Huiyong Hu1#, Xiaoping Jing2#, Xiuhua Duan3, Leiping Zhou4, Yunfeng Xu1*1 Department of the Ultrasonography, Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai 200040, China;2 Department of Traditional Chinese Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai 200040, China;3 Department of Radiology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai 200040, China;4 Department of Radiology, International Peace Maternity & Child Health Hospital of China welfare institute, Shanghai Jiao Tong University, school of medicine, Shanghai 200030, China;# These authors contributed equally to this work.* Corresponding author: Yunfeng Xu, Department of the Ultrasonography, Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of medicine;Address: 1400 West Beijing Road, Shanghai, China Lane 24 Zip Code 200040;Phone: 18917128478E-mail: xuyunfeng65@163. com (F X).During a prenatal ultrasonography examination late in the second trimester, a fetus was found to have a right diaphragmatic hernia (Figure S1). Multidepartment dynamic monitoring was instituted, and the fetus was later successfully delivered by cesarean section after fetal distress became evident. After intubation, the infant was stabilized and transferred to the Department of Neonatology at our hospital.The enhanced computed tomography of the chest and stomach displayed multiple air-filled intestinal shadows in the right chest cavity, the widest being about 20.0 mm. The right lung, mediastinum, and heart were compressed and displaced, and most of the lung tissue in the right lung was consolidated. Atelectasis is evident in the irregular enhancement shadow at the right upper abdomen, about 43.5 × 32.0 mm in size. The boundary between some sections and the posterior margin of the right lobe of the liver was unclear, but the blood supply (hepatic artery and portal vein branches) was visible (Figure). Blood gases, routine bloodwork, liver and kidney function, and myocardial enzymes were essentially normal.At 40 + 4 weeks, with the infant under total anesthesia, hernia repair was performed. The liver and intestines in the thoracic cavity were brought back into the abdominal cavity; the tissues around the hernia ring in the diaphragm were carefully dissociated; and patch repair and suturing were performed (Figures S2–S4). After the operation, the infant’s vital signs were stable and their condition remained good during follow-up.Congenital diaphragmatic hernia (CDH) is a potentially fatal birth defect[1-3]. In China today, all pregnant women undergo ultrasonography to uncover pregnancy- related conditions. A “green channel” – that is, a multidepartment collaborative for the emergency treatment of perioperative pulmonary hypertension, pulmonary dysplasia, and other complications in newborns with CDH – has been established, helping to assure the best prognosis for those infants.
Introduction: During the COVID-19 pandemic, pediatric visits due to acute lower respiratory infections (ALRIs) decreased, but most reports are from hospitalized patients. There is little information on this phenomenon in outpatients, who are the majority in IRABs. We evaluated the impact of the COVID-19 pandemic on ALRIs related outpatient visits in the City of Buenos Aires. Methods: Observational study including all outpatient visits of children under 2 years of age to the public health system of the City of Buenos Aires, between Jan 01, 2018 and Dec 31, 2022. We estimated the total number visits and the ALRIs-related visits, and their distribution throughout the study period. Results: A total of 704,426 visits were registered, 7.38% of them due to ALRIs. ALRIs-related visits decreased from the implementation of a national lockdown (2020) and increased again as the restriction measures decreased, particularly the return to full school attendance (2021). In general, the proportion of ALRIs-related vists was significantly higher in the cold months than in the warm ones (9.8% vs. 5.5%; OR: 1.76, 95%CI: 1.73-1.79; p<0.001). This difference was observed before (2018, 2019) and after the pandemic (2022), but not in 2020-2021. The peak of ALRIs-related visits occurred in the cold months in pre-pandemic years (2018-2019), did not appear in 2020, reappeared delayed in 2021 and recovered seasonality in 2022. Conclusion: Outpatient ALRIs-related visits decreased significantly in the city of Buenos Aires during the COVID-19 pandemic and currently seem to have recovered their magnitude and seasonality.
