Infants' Sleep: Israeli Parents' Knowledge, Attitudes and Practices.

The purpose of the study was to assess Israeli parents' knowledge of and attitudes towards practices promoting infants' safe sleep and their compliance with such practices. Researchers visited the homes of 335 parents in 59 different residential locations in Israel and collected their responses to structured questionnaires. SPSS 25 statistical package for data analysis was used. Attitude scales were created after the reliability tests and scaled means of parental attitudes were compared between independent groups differentiated by gender, ethnicity, and parental experience. A logistic regression was run to predict the outcome variable of babies' sleep positions. The total knowledge score was significantly higher for women (56.3%) than for men (28.6%; p < 0.001). Arabs were more committed to following recommendations (29.3%) than Jews (26.9%; p < 0.001). Consistent with safe sleep recommendations, 92% of the sampled parents reported avoiding bedsharing and 89% reported using a firm mattress and fitted sheets. The risk of not placing a baby to sleep in a supine position was higher among older parents (adjusted odds ratio-AOR = 0.36, 95%CI 0.16-0.82), smoking fathers (AOR = 2.66, 95%CI 1.12-6.33), parents who did not trust recommendations (AOR = 4.03, 95%CI 1.84-8.84), parents not committed to following recommendations (AOR = 2.83, 95%CI 1.21-6.60), and parents whose baby slept in their room (AOR = 0.38, 95%CI 0.17-0.88). Knowledge of safe sleep recommendations was not associated with actual parental practices. Trust of and commitment to recommendations were positively correlated with safe sleep position practices. It is essential to develop ethnic-/gender-focused intervention programs.

Supraglottoplasty for severe laryngomalacia. Can we predict success?

OBJECTIVES: Laryngomalacia is the dynamic collapse of supraglottic structures during inspiration, leading to a variable degree of airway obstruction. Clinical symptoms appear in the first months of life and are usually mild and resolve by the age of 12-18 months. In severe cases, surgical intervention may be considered. The goal of the study was to review the clinical outcome of pediatric patients who underwent supraglottoplasty for laryngomalacia. MATERIAL AND METHODS: Clinical and demographic data were retrieved from medical records of children diagnosed with laryngomalacia by laryngo-bronchoscopy between 2013 and 2019. Indications, outcome and long-term follow-up were collected from children undergoing surgery. RESULTS: During the study period, 115 children were diagnosed with laryngomalacia. The median age at diagnosis was 3 months. Synchronous airway lesions were diagnosed in 20% of patients. Ten (8.7%) children underwent surgical treatment because of significant respiratory symptoms and/or failure to thrive. Three of them had comorbidities. All otherwise healthy children had significant respiratory and nutritional improvement after surgery while those with comorbidities had less successful outcomes. CONCLUSION: We conclude that in severe cases of laryngomalacia, supraglottoplasty has an important role to play in management. In children with comorbidities, the surgical results may be less successful. Therefore, we recommend that the decision to operate should be individualized, ensuring full disclosure to the family regarding the probable benefit along with the limitations of surgery.

Ibuprofen does not prevent postbronchoscopy fever in children undergoing broncho-alveolar lavage.

