Clinical Pediatric Literature Updates from July 2017

Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis

Authors: Song SA, Tolisano AM, Cable BB, Camacho M.

“This meta-analysis found an improvement in neurocognitive function and IQ after pediatric adenotonsillectomy, especially in pre-school aged children. However, this must be interpreted with caution as only three studies were performed in pre-school aged children. The decreased effectiveness in older children suggests possibly a threshold age when neurocognitive deficits become irreversible.”

Impact of Adenotonsillectomy on Insulin Resistance and Lipoprotein Profile in Nonobese and Obese Children

Authors: Koren D, Gozal D, Bhattacharjee R, Philby MF, Kheirandish-Gozal L.

“T&A improved insulin resistance and high density lipoprotein, and residual OSA is predicted by baseline fasting plasma insulin and BMI z score, indicating a causal relationship; however, following T&A, residual metabolic dysfunction related to underlying adiposity rather than remaining sleep-disordered breathing.”

Clinical outcomes in a high nursing ratio ward setting for children with obstructive sleep apnea at high risk after adenotonsillectomy

Authors: Arachchi S, Armstrong DS, Roberts N, Baxter M, McLeod S, Davey MJ, Nixon GM.

“In a cohort of children with known moderate-severe OSA, post-operative AE after AT were all managed in the high acuity unit (HAU). Post-operative care in HAU provides safe and effective care for high-risk children post-AT, minimizing admissions to ICU.”

Obesity in children with different risk factors for obstructive sleep apnea: a community-based study

Authors: Su MS, Zhang HL, Cai XH, Lin Y, Liu PN, Zhang YB, Hu WZ, Li CC, Xiao YF.

“We demonstrated differential risk factors for OSA in obese children, which suggest that a different mechanism may be involved in OSA development in preschool and school-age children.”

The prevalence of obstructive sleep apnea in symptomatic patients with syndromic craniosynostosis

Authors: Inverso G, Brustowicz KA, Katz E, Padwa BL.

“Given that 56.4% of patients with syndromic craniosynostosis (SCS) are symptomatic and that 74.2% of these symptomatic patients have OSA, it is recommended that a screening level I polysomnography be part of the clinical care for all patients with SCS.”

Sleep in pediatric primary care: A review of the literature

Authors: Honaker SM, Meltzer LJ.

“Despite the high prevalence of pediatric sleep problems in primary care, rates of screening and management are low. Primary care providers receive minimal sleep training and have resulting gaps in knowledge and confidence.”

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Authors: Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S.

“This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years.”

Polysomnographic Findings after Adenotonsillectomy for Obstructive Sleep Apnea in Obese and Non-Obese Children: A Systemic review and Meta-Analysis

Authors: Lee CH, Hsu WC, Chang WH, Lin MT, Kang KT.

“Meta-analysis of current literature shows T&A offers prominent improvement in a variety of sleep parameters. Improvements in non-obese children exceeded those for obese children. Postoperative residual OSA remained in roughly half of the children, especially those with severe disease and obesity, making additional treatment strategies and/or long-term follow-up highly desirable.”