Pediatric Pulmonology最新文献

{"title":"Ethical Considerations With CFTR Modulator Use in Pregnancy.","authors":"Megan Sheppard, John Massie","doi":"10.1002/ppul.71806","DOIUrl":"10.1002/ppul.71806","url":null,"abstract":"<p><p>Since the introduction of CFTR modulators, pregnancy rates in women with CF have doubled. Individuals with CF have improved health and increased life expectancy, so that bearing children is possible without compromising the mother's health. The evidence for the use of CFTR modulators in pregnancy is emerging, but concerns remain regarding the possibility of fetal toxicity. Consequently, CF clinicians and obstetricians have the difficult role of supporting couples to make informed decisions. Here we present what is known regarding CFTR modulator use in pregnancy and highlight key ethical considerations. We present four scenarios: (1) women with CF with an unaffected fetus, (2) women with CF with an affected fetus, (3) carrier-positive women and couples with a CF fetus, and (4) breastfeeding while taking modulator therapy (affected or unaffected fetus), and explore ethical considerations in each scenario. We hope to highlight the real-world dilemma confronting parents, CF clinicians and obstetricians and the urgent need for research to allow us to make informed decisions.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71806"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813691","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":"Population-Based Epidemiology of Congenital Pulmonary Malformations in Early Infancy: A Nationwide Study From Colombia.","authors":"Jefferson Antonio Buendía, Diana Guerrero Patiño","doi":"10.1002/ppul.71841","DOIUrl":"10.1002/ppul.71841","url":null,"abstract":"<p><strong>Background: </strong>Structural congenital pulmonary malformations encompass a heterogeneous group of developmental anomalies of the lung, pleura, and mediastinum that may cause significant neonatal morbidity and require specialized care. Population-based healthcare utilization data from middle-income countries remain scarce, limiting health system planning and comparative research.</p><p><strong>Methods: </strong>We conducted a nationwide, retrospective, population-based study using Colombia's administrative healthcare registry (RIPS) to estimate the encounter-based prevalence, sex-specific distribution, age-standardized rates, and temporal trends of structural congenital pulmonary malformations among children younger than 1 year between 2016 and 2024. Cases were identified using granular ICD-10 codes and analyzed at both subgroup and diagnosis-specific levels. Crude and WHO age-standardized prevalence rates were calculated per 100,000 population. Temporal trends were assessed using Poisson regression models with population offsets.</p><p><strong>Results: </strong>A total of 12,458 healthcare encounters related to structural congenital pulmonary malformations were identified during the study period, yielding a national crude encounter-based prevalence of 111.3 per 100,000 children and a cumulative study-period age-standardized prevalence of 9.8 per 100,000 (2016-2024). Overall prevalence was higher in females than males (rate ratio 1.23, 95% CI 1.19-1.28). Temporal trend analyses demonstrated a modest but significant annual increase of approximately 2.2% (IRR 1.022; 95% CI 1.015-1.029; p < 0.001). A sensitivity analysis excluding 2019 confirmed the robustness of this trend (IRR 1.052; 95% CI 1.044-1.060; p < 0.001).</p><p><strong>Conclusions: </strong>This study provides the first nationwide healthcare utilization-based estimates of structural congenital pulmonary malformations in Colombian infants, revealing substantial diagnostic heterogeneity, sex-specific patterns, and evolving temporal trends. These findings offer essential population-based evidence to inform clinical practice, health service planning, and future epidemiological research. All estimates reflect healthcare encounter counts rather than unique individuals and should be interpreted as indicators of system-level disease burden.