Objective To describe drug-induced sleep endoscopy (DISE) findings in children with obstructive sleep apnea and to differentiate them between surgically naïve children and children who had adenotonsillectomy performed. Study Design Retrospective case series with chart review. Setting Secondary care hospital. Subjects and Methods A cohort of 56 children with the diagnosis of obstructive sleep apnea was submitted to DISE and subsequent upper airway surgery: 23 were surgically naïve, and 33 had persistent obstructive sleep apnea after adenotonsillectomy. Comparisons between groups were calculated with chi-square test and Student’s t test. Simple linear regression was used to model polysomnographic indices. Results In surgically naïve children, the most common sites of obstruction were the adenoids (78.2%) and the lateral pharyngeal walls/tonsils (82.6%). In children with persistent obstructive sleep apnea after adenotonsillectomy, the most common sites of obstruction were the adenoids (54.5%), followed by the supraglottis (48.5%) and the tongue base (45.5%). No correlation was found between obstructive apnea-hypopnea index and DISE findings. Simple linear regression revealed that the degree of obstruction at the tongue base (β = −0.73; 95% CI, −1.22 to −0.25; P = .004) and the presence of multilevel obstruction (β = −1.75; 95% CI, −3.20 to −0.30; P = .02) predicted saturation nadir in children with persistent obstructive sleep apnea after adenotonsillectomy. Conclusion DISE findings differed between surgically naïve children and children with persistent obstructive sleep apnea after adenotonsillectomy. Increased obstruction at the level of the tongue base and the presence of multilevel obstruction predicted a lower saturation nadir in children with persistent obstructive sleep apnea after adenotonsillectomy.

Objectives: Given that 30%-50% of children with trisomy 21 have persistent obstructive sleep apnoea (OSA) after adenotonsillectomy, we evaluated whether demographic, clinical and polysomnographic factors predicted persistent OSA and OSA severity after adenotonsillectomy.

The importance of anti-reticulin antibodies (ARA)--R1 pattern--has been evaluated as a diagnostic and monitoring test for childhood coeliac disease. A prospective study was performed in 140 patients: 68 children with coeliac disease, 32 with miscellaneous diarrhoea, and 40 controls. An indirect immunofluorescent test was used for ARA screening. The indirect correlation found in our study between the presence of ARA and coeliac disease in children on a normal diet and after gluten challenge and between the absence of ARA and coeliac disease in children on a gluten-free diet seems to be of value in the diagnosis of coeliac disease and in monitoring the response to treatment in coeliac disease children.

Objective To analyze auditory brainstem response (ABR) findings of preterm and term infants in the neonatal intensive care unit (NICU) with perinatal problems. Study Design Case series with chart review. Setting Secondary care hospital. Methods Analysis consisted of a consecutive series of 101 infants (69 preterm and 32 term) admitted in the NICU of Hospital Fernando Fonseca between 2016 and 2018 with perinatal problems who underwent an ABR evaluation. Results The major perinatal problems identified were hyperbilirubinemia, intravenous gentamicin >5 days, mechanical ventilation >5 days, congenital cytomegalovirus infection, meningitis, and periventricular hemorrhage. Gentamicin use significantly increased the absolute latency of wave I in preterm infants (95% CI, 0.01-0.37; P = .037). Mechanical ventilation significantly decreased the latency of wave V and intervals I-V and III-V in preterm infants (95% CI, −0.35 to −0.22; P = .026; 95% CI, −0.33 to −0.00; P = .001; 95% CI, −0.46 to 0.12; P = .049). Congenital cytomegalovirus significantly decreased interval III-V in preterm infants (95% CI, −0.36 to −0.01; P = .042). Multivariate analysis revealed that gentamicin use, lower gestational age, and lower birth weight predicted an increased ABR threshold in preterm infants (95% CI, 1.64-15.31; P = .016; 95% CI −1.72 to −0.09; P = .030; 95% CI, −14.55 to −0.63; P = .033). ABR measurements in term infants were not significantly altered, with the exception of an increased latency of wave III with a lower gestational age (95% CI, −0.49 to −0.01; P = .038). Conclusions These findings suggest that perinatal problems in the NICU significantly impair the ABR threshold and the auditory pathway maturational process in preterm but not term infants.

Objectives: Given that 30-50% of children with Down syndrome have persistent obstructive sleep apnea (OSA) after adenotonsillectomy, we evaluated whether demographic, clinical and polysomnographic factors predicted persistent OSA and OSA