{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T21:44:53Z","timestamp":1792878293458,"version":"4.5.0"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Respiratory complications are common in spinal muscular atrophy (SMA) and significantly contribute to morbidity and mortality in these patients. Generalized respiratory and bulbar muscle weakness translates into diverse and complex clinical consequences necessitating strict follow-up and specialized care. The natural history of SMA has evolved drastically in recent years as a result of the introduction of novel, disease-modifying therapies. While the impact of these therapies on motor function is well described in literature, its consequence for respiratory management has not been extensively studied. In this review we aim to provide a comprehensive overview of the respiratory morbidities, their follow-up, management, and the impact of novel therapies in SMA.<\/jats:p>","DOI":"10.3389\/fped.2024.1366943","type":"journal-article","created":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T01:04:28Z","timestamp":1710378268000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":33,"title":["Respiratory morbidity in patients with spinal muscular atrophy\u2014a changing world in the light of disease-modifying therapies"],"prefix":"10.3389","volume":"12","author":[{"given":"Leen","family":"Lagae","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijke","family":"Proesmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marleen","family":"Van den Hauwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Vermeulen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liesbeth","family":"De Waele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mieke","family":"Boon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,3,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2120","DOI":"10.1016\/S0140-6736(08)60921-6","article-title":"Seminar spinal muscular atrophy","volume":"371","author":"Lunn","year":"2008","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.3390\/genes14071377","article-title":"Spinal muscular atrophy treatment in patients identified by newborn screening\u2014a systematic review","volume":"14","author":"Aragon-Gawinska","year":"2023","journal-title":"Genes (Basel)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1016\/j.ncl.2015.07.004","article-title":"Spinal muscular atrophy","volume":"33","author":"Kolb","year":"2015","journal-title":"Neurol Clin"},{"key":"B4","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.prrv.2018.07.006","article-title":"The role of sleep diagnostics and non-invasive ventilation in children with spinal muscular atrophy","volume":"28","author":"Grychtol","year":"2018","journal-title":"Paediatr Respir Rev"},{"key":"B5","article-title":"Spinal muscle atrophy","author":"Burr","year":"2024","journal-title":"Statpearls"},{"key":"B6","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.pedneo.2022.09.016","article-title":"Respiratory phenotypes of neuromuscular diseases: a challenging issue for pediatricians","volume":"64","author":"Borrelli","year":"2023","journal-title":"Pediatr Neonatol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1038\/s41582-020-00413-4","article-title":"Spinal muscular atrophy\u2014insights and challenges in the treatment era","volume":"16","author":"Mercuri","year":"2020","journal-title":"Nat Rev Neurol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1016\/j.nmd.2017.05.011","article-title":"Spinal muscular atrophy: a changing phenotype beyond the clinical trials","volume":"27","author":"Tizzano","year":"2017","journal-title":"Neuromuscul Disord"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2935","DOI":"10.1007\/s00431-023-04883-8","article-title":"New therapies for spinal muscular atrophy: where we stand and what is next","volume":"182","author":"Antonaci","year":"2023","journal-title":"Eur J Pediatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1056\/NEJMoa1702752","article-title":"Nusinersen versus sham control in infantile-onset spinal muscular atrophy","volume":"377","author":"Finkel","year":"2017","journal-title":"New Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2004","DOI":"10.3390\/jcm9062004","article-title":"Antisense oligonucleotides: an emerging area in drug discovery and development","volume":"9","author":"Dhuri","year":"2020","journal-title":"J Clin Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1007\/s40265-019-01162-5","article-title":"Onasemnogene abeparvovec: first global approval","volume":"79","author":"Hoy","year":"2019","journal-title":"Drugs"},{"key":"B13","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1007\/s40263-022-00941-1","article-title":"Onasemnogene abeparvovec: a review in spinal muscular atrophy","volume":"36","author":"Blair","year":"2022","journal-title":"CNS Drugs"},{"key":"B14","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s40263-022-00910-8","article-title":"Risdiplam: a review in spinal muscular atrophy","volume":"36","author":"Paik","year":"2022","journal-title":"CNS Drugs"},{"key":"B15","doi-asserted-by":"publisher","first-page":"100878","DOI":"10.1016\/j.spen.2021.100878","article-title":"Spinal muscular Atrophy","volume":"37","author":"Nicolau","year":"2021","journal-title":"Semin Pediatr Neurol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s13023-022-02227-7","article-title":"Natural