Daily Respiratory Research Analysis

BACKGROUND: Invasive pneumococcal diseases (IPDs) remain a leading cause of morbidity and mortality in children worldwide, despite the widespread use of pneumococcal conjugate vaccines. Respiratory syncytial virus (RSV) disease is suspected to be associated with an increased risk of IPD. We assessed whether immunisation with nirsevimab, a monoclonal antibody targeting RSV, reduced the risk of IPD in children. METHODS: This population-based, retrospective cohort study used data from the French National Health Data System. All liveborn children in metropolitan France between Feb 6, 2023, and Jan 31, 2024, for whom nirsevimab immunisation status was available, were included. The date of nirsevimab immunisation defined the inclusion date of immunised children and their birth-month-matched non-immunised children. Children immunised with nirsevimab during the first year of life constituted the immunised group, whereas children non-immunised with nirsevimab constituted the non-immunised group. The primary outcome was hospitalisation for IPD within 6 months after inclusion. Propensity score analysis using inverse probability of treatment weighting (IPTW) was conducted to adjust for differences in baseline characteristics between the two groups. Immunisation effectiveness was calculated with the use of the following equation: effectiveness=100% × (1 - odds ratio [OR]), with the OR reflecting the association between nirsevimab and IPD. FINDINGS: Of the 608 641 children born in France during the study period, 527 971 were included, of whom 119 435 (22·6%) received nirsevimab. During the 6-month follow-up period, 112 cases of IPD occurred: 17 (14·2 per 100 000) in the immunised group versus 95 (23·3 per 100 000) in the non-immunised group. After IPTW, nirsevimab was associated with a 36% reduction in the odds of hospitalisation for IPD 6 months after immunisation (OR 0·64, 95% CI 0·46-0·82). 9 months after immunisation, effectiveness remained consistent with a 34% reduction (0·66, 0·51-0·85). INTERPRETATION: Nirsevimab immunisation in children younger than 12 months was associated with a lower risk of IPD for at least 6 months following immunisation. These findings suggest an additional benefit of nirsevimab implementation beyond RSV disease prevention, but further studies are needed to confirm these findings. FUNDING: AP-HP Research fellowship, ATIP-Avenir partnership, and AP-HP Foundation. TRANSLATIONS: For the French translation of the abstract see Supplementary Materials section.

BACKGROUND: Respiratory distress syndrome (RDS), or hyaline membrane disease, is a common condition in preterm infants (< 37 weeks' gestation) and a leading cause of neonatal morbidity and mortality. The risk is highest in extremely preterm (< 28 weeks) and very preterm (28 to < 31 weeks) infants due to immature lung and cardiovascular development. RDS results from a deficiency or dysfunction of pulmonary surfactant, which lines the alveoli to reduce surface tension, prevent atelectasis, and protect the lungs. Surfactant is primarily composed of dipalmitoylphosphatidylcholine (DPPC), other phospholipids, and four proteins that support its function, recycling, and innate lung defense. Surfactant replacement therapy improves lung compliance, reduces the need for ventilator support, and decreases the risk of pneumothorax, death, and the combined outcome of death or bronchopulmonary dysplasia. Its widespread use has substantially improved survival among preterm infants without increasing long-term neurological or developmental disability. Various surfactant preparations, including animal-derived, synthetic, and protein or peptide-containing formulations have been evaluated. Surfactant can be administered prophylactically immediately after birth or selectively once RDS develops. Both strategies are effective, with theoretical advantages and disadvantages. Prophylactic surfactant may prevent respiratory insufficiency, reduce the need for ventilator support, and distribute surfactant more evenly in fluid-filled lungs, lowering the risk of lung injury. Selective treatment targets only infants with clinical RDS, avoiding unnecessary therapy, potential risks, and costs for those who would not benefit. Administration methods include endotracheal tube, intubation with rapid extubation, thin catheter, laryngeal mask, hypopharyngeal deposition, and, more recently, aerosolized or nebulized approaches, though the effectiveness of the latter remains unproven.

BACKGROUND: Existing trajectory studies have emphasised large-airway indices, but chronic obstructive pulmonary disease (COPD) might originate in smaller airways. This study aimed to investigate mid-to-small-airway function trajectories, their associated factors, and COPD risk. METHODS: In this prospective cohort study, probands (referred to throughout as offspring) were recruited to the Tasmanian Longitudinal Health Study from local schools across Tasmania, Australia at age 7 years. Pre-bronchodilator mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF FINDINGS: Between Feb 23, 1968, and Nov 8, 2016, 2314 offspring from the Tasmanian Longitudinal Health Study were included. Six FEF INTERPRETATION: FEF FUNDING: National Health and Medical Research Council of Australia; The University of Melbourne; Clifford Craig Medical Research Trust; the Victoria, Queensland, and Tasmania Asthma Foundations; The Royal Hobart Hospital Research Foundation; Helen MacPherson Smith Trust; GlaxoSmithKline; China Scholarship Council.