DQ scores were as follows in the pre- and post-implementation groups: Full Scale (83 vs. 89; p = 0.32), Gross Motor (81 vs. 86; p = 0.45), Cognitive/Adaptive (83 vs. 90; p = 0.56), and Language/Social (71 vs. 88; p = 0.109). Modified Checklist for Autism in Toddlers score was 3 in both groups (p = 0.86). Multivariable analysis revealed that NAVA use (adjusted odds ratio [aOR] 2.99, 95% confidence interval [CI]: 1.14-7.81) and gestational age (aOR 1.59, 95% CI: 1.08-2.33) were associated with Full Scale DQ ≥ 85; whereas sex and birth weight standard deviation were not.</p><p><strong>Conclusion: </strong>Despite the prolonged tracheal intubation period, NAVA management was associated with improved neurodevelopment outcomes at 18 months.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71327"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293165","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}