This review highlights and summarizes the current evidence and knowledge of nasal high flow therapy management in infants and children. This review outlines the distinct differences in the use of NHF therapy between children and adults. A comprehensive literature review has been performed reviewing the relevant physiological studies and current evidence of support measures in these children. Despite the quick uptake of nasal high flow therapy in the clinical area there has been limited high-grade evidence, with new studies showing beneficial results with the use of nasal high flow therapy in acute respiratory disease and children.
{"title":"Nasal high-flow therapy in infants and children","authors":"D. Franklin, A. Schibler","doi":"10.4103/PRCM.PRCM_22_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_22_17","url":null,"abstract":"This review highlights and summarizes the current evidence and knowledge of nasal high flow therapy management in infants and children. This review outlines the distinct differences in the use of NHF therapy between children and adults. A comprehensive literature review has been performed reviewing the relevant physiological studies and current evidence of support measures in these children. Despite the quick uptake of nasal high flow therapy in the clinical area there has been limited high-grade evidence, with new studies showing beneficial results with the use of nasal high flow therapy in acute respiratory disease and children.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122371602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kaganov SIu, Chin-pang Wong, R. Lee, Jack Pak-Yeung Chan, Shuk-yu Leung, E. Chan, K. Kwok, Ada Yip, Rupert Phillips, D. Ng
Background: Wheeze has been reported to affect one-third of preschoolchildren. While different wheeze patterns have been shown to predict future asthma risk, limited data are available on the risk factors for preschool wheeze in Asia. Methods: Preschool children admitted to hospitals through emergency departments for wheeze, from 2004 to 2015 in Hong Kong, were retrospectively identified. Potential risk factors for admissions over the same period were retrieved (i.e., air pollutants, preterm delivery, and maternal age). Results: A total of 46,258 patients meeting the inclusion criteria were identified during the 12-year period. The preschool wheeze admission rate increased by 34% over the past 12 years, with an average year-on-year rise of 4.2%. Environmental nitrogen dioxide (NO2) concentration was significantly associated with an increase in admission for preschool wheeze (r = 0.63, P = 0.028). Univariate regression analysis was performed on potential risk factors. Annual average NO2concentration (P = 0.007) and maternal age more than 40 years (P = 0.012) were significant risk factors. For multivariable regression analysis, annual average NO2concentration (β = 0.18, 95% confidence interval = 0.06–0.30) was the only independent factor associated with preschool wheeze admission. Conclusions: The increase of NO2concentration is a significant risk factor for the increase in hospitalizations for preschool wheeze in Hong Kong.
{"title":"Air pollution as a risk factor for increasing hospitalizations of preschool wheeze in Hong Kong","authors":"Kaganov SIu, Chin-pang Wong, R. Lee, Jack Pak-Yeung Chan, Shuk-yu Leung, E. Chan, K. Kwok, Ada Yip, Rupert Phillips, D. Ng","doi":"10.4103/PRCM.PRCM_23_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_23_17","url":null,"abstract":"Background: Wheeze has been reported to affect one-third of preschoolchildren. While different wheeze patterns have been shown to predict future asthma risk, limited data are available on the risk factors for preschool wheeze in Asia. Methods: Preschool children admitted to hospitals through emergency departments for wheeze, from 2004 to 2015 in Hong Kong, were retrospectively identified. Potential risk factors for admissions over the same period were retrieved (i.e., air pollutants, preterm delivery, and maternal age). Results: A total of 46,258 patients meeting the inclusion criteria were identified during the 12-year period. The preschool wheeze admission rate increased by 34% over the past 12 years, with an average year-on-year rise of 4.2%. Environmental nitrogen dioxide (NO2) concentration was significantly associated with an increase in admission for preschool wheeze (r = 0.63, P = 0.028). Univariate regression analysis was performed on potential risk factors. Annual average NO2concentration (P = 0.007) and maternal age more than 40 years (P = 0.012) were significant risk factors. For multivariable regression analysis, annual average NO2concentration (β = 0.18, 95% confidence interval = 0.06–0.30) was the only independent factor associated with preschool wheeze admission. Conclusions: The increase of NO2concentration is a significant risk factor for the increase in hospitalizations for preschool wheeze in Hong Kong.