Pediatric Respiratory Disease Research Articles

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.

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.

Artificial Intelligence in Pediatric Respiratory Diseases: Current Status and Future Promises.

Artificial Intelligence in Pediatric Respiratory Diseases: Current Status and Future Promises.

TRespNET: A dual-route exploratory CNN model for pediatric adventitious respiratory sound identification

Pediatric respiratory diseases significantly contribute to the global burden of morbidity and mortality among children. Moreover, the long-term persistence of respiratory diseases from childhood into adulthood underscores the critical importance of early identification and diagnosis of such diseases. Auscultation, the widely recognized diagnostic method for respiratory diseases, relies on expertise and is subject to variability across different practitioners. To address these challenges, extensive research has focused on automating respiratory disease detection; however, the majority of existing studies have focused on adult populations. Therefore, in this study, we utilize the SPRSound database, which comprises respiratory events from 288 youths aged between 1 month and 18 years to develop deep learning-based models for automatic adventitious lung sound detection in children. Initially, we explore various architectures, including convolutional neural networks with and without transformer encoders, as well as vision transformer. Building upon these investigations, we propose a novel spectrotemporal deep neural network called TRespNET, which incorporates both Mel-scale spectrograms and raw time series of sound recordings. In addition, we integrate hand-crafted acoustic features with the proposed neural network feature maps for further model development. Our results yield a specificity of 0.98, a sensitivity of 0.84, and a harmonic score of 0.90, demonstrating the superiority of the proposed method over all existing methods on the SPRSound dataset. This research provides remarkable insights into an automated and accurate approach for respiratory disease classification in children.

Systematic online academic resource (SOAR) review: Pediatric respiratory infectious disease.

Free open access medical education (FOAM) resources have become increasingly popular in graduate medical education. Despite their accessibility, the assessment of FOAM resources' quality is challenging due to their decentralized nature and the diverse qualifications of their authors and distribution platforms. In this first pediatric systematic online academic resource (SOAR) review, we utilized a systematic methodology to aggregate and assess the quality of FOAM resources on pediatric respiratory infectious disease topics. We searched 177 keywords using FOAMSearch, the top 50 FOAM websites on the Social Media Index, and seven additional pediatric emergency medicine-focused blogs. Following a basic initial screen, resources then underwent full-text quality assessment utilizing the revised Medical Education Translational Resources: Impact and Quality (rMETRIQ) tool. The search yielded 44,897 resources. After 44,456 were excluded, 441 underwent quality assessment. A total of 36/441 posts (8% of posts) reached the high-quality threshold score (rMETRIQ ≥ 16). The most frequent topics overall were pneumonia and bronchiolitis. A total of 67/441 posts (15% of posts) were found to have a rMETRIQ score of less than or equal to 7, which may indicate poor quality. We systematically identified, described, and performed quality assessment on FOAM resources pertaining to the topic of pediatric respiratory infectious disease. We found that there is a paucity of high-quality posts on this topic. Despite this, the curated list of high-quality resources can help guide trainees and educators toward relevant educational information and suggest unmet needs for future FOAM resources.

Short-term exposure to extreme temperature and outpatient visits for respiratory diseases among children in the northern city of China: a time-series study.

Although studies have indicated that extreme temperature is strongly associated with respiratory diseases, there is a dearth of studies focused on children, especially in China. We aimed to explore the association between extreme temperature and children's outpatient visits for respiratory diseases and seasonal modification effects in Harbin, China. A distributed lag nonlinear model (DLNM) was used to explore the effect of extreme temperature on daily outpatient visits for respiratory diseases among children, as well as lag effects and seasonal modification effects. Extremely low temperatures were defined as the 1st percentile and 2.5th percentile of temperature. Extremely high temperatures were defined as the 97.5th percentile and 99th percentile of temperature. At extremely high temperatures, both 26°C (97.5th) and 27°C (99th) showed adverse effects at lag 0-6 days, with relative risks (RRs) of 1.34 [95% confidence interval (CI): 1.21-1.48] and 1.38 (95% CI: 1.24-1.53), respectively. However, at extremely low temperatures, both - 26°C (1st) and - 23°C (2.5th) showed protective effects on children's outpatient visits for respiratory diseases at lag 0-10 days, with RRs of 0.86 (95% CI: 0.76-0.97) and 0.85 (95% CI: 0.75-0.95), respectively. We also found seasonal modification effects, with the association being stronger in the warm season than in the cold season at extremely high temperatures. Our study indicated that extremely hot temperatures increase the risk of children's outpatient visits for respiratory diseases. Efforts to reduce the exposure of children to extremely high temperatures could potentially alleviate the burden of pediatric respiratory diseases, especially during the warm season.

