Background: Screening for obstructive sleep apnea (OSA) is recommended by current guidelines in children with sickle cell anemia (SCA), but no specific approach is described. The Pediatric Sleep Questionnaire (PSQ) is a validated detection tool for OSA in children. We assessed the utility of PSQ to screen for OSA in children with concomitant SCA and snoring. Materials and Methods: A prospective study, in children 4 to 18 years old with SCA. Subjects were assessed for snoring and PSQ administered at the same visit. All children with snoring were then referred for polysomnography. Results: A total of 106 subjects were screened. Habitual snoring prevalence was 51/106 (48.1%). In the snoring group, OSA was detected in 83.9% (apnea-hypopnea index [AHI] ≥1.0/h) and 22.6% (AHI ≥5.0/h), respectively. Sensitivity and specificity of PSQ in children with snoring was 46.2% and 20.0% (AHI ≥1.0/h), and 57.1% and 50.0% (AHI ≥5.0/h), respectively. Physician assessment for snoring had a high sensitivity of 70.3% but low specificity of 58.4% (AHI ≥1.0/h), and 87.5% and 41.5% (AHI ≥5.0/h), respectively. Conclusion: PSQ is a poor screening tool for detection of OSA in those children with SCA who snore. Physician assessment for snoring could however be an initial approach before polysomnography.

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Background Acute respiratory infections are the leading cause of morbidity and mortality with 98% of these deaths due to lower respiratory tract infections (LRTIs) particularly in infants and children with medical complexity. LRTIs contribute to the majority of healthcare acquired infections (HCAIs). In-home Palivizumab administration (PH) programs have shown a reduction in RSV-associated LRTIs likely due to improved adherence; however, the impact of these programs on HCAIs specifically non-RSV LRTIs has not been well documented. Methods In this prospective study, 41 children with gestational age less than 29 weeks, chronic lung disease of prematurity, anatomic pulmonary abnormalities, neuromuscular disorder, and/or hemodynamically significant congenital heart disease were quasi-randomized by healthcare payers to receive PH by medical personnel or Palivizumab in clinic (PC) during RSV season (Oct 2018-April 2019). Patients were stratified based on invasive vs noninvasive home ventilation. The primary outcome was total face to face encounters. Standard frequentist, Bayesian analysis, and cost-effectiveness analyses were performed. Results All demographic factors and strata were matched between PH (n=13, mean age 22 mo. SD +/-1), and PC (n=28, mean age:18 mo. SD +/-1). There was a decrease in number of total face to face encounters (adjusted for mechanical ventilation and baseline diagnosis) in PH vs PC group [(4.5 vs 8.

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