Pediatric neurology最新文献

{"title":"Effect of Piracetam and Iron Supplementation on Heart Rate Variability in Children With Breath-Holding Spells: Effective Treatment or Placebo?","authors":"Prateek Kumar Panda DM, Indar Kumar Sharawat DM","doi":"10.1016/j.pediatrneurol.2024.10.005","DOIUrl":"10.1016/j.pediatrneurol.2024.10.005","url":null,"abstract":"","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Page 262"},"PeriodicalIF":3.2,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Horner Syndrome Secondary to Rapid Enlargement of a Mediastinal Lymphatic Malformation","authors":"Elizabeth Pickup MD ,&nbsp;Kyle Spagnolo DO ,&nbsp;Alexandra B. Kornbluh MD","doi":"10.1016/j.pediatrneurol.2024.10.006","DOIUrl":"10.1016/j.pediatrneurol.2024.10.006","url":null,"abstract":"<div><div>Horner syndrome is a clinical triad of ptosis, miosis, and anhidrosis, which commonly prompts urgent neuroimaging. The differential diagnosis of new-onset Horner syndrome in children includes neurological emergencies. We report here a case of a 13-month-old male infant with acute-onset Horner syndrome, subsequently found to have a large mediastinal lymphatic malformation compressing the trachea and neck vasculature.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"162 ","pages":"Pages 9-11"},"PeriodicalIF":3.2,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial, Ethnic, and Socioeconomic Disparities in Pediatric Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder","authors":"Kelsey E. Poisson MD ,&nbsp;Linda Nguyen MD, PhD ,&nbsp;Paul S. Horn PhD ,&nbsp;Andrew F. Beck MD, MPH ,&nbsp;Helen Wu MD, PhD ,&nbsp;Kris Wesselkamper MD ,&nbsp;Jayne M. Ness MD, PhD ,&nbsp;Yolanda S. Wheeler PhD, CRNP, CPNP-AC, MSCN","doi":"10.1016/j.pediatrneurol.2024.09.028","DOIUrl":"10.1016/j.pediatrneurol.2024.09.028","url":null,"abstract":"<div><h3>Background</h3><div>Only 5% of aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) cases emerge during childhood. Poorer outcomes have been suggested in black/African American (AA) adults with NMOSD; however, conflicting and limited data exist for pediatric-onset NMOSD. This study evaluates racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes.</div></div><div><h3>Methods</h3><div>Thirty-eight pediatric patients with AQP4+ NMOSD cared for at three pediatric tertiary care centers between 2009 and 2021 were identified. Patient addresses connected to socioeconomic measures available from the US Census. Demographic characteristics, pertinent clinical outcomes, and health care utilization in the two years following diagnosis were captured.</div></div><div><h3>Results</h3><div>Compared with non-Hispanic White children, Black/AA children had a significantly higher Expanded Disability Status Scale (EDSS) (2.46 vs 0.33, <em>P</em> = 0.003), 2.37 more hospital admissions (<em>P</em> = 0.002), and 28.40 additional inpatient days (<em>P</em> = 0.002) in the two years following their NMOSD diagnosis. Additionally, children with public insurance had higher relapse rates than those with private insurance (<em>P</em> = 0.046). At two years and at the most recent follow-up, a significantly higher EDSS was correlated with children living in census tracts with a lower median income, higher deprivation index, and higher proportion of population on assisted income, in poverty, and with vacant housing (all <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>We identified racial, ethnic, and socioeconomic disparities in clinical outcomes and health care utilization in pediatric AQP4+ NMOSD. Further prospective and household-level data are needed to dissect the interplay of genetics, structural racism, and social determinants of health so that interventions to optimize care and outcomes for this population may be developed.