Pediatric Pulmonology最新文献

{"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":"Newborn Screening for Cystic Fibrosis Is Associated With the Lowest Healthcare Costs: A 10-Year Observational Follow-Up Study in France.","authors":"Erika Guyot, Floriane Deygas, Manon Belhassen, Marjorie Berard, Eric Van Ganse, Isabelle Sermet-Gaudelus, Sabrine Tiaiba, Jean-Christophe Dubus, Isabelle Durieu, Philippe Reix","doi":"10.1002/ppul.71134","DOIUrl":"10.1002/ppul.71134","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to study the healthcare (HC) costs associated with cystic fibrosis (CF) in children diagnosed prenatally (ANT), through newborn screening (NBS), after birth due to meconium ileus (MI), or later based on symptoms (LS). Additionally, it seeks to clinically characterize children with CF (chCF) with different trajectories of HC costs.</p><p><strong>Study design: </strong>A retrospective observational study was conducted on data from the French CF Registry (FCFR) and the French National Claims Database (SNDS) linked from 2006 to 2021. HC costs related to CF diagnosis circumstances were estimated per year of life among chCF up to age 10. Group-based trajectory modeling was performed to identify subgroups with similar cost trajectories.</p><p><strong>Results: </strong>Between 2006 and 2011, data from 1065 chCF were recorded in the FCFR. Nine hundred seventy-three (91.4%) were matched with SNDS, and 779 (73.1%) had at least 10 years of follow-up. During the first year, HC costs of chCF diagnosed with NBS were lower than for those diagnosed with MI and ANT (all p < 0.05). However, by the tenth year HC were no longer different between groups. Three groups with different cost trajectories were identified. Groups with the highest costs had a lower lung function at 6 and 10 years and the lowest weight and height z-scores at 2 and 10 years (all p < 0.05).</p><p><strong>Conclusion: </strong>NBS is associated with the lowest HC costs during the first year of life.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71134"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111585","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":"Impact of Social Determinants on Home Oxygen Therapy Duration in Preterm Infants: A Study Utilizing the Childhood Opportunity Index.","authors":"Kristen Richard, Rachel D'Anna, Suzanne E Dahlberg, Heather White, Amit Agarwal, Katherine Edeburn, Catherine A Sheils, Lawrence M Rhein, Jonathan C Levin","doi":"10.1002/ppul.71132","DOIUrl":"https://doi.org/10.1002/ppul.71132","url":null,"abstract":"<p><strong>Introduction: </strong>Recorded home oximetry (RHO) standardizes and reduces home oxygen therapy (HOT) duration in infants with post-prematurity related lung disease (PPRD). The impact of social determinants of health (SDoH) on HOT outcomes using RHO is unknown. We examined whether the childhood opportunity index (COI) and maternal race influence HOT duration in infants with PPRD using RHO.</p><p><strong>Methods: </strong>This secondary analysis of a cohort from the RHO Implementation Study used COI determined by zip code, dichotomized as low (very low/low) and high (moderate/high/very high) opportunity. Time-to-discontinuation was stratified by COI and maternal race, estimated using Kaplan-Meier methodology. Cox regression (stratified for NICU duration by quantiles) modeled the impact of neonatal variables and COI on HOT duration.</p><p><strong>Results: </strong>Ninety seven infants were included (34 low COI, 63 high COI). Median HOT duration was 96 days for low COI and 64 days for high COI (95% CI: 57-157; 95% CI: 52-80, p = 0.3). Longer NICU stay decreased HOT discontinuation risk (HR: 0.99, 95% CI: 0.99-1.00, p = 0.002). High COI was not associated with an increased risk of HOT discontinuation (HR: 1.44, 95% CI: 0.83-2.5, p = 0.195). Infants born to Black mothers had longer NICU stays and more often low COI, but not longer HOT use (HR: 1.49, 95% CI: 0.8-2.79, p = 0.206).</p><p><strong>Conclusion: </strong>In a multicenter cohort of infants with PPRD discharged on HOT, low COI, and Black maternal race were not associated with an increased risk for prolonged oxygen use when following a protocoled weaning approach. Further research is needed to assess if standardized HOT management mitigates SDoH-related disparities in oxygen duration.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71132"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128281","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":"Evaluating the Use of iPSC-Derived Models in Understanding the Pathogenesis of Childhood Interstitial Lung Disease.","authors":"Swetha Jinson, Shivanthan Shanthikumar, Rhiannon B Werder","doi":"10.1002/ppul.71143","DOIUrl":"10.1002/ppul.71143","url":null,"abstract":"<p><strong>Rationale: </strong>Genetic testing has significantly improved the diagnosis of childhood interstitial lung diseases (chILD), which have long challenged clinicians due to their heterogeneity and poor characterization. It is now imperative to study variants of unknown significance (VUS) to identify pathogenic mutations to optimize diagnosis and screening in patients. Furthermore, the limited treatment options for patients with chILD worsen patient outcomes. Induced pluripotent stem cell (iPSC)-derived models could be a tool to understand the effect of novel VUS and discover new therapeutic interventions.</p><p><strong>Objective: </strong>This review seeks to evaluate the fidelity of iPSC-derived models to recapitulate the pathogenic processes of chILD and test therapeutic interventions.</p><p><strong>Methods: </strong>This paper performs a systematic search over three databases to identify iPSC-derived models studying disease-causing mutations in pediatric patients with chILD and Hermansky-Pudlak Syndrome.</p><p><strong>Results: </strong>Of the 1452 papers initially reviewed, eight papers met the inclusion criteria using iPSC-derived models to study genetic variants. The diseases covered included common manifestations of chILDs such as surfactant protein deficiencies and hereditary pulmonary alveolar proteinosis, as well as fibrotic disorders like Hermansky-Pudlak Syndrome. These models recapitulated patient histology and key pathogenic features reported in the literature, delivering mechanistic insights into these conditions. Some papers also explored the efficacy of novel treatments, such as gene therapy.</p><p><strong>Conclusions: </strong>iPSC-derived models can mimic aspects of human lung responses to provide a platform for disease modeling and therapeutic testing in chILD. There are opportunities to develop more complex multi-cellular models and for the study of a wider range of variants using these tools.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 5","pages":"e71143"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161031","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}