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Pediatrics – Pulmonology

Meta-Analysis: Daily Sedation Interruption Shortens PICU Stay Without Impacting Mortality or Ventilation Duration in Pediatric MV Patients – JAMA Netw Open

11 Aug, 2024 | 13:19h | UTC

Study Design and Population: This systematic review and meta-analysis included six randomized clinical trials (RCTs) involving 2,810 pediatric patients receiving mechanical ventilation (MV) in the pediatric intensive care unit (PICU). The trials compared the effects of daily sedation interruption (DSI) with continuous intravenous (IV) sedation on clinical outcomes such as MV duration and PICU length of stay.

Main Findings: The analysis found that DSI was associated with a significant reduction in the length of PICU stay (mean difference of -1.45 days, p = 0.03). However, there was no significant difference in the duration of MV between DSI and continuous sedation (mean difference of -0.93 days, p = 0.06). Additionally, there were no significant differences in total sedative doses, adverse events, or mortality between the two groups.

Implications for Practice: The findings suggest that DSI may reduce the length of PICU stay without increasing the risk of adverse events, making it a potentially valuable strategy in managing sedation for pediatric patients on MV. However, further research is needed to explore the long-term neurodevelopmental outcomes associated with DSI.

Reference: Shu Wen Toh, T. et al. (2024). Daily Sedation Interruption vs Continuous Sedation in Pediatric Patients Receiving Mechanical Ventilation: A Systematic Review and Meta-analysis. JAMA Network Open, 7(8), e2426225. DOI: 10.1001/jamanetworkopen.2024.26225.

 

RCT: No significant benefit of adjuvant prednisone for patients with cystic fibrosis with exacerbations unresponsive to antibiotics – Eur Respir J

6 May, 2024 | 06:32h | UTC

This randomized, double-blind, placebo-controlled trial investigated the effectiveness of adjuvant oral prednisone in enhancing lung function recovery in patients with cystic fibrosis (CF) experiencing pulmonary exacerbations (PExs) unresponsive to initial intravenous (IV) antibiotic treatment. The study involved 173 participants, with 76 not achieving more than 90% of their baseline forced expiratory volume in one second (ppFEV1) by Day 7 of antibiotic treatment and subsequently randomized to receive either oral prednisone (1 mg·kg−1 twice daily, up to 60 mg/day) or placebo for an additional 7 days. Results showed that 50% of the prednisone group and 39% of the placebo group recovered over 90% of their baseline ppFEV1 by Day 14. However, the difference was not statistically significant (11% difference; 95% CI -11, 34%; p=0.34). Additionally, prednisone did not significantly prolong the time to the next exacerbation compared to placebo. This study concludes that adjuvant oral prednisone does not significantly improve lung function recovery or delay subsequent exacerbations in CF patients not responding to initial antibiotic therapy.

 

Reference (link to abstract – $ for full-text):

Valerie Waters et al. (2024). A randomized trial of oral prednisone for cystic fibrosis pulmonary exacerbation treatment. European Respiratory Journal, DOI: 10.1183/13993003.02278-2023

 

RCT: Azithromycin fails to prevent moderate or severe chronic lung disease in preterm infants – Lancet Respir Med

6 May, 2024 | 06:28h | UTC

This randomized, placebo-controlled trial evaluated the effectiveness of azithromycin in preventing chronic lung disease (CLD) in preterm infants born at less than 30 weeks’ gestation across 28 UK neonatal intensive care units. A total of 799 infants were randomized to receive either intravenous azithromycin or a placebo. The primary outcome measured was survival without moderate or severe CLD at 36 weeks postmenstrual age. Results showed no significant difference between the azithromycin group (42% survival without CLD) and the placebo group (45% survival without CLD), with an adjusted odds ratio of 0.84 (95% CI 0.55–1.29, p=0.43). Pulmonary Ureaplasma spp colonization did not affect the treatment outcome. Given the lack of efficacy and the presence of several serious adverse events in the azithromycin group, the study concluded that azithromycin should not be recommended for preventing CLD in this population.