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 194-200"},"PeriodicalIF":3.2,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Surgical Failure in Pediatric Lesional Temporal Lobe Epilepsy Surgery","authors":"Matthias Tomschik MD ,&nbsp;Katharina Moser MD ,&nbsp;Robert Diehm MD ,&nbsp;Johannes Herta MD, PhD ,&nbsp;Jonathan Wais MD ,&nbsp;Gregor Kasprian MD ,&nbsp;Thomas Czech MD ,&nbsp;Karl Roessler MD ,&nbsp;Martha Feucht MD ,&nbsp;Christian Dorfer MD","doi":"10.1016/j.pediatrneurol.2024.09.030","DOIUrl":"10.1016/j.pediatrneurol.2024.09.030","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy surgery can potentially cure pharmacoresistant temporal lobe epilepsy (TLE) in children. However, surgical failures, where patients continue to experience seizures, still exist. We evaluated outcomes in pediatric patients after resective temporal lobe surgery to identify risk factors for failure.</div></div><div><h3>Methods</h3><div>Data on pediatric patients with TLE who underwent surgery were prospectively collected at our institution. Minimum follow-up (FU) was three years after surgery. Resections were stratified into extended resections, i.e., anterior temporal lobectomies, and sparing resections, i.e., lesionectomies and selective amygdalohippocampectomies. Ongoing seizures and relapses within the first three years were considered surgical failures.</div></div><div><h3>Results</h3><div>We included 96 patients after 43 sparing and 52 extended resections from 1993 to 2019 with a median FU of 10.1 years (range 3.0 to 28.3 years). Pathohistology most frequently revealed epilepsy-associated tumors (44.8%), hippocampal sclerosis (37.5%), and focal cortical dysplasias (12.5%). One year postoperatively, 69.8% were seizure free, increasing to 78.5% after five and 72.9% after 10 years. Sparing resections increased the odds for surgical failure in a multivariate analysis (odds ratio: 4.63, <em>P</em> = 0.006). Preoperative focal onset to bilateral tonic-clonic seizures increased the likelihood of seizure relapses (hazard ratio: 3.89, <em>P</em> = 0.006) and contributed to higher odds of surgical failure (odds ratio: 2.79, <em>P</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>Pediatric patients with TLE undergoing surgery have high rates of long-lasting favorable seizure outcomes. Resection strategy is a prognostic factor for early surgical success in favor of larger resections. Relapses were more frequent in children with focal onset to bilateral tonic-clonic seizures beforesurgery.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"162 ","pages":"Pages 1-8"},"PeriodicalIF":3.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Television Viewing and Sensory Reactivity in Childhood: The Cross-Sectional InProS Study","authors":"Paula Fernández-Pires PhD ,&nbsp;Desirée Valera-Gran PhD ,&nbsp;Miriam Hurtado-Pomares PhD ,&nbsp;Cristina Espinosa-Sempere PhD ,&nbsp;Alicia Sánchez-Pérez PhD ,&nbsp;Iris Juárez-Leal PhD ,&nbsp;Rocío Muñoz-Sánchez MPH ,&nbsp;Ada-Sofía León-García OT ,&nbsp;Paula Peral-Gómez PhD ,&nbsp;Eva-María Navarrete-Muñoz PhD","doi":"10.1016/j.pediatrneurol.2024.10.001","DOIUrl":"10.1016/j.pediatrneurol.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Current evidence suggests a potential detrimental effect of increased television viewing on children's health, including sensory processing issues. Therefore, this study examined the association between television viewing time and atypical sensory reactivity (SR) in children aged from three to seven years.</div></div><div><h3>Methods</h3><div>We evaluated data from the InProS cross-sectional study (n = 545). Daily television viewing was categorized into tertiles: ≤1.5, 1.5 to 2.5, and ≥2.5 hours. SR was evaluated using the Short Sensory Profile (SSP). Children with atypical SR were those with a global SSP score below 155, 30 for tactile sensitivity, 15 for taste/olfactory sensitivity, 13 for movement sensitivity, 27 for under-responsive/seeks sensation, 23 for auditory filtering, 26 for low energy/weak, and 19 for visual/auditory sensitivity. We used multiple Poisson regression models with robust variance to explore associations.</div></div><div><h3>Results</h3><div>After adjusting for covariates, children who watched television 1.5 to 2.5 and ≥2.5 hours/day showed a higher prevalence of atypical global SR (prevalence ratio [PR]: 1.54; 95% confidence interval [CI]: 1.03 to 2.30; PR: 1.81; 95% CI: 1.19 to 2.76, respectively) and auditory filtering (PR: 1.50; 95% CI: 1.15 to 1.96; PR: 1.36; 95% CI: 1.01 to 1.83, respectively), compared with children who watched ≤1.5 hours/day. In addition, watching television ≥2.5 hours/day, compared with watching ≤1.5 hours/day, was associated with having atypical SR in movement sensitivity (PR: 1.73; 95% CI: 1.06 to 2.83), under-responsive/seeks sensation (PR: 1.31; 95% CI: 1.02 to1.69), and low energy/weak (PR: 2.02; 95% CI: 1.01 to 4.06).