Pediatric Respiratory Disease Research Articles

Pediatric Respiratory Hospitalizations in the Pre-COVID-19 Era: The Contribution of Viral Pathogens and Comorbidities to Clinical Outcomes, Valencia, Spain.

Viral respiratory diseases place a heavy burden on the healthcare system, with children making up a significant portion of related hospitalizations. While comorbidities increase the risk of complications and poor outcomes, many hospitalized children lack clear risk factors. As new vaccines for respiratory viral diseases emerge, this study examined pediatric respiratory hospitalizations, focusing on viral etiology, complication rates, and the impact of comorbidities to guide future policy. Data were analyzed from eight pre-COVID influenza seasons (2011/2012-2018/2019) involving patients under 18 years hospitalized with respiratory complaints across 4-10 hospitals in Valencia, Spain. Respiratory specimens were tested for eight viral targets using multiplex real-time reverse-transcription polymerase chain reaction. Demographics, clinical outcomes, discharge diagnoses, and laboratory results were examined. Among the hospitalized children, 26% had at least one comorbidity. These children had higher rates of pneumonia, asthma exacerbation, and pneumothorax, and were twice as likely to require ICU admission, though mechanical ventilation and length of stay were similar to those without comorbidities. Respiratory syncytial virus (RSV) was the most common virus detected (23.1%), followed by rhinovirus/enterovirus (9.5%) and influenza (7.2%). Viral codetection decreased with age, occurring in 4.6% of cases. Comorbidities increase the risk of complications in pediatric respiratory illnesses, however, healthcare utilization is driven largely by otherwise healthy children. Pediatric viral vaccines could reduce this burden and should be further evaluated.

Clinical characteristics of Chinese children with EV-D68-associated pneumonia: A single-center retrospective analysis.

Human enterovirus D68 (EV-D68) has been associated with an increase in mild-to-severe pediatric respiratory diseases in western countries. However, the prevalence and clinical characteristics of EV-D68-associated pneumonia in China remain understudied. Between January 2022 and January 2024, 28 patients with EV-D68-associated pneumonia were enrolled. We described the prevalence, demographic, and clinical characteristics of patients with EV-D68-associated pneumonia. Among the 28 enrolled patients, the male-to-female ratio was 1.5:1, and the average age at onset was 4.6 ± 2.7 years. Four (14.3%) required intensive care support. Monoinfection occurred in 11 cases (39.3%), while coinfections were seen in 17 cases (60.7%). 82.1% of patients had a history of one or more atopic diseases. The primary symptoms of EV-D68-associated pneumonia included cough (100%), wheezing (53.6%), and fever (53.6%). Radiologically, patchy opacity was the predominant feature, observed in 72.7% of cases. No statistically significant differences were found in symptoms, laboratory tests, or imaging findings between the monoinfection and coinfection groups. Except for one case who developed quadriplegia sequelae, all patients had a favorable prognosis. EV-D68 is not a common pathogen for community-acquired pneumonia in China. It mainly affects young children, particularly those with atopic constitution. The overall prognosis is favorable, although neurological complications are rare and may lead to severe sequelae. This study is the first investigation into the prevalence and clinical characteristics of EV-D68-associated pneumonia in China.

Features of the impact of the COVID-19 pandemic on the prevalence of certain respiratory diseases of infections etiology

