Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Sunday, May 16, 2010

Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea

From Dr. Rotenberg - The success in this study is similar to my experience with CPAP/BiPAP in children.

Pediatrics. 2006 Mar;117(3):e442-51.

Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea.

Marcus CL, Rosen G, Ward SL, Halbower AC, Sterni L, Lutz J, Stading PJ, Bolduc D, Gordon N.

Division of Pulmonary Medicine, Sleep Center, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. marcus@email.chop.edu

Comment in:


OBJECTIVES: Positive airway pressure therapy (PAP) is frequently used to treat children who have obstructive sleep apnea syndrome and do not respond to adenotonsillectomy. However, no studies have evaluated objectively adherence to PAP in children, and few studies have evaluated objectively the effectiveness of PAP. The objective of this study was to determine adherence and effectiveness of PAP (both continuous [CPAP] and bilevel [BPAP] pressure) in children with obstructive apnea. METHODS: A prospective, multicenter study was performed of children who were randomly assigned in a double-blind manner to 6 months of CPAP versus BPAP. Adherence was measured objectively using the equipment's computerized output. Effectiveness was evaluated using polysomnography. RESULTS: Twenty-nine children were studied. Approximately one third of children dropped out before 6 months. Of the 21 children for whom 6-month adherence data could be downloaded, the mean nightly use was 5.3 +/- 2.5 (SD) hours. Parental assessment of PAP use considerably overestimated actual use. PAP was highly effective, with a reduction in the apnea hypopnea index from 27 +/- 32 to 3 +/- 5/hour, and an improvement in arterial oxygen saturation nadir from 77 +/- 17% to 89 +/- 6%. Results were similar for children who received CPAP versus BPAP. Children also had a subjective improvement in daytime sleepiness. CONCLUSIONS: Both CPAP and BPAP are highly efficacious in pediatric obstructive apnea. However, treatment with PAP is associated with a high dropout rate, and even in the adherent children, nightly use is suboptimal considering the long sleep hours in children.


Breast milk changes intestinal gene expression when compared to formula

Breast Milk is Best for Babies, Here's Why

Scientists have long known that breast milk is best for babies because it provides components that protect the immune system and help reduce an infant’s risk for developing infections. What researchers did not know was how and why breast milk specifically protects infants, but now they are closer to an answer.

Highways, rail increase kid asthma risk

Highways, rail increase kid asthma risk

ROCHESTER, Minn., May 10 (UPI) -- U.S. researchers suggest car and rail pollutants raise a child's risk have of developing asthma.

Researchers from the Mayo Clinic in Rochester, Minn., said their data indicated those children living near major highway or railroad intersections had higher diagnoses of asthma.

"Children who lived in census tracts facing the intersection with major highways or railways had about 40 percent to 70 percent increased risk of developing childhood asthma," Dr. Young Juhn says in a statement. "What this tells us is that clinicians need to be concerned about neighborhood environment beyond home environment to understand the individual asthma case."

Juhn and colleagues looked at 3,970 people born between 1976 and 1979 in Rochester, Minn. Of the 1,947 subjects living in census tracts that faced intersections, 6.4 percent developed asthma, while 4.5 percent of those living in census tracts not facing intersections developed asthma.

The study is published in The Journal of Allergy and Clinical Immunology.


Obstructive sleep disordered breathing in children: Beyond adenotonsillectomy

From Dr. Rotenberg - So what do you do for sleep apnea after tonsils and adenoids are not a problem anymore? The cure rate is only at best 75%, and lower in chidlren with unique heath issues or severe OSA. This is a great summary article of the options. I take care of many children on CPAP and when sucessful, its restores functionality.

Obstructive sleep disordered breathing in children: Beyond adenotonsillectomy
Jean-Paul Praud, MD, PhD 1 2 *, Dominique Dorion, MD, MSc 2


Traditionally, adenotonsillectomy (AT) has long been the treatment of choice for obstructive sleep disordered breathing (SDB) in children. AT is usually considered a safe procedure, which cures 80% of children with SDB. Accumulated data have however challenged this overly simplistic view. Indeed, AT is invariably associated with significant morbidity, post-operative pain, and a mortality rate which, though low, cannot be ignored. In addition, aside from a recurrence of SDB at adolescence in an unknown percentage of cases, some recent results suggest that complete SDB cure is not achieved in as much as 75% of cases after AT. Interestingly, several treatment options have been recently proposed for replacing or complementing AT. Continuous positive airway pressure (CPAP) is now suggested in children with remaining SDB after AT; however, compliance and suitability of equipment remain important hurdles, especially in small children and infants. Anti-inflammatory treatments, including nasal glucocorticoids and/or the anti-leukotriene montelukast, appear to hold great promise. Finally, orthodontic treatments are an appealing option, with recent results in children suggesting that it is possible to improve or perhaps even cure SDB in a durable manner by enlarging the nasal passages and/or the oropharyngeal airspace. In conclusion, while we are currently in the midst of an exciting time with several new treatments being developed for childhood SDB, randomized controlled trials are urgently needed to delineate their indications. In the meantime, it appears that systematic detection of orthodontic anomalies and better collaboration with maxillofacial specialists, including orthodontists and/or dentists, is needed for deciding the best treatment options for childhood SDB.


