Non-invasive continuous positive airway pressure ventilation and high-flow nasal cannula oxygen therapy use in children without primary lung pathology: A prospective observational study

Background. Non-invasive nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula oxygen therapy (HFNC) are non-invasive ventilation (NIV) modalities appropriate for children in developing countries. There is minimal literature describing nCPAP and HFNC use in children with respiratory compromise secondary to non-pulmonary disease. Objectives. Th present study aimed to describe the characteristics and outcomes of children without primary lung pathology, who received nCPAP and HFNC during their admission to Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods. This was a prospective observational study of routinely collected data, between August 2015 and January 2016. Primary and secondary outcome measures were NIV failure (progression to intubation and invasive ventilation) and paediatric intensive care unit (PICU) admission, respectively. Comparative statistics were conducted using Mann-Whitney U or t-tests. Data significantly associated with the primary and secondary outcomes on univariate analysis were entered into backward stepwise logistic regression models to determine independent predictive factors. Results. There were 31 cases of nCPAP and 1 case of HFNC use in 31 patients (median age 3.5 (interquartile range (IQR) 1.8 - 7.6) months). The majority (n=23; 71.9%) presented with primary diarrhoeal disease. There were 2 deaths (6.5%), 17 (53.1%) PICU admissions, and 5 (15.6%) cases received invasive ventilation (NIV failure). The median duration of hospital stay was 11.5 (IQR 6.0 - 17.5) days. Patients who failed NIV had lower admission SaO2 levels than those without treatment failure (95% (IQR 95 - 99) v. 100% (IQR 100 - 100); p=0.03). On multiple logistic regression, lower temperature (adjusted OR (aOR) 0.19; 95% confidence interval (CI) 0.05 - 0.78; p=0.02) and receiving inotropes in the emergency setting (aOR 23.05; 95% CI 1.64 - 325.06; p=0.02) were independently associated with PICU admission. Conclusion. nCPAP was used clinically for the management of children with respiratory compromise secondary to non-pulmonary illnesses, particularly diarrhoeal disease. Larger controlled clinical studies are needed to determine the effectiveness and utility of nCPAP in this population. HFNC was not commonly used, and this modality requires further investigation in this population

Rate of Pulmonary Function Decline in South African Children with Cystic Fibrosis

Background. Pulmonary function tests (PFTs) objectively measure the extent and progression of cystic fibrosis (CF) lung disease. The rate of lung function decline in developing countries has not previously been studied. Aim. To investigate the average annual rates of pulmonary function decline in South African children with CF from 1999 to 2006. Methodology: The medical records and best PFT over 3-monthly intervals of children attending the CF clinic at Red Cross War Memorial Children's Hospital; Cape Town; were retrospectively reviewed and analysed using the mixed model regression method. Results. A total of 1 139 PFT were recorded on 79 patients; with a median (interquartile range) of 14 (6 - 21) PFTs per patient. The mean (standard error) forced expiratory volume in 1 second (FEV1) at age 6 years was estimated at 73.83 (3.34) per cent predicted with an FEV1 decline of 0.23 (0.43)per annum. FEV1 at age 6 was affected by age at CF diagnosis; genotype; and year of birth. Rate of FEV1 decline was significantly affected by Pseudomonas aeruginosa colonisation and genotype. Conclusions. Although FEV1 at age 6 years was low compared with developed countries; the annual rate of FEV1 decline in South African children with CF was minimal; setting the scene for improved survival in this population