A Traunero, S Ghirardo, M Aldeco, P Pascolo, S Basilicata, L Mazzari, M Maschio, A Amaddeo, U Krivec
{"title":"Outbreak of Post-Infectious Bronchiolitis Obliterans (PIBO) After Adenovirus Infection: A Case Series and Review of the Literature.","authors":"A Traunero, S Ghirardo, M Aldeco, P Pascolo, S Basilicata, L Mazzari, M Maschio, A Amaddeo, U Krivec","doi":"10.1002/ppul.71080","DOIUrl":"10.1002/ppul.71080","url":null,"abstract":"<p><strong>Background: </strong>Post-infectious bronchiolitis obliterans (PIBO) is a rare chronic pediatric pulmonary disease characterized by irreversible fibrotic narrowing of the small airways. Treatment options remain uncertain with limited success.</p><p><strong>Objective: </strong>To delineate the characteristics of patients diagnosed with PIBO in Ljubljana (Slovenia) and Trieste (Italy) in 2023.</p><p><strong>Methods: </strong>We retrospectively assessed clinical records of PIBO patients from January to December 2023, capturing data on initial viral infection, clinical presentation, radiological features, treatments, and outcomes.</p><p><strong>Results: </strong>In 2023, 11 patients were identified, contrasting with only 6 cases in the previous 7 years. Common symptoms and signs included tachypnea, chronic wet cough, and diffuse crackles following adenovirus pneumonia. Most patients were previously healthy. Chest CT findings confirmed the diagnosis in all cases. Bronchoalveolar lavage showed elevated levels of neutrophils (46% to 90% of cells), and biopsies performed in 6 patients indicated predominantly lymphocytic inflammatory infiltrate and bronchiolar fibrosis. Nocturnal pulse oximetry revealed reduced mean SpO2 (median: 96.5% Q1: 93%, Q3: 98%) and reduced lower values (median: SpO2 89% Q1: 87%, Q3: 92.5%) with an increased oxygen desaturation index (1.1 to 11.2 events/hour). Treatment involved methylprednisolone (20-30 mg/kg) for three consecutive days monthly for 6 months, resulting in clinical improvement in nine patients and radiological improvement in seven patients.</p><p><strong>Conclusions: </strong>The post-pandemic surge in PIBO cases may stem from viral ecology changes, immunologic factors, and/or adenovirus genotypes, highlighting the need for further research into its etiology and management strategies.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 4","pages":"e71080"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754099","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}
K H Naveen, Prawin Kumar, Prem Prakash Sharma, Akhil Dhanesh Goel, Jitender Aneja, Manoj Kumar Gupta, Pankaja Raghav, Naveen Dutt
{"title":"Symptoms of Depression and Inhaler Adherence Among Adolescents With Asthma: Is There an Association?","authors":"K H Naveen, Prawin Kumar, Prem Prakash Sharma, Akhil Dhanesh Goel, Jitender Aneja, Manoj Kumar Gupta, Pankaja Raghav, Naveen Dutt","doi":"10.1002/ppul.71098","DOIUrl":"https://doi.org/10.1002/ppul.71098","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of depression among adolescents with asthma is reported to be 27%-34% across different geographical regions. Asthma control depends on inhaler adherence. Studies on the association of depression and inhaler adherence among adolescents with asthma are few, especially in the Indian subcontinent. Therefore, this study was carried out to find the prevalence of depression and its association with inhaler adherence among adolescents with asthma.</p><p><strong>Methods: </strong>A hospital-based analytical cross-sectional study was carried out among 102 adolescents with asthma in a tertiary care setting. Symptoms of depression were assessed using the Center for Epidemiological Studies-Depression Scale for Children (CES-DC) and inhaler adherence using Test of Adherence to Inhalers (TAI).</p><p><strong>Result: </strong>Among the 102 adolescents with asthma, depression was detected in 39 (38.2%). As per the TAI scores, good, intermediate, and poor adherence to inhalers were, respectively, found among 35 (34.3%), 41 (40.2%), and 26 (25.5%) of the adolescents with asthma. On multivariable binary logistic regression analysis, the adolescents with intermediate and poor adherence to inhalers, respectively, had 7.093 odds (95% CI 2.189-22.977) and 9.002 odds (95% CI: 2.501-32.405) of having depression compared to those with good adherence. Those adolescents with families whose monthly income was INR 12,000 or less had 2.490 odds (95% CI: 1.002-6.187) of depression compared to those with more than INR 12,000 monthly family income.</p><p><strong>Conclusion: </strong>The level of inhaler adherence in a dose-dependent manner and lower family income were independent predictors of depression among adolescents with asthma. The findings indicate the need to screen and assess adherence and symptoms of depression among them and manage appropriately, focusing on those with low family income.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 4","pages":"e71098"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993837","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}