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125586296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The challenges for paediatric respirologists","authors":"D. Ng","doi":"10.4103/PRCM.PRCM_1_18","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_1_18","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131374382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: The aim of the study was to compare the incidence of ventilator-associated pneumonia (VAP), mortality, and ventilator circuit-related cost associated with patients using disposable ventilator circuit to those associated with patients using nondisposable ventilator circuit. Setting and Design: A prospective randomized controlled study in a 10-bed Pediatric Intensive Care Unit at Queen Sirikit National Institute of Child Health between November 2011 and October 2012. Subjects and Methods: Children aged 1 month to 18 years who were ventilated >48 h were enrolled. Patients were randomized to be ventilated with a disposable or nondisposable heated wire ventilator circuit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 17.0. The P < 0.05 was considered statistically significant. Results: Ninety-eight patients were enrolled. Of these, 48 were administered the disposable ventilator circuit, whereas 50 were administered the nondisposable ventilator circuit. The VAP rate was 20.53/1000 ventilator days for the former (n = 7) compared to 30.77/1000 ventilator days (n = 12) for the latter (odds ratio: 1.85; 95% confidence interval: 0.66–5.19, P = 0.24). The mortality rates were 2.1% in the disposable and 12% in the nondisposable circuit groups (P = 0.06). The unit cost of the disposable circuit (US dollar [USD] 51.60) was higher than that of the nondisposable circuit (USD 37.90). However, the total cost for the nondisposable group was higher due to the required use of more units (63 circuits for the disposable group vs. 95 circuits for the nondisposable group). Conclusions: The type of ventilator circuit is not likely to affect the VAP rate and mortality in children. The unit cost of a disposable circuit is higher than that of a nondisposable circuit. The total cost depends on the number of circuits used in each patient.
{"title":"Comparison of ventilator-associated pneumonia in children using disposable and nondisposable ventilator circuits","authors":"P. Srisan, Kallayanee Meechaijaroenying","doi":"10.4103/PRCM.PRCM_21_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_21_17","url":null,"abstract":"Aims: The aim of the study was to compare the incidence of ventilator-associated pneumonia (VAP), mortality, and ventilator circuit-related cost associated with patients using disposable ventilator circuit to those associated with patients using nondisposable ventilator circuit. Setting and Design: A prospective randomized controlled study in a 10-bed Pediatric Intensive Care Unit at Queen Sirikit National Institute of Child Health between November 2011 and October 2012. Subjects and Methods: Children aged 1 month to 18 years who were ventilated >48 h were enrolled. Patients were randomized to be ventilated with a disposable or nondisposable heated wire ventilator circuit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 17.0. The P < 0.05 was considered statistically significant. Results: Ninety-eight patients were enrolled. Of these, 48 were administered the disposable ventilator circuit, whereas 50 were administered the nondisposable ventilator circuit. The VAP rate was 20.53/1000 ventilator days for the former (n = 7) compared to 30.77/1000 ventilator days (n = 12) for the latter (odds ratio: 1.85; 95% confidence interval: 0.66–5.19, P = 0.24). The mortality rates were 2.1% in the disposable and 12% in the nondisposable circuit groups (P = 0.06). The unit cost of the disposable circuit (US dollar [USD] 51.60) was higher than that of the nondisposable circuit (USD 37.90). However, the total cost for the nondisposable group was higher due to the required use of more units (63 circuits for the disposable group vs. 95 circuits for the nondisposable group). Conclusions: The type of ventilator circuit is not likely to affect the VAP rate and mortality in children. The unit cost of a disposable circuit is higher than that of a nondisposable circuit. The total cost depends on the number of circuits used in each patient.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134055651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Most preterm and late preterm infants who require mechanical ventilation for respiratory failure resolve their disease process and can be extubated. A small percentage, however, continues to exhibit respiratory failure and remain ventilator dependent. There are myriad conditions that the clinician needs to consider, some of which are treatable, but some of which are lethal. Strategies for diagnosis and management are discussed herein.
