Janet Lam

The Effects of Napping on Cognitive Function in Preschoolers

Objective: To determine the relationship between napping and cognitive function in preschool-aged children. Methods: Daytime napping, nighttime sleep, and cognitive function were assessed in 59 typically developing children aged 3 to 5 years, who were enrolled in full-time childcare. Participants wore an actigraphy watch for 7 days to measure sleep and napping patterns and completed neuropsychological testing emphasizing attention, response control, and vocabulary. Parents of participants completed behavior ratings and sleep logs during the study. Sleep/wake cycles were scored with the Sadeh algorithm. Results: Children who napped more on weekdays were also more likely to nap during weekends. Weekday napping and nighttime sleep were inversely correlated, such that those who napped more slept less at night, although total weekday sleep remained relatively constant. Weekday napping was significantly (negatively) correlated with vocabulary and auditory attention span, and weekday nighttime sleep was positively correlated with vocabulary. Nighttime sleep was also significantly negatively correlated with performance, such that those who slept less at night made more impulsive errors on a computerized go/no-go test. Conclusions: Daytime napping is actually negatively correlated with neurocognitive function in preschoolers. Nighttime sleep seems to be more critical for development of cognitive performance. Cessation of napping may serve as a developmental milestone of brain maturation. Children who nap less do not appear to be sleep deprived, especially if they compensate with increased nighttime sleep. An alternative explanation is that children who sleep less at night are sleep deprived and require a nap. A randomized trial of nap restriction would be the next step in understanding the relationship between napping and neurocognitive performance.

Initial experience with octreotide in the pediatric population.

Octreotide is a somatostatin analogue that has been suggested as a therapeutic agent in various diverse disease processes including gastrointestinal bleeding, pancreatitis, hypoglycemia related to hyperinsulin states, and chylous peritoneum/thorax. Despite successful use in the adult population, there is limited information concerning its use in pediatric patients. The authors retrospectively review their experience with octreotide in 10 infants and children ranging in age from 14 days to 17 years. Octreotide, administered by continuous intravenous infusion or intermittent bolus dosing, was used in the treatment of gastrointestinal bleeding in four patients, pancreatitis in three patients, chylous leaks in two patients, and hypoglycemia related to nesidioblastosis in one patient. The clinical course of these patients and the potential therapeutic impact of octreotide are evaluated. Additionally, previous experiences with octreotide in pediatric patients, dosing regimens, and the potential role of the drug in other disease processes are discussed.

Noninvasive monitoring of carbon dioxide during mechanical ventilation in older children : End-tidal versus transcutaneous techniques

We prospectively compared the accuracy of end-tidal CO2 (ETco2) and transcutaneous CO2 (TCco2) monitoring in older pediatric patients (4 yr or older) receiving mechanical ventilation for respiratory failure. ETco2 and TCco2 were simultaneously monitored and compared with arterial CO2 (Paco2) values when arterial blood gas analysis was performed. Eighty-two sample sets were compared. The ETco2 to Paco2 difference was 6.4 ± 6.3 mm Hg, whereas the TCco2 to Paco2 difference was 2.6 ± 2.0 mm Hg (P < 0.0001). The absolute difference of ETco2 and Paco2 was 5 or less in 47 of 82 measurements, whereas the absolute TCco2 to Paco2 difference was 5 or less in 76 of 82 measurements (P < 0.00001). Regression analysis of ETco2 and Paco2 values revealed a correlation coefficient of 0.5418 and an r value of 0.8745. Regression analysis of TCco2 and Paco2 values revealed a correlation coefficient of 1.0160 and an r value of 0.9693. Bland-Altman analysis revealed a bias of −5.68 with a precision of ±6.93 when comparing ETco2 with Paco2 and a bias of 0.02 with a precision of ±3.27 when comparing TCco2 and Paco2 (P < 0.00001). TCco2 monitoring provided an accurate estimation of Paco2 over a wide range of CO2 values and was superior to ETco2 monitoring in older pediatric patients with respiratory failure. TCco2 monitoring may be considered as a useful adjunct to monitoring of ventilation in this patient population.

