Pediatric Pulmonology最新文献

{"title":"Persistent Low-Output Neonatal Chylothorax: How Long Are We Justified to Wait for Pleurodesis in Partial Responders?","authors":"G Rollo, A Zarfati, G Burini, L Valfre, C Iacusso, I Capolupo, B D Iacobelli, P Bagolan, A Conforti, F Fusaro","doi":"10.1002/ppul.71311","DOIUrl":"10.1002/ppul.71311","url":null,"abstract":"<p><strong>Aims: </strong>The aim of our study was to review our experience regarding the management of neonatal chylothorax, with particular focus on outcomes of partial responders.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of neonatal chylothorax cases between January 2015 and December 2023. First-line management included drainage, fasting, parenteral nutrition, and octreotide. Good responders had a drainage output of <2 ml/kg/day after 1 week; partial responders had 2-10 ml/kg/day, and non-responders had >10 ml/kg/day or >100 ml/day for 5 days with complications. Partial responders continued conservative management, while non-responders received second-line treatment with bedside iodopovidone chemical pleurodesis.</p><p><strong>Results: </strong>Thirty-five newborns (15 females, 20 males) were diagnosed with chylothorax, 11 congenital and 24 acquired (18 CDH, 5 esophageal atresia, 1 caval thrombosis). After first-line treatment, 7 (20%) were good responders, 19 (54%) were partial responders, and 9 (26%) were non-responders. Non-responders received iodopovidone pleurodesis, which resolved the condition in all cases (median time to resolution was 4 days). Complications during hospitalization included 8 cases of sepsis (1 fatal), 5 of atelectasis (4 related to pleurodesis), and 4 venous thromboses. Partial responders had significantly more sepsis (p = 0.029) but less atelectasis (p = 0.025) compared to non-responders, with similar resolution times and hospital stays. After a median follow-up of 3 years, there were no recurrences or thyroid dysfunction in the iodopovidone group.</p><p><strong>Conclusions: </strong>First-line conservative management, although initially appropriate, can lead to serious morbidity if prolonged. Timely second-line treatment for partial responders with low-output chylothorax can minimize morbidity and mortality. Bedside chemical pleurodesis with iodopovidone is a safe and effective second-line treatment for refractory neonatal chylothorax.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71311"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138379","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":"Letter: Does Multilevel Upper Airway Obstruction in Pediatric OSA Require Multilevel Surgical Treatment?","authors":"An Boudewyns, Alan R Schwartz","doi":"10.1002/ppul.71310","DOIUrl":"https://doi.org/10.1002/ppul.71310","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71310"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131866","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 Duration of Nasal High Flow Therapy on Respiratory Outcomes in Very Preterm Infants: A Propensity Score Analysis.","authors":"Emanuela Zannin, Camilla Rigotti, Giulia Dognini, Danila Azzolina, Maria Luisa Ventura","doi":"10.1002/ppul.71313","DOIUrl":"https://doi.org/10.1002/ppul.71313","url":null,"abstract":"<p><strong>Background: </strong>Nasal high flow therapy (nHFT) is being used earlier and for longer than in the past as an alternative to nasal Continuous Positive Airway Pressure (nCPAP) for preterm neonates. The aim of the present study was to evaluate the effect of the proportion of nHFT on respiratory outcomes.</p><p><strong>Methods: </strong>This was a single-centre retrospective study of preterm infants born <32 weeks' gestational age from 2016 to 2025. Propensity score weighting analysis was used to explore the effect of the duration of nHFT expressed as a percentage of the total duration of nHFT or nCPAP (nHFT%). The primary outcome was the total duration of respiratory support; secondary outcomes were the development of bronchopulmonary dysplasia (BPD) and the length of hospitalisation.</p><p><strong>Results: </strong>Three hundred and forty two infants were included. Infants received nHFT for a median (Q1, Q3) of 70 (46, 85) % of the duration of nHFT or nCPAP (nHFT%). After adjusting for residual confounders, the weighted nHFT% presented a significant positive association with the total duration of respiratory support (β = 0.007, p < 0.001), oxygen requirement (β = 0.006, p = 0.027), and the length of hospitalisation (β = 0.002, p = 0.007). The risk for BPD tended to increase with increasing nHFT% (OR = 1.01, p = 0.287).</p><p><strong>Conclusion: </strong>The prolonged use of nHFT as an alternative to nCPAP was associated with a longer duration of respiratory support and hospitalisation, but not with a higher risk for BPD.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71313"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186488","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":"Lung Disease in Children With Laryngotracheoesophageal Clefts.","authors":"Emily A Hosfield, Hannah C Patten, Puanani E Hopson, Shelagh A Cofer, Joshua P Wiedermann, R Paul Boesch","doi":"10.1002/ppul.71285","DOIUrl":"10.1002/ppul.71285","url":null,"abstract":"<p><strong>Introduction: </strong>Laryngotracheoesophageal clefts (LTEC) are aspiration-related lesions often assessed using swallow studies and symptoms like respiratory or feeding difficulties. However, these indicators are unreliable predictors of disease severity. Lung inflammation and injury, though significant concerns, are rarely and inconsistently evaluated or reported. As a result, the correlation between swallow study findings and actual pulmonary disease remains unclear.