BACKGROUND: Fiber-optic bronchoscopy (FOB) of the lower airways is a routine examination performed for investigating varying respiratory complaints in children. A common side effect is a transient high fever on the day of the FOB. Such episodes are usually unrelated to an infectious process but may cause clinical uncertainty and parental anxiety. We have previously shown that a single dose of systemic dexamethasone significantly reduces the rate of fever postbronchoscopy (FPB). RESEARCH QUESTION: To prospectively analyze the effect of a prophylactic dose of ibuprofen upon the FPB. STUDY DESIGN AND METHODS: Children presenting for elective FOB and broncho-alveolar lavage (BAL) were randomized, in a double-blind fashion, to receive a single dose of ibuprofen syrup 10 mg/kg or placebo prior to the procedure. Parents were contacted the next day to record the presence or absence of fever. RESULTS: Sixty-one children were included in the final analysis. Thirty-one children were in the treatment group and 30 in the placebo group. FPB occurred in 40 children (65%). There was no difference in the rate of FPB between placebo (63%) and treatment (67%) groups (P = .717). Fifty (82%) children had a positive BAL culture. Among them, 38 had FPB (76%) compared with only 2 of 11 (18%) of those with negative culture (P = .00026, relative risk 4.18). About 80% of positive cultures grew Haemophilus influenza. There was no significant difference between the number of BALs with a positive culture between the treatment and placebo groups (87% vs 77%, P = .35). CONCLUSION: FPB occurs in around twothirds of children when BAL is performed. Fever occurred significantly more frequently when BAL culture is positive. A single standard dose of the nonsteroidal anti-inflammatory drug ibuprofen administered before a FOB does not prevent FPB.

Sex-linked difference in blood oxygen saturation.

BACKGROUND: It is not known whether SpO2 in healthy volunteers is affected by sex. OBJECTIVE: To evaluate whether there are differences in SpO2 between young healthy adult males and females and to evaluate whether the differences are already present at birth. METHODS: We studied two cohorts of patients. The first one consisted of young adult volunteers (105 males and 102 females). In these patients, SpO2 was measured as well as selected anthropometric variables (height, weight), vital signs (respiratory rate, pulse rate and body temperature) and obtained data on menstrual cycle phase of the female participants. For the second cohort, we reanalyzed data from a previous prospective study that was performed to compare SpO2 of newborns infants born at different altitudes (sea level or 760 m above sea level). MEASUREMENTS AND MAIN RESULTS: In young male adults, mean SpO2 was 97.1% ± 1.2% versus 98.6% ± 1.0% in females (P < .001). This difference remained significant (P = .002) after correction for BMI, BSA and age, variables that were significantly different between sexes in univariate analysis. The SpO2 in females was unaffected by menstrual phase. In contrast to findings in adults, there were no significant differences in SpO2 measurements in newborn infants attributable to sex. CONCLUSIONS: Healthy young female adults have a higher (1.5%) SpO2 than their male counterparts. This difference is not yet present at birth. Further studies are needed to determine the timing of sex-differences, and to better define the mechanism(s) behind this observation.

Is obstructive sleep apnea syndrome in children season dependent?

INTRODUCTION: The most common cause of obstructive sleep apnea (OSA) in children is an enlargement of tonsils and/or adenoids. Previous studies have shown that the size of adenoids and tonsils is influenced by upper respiratory tract infections and exposure to allergens. The rate of exposure to bacteria, viruses, and allergens fluctuates from season to season. Therefore, we hypothesized that the rate of polysomnograms positive for OSA may vary according to season. OBJECTIVE: The objective of this study is to determine whether the prevalence of OSA in children, as determined by polysomnography, is affected by the season during which the study was performed. METHODS: We retrospectively reviewed polysomnography tests of 296 children, ages 0-12 years, referred for suspected OSA. We compared the Obstructive Apnea Hypopnea Index (OAHI) between the seasons and the rates of abnormal tests in each season according to the degree of severity. RESULTS: The mean OAHI did not significantly differ among the seasons (winter, 3.0 ± 5.0; spring, 3.0 ± 4.9; summer, 4.0 ± 6.3; fall, 3.4 ± 5.7, p = 0.183). When dividing the OAHI by levels of severity, no seasonality was found in moderate (winter, 13.8 %; spring, 6.7 %; summer, 11.7 %; fall, 14.1 %, p = NS) and severe OSA (winter, 8.8 %; spring, 11.2 %; summer, 10 %; fall, 7.8 %, p = NS). There was a small increase in the frequency of mild OSA diagnoses in the summer compared to the other seasons. CONCLUSION: In this study, season does not appear to affect the rate of diagnosis of significant OSA in children. Re-evaluation during a different season is unlikely to provide different results and may postpone surgery unnecessarily.

High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children.

