Pediatric Pulmonology最新文献

{"title":"Flexible Bronchoscopy in Neonates With Congenital Diaphragmatic Hernia.","authors":"Judith Leyens, Lukas Schroeder, Carmen Salatsch, Joachim Schmitt, Hemmen Sabir, Andreas Mueller, Florian Kipfmueller, Till Dresbach","doi":"10.1002/ppul.71128","DOIUrl":"10.1002/ppul.71128","url":null,"abstract":"<p><strong>Background: </strong>Flexible bronchoscopy (FB) may facilitate ECMO and ventilator weaning through diagnosing airway anomalies and removal of mucous plugs in the critically-ill pediatric population. Only few studies on FB in critically-ill neonates exist, and even fewer focus on neonates with congenital diaphragmatic hernia (CDH) requiring extracorporal membrane oxygenation (ECMO). This study aims to evaluate the risk and benefit of FB in infants with CDH.</p><p><strong>Methods: </strong>A retrospective review of CDH infants treated at a specialized single center between October 2019 and August 2024 was conducted. Baseline characteristics were compared between patients with and without FB. Procedural indications, findings and complications were analyzed.</p><p><strong>Results: </strong>A total of 142 newborns were analyzed. Infants requiring FB (n = 29, 20.4%) exhibited an overall higher disease burden (lower observed-to-expected lung-to-head ratio [p < 0.001), liver herniation (p = 0.002), ECMO (p < 0.001), defect size (p = 0.042), congenital anomalies (p = 0.019), heart defects (p = 0.010)]. The primary indications for the total 56 FBs were prolonged weaning and pulmonary hemorrhage. The most common complication was self-resolved hypoxemia (16.1%). Bronchial casts were found in 31.6%. Tracheo-/bronchomalacia was diagnosed in 16 infants (55.2%). Postprocedural chest Xrays were mostly unchanged (61.9%). A trend to achieve higher tidal volumes post-FB (p = 0.090) with similar peak inspiratory pressures (p = 0.917) was noted.</p><p><strong>Conclusions: </strong>In critically-ill neonates with CDH, FB was safe, with a high diagnostic and potential therapeutic yield. The necessity for FB may be an additional indicator of CDH disease severity. Further research is needed to establish uniform assessment metrics and explore other modalities such as electrical impedance tomography or lung ultrasound in the context of FB.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71128"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999187","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":"Pulmonary Findings in Children With Colchicine-Resistant Familial Mediterranean Fever.","authors":"Evrim Hepkaya, Nebahat Zeynep Özaslan, Törehan Özer, Betül Öksel, Yonca Anık, Nihal Şahin, Hafize Emine Sönmez","doi":"10.1002/ppul.71136","DOIUrl":"10.1002/ppul.71136","url":null,"abstract":"<p><strong>Background: </strong>Approximately 5%-10% of Familial Mediterranean Fever (FMF) patients fail to achieve full disease control despite adequate colchicine therapy and these patients may be vulnerable for lung involvement.</p><p><strong>Objectives: </strong>This study aimed to examine pulmonary findings on thoracic computerized tomography (CT) in children with colchicine-resistant FMF (crFMF), and their correlation with clinical characteristics regarding pulmonary involvement in childhood FMF is not well understood, and there is a lack of research specifically evaluating crFMF cases.</p><p><strong>Methods: </strong>This cross-sectional study investigated pulmonary findings in 31 patients diagnosed with crFMF, focusing on thoracic CT scan findings and respiratory symptoms such as dry cough, shortness of breath, and exercise intolerance. The study further incorporated spirometry evaluations to assess pulmonary functions.</p><p><strong>Results: </strong>Of the patients, 29.1% had normal thoracic CT scans, whereas 70.9% showed abnormalities, with nodules being the most common finding (61.2%). One patient demonstrated subpleural honeycombing and bilateral ground-glass opacities, indicating FMF-related interstitial lung disease (ILD). Chest pain was the predominant symptom during the attacks (70.9%), while shortness of breath persisted most frequently. While 32% of the patients had abnormal values of spirometry at postattack period, the rate was 14.2% when they were clinically stable. There was an increase at mean forced expiratory flow at 25%-75% of FVC (FEF25-75) at the stable phase. (83.1 ± 19.2 vs. 92.2 ± 21.6, p = 0.05). No significant differences in CT findings were noted between genotypes and ISSF scores.