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The article discusses the efficacy and safety of monoclonal anti‐interleukin (IL)‐5 antibodies for treating chronic asthma in both adults and children. Anti‐IL‐5 treatments have been found to reduce the rate of asthma exacerbations in adults with severe asthma, particularly those with elevated blood eosinophils. While improvements in health‐related quality of life and lung function were limited, no safety concerns were identified for mepolizumab and reslizumab, but there was a small incidence of adverse events leading to discontinuation of benralizumab. The study included participants with moderate to severe eosinophilic asthma and found that biologic agents like mepolizumab and benralizumab can be effective in reducing asthma exacerbations and improving quality of life, especially in patients with uncontrolled severe asthma. [Extracted from the article]

Summary: This paper investigated cortical thickness and volumetric changes in children to better understand the impact of obstructive sleep disordered breathing (SDB) on the neurodevelopment of specific regions of the brain. We also aimed to investigate how these changes were related to the behavioral and cognitive deficits observed in the condition. Neuroimaging, behavioral, and sleep data were obtained from 30 children (15 non‐snoring controls, 15 referred for assessment of SDB) aged 7 to 17 years. Gyral‐based regions of interest were identified using the Desikan‐Killiany atlas. Student's t‐tests were used to compare regions of interest between the controls and SDB groups. We found that the cortical thickness was significantly greater in the right caudal anterior cingulate and right cuneus regions and there were volumetric increases in the left caudal middle frontal, bilateral rostral anterior cingulate, left, right, and bilateral caudate brain regions in children with SDB compared with controls. Neither cortical thickness nor volumetric changes were associated with behavioral or cognitive measures. The findings of this study indicate disruptions to neural developmental processes occurring in structural regions of the brain; however, these changes appear unrelated to behavioural or cognitive outcomes. [ABSTRACT FROM AUTHOR]

Summary: Children with Down syndrome are at increased risk of obstructive sleep disordered breathing, which has deleterious effects on daytime functioning. We aimed to examine the effects of treatment of sleep disordered breathing on sleep quality and daytime functioning in children with Down syndrome, and hypothesised that these would be improved. Thirty‐four children completed a baseline study and a follow‐up 2 years later. Measures at both time points included 7 days of actigraphy and parents completed a number of questionnaires assessing sleep, behaviour, daytime functioning, and quality of life. All children had overnight polysomnography at baseline; 15 children (44%) were treated. At baseline the treated group had more severe sleep disordered breathing compared with the untreated group: obstructive apneoa–hypopnoea index 29.3 ± 38.2 events/h versus 3.3 ± 5.2 events/h (p < 0.01). Actigraphy showed no significant differences in total sleep time, sleep efficiency, sleep schedules from baseline to follow up in either group. The sleep disturbance (p < 0.01) and total problems (p < 0.05) scales on the OSA‐18 and the sleep disordered breathing subscale on the Paediatric Sleep Problem Survey Instrument (p < 0.01) improved in the treated children. There were no changes in any measure in the untreated children. Treatment of sleep disordered breathing improves symptoms, sleep disturbance and quality of life in children with Down syndrome, but has no demonstrable impact on actigraphic sleep measures or daytime behaviour or function. In contrast, children who were not treated, despite having less severe disease at baseline, had increased sleep disruption and no change in quality of life. [ABSTRACT FROM AUTHOR]

Prader‐Willi Syndrome (PWS) is a rare genetic disorder associated with emotional/behavioral disturbances. These difficulties are well documented in the literature, but the positive attributes of these individuals are not described. Taking a strengths‐based approach, the aim of this study was to describe the emotional/behavioral strengths and difficulties in children and young people with PWS from their parent caregivers' perspectives. Parent caregivers of 52 individuals with PWS aged 4–24 years (median = 12.1 years; including 22 males) completed the parent form of the Developmental Behavior Checklist (DBC‐P), including its original two open‐ended questions regarding positive traits. Prevalences of emotional/behavioral disturbances were comparable to those reported in previous literature: common behaviors of concern across studies being skin‐picking (75%), impulsivity (69%), poor sense of danger (67%), lying (67%), and tantrums (54%). Total DBC‐P scores showed that just over half (n = 28, 54%) had scores indicative of clinically significant behavior problems. However, thematic analysis of caregivers' written comments regarding their children's strengths resolved into three themes: warmth (94%), persistence (41%), and skills (41%). Warmth encompassed friendliness, happiness, and empathy. A strength‐based approach to behavioral difficulties in PWS provides a more balanced view of the children and a more holistic foundation for interventions. [ABSTRACT FROM AUTHOR]