history of respiratory muscle strength in spinal muscular atrophy: a prospective national cohort study","volume":"17","author":"Veldhoen","year":"2022","journal-title":"Orphanet J Rare Dis"},{"key":"B17","doi-asserted-by":"publisher","first-page":"625751","DOI":"10.3389\/fped.2021.625751","article-title":"All you need is evidence: what we know about pneumonia in children with neuromuscular diseases","volume":"9","author":"Cherchi","year":"2021","journal-title":"Front Pediatr"},{"key":"B18","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1002\/(SICI)1099-0496(200002)29:2%3C141::AID-PPUL9%3E3.0.CO;2-Y","article-title":"Pulmonary manifestations of neuromuscular disease with special reference to duchenne muscular dystrophy and spinal muscular atrophy","volume":"29","author":"Gozal","year":"2000","journal-title":"Pediatr Pulmonol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1002\/ppul.1950230875","article-title":"Respiratory problems in spinal muscular atrophies","volume":"24","author":"Barois","year":"1997","journal-title":"Ped Pulmonol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"107143","DOI":"10.1016\/j.rmed.2023.107143","article-title":"Evaluation of sputum cultures in children with spinal muscular atrophy","volume":"209","author":"Levine","year":"2023","journal-title":"Respir Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1044\/2021_AJSLP-20-00217","article-title":"Dysphagia phenotypes in spinal muscular atrophy: the past, present, and promise for the future","volume":"30","author":"McGrattan","year":"2021","journal-title":"Am J Speech Lang Pathol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"197","DOI":"10.5409\/wjcp.v12.i4.197","article-title":"Gastrointestinal and nutritional care in pediatric neuromuscular disorders","volume":"12","author":"Dipasquale","year":"2023","journal-title":"World J Clin Pediatr"},{"key":"B23","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.nmd.2020.12.007","article-title":"Feeding difficulties in children and adolescents with spinal muscular atrophy type 2","volume":"31","author":"Wadman","year":"2021","journal-title":"Neuromuscul Disord"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1177\/0883073807305788","article-title":"Consensus statement for standard of care in spinal muscular atrophy","volume":"22","author":"Wang","year":"2007","journal-title":"J Child Neurol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"3847","DOI":"10.1093\/hmg\/ddv127","article-title":"SMN deficiency disrupts gastrointestinal and enteric nervous system function in mice","volume":"24","author":"Gombash","year":"2015","journal-title":"Hum Mol Genet"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e500","DOI":"10.1097\/BPO.0000000000000867","article-title":"Radiographic and respiratory effects of growing rods in children with spinal muscular atrophy","volume":"37","author":"Lenhart","year":"2017","journal-title":"JPed Orthopaedics"},{"key":"B27","doi-asserted-by":"publisher","first-page":"7S29","DOI":"10.1016\/S0929-693X(20)30274-8","article-title":"Respiratory management of children with spinal muscular atrophy (SMA)","volume":"27","author":"Fauroux","year":"2020","journal-title":"Archives de P\u00e9diatrie"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.1007\/s00586-022-07182-2","article-title":"The effect of scoliosis surgery on pulmonary function in spinal muscular atrophy patients: review of the literature and a meta-analysis","volume":"31","author":"Angeli","year":"2022","journal-title":"Eur Spine J"},{"key":"B29","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1080\/17476348.2023.2192483","article-title":"Understanding and managing respiratory infections in children and young adults with neurological impairment","volume":"17","author":"Proesmans","year":"2023","journal-title":"Expert Rev Respir Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1016\/j.nmd.2015.09.009","article-title":"1st Italian SMA family association consensus meeting: management and recommendations for respiratory involvement in spinal muscular atrophy (SMA) types I\u2013III, Rome, Italy, 30\u201331 January 2015","volume":"25","author":"Sansone","year":"2015","journal-title":"Neuromuscul Disord"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13023-022-02455-x","article-title":"Natural history of type 1 spinal muscular atrophy: a retrospective, global, multicenter study","volume":"17","author":"Cances","year":"2022","journal-title":"Orphanet J Rare Dis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"7S23","DOI":"10.1016\/S0929-693X(20)30273-6","article-title":"Clinical features of spinal muscular atrophy (SMA) type 3 (kugelberg-welander disease)","volume":"27","author":"Salort-Campana","year":"2020","journal-title":"Arch Pediatr"},{"key":"B33","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1111\/ene.14587","article-title":"Clinical and radiological profile of patients with spinal muscular atrophy type 4","volume":"28","author":"Souza","year":"2021","journal-title":"Eur J Neurol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.nmd.2017.11.004","article-title":"Diagnosis and management of spinal muscular atrophy: part 2: pulmonary and acute care; medications, supplements and immunizations; other organ systems; and ethics","volume":"28","author":"Finkel","year":"2018","journal-title":"Neuromuscul