Pediatric Pulmonology最新文献

{"title":"Illness Burden in Adults With Cystic Fibrosis: Associations With Sex, Race/Ethnicity, and Socioeconomic Risk Factors.","authors":"Stephanie DiFiglia, Anna M Georgiopoulos, Elizabeth K Seng, Russell Portenoy, Nivedita Chaudhary, Lael M Yonker, Janice Wang, Patricia Walker, Teresa Stables-Carney, Brandi Middour-Oxler, Rachel W Linnemann, Catherine Kier, Deborah Friedman, Maria N Berdella, Lara Dhingra","doi":"10.1002/ppul.71306","DOIUrl":"https://doi.org/10.1002/ppul.71306","url":null,"abstract":"<p><strong>Background: </strong>Illness burden in cystic fibrosis (CF) is variable and sociodemographic characteristics-including female sex, minoritized race/ethnicity, and lower socioeconomic status (SES)-may increase the risk of burden. More information about these associations is needed.</p><p><strong>Methods: </strong>This secondary analysis used baseline data from adults with CF (AwCF) participating in a palliative care implementation trial who completed questionnaires, including the Integrated Palliative Care Outcome Scale, Memorial Symptom Assessment Scale-Cystic Fibrosis, and Cystic Fibrosis Questionnaire-Revised. Bivariate analyses and general linear models evaluated associations between measures and potential vulnerabilities.</p><p><strong>Results: </strong>There were 273 AwCF (mean [SD] age: 38.7 [14.5] years; female: 59.3%; minoritized race/ethnicity: 10.6%; taking CFTR modulators: 84.2%; advanced illness: 20.9%). In bivariate analyses, females had more palliative care needs, higher symptom burden, and lower quality of life (QOL) than males. AwCF with minoritized race/ethnicity had less modulator use, more hospitalizations, and poorer QOL. Socioeconomic risk factors (SRFs; measured by a composite with 3 SES-related variables) were associated with more advanced disease, more palliative care needs, poorer QOL, and anxiety. In multivariate models adjusting for modulator treatment and advanced illness, female sex was associated with higher palliative care needs, higher symptom burden, and lower respiratory QOL; having ≥ 2 SRFs was associated with higher needs and lower QOL; and minoritized race/ethnicity was not associated with any of these measures.</p><p><strong>Conclusions: </strong>Female sex and SRFs are independently associated with adults' CF illness burden. Burden associated with race/ethnicity may be mediated by other variables. These vulnerabilities should be investigated further and inform care.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71306"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293191","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":"Feasibility and Reproducibility of the Unsupported Upper Limb Exercise Test and Six-Minute Peg Board Ring Test for Children and Adolescents.","authors":"Marina Rodrigues, Renatha Carvalho, Brenda Vilas-Boas Gomes, Vanessa Pereira Lima, Raquel Annoni, Fernando Holguin, María Teresa Politi, Fernanda Cordoba Lanza","doi":"10.1002/ppul.71331","DOIUrl":"https://doi.org/10.1002/ppul.71331","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and reproducibility of two field tests for upper limbs (Unsupported Upper Limb Exercise Test - UULEX and 6-min Pegboard Ring Test - 6PBRT) in children and adolescents.</p><p><strong>Methods: </strong>Feasibility study. Fifteen healthy volunteers aged 6-17 years were included. Lung function was performed, followed by: Cardiopulmonary Exercise Test (CPET), UULEX and 6PBRT. The CPET was performed on an upper limb ergometer using an incremental protocol. UULEX: seated arm-raising while holding weighted bars (0.25-2.0 kg) through graded heights; outcome = test duration (min). 6PBRT: seated transfer of rings between lower and upper pegs for 6 min; outcome = total rings moved. For all tests, peak oxygen consumption (VO₂peak) was also an outcome. The UULEX and 6PBRT were performed twice each (test and retest), 30-min apart. Feasibility criteria were (i) no major procedural difficulties and (ii) < 15% of participants reaching ceiling or floor thresholds.</p><p><strong>Results: </strong>Median age 11 [9-15] years-old, and normal lung function (> 80% predicted). No volunteers considered the tests challenging.