Prevalence, patterns, and persistence of sleep problems in the first 3 years of life.

Pediatrics. 2012 Feb;129(2):e276-84

Authors: Byars KC, Yolton K, Rausch J, Lanphear B, Beebe DW

Abstract
OBJECTIVE: Examine the prevalence, patterns, and persistence of parent-reported sleep problems during the first 3 years of life.
METHODS: Three hundred fifty-nine mother/child pairs participated in a prospective birth cohort study. Sleep questionnaires were administered to mothers when children were 6, 12, 24, and 36 months old. Sleep variables included parent response to a nonspecific query about the presence/absence of a sleep problem and 8 specific sleep outcome domains: sleep onset latency, sleep maintenance, 24-hour sleep duration, daytime sleep/naps, sleep location, restlessness/vocalization, nightmares/night terrors, and snoring.
RESULTS: Prevalence of a parent-reported sleep problem was 10% at all assessment intervals. Night wakings and shorter sleep duration were associated with a parent-reported sleep problem during infancy and early toddlerhood (6-24 months), whereas nightmares and restless sleep emerged as associations with report of a sleep problem in later developmental periods (24-36 months). Prolonged sleep latency was associated with parent report of a sleep problem throughout the study period. In contrast, napping, sleep location, and snoring were not associated with parent-reported sleep problems. Twenty-one percent of children with sleep problems in infancy (compared with 6% of those without) had sleep problems in the third year of life.
CONCLUSIONS: Ten percent of children are reported to have a sleep problem at any given point during early childhood, and these problems persist in a significant minority of children throughout early development. Parent response to a single-item nonspecific sleep query may overlook relevant sleep behaviors and symptoms associated with clinical morbidity.

PMID: 22218837 [PubMed - in process]

Bronchoscopic findings in children with chronic wet cough.

Pediatrics. 2012 Feb;129(2):e364-9

Authors: Zgherea D, Pagala S, Mendiratta M, Marcus MG, Shelov SP, Kazachkov M

Abstract
OBJECTIVES: Protracted bacterial bronchitis is defined as the presence of more than 4 weeks of chronic wet cough that resolves with appropriate antibiotic therapy, in the absence of alternative diagnoses. The diagnosis of protracted bacterial bronchitis is not readily accepted within the pediatric community, however, and data on the incidence of bacterial bronchitis in children are deficient. The objective of this study was to determine the frequency of bacterial bronchitis in children with chronic wet cough and to analyze their bronchoscopic findings.
METHODS: We performed a retrospective review of charts of children who presented with chronic wet cough, unresponsive to therapy, before referral to the pediatric pulmonary clinic.
RESULTS: A total of 197 charts and bronchoscopy reports were analyzed. Of 109 children who were 0 to 3 years of age, 33 (30.3%) had laryngomalacia and/or tracheomalacia. The bronchoscopy showed purulent bronchitis in 56% (110) cases and nonpurulent bronchitis in 44% (87). The bronchoalveolar lavage bacterial cultures were positive in 46% (91) of the children and showed nontypable Haemophilus influenzae (49%), Streptococcus pneumoniae (20%), Moraxella catarrhalis (17%), Staphylococcus aureus (12%), and Klebsiella pneumoniae in 1 patient. The χ(2) analysis demonstrated that positive bacterial cultures occurred more frequently in children with purulent bronchitis (74, 69.8%) than in children with nonpurulent bronchitis (19, 19.8%) (P < .001).
CONCLUSIONS: Children who present with chronic wet cough are often found to have evidence of purulent bronchitis on bronchoscopy. This finding is often indicative of a bacterial lower airway infection in these children.

PMID: 22232311 [PubMed - in process]

Algorithm for the diagnosis and treatment of pediatric OSA: A proposal of two pediatric sleep centers.

Sleep Med. 2012 Mar;13(3):217-27

Authors: Kaditis A, Kheirandish-Gozal L, Gozal D

Abstract
There is currently no consensus on the best method of managing of obstructive sleep apnea (OSA) in childhood. In the present paper, an algorithm for the diagnosis and treatment of the disorder is proposed. Sleep apnea is suspected when parents report relevant symptoms or when there are abnormalities that predispose to OSA such as adenotonsillar hypertrophy, obesity, craniofacial anomalies, or neuromuscular disorders. OSA-associated morbidity including elevated blood pressure, daytime sleepiness or learning problems, growth failure, and enuresis should be recognized. Severity of intermittent upper airway obstruction during sleep can be determined objectively by polysomnography or, if polysomnography is not available, by nocturnal pulse oximetry. Risk factors predicting persistence of OSA in adolescence (male gender, development of obesity) need to be identified. Children with moderate-to-severe OSA, or with mild OSA, but accompanied by morbidity, or by risk factors predicting persistence of the disorder should have priority for treatment. An individualized and multifaceted therapeutic approach which addresses in a step-by-step fashion all abnormalities that contribute to upper airway obstruction during sleep is necessary.

PMID: 22300748 [PubMed - in process]

A Proposed Comprehensive Classification of Tuberculosis Disease Severity in Children.

Pediatr Infect Dis J. 2012 Feb 6;

Authors: Wiseman CA, Gie RP, Starke JR, Schaaf HS, Donald PR, Cotton MF, Hesseling AC

Abstract
BACKGROUND: Tuberculosis (TB) in children has conventionally been classified as pulmonary (PTB) and extrapulmonary (EPTB) disease, including disseminated TB (TB meningitis and miliary disease). There is no existing approach that comprehensively characterizes the spectrum and severity of pediatric TB. This limits accurate classification of patients and comparison across cohorts. AIMS: To develop a classification of pediatric TB which reflects the spectrum and severity of clinical disease better than currently available approaches. METHODS: We propose a framework for the standard classification of TB disease severity in children. From a literature search, the following sources of information were used: clinical data, bacteriologic, histopathologic and imaging data (including information from chest radiography, computerized tomography and bronchoscopy). Each individual disease entity was systematically considered. Based on the extent and the presence of complications, each entity was then classified as "severe" or "nonsevere". As an initial application, we compared the proposed classification to the convention (PTB, EPTB) in a cohort of HIV-infected and uninfected infants with culture- confirmed TB. Agreement between the two systems was poor. CONCLUSIONS: The proposed comprehensive disease classification system may more accurately reflect the clinical TB disease spectrum in children, is relevant to clinical management, and may be valuable to inform research on diagnostic tools and TB treatment strategies in children. Prospective studies are required to evaluate this approach in representative pediatric populations, correlating TB disease severity with diagnostic yield, treatment response and application in existing and novel treatment strategies.

PMID: 22315002 [PubMed - as supplied by publisher]