</div></div><div><h3>Conclusions</h3><div>The findings showed that television viewing ≥1.5 hours/day was associated with a higher prevalence of atypical SR in childhood. However, further longitudinal studies are required to confirm these results.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 255-261"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Impact of Insurance Type on Genetic Testing in Pediatric Neurology","authors":"Sydney Carnes BA ,&nbsp;Laura D. Fonseca MS ,&nbsp;Deborah Lee BS ,&nbsp;Ankur Parekh BS ,&nbsp;Anna Robertson BS ,&nbsp;Gogi Kumar MD","doi":"10.1016/j.pediatrneurol.2024.09.029","DOIUrl":"10.1016/j.pediatrneurol.2024.09.029","url":null,"abstract":"<div><h3>Background</h3><div>Studies that examine the impact of insurance type on the ease of obtaining genetic testing are scarce. Therefore, we aim to analyze how different types of insurance influence the time taken to obtain genetic test results among pediatric neurology patients.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study from Dayton Children’s Hospital. Patients who had at least one neurological genetic result found in the electronic medical record from January 1, 2014, to March 1, 2023, were included in the study. Variables collected include demographics, health insurance data, and genetic testing results.</div></div><div><h3>Results</h3><div>A total of 141 patients were included. Most patients were male (51.8%), white (78.0%), and not Hispanic/Latino (96.5%). The mean age at the time of genetic testing was 7.9 years. Most patients had Medicaid as their primary insurance (60.3%) when compared with private insurance (39.7%). Two hundred fifteen genetic reports were examined (137 Medicaid charts and 78 private insurance charts). There was no statistically significant difference from mean time lapse between test order date and results date for Medicaid patients (27.3 days) versus private insurance (31.5 days, <em>P</em> = 0.40). Molecular genetics testing and epilepsy gene panel order were the most common tests ordered for both Medicaid (86.1%, 37.2%) and private insurance (88.5%, 39.7%, respectively).</div></div><div><h3>Conclusions</h3><div>The mean time between test order date and results date was comparable between private- and Medicaid-insured patients. Our results suggest that there is no significant difference for time to result between pediatric neurology patients who carry public versus private insurance for genetic testing.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 223-226"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responsive Neurostimulation in Pediatric and Young Adult Patients With Drug-Resistant Focal, Multifocal, and Generalized Epilepsy: A Single-Center Experience","authors":"Shanna M. Swartwood MD ,&nbsp;Robert J. Bollo MD ,&nbsp;Matthew T. Sweney MD ,&nbsp;Carey A. Wilson MD ,&nbsp;Amanda G. Sandoval Karamian MD ,&nbsp;Harsheen Kaur MD ,&nbsp;Kimberly Orton RN, MHL ,&nbsp;Monika Baker BS ,&nbsp;Audie C. Espinoza MD","doi":"10.1016/j.pediatrneurol.2024.10.002","DOIUrl":"10.1016/j.pediatrneurol.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Responsive neurostimulation (RNS) is used off-label in pediatric patients with drug-resistant epilepsy (DRE). Our study aims to assess the safety and efficacy of RNS in pediatric and young adult patients with focal, multifocal, and generalized DRE.</div></div><div><h3>Methods</h3><div>All patients who underwent RNS implantation at Primary Children's Hospital in Salt Lake City, UT, between December 2017 and 2022.