INTRODUCTION: Over the last decade, high-flow nasal cannula (HFNC) therapy has become an increasingly important and popular mode of noninvasive respiratory support. HFNC facilitates delivery of humidified and heated oxygen at a high flow rate and generates positive airway pressure. METHODS: We present five cases of children with OSA without adenotonsillar hypertrophy who were treated with HFNC. RESULTS: We demonstrated a statistically significant improvement in apnea-hypopnea index and nadir oxygen saturation in this small cohort. CONCLUSION: We present our successful experience of treating severe OSA with HFNC in the home setting. Further randomized controlled trials are needed to determine whether HFNC could be considered as an established alternative for CPAP in OSA in children.

Predictive factors of morbidity in childhood parapneumonic effusion-associated pneumonia: a retrospective study.

STUDY OBJECTIVE: To find the clinical and laboratory criteria that best predict a prolonged fever in children with parapneumonic effusion-associated pneumonia treated conservatively. DESIGN: Retrospective, cohort study. PATIENTS: Children admitted to the Shaare Zedek Medical Center between January 1, 1997, and December 31, 2006, and who had been discharged with a diagnosis of empyema and pleurisy. MEASUREMENTS AND RESULTS: One hundred-twenty children were included, all of whom were treated with antibiotics; in 80 patients, a thoracic drain was introduced; in 23, pleural tap was performed; and in 17 patients, no special procedure was performed. In no case was video-assisted thoracic surgery performed. The mean total days of fever was 12.8 +/- 5.9 (2-29 days), and the mean length of stay at the hospital was 11.5 +/- 4.9 (3-25) days. In 44 patients (37%), a bacterial culture was positive either in blood or in pleural fluid or both. A positive blood or a positive pleural fluid culture was significantly associated with a prolonged fever as was a history of an underlying disease. Platelet counts, serum Na, serum protein, pleural lactate dehydrogenase (LDH), pleural glucose, pleural/serum LDH ratio, pleural/serum glucose ratio, and pleural fluid pH were the only factors significantly but weakly correlated with the total duration of fever or duration of fever after admission. A "fever duration" score using platelet count, pleural fluid pH, pleural/serum LDH ratio, and pleural/serum glucose ratio predicted a prolonged course of fever (>7 days) with a sensitivity of 91% (95% confidence interval: 60%-100%) and a specificity of 47% (95% confidence interval: 25%-71%). CONCLUSIONS: In children with parapneumonic effusion-associated pneumonia, a positive bacterial culture and an underlying disease are associated with prolonged fever. A low score based on platelet count, pH pleural fluid and glucose, and LDH pleural/serum ratio is associated with a prolonged fever. We speculate that children with the risk factors mentioned earlier may be the best candidates for an early aggressive approach.

N-terminal pro-B-type natriuretic peptide as a marker of bronchopulmonary dysplasia in premature infants.

We performed an observational pilot study of plasma concentrations of N-terminal pro-B-type natriuretic peptide (BNP) in premature infants with a diagnosis of bronchopulmonary dysplasia (BPD) at 4 weeks of age and after 1 month of conventional therapy. Thirty-four premature infants born before 34 weeks' gestational age without cardiac or infectious diseases were included. Serum NT-pro-BNP was measured in all neonates at 4 weeks of age. In infants with the diagnosis of BPD (n = 11), measurements were repeated at 6 and 8 weeks of age under conventional treatment. Specific clinical characteristics were collected prospectively. Baseline NT-pro-BNP concentrations were high in healthy premature infants compared with previously reported healthy neonates, and significantly higher in those who developed BPD. There was a significant correlation between concentrations of NT-pro-BNP and severity of respiratory distress as assessed by several methods. The concentrations of NT-pro-BNP decreased significantly over time in BPD infants. Premature infants have high concentrations of NT-pro-BNP at 1 month of age. NT-pro-BNP concentrations are significantly higher in BPD infants and decline over time. NT-pro-BNP concentrations correlate with clinical severity of respiratory disease.