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Marcus CL, Rosen G, Davidson Ward SL, Halbower AC, Sterni L, Lutz J, et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics 2006;117 e442-51.

The prevalence of obstructive sleep apnea syndrome (OSAS) in children is about 2%. A large proportion of OSAS is because of anatomic factors (eg, obesity, adenotonsillar hypertrophy). There have not been many trials of positive airway pressure (PAP) in children, and continuous positive airway pressure (CPAP) has not yet been approved for use by children by the Food and Drug Administration. This was a small (n = 29), multicenter, randomized, blinded trial of PAP in children, designed to assess the adherence and effectiveness of two forms of PAP, CPAP and bilevel pressure (BPAP). Although there was not adequate power to detect differences between the two forms of PAP, the authors did identify significant improvements in the apnea hypopnea index, the nadir of the arterial saturation, and a subjective improvement in daytime sleepiness. More significant was the low compliance rate—more than 25% of the children dropped out of the study, presumably because of difficulty with compliance. Of those who completed the 6-month trial, the mean duration of use was only 5.3 hours per night, and only three children used their equipment for 9 to 10 hours per night. Parents also substantially overestimated actual adherence. Clearly, larger studies are needed to assess the best method for administering PAP in children; future work must certainly focus on improving adherence for what appears to be an effective therapy for childhood OSAS.

Jackson LA, Dunstan M, Starkovich P, Dunn J, Yu O, Nelson JC, et al. Prophylaxis with acetaminophen or ibuprofen for prevention of local reactions to the fifth diphtheria-tetanus toxoids-acellular pertussis vaccination: a randomized, controlled trial. Pediatrics 2006;117:620-5.

It has been documented that there is an increased frequency of local reactions to successive doses of the diphtheria-tetanus-acellular pertussis vaccine (DTaP), and that almost two-thirds of children receiving their fifth dose will have a reaction. The goal of the present study was to assess whether acetaminophen (15 mg/kg) or ibuprofen (10 mg/kg), administered every 6 hours, would decrease the frequency of reactions to the fifth DTaP vaccination. This study was done as part of a larger study looking at the safety of this vaccine; as a result, the study was powered only to detect ∼50% difference in the incidence of local reactions ≥5 cm between placebo and the study medications. With this caveat, the authors did not detect any differences in the rates of reactions to the fifth DTaP.