Pediatric Respirology and Critical Care Medicine

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Background: Specialised transport teams are associated with fewer complications during interhospital transport. Such teams are currently unavailable in Hong Kong. The aim of this study was to review the clinical outcomes of critically ill infants requiring interhospital transport in Hong Kong. Methods: We retrospectively reviewed the characteristics and clinical outcomes of all infants transported from the neonatal units of regional or private hospitals into the neonatal or cardiac intensive care unit (ICU) of Queen Mary Hospital, a tertiary-wide academic centre in Hong Kong from 1^st August 2013 to 31^st July 2016. Results: A total of 256 infants with a mean gestational age of 31.7 ± 5.5 weeks and birth weight of 1732 ± 1007 g were included in the study. While 143 (55.9%) patients were intubated during transport, there was no documentation of close monitoring of physiological parameters for 91.4% of the patients. Close to half of the patients (44.1%) had complications on admission and 23.4% required significant interventions immediately after the transfer. The median length of stay in the ICU was 3.3 (range: 0.5–342.6) days. Five patients died of non-transport-related causes within 7 days of admission. Multiple logistic regression analysis showed that intubated patient (P = 0.001) or patient requiring inotropic support during transport (P = 0.027) were more likely to develop complications. Higher birth weight (P = 0.022) and younger chronological age at transfer (P = 0.030) were also significant risk factors for complications. Conclusions: Complications and interventions are considerable during interhospital neonatal transport in Hong Kong. The complication rate was higher than medical infrastructures that provided a specialised team for this process. Documentation during transport was inadequate.

Objective: The aim of this study is to investigate the use of overnight oximetry to predict high Apnea–Hypopnea Index (AHI) in Hong Kong children with habitual snoring. Methodology: We have retrospectively analyzed the polysomnography (PSG) of 573 patients with habitual snoring with age ranged from 6 months to 18 years old. Patients with syndromal diagnosis or neuromuscular disorders were excluded from the study. The sensitivity, specificity, positive predictive value , and negative predictive value (NPV) of oximetry to predict AHI were calculated. Results: McGill score >1 had high specificity 99.07% and low sensitivity 16.81% to detect AHI >1. SpO₂ nadir <95% has high sensitivity 98.56% and NPV 97.56% to predict AHI >5. Conclusion: The use of the McGill score together with nadir SpO₂ in overnight oximetry can help in stratifying the severity of obstructive sleep Apnea and thus prioritizing PSG testing.

Pneumonia is a frequent diagnosis without adequate consideration of the etiology. Pneumonia implies the presence of inflammation of the lung parenchyma with consolidation. That inflammation may be from infectious or noninfectious causes. Radiologic diagnosis of pneumonia is subject to interobserver interpretation and may misdiagnose noninflammatory radiological opacifications as pneumonia. The common diagnosis of community-acquired pneumonia in children most commonly has a viral rather than bacterial etiology. Antibiotics should be reserved for those where the clinical course, laboratory measure of biomarkers, and radiology are consistent with the diagnosis of pyogenic bacterial pneumonia.

Online since 1^st July, 2016