The aim of the study was to assess the impact of the COVID-19 pandemic on the incidence of respiratory infections of the population of Penza region in different age groups. Material and methods. The analysis of statistical reporting data (Form 12) on the number of diseases in the service area of the medical organization in Penza region was carried out. Information was sampled on respiratory diseases of infectious etiology for the period from 2015 to 2022 and on COVID-19 morbidity in the period from 2020 to 2022 among patients of different age periods. The data is presented as a calculation per 100 thousand population. Results. In 2020, compared to 2019, there was a pronounced increase in the number of respiratory diseases (p = 0.000) in adults; in 2021, the incidence decreased slightly, being higher until 2022 than in the period before the pandemic (p = 0.000). Among children and adults, there was an increase in the incidence of acute respiratory infections in 2022 compared to 2015 (p < 0.001). Peak incidence of croup and epiglottitis among children and adolescents was observed in 2020. The incidence of COVID-19 among adolescents (8339.6) and adults (7678.5) was significantly higher than the incidence among children (5949.9) (p = 0.000). Discussion. Respiratory diseases of infectious etiology have an acute course, so primary morbidity predominates. In adults, the proportion of primary morbidity is decreasing, which may be related to an increase in chronic diseases of the respiratory system. The weak impact of the pandemic on pediatric respiratory diseases incidence is supported by the low pediatric incidence of COVID-19. The increased incidence of COVID-19 among adolescents is alarming; it supports the assumption that child and young adult populations have proven to be major gateways for the spread of COVID-19 to adults. The high incidence of croup and epiglottitis in 2020 among children (p = 0.024) and adolescents could be one of the symptoms of COVID-19 characteristic of younger age. Conclusions. COVID-19 had no effect on the increase in respiratory disease among children, but children contributed to the spread of infection among adults. There is a trend towards an increase in chronic respiratory disease in adults. RBD of infectious etiology is almost impossible to predict, except for acute laryngitis and tracheitis among adults. In adolescents and children against the background of COVID-19 infection, a large number of more severe symptoms may appear.

Next-generation pediatric care: nanotechnology-based and AI-driven solutions for cardiovascular, respiratory, and gastrointestinal disorders.

Global pediatric healthcare reveals significant morbidity and mortality rates linked to respiratory, cardiac, and gastrointestinal disorders in children and newborns, mostly due to the complexity of therapeutic management in pediatrics and neonatology, owing to the lack of suitable dosage forms for these patients, often rendering them "therapeutic orphans". The development and application of pediatric drug formulations encounter numerous challenges, including physiological heterogeneity within age groups, limited profitability for the pharmaceutical industry, and ethical and clinical constraints. Many drugs are used unlicensed or off-label, posing a high risk of toxicity and reduced efficacy. Despite these circumstances, some regulatory changes are being performed, thus thrusting research innovation in this field. Up-to-date peer-reviewed journal articles, books, government and institutional reports, data repositories and databases were used as main data sources. Among the main strategies proposed to address the current pediatric care situation, nanotechnology is specially promising for pediatric respiratory diseases since they offer a non-invasive, versatile, tunable, site-specific drug release. Tissue engineering is in the spotlight as strategy to address pediatric cardiac diseases, together with theragnostic systems. The integration of nanotechnology and theragnostic stands poised to refine and propel nanomedicine approaches, ushering in an era of innovative and personalized drug delivery for pediatric patients. Finally, the intersection of drug repurposing and artificial intelligence tools in pediatric healthcare holds great potential. This promises not only to enhance efficiency in drug development in general, but also in the pediatric field, hopefully boosting clinical trials for this population. Despite the long road ahead, the deepening of nanotechnology, the evolution of tissue engineering, and the combination of traditional techniques with artificial intelligence are the most recently reported strategies in the specific field of pediatric therapeutics.

Influenza C virus in U.S. children with acute respiratory infection 2016–2019

Influenza C virus (ICV) is an orthomyxovirus related to influenza A and B, yet due to few commercial assays, epidemiologic studies may underestimate incidence of ICV infection and disease. We describe the epidemiology and characteristics of ICV within the New Vaccine Surveillance Network (NVSN), a Centers for Disease Control and Prevention (CDC)-led network that conducts population-based surveillance for pediatric acute respiratory illness (ARI). Nasal or/combined throat swabs were collected from emergency department (ED) or inpatient ARI cases, or healthy controls, between 12/05/2016–10/31/2019 and tested by molecular assays for ICV and other respiratory viruses. Parent surveys and chart review were used to analyze demographic and clinical characteristics of ICV+ children. Among 19,321 children tested for ICV, 115/17,668 (0.7 %) ARI cases and 8/1653 (0.5 %) healthy controls tested ICV+. Median age of ICV+ patients was 18 months and 88 (71.5 %) were ≤36 months. Among ICV+ ARI patients, 40 % (46/115) were enrolled in the ED, 60 % (69/115) were inpatients, with 15 admitted to intensive care. Most ICV+ ARI patients had fever (67.8 %), cough (94.8 %), or wheezing (60.9 %). Most (60.9 %) ARI cases had ≥1 co-detected viruses including rhinovirus, RSV, and adenovirus. In summary, ICV detection was rarely associated with ARI in children, and most ICV+ patients were ≤3 years old with co-detected respiratory viruses.