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71841"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991147","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":"Correction to \"Changes in Aerobic Fitness Following Initiation of CFTR Modulator Therapy: A Systematic Review and Meta-Analysis\".","authors":"","doi":"10.1002/ppul.71843","DOIUrl":"10.1002/ppul.71843","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71843"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008814","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 and Lung Function in School-Aged Children After Severe RSV-A and RSV-B Bronchiolitis, Is There Any Difference?","authors":"María Arroyas Sánchez, Patricia Alonso López, Guadalupe Tena García, Cristina Calvo, María Iglesias-Caballero, Vicente Mas, Inmaculada Casas, María-Luz García-García","doi":"10.1002/ppul.71837","DOIUrl":"10.1002/ppul.71837","url":null,"abstract":"<p><strong>Introduction: </strong>Human respiratory syncytial virus (HRSV) is a major cause of respiratory disease. It is classified into two antigenic subgroups. While several authors have studied the potential link between HRSV infection and later development of recurrent wheezing (RW) or asthma, no previous studies have assessed the role of HRSV subtypes. The aim of this study was to assess the medium-term respiratory morbidity in children and adolescents with prior severe bronchiolitis due to HRSV-A or HRSV-B infection.</p><p><strong>Methods: </strong>From September 2023 to June 2025 an observational, prospective, cross-sectional follow-up study was conducted, including children and adolescents (5-18 years) with a history of hospital admission due to single HRSV infection. Patients underwent a structured questionnaire, measurement of exhaled nitric oxide, spirometry and skin prick testing for allergic sensitization.</p><p><strong>Results: </strong>A total of 185 patients were recruited (129 HRSV-A, 56 HRSV-B). No differences in the variables regarding hospital admission for bronchiolitis were detected. The prevalence of current asthma in both groups was similar (HRSV-A 17.2% vs. 25.5%, p = 0.190). Patients with prior HRSV-B bronchiolitis reported more severe respiratory symptoms, particularly speech-limiting wheezing (HRSV-A 1.5% vs. HRSV-B: 8.9%, p = 0.039, OR 2.62 (95% CI: 1.3-5.4)) and more frequent nocturnal dry cough not associated with infections (HRSV-A: 7.7% vs. HRSV-B 16.9%, p = 0.044, OR: 1.78, (95% CI: 1.78-2.9)). Multivariate analysis revealed HRSV-B prior bronchiolitis to be an independent risk factor for medical diagnoses of asthma and nocturnal cough.</p><p><strong>Conclusions: </strong>Schoolchildren and adolescents with prior severe bronchiolitis due to HRSV-B have poorer respiratory outcome compared to those with HRSV-A, with more frequent intercrisis symptoms.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71837"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012788","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":"Hyperpolarized ¹²⁹Xe MRI in Pediatric Hematopoietic Stem Cell Transplant Recipients With and Without Bronchiolitis Obliterans Syndrome.","authors":"Brandon Zanette, Faiyza S Alam, Felix Ratjen, Tal Schechter, Joerg Krueger, Giles Santyr","doi":"10.1002/ppul.71818","DOIUrl":"10.1002/ppul.71818","url":null,"abstract":"<p><strong>Background: </strong>Bronchiolitis obliterans syndrome (BOS) is the most common non-infectious complication of allogenic hematopoietic stem cell transplantation (HSCT) and is associated with poor outcomes. Hyperpolarized ¹²⁹Xe MRI (Xe-MRI) holds promise for sensitive and non-ionizing imaging of lung ventilation in children and has been explored in the post-HSCT population. However, previous work was weighted towards children without BOS. In this pilot cross-sectional study, we hypothesize that ventilation abnormalities measured with Xe-MRI are increased in pediatric post-HSCT participants with BOS compared to those without.</p><p><strong>Methods: </strong>Two groups of pediatric post-HSCT participants were recruited: those with a diagnosis or clinical findings consistent with BOS and those without. Xe-MRI was performed to calculate the ventilation defect percentage (VDP) and ventilation heterogeneity index (VHI) in all subjects. Group-wise differences were tested with Mann-Whitney U-test. Xe-MRI was compared to same-day spirometry and nitrogen multiple breath washout (MBW).</p><p><strong>Results: </strong>Twelve (6 non-BOS and 6 BOS) participants aged 9-17 years (median 12.5 years) were recruited. VDP (median [range]) was elevated (p < 0.05) in participants with BOS (11.8 [4.3, 20.8]%) compared to those without BOS (4.0 [3.1, 4.9]%). A similar elevation (p < 0.01) in VHI was observed in those with BOS (12.1 [8.3, 16.3])%) compared to those without (7.4 [7.4, 8.1]%). Both VDP and VHI were correlated with forced expiratory volume in 1-second (FEV₁) and the lung clearance index (LCI), while VDP also correlated with FEV₁ over forced vital capacity ratio (FEV₁/FVC).</p><p><strong>Conclusion: </strong>Xe-MRI ventilation measures were elevated in pediatric post-HSCT participants within the BOS group compared to those without BOS and correlated with same-day spirometry and MBW.