Early outpatient use of low-molecular-weight heparin benefits COVID-19 outcome in association with hospitalization - Lessons learned.

The management of cystic fibrosis (CF) has significantly improved with the approval of the CF transmembrane conductance regulator (CFTR) modulators. Elexacaftor/tezacaftor/ivacaftor (ETI) is approved for treatment in people with CF (pwCF) over the age of 2 years with eligible mutations. We report 2 cases highlighting improved clinical outcomes following exposure to ETI in an off-label use, including enhanced nutrition status, decrease in respiratory support, exacerbation rates, and need for antibiotics in one of the infants and resolution of echogenic bowel that was diagnosed in utero in the second.

Guidelines recommend implementing early enteral nutrition (EN) (EEN) in critically ill children. The aim of the study was to determine if EEN for critically ill children is associated with improved clinical outcomes compared with delayed enteral nutrition (DEN), prioritizing associations adjusted for severity of illness. PROSPERO (CRD42021286271). MEDLINE, Embase, CINAHL, and CENTRAL databases to October 2024. The population was critically ill children, the intervention was EEN, the comparator was DEN, the outcome was mortality or clinical outcomes, and the study designs included randomized control trials (RCTs), quasi-experimental, observational cohort, or case-control. Screening, extraction, and risk of bias assessment using the Newcastle-Ottawa Scale and Cochrane Risk of Bias and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were conducted in duplicate by two reviewers. Eighteen of 8478 screened studies were included. Mortality outcomes were pooled and meta-analyzed using random-effects models. Secondary outcomes were described qualitatively, and directions of associations were reported. Thirteen studies (1 RCT, 12 cohort) reported mortality; however, only three adjusted for illness severity. In the adjusted analysis, receiving EEN was associated with reduced mortality (adjusted odds ratio 0.36 (95% CI, 0.14-0.91), I2 = 78.6%, n = 5864). The certainty of evidence, as assessed by GRADE, was very low due to indirectness. In the qualitative review of 18 studies (1 RCT, 17 cohort studies, n = 9829), EEN had an association with reduced length of stay, length of invasive respiratory support, improved nutrition adequacy, reduced maximum pediatric logistic organ dysfunction score, and infection. No harmful effects of EEN were found after adjusting for confounding variables. EEN was associated with beneficial outcomes. However, the inclusion of mostly cohort studies with limited confounding adjustment, the small number of studies, the presence of between-study heterogeneity and residual confounding, and heterogeneity in measured outcomes and assessment methods resulted in very low certainty of evidence.

There is considerable practice variation nationally for using high-flow nasal cannula (HFNC) to treat hospitalized children with bronchiolitis, despite an abundance of literature supporting specific practices. We developed recommendations for using HFNC based on available evidence and expert opinion. Following the Research and Development (RAND)/University of California, Los Angeles Appropriateness Method, we conducted an exhaustive literature search for studies regarding the use of HFNC in bronchiolitis and drafted proposed use recommendations based on these findings. We convened an expert panel composed of nominees from national professional organizations with a range of professions (nursing, respiratory therapy, medicine) and clinical expertise (intensive care, emergency medicine, hospital-based care). Panelists rated recommendations for appropriateness and necessity in 3 sequential rating sessions and a moderated meeting. The 15-member panel evaluated 60 recommendations for the initiation, reassessment, escalation, and de-escalation of HFNC in bronchiolitis. The panel reached agreement on the appropriateness of HFNC for 52 of 60 recommendations and on necessity for 46 of 52. The panel agreed with practices that may curtail HFNC use, including initiating HFNC only for refractory hypoxemia or impending respiratory failure, initiating HFNC at flow rates of 1.5 to 2L/kg/min, and discontinuing HFNC once a patient is stable on fraction of inspired oxygen of 0.21 for 1-4 hours. A national expert panel agreed on the appropriateness and necessity of parameters for HFNC use in bronchiolitis. These recommendations allow for standardization of practice that may optimize outcomes and curb indiscriminate use of this respiratory support modality.

