Search Results (354)

Hematopoietic stem cell transplant (HSCT) recipients are at high risk for opportunistic infections due to profound immunosuppression and graft-versus-host disease (GvHD). Molds and nontuberculous mycobacteria (NTM) pose diagnostic and therapeutic challenges, especially when infections overlap. A 42-year-old woman with prior allogeneic HSCT for acute myeloid leukemia (AML) developed pulmonary infections with Microascus spp. and Mycobacterium chimaera, later complicated by Aspergillus calidoustus and RSV infection. Initial therapy included voriconazole, amphotericin B, and a macrolide-based multidrug regimen for NTM. Modifications were required for drug resistance and hepatotoxicity. Despite partial response, recurrent fungal infection necessitated prolonged antifungal therapy, including adjunctive inhaled amphotericin B and terbinafine. Ultimately, progressive bronchiolitis obliterans prompted bilateral lung transplantation. Explant pathology revealed necrotizing granulomas positive for NTM and Microascus spp. Post-transplant prophylaxis with voriconazole, rifabutin, azithromycin, and inhaled amikacin prevented recurrence, and the patient remained clinically stable at 6-month follow-up. This case illustrates the complexity of managing overlapping mold and NTM infections in HSCT recipients, highlighting the need for individualized, multidisciplinary care. Therapeutic drug monitoring, careful adjustment for drug–drug interactions, and the use of adjunctive inhaled antifungals were critical to achieving a favorable outcome. Full article

Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTI) in infants and young children, with significant morbidity, hospitalizations, and healthcare costs. Passive immunoprophylaxis has historically relied on palivizumab, while nirsevimab, a long-acting monoclonal antibody, has recently emerged as an alternative and has broader indications. Methods: We conducted a systematic review of randomized controlled trials, observational studies, real-world effectiveness analyses, and economic evaluations assessing the efficacy, safety, and cost-effectiveness of palivizumab and nirsevimab for RSV prevention in children under 24 months. Results: 41 studies were included in this review. Palivizumab demonstrated consistent efficacy in reducing RSV-related hospitalizations in high-risk infants, with relative risk reductions of approximately 45–55%. Nirsevimab showed higher relative efficacy, with reductions of 70–85% in RSV-associated lower respiratory tract infections and hospitalizations across randomized trials and real-world studies, including healthy term and late-preterm infants. Both monoclonal antibodies have favorable safety profiles, with adverse event rates comparable to the placebo. Economic analyses indicated that palivizumab is cost-effective primarily in narrowly defined high-risk populations, whereas nirsevimab may offer improved cost-effectiveness, particularly at lower acquisition prices and with seasonal administration strategies. Conclusions: Nirsevimab represents a promising advancement in RSV prevention, with broader protection, a simpler administration, and potential economic advantages compared to palivizumab. Full article

Background: Readmission of newborns within the first 28 days after initial discharge represents a significant healthcare concern, causing distress to families and financial burden on healthcare systems. Understanding readmission patterns and risk factors is essential for implementing preventive strategies. Objective: This retrospective observational study aimed to evaluate the prevalence and characteristics of neonatal readmissions to a pediatric center in Ploiești, Romania, during a 12-month period (1 January 2024–31 December 2024). Methods: We reviewed medical records of all newborns aged 0–28 days admitted to the pediatric hospital after initial discharge from maternity wards. Clinical characteristics, diagnoses, paraclinical findings, and demographic data were analyzed. Results: A total of 131 newborns were readmitted, representing a 1.9% readmission rate, and only the first readmission for each patient was included in the analysis. The majority (60.9%) presented with preventable infectious pathology, including bronchiolitis (18.3%), rhinoconjunctivitis (16%), pyoderma (11.4%), infectious gastroenteritis (8.4%), and COVID-19 infection (6.8%). Males comprised 61.3% of cases, and 74.8% were born via cesarean section. Exclusive breastfeeding rate was 45.8%. Concerningly, two cases (1.5%) presented with measles, reflecting declining vaccination coverage in Romania (the lowest in the European Union at 62%). Conclusions: The predominance of preventable infectious conditions among neonatal readmissions highlights critical gaps in post-discharge care and infection prevention education. The presence of vaccine-preventable diseases underscores the urgent need to address declining immunization rates in Romania. Enhanced parental education on hygiene practices, infection prevention, and improved post-discharge follow-up systems are essential to reduce neonatal morbidity and readmission rates. Full article

