Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016) / Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016)

Introducción: La información existente sobre el impacto de la gripe en la población infantil española es escasa. El presente trabajo pretende aumentar este conocimiento estudiando aspectos clave como la incidencia de hospitalización, clínica, comorbilidades y el estado vacunal en los niños hospitalizados. Métodos: Estudio retrospectivo, observacional, por revisión de historias clínicas, en menores de 15 años hospitalizados por gripe adquirida en la comunidad, confirmada microbiológicamente, durante 2 temporadas gripales (2014-2015 y 2015-2016). El estudio se realizó en 10 hospitales de 6 ciudades, que atienden aproximadamente al 12% de la población infantil española. Resultados: Fueron hospitalizados 907 niños con diagnóstico principal de gripe (447 < 2 años), con una tasa media anual de incidencia de hospitalización de 0,51 casos/1.000 niños (IC del 95% 0,48-0,55). El 45% presentó enfermedades subyacentes consideradas factores de riesgo para gripe grave, y la mayor parte de ellos (74%) no habían sido vacunados. El porcentaje con enfermedades subyacentes aumentó con la edad, desde el 26% en menores de 6 meses al 74% en mayores de 10 años. El 10% de los casos (n = 92) precisaron cuidados intensivos pediátricos por fallo respiratorio agudo. Conclusión: La gripe es causa importante de hospitalización en la población infantil española. Los menores de 6 meses de edad y los niños con enfermedades subyacentes constituyen una parte mayoritaria (> 50%) de los casos. Una gran parte de las formas graves de gripe en población infantil podrían ser evitada si se cumplieran las indicaciones actuales de vacunación

Introduction: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. Methods: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́ flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. Results: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 < 2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children < 6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. Conclusion: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children < 6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met

[Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016)]. / Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016).

INTRODUCTION: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. METHODS: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. RESULTS: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 <2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children <6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. CONCLUSION: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children <6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met.

Physicochemical factors of the urine of children with hypercalciuria. / Características de los factores fisicoquímicos que componen la orina de los niños con hipercalciuria.

OBJECTIVE: Hypercalciuria is a common lithogenic risk factor. The aim of this study was, first, to study the characteristics of urine biochemical factors of children with hypercalciuria (HC) and compare them with those of children without hypercalciuria. Second, to analyze the differences between children with HC and lithiasis (HCL) and children with HC and no lithiasis (HCNL). METHODS: The sample was composed by 111 cases with HC, divided into 2 groups: HCNL group, consisting of 93 cases with no personal history of kidney stones, and HCL group, 18 cases with personal history of kidney stones. As a cohort control group, 113 healthy children were used. Creatinine, urea, sodium, potassium, chlorine, uric acid, calcium, phosphorus, magnesium and osmolality: blood and 24-hour urine following parameters were determined. Oxalate and citrate were determined in urine. RESULTS: The mean values of natriuresis, uricosuria, phosphaturia, magnesuria, citraturia, calcium oxalate and calcium phosphate saturation were higher in HCNL than in control group. The HCL group had phosphaturia, calcium oxalate and calcium phosphate saturations more elevated compared with the control group. There were no significant differences in urinary excretion of various parameters when the groups HCL and HCNL were compared. CONCLUSIONS: Our results show that children with hypercalciuria without lithiasis associated show an increase in natriuresis, phosphaturia, uricosuria, magnesuria and citraturia. We found no differences between these urinary abnormalities when compared hypercalciuric children without lithiasis with those with hypercalciuria and urolithiasis.

Características de los factores fisicoquímicos que componen la orina de los niños con hipercalciuria / Characteristics of the physicochemical factors that compound the urine of children with hypercalciuria

OBJETIVO: La hipercalciuria constituye un factor de riesgo litógeno frecuente. El objetivo de este estudio ha sido, en primer lugar, examinar las características de los factores bioquímicos que componen la orina de los niños con hipercalciuria (HC) y compararlas con las de niños normales. En segundo lugar, analizar las diferencias que presentan los niños con hipercalciuria y litiasis (HCL) de los niños con hipercalciuria sin litiasis (HSL) MÉTODOS: Muestra constituida por 111 casos con HC, divididos en 2 grupos: grupo HSL, compuesto por 93 casos sin historia personal de litiasis renal, grupo HCL, 18 casos con historia personal de litiasis renal. Como grupo control se utilizó una cohorte de 113 niños sanos. En sangre y en orina de 24 horas se determinaron los siguientes parámetros: creatinina, urea, sodio, potasio, cloro, ácido úrico, calcio, fósforo, magnesio y osmolalidad. En la orina se determinó oxalato y citrato. RESULTADOS: En comparación con el grupo control, los valores medios de la natriuresis, uricosuria, fosfaturia, magnesuria, citraturia, saturación de sales oxalato cálcico y saturación de fosfato cálcico estaban más elevados en las HSL. El grupo HCL presentaba la fosfaturia, saturación de oxalato cálcico y fosfato cálcico más elevadas en comparación con el grupo control. No había diferencias significativas en la excreción urinaria de los distintos parámetros cuando se compararon los grupos HSL y HCL. CONCLUSIONES: Nuestros resultados muestran que en los niños con hipercalciuria sin litiasis asociada existe una elevación en la excreción renal de sodio, ácido úrico, magnesio, y citrato. No encontramos diferencias entre estas anomalías urinarias cuando comparamos los casos con hipercalciuria sin litiasis de aquellos que presentan hipercalciuria y litiasis asociada

