Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital. / Manejo de la patología congénita y adquirida de la vía aérea en el neonato por parte de un comité multidisciplinar en un centro terciario.

INTRODUCTION: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persistent stridor and extubation failure, as well as to assess complications following cardiac surgery. At our institution, these examinations are carried out by a pulmonologist, a neonatologist, an otorhinolaryngologist, and a pediatric surgeon from the pediatric airway committee, established in 2014. OBJECTIVE: To analyze the airway examinations performed in neonates during their stay at the neonatology/neonatal intensive care unit since the airway committee was established. MATERIAL AND METHODS: A retrospective study of the airway examinations conducted in neonates from 2015 to 2019 was carried out. Clinical and demographic data, number of examinations, indications, findings, and complications were collected. Results are presented as mean and standard deviation. Statistical significance was established at p < 0.05. RESULTS: 92 airway examinations were analyzed in 51 patients (54.9% of whom were female). 51% of the patients were premature. Extubation failure and persistent respiratory symptoms following successful extubation were the most frequent indications for airway examination (35.3%). Stratification by gestational age or weight at birth was not associated with an increased risk of pathological findings at examination (p > 0.05). The most frequent finding was vocal cord paralysis (n = 14; 27.5%). In 10 patients (19.6%), no pathological findings were observed. CONCLUSION: Airway examination is useful in patients with stridor to identify vocal cord paralysis following extubation failure. It also allows congenital airway pathologies to be diagnosed and treated. The number of examinations with no pathological findings was similar to that reported in international series.

INTRODUCCION: La exploración de vía aérea mediante broncoscopia flexible/rígida en el neonato ha demostrado utilidad en el estridor persistente, extubaciones fallidas o para valorar complicaciones tras cirugía cardiaca. En nuestro hospital estas exploraciones son practicadas por un neumólogo, neonatólogo, otorrinolaringólogo y cirujano pediátrico del Comité de Vía Aérea Pediátrica, formado en 2014. OBJETIVO: Analizar las exploraciones de vía aérea practicadas a neonatos durante su estancia en Neonatología/Unidad de Cuidados Intensivos Neonatales desde la constitución del Comité de Vía Aérea. MATERIAL Y METODOS: Estudio retrospectivo de exploraciones de vía aérea practicadas a neonatos de 2015-2019. Se recogen datos clínicos y demográficos, número de exploraciones, indicación, hallazgos y complicaciones. Se presentan las medias con su desviación estándar. Se consideró un resultado estadísticamente significativo cuando p < 0,05. RESULTADOS: Se analizaron 92 exploraciones de vía aérea en 51 pacientes (género femenino: 54,9%). El 51% de los pacientes fueron prematuros. La extubación fallida y la persistencia de sintomatología respiratoria tras una extubación satisfactoria fueron las indicaciones más frecuentes (35,3%). La estratificación por edad gestacional o por peso al nacimiento no se asociaba a un mayor riesgo de presentar hallazgos patológicos en la exploración. El hallazgo más frecuente fue la parálisis de cuerda vocal (n = 14; 27,5%). En 10 pacientes (19,6%) no se encontraron hallazgos patológicos. CONCLUSION: La exploración de la vía aérea es útil en pacientes con estridor postextubación y para identificar parálisis de cuerda vocal tras extubación fallida. Además, permite el diagnóstico y tratamiento de patologías congénitas de la vía aérea.

Manejo de la patología congénita y adquirida de la vía aérea en el neonato por parte de un comité multidisciplinar en un centro terciario / Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital

Introducción: La exploración de vía aérea mediante broncoscopiaflexible/rígida en el neonato ha demostrado utilidad en el estridor persistente, extubaciones fallidas o para valorar complicaciones tras cirugíacardiaca. En nuestro hospital estas exploraciones son practicadas porun neumólogo, neonatólogo, otorrinolaringólogo y cirujano pediátricodel Comité de Vía Aérea Pediátrica, formado en 2014. Objetivo: Analizar las exploraciones de vía aérea practicadas aneonatos durante su estancia en Neonatología/Unidad de CuidadosIntensivos Neonatales desde la constitución del Comité de Vía Aérea.Materiales. Estudio retrospectivo de exploraciones de vía aéreapracticadas a neonatos en el periodo 2015-2019. Se recogen datosclínicos y demográficos, número de exploraciones, indicación, hallazgos y complicaciones. Se presentan las medias con su desviaciónestándar. Se consideró un resultado estadísticamente significativocuando p < 0,05. Resultados: Se analizaron 92 exploraciones de vía aérea en 51pacientes (género femenino: 54,9%). El 51% de los pacientes fueronprematuros. La extubación fallida y la persistencia de sintomatologíarespiratoria tras una extubación satisfactoria fueron las indicacionesmás frecuentes (35,3%). La estratificación por edad gestacional o porpeso al nacimiento no se asociaba a un mayor riesgo de presentar ha-llazgos patológicos en la exploración. El hallazgo más frecuente fue laparálisis de cuerda vocal (n = 14; 27,5%). En 10 pacientes (19,6%) nose encontraron hallazgos patológicos. Conclusión: La exploración de la vía aérea es útil en pacientes conestridor postextubación y para identificar parálisis de cuerda vocal trasextubación fallida. Además, permite el diagnóstico y tratamiento depatologías congénitas de la vía aérea.(AU)

