Managing Pediatric Pulmonary Care From Preterm Birth to Symptom Recovery

A home air filtration intervention showed a small, nonsignificant benefit for infants recovering from bronchiolitis, while cardiac imaging in school-aged children born preterm revealed signs of right ventricular hypertension in nearly a quarter of participants. Meanwhile, a quality improvement initiative successfully increased independent rounding among senior pediatric fellows and improved perceptions of confidence and communication.

These findings were presented as a trio of posters at the American Thoracic Society (ATS) 2025 International Conference, where researchers highlighted emerging data on environmental interventions, long-term cardiopulmonary monitoring, and training innovations in pediatric and pulmonary care.

HEPA Filters for Symptom Relief After Bronchiolitis

In a randomized controlled trial of infants recovering from bronchiolitis, researchers tested whether in-home HEPA filtration could reduce respiratory symptoms over a 24-week period.1 The BREATHE study (NCT06283953) enrolled 228 infants younger than 12 months hospitalized for their first episode of bronchiolitis. Families were randomized to receive either 2 functioning HEPA filters or placebo units without filters, with one unit in the room where the infant is sleeping and the other in a common room.

The main outcome was the number of symptom-free days (SFDs), defined as a full day without cough, wheeze, or trouble breathing. Although infants in the HEPA group experienced 5.4 more SFDs than those in the placebo group (118.0 vs 112.6), the difference was not statistically significant (P = .54). Upcoming analyses will examine unscheduled health care visits, quality of life, and home air quality throughout the study duration.

Cardiac Monitoring in Children Born Preterm

Three studies underscore the challenges and opportunities in pediatric pulmonary care. | Image credit: peopleimages.com – stock.adobe.com

A study from Cincinnati Children’s Hospital explored whether bronchopulmonary dysplasia (BPD), a common complication of preterm birth, impacts heart structure and function later in childhood.2 The study included 39 children who were born preterm and underwent cardiac MRI (CMR) around age 6. Twenty-six of these children had a history of BPD, and 3 specifically had a history of BPD-associated pulmonary hypertension.

Researchers found that children with a history of BPD had a higher cardiac index—the amount of blood pumped by someone’s heart relative to their body size—and left ventricular stroke volume (P = .014) than their peers (P = .004). However, the actual size of their heart chambers and the strength of their heart’s pumping were no different than those in children who never developed BPD. Additionally, nearly 1 in 4 children showed signs of right ventricular hypertension regardless of BPD severity.

“Alterations in cardiac performance and evidence of pulmonary vascular disease are present in school-aged children with history of prematurity and BPD,” the authors said, “suggesting cardiopulmonary evaluation is warranted throughout childhood in this at-risk population.”

Improving Autonomy for Pediatric Fellows

In an effort to promote graduated autonomy in training, the Division of Pulmonary Medicine at Cincinnati Children’s Hospital implemented a quality improvement project to increase independent rounding by senior fellows.3 The project aimed to boost independent rounding from 25% to 75% of eligible service weeks and surpassed this target by reaching 90% compliance.

Independent rounding occurred in 9 of 10 eligible weeks, and the authors said the single missed week was due to unclear expectations, leading them to clarify for the next week. Of 20 surveys sent, 19 pre- and 14 postintervention responses were received. After the 10-week initiative, fellows reported greater confidence leading rounds and fewer communication or safety concerns, but a drop in confidence around teaching.

“Attendings experienced improved confidence in fellows’ ability to lead rounds independently, decreased communication and safety concerns, and decreased concerns regarding teaching on rounds,” the authors added. “There were no perceived adverse events to patient care as a result of these independent rounding days.”

According to the researchers, this initiative can be readily adopted by academic centers to support graduated autonomy in pediatric subspecialty training.

References

1. Cowan K, Semmens EO, Walker ES, et al. The BREATHE study: a randomized controlled trial of bronchiolitis recovery and use of HEPA filters. Presented at: ATS 2025 International Conference; May 20, 2025; San Francisco, CA. https://www.atsjournals.org/doi/abs/10.1164/ajrccm.2025.211.Abstracts.A7226
2. Papathanasiou A, Miles KG, Willmering M, et al. School-aged children with history of prematurity and bronchopulmonary dysplasia demonstrate alterations in cardiac performance and evidence of pulmonary vascular disease. Presented at: ATS 2025 International Conference; May 20, 2025; San Francisco, CA. https://www.atsjournals.org/doi/abs/10.1164/ajrccm.2025.211.Abstracts.A7233
3. Kretovics E, Mullen L, Shipp C. Enhancing fellow autonomy through independent rounding: a quality improvement initiative. Presented at: ATS 2025 International Conference; May 20, 2025; San Francisco, CA. https://www.atsjournals.org/doi/10.1164/ajrccm.2025.211.Abstracts.A7234