Friday, May 14, 2010

A new predictor of newborn health: Umbilical cord blood pH

Infant Death, Brain Damage And The Development Of Cerebral Palsy Linked To Low Umbilical Cord PH - 14 May 2010

If the umbilical cord has a low pH when a baby is born, he/she has a higher risk of infant death, developing cerebral palsy in childhood, and brain damage, according to a study carried out by researchers in Birmingham, England. The study has been published in the British Medical Journal (BMJ), and is the first BMJ research paper to carry a continuing medical education (CME) credit through a new collaboration between the BMJ and Cleveland Clinic. The researchers say their findings justify increased monitoring of babies born with a low cord Ph. They add that further research is needed to determine whether all newborns should have their umbilical cord blood tested.....


Wednesday, May 12, 2010

Sleep Apnea Drops IQ by 10 Points in Children

From Dr. Rotenberg...
Sleep Apnea Drops IQ by 10 Points in Children

"Wide ranging neurocognitive deficits were found at baseline in SDB children compared to controls, most notably a 10 point IQ difference (p<.001) & similar deficits in language and executive function."

What about treatment?

At 6 months s/p adenotnosillectomy, children with OSA still had a lower IQ than controls. Previous studies in adults have shown similar results. But a previous study in children showed normalization with treatment.

Take home message...snoring is not funny. Add sleep disorders to you differential for neuropsychiatric problems. And, remember that disordered sleep can exacerbate any primary neurologic problems.


Thursday, May 6, 2010

Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy.

Am J Obstet Gynecol. 2010 Mar;202(3):261.e1-5. Epub 2009 Dec 14.

Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy.

Louis JM, Auckley D, Sokol RJ, Mercer BM.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.


OBJECTIVE: The objective of the study was to estimate the maternal and neonatal morbidities associated with obstructive sleep apnea (OSA) in pregnancy. STUDY DESIGN: Women delivering between 2000-2008 with confirmed OSA in an academic center were included. Normal-weight and obese controls were randomly selected at a 2:1 ratio. Maternal and neonatal morbidities were compared between the groups. Multivariate analyses were performed to evaluate maternal morbidity and preterm birth (PTB). RESULTS: The analysis included 57 pregnancies complicated by OSA. Compared with normal-weight (n = 114) controls, OSA patients had more preeclampsia (PET) (19.3% vs 7.0%; P = .02) and PTB (29.8% vs 12.3%; P = .007). Controlling for comorbid conditions, OSA was associated with an increased risk of PTB (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.02-6.6), mostly secondary to PET (63%). Cesarean delivery (OR, 8.1; 95% CI, 2.9-22.1) and OSA were associated with maternal morbidity (OR, 4.6; 95% CI, 1.5-13.7). CONCLUSION: Pregnancies complicated by OSA are at increased risk for preeclampsia, medical complications, and indicated PTB. Copyright 2010 Mosby, Inc. All rights reserved.

PMID: 20005507 [PubMed - indexed for MEDLINE]


Grandparents May Play Key Role In Lives Of Children With Autism.

from dr wright...

Grandparents May Play Key Role In Lives Of Children With Autism.

HealthDay (4/30, Gordon) reported that, according to a report detailing the results of a survey of over 2,600 people, "many grandparents...play a key role in the lives of" children with autism. Specifically, "grandparents are helping with child care and contributing financially to the care of youngsters with autism. In fact, the report found that grandparents are so involved that as many as one in three may have been the first to raise concerns about their grandchild prior to diagnosis."

One In Five Children With Autism Uses Alternative Treatments.

from dr wright...

One In Five Children With Autism Uses Alternative Treatments.

HealthDay (5/2, Goodwin) reported that, according to research presented Sunday at the Pediatric Academic Societies' annual meeting, "about one in five children with autism uses alternative treatments to help with the neurodevelopmental disorder, most often a special diet." In a study of "1,212 children with an autism spectrum disorder," approximately "17 percent were on special diets. More than half of those were on a gluten-free, casein-free diet, which eliminates wheat and dairy products." Another study of 1,185 children with autism presented at the meeting "found that parents reported GI symptoms in" 45% of them.