{"title":"Babies who don't get better: When it's not respiratory distress syndrome","authors":"S. Donn","doi":"10.4103/PRCM.PRCM_28_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_28_17","url":null,"abstract":"Most preterm and late preterm infants who require mechanical ventilation for respiratory failure resolve their disease process and can be extubated. A small percentage, however, continues to exhibit respiratory failure and remain ventilator dependent. There are myriad conditions that the clinician needs to consider, some of which are treatable, but some of which are lethal. Strategies for diagnosis and management are discussed herein.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134189487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Atopic eczema (AE) is one of the most common skin diseases affecting children and adults worldwide. The “Atopic March” paradigm suggests AE is part of a complex condition with related airway disease. Objective: This study aimed to evaluate the prevalence of airway disease, environmental aeroallergens, and review factors associated with eczema severity and quality of life (QoL) when AE patients approached adulthood. Methods: Patients who were diagnosed with AE at a young age were included in the study and followed up till their adolescence at pediatric dermatology clinics from 2000 to 2017. Demographic characteristics, clinical laboratory parameters, treatment history, personal atopic history, as well as disease outcomes assessed by Nottingham Eczema Severity Score (NESS) and Children Dermatology Quality Life Index (CDLQI) were reviewed. Results: Three hundred and eighty-three patients (55.4% males) with latest NESS at mean (standard deviation) age 16.23 (2.50) years were reviewed. Personal history of asthma (45%), allergic rhinitis (74%), and family history of atopy were prevalent. Seventy-two percent of the patients were skin prick testing positive for house dust mite, 27% for cockroach, 33% for cat fur, and 13% for dog fur. Fourteen percent reported “smokers in family”. Multiple logistic regression showed “food avoidance ever” (adjusted odds ratio [OR] =3.00, 95% confidence interval [CI] =1.08–8.32; P = 0.035) and log-transformed immunoglobulin E (IgE) (adjusted OR = 1.45, 95% CI = 1.09–1.92; P = 0.011) were significantly associated with more severe AE. Linear regression showed “food avoidance ever” (β = 1.79, 95% CI = 0.34–3.24; P = 0.016), higher log-transformed IgE (β = 0.62; 95% CI = 0.22–1.03; P = 0.003), dog dander sensitization (β = 2.07, 95% CI = 0.24–3.89; P = 0.027), and severe disease (β = 2.97, 95% CI = 2.26–3.68; P < 0.001) were significantly associated with QoL impairment. Conclusions: A number of patients do not grow out of their eczema, and many of them have allergic rhinitis and asthma co-morbidities. Toward adulthood, AE severity and QoL are associated with food avoidance and high IgE, but generally independent of family or personal history of airway disease and allergen sensitization. Blood IgE measurement may help assess the risk for more severe eczema when patients are becoming adults.
背景:特应性湿疹(AE)是全球儿童和成人最常见的皮肤病之一。“特应性行军”模式提示AE是伴随相关气道疾病的复杂病症的一部分。目的:本研究旨在评估AE患者接近成年时气道疾病、环境空气过敏原的患病率，并回顾与湿疹严重程度和生活质量(QoL)相关的因素。方法:将2000年至2017年在儿科皮肤科门诊诊断为幼年AE的患者纳入研究，随访至青春期。回顾了人口统计学特征、临床实验室参数、治疗史、个人特应性史以及由诺丁汉湿疹严重程度评分(NESS)和儿童皮肤病质量生活指数(CDLQI)评估的疾病结局。结果:回顾了383例最新NESS患者(55.4%)，平均(标准差)年龄为16.23(2.50)岁。个人哮喘史(45%)、变应性鼻炎(74%)和特应性家族史普遍存在。室内尘螨阳性占72%，蟑螂阳性占27%，猫毛阳性占33%，狗毛阳性占13%。14%的人报告“家里有吸烟者”。多元logistic回归显示“从不避免食物”(校正优势比[OR] =3.00, 95%可信区间[CI] = 1.08-8.32;P = 0.035)和对数转化免疫球蛋白E (IgE)(校正OR = 1.45, 95% CI = 1.09-1.92;P = 0.011)与更严重的AE显著相关。线性回归显示“从不回避食物”(β = 1.79, 95% CI = 0.34-3.24;P = 0.016)，较高的对数转化IgE (β = 0.62;95% ci = 0.22-1.03;P = 0.003)，狗皮屑致敏性(β = 2.07, 95% CI = 0.24-3.89;P = 0.027)，重症(β = 2.97, 95% CI = 2.26-3.68;P < 0.001)与生活质量损害显著相关。结论:许多患者的湿疹并没有长出来，其中许多患者有过敏性鼻炎和哮喘合并症。成年后，AE的严重程度和生活质量与食物避免和高IgE有关，但通常与气道疾病和过敏原敏感的家庭或个人病史无关。当患者成年后，血液IgE测量可能有助于评估更严重湿疹的风险。