Perioperative cost-finding analysis of the routine use of intraoperative forced-air warming during general anesthesia

Background Despite the well‐documented ability of forced‐air warming (FAW) to maintain normothermia, it is unclear whether this technique results in a net increase or decrease in costs. The authors did a prospective cost‐finding study comparing FAW with routine thermal care in patients at low risk for perioperative complications who were undergoing general anesthesia. Methods After institutional review board approval was received, 100 patients were studied who were having elective surgery scheduled for more than 2 h during general endotracheal anesthesia. Patients were randomly assigned to one of two groups: FAW or routine thermal care. All patients received a standardized anesthetic. Anesthesia providers were blinded to core temperatures and the use of FAW. Primary outcomes were those associated with perioperative costs. Results The time from completion of surgical dressing until tracheal extubation was significantly reduced in the FAW group (10 +/‐ 1 min compared with 14 +/‐ 1 min; mean +/‐ SEM; P < 0.01). There was no demonstrable difference in attainment of postanesthesia care unit discharge criteria between the two groups, although the FAW group used one less cotton blanket there. The net savings related to the use of the FAW depends on the percentage of the intraoperative costs that are fixed rather than variable (

Defining the Roles of Actigraphy and Parent Logs for Assessing Sleep Variables in Preschool Children

15 additional for FAW if all costs are fixed compared with

Does Increased Consolidated Nighttime Sleep Facilitate Attentional Control? A Pilot Study of Nap Restriction in Preschoolers:

29 savings if all costs were variable). Conclusions Routine intraoperative FAW significantly reduced time until extubation and use of cotton blankets in the postanesthesia care unit. These results suggest that the influence of FAW on net total perioperative costs depends on patient and surgical characteristics and institutional factors related to cost accounting.

Disseminating information using an anesthesiology consultant report: impact on patient perceptions of quality of care

Actigraphy provides a non-invasive objective means to assess sleep–wake cycles. In young children, parent logs can also be useful for obtaining sleep–wake information. The authors hypothesized that actigraphy and parent logs were both equally valid instruments in healthy preschool-aged children. The authors studied 59 children aged 3 to 5 years in full-time day care. Each child was screened for medical problems and developmental delays before being fitted with an actigraphy watch, which was worn for 1 week. Parents maintained logs of sleep and wakefulness during the same period, with input from day care workers. In general, parents overestimated the amount of nighttime sleep measured by actigraphy by 13% to 22% (all significant). Although there was no difference in sleep onset times, parents reported later rise times on the weekend and fewer nighttime awakenings. There was no significant difference between parent logs and actigraphy with regard to daytime napping. The authors conclude that parent logs are best utilized in assessing daytime sleep and sleep onset, whereas actigraphy should be used to assess nighttime sleep and sleep offset time.

Patient preferences for early discharge after laparoscopic cholecystectomy

Objective: The aim of this study is to understand the impact of a 5-day period of nap restriction on sleep patterns and cognitive function in typically developing preschoolers, aged 3 to 4 years. Method: Following 1 week of baseline assessment, 28 children were randomly assigned to either a “napping as usual” group (n = 15) or a 5-day period of nap restriction (n = 13). Sleep was assessed with sleep logs and actigraphy; cognition was assessed at baseline and at the end of the intervention week. Results: No group differences in sleep or cognitive function were observed at baseline. For the no-nap group, the 5-day period of daytime nap restriction resulted in increased nighttime sleep. Children in the no-nap group also showed a significant improvement in attentional control compared with baseline, whereas no such changes were observed among children in the napping-as-usual group. Conclusion: In preschool children who typically take naps, short-term nap restriction is associated with increased nighttime sleep and may contribute to improved attentional function.