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Marpole R, Blackmore AM, Wilson AC, Cooper MS, Depiazzi J, Langdon K, Moshovis L, Geelhoed E, Bowen A, Gibson N. Can RESPiratory hospital Admissions in children with cerebral palsy be reduced? A feasibility randomised Controlled Trial pilot study protocol (RESP-ACT). BMJ Open 2024; 14:e076730. [PMID: 38365293 PMCID: PMC10875547 DOI: 10.1136/bmjopen-2023-076730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/11/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION The most common cause of morbidity and mortality in children with severe cerebral palsy (CP) is respiratory disease. BREATHE-CP (Better REspiratory and Airway Treatment and HEalth in Cerebral Palsy) is a multidisciplinary research team who have conducted research on the risk factors associated with CP respiratory disease, a systematic review on management and a Delphi study on the development of a consensus for the prevention and management of respiratory disease in CP. These strategies have not been investigated; therefore, it is not known if implementation is feasible, if they improve patient outcomes or if they are acceptable for families. METHODS AND ANALYSIS Mixed-method feasibility pilot randomised controlled trial with economic analysis. Twenty children with CP aged 0-12 years who are at risk of respiratory disease will be followed up for 1 year. All children will receive baseline assessments for comparison. The control group will receive usual care from their treating teams. The intervention group will receive comprehensive assessments from physiotherapy, speech pathology and respiratory medicine. An individualised investigation and treatment plan will then be made. Participants in both groups will complete fortnightly patient-reported outcome surveys to assess symptoms and health service use. Analysis will include assessments of acceptability through qualitative interviews, implementation by ability to recruit, randomise and retain, practicality including costs of intervention and hospitalisation, and explore efficacy through quality-of-life surveys and decreased health service use for respiratory-related symptoms. ETHICS AND DISSEMINATION Ethics and governance approvals have been obtained through Child and Adolescent Health Service Human Research Ethics Committee. At completion, this study will lead to the design of the definitive protocol to test intervention efficacy that maximises recruitment, retention and adherence to interventions. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12620000114943).
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Affiliation(s)
- Rachael Marpole
- Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Cerebral Palsy Alliance, Forestville, New South Wales, Australia
| | - A Marie Blackmore
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew C Wilson
- Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Monica S Cooper
- Department of Neurodevelopment & Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julie Depiazzi
- Physiotherapy Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Katherine Langdon
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Kids Rehab, Perth Children's Hospital, Nedlands, Perth, Australia
| | - Lisa Moshovis
- Therapy Services, Ability Centre, Coolbinia, Western Australia, Australia
| | - Elizabeth Geelhoed
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Asha Bowen
- Menzies School of Health Research, Casuarina, Northern Territory of Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Noula Gibson
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Physiotherapy Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Marpole R, Wilson AC. Benefits of reviewing pancreatic function in children with cystic fibrosis. Pediatr Pulmonol 2022; 57:1537-1539. [PMID: 35258175 PMCID: PMC9313857 DOI: 10.1002/ppul.25884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/27/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Rachael Marpole
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia.,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Andrew C Wilson
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia.,Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
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Marpole R, Langdon K, Wilson A. Gastrostomy feeding in children with severe cerebral palsy in Western Australia. Acta Paediatr 2022; 111:680-681. [PMID: 34905225 DOI: 10.1111/apa.16214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rachael Marpole
- Respiratory and Sleep Medicine CAHS Nedlands WA Australia
- Department of Paediatrics University of Western Australia Perth WA Australia
| | - Katherine Langdon
- Kid’s Rehab WACAHS Nedlands WA Australia
- Telethon Kids Institute Nedlands WA Australia
| | - Andrew Wilson
- Respiratory and Sleep Medicine CAHS Nedlands WA Australia
- Department of Paediatrics University of Western Australia Perth WA Australia
- Wal‐Yan Respiratory Research CentreTelethon Kids Institute Nedlands WA Australia
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Marpole R, Ohn M, O'Dea CA, von Ungern-Sternberg BS. Clinical utility of preoperative pulmonary function testing in pediatrics. Paediatr Anaesth 2022; 32:191-201. [PMID: 34875135 DOI: 10.1111/pan.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
Perioperative respiratory adverse events pose a significant risk in pediatric anesthesia, and identifying these risks is vital. Traditionally, this is assessed using history and examination. However, the perioperative risk is multifactorial, and children with complex medical backgrounds such as chronic lung disease or obesity may benefit from additional objective preoperative pulmonary function tests. This article summarizes the utility of available pulmonary function assessment tools as preoperative tests in improving post-anesthetic outcomes. Currently, there is no evidence to support or discourage any pulmonary function assessment as a routine preoperative test for children undergoing anesthesia. In addition, there is uncertainty about which patients with the known or suspected respiratory disease require preoperative pulmonary function tests, what time period prior to surgery these are required, and whether spirometry or more sophisticated tests are indicated. Therefore, the need for any test should be based on information obtained from the history and examination, the child's age, and the complexity of the surgery.
