Pediatric Pulmonology最新文献

{"title":"End-Tidal Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy.","authors":"Mate Detar, Barbara Szasz, Hajnalka Barta, Miklos Szabo, Agnes Jermendy, Eniko Szakmar","doi":"10.1002/ppul.71144","DOIUrl":"10.1002/ppul.71144","url":null,"abstract":"<p><strong>Introduction: </strong>Primary aim was to assess the agreement between end-tidal carbon dioxide (etCO₂) monitoring and arterial, capillary and venous PCO₂ values in mechanically ventilated patients receiving therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE). Secondary, to assess the percentage of time spent in predefined PCO₂ ranges based on continuous etCO₂ monitoring.</p><p><strong>Methods: </strong>In this prospective observational single center trial, infants with moderate-to-severe HIE receiving conventional ventilation with sidestream capnography were enrolled. Blood gas measurements were performed based on clinical indication. The mean of 12,000 etCO₂ values obtained over 10 min before each corresponding blood gas was used for analysis. The agreement between mean etCO₂ and temperature corrected and uncorrected PCO₂ at 37^◦C were analyzed using Bland-Altman (BA) plots.</p><p><strong>Results: </strong>A total of 262 paired PCO₂ and etCO₂ values were analyzed from 35 patients. The bias between temperature corrected arterial PCO₂ and etCO₂ (n = 116) was 1.87 mmHg (SD 5.54) with -8.99 and 12.73 limits of agreement; whereas the bias between capillary PCO₂ and etCO₂ (n = 132) was 7.22 mmHg (SD 6.08). EtCO₂ underestimated PCO₂ of any source at 37°C. Excluding patients with lung diseases from BA analysis did not show improvement in the agreement. Infants spent median 23.9% [IQR 8.5; 36.7] of monitoring time in etCO₂ range < 35 mmHg and median 75.0% [IQR 61.1; 87.7] in etCO₂ range of 35-55 mmHg.</p><p><strong>Conclusions: </strong>EtCO₂ monitoring may be a valuable addition to neurocritical care of infants with HIE as it showed a strong level of agreement with temperature corrected arterial PCO₂.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71144"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143356","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":"Nasal Nitric Oxide Measurements During Tidal Breathing: A Device Comparison Study in Ciliary Disease.","authors":"Nils Oskar Jõgi, Karin Ersson, Kjell Alving, Christina Krantz, Andrei Malinovschi","doi":"10.1002/ppul.71092","DOIUrl":"10.1002/ppul.71092","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71092"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161039","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":"Transcutaneous Carbon Dioxide Monitoring During Weaning From Mechanical Ventilation in Children: The WeanCO₂ Study.","authors":"Meryl Vedrenne-Cloquet, Charlotte Collignon, Noémie De Cacqueray, Mathilde Grapin, Mehdi Oualha, Sylvain Renolleau, Lucie Griffon, Sonia Khirani, Brigitte Fauroux","doi":"10.1002/ppul.71115","DOIUrl":"https://doi.org/10.1002/ppul.71115","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous breathing trial (SBT) is recommended during weaning from mechanical ventilation (MV), but objective and easy tools lack to identify pediatric weaning failure. We aimed to assess whether changes in estimated arterial CO₂ (PaCO₂) derived from transcutaneous measurements (P_TCCO₂) were associated with pediatric weaning failure.</p><p><strong>Methods: </strong>Children (age 72 h -18 years) with MV > 12 h were continuously monitored using a transcutaneous sensor to estimate PaCO₂ from skin CO₂ tension (P_TCCO₂). Values were recorded during SBT (30 min on positive end-expiratory pressure (PEEP) +5 cmH₂O, with pressure support of +5 cmH₂O for endotracheal tubes with internal diameter ≤ 3.5 mm), then up to 6 h after extubation. Mean P_TCCO₂ and P_TCCO₂ changes during SBT, and after extubation, were retrospectively collected to evaluate their association with SBT failure and extubation failure (reintubation within 48 h).</p><p><strong>Results: </strong>Eighty children (median [IQR] age 1.1 [0.3; 8.7] years) were included, with 89 SBT (14 failures, 75 successes). Sixty-four patients were extubated following their first SBT, with 10 (16%) extubation failures. P_TCCO₂ changes were not associated with SBT and extubation failures. Patients who failed extubation had a higher mean P_TCCO₂ value after extubation as compared to those who were successfully extubated (mean P_TCCO₂ of 51.8 [46.2; 55.4] vs. 42.3 [37.5; 47.2] mmHg, p = 0.02). The difference between the maximal P_TCCO₂ value within the 2 h following extubation and the value at extubation were higher in patients who failed extubation (ΔP_TCCO₂ of 20 [9.1; 26] vs. 6.8 [2.9; 9.7] mmHg, p < 10^-2).</p><p><strong>Conclusion: </strong>Early post-extubation increase in estimated PaCO₂ was associated with extubation failure, whereas P_TCCO₂ changes during SBT were not.