{"title":"Airway disease and environmental aeroallergens in eczematics approaching adulthood","authors":"Ellis Kam Lun Hon, Mei-juan Liu, B. Zee","doi":"10.4103/PRCM.PRCM_18_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_18_17","url":null,"abstract":"Background: Atopic eczema (AE) is one of the most common skin diseases affecting children and adults worldwide. The “Atopic March” paradigm suggests AE is part of a complex condition with related airway disease. Objective: This study aimed to evaluate the prevalence of airway disease, environmental aeroallergens, and review factors associated with eczema severity and quality of life (QoL) when AE patients approached adulthood. Methods: Patients who were diagnosed with AE at a young age were included in the study and followed up till their adolescence at pediatric dermatology clinics from 2000 to 2017. Demographic characteristics, clinical laboratory parameters, treatment history, personal atopic history, as well as disease outcomes assessed by Nottingham Eczema Severity Score (NESS) and Children Dermatology Quality Life Index (CDLQI) were reviewed. Results: Three hundred and eighty-three patients (55.4% males) with latest NESS at mean (standard deviation) age 16.23 (2.50) years were reviewed. Personal history of asthma (45%), allergic rhinitis (74%), and family history of atopy were prevalent. Seventy-two percent of the patients were skin prick testing positive for house dust mite, 27% for cockroach, 33% for cat fur, and 13% for dog fur. Fourteen percent reported “smokers in family”. Multiple logistic regression showed “food avoidance ever” (adjusted odds ratio [OR] =3.00, 95% confidence interval [CI] =1.08–8.32; P = 0.035) and log-transformed immunoglobulin E (IgE) (adjusted OR = 1.45, 95% CI = 1.09–1.92; P = 0.011) were significantly associated with more severe AE. Linear regression showed “food avoidance ever” (β = 1.79, 95% CI = 0.34–3.24; P = 0.016), higher log-transformed IgE (β = 0.62; 95% CI = 0.22–1.03; P = 0.003), dog dander sensitization (β = 2.07, 95% CI = 0.24–3.89; P = 0.027), and severe disease (β = 2.97, 95% CI = 2.26–3.68; P < 0.001) were significantly associated with QoL impairment. Conclusions: A number of patients do not grow out of their eczema, and many of them have allergic rhinitis and asthma co-morbidities. Toward adulthood, AE severity and QoL are associated with food avoidance and high IgE, but generally independent of family or personal history of airway disease and allergen sensitization. Blood IgE measurement may help assess the risk for more severe eczema when patients are becoming adults.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121146369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I-Ping Wu, Ming-Yi Chien, Hsiu-Feng Hsiao, Eric Chen, Yun-Yueh Liu, Chang-Wei Chou, S. Lai
Background: Bronchiolitis is a disease that is predominantly caused by the infection of peripheral airway due to respiratory syncytial virus (RSV). The occurrence is highly prevalent among childhood stage with seasonal outbreak peak during fall and spring. Treatment of bronchiolitis invariably involves lengthy hospitalization, which places significant socio-economic burden on family caregivers and healthcare system. Aerosolizing hypertonic saline using small-volume jet nebulizer (SVN) remains as one of the effective therapies to alleviate symptoms in infants with acute bronchiolitis. However, such approach not only restraints treatment to hospitalization and can irritate patients with loud noise. It is unclear whether an alternative aerosol therapy that offers similar efficacy yet enhances portability, convenience and quiet operation is available. Materials and Methods: Herein we showed that a vibrating mesh nebulizer (VMN) offered quiet delivery and undisturbed nebulization yet harnessed similar improvement in clinical symptoms in contrast with SVN when treating hospitalized infants with acute bronchiolitis. Results: A total of 64 hospitalized infants (<12 months of age) with acute bronchiolitis were enrolled. Subjects were randomly assigned to SVN (n=32) and VMN (n=32) groups and had received the same aerosol treatment protocol during hospitalization. Besides respiratory rate, the initial overall severity score; hospital stay duration; and intravascular-line day for both groups (SVN vs VMN) were similar. The data were 4.30±1.44 vs 4.92±1.3; 3.97±1.88 vs 3.94±1.66 days; 2.31±1.47 vs 2.16±1.46 days correspondingly. However, a higher satisfaction score (4.8/5) was shown in a corresponding questionnaire indicating user preference in VMN due to enhanced portability, ease of clean and operation, and less-noise. These advantages could potentially facilitate bronchiolitis treatment and follow-up maintenance at home. Conclusion: In sum, the treatment outcome for infants with acute bronchiolitis was equivalent between SVN and VMN. Easy portability and simple operation features of VMN may present a much favored therapeutic option for home care users.