Aim: In children with Prader‐Willi syndrome (PWS), growth hormone (GH) improves height and body composition; however, may be associated with worsening sleep‐disordered breathing (SDB). Some studies have reported less SDB after GH initiation, but follow‐up with polysomnography is still advised in most clinical guidelines. Methods: This retrospective, multicentre study, included children with PWS treated with GH at seven PWS treatment centres in Australia over the last 18 years. A paired analysis comparing polysomnographic measures of central and obstructive SDB in the same child, before and after GH initiation was performed with Wilcoxon signed‐rank test. The proportion of children who developed moderate/severe obstructive sleep apnoea (OSA) was calculated with their binomial confidence intervals. Results: We included 112 patients with available paired data. The median age at start of GH was 1.9 years (range 0.1–13.5 years). Median obstructive apnoea hypopnoea index (AHI) at baseline was 0.43/h (range 0–32.9); 35% had an obstructive AHI above 1.0/h. Follow‐up polysomnography within 2 years after the start of GH was available in 94 children who did not receive OSA treatment. After GH initiation, there was no change in central AHI. The median obstructive AHI did not increase significantly (P = 0.13), but 12 children (13%, CI95% 7–21%) developed moderate/severe OSA, with clinical management implications. Conclusions: Our findings of a worsening of OSA severity in 13% of children with PWS support current advice to perform polysomnography after GH initiation. Early identification of worsening OSA may prevent severe sequelae in a subgroup of children. [ABSTRACT FROM AUTHOR]

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This article discusses the use of overnight oximetry as a diagnostic tool for sleep apnea and other respiratory and sleep conditions. The study compares the success of a new "drive-through" model of home oximetry with the previous face-to-face model. The results show that there was no difference in failure rates between the two models, and the drive-through model was found to be more efficient and convenient for both staff and families. The authors recommend the use of the drive-through model for routine care and plan to continue this service even after pandemic-related restrictions are eased. [Extracted from the article]

The goal of this position paper on ventilatory support at home for children is to provide expert consensus from Australia and New Zealand on optimal care for children requiring ventilatory support at home, both non-invasive and invasive. It was compiled by members of the Thoracic Society of Australia and New Zealand (TSANZ) and the Australasian Sleep Association (ASA). This document provides recommendations to support the development of improved services for Australian and New Zealand children who require long-term ventilatory support. Issues relevant to providers of equipment and areas of research need are highlighted. [ABSTRACT FROM AUTHOR]

Montelukast has a short-term beneficial effect for the treatment of OSA in otherwise healthy, non-obese, surgically untreated children with OSA but there is insufficient evidence to recommend use as a first line treatment given the potential for side effects. Anti-inflammatory medications for obstructive sleep apnoea in children.1 Stefan Kuhle, Dorle U Hoffmann, Souvik Mitra, Michael Siegfried Urschitz https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007074.pub3/full?highlightAbstract=obstructiv%7Cobstruct%7Cobstructive%7Cantiinflammatory%7Cantiinflammatori What Is the Review about? The efficacy and safety of anti-inflammatory drugs for the treatment of obstructive sleep apnoea (OSA) in children. [Extracted from the article]

