Most children treated for obstructive sleep disordered breathing (oSDB) are not systematically assessed by polysomnography (PSG) nor by structuredsymptom quantification before surgical treatment. The main objective of this study wasto investigate the effect of adeno-tonsillotomy (ATO) on symptom burden and PSGparameters.
BACKGROUND To the best of our knowledge, no studies have investigated the withdrawal strategy of pharmacological treatment with solifenacin and/or mirabegron in children diagnosed with urinary incontinence that have achieved continence on pharmacotherapy. OBJECTIVE The primary objective is to investigate if abrupt withdrawal versus gradual withdrawal of pharmacotherapy (solifenacin and/or mirabegron) influences the risk of recurrence of incontinence. METHODS Children aged 5-14 years diagnosed with urinary incontinence, treated with pharmacotherapy of solifenacin and/or mirabegron and ready for withdrawal will be randomized 1:1 to either abrupt or gradual withdrawal, according to the medical treatment that the child is receiving. The primary outcome measure is recurrence of incontinence after withdrawal and up to 12 months follow-up, assessed by 14-day calendar of incontinence episodes. RESULTS Participants will be recruited from May 2024 to December 2027. CONCLUSIONS The results are expected to influence the withdrawal strategy of pharmacological treatment with solifenacin and/or mirabegron in children with daytime urinary incontinence. CLINICALTRIAL EU CT 2023-510280-35-00.
Abstract Background Nocturnal enuresis (NE) is a common disease with multiple pathogenic mechanisms. This study aimed to compare levels of metabolites and proteins between wet and dry nights in urine samples from children with monosymptomatic NE (MNE). Methods Ten boys with MNE and nocturnal polyuria (age: 7.6 ± 1.3 years) collected their total nighttime urine production during a wet and a dry night. Untargeted metabolomics and proteomics were performed on the urine samples by liquid chromatography coupled with high-mass accuracy tandem mass spectrometry (LC-MS/MS). Results On wet nights, we found reduced urine osmolality ( P = 0.025) and increased excretion of urinary potassium and sodium by a factor of, respectively, 2.1 ( P = 0.038) and 1.9 ( P = 0.19) compared with dry nights. LC-MS identified 59 metabolites and 84 proteins with significantly different levels between wet and dry nights (fold change (FC) < 0.67 or > 1.5, P < 0.05). Some compounds were validated by different methodologies. During wet nights, levels of compounds related to oxidative stress and blood pressure, including adrenalin, were increased. We found reduced levels of aquaporin-2 on wet nights. The FCs in the 59 metabolites were positively correlated to the FCs in the same metabolites identified in urine samples obtained during the evening preceding wet and dry nights. Conclusions Oxidative stress, which in the literature has been associated with nocturia and disturbances in sleep, might be increased during wet nights in children with MNE. We further found evidence of increased sympathetic activity. The mechanisms related to having wet nights in children with MNE seem complex, and both free water and solute handling appear to be important. Graphical abstract
To study and compare the demography of enuretic children 7-16 years old attending a tertiary referral centre for childhood urinary incontinence, with that of normal children and what is generally known about enuretics from population-based studies.This was a retrospective analysis of data compiled from 298 enuretic patients referred to The Centre of Child Incontinence, Aarhus University Hospital, Skejby, Denmark, and 53 healthy controls. Data was obtained by conducting standardised questionnaire interviews. Patients were stratified according to accompanying symptoms and severity of enuresis. Statistical analysis of the results was then performed.Two hundred and ninety-three patients had sufficient data registered to allow reliable analysis. Male-female ratio was 2.2:1. Primary and secondary enuresis was found in 87.4% and 11.6% of the patients respectively. Enuresis was associated with a reported history of bronchial asthma (p < 0.05), verified allergy (p < 0.05) and a positive family history of the same disorder (p < 0.01). No association with psycho-developmental factors was evident. Approximately 98% of the patients had undergone some form of therapy at presentation. 74.1% of the patients had pure monosymptomatic enuresis, 16.4% had day and night time incontinence, while the remaining 9.6% had nocturnal incontinence combined with other lower urinary tract symptoms other than daytime wetting.The demography of our patient population was, with a few exceptions, within the confines of what has previously been reported. Our results also reaffirmed the heterogeneity of enuretic patients.