Disord"},{"key":"B35","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s13023-020-01367-y","article-title":"Natural history of lung function in spinal muscular atrophy","volume":"15","author":"Wijngaarde","year":"2020","journal-title":"Orphanet J Rare Dis"},{"key":"B36","doi-asserted-by":"publisher","first-page":"E587","DOI":"10.1212\/WNL.0000000000011051","article-title":"Respiratory trajectories in type 2 and 3 spinal muscular atrophy in the iSMAC cohort study","volume":"96","author":"Trucco","year":"2021","journal-title":"Neurology"},{"key":"B37","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1016\/j.ejpn.2013.04.004","article-title":"Longitudinal course of lung function and respiratory muscle strength in spinal muscular atrophy type 2 and 3","volume":"17","author":"Khirani","year":"2013","journal-title":"Eur J Paediatr Neurol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/j.nmd.2006.02.003","article-title":"Predictors of severe chest infections in pediatric neuromuscular disorders","volume":"16","author":"Dohna-Schwake","year":"2006","journal-title":"Neuromuscul Disord"},{"key":"B39","doi-asserted-by":"publisher","first-page":"i1","DOI":"10.1136\/thoraxjnl-2012-201964","article-title":"British thoracic society guideline for respiratory management of children with neuromuscular weakness","volume":"67","author":"Hull","year":"2012","journal-title":"Thorax"},{"key":"B40","doi-asserted-by":"publisher","first-page":"S406","DOI":"10.1007\/s00586-014-3335-6","article-title":"Non-invasive positive pressure ventilation to facilitate the post-operative respiratory outcome of spine surgery in neuromuscular children","volume":"23","author":"Khirani","year":"2014","journal-title":"Eur Spine J"},{"key":"B41","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1111\/pan.12159","article-title":"Anesthesia and spinal muscle atrophy","volume":"23","author":"Islander","year":"2013","journal-title":"Pediatric Anesthesia"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e161","DOI":"10.1097\/PCC.0b013e3182388ad1","article-title":"Spinal muscular atrophy type 1: are proactive respiratory interventions associated with longer survival?","volume":"13","author":"Lemoine","year":"2012","journal-title":"Pediatr Crit Care Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"105666","DOI":"10.1016\/j.earlhumdev.2022.105666","article-title":"New strategies for the prevention of respiratory syncytial virus (RSV)","volume":"174","author":"Messina","year":"2022","journal-title":"Early Hum Dev"},{"key":"B44","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1097\/PHM.0000000000000989","article-title":"Onabotulinum toxin A injections into the salivary glands for spinal muscle atrophy type I: a prospective case series of 4 patients","volume":"97","author":"Shoval","year":"2018","journal-title":"Am J Phys Med Rehabil"},{"key":"B45","doi-asserted-by":"publisher","first-page":"S245","DOI":"10.1542\/peds.2008-2952K","article-title":"Special considerations in the respiratory management of spinal muscular atrophy","volume":"123","author":"Schroth","year":"2009","journal-title":"Pediatrics"},{"key":"B46","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1136\/adc.2009.177832","article-title":"Outcome of goal-directed non-invasive ventilation and mechanical insufflation\/exsufflation in spinal muscular atrophy type I","volume":"96","author":"Chatwin","year":"2011","journal-title":"Arch Dis Child"},{"key":"B47","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1097\/00002060-200302000-00009","article-title":"Spinal muscular atrophy type 1 quality of life","volume":"82","author":"Bach","year":"2003","journal-title":"Am J Phys Med Rehabil"},{"key":"B48","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/S2213-2600(16)30151-5","article-title":"Long-term non-invasive ventilation in children","volume":"4","author":"Amaddeo","year":"2016","journal-title":"Lancet Respir Med"},{"key":"B49","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1183\/13993003.00385-2015","article-title":"Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management","volume":"47","author":"Kaditis","year":"2016","journal-title":"Eur Respir J"},{"key":"B50","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.prrv.2020.09.002","article-title":"Real-world respiratory and bulbar comorbidities of SMA type 1 children treated with nusinersen: 2-year single centre Australian experience","volume":"39","author":"Chen","year":"2021","journal-title":"Paediatr Respir Rev"},{"key":"B51","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1002\/ppul.25135","article-title":"The respiratory impact of novel therapies for spinal muscular atrophy","volume":"56","author":"Paul","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/j.nmd.2019.09.007","article-title":"Nusinersen initiated in infants during the presymptomatic stage of spinal muscular atrophy: interim efficacy and safety results from the phase 2 NURTURE study","volume":"29","author":"De Vivo","year":"2019","journal-title":"Neuromuscul Disord"},{"key":"B53","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1016\/j.nmd.2023.04.007","article-title":"Respiratory and sleep outcomes in children with SMA treated with nusinersen\u2014real world experience","volume":"33","author":"Gonski","year":"2023","journal-title":"Neuromuscul Disord"},{"key":"B54","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1136\/jnnp-2017-317412","article-title":"Nusinersen for