The role of physiological traits such as ventilatory control instability in children with SDB is currently unclear. Our study indicates that altered ventilatory control sensitivity may contribute to SDB in a subgroup of children, depending on their degree of upper airway anatomical compromise. See related Editorial Background and objective: The contribution of non‐anatomical factors, such as ventilatory control instability (i.e. LG), to the pathogenesis of obstructive SDB in children is unclear. Therefore, we aimed to identify the relationship between LG and severity of SDB, demographic, anthropometric and anatomical characteristics in a clinically representative cohort of children. Methods: Children (aged 3–18 years) with various severities of SDB (n = 110) and non‐snoring controls (n = 36) were studied. Children were grouped according to their OAHI. Anthropometric and upper airway anatomical characteristics were measured. Spontaneous sighs were identified on polysomnography and LG, a measure of the sensitivity of the negative feedback loop that controls ventilation, was estimated by fitting a mathematical model of ventilatory control to the post‐sigh ventilatory pattern. Results: There was no difference in LG between controls and any of the SDB severity groups. However, LG was significantly lower in children with larger tonsils (tonsil grade 4) compared with children with smaller tonsils (tonsil grade 1) (median LG (range): 0.25 (0.20–0.42) vs 0.32 (0.25–0.44); P = 0.009) and in children with a modified Mallampati score of class III/IV compared with class I (0.28 (0.24–0.33) vs 0.37 (0.27–0.44); P = 0.009). Conclusion: A direct relationship was not found between the severity of paediatric SDB and LG. However, an altered ventilatory control sensitivity may contribute to SDB in a subgroup of children depending on their degree of anatomical compromise of the airway. [ABSTRACT FROM AUTHOR]

Background and objective: Frequent central apnoeas are sometimes observed in healthy children; however; the pathophysiology of an elevated central apnoea index (CAI) is poorly understood. A raised CAI may indicate underlying ventilatory control instability (i.e. elevated loop gain, LG) or a depressed ventilatory drive. This pilot study aimed to compare LG in otherwise healthy children with an elevated CAI to healthy controls. Methods: Polysomnographic recordings from children (age > 6 months) without obstructive sleep apnoea and with a CAI > 5 events/h (n = 13) were compared with age and gender‐matched controls with a CAI < 5 events/h (n = 13). Spontaneous sighs were identified during non‐rapid eye movement (NREM) sleep, and breath–breath measurements of ventilation were derived from the nasal pressure signal. A standard model of ventilatory control (gain, time constant and delay) was used to calculate LG by transforming ventilatory fluctuations seen in response to a sigh into a ventilatory‐drive signal that best matches observed ventilation. Results: The high CAI group had an elevated LG (median = 0.36 (interquartile range, IQR = 0.35–0.53) vs 0.28 (0.23–0.36); P ≤ 0.01). There was no difference in either the time constant (P = 0.63) or delay (P = 0.29) between groups. Elevated LG observed in the high CAI group remained after accounting for degree of hypoxia (average oxygen saturation (SpO2) during each analysable window) experienced (0.40 (0.30–0.53) vs 0.25 (0.23–0.37); P = 0.04). Conclusion: An elevated CAI in otherwise healthy children is associated with a raised LG compared to matched controls with a low CAI, irrespective of level of hypoxia. This relative ventilatory instability helps explain the high CAI and may ultimately be able to help guide diagnosis and management in patients with high CAI. While central apnoeas are common in children, a central apnoea index of >5 events/h is outside normal ranges and raises concern regarding origins of such events. Our study indicates that an elevated index of >5 is associated with a hypersensitive ventilatory control system and supports literature that neuroimaging may not be needed. [ABSTRACT FROM AUTHOR]

Objective: To describe the contemporary epidemiology of paediatric adenotonsillectomy in an Australian setting, examine the incidence rate over 2010‐2015 and investigate factors associated with inter‐hospital transfer. Design: Retrospective population‐based study. Setting: Multicentre study in the state of Victoria, Australia. Participants: From the Victorian Admitted Episodes Dataset, which included all patients aged 0‐19 years who underwent adenoidectomy and/or tonsillectomy in Victoria, Australia between 2010 and 2015. Main Outcome Measures: Annual incidence rate, hospital volume, inter‐hospital transfer. Results: Between 2010 and 2015, 59 008 patients underwent 61 281 procedures, with highest number performed in males (52.7%), children aged under 10 years (73.5%) and in the higher socioeconomic groups (24.6% in quintile 4 and 23.2% in quintile 5). Seventy‐five cases (0.12%) resulted in inter‐hospital transfer, which was significantly associated with young age (under 5 years). More than a third of hospitals (35.7%) performed an average rate of <1 procedure per week. Hospital volume was not associated with risk of inter‐hospital transfer. The incidence rate of adenotonsillectomy procedures significantly increased over the study period (P < .001), driven by a significant increase in the rate of surgery performed for obstructive symptoms (P < .001). Conclusions: The rate of adenoidectomy/tonsillectomy procedures is rising, with a higher proportion being performed in socioeconomically advantaged patients. This raises concerns regarding healthcare access, given the literature supporting higher rates of obstructive sleep‐disordered breathing and sore throat in lower socioeconomic groups. A third of hospitals performed small numbers of procedures, but we found no association between hospital volume and inter‐hospital transfers. [ABSTRACT FROM AUTHOR]

