Pediatric Pulmonology最新文献

{"title":"Medical and social factors associated with prolonged length of stay for chronically ventilated children.","authors":"Katelyn G Enzer, Jessica A Dawson, Jessalyn A Langevin, John T Brinton, Christopher D Baker","doi":"10.1002/ppul.27320","DOIUrl":"10.1002/ppul.27320","url":null,"abstract":"<p><strong>Objectives: </strong>This study seeks to determine the overall and post-intensive care unit (ICU) length of stay (LOS) for children with tracheostomies and chronic mechanical ventilation. We hypothesized that medical and social factors would be associated with prolonged LOS.</p><p><strong>Study design: </strong>This single-center retrospective review included children who were discharged after initiation of chronic ventilation via tracheostomy over an 8-year period (2015-2022). Patients were divided into two groups for analysis, those who had been previously home before admission (HBA) and those who had not (Not HBA). Medical and social determinants of health (SDOH) data were obtained from the electronic medical record for univariate and multivariable analyses.</p><p><strong>Results: </strong>A total of 161 patients were included. HBA subjects (n = 52) were expectedly older at the time of tracheostomy. Not HBA subjects (n = 109) were more likely to be born prematurely and have sequelae of premature birth. Overall and post-ICU LOS increased for both groups during the study period. In the HBA subgroup, congenital heart disease and younger age were associated with longer overall LOS with these factors and the absence of gastric fundoplication being associated with longer post-ICU LOS. For Not HBA patients, younger age, pulmonary hypertension, seizures, and several SDOH were associated with longer overall LOS, whereas only SDOH were associated with a longer post-ICU LOS.</p><p><strong>Conclusions: </strong>Overall and post-ICU LOS for all children hospitalized for tracheostomy and chronic mechanical ventilation are increasing. Prolonged LOS is significantly associated with several medical factors and SDOH.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27320"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472195","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":"Effect and mechanism of allergen-specific immunotherapy on small airway dysfunction in children with asthma.","authors":"Wenwei Zhong, Xiaolan Ying, Lei Zhang, Wenfang Dong, Jie Lin, Lin Yang, Li Hong, Yong Yin, Jinhong Wu","doi":"10.1002/ppul.27341","DOIUrl":"10.1002/ppul.27341","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to investigate the effectiveness of allergen-specific immunotherapy (AIT) on small airway dysfunction (SAD) and the underlying mechanism with a special focus on basophils.</p><p><strong>Methods: </strong>Sixty-five children with mild to moderate asthma who were under regular inhaled corticosteroid (ICS) treatment for more than 1 year but whose FEF₇₅ remained below 65% of the predicted value and had positive results for serum Der p or Der f were enrolled. Children with asthma underwent house dust mite (HDM) subcutaneous immunotherapy (SCIT) treatment for 1 year. Clinical symptoms and lung function were evaluated every 3 months during HDM SCIT treatment. Basophil activation test (BAT) was carried out before and after HDM SCIT treatment. RNA sequencing was performed in isolated basophils from peripheral blood after 6 months of HDM SCIT treatment, followed by GO term and KEGG pathway enrichment analysis between patients with and without HDM SCIT treatment.</p><p><strong>Results: </strong>HDM AIT treatment ameliorated clinical symptoms while concurrently improved lung function parameters, such as FEV₁/FVC, FEF₇₅, FEF₅₀ and MMEF (p < .05). It is worth noting that FEF₇₅ values showed a highly significant, gradual and persistent increase (from 49.55 ± 1.27% at baseline to 71.89 ± 2.64% after 1 year of therapy) and 22 of 35 patients no longer had SAD after 1 year of treatment. BAT results revealed that AIT treatment significantly reduced basophil activity to the inhalant allergen mixtures containing HDM in vitro challenge from baseline. GO term and KEGG pathway enrichment analysis of basophils revealed that downregulated genes were mainly involved in immune cell activation, antigen presentation, and Th2 cell differentiation.