Olaia Sardon

Características clínicas de los niños hospitalizados por infección por virus Influenza

Antecedentes Las manifestaciones clinicas de la gripe son bastante inespecificas y similares a otras infecciones virales, a procesos respiratorios de otra etiologia e incluso a cuadros septicos en lactantes. Existen pocos estudios sobre las caracteristicas clinicas de la infeccion por virus Influenza en ninos hospitalizados. Objetivo Evaluar las caracteristicas clinicas de los ninos hospitalizados por infeccion por virus Influenza en cuatro ondas epidemicas consecutivas (2000-2004). Material y metodos Estudio retrospectivo por revision de historias clinicas de los ninos hospitalizados por infeccion confirmada por virus Influenza A y B, mediante cultivo celular y reaccion en cadena de la polimerasa. Se registraron las variables:sexo, edad, clinica al ingreso, exploraciones complementarias,diagnostico y evolucion posterior. Resultados Fueron hospitalizados 84 ninos, 74 casos debidos a infeccion por virus Influenza AH3, 5 casos por virus Influenza AH1 y cinco por Influenza B. El 42,8% fueron menores de 6 meses. El cuadro clinico principal fue fiebre (75 casos), tos (56 casos), afectacion otorrinolaringologica (53 casos). Los diagnosticos mas frecuentes que motivaron el ingreso fueron sindrome febril (75 casos), bronquiolitis (19 casos), neumonia (13 casos) y bronquitis (8 casos). En 21 casos se objetivo coinfeccion viral o bacteriana,siendo la asociacion con virus respiratorio sincitial la coinfeccion mas frecuente (10 casos). Se han observado pocas diferencias entre los diferentes grupos de edad, excepto para neumonia y fiebre prolongada (mas frecuentes en mayores de 6 meses) y linfocitosis (en menores de 6 meses). El cuadro febril agudo en menores de 6 meses ha originado mayor numero de exploraciones complementarias en los de menor edad. Solo en tres ninos se encontraron factores de riesgo para hospitalizacion,todos ellos mayores de 6 meses. Todos los casos evolucionaron favorablemente. Conclusiones La infeccion por virus Influenza en los ninos que estan hospitalizados predomina en lactantes sanos, con fiebre y signos y sintomas respiratorios poco especificos, similares a otros cuadros infecciosos. Es necesario aplicar tecnicas diagnosticas microbiologicas especificas para el diagnostico precoz. Los lactantes sanos y menores de 24 meses constituyen el grupo de mayor riesgo para la hospitalizacion por infeccion por virus Influenza.

Reliability and validity of the Spanish version of the TAPQOL: a health-related quality of life (HRQOL) instrument for 1- to 5-year-old children.

OBJECTIVES To evaluate the reliability, and construct validity of the Spanish version of the TNO-AZL preschool children quality of life (TAPQOL). METHODS A consecutive sample of children (3 months to 5 years old) was recruited from primary care centers and two teaching hospitals in Spain. The TAPQOL and a set of questions related to their childs health status were administered to parents. Clinical diagnoses were collected from clinical records. Principal component analysis (PCA) with varimax rotation was used to analyze the instruments structure. Effect size (ES) and analysis of variance (ANOVA) were used to analyze differences between subgroups known to be in poor health compared to the healthy subgroup. RESULTS A total of 228 children participated in the study (response rate=95%). Ten of the 12 scales showed more than 30% ceiling effect. All dimensions except one had Cronbachs alpha coefficients greater than 0.7. PCA explained 75% of the variance. Healthy children in general had better scores than the other subgroups. Children at risk of poor health outcomes and those with respiratory problems scored lower in several scales than the healthy subgroup. CONCLUSIONS Although the Spanish TAPQOL shows a non-negligible ceiling effect, it seems to be a reliable and valid instrument for Spanish infants and toddlers, and with similar psychometric characteristics to the original version. Future studies should try to improve questionnaires structure and assess its sensitivity to change.

