Pediatric Pulmonology最新文献

{"title":"Nebulized Treprostinil in Mechanically Ventilated Children.","authors":"Sarah P Cohen, Diane Paulus, Ashley Hattie, Beth Malehorn, Mary Irmen, Robert Gajarski","doi":"10.1002/ppul.71278","DOIUrl":"10.1002/ppul.71278","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71278"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023963","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":"Chest X-Ray Interpretation in the EPICO Pediatric COVID-19 Study: Addressing Misconceptions.","authors":"Luis Miguel Navarro-Ramirez, Pablo Vásquez-Hoyos, María Lucía Mesa-Rubio, Melisa Naranjo Vanegas, Daniela Duarte-Montero, Claudia Burgos, Laura Melissa Mendez, María Margarita Rodriguez, Arianna Martinez, Paola Sanchez, Carolina Tovar, Gabriela Friedrich, Gustavo Adolfo Triana-Rodriguez, Mónica Royero-Arias, Jessica Echeverry, Tamara Gamo, Luz Ángela Moreno, Olga Lucía Baquero, Luz Marina Mejía, Sonia Restrepo-Gualteros, Sergio Moreno-Lopez, Juan Gabriel Piñeros, Carlos Álvarez-Moreno, Alejandro Díaz-Díaz, Iván Felipe Gutierrez, Clara Galvis-Diaz, José Manuel Nieto, Irati Gastesi, Cinta Moraleda, Alfredo Tagarro García, Andrea Ramirez Varela","doi":"10.1002/ppul.71274","DOIUrl":"10.1002/ppul.71274","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71274"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024012","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":"Estimating the Effects of Continuous Albuterol Dosage on Clinical Outcomes for Pediatric Critical Asthma Exacerbation: A Retrospective Cohort Study.","authors":"Daniel P Riggins, Eneida A Mendonca, Lucas Bulgarelli, Patricia Tachinardi, Wanzhu Tu, Colin Rogerson","doi":"10.1002/ppul.71293","DOIUrl":"10.1002/ppul.71293","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric asthma exacerbations sometimes require aggressive intervention including continuous albuterol, a cornerstone therapy for reversing airway obstruction. However, pediatric dosing typically follows adult guidelines, with limited evidence for specific dosing ranges. This study aimed to compare the clinical outcomes of a reduced initial dose (10 mg/h) of continuous albuterol with a standard dose (15 mg/h) in children hospitalized for critical asthma exacerbations.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at Riley Hospital for Children, analyzing pediatric patients (ages: 2-18) admitted with critical asthma exacerbations between 2014 and 2022. Stabilized inverse probability weighting (SIPW) was used to adjust for confounding factors between groups. The primary outcome was the percentage change in the Pediatric Asthma Severity Score (PASS) at 24 h, with secondary outcomes including the duration of continuous albuterol, PICU length of stay, and hospital length of stay.</p><p><strong>Results: </strong>Analysis of 1,486 encounters revealed no significant difference in percent PASS changes at 24 h between the 10 mg/h and 15 mg/h groups (Additive Treatment Effect of 1.69, 95% CI: -0.93-4.31, p = 0.207). PICU and hospital lengths of stay were also similar. However, the 10 mg/h group showed a significantly shorter duration of continuous albuterol therapy compared to the 15 mg/h group (Multiplicative Treatment Effect of 1.29, 95% CI: 1.14-1.45, p < 0.001).</p><p><strong>Conclusions: </strong>Findings suggest that starting continuous albuterol at 10 mg/h provides clinical outcomes comparable to 15 mg/h in managing pediatric critical asthma exacerbations. A lower starting dose may optimize resource use and reduce treatment-related adverse effects.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71293"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12424099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033987","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":"Child Opportunity Index and Outcomes of Children Admitted to US PICUs for Critical Asthma.","authors":"Michael C McCrory, Amit K Saha, Colin M Rogerson, Jocelyn R Grunwell, Curtis E Kennedy, Meredith C Winter, Martin K Wakeham, Adrian D Zurca, Adam C Dziorny, Aline B Maddux, Mary E Hartman, Neethi P Pinto, Jia Xin Huang, Meesha Sharma, Kyle A Barnack, Anjali Garg, Manzilat Y Akande","doi":"10.1002/ppul.71309","DOIUrl":"https://doi.org/10.1002/ppul.71309","url":null,"abstract":"<p><strong>Background: </strong>Social drivers of health affect severity of asthma in children, but any association with outcomes in children with critical asthma is unknown.</p><p><strong>Methods: </strong>Retrospective cohort study of children 2-17 years old admitted to 15 United States PICUs for asthma from 2019 to 2020. Child Opportunity Index (COI) was assigned by census tract. Primary outcome was use of positive pressure ventilation (PPV), including invasive mechanical ventilation or non-invasive continuous or bilevel support.