Lung transplantation provides a curative option for patients living with end-stage lung disease, with a goal of improving survival and quality of life. Chronic lung allograft dysfunction, or CLAD, represents a major cause of morbidity and mortality, particularly after the first year of transplant. Background/Objectives: The goal of this review is to outline the diagnosis and management of CLAD within the lung transplant population, as well as discuss future areas of potential research interest. Methods: A PubMed literature review of relevant publications regarding CLAD epidemiology, diagnosis, and management was performed to assess current understandings. Results: CLAD is the leading cause of death in lung transplant patients following the first year of transplant, and is common, with approximately 50% of patients exhibiting some degree of CLAD within five years of surgery. Well-established guidelines on diagnosis were recently published to aid clinicians in diagnosing and characterizing CLAD. Several medical and surgical interventions exist, although no therapy consistently and reliably stabilizes or reverses CLAD. Conclusions: CLAD management remains a priority within the lung transplant field as a leading cause of morbidity and mortality. Full article

Purpose: Respiratory syncytial virus-positive bronchiolitis continues to be the main diagnosis prompting transportation in children younger than one year of age. It represents approximately 15–20% of all services performed by a specialized pediatric transport team. In October 2023, an immunization program with nirsevimab, a monoclonal antibody against RSV, was started in Spain. The purpose of the present study is to describe how nirsevimab affects the rates of bronchiolitis managed by a pediatric team specialized in critical patient transport. Secondary objectives included describing and comparing the clinical aspects of the two cohorts—pre-nirsevimab (pre-n) and post-nirsevimab (post-n)—to quantify how immunization has modified the clinical phenotype of bronchiolitis. Methods: This is a descriptive and observational study. Patients with bronchiolitis transported by a specialized pediatric transport team between September 2021 and August 2025 were included. Demographic, clinical, and microbiological data were collected. The pre-n and post-n periods were compared. Results: From a total of 2347 interfacility transports conducted by the unit between 2021 and 2025, 463 (19.7%) involved bronchiolitis patients, all of whom were recruited: 307 in the pre-n period and 156 in the post-n. The median age was 2.5 months (IQR 1.3–5.7), and 55% were male. There was a significant decrease in bronchiolitis cases that required specialized transport between the two periods: 28.2% (307/1089) pre-n vs. 12.4% (156/1258) post-n (p < 0.001). RSV detection also declined (74.3% vs. 47.4%, p < 0.001), while other viruses increased significantly in the post-n period, including rhinovirus, metapneumovirus and bocavirus. Age at admission showed statistically significant differences across the two periods (2.2 vs. 3.4 months, p < 0.001). There were no differences in severity between the two periods in terms of respiratory and inotropic support and length of stay. No mortality was reported. Conclusions: Universal nirsevimab immunization was associated with a marked reduction in pediatric transports for bronchiolitis, particularly RSV-related cases, without modifying disease severity among those requiring transfer. Full article

Post-infectious bronchiolitis obliterans (PIBO) is a rare but severe chronic lung disease of childhood, characterized by irreversible small-airway obstruction following severe lower respiratory tract infections early in life. The disease course is often progressive and associated with long-term respiratory morbidity, while effective disease-modifying therapies remain limited. We report the case of a young child who developed severe PIBO following adenovirus pneumonia complicated by prolonged respiratory failure and multisystem involvement. Diagnosis was based on persistent respiratory symptoms, characteristic radiologic findings, and poor response to conventional anti-inflammatory treatment. Given the severity of the clinical course and steroid-refractory disease, an individualized immunomodulatory strategy, including hydroxychloroquine, was initiated within a multidisciplinary framework. During follow-up, the patient showed progressive clinical improvement, with gradual weaning from continuous oxygen supplementation, fewer respiratory exacerbations, simplification of systemic therapies, and radiologic findings consistent with partial improvement. Although causal conclusions regarding treatment efficacy cannot be drawn from a single case, the overall disease trajectory appeared more favorable than typically reported in PIBO cohorts. This case supports the emerging view of PIBO as an immune-mediated airway fibrotic disorder and underscores the importance of integrating detailed clinical phenotyping with evolving molecular insights to inform future precision medicine in pediatric post-infectious airway disease. Full article