Potentially Avoidable Emergency Department Transfers for Acute Pediatric Respiratory Illness

BackgroundAcute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness. MethodsCross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other URI, bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates. ResultsAmong 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI (OR 2.72 (2.09–3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% CI 0.26–0.88). ConclusionsPediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.

Three-Stage Framework for Accurate Pediatric Chest X-ray Diagnosis Using Self-Supervision and Transfer Learning on Small Datasets.

Pediatric respiratory disease diagnosis and subsequent treatment require accurate and interpretable analysis. A chest X-ray is the most cost-effective and rapid method for identifying and monitoring various thoracic diseases in children. Recent developments in self-supervised and transfer learning have shown their potential in medical imaging, including chest X-ray areas. In this article, we propose a three-stage framework with knowledge transfer from adult chest X-rays to aid the diagnosis and interpretation of pediatric thorax diseases. We conducted comprehensive experiments with different pre-training and fine-tuning strategies to develop transformer or convolutional neural network models and then evaluate them qualitatively and quantitatively. The ViT-Base/16 model, fine-tuned with the CheXpert dataset, a large chest X-ray dataset, emerged as the most effective, achieving a mean AUC of 0.761 (95% CI: 0.759-0.763) across six disease categories and demonstrating a high sensitivity (average 0.639) and specificity (average 0.683), which are indicative of its strong discriminative ability. The baseline models, ViT-Small/16 and ViT-Base/16, when directly trained on the Pediatric CXR dataset, only achieved mean AUC scores of 0.646 (95% CI: 0.641-0.651) and 0.654 (95% CI: 0.648-0.660), respectively. Qualitatively, our model excels in localizing diseased regions, outperforming models pre-trained on ImageNet and other fine-tuning approaches, thus providing superior explanations. The source code is available online and the data can be obtained from PhysioNet.

Approach to the patient with Childhood Interstitial and Diffuse Lung Disease.

Childhood Interstitial and Diffuse Lung Disease (chILD) encompasses a group of rare, chronic lung disorders in infants and children with overlapping clinical features but diverse etiologies. The clinical presentation of chILD is of chronic or recurring respiratory signs and symptoms, often including increased work of breathing and hypoxia, with diffuse radiographic abnormalities on chest imaging. Recognition can be challenging since some clinical features overlap with those of more common pediatric respiratory diseases including asthma and recurrent viral infections, among others. chILD should be considered as an underlying diagnosis when a patient's respiratory symptoms seem disproportionate to the clinical scenario and/or persist. The diagnostic process involves multiple steps and is tailored to the individual patient. Nearly all children will undergo imaging and pulmonary function testing, many will undergo bronchoscopy with bronchoalveolar lavage, many will receive genetic testing, and some will require lung biopsy. Treatment includes preventive care, evaluation for comorbidities, pharmacotherapy according to diagnosis, and ongoing disease surveillance, including revisiting genetic and histopathologic results as new clinical information becomes available and as our understanding of these rare disorders improves. The purpose of this review is to provide a broad approach to the diagnosis and management of patients with chILD.

New noninvasive modalities in long-term pediatric ventilation: a scoping review.

Long-term noninvasive ventilation modalities for the pediatric population have undergone a continuous evolution. Hybrid noninvasive ventilation modalities have been recently introduced in clinical practice. Combining the advantages of conventional ventilation, hybrid modes use algorithms that automatically adjust the ventilator's settings to achieve a predefined ventilation target. Most of the recommendations on the use and settings of hybrid noninvasive ventilation modalities in children are derived from adult experience. Therefore, there is a lack of evidence on its implementation in pediatric chronic respiratory diseases. This scoping review aims to map the existing information regarding the use of hybrid ventilation modalities in the pediatric population and identify knowledge or research gaps. We performed a literature search using MEDLINE and Pubmed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We included 13 studies (ten studies on average volume-assured pressure-support ventilation; two studies on intelligent volume-assured pressure-support ventilation; and one study on adaptive servoventilation). The use of new noninvasive ventilation modes in the pediatric population has been applied for the treatment of neuromuscular and hypoventilation syndromes as an alternative therapeutic option in the case of the failure of conventional noninvasive ventilation. Their widespread use has been hampered by the limited evidence available. Longitudinal studies on a larger number of patients are needed to confirm their effectiveness and evaluate their long-term clinical and functional outcomes.

