Clinical Pediatric Literature Updates from January 2018

Postoperative bradycardia following adenotonsillectomy in children: Does intraoperative administration of dexmedetomidine play a role?

“The increased incidence of asymptomatic bradycardia in our post-adenotonsillectomy patients seemed to relate more to increased utilization of postoperative cardiac telemetry, and did not appear associated with the use of dexmedetomidine use intra-operatively.”

The Effect of Midface Advancement Surgery on Obstructive Sleep Apnoea in Syndromic Craniosynostosis

“Most patients showed improvements in Apnoea-Hypopnoea Index and OSA grading, although measures of oxygenation showed no consistent change.”

Down syndrome and pediatric obstructive sleep apnea surgery: A national cohort

“Tonsillectomy with adenoidectomy remains the most commonly performed procedure, although there was a significant increase in other sleep surgeries performed (lingual tonsillectomy, tongue-base reduction, and supraglottoplasty) between the two study periods, especially in children with DS.”

Systolic Blood Pressure Elevation in Children with Obstructive Sleep Apnea Is Improved with Positive Airway Pressure Use

“Children with OSA have higher systolic BP than habitual snorers. Treatment with CPAP in children with OSA for 6 months reduced their systolic BP despite a small increase in their BMI.”

Regional Brain Tissue Changes and Associations with Disease Severity in Children with Sleep Disordered Breathing

“Pediatric SDB is accompanied by predominantly acute brain changes in areas that regulate autonomic, cognitive, and mood functions, and chronic changes in frontal cortices essential for behavioral control. Interventions need to be keyed to address acute vs chronic injury.”

Adenotonsillectomy for Obstructive Sleep Apnea in Children with Complex Chronic Conditions

“Although adenotonsillectomy is considered first-line therapy in healthy children older than 2 years for the treatment of obstructive sleep apnea, there is a significantly greater risk of persistent obstructive sleep apnea postadenotonsillectomy in children with complex chronic conditions. Therefore, other surgical procedures or nonsurgical management may need to be considered as first-line treatment for this cohort”.

Tonsillectomy or tonsillotomy? A systematic review for paediatric sleep-disordered breathing

“Current evidence supports tonsillotomy in children with obstructive surgical indications. It is likely to reduce post-operative haemorrhage, pain, and facilitate a faster return to normal diet and activity. Healthcare burden is decreased due to fewer post-operative complications and reduced need for medical re-contact. More research is necessary to assess the risk of recurrence, and further classification of secondary haemorrhage severity is required to fully clarify the clinical benefit of tonsillotomy.”

Sleep disorders in obese children are not limited to obstructive sleep apnoea syndrome

“Sleep disorders in obese children were not limited to respiratory sleep disorders including OSAS. A systematic specific consultation with a sleep specialist is essential for the diagnosis and care of such children and would be beneficial when treating paediatric obesity.”

Sleep Architecture in Children With Common Phenotype of Obstructive Sleep Apnea

“These findings suggest that the most common phenotype of pediatric OSA has a negative effect on the structure of sleep, but other clinical studies are needed to confirm this result.”

Impact of adenotonsillectomy on pediatric quality of life: review of the literature

“Our findings suggest that literature supports that ADT is associated with positive changes in QOL; however further studies using comparable standardised criteria are necessary to confirm the size and duration of this benefit.”