Year : 2021 | Volume
: 5 | Issue : 4 | Page : 55--56
Department of Paediatrics, KK Women’s and Children’s Hospital, Bukit Timah Road, Singapore
Department of Paediatrics, KK Women’s and Children’s Hospital, 100 Bukit Timah Road
|How to cite this article:|
Goh A. Editorial.Pediatr Respirol Crit Care Med 2021;5:55-56
|How to cite this URL:|
Goh A. Editorial. Pediatr Respirol Crit Care Med [serial online] 2021 [cited 2022 Dec 9 ];5:55-56
Available from: https://www.prccm.org/text.asp?2021/5/4/55/356802
This edition of the journal covers three important common respiratory childhood conditions, namely respiratory tract infections, allergic rhinitis, and obstructive sleep apnea (OSA).
Acute respiratory infections are common in young children and account for frequent visits to the doctor as well as the emergency room. It is important to be able to accurately evaluate the severity of the respiratory disease so that those with more severe diseases requiring admission can be recognized and managed early in the appropriate setting. Several respiratory severity scores have been developed with varying complexities. Examples of such scores are the Tal score, Respiratory Distress Assessment Instrument (RDAI), the Wang Respiratory score (WRS), and the Kristjansson Respiratory score (KRS). Most of the scores are quite similar to the Paediatric Severity Respiratory Score (PRESS) but WRS, KRS, Tal score, and RDAI do not use SaO2 in the score and uses mainly the components of respiratory rate, wheezing, and retractions with/without the general condition for the score. These were designed mainly to assess bronchiolitis in children.
The utility of the PRESS as reported by Jagalamarri et al. in this publication has the advantage of being a simple and easy-to-use score that can be easily used in community settings as it uses five components, namely respiratory rate, wheezing, accessory muscle use, SaO2, and feeding difficulties. SaO2 is easy to measure in most clinical settings in this day and age. The authors showed a significantly increased need for respiratory support in those who had a severe PRESS as compared with those with a moderate score. The use of the PRESS may be useful in resource-limited countries to differentiate those children who should be admitted for management from those who can be continued to be managed in the community. To better answer that question, a larger community study should be performed. Subsequent management of the child is still dependent on an accurate diagnosis of the respiratory disease as the PRESS is a measure of respiratory distress and is not specific for any disease condition.
Another common disease in childhood is allergic rhinitis, which in Asia can affect up to 40% of children. The mainstay of treatment for allergic rhinitis is the use of intranasal steroids and antihistamines. There are still many parents who have concerns about giving their children long-term steroids due to the perceived complications with steroids. Nonsteroidal treatments are therefore very appealing to parents and especially the use of probiotics that are perceived to be harmless and beneficial to health. This article by Huang et al. conducted in Taiwan highlights the acceptability and tolerability of heat-killed Lactobacillus paracasei LCW23 in the management of allergic rhinitis. A 12-week treatment with L. paracasei LCW23 led to improvement in nasal symptoms. The use of probiotics for the management of allergic diseases is very species dependent and hence the results cannot be generalized to all probiotics.
The third article in this publication is on the use of pulse oximetry to screen for OSA in infants. Infants born prematurely with bronchopulmonary dysplasia, upper airway obstruction, and recurrent clinical apneas are at increased risk of OSA. The gold standard for diagnosing OSA is with polysomnography. However, polysomnography is labor intensive and is not available in many resource-limited countries. Even in countries where it is available, the wait time for a study can be very long due to limited availability. The study by Hou et al. is important as it targets a specific age group which are infants who are difficult to evaluate even on a sleep study. They showed that an overnight pulse oximetry had a good correlation with the polysomnogram. Their study showed that an oxygen desaturation index (ODI) < 90% of >1.3/h can detect an Obstructive Apnea-Hypopnea Index of >2/h with a sensitivity of 77% and specificity of 71%. This will allow more patients to be evaluated in a timely manner and especially in infants where doing an overnight polysomnography can be challenging.
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