Objectives: Lung transplantation is a life-saving option for patients with end-stage lung diseases, yet immunosuppression management remains challenging. Induction therapy with interleukin-2 receptor antagonists (IL2-AR), such as basiliximab and daclizumab, is designed to reduce acute rejection and improve graft survival. However, its efficacy compared with alternative agents or no induction therapy remains uncertain. This study aimed to evaluate the impact of IL2-AR induction on clinical outcomes in lung transplant recipients. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies comparing IL2-AR induction with antithymocyte globulin (ATG), alemtuzumab, or no induction therapy were included. The primary outcomes were overall survival and freedom from acute rejection. Secondary outcomes included freedom from bronchiolitis obliterans syndrome (BOS), hospital length of stay (LOS), and time until extubation. Kaplan–Meier curves were reconstructed for long-term outcomes. Random effects model was performed. Results: Twelve studies comprising 27,855 patients were included. IL2-AR induction was associated with improved overall survival compared to standard of care (HR 0.88; 95%CI 0.85–0.93; p < 0.01). However, sensitivity analyses, including two-stage meta-analysis and leave-one-out analysis, revealed a loss of statistical significance. No significant differences were found for freedom from acute rejection (p = 0.774) or secondary outcomes, including freedom from BOS (p = 0.455), hospital LOS (p = 0.423), and time until extubation (p = 0.186). Conclusions: IL2-AR therapy may be associated with improved survival after lung transplantation; however, evidence remains inconclusive due to heterogeneity and limitations in study design. Full article

Background/Objectives: Zinc is an essential trace element involved in multiple aspects of immune function, including epithelial barrier integrity, innate and adaptive immune responses, regulation of inflammation and oxidative stress. Zinc deficiency has been associated with increased susceptibility to infections, particularly in the pediatric population. This narrative review aims to summarize and discuss current evidence on the role of zinc in the prevention and management of pediatric respiratory infections. Methods: A comprehensive literature review was conducted including randomized controlled trials, real-world studies, and international guidelines published in recent years. Both zinc monotherapy and multicomponent dietary supplements containing zinc were considered. Results: Evidence consistently supports a preventive role of zinc supplementation in reducing the incidence and burden of respiratory infections, particularly in children with recurrent disease and in zinc-deficient populations. Zinc-containing multicomponent supplements demonstrated significant reductions in infection frequency and duration, alongside improved patient and parent-reported outcomes, with a favorable safety profile. In contrast, data on zinc as an adjunctive treatment during acute infections, especially severe pneumonia, are less consistent, with limited impact on major clinical outcomes. The effectiveness of zinc appears to be influenced by treatment duration, baseline nutritional status, and formulation. Conclusions: In conclusion, zinc may represent a valuable component of preventive immune-nutritional strategies for pediatric respiratory infections, especially when administered as part of multicomponent formulations and over prolonged periods. While its role in acute disease management remains uncertain, optimizing zinc status may contribute to reducing infection recurrence and overall disease burden. Further well-designed trials are warranted to clarify optimal dosing, timing, and target populations. Full article

