First name
Ignacio
Middle name
E
Last name
Tapia

Title

Neuroendocrine cell hyperplasia of infancy: Feasibility of objective evaluation with quantitative CT.

Year of Publication

2022

Number of Pages

43-48

Date Published

06/2022

ISSN Number

1873-4499

Abstract

OBJECTIVE: To describe quantitative CT parameters of children with a typical pattern for NEHI and compare them to controls.

MATERIALS AND METHODS: Eleven patients (7 boys) with NEHI and an available chest CT concordant NEHI were identified. Eleven age-, sex-, height-matched, with CT technique-matching were identified for comparison. An open-source software was used to segment the lung parenchyma into lobes using the fissures. Quantitative parameters such as low attenuation areas, mean lung density, kurtosis, skewness, ventilation heterogeneity, lung mass, and volume were calculated for both controls and cases.

RESULTS: Analysis of the lung parenchyma showed that patients with NEHI had a lower mean lung density (-615 HU vs -556 HU, p = 0.03) with higher ventilation heterogeneity (0.23 vs 0.19, p = 0.04), lung mass (232 g vs 146 g, p = 0.01) and volume (595 mL vs 339 mL, p = 0.008) compared to controls. Most lobes followed this trend, except the middle lobe that showed only a higher lung mass (32.9 g vs 19.6 g, p = 0.02) and volume (77.4 vs 46.9, p = 0.005) in patients with NEHI compared to controls.

CONCLUSION: Quantitative CT is a feasible technique in children with a typical pattern for NEHI and is associated with differences in attenuation, ventilation heterogeneity, and lung volume.

DOI

10.1016/j.clinimag.2022.06.004

Alternate Title

Clin Imaging

PMID

35700553

Title

Continuous positive airway pressure care for pediatric obstructive sleep apnea: A long-term quality improvement initiative.

Year of Publication

2022

Date Published

07/2022

ISSN Number

1099-0496

Abstract

Successful treatment of pediatric obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) is challenging due to behavioral, technical, medical, and systems factors. We undertook a quality improvement (QI) initiative involving physicians, nurses, psychologists, and respiratory therapists to improve CPAP outpatient care and processes. We aimed to: (1) increase the proportion of patients with a follow-up visit within 4 months of initiation of CPAP, (2) reduce the median time to first follow-up visit to under 4 months, and (3) increase the proportion of patients obtaining a post-initiation polysomnogram within 1 year to >50%. We also explored healthcare utilization (HCU) in a subsample of patients. Interventions focused on developing a tracking system and standardizing interdisciplinary clinical care. The proportion of patients returning to clinic within 4 months improved from 38.2% to 65.5% and median time to first follow-up visit improved from 133 to 56 days. The percentage of patients who returned for a post-initiation polysomnogram within 1 year was 71.1%. Subsample analyses showed significant reductions in the length of stay for emergency department visits from pre-CPAP initiation (Mdn = 3.00 h; interquartile range [IQR] = 7.00) to post-initiation (Mdn = 2.00 h, IQR = 5.00). The length of hospitalizations was also significantly shorter from pre (Mdn = 48.00 h, IQR = 243.00) to post-CPAP initiation (Mdn = 0.00 h, IQR = 73.00). A standardized, tracked approach to interdisciplinary outpatient CPAP care can improve follow-up care and potentially HCU.

DOI

10.1002/ppul.26075

Alternate Title

Pediatr Pulmonol

PMID

35831944

Title

Respiratory indices during sleep in healthy infants: A prospective longitudinal study and meta-analysis.

Year of Publication

2022

Number of Pages

49-57

Date Published

11/2022

ISSN Number

1878-5506

Abstract

STUDY OBJECTIVES: Healthy infants may have a greater apnea hypopnea index (AHI) than older children during the newborn period, but the trajectory of these sleep-related events beyond the first month of life is poorly understood. In this study, we evaluated the longitudinal changes in respiratory indices during sleep in healthy infants during the first six months of life.

METHODS: Single-center prospective cohort study. Thirty healthy infants underwent overnight in-lab polysomnography at one and five months of age and findings were compared between assessments. Systematic review of studies evaluating infant polysomnography and meta-analysis was conducted.

RESULTS: At one month of age, total AHI, obstructive AHI, and central AHI model-adjusted means (95% confidence interval) were 16.9 events/hour (12.2, 21.5), 10.2 events/hour (7.4, 13.1), and 6.6 events/hour (4.2, 9.0), respectively. 16.8% of events were obstructive apneas and 36.1% central apneas. By five months of age, there were significant reductions in each index to 4.1 events/hour (3.2, 5.0), 1.9 events/hour (1.4, 2.4), and 2.2 events/hour (1.6, 2.9), respectively (p < 0.001 for each), and a lower proportion of events were obstructive apneas (8.6%, p = 0.007) and a greater proportion central apneas (52.3%, p = 0.002). Meta-analysis found high AHI in infants with significant heterogeneity.