Introduction: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persis-tent stridor and extubation failure, as well as to assess complicationsfollowing cardiac surgery. At our institution, these examinations arecarried out by a pulmonologist, a neonatologist, an otorhinolaryngolo-gist, and a pediatric surgeon from the pediatric airway committee,established in 2014. Objective: To analyze the airway examinations performed in neo-nates during their stay at the neonatology/neonatal intensive care unitsince the airway committee was established.Materials and methods. A retrospective study of the airway ex-aminations conducted in neonates from 2015 to 2019 was carried out.Clinical and demographic data, number of examinations, indications,findings, and complications were collected. Results are presented asmean and standard deviation. Statistical significance was establishedat p < 0.05. Results: 92 airway examinations were analyzed in 51 patients(54.9% of whom were female). 51% of the patients were premature.Extubation failure and persistent respiratory symptoms followingsuccessful extubation were the most frequent indications for airwayexamination (35.3%). Stratification by gestational age or weight atbirth was not associated with an increased risk of pathological findingsat examination (p > 0.05). The most frequent finding was vocal cordparalysis (n = 14; 27.5%). In 10 patients (19.6%), no pathologicalfindings were observed. Conclusion: Airway examination is useful in patients with stridorto identify vocal cord paralysis following extubation failure. It alsoallows congenital airway pathologies to be diagnosed and treated. Thenumber of examinations with no pathological findings was similar tothat reported in international series.(AU)

Bronchopulmonary dysplasia as a risk factor for asthma in school children and adolescents: A systematic review

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mainly affects extremely pre-term infants, and remains the most common complication of prematurity. Several studies have shown that prematurity predisposes to the development of asthma in school children and adolescents. Nevertheless, it is not clear to what extent a history of BPD involves an additional risk. Methods: A systematic review of studies assessing the association between BPD and asthma in school-children and adolescents was made. A literature search was carried out in the MEDLINE and EMBASE databases to retrieve articles published between 1 January 2000 and 31 August 2016. Results: A total of 17 studies comprising 7433 patients were included in the review. There was considerable heterogeneity in the definitions of BPD and asthma among studies. Overall, the prevalence of asthma was higher in children and adolescents with a history of prematurity and BPD compared with those who did not develop BPD. However, in only one of the studies did this difference reach statistical significance. The main limitation of this review was potential bias due to the lack of adjustment for confounding factors between exposure (BPD) and outcome (asthma) in most of the studies. Conclusion:Based on the studies reviewed, it cannot be argued that BPD, as an independent factor of prematurity, increases the risk of asthma defined by clinical parameters in school-children and adolescents. Further studies of greater methodological quality and homogeneous diagnostic criteria of BPD and asthma are needed for improved assessment of this association (AU)

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Bronchopulmonary dysplasia as a risk factor for asthma in school children and adolescents: A systematic review.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mainly affects extremely pre-term infants, and remains the most common complication of prematurity. Several studies have shown that prematurity predisposes to the development of asthma in school children and adolescents. Nevertheless, it is not clear to what extent a history of BPD involves an additional risk. METHODS: A systematic review of studies assessing the association between BPD and asthma in school-children and adolescents was made. A literature search was carried out in the MEDLINE and EMBASE databases to retrieve articles published between 1 January 2000 and 31 August 2016. RESULTS: A total of 17 studies comprising 7433 patients were included in the review. There was considerable heterogeneity in the definitions of BPD and asthma among studies. Overall, the prevalence of asthma was higher in children and adolescents with a history of prematurity and BPD compared with those who did not develop BPD. However, in only one of the studies did this difference reach statistical significance. The main limitation of this review was potential bias due to the lack of adjustment for confounding factors between exposure (BPD) and outcome (asthma) in most of the studies. CONCLUSION: Based on the studies reviewed, it cannot be argued that BPD, as an independent factor of prematurity, increases the risk of asthma defined by clinical parameters in school-children and adolescents. Further studies of greater methodological quality and homogeneous diagnostic criteria of BPD and asthma are needed for improved assessment of this association.