Introduction: This study aimed to determine if a respiratory therapist (RT)-driven high flow nasal cannula (HFNC) protocol could decrease duration of HFNC use, pediatric intensive care unit (PICU) and hospital length of stay (LOS), and duration of continuous albuterol use in pediatric patients with critical asthma. Methods: This was a quality improvement project performed at a quaternary academic PICU. Patients admitted to the PICU between 2 and 18 years of age with a diagnosis of asthma requiring continuous albuterol and HFNC were included. Implementation of a RT-driven HFNC protocol [Plan-Do-Study-Act (PDSA) 1] occurred in October 2017. Additional interventions included weaning continuous albuterol and HFNC simultaneously (PDSA 2; March 2019), adjusting HFNC wean rate (PDSA 3; July 2020), and a HFNC holiday (PDSA 4; October 2021). HFNC duration was the primary outcome. Secondary outcomes included LOS data and continuous albuterol duration. Noninvasive ventilation (NIV), invasive mechanical ventilation (IMV), and 7-day PICU and hospital readmission rates were balancing measures. Results: 410 patients were included. Patient demographics and adjunct therapy use did not differ among the groups. HFNC duration decreased from 26.8 to 18.1 hours, both PICU and hospital LOS were decreased (41 to 31.8 hours, and 86.5 to 68 hours respectively) after PDSA 2. These outcomes remained stable during PDSA 3 and 4. Continuous albuterol duration and NIV use remained stable, while IMV use decreased throughout the study. Conclusions: An RT-driven HFNC protocol led to an improvement in clinical outcomes for pediatric patients with critical asthma without an increase in adverse events.
6 month old child presented with complaints of recurrent respiratory infection, tachypnea and decreased air entry on right side . Xray chest AP view (Fig(#fig-cap-0001)) showed opaque right hemithorax with ipsilateral mediastinal shift and compensatory hyperinflation of left lung. Further evaluation with CECT thorax (Fig (#fig-cap-0002)) showed hypoplastic right lung with collapse consolidation and right sided mediastinal shift. Bifurcation of trachea was not seen with trachea continuing as left main bronchus with normal segmental division. Right bronchus appears to be arising from lower part of esophagus, precise communication was not demonstrated (Fig (#fig-cap-0003)). Conventional contrast (non ionic) esophagogram was performed and free flow of contrast was seen from lower third of esophagus to the right main bronchus (Fig (#fig-cap-0004)) confirming the diagnosis of Congenital bronchopulmonary foregut malformation (CBPFM)
Background: Small air filled peripheral subpleural cysts are a well described feature of pulmonary anatomy at computerised tomographic (CAT) scan in children with Trisomy 21, yet only anecdotally described in association with other pathologies. The significance of these cysts is unknown. Objective: To investigate and explore the pathogenesis of these subpleural cysts in children. Materials and Methods: A retrospective review of 16 cases with subpleural cysts diagnosed on CT chest was performed. The distribution, location and ancillary CT findings were recorded. Hospital charts were reviewed for clinical details, especially cardiac abnormalities, pulmonary artery hypertension (PAH) and genetic associations. Histopathological and clinical correlative data were recorded. Results: 11/16 children (69%) were found to have an underlying chromosomal or genetic abnormality, six of whom had Trisomy 21. The remaining 5/16 cases (21%) had miscellaneous disorders without an identifiable genetic basis. The most common co-morbidities were cardiac abnormalities (81%) and PAH (62.5%). Regardless of their underlying etiologies, the cysts were present bilaterally in most cases (14/16, 88%). We observed both the postnatal development and the progression of cysts in our cohort . On long term follow-up, there were five deaths (31%) and six cases (38%) requiring maintenance oxygen therapy due to chronic hypoxia. Two cases (12.5%) became completely asymptomatic after correction of their underlying abnormalities. Conclusion: Subpleural cysts are not exclusive to Trisomy 21 and may be seen in other inherited or acquired causes, likely due to altered alveolar growth. We suspect these cysts are a sign of an underlying developmental disorder with variable clinical effect, especially in children with congenital cardiac disease.