</p><p><strong>Conclusions: </strong>The study highlights a high prevalence of radiological findings in patients with crFMF; notably, a case with findings suggestive of FMF-related interstitial lung involvement was defined. Respiratory symptoms and abnormal values at spirometry were frequently accompanied by FMF attacks. These findings underscore the need for respiratory evaluation thoroughly in patients with crFMF to detect subclinical or overt pulmonary involvement and to guide appropriate management strategies.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71136"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111589","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":"Crushing Elexacaftor/Tezacaftor/Ivacaftor Oral Granules for Gastrostomy Tube Administration.","authors":"Alexander S Kim, Elizabeth Autry","doi":"10.1002/ppul.71124","DOIUrl":"https://doi.org/10.1002/ppul.71124","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71124"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017116","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":"Childhood Interstitial Lung Diseases: Lessons Learned From 15-Year Observation at a Polish Referral Center.","authors":"Honorata Marczak, Katarzyna Krenke, Katarzyna Solarska-Rydz, Joanna Lange, Teresa Bielecka, Marek Kulus","doi":"10.1002/ppul.71112","DOIUrl":"https://doi.org/10.1002/ppul.71112","url":null,"abstract":"<p><strong>Background: </strong>Childhood interstitial lung diseases (chILD) are rare, chronic lung diseases characterized by symptoms such as tachypnea, dyspnea, hypoxemia, crackles, and diffuse parenchymal abnormalities on chest imaging.</p><p><strong>Objective: </strong>To evaluate the etiologic spectrum, clinical presentation, management, and outcomes of chILD at a Polish referral center.</p><p><strong>Methods: </strong>We retrospectively reviewed data from patients (0-18 years) diagnosed with chILD, admitted to the Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, from June 2009 to February 2024, classified according to the chILD-EU categorization system.</p><p><strong>Results: </strong>A total of 275 patients (65.5% male) were included, with a median age at diagnosis of 13 months (range: 1-221). Persistent tachypnea of infancy (PTI)/neuroendocrine cell hyperplasia of infancy (NEHI) was the most common diagnosis (52.4%), followed by disorders related to systemic diseases (11.3%) and related to exposures (10.2%). 13.8% of diseases remained undefined. The predominant symptoms included crackles (81.5%), dyspnea (72.7%) and tachypnea (68.3%). All children underwent chest computed tomography. Bronchoscopy, genetic testing, and lung biopsy were performed in 46.2%, 34.9%, and 21.4% of cases, respectively. Most children (92.7%) received some form of treatment, including inhaled bronchodilators/steroids (68.8%), systemic steroids (26.5%), long-term macrolides (16.3%), and immunosuppressants (11.6%). Oxygen supplementation and nutritional support were required in 50.5% and 29.8% of patients, respectively. At a median follow-up of 31.5 months, 92.9% of patients achieved clinical improvement or stabilization, and 6.2% deteriorated, including seven deaths. The 5-year survival rate was 95.66%.</p><p><strong>Conclusion: </strong>This study highlights the significant diversity within chILD, with PTI/NEHI being the most common condition.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71112"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026000","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":"Infant Lung Function in Cystic Fibrosis: A Real-World Study.","authors":"Michele Arigliani, Sidrah Chaudhry, Rossa Brugha, Ranjan Suri, Paul Aurora","doi":"10.1002/ppul.71117","DOIUrl":"https://doi.org/10.1002/ppul.71117","url":null,"abstract":"<p><strong>Background: </strong>Previous research showed that lung function abnormalities are common in infants with cystic fibrosis (IwCF) but real-world data are missing.