</p><p><strong>Methods: </strong>A retrospective cohort of children with LTEC seen in our Aerodigestive Program between October 1, 2012, and September 30, 2023, who underwent videofluoroscopic swallow study (VFSS) or flexible endoscopic evaluation of swallowing (FEES) were included. Data collected included clinical history, risk factors, BAL, chest CT, impedance probe, VFSS/FEES findings, and FOIS-P/I scores at baseline and follow-up.</p><p><strong>Results: </strong>Eight-two subjects identified. Lung inflammation and bronchiectasis were common and correlated. Clinical factors, impedance probe, and the presence/severity of swallowing abnormalities on VFSS/FEES were not predictive of lung disease. Fifty-seven patients underwent LTEC repair for a range of indications, only 49% based on CT and/or BAL findings. Of 57 children who had LTEC repair, only 49% were based on CT or BAL findings. LTEC repair was associated with modest improvement feeding and swallowing.</p><p><strong>Discussion: </strong>Children with LTEC have a high prevalence of inflammatory lung disease and injury and undergo repair for a variety of reasons. Swallow studies detect functional swallowing issues but do not reliably identify lung disease. Despite this limitation, LTEC repair is linked to improved feeding and swallowing in some patients, though not all benefit.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71285"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054884","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":"Implementation of a Feeding Protocol in Patients With Humidified HIGH Flow Nasal Cannula in a Pediatric Intensive Care Unit Improves Enteral Nutrition: The HIGHPE Study.","authors":"Javier Rodriguez-Fanjul, Felipe Stacey, Unai Urrutia, Sara Bobillo-Perez, Maria Luisa Bordejé Laguna","doi":"10.1002/ppul.71279","DOIUrl":"https://doi.org/10.1002/ppul.71279","url":null,"abstract":"<p><strong>Purpose: </strong>There is limited evidence to guide the use of enteral nutrition (EN) for children with bronchiolitis who received Humidified high flow nasal cannula (HHFNC) and often kept nil per mouth for aspiration and progression to mechanical ventilation risk.</p><p><strong>Methods: </strong>This quality improvement project included children with bronchiolitis who were supported by HHFNC in the paediatric intensive care unit (PICU). An algorithm to increase EN use in those participants was created by stakeholders. Two periods of time were compared: Group 1 pre-intervention (October 1, 2022-May 1, 2023): without nutrition implementation protocol vs Group 2 (October 1, 2023-May 1 2024), once the protocol was implemented. EN was provided via naso-gastric tubes. The project aim was to decrease the mean time to initiation of EN by more than 50% after the start of HHFNC. Secondary endpoints were time to reach target calories (100 kcal/kg/day), HHFNC total duration, and the proportion of subjects with adverse effects.</p><p><strong>Results: </strong>A total of 98 patients were included in the study. Forty five children in group 1, 53 children in group 2. Median time to the start of EN decreased from 24 (16-24) to 4 (2-6) hours (p < 0.05). No episodes of aspiration or other adverse effect were documented.</p><p><strong>Conclusions: </strong>The implementation of a standardized pathway for EN in children with HHFNC was associated with faster initiation of EN and a shorter time to reaching caloric goals without adverse events. Moreover, there was a reduction in the group 2 in the days of HHFNC, PICU length of stay (LOS) and Hospital LOS.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71279"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023940","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":"Current Practices for Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension in Neonates: A Survey Study in Spain.","authors":"Macarena García-Gozalo, Adelina Pellicer, Maria Carmen Bravo","doi":"10.1002/ppul.71259","DOIUrl":"https://doi.org/10.1002/ppul.71259","url":null,"abstract":"<p><strong>Objective: </strong>To describe national patterns in the screening, diagnosis, and clinical management of bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) in Spanish neonatal intensive care units (NICUs) and assess the need for standardized screening and management protocols and unified follow-up strategies.</p><p><strong>Methods: </strong>A 20-question electronic survey was distributed to all Level III NICUs in the Spanish public health system to evaluate practices in BPD-PH screening, diagnosis, and clinical management. Results were analyzed globally and by NICU level (IIIB vs. IIIC).