Laura Ojanperä, Lauri Lehtimäki, Heini Huhtala, Péter Csonka
{"title":"Inhaled corticosteroid delivery is markedly affected by breathing pattern and valved holding chamber model.","authors":"Laura Ojanperä, Lauri Lehtimäki, Heini Huhtala, Péter Csonka","doi":"10.1002/ppul.27300","DOIUrl":"https://doi.org/10.1002/ppul.27300","url":null,"abstract":"<p><strong>Background: </strong>There is a scarcity of high-quality research on the efficient delivery of inhaled corticosteroids using valved holding chambers (VHCs) in children.</p><p><strong>Methods: </strong>The delivered dose (DD) of fluticasone from a metered dose inhaler (pMDI) was tested using four VHCs: AeroChamber plus Flow-Vu (AC), Babyhaler (BH), EasyChamber (EC), and Optichamber Diamond (OD). The in vitro setup included an anatomical child throat model, Next Generation Impactor, and a breathing simulator to generate tidal breathing of a four and a 6-year-old child, and adult type single inhalation.</p><p><strong>Results: </strong>OD showed the lowest proportion of fluticasone trapped in the throat with all breathing patterns. AC showed similar fine particle dose (FPD) in the respirable range (1-5 µm) irrespective of the breathing pattern. For BH, the median FPD 1-5 µm was highest during adult breathing. OD and EC showed higher overall DD and higher doses in the 1-5 µm range with paediatric breathing profiles compared to adult inhalation. The median DD and FPD 1-5 µm were significantly lower with BH compared to any other VHCs during tidal breathing. Compared to EC, the FPD of the other VHCs were skewed towards <2 µm particles.</p><p><strong>Conclusion: </strong>Fluticasone delivery is markedly affected by breathing pattern and VHC model. The observed differences in throat deposition and FPD delivered may have significant clinical implications for side effects and controlling airway inflammation. All VHCs intended for paediatric use should undergo testing using internationally recognised standardised methods incorporating clinically relevant paediatric breathing patterns.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351752","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":"Striving for healthy lungs: Enhancing respiratory outcomes of prematurity.","authors":"Amir Kugelman","doi":"10.1002/ppul.27309","DOIUrl":"https://doi.org/10.1002/ppul.27309","url":null,"abstract":"<p><p>Infants born prematurely are born in a critical developmental time period and because of arrest of lung maturation at that period their pulmonary functions are below the normal for their age. Early lung development has a lifelong effect on respiratory health and disease. Can we affect that sequence of events and change the outcome of chronic lung disease of prematurity?</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351758","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":"Saving lives, one breath at a time: The key role of noninvasive ventilation interfaces.","authors":"Jean-Paul Praud","doi":"10.1002/ppul.27306","DOIUrl":"https://doi.org/10.1002/ppul.27306","url":null,"abstract":"<p><p>Home noninvasive ventilation (NIV) for children must consider the key role of the interface, in addition to selecting the ventilatory mode and settings. Acceptance and adherence to NIV often depend on the time spent selecting the right mask, as well as on regular and careful attention to preventing and addressing various issues that arise during NIV.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351757","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}
Georgia Apostolou, Monica S Cooper, Giuliana Antolovich, Moya Vandeleur, Katherine B Frayman
{"title":"The management of Pseudomonas aeruginosa respiratory infection in children with cerebral palsy: A narrative review.","authors":"Georgia Apostolou, Monica S Cooper, Giuliana Antolovich, Moya Vandeleur, Katherine B Frayman","doi":"10.1002/ppul.27284","DOIUrl":"https://doi.org/10.1002/ppul.27284","url":null,"abstract":"<p><p>Children with cerebral palsy have increased respiratory morbidity and mortality. Infection with Pseudomonas aeruginosa (PA) is associated with poorer outcomes, yet there are no formal guidelines to inform treatment of respiratory infection in children with cerebral palsy. This review explores the existing literature regarding management of PA-infection in children with cerebral palsy, with the aim of synthesising