Background: While bacteria identification on respiratory cultures is associated with poor short-term outcomes in children with bronchopulmonary dysplasia (BPD) and tracheostomies, the influence on longer-term respiratory support needs remains unknown. Objective: To determine if respiratory culture growth of pathogenic organisms is associated with ongoing need for respiratory support, decannulation, and death at 3 years post-tracheostomy placement in children with BPD and tracheostomies. Methods: This single center, retrospective cohort study included infants and children with BPD and tracheostomies placed 2010-2018 and >1 respiratory culture obtained in 36 months post-tracheostomy. Primary predictor was any pathogen identified on respiratory culture. Additional predictors were any Pseudomonas aeruginosa and chronic P. aeruginosa identification. Outcomes included continued use of respiratory support (e.g., oxygen, positive pressure), decannulation, and death at 3 years post-tracheostomy. We used Poisson regression models to examine the relationship between respiratory organisms and outcomes, controlling for patient-level covariates and within-patient clustering. Results: Among 170 children, 59.4% had a pathogen identified, 28.8% ever had P. aeruginosa, and 3.5% had chronic P. aeruginosa. At 3 years, 33.1% of alive children required ongoing respiratory support and 24.8% achieved decannulation; 18.9% were deceased. In adjusted analysis, any pathogen and P. aeruginosa were not associated with ongoing respiratory support or mortality. However, P. aeruginosa was associated with decreased risk of decannulation (aRR 0.48, 95% CI 0.23-0.98). Chronic P. aeruginosa was associated with lower survival probability. Conclusion: Our findings suggest that respiratory pathogens including P. aeruginosa may not promote long-term respiratory dysfunction, but identification of P. aeruginosa may delay decannulation.
Introduction Viral infections are associated with pulmonary exacerbations in children with Cystic Fibrosis (cwCF), but after 3 years of SARS-CoV-2 pandemic, whether cwCF are at higher risk of developing COVID-19 or its adverse consequences remains controversial. Methods We conducted an observational, multicenter, cross-sectional study of cwCF infected by SARS-CoV-2 between March 2020 and June 2022, (1 st to 6 th COVID-19 pandemic waves) in Spain. The study aimed to describe patients’ basal characteristics, SARS-CoV-2 clinical manifestations and outcomes, and whether there were differences across the pandemic waves. Results During study time, 351 SARS-CoV2 infections were reported among 341 cwCF. Median age was 8.5 years (range 0-17) and 51% were female. Cases were unevenly distributed across the pandemic, with most cases (82%) clustered between November 2021 and June 2022 (6 th wave, also known as Omicron Wave due to the higher prevalence of this strain in that period in Spain). Most cwCF were asymptomatic (24.8%) or presented with mild Covid-19 symptoms (72.9%). Among symptomatic, most prevalent symptoms were fever (62%) and increased cough (53%). No multisystem inflammatory syndrome (MIS-C), persisting symptoms, long-term sequelae or deaths were reported. Conclusions Spanish current data indicate that cwCF do not experience higher risks of SARS-CoV-2 infection nor worse health outcomes or sequelae. Changes in patients’ basal characteristics, clinical courses and outcomes were detected across waves. While the pandemic continues, and new SARS-CoV-2 variants are being identified, a worldwide monitoring of COVID-19 in pediatric CF patients is needed.