A systematic review and meta-analysis on nutritional and dietary interventions for the treatment of acute respiratory infection in pediatric patients: An EAACI taskforce.

Acute respiratory infections are a major cause of morbidity and mortality in children worldwide. Dietary and nutritional interventions, including minerals and vitamin supplementation, have been explored as potential treatments for these infections. However, the evidence on their efficacy is limited and inconclusive. This systematic review and meta-analysis aim to provide a comprehensive summary of the available evidence on the effectiveness of dietary and nutritional interventions for treating acute respiratory tract infections in children. A systematic review was conducted according to the PRISMA 2020 guidelines in April 2022 and updated in April 2023. Clinical trials focusing on dietary or nutritional interventions, including supplementations, in children with acute respiratory tract infections were included. The selection of interventions and outcomes was based on biological plausibility. Data were extracted using a standardized form, and the risk of bias was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was performed using random-effect models. A total of 50 studies were included in the review. Four trials were conducted in low, 32 in lower-middle, 12 in upper-middle, and only two in high-income countries. The studies evaluated various dietary interventions, including zinc, vitamin A, vitamin E, vitamin D, and probiotics. The results of individual studies on the efficacy of these interventions were mixed, with some showing positive effects on clinical outcomes such as duration of symptoms, while others showed no significant impact. Meta-analysis was conducted for zinc supplementation in children with pneumonia, and the pooled results suggested a potential limited benefit in terms of reduced hospital length of stay but not time to recovery. Meta-analyses on vitamin D did not show any effect in children with pneumonia. This systematic review fills a critical gap in the literature by synthesizing the available evidence on the efficacy and safety of nutritional or dietary interventions for acute respiratory tract infections in children. The findings indicate no dietary or nutritional intervention can currently be recommended for the routine treatment of respiratory tract infections in children based on single supplement studies. The metanalysis suggests that zinc supplementation might have a beneficial effect on length of hospitalization in children with pneumonia. New studies are needed to establish more conclusive evidence for pediatric acute respiratory diseases especially for children living in a context of high-income countries.

Prevalence, Symptoms, and Treatment of Bronchiolitis and Pneumonia in Pediatric Patients

Background: Pediatric respiratory diseases, particularly pneumonia and bronchiolitis, pose significant health challenges worldwide. Understanding their prevalence, symptomatology, and effective treatment is crucial for improving pediatric health outcomes. Objective: This study aimed to investigate the occurrence, symptoms, and treatment outcomes of pneumonia and bronchiolitis in children under five years of age at the GKMC Swabi Department of Pediatrics. Methods: The study design was retrospective study, conducted from January 2022 to January 2023, at GKMC Swabi Department of Paediatrics included 100 pediatric patients diagnosed with either pneumonia (n=40) or bronchiolitis (n=60). Patients aged 0 to 10 years with respiratory symptoms indicative of these diseases were selected, excluding those with severe comorbidities or chronic respiratory disorders. Data on demographic characteristics, clinical symptoms, diagnostic test results, and treatment outcomes were collected from medical records. Diagnosis was based on clinical examination, chest Xrays, blood tests, and other relevant procedures. Descriptive statistics were used for data analysis, utilizing SPSS version 25. Results: The mean age of patients was 3.2 years (±0.5). Gender distribution was equal, with a 50/50 maletofemale ratio. Bronchiolitis and pneumonia accounted for 60% and 40% of cases, respectively. Common symptoms included cough (88%), fever (80%), and difficulty in breathing (65%). The positive treatment response was observed in 77.5% of cases, with 32.5% requiring hospitalization. The average duration of hospital stay was 5.0 days (±1.3). Secondary symptoms like wheezing (35%), chest pain (17.5%), runny nose (32.5%), and vomiting (17.5%) were also noted. Conclusion: The study highlights the significant burden of pneumonia and bronchiolitis in young children and the effectiveness of current treatment modalities. The findings emphasize the need for early recognition and treatment of these diseases, along with continued research into preventive measures and longterm outcomes. Keywords: Pediatric Respiratory Diseases, Pneumonia, Bronchiolitis, Child Health, Hospitalization, Treatment Outcomes.

