搜索结果：Paediatric respiratory reviews

Proponents of artificial intelligence (AI) believe that it will revolutionise the modern world, affecting how healthcare is delivered and improve both the clinical care we provide and the ease with which we perform our work. In this paper we explain what is meant by 'artificial intelligence' and explore how this technology has been implemented, or might be implemented, with respect to paediatric respiratory medicine. We review the current literature on how AI has been used to improve diagnostics - including examples in radiology, primary ciliary dyskinesia (PCD) diagnostics, sleep medicine, and pulmonary function tests. We also review how AI has been applied to therapeutics and drug discovery, how it will impact evidence-based medicine and literature review, and how clinician support tools will assist us in our work.

To systematically review the current knowledge gap in, and impact of, long-term respiratory support in children and young people (CYP) with cerebral palsy (CP). We searched six databases from inception until 30th January 2025. Grey literature was also searched. Screening and data extraction using Covidence software, quality of evidence (Risk Of Bias In Non-randomized Studies - of Interventions), and certainty of evidence (Grading of Recommendation, Assessment, Development and Evaluation) grading were independently conducted by two reviewers, with a third reviewer resolving any lack of consensus. Title and abstract screening (n = 1994) and full-text reviews (n = 45) identified four studies (with moderate to severe risk of bias) for data extraction. Findings presented as a narrative synthesis from vote counting suggest improvement in sleep study parameters for CYP with CP on long-term respiratory support and quality of life for their parents (low certainty of evidence). This review identified a significant knowledge gap in the use of long-term respiratory support in CYP with CP and its impact on health-related outcomes for such young people. This limits the information that can be offered when counselling parents/carers before initiating respiratory support in CYP with CP. Further research is needed to allow better service-planning at national and local levels.

Paediatric lung transplantation is a rare but increasingly successful therapeutic option for children with end-stage respiratory failure. Over the past decade, its epidemiology has shifted, with cystic fibrosis becoming an uncommon indication and a growing proportion of candidates presenting with interstitial lung disease or pulmonary arterial hypertension. In parallel, advances in donor allocation, the development of size-reduction surgical techniques and the reconditioning of marginal lungs have expanded the donor pool and reduced waiting-list mortality, including in small children. Peri-operative improvements-including broader use of extracorporeal life support as a bridge to transplantation-have further strengthened early and long-term outcomes. At the same time, progress in infectious disease prophylaxis and antiviral therapy, coupled with a more refined understanding of rejection mechanisms, is reshaping post-transplant care. Together, these developments underscore the importance of early referral to specialised paediatric transplant centres to ensure timely assessment and optimal access to advanced supportive strategies.

Following the 2009 H1N1 influenza pandemic, the World Health Organization (WHO) established a new case definition for severe acute respiratory infection (SARI) for viral surveillance. Several studies have suggested that SARI case definitions are inaccurate at detecting pediatric disease burden. Understanding the performance of SARI case definitions in children is important for pandemic preparedness. To evaluate the diagnostic accuracy of SARI case definitions in detecting microbiologically confirmed viral respiratory tract infections among hospitalized children. The MEDLINE(R), Embase Classic + Embase, Ovid EBM Reviews Cochrane Central Register of Controlled Trials, Elsevier SCOPUS, and the WHO Global Index Medicus databases were searched from inception to March 31, 2025. Study screening was conducted in duplicate by 2 independent reviewers. Any studies that assessed any SARI definition in hospitalized children were included. There were no restrictions by design, time period, or geographical location. Data extraction using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was conducted by 1 author using a predefined template and independently validated by a second author. Diagnostic accuracy was extracted as 2 × 2 tables from each study and pooled using a bivariate random-effects model. Quality assessments were conducted using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The primary outcomes were sensitivity and specificity. For each case definition-virus combination with at least 4 included studies, pooled estimates of sensitivity and specificity were calculated. Of 1144 studies identified, 13 were included. Included studies represent surveillance data from 65 inpatient sites across 8 countries, using data from 2007 to 2023. The most common definition was the 2014 WHO SARI (9 studies). Viral pathogens included influenza (10 studies) and respiratory syncytial virus (RSV; 6 studies). Meta-analysis of the WHO 2014 SARI definition yielded a sensitivity of 75.7% (95% CI, 65.0%-83.9%; I2 = 89.2%) and specificity of 30.6% (95% CI, 19.8%-44.0%; I2 = 99.0%) for influenza (7 studies) and sensitivity of 70.6% (95% CI, 56.9%-81.9%; I2 = 98.8%) and specificity of 38.7% (95% CI, 25.7%-53.5%; I2 = 99.5%) for RSV (5 studies). In younger subgroups, sensitivity appeared to decrease while specificity appeared to increase for both influenza and RSV. In this systematic review and meta-analysis of 13 studies, the WHO 2014 SARI definition demonstrated reduced sensitivity and increased specificity in younger pediatric cohorts, suggesting that surveillance systems that rely on SARI case definitions may potentially underestimate disease burden in children.