</p><p><strong>Results: </strong>A total of 2093 admissions in 1926 patients were included; median age was 6.9 years (IQR 4.3-10.8). Patients were often from very low COI neighborhoods (46.7%), a higher percentage than in children admitted to participating PICUs concurrently for other respiratory (28.2% very low COI) or non-respiratory causes (24.8%) (p < 0.0001 for each comparison). PICU mortality was low (0.57%), with no difference by COI category. Median PICU length of stay was within 8.5 h across COI categories (1.0-1.4 days). PPV was used in 39% of admissions. Multivariable analysis revealed no association of COI category with use of PPV; older age, commercial insurance, and origin of admission were associated with PPV use. PICU readmission for asthma during a subsequent hospitalization occurred in 7.1% patients during the study period, with a stepwise decrease as COI category increased [very low 8.9%; low 7.4%; moderate 5.0%; high 4.4%; very high 3.8%, p = 0.02].</p><p><strong>Conclusions: </strong>Children admitted to 15 PICUs for asthma were disproportionately from very low COI neighborhoods. Mortality and use of PPV were not significantly associated with COI; however, PICU readmission was significantly associated with lower COI.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71309"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150254","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":"Impact of Home Collection and Shipping of Respiratory Specimens on Bacterial Pathogen Detection in Children With Cystic Fibrosis.","authors":"Jordana E Hoppe, Tim Vigers, Arianne Trujillo, Elinor Hanley, Scott D Sagel, Edith T Zemanick","doi":"10.1002/ppul.71289","DOIUrl":"10.1002/ppul.71289","url":null,"abstract":"<p><strong>Introduction: </strong>Evaluation for respiratory pathogens is a key component of cystic fibrosis (CF) care but is often lacking during remote visits. We aimed to address the impact of shipping and home collection of respiratory samples on CF pathogen identification and the feasibility of home collection in children with CF.</p><p><strong>Methods: </strong>Participants were enrolled during a routine well clinic visit. Three respiratory samples (clinic obtained with immediate processing per CF center guidelines, clinic obtained with delayed processing, and a home sample obtained within 1 week of clinic visit) were collected and concordance between CF pathogens was evaluated using Fleiss' Kappa comparisons. Survey to assess feasibility and acceptability was completed, and descriptive statistics were used to report results.</p><p><strong>Results: </strong>Fifty children were enrolled, and home samples were returned by 46 (92%). Fleiss' Kappa value for methicillin-susceptible Staphylococcus aureus was 0.676, suggesting substantial agreement. No significant differences were seen in pathogen detection between immediately processed (gold standard) and delayed processed or home collected samples. Home collection was acceptable based on participant survey responses related to ease of collection and shipping, and willingness to repeat a home collection. No significant barriers to collection or shipping were identified.</p><p><strong>Conclusion: </strong>Good concordance between CF pathogens identified on culture between the three sample types and good accuracy between pairwise comparisons were observed in children with CF. Home collection of respiratory samples for culture in children with CF was feasible and acceptable based on high sample return rate and survey responses.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71289"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041038","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":"Airway Administration of Budesonide Combined With Pulmonary Surfactant to Prevent Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review and Meta-Analysis.","authors":"Kaixu Wang, Chen Dan, Shuqiang Gao, Yue Guang, Rong Ju","doi":"10.1002/ppul.71308","DOIUrl":"10.1002/ppul.71308","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness and safety of using budesonide in combination with pulmonary surfactant compared with the pulmonary surfactant alone in preventing bronchopulmonary dysplasia in preterm infants.</p><p><strong>Design: </strong>Four databases (EMBASE, MEDLINE, Web of science, and Cochrane Central) were searched for randomized controlled trials comparing the use of intratracheal budesonide in combination with pulmonary surfactant to the use of pulmonary surfactant alone. Review manager 5.3 and Stata 17 software were used for statistical analysis.