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Sornsiri Yimlamai, Kanokpan Ruangnapa, Wanaporn Anuntaseree, Kantara Saelim, Pharsai Prasertsan, Kantisa Sirianansopa Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, ThailandCorrespondence: Kanokpan Ruangnapa, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, 90110, Thailand, Tel +66-74-451250-1, Fax +66-74-451250-3, Email kanoknokpan@gmail.comPurpose: It is still unclear whether considering abnormal spirometry as a marker for disease control can help physicians adjust asthma controllers in children because of the scarcity of pediatric studies. We aimed to investigate the prevalence of abnormal spirometry in a selected pediatric asthmatic population and its effect on longitudinal outcomes.Patients and Methods: This retrospective cohort study was conducted at the Songklanagarind Hospital, Thailand. Children with asthma aged < 18 years were recruited for review if they attended the clinic and underwent acceptable spirometry with bronchodilator responsiveness (BDR) tests after receiving asthma treatment for at least 3 months between January 2011 and June 2022. Differences in baseline characteristics, atopic factors, asthma treatment, and outcomes were analyzed between the normal and abnormal spirometry groups over a 12-month post-spirometry period.Results: The mean age of the 203 enrolled patients was 10.9 ± 2.6 years. Abnormal spirometry, defined as airflow limitation or the presence of BDR, was observed in 58.1% of patients. No significant differences were observed in baseline characteristics, atopic factors, asthma treatment, or outcomes between the normal and abnormal spirometry groups. Further analysis of 107 patients with abnormal spirometry with symptom control revealed that physicians adjusted the asthma controller based on spirometry and symptoms in 84 and 23 patients, respectively. There was no significant difference in the loss of disease control over the 12-month post-spirometry period between the two groups.Conclusion: Abnormal spirometry was found in 58.1% of treated school-aged patients with asthma. Abnormal spirometry results were not associated with poor asthma outcomes during the 12-month follow-up. Both symptom-based and spirometry-based adjustments of asthma controllers resulted in comparable symptom control over a 12-month follow-up period in the selected population.Keywords: pulmonary function test, lung function test, childhood asthma, bronchodilator responsiveness

Central sleep apnea (CSA) is a significant concern in children with neurodevelopmental disorders and genetic syndromes, where conventional treatments such as bilevel positive airway pressure (BiLevelPAP) therapy may be poorly tolerated. Acetazolamide, a carbonic anhydrase inhibitor, is an alternative treatment that induces a metabolic acidosis, which may help stabilize respiratory disturbances by enhancing ventilatory drive. However, evidence regarding its use in pediatric populations remains limited. We report the case of a 12-year-old male with an FBXO28 gene-related disorders with significant CSA. Due to intolerance to BiLevelPAP therapy, a trial of acetazolamide was initiated. The dose was adjusted to maintain a mild metabolic acidosis, with regular blood work and clinical monitoring to assess for potential side effects. Follow-up polysomnography (PSG) demonstrated significant improvements in the central apnea-hypopnea index (CAHI) and periodic breathing. No significant adverse effects were reported, and the family noted a substantial improvement in quality of life. BRIEF SUMMARY: This case highlights that maintaining a mild metabolic acidosis with acetazolamide is sufficient to stimulate respiratory drive and stabilize breathing in pediatric CSA, while minimizing risks of electrolyte imbalances and long-term renal consequences. Our findings align with existing literature, which indicates that acetazolamide may be effective for CSA without hypoventilation in children, particularly those with genetic syndromes. Further research is necessary to establish standardized treatment protocols, optimal dosing, and long-term safety., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Formative assessment promotes positive learning outcomes and evaluates students over time. We aimed to evaluate students' learning achievements after implementing a formative assessment technique by using a normalised gain method., Methods: This retrospective observational study was conducted at the School of Medicine and Health Science, Faculty of Medicine, Prince of Songkla University, Thailand. There were 118 fifth-year medical students who attended a general pediatric course in the 2021-2022 academic year., Results: In the summative assessment, the post-test scores were significantly greater than the pretest scores (mean difference 20.53, 95% CI (18.63-22.44), P < 0.001). The median value of the overall student learning gain (g) was 0.34 (0.23, 0.45). Students with medium gains had significantly higher scores than those with low gains (P < 0.001). Students' learning gains had a positive correlation with post-test scores. (R = 0.6, P = 0.01)., Conclusions: The formative assessment technique is a valuable method for enhancing students' learning outcomes by offering timely and effective feedback through mentoring systems. It is essential to integrate formative assessments into standard assessment strategies in undergraduate medical education., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Human Research Ethics Committee (REC. 65-486-1-1), Faculty of Medicine, Prince of Songkhla University, Thailand. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Prolonged mechanical ventilation is associated with significant morbidity in critically ill pediatric patients. In addition, extubation failure and deteriorating respiratory status after extubation contribute to increased morbidity. Well-prepared weaning procedures and accurate identification of at-risk patients using multimodal ventilator parameters are warranted to improve patient outcomes. This study aimed to identify and assess the diagnostic accuracy of single parameters and to develop a model that can help predict extubation outcomes., Materials and Methods: This prospective observational study was conducted at a university hospital between January 2021 and April 2022. Patients aged 1 month to 15 years who were intubated for more than 12 h and deemed clinically ready for extubation were enrolled. A weaning process with a spontaneous breathing trial (SBT), with or without minimal setting, was employed. The ventilator and patient parameters during the weaning period at 0, 30, and 120 min and right before extubation were recorded and analyzed., Results: A total of 188 eligible patients were extubated during the study. Of them, 45 (23.9%) patients required respiratory support escalation within 48 h. Of 45, 13 (6.9%) were reintubated. The predictors of respiratory support escalation consisted of a nonminimal-setting SBT [odds ratio (OR) 2.2 (1.1, 4.6), P  = 0.03], >3 ventilator days [OR 2.4 (1.2, 4.9), P  = 0.02], occlusion pressure (P0.1) at 30 min ≥0.9 cmH 2 O [OR 2.3 (1.1, 4.9), P  = 0.03], and exhaled tidal volume per kg at 120 min ≤8 ml/kg [OR 2.2 (1.1, 4.6), P  = 0.03]; all of these predictors had an area under the curve (AUC) of 0.72. A predictive scoring system to determine the probability of respiratory support escalation was developed using a nomogram., Conclusion: The proposed predictive model, which integrated both patient and ventilator parameters, showed a modest performance level (AUC 0.72); however, it could facilitate the process of patient care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Charernjiratragul, Saelim, Ruangnapa, Sirianansopa, Prasertsan and Anuntaseree.)

Alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV) is a rare congenital diffuse lung disorder, with a fatal course during the neonatal period. We describe an 18-month-old boy who presented with respiratory syncytial virus pneumonia and pulmonary hypertensive crisis requiring extracorporeal membrane oxygenation. Exome sequencing revealed a FOXF1 frameshift variant, NM&#95;001451.2:c.995&#95;998delACTC, inherited from his asymptomatic mother. Genetic findings were compatible with histopathology findings from a lung biopsy. Based on the disease course, histopathology, and outcomes of this case, we believe ACDMPV should be considered a possibility in an infant presenting with hypoxemic respiratory failure, resistant pulmonary hypertension, and vasodilator-induced pulmonary edema. Genetic testing can contribute to the diagnostic process., Competing Interests: The authors declare that they have no competing interests., (© 2023 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Nearly all asthma predictive tools estimate the future risk of asthma development. However, there is no tool to predict the probability of successful ICS cessation at an early age. Therefore, we aimed to determine the predictors of successful ICS cessation in preschool wheezers, and developed a simple predictive tool for clinical practice. This was a retrospective cohort study involving preschool wheezers who had undergone an ICS therapeutic trial during 2015-2020 at the University Hospital, Southern, Thailand. A predictive scoring system was developed using a nomogram to estimate the probability of successful ICS cessation. We calculated area under ROC curve and used a calibration plot for assessing the tool's performance. A total of 131 medical records were eligible for analysis. Most of the participants were male (68.9%). More than half of the preschool wheezers had successful ICS cessation after an initial therapeutic trial regimen. The predictors of less successful ICS cessation were perinatal oxygen use [OR 0.10 (0.01, 0.70), P = 0.02], allergic rhinitis [OR 0.20 (0.08, 0.56), P = 0.002], blood eosinophil count > 500 cell/mm 3 [OR 0.20 (0.06, 0.67), P = 0.008], and previous ICS use > 6 months [OR 0.30 (0.09, 0.72), P = 0.009]., Conclusions: Predictors of less successful ICS cessation were the following: perinatal oxygen use, allergic rhinitis, blood eosinophil count > 500 cell/mm 3 , and previous ICS use > 6 months. A simple predictive score developed in this study may help general practitioners to be more confident in making a decision regarding the discontinuation of ICS after initial therapeutic trials., What Is Known: • Early allergic sensitization is associated with reduced chances of inhaled corticosteroid cessation at school age. • Prolonged ICS is associated with the emergence of adverse effect and discontinuing too early can result in recurrence symptoms., What Is New: • Requirement of oxygen support within 7 days after birth in term neonate is a postnatal factor