The mammalian lung operates under a biological paradox, requiring architectural fragility for gas exchange while maintaining robust regenerative plasticity to withstand injury. The Hippo signaling pathway has emerged as a central “rheostat” in orchestrating these opposing needs, yet the distinct roles of its downstream effectors remain underappreciated. This review synthesizes recent genetic and mechanobiological advances to propose a “Tale of Two Effectors” model, arguing for the functional non-redundancy of YAP and TAZ. We posit that YAP functions to drive airway progenitor expansion, mechanical force generation, and maladaptive remodeling. Conversely, TAZ—regulated uniquely via transcriptional mechanisms and mechanotransduction—acts as an obligate driver of alveolar differentiation and adaptive repair through an NKX2-1 feed-forward loop. Furthermore, we introduce the “See-Saw” model of tissue fitness, where mesenchymal niche collapse releases the mechanical brake on the epithelium, triggering the bronchiolization characteristic of pulmonary fibrosis. Finally, we extend this framework to malignancy, illustrating how Small Cell Lung Cancer (SCLC) subtypes mirror these developmental and regenerative states. This integrated framework offers new therapeutic distinct targets for modulating tissue fitness and resolving fibrosis. Full article

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. Full article

Background/Objectives: Asthma is a prevalent chronic respiratory disease in children, and poor asthma control remains a major clinical challenge worldwide. In Jordan, the rising prevalence of pediatric asthma highlights a need to better understand the factors influencing asthma control and to evaluate new assessment tools. Methods: This cross-sectional study aimed to identify predictors of asthma control and to assess the clinical utility of fractional exhaled nitric oxide (FeNO) as a supplementary biomarker. A total of 329 children with physician-diagnosed asthma, aged 7–17 years, were recruited from Jordan University Hospital. Clinical history, spirometry, FeNO measurements, and Asthma Control Test scores were collected. Results: Overall, 62.6% of participants had uncontrolled asthma. Logistic regression analysis revealed that comorbidities such as obstructive sleep apnea, gastroesophageal reflux disease, allergic rhinitis, and bronchiolitis obliterans were significantly associated with poorer asthma control. Antihistamine use and elevated FeNO levels were also linked to lower odds of asthma control. Conclusions: While FeNO showed promise as a non-invasive marker of airway inflammation, its clinical application remains limited due to variability and confounding factors. A comprehensive, individualized approach to asthma management, considering comorbidities and conventional assessments, is essential. Larger, longitudinal studies are needed to establish the role of FeNO in routine pediatric asthma care. Full article

Background: Severe pediatric influenza remains a major clinical burden, yet its phenotype in the post-COVID-19 period has not been fully characterized. The pandemic’s infection-control measures created an “immunity gap” among children, altering viral epidemiology and severity. This multicenter study from Türkiye defines the clinical spectrum and outcomes of influenza cases requiring intensive care, providing one of the first regional datasets after the pandemic. Methods: We retrospectively analyzed 85 children with influenza admitted to five tertiary PICUs in İstanbul between 2024 and 2025. Demographics, clinical features and outcomes were compared across groups. Predictors of sepsis, pediatric ARDS, and mechanical ventilation were identified through multivariate logistic regression. Results: Influenza A + RSV co-infection occurred in 14% and affected significantly younger infants, presenting with more severe respiratory distress, hypoxemia, and bronchiolitis. Influenza B was associated with distinct neurotropic features—encephalopathy and seizures in 48%—and a higher risk of sepsis (OR 3.27, 95% CI 1.02–10.53). Hypoxemia, elevated vasoactive–inotropic score, and high PaCO₂ independently predicted mechanical ventilation and poor outcomes. Only 2–4% of children had received influenza vaccination. Conclusions: This multicenter analysis reveals a post-pandemic surge of severe pediatric influenza characterized by dual respiratory and neurological phenotypes. RSV co-infection drives early respiratory failure in infants, whereas Influenza B carries a disproportionate risk of neuroinflammation and sepsis. The study provides evidence from Türkiye that the post-COVID “immunity gap” and critically low vaccination coverage contribute to increased PICU admissions. Strengthening pediatric influenza immunization and RSV prevention policies is urgently warranted to mitigate these outcomes. Full article

