Publications by authors named "Ajay Kevat"

Positional obstructive sleep apnea, in which there is a ≥ 2:1 predominance of obstructive events in the supine position, is a sleep-disordered breathing phenotype with a targeted treatment in the form of positional device therapy. We sought to determine the prevalence of positional obstructive sleep apnea in a cohort of children prescribed continuous positive airway pressure therapy, ascertain risk factors for the condition, and determine the associated continuous positive airway pressure treatment adherence rate. A retrospective cohort study of all children > 2 years old from a single tertiary paediatric centre prescribed continuous positive airway pressure therapy over an 8-year period was conducted.

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Article Synopsis
  • Osteogenesis imperfecta (OI) is a rare bone disorder in children, primarily known for its orthopedic issues, but respiratory complications are underreported.
  • The case study focuses on an infant with genetically confirmed Type 2 OI who experienced significant respiratory insufficiency, detailing clinical, radiological, and histopathological findings.
  • It emphasizes the need for better awareness and management of respiratory challenges in patients with OI.
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Article Synopsis
  • - U-Sleep, an automated sleep stager, was tested for accuracy against trained human scorers using a dataset of 50 pediatric polysomnograms and a larger clinical dataset of 3114 polysomnograms to see if it can effectively replace human analysis.
  • - The study found that U-Sleep's performance was statistically equivalent to human scorers with a kappa statistic of 0.79 compared to 0.78 for humans, indicating it was reliable for sleep staging in children.
  • - However, U-Sleep's accuracy decreased in children under 2 years and those with sleep-related health issues, suggesting it can be utilized clinically for pediatric patients, but caution is needed for specific subgroups.
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Background: Adolescence is a stage of significant transition as children develop into young adults. Optimal sleep is crucial during this period to ensure physical, emotional and mental wellbeing. However, it is well recognised that insufficient quality and quantity of sleep is common among adolescents worldwide.

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Background: Healthy sleep is vital for optimal child development, yet over 30% of Australian parents report having children with disrupted sleep affecting all family members. These sleep difficulties might co-exist with sleep breathing disorders, contributing to morbidity and reduced quality of life.

Objective: This article aims to provide general practitioners (GPs) with an evidence-based, biopsychosocial approach to managing common sleep problems in infants and preschool-aged children.

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Background: In children, objective, quantitative tools that determine functional neurodevelopment are scarce and rarely scalable for clinical use. Direct recordings of cortical activity using routinely acquired electroencephalography (EEG) offer reliable measures of brain function.

Methods: We developed and validated a measure of functional brain age (FBA) using a residual neural network-based interpretation of the paediatric EEG.

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Background: Obstructive sleep apnea (OSA) is a common problem in children and can result in developmental and cognitive complications if untreated. The gold-standard tool for diagnosis is polysomnography (PSG); however, it is an expensive and time-consuming test to undertake. Overnight oximetry has been suggested as a faster and cheaper initial test in comparison to PSG as it can be performed at home using limited, reusable equipment.

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Functional brain age measures in children, derived from the electroencephalogram (EEG), offer direct and objective measures in assessing neurodevelopmental status. Here we explored the effectiveness of 32 preselected 'handcrafted' EEG features in predicting brain age in children. These features were benchmarked against a large library of highly comparative multivariate time series features (>7000 features).

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Study Objectives: Diagnostic polysomnography (PSG) is the gold standard test to evaluate sleep-disordered breathing in children. Little is known about how children with neurodevelopmental disorders (NDD) tolerate electrodes and sensors in PSG compared to neurotypical children.

Methods: In this retrospective cohort study of children > 12 months of age who underwent diagnostic PSG at our center from 01/01/2021-30/06/2021, we used sleep technician and physician reports to determine how PSG was tolerated in children with NDD compared to neurotypical children.

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Study Objectives: Adenotonsillectomy (AT) forms part of first-line management for pediatric obstructive sleep apnea. In nonrandomized studies of preschool-aged children, postoperative weight gain has been seen following AT, raising concerns regarding later obesity. Using longitudinal data from a multicenter randomized controlled trial, we assessed the impact of AT on growth trajectories in preschool-aged children with mild-moderate obstructive sleep apnea.

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Study Objectives: To describe the outcomes of central sleep apnea requiring home supplemental oxygen therapy in otherwise healthy term infants.

Methods: All children < 1 year of age undergoing polysomnography between 2015 and 2020 at the Queensland Children's Hospital were retrospectively studied. Children with gestational age < 37 weeks, underlying syndrome, cleft palate, those with obstructive apnea-hypopnea index > 50% of total apnea-hypopnea index, or with underlying cardiac or pulmonary parenchymal pathology were excluded.

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Pulmonary embolism (PE) is a rare presentation in the pediatric population. We report a case of submassive PE in an adolescent female following commencement of a combined oral contraceptive pill (COCP). In the setting of cardiac dysfunction, she received systemic thrombolysis with significant reduction of clot burden and clinical improvement objectively demonstrated shortly thereafter.

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Background: Manual auscultation to detect abnormal breath sounds has poor inter-observer reliability. Digital stethoscopes with artificial intelligence (AI) could improve reliable detection of these sounds. We aimed to independently test the abilities of AI developed for this purpose.

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Epidemic thunderstorm asthma has been reported to have occurred around twenty times over the past three decades in locations around the world. Thunderstorm asthma events are characterized by a significant increase in asthma presentations, which on occasion can overwhelm local medical services and result in fatalities. This review article presents the epidemiological data underpinning previous thunderstorm asthma events and analyzes what is known about the etiology of this unusual phenomenon.

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Newborn transition is a phase of complex change involving lung fluid clearance and lung aeration. We aimed to use a digital stethoscope (DS) to assess the change in breath sound characteristics over the first 2 h of life and its relationship to mode of delivery. A commercially available DS was used to record breath sounds of term newborns at 1-min and 2-h post-delivery via normal vaginal delivery (NVD) or elective caesarean section (CS).

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Background: Serum Glycoprotein A (GlycA) levels are increased in a variety of inflammatory disease states. However, GlycA has not been previously evaluated in children with cystic fibrosis (CF). We assessed the relationship between GlycA and pulmonary infection, inflammation, bronchial wall thickening (BWT) and bronchiectasis in young children with CF.

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Background: Mycobacterium abscessus is an emerging pathogen in cystic fibrosis (CF) lung disease. Hospital transmission of M. abscessus has been described.

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Aim: To explore, synthesise and discuss currently available digital stethoscopes (DS) and the evidence for their use in paediatric medicine.

Methods: Systematic review and narrative synthesis of digital stethoscope use in paediatrics following searches of OVID Medline, Embase, Scopus, PubMed and Google Scholar databases.

Results: Six digital stethoscope makes were identified to have been used in paediatric focused studies so far.

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Introduction: In this cohort study spanning an 18-year period, we evaluated the prevalence and associated mortality rate of epidemic strains of pseudomonas aeruginosa (PsA), especially Australian Epidemic Strain Type 1 (AES1), in a pediatric cystic fibrosis center practicing cohort segregation and early PsA eradication.

Methods: Cohort segregation was introduced in January 2000. PsA clonal strain was determined by pulse-field-gel-electrophoresis (PFGE) at the time of routine collection of airway specimens.

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