</p><p><strong>Conclusions: </strong>Our study demonstrated that HDM AIT not only improved SAD related lung function parameters, but also reduced basophil activity. RNA sequencing revealed the inhibition of phagocytosis and the phagosome pathway in basophils which may affect the polarization of Th2 cell differentiation after HDM AIT.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27341"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472188","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":"Six Versus Three Doses of Intrapleural Streptokinase in Childhood Empyema: A Randomized Controlled Trial.","authors":"Chirag Thakur, Joseph L Mathew, Akshay K Saxena, Archana Angrup, Ram Samujh","doi":"10.1002/ppul.27465","DOIUrl":"10.1002/ppul.27465","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy and safety of administering six doses of intrapleural streptokinase (SK) versus the conventional three doses, in children with empyema.</p><p><strong>Study design: </strong>In this open label, placebo-controlled, randomized trial, we enrolled 53 children with empyema, who received three doses of intrapleural SK. Thereafter, those without clinical improvement (n = 34) and those showing clinical improvement but having persistent pleural fluid width > 10 mm on chest ultrasonography (n = 13), were randomized to receive three additional doses of SK, or three doses of placebo (normal saline). The remaining 6 children improved clinically and radiologically, hence were not randomized. The outcomes recorded were cumulative volume of pleural fluid drained, total duration of intercostal drainage, time taken for clinical improvement, duration of hospitalization, proportion of children with treatment failure requiring surgery, and adverse events. Spirometry, 6-min walk test, chest X-ray and ultrasonography were done 3 months following discharge. We analyzed by intention-to-treat.</p><p><strong>Results: </strong>The baseline characteristics of children who received six versus three doses SK were comparable. There was no statistically significant difference in the cumulative volume of fluid drained; median (IQR): 810.0 (330.0, 1630.0) [95% CI: 505, 1463] mL versus 530.0 (255.2, 1325.0) [95% CI: 325, 1131] mL, p 0.46. There were no significant inter-group differences in the total duration of intercostal drainage, time taken for clinical improvement, duration of hospitalization, treatment failure, surgical decortication and adverse events.</p><p><strong>Conclusion: </strong>In children with empyema, intrapleural therapy with six doses of SK is not superior to three doses, although it is safe.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27465"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909932","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":"Congenital lobar overinflation, from antenatal diagnosis to long-term follow-up: A single-center experience.","authors":"I Testa, N Muthialu, A Beeman, P Aurora","doi":"10.1002/ppul.27346","DOIUrl":"10.1002/ppul.27346","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27346"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505717","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":"PTB airway compression complicated by vascular abnormalities and cardiac involvement: A case series demonstrating diagnosis and management.","authors":"P Goussard, E Eber, J Janson, A G Gie, B Fourie, C M Jacobs, S S B Venkatakrishna, S Andronikou, S Van der Westhuizen, P Schubert, C Burger, J Verster, L Ebert, E Deininger-Czermak","doi":"10.1002/ppul.27351","DOIUrl":"10.1002/ppul.27351","url":null,"abstract":"<p><strong>Introduction: </strong>Lymphobronchial tuberculosis (LBTB) is a tuberculous lymphadenopathy causing airway compression in young children. While it can occur in older children due to factors such as airway size, wall weakness, and immune reconstitutions, severe airway obstruction is more common in younger children.</p><p><strong>Methods: </strong>Chest X-rays show airway compression, while bronchoscopy is the gold standard for confirming TB-induced airway compression. Previous research has demonstrated that drug resistance and HIV have no effect on the outcome of children with significant airway compression caused by TB.</p><p><strong>Results: </strong>This case series describes the management and outcome of three young children who had simultaneous vascular abnormalities and airway obstruction due to pulmonary tuberculosis (PTB). Concomitant PTB and vascular abnormalities are uncommon, even in high-TB-intensity areas, and affected children may present differently and require individualised treatment.