 

Reference (link to free full-text):

John Lowe et al. (2024). Azithromycin therapy for prevention of chronic lung disease of prematurity (AZTEC): a multicentre, double-blind, randomised, placebo-controlled trial. The Lancet Respiratory Medicine. DOI: https://doi.org/10.1016/S2213-2600(24)00079-1

 

ERS statement on protracted bacterial bronchitis in children

11 Aug, 2023 | 15:32h | UTC

ERS statement on protracted bacterial bronchitis in children – European Respiratory Journal

 

RCT – 2ry analysis | Use of NIPPV, NHFOV post-extubation outperforms NCPAP in neonates with severe respiratory failure or extremely preterm

4 Aug, 2023 | 11:48h | UTC

Effectiveness of Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation vs Noninvasive High-Frequency Oscillatory Ventilation as Support After Extubation of Neonates Born Extremely Preterm or With More Severe Respiratory Failure: A Secondary Analysis of a Randomized Clinical Trial – JAMA Network Open

Original Study: Noninvasive High-Frequency Oscillatory Ventilation vs Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation as Postextubation Support for Preterm Neonates in China: A Randomized Clinical Trial – JAMA Pediatrics

Related: Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation – Cochrane Library

 

Commentary on Twitter

 

Systematic Review | NIPPV potentially superior to NCPAP in reducing reintubation in extubated preterm neonates

4 Aug, 2023 | 11:46h | UTC

Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation – Cochrane Library

Related: M-A | Early NIPPV likely reduces the risk of respiratory failure and intubation in very preterm infants

 

M-A | Early NIPPV likely reduces the risk of respiratory failure and intubation in very preterm infants

25 Jul, 2023 | 13:39h | UTC

Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants – Cochrane Library

 

M-A | Exposure to smoke, overcrowding, poor living conditions, and contact with TB cases identified as risk conditions for pediatric TB

24 Jul, 2023 | 12:43h | UTC

Risk factors for the development of tuberculosis among the pediatric population: a systematic review and meta-analysis – European Journal of Pediatrics

 

RCT | Preterm infants show same feeding tolerance with NCPAP or HHHFNC

20 Jul, 2023 | 11:01h | UTC

Effect of Nasal Continuous Positive Airway Pressure vs Heated Humidified High-Flow Nasal Cannula on Feeding Intolerance in Preterm Infants With Respiratory Distress Syndrome: The ENTARES Randomized Clinical Trial – JAMA Network Open

Commentary: Changing oxygenation strategies not associated with differences in feeding intolerance in preterm infants – Physician’s Weekly

 

Cohort Study | Intermittent hypoxemia is associated with unfavorable respiratory outcomes in extremely preterm infants

17 Jul, 2023 | 13:28h | UTC

Cardiorespiratory Monitoring Data to Predict Respiratory Outcomes in Extremely Preterm Infants – American Journal of Respiratory and Critical Care Medicine

 

The exposome in respiratory diseases: multiple preventable risk factors from early life to adulthood

27 Jun, 2023 | 13:32h | UTC

The exposome in respiratory diseases: multiple preventable risk factors from early life to adulthood – Breathe

 

Commentary on Twitter

 

Cohort Study | Association of preterm birth with increased asthma and COPD risk in adulthood

26 Jun, 2023 | 00:45h | UTC

Summary: This population-based register study investigated the correlation between gestational ages (GA) and obstructive airway diseases like asthma and chronic obstructive pulmonary disease (COPD) in adulthood. The study used registry data from 706,717 individuals born between 1987-1998 in Finland (4.8% preterm), and 1,669,528 individuals born from 1967-1999 in Norway (5.0% preterm). The study observed care episodes of asthma and COPD using nationwide healthcare registers.

The results showed an increased risk of obstructive airway disease in adulthood for those born at <28 or 28–31 completed weeks of gestation. Even after adjustments, the risk remained 2-3 times greater compared to those who were born full term (at 39-41 completed weeks). Additionally, the risk for COPD at age 30–50 was significantly higher for those born at <28 weeks, with an odds ratio (OR) of 7.44. The study also identified that bronchopulmonary dysplasia (BPD) in infancy increased the odds of obstructive airway disease for those born at <28 and 28–31 weeks.

These findings suggest that preterm birth is a notable risk factor for asthma and COPD in adulthood, and this risk was observed across all gestational ages before full term. The study recommends diagnostic vigilance for adults born very preterm presenting with respiratory symptoms. However, the researchers also noted the potential limitations of using registry data, which might include residual confounding from unmeasured confounders and lack of data on certain prenatal or early life factors.

Article: Preterm birth and asthma and COPD in adulthood: a nationwide register study from two Nordic countries – European Respiratory Journal (free for a limited period)

 

Commentary on Twitter

 

M-A | HFNC, CPAP, BiPAP prove more effective than conventional oxygen therapy in minimizing pediatric extubation failure

19 Jun, 2023 | 13:35h | UTC

Association of Extubation Failure Rates With High-Flow Nasal Cannula, Continuous Positive Airway Pressure, and Bilevel Positive Airway Pressure vs Conventional Oxygen Therapy in Infants and Young Children: A Systematic Review and Network Meta-Analysis – JAMA Pediatrics

 

Commentary on Twitter

 

