Outpatient Diuretic Use and Respiratory Outcomes in Children with Bronchopulmonary Dysplasia During the First Three Years of Life.

Objective: To investigate the link between outpatient respiratory outcomes in children with bronchopulmonary dysplasia (BPD) who are prescribed outpatient diuretics versus those who are not at the time of their initial pediatric pulmonary clinic visit.

Study Design: Patient data were gathered by chart review and validated questionnaires on 1,002 children with BPD discharged between 2008 and 2023 seen at the Children's Hospital of Philadelphia and Johns Hopkins Children's Center outpatient pediatric pulmonary clinics.

Results: Children prescribed outpatient diuretics (n=634) at time of first pulmonary appointment were more likely to have severe BPD and require home supplemental oxygen.

Outpatient Respiratory Outcomes in Extremely Preterm Children During the First 3 Years of Life.

Rationale: Extremely preterm infants are at highest risk for developing bronchopulmonary dysplasia (BPD). This study aimed to examine the relationship between gestational age and respiratory outcomes in children with BPD in the outpatient setting.

Methods: Data were collected from 1025 preterm children with BPD recruited from outpatient bronchopulmonary (BPD) clinics at Johns Hopkins and Children's Hospital of Philadelphia (CHOP).

Modifies Chronic Airway Infection Risk in Cystic Fibrosis.

Rationale: Chronic () airway infection is common and a key contributor to diminished lung function and early mortality in persons with cystic fibrosis (PwCF). Risk factors for chronic among PwCF include cystic fibrosis transmembrane conductance regulator genotype, genetic modifiers, and environmental factors. Intensive antibiotic therapy and highly effective modulators do not eradicate in most adolescents and adults with cystic fibrosis.

Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States.

Background: There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit (NICU) to the pediatric intensive care unit (PICU) without an interim discharge home. These infants are often medically complex and have higher mortality relative to NICU or PICU-only admissions. Given an absence of data surrounding practice patterns for non-emergent NICU to PICU transfers, we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.

Bronchopulmonary dysplasia and diuretic use in an outpatient setting.

Introduction: During Neonatal Intensive Care Unit hospitalization, children born preterm with bronchopulmonary dysplasia (BPD) are frequently prescribed diuretics for chronic respiratory symptoms. However, less is known about diuretic use and weaning in an outpatient setting. The study sought to characterize clinical features associated with outpatient diuretic use and timing of diuretic weaning in children with BPD.

Outpatient inhaled corticosteroid use in bronchopulmonary dysplasia.

Rationale: In the outpatient setting, inhaled corticosteroids (ICS) are frequently given to children with bronchopulmonary dysplasia (BPD) for treatment of respiratory and asthma-associated symptoms. In this study we sought to determine if correlations existed between ICS use and ICS initiation and patient characteristics and outpatient respiratory outcomes.

Methods: This study included children with the diagnosis of BPD (n = 661) who were seen in outpatient pulmonary clinics at the Children's Hospital of Philadelphia between 2016 and 2021.

Long-term pulmonary outcomes in BPD throughout the life-course.

Respiratory disease is one of the most common complications of preterm birth. Survivors of prematurity have increased risks of morbidities and mortalities independent of prematurity, and frequently require multiple medications, home respiratory support, and subspecialty care to maintain health. Although advances in neonatal and pulmonary care have improved overall survival, earlier gestational age, lower birth weight, chorioamnionitis and late onset sepsis continue to be major factors in the development of bronchopulmonary dysplasia.

Long-term outcomes of infants with severe BPD.

Preterm birth disrupts the normal sequence of lung development. Additionally, interventions that support gas exchange, including positive pressure ventilation and supplemental oxygen can further exacerbate lung injury, increasing the risk of developing bronchopulmonary dysplasia (BPD) in infants born preterm. Approximately 50,000 preterm infants each year in the United States develop BPD.

Actigraphy methodology in the Kids Mod PAH trial: Physical activity as a functional endpoint in pediatric clinical trials.

Pulmonary vasodilator treatment can improve hemodynamics, right ventricular function, symptoms, and survival in pediatric pulmonary hypertension (PH). However, clinical trial data are lacking due to many constraints. One major limitation is the lack of relevant trial endpoints reflective of hemodynamics or functional status in patients in whom standard exercise testing is impractical, unreliable, or not reproducible.

Continuous Neuromuscular Blockade for Bronchopulmonary Dysplasia.

Objective:  Bronchopulmonary dysplasia (BPD) is the most common late morbidity for premature infants. Continuous neuromuscular blockade (CNMB) is suggested for the most unstable phase of BPD, despite no outcome data. We explored the association between duration of CNMB for severe BPD and mortality.

Kids Mod PAH trial: A multicenter trial comparing mono- versus duo-therapy for initial treatment of pediatric pulmonary hypertension.

Pulmonary hypertension (PH) is a significant health problem that contributes to high morbidity and mortality in diverse cardiac, pulmonary, and systemic diseases in children. Evidence-based advances in PH care have been challenged by a paucity of quality endpoints for assessing clinical course and the lack of robust clinical trial data to guide pharmacologic therapies in children. While the landmark adult AMBITION trial demonstrated the benefit of up-front combination PH therapy with ambrisentan and tadalafil, it remains unknown whether upfront combination therapy leads to more rapid and sustained clinical benefits in children with various categories of PH.

Ambient Air Pollution and Outpatient Morbidities in Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common long-term complication of prematurity. Although socioeconomic status is associated with BPD morbidities, the drivers of this association are poorly understood. In the United States, ambient air pollution (AAP) exposure is linked to both race/ethnicity and socioeconomic status.

Patterns of early life somatic growth in infants and children with a history of chronic lung disease of prematurity.

Objective: Preterm infants, and especially those with additional comorbidities, are at risk of early life growth failure, which may impact postnatal lung growth and attainment of peak lung function. However, little is known about the early life growth patterns of those with chronic lung disease. The goal of this study was to describe the patterns appreciated in this population and their association with certain clinical characteristics.

Association of Pseudomonas aeruginosa infection stage with lung function trajectory in children with cystic fibrosis.

Background: Pseudomonas aeruginosa (Pa) infection in cystic fibrosis (CF) is characterized in stages: never (prior to first positive culture) to incident (first positive culture) to chronic. The association of Pa infection stage with lung function trajectory is poorly understood and the impact of age on this association has not been examined. We hypothesized that FEV decline would be slowest prior to Pa infection, intermediate after incident infection and greatest after chronic Pa infection.

Sex-Specific Differences in Congenital Diaphragmatic Hernia Mortality.

Objective: To compare disease severity and mortality differences between female and male patients with congenital diaphragmatic hernia (CDH).

Study Design: We queried the CDH Study Group (CDHSG) database for CDH neonates managed between 2007 and 2018. Female and males were compared in statistical analyses using t tests, χ² tests, and Cox regression, as appropriate (P ≤ .

Lung function and secondhand smoke exposure among children with cystic fibrosis: A Bayesian meta-analysis.

Background: Secondhand smoke exposure, an important environmental health factor in cystic fibrosis (CF), remains uniquely challenging to children with CF as they strive to maintain pulmonary function during early stages of growth and throughout adolescence. Despite various epidemiologic studies among CF populations, little has been done to coalesce estimates of the association between secondhand smoke exposure and lung function decline.

Methods: A systematic review was performed using PRISMA guidelines.