Central apneas are a prevalent yet complex phenomenon, particularly among children. This retrospective study, conducted over a decade (from 2012 to 2022), analyzed central apneas in a cohort of 612 pediatric patients who underwent ventilation at the Sleep Medicine and Long-Term Ventilation Unit of the Bambino Gesù Children’s Hospital in Rome, Italy. Among this group, 67 patients met the inclusion criteria for central apneas. Central apneas often arise within the context of various underlying pathologies, including neurological disorders, genetic syndromes, and brain tumors. We categorized patients into three main groups including patients with “exclusively central apneas”, “predominantly central apneas”, and “predominantly obstructive apneas”. Ventilation modes were diverse, with pressure-controlled ventilation and pressure support being commonly used, reflecting the individualized nature of therapy. The choice of ventilation mode has been influenced by the underlying diagnosis and the severity of central apneas, with pressure support ventilation being the most frequently employed mode. Continuous Positive Airway Pressure was also employed in select cases. A statistically significant reduction (p<0.05) in mean cAHI was observed in patients with multimalformation syndromes, hypoxic-ischemic encephalopathy and Prader-Willi Syndrome. The reduction in mean cAHI was not statistically significant in the case of patients with brain tumors. While non-invasive ventilation was commonly used, invasive mechanical ventilation was selectively employed in more severe cases. The study highlights the need for personalized therapeutic strategies when managing central apneas in pediatric patients.

Breathing disturbances are often a major clinical concern during wakefulness of classic form of Rett syndrome, but data for atypical forms are lacking. We report the case of a 20-month-old female affected by the congenital variant of Rett syndrome, that is characterized by severe hypotonia and neurodevelopment impairment. She presented hypoventilation, persistent periodic breathing and sustained desaturation during sleep time, without obstructive nor central events; pulse oximetry and capnography during wakefulness were strictly normal. To the best of our knowledge, this is the first case of Rett syndrome presenting hypoventilation. Hypotonia may play a major role in the genesis of hypoventilation and hypoxemia in our patient. Non-invasive ventilation led to quality-of-life improvements. Thus, we suggest screening patients with congenital Rett variant through transcutaneous bedtime carbon dioxide and oxygen monitoring. Moreover, in our case, assisted control mode was a breakthrough to achieve adequate ventilation.

Pediatric palliative care (PPC) is an active and total approach to the care of children with life-limiting conditions and to their families. PPC programs provide ongoing care for children with medical complexity (CMC), many of whom will reach adulthood. The aim of the study is to describe a population of CMC afferent in 4 months to the Intermediate Care Unit of a tertiary referral hospital for southern and central Italy. We enrolled all CMC patients admitted at our unit in 4 randomized months. We registered pathologies and different categories of childhood diseases, devices and needs, hospitalization and home care plan. Among 195 admitted to our unit, 87 CMC were included. Median age was 9 (0.1 – 35.7) years. The main pathologies recorded were neuromuscular, neurological, respiratory, metabolic, malformative, genetic syndromes and outcomes of prematurity. Comorbidity made by respiratory, digestive, neurological, cardiac and urological involvement was present in a high percentage of cases. Among our patients, only 24 hadn’t any devices. The average length of hospitalization was 7.0 (1.0 – 270.0) days with 2 (1.0 – 7.0) admissions per year for patient. Home care activation was not required for only 24 of 87 patients. Children eligible for CPP are increasing and their survival results in a rise in comorbidities and special needs demanding multi-level interventions. Respiratory symptoms are the most recurrent observed demonstrating the need for an expert in CPP to have respiratory skills. Sharing data and knowledge of CMC needs may help to improve care coordination and interventions.