clinical recommendations and identifying gaps in current understanding. Medline (Ovid), PubMed and Embase were searched using keywords. Full-text articles involving the paediatric population and antimicrobial therapy were included. There was no limit on date of publication. Four retrospective case series were identified. Respiratory microbiology, in samples collected from a range of sites along the respiratory tract, was reported in three studies. Patients who received PA-specific antibiotics clinically improved. Two studies suggest that the use of suppressive inhaled anti-pseudomonal therapy may improve respiratory morbidity in the chronic setting. There is minimal evidence to guide management of PA respiratory infection in children with cerebral palsy. Children with cerebral palsy are at risk of developing bronchiectasis, so in the absence of high-quality evidence, management should be informed by extrapolating from the non-cystic fibrosis bronchiectasis guidelines. Further research examining surveillance and management of PA-infection in this population is required given that early intervention may prevent irreversible lung damage.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351784","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":"Recurrent wheezing and asthma-Epidemiology and environmental determinants.","authors":"Adaeze C Ayuk","doi":"10.1002/ppul.27301","DOIUrl":"https://doi.org/10.1002/ppul.27301","url":null,"abstract":"<p><p>Wheeze is the musical continuous sound produced by oscillations in any critically narrowed airways, and heard mostly on expiration. It is common in preschool age, about half of all children will experience an episode of wheezing by their sixth birthday. Asthma is usually characterized by cough, wheeze, chest tightness and fast breathing. It is a significant global health issue and affects both children and adults. The prevalence is on the increase, especially in LMIC. Studies from different populations have revealed the key role influencing the progression from preschool wheezing to childhood asthma. Recurrent wheezing is four or more episodes in the preceding year and has a spectrum of phenotypes and with heterogeneous features. Phenotypes of wheezing were proposed to facilitate the identification of young children who are at risk of subsequent development of asthma. The epidemiology and environmental determinants of recurrent wheezing and asthma are discussed.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351756","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":"Complications and long-term impact of early life pneumonia.","authors":"Adaeze C Ayuk","doi":"10.1002/ppul.27299","DOIUrl":"https://doi.org/10.1002/ppul.27299","url":null,"abstract":"<p><p>Pneumonia is an infection affecting the lower airway, where the air sacs are filled with mucus and pus; and typically presents with cough, fever, and fast breathing. Pneumonia is estimated to be the leading cause of mortality in children under five worldwide with 120 million episodes result in 1 million deaths globally. The Low-Income and Middle-Income Countries (LMICs) are more affected. In a study in southeast Nigeria, bronchopneumonia accounted for 41.9%, of the cases admitted in the tertiary hospitals and in another hospital based study among children, pneumonia had the highest respiratory admission rates at 34.0%. Pneumonia can be caused by various organisms: Bacterial (Streptococcus, staphylococcus etc), Viral (RSV) and recently COVID 19 pneumonia. RSV has been noted globally to be a major cause of childhood lower respiratory tract infection, with morbidity/mortality occurring in 99% of (LMICs). Some of the long term sequalae are discussed.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351750","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}
Kylie M Bushroe, Kelly D Crisp, Ashley J Housten, Mary C Politi