背景:毛细支气管炎是一种主要由呼吸道合胞病毒(RSV)感染周围气道引起的疾病。儿童期发病率高，季节性暴发高峰期为秋季和春季。毛细支气管炎的治疗总是需要长时间的住院治疗，这给家庭照顾者和卫生保健系统带来了重大的社会经济负担。小体积喷射雾化器雾化高渗生理盐水是缓解婴幼儿急性细支气管炎症状的有效方法之一。然而，这种方法不仅限制了住院治疗，而且噪音很大，会刺激患者。目前尚不清楚是否有一种替代的气溶胶疗法可以提供类似的疗效，同时提高便携性、便利性和安静的操作。材料和方法:本研究表明，在治疗急性毛细支气管炎住院婴儿时，振动网状雾化器(VMN)提供安静的输送和不受干扰的雾化，但与SVN相比，在临床症状方面有相似的改善。结果:共纳入64例急性细支气管炎住院婴儿(<12个月)。受试者被随机分为SVN组(n=32)和VMN组(n=32)，并在住院期间接受相同的气溶胶治疗方案。除呼吸频率外，初始总严重程度评分;住院时间;两组(SVN vs VMN)的血管内线日相似。数据分别为4.30±1.44 vs 4.92±1.3;3.97±1.88 vs 3.94±1.66天;分别为2.31±1.47天和2.16±1.46天。然而，在相应的问卷调查中显示出更高的满意度得分(4.8/5)，表明用户更喜欢VMN，因为它具有更强的便携性，易于清洁和操作，并且噪音更小。这些优点可能会促进细支气管炎的治疗和在家中的后续维护。结论:综上所述，婴儿急性细支气管炎的治疗结果在SVN和VMN之间是相同的。VMN的便携性和简单的操作特点可能为家庭护理用户提供一个非常受欢迎的治疗选择。
{"title":"Utilization of vibrating mesh nebulizer in the treatment of infants with acute bronchiolitis: A randomized, controlled trial","authors":"I-Ping Wu, Ming-Yi Chien, Hsiu-Feng Hsiao, Eric Chen, Yun-Yueh Liu, Chang-Wei Chou, S. Lai","doi":"10.4103/PRCM.PRCM_17_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_17_17","url":null,"abstract":"Background: Bronchiolitis is a disease that is predominantly caused by the infection of peripheral airway due to respiratory syncytial virus (RSV). The occurrence is highly prevalent among childhood stage with seasonal outbreak peak during fall and spring. Treatment of bronchiolitis invariably involves lengthy hospitalization, which places significant socio-economic burden on family caregivers and healthcare system. Aerosolizing hypertonic saline using small-volume jet nebulizer (SVN) remains as one of the effective therapies to alleviate symptoms in infants with acute bronchiolitis. However, such approach not only restraints treatment to hospitalization and can irritate patients with loud noise. It is unclear whether an alternative aerosol therapy that offers similar efficacy yet enhances portability, convenience and quiet operation is available. Materials and Methods: Herein we showed that a vibrating mesh nebulizer (VMN) offered quiet delivery and undisturbed nebulization yet harnessed similar improvement in clinical symptoms in contrast with SVN when treating hospitalized infants with acute bronchiolitis. Results: A total of 64 hospitalized infants (<12 months of age) with acute bronchiolitis were enrolled. Subjects were randomly assigned to SVN (n=32) and VMN (n=32) groups and had received the same aerosol treatment protocol during hospitalization. Besides respiratory rate, the initial overall severity score; hospital stay duration; and intravascular-line day for both groups (SVN vs VMN) were similar. The data were 4.30±1.44 vs 4.92±1.3; 3.97±1.88 vs 3.94±1.66 days; 2.31±1.47 vs 2.16±1.46 days correspondingly. However, a higher satisfaction score (4.8/5) was shown in a corresponding questionnaire indicating user preference in VMN due to enhanced portability, ease of clean and operation, and less-noise. These advantages could potentially facilitate bronchiolitis treatment and follow-up maintenance at home. Conclusion: In sum, the treatment outcome for infants with acute bronchiolitis was equivalent between SVN and VMN. Easy portability and simple operation features of VMN may present a much favored therapeutic option for home care users.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127831755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Chan, S. Cherk, K. Kwok, Shuk-yu Leung, J. Ng, R. Lee, Tracy M. Ma