</p><p><strong>Main outcomes measures: </strong>The primary outcome was the incidence of bronchopulmonary dysplasia in the group treated with budesonide combined with pulmonary surfactant, compared to the group treated with pulmonary surfactant alone. Secondary outcomes contained mortality rate, repeated use of pulmonary surfactant, length of hospital stay, and complications.</p><p><strong>Results: </strong>12 randomized controlled studies were included in this meta-analysis, including 2428 preterm infants. Compared to the use of pulmonary surfactant alone, the combination of budesonide and pulmonary surfactant can significantly reduce the incidence of bronchopulmonary dysplasia (p < 0.01, RR = 0.66, 95% CI: 0.53-0.84, low quality of evidence). Even after adjusting for the impact of publication bias, the results still indicate that the combination of budesonide and pulmonary surfactant significantly lowers the risk of BPD (RR = 0.77, 95% CI: 0.63-0.93). Additionally, it significantly decreases in-hospital mortality rates in premature infants (p = 0.02, RR = 0.80, 95% CI: 0.67-0.96, moderate quality of evidence), the incidence of pulmonary hemorrhage (p < 0.01, RR = 0.61, 95% CI: 0.43-0.85, moderate quality of evidence), and the need of repeated use of pulmonary surfactant (p < 0.01, RR = 0.52, 95% CI: 0.44-0.62, high quality of evidence). No statistically significant differences were observed in related complications.</p><p><strong>Conclusion: </strong>Compared to the use of pulmonary surfactant alone, the combination of budesonide and pulmonary surfactant may prevent bronchopulmonary dysplasia in preterm infants, and does not increase the occurrence of related complications.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71308"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138314","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":"Radiographic Findings in Severe Bronchopulmonary Dysplasia (BPD).","authors":"Avram Rago, Katiana Garagozlo","doi":"10.1002/ppul.71317","DOIUrl":"https://doi.org/10.1002/ppul.71317","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71317"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186504","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":"Respiratory Outcomes Following Late Postnatal Dexamethasone Administration in Preterm Infants With Bronchopulmonary Dysplasia.","authors":"Melissa House, James Rowe, Audrey Walters, Chunyan Liu, Shelley R Ehrlich, Thomas Nienaber, Erik B Hysinger, Paul Kingma, Shawn K Ahlfeld","doi":"10.1002/ppul.71275","DOIUrl":"https://doi.org/10.1002/ppul.71275","url":null,"abstract":"<p><strong>Objective: </strong>To wean respiratory support, preterm infants with severe respiratory failure are often administered systemic corticosteroids. We sought to evaluate if postnatal age or clinical characteristics predicted death or tracheostomy following systemic dexamethasone in evolving bronchopulmonary dysplasia.</p><p><strong>Study design: </strong>We performed a retrospective study of infants born at ≤ 30 weeks' gestational age cared for at a Level IV referral center from 2009 to 2019 who received a complete course of systemic dexamethasone beyond 4 weeks of age for the indication of preventing death and/or liberating from positive pressure ventilation. Clinical variables at the initiation of dexamethasone were examined by regression analysis, and receiver operator curves were constructed for their ability to predict death or tracheostomy.</p><p><strong>Results: </strong>Of the 81 infants that received a complete course of dexamethasone, 52% died or required tracheostomy. At onset of the dexamethasone course, infants ultimately requiring tracheostomy were more likely to be small for gestational age (SGA) (p = 0.02), receive dexamethasone at a significantly later postmenstrual age (p < 0.01), require higher respiratory support (p < 0.01), and have concomitant pulmonary hypertension (p < 0.01). The combination of SGA, a history of late bacterial sepsis, the need for multiple dexamethasone courses, a diagnosis of pulmonary hypertension, and higher respiratory support at onset of dexamethasone course predicted tracheostomy or death (AUC 0.87).</p><p><strong>Conclusion: </strong>For infants receiving systemic dexamethasone for severe respiratory failure, a combination of clinical characteristics and magnitude of respiratory support may reliably predict inability to wean from positive pressure ventilation, potentially avoiding ineffective dexamethasone exposure. Further validation is required before clinical use.