</p><p><strong>Uulex: </strong>Two volunteers (13%) reached the celling (13 min), none reached the floor (1 min). 6MPRT: no ceiling cases, one volunteer (6%) stopped above the floor (206 rings). The UULEX test versus retest was 9.5 [8.0-12.0] min versus 9.4 [8.2-12.0] min (p = 0.13) (ICC = 0.93 (0.78-0.97), p < 0.001). The 6PBRT test vs. retest was 299 [258-373] rings vs. 340 [244-387] rings (p = 0.05) (ICC = 0.97 (0.91-0.99), p < 0.001). Standard errors were < 10% of their respective medians. The CPET elicited higher VO₂peak (22.8 [19.4-26] mL/kg·min^-1) compared to UULEX (11.8 [10.2-13.6] mL/kg) or 6PBRT (11.6 [9-12] mL/kg) (p = 0.001).</p><p><strong>Conclusion: </strong>Both UULEX and 6PBRT are feasible and reproducible field tests for upper limbs in children and adolescents, providing practical options for upper-limb functional assessment.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71331"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293202","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":"Domain-Specific Olfaction in Children and Adults in the Era of Modulator Therapy for Cystic Fibrosis.","authors":"Jeremy P Tervo, Brandon M Moore, Emily DiMango, Hossein Sadeghi, Claire Keating, Daniel M Beswick, David A Gudis, Jonathan B Overdevest","doi":"10.1002/ppul.71348","DOIUrl":"https://doi.org/10.1002/ppul.71348","url":null,"abstract":"<p><strong>Background: </strong>Little is known about when people with cystic fibrosis (PwCF) begin to experience olfactory decline, or whether sustained use of novel highly effective modulator therapies (HEMT) is predictive of better olfaction. This study evaluated psychophysical olfactory performance and HEMT-associated olfactory outcomes in children and adults with CF.</p><p><strong>Methods: </strong>In this cross-sectional installment of a longitudinal study, individuals with a physician-confirmed diagnosis of CF completed questionnaires and psychophysical olfactory assessment (i.e., standardized assessment of olfactory domains involving a battery of olfactory stimuli). HEMT consisted of either elexacaftor-tezacaftor-ivacaftor (ETI) or vezacaftor-tezacaftor-deuivacaftor (VTD). Analysis compared performance between pediatric versus adult cohorts and assessed the impact of HEMT on psychophysical olfactory performance while controlling for age, sex, genotype, and history of sinus surgery.</p><p><strong>Results: </strong>Individuals < 21 years old had better psychophysical olfactory performance than those ≥ 21 years old (61% vs. 24% normosmia). Younger age at the start of HEMT was not associated with lowered odds of threshold hyposmia [OR: 0.73; 95% CI: (0.34, 1.50)] or identification hyposmia [OR: 0.67; 95% CI: (0.35, 1.22)] within this cohort.</p><p><strong>Conclusion: </strong>Younger people with CF appear to have relatively preserved psychophysical olfactory function that appears to prematurely decline through early adulthood compared to the general population. Although younger age at the start of HEMT therapy was not associated with better olfactory outcomes, future prospective longitudinal studies could evaluate individuals' olfaction across their lifespan to assess the full impact of HEMT on olfaction.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71348"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293354","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 Effect of Chronic Azithromycin Use in Winter on Health Care Utilization for Children With Bronchopulmonary Dysplasia: A Double Blind Randomized Controlled Study (RCT).","authors":"Ricardo A Mosquera, Aravind Yadav, Maria Del Mar Romero-Lopez, Ivan G Magana-Ceballos, S Shahrukh Hashmi, Wilfredo De Jesus Rojas, Maria E Tellez, Kaleigh Riggs-Harpur, Fatima M Boricha, Tina S Reddy, Janice L John, Tomika S Harris, Carlos E Rodriguez-Martinez, Jefferson Buendia, Katrina E McBeth, Cindy K Jon, James M Stark, Giuseppe N Colasurdo","doi":"10.1002/ppul.71314","DOIUrl":"10.1002/ppul.71314","url":null,"abstract":"<p><strong>Background: </strong>Bronchopulmonary dysplasia (BPD), a chronic lung disease in preterm infants, often leads to acute respiratory exacerbations triggered by infections. Our previous mouse study suggested that azithromycin's anti-inflammatory properties may benefit virus-induced respiratory illnesses prophylactically.