</p><p><strong>Methods: </strong>This single-center retrospective study analyzed infant lung function results from IwCF born in 2012-2018. The tests were conducted at Great Ormond Street Hospital, London, as part of routine care at 3 months, 1 year, and 2 years of age. Z-scores for SF₆ Lung Clearance Index (zLCI), plethysmographic FRC (zFRC_pleth) and FEV_0.5 were derived. Microbiology and antibiotics prescription from 3 months before lung function assessments, up to the closest medical review following the lung function encounter, were analyzed, along with changes in management advised by the physician.</p><p><strong>Results: </strong>A total of 126 lung function encounters (n = 43 at 3 months, 46 at 1 year, 37 at 2 years) from 60 IwCF were included. LCI was abnormal (zLCI > 1.96) in 31% (12/39) of 3-month-olds (mean± zLCI 1.21 ± 1.08), 28% (12/43) of 1-year-olds and 19% (7/36) of 2-year-olds (mean± zLCI 1.13 ± 1.10). Among 74 cases with recent positive microbiology or abnormal chest findings at medical review, 100% (31/31) of those with abnormal lung function and 86% (37/43) of those with normal lung function (p = 0.04) had a recent antibiotic prescription or a change in clinical management. Conversely, in encounters with abnormal lung function but normal clinical findings, management changes occurred in only 12% (2/16) of cases.</p><p><strong>Conclusion: </strong>In this real-word cohort of IwCF, clinical management was mainly influenced by clinical findings and only marginally by abnormal lung function (elevated FRC or LCI).</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71117"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038047","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":"Discharge Practice Variability in Pediatric Chronic Home Invasive Ventilation.","authors":"Guillermo Beltran-Ale, Ryne Simpson, Terri Magruder, Ajay S Kasi, Amit Agarwal, Jake A Kaslow","doi":"10.1002/ppul.71130","DOIUrl":"10.1002/ppul.71130","url":null,"abstract":"<p><strong>Introduction: </strong>The Pediatric Mechanical Ventilation Society is a collaboration of pediatric pulmonologists with a focus on pediatric chronic home invasive ventilation (PCHIV). Since the initial discharge on PCHIV is not always directed by pediatric pulmonologists, we sought to understand how this variability between centers impact adherence to American Thoracic Society (ATS) guidelines for PCHIV.</p><p><strong>Methods: </strong>A survey was distributed to pediatric pulmonologists across multiple platforms inquiring about discharging practices for PCHIV and adherence to six of the nine ATS recommendations for PCHIV. Two subgroups were created based on common practices - discharge by pediatric pulmonologists from a non-ICU unit (pulmonary group) and discharge by ICU team from an ICU unit (ICU group).</p><p><strong>Results: </strong>A total of 107 surveys were completed, 90 from the US. Among the US centers, the ATS recommendations with lowest adherence were offering ongoing education to caregivers and the utilization of standardized criteria for discharge. Despite better adherence, the requirement of two caregivers for discharge was often made an exception for. When comparing the pulmonary and ICU groups, the number of annual discharges (p < 0.001), caregiver length of training (p = 0.003), and the utilization of standardized discharge criteria (p = 0.04) were significantly different.</p><p><strong>Discussion: </strong>Our study demonstrates variable adherence to expert consensus recommendations outlined by the ATS. A significant proportion of PCHIV patients were discharged directly from the ICU and by ICU teams. Practice variability was evident between institutions and discharging teams; therefore, the identification of barriers to guideline implementation and multidisciplinary collaboration is paramount to optimizing care.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71130"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111579","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":"Bronchiolitis in Early Infancy Is Associated With Irreversible Airway Obstruction in Young Adulthood.","authors":"Sanna Saarikallio, Riikka Riikonen, Antti Tikkakoski, Sonja Laitinen, Annukka Holster, Matti Korppi, Eero Lauhkonen","doi":"10.1002/ppul.71139","DOIUrl":"https://doi.org/10.1002/ppul.71139","url":null,"abstract":"<p><strong>Background: </strong>Childhood risk factors, such as bronchiolitis, have been associated with airway obstruction later in life. However, assessing childhood risk factors for airway obstruction in adulthood requires long follow-ups with carefully gathered data. Our long-term follow-up represents lung function in early adulthood after infant bronchiolitis with evaluation of asthma and tobacco smoke exposure as childhood risk factors.