Summary. Rationale: Increased neck circumference is a risk factor for obstructive sleep apnea in adults. With rising obesity prevalence in children, it may be an important identifier of obstructive sleep apnea in children. The reliability of measuring neck circumference in children has not been systematically evaluated. Objective: To determine the inter-and intra-rater reliability of neck circumference measurements in children aged 2-16 years. Methods: Children aged 2-16 years with limb fractures were recruited. Neck circumference was measured by three investigators each using two separate unmarked paper tapes in the 2-5 year age group (N ¼ 43), and three separate tapes in the 6-10 and 11-16 year age groups (N ¼ 18 and 40). Results: Neck circumference measurements showed excellent inter-rater reliability for children 6-10 and 11-16 years (ICC ¼ 0.952 and 0.989). Substantial variation was observed for the 2-5 year age group (ICC ¼ 0.701). Good intra-rater reliability was demonstrated for the three groups (ICC range: 0.776, 0.950). Repeatability coefficients were 2.5-3.4 cm in the youngest age group and were 1.2-1.4 cm in the 6-16 year age group. Conclusion: In children 6-16 years old, neck circumference shows very good inter and good intra-rater reliability. Multiple measurements are not required for precision and reliability.

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Objective Sleep‐disordered breathing (SDB) is common in children with Down syndrome, but the trajectory and long‐term outcomes are not well‐described. In a retrospective longitudinal cohort of children with Down syndrome, study objectives were to (1) characterize polysomnography (PSG), treatments received, and persistence/recurrence of SDB and (2) explore predictors of SDB persistence/recurrence. Methods A retrospective cohort study was conducted of children who underwent PSGs between 2004 and 2014. SDB was defined as obstructive sleep apnea (OSA)‐mixed (apnea‐hypopnea index [AHI] >5 events/hour), central sleep apnea or hypoventilation. PSGs, interventions, and trajectory of SDB were described. Age, body mass index (BMI) Z‐score and AHI at first SDB diagnosis were evaluated as predictors of persistent/recurrent SDB. Results Of 506 children, 120 had ≥1 PSG; 54 had subsequent PSGs. Children with ≥2 PSGs were more likely to have higher total AHI (P = .02) and obstructive‐mixed AHI (P = .01). Thirty‐five of fifty‐four (65%) were initially diagnosed with OSA‐mixed SDB. After first PSG, 67 of 120 had OSA‐mixed SDB, of whom 25 (37.3%) underwent adenotonsillectomy (T&A), 13 (19.4%) received positive airway pressure (PAP). Those who underwent T&A after PSG were significantly younger than those who received PAP (median age 6.2 vs 12.5 years; P = .005). OSA‐mixed SDB persisted/recurred in 33 of 54 (73.3%) with ≥2 PSGs. Persistence/recurrence was not associated with age, AHI or BMI Z‐score at first SDB. Conclusion Children with Down syndrome undergoing T&A for SDB were significantly younger than those treated with PAP. SDB persisted/recurred in three of four and was not predicted by age, SDB severity or BMI Z‐score. Longitudinal PSG assessment for persistence/recurrence of SDB is required in this population.

Children and youth with NC>95th percentile for age and sex have significantly increased risk of OSA. This effect is significant in males ≥ 12 years, whereas BMI is not. NC percentile may be an additional screening tool for OSA in children and youth.

Sensitization, as measured by panel reactive antibodies (PRAs), occurs as a result of previous organ transplantation, blood transfusions, or pregnancy. The high-PRA levels increase the risk of complications during transplantation and may result in long time duration for future transplants. Mycophenolate mofetil (MMF) has been shown to decrease lymphocyte proliferation and antibody formation. We report the use of prophylactic MMF in preventing the formation of PRAs in a pediatric renal transplant recipient with multiple donor exposures. A four-yr-old girl received an unsuccessful living-related renal transplant in February 2003 and was subject to multiple blood transfusions in the perioperative period. MMF, 500 mg/m2/day in two divided doses, achieved suppression of PRAs to less than 20% and allowed successful renal transplantation within nine months. No side effects occurred. This approach may reduce the risk of sensitization in future potential organ donor recipients in similar situations.

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