</p><p><strong>Methods: </strong>In this single-center, double-blind RCT, 60 children (6 months to 6 years) with BPD received azithromycin (5 mg/kg three times weekly; n = 30) or placebo (n = 30) for one winter season (October to March). Primary outcome was the total number of days of unscheduled healthcare clinic visits, ER visits, and hospital days. Secondary outcomes comprised clinic visits, ER visits, hospital admissions, hospital days, and adverse events. Standard frequentist and Bayesian analyses were used.</p><p><strong>Results: </strong>No significant difference in primary outcomes, unscheduled healthcare visits (macrolides 14.9 vs. 4.2 per child-year; p = 0.1, IRR = 2.1; 95% CI: 0.8-5.4), Bayesian analysis showing 11% probability of benefit; however, high-risk children (< 2 years, no tracheostomy), rates were lower with the macrolide group (2.7 vs. 4.6 per child-year; IRR = 0.6; 95% CI: 0.2-1.5), with an 82% probability of benefit. Two outliers in the macrolide group stayed > 40 days in the hospital for non-medical reasons. For secondary outcomes, we observe a decrease in the intervention group on ER visits (0.5 vs. 1.3 per child-year; p = 0.047, IRR = 0.4; 95% CI: 0.1-0.9). Hospital days increased (12.1 vs. 1.2 per child-year; IRR = 9.3; 95% CI: 5.5-16.8).</p><p><strong>Conclusions: </strong>Macrolide prophylaxis did not lead to a significant reduction in the primary outcome of unscheduled healthcare encounter days, but subgroup analysis suggests a potential benefit in high-risk children, with 82% probability of benefit.</p><p><strong>Trial registration: </strong>NCT02544984.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71314"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293108","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":"Vaccine Coverage Among People With Cystic Fibrosis: A National Multicenter Cross-Sectional Study in Israel.","authors":"Lior Tsviban, Nofar Amitai, Hagit Levine, Eyal Jacobi, Einat Shmueli, Miri Dotan, Huda Mussaffi, Hannah Blau, Patrick Stafler, Meir Mei-Zahav, Aielet Stolovas, Malena Cohen-Cymberknoh, Michal Gur, Ronen Bar-Yoseph, Karin Yaacoby-Bianu, Anna Ostrovsky, Galit Livnat, Noga Arwas, Inbal Golan-Tripto, Adi Dagan, Dario Prais, Ophir Bar-On","doi":"10.1002/ppul.71343","DOIUrl":"https://doi.org/10.1002/ppul.71343","url":null,"abstract":"<p><strong>Background: </strong>Vaccines are a cornerstone of modern medicine, however, in some regions, low coverage is reported in patients with chronic diseases, including people with cystic fibrosis (pwCF), compared to the general population.</p><p><strong>Methods: </strong>This retrospective multicenter study in Israel included pwCF born after January 1, 2000, and compared them to the general population. Vaccination data were collected from patient databases and the Ministry of Health reports for the general population.</p><p><strong>Results: </strong>Out of 269 eligible pwCF aged 6 months to 23 years, a total of 173 were included. Coverage for the initial DTaP-IPV-HiB vaccine, administered in the first year of life, was similar between pwCF and the general population (92% compared with 96%, p = 0.23). In contrast, coverage for other routine vaccines given in the first year of life was significantly lower in pwCF: HAV (76% compared with 92%), HBV (85% compared with 96%), and the first dose of MMRV (85% compared with 97%) (all p < 0.001). Booster dose coverage for DTaP-IPV-HiB and MMRV, given at age 6-7 years, was also significantly reduced in pwCF (72% compared with 95% and 68% compared with 96% respectively, p < 0.001). Pneumococcal conjugate vaccine uptake was significantly lower in pwCF (61.8% vs. 94% in the general population p < 0.001), while the 23-valent pneumococcal vaccine was slightly more prevalent among pwCF compared to those with other chronic conditions, although uptake was low in both groups (15% vs. 10%, p = 0.001). Influenza vaccination rates during 3 seasons were significantly higher in pwCF (65%-70% vs. 20-27% in the general population, p < 0.001), whereas COVID-19 vaccine uptake was lower in adolescent pwCF compared to their general population peers (38.5% vs. 57.4%, p = 0.04).