We read with interest the article by Zielinsky et al. 1 , and we have some questions about the study methods and conclusions.In this paper, Zielinsky et al. 1 show alterations in ductal dynamics in fetuses exposed to polyphenol-rich foods and argued that maternal consumption of polyphenol-rich food is a risk factor for ductal constriction.Our first concern is related to the study design: was it a prospective study or a transversal study? The relative risks were adjusted for gestational age?Although the paper says: 'Pregnant women with systemic abnormalities or taking any medicines were excluded from the study', what about other confounding factors? Were the patients asked about smoking and illicit drug use that could also amend the echocardiography parameters? Some other important factors can also modify the fetal echocardiography during the pregnancy as urinary tract infection, diabetes, asthma or vaginal bleeding, with potentially harmful consequences in the neonatal period, such as pulmonary hypertension. Other confounding factors such as education, race or ethnicity, fetal gender and prepregnancy body mass index (BMI) could also affect the results. 2 Mean maternal BMI is described as 28.13±3.00 kg/m 2 , and the literature shows that persistent pulmonary hypertension of the newborn occurs in 15.5% in women with BMI >27 kg/m 2 and 7.2% for those with BMI <20 kg/m 2 . We question whether both groups presented similar BMI values.We calculated the effect size of mean peak systolic velocity as 1.61 (1.20-2.01), mean diastolic velocity was 1.27 (0.87-1.65) and mean right-to-left ventricular dimensions ratio (RV/LV) ratio was 1.39 (0.99-1.78), and although it seems a large effect, these variations do not have clinical relevance. Other point is the determination of the cutoff points: fetal systolic ductal velocity >0.85 m/s, diastolic velocity >0.15 m/s and RV/LV >1.1. Have they been determined by an receiver-operator characteristic curve with the maternal consumption of polyphenol-rich food? Would it not be interesting to use the known ultrasound parameters as shown in users of nonsteroidal anti-inflammatory drugs 3,4 with constrictive effect on the fetal ductus? We really think it is extremely important to follow-up the newborns in neonatal life to verify the real impact of these findings. The modifications in sonographic parameters and the other known risk factors may suggest a need for monitoring and intervention during antenatal period.Although differences were founded in mean diastolic velocity and mean diastolic velocity between the groups, both values are in the normal range. Previous reports suggest that a peak systolic velocity of >1.4 m/s and a diastolic peak flow velocity >0.35 m/s are suggestive of ductal constriction. 5 Huhta et al. 6 described the maximum systolic velocity ranged from 50 to 140 cm/s, with a mean of 80 cm/s and normal ductal velocity in diastole ranged from 6 to 30 cm/s in >20 weeks fetuses. This fact does not permit to state that 'changes in perinatal dietary orientation are warranted'...
response was collected unanimously by teachers. High risk children for sleep apnea were identified using apnea-associated symptoms related either to sleeping, anxiety, attention deficiency or emotional behavior. The participants whose information was not available were omitted from the analysis. Uni-variable and multivariable regression and logistic analyses were conducted, using SAS version 9.0 software. Results: More than 90% of care-givers responded to the questionnaire, and 75% of them revealed the STBUR score of 0, while 0.3% did STBUR score of 3 or greater. Mostly 1,800 pupils were regarded as having higher risk for sleep apnea, and thus invited for detailed examination. Data from around 700 participants were available for the subsequent analysis. The prevalence of severe sleep apnea (RDI = 5 or over) was 0.9% in those with STBUR scores of 0, 3.0% with STBUR scores of 1, 6.4% with STBUR scores of 2, and 13.3 with STBUR scores of 3, 4, and 5. According to multivariable logistic analysis odds ratio (95% confidence interval) vs STBURN score 0 were 3.54 (0.76 to 16.64) in STBURN score 1, those STBURN score 2 were 8. Children's Hospital of Philadelphia, Philadelphia, PA Introduction: Pediatric obstructive sleep apnea (OSA) is more common in obese children. However, the role of fat distribution in the pathogenesis of OSA in this age group is controversial. We evaluated the association of OSA to excess adiposity and abdominal fat. We hypothesized a positive correlation between anthropometric parameters and OSA and an inverse correlation between obesity and the oxyhemoglobin saturation (SpO2) nadir in a large sample of school-aged children with OSA. Methods: We investigated the baseline data from the childhood adenotonsillectomy trial (CHAT). The relationship between apnea hypopnea index (AHI), SpO2 nadir, peak CO 2 during sleep and body-mass index Z-score (BMI z-score), waist:height ratio (WTHR) and neck:height ratio (NHR) was evaluated. AHI was evaluated using linear regression in log scale which improved its distribution towards normal. Other outcomes were evaluated using Spearman correlations. Results: 452 children were analyzed (52% girls). The mean ± SD age was 7 ± 1.4years. The mean BMI Z-score was 0.8 ± 1.3. There was a positive correlation between log AHI and BMI r=0.10, p=0.03) and WTHR; (β=1.00, r=0.10, p=0.03), and an inverse correlation between SpO2 nadir and BMI z-score (r=-0.19, p=0.00005), and WTHR (r=-0.17, p=0.0002) and NHR (r=-0.12, p=0.008). When corrected for multiple comparisons, there remained an inverse correlation between SpO2 nadir and BMI z-score and SpO2 nadir and WTHR. Conclusion: BMI Z-score and WTHR, an index of visceral fat, correlate with the degree of desaturation during sleep in school-age children. However, in contrast to adults, anthropometric measures do not correlate with indices of upper airway obstruction such as the AHI. We speculate that restrictive lung disease and a lower pulmonary reserve
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