Molar incisor hypomineralisation (MIH) is a developmental defect affecting permanent first molars and often the incisors too. Hypomineralised second primary molars (HSPM) have been proposed as potential early indicators of MIH. Aim: The aim was to identify potential aetiological factors associated with MIH and assess their relationship with HSPM in a pilot study. Methods: A cross-sectional case–control study was conducted with 120 patients (60 cases and 60 controls), aged 7–15 years, from the Paediatric Dentistry Postgraduate Programme. MIH was diagnosed following European Academy of Paediatric Dentistry (EAPD) guidelines. Parents completed a structured questionnaire on potential aetiological factors. Results: MIH was significantly associated with maternal smoking during pregnancy (p = 0.013), birth hypoxia (p = 0.013) and the use of amoxicillin and inhalation therapy during infancy (p < 0.001). It was also associated with tonsillitis (p = 0.022), bronchiolitis (p = 0.005) and other respiratory disorders (p = 0.049). HSPM was associated with anaemia and hypotension during pregnancy (p = 0.001), bottle-feeding (p = 0.044) and urinary tract infections (p = 0.003). No statistically significant association was found between MIH and HSPM. Conclusions: This pilot study has identified specific prenatal, perinatal, and postnatal factors associated with MIH and HSPM. The findings emphasise the clinical relevance for early diagnosis and management and highlight the need for studies with larger sample sizes to validate these associations. Full article

Objectives: The introduction of universal prophylaxis with Nirsevimab represents a major innovation in preventing respiratory syncytial virus (RSV) infections in newborns. In Sicily, Nirsevimab administration began on 1 November 2024, for all newborns under one year and at-risk infants during the 2024–2025 season. This study assessed the real-world impact of this strategy in reducing RSV-related hospitalizations. Methods: This retrospective cohort study examined newborns residing in Sicily from 2015 to May 2025, evaluating hospitalization incidence rates attributable to RSV during the first year of life. RSV hospitalizations were identified using ICD-9 codes (079.6, 466.11, 480.1) in any diagnostic position. Incidence rates in the 2024–2025 season (intervention period) were compared with preceding seasons. Results: During the study period, 4431 RSV hospitalization cases occurred (19.84 cases per 1000 person-years), peaking in 2023–2024 (53.47 cases per 1000 person-years). A statistically significant 40% reduction in RSV hospitalizations was observed during the 2024–2025 season (October–April) compared with the preceding season, with a relative reduction ranging between 33.4% and 54.8% across sensitivity models. Conclusions: These results confirm the significant impact of the universal prophylaxis program in real-world practice, consistent with other European programs. These findings support universal RSV prevention strategies and provide insights for optimizing regional and national health policies. Full article

Objective: Chest computed tomography (CT) is a key component of the diagnostic assessment of people with cystic fibrosis (PwCF) and is increasingly replacing chest radiography. Due to improvements in life expectancy, radiation exposure has become a growing concern in PwCF. Photon-counting CT (PCCT) has the potential to reduce the risk of radiation-induced malignancies while maintaining diagnostic accuracy. This study aimed to compare the radiation dose and image quality of low-dose high-resolution (LD-HR) and ultra-low-dose high-resolution (ULD-HR) CT protocols using PCCT in PwCF. Methods: This retrospective study included 72 PwCF, with 36 undergoing a LD-HR chest CT protocol and 36 receiving an ULD-HR protocol on a PCCT. The radiation dose and image quality were assessed by comparing the effective dose and signal-to-noise ratio (SNR). Three blinded radiologists evaluated the overall image quality, sharpness, noise, and assessability of the bronchi, bronchial wall thickening, and bronchiolitis using a five-point Likert scale. Results: The ULD-HR PCCT protocol reduced radiation exposure by approximately 65% compared with the LD-HR PCCT protocol (median effective dose: 0.19 vs. 0.55 mSv, p < 0.001). While LD-HR images were consistently rated higher than ULD-HR images (p < 0.001), both protocols maintained diagnostic significance (median image quality rating of “4-good”). The average SNR of the lung parenchyma was significantly lower with ULD-HR PCCT compared to LD-HR PCCT (p < 0.001). Conclusions: ULD-HR PCCT significantly reduced radiation exposure while maintaining good diagnostic image quality in PwCF. The effective dose of ULD-HR PCCT is only twice that of a two-plane chest X-ray, making it a viable low-radiation alternative for routine imaging in PwCF. Full article