Pediatric Respirology and Critical Care Medicine

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Objective: The objective of this study is to compare the performance of a modified Pediatric Risk of Mortality (PRISM) III model with the original PRISM III in prediction of mortality risk in a Thailand pediatric intensive care unit (PICU). Subjects and Methods: Children aged 1 month to 18 years who stayed in the PICU for more than 8 h during November 2013 to December 2016 were included in the study. Results: The medical records of 1175 PICU patients were included in the analysis. The patients were randomly split into two equal groups: a development (n = 588) and a validation (n = 587) sample. A modified PRISM III model was derived from the original PRISM III by omitting arterial blood gas parameters and adding selected clinical variables. The model was developed using a multiple logistic regression model on the development sample and assessed using the area under the curve (AUC) obtained from a receiver operating characteristic curve. The modified PRISM III scores were significantly higher in nonsurvivors (median = 9, interquartile range [IQR] = 4 − 13) compared to survivors (median = 2, IQR = 0 − 5). The modified PRISM III model had similar discriminative performances compared to the original PRISM III in predicting 2-day mortality (AUC: 0.874 vs. 0.873), 7-day mortality (AUC: 0.851 vs. 0.851) and overall mortality (AUC: 0.845 vs. 0.956). The modified PRISM III model was calibrated in the validation sample, and the standardized mortality ratios (SMRs) were similar. Conclusions: The performance of a modified PRISM III model in predicting mortality risk was comparable to the original PRISM III. Both had similar discriminative performance and SMR for overall mortality prediction in a PICU.

Background: Advances in care of children with sickle cell anaemia (SCA) have increased their chances of survival to adolescence and adulthood though this is often associated with multi-organ system pathologies including lung dysfunctions. This study aimed to determine the prevalence, pattern and factors associated with pulmonary function abnormalities in Nigerian children with SCA. Methods: Pulmonary functions of 104 children with SCA in steady state and 104 age- and sex-matched haemoglobin AA controls aged 6 to 16 years at the Wesley Guild Hospital, Ilesa Nigeria, were assessed using Spirolab III (Medical International Research, Italy) spirometer following standard protocol. Socio-demographic characteristics, nutritional status and pulmonary function parameters of these children were compared, and the predictive factors of pulmonary function abnormalities in SCA children were determined using binary logistic regression. Results: SCA children had lower lung volumes and capacities and higher prevalence of pulmonary function abnormalities compared to controls, and a restrictive ventilatory pattern (22.1%) was the most predominant form. Adolescent age, previous acute chest syndrome (ACS), repeated painful crises and multiple hospitalisations in the previous year were significantly associated with pulmonary function abnormalities (P < 0.05). Only adolescent age group (odds ratio [OR] = 3.738; 95% confidence interval [CI] = 1.480–9.440; P = 0.005) and previous ACS (OR = 8.500; 95% CI = 2.044–12.959; P = 0.044) independently predicted pulmonary function impairments among the SCA children. Conclusion: SCA predisposes children to pulmonary dysfunction, particularly during adolescent years and in those with ACS, multiple crises and hospitalisations. Routine pulmonary function assessment in these children will facilitate early recognition and prompt management.

Obstructive sleep-disordered breathing (SDB) affects up to 11% of children and forms a continuum of severity ranging from primary snoring to obstructive sleep apnea. Children with SDB exhibit significant neurocognitive and cardiovascular dysfunction, which is associated with repetitive hypoxia and sleep fragmentation that characterize the condition. We reviewed the recent literature pertaining to the effect of SDB on the brain in children. These include studies that utilized near-infrared spectroscopy to determine cerebral oxygenation and structural and functional magnetic resonance imaging (MRI) of the brain. Studies have identified that the effect of SDB on cerebral oxygenation in children is minimal and not clinically significant. There are conflicting reports on the association between the measures of cerebral oxygenation and peripheral arterial oxygen saturation (SpO₂), and further research needs to be conducted to elucidate the relationship between peripheral SpO₂, cerebral oxygenation, and SDB in children. MRI studies have reported significant structural and functional changes to the brains of children with SDB, in brain regions associated with neurocognition, behavior, and autonomic function. These include reduced white and gray matter and structural changes to a multitude of brain areas including, but not limited to, the hippocampus, cortex, amygdala, insula, thalamus, cerebellum, and basal ganglia. These studies utilize a variety of MRI techniques to address different research questions, but contribute to the gradually developing picture of the adverse effects of SDB on the brain in children.

Online since 1^st July, 2016