Alan T. Cheng

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. A total of 190 children (aged 3-5 years) with obstructive apnea-hypopnea index ≤ 10 events/h were randomly assigned to early (within 2 months) or routine (12-month wait) AT. Anthropometry and polysomnography were performed at baseline, 12-month, and 24-month time points for 126 children. Baseline characteristics were compared using a Mann-Whitney or t test for continuous variables and Fisher's exact test for categorical variables. Longitudinal data underwent linear mixed modeling. For body mass index (BMI) z-score there was a significant increase in the early surgery group between 0 and 12 months (0.4, 95% confidence interval 0.1-0.8) but not from 12-24 months. For the routine surgery group there was an identical significant BMI z-score increase in the first 12 months following surgery, ie, between 12- and 24-month time points (0.45, 95% confidence interval 0.1-0.8) but not from 0-12 months (preoperative time). Final BMI z-score was similar between groups. Findings for weight-for-age z-score were similar to the findings for BMI z-score. Height-for-age z-score was not significantly different between different time points or intervention groups. This study provides randomized controlled trial evidence of notable, but time-limited, increase in the BMI and weight of preschool children with mild-moderate obstructive sleep apnea in the months immediately following AT. Registry: Australian New Zealand Clinical Trials Registry; Name: POSTA Child Study (Preschool Obstructive Sleep Apnea Tonsillectomy Adenoidectomy Study); URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336273&isReview=true; Identifier: ACTRN12611000021976. Kevat A, Bernard A, Harris M-A, et al. Impact of adenotonsillectomy on growth trajectories in preschool children with mild-moderate obstructive sleep apnea. J Clin Sleep Med. 2023;19(1):55-62.

Purpose of Review The current COVID-19 pandemic has challenged the international paediatric otolaryngology community: we review its impact in clinical, resource, and human settings. Recent Findings The SARS-CoV-2 virus, while generally mild in paediatric populations, has caused an increased incidence in severe croup, invasive fungal sinus disease, and multi system inflammatory syndrome (MIS-C). The incidence of other common otolaryngology presentations such as otitis media and tonsillitis has decreased due to quarantine measures. The pandemic has also changed the way in which we work: guidelines for aerosol-generating procedures (AGPs) have changed, digital technology and videoconferencing platforms have flourished, and new pathways of providing healthcare have been developed to minimise footfall and avoid overcrowded waiting rooms. Finally, the importance of personal protective equipment (PPE) to protect healthcare workers and patients cannot be understated, although the mental and physical toll is considerable. Summary There has been a tectonic shift in paediatric otolaryngology and healthcare globally. Continued adaptability and resilience are required to face these challenges in the coming months. With lessons learnt from managing SARS-CoV-2, we are hopefully well equipped to combat any future pandemics.