Nirsevimab immunization's real-world effectiveness in preventing severe bronchiolitis: A test-negative case-control study.

BACKGROUND: Several clinical trials have shown that nirsevimab, an antibody targeting the respiratory syncytial virus (RSV), reduces RSV bronchiolitis requiring admission. In 2023-2024, Catalonia and Andorra adopted immunization strategies for children <6 months and those born during the epidemic season. This study evaluates the effectiveness of nirsevimab in preventing hospitalizations from RSV bronchiolitis. METHODS: In the epidemic season of 2023-2024, a test-negative case-control study was conducted in three hospitals from Catalonia and Andorra. Patients <12 months old admitted with bronchiolitis and tested for RSV using molecular microbiology tests were included. The effectiveness in preventing RSV bronchiolitis hospitalization and severe disease was estimated using multivariate models. Comparisons between immunized, non-immunized, and non-eligible patients were made in prospectively collected epidemiological, clinical, and microbiological variables. RESULTS: Two hundred thirty-four patients were included. RSV was detected in 141/234 (60.2%), being less common in the immunized group (37% vs 75%, p < .001). The rate of immunized patients among those eligible was 59.7%. The estimated effectiveness for RSV-associated lower respiratory tract infection was 81.0% (95% confidence interval: 60.9-90.7), and for preventing severe disease (the need for NIV/CMV), 85.6% (41.7-96.4%). No significant differences by immunization status were observed in patients with RSV concerning viral coinfections, the need for NIV/CMV or length of hospital stay. CONCLUSIONS: This study provides real-world evidence of the effectiveness of nirsevimab in preventing RSV-lower respiratory tract infection hospitalization and severe disease in infants during their first RSV season following a systematic immunization program. Immunized patients did not exhibit a higher rate of viral coinfections nor differences in clinical severity once admitted.

[Consultations for digestive foreign bodies ingestion in a pediatric emergency department.] / Consultas por ingestión de cuerpos extraños digestivos en unas urgencias pediátricas.

OBJECTIVE: Foreign body (FB) ingestion distresses many families who consult the emergency department promptly. The objective of the study is to determine the epidemiological characteristics of children who consult due to suspected FB intake and its consequences. METHODS: Descriptive-observational study, carried out in a third-level maternal and child center. Emergency reports were selected from patients under 18 years of age with a diagnosis of discharge "Ingesta CE" (code 938 CIM-9-MC until May 2018; code T18.9XXA CIM-10-MC later) from 1/1/2017 until 12/31/2018. Miscoded and reconsultations within the same episode were excluded. Data was analysed with the statistics program SPSS 25.0. RESULTS: 458 cases were included; median age 3.8 years (p25-75: 1.9-6.6 years); 267 (58.3%) males. 78.9% consulted in the first 6 hours after intake. Accidental cause was reported in 98.9% of cases. In 96.7% a single FB was ingested. The most frequent types of object were metallic (46.7%), plastics (16.4%) and food bones/shells (12.9%). The 23.6% of FB involved were sharp/pointed. 49.1% of the patients presented symptoms. A complementary test was performed in 69.4%, especially radiographs (63.5%). Metal detector was used in 10%. 9.6% required endoscopy. 90.4% were discharged from the emergency department, with 12.1% of reconsultations. CONCLUSIONS: Consultations for FB ingestion are relatively frequent in the emergency department and, although most of them are discharged, many patients require complementary tests and a non-negligible number, endoscopy. The patient's profile is that of a preschooler who spontaneously goes to the emergency room due to an accidental ingestion of a blunt metallic object.

OBJETIVO: La ingestión de un cuerpo extraño (CE) angustia a muchas familias que consultan con premura a Urgencias. El objetivo del estudio fue determinar las características epidemiológicas de los niños que consultaban por sospecha de ingesta de CE y sus consecuencias. METODOS: Se realizó un estudio descriptivo-observacional, realizado en un centro materno-infantil de tercer nivel. Se seleccionaron los informes de Urgencias de pacientes menores de 18 años con diagnóstico de alta por "Ingesta CE" (código 938 CIM-9-MC hasta mayo 2018; código T18.9XXA CIM-10-MC posteriormente) del 1/1/2017 al 31/12/2018. Los datos fueron analizados con el programa estadístico SPSS 25.0. RESULTADOS: Se incluyeron 458 casos. La edad mediana fue de 3,8 años (p25-75: 1,9-6,6 años); 267 personas (58,3%) fueron varones. El 78,9% consultaron durante las 6 horas posteriores a la ingesta. Refirieron causa accidental el 98,9% los casos. En el 96,7%, la ingesta fue de un único CE. Los objetos más frecuentes fueron metálicos (46,7%), plásticos (16,4%) y huesos/cáscaras de alimentos (12,9%). El 23,6% de CE implicados fueron afilados/puntiagudos. El 49,1% de los pacientes presentaron algún síntoma. Se realizó alguna prueba complementaria en un 69,4% de los casos, sobre todo radiografías (63,5%). Se usó el detector de metales en el 10%. El 9,6% precisó endoscopia. El 90,4% fue dado de alta desde Urgencias, con un 12,1% de reconsultas. CONCLUSIONES: Las consultas por ingestión de CE son relativamente frecuentes en Urgencias y, aunque la mayoría son dados de alta, muchos pacientes requieren pruebas complementarias, y un número no despreciable, necesita endoscopia. El perfil del paciente es el de un varón en edad preescolar que acude espontáneamente a Urgencias por ingesta accidental de un objeto romo metálico.