Objective: To evaluate the frequency and burden of disease of SARS-CoV-2 and other respiratory viruses in children under the age of 2 months. Methods: A retrospective, cross-sectional, single-center study was conducted between March 2021, and February 2022. All children under the age of 2 months and tested for SARS-CoV-2 were included. The frequency of SARS-CoV-2, of other respiratory viruses and the burden of disease caused by SARS-CoV-2 and other respiratory viruses were evaluated. Results: 727 children with an RT-PCR test for SARS-CoV-2 were included (mean age: 0.9 months (±0.6); boys: 57%); 514 (71%) in the emergency room and 213 (29%) in hospital. Among them, 62 (8.5%) had a positive RT-PCR test for SARS-CoV-2, more often in the Omicron period (23%) than in the Alpha period (4%). Of the 565 (78%) with a multiplex RT-PCR test for other viruses, 325 (58%) were positive. Children with a positive SARS-CoV-2 were less likely to have required respiratory support (p=.001), enteral nutrition (p=.03), or intensive care admission (p=.01) and had a shorter hospital stay than children with other respiratory viruses (5d vs. 7d, p=.007). Conclusion: In this young population of children, SARS-CoV-2 infection was less frequent and less severe than other viral respiratory infections.
Less Invasive Surfactant Administration (LISA) is a growing method for treatment of respiratory distress syndrome. Although it has become standard of care in parts of Europe, its adoption in North America remains slow, but with increased interest. Many centers are developing their own guidelines and procedures[3, 4]. This study in Pediatric Pulmonology directly compares two different techniques for administration of surfactant via thin catheter (LISA). Studies like this highlight the importance of fine-tuning techniques for common procedures using an evidence-based approach; allowing new therapies to reach our patient population.Prospective trials of LISA were first performed by Verder et all. A thin, flexible catheter is guided into the trachea and surfactant is administered. The thin catheter does not occlude the airway, allowing the infant to remain on non-invasive respiratory support. While comparable to Intubate-Surfactant-Extubate (INSURE), the use of an endotracheal tube occludes the infant’s airway and nessecitates the use of positive pressure ventilation (PPV). The avoidance of PPV prevents volutrauma and the subsequent inflammatory cascade that is associated with chronic lung disease of prematurity or bronchopulmonary dysplasia[6, 7]. Randomized control trials and subsequent meta-analyses demonstrated that LISA reduced rates of bronchopulmonary dysplasia and death compared to the CPAP, surfactant and mechanical ventilation and the standard of care, INSURE [8-11].Thin catheter administration of surfactant is one of the most popular ways to administer surfactant. Two main techniques have emerged over the past decade. Both techniques require direct visualization of the airway. The first technique is insertion of a rigid catheter (such as the off-label use of an Angiocath) using direct manipulation. The second technique involves the use of Magill forceps to guide a more flexible catheter (such as a feeding tube) into the airway for instillation of surfactant. Both techniques require a highly skilled operator who is familiar with direct visualization of the airway. The study shared in this issue of Pediatric Pulmonology compares the two techniques and demonstrated decreased time to placement and increased success at first attempt with a rigid vs. soft catheter. As this practice was refined most institutions have reappropriated instruments and devices intended for another purpose to successfully implement this practice. Quality improvement initiatives have been helpful in streamlining this process and guiding implementation at individual institutions . It is important for each institution to identify the target patient population, standardize the instruments used for the procedure, and adequately train staff on the procedure.In recent years, some manufacturers have recognized the need for specialized equipment for this procedure. There are three devices that have been specifically designed for surfactant administration, including Surfcath™ (Vygon, Ecouen, France), LISAcath® (Chiesi, Parma, Italy), and Neofact® (Lyomark Pharma, Oberhaching, Germany). Surfcath™ has added benefits over an Angiocath, including a centimeter marking to guide insertion. The distal tip of the device is a blunt black tip of 2 cm, bent at 30 degrees which allows ease of use for insertion. It can be manipulated into the desired shape more easily than an Angiocath. LISAcath® is very similar including a rounded, soft tip at the distal edge and printed markings on the outer surface. One multi-center study surveyed neonatologists and found that they preferred the LISAcath® for ease of use and safety compared to an Angiocath. LISAcath® is currently no longer being produced. Neofact® is an application device with a tracheal catheter. It has an angled applicator tip which allows for