Aim: Pulse oximetry has become a widely used technology in medicine and is a standard part of monitoring in neonatal medicine. Knowledge of basic principles, clinical and technical considerations is important to optimise clinical benefit of use, but have been shown to be insufficient in paediatric staff. We aimed to assess knowledge of pulse oximetry in neonatal medical staff, a population not previously studied.Methods: A 21-item questionnaire (seven demographic, 14 knowledge) was devised and then administered to neonatal medical staff at all postgraduate levels working in the major public neonatal services in the state of Victoria, Australia.Results: Average test score was 64.4% (range 30.8-92.3%) with no correlation between years of experience and score. All respondents reported experience with oximetry, but only 57% reported adequate training in practical oximetry skills and only 28% in interpretation of downloaded oximetry data. About 45% reported knowing what an averaging time was but only 29% were able to provide an acceptable definition and only 10% knew what averaging time was used on devices in their units.Conclusion: Significant knowledge deficits regarding oximetry are evident in neonatal staff, supporting the need for targeted and continuous training in oximetry. [ABSTRACT FROM AUTHOR]

Key points: Sleep disordered breathing (SDB) affects 4–11% of children and is associated with adverse neurocognitive, behavioural and cardiovascular outcomes, including reduced autonomic control.The relationship between heart rate variability (HRV; a measure of autonomic control) and age found in non‐snoring control children was absent during sleep in children with SDB.Age significantly predicted increasing cerebral oxygenation during wake in non‐snoring control children, whereas during sleep, HRV significantly predicted decreasing cerebral oxygenation.Cerebral oxygenation was not associated with either age or HRV in children with SDB during both wake and sleep.SDB significantly disrupts the normal maturation of autonomic control and the positive association between autonomic control and cerebral oxygenation found in non‐snoring children, and we speculate that the dampened autonomic control exhibited by children with SDB may have an attenuating effect on cerebral autoregulation via the moderating influence of HRV on cerebral blood flow. The repetitive episodes of hypoxia that are features of sleep disordered breathing (SDB) in children are associated with alterations in autonomic control of heart rate in an age‐dependent manner. We aimed to relate heart rate variability (HRV) parameters to age and measures of cerebral oxygenation in children (3–12 years old) with SDB and non‐snoring controls. Children (SDB, n = 117; controls, n = 42; 3–12 years) underwent overnight polysomnography. Total (TP), low‐ (LF) and high‐frequency (HF) power, tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) were analysed during wake and sleep. Pearson's correlations determined the association between age and HRV parameters, and multiple linear regressions between HRV, age and cerebral oxygenation parameters. During wake, age had a positive association with LF power, reflecting increased parasympathetic and sympathetic activity with increasing age for both control and SDB groups. This association was also evident during sleep in controls, but was absent in children with SDB. In controls, during wake TOI had a positive, and FTOE a negative association with age. During sleep, TP, LF and HF power were significant, negative determinants of TOI and positive determinants of FTOE. These associations were not seen in children with SDB during wake or sleep. SDB disrupts the normal maturation of the autonomic control of heart rate and the association between HRV and cerebral oxygenation exhibited by non‐snoring control children of primary school age. These results highlight the impact SDB has on cardiovascular control and the potential impact on adverse cardiovascular outcomes. Key points: Sleep disordered breathing (SDB) affects 4–11% of children and is associated with adverse neurocognitive, behavioural and cardiovascular outcomes, including reduced autonomic control.The relationship between heart rate variability (HRV; a measure of autonomic control) and age found in non‐snoring control children was absent during sleep in children with SDB.Age significantly predicted increasing cerebral oxygenation during wake in non‐snoring control children, whereas during sleep, HRV significantly predicted decreasing cerebral oxygenation.Cerebral oxygenation was not associated with either age or HRV in children with SDB during both wake and sleep.SDB significantly disrupts the normal maturation of autonomic control and the positive association between autonomic control and cerebral oxygenation found in non‐snoring children, and we speculate that the dampened autonomic control exhibited by children with SDB may have an attenuating effect on cerebral autoregulation via the moderating influence of HRV on cerebral blood flow. [ABSTRACT FROM AUTHOR]