Fazılcan Zirek, Gizem Özcan, Merve Nur Tekin, Beste Özsezen, Birce Sunman, Secahattin Bayav, Mukaddes Ağirtici, Ebru Yalçin, Nazan Çobanoğlu
{"title":"Intra-Observer and Interobserver Consistency in the Diagnosis of Lower Airway Malacia Using Dynamic Flexible Bronchoscopy in Pediatric Patients.","authors":"Fazılcan Zirek, Gizem Özcan, Merve Nur Tekin, Beste Özsezen, Birce Sunman, Secahattin Bayav, Mukaddes Ağirtici, Ebru Yalçin, Nazan Çobanoğlu","doi":"10.1002/ppul.71099","DOIUrl":"https://doi.org/10.1002/ppul.71099","url":null,"abstract":"<p><strong>Background: </strong>Lower airway malacia (LAM) is characterized by excessive collapsibility of the airway during expiration. Although flexible bronchoscopy is widely employed for diagnosis, it is prone to Interobserver variability and technical limitations. This study aims to evaluate intra- and Interobserver consistency in diagnosing LAM in pediatric patients using dynamic flexible bronchoscopy and to assess the impact of bronchoscope size and observer training on diagnostic agreement.</p><p><strong>Methods: </strong>Pediatric patients who underwent fiberoptic flexible bronchoscopy for dynamic evaluation of LAM were included in this study. A total of 100 anonymized video recordings (50 with diagnosed with LAM and 50 classified as normal) were randomly selected for review. Six pediatric pulmonology specialists independently evaluated these recordings for the presence of LAM, including tracheomalacia (TM) and bronchomalacia (BM), using standardized diagnostic criteria. Interobserver and intra-observer consistency were assessed through statistical analysis with Cohen's Kappa coefficient.</p><p><strong>Results: </strong>Intraobserver consistency for diagnosing LAM ranged from substantial to almost perfect (0.675 to 0.857). Interobserver consistency was moderate to substantial (0.583 to 0.689), showing the highest agreement for TM when using the 2.8 mm bronchoscope. Center 1, where evaluations were conducted by a single trainer, demonstrated higher Interobserver consistency (0.606 to 0.689) than Center 2, which involved multiple trainers (0.502 to 0.562). The agreement was notably lower for BM, especially within the intermediate bronchi.</p><p><strong>Conclusion: </strong>The observed variability in diagnostic consistency highlights the critical need for standardized diagnostic guidelines, which could improve treatment outcomes for pediatric patients with LAM.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 4","pages":"e71099"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047706","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":"Noninvasive Respiratory Support Weaning in Infants With Severe Bronchiolitis: High Flow Nasal Cannula May Reduce the Length of Stay.","authors":"Guillaume Mortamet, Christophe Milési, Julie Cassibba, Anne Ego, Dimitri Sourd, Julie Guichoux, Jean-Eudes Piloquet, Florent Baudin","doi":"10.1002/ppul.71108","DOIUrl":"10.1002/ppul.71108","url":null,"abstract":"<p><strong>Introduction: </strong>The aim is to describe weaning procedures, weaning failure rates, and predictors and consequences of weaning failure in infants admitted to pediatric intensive care units (PICUs) for severe bronchiolitis.</p><p><strong>Methods: </strong>This is a multicenter prospective observational cohort study in five PICUs in French university hospitals. Consecutive infants aged 3 days to 6 months admitted between November 2020 and April 2022 with a clinical diagnosis of severe bronchiolitis requiring noninvasive ventilatory support by bilevel positive airway pressure (BiPAP), continuous positive airway pressure (CPAP), or high-flow nasal cannula (HFNC).</p><p><strong>Results: </strong>Demographic and clinical data were collected prospectively. Weaning strategies were classified as direct, HFNC for de-escalation, and gradual with decreasing support levels. Multivariate analysis was performed to identify independent predictors of weaning failure. Of the 135 included patients (median age 1 [1-2] months), 60 (44%), 49 (36%), and 26 (19%) were managed by HFNC-based, direct, and gradual weaning, respectively. Bronchiolitis severity was similar in the three groups. By multivariate analysis, predictors of weaning failure was gradual weaning (odds ratio, 10.56 [2.87-38.86], p < 0.01), while apnea at admission (0.26 [0.07-0.96], p = 0.04) and younger age (0.44 [0.23-0.84], p = 0.02) were protective factors. PICU length of stay was shorter with HFNC-based weaning (3.8 [1.9-5.4] days vs. 4.3 [3.0-6.9] and 5.1 [3.8-7.4] with direct and gradual weaning, respectively, p = 0.02).</p><p><strong>Conclusions: </strong>Among patients with severe bronchiolitis, a weaning strategy using HFNC for de-escalation was associated with shorter PICU stays. Whether this method also decreases the risk of weaning failure deserves investigation.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 4","pages":"e71108"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12023720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017057","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}