Comparative Study on the Effect of Different Modes of Administration of Ambroxol Hydrochloride in the Treatment of Pediatric Respiratory Diseases

Objective: To investigate the comparison of the effects of intravenous infusion of Ambroxol Hydrochloride and nebulized inhalation in the treatment of pediatric respiratory diseases. Methods: 188 children with respiratory diseases admitted to the pediatrics department of the hospital from September 2022 to March 2024 were selected as the study subjects, and were randomly divided into the control group (n = 41) and the observation group (n = 41) according to the random number table method. Both groups of patients were first treated with conventional treatment, and based on conventional treatment, the control group was treated with intravenous infusion of Ambroxol Hydrochloride, and the observation group was treated with nebulized inhalation of Ambroxol Hydrochloride. The general information, clinical symptom improvement time, oxygen therapy time, sputum aspiration frequency, hospitalization time, and the occurrence of adverse reactions were observed in the two groups. Results: The baseline data of the two groups of patients were not statistically significant (P > 0.05); the disappearance time of clinical symptoms such as cough, lung rales, and shortness of breath in the observation group was shorter than that in the control group (t = 8.739, t = 10.108, t = 19.448, P < 0.001); the time of oxygen therapy, number of sputum aspirations, and hospital stay of the patients in the observation group were significantly shorter than that of the control group (t = 10.593, t = 10.665, t = 14.673, all P < 0.001); the total incidence of adverse reactions in patients in the observation group (3/3.18%) was significantly lower than that in the control group (14/14.89%) (x2 = 7.825, P = 0.005 < 0.01). Conclusion: In the treatment of pediatric respiratory diseases with Ambroxol Hydrochloride, nebulized inhalation has better efficacy than intravenous drip, and can better improve the clinical symptoms and reduce the side effects in children.

Pediatric respiratory infectious emergencies: clinical profiles and outcomes.

Infectious diseases are among the most frequent causes of hospital admission and a substantial contributor to morbidity and mortality. These diseases pose a persistent concern, particularly within the pediatric population, where delays or inappropriate management can result in serious harm. Additionally, infectious diseases contribute to overcrowding in pediatric emergency departments (EDs). This study aimed to explore the epidemiology, clinical presentation, diagnostics, outcome, and social and behavioral impacts of infectious diseases on child health. We conducted a retrospective, single-hospital study at a tertiary care center that is publicly funded and owned to serve the entire community. Pediatric patients with at least one or more chief complaints related to the respiratory system or infectious etiology were included. Data analysis was performed using SPSS to assess relationships between variables. A total of 15,106 patients were included, with a mean age of 3.80 years. The largest age group was toddlers (42.8%). Most cases (71.9%) were classified as urgent (Priority 3). Regarding patient outcomes, 76.1% were discharged after receiving appropriate treatment in the ED, and 22.9% required admission for further management. Nearly 38% of patients presented with a single complaint. Fever was the most frequent complaint across all groups. In summary, this study provides insights into the presentation of pediatric respiratory infectious diseases in the emergency room. The study revealed that toddlers were the most affected age group, with fever and cough being the common symptoms.

The Greatest Challenges of Pediatric Critical Care Pulmonology in the After-COVID Era: A Narrative Review

Abstract The COVID pandemic has had a profound effect on pediatric intensive care and especially on pediatric critical care pulmonology. The indirect impacts caused by the most profound global healthcare challenge in a generation continue to define the current post-COVID era. This era is characterized by postpandemic surges in acute pediatric respiratory illness, disruption of seasonal disease patterns, and an apparent increase in disease severity with a rise in complicated pneumonia as well as associated severe sepsis and septic shock. The consequent demand is met by pediatric intensive care units that are recovering from the strain of the pandemic but also building on progress made during a time of great challenges.

Impact of the COVID-19 Pandemic on Inpatient Pediatric Medical Student Education in Hawai'i.