Aim: Primary snoring was reported to affect 7.2% of school children in Hong Kong, and emerging evidence suggested that neurobehavioural symptoms were more frequently found among this group of children. The current study investigated the prevalence of symptoms of attention deficit hyperactivity disorder (ADHD) i.e., attention deficit, hyperactivity and impulsivity (ADHI), in Chinese children with primary snoring. Materials and Methods: Polysomnography results and relevant clinical notes for all Chinese children aged 4–18-year performed from January 2009 to December 2010 in our sleep laboratory were retrospectively reviewed. Data of the Chinese version of modified Epworth Sleepiness Scale and C-domain of Paediatric Sleep Questionnaire were analysed. Results: In primary snorers, the presence of excessive daytime sleepiness (EDS) and higher apnoea–hypopnea index (AHI) were risk factors for symptoms of AD with adjusted odds ratio of 3.2 (95% confidence interval [CI] = 1.2–8.1) and 4.7 (95% CI = 1.1–20.7), respectively. Primary snorer with AD symptoms had higher AHI, 0.32 ± 0.31 compared those without symptoms, 0.21 ± 0.29, P = 0.038. EDS was an independent risk factor for ADHI with odds ratio of 4.7 (95% CI = 1.1–20.0). Conclusion: Early screening for symptoms of ADHD should be performed in children with primary snoring.
目的:据报道，香港有7.2%的学龄儿童患有原发性打鼾，新出现的证据表明，在这一组儿童中，神经行为症状更为常见。本研究调查了中国原发性打鼾儿童的注意缺陷多动障碍(ADHD)症状，即注意缺陷、多动和冲动(ADHI)的患病率。材料与方法:回顾性分析2009年1月至2010年12月在睡眠实验室进行的4 - 18岁中国儿童多导睡眠图检查结果及相关临床记录。对中文版修正Epworth嗜睡量表和儿童睡眠问卷c域数据进行分析。结果:在原发性打鼾者中，白天过度嗜睡(EDS)和较高的呼吸暂停低通气指数(AHI)是AD症状的危险因素，校正优势比分别为3.2(95%可信区间[CI] = 1.2-8.1)和4.7 (95% CI = 1.1-20.7)。有AD症状的原发性打鼾者AHI水平为0.32±0.31，高于无症状者(0.21±0.29)，P = 0.038。EDS是ADHI的独立危险因素，比值比为4.7 (95% CI = 1.1-20.0)。结论:对原发性打鼾患儿应进行ADHD症状的早期筛查。
{"title":"Prevalence and risk factors for symptoms of attention deficit and hyperactivity in primary snoring children","authors":"M. Chan, S. Cherk, K. Kwok, Shuk-yu Leung, J. Ng, R. Lee, Tracy M. Ma","doi":"10.4103/PRCM.PRCM_15_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_15_17","url":null,"abstract":"Aim: Primary snoring was reported to affect 7.2% of school children in Hong Kong, and emerging evidence suggested that neurobehavioural symptoms were more frequently found among this group of children. The current study investigated the prevalence of symptoms of attention deficit hyperactivity disorder (ADHD) i.e., attention deficit, hyperactivity and impulsivity (ADHI), in Chinese children with primary snoring. Materials and Methods: Polysomnography results and relevant clinical notes for all Chinese children aged 4–18-year performed from January 2009 to December 2010 in our sleep laboratory were retrospectively reviewed. Data of the Chinese version of modified Epworth Sleepiness Scale and C-domain of Paediatric Sleep Questionnaire were analysed. Results: In primary snorers, the presence of excessive daytime sleepiness (EDS) and higher apnoea–hypopnea index (AHI) were risk factors for symptoms of AD with adjusted odds ratio of 3.2 (95% confidence interval [CI] = 1.2–8.1) and 4.7 (95% CI = 1.1–20.7), respectively. Primary snorer with AD symptoms had higher AHI, 0.32 ± 0.31 compared those without symptoms, 0.21 ± 0.29, P = 0.038. EDS was an independent risk factor for ADHI with odds ratio of 4.7 (95% CI = 1.1–20.0). Conclusion: Early screening for symptoms of ADHD should be performed in children with primary snoring.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129948704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Habitual snoring is probably pathological in children","authors":"D. Ng","doi":"10.4103/PRCM.PRCM_19_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_19_17","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132037606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The clinical presentation of paediatric obstructive sleep apnoea (OSA) is different from that reported in adults. Children with paediatric OSA have more disturbed nocturnal sleep than excessive daytime sleepiness and present with more behavioural problems such as hyperactivity. They have sleep-related issues such as nocturnal enuresis and sleep-terrors and psychiatric problems such as depression and insomnia. Adenotonsillectomy has been the recommended treatment for paediatric OSA, but this practice as the initial treatment for all children has been questioned. The orthodontic approaches have been studied in children. Preliminary studies have suggested that rapid maxillary expansion