Protocolo de seguimiento de los pacientes con displasia broncopulmonar / Guidelines for the follow up of patients with bronchopulmonary dysplasia

La displasia broncopulmonar (DBP) es la secuela más prevalente del recién nacido pretérmino, y sigue suponiendo un motivo frecuente de consulta en las unidades de Neumología Pediátrica. La decisión del alta de la unidad neonatal debe apoyarse en una valoración exhaustiva de la situación clínica del paciente y en el cumplimiento de unos requisitos, que incluyen la estabilidad respiratoria y nutricional, y la instrucción a los cuidadores en el manejo domiciliario. Para un control adecuado de la enfermedad, es necesario que quede establecido, previamente al alta, un calendario de visitas y de exploraciones complementarias, y deben aplicarse las pautas de prevención de exacerbaciones y el tratamiento apropiados. El concepto de DBP como enfermedad multisistémica es fundamental en el seguimiento de los pacientes y debe ser tenido en cuenta para un buen control de la enfermedad. En este documento, el Grupo de Trabajo de Patología Respiratoria Perinatal de la Sociedad Española de Neumología Pediátrica propone un protocolo que sirva como referencia para unificar el seguimiento de los pacientes con DBP entre los diferentes centros y ámbitos asistenciales. Se revisan los aspectos a tener en cuenta en la evaluación previa al alta de la Unidad Neonatal y las principales complicaciones durante el seguimiento. Seguidamente, se detallan las recomendaciones en materia de tratamiento de la enfermedad y prevención de complicaciones, los controles tras el alta y su cronología

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD

Infección por parechovirus 3 en un neonato con fiebre y sospecha de sepsis / Human parechovirus-3 infection in a neonate with fever and suspected sepsis

Los parechovirus humanos (HPeV) son virus de la familia Picornaviridae recientemente descritos y causantes de numerosas infecciones en niños pequeños. La afección asociada a estos virus se está empezando a conocer. El HPeV tipo 3 se ha descrito especialmente asociado a síndromes febriles, sepsis-like, meningitis y encefalitis en lactantes muy pequeños y neonatos. Presentamos el caso de una niña de 14 días de vida con un cuadro de fiebre que precisó hospitalización por sospecha de sepsis y en la que se identificó en líquido cefalorraquídeo un HPeV-3. Las pruebas analíticas (leucocitos, fórmula diferencial y procalcitonina en sangre) fueron normales. Los cultivos bacterianos de sangre, orina y líquido cefalorraquídeo fueron estériles. La paciente evolucionó favorablemente. Este caso ilustra la utilidad de investigar la infección por parechovirus en los recién nacidos con fiebre o sospecha de sepsis

The human parechovirus (HPeV) are viruses of the recently described Picornaviridae family and are causing several infections in young children. The pathology associated with these viruses is beginning to emerge. The HPeV type 3, has been described particularly in association with sepsis-like febrile syndromes, meningitis and encephalitis in very young infants and neonates. We report the case of a 14-day-old girl with a fever and clinical sepsis that required hospitalization and in which HPeV-3 was identified in the cerebrospinal fluid. The blood, urine and cerebrospinal fluid bacterial cultures were negative, and the patient improved. This case illustrates the usefulness of investigating parechovirus infection in neonates with fever or suspected sepsis

