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OBJECTIVE: To determine whether parents' observations can be used to predict the severity of the obstructive sleep apnoea syndrome (OSAS) in children. STUDY DESIGN: Sixty-five children with OSAS diagnosed by overnight polysomnography were consecutively recruited and classified as having severe or non-severe OSAS according to the obstructive apnoea index (OAI) and the oxygen saturation measured by pulse oximetry (SpO2) nadir. Parents were asked to complete a questionnaire about the child's breathing difficulties at night. RESULTS: Twenty-eight patients were classified as severe OSAS and 37 as non-severe OSAS. There were no differences between the two groups with respect to age, sex or body mass index. Male to female ratio was 5:1. Parents of children with severe OSAS more frequently reported observed cyanosis (35 vs 8%; p=0.02); obstructive apnoea (60 vs 35%; p = 0.04); snoring extremely loudly (52 vs 22%; p = 0.01); shaking the child (64 vs 35%; p = 0.02); watching the child during sleep and being afraid of apnoea (85 vs 60%; p = 0.03). However, neither any single nor combinations of observations showed high values for both sensitivity and specificity. CONCLUSIONS: Although some parents' observations are more frequently reported in children with severe OSAS, neither any single nor combinations of observations accurately predict the severity of OSAS. Polysomnography is still needed to determine the severity of obstruction.

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Twenty-four children (aged 6-15 years, M:F = 1:11) with systemic lupus erythematosus (SLE), who had respiratory symptoms, were retrospectively reviewed. Chest radiographs obtained from all patients revealed pleural effusion in 13, alveolar infiltration in 9, pericardial effusion and cardiomegaly in 6, interstitial infiltration in 4, hilar adenopathy in 3, lung abscess in 2 and pneumatocele with pneumothorax in 1. Etiologic organisms were identified in 7 cases; (3 cases of nocardia isolated from pleural effusion and sputum, 2 cases of tuberculosis, 1 case with staphylococcus aureus septicemia and 1 case with salmonella septicemia). All except one patient improved with medical treatment. One patient died from pneumonitis. Although pulmonary involvement is increasingly recognized in children with SLE, neither roentgenogram nor clinical findings were specific. The differentiation of pulmonary infiltrates caused by lupus lung disease from pulmonary infection should be carefully evaluated.

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OBJECTIVE: To report the occurrence of asthma, pulmonary function and exercise challenge test abnormalities found in Thai children, who 10 years earlier had lower respiratory tract infection caused by respiratory syncytial virus (RSV-LRI). PATIENTS AND METHODS: 37 children, with RSV-LRI admitted at Ramathibodi Hospital during January 1986 through December 1987, were contacted, of whom 13 patients responded and completed history-review-questionnaires. Pulmonary function measurements at pre- and post-exercise and testing for bronchodilator response were performed. RESULTS: The occurrence of physician-diagnosed asthma in the patients with and without family history of allergic diseases was 75 per cent and 40 per cent, respectively. Of 11 patients who performed spirometry, 45 per cent had concave flow-volume curves, 36 per cent showed decreased ratio of forced expiratory flow in the first second (FEV1) to forced vital capacity (FVC) and 27 per cent showed either decreased forced expiratory flow between 25-75 per cent of FVC (FEF25-75%) or peak expiratory flow rate (PEFR). Of 8 patients who completed exercise challenge tests, 87.5 per cent showed markedly decreased PEFR at post exercise challenge tests and 37.5 per cent had markedly decreased FEV1. 62.5 per cent and 25 per cent showed markedly increased PEFR and FEV, respectively, after inhalation of bronchodilators. CONCLUSION: This study suggests that the occurrence of asthma in children, who had previous RSV-LRI, is relatively high compared with that reported in general Thai children. Baseline pulmonary function tests showed evidence of airway obstruction as demonstrated by concave-shaped flow-volume curves, decreased FEV1/FVC ratio, FEF25-75% and PEFR. The presence of bronchial hyperreactivity to exercise challenge test and positive response to bronchodilators confirms the evidence of exercise-induced bronchospasm in children with history of RSV-LRI.

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Overnight polysomnography was conducted in 39 Thai children with clinically suspected obstructive sleep apnea syndrome (OSAS) during the years 1994 to 1996. Eighty-five percent of these children met the polysomnographic criteria of pediatric OSAS, 42.4% among whom had severe OSAS. Male : female ratio of children with OSAS was 4.5:1. The peak age at the time of diagnosis was 3 to 4 years. The most common predisposing factor was adenoidal and tonsillar hypertrophy. Adenoidectomy and/or tonsillectomy was the most effective therapeutic option. Recovery of symptoms was observed following surgery and nasal continuous positive airway pressure.

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Reduced forced vital capacity may confound assessment of small-airway function. In 17 healthy and 16 asthmatic volunteers, we validated a method for measuring mean expiratory flow during the middle half of the forced vital capacity, mean expiratory flow during the third quarter of the forced vital capacity, instantaneous forced expiratory flow at 50% of forced vital capacity , and instantaneous expiratory flow at 75% of forced vital capacity. These measurements were conducted at the same absolute lung volume (isovolume) when forced vital capacity was reduced voluntarily to 100%, 85%, and 75% of maximum, and the variances, expressed as the coefficients of variations, were compared. Absolute lung volumes above residual volume were determined with two reference spirograms: 100% and 75% forced vital capacity. In normals, means of flow rates at the same absolute lung volume did not differ with the three forced vital capacities, regardless of whether the 100% or 75% forced vital capacity served as the reference spirogram. Reduced forced vital capacity among asthmatics was associated with modest increases in isovolume flow rates, an effect that may underestimate airway narrowing. Intrasubject variability was least among volume-averaged flow rates (e.g., mean expiratory flow during the middle half of the forced vital capacity). Volume-adjusted flow rates can be used to assess small-airways narrowing when forced vital capacity is reduced, and volume-averaged rates provide the least variability.

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Breast feeding seems to be a cause of neonatal jaundice during the first five days of life; the mechanism of which needs further study. Thai infants appear to exhibit a higher level of "physiological jaundice" bilirubin level than Caucasians.

PIP: Neonatal jaundice remains the most common problem in the well baby nursery. Pediatricians and neonatologists believe that breast-fed infants have a generally increased severity of jaundice during the first week of life. The authors report findings from their study of whether healthy breast-fed Thai infants have significantly higher serum bilirubin levels than those of formula-fed infants in the first 3-5 days of life. Of 190 infants born, 130 were delivered by cesarean section. The authors studied 76 infants fed with formulated milk and 54 fed with breast milk; the study did not include infants who were delivered normally and fed with formulated milk. All mothers with normal delivery insisted upon breast feeding, while discomfort among many mothers who delivered by cesarean section led them to agree to feed their babies with formulated milk. The study found breast feeding to be an apparent cause of neonatal jaundice during the first five days of life, although more study is needed on the phenomenon. Thai infants seem to have more physiological jaundice than Caucasians.

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