</div></div><div><h3>Results</h3><div>A total of 47 patients were retrospectively identified, of which 32 patients were included in the final analysis. Patients ranged in age from five to 21 years (pediatric n = 22, young adult n = 10) at the time of RNS implantation with focal (20 [63%]), multifocal (8 [25%]), and generalized (4 [12%]) DRE. Operative complications (3 [9%]) and negative side effects (6 [19%]) were minor. At the time of most recent clinic visit (mean 18.6 months, S.D. 13.9), 19 of 32 patients (59%) were responders with ≥50% reduction in seizure frequency (pediatric n = 14, young adult n = 5). The rate of responders increased with prolonged activation of RNS stimulation, reaching 71% (five of seven patients) after 24 months. Antiseizure medication was reduced in five (16%) patients, and seizure rescue medication usage was reduced in 10 (31%) patients. Quality of life improved in 15 (47%) patients.</div></div><div><h3>Conclusions</h3><div>RNS implantation resulted in a sustained reduction in seizure frequency with minimal side effects in a majority of patients. Taken together, our data suggest that RNS is an effective and safe treatment option for focal, multifocal, and potentially generalized DRE in the pediatric and young adult population.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 247-254"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Central Nervous System Embryonal Tumors: Presentation, Diagnosis, Therapeutic Strategies, and Survivorship—A Review","authors":"Rebecca Ronsley MD ,&nbsp;Bonnie Cole MD ,&nbsp;Tyler Ketterl MD ,&nbsp;Jason Wright MD ,&nbsp;Ralph Ermoian MD ,&nbsp;Lindsey M. Hoffman MD ,&nbsp;Ashley S. Margol MD ,&nbsp;Sarah E.S. Leary MD","doi":"10.1016/j.pediatrneurol.2024.09.031","DOIUrl":"10.1016/j.pediatrneurol.2024.09.031","url":null,"abstract":"<div><div>Central nervous system (CNS) embryonal tumors represent a diverse group of neoplasms and have a peak incidence in early childhood. These tumors can be located anywhere within the CNS, and presenting symptoms typically represent tumor location. These tumors display distinctive findings on neuroimaging and are staged using magnetic resonance imaging of the brain and spine as well as evaluation of cerebrospinal fluid. Diagnosis is made based on an integrated analysis of histologic and molecular features via tissue sampling. Risk stratification is based on integration of clinical staging and extent of resection with histologic and molecular risk factors. The therapeutic approach for these tumors is multimodal and includes surgery, chemotherapy, and radiation, tailored to the individual patient factors (including age) and specific tumor type. Comprehensive supportive care including management of nausea, nutrition support, pain, fertility preservation, and mitigation of therapy-related morbidity (including hearing protection) is imperative through treatment of CNS embryonal tumors. Despite advances in therapy and supportive care, the long-term consequences of current treatment strategies are substantial. Integration of less toxic, molecularly targeted therapies and a comprehensive, multidisciplinary approach to survivorship care are essential to improving survival and the overall quality of life for survivors.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 237-246"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant High-Dose Erythropoietin With Delayed Therapeutic Hypothermia in Neonatal Hypoxic-Ischemic Encephalopathy","authors":"Piyathida Jongruk MD ,&nbsp;Nawamon Soontaravarapas MD ,&nbsp;Salita Angkurawaranon MD ,&nbsp;Shanika Kosarat MD ,&nbsp;Varangthip Khuwuthyakorn MD ,&nbsp;Watcharee Tantiprabha MD ,&nbsp;Satit Manopunya MD ,&nbsp;Nonglak Boonchooduang MD ,&nbsp;Orawan Louthrenoo MD ,&nbsp;Narueporn Likhitweerawong MD ,&nbsp;Kamornwan Katanyuwong MD ,&nbsp;Chinnuwat Sanguansermsri MD ,&nbsp;Natrujee Wiwattanadittakul MD","doi":"10.1016/j.pediatrneurol.2024.10.003","DOIUrl":"10.1016/j.pediatrneurol.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the benefits of high-dose erythropoietin (EPO) combined with therapeutic hypothermia (TH) on brain magnetic resonance imaging (MRI) scores and neurodevelopmental outcomes in neonates with moderate to severe hypoxic-ischemic-ecephalopathy (HIE), especially in neonates who received TH between six to 12 hours of birth.