{"title":"Pilot testing of \"A NICU guide to tracheostomy\".","authors":"Kylie M Bushroe, Kelly D Crisp, Ashley J Housten, Mary C Politi","doi":"10.1002/ppul.27283","DOIUrl":"https://doi.org/10.1002/ppul.27283","url":null,"abstract":"","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351755","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":"Neurally adjusted ventilatory assist (NAVA) in neonatal and pediatric critical care-A scoping review of randomized controlled trials.","authors":"Ilari Kuitunen, Markus Rannankari, Kati Räsänen","doi":"10.1002/ppul.27293","DOIUrl":"https://doi.org/10.1002/ppul.27293","url":null,"abstract":"<p><p>We Aimed to analyze for which indications neurally adjusted ventilatory assist (NAVA) has been studied in pediatric patients by conducting a scoping review. PubMed, Scopus, and Web of Science databases were searched in September 2023. We included all randomized trials (including crossover, parallel, and cluster) comparing NAVA to other invasive ventilation modalities in children aged <18 years. We had three key outcomes. What have been the patient and disease groups where NAVA has been studied? What kind of trials and what has been the risk of bias in these randomized trials? What have been the most used outcomes and main findings? The risk of bias was assessed according to the risk of bias 2.0 tool. This review has been reported as preferred in PRISMA-ScR guidelines. After screening 367 abstracts, 27 full reports were assessed and finally 13 studies were included. Six studies were conducted in neonates and seven in older pediatric patients. Ten of the studies were crossover and three were parallel randomized. Overall risk of bias was low in two studies, had some concerns in six studies, and was high in five studies. Most issues came from the randomization process and bias in the selection of reported results. Most used outcomes were changes in clinical parameters or measurements (such as ventilation peak and mean airway pressures, oxygenation index), and ventilator synchrony. Three parallel group trials focused on ventilation duration. The majority of the studies found NAVA as a possible alternative ventilation strategy. Although NAVA is a widely used strategy in neonatal and pediatric intensive care the current literature has notable limitations due to the risk of bias in the original studies and lack of parallel studies focusing on clinical or cost-effectiveness outcomes.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351754","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}
Phuc Huu Phan, Hanh My Thi Tran, Canh Ngoc Hoang, Thang Van Nguyen, Bin Huey Quek, Jan Hau Lee
{"title":"The epidemiology of critical respiratory diseases in ex-premature infants in Vietnam: A prospective single-center study.","authors":"Phuc Huu Phan, Hanh My Thi Tran, Canh Ngoc Hoang, Thang Van Nguyen, Bin Huey Quek, Jan Hau Lee","doi":"10.1002/ppul.27289","DOIUrl":"https://doi.org/10.1002/ppul.27289","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to describe the epidemiology and etiologies of critical respiratory diseases of ex-premature infants (EPIs) admitted to the Pediatric Intensive Care unit (PICU).</p><p><strong>Methods: </strong>Infants ≤2 years old with acute respiratory illnesses admitted to PICU of Vietnam National Children's Hospital from November 2019 to April 2021 were enrolled and followed up to hospital discharge. We compared respiratory pathogens, outcomes, and PICU resources utilized between EPIs and term infants. Among EPIs, we described clinical characteristics and evaluated the association between associated factors and mortality.</p><p><strong>Results: </strong>Among 1183 patients, aged ≤2 years were admitted for critical respiratory illnesses, 202 (17.1%) were EPIs. Respiratory viruses were detected in 53.5% and 38.2% among EPIs and term infants, respectively. Compared to term infants, a higher proportion of EPIs required mechanical ventilation (MV) (85.6 vs. 66.5%, p < .005) and vasopressor support (37.6 vs. 10.7%%, p < .005). EPIs had a higher median PICU length of stay (11.0 [IQR: 7; 22] vs. 6.0 days [IQR: 3; 11], p = .09), hospital length of stay (21.5 [IQR: 13; 40] vs. 10.0 days [IQR: 5; 18], p < .005) and case fatality rate (31.3% vs. 22.6%) compared to term infants. Among EPIs, PIM-3 score (adjusted odds ratio [aOR]: 1.51; 95% confidence interval [CI]: 1.30-1.75) and PELOD-2 score at admission (aOR: 1.41; 95% CI: 1.08-1.85) were associated with mortality.</p><p><strong>Conclusions: </strong>EPIs with critical respiratory illnesses constituted a significant population in the PICU, required more PICU support, and had worse clinical outcomes compared to term infants.</p>","PeriodicalId":19932,"journal":{"name":"Pediatric Pulmonology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351783","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}