Pediatric Respirology and Critical Care Medicine

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Despite increasing survival for babies born preterm, the incidence of bronchopulmonary dysplasia (BPD) remains similar and continues to be the most common chronic lung disease in the preterm population. Advances in neonatal management, including the use of antenatal steroids, exogenous surfactants and changes in ventilation, have resulted in a change in the pathophysiology of BPD to a condition characterized by an arrest in alveolar development and vascular remodeling. There are numerous diagnostic definitions used for this heterogeneous condition with those using the extent of respiratory support required at 36 weeks postmenstrual age shown to be the most effective in predicting long-term pulmonary outcomes. In this article, we will discuss definitions, etiology, and pathophysiology of BPD. Management of infants with established BPD requires a multi-disciplinary team, including neonatologists and respiratory pediatricians with support for families being crucial to long term care. In this article, we will review current guidelines on oxygen saturation targets for established BPD and discuss how the use of a structured weaning pathway, as used at our center, has been shown to reduce the total duration of home oxygen. Other cornerstones of management, including optimizing growth and nutrition, reducing second-hand smoke exposure, and infection prevention, are discussed. For infants with the most severe BPD, we will review the evidence base for pharmacological therapies and indications for long-term ventilatory support. With a number of emerging therapies such as mesenchymal stem cells at the stage of phase one clinical trials, we will discuss future directions in BPD management.

Context: Overnight oximetry is a screening test for pediatric obstructive sleep apnea (OSA). However, those who demonstrate normal/inconclusive test still require diagnostic polysomnography (PSG). Since PSG has a long waiting list, an adjunct simple test for the prioritization would be helpful. Aims: The aim of this study is to determine whether the OSA-18 quality of life (QoL) questionnaire could predict moderate-to-severe OSA in children with normal/inconclusive overnight oximetry. Settings and Design: The study involves a cross-sectional study at a university hospital. Subjects and Methods: Overnight PSG and QoL assessed by the Thai-Version OSA-18 were performed in snoring children with normal/inconclusive overnight oximetry. Statistical Analysis: Unpaired Student's t-test, Chi-square, and receiver operating characteristic curve analysis were used. Results: A total of 218 children (age 6.4 ± 2.5 years, 62% male) were studied. Sixty percent had moderate-to-severe OSA, while 40% had primary snoring/mild OSA. The mean total OSA-18 score was not different between the two groups. Subgroup analysis among those who never had medical treatment for OSA (n = 55) showed a higher total OSA-18 score in moderate-to-severe compared to primary snoring/mild OSA groups (80.5 ± 10.7 vs. 72.2 ± 14.4; P = 0.02). Total OSA-18 score >78 was the best cutoff value for predicting moderate-to-severe OSA (61.5% sensitivity, 80% specificity, 72.7% positive predictive value, and 69.7% negative predictive value). Combining this cutoff value with overweight/obesity did not improve its predictivity. Conclusions: We found the association between high total OSA-18 score and moderate-to-severe OSA in snoring children who had normal/inconclusive overnight oximetry and never had medical treatment for OSA. However, the best cutoff value of the score and other potential add-on parameters are still needed to be investigated.

Objective: The aim of this study is to investigate the current clinical factors associated with preterm birth in women delivering newborn infants in a tertiary medical center of a modern city. Methods: The medical records of women who delivered newborn infants in a tertiary medical center in Taipei city in 2015 were reviewed. To compare with the full-term group, the preterm group was defined by gestations of <37 weeks. Maternal characteristics, pregnant histories, underlying diseases, and peripartum conditions of enrolled mothers and the characteristics of their newborn infants were recorded and analyzed. Odds ratios (OR) were analyzed using logistic regression for factors associated with preterm deliveries. Results: A total of 1729 pregnant women (15–48 years) gave birth during the study period, including 1520 full-term and 209 (12.1%) preterm deliveries, accounting for 1778 newborns with 49 pairs of twins. After multivariate analysis, the following significant factors were found to be associated with preterm birth: multiple pregnancy (OR, 26.5; 95% confidence interval [CI], 12.7–55.4]), presence of maternal systemic lupus erythematosus (SLE) (OR, 10.4; 95% CI, 2.3–46.2), preeclampsia/eclampsia (OR, 7.6; 95% CI, 3.9–14.8), tocolysis requirement (OR, 6.6; 95% CI, 4.6–9.7), infection (OR, 2.4; 95% CI, 1.7–3.5), maternal diabetes (OR, 2.2; 95% CI, 1.0–4.4), and low maternal height (<155 cm) (OR, 2.2; 95% CI, 1.4–3.4). The preterm group also had more maternal blood loss (623 ± 543 vs. 399 ± 375 mL, P < 0.05) and a higher ratio of cesarean sections (59.3% vs. 26.8%, P < 0.05) than the full-term group. Conclusion: Multiple pregnancy, tocolysis requirement, lower maternal height (<155 cm), and the presence of maternal diseases during pregnancy, including SLE, preeclampsia/eclampsia, infection, and maternal diabetes, are significantly associated with preterm birth in Taipei city.

Online since 1^st July, 2016