The COVID-19 pandemic has had many effects on medical student education, ranging from safety measures limiting patient exposure to changes in patient diagnoses encountered by medical students in their clerkship experience. This study aimed to identify the impact of the pandemic on the inpatient experiences of third- and fourth-year medical students by assessing patient volumes and diagnoses seen by students. Frequency and types of notes written by medical students on hospital-based pediatric rotations at Kapi'olani Medical Center for Women and Children as well as patient diagnoses and ages were compared between 2 time periods: pre-pandemic (July 2018-February 2020) and pandemic (May 2020-September 2021). On average, the number of patients seen by medical students was significantly reduced in the pandemic period from 112 patients/month to 88 patients/month (P=.041). The proportion of patients with bronchiolitis or pneumonia were also significantly reduced in the pandemic period (P<.001). Bronchiolitis was diagnosed in 1.3% of patients seen by medical students during the pandemic period, compared with 5.9% of patients pre-pandemic. Pneumonia was diagnosed in 1.0% of patients seen by medical students in the pandemic period compared with 4.6% pre-pandemic. There was no significant difference in patient age between the 2 groups (P=.092). During the first 18 months of the COVID-19 pandemic, medical students in this institution had a remarkably different inpatient experience from that of their predecessors. They saw fewer patients, and those patients had fewer common pediatric respiratory diseases. These decreases suggest these students may require supplemental education to compensate for these gaps in direct pediatric clinical experience.

The Effectiveness of a Dietary Supplement with Honey, Propolis, Pelargonium sidoides Extract, and Zinc in Children Affected by Acute Tonsillopharyngitis: An Open, Randomized, and Controlled Trial.

Physicians are currently finding products for pediatric respiratory diseases of viral etiology to reduce the inappropriate use of antibiotic therapy. This study evaluated PediaFlù (Pediatrica S.r.l.), a dietary supplement already on the market composed of honey, propolis, Pelargonium sidoides extract, and zinc (DSHPP), in children affected by acute tonsillopharyngitis (ATR). The open-label, randomized, and controlled study compared DSHPP + standard of care (SoC) versus SoC alone for six days. Children between 3 and 10 years with an ATR ≤ 48 h, a negative rapid test for beta-hemolytic Streptococcus, or a culture identification of nasal and/or pharyngeal exudates were included. A tonsillitis severity score (TSS) and the number of treatment failures (using ibuprofen or high-dose paracetamol as rescue medication) were the primary endpoints. DSHPP+ SoC showed better performance than SoC alone for TSS sub-scores: throat pain and erythema on day 6 (p < 0.001 and p < 0.05), swallowing (p < 0.01 on day 4), and TSS total score on days 4 and 6 (p < 0.05 and p < 0.001). Only one patient (SoC group) had treatment failure for ibuprofen administration. No adverse events were reported. DSHPP is an optimal adjuvant in the treatment of URTI and could potentially be useful in the daily clinical practice of paediatricians evaluating the correct antibiotic prescription.

Intranasal respiratory syncytial virus vaccine attenuated by codon-pair deoptimization of seven open reading frames is genetically stable and elicits mucosal and systemic immunity and protection against challenge virus replication in hamsters.

Respiratory syncytial virus (RSV) is the most important viral agent of severe pediatric respiratory illness worldwide, but there is no approved pediatric vaccine. Here, we describe the development of the live-attenuated RSV vaccine candidate Min AL as well as engineered derivatives. Min AL was attenuated by codon-pair deoptimization (CPD) of seven of the 11 RSV open reading frames (ORFs) (NS1, NS2, N, P, M, SH and L; 2,073 silent nucleotide substitutions in total). Min AL replicated efficiently in vitro at the permissive temperature of 32°C but was highly temperature sensitive (shut-off temperature of 36°C). When serially passaged at increasing temperatures, Min AL retained greater temperature sensitivity compared to previous candidates with fewer CPD ORFs. However, whole-genome deep-sequencing of passaged Min AL revealed mutations throughout its genome, most commonly missense mutations in the polymerase cofactor P and anti-termination transcription factor M2-1 (the latter was not CPD). Reintroduction of selected mutations into Min AL partially rescued its replication in vitro at temperatures up to 40°C, confirming their compensatory effect. These mutations restored the accumulation of positive-sense RNAs to wild-type (wt) RSV levels, suggesting increased activity by the viral transcriptase, whereas viral protein expression, RNA replication, and virus production were only partly rescued. In hamsters, Min AL and derivatives remained highly restricted in replication in the upper and lower airways, but induced serum IgG and IgA responses to the prefusion form of F (pre F) that were comparable to those induced by wt RSV, as well as robust mucosal and systemic IgG and IgA responses against RSV G. Min AL and derivatives were fully protective against challenge virus replication. The derivatives had increased genetic stability compared to Min AL. Thus, Min AL and derivatives with selected mutations are stable, attenuated, yet highly-immunogenic RSV vaccine candidates that are available for further evaluation.

