Taking nine healthy children to the Everest region has produced
valuable lessons in how we can improve methods of assessing lung disease
in children, improve methods of home monitoring to reduce the number
of hospital visits required, and provide sound health advice for
children at altitude.
Smiths Medical Young Everest is a scientific
study of how healthy children react to reduced oxygen at high
altitudes. It involved nine healthy volunteer children aged 6-13, who
were going on a family trekking holiday in Nepal. The study worked
closely with Caudwell Xtreme Everest (www.xtreme-everest.co.uk),
a pioneering study of over 200 healthy adults which was being
undertaken at the same time, and which provided essential
infrastructure.
Professor Janet Stocks UCL Institute of Child
Health will present some preliminary results at the Scientific
Conference of the Royal College of Paediatrics and Child Health, York,
April 15 2008.
The background is that children with reduced lung
function, for example those born prematurely or with cystic fibrosis,
often suffer low oxygenation in the blood. When healthy children live
and sleep at an altitude of around 3,500 m (11,000 feet) a similar
reduction in oxygenation occurs. This allows us to study their
responses in a much more controlled manner than when dealing with
acutely ill children.
Much analysis remains to be completed and
the results coordinated with those from the Caudwell Xtreme Everest
adult study. However Professor Stocks will report a number of early
findings:
“We found that children’s response to low oxygen levels
is very variable depending on the individual. This is understood in
adults, and may well be for genetic reasons. It explains, for example,
why we cannot always predict which children will do poorly or well in
intensive care. Around one quarter of all children will suffer
particularly badly from exposure to low oxygen as a result of disease or
trauma. Increased knowledge from studies in healthy subjects at
altitude could help to stratify risk, and develop tailored treatment
plans for such children.
“Insight from the Young Everest study
is already affecting the way in which we assess sick children at the
Institute and at Great Ormond Street Hospital for Children.
“We
found that children could perform well with oxygenation levels which
would be a matter of concern at sea level/in the intensive care unit.
It may be that after further careful study we can be a little more
relaxed about what an acceptable oxygenation level is in some preterm
babies and patients receiving intensive care/on the intensive care
unit. In some cases, we may be able to reduce treatments safely,
reducing risks/side effects”.
“Since we were working with healthy
children, we needed to measure changes in breathing pattern and levels
of blood oxygenation in a completely non-invasive way (No invasive
tests were used.) This provided an excellent opportunity to assess how
well such methods performed under field conditions, away from the
specialised laboratory facilities we are used to working in”.
“Our
aim in the clinical service would be to reduce the use of hospital
facilities and enable more sleep and respiratory studies to be performed
at home, which would be less stressful for families, reduce waiting
times, and use hospital resources more productively. It is fair to say
that under the challenging conditions experienced in Nepal, we learned a
massive amount. As a result of our feedback, the manufacturers are
providing revised equipment and additional support, and we plan more
field tests in the UK and at altitude abroad. Remote testing (at home)
of NHS patients in this way could be achieved within two years, if all
proceeds according to plan.
“Health advice for high altitude travel in children: Current
advice is based on adults, and tends to be very conservative. We took
every precaution with these childrens’ safety and monitored them
extremely closely. This proved more useful than adult measures such as
the Lake Louise scoring system. The latter proved unsatisfactory, in
that it had no predictive power as to which children would become sick
and indeed, was falsely reassuring for some children.
We found the
conventional advice was unhelpful. Children do not always report
important symptoms like headaches accurately, sometimes saying they are
sicker or less acclimatised than they are, and at other times hiding
it. As paediatric specialists this does not entirely surprise us and
this was one of the reasons for careful monitoring. We hope to produce
more helpful and targeted advice on these matters. We believe that it
is safe, with all sensible precautions, to take healthy six year olds to
3,500 m. Prolonged time at altitude allows us to study
acclimatisation properly, which is obviously important.
The case for adventure:
We have become a cotton wool society. These children had the chance of
a holiday of a lifetime. They have grown in confidence and
understanding of the world. One has begun fundraising for an orphanage
in Nepal.
In terms of altitude, the children went no higher than
the highest ski lift in Switzerland, although obviously they were at
altitude for a week –; they were carefully consented, and given a full
medical before, during, and after the trip. The children not only
enjoyed the trip but were delighted to know that they were helping other
children.
Contact information:
GOSH-ICH Press Office: 020 7239 3125
Email: Coxs@gosh.nhs.uk
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