SMA: expanded access programme","volume":"89","author":"Farrar","year":"2018","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B55","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/J.PRRV.2023.06.004","article-title":"Evaluation of the therapeutic efficacy and tolerability of current drug treatments on the clinical outcomes of paediatric spinal muscular atrophy type 1: a systematic review","volume":"48","author":"Al-Taie","year":"2023","journal-title":"Paediatr Respir Rev"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e15175","DOI":"10.1111\/ped.15175","article-title":"Respiratory outcome of spinal muscular atrophy type 1 patients treated with nusinersen","volume":"64","author":"Ergenekon","year":"2022","journal-title":"Pediatr Int"},{"key":"B57","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1002\/ppul.25140","article-title":"Nusinersen for spinal muscular atrophy type 1: real-world respiratory experience","volume":"56","author":"Lavie","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"B58","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.nmd.2022.02.001","article-title":"Evaluation of real-life outcome data of patients with spinal muscular atrophy treated with nusinersen in Switzerland","volume":"32","author":"Tscherter","year":"2022","journal-title":"Neuromuscul Disord"},{"key":"B59","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1093\/brain\/awac252","article-title":"Effect of nusinersen on motor, respiratory and bulbar function in early-onset spinal muscular atrophy","volume":"146","author":"Pechmann","year":"2022","journal-title":"Brain"},{"key":"B60","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.ejpn.2021.02.007","article-title":"Nusinersen does not improve lung function in a cohort of children with spinal muscular atrophy","volume":"31","author":"Heitschmidt","year":"2021","journal-title":"Eur J Paediatr Neurol"},{"key":"B61","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1136\/thoraxjnl-2020-216564","article-title":"Effect of nusinersen on respiratory function in paediatric spinal muscular atrophy types 1\u20133 paediatric lung disease","volume":"77","author":"Chacko","year":"2022","journal-title":"Thorax"},{"key":"B62","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1002\/ppul.25142","article-title":"Assessment of respiratory muscles and motor function in children with SMA treated with nusinersen","volume":"56","author":"G\u00f3mez-Garc\u00eda de la Banda","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"B63","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1001\/jamaneurol.2021.1272","article-title":"Five-year extension results of the phase 1 START trial of onasemnogene abeparvovec in spinal muscular atrophy","volume":"78","author":"Mendell","year":"2021","journal-title":"JAMA Neurol"},{"key":"B64","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/S1474-4422(21)00001-6","article-title":"Onasemnogene abeparvovec gene therapy for symptomatic infantile-onset spinal muscular atrophy in patients with two copies of SMN2 (STR1VE): an open-label, single-arm, multicentre, phase 3 trial","volume":"20","author":"Day","year":"2021","journal-title":"Lancet Neurol"},{"key":"B65","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1016\/S1474-4422(21)00251-9","article-title":"Onasemnogene abeparvovec gene therapy for symptomatic infantile-onset spinal muscular atrophy type 1 (STR1VE-EU): an open-label, single-arm, multicentre, phase 3 trial","volume":"20","author":"Mercuri","year":"2021","journal-title":"Lancet Neurol"},{"key":"B66","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1111\/jpc.16340","article-title":"Safety and efficacy of gene therapy with onasemnogene abeparvovec in the treatment of spinal muscular atrophy: a systematic review and meta-analysis","volume":"59","author":"Yang","year":"2023","journal-title":"J Paediatr Child Health"},{"key":"B67","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1038\/s41591-022-01866-4","article-title":"Onasemnogene abeparvovec for presymptomatic infants with two copies of SMN2 at risk for spinal muscular atrophy type 1: the phase III SPR1NT trial","volume":"28","author":"Strauss","year":"2022","journal-title":"Nat Med"},{"key":"B68","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/S1474-4422(21)00367-7","article-title":"Safety and efficacy of once-daily risdiplam in type 2 and non-ambulant type 3 spinal muscular atrophy (SUNFISH part 2): a phase 3, double-blind, randomised, placebo-controlled trial","volume":"21","author":"Mercuri","year":"2022","journal-title":"Lancet Neurol"},{"key":"B69","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1007\/s40120-023-00444-1","article-title":"Risdiplam in patients previously treated with other therapies for spinal muscular atrophy: an interim analysis from the JEWELFISH study","volume":"12","author":"Chiriboga","year":"2023","journal-title":"Neurol Ther"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2024.1366943\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T01:04:30Z","timestamp":1710378270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2024.1366943\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,14]]},"references-count":69,"alternative-id":["10.3389\/fped.2024.1366943"],"URL":"https:\/\/doi.org\/10.3389\/fped.2024.1366943","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,14]]},"article-number":"1366943"}}