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71818"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888185","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":"Detection of Post- Hematopoietic Stem Cell Transplant Bronchiolitis Obliterans Syndrome (BOS)-The Use of Airway Oscillometry.","authors":"Samuel B Goldfarb, Richard Cooper, Jane Koo, Kasiani C Myers, Laura Walkup, Jason Woods, Eleanor Cook, Brian Hils, Adam Lane, Julian Allen, Stella M Davies, Christopher Towe","doi":"10.1002/ppul.71831","DOIUrl":"10.1002/ppul.71831","url":null,"abstract":"<p><strong>Background: </strong>Bronchiolitis obliterans syndrome (BOS) is a devastating complication of allogeneic hematopoietic stem cell transplantation (HSCT) characterized by onset of obstructive lung disease. Oscillometry is a novel pulmonary function assessment technology which superimposes pressure waves on normal tidal breathing, and the alterations in flow and pressure caused by the external waves are measured. Oscillometry assesses physiological parameters that provide insight into respiratory mechanics. We hypothesized that oscillometry may allow for detection of small airway disease to diagnose BOS, especially in children unable to perform spirometry.</p><p><strong>Methods: </strong>We conducted a cross-sectional study to characterize oscillometry findings in patients with BOS compared to a control cohort of HSCT patients without BOS. PFT testing were performed on all patients at the time of oscillometry testing.</p><p><strong>Results: </strong>Thirty-six patients post HSCT were approached, 18 with BOS and 18 controls. These two groups were similar in demographic parameters. BOS patients had significantly abnormal spirometry values. Oscillometry results demonstrated significant differences between the two cohorts in X5, AX, R5, R5-19 and (R5-19)/R5. There were significant differences between BOS and transplant control groups when assessing the association between oscillometry parameter and spirometry parameters.</p><p><strong>Conclusion: </strong>In our cohort oscillometry revealed significant differences between the BOS and non- BOS cohort. Resistance at R5 Hz and the difference between R5-R19 Hz, which characterizes peripheral lung resistance, were both abnormally increased when compared with non- BOS subjects. In addition, reactance parameters, X5 and AX, which correlate with lung stiffness demonstrated significant differences between the BOS and non- BOS cohorts. Our data reveal a strong correlation between oscillometric and spirometric abnormalities in patients with established BOS originally identified by standard spirometry testing. In addition, oscillometry suggests localization of increased resistance in the lung periphery supporting our hypothesis that oscillometry might be complementary to spirometry, and enhance our ability to diagnose BOS.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04098445.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71831"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977720","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":"Development and National Implementation of a Standardized Physiotherapy Assessment Package for Pediatric Asthma and Dysfunctional Breathing.","authors":"Charlotte Wells, Claire Hepworth, Nicki Barker","doi":"10.1002/ppul.71845","DOIUrl":"10.1002/ppul.71845","url":null,"abstract":"<p><strong>Introduction: </strong>Variation in pediatric respiratory physiotherapy assessment for asthma and dysfunctional breathing (DB) across NHS services creates inconsistency in clinical reasoning, workforce development, and data harmonization. We aimed to design and implement a standardized, evidence-informed assessment package to support physiotherapists working with children and young people (CYP) with asthma and DB.</p><p><strong>Methods: </strong>Evidence from a previously conducted structured scoping review (PROSPERO ID: 112227) informed key assessment domains. A national collaborative of specialist pediatric respiratory physiotherapists (Kids' Cornerstone Collaborative) co-developed a standardized assessment proforma, competency framework (Agenda for Change Band 5-8), and supporting educational materials. An iterative, problem-driven implementation approach was piloted across five NHS sites and refined using a Theory of Change framework. National dissemination occurred via professional networks and conferences. Uptake was assessed through formal access requests and user agreements.