Age-dependent nasal immune responses in non-hospitalized bronchiolitis children.

Bronchiolitis in children is associated with significant rates of morbidity and mortality. Many studies have been performed using samples from hospitalized bronchiolitis patients, but little is known about the immunological responses from infants suffering from mild/moderate bronchiolitis that do not require hospitalization. We have studied a collection of nasal lavage fluid (NLF) samples from outpatient bronchiolitis children as a novel strategy to unravel local humoral and cellular responses, which are not fully characterized. The children were age-stratified in three groups, two of them (GI under 2-months, GII between 2-4 months) presenting a first episode of bronchiolitis, and GIII (between 4 months and 2 years) with recurrent respiratory infections. Here we show that elevated levels of pro-inflammatory cytokines (IL1ß, IL6, TNFα, IL18, IL23), regulatory cytokines (IL10, IL17A) and IFNγ were found in the three bronchiolitis cohorts. However, little or no change was observed for IL33 and MCP1, at difference to previous results from bronchiolitis hospitalized patients. Furthermore, our results show a tendency to IL1ß, IL6, IL18 and TNFα increased levels in children with mild pattern of symptom severity and in those in which non RSV respiratory virus were detected compared to RSV+ samples. By contrast, no such differences were found based on gender distribution. Bronchiolitis NLFs contained more IgM, IgG1, IgG3 IgG4 and IgA than NLF from their age-matched healthy controls. NLF from bronchiolitis children predominantly contained neutrophils, and also low frequency of monocytes and few CD4+ and CD8+ T cells. NLF from infants older than 4-months contained more intermediate monocytes and B cell subsets, including naïve and memory cells. BCR repertoire analysis of NLF samples showed a biased VH1 usage in IgM repertoires, with low levels of somatic hypermutation. Strikingly, algorithmic studies of the mutation profiles, denoted antigenic selection on IgA-NLF repertoires. Our results support the use of NLF samples to analyze immune responses and may have therapeutic implications.

Cuidar el sueño. Valoración y cuidados del sueño en la población infantil / Take care of sleep. Assessment and care of sleep in the child population

Se presenta un trabajo conceptual sobre el cuidado del sueño en las edades pediátricas con el objetivo de describir las características, consecuencias de privación o mala higiene del sueño y presentar instrumentos de valoración y propuestas de cuidados. La información se estructura en seis áreas temáticas: 1. Características del sueño en la edad pediátrica, 2. Consecuencias de inadecuada calidad del sueño en los niños/as, 3. Problemas y trastornos del sueño en la edad pediátrica, 4. Prevalencia de la afectación del sueño en la edad pediátrica, 5. Valoración del sueño en edad pediátrica, 6. Cuidados de enfermería relacionados con el sueño. Se presentan los instrumentos de valoración por edades y los diagnósticos, objetivos e intervenciones específicas en cuidados que se deben considerar en la educación sanitaria en estas edades. Son pocos los estudios sobre el sueño en las edades pediátricas. Futuras líneas de investigación serían de interés para la descripción de los hábitos de sueño en la población infantil y la identificación de necesidades en cuidados, para incorporar intervenciones enfermeras y probar su eficacia por grupos de edad dada la trascendencia, para incorporar evidencia relevante a la práctica en cuidados. (AU)

A conceptual work on sleep care in pediatric ages is presented with the aim of describing the characteristics, consequences of sleep deprivation or poor hygiene and presenting assessment instruments and care proposals. The information is structured in six thematic areas: 1. Sleep characteristics in pediatric age, 2. Consequences of poor sleep quality in children, 3. Sleep problems and disorders in pediatric age, 4. Prevalence of sleep impairment in pediatric age, 5. Sleep assessment in pediatric age, 6. Sleep-related nursing care. The assessment instruments by age and the diagnoses, objectives and specific interventions in care that should be considered in health education at these ages are presented. There are few studies on sleep in pediatric ages. Future lines of research would be of interest for the description of sleep habits in the child population and the identification of care needs to incorporate nursing interventions and test their effectiveness by age groups given the relevance to incorporate relevant evidence to care practice. (AU)