A randomised trial of high-flow nasal cannula in infants with moderate bronchiolitis.

BACKGROUND: The objective was to determine whether high-flow nasal cannula (HFNC), a promising respiratory support in infant bronchiolitis, could reduce the proportion of treatment failure requiring escalation of care. METHODS: In this randomised controlled trial, we assigned infants aged <6 months who had moderate bronchiolitis to receive either HFNC at 3 L·kg-1·min-1 or standard oxygen therapy. Crossover was not allowed. The primary outcome was the proportion of patients in treatment failure requiring escalation of care (mostly noninvasive ventilation) within 7 days following randomisation. Secondary outcomes included rates of transfer to the paediatric intensive care unit (PICU), oxygen, number of artificial nutritional support-free days and adverse events. RESULTS: The analyses included 268 patients among the 2621 infants assessed for inclusion during two consecutive seasons in 17 French paediatric emergency departments. The percentage of infants in treatment failure was 14% (19 out of 133) in the study group, compared to 20% (27 out of 135) in the control group (OR 0.66, 95% CI 0.35-1.26; p=0.21). HFNC did not reduce the risk of admission to PICU (21 (15%) out of 133 in the study group versus 26 (19%) out of 135 in the control group) (OR 0.78, 95% CI 0.41-1.41; p=0.45). The main reason for treatment failure was the worsening of modified Wood clinical asthma score (m-WCAS). Short-term assessment of respiratory status showed a significant difference for m-WCAS and respiratory rate in favour of HFNC. Three pneumothoraces were reported in the study group. CONCLUSIONS: In patients with moderate bronchiolitis, there was no evidence of lower rate of escalating respiratory support among those receiving HFNC therapy.

Continuous Positive Airway Pressure and the Burden of Care for Transient Tachypnea of the Neonate: Retrospective Cohort Study.

OBJECTIVES: Transient tachypnea of the neonate (TTN) is the commonest neonatal respiratory disorder. Given TTN physiopathology, continuous positive airway pressure (CPAP) could be indicated for its treatment, but no data are available. Our aim is to clarify if CPAP might reduce the TTN burden of care. DESIGN: Retrospective multicenter cohort study enrolling 42 full-term TTN babies treated with CPAP and 40 with oxygen supplementation. RESULTS: CPAP-treated infants show shorter intensive care unit stay (CPAP, 2.5 ± 2 vs. Oxygen, 4.4 ± 2.6 days; adjß, -2.1 [95% confidence interval (CI): -3.1; -1]); p < 0.001) and lower maximal oxygen fraction (adjß, -4.7 [95% CI: -7.7; -1.7]; p = 0.003). Air leak incidence was similar between the groups (adjOR, 0.36 [95% CI: 0.1; 1.1); p = 0.08). Patients' comfort as per EDIN score was also unchanged. Given the shorter length of intensive care, the use of CPAP for treating TTN would spare on average around 7,000 Euros/infant. CONCLUSION: CPAP seems a useful therapeutics for TTN, as it may reduce the burden of care without increasing air leaks or patients' discomfort.

Pediatric onset multiple sclerosis: Future challenge for early diagnosis and treatment.

Multiple sclerosis is a major socio-economical burden as it represents the most common cause of non-traumatic neurological disability in young adults [1]. It affects also children with a lower prevalence and incidence but remains a major concern as disability may occur later during their adulthood. Therefore, there is an absolute need for earlier diagnosis and treatment. In this review, we would focus on how these objectives can be achieved.