ABSTRACT
Introduction: The prevalence of obstructive sleep apnea (OSA) is 1-4 %. Some reports describe its association with pulmonary hypertension (PH), but its prevalence is unknown. No studies at high altitude have determined the relationship between OSA and PH. The aim of this study was to establish the prevalence of PH in children diagnosed with OSA living in a high-altitude city at 2640 m above sea level. Methods: Children between 2 and 16 years of age referred to the Sleep Laboratory of the Fundación Neumológica Colombiana in Bogotá with a positive polysomnogram for OSA were included, and a two-dimensional transthoracic echocardiogram (TTE) was performed to evaluate PH. Statistical analysis was performed using median, interquartile range, chi-squared test, and Kruskall-Wallis test. Results: Of the 55 patients (n: 55), 63.6 % were male, with a median age of 6 years, 14 children (25.5 %) were overweight; 12 children (21.8 %) had mild OSA, 12 (21.8 %) had moderate OSA and 31 (56.4 %) severe OSA. In patients with severe OSA, the minimum saturation during events was 78 % with a desaturation index (DI) of 33.8/hour (p < 0.01). T90 and T85 increased proportionally with OSA severity (p < 0.05). Of the 55 patients with OSA, none had PH according to echocardiography; 4 patients (7.2 %) had pulmonary artery systolic pressure (PASP) at the upper limit of normal (ULN), and it was not related to a higher body mass index (BMI). Conclusions: We found no association between OSA and PH in children with OSA at high altitude.
ABSTRACT
BACKGROUND: Palivizumab is the standard immunoprophylaxis against serious disease due to respiratory syncytial virus infection. Current evidence-based prophylaxis guidelines may not address certain children with CHD within specific high-risk groups or clinical/management settings. METHODS: An international steering committee of clinicians with expertise in paediatric heart disease identified key questions concerning palivizumab administration; in collaboration with an additional international expert faculty, evidence-based recommendations were formulated using a quasi-Delphi consensus methodology. RESULTS: Palivizumab prophylaxis was recommended for children with the following conditions: <2 years with unoperated haemodynamically significant CHD, who are cyanotic, who have pulmonary hypertension, or symptomatic airway abnormalities; <1 year with cardiomyopathies requiring treatment; in the 1st year of life with surgically operated CHD with haemodynamically significant residual problems or aged 1-2 years up to 6 months postoperatively; and on heart transplant waiting lists or in their 1st year after heart transplant. Unanimous consensus was not reached for use of immunoprophylaxis in children with asymptomatic CHD and other co-morbid factors such as arrhythmias, Down syndrome, or immunodeficiency, or during a nosocomial outbreak. Challenges to effective immunoprophylaxis included the following: multidisciplinary variations in identifying candidates with CHD and prophylaxis compliance; limited awareness of severe disease risks/burden; and limited knowledge of respiratory syncytial virus seasonal patterns in subtropical/tropical regions. CONCLUSION: Evidence-based immunoprophylaxis recommendations were formulated for subgroups of children with CHD, but more data are needed to guide use in tropical/subtropical countries and in children with certain co-morbidities.
Subject(s)
Consensus , Heart Defects, Congenital/complications , Palivizumab/administration & dosage , Respiratory Syncytial Virus Infections/complications , Respiratory Syncytial Virus Infections/virology , Antiviral Agents/administration & dosage , Child, Preschool , DNA, Viral/genetics , Dose-Response Relationship, Drug , Female , Heart Defects, Congenital/therapy , Humans , Immunization/methods , Infant , Male , Respiratory Syncytial Virus Infections/therapy , Respiratory Syncytial Viruses/geneticsABSTRACT
Objetivos. Se desea revisar en forma retrospectiva la experiencia de cierre percutáneo de ductus arterioso persistente (DAP) de enero de 1997 a enero del 2000, no fueron sometidos a cierre 12 DAP silentes. Métodos: Todos los pacientes con diagnóstico de DAP fueron ingresados al protocolo de estudio, se dividieron en dos grupos 1. Tratamiento percutáneo (diámetro 3 mm o menos). 2. Tratamiento quirúrgico (defecto mayor de 3 mm). Resultados: Se estudiaron un total de 334 pacientes 215 pacientes operados (1997 : 99 pacientes, 1998: 74 pacientes, 1999: 42 pacientes). 119 cierre percutáneo, de los cuales cinco fueron considerados no aptos para cierre por defectos muy grandes en cateterismo. El tamaño del DAP medido por Eco no tiene una buena correlación respecto al medido mediante cateterismo. De los 114 pacientes intervenidos en cateterismo se colocaron 124 resortes distribuidos así: Jackson 103 (81 por ciento), Gianturco 21 (11 por ciento) colocando doble resorte en 10 pacientes (8.4 por ciento) todos los casos fueron evaluados a las 24 horas, 6 y 12 meses, encontrando cierre total a las 24 horas en 83 por ciento, cortocircuito (C-C) residual en 19 de los cuales fue mínimo en 16 y moderado en tres. Uno de estos pacientes fue sometido a nuevo cierre percutáneo por hemolisis y C-C residual moderado. A los seis meses: se controlaron 15 de 19 pacientes con C-C residual, seis evolucionaron a cierre y en los seis restantes persistió el C-C, dos de los pacientes con C-C moderado evolucionaron a C-C mínimo, el restante persiste igual y esta pendiente de control del año. De los ocho pacientes con C-C residual, fueron controlados seis al año con cierre espontáneo en uno. Finalmente se logró un cierre total del defecto en 92 por ciento, con C-C residual mínimo en cinco y moderado en uno, perdiéndose para seguimiento seis pacientes con C-C mínim