</p><p><strong>Methods: </strong>We prospectively followed 166 term children hospitalized for bronchiolitis under 6 months of age. Lung function was measured at the mean age of 18.3 years by spirometry on 72 former bronchiolitis patients and 28 controls. We compared z-scores of FEV1 (forced expiratory volume in first second), FVC (forced vital capacity), and FEV1/FVC before and after bronchodilation. Reversibility was tested as FEV1 change in the bronchodilation test. The roles of asthma and smoke exposure were controlled in the analysis.</p><p><strong>Results: </strong>FEV1/FVC was lower in cases versus controls at baseline (mean z-score -0.90, SD 1.40 vs 0.10 SD 1.17; p = 0.001) and after bronchodilatation (0.54, SD 1.06 vs. -0.05, SD 1.22; p = 0.028). FEV1 increase in the bronchodilation test was greater in cases versus controls (6.3%, SD 5.3 vs. 2.3%, SD 3.7; p = 0.001). After excluding subjects with current asthma, the differences remained significant in baseline and post-bronchodilator FEV1/FVC and in FEV1 change in bronchodilation test, and after adjusting for previous asthma and household smoking, the differences remained significant in baseline and post-bronchodilator FEV1/FVC.</p><p><strong>Conclusion: </strong>Lower FEV1/FVC after bronchodilation in cases suggests a risk of irreversible obstructive lung function in young adults after infant bronchiolitis.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71139"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161013","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 Newborn Screening Experience of Caregivers of Children With Cystic Fibrosis in the United States: A Cross-Sectional Survey.","authors":"Marie E Heffernan, Leo Barrera, MicKayla Jones, Ashley Hayes, Marisol Roldan, Michele Wright, Meghan E McGarry, Lainie F Ross, Susanna A McColley","doi":"10.1002/ppul.71110","DOIUrl":"https://doi.org/10.1002/ppul.71110","url":null,"abstract":"<p><strong>Background: </strong>There have been significant improvements in the health of infants and children with cystic fibrosis (CF) since universal newborn screening (NBS) was implemented in the United States (US). However, a significant proportion of infants with CF are not evaluated in a timely manner, and delays disproportionately affect children from minoritized racial/ethnic groups. The aim of this study was to understand experiences of NBS in caregivers of young children with CF in the United States.</p><p><strong>Methods: </strong>We recruited caregivers of children (0-13 years) with CF through listservs and social media of CF organizations. The survey was administered online in 2023 and included questions about their recollections of their child's NBS and the process of getting a CF diagnosis.</p><p><strong>Results: </strong>Of 383 caregiver respondents, 43% reported being informed that their child's race or ethnicity was a predictor of the chances of their child having CF. Most reported that after they were notified of a positive NBS test, the initial evaluation for CF was scheduled ≥ 4 days later, 45% reported a delay of ≥ 8 days, and 5% reporting a delay of ≥ 15 days. Most (91%) felt the initial evaluation for CF was thorough, but 35% reported delays in getting information about their child's diagnosis.</p><p><strong>Conclusions: </strong>Caregivers report delays in evaluation after a positive NBS. A significant proportion reported delays in receiving information about their child's diagnosis or being told that race or ethnicity were related to risk of CF. These findings show the need for education and practice changes in both primary care and CF center settings.