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Ventilatory function in children with severe motor disorders using night-time postural equipment.

Nicola C Dawson1, Kathryn A Padoa, Romola S Bucks

  • 1Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.

Developmental Medicine and Child Neurology
|April 16, 2013
PubMed
Summary

Night-time postural equipment (NTPE) may impact breathing in children with severe motor disorders (SMDs). Monitoring for at least three nights is recommended to ensure safe and effective ventilation, especially due to night-to-night variability.

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Area of Science:

  • Pediatric Pulmonology
  • Rehabilitation Engineering
  • Neuromuscular Disorders

Background:

  • Night-time postural equipment (NTPE) is crucial for preventing hip subluxation in children with severe motor disorders (SMDs).
  • The impact of NTPE on ventilatory function in this population remains largely uncharacterized.
  • Understanding these effects is vital for comprehensive care of children with SMDs.

Purpose of the Study:

  • To investigate the effects of NTPE on ventilatory function in children with SMDs.
  • To compare the night-to-night variability of ventilatory function between children with SMDs using NTPE and typically developing children.
  • To identify potential risks and benefits of NTPE concerning respiratory health.

Main Methods:

  • A crossover study design was employed, with 15 children with SMDs (GMFCS IV-V) alternating between NTPE and unsupported sleep for 14 nights.
  • Oxyhaemoglobin saturation (SpO2) was monitored nightly, and transcutaneous carbon dioxide (PtcCO2) was measured for one night in each condition.
  • Seventeen typically developing children underwent SpO2 monitoring for seven nights for comparison.

Main Results:

  • Satisfactory SpO2 monitoring was achieved in most participants (13/15 SMDs, 12/17 controls).
  • One child with SMDs experienced SpO2 levels below the supplemental oxygen threshold uniquely with NTPE use.
  • Nocturnal hypoventilation was observed in three children with SMDs, uniquely associated with NTPE in one case.
  • Night-to-night SpO2 variability was significantly higher in children with SMDs compared to controls.

Conclusions:

  • NTPE can potentially impair or enhance ventilatory function in a subset of children with SMDs.
  • Significant night-to-night variability in SpO2 necessitates extended monitoring.
  • A minimum of three nights of monitoring is recommended to assess optimal positioning for effective ventilation before and after NTPE introduction.