Helping High Risk Infants and Parents Sleep Better: ATS Guidelines for Outpatient Care of Premature Infants

Premature infants, particularly born before 30 weeks gestation who have been given a diagnosis of chronic lung disease, bronchopulmonary dysplasia, or post-prematurity respiratory disease face significant challenges in transition from the NICU environment to life at home.  The lack of guidelines to help focus care and quality medical literature differentiating outcomes is stark.  Parents and physicians need tools to care for these high risk infants. These new ATS guidelines nicely evaluate the role of inhaled medications, swallowing assessment, airway endoscopy, and especially sleep testing and provide timely recommendations.

Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline

New recommendations are available to help guide physicians who must determine when and how to treat infants, children and adolescents with post-prematurity respiratory disease (PPRD). The American Thoracic Society has published an official clinical practice guideline in which a multidisciplinary panel of experts provide 13 conditional recommendations on the diagnostic testing and clinical management of these young people. The complete guideline detailing these recommendations was posted online ahead of print in the American Journal of Respiratory and Critical Care Medicine.

Worldwide, approximately 12 million infants—10 percent of live births—are born prematurely and are at risk for respiratory disease, the most common of which is bronchopulmonary dysplasia (BPD). However, all premature infants, even those who do not meet the criteria for having BPD, may develop poor respiratory health later in life with signs and symptoms including cough, recurrent wheezing, exercise intolerance, low blood oxygen (hypoxemia) and reduced pulmonary function. These individuals are classified as having PPRD.

Read article here.

Does anesthesia in children cause developmental delay?

Many parents I counsel regarding need for flexible bronchoscopy hesitate when they realize anesthesia is involved, albeit even for a short procedure.  This study suggests risk may be exaggerated. Dr. Susarla

Young children who had surgical procedures with general anesthesia prior to primary school entry did not have an increased risk of detectable adverse neurodevelopment outcomes compared with their siblings who did not have surgery, according to a Canadian analysis.

After adjusting for confounding factors, no significant differences were found between exposed and unexposed children in early developmental vulnerability or in each of the major domains of the Early Development Instrument (EDI), a teacher-assessed measure of primary school readiness, reported James O'Leary, MD, and co-authors of the Hospital for Sick Children in Toronto, writing in JAMA Pediatrics.

"These findings further support that exposure to anesthesia and surgery in early childhood is not associated with detectable adverse child development outcomes," O'Leary told MedPage Today.

But "while the findings are generalizable to the majority of young children who have a single surgical procedure performed, it is still not known whether children with repeated or lengthy exposures to surgery and anesthesia are at increased risk of altered neurodevelopment," he added.

Read article here.