Updates in Pediatric Pulmonology: Transport, Home Ventilation, Spinal Muscular Atrophy, and Zinc

The June 2025 issue of Pediatric Respirology and Critical Care Medicine (PRCCM) presents an important selection of original and review articles that reflect the dynamic advances and ongoing challenges in pediatric respiratory and critical care. From interhospital transport of critically ill infants to the development of pediatric home ventilation, this issue signifies the collaborative efforts of multidisciplinary physicians and researchers to improve outcomes for vulnerable children that will benefit our readership. Chee et al. reviewed the three-year clinical outcomes of a specialized Paediatric Critical Care Transport (CCT) service operating within Hong Kong’s “hub-and-spoke” healthcare model.[1] With 283 transports analyzed, 180 (63.6%) were preterm infants. The two most common complications were metabolic acidosis (25.1%) and hypothermia (8.1%), and 36 (12.7%) required interventions during transfer, mostly fluid resuscitation. This article indicates the essential role of the specialized and well-trained transport team in achieving better outcomes for critically ill neonates and the opportunity to enhance subsequent quality improvement in the future. Nusinersen is the first disease-modifying drug for patients with spinal muscular atrophy (SMA), which was approved by the US Food and Drug Administration (FDA) in 2016 but is still not available worldwide due to the extremely high cost. Hong Kong children were fortunate to receive this drug under the expanded access program. Hung et al. evaluated respiratory outcomes in children with SMA who received Nusinersen during 2018-2022; 10 of 23 patients (43.5%) were supported with noninvasive ventilation before commencing this drug.[2] Although Nusinersen did not significantly improve respiratory status, 2 patients with type 1 SMA needed noninvasive ventilation after one year of age, which was later than typically expected. The authors also proposed using the Queen Mary Hospital SMA Respiratory Score, which may have broader utility in research and clinical follow-up for patients with other neuromuscular weakness. Wang et al. described another interesting aspect of respiratory care, which is home mechanical ventilation. This review provides the historical development, technological advancement, and the increasing trend of ventilator-dependent children globally. Various indications of children that differ from adults are discussed.[3] The authors call attention to the burden on caregivers who must be capable of managing the ventilators and related complications on their own. Future potential research on pediatric home mechanical ventilation is also suggested. Finally, Wong and Ng presented a timely review of zinc deficiency in children and its impact on respiratory health.[4] Infants have shown to have the highest rate of zinc deficiency compared to other age groups. Serum zinc levels appear to be lower in children with COVID-19 infection than in controls, especially those with deteriorating conditions. In addition, zinc deficiency is shown to be associated with higher morbidity and mortality in childhood pneumonia, probably due to a compromised immune response against the pneumococcal pathogen. Surprisingly, zinc has also reported to be related to wheezing and the severity of asthma. Zinc supplementation may be another promising adjuvant strategy to reduce the duration, severity, and occurrence of respiratory diseases in children. We hope this issue stimulates further inquiry, collaboration, and commitment to improving care across the continuum—from hospital transport bays to homes, from genetic therapies to nutritional strategies. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.