Oxigenoterapia de alto flujo con cánula nasal en el tratamiento de la bronquiolitis aguda en neonatos / High flow nasal cannula oxygen therapy in the treatment of acute bronchiolitis in neonates

OBJETIVO: Determinar si el uso de oxigenoterapia de alto flujo (OAF) en cánulas nasales disminuye la necesidad de ventilación mecánica en neonatos hospitalizados con bronquiolitis aguda. MÉTODOS: Estudio de cohortes ambispectivo, realizado en una unidad neonatal IIB, que incluyó neonatos ingresados con bronquiolitis desde la instauración de la técnica de OAF (período-OAF: octubre de 2011-abril de 2015), comparándolo con una cohorte histórica de la temporada previa a su uso (período pre-OAF: enero de 2008-mayo de 2011). Se analizó la proporción de ventilación mecánica antes y después del inicio del tratamiento con OAF y se evaluaron parámetros clínicos y complicaciones de los pacientes tratados con esta técnica. RESULTADOS: Se incluyeron 112 neonatos, 56 del período-OAF y 56 de la temporada pre-OAF. En el período-OAF ningún paciente requirió intubación en comparación con la temporada previa, donde el 3,6% precisó ventilación mecánica invasiva. El uso de OAF se asoció con una disminución significativa de ventilación mecánica no invasiva (30,4% vs 10,7%; p = 0,01), con un RR de 0,353 (IC 95%: 0,150-0,829), RAR de 19,6% (IC 95%: 5,13-34,2) y NNT de 5. En el período-OAF 22 pacientes recibieron terapia de alto flujo y 22,7% de ellos (IC 95%: 7,8-45,4) requirieron ventilación no invasiva. Tras el inicio de OAF se observó una mejoría rápida y progresiva de la frecuencia cardiaca (p = 0,03), frecuencia respiratoria (p = 0,01) y escala clínica (p = 0,00) a partir de 3 h. No se registraron efectos adversos. CONCLUSIONES: El uso de OAF disminuye la necesidad de ventilación no invasiva y es un tratamiento seguro que consigue mejoría clínica de neonatos con bronquiolitis

OBJECTIVE: To determine whether the availability of heated humidified high-flow nasal cannula (HFNC) therapy was associated with a decrease in need for mechanical ventilation in neonates hospitalised with acute bronchiolitis. METHODS: A combined retrospective and prospective (ambispective) cohort study was performed in a type II-B Neonatal Unit, including hospitalised neonates with acute bronchiolitis after the introduction of HFNC (HFNC-period; October 2011-April 2015). They were compared with a historical cohort prior to the availability of this technique (pre-HFNC; January 2008-May 2011). The need for mechanical ventilation between the two study groups was analysed. Clinical parameters and technique-related complications were evaluated in neonates treated with HFNC. RESULTS: A total of 112 neonates were included, 56 after the introduction of HFNC and 56 from the period before the introduction of HFNC. None of patients in the HFNC-period required intubation, compared with 3.6% of the patients in the pre-HFNC group. The availability of HFNC resulted in a significant decrease in the need for non-invasive mechanical ventilation (30.4% vs 10.7%; P = .01), with a relative risk (RR) of .353 (95% CI; .150-.829), an absolute risk reduction (ARR) of 19.6% (95% CI; 5.13 - 34.2), yielding a NNT of 5. In the HFNC-period, 22 patients received high flow therapy, and 22.7% (95% CI; 7.8 to 45.4) required non-invasive ventilation. Treatment with HFNC was associated with a significant decrease in heart rate (P = .03), respiratory rate (P = .01), and an improvement in the Wood-Downes Férres score (P = .00). No adverse effects were observed. CONCLUSIONS: The availability of HFNC reduces the need for non-invasive mechanical ventilation, allowing a safe and effective medical management of neonates with acute bronchiolitis

Bronquitis plástica idiopática como causa infrecuente de atelectasia pulmonar masiva recurrente / Idiopathic Plastic Bronchitis as an Uncommon Cause of Massive Pulmonary Atelectasis

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Maternal smoking during pregnancy and lower respiratory tract illness in early life.

In a national study of 12,743 children maternal, but not paternal, smoking was confirmed as having a significant influence on the reported incidence of bronchitis and admission to hospital for lower respiratory tract illness during the first five years of life. Reported rates of admissions to hospital for lower respiratory tract diseases were found to be as high in children born to mothers who stopped smoking during pregnancy as in those whose mothers smoked continuously both during and after pregnancy. Rates of admissions to hospital for lower respiratory tract diseases in children whose mothers started smoking only postnatally were no higher than in those whose mothers remained non-smokers. Postnatal smoking seemed to exert a significant influence on the reported incidence of bronchitis, but less than smoking during pregnancy. These findings suggest that maternal smoking influences the incidence of respiratory illnesses in children mainly through a congenital effect, and only to a lesser extent through passive exposure after birth.

[Congenital obliterating bronchiolitis (report on the diagnosis of the disease in 2 late abortions)]. / Zur Kenntnis der Bronchiolitis obliterans connata (Bericht über das Krankheitsbild bei 2 Spätaborten).

The clinical and histopathologic features are presented for two cases of congenital bronchiolitis obliterans which were diagnosed in fetal lungs from two miscarriages (in the 24th and 28th week of pregnancy respectively). Based on the relevant medical literature we regard a transplacental hematogenous viral infection in association with aspiration of infected amnionic fluid, following ascending bacterial chorioamnionitis as the etiopathogenic process underlying the lung alterations. In both cases an increased erythrocyte sedimentation rate was the only clinical evidence of a maternal disorder. Therefore this laboratory abnormality in a pregnant women makes a clinical examination advisable.

Congenital bronchiolitis obliterans.

A case is described of intrauterine pneumonia with "Congenital Bronchiolitis Obliterans" in a premature infant who died 35 hours after delivery. The patient presented from birth with increasingly severe respiratory insufficiency. Post-mortem histological examination of the lung revealed obliterative bronchiolitis, a rare disease which the patient most probably developed in utero. Only two other similar cases of congenital obliterative bronchiolitis have been reported in the literature, both with obscure etiology. A detailed pathological description of pulmonary changes is given and the literature is reviewed.