</p><p><strong>Conclusion: </strong>Our study highlights suboptimal vaccine coverage among pwCF, particularly after the first year of life, affecting both routine early-life vaccines and booster doses. Greater awareness and proactive measures are needed to ensure adequate vaccination.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71343"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346432","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":"Asthma Phenotype Progression in Children and Adolescents: A Single Center Experience.","authors":"Christine L Schuler, Stephanie Shi, Yin Zhang, Md Monir Hossain, Theresa W Guilbert","doi":"10.1002/ppul.71319","DOIUrl":"10.1002/ppul.71319","url":null,"abstract":"<p><strong>Background: </strong>Asthma phenotype has implications for presentation and treatment selection.</p><p><strong>Methods: </strong>This was a retrospective study of patients attending a pediatric pulmonary clinic (2009-2015) with EHR data available for phenotyping (allergic, eosinophilic/non-allergic or non-allergic/non-eosinophilic). Patients were classified by age. A multinomial regression model examined factors associated with phenotype. A logistic regression model examined factors associated with a change in phenotype (present/absent).</p><p><strong>Results: </strong>There were 2042 patients included. Approximately 44% of participants were allergic, 17% eosinophilic/non-allergic and 39% non-allergic/non-eosinophilic. Among children 0-4 years, age of asthma onset (aOR 1.42, 95% CI 1.21, 1.65) and mean exacerbations (aOR 1.26 95% CI 1.09, 1.44) were associated with higher odds of an allergic phenotype (vs. non-allergic/non-eosinophilic). Among those aged 5-11 and 12-21, male sex and mild obstruction were positively associated, and age was negatively associated, with an allergic phenotype. Moderate/severe obstruction on spirometry (aOR 6.67, 95% CI 2.00, 22.29) and smoke exposure (aOR 1.77, 95% CI 1.17, 2.67) were also positively associated with an allergic phenotype in patients 12-21 years. Factors positively associated with a change in phenotype included index phenotype (eosinophilic/non-allergic: aOR 5.31, 95% CI 3.46, 8.14) and mean exacerbations (aOR 1.34, 95% CI 1.16, 1.55) (n = 1379). The allergic phenotype was most stable (> 95% predicted probability of remaining allergic); an eosinophilic/non-allergic phenotype had the greatest predicted probability of change (48%).</p><p><strong>Conclusions: </strong>Factors associated with asthma phenotype vary by age. The allergic phenotype was the most stable, while an eosinophilic/non-allergic phenotype was most prone to change.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71319"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293311","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":"ATS Pediatric Core Curriculum 2024: The Role of the Pediatric Pulmonologist in the Intensive Care Unit.","authors":"Carmen Leon-Astudillo, Moshe Y Prero, Fei J Dy, Jacob Kaslow, Holly Hoa Vo, Tori Endres, Ina St Onge, Pelton Phinizy, Karan Kumar, Stephen Kirkby, Iris A Perez, Jane E Gross, Caroline U A Okorie","doi":"10.1002/ppul.71329","DOIUrl":"https://doi.org/10.1002/ppul.71329","url":null,"abstract":"<p><p>The American Thoracic Society Core Curriculum updates clinicians annually in relevant topics related to pediatric pulmonary diseases. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2024 American Thoracic Society International Conference. The curriculum focused on clinical topics that are essential to caring for patients in the intensive care unit (ICU), highlighting the specific care of patients with severe asthma, pediatric acute respiratory distress syndrome (PARDS), hemoptysis and pulmonary hemorrhage, serious cardiovascular disease within the cardiac ICU and chronic respiratory failure. In the case of severe asthma, we review risk factors for ICU admission, adjunct pharmacologic therapies and appropriate ventilatory strategies. We discuss the highlights of the recently updated PARDS guidelines are offer further diagnostic stratification including possible and at risk categories to help facilitate early intervention and possibly prevent disease progression. Though relatively