Comparison of the longitudinal effects of persistent periodic breathing and apnoea on cerebral oxygenation in term- and preterm-born infants.

KEY POINTS: Periodic breathing and apnoea were more common in preterm compared to age-matched term-born infants across the first 6 months after term-corrected age. Periodic breathing decreased with age in both term and preterm infants. Apnoea duration was not different between groups; however, the decline in apnoea index with postnatal age observed in the term infants was not seen in the preterm infants. Falls in tissue oxygenation index (brain TOI) associated with apnoeas were greater in the preterm infants at all three ages studied. The clinical significance of falls in brain TOI during periodic breathing and apnoea on neurodevelopmental outcome is unknown and warrants further investigations. ABSTRACT: Periodic breathing and short apnoeas are common in infants, particularly those born preterm, but are thought to be benign. The aim of our study was to assess the incidence and impact of periodic breathing and apnoea on heart rate, oxygen saturation and brain tissue oxygenation index (TOI) in infants born at term and preterm over the first 6 months after term equivalent age. Nineteen term-born infants (38-42 weeks gestational age) and 24 preterm infants (born at 27-36 weeks gestational age) were studied at 2-4 weeks, 2-3 months and 5-6 months post-term-corrected age during sleep. Periodic breathing episodes were defined as three or more sequential apnoeas each lasting ≥3 s and apnoeas as ≥3 s in duration. The mean duration of periodic breathing episodes was longer in term infants than in preterm infants at 2-4 weeks (P < 0.05) and at 5-6 months (P < 0.05); however, the nadir in TOI was significantly less in the term infants at 2-3 months (P < 0.001). Apnoea duration was not different between groups; however, the decline in apnoea index with postnatal age observed in the term infants was not seen in the preterm infants. Falls in TOI associated with apnoeas were greater in the preterm infants at all three ages studied. In conclusion, periodic breathing and short apnoeas were more common in infants born preterm and falls in cerebral oxygenation were greater than in the term group. The clinical significance of this on neurodevelopmental outcome is unknown and warrants further investigations.

Respiratory management and bronchopulmonary dysplasia in extremely preterm infants: a comparison of practice between centres in Oxford and Melbourne.

OBJECTIVE: Considerable variation in the care of extremely low gestational age infants (ELGAN) contributes to the variation in incidence of bronchopulmonary dysplasia (BPD). We compared management and outcomes of two neonatal centres with different respiratory support strategies. STUDY DESIGN: Retrospective cohort study of infants <28 weeks gestational age treated at two units in Australia and the UK between 2015 and 2017. RESULT: Of 492 infants, the overall incidence of BPD for extremely preterm infants was 62.20% and was similar across both sites (64.84% at Monash vs. 60.65% at Oxford). Independent predictors for the development of BPD or mortality included the days on mechanical ventilation (MV, adjusted OR 1.13, 95% Cl 1.07-1.19) and use of inhaled nitric oxide (adjusted OR 13.42, 95% Cl 1.75-103.28). CONCLUSION: Primary choice of non-invasive respiratory support had no significant impact on BPD development. Duration of MV and using nitric oxide were independent predictors for death or BPD.

Management of tuberculosis infection in Victorian children: A retrospective clinical audit of factors affecting treatment completion.

BACKGROUND: Tuberculosis preventive treatment (TPT) is strongly recommended for children following infection with Mycobacterium tuberculosis because of their high risk of progression to active tuberculosis, including severe disseminated disease. We describe the implementation of TPT for children and adolescents with evidence of tuberculosis infection (TBI) at Victoria's largest children's hospital and examine factors affecting treatment completion. METHODS: We conducted a retrospective clinical audit of all children and adolescents aged <18 years diagnosed with latent TBI at the Royal Children's Hospital, Melbourne, between 2010 and 2016 inclusive. The primary outcome was treatment completion, defined as completing TPT to within one month of a target duration for the specified regimen (for instance, at least five months of a six-month isoniazid course), confirmed by the treating clinician. Factors associated with treatment adherence were evaluated by univariate and multivariate analysis. RESULTS: Of 402 participants with TBI, 296 (74%) met the criteria for treatment "complete". The most common TPT regimen was six months of daily isoniazid (377, 94%). On multivariate logistic regression analysis, treatment completion was more likely among children and adolescents who had refugee health screening performed (OR 2.31, 95%CI 1.34-4.00) or who were also treated for other medical conditions (OR 1.67 95%CI 1.0-2.85), and less likely among those who experienced side-effects (OR 0.32, 95%CI 0.11-0.94). However, TPT was generally well tolerated with side-effects reported in 15 participants (3.7%). CONCLUSION: Identification of factors associated with TPT completion and deficiencies in the existing care pathway have informed service provision changes to further improve outcomes for Victorian children and adolescents with TBI.

Prevalence and Causes of Visual Impairment and Blindness in Three Ecological Regions of Nepal.

INTRODUCTION: Visual impairment and blindness are significant public health issues worldwide. The objective of this study was to estimate the prevalence and causes of moderate to severe visual impairment (MSVI) and blindness in people aged 15 years and above across three ecological regions of Nepal. MATERIALS AND METHODS: A comparative cross-sectional study was conducted in one district in each of the three ecological regions of Nepal. Number of participants from each region was distributed as per the prevalence findings of pilot study, with 2815 participants enrolled in Dolakha, 1509 in Dhading and 910 in Sarlahi. Intensive training was provided to health workers on how to conduct door-to-door enumeration, visual acuity testing and referral when indicated for comprehensive ocular examination by technicians and ophthalmologists to diagnose and treat ocular morbidities. Collected data were analyzed using standard software. For categorical data, frequency, percentage and 95% CI were calculated and statistical tests were done using Chi-square/Fisher exact test. RESULTS: Altogether 5234 participants were enrolled in the study (participation rate 96.4%). The overall prevalence of MSVI was 9.5% (495). It was 4.7% (133) in the mountainous region, 11.2% (169) in the Hill and 21.2% (193) in the Tarai. In those aged 15-49 years, MSVI prevalence was 1.5% (52) and 25.1% (433) in ≥50 years. The overall prevalence of blindness was 0.9% (47). It was 0.2% (6) in 15-49 and 2.3% (41) in ≥50 age groups. More than 95% visual impairment and blindness were due to cataract and uncorrected refractive error. Cataract was the leading cause of visual impairment and blindness (290, 53.5%), followed by uncorrected refractive error. CONCLUSION: The prevalence of visual impairment and blindness varied significantly with age, ethnicity and locality. The management of uncorrected refractive error and operable cataract would reduce nine in ten cases of moderate to severe visual impairment and blindness.