Protocolo de seguimiento de los pacientes con displasia broncopulmonar / Guidelines for the follow up of patients with bronchopulmonary dysplasia

La displasia broncopulmonar (DBP) es la secuela más prevalente del recién nacido pretérmino, y sigue suponiendo un motivo frecuente de consulta en las unidades de Neumología Pediátrica. La decisión del alta de la unidad neonatal debe apoyarse en una valoración exhaustiva de la situación clínica del paciente y en el cumplimiento de unos requisitos, que incluyen la estabilidad respiratoria y nutricional, y la instrucción a los cuidadores en el manejo domiciliario. Para un control adecuado de la enfermedad, es necesario que quede establecido, previamente al alta, un calendario de visitas y de exploraciones complementarias, y deben aplicarse las pautas de prevención de exacerbaciones y el tratamiento apropiados. El concepto de DBP como enfermedad multisistémica es fundamental en el seguimiento de los pacientes y debe ser tenido en cuenta para un buen control de la enfermedad. En este documento, el Grupo de Trabajo de Patología Respiratoria Perinatal de la Sociedad Española de Neumología Pediátrica propone un protocolo que sirva como referencia para unificar el seguimiento de los pacientes con DBP entre los diferentes centros y ámbitos asistenciales. Se revisan los aspectos a tener en cuenta en la evaluación previa al alta de la Unidad Neonatal y las principales complicaciones durante el seguimiento. Seguidamente, se detallan las recomendaciones en materia de tratamiento de la enfermedad y prevención de complicaciones, los controles tras el alta y su cronología

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD

[Guidelines for the follow up of patients with bronchopulmonary dysplasia]. / Protocolo de seguimiento de los pacientes con displasia broncopulmonar.

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD.

Valor de la determinación de óxido nítrico exhalado en el diagnóstico de asma episódica / Diagnostic value of exhaled nitric oxide measurement in mild asthma

Objetivos: Determinar el valor diagnóstico de la fracción exhalada del óxido nítrico (FENO) en el asma episódica. Material y métodos: Estudio descriptivo y transversal llevado a cabo en un grupo de pacientes sin antecedentes de patología respiratoria o alérgica (grupo control) y un grupo de pacientes con asma episódica sin tratamiento de base (grupo asma), con edades comprendidas entre los 6 y los 14 años. El protocolo incluyó la medición de la FENO con el analizador portátil NIOX MINO®, seguido de estudio alergológico y espirometría forzada. La repetibilidad de la técnica se analizó con el coeficiente de correlación intraclase, el coeficiente de repetibilidad y el coeficiente de variación. El valor diagnóstico se determinó con la sensibilidad, especificidad, área bajo la curva ROC y la razón de verosimilitud positiva. Resultados: Fueron incluidos 87 pacientes en el grupo control y 57 en el grupo asma. El valor medio ± desviación estándar de la FENO en el grupo control fue de 12,1±13,5 ppb y en asmáticos de 42,9±24,5 ppb (p<0,001). El coeficiente de correlación intraclase fue de 0,98 (IC del 95%, 0,96-0,99) y de 0,97 (IC del 95%, 0,92-0,99) en controles y asmáticos, respectivamente; el coeficiente de repetibilidad de 5,5 y 9,2; y el coeficiente de variación (mediana) del 8,3 y el 6,1%. El punto de corte de la FENO que optimizó el valor de la sensibilidad y especificidad (el 91,4 y el 87,2%, respectivamente), fue de 19 ppb, con un área bajo la curva ROC de 0,93 (IC del 95%, 0,88-0,97) (p<0,001) y una RVP de 7,1. La sensibilización subclínica a neumoalérgenos fue la principal causa de falsos positivos. Conclusiones: La determinación de la FENO con NIOX-MINO® tiene una adecuada repetibilidad, especialmente en los pacientes sanos. En los asmáticos sería recomendable obtener el promedio de dos mediciones. La prueba posee un alto valor diagnóstico en el asma episódica. La sensibilización subclínica a neumoalérgenos puede elevar la FENO hasta niveles patológicos (AU)