Obstructive Sleep Apnea-Hypopnea Syndrome in Children Is Not Associated With Obesity

OBJECTIVE The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in the general pediatric population ranges from 1% to 3%. However, its prevalence in an unselected population of obese children is unknown. We studied the association between obesity and OSAHS in children diagnosed with the syndrome in a cohort of boys and girls (age range, 2-14 years) referred to the pediatric respiratory medicine outpatient clinic at our hospital for suspected apnea, snoring, or both over the past 5 years. PATIENTS AND METHODS The medical history of each patient was recorded and all patients underwent a physical examination, chest and nasal cavities radiography, and 8-channel respiratory polygraphy during sleep. The following variables were evaluated: sex, reason for consultation, source of referral, findings during upper airway examination, age, weight z-score (reflecting how much a finding differs from the mean and in what direction in a normally distributed sample), height z-score, body mass index (BMI) z-score, number of apneas, number of hypopneas, apnea index, hypopnea index, apnea-hypopnea index (AHI), oxygen saturation (mean and minimum) measured by pulse oximetry, number of snores, and snore index. RESULTS Of the 400 patients studied, 242 (60.5%) were male and 158 (39.5%) female. The mean age was 4.95 years. OSAHS (AHI> or =3) was diagnosed in 298 cases (74.5%) and these patients were then studied to determine the relation between OSAHS and obesity. The anthropometric distribution (expressed as mean [SD]) was as follows: weight z-score, 0.37 (1.31); height z-score, 0.23 (1.19); BMI, 17.063 kg/m(2) (2.51); and BMI z-score, 0.39 (1.36). The respiratory polygraph during sleep recorded an AHI of 6.56 (7.56). CONCLUSIONS No differences were observed between the height z-score, weight z-score, BMI z-score, age, and AHI. No association between obesity and OSAHS was found in this series. However, studies of larger, unselected populations are needed to determine if obesity is a risk factor for OSAHS in children.

Young Infants with Recurrent Wheezing and Positive Asthma Predictive Index Have Higher Levels of Exhaled Nitric Oxide

Objective. The aim of this post hoc analysis was to establish the relationship between FENO levels and the asthma predictive index (API) among infants with recurrent wheezing. Methods. Infants with recurrent wheezing (three or more episodes) were recruited consecutively and online FENO tests at tidal breathing with multiple breaths were performed. Results. Twenty-seven (84%) out of 32 infants (median age of 12 months) who met the inclusion criteria for this post hoc analysis, successfully performed the FENO determinations. Eighteen (66%) infants were classified with positive stringent API. FENO levels were significantly higher among patients with positive API than those with negative (median [IQR] of 12.3 [14.8] ppb vs. 4.1 [7.9] ppb, respectively, p = .016). Furthermore, FENO and positive API had a significant correlation (Spearman’s rho, ρ = 0.4741, p = .0125). After logistic regression analysis including FENO levels, gender, age, and use of controller therapy, FENO was the only variable that was marginally related to API (OR = 1.12, 95% CI: 0.99–1.27, p = .07). Conclusion. Infants with recurrent wheezing who had a positive stringent API already had higher FENO levels than those with a negative API. This finding needs to be corroborated in a larger prospective study.

Risk factors for bronchiolitis, recurrent wheezing, and related hospitalization in preterm infants during the first year of life

Airway diseases are highly prevalent in infants and cause significant morbidity. We aimed to determine the incidence and risk factors for respiratory morbidity in a Spanish cohort of moderate‐to‐late preterm (MLP) infants prospectively followed during their first year of life.

Tos psicógena: una causa de tos crónica

The most common causes of persistent cough are upper respiratory tract disease (postnasal drip syndrome, infections) and asthma. In the last year, six patients (four boys and two girls), aged 7-12 years old, with a diagnosis of hard-to-manage asthma and/or persistent cough were referred to our department. All the patients had undergone treatment with multiple drugs for long periods without favorable clinical response. The findings of physical examination, radiology, basal pulmonary function and post-bronchodilation and fibrobronchoscopy were normal. Organic disease was ruled out and a psychiatric evaluation was performed. Intelligence quotient was in the lower normal range and generalized anxiety order was identified, thus establishing a diagnosis of psychogenic cough. Treatment consisted of relaxation techniques and psychopedagogic support with favorable outcome. To avoid diagnostic errors and inappropriate treatment, psychogenic cough should be included in the differential diagnosis of persistent cough and hard-to-manage asthma.