</p><p><strong>Conclusions: </strong>Advanced imaging is critical for detecting complicated cases of airway compression due to PTB in young children, as vascular abnormalities are uncommon. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) may show metabolically active intracardiac lesions. Individualised management plans are required for these children, and echocardiography is critical for patients with disseminated disease.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27351"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522562","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":"Efficacy of a prototype inspiratory-synchronized small particle versus conventional vibrating mesh nebulizer during pediatric and neonatal mechanical ventilation.","authors":"Jie Li, Paul Karabelas, Lingyue Gong, Caylie A Sheridan, James B Fink","doi":"10.1002/ppul.27356","DOIUrl":"10.1002/ppul.27356","url":null,"abstract":"<p><strong>Background: </strong>An inspiration-synchronized vibrating mesh nebulizer (VMN) has been reported to improve aerosol delivery during adult mechanical ventilation. A prototype VMN generating smaller particles was developed. We aimed to compare the aerosol delivery efficiency of small-particle and conventional VMNs in inspiration-synchronized and continuous modes during neonatal and pediatric mechanical ventilation.</p><p><strong>Methods: </strong>A critical care ventilator with heated humidified circuits connected to an endotracheal tube (ETT) and passive test lung was set to pediatric and neonate parameters. Albuterol (2.5 mg/ml, 1 ml) was administered using both small-particle and conventional VMNs in inspiration-synchronization and continuous modes. For the pediatric model, VMN was placed at the humidifier inlet, inspiratory limb at Y-piece, and between Y-piece and ETT (Y-ETT). For the neonatal model, VMN was placed at the humidifier inlet and between Y-ETT. Each setup was repeated five times. Albuterol collected on the filter distal to the ETT was eluted and assayed with UV spectrophotometry (276 nm).</p><p><strong>Results: </strong>The inspiration-synchronized VMN generated higher inhaled doses compared to continuous VMN across all nebulizer placements, particle sizes, and aerosol generation models (all p < .05). The highest inhaled doses (42.2 ± 2.0% and 40.7 ± 1.0% for pediatric and neonate, respectively) were observed with the small-particle inspiration-synchronized VMN placed at Y-ETT. In the pediatric model, the inhaled dose with inspiration-synchronized conventional VMN was similar, independent of nebulizer placements (24.4 ~ 27.0%). In contrast, the inhaled dose was greatest with continuous VMN placed at the humidifier inlet. With the neonatal model, VMN placed at Y-ETT yielded higher doses than the humidifier inlet, and small-particle VMNs outperformed conventional VMNs across all settings (all p < .05).</p><p><strong>Conclusion: </strong>The prototype small-particle VMN positioned between Y-piece and ETT in an inspiration-synchronized mode optimized aerosol delivery during mechanical ventilation in both pediatric and neonatal models.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27356"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583968","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 physiotherapy management of airway clearance therapy and exercise: Data from the Australian Bronchiectasis Registry.","authors":"Elizabeth M Webb, Anne E Holland, Anne B Chang, Peter G Middleton, Rachel Thomson, Conroy Wong, Lata Jayaram, Chien-Li Holmes-Liew, Lucy Morgan, Annemarie L Lee","doi":"10.1002/ppul.27370","DOIUrl":"10.1002/ppul.27370","url":null,"abstract":"<p><strong>Background: </strong>Regular airway clearance techniques (ACTs) and exercise are recommended for children with bronchiectasis, but current clinical practice and their predictors are unknown.</p><p><strong>Objective: </strong>We aimed to describe current use of ACTs and exercise among Australian children with bronchiectasis and identify associated predictors.</p><p><strong>Methods: </strong>Physiotherapy-specific data of 397 children (median age = 8 were extracted from the Australian Bronchiectasis Registry. A multivariate analysis was undertaken to identify predictors associated with the use of regular ACTs and physical exercise.