To date, our knowledge on antihypertensive pharmacological treatment in children and adolescents is still limited because there are few randomized clinical trials (CTs), hampering appropriate management. The objective was to perform a narrative review of the most relevant aspects of clinical trials carried out in primary and secondary hypertension.Studies published in PubMed with the following descriptors: clinical trial, antihypertensive drug, children, adolescents were selected. A previous Cochrane review of 21 randomized CTs pointed out the difficulty that statistical analysis could not assess heterogeneity because there were not enough data. A more recent meta-analysis, that applied more stringent inclusion criteria and selected 13 CTs, also concluded that heterogeneity, small sample size, and short follow-up time, as well as the absence of studies comparing drugs of different classes, limit the utility.In the presented narrative review, including 30 studies, there is a paucity of CTs focusing only on children with primary or secondary, mainly renoparenchymal, hypertension. In trials on angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics, a significant reduction of both SBP and DBP in mixed cohorts of children with primary and secondary hypertension was achieved. However, few studies assessed the effect of antihypertensive drugs on hypertensive organ damage.Given the increasing prevalence and undertreatment of hypertension in this age group, innovative solutions including new design, such as 'n-of-1', and optimizing the use of digital health technologies could provide more precise and faster information about the efficacy of each antihypertensive drug class and the potential benefits according to patient characteristics.
Abstract The objective of this study is to examine the effect of discontinuing wearing protective garments (absorbent pyjama pants — APP) in children with severe childhood nocturnal enuresis (NE). The study employs a multicenter, parallel, randomized controlled trial. Following a 4-week run-in period, participants were randomly allocated in a 2:1 group allocation to discontinue or continue using APP. The research was conducted across seven European pediatric incontinence centers. The study included treatment-naïve children aged 4–8 years with severe (7/7 wet nights per week) mono-symptomatic NE, who had used nighttime protection for at least 6 months prior to the study. The study consisted of a 4-week run-in period (± 7 days), where all children slept wearing APP (DryNites ® ). At week 4 (± 7 days), if meeting randomization criteria (7/7 wet nights during the last week of run-in), participants were randomized to continue to sleep in APP or to discontinue their use for a further 4 weeks, with the option of another 4 weeks in the extension period. The primary outcome was the difference between groups of wet nights during the last week of intervention. Quality of life (QoL) and sleep were secondary endpoints. In total, 105 children (43 girls and 62 boys, mean age 5.6 years [SD 1.13]) were randomized (no-pants group n = 70, pants group n = 35). Fifteen children (21%) in the no-pants group discontinued early due to stress related to the intervention. Children in the no-pants group experienced fewer wet nights compared to the pants group during the last week (difference 2.3 nights, 95% CI 1.54–3.08; p < 0.0001). In the no-pants group, 20% responded to the intervention, of whom 13% had a full response. Clinical improvement was detected within 2 weeks. Sleep and QoL were reported as negatively affected by APP discontinuation in the extension period but not in the core period. Conclusion : A ~ 10% complete resolution rate was associated with discontinuing APP. While statistically significant, the clinical relevance is debatable, and the intervention should be tried only if the family is motivated. Response was detectable within 2 weeks. Discontinuing APP for 4–8 weeks was reported to negatively affect QoL and sleep quality. No severe side effects were seen. Trial registration : Clinicaltrials.gov Identifier: NCT04620356; date registered: September 23, 2020. Registered under the name: “Effect of Use of DryNites Absorbent Pyjama Pants on the Rate of Spontaneous Resolution of Paediatric Nocturnal Enuresis (NE).” What is Known? • APP has been hypothesized to delay time until spontaneous resolution of bedwetting, but no prospective randomized evidence is available regarding if APP use sustains symptoms. • No evidence whether discontinuation of APP can lead to dryness or impact sleep quality and QoL. What is New? • Thirteen percent became dry after removing APP for up to 8 weeks and initial response was detectable within 2 weeks. • Even though prolonged discontinuation was reported to lead to sleep disturbances and rediced QoL, still our results suggest trying 2 weeks of the intervention if the family is motivated, prior to engaging established treatments for nocturnal enuresis.
