Deborah C. Givan

COMMON PLEURAL EFFUSIONS IN CHILDREN

The evaluation of pleural effusions in children differ from that of the adult in cause, symptom presentation, character of the fluid, techniques for diagnosis, treatment or management, and prognosis. These similarities and differences are reviewed with emphasis on the treatment of empyema.

Surgical management of obstructive sleep apnea in infants and young toddlers

Objective: Review surgical management of obstructive sleep apnea (OSA) in infants and young toddlers compared with a medically treated group. Study Design: Case series with chart review of children younger than 24 months treated at a tertiary pediatric hospital between 2000 and 2005. Subjects and Methods: Surgical treatment included adenotonsillectomy, adenoidectomy, and tonsillectomy. Polysomnography results, comorbidities, and major complications were recorded. The change in apnea-hypopnea index (AHI) before and after treatment was analyzed. Logistic regression analysis reviewed effects of comorbidities and OSA severity on complications. Results: A total of 73 children met inclusion criteria. The surgical treatment group (AHI) improved posttreatment: mean AHI change was 9.6 (95% CI, 5.8-13.4). The medical treatment group did not improve posttreatment: mean AHI change was −3.0 (95% CI, −15.1 to 9.1). The difference in AHI change between surgical and medical groups was 12.56 (95% CI, 2.7-22.4). An independent t test found this difference to be statistically significant (P = 0.01). Eleven (18%) patients suffered significant postoperative surgical complications; 55 surgical patients and 8 medical patients had comorbidities. There were no long-term morbidities or mortalities. Conclusions: AHI in the surgically treated group significantly improved. The complication rate for a tertiary pediatric hospital population that included patients with multiple comorbidities was acceptable.

The sleepy child

Disorders of excessive sleepiness are uncommon in children. When they occur, the presentation is often consistent with the developmental age of the child and does not meet either historical or laboratory criteria determined with adults in mind. Because of these differences, the true diagnosis can be missed or inadequately treated. Knowledge of the differences in presentation, diagnosis, and treatment between adult and childhood sleep disorders is imperative to prevent serious cardiac, respiratory, psychiatric, and cognitive morbidity.

Physiology of breathing and related pathological processes in infants

There is little information describing control of breathing in the fetus and infant. The available data have largely been drawn from studies in animals and awake adults. Although the hierarchy of control of breathing is the same in adults and infants, feedback emphasis is different, with behavioral states and the sleep/wake cycle primary in the fetus and infant and integrated chemoreceptor response primary in the older child and adult. Control of breathing during the transition from the fetal state to a breathing child and the process of maturation are very different from that in adults. The article begins with an overview of the changes in the systems responsible for breathing at the developmental stages from fetus to neonate, with differences highlighted. It then discusses the possible pathology related to difficulties in negotiating this transition period, including apnea, sudden infant death syndrome, and chemoreceptor control abnormalities.

Use of polysomnography to assess safe decannulation in children

Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process.