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1.
Int J Pediatr Otorhinolaryngol ; 77(4): 525-9, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23352338

ABSTRACT

OBJECTIVES: To determine the efficacy of adenotonsillectomy (T&A) in the treatment of pediatric sleep-disordered breathing, and to determine the natural history in untreated children. METHODS: The charts of children aged 1-12 who underwent polysomnography (PSG) between 1/2006 and 6/2009 were reviewed to identify children with positive studies. Children not treated by T&A were recruited and matched by age, time since initial PSG, and apnea-hypopnea index (AHI) to children who underwent T&A. All participants were evaluated by a clinical assessment score (CAS-15), follow-up PSG, and the Child Behavior Checklist (CBCL). RESULTS: Sixteen matched pairs completed the study. Ten (63%) T&A patients were overweight or obese compared with 14 (88%) untreated patients. There was a greater median improvement in AHI in the surgical group compared to the nonsurgical group (10.3 vs. 6.5, p=0.044). Although the T&A children were more likely to have a follow-up AHI<5 (81% vs. 69%) and <1 (44% vs. 25%), these results were not significant. The T&A group had significantly lower mean (SD) scores on the CAS-15 [8.9(6.1) vs. 29.4(16.2), p<0.001] and the CBCL total problem score [43.9(8.7) vs. 58.9(13.0), p<0.001]. Younger age at presentation (rho=-0.76, p<0.001), initial AHI (0.87, p<0.001), and initial AI (0.63, p=0.05) were correlated with change in AHI among T&A subjects. CONCLUSIONS: T&A was more effective in reducing AHI than no surgery. Median AHI improved in the nonsurgical group, and 4/16 (25%) untreated patients were cured (AHI<1).


Subject(s)
Adenoidectomy/methods , Obesity/surgery , Sleep Apnea Syndromes/surgery , Tonsillectomy/methods , Child , Child, Preschool , Female , Humans , Infant , Male , Polysomnography , Severity of Illness Index , Treatment Outcome
2.
Pediatr Emerg Care ; 28(9): 915-7, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22940892

ABSTRACT

OBJECTIVE: We report a case of missed foreign body aspiration in a child presenting with status epilepticus. On admission, the patient was found to have pneumonia, which progressed to respiratory failure and acute respiratory distress syndrome. While the patient was intubated and mechanically ventilated, the patient experienced acute respiratory deterioration. Subsequently, it was determined that a previously undetected foreign body had dislodged from the right main to the left main bronchus and was the underlying cause for the child's illness. CONCLUSIONS: A combination of sudden change of physical and radiographic findings with unilateral lung hyperinflation is highly suspicious for an obstructing airway foreign body. This case demonstrates that foreign body aspiration can lead to significant morbidity. It should be in the differential diagnosis for any acute pulmonary process in an otherwise well child because there is no specific clinical or radiographic finding to rule it out.


Subject(s)
Airway Obstruction/diagnosis , Airway Obstruction/etiology , Foreign Bodies/complications , Foreign Bodies/diagnosis , Intubation, Intratracheal , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiology , Airway Obstruction/surgery , Diagnosis, Differential , Diagnostic Errors , Electroencephalography , Female , Foreign Bodies/surgery , Humans , Infant , Radiography, Thoracic , Respiratory Distress Syndrome/surgery , Status Epilepticus , Tomography, X-Ray Computed
3.
Laryngoscope ; 122(9): 2096-104, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22890967