OBJECTIVE: Hypercalciuria is a common lithogenic risk factor. The aim of this study was, first, to study the characteristics of urine biochemical factors of children with hypercalciuria (HC) and compare them with those of children without hypercalciuria. Second, to analyze the differences between children with HC and lithiasis (HCL) and children with HC and no lithiasis (HCNL). METHODS: The sample was composed by 111 cases with HC, divided into 2 groups: HCNL group, consisting of 93 cases with no personal history of kidney stones, and HCL group, 18 cases with personal history of kidney stones. As a cohort control group, 113 healthy children were used. Creatinine, urea, sodium, potassium, chlorine, uric acid, calcium, phosphorus, magnesium and osmolality: blood and 24-hour urine following parameters were determined. Oxalate and citrate were determined in urine. RESULTS: The mean values of natriuresis, uricosuria, phosphaturia, magnesuria, citraturia, calcium oxalate and calcium phosphate saturation were higher in HCNL than in control group. The HCL group had phosphaturia, calcium oxalate and calcium phosphate saturations more elevated compared with the control group. There were no significant differences in urinary excretion of various parameters when the groups HCL and HCNL were compared. CONCLUSIONS: Our results show that children with hypercalciuria without lithiasis associated show an increase in natriuresis, phosphaturia, uricosuria, magnesuria and citraturia. We found no differences between these urinary abnormalities when compared hypercalciuric children without lithiasis with those with hypercalciuria and urolithiasis

Asma en la infancia, ¿se corresponden las respuestas con las preguntas? / Childhood asthma: do the answers coincide with the questions?

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Mesa redonda. Trastornos respiratorios relacionados con el sueño: encuentros y desencuentros: Introducción / No disponible

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[The shuttle run test is not valid for the detection of asthma in school physical education programs]. / La prueba course-navette no es válida para detectar asma en programas de educación física escolar.

OBJECTIVE: Certain sporting activities may trigger asthma exacerbations of varying intensity in children. Such exacerbations may lead to limitations in and rejection of such activities. During school hours, teachers are in a good position to observe these phenomena. The aim of the present study was to evaluate the shuttle run, a test of physical fitness used in school physical education programs, as a way of detecting asthma. PATIENTS AND METHODS: We carried out a cross-sectional observational study of school children between the ages of 6 and 12 years using the asthma symptom questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), a shuttle run test, and a free running test at maximum effort in order to study bronchial hyperresponsiveness. The principal measure of bronchial hyperresponsiveness used in both physical fitness tests was peak expiratory flow rate as measured with a peak flow meter. In comparing the results of the shuttle run test with those of the free running test and the ISAAC questionnaire we used the chi(2) test to measure association and the Cohen kappa coefficient to measure agreement. RESULTS: We distributed the ISAAC questionnaire (n=919) to 460 (50.1%) boys and 459 (49.9%) girls between the ages of 6 and 12 years. All the tests were completed by 826 children. The level of agreement between the shuttle run test and free running test was positive but low for decreases in peak expiratory flow rate compared to baseline of 15% (chi(2)=5.6; P< .05; kappa=0.093; SE, 0.042) and of 20% (chi(2)=4.5; P< .05; kappa=0.08; SE, 0.046). For 10% decreases association was not significant and agreement was low (kappa=0.05; SE, 0.04). There was no agreement between the ISAAC questionnaire and the shuttle run test (kappa=0.095; SE, 0.63). CONCLUSIONS: The shuttle run test using peak expiratory flow rate as the principal measure of bronchial hyperresponsiveness is not valid for the detection of asthma in schoolchildren.

La prueba course-navette no es válida para detectar asma en programas de educación física escolar / The shuttle run test is not valid for the detection of asthma in school physical education programs