</p><p><strong>Results: </strong>The final package included a standardized pediatric asthma and DB assessment proforma (digital and paper formats), an implementation playbook, competency framework, and educational resources. Intellectual property agreements enabled free NHS national adoption. Fifty-six NHS Trusts across all UK regions requested access; 30 completed user agreements and received the full package. Pilot implementation informed iterative refinement and strengthened the national collaborative infrastructure.</p><p><strong>Conclusion: </strong>We developed and nationally disseminated a standardized physiotherapy assessment package for CYP with asthma and/or DB, achieving broad professional engagement across the United KIngdom. This initiative supports consistent evidence-based clinical practice, structured competency development, and future harmonized outcome evaluation across NHS services.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71845"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017606","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":"Statewide Implementation of Stock Inhaler Programming: Respiratory Distress De-Escalation, Implementation and Utilization Experiences.","authors":"Paige Hardy, Haania Rizwan, Lynn B Gerald, Alexandra Knitter, Anna Volerman, Erica Salem, Naomi Soto, Chris Martinez, Sam Weigley, Andrea A Pappalardo","doi":"10.1002/ppul.71816","DOIUrl":"10.1002/ppul.71816","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma is common in children, but many do not have access to a personal inhaler at school. The Resources for Every School Confronting Unexpected Emergencies- Illinois (RESCUE-IL) program provided stock undesignated asthma medication for respiratory distress to 77% of Illinois schools over the first implementation year (2023-2024). A qualitative study was conducted to examine utilization experiences with emphasis on program benefits and barriers in the inaugural year of RESCUE-IL.</p><p><strong>Methods: </strong>Interviews were conducted from March to May 2024. Primary data was collected from trained Illinois school health staff who had administered a stock inhaler in the 2023-2024 school year. Semi-structured interviews were transcribed, de-identified, and qualitatively coded in Dedoose. Thematic data analysis using a hybrid inductive and deductive approach based on grounded theory was performed by trained researchers.</p><p><strong>Results: </strong>Out of 37 nurses interested, 24 participated. The first theme surrounding stock inhaler benefits included the program's ability to address asthma burden, health equity concerns, and improve student-level outcomes. Barriers included administrative support and non-health staff training, among others. Stock inhaler utilization experiences referred to events leading up to the respiratory event, its management, student disposition and follow-up demonstrating the program's effectiveness. The final theme-RESCUE-IL implementation and support-pertained to logistics regarding program startup, training, supplies, and event documentation. Overall, participants felt the program enhanced accessibility and ability to de-escalate events, but there were concerns regarding protocols and reporting.</p><p><strong>Conclusions: </strong>A statewide stock inhaler program allowed respiratory distress de-escalation in schools. These real-world experiences by nurses highlight the need for ongoing funding and expansion. Further research is needed to ensure comprehensive training is universally available.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71816"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841153","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":"The Cost of Control: Financial and Administrative Burdens of Limited Distribution Network Changes in Cystic Fibrosis.","authors":"Brittany A Wright, Cameron J McKinzie, Charissa W Kam, Casey R Tak, Lynnsey M Knockel, Julie Langhorst, Rebecca S Pettit, Lynda Roe, Billie Simonson, Hilary Vogt, Nicole Willer, David C Young","doi":"10.1002/ppul.71829","DOIUrl":"10.1002/ppul.71829","url":null,"abstract":"<p><strong>Background: </strong>The clinical impact of pharmacists and pharmacy technicians on the care of people with cystic fibrosis (pwCF) has been well documented within the literature, including medication access, reduction of hospitalizations, and consolidation of pharmaceutical delivery for pwCF with complex medication regimens. However, challenges related to access and affordability have become increasingly complex, increasing the administrative burden placed upon these members of the multidisciplinary CF care team. The goal of this study was to quantify the time pharmacists and pharmacy technicians at CF Foundation-accredited care centers (CFACC) spent triaging and resolving errors, categorize the types of interventions required, and tabulate the financial burden for pwCF averted through these interventions.