Paediatric eosinophilic oesophagitis in New Zealand: A 3-year prospective study.

AIM: Eosinophilic oesophagitis (EoE) is a rare, chronic, relapsing immune/antigen-mediated disease characterised by symptoms of oesophageal dysfunction, with a paucity of data among New Zealand (NZ) children. This 3-year prospective study aimed to characterise EoE diagnosed nationally and to describe initial treatment strategies adopted. METHODS: Information on new diagnoses of paediatric EoE was obtained via the New Zealand Paediatric Surveillance Unit, through monthly questionnaires. RESULTS: From February 2014 to January 2017, 73 new cases (74% male) of EoE were reported, including 74% NZ European, 10% Asian, 7% Maori, 5% Middle-Eastern and 3% Pacific peoples. Median age of symptom onset was 4 years; dysphagia (48%) was the most common, followed by vomiting/regurgitation (40%), food impaction (19%) and epigastric pain (16%). A co-morbid history of other allergic conditions was present in 62% of patients, and 41% had a first degree relative with atopy. Seventy-nine percent of patients had abnormal endoscopic findings, most commonly linear furrows and white plaques; none had strictures. Median eosinophil count per high-powered field was 40 and 50 in the mid and distal oesophagus, respectively. Fifty-four percent of patients were initially managed with dietary manipulation alone (four required elemental feeds, five nasogastric tubes). Fifty-four percent of patients were treated with swallowed corticosteroids and 7% with prednisone. One patient was also treated with a leukotriene receptor antagonist. CONCLUSION: This first prospective study on paediatric patients with EoE in NZ finds similar demographics and disease characteristics as in other populations despite our unique ethnic population. Long-term prospective observational data should significantly improve our knowledge of this rare condition.

Intermittent hypoxia in preterm infants: Measurement using the desaturation index.

OBJECTIVE: The aims of this study were to: (i) Determine in preterm infants at neonatal discharge the prevalence of intermittent hypoxia (IH), as measured by the oxygen desaturation index (DSI) recorded by pulse oximetry and (ii) Determine the change in values for very preterm infants at 1-month post discharge. METHODS: Preterm infants were recruited from the Wellington regional neonatal intensive care unit (NICU) and 24-h pulse oximetry recordings performed immediately before discharge. Infants born <32 weeks gestational age (GA) had repeat oximetry 1-month post discharge. Oxygenation measures included the 3% and 4% desaturation (DSI 3%, DSI 4%) indices. RESULTS: At discharge from the neonatal unit the median and interquartile range (IQR) for DSI 4% was 51 (31-74) events per hour with normal mean SpO2 (median of 97.9% [97.2-98.8 IQR]). Episodes of IH 1 month post discharge decreased with improvements of between 42% and 57% seen for the three DSI measures. Infants <32 weeks GA had higher median DSI 3 and 4% values at discharge but differences when compared with late preterm infants were not significant. CONCLUSIONS: Preterm infants have frequent episodes of IH as measured by the 3% and 4% DSI when deemed otherwise ready for discharge home. Further research in a larger cohort of very preterm infants and also in term infants is needed to determine the significance of this finding.

Comparison of 12-hour and 24-hour oximetry recordings in preterm infants.

AIM: To compare the overnight 12-hour oximetry component of 24-hour oximetry recordings with the complete 24-h recording in terms of cardiorespiratory status data in preterm infants. METHODS: Preterm infants from the Wellington neonatal intensive care unit underwent a 24-h pulse oximetry recording immediately prior to discharge home. Each recording was edited to resemble a 12-h overnight recording and compared to the full 24-h recording. Differences in a range of cardiorespiratory variables were assessed as to whether they were statistically significant and, if so, likely to be clinically significant. RESULTS: The nadirs for heart rate and SpO2 (both P < 0.001), the time spent <80% SpO2 (P = 0.017) and highest heart rate (P < 0.001) were significantly different between the two recordings. Only the heart rate nadir differed by more than 5%, suggesting that this may be of clinical significance (median (interquartile range) 54 (28-69) for 24-h recording vs. 78 (54-96) for 12-h recording). CONCLUSION: The 24-h oximetry reports were clinically similar to 12-h recordings for the majority of variables, and therefore, we suggest that 12-h oximetry studies are sufficient for determining cardiorespiratory status in infants.

24-hour oxygen saturation recordings in preterm infants: editing artefact.

AIM: To create editing guidelines for artefact removal in preterm infant pulse oximetry recordings. METHODS: 38 preterm infants ready for discharge home from the neonatal intensive care unit underwent 24-hour pulse oximetry recording using the Masimo® Rad-8 device. An expert panel determined editing rules based on clinical protocols. For each recording, three reports were generated, 'raw' no editing, 'auto' using the software editing feature and 'manual' reviewed and edited according to the rules. Primary outcome measures were desaturation indices including desaturation index 3% and 4%. Secondary measures included heart rate, mean oxygen saturation and time below 90%. RESULTS: While all oximetry outcomes differed significantly between editing modes, the majority were not considered likely to influence clinical management. Use of the auto editing compared to no editing did alter by >5%: Time spent <90% oxygen saturation and Desaturation index 4% >10 seconds. The use of manual editing removed extremely low pulse values that were considered unphysiological in this group of otherwise healthy infants. CONCLUSION: We recommend that oximetry recordings to determine cardiorespiratory stability in newborn infants ready for discharge from the neonatal unit have software editing features applied. This will remove artefact without consuming time in a busy unit.

Oximetry for preterm infants at neonatal discharge: What is current practice in New Zealand and Australia?

AIM: The aim of the study was to survey level 2 and 3 neonatal units in Australasia to determine the prevalence of oximetry studies at discharge for preterm infants, how these oximetry studies are performed, and which measures are included in an oximetry report. METHODS: A 10-question online survey was created using Survey Monkey regarding use of predischarge oximetry and e-mailed to 46 neonatal units (all level 2 and three units in NZ and all level 3 units in Australia). RESULTS: The response rate was 59% (27/46) with a NZ response rate of 78% (18/23). There was variation in the groups of infants receiving predischarge oximetry studies, with one fifth of responding neonatal units never performing oximetry at discharge. Of the units using predischarge oximetry screening, infants being discharged home on supplemental oxygen were the only group for which all units perform predischarge oximetry. Masimo (Masimo, Irvine, California, USA) is the most common oximeter brand and profox Associates, Inc. (PROFOX Associates, Inc., Escondido, CA 92025, USA) the most common analysis software used. Measures included in oximetry reports vary between units, with profox Associates, Inc.'s default event definition of 'a drop in saturation by four or more' being the most commonly reported desaturation definition. CONCLUSIONS: These findings indicate a need for guidelines to standardise preterm infant oximetry monitoring at neonatal discharge. Further research is required to determine the utility of predischarge oximetry and to establish which infants should be screened.