positioning directly in front of the glottis. This facilitates the use of a flexible catheter without the use of Magill forceps. This device was studied in a feasibility study and found to be successful in 19 of 20 infants, with a median of 2 attempts. These devices are not available for use in the United States at the time of this publication.Ultimately, direct laryngoscopy remains a noxious procedure for neonates despite incremental improvements over intubation. Alternative approaches continue to be tested including techniques such as surfactant administration via laryngeal or supraglottic airways. These techniques allow for administration of surfactant without direct visualization of the airway. This could be especially helpful in settings where a provider skilled in airway manipulation is not available. Meanwhile, the search for a nebulized surfactant product with similar efficacy continues as a method for truly non-invasive surfactant administration to treat respiratory distress syndrome.1. Klotz, D., et al., European perspective on less invasive surfactant administration—a survey. European journal of pediatrics, 2017. 176 : p. 147-154.2. Kurepa, D., et al., The use of less invasive surfactant administration (LISA) in the United States with review of the literature. Journal of Perinatology, 2019. 39 (3): p. 426-432.3. Conlon, S.M., et al., Introducing less-invasive surfactant administration into a level IV NICU: a quality improvement initiative.Children, 2021. 8 (7): p. 580.4. Williamson, S.L., H. McDermott, and H. Gowda, Implementing less invasive surfactant administration on a neonatal unit. Archives of Disease in Childhood-Education and Practice, 2022. 107 (4): p. 298-301.5. Verder, H., et al., Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study. Ugeskrift for laeger, 1992. 154 (31): p. 2136-2139.6. Keszler, M. and G. Sant’Anna, Mechanical ventilation and bronchopulmonary dysplasia. Clinics in perinatology, 2015.42 (4): p. 781-796.7. Walsh, M.C., et al., Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics, 2004. 114 (5): p. 1305-1311.8. Rigo, V., C. Lefebvre, and I. Broux, Surfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis. European journal of pediatrics, 2016. 175 : p. 1933-1942.9. Mehler, K., et al., Developmental outcome of extremely preterm infants is improved after less invasive surfactant application: developmental outcome after LISA. Acta Paediatrica, 2021.110 (3): p. 818-825.10. Göpel, W., et al., Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta paediatrica, 2015. 104 (3): p. 241-246.11. Göpel, W., et al., Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. The Lancet, 2011.378 (9803): p. 1627-1634.12. Fabbri, L., et al., Five‐country manikin study found that neonatologists preferred using the LISA cath rather than the Angiocath for less invasive surfactant administration. Acta Paediatrica, 2018.107 (5): p. 780-783.13. Maiwald, C.A., et al., Clinical evaluation of an application aid for less-invasive surfactant administration (LISA). Archives of Disease in Childhood-Fetal and Neonatal Edition, 2021. 106 (2): p. 211-214.14. Zapata, H.A., et al., Surfactant administration through laryngeal or supraglottic airways (SALSA): A viable method for low-income and middle-income countries. Frontiers in Pediatrics, 2022.10 .
Background and aims Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83% to 3.08% patients after allogenic hematopoietic stem cell transplant. Such complication is defined as the occurrence of any form of air leak in the thorax, including spontaneous pneumomediastinum or pneumopericardium, subcutaneous emphysema, interstitial emphysema and pneumothorax and has a negative impact on post-transplant survival. The aim of the present study is to describe a single-center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome. Methods We retrospectively reviewed the clinical notes of patients with previous allogenic hematopoietic stem cell transplant who underwent surgical procedures for recurrent TALS from January 2016 until March 2021. As well we analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome. Results In the examined period, four patients, aged 16 to 25 years, underwent surgical procedures for TALS, including thoracostomy tube placement, thoracoscopic pleurodesis and thoracotomy. All the patients had been diagnosed with pGvHD before the onset of TALS, with a mean time lapse of 276 days (range 42 – 513). These patients experienced on average 4.5 air leak episodes (range 3 – 6). All the patients experienced at least two episodes before surgery. One patient underwent emergency tube thoracostomy only, three patients underwent thoracoscopic pleurodesis and two patients underwent thoracotomy. After surgery, patients were free from air leak symptoms for a mean time of 176 days (range 25 – 477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127 – 1045) after the first episode of air leak. Conclusions Surgery provides temporary relief to symptoms related to TALS. When TALS develops, pulmonary function progressively worsens toward respiratory failure and death.