Clinical Course and Outcomes of Invasive Haemophilus influenzae Infections among Children at Two Hospitals in Alaska.

Prenatal Imaging Predicts Need for Early Intervention in Neonates With Congenital Lung Malformations.

Measles is a highly contagious infectious disease caused by the measles virus. Recent declines in population-level immunity and outbreaks linked to imported cases have led to the highest U.S. incidence of measles since its elimination in 2000. Measles infection during pregnancy is associated with increased risk of pneumonia, need for respiratory support and mortality, prematurity, and stillbirth. Although perinatal transmission is rare, congenital measles is linked to higher infant mortality. No licensed antiviral therapies or curative treatments exist, making prevention critical. Measles-containing vaccines are safe and 97% effective in preventing infection when two doses are administered. Measles vaccination is contraindicated during pregnancy; obstetricians and gynecologists should strongly recommend vaccination to all nonpregnant susceptible patients.

Detection of Pseudomonas aeruginosa in 5,021 hospitalized pediatric patients presenting with acute respiratory tract infections utilizing targeted next-generation sequencing.

Contemporary Trends in Pediatric Extubation Failure and Noninvasive Respiratory Support Use.

Pediatric acute respiratory distress syndrome (PARDS) complicated by ventilator-associated pneumonia (VAP) poses significant management challenges, particularly when caused by multidrug-resistant organisms such as Stenotrophomonas maltophilia and Pseudomonas aeruginosa. A frequent and deleterious complication is plate-like atelectasis, which may prove refractory to conservative management due to anatomical constraints in the pediatric airway and biofilm formation. A 23-month-old male presented with severe PARDS and polymicrobial VAP. Despite extubation to High-Flow Nasal Cannula (HFNC), the patient developed persistent right upper lobe plate-like atelectasis refractory to aggressive physiotherapy and targeted antibiotic therapy with Levofloxacin and Ceftazidime for 21 days. On Day 75 of illness, a flexible bronchoscopy was performed. Intraoperative findings revealed hyperemic mucosa without macroscopic mucus plugging. However, the procedure, involving saline lavage and suctioning, resulted in immediate recruitment. Within 24 hours, the respiratory rate decreased from 45 to 24 breaths per minute, and the SpO2/FiO2 ratio improved significantly from 185 to 310, allowing weaning from respiratory support. In conclusion, in toddlers with multidrug-resistant VAP, atelectasis may persist due to biofilm-mediated micro-obstruction rather than macroscopic plugging. Flexible bronchoscopy is a safe and effective therapeutic adjunct in these cases, facilitating distal airway recruitment and breaking the cycle of chronic infection.

Spinal muscular atrophy (SMA) type 1 is a severe neuromuscular disorder caused by mutations in the SMN1 gene. Historically associated with poor survival, recent advances in targeted therapies have significantly improved prognosis. This study aimed to describe the evolution of nutritional support in patients with SMA type 1 at a tertiary care reference center between 2008 and 2023. A retrospective descriptive analysis was conducted including 19 patients, classified into three treatment groups: supportive care, pharmacologic treatment (intrathecal Nusinersen or Risdiplam), and gene therapy. Nutritional interventions, respiratory support, complications, and clinical evolution were recorded. Among patients receiving only supportive care, 83% required nasogastric feeding and experienced 100% mortality by a median of 5 months. In the pharmacologic treatment group, 63% required long-term enteral feeding and one death occurred due to non-neurological causes. In the gene therapy group, only one child required long-term nutritional support, and all patients showed favorable clinical progression. Our findings highlight the transformation in nutritional needs prompted by disease-modifying therapies, underscoring the importance of early and specialized nutritional intervention. Multidisciplinary management including pediatric nutrition specialists is essential for optimal care of SMA type 1 patients.

In preterm neonates, does extending non-invasive respiratory support beyond ventilatory needs improve somatic growth?