Aim: This study aims to determine whether demographic or clinical factors predict obstructive sleep apnoea (OSA) severity in Australian children.Methods: Demographic details and medical histories of 301 Australian children (3-17 years old) referred for assessment of OSA were examined retrospectively. Children underwent overnight polysomnography and were classified as having primary snoring (PS) (obstructive apnoea hypopnoea index (OAHI) ≤ 1 event per hour; n = 150), mild OSA (>1 OAHI ≤ 5 events per hour; n = 76) or moderate/severe (MS) OSA (OAHI > 5 events per hour; n = 75). Information obtained from parent-report questionnaire determined the predictive value of the following factors for determining OSA severity: gender, ethnicity, body mass index, asthma and/or allergic rhinitis, socio-economic status and parental smoking status (mother/father/both). Chi-squared analyses were used to compare the distribution of the demographic and clinical factors across the three groups. Statistically significant risk factors were subsequently entered into logistic regression analysis.Results: Ethnicity and parental smoking were significant risk factors for MS OSA. Children with non-Caucasian ethnicity were 36% more likely than Caucasian children to be diagnosed with MS OSA than PS (P = 0.002). Children with fathers who smoked were 53% more likely to have MS OSA than PS compared with those with fathers who did not smoke (P = 0.008). Obesity was associated with OSA severity in primary school-aged children only. Gender, socio-economic status and history of asthma and/or allergic rhinitis were not risk factors.Conclusions: Non-Caucasian ethnicity, paternal smoking and obesity in older children were associated with an increased risk of polysomnography-confirmed MS OSA in Australian children. [ABSTRACT FROM AUTHOR]

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Pulse transit time has been proposed as a surrogate measure of systolic arterial pressure, as it is dependent upon arterial stiffness. Past research has shown that pulse transit time has a significant inverse relationship to systolic arterial pressure in adults; however, studies in children are limited. This study aimed to explore the relationship between systolic arterial pressure and pulse transit time in children during sleep. Twentyfive children (13.1 ± 1.6 years, 48% male) underwent overnight polysomnography (PSG) with a simultaneous recording of continuous systolic arterial pressure and photoplethysmography. Pulse transit time was calculated as the time delay between the R-wave peak of the electrocardiogram (ECG) to the 50% point of the upstroke of the corresponding photoplethysmography waveform; 500 beats of simultaneous systolic arterial pressure and pulse transit time were analysed in each sleep stage for each child. Pulse transit time was normalized to each subject's mean wake pulse transit time. The ability of pulse transit time to predict systolic arterial pressure change was determined by linear mixed-effects modelling. Significant negative correlations between pulse transit time and systolic arterial pressure were found for individual children for each sleep stage [mean correlations for cohort: non-rapid eye movement (NREM) sleep 1 and 2 r = -0.57, slow wave sleep (SWS) r = -0.76, REM r = -0.65, P < 0.01 for all]. Linear mixed-model analysis demonstrated that changes in pulse transit time were a significant predictor of changes in systolic arterial pressure for each sleep stage (P < 0.001). The model of pulse transit time-predicted systolic arterial pressure closely tracked actual systolic arterial pressure changes over time. This study demonstrated that pulse transit time was accurate in tracking systolic arterial pressure changes over time. Thus, the use of pulse transit time as a surrogate measure of changes in systolic arterial pressure in children is a valid, non-invasive and inexpensive method with many potential applications. [ABSTRACT FROM AUTHOR]

The article focuses on sleep problems in children including management strategies, sleep variations, and initial screening.

