Kamal Masarweh

Background: Respiratory syncytial virus (RSV) is a leading cause of pediatric hospitalization, yet data on children hospitalized with RSV in their second year of life are limited. Objective: To compare clinical characteristics and management practices of children hospitalized with RSV during their second versus first year of life. Methods: This retrospective multicenter study included children aged 0–23 months hospitalized with RSV infection across 11 medical centers between 2017 and 2021. We compared demographics, outcomes (length of stay [LOS] > 3 days, and pediatric intensive care unit [PICU] admission), and systemic corticosteroid and antibiotic use between the second and first years of life, adjusting for prematurity, comorbidities, and the COVID‐19 pandemic. Results: Among 6260 children hospitalized with laboratory‐confirmed RSV infection, 1321 (21%) were hospitalized during their second year of life. Compared with first‐year admissions, second‐year patients had higher rates of prematurity (18.0% vs. 13.4%) and comorbidities (6.3% vs. 2.6%) (both p < 0.001). They more frequently received corticosteroids (53.5% vs. 23.2%) and antibiotics (63.4% vs. 45.9%) (both p < 0.001) and had lower PICU admission rates (4.6% vs. 7.0%; p < 0 0.001) and similar rates of prolonged LOS (35.0% vs. 35.6%; p = 0.64). In adjusted analyses, second‐year hospitalization was associated with increased corticosteroid use (adjusted odds ratio [aOR], 4.28; 95% CI, 3.67–4.99) and antibiotic use (aOR, 2.09; 95% CI, 1.80–2.43), and lower odds of PICU admission (aOR, 0.56; 95% CI, 0.40–0.79). Conclusions: RSV hospitalization in the second year of life carries a significant burden, with higher antibiotic and corticosteroid use despite lower PICU rates and similar LOS. These findings highlight the need for better characterization of this age group to optimize future immunoprophylaxis strategies.

Purpose The second year of life is gaining increased attention in the era of long-acting RSV immunoprophylaxis. This multicenter study, across pre- and post-COVID seasons, aimed to assess the association between specific key risk-factors and severe RSV-related disease among hospitalized children aged 12–23 months. Methods This retrospective study included children aged 12–23 months hospitalized with RSV across 11 medical-centers (2017–2021). We compared outcomes of prolonged hospitalization (> 3 days) and PICU (Pediatric Intensive Care Unit) admission for children with risk factors (prematurity < 37 weeks, major congenital heart disease (CHD), chronic lung disease of prematurity (CLD) or Down syndrome (DS)) and those without the respective risk factor, adjusting for demographic variables and COVID-19 pandemic admission. Clinical outcomes were also compared between children with ≥ 1 risk factors and those with none. Results Among 1023 children, 228 (22%) had ≥ 1 risk factor: prematurity (n = 183), CLD (n = 28), CHD (n = 45) or DS (n = 20). In multivariable analysis, prematurity with CLD (aOR 4.7,95%CI:1.97–11.22) or without CLD (aOR 2.26, 95%CI:1.54–3.3), CHD (aOR-3.29, 95%CI:1.6–6.77), DS (aOR-4.14, 95%CI:1.26–13.6) and having ≥ 1 risk (aOR-3.55, 95%CI:2.55–4.96) were independently associated with prolonged hospitalization. DS (aOR 6.7, 95%CI:2.1–22.4), CHD (aOR 3.0,95%CI:1.04–8.66) and having ≥ 1 risk factor (aOR-3.58, 95%CI:1.89–6.80) were also associated with PICU admission. Conclusion Children aged 12–23 months with prematurity, CLD, major CHD or DS had significantly higher rates of prolonged RSV hospitalization. Those with ≥ 1 risk factor, and presumably patients with DS and CHD are at highest risk for severe complications. Preventive strategies for these high-risk populations should be considered in their second-year of life. What is Known: • Children with prematurity, congenital heart disease (CHD), chronic lung disease of prematurity (CLD) or Down syndrome (DS) are at increased risk for severe RSV-related illness in the first year of life. • The second year of life is now relevant for long-acting RSV prevention strategies. What is New: • This multicenter study shows that prematurity, CLD, CHD, and DS remain strong predictors of prolonged RSV hospitalization in children aged 12–23 months. • Those with ≥ 1 risk factor, and presumably those with DS and major CHD, faced the highest risk, with increased likelihood of PICU admission.