CF is considered a rare disease among the non-Caucasian population. The clinical phenotypes and genotypic spectrum of Chinese CF patients are reported to be different from that observed in Caucasians[(1)](#ref-0001). Our patient carried compound heterozygous mutations which are not included in the Caucasian CFTR common mutation-screening panel and have not been reported yet. CFTR dysfunction causes a spectrum of diseases, with a range in the number of organs involved and varying disease severity. Typical phenotypic features of CF include respiratory diseases (bronchiectasis with persistent airway-based infection and inflammation), gastrointestinal diseases (meconium ileus (MI)), hepatobiliary manifestations (pancreatic insufficiency), and male infertility[(2)](#ref-0002). Our patient presented severe manifestations, namely colonic perforation, meconium thorax, severe pneumonia, diaphragmatic defects-caused marked diaphragm elevation and respiratory failure. It’s difficult to ascertain whether the diaphragmatic defects in our patient is related to CF. MI is often the first manifestation of CF and occurs in approximately 20% of CF patients. CF should therefore be high in the differential diagnosis of any infant presenting with MI[(3)](#ref-0003).
VACTERL association is linked to multiple congenital anomalies including tracheoesophageal fistula. In rare cases, VACTERL has been complicated by other airway malformations including severe bronchial stenosis or unilateral pulmonary agenesis. We report a child who developed episodes of oxygen desaturation during sleep associated with high pressure support requirements to maintain ventilation. He was known to have VACTERL association as well as spinal muscular atrophy (SMA) type II, a genetic neuromuscular disorder. Children with SMA can show progressive respiratory symptoms, including intercostal muscle weakness and accompanying paradoxical abdominal breathing with sparing of diaphragm function. Our patient was very difficult to ventilate non-invasively despite high pressures. CT chest with dynamic airway evaluation showed bilateral bronchial stenosis. High inspiratory pressures with non-invasive ventilation as seen in our case are required to overcome stenotic airways but are not expected in neuromuscular respiratory failure.
Childhood interstitial lung disease (chILD) is a heterogeneous group of diffuse lung diseases (DLD) that can be challenging to diagnose. With relative rarity of individual entities, data are limited on disease prevalence, care patterns, and healthcare utilization. The objective of this study was to evaluate chILD prevalence and review diagnostic and clinical care patterns at our center. A single-center, retrospective cohort study was conducted of patients receiving care at the Children’s Hospital of Philadelphia (CHOP) between January 1, 2019, and December 31, 2021. Through query of selected ICD-10 billing codes relevant for chILD/DLD, a total of 306 patients were identified receiving care during this period. Respiratory symptom onset was documented to have developed before two years of age for 40% of cases. The most common diagnostic categories included those with oncologic disease (21.2%), bronchiolitis obliterans (10.1%), and connective tissue disease (9.5%). Genetic testing was performed in 49% of cases, while 36% underwent lung biopsy. Hospitalization at CHOP had occurred for 80.4% of patients, with 45.1% ever hospitalized in an intensive care unit. One-third of children had required chronic supplemental oxygen. Seven (2.3%) patients died during this three-year period. Collectively, these data demonstrate the scope of chILD and extent of health care utilization at a large volume tertiary care center. This approach to cohort identification and EMR-driven data collection in chILD provides new opportunities for cohort analysis and will inform the feasibility of future studies.