Clementine Delporte, Lore Van Bruwaene, Nicolas Bruffaerts, Elisabeth Rebuffat, Tessa Goetghebuer
{"title":"Wheezing Episodes in Children Before and After the Onset of the COVID-19 Pandemic in Brussels.","authors":"Clementine Delporte, Lore Van Bruwaene, Nicolas Bruffaerts, Elisabeth Rebuffat, Tessa Goetghebuer","doi":"10.1002/ppul.71068","DOIUrl":"10.1002/ppul.71068","url":null,"abstract":"<p><strong>Purpose: </strong>Studies have demonstrated important changes in the seasonality of pediatric respiratory illnesses since the onset of the COVID-19 pandemic. The aim of this study was to describe the epidemiology of childhood wheezing episodes before and after the start of the COVID-19 pandemic in relation to their potentially associated environmental triggers.</p><p><strong>Methods: </strong>Files of all children treated with salbutamol for an acute wheezing episode in September and October 2019, 2020, and 2021 were retrospectively reviewed. Infection epidemiology, daily concentrations of air pollutants (NO<sub>2</sub>, O<sub>3</sub>, PM<sub>10</sub>, and PM<sub>2.5</sub>), and fungal spores were collected over the same time period.</p><p><strong>Results: </strong>In 2021, 298 episodes of wheezing were observed compared to 111 in 2020 and 86 in 2019 (p < 0.001). Compared to 2019, children with wheezing in 2021 were significantly older (p < 0.001), less likely to have a history of recurrent wheezing (p < 0.001) and required less hospitalization (p = 0.034). Adenovirus and SARS-CoV-2 were more prevalent in 2021 as compared to 2019 (p < 0.001). The concentration of PM<sub>10</sub>, PM<sub>2.5</sub>, and O<sub>3</sub> was higher in 2021, as compared to both 2019 and 2020 (p < 0.001) while the concentration of NO<sub>2</sub> and airborne spores was lower in 2021 compared to 2019 (p < 0.0001).</p><p><strong>Conclusion: </strong>A threefold increase in wheezing episodes was observed in the autumn post-COVID (2021) compared to pre-COVID (2019) together with very high circulation of SARS-CoV-2 and a significant increase of PM<sub>10</sub>, PM<sub>2.5</sub>, and O<sub>3.</sub></p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 4","pages":"e71068"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731224","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}
F-X Anzinger, T J Hashagen, P Palaniappan, A Lindner, M Riboldi, J Gödeke, O J Muensterer
{"title":"Comparative Analysis of Analog and Digital Chest Tube Drainage Systems Using a High-Fidelity 3D-Printed Neonatal Chest Model.","authors":"F-X Anzinger, T J Hashagen, P Palaniappan, A Lindner, M Riboldi, J Gödeke, O J Muensterer","doi":"10.1002/ppul.71090","DOIUrl":"https://doi.org/10.1002/ppul.71090","url":null,"abstract":"<p><strong>Background: </strong>In recent years, digital chest tube drainage systems have been introduced. Limited studies address their benefits and risks in pediatric patients, particularly neonates. This study compares a three-chamber chest drainage system with a digital system using a high-fidelity 3D-printed model.</p><p><strong>Methods: </strong>We conducted direct measurements and 3D-printed model tests with both systems at different suction pressures (-1 to -20 cmH<sub>2</sub>O) to assess the actual pressures. The effects of siphon and automatic flushes in the digital system were also studied.</p><p><strong>Results: </strong>At -20 and -10 cmH<sub>2</sub>O, significant differences were found between the digital and analog systems in direct and model measurements. The analog system became unreliable below -10 cmH<sub>2</sub>O. For the digital system, most measurements remained within the set pressures, with outliers up to -30 cmH<sub>2</sub>O due to regular flushing.</p><p><strong>Conclusion: </strong>This experimental study evaluates the suitability of digital drainage systems for the pediatric and neonatal populations. Our model demonstrated reliable simulation of thoracic conditions, making it a useful tool for pre-clinical testing where patient testing may be limited. Both systems yielded satisfactory results at -20 and -10 cmH<sub>2</sub>O, but the digital system showed greater flexibility, maintaining pressures as low as -5 cmH<sub>2</sub>O. The analog system was consistent but less adaptable, which may limit its use in dynamic situations. The digital system's ability to simulate more flexible scenarios offers potential clinical advantages, though further investigation is needed to assess its impact on neonatal safety. The increase in suction during flushing may pose a risk for neonatal patients.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 4","pages":"e71090"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041491","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}