Coronavirus disease 2019 (COVID-19) affected billions of individuals globally, with symptoms ranging from isolated blood clotting to severe acute hypoxemic respiratory failure requiring intensive respiratory support ventilators. Those with advanced chronic kidney disease (CKD stage 5) were at high risk of severe disease faced a particularly heightened risk of severe illness. Inflammation and associated immune-thrombotic events in CKD stage 5 have attracted increasing attention, yet remain poorly understood. In this prospective cohort study, we examined and compared neutrophil extracellular traps (NETs) and low-density granulocytes (LDGs) in heathy controls (n = 15), CKD stage 5 patients without COVID-19 (n = 15), patients with COVID-19 (n = 15), and CKD stage 5 patients with COVID-19 (n = 90). Serum citrullinated histone H3 (CitH3) and related gene expression (PAD4, ERK1, PKC), NET complexes, platelet factor 4 (PF4), von Willebrand factor (vWF), RANTES, and specific cytokines were quantified. Proof-of-concept experiments were conducted to assess the role of lipopolysaccharide-LDG complexes in NETs detected in COVID-19 plasma. NETs complexes were significantly higher in COVID-19 cases, and more so in patients with CKD stage 5D, and those who died. Disease severity was directly correlated with NETs complex levels (p = 0.016). CitH3 and gene expression levels were not correlated with advanced CKD stage, while levels of components that initiate NETs formation were higher in patients with COVID-19 and in CKD stage 5 patients. In conclusion, NET activation could partially explain the thrombotic manifestations in patients with COVID-19 and in CKD stage 5 patients.

Background: Respiratory syncytial virus (RSV) is one of the leading causes of lower respiratory tract illness and hospitalizations in children aged ≤5 years worldwide. The aim of this study was to characterize the Polish population of patients aged ≤5 years who were hospitalized due to RSV infection, focusing on their clinical and epidemiological characteristics as well as treatment patterns. Methods: This retrospective observational study was conducted between November 2023 and February 2024 in 41 hospitals with pediatric departments across Poland. Data from patients aged ≤5 years admitted due to RSV infection confirmed with antigen test or RT-PCR were collected. The dataset was weighted and extrapolated to allow conclusions applicable to the general population of patients aged 0–5 years hospitalized with RSV infection in Poland. Results: Data from 419 patients were analyzed. Over half (57.4%) were younger than 12 months, 84% were born at term, and 85.8% had no comorbidities. The most frequent manifestations of RSV infections were pneumonia (56.8%), bronchiolitis (35.9%), and bronchitis (12.4%). Viral co-infections were identified in 8% of patients. Regarding treatment, 21.1% of patients required respiratory support, 67.6% received inhaled steroid therapy, 61.5% were treated with antibiotics, 48.1% received beta2-mimetics and anticholinergics, and 44.3% underwent systemic steroid therapy. Conclusions: Our findings confirm that severe RSV primarily affects the youngest children with no comorbidities who do not present high risk conditions. To reduce the overall disease burden, preventive strategies should be offered to all children, not being limited to those in risk groups.

Background: The appropriate identification of target patients for methylxanthine therapy may optimize resource allocation and improve clinical outcomes, but data on routine care in low-resource settings are limited. Our study assessed methylxanthine use in clinical practice in two Sub-Saharan settings. Methods: This retrospective, registry-based study investigated methylxanthine use in newborns who were admitted to Tosamaganga Hospital (Tanzania) and Wolisso Hospital (Ethiopia) in 2022–2023. The prevalence and type of methylxanthine treatment were investigated. Neonates receiving methylxanthine were compared to those not receiving it in terms of baseline characteristics, clinical data, treatments, and discharge information. All data were retrieved from local registries. Results: Aminophylline was administered to 196/1674 neonates (11.7%), while caffeine was not available in these settings. This treatment was more common in preterm and smaller infants (p < 0.0001), asphyxiated neonates (p < 0.0001), and the sickest patients (p < 0.001). The need for respiratory support (p < 0.0001), intravenous lines (p < 0.0001), and antibiotic therapy (p < 0.0001), as well as the length of hospital stay (p < 0.0001) and mortality rate (p < 0.0001), were higher in neonates receiving aminophylline. Conclusions: In two Sub-Saharan settings, methylxanthine treatment was limited to aminophylline, which was given to around 12% of infants admitted to the special care units. Overall, the treatment was appropriately given to most eligible neonates, although a considerable subgroup of very preterm infants did not receive aminophylline prophylaxis. Further studies may investigate the reasons for protocol incompliance regarding aminophylline treatment and healthcare staff’s opinions on such an aspect.