</p><p><strong>Results: </strong>A total of 47 NICUs (59% response rate) participated, with a complete (100%) response rate from Level IIIC units, which represent the highest complexity centers. Although 70% of units reported routine screening for BPD-PH, only 36% used formal screening protocols, revealing inconsistencies in timing and criteria. Diagnostic approaches relied heavily on echocardiographic indicators of pulmonary hypertension, particularly interventricular septal flattening, and right-to-left shunting, but adjunct tests (e.g., NT-proBNP, catheterization) varied between centers. Only 19% of NICUs-mostly Level IIIC-used standardized clinical management algorithms. Asymptomatic infants were typically managed with conservative strategies (oxygen targeting, fluid restriction), while sildenafil was the predominant therapy for symptomatic BPD-PH cases (80% of units). Follow-up protocols showed significant heterogeneity, especially in asymptomatic patients discharged without treatment.</p><p><strong>Conclusions: </strong>There is a clear need for national guidelines to address variability in screening protocols, diagnostic strategies, clinical management and follow-up practice of BPD-PH. Establishing uniform care standards across Spanish NICUs could improve equity and outcomes in this high-risk preterm population.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71259"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006438","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":"An Unexpected Cause of Tension Pneumothorax: A Case Report.","authors":"Mehmet Nur Talay, Ahmet Sızlanan, Emre Güngör, Ferhat Kalkan, Özhan Orhan, Halime Nayır Büyüksahin","doi":"10.1002/ppul.71321","DOIUrl":"https://doi.org/10.1002/ppul.71321","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71321"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186496","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":"Survey Validation of Exercise and Body Composition Testing and Exercise Training Programs for People With Cystic Fibrosis: A Delphi Study.","authors":"Najlaa Z Alotaibi, Donald H Lein, Hon K Yuen, Ryan A Harris, Stefanie Krick, Eric P Plaisance, John D Lowman","doi":"10.1002/ppul.71262","DOIUrl":"https://doi.org/10.1002/ppul.71262","url":null,"abstract":"<p><strong>Background: </strong>Exercise is an important part of a healthy lifestyle for people with cystic fibrosis (CF). Exercise testing is also recommended as part of a routine assessment to provide physical activity counseling/exercise prescription. Body composition assessment is also an important assessment that can also guide dietary counseling. Prior studies have found that exercise testing and exercise training programs are underutilized in CF care centers, and no one has assessed the prevalence of body composition assessment. Thus, the purpose of this study was to develop and validate a survey to explore the barriers and facilitators that obstruct or promote the use of exercise and body composition testing in the CF care centers.</p><p><strong>Methods: </strong>Seventy-nine individuals with expertise in exercise and CF were invited to participate in a Delphi study. They rated the importance and quality of a 106-item survey on exercise and body composition testing and exercise training and shared their feedback.</p><p><strong>Results: </strong>Thirteen subject matter experts agreed to participate in the study, which lasted three rounds, but only six of them were in the final round. Of the 106 original items, 46 were kept with revisions, 58 were revised, 2 items were dropped, and 8 items were added, resulting in a final survey of 114 items.</p><p><strong>Conclusions: </strong>This Delphi study validated a survey to be used in CF care centers to provide valuable information about the benefits and barriers to exercise testing, exercise training, and body composition assessment in people with CF in the CFTR-modulator era.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71262"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006494","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":"Atypical Pneumonia Mimicking Childhood Interstitial Lung Disease With Imaging Findings: A Case Report.","authors":"Mehmet Adnan Öncül, Halime Nayır Büyüksahin, Eylem Unay, Özhan Orhan, Gökalp Çıkman, Asuman Demirbuga, Mehmet Nuri Özbek","doi":"10.1002/ppul.71315","DOIUrl":"https://doi.org/10.1002/ppul.71315","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71315"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186511","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":"Pediatric Sleep-Disordered Breathing Year in Review 2024.","authors":"Vincent Lavoie, Jean-Paul Praud","doi":"10.1002/ppul.71304","DOIUrl":"10.1002/ppul.71304","url":null,"abstract":"<p><strong>Background: </strong>Numerous articles on pediatric sleep-disordered breathing were published in the medical literature in 2024. While not intended to be exhaustive, this review aims to spark interest within the scientific community focused on pediatric sleep-disordered breathing.</p><p><strong>Methods: </strong>It briefly summarizes recent advances in the diagnosis and screening of obstructive sleep-disordered breathing (SDB), the pathophysiology of obstructive SDB, and its treatment, including home mechanical respiratory support.</p><p><strong>Conclusion: </strong>The goal is to provide some of the latest and most relevant information from 2024 to support the clinical care of children affected by sleep-disordered breathing.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":"60 9","pages":"e71304"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086654","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}