The epidemiology of pediatric outpatient acute respiratory tract infections in the US: a multi-facility analysis of multiplex PCR testing from 2018 to 2023.

Post-pandemic, it is essential to understand the epidemiology of pediatric acute respiratory tract infections (ARTIs). Our multi-facility study elucidates the outpatient epidemiology of pediatric ARTI using highly multiplexed PCR testing, providing critical insights into the evolving landscape of the etiological agents with a particular focus on the years following the emergence of SARS-CoV-2. Utilizing data from two different multiplex PCR panels, our research provides a comprehensive analysis of respiratory pathogen positivity from 2018 to 2023. Our findings indicate that over half of the annual test results identified at least one pathogen, primarily of viral origin. Intriguingly, despite the surge in testing during the COVID-19 pandemic, pathogen detection rates remain similar to the pre-pandemic era. These data hold significant implications for directing antimicrobial stewardship strategies, curbing unnecessary antibiotic use in pediatric respiratory diseases, and the value of multiplex PCR testing in the outpatient setting among pediatrics.

Expert group recommendation on inhaled mucoactive drugs in pediatric respiratory diseases: an Indian perspective.

Currently, there are no guidelines or consensus statements about the usage of inhaled mucoactive drugs in pediatric respiratory disease conditions from an Indian perspective. To develop a practical consensus document to help pediatricians in clinical decision-making when choosing an appropriate mucoactive drug for the management of specific respiratory disease conditions. A committee of nine experts with significant experience in pediatric respiratory disease conditions and a microbiological expert constituted the panel. An electronic search of the PubMed/MEDLINE, Cochrane Library, Scopus, and Embase databases was undertaken to identify relevant articles. Various combinations of keywords such as inhaled, nebulized, mucoactive, mucolytic, mucokinetic, expectorants, mucoregulators, mucociliary clearance, respiratory disorders, pediatric, cystic fibrosis (CF), non-CF bronchiectasis, acute wheezing, asthma, primary ciliary dyskinesia (PCD), critically ill, mechanical ventilation, tracheomalacia, tracheobronchomalacia, esophageal atresia (EA), tracheoesophageal fistula (TEF), acute bronchiolitis, sputum induction, guideline, and management were used. Twelve questions were drafted for discussion. A roundtable meeting of experts was conducted to arrive at a consensus. The level of evidence and class of recommendation were weighed and graded. Inhaled mucoactive drugs (hypertonic saline, dry powder mannitol, and dornase alfa) can enhance mucociliary clearance in children with CF. Experts opined that hypertonic saline could be beneficial in non-CF bronchiectasis, acute bronchiolitis, and PCD. The current state of evidence is inadequate to support the use of inhaled mucoactive drugs in asthma, acute wheezing, tracheomalacia, tracheobronchomalacia, and EA with TEF.

Ambulatory amoxicillin use for common acute respiratory infections during a national shortage: Results from the SHARPS-OP benchmarking collaborative

We quantified antibiotic prescribing for ambulatory pediatric acute respiratory illness (ARI) at 22 institutions in "pre-shortage" (Jan 2019 - Sep 2022) and "shortage" (Oct 2022 - Mar 2023) periods for amoxicillin. While ARI prescribing increased across settings, the proportion of amoxicillin prescriptions decreased. Variation was seen within and between institutions.

Safety profiles and adverse reactions of azithromycin in the treatment of pediatric respiratory diseases: A systematic review and meta-analysis.