rare, pediatric hemoptysis and pulmonary hemorrhage can be devastating clinical scenarios and this review includes the discussion of pharmacologic and bronchoscopic interventions that should be considered in these cases. Additionally, we provide a summary of some of the common respiratory pathophysiology encountered in the cardiac ICU, as well as the diagnostic and therapeutic interventions available to the pulmonologist. Lastly, we review the decision-making considerations when transitioning patients from the ICU to chronic home mechanical ventilation. This manuscript aims to provide basic knowledge regarding each of these topics, in addition to up-to-date literature and resources for practicing pulmonologists and trainees.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71329"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293401","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":"Impacts of Community Pediatric Asthma Education Program on Asthma Outcomes in Alberta, Canada.","authors":"Linn E Moore, Manizheh Ghaemidizaji, Caseng Zhang, Florence Birru, David W Johnson, Karen Kam, Laleh Behjat, Anne Hicks","doi":"10.1002/ppul.71326","DOIUrl":"10.1002/ppul.71326","url":null,"abstract":"<p><strong>Objective: </strong>Asthma affects about 10% of Canadian children, with significant impacts on the healthcare system. This study describes a cohort of children with asthma, exploring outcomes of targeted asthma education through a Community Pediatric Asthma Service (CPAS).</p><p><strong>Methods: </strong>This retrospective cohort of children aged 1-17 years in Calgary, Alberta with asthma compares those who received CPAS 2016-2019 to the entire cohort. For CPAS recipients, rates of severe asthma exacerbations were evaluated biannually from 12 months before to 24 months after CPAS.</p><p><strong>Results: </strong>Of 60,555 children with asthma, 3589 attended CPAS. Compared to the 56,966 controls, CPAS attendees were more likely to be male (60.2% vs. 58.4%), approximately 2 years younger at asthma diagnosis, and demonstrate poor asthma control (32.7% vs. 19.1% ED visits in the year following diagnosis). The incidence risk ratio (IRR) for asthma exacerbations for 2 years following CPAS was 0.85 (95% CI: 0.80-0.90). There was a reduction in ED visits (IRR: 0.82; 95% CI: 0.76-0.90) and oral steroid use (IRR: 0.86; 95% CI: 0.80-0.93). CPAS was not associated with reduced hospitalizations for asthma (IRR: 0.91; 95% CI: 0.68-1.22). A subset analysis demonstrated an 18-month decrease in severe exacerbations for CPAS recipients (985) compared to propensity-matched controls (985) that reached significance at 12-18 months with extinction of the positive CPAS effect by 2 years.</p><p><strong>Conclusion: </strong>A targeted community asthma education service decreased severe exacerbations, with effect retention for at least 18 months. Educating children and their caretakers on asthma management thus provides an opportunity to improve pediatric lung health and should be considered for children at risk of asthma exacerbations.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71326"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12522025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293121","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":"Dynamic Risk-Stratification Models for Bronchopulmonary Dysplasia in Extremely Preterm Very Low Birth Weight Infants.","authors":"Ting Zhao, Ning An, Yanping Zhu, Jingwen Yang, Rong Zhang, Wen Han, Xuchen Zhou, Rong Yang, Mingxia Li, Le Wang","doi":"10.1002/ppul.71322","DOIUrl":"https://doi.org/10.1002/ppul.71322","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify independent risk factors for bronchopulmonary dysplasia (BPD) at multiple postnatal time points in extremely preterm (EP) or very low birth weight (VLBW) infants and to develop machine learning-based dynamic prediction models for early risk stratification and intervention.