Pediatric News Items-Fall 2012

Dr. James Lee's Blog - PediatricsTwo recent AAP guidelines were published which I thought would warrant review.

A.      Guidelines for diagnosis and management of childhood obstructive sleep apnea (OSA) syndrome

Upwards of 5% of children experience OSA, a medical condition characterized by prolonged, partial obstruction of the upper airway during sleep. Apnea implies actual interruption or pauses during breathing. OSA can be overlooked if not specifically questioned about.  OSA is associated with both short and long term complications which include learning and behavioral problems, cardiovascular complications such as hypertension and enlarged heart and growth concerns. The pediatric literature is now very clear about the significance and complications of OSA. The updated guidelines have the following recommendations:

  1. Healthcare professionals should screen for and parents should question the relevance of snoring or other disordered sleep patterns.
  2. Children with a positive history for OSA signs or symptoms should be evaluated by a sleep study (preferred) or by a specialist (sleep specialist or ENT).
  3. For confirmed cases, a T and A is the first line treatment. High risk patients undergoing T and A for OSA need overnight post-operative observation. High risk is defined as less than 3 years old, severe OSA on sleep study, over or under weight, other genetic neuromuscular or respiratory conditions.
  4. Patients should have follow up reassessment to verify improvement, ideally in 6-8 weeks.

Fortunately, pediatric sleep studies are available at our nearby university centers with outreach at FMH.

B.     Health benefits of newborn circumcision

The AAP has not historically made a circumcision recommendation, previously stating there was insufficient evidence for a recommendation either way. A newly released policy statement still does not recommend routine circumcision but does say that current evidence indicates the health benefits of the procedure outweigh the risks. Since the last policy statement in 2005, more recent studies suggest that newborn circumcision can reduce UTI’s, penile cancers and some sexually transmitted infections (HPV and HIV).

The AAP stressed that the decision to circumcise should be made by the parents, allowing for cultural, religious and ethical beliefs to play a primary role in the decision. Health professionals should inform parents of the health benefits and risks in an unbiased manner.

– Dr. James Lee, Pediatrician

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