Azithromycin (AZM) is an antimicrobial agent and frequently used in the treatment of pediatric respiratory diseases due to its well-recognized clinical efficacy. Despite some favorable findings from many studies, there is a lack of research reports focusing on the safety profiles and adverse reactions. The randomized controlled trials of AZM in the treatment of pediatric respiratory diseases on internet databases were searched. The search databases included Chinese CNKI, Wanfang, VIP, PubMed, EMBASE, and Cochrane Library. Two researchers of this study independently assessed the eligibility, risk of bias, and extracted the data. The included literature was meta-analyzed and subgroup analyzed by revman 5.1 software. A total of 14 eligible studies were included. The results of meta-analysis showed that the incidence of adverse reactions after AZM treatment was 24.20%, which was lower than 48.05% in the control group (OR = 0.42, 95% CI 0.12-0.72, P < .001). In the subgroup of sequential therapy, AZM had a lower incidence of adverse reactions in sequential therapy (OR = 0.29, 95% CI 0.09-0.60, P < .001). In the subgroup of intravenous administration, AZM had a lower the incidence of adverse reactions (OR = 0.57, 95% CI 0.12-0.84, P = .003). In the subgroup of oral administration, AZM had a lower the incidence of adverse reactions (OR = 0.45, 95% CI 0.13-0.69 P < .001). Overall, it was also found that the incidence of adverse reactions in the AZM subgroup was significantly lower than that in other treatment subgroup. AZM has fewer adverse reactions and better safety profiles, which make AZM a more attractive option in the treatment of pediatric respiratory diseases.

Paediatric Respiratory Diseases: From Clinical Experience to Literature Review

Paediatric Respiratory Diseases: From Clinical Experience to Literature Review

Analysis of respiratory sounds based on electronic stethoscope and its application in pediatric respiratory diseases: current status and future prospects

Analysis of respiratory sounds based on electronic stethoscope and its application in pediatric respiratory diseases: current status and future prospects

A Comparative Study between Nebulized Ketamine, Nebulized Dexmedetomidine and Topical Lidocaine as Premedications for Flexible Fiberoptic Bronchoscopy in Pediatrics

Abstract Background Flexible fiberoptic bronchoscopy remains an invaluable tool in the evaluation and management of infant and pediatric respiratory disease. Anesthetic strategies in pediatric fiberoptic bronchoscopy should aim at minimizing respiratory complications as oxygen desaturation, hypoxemia, cough, bronchospasm and airway trauma. Objective To compare between the efficacy and safety of nebulized ketamine, nebulized dexmedetomidine and topical lidocaine as premedication for flexible fiberoptic bronchoscopy in pediatrics regarding the incidence of moderate to severe cough. Patients and Methods This prospective randomized clinical study was conducted in Ain shams University, Pediatric endoscopy unit on 186 children aged 2 to 8 years and classified according to the American Society of Anesthesiologists (ASA) physical status I or II and scheduled for flexible fiberoptic bronchoscopy (either diagnostic or therapeutic). The included patients were divided into 3 equal groups. Group D (Dexmedetomidine group) received nebulized dexmedetomidine 30 minutes before procedure (2 mic/kg), Group K (Ketamine group) received nebulized ketamine 30 minutes before procedure (2 mg/kg), and Group L (lidocaine group) received topical lidocaine 2% (3 mg/kg). Results Mean heart rate was insignificantly different at baseline among the three groups. Heart rate before induction, 15 minutes after induction and in PACU was significantly lower in group D compared with group K and group L (P &amp;lt; 0.001) and significantly higher in group K compared with group L (P &amp;lt; 0.001). Mean arterial blood pressure at baseline, before induction, 15 minutes after induction, and in PACU were insignificantly different among the three groups. Mean propofol requirements in group L were significantly higher compared with group D, and group K (p &amp;lt; 0.001) but insignificantly different between group D and group K. Conclusion Incidence of moderate to severe cough was less with nebulized dexmedtomidine and nebulized ketamine compared with topical lidocaine. There were no significant differences between nebulized dexmedtomidine and nebulized ketamine with regards to the incidence of moderate to severe cough. There was an insignificant difference between dexmedetomidine and ketamine in the incidence of moderate to severe cough, but it was significantly different between dexmedetomidine and lidocaine, and group ketamine and group lidocaine.

Pediatric Respiratory Illnesses: An Update on Achievable Benchmarks of Care.

