Incidencia y factores de riesgo de bronquitis sibilantes en los primeros 6 meses de vida en una cohorte de Alzira (Valencia) / Incidence of wheezing and associated risk factors in the first 6 months of life of a cohort in Valencia (Spain)

Objetivos Determinar la incidencia de bronquitis sibilantes (BS) en los primeros 6 meses de vida en la población de Alzira (Valencia) y analizar los factores de riesgo asociados. Métodos Estudio longitudinal prospectivo basado en una cohorte de 636 niños, incluidos consecutivamente entre marzo de 2007 y noviembre de 2008 tras el nacimiento. Revisión de historias clínicas hospitalarias y ambulatorias a los 6 meses de vida y envío de cuestionarios por correo. Análisis bivariante y multivariante de los distintos factores de riesgo registrados mediante regresión de Cox. Resultados A los 6 meses, el 25,2% de los niños había presentado al menos un episodio de BS, y el 5,6% había presentado 3 o más episodios. El 11,6% de los niños recibió atención en urgencias en alguna ocasión, el 6,6% recibió corticoides orales y el 4% precisó ingreso hospitalario. Se comportaron como factores de riesgo independientes de BS el sexo masculino (riesgo relativo [RR]: 2,1; intervalo de confianza [IC] del 95%: 1,5-2,9), la menor edad gestacional (RR: 1,1; IC del 95%: 1,0-1,2), el nacimiento en el tercer trimestre (RR: 3,5; IC del 95%: 2,0-5,9), el cuarto trimestre (RR: 2,0; IC del 95%: 1,1-3,6) del año, la menor edad materna (RR: 0,9; IC del 95%: 1,0-1,1), la existencia de hermanos mayores (RR: 3,1; IC del 95%: 2,2-4,5), la exposición al tabaco (RR: 1,4; IC del 95%: 1,0-2,0) y el antecedente de asma en la madre (RR: 1,7; IC del 95%: 1,0-3,0); lo hicieron como factores protectores la lactancia materna durante un período igual o superior a 3 meses (RR: 0,6; IC del 95%: 0,4-0,8) y el origen inmigrante de los padres (RR: 0,6, IC del 95%: 0,4- 0,9). Conclusiones La incidencia acumulada de BS en los primeros 6 meses de vida en nuestra población es elevada, y supera la descrita en otros estudios. La mayor parte de los factores de riesgo coinciden con los que señalan otros autores. Destacan como más importantes la existencia de hermanos mayores y el nacimiento en el tercer trimestre del año, lo que refleja el importante papel de las infecciones víricas en la patogenia de las BS a estas edades (AU)

Objectives To determine the incidence of wheezing at 6 months of life in the town of Alzira (Valencia, Spain), and to analyse associated risk factors. Methods We included 636 newborns in a longitudinal birth cohort study between March 2007 and November 2008. Data were collected from hospital and primary care medical records and from questionnaires sent at 6 months post-natal. Bivariate and multivariate Cox regression analysis were performed to examine the risk factors associated with wheezing. Results At 6 months, 25.2% of infants had had 1 or more episodes of wheezing, whereas 5.6% had had 3 or more episodes. Emergency visits were reported in 11.6% of the infants, treatment with oral corticosteroids in 6.6% and admission to hospital in 4%. Independent risk factors for wheezing were male sex (relative risk [RR]: 2.1, 95% confidence interval [95% CI]: 1.5 to 2.9), younger gestational age (RR: 1.1, 95% CI: 1.0 to 1.2), season of birth between July and September (RR: 3.5, 95% CI: 2.0 to 5.9) and between October and December (RR: 2.0, 95% CI: 1.1 to 3.6), younger maternal age (RR: 1.0, 95% CI: 1.0 to 1.1), having siblings (RR: 3.1, 95% CI: 2.2 to 4.5), exposure to smoke (RR: 1.4, 95% CI: 12.0 to 2.0) and history of maternal asthma (RR: 1.7, 95% CI: 1.0 to 3.0). Breast feeding for at least 3 months (RR: 0.6, 95% CI: 0.4 to 0.8) and having immigrant parents (RR: 0.6, 95% CI: 0.4 to 0.9) were protective against wheezing. Conclusion A high cumulative incidence of wheezing in the first 6 months of life was found in our population, in comparison with data reported in other cohort studies. Estimated risk factors were generally in accordance with those described by other authors. Having siblings and season of birth between July and September were the most important risk factors, reflecting the role of viral infections in the pathogenesis of wheezing in early childhood (AU)

[Incidence of wheezing and associated risk factors in the first 6 months of life of a cohort in Valencia (Spain)]. / Incidencia y factores de riesgo de bronquitis sibilantes en los primeros 6 meses de vida en una cohorte de Alzira (Valencia).

OBJECTIVES: To determine the incidence of wheezing at 6 months of life in the town of Alzira (Valencia, Spain), and to analyse associated risk factors. METHODS: We included 636 newborns in a longitudinal birth cohort study between March 2007 and November 2008. Data were collected from hospital and primary care medical records and from questionnaires sent at 6 months post-natal. Bivariate and multivariate Cox regression analysis were performed to examine the risk factors associated with wheezing. RESULTS: At 6 months, 25.2% of infants had had 1 or more episodes of wheezing, whereas 5.6% had had 3 or more episodes. Emergency visits were reported in 11.6% of the infants, treatment with oral corticosteroids in 6.6% and admission to hospital in 4%. Independent risk factors for wheezing were male sex (relative risk [RR]: 2.1, 95% confidence interval [95% CI]: 1.5 to 2.9), younger gestational age (RR: 1.1, 95% CI: 1.0 to 1.2), season of birth between July and September (RR: 3.5, 95% CI: 2.0 to 5.9) and between October and December (RR: 2.0, 95% CI: 1.1 to 3.6), younger maternal age (RR: 1.0, 95% CI: 1.0 to 1.1), having siblings (RR: 3.1, 95% CI: 2.2 to 4.5), exposure to smoke (RR: 1.4, 95% CI: 12.0 to 2.0) and history of maternal asthma (RR: 1.7, 95% CI: 1.0 to 3.0). Breast feeding for at least 3 months (RR: 0.6, 95% CI: 0.4 to 0.8) and having immigrant parents (RR: 0.6, 95% CI: 0.4 to 0.9) were protective against wheezing. CONCLUSION: A high cumulative incidence of wheezing in the first 6 months of life was found in our population, in comparison with data reported in other cohort studies. Estimated risk factors were generally in accordance with those described by other authors. Having siblings and season of birth between July and September were the most important risk factors, reflecting the role of viral infections in the pathogenesis of wheezing in early childhood.

"Hymenolepis nana", un parásito a tener en cuenta en nuestro medio / "Hymenolepis nana", a parasite to be taken into consideration in our patient population

Los autores estudian retrospectivamente las características epidemiológicas y clínicas de 13 pacientes parasitados por Hymenolepis nana, e inciden especialmente en la importancia de la higiene en la transmisión de la enfermedad y en el incremento de casos identificados en niños adoptados e inmigrantes. También hacen hincapié en manifestaciones clínicas menos habituales, como la enfermedad neurológica que presentan dos de los pacientes. El tratamiento se realizó en todos los casos con praziquantel, y se tomaron las medidas oportunas para eliminar las fuentes de infección y prevenir la transmisión de la enfermedad, cuyo mecanismo más habitual es persona a persona (AU)