and mandibular advancement with functional appliances may be effective even in children. Mandibular advancement devices, however, are not recommended for pre-pubertal children. These devices have been used in children in the late-teens, but long-term follow-up data are still lacking. Another non-invasive treatment is myofunctional therapy that has not been widely investigated. In syndromic children and where hypoventilation during sleep is present, positive airway pressure ventilation can be given. Nasal allergies are common in children. Increased nasal resistance impacts on breathing during sleep. Therefore, the treatment of nasal allergies with anti-inflammatory agents is an integral part of the management of paediatric OSA. Another important aspect of paediatric OSA is the presence of a short lingual frenulum and less frequently, a short nasal frenulum. They have been shown to cause abnormal growth of oral-facial region leading to OSA. Gastroesophageal reflux is both a cause and consequence of OSA and should be treated if present. The recent advance in the understanding of the pathogenesis of paediatric OSA lends hope that early recognition and management of factors that lead to the development of OSA may reduce the frequency of this disease and its sequelae. However, these factors are mostly unknown or ignored by specialists and general paediatricians during the early childhood orofacial development.
{"title":"A review of treatment options in paediatric sleep-disordered breathing","authors":"Yu-Shu Huang, C. Guilleminault","doi":"10.4103/PRCM.PRCM_5_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_5_17","url":null,"abstract":"The clinical presentation of paediatric obstructive sleep apnoea (OSA) is different from that reported in adults. Children with paediatric OSA have more disturbed nocturnal sleep than excessive daytime sleepiness and present with more behavioural problems such as hyperactivity. They have sleep-related issues such as nocturnal enuresis and sleep-terrors and psychiatric problems such as depression and insomnia. Adenotonsillectomy has been the recommended treatment for paediatric OSA, but this practice as the initial treatment for all children has been questioned. The orthodontic approaches have been studied in children. Preliminary studies have suggested that rapid maxillary expansion and mandibular advancement with functional appliances may be effective even in children. Mandibular advancement devices, however, are not recommended for pre-pubertal children. These devices have been used in children in the late-teens, but long-term follow-up data are still lacking. Another non-invasive treatment is myofunctional therapy that has not been widely investigated. In syndromic children and where hypoventilation during sleep is present, positive airway pressure ventilation can be given. Nasal allergies are common in children. Increased nasal resistance impacts on breathing during sleep. Therefore, the treatment of nasal allergies with anti-inflammatory agents is an integral part of the management of paediatric OSA. Another important aspect of paediatric OSA is the presence of a short lingual frenulum and less frequently, a short nasal frenulum. They have been shown to cause abnormal growth of oral-facial region leading to OSA. Gastroesophageal reflux is both a cause and consequence of OSA and should be treated if present. The recent advance in the understanding of the pathogenesis of paediatric OSA lends hope that early recognition and management of factors that lead to the development of OSA may reduce the frequency of this disease and its sequelae. However, these factors are mostly unknown or ignored by specialists and general paediatricians during the early childhood orofacial development.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131267668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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