Epidemic features and megagenomic analysis of childhood Mycoplasma pneumoniae post COVID-19 pandemic: a 6-year study in southern China

ABSTRACT With the atypical rise of Mycoplasma pneumoniae infection (MPI) in 2023, prompt studies are needed to determine the current epidemic features and risk factors with emerging trends of MPI to furnish a framework for subsequent investigations. This multicentre, retrospective study was designed to analyse the epidemic patterns of MPI before and after the COVID-19 pandemic, as well as genotypes and the macrolide-resistance-associated mutations in MP sampled from paediatric patients in Southern China. Clinical data was collected from 1,33,674 patients admitted into investigational hospitals from 1 June 2017 to 30 November 2023. Metagenomic next-generation sequencing (mNGS) data were retrieved based on MP sequence positive samples from 299 paediatric patients for macrolide-resistance-associated mutations analysis. Pearson's chi-squared test was used to compare categorical variables between different time frames. The monthly average cases of paediatric common respiratory infection diseases increased without enhanced public health measures after the pandemic, especially for influenza, respiratory syncytial virus infection, and MPI. The contribution of MPI to pneumoniae was similar to that in the outbreak in 2019. Compared to mNGS data between 2019–2022 and 2023, the severity of MP did not grow stronger despite higher rates of macrolide-resistance hypervariable sites, including loci 2063 and 2064, were detected in childhood MP samples of 2023. Our findings indicated that ongoing surveillance is necessary to understand the impact of post pandemic on MP transmission disruption during epidemic season and the severity of clinical outcomes in different scenarios.

Impact of climate change on paediatric respiratory health: pollutants and aeroallergens.

Paediatric populations are particularly vulnerable to respiratory diseases caused and exacerbated by aeroallergens, pollutants and infectious agents. Worsening climate change is expected to increase the prevalence of pollutants and aeroallergens while amplifying disease severity and causing disproportionate effects in under-resourced areas. The purpose of this narrative review is to summarise the role of anthropogenic climate change in the literature examining the future impact of aeroallergens, pollutants and infectious agents on paediatric respiratory diseases with a focus on equitable disease mitigation. The aeroallergens selected for discussion include pollen, dust mites and mould as these are prevalent triggers of paediatric asthma worldwide. Human rhinovirus and respiratory syncytial virus are key viruses interacting with climate change and pollution and are primary causal agents of viral respiratory disease. Within this review, we present the propensity for aeroallergens, climate change and pollution to synergistically exacerbate paediatric respiratory disease and outline measures that can ameliorate the expected increase in morbidity and severity of disease through a health equity lens. We support shifting from fossil fuels to renewable energy worldwide, across sectors, as a primary means of reducing increases in morbidity.

Feasibility of Home-Based Pulmonary Rehabilitation of Pediatric Patients with Chronic Respiratory Diseases.