Consultas por ingestión de cuerpos extraños digestivos en unas urgencias pediátricas / Consultations for digestive foreign bodies ingestion in a pediatric emergency department

OBJETIVO: La ingestión de un cuerpo extraño (CE) angustia a muchas familias que consultan con premura a Urgencias. El objetivo del estudio fue determinar las características epidemiológicas de los niños que consultaban por sospecha de ingesta de CE y sus consecuencias. MÉTODOS: Se realizó un estudio descriptivo-observacional, realizado en un centro materno-infantil de tercer nivel. Se seleccionaron los informes de Urgencias de pacientes menores de 18 años con diagnóstico de alta por "Ingesta CE" (código 938 CIM-9-MC hasta mayo 2018; código T18.9XXA CIM-10-MC posteriormente) del 1/1/2017 al 31/12/2018. Los datos fueron analizados con el programa estadístico SPSS 25.0. RESULTADOS: Se incluyeron 458 casos. La edad mediana fue de 3,8 años (p25-75: 1,9-6,6 años); 267 personas (58,3%) fueron varones. El 78,9% consultaron durante las 6 horas posteriores a la ingesta. Refirieron causa accidental el 98,9% los casos. En el 96,7%, la ingesta fue de un único CE. Los objetos más frecuentes fueron metálicos (46,7%), plásticos (16,4%) y huesos/cáscaras de alimentos (12,9%). El 23,6% de CE implicados fueron afilados/puntiagudos. El 49,1% de los pacientes presentaron algún síntoma. Se realizó alguna prueba complementaria en un 69,4% de los casos, sobre todo radiografías (63,5%). Se usó el detector de metales en el 10%. El 9,6% precisó endoscopia. El 90,4% fue dado de alta desde Urgencias, con un 12,1% de reconsultas. CONCLUSIONES: Las consultas por ingestión de CE son relativamente frecuentes en Urgencias y, aunque la mayoría son dados de alta, muchos pacientes requieren pruebas complementarias, y un número no despreciable, necesita endoscopia. El perfil del paciente es el de un varón en edad preescolar que acude espontáneamente a Urgencias por ingesta accidental de un objeto romo metálico

OBJECTIVE: Foreign body (FB) ingestion distresses many families who consult the emergency department promptly. The objective of the study is to determine the epidemiological characteristics of children who consult due to suspected FB intake and its consequences. METHODS: Descriptive-observational study, carried out in a third-level maternal and child center. Emergency reports were selected from patients under 18 years of age with a diagnosis of discharge "Ingesta CE" (code 938 CIM-9-MC until May 2018; code T18.9XXA CIM-10-MC later) from 1/1/2017 until 12/31/2018. Miscoded and reconsultations within the same episode were excluded. Data was analysed with the statistics program SPSS 25.0. RESULTS: 458 cases were included; median age 3.8 years (p25-75: 1.9-6.6 years); 267 (58.3%) males. 78.9% consulted in the first 6 hours after intake. Accidental cause was reported in 98.9% of cases. In 96.7% a single FB was ingested. The most frequent types of object were metallic (46.7%), plastics (16.4%) and food bones/shells (12.9%). The 23.6% of FB involved were sharp/pointed. 49.1% of the patients presented symptoms. A complementary test was performed in 69.4%, especially radiographs (63.5%). Metal detector was used in 10%. 9.6% required endoscopy. 90.4% were discharged from the emergency department, with 12.1% of reconsultations. CONCLUSIONS: Consultations for FB ingestion are relatively frequent in the emergency department and, although most of them are discharged, many patients require complementary tests and a non-negligible number, endoscopy. The patient's profile is that of a preschooler who spontaneously goes to the emergency room due to an accidental ingestion of a blunt metallic object