Objective: Human metapneumovirus (hMPV) is a significant agent of respiratory infections in pediatric populations. Despite its global prevalence, the epidemiological characteristics and clinical burden of hMPV infections remain insufficiently recognized. This study aimed to evalu ate the clinical features and outcomes of severe pneumonia among children hospitalized with hMPV infection. Materials and Methods: This retrospective study analyzed pediatric patients diagnosed with hMPV infection at Hacettepe University İhsan Doğramacı Children’s Hospitalbetween January 2018 and December 2024. Demographic, clinical, and laboratory data were systematically reviewed to identify factors associated with severe pneumonia. Results: A total of 116 children with hMPV infection were included, of whom 17.2% (n = 20) developed severe pneumonia requiring respiratory support. Notably, 85% (n = 17) of these severe cases occurred in children under 5 years of age, and 90% (n = 18) had underlying chronic medi cal conditions. In cases of non-severe pneumonia, hMPV monoinfection was identified in 74.8% (n = 56) of patients, while 25.2% (n = 19) had coinfections, most commonly involving rhinovirus (14.7%, n = 17). Conversely, among severe pneumonia cases, hMPV monoinfection was predom inant (90%, n = 18), with coinfections detected in only 10% (n = 2). A substantial increase in hospi talization rates was observed in 2024 (36%), potentially indicating an evolving diseaseseverity. Additionally, 1 infection-related mortality (3.1%) was recorded in an older pediatric patient. Conclusion: Severe pneumonia in this single-center series was mainly linked to hMPV monoin fection, with hospitalizations rising in 2024. These findings underscore the clinical impact of hMPV and the need for strengthened surveillance and timely diagnostics, while informing pre ventive strategies, including future vaccines/therapeutics. Cite this article as: Aykac K, Develi ZT, Onel D, et al. Clinical features and outcomes of severe pneumonia in pediatric human metapneumovirus infections. Turk Arch Pediatr. Published online December 29, 2025. doi:10.5152/TurkArchPediatr.2025.25295.

Bronchiolitis is a prevalent viral respiratory illness in infants, often caused by respiratory syncytial virus (RSV). It is the leading cause of hospitalization in children under 1 year of age. The introduction of Nirsevimab, a long-acting monoclonal antibody approved in 2022, aimed to reduce RSV-related hospitalizations and severe cases. This study assesses the impact of Nirsevimab on bronchiolitis incidence, severity, and viral etiology in Sicily from 2021 to 2025. This observational study included all pediatric patients hospitalized for bronchiolitis at the University of Catania's Pediatric Respiratory Unit between October 2021 and March 2025. Data were collected on viral etiology, hospital stay duration, clinical severity and respiratory support requirements across four epidemic seasons. Statistical analysis was used to compare outcomes across the different years, with a focus on the 2024-2025 season, which was the first to implement Nirsevimab immunization. From 2022 to 2025, the incidence of hospitalized bronchiolitis decreased significantly, with a reduction of 84% in the 2024-2025 season compared to previous (2021-22, 2022-23, 2023-24) years (p < 0.0001). In the 2024-2025 season, a significant difference was observed in the percentage of RSV cases in 2025 compared to previous years and a significant reduction in the circulation of non-RSV viruses. The average hospital stay and clinical severity remained stable throughout the years. Only one hospitalized patient in the 2024-2025 season had received Nirsevimab, presenting with mild bronchiolitis. The introduction of Nirsevimab in Sicily led to a significant reduction in bronchiolitis incidence, with a reduction of RSV and non-RSV cases. Clinical severity and hospital stay duration remained unchanged. The findings support the efficacy of Nirsevimab in preventing severe bronchiolitis requiring hospitalization.