Childhood interstitial and diffuse lung disease (chILD) encompasses a broad spectrum of rare disorders. The Children’s Interstitial and Diffuse Lung Disease Research Network (chILDRN) established a prospective registry to advance knowledge regarding etiology, phenotype, natural history, and management of these disorders. This longitudinal, observational, multicenter registry utilizes single-IRB reliance agreements, with participation from 25 chILDRN centers across the U.S. Clinical data are collected and managed using the Research Electronic Data Capture (REDCap) electronic data platform. We report the study design and some elements of the initial Registry enrollment cohort, which includes 683 subjects with a broad range of chILD diagnoses. The most common diagnosis reported was neuroendocrine cell hyperplasia of infancy (NEHI), with 155 (23%) subjects. Components of underlying disease biology were identified by enrolling sites, with cohorts of interstitial fibrosis, immune dysregulation, and airway disease being most commonly reported. Prominent morbidities affecting enrolled children included home supplemental oxygen use (63%) and failure to thrive (46%). This Registry is the largest longitudinal chILD cohort in the U.S. to date, providing a powerful framework for collaborating centers committed to improving the understanding and treatment of these rare disorders.
Dear Editor, I am writing to submit a letter titled “Usage of a Novel Inhaler Device for the Management of Asthma in Children with Special Needs” for your consideration. This letter highlights the importance of the inhaler device technique in children with asthma when they have comorbid conditions such as attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD). These comorbidities often make it challenging for physicians to plan a treatment regimen, as it impacts the patient’s adherence to medication. We evaluated the effectiveness of a breath-actuated inhaler (BAI) in managing poorly controlled asthma in three pediatric patients with special needs. All patients showed significant improvement in their asthma symptoms, were well-controlled after one month of using the BAI and they found that device was easy to use. This letter contributes to the growing body of evidence supporting the effectiveness of BAI in the management of asthma, particularly in children with special needs. We hope this work to be submitted under the letter to editor section and it will be of interest to your readership and contribute to improving asthma management in children with comorbidities. Thank you for your consideration.
A dynamic case report in which the authors present a multidisciplinary collaboration in a dyspnoic adolescent girl who coughs up blood, has a high temperature and rapidly progresses to respiratory failure. Laboratory findings, imaging results, and their interpretation are shown. Current recommended management is discussed.
Background: People with cystic fibrosis (PwCF) have chronic lung disease and may be at increased risk of COVID-19-related morbidity and mortality. This study aimed to determine seroprevalence and clinical characteristics of SARS-CoV-2 infection in children with CF, and to assess antibody responses following SARS-CoV-2 infection or vaccination. Methods: Children and adolescents with CF followed at Seattle Children’s Hospital were enrolled between July 20, 2020 and February 28, 2021. SARS-CoV-2 serostatus was determined on enrollment, at 6 and 11 months (+/-2 months) for nucleocapsid and spike IgG. Participants completed intake and weekly surveys inquiring about SARS-CoV-2 exposures, viral/respiratory illnesses, and symptoms. Results: Of 125 PwCF enrolled, 14 (11%) had positive SARS-CoV-2 antibodies consistent with recent or past infection. Seropositive participants were more likely to identify as Hispanic (29% vs 8%, p=0.04) and have pulmonary exacerbations requiring oral antibiotics in the year prior (71% vs 41%, p = 0.04). Five seropositive individuals (35.7%) were asymptomatic, while six (42.9%) reported mild symptoms, primarily cough and nasal congestion. Anti-spike protein IgG levels were approximately 10-fold higher in participants following vaccination compared with participants who had natural infection alone (p < 0.0001) and resembled levels previously reported in the general population. Conclusions: A majority of PwCF have mild or no symptoms of SARS-CoV-2 making it difficult to distinguish from baseline respiratory symptoms. Hispanic PwCF may be disproportionately impacted, consistent with racial and ethnic COVID-19 disparities among the general US population. Vaccination in PwCF generated antibody responses similar to those previously reported in the general population.