</p><p><strong>Results: </strong>Regular ACTs were undertaken by 118 (30%) children while 192 (48%) engaged in regular exercise. Physical exercise was the most common ACT modality (n = 83, 20%). The likelihood of regular ACT increased in children whose sputum isolated Pseudomonas aeruginosa (OR = 3.88, 95% CI 1.69-8.89) and was 50% higher for every respiratory exacerbation in the previous 12-months that required hospitalization (OR = 1.50, 95% CI 1.15-1.95). For every year older in age, children had increased odds of engaging in physical exercise (OR = 1.21, 95% CI 1.08-1.34) or using an ACT device (OR = 1.21, 95% CI 1.05-1.34). Regular exercise was twice as likely in the presence of bibasal bronchiectasis (OR = 2.43, 95% CI 1.14-5.16), yet less likely in those with ≥1 hospitalizations in the previous 12-months (OR = 0.76, 0.95% CI 0.57-1.03).</p><p><strong>Conclusion: </strong>Approximately one-third of children with bronchiectasis undertake regular ACTs while physical exercise was undertaken in approximately one in two children. Age, frequent respiratory exacerbations requiring hospitalization and the extent of disease are predictors of undertaking regular ACTs and exercise. Identification of these factors may assist in tailoring ACT, exercise and ACT modality prescription in clinical practice.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27370"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583975","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":"Oxygen Prescribing and Compatibility Issues in Infants Requiring Long Term Ventilation.","authors":"Emily McInnes, Caroline Lock, Katharine Harman, Jennifer Parker, Cara J Bossley","doi":"10.1002/ppul.27408","DOIUrl":"10.1002/ppul.27408","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27408"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818836","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":"E-Cigarettes and Cystic Fibrosis-Current Perceptions and Future Directions.","authors":"Maryam Sahibqran, Gordon MacGregor, Louise Thomson, Patrick McCrossan, Anne Devenny, Ross J Langley","doi":"10.1002/ppul.27406","DOIUrl":"10.1002/ppul.27406","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27406"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639409","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":"Post-Discharge Growth Among Extremely Preterm Infants With or Without Bronchopulmonary Dysplasia.","authors":"Yasuka Kimoto, Katsuya Hirata, Shinya Hirano, Kazuko Wada, Akinori Moriichi, Yoshiya Ito, Kazutoshi Cho, Katsumi Mizuno, Katsuaki Toyoshima, Reiko Kushima, Nozomi Ishii, Takeshi Yamaguchi, Keiji Hashimoto, Yukari Yada, Yumi Kono","doi":"10.1002/ppul.27388","DOIUrl":"10.1002/ppul.27388","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate whether bronchopulmonary dysplasia (BPD) and home respiratory care (HRC) after discharge, including home oxygen therapy (HOT) or home mechanical ventilation (HMV), were associated with the growth of extremely preterm infants.</p><p><strong>Study design: </strong>This secondary study uses data from a study on the infant and early childhood development survey of low-birth-weight infants in the Health, Labor, and Welfare Science Research. We enrolled 788 singleton extremely preterm infants appropriate for gestational age (GA). BPD was defined as the requirement of supplemental oxygen or respiratory support at 36 weeks corrected GA. We compared trends of anthropometric measurements from age 0 to 5 years among infants with non-BPD, BPD without HRC, and BPD with HRC.</p><p><strong>Results: </strong>We obtained 4113 weight and length measurements. At age 0-5 years, the BPD with the HRC group weighed less and was shorter than the other two groups. Lower GA and BPD status were significantly associated with growth failure of weight at 3 and 5 years after adjustment for potential risk factors. Lower GA was significantly associated with growth failure of length at 3 and 5 years. Conversely, although BPD status was significantly associated with growth failure of length at 3 years, it was not at 5 years.</p><p><strong>Conclusion: </strong>Among extremely preterm infants, BPD with HRC was associated with a significant growth delay at 0-5 years compared with non-BPD and BPD without HRC. However, the effect of different severities of BPD on growth failure of length was attenuated with age.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":" ","pages":"e27388"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605740","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}