To assess the effect of antenatal dexamethasone on reducing the need for respiratory support in late preterm infants. The study was an open-label randomised controlled trial. Participants included 294 pregnant women at risk of late preterm delivery, admitted to Da Nang Hospital for Women and Children, Vietnam. Women in the intervention group received antenatal dexamethasone, compared with standard care for the control group. Statistical analysis was conducted using STATA 18 with an intention-to-treat approach. Comparisons were performed using the chi-squared test or Fisher's exact test for categorical data and the unpaired t-test or Wilcoxon rank-sum test for continuous data. Infants in the control group required respiratory support after birth more frequently than those in the dexamethasone group (24.5% vs. 15%, p = 0.04). The neonatal unit admission rate was significantly higher in the control group (p = 0.01), with respiratory problems accounting for the most common reason for admission. Regarding morbidities, jaundice requiring phototherapy was significantly higher in the control group. Antenatal dexamethasone significantly reduced the need for respiratory support after birth and neonatal unit admission. Dexamethasone administration was not associated with increased maternal postnatal infection or neonatal hypoglycaemia. ClinicalTrial.gov NCT05841121.

ABSTRACTBackgroundRespiratory viral infections are increasingly recognized as important triggers of acute exacerbations in bronchiectasis (AEB); the virological profiles and immunological mechanisms in elderly patients remain poorly characterized.MethodsA prospective cohort of 102 elderly bronchiectasis patients was followed for 12 months. Upon AEB occurrence, nasopharyngeal swabs were obtained for multiplex fluorescence quantitative PCR detection of eight respiratory viruses, while peripheral blood samples were analyzed for T lymphocyte subsets by flow cytometry. Clinical characteristics, inflammatory markers, and T cell subsets were compared between virus‐positive and virus‐negative groups at first AEB; ROC curve analysis evaluated the predictive value of T cell subsets for viral infection.ResultsA total of 93 AEB episodes were captured from 68 patients during 12‐month follow‐up, with viruses detected in 54.8% (51 of 93) of episodes, influenza virus being the most common pathogen (24 of 51, 47.1%). Compared with the virus‐negative group, the virus‐positive group showed higher IL‐6 and TNF‐α and lower CRP and WBC levels (p < 0.05), higher sputum culture positivity with Haemophilus influenzae predominating, along with increased use of intravenous antibiotics and respiratory support, while quality of life, pulmonary function, and oxygenation remained comparable. The virus‐positive group showed lower CD4+ T cell counts (431.28 ± 152.36 vs. 508.42 ± 158.94, p = 0.025) and CD4+/CD8+ ratios (1.41 ± 0.44 vs. 1.63 ± 0.49, p = 0.013).ConclusionsViral infections are frequent in elderly bronchiectasis patients with AEB and are characterized by reduced CD4+ T‐cell counts, lower CD4+/CD8+ ratios, and heightened inflammatory responses, reflecting underlying age‐related immune vulnerability.

Objective. To evaluate short-term APAP therapy safety and efficacy in patients with moderate-to-severe OSA and CTEPH. Material and methods. The study included 67 patients with CTEPH between December 2023 and February 2025. Clinical status, echocardiography and right heart catheterization data were assessed. All patients competed international questionnaires (STOP-Bang, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and multifunctional sleep study was performed. In case of moderate-to-severe OSA, we initiated APAP therapy. Results. In 39 patients, we diagnosed moderate-to-severe OSA and offered initiation of in-hospital APAP. Among 30 patients agreed to continue study, 5 ones refused further titration of respiratory support due to inability to sleep, and 25 patients achieved efficacy criteria (residual apnea/hypopnea index &lt;5.0, mean night saturation&gt; 90%) within 1.8±1.2 nights. Supplemental oxygen therapy was required in 5 patients. Safety of APAP therapy was confirmed by daily monitoring. Conclusion. APAP therapy demonstrated a favorable safety and efficacy profile in patients with OSA and CTEPH. Our findings support consideration of APAP therapy as initial treatment option that can improve the quality of medical care.