Recurrent wheezing and asthma after bocavirus bronchiolitis

BACKGROUND: Human bocavirus (HBoV) was recently discovered and identified as an important cause of respiratory infection in young children. However, the relationship between HBoV-bronchiolitis and the development of recurrent wheezing has not yet been established. OBJECTIVE: We designed this study in order to describe the mid-term outcome, regarding the development of recurrent wheezing and asthma of HBoV-bronchiolitis patients and to compare it with RSV-bronchiolitis infants. METHODS: We studied 80 children (10 with HBoV and 70 with RSV infection), currently aged ≥4 years and previously hospitalised during the seasons 2004-2009 due to acute bronchiolitis. Epidemiological and clinical data were collected through structured clinical interviews at the follow-up visit. Spirometry and skin prick tests to common food and inhaled allergens were performed. RESULTS: All HBoV-patients developed recurrent wheezing and half of them had asthma at age 5-7 years. Almost 30% required hospital admission for recurrent wheezing. Asthma (odds ratio (OR)=1.28) and current asthma (OR=2.18) were significantly more frequent in children with HBoV-bronchiolitis than in RSV-bronchiolitis. FEV1 values were 99.2±4.8 in HBoV-group vs.103±11 in RSV-group, p: 0.09. No differences were found with respect to allergic rhinitis, atopic dermatitis, food allergy, proportion of positive prick tests, and family history of atopy or asthma. CONCLUSIONS: Severe HBoV-bronchiolitis in infancy was strongly associated with asthma at 5-7 years

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Hospital admission due to respiratory viral infections in moderate preterm, late preterm and term infants during their first year of life

BACKGROUND: Respiratory viral infections are a major cause of hospitalisation in infants <1 year and might cause severe symptoms in preterm infants. Our aim was to analyse admissions due to respiratory infections in moderate, late and term infants, and to identify risk factors for hospitalisation in preterm versus term. METHODS: Prospective study in a cohort of moderate and late preterm, and term infants born between October/2011 and December/2012. Admissions due to respiratory infections during the first year of life were analysed and compared among moderate (32-33), late (34-36) and term infants. Sixteen respiratory viruses were detected by RT-PCR. Clinical data were collected. RESULTS: 30 (20.9%) out of 143 preterm infants required admission for respiratory infection, versus 129 (6.9%) of 1858 term infants born in the same period (p < 0.0001, OR: 3.6 CI 2.0 to 5.0). Hospitalised children had a higher prevalence of hyaline membrane disease (HMD) at birth (p < 0.001, OR: 7.7 CI: 2.121 to 27.954) and needed more mechanical ventilation (p < 0.001, OR: 5.7 CI: 1.813 to 18.396). Virus was identified in 25/30 (83%) preterm babies, and in 110/129 (85%) term infants. The most frequent viruses in preterm infants were RSV (76%) rhinovirus (20%). Clinical and epidemiological characteristics among term and preterm infants were similar. CONCLUSIONS: The risk of respiratory admissions during the first year of life is up to 3.6 times higher in moderate and late preterm. Once admitted, clinical features of respiratory episodes requiring hospitalisation are similar among term and preterm infants. Hyaline membrane disease and mechanical ventilation were also risk factors for respiratory admissions

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Guía de diagnóstico y tratamiento del asma de control difícil en el niño / Diagnosis and treatment guidelines for difficult-to-control asthma in children

Los niños con asma de control difícil (ACD) requieren frecuentes consultas, reciben complejos regímenes de tratamiento y, a menudo, requieren ingresos en el hospital. Su frecuencia es escasa, y abarca no más del 5% de la población asmática. El ACD requiere un diagnóstico de certeza, por lo que se tendrán que descartar causas de falso ACD, y es necesario hacer un diagnóstico diferencial con factores de enfermedad sobreañadida, medioambientales, psicológicos, y analizar causas que determinen una baja adherencia al tratamiento. Ante un verdadero ACD, el estudio de la inflamación (óxido nítrico exhalado, esputo inducido, lavado broncoalveolar y biopsia bronquial), la función pulmonar y la clínica nos pueden permitir clasificar el ACD en diversos fenotipos que nos facilitarán la toma de decisiones terapéuticas (AU)

Children suffering from difficult-to-control asthma (DCA) require frequent appointments with their physician, complex treatment regimes and often admissions to hospital. Less than 5% of the asthmatic population suffer this condition. DCA must be correctly characterised to rule out false causes of DCA and requires making a differential diagnosis from pathologies that mimic asthma, comorbidity, environmental and psychological factors, and analysing the factors to determine poor treatment compliance. In true DCA cases, inflammation studies (exhaled nitric oxide, induced sputum, broncho-alveolar lavage and bronchial biopsy), pulmonary function and other clinical aspects can classify DCA into different phenotypes which could make therapeutic decision-making easier (AU)

Infecciones por bocavirus humano en niños españoles: características clínicas y epidemiológicas de un virus respiratorio emergente / Human bocavirus infections in Spanish 0-14 year-old: Clinical and epidemiological characteristics of an emerging respiratory virus

Introducción En el año 2005 se ha clonado un nuevo virus respiratorio, llamado bocavirus humano (HBoV) de muestras respiratorias procedentes de lactantes y niños suecos con infección respiratoria de vías bajas. Objetivos Determinar si HBoV ha circulado en España, estimar la frecuencia de infecciones por HBoV en los niños hospitalizados por infección respiratoria y describir sus características clínicas y epidemiológicas. Pacientes y métodos Estudio descriptivo, prospectivo de las infecciones confirmadas por HBoV en niños menores de 14 años, hospitalizados por infección respiratoria desde octubre de 2004 a junio de 2005. Para el diagnóstico virológico se realizó reacción en cadena de la polimerasa-transcripción inversa (RT-PCR) múltiple para virus respiratorio sincitial (VRS) A y B, influenza A, B y C, parainfluenza 1-4, adenovirus y rinovirus; PCR para metapneumovirus humano (hMPV) y PCR para HBoV en aspirado nasofaríngeo. Se describen las características clínicas y epidemiológicas de los pacientes. Resultados Se detectaron 52 casos de infección por HBoV, lo que supuso el 17,1 % (IC [intervalo de confianza] 95 %: 13 a 21) de los pacientes hospitalizados por procesos respiratorios. HBoV fue el tercer agente viral tras el VRS (30 %) y el rinovirus (25 %). En 39 casos (71,1 %) se detectó coinfección con otro virus respiratorio. El 50 % de los pacientes eran menores de 13,6 meses y el 75% menores de 2 años. Los diagnósticos más frecuentes fueron sibilancias recurrentes (55,8 %), bronquiolitis (21,2 %) y neumonía (15,4 %). Dos niños presentaron sepsis clínica con exantema petequial. El 71,2 % presentó fiebre superior a 38 °C e infiltrado radiológico el 44 %. Presentaron hipoxia el 55,8 % de los niños. Dos pacientes presentaron aislamientos positivos para HBoV en distintos episodios. Las coinfecciones fueron similares a las infecciones simples, excepto que presentaron hipoxia con más frecuencia, p = 0,038. Conclusiones HBoV es uno de los virus más frecuentes en las infecciones respiratorias graves de los niños, sólo precedido por VRS y rinovirus. Las coinfecciones son muy frecuentes. La mayoría de los niños son lactantes con sibilancias recurrentes y bronquiolitis

Introduction In 2005 a new respiratory virus, called human bocavirus (HBoV), was cloned from respiratory samples from Swedish infants and children with lower respiratory tract infections. Objectives To determine whether HBoV has circulated in Spain, estimate the frequency of HBoV infections in patients hospitalized for respiratory infection and describe the clinical and epidemiological characteristics of these patients. Patients and methods We performed a descriptive prospective study of confirmed HBoV infections in patients aged 38 °C was found in 72.1 % and radiological infiltrate in 44 %. Hypoxia was present in 55.8 % of the patients. HBoV was isolated in distinct episodes in two patients. Coinfections were similar to simple infections except that hypoxia was more frequent in the former (p 0.038). Conclusions HBoV is one of the most frequent viruses in severe respiratory infections in patients aged less than 14 years old. Only RSV and rhinovirus are more frequent. Coinfections are highly frequent. Most patients are infants with recurrent wheezing and bronchiolitis

Opciones terapéuticas en el asma de difícil control / No disponible

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