Chronic respiratory diseases in children deteriorate their daily life due to dyspnea and reduced lung function. We aimed to evaluate the feasibility of home-based pulmonary rehabilitation in pediatric chronic respiratory diseases. This prospective, single-arm, cohort study included children with chronic lung disease. They were instructed to perform home-based pulmonary rehabilitation 30 min/session, three sessions/week for three months. Pulmonary function test (PFT) using spirometry, respiratory muscle strength (RMT), cardiopulmonary exercise test (CPET), 6 min walk test (6MWT), dyspnea questionnaires, speech evaluation, and pediatric quality of life inventory (PedsQL) were assessed pre- and post-pulmonary rehabilitation. Compliance and satisfaction of the program were also evaluated. Twenty children (mean age: 11.2 ± 3.1 years) with chronic respiratory diseases without cardiopulmonary instability participated. The overall compliance was 71.1% with no related adverse events. After pulmonary rehabilitation, forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), RMT, 6MWT, dyspnea questionnaire, speech rate, and PedsQL (child) significantly improved (p < 0.05), particularly better in the FEV1 < 60% group than in the FEV1 ≥ 60% group and in the high-compliance group (compliance ≥ 50%) than in the low-compliance group (compliance < 50%). Home-based pulmonary rehabilitation for children with chronic lung disease was feasible with high compliance and effective in terms of objective functions, subjective dyspnea symptom, and quality of life.

Removal of airway foreign body using flexible bronchoscopy in children

BackgroundFlexible bronchoscopy is mainly used to diagnose airway foreign bodies (AFBs). Due to advances in pediatric anesthesia, many teams have considered the extraction of AFBs by flexible bronchoscopy. We aimed to assess the success of flexible bronchoscopy in AFB removal in children. Patients and methodsWe analyzed retrospectively the data of children admitted for AFB aspiration in the Pediatric Respiratory Diseases Department B of Abderrahmane Mami Hospital in Tunisia between January 2012 and December 2022. AFB removal was performed by flexible bronchoscopy through the use of a laryngeal mask airway (LMA) or intubation. ResultsOf the 105 children included, AFB was removed by flexible bronchoscopy in 99 children (94.3 %). The mean age of the children was 32 months (9–150 months) with a sex ratio of 2:3. The foreign body was organic in 67 % of cases. Overall, 37 children underwent rigid bronchoscopy first (35.2 %). Flexible bronchoscopy was performed through the LMA in 77 cases (73 %) and after intubation in the other cases. Thoracic surgery was needed in two cases (1.9 %). Four infants expectorated the AFB after the procedure (3.8 %). Only two children developed laryngeal edema with transient oxygen desaturation. ConclusionAFB removal using a flexible bronchoscope is an efficient and safe procedure when performed by an experienced team. The recent use of LMA has facilitated the use of a larger bronchofiberscope and the insertion of multiple tools that can reach distal airways.

Comparing accuracy of clinical prediction rules to predict pneumonia in children and adolescents with acute febrile respiratory illness

AbstractBackgroundIt is a common challenge for emergency physicians to differentiate pneumonia from simple upper respiratory tract infections. Several clinical prediction rules exist to assist the diagnosis process and guide the clinical decisions of ordering investigations such as chest X‐ray (CXR).ObjectiveThis study aims to validate and compare the accuracy of various prediction rules in the setting of children and adolescents presenting with acute febrile respiratory illness (AFRI).MethodThis was a prospective multicentre study. Three hundred and fifty‐five patients, aged 6–18 years, were recruited. Patients with immunocompromised state or hypoxia were excluded. Pneumonia was defined as diagnosis by CXR or subsequent diagnosis of pneumonia upon re‐attendance within 7 days. Clinical rules including Diehr rule, Heckerling rule, Bilkis simpler rule, the AFRI rule, the paediatric acute febrile respiratory illness rule (PAFRI) were compared in terms of accuracy of predicting pneumonia in the recruited subjects and presented as receiver operating characteristic curves.ResultsFive patients were excluded. In the 350 patients included, 38 were diagnosed as pneumonia by CXR and 1 was subsequently diagnosed as pneumonia upon re‐attendance. The area under the receiver operating characteristic curve of Diehr rule, Heckerling rule, Bilkis simpler rule, AFRI rule and PAFRI rule were 0.703, 0.565, 0.59, 0.807 and 0.846 respectively. The PAFRI rule is superior to other prediction rules in terms of diagnostic accuracy. At the cut‐off of PAFRI ≥0, the rule has high sensitivity of 97.44% and negative predictive value of 99.09%.ConclusionAmong the rules compared, the PAFRI rule has the highest diagnostic accuracy in assisting emergency physicians to identify pneumonia among children and adolescents aged 6–18 years presenting with AFRI.