</div></div><div><h3>Methods</h3><div>This prospective, single-blind, randomized, placebo-controlled trial enrolled term newborns with moderate to severe HIE admitted to neonatal intensive care unit between April 2018 and April 2022. Hypothermia was started within 12 hours of birth. Infants were randomized to receive EPO 1000 U/kg or an equal volume of normal saline (placebo) on days 1, 2, 3, 5, and 7 of age in combination with hypothermia.</div></div><div><h3>Results</h3><div>Fifty-seven neonates with moderate to severe HIE were recruited; 10 were excluded. Forty-seven patients were included: 32 received TH within six hours (group I) and in 15 TH was started within six to 12 hours of birth (group II). The clinical characteristics of mothers and infants, maternal complications, and resuscitations performed during the perinatal period showed no statistical differences between EPO group and placebo groups I and II. The MRI scores and brain injury patterns did not differ between the EPO and placebo groups. There is no statistical significance in either group's seizure and severe electroencephalography background (initial and after rewarming) between EPO and placebo in each group. There were no differences in developmental outcomes (abnormal Denver II &gt; 2 area, Gross Motor Function Classification Score &gt;1); Bayley Scales of Infant and Toddler Development, third edition (BSID-III) score (cognitive, language, and motor); or disability (hearing impairment and impaired vision) between the EPO and placebo groups I and II at 12 and 18 months.</div></div><div><h3>Conclusions</h3><div>Among term infants with moderate to severe HIE, TH with EPO administration, compared with TH alone, did not reduce brain injury on MRI or the risk of neurological sequelae both in patients who received TH within six hours and in those who received TH later (six to 12 hours). Further studies on the benefit of EPO injection alone or before TH in situations where TH cannot be performed are required.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 268-276"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Study: Behavioral and Medical Clinical Partnership for Optimization of Positive Airway Pressure Therapy in Pediatric Patients","authors":"Emily V. Singer MD ,&nbsp;Hayley Martins DO ,&nbsp;Lana Boursoulian MD ,&nbsp;Amanda Hicklin APRN ,&nbsp;Whitney Loring PsyD ,&nbsp;Beth A. Malow MD ,&nbsp;Nicole Poirier APRN ,&nbsp;Denise Smith BS ,&nbsp;Althea Shelton MD","doi":"10.1016/j.pediatrneurol.2024.09.027","DOIUrl":"10.1016/j.pediatrneurol.2024.09.027","url":null,"abstract":"<div><h3>Background</h3><div>To assess the effectiveness of a structured algorithm for pediatric positive airway pressure (PAP) initiation for the treatment of obstructive sleep apnea (OSA).</div></div><div><h3>Methods</h3><div>An algorithm was created to support pediatric PAP use and identify patients who could benefit from early behavioral consultation and education. Sleep providers implemented a unified introduction to PAP therapy with the PAP therapy toolkit. Through a collaborative approach with the medical equipment companies, pediatric patients were provided with PAP equipment before PAP titration studies and were allowed a gradual initiation of PAP therapy. PAP downloads were reviewed to determine improvements in compliance measured by percent of average days used and average minutes per night used.</div></div><div><h3>Results</h3><div>Thirty-eight pediatric patients completed the PAP therapy algorithm. There was significant improvement in PAP compliance in percentage of days used (paired <em>t</em> test <em>P</em> value = 0.04), as well as an improvement (although not statistically significant) in average nightly use. Patients benefitted from close follow-up visits with the sleep advanced practice providers. Patients seen for the consultation with the pediatric behavioral psychologist showed statistically significant improvement in both percentage of days and average nightly use.</div></div><div><h3>Conclusions</h3><div>Our pilot study shows that a behavioral and medical partnership using a structured algorithm was feasible and resulted in improved PAP compliance for our pediatric patients.</div></div>","PeriodicalId":19956,"journal":{"name":"Pediatric neurology","volume":"161 ","pages":"Pages 277-282"},"PeriodicalIF":3.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}