In this issue, we have 5 articles, including both original studies and reviews. Climate change and global warming are among the major threats to global health. The pediatric population is a vulnerable group highly susceptible to the detrimental effects of climate change. The review by Dr. Almohammadi1 clearly outlined the factors associated with climate change and discussed how these factors might affect the developing respiratory system. Since we cannot reverse the trend of climate change in the short term, we need to understand what we can do to mitigate the long-term adverse effects. With regards to high-risk populations, the preterm infants represent a special group as they were born before the respiratory system was properly developed. Both oxygenation and positive pressure could damage the developing respiratory tract and lung parenchyma. Cheung and colleagues2 reported in this issue a long-term assessment of lung function in 239 infants. Among them, 70 (40%) were term babies. Subgroups of these infants had infant lung function testing at a mean age of 14.3 months, and subsequent IOS assessment at 3 years of age. Infants born between 24-28 weeks of gestation showed persistent obstructive deficits. Early assessment using raised-volume rapid thoracoabdominal compression (RVRTC) could reliably predict subsequent small airway disease. The challenge will be to identify effective interventions that can modify the natural history of these lung function deficits in preterm infants. Despite medical advancements, respiratory failure remains one of the major challenges in the pediatric ICU. Pediatric respiratory failure is the result of a group of heterogeneous conditions with variable prognosis, and they require different therapeutic interventions at different stages of their disease. The lack of reliable biomarkers to predict prognosis and guide therapeutic interventions makes the management of this group of conditions very difficult. Dr. Takaba and colleagues3 summarized the current state of the art and the potential of metabolomics to address the unmet need. There are many new platforms for metabolomic studies, such as nuclear magnetic resonance and liquid chromatography-mass spectrometry, for the determination of various metabolites, which in turn could provide important information about the course of the disease in a particular patient. Due to the vast amount of data generated, prospective assessments, along with advanced data processing, would be needed to determine the utility of these metabolomic measurements. Bronchoscopy has been well established for both diagnostic and therapeutic purposes in the adult population. Successive generations of bronchoscopes have significantly improved their diagnostic and therapeutic capabilities. Pediatric bronchoscopy has become a standard procedure in the developed world. Data on pediatric bronchoscopy from developing countries are limited. Dr. Harder and colleagues4 reported a retrospective study of 230 flexible bronchoscopies from India. Their study clearly indicated the utility of such procedures in the developing world. Their results demonstrated that important information regarding diagnosis and treatment options could be reliably obtained by the procedure. Furthermore, in experienced hands, such procedures are relatively safe. This highlights the importance of establishing bronchoscopy suites staffed by trained personnel in developing countries, despite financial constraints. Although the COVID-19 pandemic is over, the timely review by Dr. Hon and colleagues5 reminded us that COVID-19 still contributes significantly to the morbidity, especially among at-risk populations. Vaccinations remain one of the most important strategies in minimizing the morbidity associated with COVID-19. The articles in the current issue not only provide up-to-date information on the daily care of pediatric patients with respiratory disorders, but also novel research data on the use of flexible bronchoscopy and infant lung function studies. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Gary Wong (Thu,) studied this question.