Data analysis using this classification system revealed that the majority of children in this sample had a behavioral component to their complex feeding problem, regardless of concurrent physical factors. These findings suggest that complex pediatric feeding problems are biobehavioral conditions in which biological and behavioral aspects mutually interact, and both need to be addressed to achieve normal feeding.

Abstract-Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index Ͻ5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity. Key Words: sleep apnea Ⅲ children Ⅲ ambulatory blood pressure Ⅲ blood pressure surge Ⅲ blood pressure load Ⅲ cardiac remodeling Ⅲ hypertrophy T he association between sleep disordered breathing (SDB) and cardiovascular morbidity in adults has become an important consideration in the management of patients with SDB. Results from numerous cross-sectional and prospective studies of blood pressure (BP) control in adults support the concept that hypertension is an intermediate end point between SDB and cardiovascular disease. 1,2 Further support of this concept is derived from studies linking SDB to atherosclerotic pathways. [3][4][5][6] These studies provide insight into the mechanisms of vascular injury secondary to SDB. Although the impact of duration of this disorder on the development of risk factors for cardiovascular disease is difficult to estimate, morbidity secondary to SDB seems to manifest gradually, often taking decades. As such, with the exception of isolated cases of heart failure, children with SDB rarely show evidence of cardiovascular disease. Thus far, studies addressing whether children with SDB acquire risk factors for the early development of cardiovascular disease are inconclusive.Findings from several pediatric studies suggest ...

Rationale: Adenotonsillectomy, the first line of treatment of sleepdisordered breathing (SDB), is the most commonly performed pediatric surgery. Predictors of the recurrence of SDB after adenotonsillectomy and its impact on cardiovascular risk factors have not been identified. Objectives: Demonstrate that gain velocity in body mass index (BMI) defined as unit increase in BMI/year confers an independent risk for the recurrence of SDB 1 year after adenotonsillectomy. Methods: Children with SDB and hypertrophy of the tonsils and a comparison group of healthy children were followed prospectively for 1 year. Measurements and Main Results: Serial polysomnographies, BMI, and blood pressure were obtained before adenotonsillectomy and 6 weeks, 6 months, and 1 year postoperatively. Gain velocity in BMI, BMI and being African American (odds ratios, 4-6/unit change/yr; 1.4/unit and 15, respectively) provided equal amounts of predictive power to the risk of recurrence of SDB. In the group that experienced recurrence, systolic blood pressure at 1 year was higher than at baseline and higher than in children who did not experience recurrence. Conclusions: Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. A long-term follow-up of children with SDB and monitoring of gain velocity in BMI are essential to identifying children at risk for recurrence of SDB and in turn at risk for hypertension. Keywords: growth velocity; adenotonsillectomy; sleep-disordered breathingOne of the most frequently encountered conditions associated with obesity is sleep-disordered breathing (SDB). In adults, the risk of SDB increases by 1.14 for every unit increase in body mass index (BMI) (1). In the pediatric population, the risk for developing SDB is fourfold greater in obese children than in children who are not obese (2). Although the prevalence of SDB in all children is believed to range from 2 to 3% (3-5), the prevalence in adolescents who are morbidly obese exceeds 50% (6, 7). Obesity is therefore strongly associated with abnormal upper airway control during sleep across all age groups.Adenotonsillectomy, the first line of treatment in the management of childhood SDB, is the most commonly performed surgical procedure in children. The annual rate of adenotonsillectomy in children aged 0 to 14 years ranges from 19 per 10,000 in Canada to 115 per 10,000 in the Netherlands (8). At least half of these procedures are performed to relieve symptoms of SDB. In the first few weeks after adenotonsillectomy, obese children with SDB have a less favorable response to surgery than lean children. However, neither the long-term outcome nor the factors that contribute to recurrence of the disorder after adenotonsillectomy are clearly understood. Moreover, the impact of recurrence of SDB on important cardiovascular risk factors, such as blood pressure (BP), has never been examined.Research investigating the relationship between adiposity and SDB h...

Pulmonary function was assessed in newborn wild-type and homozygous and heterozygous surfactant protein B (SP-B)-deficient mice after birth. SP-B+/+ and SP-B+/− mice became well oxygenated and survived postnatally. Although lung compliance was decreased slightly in the SP-B+/− mice, lung volumes and compliances were decreased markedly in homozygous SP-B−/− mice. They died rapidly after birth, failing to inflate their lungs or oxygenate. SP-B proprotein was absent in the SP-B−/− mice and was reduced in the SP-B+/− mice, as assessed by Western analysis. Surfactant protein A, surfactant proprotein C, surfactant protein D, and surfactant phospholipid content in lungs from SP-B+/− and SP-B−/− mice were not altered. Lung saturated phosphatidylcholine and precursor incorporation into saturated phosphatidylcholine were not influenced by SP-B genotype. Intratracheal administration of perfluorocarbon resulted in lung expansion, oxygenation, and prolonged survival of SP-B−/− mice and in reduced lung compliance in SP-B+/+ and SP-B+/− mice. Lack of SP-B caused respiratory failure at birth, and decreased SP-B protein was associated with reduced lung compliance. These findings demonstrate the critical role of SP-B in perinatal adaptation to air breathing.