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      Poligrafía en menores de 3 meses hospitalizados Translated title: Polygraphy in hospitalized children under 3 months

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          Abstract

          La apnea y eventos aparentemente letales poseen una gran diversidad etiológica por tanto exámenes complementarios podrían contribuir a su diagnóstico. El objetivo del presente estudio fue describir los resultados de estudios poligráficos de niños menores de 3 meses hospitalizados con sospecha de apnea. Pacientes y Método: Serie retrospectiva de casos. Se consideraron niños menores de 3 meses con sospecha de apnea y en quienes se realizó una poligrafía (PG) durante su hospitalización. Se registraron datos generales, así como también, el índice de apnea/hipopnea (IAH), índice de apnea central, índice de apnea obstructiva, saturación promedio y mínima. Como criterios de trastornos respiratorios del sueño (TRS) fueron considerados: índice de desaturaciones (ID) por debajo de 80% mayor 1 por hora; uno o más eventos de desaturaciones por debajo de 80% por más de 20 segundos; o un IAH mayor o igual 1. Se realizó estadística descriptiva y se determinó la posible asociación entre el IAH y parámetros de saturación. Resultados: Ingresaron 51 pacientes, 32 varones. 8 (15,6%) presento PG alteradas, de ellos, en 5 coexistió más de un criterio diagnóstico. En el 15,6% se observó un IAH mayor o igual a 1, en el 7,8% se observó un índice de desaturación bajo 80% y en el 11,8% un índice de desaturación bajo 80% por más de 20 segundos. El IAH se asoció con los parámetros de saturación. Conclusión: La mayoría de los pacientes presentó PG normales y entre los pacientes con TRS predominó un patrón poligráfico sugerente de inmadurez respiratoria, lo cual, es característico de esta edad.

          Translated abstract

          Apnea and apparently lethal events have great etiological diversity thus complementary tests may help diagnosis. The aim of this study was to describe the results of polygraph studies of children under 3 months hospitalized with suspected apnea. Patients and Methods: Retrospective case series. Children under 3 months with suspected apnea were considered and in whom a polygraphy (PG) was performed during hospitalization. General data, the apnea/hypopnea index (AHI), index of central. apnea, obstructive apnea index, average and minimum saturation were recorded. Desaturation index (ID) below 80% higher 1 per hour, one or more events of desaturation below 80% for more than 20 seconds or an AHI greater than or equal 1 were considered as criteria of sleep disorder breathing (SLB). Descriptive analysis was performed and the associations between AHI and saturation parameters were determined. Results: 51 patients, 32 males, entered the study. 15,6% had altered PG. In 5 of them coexisted more than one diagnostic criterion. Iin 15,6% of the patients was observed an IAH greater 1, in 7.8% a desaturation index below 80% and in 11,8% a desaturation index under 80% for 20 seconds greater than 1. The AHI was associated with the parameters of saturation. Conclusion: Most of the patients had normal PG and among patients with a suggestive SLB a pattern of respiratory immaturity prevailed, which is characteristic of this age.

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          Feasibility of unattended home polysomnography in children with sleep-disordered breathing.

          To investigate the technical feasibility of unattended polysomnography (HPSG) for diagnosis of obstructive sleep apnea (OSA) in children.
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            Apparent life-threatening events: an update.

            Based on strong research evidence, the most common causes of apparent life-threatening events (ALTEs) are gastroesophageal reflux, lower respiratory tract infection, and seizure. • The minimum initial diagnostic panel for ALTE should include complete blood cell (CBC) count with differential; blood levels of C-reactive protein,glucose, sodium, potassium, urea, calcium,magnesium, ammonia, lactate, and pyruvate; arterial blood gas determination, urinalysis, and toxicology screen; electrocardiography; and assessments for Bordetella pertussis and respiratory syncytial virus in season. • Other testing should be done based on the infant’s clinical presentation and clinician’s degree of suspicion.• Most infants should be hospitalized for cardiorespiratory monitoring for 23 hours after an ALTE. • There is strong evidence that newborns are at higher risk of ALTE and sudden infant death syndrome (SIDS)within the first 24 hours after birth and therefore should be frequently monitored as much as possible while room sharing with their mothers. • Evidence suggests that maternal smoking may place an infant for higher risk of SIDS after an ALTE.
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              Reference values for pulse oximetry recordings in healthy term neonates during their first 5 days of life.

              To determine reference values for pulse oximeter saturation (SpO(2)) variables and desaturation event indices in healthy term neonates during their first 5 days of life, and to compare two definitions for the identification of desaturation events. Observational study (case series). Setting Maternity ward, Department of Neonatology, University Children's Hospital, Tuebingen, Germany. 209 healthy term neonates (50% boys), median (minimum-maximum) age 2 (0-5) days. SpO(2) variables (eg, median SpO(2)) and desaturation events obtained by motion-resistant pulse oximetry (VitaGuard 310; Getemed, incorporating Masimo SET). Desaturation events were identified based either on a good signal quality (SIQ) provided by the device or on the combination of a good SIQ and an undisturbed pulse waveform (SIQ+PW). Desaturation event indices were calculated as desaturation events divided by hour of artefact-free recording time. The mean (SD) of the obtained median SpO(2) was 97.3% (1.4%). There were 36 (17%) subjects with desaturation events to <80% SpO(2) based on SIQ, and 26 (12%) based on SIQ+PW. Median desaturation event rate to <80% SpO(2)/h (75th centile; 95th centile; maximum) was 0 (0; 0.6; 2.3) based on SIQ, and 0 (0; 0.4; 1.7) based on SIQ+PW. Desaturation events to <80% SpO(2) were rare in our sample of healthy term neonates during their first 5 days of life. Analysis of SIQ alone could be a quick and simple alternative to traditional analysis of PW. The presented reference values may be used for clinical decision making.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcp
                Revista chilena de pediatría
                Rev. chil. pediatr.
                Sociedad Chilena de Pediatría (Santiago, , Chile )
                0370-4106
                April 2017
                : 88
                : 2
                : 230-235
                Affiliations
                [02] Concepción orgnameUniversidad San Sebastián orgdiv1Facultad de Ciencias de la Salud orgdiv2Escuela de Kinesiología Chile
                [04] Concepción orgnameHospital Guillermo Grant Benavente Chile
                [01] Concepción orgnameUniversidad de Concepción orgdiv1Facultad de Medicina orgdiv2Hospital Guillermo Grant Benavente Chile
                [05] Santiago orgnamePontificia Universidad Católica de Chile orgdiv1Escuela de Medicina orgdiv2Departamento de Cardiología y Respiratorio Pediátrico Chile
                [03] orgnameUniversidad de Concepción orgdiv1Facultad de Medicina orgdiv2Departamento de Pediatría Chile
                Article
                S0370-41062017000200006
                10.4067/S0370-41062017000200006
                367f29e8-b465-4796-a74a-f9d74d5993dc

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 27 September 2016
                : 04 February 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 6
                Product

                SciELO Chile


                Poligrafía,Lactante,Apnea,Trastorno respiratorio del sueño,Poligraphy,Infant,Sleep disorder breathing

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