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Affiliation(s)
- Rachael Marpole
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Paediatrics, School of Medical, University of Western Australia, Crawley, WA, Australia
| | - Mon Ohn
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Paediatrics, School of Medical, University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
| | - Christopher A O'Dea
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, School of Medical, University of Western Australia, Crawley, WA, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia
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Marpole R, Yeoh DK, Withers AL. Posaconazole-induced hypertension in children with cystic fibrosis. Respirol Case Rep 2021; 9:e0822. [PMID: 34377495 PMCID: PMC8334806 DOI: 10.1002/rcr2.822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 11/28/2022] Open
Abstract
Posaconazole is a triazole antifungal with a broad spectrum of activity against moulds including Aspergillus spp. Emerging data suggest posaconazole may be effective in the treatment of allergic bronchopulmonary aspergillosis (ABPA) complicating cystic fibrosis (CF). Rarely, posaconazole can cause pseudohyperaldosteronism, manifesting as hypertension and electrolyte abnormalities, with a number of cases recently reported in individuals without CF. We describe two cases of children with CF who developed hypertension, likely due to pseudohyperaldosteronism, following the initiation of posaconazole for the treatment of ABPA.
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Affiliation(s)
- Rachael Marpole
- Department of Respiratory and Sleep MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
| | - Daniel K. Yeoh
- Department of Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia
- Department of OncologyUniversity of Melbourne, Sir Peter MacCallumParkvilleVictoriaAustralia
| | - Adelaide L. Withers
- Department of Respiratory and Sleep MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
- Wal‐Yan Respiratory Research CentreTelethon Kids InstitutePerthWestern AustraliaAustralia
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Marpole R, Blackmore AM, Gibson N, Cooper MS, Langdon K, Wilson AC. Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy. Front Pediatr 2020; 8:333. [PMID: 32671000 PMCID: PMC7326778 DOI: 10.3389/fped.2020.00333] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/21/2020] [Indexed: 12/15/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of disability in childhood. Respiratory illness is the most common cause of mortality, morbidity, and poor quality of life in the most severely affected children. Respiratory illness is caused by multiple and combined factors. This review describes these factors and discusses assessments and treatments. Oropharyngeal dysphagia causes pulmonary aspiration of food, drink, and saliva. Speech pathology assessments evaluate safety and adequacy of nutritional intake. Management is holistic and may include dental care, and interventions to improve nutritional intake, and ease, and efficiency of feeding. Behavioral, medical, and surgical approaches to drooling aim to reduce salivary aspiration. Gastrointestinal dysfunction, leading to aspiration from reflux, should be assessed objectively, and may be managed by lifestyle changes, medications, or surgical interventions. The motor disorder that defines cerebral palsy may impair fitness, breathing mechanics, effective coughing, and cause scoliosis in individuals with severe impairments; therefore, interventions should maximize physical, musculoskeletal functions. Airway clearance techniques help to clear secretions. Upper airway obstruction may be treated with medications and/or surgery. Malnutrition leads to poor general health and susceptibility to infection, and improved nutritional intake may improve not only respiratory health but also constipation, gastroesophageal reflux, and participation in activities. There is some evidence that children with CP carry pathogenic bacteria. Prophylactic antibiotics may be considered for children with recurrent exacerbations. Uncontrolled seizures place children with CP at risk of respiratory illness by increasing their risk of salivary aspiration; therefore optimal control of epilepsy may reduce respiratory illness. Respiratory illnesses in children with CP are sometimes diagnosed as asthma; a short trial of asthma medications may be considered, but should be discontinued if ineffective. Overall, management of respiratory illness in children with CP is complex and needs well-coordinated multidisciplinary teams who communicate clearly with families. Regular immunizations, including annual influenza vaccination, should be encouraged, as well as good oral hygiene. Treatments should aim to improve quality of life for children and families and reduce burden of care for carers.
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Affiliation(s)
- Rachael Marpole
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - A Marie Blackmore
- Research, Ability Centre, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Noula Gibson
- Research, Ability Centre, Perth, WA, Australia.,Department of Physiotherapy, Perth Children's Hospital, Perth, WA, Australia
| | - Monica S Cooper
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, VIC, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Perth Children's Hospital, Perth, WA, Australia
| | - Andrew C Wilson
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Department of Paediatrics, The University of Western Australia, Perth, WA, Australia
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