OBJECTIVE:To report central sleep apnea (CSA) as an underrecognized cause of respiratory morbidity in pediatric posterior fossa tumors and highlight the benefit of CPAP. METHODS:A 3-year-old child with metastatic medulloblastoma involving the fourth ventricle underwent resection, radiotherapy, and chemotherapy. The course was complicated by recurrent respiratory failure, multiple PICU admissions, and unexplained desaturations initially attributed to seizures. Persistent daytime somnolence and episodic apnea prompted polysomnography. RESULTS:Polysomnography showed severe CSA (respiratory event index 68.3/hour; nadir SpO₂ 75%), unifying the prior hypoxic episodes. CPAP (5 cm H₂O) produced rapid improvement, with restored sleep architecture, fewer respiratory events (index 6.3/hour), stable saturation (~97%), and no further prolonged intensive care admissions. The patient completed oncologic therapy and remained stable on domiciliary CPAP. CONCLUSION:CSA should be considered in children with posterior fossa or brainstem-adjacent lesions presenting with unexplained respiratory events; recognition has important implications for multidisciplinary management and long-term outcomes.

Hepatoblastoma is a common malignant liver tumor in children with a peak incidence in the first two years. Its previous mortality was reported to be 24

OBJECTIVE To evaluate the role of serum procalcitonin (PCT) level at admission in predicting significant infections and deaths among children on chemotherapy presenting with fever. METHODS Children with clinically significant (CSI) and microbiologically documented (MDI) infections were identified using standard definitions. Association of PCT with CSI, MDI and mortality was analyzed. RESULTS We evaluated 821 febrile episodes in 316 children. CSI, MDI and deaths were seen in 40.9%, 20.1% and 2.9%, respectively. PCT levels ranged from 0.05-560ng/mL. Median PCT was higher in episodes with CSI (0.80 vs. 0.28) and MDI (0.71 vs. 0.34) (P<0.001). PCT ≥0.7ng/mL optimally predicted CSI (AUC-0.740) and MDI (AUC-0.636). Relative risk of mortality for PCT ≥5ng/mL was 7.1. PCT ≥0.7ng/mL had poor sensitivity (45-55%) but good specificity and NPV (70-90%). PCT was elevated in nearly half of documented viral and fungal infections. CONCLUSION PCT predicts significant infections and mortality in pediatric oncology but it has poor sensitivity to guide clinical decisions.

Hepatoblastoma is the commonest primary liver tumour in children. Recent reports suggest better outcomes with a team approach combining neoadjuvant chemotherapy followed by resection, especially in larger tumours. We present the management of a 7-month-old child who presented to us with a large hepatoblastoma.