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71275"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023990","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 (≤ 2 h) Bolus Surfactant Replacement Therapy Versus Standard Care in Term (≥ 37 Weeks) Neonates With Meconium Aspiration Syndrome: An Open-Label Randomized Controlled Trial.","authors":"Vedeesh Sombattina, Sushma Nangia, Gunjana Kumar, Tapas Bandyopadhyay","doi":"10.1002/ppul.71292","DOIUrl":"10.1002/ppul.71292","url":null,"abstract":"<p><strong>Background: </strong>Meconium aspiration syndrome (MAS), a common cause of respiratory failure in late preterm and term neonates, is associated with a high risk of mortality and morbidity. Amongst all the treatment modalities for severe MAS, surfactant administration has a proven role in decreasing progressive respiratory failure.</p><p><strong>Methods: </strong>The present open-label randomised controlled trial aimed to determine the effect of early (≤ 2 h) bolus surfactant therapy as compared to standard care on the total duration of respiratory support. Term (≥ 37 weeks) neonates with MAS who had respiratory distress (Downes ≥ 4, and FiO2 ≥ 0.5 despite the effective CPAP support) with radiological evidence of MAS received either bolus surfactant or standard care within 2 h after birth. The primary endpoint was the total duration of respiratory support (i.e. both invasive and Noninvasive ventilation).</p><p><strong>Results: </strong>Sixty neonates were enrolled in the study, 30 each in the surfactant group and standard care group, respectively. Baseline characteristics were similar between the two groups. The median (IQR) total duration of respiratory support was significantly lower in the surfactant group (48 [24-120] h vs. 132 [66-234] h; mean difference, 84 h; 95% CI: 31.6 to 136.3; p: 0.005 respectively). There was a significant reduction in the requirement of both invasive and Noninvasive ventilation. Other clinical parameters like mortality, the incidence of air leak, persistent pulmonary hypertension, hypoxic-ischemic encephalopathy, and pulmonary hemorrhage were comparable between both groups.</p><p><strong>Conclusion: </strong>Early bolus surfactant replacement therapy significantly reduces the total duration of respiratory support among term neonates with MAS without increasing adverse outcome.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71292"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023936","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":"Comparison of Bovine Lipid Extract Surfactant and Poractant Alfa Administered via LISA in Preterm Infants(28⁺⁰ to 34⁺⁶ Week) With Respiratory Distress Syndrome: A Randomized Controlled Trial.","authors":"Ashadur Zamal, Md Habibullah Sk, Bijan Saha, Avijit Hazra","doi":"10.1002/ppul.71281","DOIUrl":"10.1002/ppul.71281","url":null,"abstract":"<p><strong>Background: </strong>Respiratory distress syndrome (RDS) is a leading cause of neonatal morbidity and mortality in low- and middle-income countries (LMICs). The feasibility and effectiveness of bovine versus porcine surfactants via less invasive surfactant administration (LISA) remain unstudied in LMICs. We compared clinical outcomes and cost-effectiveness of BLES versus poractant alfa in preterm infants with RDS managed with LISA.</p><p><strong>Methods: </strong>This randomized controlled trial was conducted in a level 3 neonatal intensive care unit in India. Eligible preterm infants born between 28⁺⁰ and 34⁺⁶ weeks of gestation who developed RDS requiring Noninvasive respiratory support and supplemental oxygen (FiO₂ ≥ 30%) within 6 h of birth were enrolled. Infants were randomly assigned (1:1) to receive either BLES 135 mg/kg (5 mL/kg) or poractant alfa 200 mg/kg (2.5 mL/kg) via the LISA technique. The primary outcome was need for intubation within 72 h of life.</p><p><strong>Result: </strong>From Jan 24, 2024 to Mar 15, 2025, 282 infants were randomized to BLES or poractant alfa (n = 141 each). Intubation within 72 h occurred in 19 (13.5%) infants in the BLES group and 16 (11.3%) in the poractant alfa group (p = 0.710). There were no statistically significant differences in FiO₂, SpO₂, heart rate, or mean airway pressure at any time point before or after surfactant administration between the two groups. No significant differences were observed in major morbidities or mortality. The average cost of surfactant per infant was significantly lower with BLES (INR 20,539 vs 29,677; p < 0.001).</p><p><strong>Conclusion: </strong>In LMIC settings, BLES and poractant alfa showed similar effectiveness for RDS management via LISA, with no difference in clinical outcomes. BLES provides a cost-effective alternative in resource-constrained neonatal care.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71281"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023955","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}