Patients receiving extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (SARF) often experience significant challenges with airway clearance due to disease severity, ultra-protective ventilation strategies and suppression of mucociliary and cough mechanisms. Extremely low tidal volumes and minimal flow rates further hinder secretion mobilisation. Despite increasing global use of ECMO, there is currently no synthesis of evidence describing airway clearance practices, their physiological rationale or outcomes in this population.This scoping review aims to explore the extent and nature of evidence on airway clearance interventions in invasively ventilated adult patients receiving ECMO for SARF. Specific objectives include mapping the types of interventions described and specific parameters, their intended physiological effects, reported outcomes and safety considerations. This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be undertaken across Embase, Ovid Emcare, Ovid Medline, CINAHL and grey literature sources including TRIP and Google Scholar. Eligible studies will include original data on airway clearance interventions in adult patients (≥16 years) receiving ECMO for SARF. Studies focused on paediatric populations, extracorporeal carbon dioxide removal, or solely cardiac ECMO will be excluded.Two independent reviewers will screen titles, abstracts and full texts, extract data using a piloted tool and summarise findings using descriptive statistics and narrative synthesis. Basic qualitative content analysis will support mapping of interventions including parameters, their physiological and clinical rationale, and reported outcomes including adverse effects. As this study involves a review of existing literature and does not include collection of primary data, ethical approval is not required. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic and professional meetings. The results are expected to highlight variations in practice and provide a foundation for future research aimed at optimising respiratory care and improving outcomes for patients receiving ECMO for SARF. osf.io/ptfr7.

Molecular point-of-care testing (mPOCT) offers rapid identification of respiratory pathogens, but its impact on antibiotic use and patient outcomes remains uncertain. We aimed to comprehensively evaluate the effects of mPOCT on antibiotic use and major clinical outcomes in patients presenting with acute respiratory tract infections (ARTIs). We searched MEDLINE, Embase, Web of Science, CENTRAL, CNKI, and Wanfang Data from inception to July 1, 2025, for randomised controlled trials (RCTs) evaluating mPOCT for patients presenting with ARTIs (PROSPERO CRD420251069333). The primary outcome was antibiotic use, assessed using pooled risk ratio (RR) with random-effects models. Risk of bias and certainty of evidence were assessed using the Risk Of Bias instrument for Use in SysTematic reviews-for Randomised Controlled Trials (ROBUST-RCT) and core Grading of Recommendations, Assessment, Development and Evaluation (GRADE), respectively. We included 25 RCTs involving 12,638 patients, of whom 61.0% were adults. Overall, mPOCT probably had little to no important effect on antibiotic use (RR 0.95, 95% CI 0.90-1.00; moderate certainty) or treatment duration (mean difference -0.44 days, 95% CI -0.98 to 0.09; moderate certainty). In adults, high-certainty evidence showed no effect on antibiotic use (RR 1.00, 95% CI 0.98-1.02), whereas in children, low-certainty evidence suggested a potential reduction (RR 0.79, 95% CI 0.65-0.97). Although mPOCT increased appropriate antibiotic prescribing (RR 2.07, 95% CI 1.55-2.77; moderate certainty), it did not affect 30-day mortality (RR 0.97, 95% CI 0.82-1.15; high certainty) and intensive care unit admission (RR 0.90, 95% CI 0.65-1.25; high certainty). Moderate to high certainty evidence suggests that mPOCT does not meaningfully reduce overall antibiotic use or improve patient outcomes, particularly in adults, despite enhancing prescribing appropriateness. Routine use of mPOCT for adults with ARTIs is therefore not supported. National Natural Science Foundation of China, the Postdoctoral Science Foundation, the Chongqing Municipality Joint Science and Health Major Medical Research Project, Outstanding Youth in Science and Technology, the Chongqing Youth Talent Fund, and the Research Foundation Flanders.