Review | Point-of-care thoracic ultrasound in children: new advances in pediatric emergency setting

16 Jun, 2023 | 13:59h | UTC

Point-of-Care Thoracic Ultrasound in Children: New Advances in Pediatric Emergency Setting – Diagnostics

 

Cluster RCT | Point-of-care CRP testing cuts antibiotic prescriptions in respiratory illnesses in primary care

1 Jun, 2023 | 11:58h | UTC

Implementation of point-of-care testing of C-reactive protein concentrations to improve antibiotic targeting in respiratory illness in Vietnamese primary care: a pragmatic cluster-randomised controlled trial – The Lancet Infectious Diseases

Commentary: Use of CRP testing reduced antibiotics for respiratory infections, trial finds – CIDRAP

 

SR | Nasal high flow therapy for primary respiratory support in preterm infants

12 May, 2023 | 13:31h | UTC

Nasal high flow therapy for primary respiratory support in preterm infants – Cochrane Library

Summary: Nasal high flow therapy for breathing support in preterm babies – Cochrane Library

 

Commentary on Twitter

 

AAP Policy Statement | Protecting children and adolescents from tobacco and nicotine

4 May, 2023 | 13:43h | UTC

Protecting Children and Adolescents From Tobacco and Nicotine – Pediatrics

Clinical Report: Protecting Children and Adolescents From Tobacco and Nicotine – Pediatrics

Commentaries:

Protecting Kids From Tobacco’s Harms: AAP Policy Explained – Health Children

To protect kids from tobacco, pediatricians say, focus should be on quitting – or never starting – CNN

 

SR | Nebulized hypertonic saline solution for acute bronchiolitis in infants

17 Apr, 2023 | 12:37h | UTC

Nebulised hypertonic saline solution for acute bronchiolitis in infants – Cochrane Library

 

SR | Chest physiotherapy for acute bronchiolitis in pediatric patients between 0 and 24 months old

10 Apr, 2023 | 13:32h | UTC

Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old – Cochrane Database of Systematic Reviews

 

Prematurity and bronchopulmonary dysplasia: what general pediatricians should know

30 Mar, 2023 | 14:12h | UTC

Prematurity and BPD: what general pediatricians should know – European Journal of Pediatrics

 

Guidelines | Management of bronchiolitis in infants

28 Mar, 2023 | 14:47h | UTC

UPDATE – 2022 Italian guidelines on the management of bronchiolitis in infants – Italian Journal of Pediatrics

 

SR | Post-tuberculosis sequelae in children and adolescents

27 Mar, 2023 | 13:16h | UTC

Post-tuberculosis sequelae in children and adolescents: a systematic review – The Lancet Infectious Diseases (free registration required)

 

Cohort Study | Early childhood respiratory infections linked to increased risk of premature respiratory disease mortality in adulthood

20 Mar, 2023 | 13:52h | UTC

Summary: The study aimed to determine the link between lower respiratory tract infections (LRTIs) in early childhood and premature adult death from respiratory disease. The study used data from a nationally representative cohort recruited at birth in Great Britain in 1946 and followed participants across eight decades.

After adjusting for multiple markers of childhood social disadvantage and adult smoking, the study found that individuals who had an LRTI by age 2 years were 93% more likely to die prematurely from respiratory disease as adults than those who did not have early childhood LRTI, accounting for one-fifth of these deaths and an estimated 179,188 excess deaths across England and Wales between 1972 and 2019.

However, it is important to note that this observational study cannot establish causality, but rather suggests that early childhood LRTI is a marker of increased risk of respiratory-cause deaths later in life.

Article: Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study – The Lancet

News Release: Respiratory disease in early childhood linked to higher risk of death for adults – Imperial College London

Commentaries:

Childhood bronchitis, pneumonia tied to premature respiratory death in adults – CIDRAP

Lower respiratory tract infection in early childhood linked with higher risk of dying from respiratory disease as an adult, study finds – CNN

Early childhood lower respiratory tract infection: a key determinant of premature adult respiratory mortality – The Lancet (free registration required)

 

Commentary from the author on Twitter (thread – click for more)

 

Position Statement | Chronic suppurative lung disease and bronchiectasis in children, adolescents and adults

7 Mar, 2023 | 13:04h | UTC

Thoracic Society of Australia and New Zealand (TSANZ) position statement on chronic suppurative lung disease and bronchiectasis in children, adolescents and adults in Australia and New Zealand – Respirology

 

BTS Clinical Guidance | Prevention and management of community-acquired pneumonia in people with learning disability

6 Mar, 2023 | 14:34h | UTC

BTS Clinical Statement on the prevention and management of community-acquired pneumonia in people with learning disability – Thorax

 

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