Sleep-disordered Breathing in Children With Craniofacial Anomalies.

Sleep-disordered breathing (SDB) is a common disorder in children, characterized by snoring and/or increased breathing force due to narrowing and increased upper airway collapse while sleeping. Over the last decade, it has been recognized that SDB occurs more frequently in children with craniofacial anomalies, but data in Thailand is quite limited. This study retrospective descriptive study aims to find the prevalence of SDB among children with craniofacial anomalies in Thailand and associated risk factors by collecting data among Thai children with congenital craniofacial anomalies younger than 15 years old who visited the Princess Sirindhorn Craniofacial Center at King Chulalongkorn Memorial Hospital between 2016 and 2021. All children were defined into syndromic and nonsyndromic groups. Data collected from the electronic medical record includes baseline characteristics, diagnosis of craniofacial anomalies, associated risk factors, diagnosis of SDB, diagnostic tools, and treatment. Total of 512 children, there were 80 children (15.4%) who had SDB. The most diagnosis was 51 (10%) obstructive sleep apnea followed by 27 (5.3%) primary snoring and 2 (0.4%) obstructive hypoventilation. The prevalence of SDB in the syndromic group was 43 (46.7%) while the nonsyndromic group was 37 (8.6%), ( P <0.001). The risk factors associated with SDB were overweight, allergic rhinitis, tonsillar hypertrophy, high arch palate, micrognathia, and syndromic craniofacial anomalies. The prevalence of SDB is higher in children with syndromic craniofacial anomalies than in the nonsyndromic group. Knowledge of the prevalence and related factors can lead to better care, including early screening and monitoring of SDB in craniofacial patients.

Burden of Respiratory Syncytial Virus Related Acute Lower Respiratory Tract Infection in Hospitalized Thai Children: A 6-Year National Data Analysis.

Objectives: This study sought to determine the epidemiology, seasonal variations, morbidity, and mortality of respiratory syncytial virus (RSV) infection among hospitalized children with lower respiratory tract infection in Thailand. In addition, we assessed the risk factors associated with severe RSV lower respiratory tract infection (LRTI)-related morbidity and mortality. Methods: The data were reviewed retrospectively from the National Health Security Office for hospitalized children younger than 18 years old diagnosed with RSV-related LRTI in Thailand, between the fiscal years of 2015 to 2020. The RSV-related LRTIs were identified using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification. ICD-10-TM codes J12.1, J20.5, and J21.0, which represent respiratory syncytial virus pneumonia, acute bronchitis due to respiratory syncytial virus, and acute bronchiolitis due to respiratory syncytial virus, respectively, were studied. Results: During the study period, RSV-related LRTI accounted for 19,340 of the 1,610,160 hospital admissions due to LRTI. RSV pneumonia was the leading cause of hospitalization (13,684/19,340; 70.76%), followed by bronchiolitis (2849/19,340; 14.73%) and bronchitis (2807/19,340; 14.51%), respectively. The highest peak incidence of 73.55 percent occurred during Thailand's rainy season, from August to October. The mortality rate of RSV-related LRTI in infants younger than 1 year of age was 1.75 per 100,000 person years, which was significantly higher than that of children 1 to younger than 5 years old and children 5 to younger than 18 years old (0.21 per 100,000 person years and 0.01 per 100,000 person years, respectively, p-value < 0.001). Factors associated with mortality were congenital heart disease, hematologic malignancy, malnutrition, and neurological disease. Conclusions: In children with RSV LRTI, pneumonia was the leading cause of hospitalization. The admission rate was highest during the rainy season. Mortality from RSV-related LRTI was higher in children under 1 year old and in children with underlying illnesses; future preventive interventions should target these groups of patients.

Development and validation of the predictive score for pediatric COVID-19 pneumonia: A nationwide, multicenter study.

BACKGROUND: Due to the possibility of asymptomatic pneumonia in children with COVID-19 leading to overexposure to radiation and problems in limited-resource settings, we conducted a nationwide, multi-center study to determine the risk factors of pneumonia in children with COVID-19 in order to create a pediatric pneumonia predictive score, with score validation. METHODS: This was a retrospective cohort study done by chart review of all children aged 0-15 years admitted to 13 medical centers across Thailand during the study period. Univariate and multivariate analyses as well as backward and forward stepwise logistic regression were used to generate a final prediction model of the pneumonia score. Data during the pre-Delta era was used to create a prediction model whilst data from the Delta one was used as a validation cohort. RESULTS: The score development cohort consisted of 1,076 patients in the pre-Delta era, and the validation cohort included 2,856 patients in the Delta one. Four predictors remained after backward and forward stepwise logistic regression: age < 5 years, number of comorbidities, fever, and dyspnea symptoms. The predictive ability of the novel pneumonia score was acceptable with the area under the receiver operating characteristics curve of 0.677 and a well-calibrated goodness-of-fit test (p = 0.098). The positive likelihood ratio for pneumonia was 0.544 (95% confidence interval (CI): 0.491-0.602) in the low-risk category, 1.563 (95% CI: 1.454-1.679) in the moderate, and 4.339 (95% CI: 2.527-7.449) in the high-risk. CONCLUSION: This study created an acceptable clinical prediction model which can aid clinicians in performing an appropriate triage for children with COVID-19.