Objective: Children less than two years of age with a prolonged or severe course of bronchiolitis are usually referred for Echocardiographic evaluation during hospitalization. Our aim was to assess the yield of Echocardiography (Echo) in these children and to assess possible characteristics predicting positive Echo findings.Study Design: This retrospective study over 10 years included all children under two years of age admitted with acute bronchiolitis. Data was collected using the MDClone query tool. Children with abnormal Echo findings (positive Echo) were compared to a control group (comprised of all other admitted patients with bronchiolitis, and to bronchiolitis patients referred for cardiologic evaluation and found to have normal Echo).Results: Echocardiography was performed in 251/2137 eligible patients with a clinical diagnosis of bronchiolitis. Twenty‐six of 251 had abnormal findings, 20 of mild and six of moderate to severe clinical significance. Younger age at diagnosis, Arab ethnicity, higher respiratory rate, lower pH, higher pCO₂, longer hospital length of stay, PICU admission and mechanical ventilation were more likely to be associated with positive Echo findings.Conclusion: Although Echocardiographic assessment of healthy infants during bronchiolitis is normal in the vast majority of children, the noninvasive, non‐irradiating nature of the assessment, combined with the possible detrimental repercussions of a missed congenital cardiac anomaly, suggests performing Echocardiography during an atypical or severe course of bronchiolitis. However, larger studies are required to assess the yield of Echocardiography in bronchiolitis.

Objectives: We aimed to evaluate the impact of respiratory symptoms and positive viral testing on the risk of serious bacterial infections (SBIs). Methods: A retrospective study was conducted that included infants (0–60 days) presenting with a fever between 2001 and 2022 at a tertiary hospital in northern Israel. Demographic, clinical, and laboratory parameters were collected, and risk factors for SBIs were analyzed. Results: Data from a total of 3106 infants, including data from blood, urine, and CSF cultures, were obtained in 96.6%, 89%, and 29% of cases, respectively. A fever without respiratory symptoms (fever only) was present in 1312 infants, while 1794 had a fever and respiratory symptoms—427 were positive for a respiratory virus (virus+), 759 tested negative (virus−), and 608 were not tested. The SBI rate was 5.1% vs. 7.5% in the fever-and-respiratory group vs. the fever-only group (p = 0.004, OR = 0.65 (95% CI = 0.49–0.88)) and 2.8% vs. 7% in the virus+ vs. virus− group (p = 0.002, OR = 0.385, (95% CI = 0.203–0.728)). The male gender, an age < 1 month, leukocytosis > 15 × 10⁹/L, or a CRP > 2 mg/dL increased the risk of SBIs. Respiratory symptoms or a confirmed viral infection reduced the risk of SBIs in the presence of the above risk factors. Conclusions: Respiratory symptoms and a positive viral test decreased the risk of SBIs. Combining rapid viral testing with clinical variables may identify low-risk infants. Despite the relatively low risk of SBIs in individuals with viral infections, conducting prospective studies remains essential for accurately predicting the occurrence of these potentially life-threatening infections.

Pleuropulmonary blastoma (PPB) is a tumor occurring almost exclusively in infants and young children. This is the most common primary-lung malignancy in childhood. There is age-associated progression through a distinctive sequence of pathologic changes, from a purely multicystic lesion type I to a high-grade sarcoma type II and III. While complete resection is the cornerstone treatment for type I PPB, aggressive chemotherapy with a less favorable prognosis is associated with type II and III. DICER1 germline mutation is positive in 70% of children with PPB. Diagnosis is challenging, as it resembles congenital pulmonary airway malformation (CPAM) in imaging. Although PPB is an extremely rare malignancy, over the past five years we have encountered several children diagnosed with PPB in our medical center. Herein, we present some of these children and discuss diagnostic, ethical, and therapeutic challenges.

Background: Vascular rings are congenital anomalies of the aortic arch that compress the trachea and esophagus and may require corrective surgery. Data about the long‐term effects of vascular rings are scarce. We aimed to evaluate the long‐term cardiorespiratory, exercise capacity, and quality of life of vascular ring patients.Methods: A single center prospective study evaluating spirometry, echocardiography, six‐minute walk test (6MWT), cardiopulmonary exercise testing (CPET), and quality of life questionnaire (SF36) in patients with a diagnosis of vascular ring, with or without corrective surgery.Results: Twenty‐seven patients participated (11.9 ± 6 years, 52% males). The most common diagnosis was double aortic arch (16 patients, 59%). Nineteen patients had corrective surgery (O) and 8 did not (NO). Pulmonary function tests were within normal range in both groups (FEV₁% predicted O = 87.6 ± 16.5, NO = 83 ± 10.8%). However, 11/27 had abnormal FEV₁, 5 had abnormal FVC, and 13 (48%) had flattening of the expiratory curve. 6MWD and oxygen uptake were similarly mildly reduced in both groups; (6MWD O = 80.1 ± 10.7% predicted, NO = 74.1 ± 10.9% and oxygen uptake O = 78.5 ± 23.2% predicted, NO = 73.4 ± 14.3%). Peak O₂ pulse (V̇O₂/HR% predicted) was mildly reduced in the NO group (O = 88.4 ± 17.3%, NO = 75.8 ± 16.2%). Echocardiogram and SF36 scores were normal in all patients.Conclusions: Long‐term evaluation of patients born with vascular rings revealed mild pulmonary impairment, reduction in 6MWD, and oxygen uptake. The NO group had also mild reduced peak O₂ pulse. Larger, long‐term studies assessing functional parameters in operated and non‐operated patients are needed to assess disease/surgery limitation in patients with vascular rings. Clinical trial registration number: NCT04781738.