Objectives: To assess the diagnostic value of fractional exhaled nitric oxide (FENO) in mild asthma. Material and methods: Cross-sectional descriptive study in a group of patients with no history of respiratory or allergic illness (control group) and a group of patients with a history of mild asthma with no baseline treatment (asthma group), both aged 6 to 14 years. The following examinations were performed: measurement of FENO using the portable NIOX MINO® device, allergy tests and spirometry. Repeatability of paired FENO measurements was estimated with the intraclass correlation coefficient, the repeatability coefficient and the variation coefficient. The diagnostic value was assessed with the sensitivity, specificity, area under the ROC curve and positive likelihood ratio (LR+) for each cut-off point. Results: Eighty-seven patients were included in the control group and 57 in the asthma group. The mean FENO value was 12.1 ppb (SD 13.5) in the control group and 42.9 ppb (SD 24.5) in asthmatics (P<0.001). The intraclass correlation coefficient was 0.98 (95% CI: 0.96-0.99) and of 0.97 (95% CI: 0.92-0.99) in controls and asthmatics, respectively. The repeatability coefficient was 5.5 in controls and 9.2 in asthmatic children, and the median variation coefficient was 8.3% and 6.1%. The optimal cut-off value for FENO was 19 ppb (sensitivity and specificity were 91.4% and 87.2%, respectively). The area under the ROC curve was 0.93 (95% CI: 0.88-0.97) (P<0.001) and the LR+ was 7.1. Subclinical sensitisation to pneumoallergens accounted for most false positive cases. Conclusions: The determination of FENO with NIOX MINO® has an adequate repeatability, especially for healthy patients. For asthmatic patients we recommend determining the average of two measurements. The test has a high diagnostic value in mild asthma. Subclinical sensitisation to pneumoallergens can cause the FENO value to rise to pathologic levels (AU)

[Diagnostic value of exhaled nitric oxide measurement in mild asthma]. / Valor de la determinación de óxido nítrico exhalado en el diagnóstico de asma episódica.

OBJECTIVES: To assess the diagnostic value of fractional exhaled nitric oxide (FE(NO)) in mild asthma. MATERIAL AND METHODS: Cross-sectional descriptive study in a group of patients with no history of respiratory or allergic illness (control group) and a group of patients with a history of mild asthma with no baseline treatment (asthma group), both aged 6 to 14 years. The following examinations were performed: measurement of FE(NO) using the portable NIOX MINO(®) device, allergy tests and spirometry. Repeatability of paired FE(NO) measurements was estimated with the intraclass correlation coefficient, the repeatability coefficient and the variation coefficient. The diagnostic value was assessed with the sensitivity, specificity, area under the ROC curve and positive likelihood ratio (LR+) for each cut-off point. RESULTS: Eighty-seven patients were included in the control group and 57 in the asthma group. The mean FE(NO) value was 12.1 ppb (SD 13.5) in the control group and 42.9 ppb (SD 24.5) in asthmatics (P<.001). The intraclass correlation coefficient was 0.98 (95% CI: 0.96-0.99) and of 0.97 (95% CI: 0.92-0.99) in controls and asthmatics, respectively. The repeatability coefficient was 5.5 in controls and 9.2 in asthmatic children, and the median variation coefficient was 8.3% and 6.1%. The optimal cut-off value for FE(NO) was 19 ppb (sensitivity and specificity were 91.4% and 87.2%, respectively). The area under the ROC curve was 0.93 (95% CI: 0.88-0.97) (P<.001) and the LR+ was 7.1. Subclinical sensitisation to pneumoallergens accounted for most false positive cases. CONCLUSIONS: The determination of FE(NO) with NIOX MINO(®) has an adequate repeatability, especially for healthy patients. For asthmatic patients we recommend determining the average of two measurements. The test has a high diagnostic value in mild asthma. Subclinical sensitisation to pneumoallergens can cause the FE(NO) value to rise to pathologic levels.

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.

[Respiratory function and clinical outcome in infants after premature birth and chronic pulmonary disease]. / Función respiratoria y evolución clínica en lactantes con antecedentes de prematuridad y enfermedad pulmonar crónica.