</p><p><strong>Methods: </strong>This study was a retrospective review of pharmacy team members' interactions following a change in limited distribution network of cystic fibrosis transmembrane conductance regulator modulators (CFTRm) over a 4-month period of time. Each site received institutional review board exemption. Measures were characterized using descriptive statistics and were analyzed in SAS v9.4 (Cary, NC). Collected data were extrapolated to be nationally representative based on the 2023 CFF Patient Registry report.</p><p><strong>Results: </strong>Six CFACC and 1781 pwCF were included in this review. Of these pwCF, 216 required additional interventions following a required change in the dispensing pharmacy for their CFTRm. Collectively, 201.5 h were spent on resolution of issues during the study period with interventions successfully averting a financial burden to pwCF of $226,094.73. Extrapolations of time and financial burden were estimated to be 3700 h and over $4.2 million, respectively.</p><p><strong>Conclusions: </strong>Medication access and affordability continue to present significant barriers for pwCF. We aim to highlight the critical services provided by clinical pharmacy teams at CFACC as well as their integrated health-system specialty pharmacies, and the vital role they play in improving outcomes and providing cost-effective care for pwCF.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71829"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963306","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":"Early Identification of Children at Risk for Complicated Parapneumonic Pleural Effusion: Development of a Prediction Model.","authors":"Bernat Servitje-Verdaguer, Romina Conti-Degiorgis, Roberto Velasco, Anna Gelman-Bagaria","doi":"10.1002/ppul.71817","DOIUrl":"10.1002/ppul.71817","url":null,"abstract":"<p><strong>Background: </strong>Parapneumonic pleural effusion (PPE) is a frequent complication of pediatric pneumonia. Some cases progress to complicated PPE (cPPE), which is associated with greater morbidity, longer treatment, and a higher likelihood of need for pleural drainage. Early identification of children at risk of progression remains difficult at presentation, and pediatric evidence on early predictors is scarce and inconsistent.</p><p><strong>Methods: </strong>We conducted a retrospective observational study including children aged <18 years admitted with PPE between 2015 and 2025. cPPE was defined through standard laboratory and/or imaging criteria. Twenty clinical, laboratory, and radiological candidate predictors available at initial evaluation were assessed. After univariate screening, variables with statistical association and clinical relevance were entered into a multivariate logistic regression model. After model assessment, a simplified score was derived from the original model for bedside use.</p><p><strong>Results: </strong>A total of 122 children were included, 77 (63%) with cPPE and 45 (37%) with uncomplicated PPE. In univariate analyses, younger age, dyspnea, chest wall retractions, reduced lung sounds, C-reactive protein, lower hemoglobin, pleural effusion thickness, and mediastinal shift were associated with cPPE. In the final multivariate model, five variables remained independently associated: age (OR 0.73, 95% CI 0.63-0.84), retractions (OR 3.23, 95% CI 1.16-8.95), C-reactive protein ≥176.5 mg/L (OR 2.83, 95% CI 1.02-7.82), pleural effusion thickness (OR 2.16, 95% CI 1.27-3.70), and mediastinal shift (OR 10.75, 95% CI 2.24-51.64). The model showed good discriminatory performance, with an AUC of 0.883 (95% CI 0.817-0.948). The optimal probability threshold was 0.49, yielding a sensitivity of 92.2% and a specificity of 71.1%. A simplified additive clinical score derived from the model demonstrated similar performance, allowing stratification into four risk groups with progressively increasing observed rates of cPPE.</p><p><strong>Conclusions: </strong>Early risk stratification of pediatric PPE is feasible using a small set of readily available clinical, laboratory, and radiological variables. The proposed model and the adapted clinical score showed good discriminatory ability and may help identify children at increased risk of progression to cPPE who could benefit from closer monitoring and early optimized management. External validation is needed before routine clinical implementation.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"61 9","pages":"e71817"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857537","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}