What are some potential research questions for a pediatric resident to investigate?

Research Questions for Pediatric Residents

Respiratory and Pulmonary Research Priorities

The most impactful research areas for pediatric residents center on lung development, infectious diseases, and asthma—conditions with the highest morbidity and mortality burden in children. 1

Lung Growth, Development, and Repair

• Investigate the pathogenesis and repair mechanisms of chronic lung disease in extremely premature infants, particularly those born at earlier gestational ages who now survive with modern neonatal care but develop a different pattern of bronchopulmonary dysplasia than historically described 1
• Examine the role and timing of growth factors required for normal lung maturation, including alveolarization, branching morphogenesis, and vascular development, using cellular and animal models 1
• Study how prematurity and intrauterine infection affect lung development and postnatal lung responses 1
• Explore whether children with chronic lung disease of infancy become adults with chronic obstructive pulmonary disease—the natural history remains unknown 1

Infectious Disease Research

• Develop simple, noninvasive diagnostic tests to distinguish viral from bacterial pneumonia, as the lack of such tests results in inappropriate antibiotic use and rising antimicrobial resistance 1
• Investigate optimal antibiotic dosing for community-acquired pneumonia in children, as current amoxicillin dosing recommendations lack sufficient pharmacological and clinical evidence 2, 3
• Study the optimal duration of antibiotic therapy for pediatric pneumonia, as evidence is limited 3, 4
• Develop rapid diagnostic field tests for tuberculosis and shorter, more tolerable treatment regimens for children 1
• Research respiratory syncytial virus prevention strategies beyond monthly injections, aiming for a true vaccine with simple vaccination schedule and improved efficacy 1

Asthma Research

• Investigate why asthma prevalence has increased dramatically over the past 20 years, now affecting 10-20% of children 1
• Define minimal important differences for asthma diary measures to allow proper power calculations when used as primary endpoints in clinical trials 1
• Develop reliable, low-cost, user-friendly electronic devices for symptom and lung function diaries to eliminate data fabrication 1
• Study the internal consistency and test-retest reproducibility of diary measures and their correlation with other asthma outcomes 1

Acute Otitis Media Research

• Investigate clinical efficacy of antibiotics for less stringent diagnostic criteria of acute otitis media—specifically, combinations of symptoms, middle ear effusion, and tympanic membrane appearance not completely consistent with otitis media with effusion 1
• Conduct randomized controlled trials using severity scales to clarify the benefit of initial antibiotics versus initial observation for uncertain tympanic membrane appearances 1
• Develop devices that more accurately identify middle ear effusion and bulging that are easier to use than tympanometry during office visits 1
• Study whether tympanic membrane appearance in patients without clinical symptoms at study end is significant for relapse, recurrence, or optimal antibiotic duration 1

Chronic Disease and Quality of Life Research

Sickle Cell Disease

• Investigate the origins of airway hyperreactivity in sickle cell disease and the consequences of aggressive asthma treatment, as this component is now recognized as frequent but poorly understood 1
• Study methods for prevention, early detection, and treatment of chronic occult pulmonary injury in sickle cell disease 1
• Examine the interaction between hemolysis and secondary pulmonary hypertension, as pulmonary hypertension and cardiac dysfunction are relatively early complications 1

Cystic Fibrosis

• Research the psychology of adherence to prescribed therapies in cystic fibrosis patients and their families 1
• Develop strategies for transitioning cystic fibrosis patients from pediatric to adult care, which can serve as general models for other pediatric conditions 1

Methodological and Epidemiological Research

Chronic Lung Disease Definitions and Natural History

• Determine whether supplemental oxygen requirement at 36 weeks postconceptional age differs from oxygen requirement at 28 days of life as a predictor of subsequent chronic lung disease 1
• Investigate whether the incidence of bronchopulmonary dysplasia is increasing or decreasing with modern therapies, and whether there are clinically important differences between "new" and "old" bronchopulmonary dysplasia 1
• Study the natural history of lung function changes in chronic lung disease of infancy—specifically, whether these children become adults with chronic obstructive pulmonary disease 1

Sleep and Respiratory Control

• Define normative developmental neurocognitive and behavioral criteria to recognize pathologic sleep events requiring medical or surgical intervention, as it remains unclear whether primary snoring has negative long-term consequences 1
• Investigate the normal respiratory pattern and oxygenation status of infants in the 2- to 8-month age range at risk for sudden infant death syndrome 1
• Develop and validate simpler, home-based diagnostic technologies for obstructive sleep apnea syndrome as alternatives to polysomnography 1

Environmental Health Research

• Study the health risks of environmental exposures at different maturational stages, particularly how risks vary with developmental status 1
• Investigate the effects of passive cigarette smoke exposure, both in utero and postnatal, on pediatric respiratory health 1
• Examine the contribution of biomass fuel exposure to lung disease development in children in developing countries 1

Common Pitfalls to Avoid

• Avoid research questions that require placebo-controlled trials in children with community-acquired pneumonia, as these are not ethically acceptable given that antibiotics are standard of care and children are a vulnerable population 5
• Do not design studies without age, sex, and ethnicity-specific standards for new diagnostic technologies, as these are essential for pediatric applications 1
• Ensure large, well-designed, multicenter prospective studies for chronic lung disease questions, as most important questions cannot be answered with single-center studies 1
• Recognize that paper diaries in pediatric studies are subject to poor adherence and data fabrication—electronic monitoring should be prioritized 1