Purpose Relvar® (fluticasone furoate [FF]/vilanterol [VI]) is a once-daily inhaler with bronchodilator effect lasting 24 h. Our aim was to investigate the short- and long-term effects of FF/VI on exercise-induced asthma (EIA) in adolescents. Methods Ninety-three adolescent asthmatics aged 12–18 years were referred for evaluation of EIA. Following a positive exercise challenge test (ECT), 22/44 were allocated to a single administration of salbutamol (400 μg) and 22/44 to FF/VI (92/22 μg) in a double-blind method. Thirty-five subjects were reassessed by repeat ECT 30–60 days of FF/VI. Results Median FEV₁ change post-ECT at baseline was −22.8% predicted (interquartile range [IQR] −26.1 and −18.0) for salbutamol and −21.0 (IQR −30.7 and −16.8) for FF/VI. Following bronchodilator, FEV₁ improved similarly in both groups. Repeat ECT following 30–60 days of FF/VI resulted in negative ECT in 33/35 subjects; the median decrease in FEV₁ of these 35 subjects was 22.6% predicted (IQR 29–18) before, and 4.6% predicted (IQR 8.7–2.5) after 30–60 days of FF/VI treatment (p < 0.0001). Conclusions FF/VI is effective in reversing EIA after 15 min in adolescents and in protecting EIA after 30–60 days in adolescents. Larger studies are needed to assess the effect of FF/VI on EIA.

Assessing disease severity in patients with cystic fibrosis (CF) is essential when directing therapies. Serum immunoglobulin G (IgG) levels increase with disease severity. Lung clearance index (LCI) is recognized as an outcome measure for CF clinical trials. Our aim was to evaluate the correlations between IgG and disease severity markers. This was a single-center retrospective study, evaluating association between IgG and markers of severity in CF patients (including clinical characteristics, lung spirometry, LCI, clinical scores and computed tomography (CT) scores) during stable conditions. There were 69 patients, age 20.5 ± 11.6 years. Nineteen (27.5%) patients had elevated IgG. IgG correlated positively with LCI (r = 0.342, p = 0.005). IgG was higher in pancreatic insufficient (PI) and patients with liver disease (1504.3 ± 625.5 vs. 1229 ± 276.1 mg/dL in PI vs. PS, p = 0.023, and 1702.6 ± 720.3 vs. 1256.2 ± 345.5 mg/dL with vs. without liver disease, p = 0.001, respectively). IgG also correlated positively with CRP, CT score, and days with antibiotics in the previous year (r = 0.38, p = 0.003; r = 0.435, p = 0.001; and r = 0.361, p = 0.002, respectively), and negatively with FEV1% and SK score (r = −0.527, p < 0.001 and r = −0.613, p < 0.001, respectively). IgG correlated with clinical parameters, pulmonary functions, and imaging. However, this is still an auxiliary test, complementing other tests, including lung function and imaging tests. Larger multi-center longitudinal studies are warranted.

Introduction: Community acquired pneumonia (CAP) is a leading cause of morbidity in children, despite advances in health care and anti‐pneumococcal vaccine. Complicated pneumonia accounts for a significant burden with prolonged hospitalization. Finding risk factors for complicated pneumonia may help in tailoring management. We aimed to identify risk factors for developing complicated pneumonia and need for intervention.Methods: A retrospective single tertiary center study. Children admitted with a diagnosis of CAP and/or complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, and lung abscess) on January 2001–March 2020 were included. Demographic, clinical, and laboratory parameters were collected using MDclone, a data acquisition tool. Risk factors for complicated pneumonia (on admission or during hospitalization) and risk for intervention were analyzed.Results: A total of 6778 children with pneumonia were included; 323 arrived at the Emergency Department with complicated pneumonia while 232 developed a complication during hospitalization. Risk factors for complicated pneumonia (on admission or during hospitalization) were Arab ethnicity, cardiac disease, increased age, and CRP and low O₂ Sat (OR = 2.236 p < .001, OR = 4.376 p < .001, OR = 1.131 p < .001, OR = 1.065 p < .001 and OR = 0.959 p = .029, respectively). O₂ Sat was lower, while fever and CRP were higher in patients with complicated pneumonia requiring intervention.Conclusions: Identifying children at risk for complicated pneumonia may help in decision‐making in the Emergency Department and during hospitalization. The increased risk of the Arab population for complicated pneumonia requires further understanding. Addressing the underlying socioeconomic and ethnic health inequities may help to decrease the disease burden in this population.