associated with less successful ICS cessation. • We propose a simple predictive tool with easily available clinical parameters (perinatal oxygen use, allergic rhinitis, blood eosinophil count, parental asthma history, and duration of previous ICS use) to determine the timing of inhalational corticosteroid cessation in preschool wheezers., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Most patients with childhood asthma present their first symptoms at preschool age. Identifying modifiable risks and protective factors at an early age may help develop asthma prevention and control strategies. This study aimed to identify factors at preschool age that are associated with persistent asthma at school age. This retrospective observational study included preschool children with asthma from 2015 to 2020 at a university hospital in Southern Thailand. In total, 189 eligible participants (70.9% boys; median age, 7.6 [6.7, 8.5] years) were included. Wheeze characteristics included early transient wheeze, persistent wheeze, and late-onset wheeze that accounted for 55%, 27.5%, and 19.5% of the patients, respectively. Approximately 20% of the participants had persistent asthma. Breastfeeding was a protective factor (odds ratio [OR] 0.4 [0.2, 0.9], p = 0.04). The modifiable risk factors were siblings living in the same household (OR 2.6 [1.1, 6.2], p = 0.02) and residence in an industrial area (OR 3.8 [1.4, 10.5], p = 0.009). Additionally, presence of allergic rhinitis was associated with an increased risk of persistent asthma at school age (OR 3.6 [1.6, 8.2], p = 0.002). Early therapeutic interventions targeting modifiable factors provide a window of opportunity to prevent persistent asthma at school age.

Background: Inflammation and immobility are the most relevant mechanisms that alter protein synthesis and increase protein breakdown. Protein catabolism is associated with morbidity and mortality in critically ill children., Objective: To demonstrate the effectiveness of the routinely used enteral nutrition support guideline in preventing muscle breakdown in critically ill children., Methods: A prospective cohort study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital. Critically ill children (aged 1 month to 15 years) admitted to the PICU were enrolled. All patients were assessed for nutritional status and nutritional requirement. Enteral nutrition support following the guideline was initiated within the first 24 hours if no contraindication. The calorie target was defined either by direct measurement from indirect calorimetry or estimated from Schofield equation with protein target at least 1.5 g/kg/day. Anthropometric assessments and body composition measurements by bioelectrical impedance analysis (BIA) were examined at baseline and on the seventh day of the PICU admission., Results: Sixty-three patients were enrolled in the study. The most common age group was 1-5 years old (38.1%). The length of PICU stay was 9.1 (SD = 12.7) days. Respiratory problems were the major cause of PICU admission (50.8%). Mechanical ventilation was required in 55.6% of the patients with the average duration of 6.3 (SD = 12.4) days. Undernutrition was found in 36.5% of the patients. Enteral feeding was the major route of nutrition support (95.2%). After the first week of admission, muscle mass was significantly preserved ( p < 0.01). All patients received the nutrition support at their target energy and protein goal within the first week. The enteral feeding-related complication was reported in 1.6% of the patients., Conclusion: Protein catabolism during critically ill period can be minimized by optimal nutrition support. Nutrition practice using the enteral nutrition support guideline was effective in helping critically ill children reach their target caloric and protein intake., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Kantisa Sirianansopa et al.)

Objective: This study aimed to compare the endotracheal reintubation between nasal high-frequency oscillation (nHFO) and nasal continuous positive airway pressure (nCPAP) with face mask groups who were followed up for up to 7 days., Study Design: We performed a retrospective cohort study of extubated neonates admitted between 2013 and 2017. We used a Cox's proportional hazards model to adjust for significant between-group differences in baseline characteristics., Results: One hundred and ninety-nine neonates were on either nHFO or nCPAP after extubation. The median (interquartile range) gestational age and birth weight were 31 (29, 33) weeks and 1,450 (1,065, 1,908) grams, respectively. From the univariate analysis, gestational age, ventilator modes, mean airway pressure, fraction of inspired oxygen, oxygen index, caffeine therapy, and initial continuous positive airway pressure level were significantly different between the nHFO and nCPAP groups. There was no significant difference in the 7-day reintubation rate of neonates on nHFO compared with nCPAP (hazard ratio: 2.39; 95% confidence interval: 0.97-5.84; p  = 0.05). By multivariate analysis, there was no statistically significant difference of reintubation rate between nHFO and nCPAP by Cox's proportional hazards model., Conclusion: The nHFO mode with face mask is the choice for noninvasive ventilation to prevent reintubation during the week following extubation., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)