Journal Club: Colic, snorers with high BP and lice killers

November 1, 2009

Journal research looks at elevated BP in children who snore, leading treatments for lice and cause of colic.

Study may shed light on cause of colic

By studying whether colonization patterns of the major gas-forming coliforms differ in colicky infants and healthy controls, investigators in Turin, Italy, examined the hypothesis that colonic gas production and dismicrobism are implicated in infantile colic.

Study patients were 80 exclusively breast-fed infants from 4 to 16 weeks of age: 41 had a diagnosis of colic, 39 did not.

Commentary

This study complements previous work by Savino et al that showed the benefit of probiotic modification of gut flora in colicky infants (Pediatrics. 2007;119:e124-e130). It may be that poor gut flora is what is ailing at least some unhappy babies. -MB

BLOOD PRESSURE IS ELEVATED IN CHILDREN WHO SNORE

Primary snoring appears to be an aspect of the dose-response relationship between sleep-disordered breathing and blood pressure (BP) measurements, according to a study conducted in youngsters from 6 to 13 years of age who were recruited from 13 Hong Kong schools.

Parents of 466 children completed an obstructive sleep apnea (OSA) questionnaire that stratified their offspring as low or high risk for OSA. All children at high risk and a randomly selected sample of those at low risk underwent overnight polysomnography and ambulatory BP monitoring. Data for 190 children, limited to those who were prepubertal and of normal weight, were included in the final analysis. The limitations controlled for the potential confounding of obesity and pubertal growth, both of which are associated with elevated BP. Median age of the study patients was 10 years.

Of the 190 children, 46 were found to snore, 56 did not snore (the controls), 62 had OSA with an apnea-hypopnea index of 1 to 3, and 26 had OSA with an apnea-hypopnea index of more than 3. Daytime and nighttime BP increased across the severity spectrum from no snoring to snoring and to increasing OSA severity. This relationship remained significant even after adjusting for age, sex, and body mass index. The dose-response trends for the patients with nighttime systolic and diastolic hypertension also were significant. The authors concluded that primary snoring could be the beginning of the severity spectrum of sleep-disordered breathing and that the condition therefore should no longer be considered entirely benign (Li AM et al. J Pediatr. 2009;155:362-368.e1).

Commentary

It makes sense that sleep-associated upper airway obstruction is a spectrum, rather than an all-or-nothing condition. These authors have helped define the lower end of this scale. In doing so, they may have changed how we think about the snoring child. -MB