The aim of this study was to evaluate oral health in paediatric and adult patients affected by cystic fibrosis (CF). A systematic review was conducted following PRISMA guidelines. Electronic search was performed on scientific databases to identify studies reporting relevant oral health parameters. Eleven studies met inclusion criteria, mostly cross-sectional and from tertiary care settings. Paediatric CF cohorts showed caries risk comparable or lower than controls but a higher prevalence of developmental enamel defects (DDE) and altered salivary function. Adult CF patients exhibited increased DMFT scores with more untreated decay, while severe periodontitis (PD ≥ 6 mm) remained rare despite high plaque accumulation. CF is associated with a distinctive oral health profile, characterized by age-dependent caries risk, frequent enamel anomalies, altered salivary physiology, and relatively preserved periodontal status. Standardized longitudinal studies are needed to clarify these associations, evaluate CFTR modulators effects, and support the integration of dental care within multidisciplinary CF management.

Behavioural sleep problems are common in children. The challenges with establishing and maintaining good sleep hygiene may prove challenging to overcome based on environmental issues such as the liberal availability of electronic media from a young age, permissive parenting, difficult family dynamics and limited parental/carer understanding of a child's sleep needs as they progress through childhood and adolescence. Melatonin is inexpensive, easily accessible, in high demand from the community and, at its simplest, may be perceived as a harmless "silver bullet" for "sleep problems". Clinicians are encountering children already using melatonin, sometimes with minimal behavioural support and misconceptions about its safety. This article provides frontline clinicians with an evidence-based overview of melatonin's role in paediatric care, emphasising its approved indications, the dangers of unregulated products and the risks of unsupervised use.

In the era of cystic fibrosis transmembrane conductance regulator (CFTR) modulators, we have seen impressive improvements to quality of life and life expectancy in people with cystic fibrosis (pwCF). However, there have been emerging adverse events related to elexacaftor/tezacaftor/ivacaftor (ETI). We present 8 paediatric pwCF who developed chalazion/hordeolum on standard dosing of ETI, of which one third needed interruption of ETI therapy to achieve resolution. This report highlights a 5.5-fold increased incidence of chalazion/hordeolum in pwCF and raises concerns of a clinical association between ETI and chalazion/hordeolum.

To provide consensus-based recommendations on safe and effective physical activity and sports participation for children and adolescents with chronic health conditions. The Task Force of the European Academy of Pediatrics (EAP) reviewed English-language meta-analyses, systematic reviews, randomised clinical trials and observational studies published between 2000 and 2024 in major databases (Scopus, PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE and EBSCO). Evidence from scientific organisations, including the WHO, was also considered. Recommendations were developed through expert consensus. The position statement provides tailored guidelines for children with juvenile idiopathic arthritis, congenital osteoarticular and musculoskeletal defects, haemophilia, asthma, cystic fibrosis, diabetes, sickle cell trait, hypertension, nephrotic syndrome, inflammatory bowel disease, epilepsy, a history of severe allergic reactions and reduced nephron number. Practical recommendations are summarised for each condition. This consensus statement offers a structured, evidence-based framework for healthcare professionals, parents and caregivers to promote safe physical activity and sport participation in pediatric populations with chronic diseases, thereby supporting quality of life and long-term health outcomes.