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71115"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973754","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":"We Treat Children Not Guidelines.","authors":"Aaron J Stein, W Gerald Teague","doi":"10.1002/ppul.71123","DOIUrl":"https://doi.org/10.1002/ppul.71123","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71123"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987336","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":"Pre-Hospital Pulse-Oximetry and Supplemental Oxygen Utilization in Malawi: An Exploratory Cost-Effectiveness Analysis.","authors":"James B Newton, Michael T Hawkes, Eugene Katenga-Kaunda, Kenneth J Smith","doi":"10.1002/ppul.71095","DOIUrl":"https://doi.org/10.1002/ppul.71095","url":null,"abstract":"<p><strong>Background: </strong>Pneumonia is the leading cause of death globally in children aged 0-5 years. Early access to pulse-oximetry and supplemental oxygen in low-resource, pre-hospital settings may result in improved pediatric pneumonia outcomes. However, few data exist regarding their application in such settings.</p><p><strong>Methods: </strong>We performed an exploratory cost-effectiveness analysis using a decision analytic model to examine use of pulse-oximetry and supplemental oxygen in pre-hospital environments of Malawi.</p><p><strong>Results: </strong>Our model yielded an Incremental Cost-Effectiveness Ratio (ICER) for pre-hospital pulse-oximetry use of $35 (USD) per disability-adjusted life-year (DALY) averted compared to no pulse-oximetry use. One-way sensitivity analysis showed highest sensitivity to the parameter of downstream hospitalization cost. Given that inpatient management is the standard of care for hypoxemic pneumonia, when only pre-hospital costs were considered the result was an ICER of $9.9/DALY averted. Both values were considered cost-effective according to a conservative willingness-to-pay (WTP) threshold set for 1x the average GDP per capita in Malawi ($588, 2018). When oxygen was analyzed in combination with pulse-oximetry, we found a baseline WTP threshold for pre-hospital oxygen of $71 per patient. For every 1% reduction in total pediatric pneumonia mortality consequent to pre-hospital oxygen use, we determined the recommended WTP allowance for oxygen would increase by approximately $4.53.</p><p><strong>Conclusion: </strong>We conclude that pulse-oximetry is likely cost-effective in low-resource, pre-hospital environments. We acknowledge the need for further research on the effectiveness of pre-hospital oxygen in reducing pediatric pneumonia mortality and suggest ranges of cost and efficacy for which oxygen is likely to be found cost-effective in tandem with pulse-oximetry.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71095"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034972","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":"Correction to \"Hidden in Plain Sight: An Unusual Case of Chronic Cough and Dyspnea in an Adolescent Boy\".","authors":"","doi":"10.1002/ppul.71142","DOIUrl":"https://doi.org/10.1002/ppul.71142","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71142"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128278","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":"Machine Learning Models for Predicting Pediatric Hospitalizations Due to Air Pollution and Humidity: A Retrospective Study.","authors":"Zohar Barnett-Itzhaki, Vered Nir, Almog Kellner, Ofir Biton, Shir Toledano, Adi Klein","doi":"10.1002/ppul.71106","DOIUrl":"https://doi.org/10.1002/ppul.71106","url":null,"abstract":"<p><strong>Background: </strong>Exposure to air pollution and meteorological conditions, such as humidity, has been linked to adverse respiratory health outcomes in children. This study aims to develop predictive models for pediatric hospitalizations based on both environmental exposures and clinical features.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 2500 children (aged 1-18) who presented with respiratory symptoms at the emergency department, during 2016-2017. Air pollution data, including NOx and NO₂ concentrations, and relative humidity (RH) were collected from nine monitoring stations and were cross-referenced with the children's residential locations to assess their specific exposure level. Statistical tests, including Chi-square and Wilcoxon tests, were used to analyze the data. Machine learning models, specifically Random Forest (RF) and eXtreme Gradient Boosting (XGBoost), were developed to predict the children's hospitalizations.</p><p><strong>Results: </strong>Boys were more likely to be hospitalized than girls (60.6% vs. 39.4%, p = 4.31e-06). Hospital visits peaked during winter (p = 3.56e-37). Increased emergency room visits were statistically significantly associated with highly polluted days (p = 0.038). Hospitalized children were exposed to lower RH (median 64.9%) compared to nonhospitalized children (median 69.4%, p = 0.005). The RF and XGBoost models were reliable, with accuracy rates of 0.7-0.98, Precision scores of 0.88-0.99, and AUC scores of 81%-99%. Key features included temperature, NOx levels, RH, and exposure to SO₂.</p><p><strong>Conclusion: </strong>This study investigates the effects of air pollution and humidity on pediatric respiratory health. The models developed offer valuable tools for predicting hospitalizations and are intended to support public health planning and resource allocation.