Deborah Friedman, Tara M D Mullen, Megan Behrman, Lenna Nikravan, Nivedita Chaudhary, Ruobin Wei, Anna M Georgiopoulos, Lael M Yonker, Jianghua He, Andrea L Chadwick, Jonathan Greenberg, Amanda S Bruce
{"title":"\"How Do You Live the Best Life You Can With This Pain?\" A Qualitative Study of Adults Living With CF and Pain in the Modulator ERA.","authors":"Deborah Friedman, Tara M D Mullen, Megan Behrman, Lenna Nikravan, Nivedita Chaudhary, Ruobin Wei, Anna M Georgiopoulos, Lael M Yonker, Jianghua He, Andrea L Chadwick, Jonathan Greenberg, Amanda S Bruce","doi":"10.1002/ppul.71087","DOIUrl":"https://doi.org/10.1002/ppul.71087","url":null,"abstract":"<p><strong>Background: </strong>Despite pain's high prevalence and impact on quality of life and health outcomes, no studies have examined psychosocial approaches for treating pain in CF. We interviewed adults with CF and pain about their experiences to inform development of a CF-specific psychosocial pain management intervention.</p><p><strong>Methods: </strong>We partnered with CF Community Voice to recruit 14 adults with CF and pain for 1.5 h individual qualitative interviews and conducted a hybrid inductive-deductive thematic analysis (NVivo 14).</p><p><strong>Results: </strong>Participants' age ranged from 23 to 64 years; Seven were taking a modulator, 4 eligible/not taking, 3 ineligible. Pain sources included lung/chest, head/sinus, joint, bone, back, neuropathic, GI; 100% reported multiple sources. Pain experience: A major theme was the close interrelationship of pain and CF. Subthemes included pain being part of life with CF, having CF leads to high pain tolerance and effects of aging with CF. Participants described CFTR modulators effect pain experiences with 3 noting improvement and 4 worsening pain. Pain centralization was common: fatigue, difficulties with cognition/sleep, increased sensitivity to nonpainful stimuli. Pain impact: Pain has a widespread negative impact on quality of life and especially mental health. Resiliency was a theme: the need for coping strategies, support and strong self-advocacy. Advice for CF Care Teams: Participants endorsed a need for increased acknowledgment of pain experiences and co-development of a treatment plan.</p><p><strong>Conclusions: </strong>Pain remains a prominent, burdensome symptom in the modulator era, necessitating a multi-component management approach. Results informed the development and pilot of a mind-body pain intervention for adults with CF.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 4","pages":"e71087"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020572","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":"Controversies in Pediatric Asthma: A Bibliometric Evaluation.","authors":"Kadeliya Abulimiti, Kutiluke Shoukeer, Xinhui Luo","doi":"10.1002/ppul.71064","DOIUrl":"10.1002/ppul.71064","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric asthma is a common chronic inflammatory airway disease in children. This paper analyzes research literature on pediatric asthma and its treatment over the past decade using bibliometric methods, discussing research hotspots and trends to guide future studies.</p><p><strong>Method: </strong>The Web of Science database was selected as the data source, with the retrieval period from January 1, 2014, to January 1, 2025. This study collected and analyzed literature on pediatric asthma and its treatment from the past decade, covering aspects such as publication volume, countries, institutions, journals, authors, and keywords.</p><p><strong>Results: </strong>The search yielded 640 documents involving 68 countries and 1208 institutions, authored by 3506 researchers and published across 259 journals. The global annual average publication volume of 56.8 articles indicates active research in this field. China ranks second globally in publication volume, yet there is a gap in research quality and international influence compared to Western countries. Pediatric asthma treatment remains a core challenge in the pediatric and respiratory fields, making it a central research focus for the future.</p><p><strong>Conclusion: </strong>Asthma has become a major health issue among children. Over the past decade, substantial progress has been made globally in the research of pediatric asthma and its treatment. Despite surpassing many developed countries in publication volume, China needs to enhance the quality and impact of its research. There is a hope that China will increase investment in scientific research and publish more high-quality articles in both domestic and international prestigious journals, advancing the country's development in this field.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 4","pages":"e71064"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731216","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}