Aims To examine sleep study findings in children with Prader- Willi syndrome ( PWS) referred for polysomnography ( PSG) before commencement of growth hormone ( GH) and to evaluate the impact of sleep testing on treatment decisions. Methods The sleep unit database was used to identify all cases over an 8-year period (2003-2011). Standard overnight PSG was performed in the sleep laboratory. Obstructive sleep apnoea ( OSA) was defined by an obstructive apnoea-hypopnoea index >1/h. Age, symptoms of OSA, tonsillar size and body mass index ( BMI) Z-score were obtained through chart review. Results OSA was diagnosed in 15 of 34 (44%) cases identified. Those with OSA were significantly older ( P = 0.009) and more likely to have enlarged tonsils ( P = 0.05) than those without OSA. There was no difference in BMI Z-score or the presence of symptoms of OSA. GH was deferred in 13 (38%) pending treatment for OSA. Conclusions OSA was frequently present in children with PWS referred simply to meet the requirement for PSG before starting GH. OSA was more likely in older children and those with enlarged tonsils. GH treatment was deferred in 38% of cases. This study supports routine performance of PSG prior to GH, regardless of clinical history. [ABSTRACT FROM AUTHOR]

The authors discuss the issues concerning home ventilator support for children in Australia and New Zealand. They cites the lack of formal register or resources on the size of children cared with home ventilatory support and the lack of co-ordination of care for children in-need of invasive ventilatory support. They suggest the need of proper funding packages to support home care of children, carer support on children requiring ventilator, and regular audit on home ventilatory support.

Obstructive sleep apnoea (OSA) in children is commonly considered to occur predominantly in rapid eye movement (REM) sleep, but clinical experience suggests that this is not universally the case. We hypothesized that there would be a subgroup of children with OSA who have non-REM (NREM) predominance of obstructive events and that these children share certain clinical characteristics. Thus, we aimed to compare the obstructive apnoea–hypopnoea index (OAHI) in REM versus NREM sleep and to assess factors influencing the distribution of events by sleep state. Polysomnography (PSG) recordings of 102 children aged 0–18 years with moderate to severe OSA (OAHI ≥5 h−1) were reviewed. OAHI was calculated separately for REM and NREM sleep. A REM predominance index (RPI) was determined using log transformation [RPI = log (REM OAHI + 0.5) − log (NREM OAHI + 0.5)] and compared with possible influencing factors using multiple linear regression. Analysis showed that obstructive events were more common in REM sleep (median REM OAHI 21.4 h−1, median NREM OAHI 8.3 h−1, P < 0.001). Mean RPI was significantly greater than zero ( P = 0.003). However, a substantial minority of children (30.4%) had a higher NREM than REM OAHI. The factors that were related significantly to NREM predominance were older age ( P = 0.02), higher arousal index ( P < 0.001) and higher SpO2 nadir ( P < 0.001). Our findings demonstrate that while OSA is a REM sleep-related problem in the majority of children, there is a significant subset of children with NREM predominance of obstructive events. This finding highlights the importance of considering sleep state distribution of events in studies of the pathophysiology and outcomes of OSA in childhood. [ABSTRACT FROM AUTHOR]

Brief central apnoeas (CAs) during sleep are common in children and are not usually considered clinically significant unless associated with oxygen desaturation. CAs can occur spontaneously or following a movement or sigh. The aim of this study was to investigate acute cardiovascular changes associated with CAs in children. Beat-by-beat mean arterial pressure (MAP) and heart rate (HR) were analysed across CAs, and spontaneous and movement-induced events were compared using two-way analysis of variance with post hoc analyses. Fifty-three children (28 male/25 female) aged 7–12 years referred for investigation of sleep-disordered breathing (SDB) and 21 age-matched healthy controls (8 male/13 female) were studied. Children underwent routine clinical polysomnography with continuous blood pressure (BP) recordings. Movement-induced, but not spontaneous, CAs were more frequent in children with mild or moderate/severe obstructive sleep apnoea (OSA) compared with healthy controls ( P < 0.05 for both). Movement-induced CAs were associated with significantly larger MAP and HR changes across the event compared with spontaneous CAs. The percentage changes in MAP and HR between late-event and post-event were significantly greater for movement-induced compared with spontaneous CAs (MAP 20.6 ± 2.3 versus 12.2 ± 1.8%, P < 0.01; HR 28.2 ± 2.6 versus 14.7 ± 2.5%, P < 0.001). This study demonstrates that movement-induced CAs are more common in children with OSA, and are associated with significantly greater changes in HR and BP compared with spontaneous CAs. These data suggest that movement-induced CAs should be considered when assessing the cardiovascular impact of SDB. [ABSTRACT FROM AUTHOR]

