A cohort study reporting normal oximetry values in healthy infants under 4 months of age using Masimo technology

Objective: To determine sleeping saturation indices in healthy infants using a modern pulse oximeter with motion artefact extraction technology. Design: Prospective cohort. Setting: Home. Subjects: Healthy term infants. Intervention: Nocturnal pulse oximetry at home at 1 month of age (Recording 1) and repeated at age 3-4 months (Recording 2). Parents documented sleep times. Visi-Download software (Stowood Scientific) analysed data with artefact and wake periods removed. Main outcome measures: Saturations (SAT50), desaturation index &gt;4% (DI4) and &gt;3% (DI3) from baseline/hour, delta index 12 s (DI12s), minimum saturations (SATmin), percentage time with saturations below 90% and 92%. Results: Forty-five babies were studied at 1 month and 38 babies at 3-4 months. Mean (CI) SAT50, DI4, DI3, DI12s and SATmin (CI) were 97.05 (96.59 to 97.52), 16.16 (13.72 to 18.59), 25.41 (22.00 to 28.82), 0.96 (0.88 to 1.04) and 80.4% (78.8% to 82.0%) at 1 month, respectively, and 97.65 (97.19 to 98.12), 8.12 (6.46 to 9.77), 13.92 (11.38 to 16.47), 0.72 (0.65 to 0.78) and 84.7% (83.3% to 86.1%) at 3-4 months. Median (CI) percentage times with saturations below 90% and 92% were 0.39 (0.26 to 0.55) and 0.82 (0.60 to 1.23), respectively, at 1 month and 0.11 (0.06 to 0.20) and 0.25 (0.17 to 0.44) at 3-4 months. For paired samples (n=32) DI4 (P=0.006), DI3 (P=0.03), DI12s (P=0.001), percentage time with saturations below 90% (P=0.001) and 92% (P=0.000) all fell significantly and SATmin (P=0.004) rose between the two recordings. Conclusion: Desaturation indices are substantially higher in young infants than older children where a DI4 over 4 is considered abnormal. These decrease by 3-4 months of age but still remain elevated compared with older children.</p

Sleep quality and noise: comparisons between hospital and home settings

Objective: Children and their parents report poor sleep in hospital and complain about noise. We aimed to measure sleep quality and noise levels in hospital and compare these to the home environment.Design: Observational within case controlled study. Setting: Paediatric medical wards at Southampton Children’s Hospital and bedrooms at home.Participants: Children aged 3-16 years and their co-sleeping parents. Interventions: Sleep quality was measured using actigraphy for a maximum of 5 nights in each setting. Median sound levels at the bedside were monitored overnight in a sub-group in both settings. Main outcome measures: Total sleep time, sleep efficiency, median sound levels overnight Results: 40 children and 16 mothers completed actigraphy in both settings. Children had on average 62.9 minutes, and parents 72.8 minutes per night less sleep in hospital than at home. Both children and parents had poorer sleep quality in hospital compared to home: mean sleep efficiency 77.0% v 83.2% children and 77.1%v88.9% parents respectively. Median sound levels in hospital measured in 8 children averaged 48.6 dBA compared to 34.7 dBA at home and exceeded World Health Organisation recommendations of 30dB.Conclusions: Children and their mothers have poor quality sleep in paediatric wards. This may impact the child’s behavior, recovery and pain tolerance. Sleep deprivation adds to parental burden and stress levels. Sound levels are significantly elevated in hospital and may contribute to poor sleep. Reduction in noise level could therefore lead to an improvement in sleep impacting both parent and child quality of stay. <br/

Can foodborne illness estimates from different countries be legitimately compared?: case study of rates in the UK compared with Australia, Canada and USA

Objective Mathematical models have gained traction when estimating cases of foodborne illness. Model structures vary due to differences in data availability. This begs the question as to whether differences in foodborne illness rates internationally are real or due to differences in modelling approaches.Difficulties in comparing illness rates have come into focus with COVID-19 infection rates being contrasted between countries. Furthermore, with post-EU Exit trade talks ongoing, being able to understand and compare foodborne illness rates internationally is a vital part of risk assessments related to trade in food commodities.Design We compared foodborne illness estimates for the United Kingdom (UK) with those from Australia, Canada and the USA. We then undertook sensitivity analysis, by recreating the mathematical models used in each country, to understand the impact of some of the key differences in approach and to enable more like-for-like comparisons.Results Published estimates of overall foodborne illness rates in the UK were lower than the other countries. However, when UK estimates were adjusted to a more like-for-like approach to the other countries, differences were smaller and often had overlapping credible intervals. When comparing rates by specific pathogens, there were fewer differences between countries. The few large differences found, such as virus rates in Canada, could at least partly be traced to methodological differences.Conclusion Foodborne illness estimation models are country specific, making international comparisons problematic. Some of the disparities in estimated rates between countries can be shown to be attributed to differences in methodology rather than real differences in risk

Psychometric properties and predictive value of a screening questionnaire for obstructive sleep apnoea in young children with Down syndrome

Study objectives: Obstructive sleep apnoea (OSA) is common in children with Down syndrome and is associated with adverse health and cognitive outcomes. Daytime clinical assessment is poorly predictive of OSA, so regular screening with sleep studies is recommended. However, sleep studies are costly and not available to all children worldwide. We aimed to evaluate the psychometric properties and predictive value of a newly developed screening questionnaire for OSA in this population. Methods: 202 children aged 6 months to 6th birthday were recruited, of whomich 188 completed cardio-respiratory sleep studies to generate an obstructive apnoea hypopnoea index (OAHI). Parents completed the 14-item Down syndrome OSA screening questionnaire. Responses were screened, a factor analysis undertaken, internal consistency calculated and receiver operator characteristic (ROC) curves drawn to generate an area under the curve (AUC) to assess criterion related validity. Results: Of 188 children who completed cardiorespiratory sleep studies; parents completed the screening questionnaire for 186. Of this study population 15.4% had moderate to severe OSA defined by an OAHI of &gt;5/hour. Sixty-three participants were excluded due to ‘unsure’ responses or where questions were not answered. Using the remaining 123 questionnaires a four-factor solution was found, with the 1st factor representing breathing related symptoms, explaining a high proportion of the variance. Internal consistency was acceptable with a Cronbach alpha of 0.87. ROC curves for the total score generated an AUC statistic of 0.497 and for the breathing subscale an AUC of 0.603 for moderate to severe OSA. Conclusion: A well designed questionnaire with good psychometric properties had limited predictive value to screen for moderate to severe OSA in young children with DS. The use of a screening questionnaire is not recommended. Screening for OSA in this population requires objective sleep study measure

Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery

Background: Remote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings. Methods: A mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004-2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians' perspectives on barriers to effective remote health service delivery. Results: Data from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians' to impact upon the quality of service delivery. Conclusion: Among Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians' adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants