Necrotizing Pneumonia In Children: A Review.

The objective of the review was to determine the long-term outcomes of necrotising pneumonia (NP). Studies published since 1990 in English, Portuguese, or Spanish, published on PubMed and Scielo were evaluated. Our findings showed ultrasound scanning is the diagnostic modality of choice. Despite prolonged hospitalisation (median 13-27 days) and fever (median 9-16 days), most patients recover completely. Empyema and bronchopleural fistulae are frequent in bacterial NP. Streptococcus pneumoniae is the most prevalent cause. Seventeen studies with 497 patients followed for 30 days to 8.75 years showed that most patients were clinically asymptomatic and had normal lung function. X-ray or CT chest imaging demonstrated that almost all lung lesions recovered within 4-6 months. We suggest that it is not necessary to request frequent chest X-rays during the treatment and recovery process. Chest CT scans should be reserved for specific cases not following the expected clinical course.

When should parapneumonic pleural effusions be drained in children?

Pneumonia is an important health problem in children, and parapneumonic pleural effusion (PPE) is a frequent complication. There is no standard strategy for treating PPE, reflected in the few international guidelines that have been published on the issue. Compared to adults, there is no consensus on the utility of pleural fluid analysis in paediatric PPE. This is because of the lack of good evidence either in favour or against it and the risks of procedural sedation for acquiring pleural fluid for analysis to guide management. In this paper we provide a succinct review of the different approaches to the management of PPE, including diagnosis, pleural fluid analysis (Light's criteria) and treatment, both medical and surgical.

ANTHROPOMETRIC INDICATORS OF GENERAL AND CENTRAL OBESITY IN THE PREDICTION OF ASTHMA IN ADOLESCENTS; CENTRAL OBESITY IN ASTHMA.

OBJECTIVE: to determine the prevalence of asthma risk associated with anthropometric indicators of excess weight and body fat distribution. METHODOLOGY: cross-sectional study including adolescents between 10 and 19 years of age. The anthropometric indicator used to classify excess weight was the body mass index (BMI-Z); those used for abdominal adiposity were waist circumference (WC), waist-to-height ratio (WHtR) and the conicity index (CI). Asthma characteristics were evaluated using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The significance level was 5%, and the analyses were performed using Statistical Package for the Social Sciences (SPSS) Version 18.0. RESULTS: adolescent students (n = 1362; 788 [57.9%] female) with a mean age of 15.65 ± 1.24 years were evaluated. A high prevalence of asthma, excess weight (BMI-Z) and excess abdominal adiposity (WC and WHtR) was observed in the females. Only CI values for excess abdominal adiposity were higher for males than for females. Adolescents with excess abdominal adiposity, as shown by the WHtR, had a 1.24 times higher risk of having asthma compared with non-obese adolescents. Boys with excess abdominal adiposity, as classified by CI, presented a 1.8 times greater risk of asthma. The risk of severe asthma was 3 times higher among adolescents who were classified as severely obese via the BMI-Z. CONCLUSION: this study showed that excess body weight and abdominal obesity are associated with an increased risk of asthma and asthma severity in adolescents. Thus, additional BMI measurements are suggested for asthmatics.

Objetivo: determinar la prevalencia de riesgo de asma asociado con indicadores antropométricos de exceso de peso y la distribución de la grasa corporal. Metodología: estudio transversal que incluye adolescentes entre 10 y 19 años de edad. El indicador antropométrico utilizado para clasificar el exceso de peso fue el índice de masa corporal (IMC-Z); los utilizados para la adiposidad abdominal fueron la circunferencia de la cintura (CC), la relación cintura-estatura (RCE) y el índice de conicidad (IC). Las características del asma se evaluaron utilizando el cuestionario International Study of Asthma and Allergies in Childhood (ISAAC). El nivel de significación fue del 5%, y los análisis se realizaron con el Statistical Package for the Social Sciences (SPSS) versión 18.0. Resultados: fueron evaluados estudiantes adolescentes (n = 1362; 788 [57,9%] mujeres) con una edad media de 15,65 ± 1,24 años. Se observó en las mujeres una alta prevalencia de asma, exceso de peso (IMC-Z) y exceso de adiposidad abdominal (WC y RCE). Solo los valores de IC para el exceso de adiposidad abdominal fueron mayores para los hombres que para las mujeres. Los adolescentes con exceso de adiposidad abdominal, como lo demuestra la RCE, tenían 1,24 veces más riesgo de tener asma en comparación con los adolescentes no obesos. Los niños con exceso de adiposidad abdominal, según la clasificación de IC, presentaron 1,8 veces mayor riesgo de asma. El riesgo de asma grave era 3 veces mayor entre las adolescentes que fueron clasificados como severamente obesos a través del IMC-Z. Conclusión: este estudio mostró que el exceso de peso y la obesidad abdominal se asocian con un mayor riesgo de asma y asma severa en adolescentes. Por lo tanto, se sugieren mediciones de IMC adicionales para los asmáticos.

Disfagia orofaríngea y neumopatías en la infancia / Oropharyngeal dysphagia and childhood pneumopathies

OBJETIVOS: Presentar brevemente las principales patologías pulmonares y sus interferencias en la alimentación de niños. MÉTODOS: Se trata de una Actualización, basada en referencias bibliográficas actuales y referencias en pediatría. RESULTADOS: Se presentaron las posibles alteraciones de deglución en niños con: Bronquilitis Viral Aguda, Displasia Broncopulmonar, Enfermedades Intersticiales Pulmonares y Neumonias Aspirativas. CONCLUSIONES: Este material sirve para dirigir la atención del público de atención en salud en general, para trastornos de deglución niños neumópatas.

OBJECTIVES: Present briefly the main pulmonary pathologies and their interferences in the feeding of children. METHODS: This is an Update, based on current bibliographical references and references in pediatrics. RESULTS: Possible alterations of swallowing were presented in children with: Acute Viral Bronchitis, Bronchopulmonary Dysplasia, Pulmonary Interstitial Diseases and Aspirative Pneumonia. CONCLUSIONS: This material serves to direct the attention of the health care public in general, for children swallowing disorders pneumatics.