This systematic review protocol introduces the rationale to investigate how well the Vojta approach works to improve respiratory function and lessen neuromuscular deficits in premature newborns. Innovative approaches like the Vojta technique may offer a possible therapeutic path for preterm newborns, who frequently suffer significant obstacles in their early development. We outline a rigorous methodology for this systematic review. A comprehensive search strategy will be implemented across various databases to identify relevant studies. This systematic review will encompass randomized controlled trials through electronic and manual searches. Electronic searches will be carried out in databases such as PubMed, Medline, Scopus, and Web of Science. The search will span articles published from 2000 to 2025; predefined eligibility criteria involve participants who were premature babies (those born before 37 weeks gestation). Exposure includes participants diagnosed with any other diagnosis that does not include NRDS. Outcome measures focus on oxygen saturation levels (SpO₂), arterial blood gas (ABG) analysis (e.g., PaO₂, PaCO₂, and pH), respiratory rate (breaths per minute), and lung compliance (static or dynamic) will all be used to quantify respiratory function. Two independent reviewers will conduct study selection, data extraction, and risk of bias assessment. The primary outcomes encompassing SpO₂, ABG, Ballard, and APGAR will be systematically analysed.Dissemination and ethics As no primary data will be collected, ethical approval is not required. The findings will be presented at relevant conferences and published in a peer-reviewed journal.Systematic review registration PROSPERO CRD420250643755.

Measles is an important vaccine-preventable disease that has re-emerged in recent years. Since the COVID-19 pandemic, interruptions to routine immunisation programs and declining vaccine coverage have altered the incidence and patterns of respiratory virus infections. Global outbreaks have intensified, and vaccine hesitancy is recognised as major health threat. Revisiting the clinical presentation of measles is crucial for early diagnosis and to reduce transmission of this highly contagious infection. As serious respiratory and neurological complications can follow natural infection and no specific antiviral therapy is available, vaccination remains the most effective strategy for prevention and control.

Despite a high burden of respiratory disease among infants globally, limited options exist for lung function testing in this age group. Tidal breathing techniques such as oscillometry allow for understanding the pathophysiology of diseases that originate early in life, thus providing the opportunity to develop timely prevention and treatment strategies. This review summarises the principles of infant oscillometry, the primary oscillometry measures, physiological differences compared to older age groups, commonly used testing platforms, laboratory benchmarking, and future directions for research. Expanding the use of infant oscillometry will require further standardisation of equipment, calibration, protocols, and technical standards, followed by well-designed studies to outline clinical utility. While infant oscillometry is currently limited to the research setting, this technique has the potential for clinical applications in the future, ultimately providing opportunities for improving respiratory outcomes in infants globally.

Childhood interstitial lung diseases (chILDs) associated with inflammatory diseases represent a heterogeneous group of rare conditions. To date, therapeutic approaches predominantly rely on broad-spectrum immunosuppressive agents, often independently of the underlying mechanism. During the last ten years, next generation sequencing techniques allowed the identification of monogenic auto-inflammatory diseases with the subsequent development of mechanism-based targeted immunomodulatory therapies. Among these emerging therapies, anti-cytokine agents occupy an increasingly prominent role in inflammatory chILDs. Janus kinase (JAK) inhibitors have emerged as a promising strategy, with initial efficacy demonstrated in monogenic type I interferonopathies involving the lung, such as STING-associated vasculopathy with onset in infancy (SAVI) and COPA syndrome. Their therapeutic scope has subsequently expanded to include disorders driven by type II interferon signalling, notably systemic juvenile idiopathic arthritis-associated lung disease and refractory pulmonary granulomatosis. In juvenile dermatomyositis with anti-melanoma differentiation-associated gene 5 (MDA5) antibodies, JAK inhibitors address refractory rapidly progressive interstitial lung disease. Further anti-cytokine therapies include tocilizumab (anti-interleukin-6) for juvenile systemic sclerosis-associated interstitial lung disease, anti-interleukin-1β/18 combinations (MAS-825), and anti-tumour necrosis factor-alpha. Whilst evidence remains predominantly limited to case reports and small series, these mechanism-based approaches represent a paradigm shift towards personalised medicine in chILDs. Understanding disease-specific pathophysiology-from interferon activity assessment to genomic sequencing-is essential for optimal therapeutic targeting. Multicentre collaborations are needed to evaluate long-term efficacy and safety of these targeted interventions.