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71110"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028136","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":"Cystic Fibrosis Learning Network Telehealth Innovation Lab During the COVID-19 Pandemic: Impact on Access to Care, Outcomes, and a New CF Care Model.","authors":"Dana Albon, Thida Ong, Bethany Horton, David Brighton, Shiyi Shen, Rhonda List, Nicholas Antos, Fadi Asfour, Ella Balasa, Danielle Beachler, Cori Daines, Deborah Froh, Catherine Kier, Samya Nasr, Meghana Sathe, Gregory Sawicki, Michael Schechter, George Solomon, Michael Powers","doi":"10.1002/ppul.71102","DOIUrl":"https://doi.org/10.1002/ppul.71102","url":null,"abstract":"<p><strong>Background: </strong>Cystic fibrosis (CF) is a chronic genetic disorder requiring regimented visits for maintenance of care. The COVID-19 pandemic accelerated the accessibility of telehealth (TH) and forced a trial of incorporating remote care into routine CF care. The CF Learning Network (CFLN) organized for data sharing into a telehealth innovation lab (TH-iLab) to improve access to the interdisciplinary care team and co-produced shared agenda-setting.</p><p><strong>Methods: </strong>All persons with CF (PwCF) with a CF diagnosis in the CF Foundation Registry (CFFPR) from 1/2020-12/2021 were included and categorized into CFLN TH-iLab, CFLN TH-iLab non-participants, and non-CFLN programs.</p><p><strong>Hypothesis: </strong>standardized TH implementation in the CFLN TH-iLab is associated with increased access to the CF care model and results in similar lung function and nutrition health outcomes.</p><p><strong>Results: </strong>In 2020 and 2021, the average number of TH visits per person per year and the percentage of PwCF with one or more TH visits per year were higher in the CFLN TH-iLab than in the other groups. Lung function was highest in PwCF, followed by a program that was part of the CFLN TH-iLab in 2020 and 2021. Anthropometric measurements, spirometry, and attainment of microbiology cultures were similar among all three groups. Access to interdisciplinary care was highest in the CFLN non-TH-iLab group.</p><p><strong>Conclusion: </strong>Integrating TH into CF care in the CFLN TH-iLab provided access to care during the COVID-19 pandemic without compromising clinical outcomes. Further research on optimizing the telehealth experience for PwCF can help better understand TH's long-term impact on CF care.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71102"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037335","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":"Risk Factors and Prediction Models for Less Invasive Surfactant Administration Failure in Preterm Infants: A Retrospective Cohort Study in a Low-and-Middle Income Country.","authors":"Somnath Pal, Moumita Ghosh","doi":"10.1002/ppul.71127","DOIUrl":"https://doi.org/10.1002/ppul.71127","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify risk factors associated with less invasive surfactant administration (LISA) failure in preterm infants with respiratory distress syndrome (RDS) in a low-and-middle income country (LMIC) and develop a prediction model to estimate the risk of LISA failure.</p><p><strong>Methods: </strong>This retrospective cohort study included 600 preterm infants who received LISA at a tertiary care neonatal unit in eastern India from January 2020 to December 2024.</p><p><strong>Results: </strong>LISA failure, defined as the need for intubation and mechanical ventilation within 72 h of the procedure, ranged from 30% to 40%. The most important risk factors for LISA failure identified by random forest analysis were higher oxygen saturation index (OSI), higher cord base deficit, lower birth weight, lower admission temperature, and incomplete course of antenatal corticosteroids (ANS). Various prediction models were developed and validated on the testing set, with random forest and support vector machine using radial kernel demonstrating the highest accuracy (92.42% and 90.91%, respectively). In terms of sensitivity, Lasso penalized logistic regression was the best performing model followed by the random forest (96.55% and 93.88% respectively). The incidence of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) requiring treatment, mortality, median duration of respiratory support, and time to discharge were significantly higher in the LISA failure group compared to the successful LISA group.</p><p><strong>Conclusion: </strong>This study highlights the need for prediction models to estimate the risk of LISA failure in individual patients, which may inform decisions regarding alternative methods of surfactant administration in patients at high risk of LISA failure.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71127"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039110","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}