Pediatric respiratory illnesses (PRI): asthma, bronchiolitis, pneumonia, croup, and influenza are leading causes of pediatric hospitalizations, and emergency department (ED) visits in the United States. There is a lack of standardized measures to assess the quality of hospital care delivered for these conditions. We aimed to develop a measure set for automated data extraction from administrative data sets and evaluate its performance including updated achievable benchmarks of care (ABC). A multidisciplinary subject-matter experts team selected quality measures from multiple sources. The measure set was applied to the Public Health Information System database (Children's Hospital Association, Lenexa, KS) to cohorts of ED visits and hospitalizations from 2017 to 2019. ABC for pertinent measures and performance gaps of mean values from the ABC were estimated. ABC were compared with previous reports. The measure set: PRI report includes a total of 94 quality measures. The study cohort included 984 337 episodes of care, and 82.3% were discharged from the ED. Measures with low performance included bronchodilators (19.7%) and chest x-rays (14.4%) for bronchiolitis in the ED. These indicators were (34.6%) and (29.5%) in the hospitalized cohort. In pneumonia, there was a 57.3% use of narrow spectrum antibiotics. In general, compared with previous reports, there was improvement toward optimal performance for the ABCs. The PRI report provides performance data including ABC and identifies performance gaps in the quality of care for common respiratory illnesses. Future directions include examining health inequities, and understanding and addressing the effects of the coronavirus disease 2019 pandemic on care quality.

Changing Degrees: Incorporating the Impacts of Climate Change on Health into Pediatric Residency Education and Practice.

The American Academy of Pediatrics (AAP) was the first major medical society to release a policy statement on the impacts of climate change on pediatric health. It is estimated that globally, children bear the burden of climate-induced disease. However, many undergraduate and graduate medical curricula do not cover this topic. This article builds on previous literature to propose a framework for such a curriculum as well as justify its relevance in light of current accreditation requirements. Some curricular topics include extreme heat and heat-related injury, degradations in air quality and pediatric respiratory disease, spread of vector-borne and diarrheal illness, and mental health effects. Lastly, it addresses clinical applications for this knowledge, including screening vulnerable patients, offering anticipatory guidance, and advocating for the medical benefits of planetary health.

Indications, Efficacy, and Complications of Pediatric Bronchoscopy: A Retrospective Study at a Tertiary Center.

Background Bronchoscopy is an essential procedure for evaluating, diagnosing, and treating pediatric respiratory diseases. In this study, we demonstrate the indications and contraindications of bronchoscopy done in a tertiary referral hospital, Al Qassimi Woman's and Children's Hospital (AQWCH) in Sharjah, United Arab Emirates (UAE), in order to achieve better service. This study aims to evaluate patients' characteristics, diagnostic and therapeutic indications, and complications of bronchoscopy. Material and method This retrospective chart review included children aged between one day and 13 years, admitted to AQWCH, who underwent bronchoscopy (rigid or flexible) procedures between January 2018 and December 2019. All patients were identified by using a computerized search of hospital discharge diagnosis, which was codified as "pediatric bronchoscopy, flexible, rigid, bronchoalveolar lavage". The main study outcome measure was to evaluate patients' characteristics, diagnostic or therapeutic indications, bronchoalveolar lavage (BAL) analysis, as well as complications of bronchoscopy at AQWCH. Results There were 72 pediatric bronchoscopies (rigid and flexible) performed in patients aged less than 13 years old; the reason for bronchoscopy procedure was diagnostic in 51% and both diagnostic and therapeutic in 49%. Cough was the most common symptom (n=53; 74%), and chest recession was the most common clinical finding (n=46; 64%). Foreign body aspiration was the main indication (n=23; 32%), followed by stridor (26%). Consolidation was the most common radiological finding. Foreign body was the common finding, seen in 25% of bronchoscopies, followed by tracheomalacia in 17%. The suspected diagnosis was confirmed in 89%, and management change was needed in 54% of patients. The main complication during the procedure was desaturation (26%), and cough was the main post-bronchoscopy complication (14%). BAL was done for 28 (39%) patients, in which BAL culture was positive in 75%.Rigid bronchoscopy was done when foreign body aspiration was suspected based on positive history in 70%, abnormal physical examination in 60%, and chest X-ray abnormalities in 39% of patients. Sensitivity and specificity for patient history, physical examination, and chest X-ray were 80% and 83%, 66% and 60%, and 40% and 66 %, respectively. Conclusion Bronchoscopy is an important tool for evaluating, diagnosing, and treating pediatric respiratory diseases. While it is a safe procedure, it still needs a careful selection of patients as it is invasive.