CONCLUSIONS: Central AHI and obstructive AHI are greater in healthy newborns than older children. There is a significant spontaneous reduction in events and change in type of events in the first six months of life in this low-risk population. These findings may serve as a reference for clinicians evaluating for obstructive sleep apnea in infants.

DOI

10.1016/j.sleep.2022.07.010

Alternate Title

Sleep Med

PMID

35963199

Title

Health disparities in pediatric sleep-disordered breathing.

Year of Publication

2022

Date Published

2022 Jan 28

ISSN Number

1526-0550

Abstract

<p>Sleep-disordered breathing reflects a continuum of overnight breathing difficulties, ranging from mild snoring to obstructive sleep apnea syndrome. Sleep-disordered breathing in childhood is associated with significant adverse outcomes in multiple domains of functioning. This review summarizes the evidence of well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes. Research on potential socio-ecological contributors to these disparities is also reviewed. Critical future research directions include the development of interventions that address the modifiable social and environmental determinants of these health disparities.</p>

DOI

10.1016/j.prrv.2022.01.005

Alternate Title

Paediatr Respir Rev

PMID

35277358

Title

Positive airway pressure for the treatment of the childhood obstructive sleep apnea syndrome.

Year of Publication

2021

Date Published

2021 Mar 01

ISSN Number

1099-0496

Abstract

<p>In this review, we have summarized the benefits of treatment with positive airway pressure for the childhood obstructive sleep apnea syndrome and presented a socio-ecological framework to enhance our understanding of positive airway pressure adherence predictors and important targets of comprehensive positive airway pressure treatment models across different pediatric populations. Although positive airway pressure is clearly a beneficial treatment for pediatric obstructive sleep apnea syndrome, additional research is needed to evaluate how socio-ecological factors may interact to predict positive airway pressure adherence, with more attention to the impact of the broader healthcare setting and on treatment approaches and outcomes in special pediatric populations.</p>

DOI

10.1002/ppul.25318

Alternate Title

Pediatr Pulmonol

PMID

33647183

Title

Normal age-related quantitative CT values in the pediatric lung: from the first breath to adulthood.

Year of Publication

2021

Number of Pages

111-118

Date Published

2021 Jan 04

ISSN Number

1873-4499

Abstract

<p><strong>OBJECTIVE: </strong>To characterize the normal progression of quantitative CT parameters in normal children from birth to adulthood.</p>

<p><strong>MATERIALS AND METHODS: </strong>Patients aged 0-18&nbsp;years with non-contrast-enhanced chest CT and evidence of normal lung parenchyma were included. Patients with respiratory symptoms, incomplete anthropometric measurements, or sub-optimal imaging technique were excluded. Segmentation was performed using an open-source software with an automated threshold segmentation. The following parameters were obtained: mean lung density, kurtosis, skewness, lung volume, and mass. Linear and exponential regression models were calculated with age and height as independent variables. A p-value of &lt;0.05 was considered significant.</p>

<p><strong>RESULTS: </strong>220 patients (111 females, 109 males) were included. Mean age was 9.6&nbsp;±&nbsp;5.9&nbsp;years and mean height was 133.9&nbsp;±&nbsp;35.1&nbsp;cm. Simple linear regression showed a significant relationship between mean lung density with age (R 2&nbsp;=&nbsp;0.70) and height (R 2&nbsp;=&nbsp;0.73). Kurtosis displayed a significant exponential correlation with age (R 2&nbsp;=&nbsp;0.70) and height (R 2&nbsp;=&nbsp;0.71). Skewness showed a significant exponential correlation with age (R 2&nbsp;=&nbsp;0.71) and height (R 2&nbsp;=&nbsp;0.73). Lung mass showed a correlation with age (R 2&nbsp;=&nbsp;0.93) and height (R 2&nbsp;=&nbsp;0.92). Exponential regression showed a significant relationship between lung volume with age (R 2&nbsp;=&nbsp;0.88) and height (R 2&nbsp;=&nbsp;0.93).</p>

<p><strong>CONCLUSION: </strong>Quantitative CT parameters of the lung parenchyma demonstrate changes from birth to adulthood. As children grow, the mean lung density decreases, and the lung parenchyma becomes more homogenous.</p>

DOI

10.1016/j.clinimag.2020.12.021

Alternate Title

Clin Imaging

PMID

33524938

Title

Disparities in Sleep Health and Potential Intervention Models: A Focused Review.

Year of Publication

2020

Date Published

2020 Sep 29

ISSN Number

1931-3543

Abstract

<p>Disparities in sleep health are important but under-recognized contributors to health disparities. Understanding the factors contributing to sleep heath disparities and developing effective interventions are critical to improving all aspects of heath. Sleep heath disparities are impacted by socio-economic status, racism, discrimination, neighborhood segregation, geography, social patterns and access to healthcare as well as by cultural beliefs necessitating a cultural appropriateness component in any intervention devised for reducing sleep health disparities. Pediatric sleep disparities require innovative and urgent intervention to establish a foundation of lifelong healthy sleep. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.</p>

DOI

10.1016/j.chest.2020.09.249

Alternate Title

Chest

PMID

33007324

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