Chronic neonatal lung disease (CNLD) is defined as a supplemental oxygen requirement beyond 36 weeks' postmenstrual age, with more severely affected infants requiring oxygen beyond a full-term-equivalent age. Low-flow supplemental oxygen facilitates discharge from hospital of infants with CNLD who develop hypoxia in air. There is a lack of data on the most appropriate minimum mean target oxygen saturation (Spo(2)) level. Reflecting a variety of clinical practices and infant comorbidities (frequency of oxygen desaturation, presence of pulmonary hypertension, retinopathy of prematurity, and adequacy of growth), the minimum mean target range for Spo(2) during overnight oximetry should be 93%-95%. The effect of supplemental oxygen on carbon dioxide retention should be considered before deciding on an oxygen flow. Most infants with CNLD are not ready for discharge until their supplemental oxygen requirement is < or = 0.5 litres per minute delivered through a nasal cannula. The safety of short-term disconnection from supplemental oxygen should be assessed before discharge. Assessment of oxygenation during sleep with continuous overnight oximetry or polysomnography is recommended when weaning infants from supplemental oxygen. Discontinuation of oxygen therapy is based on clinical assessments and documentation of adequate oxygenation in room air. There is limited objective evidence on which to base recommendations. [ABSTRACT FROM AUTHOR]

The article presents a position statement from the Thoracic Society of Australia and New Zealand on the use of home oxygen therapy in infants with chronic neonatal lung disease (CNLD). The features of CNLD are described, as well as its pathophysiology. Home oxygen therapy is intended to prevent the effects of chronic hypoxaemia and improved oxygenation may lead in improved lung growth and repair. The duration of supplemental oxygen therapy and delivery of supplemental oxygen are also discussed.

Objectives: To determine whether episodes of haemoglobin oxygen (SpO2) desaturation in full-term infants restrained in car seats can be reduced by a simple foam plastic infant car seat insert designed to push the body forward, with space for the protuberant occiput to lie behind the spine, and so reduce flexion of the infant's head on the trunk. Methods: Eighteen healthy full-term babies were evaluated while restrained in an infant car safety seat with, and without, the foam insert. Infants were monitored in each position for 30 min with continuous polygraphic recording of respiratory and heart rate, nasal airflow and SpO2. Results: Placement of the insert in the car seat was associated with a significant reduction in the rate of apneas with a fall in SpO2 >5% (median, interquartile range: 4.4 (0, 10.6) vs. 9.2 (5.4, 15.2) events per hour, p=0.03). The one clinically severe episode of apnea, with a fall in SpO2 of more than 30%, occurred in the car seat without the insert. Conclusions: A car seat insert that allows the newborn's head to lie in a neutral position during sleep may reduce the frequency of mild episodes of reduced SpO2 in some full-term newborn babies. [ABSTRACT FROM AUTHOR]

Aim: International guidelines recommend that children who are managed at home with mechanical respiratory support (RS) should have sleep studies performed every 6–12 months. This recommendation is based on expert opinion, with little evidence to support it. No studies have been undertaken to examine the utility of sleep studies in children on RS. Methods: A retrospective review of sleep studies performed over a 12-month period was undertaken at a New Zealand paediatric sleep medicine referral centre, to determine changes made to RS following sleep studies. Results: Sixty-one sleep studies were performed for assessment of RS in 45 children (27 boys; median age 8.3 years; range 0.4–18.6 years). Twenty-nine (64%) children were on continuous positive airway pressure, 14 (31%) on bi-level non-invasive ventilation, and two (4%) on tracheostomy ventilation. A change was made to RS settings after 66% of studies. No clinical parameters predicted which children would require a change in settings. Conclusions: Although sleep studies are expensive and time-consuming, follow-up studies of children on RS provide important information for optimising management into the long term. [ABSTRACT FROM AUTHOR]

Discusses the evidence for the use of methylxanthines in premature infants, ex-premature infants, and infants born at term, and how this applies to both the postanesthetic care and the management of apnea associated with bronchiolitis in intensive care units. Changes with age of the pharmacokinetic profile of the methylxanthines; Clinical and dosing implications of maturing renal and hepatic clearance.

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A letter to the editor is presented in response to the article "Snoring is not associated with adverse effects on blood pressure, arterial structure or function in 8-year-old children: The Childhood Asthma Prevention Study (CAPS)" in the August 2011 issue.