</p><p><strong>Methods: </strong>This study utilized retrospective data from EP or VLBW infants (gestational age (GA) < 32 weeks or birth weight (BW) < 1500 g) admitted to the First Affiliated Hospital of Xinjiang between 2017 and 2022. The dataset was randomly divided into training (70%) and validation (30%) cohorts. Prospective data from six Xinjiang neonatal centers (January-October 2023) were collected for external validation. Infants were classified into three groups: no BPD, mild BPD, and moderate-to-severe BPD. Four machine learning algorithms-logistic regression (LR), random forest, XGBoost (XGB), and gradient boosting decision tree-were trained using clinical data from postnatal days 1, 3, and 7. The most predictive models were selected for external validation.</p><p><strong>Results: </strong>The retrospective cohort included 554 infants (no BPD: 286; mild: 212; msBPD: 56), and the prospective cohort comprised 387 infants (no BPD: 208; mild: 138; msBPD: 41). Ordinal logistic regression identified significant independent risk factors for BPD severity, including GA, BW, prenatal steroids, umbilical flow interruption, severe Pre-eclampsia, FIO₂, C-reactive protein, red blood cell count, systemic inflammatory response index, prognostic nutritional index, platelet mass index, alveolar-arterial oxygen difference, and oxygenation index. The LR and XGB models demonstrated the highest predictive performance for BPD stratification on days 1, 3, and 7 (Area under the curve: day 1 = 0.810, day 3 = 0.837, day 7 = 0.813).</p><p><strong>Conclusion: </strong>Machine learning-based dynamic prediction models for BPD were successfully developed and validated using data from postnatal days 1, 3, and 7. These models facilitate early identification of EP/VLBW infants at high-risk of BPD, supporting timely and targeted interventions to improve neonatal outcomes.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71322"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293339","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":"Early Pulmonary Complications After Paediatric Liver Transplantation: A Single Center Experience.","authors":"Gizem Özcan, Ceyda T Kirsaçlioğlu, Esin G Olgun, Hasan Özen, Elvan O Kirimker, Zarife Kuloğlu, Tanıl Kendirli, Meltem Koloğlu, Fazılcan Zirek, Arzu M Demir, Merve Havan, Deniz Balci, Merve N Tekin, Nazan Çobanoğlu","doi":"10.1002/ppul.71342","DOIUrl":"https://doi.org/10.1002/ppul.71342","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate early pulmonary complications (EPCs) and factors affecting mechanical ventilation duration in paediatric patients following liver transplantation (LT).</p><p><strong>Methods: </strong>Between June 2014 and June 2024, 56 paediatric patients who underwent LT at our centre were retrospectively included. Pre- and post-transplant clinical features, nutritional status, surgical details, and respiratory outcomes were analysed. Patients were compared according to the presence or absence of EPCs.</p><p><strong>Results: </strong>Among the 56 patients (53.6% male, median age 26 months [IQR: 11.25-120]), EPCs 9 in 71.4% of patients, with atelectasis being the most frequent (58.9%), followed by pleural effusion (37.5%) and pneumonia (33.9%). The median postoperative PICU stay was 10.5 days (IQR: 5.25-20.75), and 17.9% of patients died within 3 months, none due to acute pulmonary complications. Patients with EPCs had significantly longer PICU stays (13.5 [7-25] vs. 5.5 [3.5-11.8] days, p = 0.007), higher reintubation rates (40% vs. 6.3%, p = 0.022), and longer durations of invasive mechanical ventilation (IMV) (5.5 [1-14.5] vs. 2 [1-4.5] days, p = 0.044). Underweight status (p = 0.038), history of lower respiratory tract infection (LRTI) before LT (p = 0.047), and postoperative surgery within 1 month (p = 0.002) were associated with prolonged IMV. Use of noninvasive ventilation (NIV) post-LT was associated with a shorter IMV duration (p = 0.011).</p><p><strong>Conclusions: </strong>Early pulmonary complications are common following paediatric LT and are associated with increased respiratory morbidity and longer PICU stays. Undernutrition, prior LRTI, and early postoperative surgery are risk factors for prolonged IMV. Early recognition and management strategies may improve respiratory outcomes in this population.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 10","pages":"e71342"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293344","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}