OBJECTIVE: The purpose of this study was to assess the clinical status and respiratory function of infants with premature birth-related pulmonary sequelae and their correlation. PATIENTS AND METHODS: We studied 23 patients with a mean postnatal age of 32 weeks. All infants were born prematurely and developed respiratory disease with radiological features of bronchopulmonary dysplasia. The neonatal clinical status and evolution were quantified by using clinical scoring systems described previously. Parameters of tidal flow volume curves were assessed by pneumotachography. Static compliance and resistance of the respiratory system were obtained using the single-breath occlusion technique. Results were compared with reference values available in the medical literature. RESULTS: Both the neonatal and evolutive clinical status were given a score of moderate severity. Mean values for weight adjusted compliance and resistance and those for respiratory rate and tidal volume were within the normal range. The mean value for time to peak expiratory flow as a ratio of total expiratory time was under the normal range, showing obstructive airway disease. There was a significant correlation (p < 0.05) between the evolutive clinical score and neonatal clinical score (r = 0.48), compliance (r = 0.50) and respiratory rate (r = 0.67). CONCLUSIONS: Measuring pulmonary function is useful in the follow-up of infants with respiratory disease, providing additional information about the clinical findings, evolution of the illness and subsequent outcome. The development of simple and noninvasive methods explains their increasing application to clinical uses and not exclusively research purposes.

[Risk factors for lung toxicity in pediatric cancer survivors]. / Factores de riesgo para toxicidad pulmonar en supervivientes de cáncer pediátrico.

OBJECTIVE: Our objectives were to determine the prevalence of alterations in lung function among pediatric cancer survivors with known risk factors and to establish clinical and imaging correlations, as well as to establish follow-up criteria. PATIENTS AND METHODS: Cancer survivors diagnosed at the Pediatric Oncology Unit between 1971 and 1997 who fulfilled at least one of the following criteria were eligible: 1) primary lung or thoracic wall neoplasm; 2) lung metastasis at diagnosis or later, or; 3) irradiation of mediastinum and/or lung fields. Assessment included respiratory symptomatology questionnaire, physical examination, forced spirometry, static lung volumes, maximal static respiratory pressures, single breath CO diffusing capacity, pulse oximetry and imaging studies. RESULTS: Thirty-five (14 females and 21 males) out of 41 survivors were assessed. Mean age at diagnosis, evaluation and follow-up were 9 (1-14), 18 (10-28) and 9 (3-27) years, respectively. The diagnoses included pleuropulmonary blastoma (1), chest wall Ewing's sarcoma (1), Hodgkin's disease (18), nephroblastoma (7), yolk-sac tumor (2), acute leukemia2), non-Hodgkin's lymphoma (1), rhabdomyosarcoma (1), coriocarcinoma of the ovary (1) and osteosarcoma (1). Thirteen patients presented lung metastasis at diagnosis or later. All were administered chemotherapy. Irradiated fields were the mediastinum (dose 20-56 Gy) in 20 cases, the lung (8-30 Gy) in 6 and the spine (24 Gy) in one. Eight underwent thoracotomy. Fourteen percent were dyspneic when walking at the same rate as a person of the same sex and age (grade 2). Twenty percent had a restrictive ventilatory disorder, but none were obstructive. The presence of dyspnea had sensitivity, specificity, positive predictive values and negative predictive value for the diagnosis of restrictive ventilatory disorder of 67%, 96%, 80% and 93%, respectively. Lung irradiation was associated with an increased risk for the development of restrictive disease. Excluding those who received lung irradiation, survivors under 6 years of age at diagnosis obtained lower spirometric values, lung volumes and DLCO values than survivors aged 6 years or older at diagnosis. There were no differences in pulmonary function values between survivors who received mediastinum irradiation and those who did not. The cumulative dose of cyclophosphamide significantly correlated with FVC, FEV1 and FRC. Pulse oximetry values were > or = 95% in all survivors. Maximal static respiratory pressures were within normal limits in all but one survivors whose other pulmonary function results were normal. Thirty-two percent (11 out of 34) had KCO (diffusing capacity adjusted to alveolar volume) values lower than 80% of reference values. Two survivors of nephroblastoma with pulmonary metastasis and who underwent lung irradiation had radiological signs of lung fibrosis. CONCLUSIONS: Pediatric cancer survivors who were administered intensive chemotherapy and/or lung irradiation are eligible for follow-up of lung function. Those diagnosed before 6 years of age and/or with moderate dyspnea are at high risk of having pulmonary restrictive disease. Imaging studies (chest X-ray) have a low sensitivity that prevents their use as a screening method in the follow-up of cancer survivors.