ABSTRACT

OBJECTIVES/HYPOTHESIS: To validate a clinical assessment score for pediatric sleep-disordered breathing. STUDY DESIGN: Prospective instrument validation. METHODS: One hundred children scheduled for overnight polysomnography were evaluated by a standardized history and physical examination and assigned a clinical assessment score. Parents completed the Obstructive Sleep Apnea (OSA)-18, the Pediatric Quality of Life Inventory (PedsQL) 4.0, and the Child Behavior Checklist questionnaires. Children with positive polysomnography underwent adenotonsillectomy or adenoidectomy. The identical assessments were performed at a mean follow-up of 8 months. RESULTS: Item reduction yielded a score of 15 items (Clinical Assessment Score-15 [CAS-15]) that demonstrated the best internal consistency and predictive utility (Cronbach α = .80). Intraclass correlation (ICC) demonstrated good intrarater (ICC, 0.78; 95% confidence interval [CI], 0.58 to 0.89) and inter-rater agreement (ICC, 0.65; 95% CI, 0.26 to 0.84). All change scores were significantly improved after surgery. Effect sizes were large for the CAS-15 (2.6), OSA-18 (2.4), and apnea-hypopnea index (1.4), and moderate for the Child Behavior Checklist (0.7) and PedsQL 4.0 (-0.5). Moderate to strong correlation was found between the initial CAS-15 scores and the external measures (|r| between 0.32 and 0.65). Receiver operating characteristic curves were constructed to determine the optimal initial CAS-15 score for predicting positive polysomnography. The area under the curve was 0.77 (95% CI, 0.67 to 0.87); and a score ≥32 yielded a sensitivity of 77.3% (95% CI, 65.3 to 86.7) and a specificity of 60.7% (95% CI, 40.6 to 78.5). CONCLUSIONS: The CAS-15 proved useful in an office setting and correctly diagnosed 72% of referred children when compared to polysomnography. It correlated well with external measures and demonstrated a good response to clinical change.


Subject(s)
Polysomnography/methods , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/epidemiology , Age Distribution , Anthropometry , Body Mass Index , Child , Child, Preschool , Cohort Studies , Confidence Intervals , Female , Follow-Up Studies , Humans , Incidence , Male , Observer Variation , Prospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/epidemiology
4.
Int J Pediatr Otorhinolaryngol ; 74(12): 1361-6, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20880595

ABSTRACT

OBJECTIVE: To demonstrate similar improvement in pediatric sleep-disordered breathing (SDB) as determined by polysomnography (PSG) with microdebrider-assisted partial intracapsular tonsillectomy and adenoidectomy (PITA) versus Bovie electrocautery complete tonsillectomy and adenoidectomy (T&A). METHODS: In this retrospective cohort study, 30 children found to have SDB by PSG who have undergone either PITA (15 participants) or T&A (15 participants) as treatment were evaluated with standardized history and physical examination and unattended home overnight PSG. RESULTS: Median change in apnea-hypopnea index (AHI) was 1.7 (-4.9 to 29.8) for the PITA group and 2.3 (-10.9 to 64.1) for the T&A group, although there was substantially more variability in the T&A group. A mixed linear model evaluating the relation of surgical group with change in AHI demonstrated no significant differences in group means (F[1,13]=0.31, P=.590) but the variances differed significantly (residual likelihood ratio chi-square=5.24, df=1, P=.022). Five of 15 (33%) PITA patients and 4 of 15 (27%) T&A patients had postoperative AHI scores of ≤5; this difference was not statistically significant (Fisher exact test P=1.000). There was no significant interaction or substantial confounding effect of age, sex, race, preoperative tonsil size, preoperative AHI, or body mass index in the model relating surgery type to reduction of postoperative AHI to ≤5. CONCLUSIONS: Our study demonstrates no clinically or statistically significant differences in PSG and clinical outcomes between PITA and T&A for treatment of pediatric SDB in otherwise healthy children.


Subject(s)
Polysomnography , Sleep Apnea Syndromes/physiopathology , Sleep Apnea Syndromes/surgery , Tonsillectomy , Adenoidectomy , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Sleep Apnea Syndromes/diagnosis , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/surgery , Tonsillectomy/methods
5.
J Natl Med Assoc ; 101(9): 956-8, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19806855

ABSTRACT

A 13-year-old boy with Mycoplasma pneumoniae pulmonary infection developed deep vein thrombosis and pulmonary embolism. He was found to have protein S deficiency and transient antiphospholipid antibodies. Though uncommon, it is important to consider venous thromboembolic disease in children whose clinical course is atypically severe.


Subject(s)
Lupus Erythematosus, Systemic/complications , Pneumonia, Mycoplasma/complications , Pulmonary Embolism/etiology , Venous Thrombosis/etiology , Adolescent , Anticoagulants/therapeutic use , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/immunology , Heparin/therapeutic use , Humans , Lupus Erythematosus, Systemic/immunology , Male , Pneumonia, Mycoplasma/drug therapy , Protein S Deficiency/complications , Protein S Deficiency/immunology , Pulmonary Embolism/drug therapy , Venous Thrombosis/drug therapy , Warfarin/therapeutic use
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