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71106"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009161","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":"Continuous Application of Closed-Loop FiO2-Control in Extremely Preterm Infants: A Matched Cohort Single-Center Study.","authors":"Koen P Dijkman, Jesse J Delbressine, Jeanne P Dieleman, Thilo Mohns, Peter Andriessen, Carola van Pul, Irwin K M Reiss, Axel R Franz, Hendrik J Niemarkt","doi":"10.1002/ppul.71122","DOIUrl":"https://doi.org/10.1002/ppul.71122","url":null,"abstract":"<p><strong>Introduction: </strong>Automated or closed-loop FiO2-control (FiO2-c) has been developed to maintain oxygen saturation (SpO2) within a target range more effectively. However, knowledge of the effects of prolonged use of FiO2-c in extremely preterm infants during a more integral part of NICU admission is limited.</p><p><strong>Methods: </strong>Twenty five extremely preterm infants (gestational age [GA] < 28 weeks) who survived until NICU discharge and received FiO2-c by Predictive Intelligent Control of Oxygenation (PRICO) were matched 1:1 for GA, birthweight, sex and survival to a cohort receiving routine manual FiO2-c. The proportions of time within the SpO2 target range, (severe) hypoxia, hyperoxia, FiO2 and SpO2 for all days and days on supplemental oxygen, for both the whole period and per week, were compared.</p><p><strong>Results: </strong>Infants in the FiO2-c cohort received the intervention during 98% of the 7-week study period. Overall, with FiO2-c, a small, non-significant increase in time within SpO2 target range was observed: mean difference 0.5% (95% CI [-5.0, 6.0]). However, when requiring supplemental oxygen during the first 2 weeks of life, time within SpO2 target range significantly increased with FiO2-c, while time in hyperoxia decreased: mean differences in Week 1: 9.9% (95% CI [3.1, 16.7]) and -10.2% (95% CI [-17.1, -3.3]); in Week 2: 9.5% (95% CI [1.4, 17.6]) and -9.9% (95% CI [-19.2, -0.2]).</p><p><strong>Conclusion: </strong>Despite limited overall effect, continuous use of FiO2-c in extremely preterm infants requiring supplemental oxygen was associated with an increased time within the SpO2 target range during the first 2 weeks of life, a critical window for hyperoxia-related diseases.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71122"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047647","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":"Effectiveness of Intratracheal Surfactant Mixed With Budesonide for Prevention of Bronchopulmonary Dysplasia.","authors":"Adnan S Ahmad, Paola J Fliman, Patrick J Peebles, Daniel P Gorski, Nina S Menda, Jens C Eickhoff, Dinushan C Kaluarachchi","doi":"10.1002/ppul.71114","DOIUrl":"10.1002/ppul.71114","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71114"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143354","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":"Clinical Outcomes of Children Meeting the At-Risk for PARDS Criteria Before PICU Admission: A Single-Center Study.","authors":"Fernando D Bustos-Gajardo, Rodrigo Adasme Jeria, Thomas Piraino, Pablo Cruces, L Felipe Damiani","doi":"10.1002/ppul.71146","DOIUrl":"https://doi.org/10.1002/ppul.71146","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the ability of the criteria \"At-risk for PARDS\" to identify patients with acute respiratory infection hospitalized outside the pediatric intensive care unit (PICU) who are at high risk of developing pediatric acute respiratory distress syndrome (PARDS) and describe the timing for the identification. The secondary aim was to explore clinical outcome differences between patients with and without risk for PARDS.</p><p><strong>Methods: </strong>We conducted an observational prospective cohort study from June to August 2019. Children under 15 years old hospitalized in a pediatric ward due to an acute respiratory tract infection were included.</p><p><strong>Main results: </strong>A total of 177 patients with a median age of 12 (IQR 5; 25) months were included. Registered data included demographics, respiratory support, at-risk for PARDS and PARDS diagnosis according to PALICC consensus. PICU admission, hospital length of stay (LOS) and intrahospital mortality were the outcomes compared between children with and without risk for PARDS. The at-risk criteria, within 48 h of admission, showed an overall accuracy, sensitivity, and specificity of 82.5%, 100%, and 81.9% respectively, to detect patients that progress to PARDS. The at-risk for PARDS criteria was met in 37 cases (20.9%), which also were more likely to developed PARDS (6/37 [16.2%] vs. 0/140 [0%]; p < 0.001), had higher admission to PICU (16/37 [43.2%] vs. 0 [0%]; p < 0.001) and hospital LOS (7 [6; 12] days vs. 5 [3-6] days; p < 0.001), compared with the group without at-risk for PARDS.</p><p><strong>Conclusions: </strong>The at-risk for PARDS criteria within 48 h of admission demonstrated an adequate ability to identify patients with a respiratory infection at increased risk of developing PARDS. Patients who met the at-risk for PARDS criteria before PICU admission presented with unfavorable clinical outcomes compared with those without risk.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71146"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161027","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}