Concordancia en niños entre las resistencias de la vía aérea medidas mediante pletismografía con y sin cierre del oclusor

BACKGROUND There have been several studies that have measured airway resistances using plethysmography without closing the occluder. OBJECTIVE To investigate the differences between the total resistances (sRaw(TOT)) and the specific resistances (sRaw) with the same technique (plethysmography) but different methodology (with and without closure of the occluder) in child subjects. MATERIAL AND METHODS An observational and cross-sectional study of a consecutive sample of children between 6 and 14 years old who were seen at the Childhood Pneumology clinics from 15th January to 15th February 2009. Determination of sRaw(TOT), sRaw and specific conductance (sGaw) using plethysmography (MasterLab V5.1, Viasys, Wuerzburg, Germany) without closing the occluder. The same determinations were then performed with the occluder closed. The qualitative variables were: sex, diagnosis and treatment, and the quantitative variables: age, weight, height, sRaw(TOT), sRaw, sGaw and respiratory rate with and without closing the occluder. The results were analysed for association and concordance between sRaw(TOT), sRaw and sGaw with and without closure of the occluder using paired Student t test, Bland-Altman method and a scatter plot. RESULTS Thirty-six cases were included and all (100%) the tests were performed successfully. The mean age was 9.91+/-2.37 years. There were no differences between sRawTOT, sRaw or sGaw with and without closure of the occluder. Neither were there any differences between the regression of the means obtained for sRaw(TOT), sRaw and sGaw with and without closure of the occluder. CONCLUSIONS There is good agreement between the sRaw(TOT) y sRaw obtained by plethysmography with and without closure of the occluder.

Differences in Airway Resistances in Children Measured by Plethysmography With and Without Closure of the Occluder

Abstract Background There have been several studies that have measured airway resistances using plethysmography without closing the occluder Objective To investigate the differences between the total resistances (sRawTOT) and the specific resistances (sRaw) with the same technique (plethysmography) but different methodology (with and without closure of the occluder) in child subjects. Material and methods An observational and cross-sectional study of a consecutive sample of children between 6 and 14 years old who were seen at the Childhood Pneumology clinics from 15th January to 15th February 2009. Determination of sRawTOT, sRaw and specific conductance (sGaw) using plethysmography (MasterLab V5.1, Viasys®, Wuerzburg, Germany) without closing the occluder. The same determinations were then performed with the occluder closed. The qualitative variables were: sex, diagnosis and treatment, and the quantitative variables: age, weight, height, sRawTOT, sRaw, sGaw and respiratory rate with and without closing the occluder. The results were analysed for association and concordance between sRawTOT, sRaw and sGaw with and without closure of the occluder using paired Student t test, Bland-Altman method and a scatter plot. Results Thirty-six cases were included and all (100%) the tests were performed successfully. The mean age was 9.91±2.37 years. There were no differences between sRawTOT, sRaw or sGaw with and without closure of the occluder. Neither were there any differences between the regression of the means obtained for sRawTOT, sRaw and sGaw with and without closure of the occluder. Conclusions There is good agreement between the sRawTOT y sRaw obtained by plethysmography with and without closure of the occluder.

Alveolar nitric oxide contribution to assess asthma control

A03-17 Alveolar nitric oxide contribution to assess asthma control O. Sardon, P. Corcuera, A. Aldasoro, J. Korta, J. Mintegui, J.I. Emparanza, E.G. Perez Yarza. 1 Department of Pediatrics, Division of Respiratory Medicine, University Hospital Donostia; Medical School (U.D. San Sebastian), University of the Basque Country, Department of Pediatrics, San Sebastian, Spain; Department of Pediatrics, Division of Respiratory Medicine, University Hospital Donostia, San Sebastian, Spain; University Donostia Hospital Epidemiology Unit (CIBER-ESP), San Sebastian, Spain

Hamartoma condromesenquimal endobronquial

Primary lung tumours are uncommon in childhood. Among these tumours, endobronchial masses are even less common and, among benign tumours, inflammatory pseudotumours and hamartomas have the highest incidence in children. We present the case of a 2.5-year-old girl with a left endobronchial chondromesenchymal hamartoma with obstruction of 90% of the bronchial lumen. Complete resection of the endobronchial mass was performed by rigid bronchoscopy and application of topical mitomycin C. After tumour resection and a 12-month follow-up, the patient has shown a favourable outcome with immediate disappearance of respiratory symptoms. Successive fibreoptic bronchoscopies have shown no residual tumour.