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BACKGROUND:The upper airway humidifies and warms inspired gases before they reach the trachea, a process bypassed by the insertion of a tracheostomy, necessitating humidification of inspired gases. The optimal method of humidification is not known. METHODS: We conducted a short-term 20-hour study and a long-term 10-week randomized crossover study comparing a heated humidifier (HH) to a heat and moisture exchanger (HME) in children with established tracheostomies. Subjects were assessed for clinical events, clinical examination findings, airway cytokine levels, and airway secretion viscoelasticity. RESULTS: For the short-term study, 15 children were recruited; for the long-term study, 14 children were recruited. Children using the HH had decreased respiratory examination score (P < .001) but no change in clinical events over the short term. There was a decrease in acute clinical events (P ‫؍‬ .008) in the long-term study. No differences were found in airway secretion viscoelasticity results or cytokine levels in either study, but these sample numbers were limited. CONCLUSIONS: Over 20 hours use, HH, compared to HME, improved work of breathing. Over a longer 10 week treatment period HH resulted in decreased adverse clinical events.

ObjectiveTo establish the most effective and best tolerated dose of caffeine citrate for the prevention of intermittent hypoxaemia (IH) in late preterm infants.DesignPhase IIB, double-blind, five-arm, parallel, randomised controlled trial.SettingNeonatal units and postnatal wards of two tertiary maternity hospitals in New Zealand.ParticipantsLate preterm infants born at 34+0–36+6 weeks’ gestation, recruited within 72 hours of birth.InterventionInfants were randomly assigned to receive a loading dose (10, 20, 30 or 40 mg/kg) followed by 5, 10, 15 or 20 mg/kg/day equivolume enteral caffeine citrate or placebo daily until term corrected age.Primary outcomeIH (events/hour with oxygen saturation concentration ≥10% below baseline for ≤2 min), 2 weeks postrandomisation.Results132 infants with mean (SD) birth weight 2561 (481) g and gestational age 35.7 (0.8) weeks were randomised (24–28 per group). Caffeine reduced the rate of IH at 2 weeks postrandomisation (geometric mean (GM): 4.6, 4.6, 2.0, 3.8 and 1.7 events/hour for placebo, 5, 10, 15 and 20 mg/kg/day, respectively), with differences statistically significant for 10 mg/kg/day (GM ratio (95% CI] 0.39 (0.20 to 0.76]; p=0.006) and 20 mg/kg/day (GM ratio (95% CI] 0.33 (0.17 to 0.68]; p=0.003) compared with placebo. The 20 mg/kg/day dose increased mean (SD) pulse oximetry oxygen saturation (SpO2) (97.2 (1.0) vs placebo 96.0 (0.8); p<0.001), and reduced median (IQR) percentage of time SpO2 <90% (0.5 (0.2–0.8) vs 1.1 (0.6–2.4); p<0.001) at 2 weeks, without significant adverse effects on growth velocity or sleeping.ConclusionCaffeine reduces IH in late preterm infants at 2 weeks of age, with 20 mg/kg/day being the most effective dose.Trial registration numberACTRN12618001745235.

ObjectiveTo determine if administration of oral prednisolone to preschool children with acute wheeze alters respiratory outcomes.DesignDouble-blind, randomised, placebo-controlled equivalence trial.SettingThree hospitals in New Zealand.Patients477 children aged 24–59 months with acute wheeze associated with respiratory illness.Interventions2 mg/kg (maximum 40 mg) oral prednisolone or similar placebo, once daily for 3 days.Main outcome measuresPrimary outcome was change in Preschool Respiratory Assessment Measure (PRAM) score 24 hours after intervention. Secondary outcomes included PRAM score at 4 hours, length of emergency department and inpatient stays, admission and representation rates, time to return to normal activities and use of additional oral prednisolone or intravenous medications. Analysis was by intention-to-treat.ResultsThere was no difference between groups for change in PRAM score at 24 hours (difference between means −0.39, 95% CI −0.84 to 0.06, p=0.09). Absolute PRAM score was lower in the prednisolone group at 4 hours (median (IQR) 1 (0–2) vs 2 (0–3), p=0.01) and 24 hours (0 (0–1) vs 0 (0–1), p=0.01), when symptoms had resolved for most children regardless of initial treatment. Admission rate, requirement for additional oral prednisolone and use of intravenous medication were lower in the prednisolone group, although there were no differences between groups for time taken to return to normal activities or rates of representation within 7 days.ConclusionOral prednisolone does not alter respiratory outcomes at 24 hours or beyond in preschool children presenting with acute wheeze.