Lung ultrasound (LUS) is increasingly used in the delivery room to assess respiratory transition and guide early respiratory management. The objective of this systematic review was to evaluate current evidence on the diagnostic applications of neonatologist-performed LUS during neonatal resuscitation and immediate postnatal stabilization in late preterm and term neonates. Twelve studies were included in this qualitative systematic review, addressing physiological LUS patterns after birth, the use of LUS scoring systems to predict the requirement of respiratory support, and applications of LUS during neonatal resuscitation and immediate postnatal stabilization. Normal postnatal adaptation was characterized by rapid progression from fluid-rich to aerated lung patterns, whereas persistent high-risk LUS patterns were associated with respiratory morbidity. Several LUS scoring systems demonstrated good discriminative ability for predicting the need for respiratory support shortly after birth. In addition, characteristic ultrasound patterns supported early identification of late preterm and term neonates at risk for surfactant requirement and mechanical ventilation. Despite substantial heterogeneity in study design, timing of imaging, and analytic methods, the evidence supports the feasibility and clinical value of LUS in the delivery room. Neonatologist-performed LUS represents a promising bedside tool that may complement clinical assessment during early postnatal transition in late preterm and term neonates.

Smart inhaler systems represent a major opportunity to transform paediatric asthma care by potentially addressing three fundamental problems affecting paediatric asthma outcomes: medication adherence, inhalation technique and reliever overuse. The data generated across these domains opens up multiple applications - from supporting patient self-management to enabling early detection of asthma deterioration. In this review, we outline the main categories of smart inhalers - including digital dose counters, smart spacers, and smart nebulisers - and summarise the current evidence surrounding their use in children. We discuss key obstacles to implementation, including technical limitations, behavioural factors, and health system-level challenges. Establishing clear smart inhaler systems quality standards, defining appropriate indications resulting in better asthma outcomes, achieving better integration of smart inhaler data into electronic health care records, and generating robust cost-effectiveness data will be essential to support the widespread clinical adoption of these technologies.

Bronchiectasis in children is a heterogeneous, chronic respiratory condition for which standardised, evidence-based management is essential. While international guidelines have improved diagnostic and therapeutic consistency, the treatable traits (TT) approach offers a complementary precision-medicine framework aimed at identifying all clinically relevant, measurable, and modifiable factors in individual patients. Through a comprehensive literature review, we identified 40 potential TT in paediatric bronchiectasis, spanning aetiological, pulmonary, extrapulmonary, and behavioural/environmental domains. However, the level of evidence supporting many TT remains limited in children, with most data extrapolated from adults or other respiratory diseases. This framework should therefore be considered dynamic, guiding systematic assessment while emphasising the urgent need for paediatric-specific clinical trials.

Ambulatory care sensitive conditions (ACSC) are health conditions that can be adequately managed in the outpatient setting. Timely treatment and interventions may avoid the need for hospitalisation and emergency department visits. We aimed to identify ACSC lists developed for European populations. Systematic review. We included primary studies that aimed to develop a list of ACSC for the general population or subpopulations within European countries. Studies reporting a formal methodology were eligible. Systematic or narrative reviews, and protocols were excluded. PubMed, Web of Science and Scopus were searched on 21 October 2025. Data search was complemented with the search for 'ambulatory OR preventable' in the websites of the WHO Regional Office for Europe, OECD (Organisation for Economic Co-operation and Development) and NHSOF (British National Health Service Outcomes Framework). Two reviewers independently collected data on type of population, geographical coverage, bibliographic support, use of qualitative or quantitative methods, ontology system, as well as the identified conditions per list. Data on methodological characteristics was qualitatively synthesised. Conditions identified as ACSC were aggregated under International Classification of Diseases 10th Revision (ICD-10). Each primary study with Delphi component was assessed using the Diamond et al risk of bias tool. Studies with a qualitative component were assessed using Joanna Briggs Institute (JBI) checklist for qualitative research. A total of 12 articles were included. Six European countries have lists developed for general populations. A total of 263 unique ACSC have been defined (932 codes) for the general populations. For the paediatric age, 28 conditions (70 codes) were identified, while 37 diagnoses (58 codes) were listed for the nursing home population. Most commonly identified ACSCs were infection-related, chronic cardiovascular or respiratory diseases. Delphi methods were employed in eight studies, with a median of 3 (2-3.25) rounds with a median of 36.5 (32.8-42.5) panellists. Risk of bias assessment yielded a quality score of 2 (out of 4) for six studies and of 3 for the remaining two studies. Remaining studies were assessed with JBI yielding a median 6.5 (6.0-7.0) points (out of 10 possible points). The most used code system was ICD-10. Use of nationwide real-world databases was limited to six studies. No identified ACSC lists explicitly fulfilled all criteria defined by Solberg and Weissman for ACSC establishment. The evidence on ambulatory care sensitive conditions is heterogeneous and derives from different methodologies and covers six European countries. Most lists are diagnosis-based, aim at national, general populations and include Delphi components to define ACSC. We speculate that the future inclusion of primary care data could enhance ACSC evidence. CRD42022349270.

Woakes' syndrome is a rare form of chronic rhinosinusitis with nasal polyps (CRSwNP) characterized by the progressive expansion of the nasal framework. We aimed to systematically review the literature on Woakes' syndrome to characterize its clinical features, comorbidities, management strategies, and outcomes. A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of several databases (PubMed, Embase, Cochrane Library, etc.) was conducted for all reports of Woakes' syndrome. All study types (case reports, case series) were included if they provided clinical data on Woakes' syndrome. Non-English-language papers were excluded. Data on patient demographics, comorbidities (e.g., asthma, aspirin-exacerbated respiratory disease), treatments, and outcomes were extracted and synthesized descriptively. Twenty-three studies met the inclusion criteria, comprising 39 unique patients (mean age 39.5 years; range 5-81; 65% male). Both paediatric and adult-onset cases were identified. Common comorbidities included Samter's triad (seven cases) and bronchiectasis or sinobronchial disease (two cases). All patients underwent surgical treatment, most commonly functional endoscopic sinus surgery, with adjunctive procedures including digital nasal bone compression (six cases) and formal rhinoplasty or septorhinoplasty (seven cases). Pre- and postoperative steroid therapy was variably reported with most prescribed topical or systemic corticosteroids. Follow-up data were inconsistently reported; where available, the mean follow-up was approximately 12.5 months, with seven documented recurrences (six despite nasal steroid therapy). Woakes' syndrome is an extremely rare but distinct clinical entity in rhinology, representing an aggressive phenotype of CRSwNP that causes facial deformity. Both paediatric and adult-onset cases occur, frequently associated with underlying conditions such as aspirin-exacerbated respiratory disease in adults. Management requires a combination of aggressive surgical polyp removal and prolonged treatment with steroids to maintain remission. Long-term disease control remains challenging, and emerging treatments such as biological therapies to target chronic inflammation may provide benefit in the most refractory cases.