Objetivo: Determinadas actividades deportivas pueden desencadenar en el niño agudizaciones de asma de intensidad variable, limitaciones y rechazo de las actividades deportivas. Durante el horario escolar los profesores son observadores privilegiados de estos fenómenos. El objetivo del presente estudio ha sido evaluar la prueba course-navette ("carrera de ida y vuelta", PCN), prueba de rendimiento físico de los programas de educación física escolar, como medida para detectar asma. Pacientes y métodos: Se ha realizado un estudio observacional y transversal en escolares de 6 a 12 años de edad, mediante cuestionario de síntomas relacionados con el asma (ISAAC) y pruebas de rendimiento físico (PCN) y de carrera libre con esfuerzo máximo para estudiar la hiperrespuesta bronquial, utilizando en ambas como medida principal el flujo espiratorio máximo (FEM) determinado con medidor del ápice de flujo espiratorio. En la comparación de los resultados de la PCN con los del test de carrera libre y el cuestionario ISAAC se midió el grado de asociación (con la prueba de la χ²) y de acuerdo (estadístico kappa de Cohen). Resultados: Se distribuyó el cuestionario ISAAC (n = 919) a 460 niños (50,1%) y 459 niñas (49,9%) de 6 a 12 años de edad (mediana ± desviación estándar: 8 ± 1,87 años). Completaron todas las pruebas 826. Se observó una asociación con bajo acuerdo entre la PCN positiva y el test de carrera libre positivo para descensos del FEM, en relación con el basal, del 15% χ² = 5,6; p < 0,05; kappa = 0,093; error estándar [EE] = 0,042) y del 20% (χ² = 4,5; p < 0,05; kappa = 0,08; EE = 0,046). Para descensos del FEM del 10% la asociación no fue significativa y el acuerdo resultó débil (kappa = 0,05; EE = 0,04). No hubo acuerdo entre ISAAC y la PCN (kappa = 0,095; EE = 0,63). Conclusiones: La PCN con el FEM como medida principal del efecto no es válida para detectar asma en escolares

Objective: Certain sporting activities may trigger asthma exacerbations of varying intensity in children. Such exacerbations may lead to limitations in and rejection of such activities. During school hours, teachers are in a good position to observe these phenomena. The aim of the present study was to evaluate the shuttle run, a test of physical fitness used in school physical education programs, as a way of detecting asthma. Patients and methods: We carried out a cross-sectional observational study of school children between the ages of 6 and 12 years using the asthma symptom questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), a shuttle run test, and a free running test at maximum effort in order to study bronchial hyperresponsiveness. The principal measure of bronchial hyperresponsiveness used in both physical fitness tests was peak expiratory flow rate as measured with a peak flow meter. In comparing the results of the shuttle run test with those of the free running test and the ISAAC questionnaire we used the χ² test to measure association and the Cohen κ coefficient to measure agreement. Results: We distributed the ISAAC questionnaire (n=919) to 460 (50.1%) boys and 459 (49.9%) girls between the ages of 6 and 12 years. All the tests were completed by 826 children. The level of agreement between the shuttle run test and free running test was positive but low for decreases in peak expiratory flow rate compared to baseline of 15% (χ²=5.6; P<.05; κ=0.093; SE, 0.042) and of 20% (χ²=4.5; P<.05; κ=0.08; SE, 0.046). For 10% decreases association was not significant and agreement was low (κ=0.05; SE, 0.04). There was no agreement between the ISAAC questionnaire and the shuttle run test (κ=0.095; SE, 0.63). Conclusions: The shuttle run test using peak expiratory flow rate as the principal measure of bronchial hyperresponsiveness is not valid for the detection of asthma in schoolchildren

El síndrome de apneas-hipopneas obstructivas durante el sueño en niños no se asocia a obesidad / Obstructive sleep apnea-hypopnea syndrome in children is not associated with obesity

Objetivo: El síndrome de apneas-hipopneas obstructivas durante el sueño (SAHOS) alcanza una prevalencia del 1-3% en población general infantil. Sin embargo, en población obesa no preseleccionada la prevalencia es desconocida. Para estudiar la asociación entre SAHOS y obesidad en niños diagnosticados de dicho trastorno, hemos analizado a una cohorte de niños y niñas (2-14 años) remitidos en los últimos 5 años a consulta externas de neumología infantil por sospecha de apneas durante el sueño, ronquido o ambos. Pacientes y métodos: A los pacientes incluidos se les realizaron anamnesis, exploración física, radiografía de tórax y cávum y poligrafía respiratoria durante el sueño con 8 canales. Se analizaron las siguientes variables: sexo, motivo de consulta, procedencia, exploración de la vía aérea superior, edad, z-score del peso (cuánto se desvía la media de peso y en qué dirección respecto de la media de peso de una distribución normal), z-score de la talla (cuánto se desvía la media de la talla y en qué dirección respecto de la media de la talla de una distribución normal), z-score del índice de masa corporal (IMC; cuánto se desvía la media del IMC y en qué dirección respecto de la media del IMC de una distribución normal), número de apneas, número de hipopneas, índice de apneas/h, índice de hipopneas/h, índice de apneas-hipopneas/h (IAH/h), saturación de oxígeno por pulsioximetría (media y mínima), número de ronquidos e índice de ronquidos/h. Resultados: Se estudió a 400 pacientes, con una edad media de 4,95 años, de los que 242 eran varones (60,5%) y 158 niñas (39,5%). Se diagnosticó de SAHOS (IAH/h ≥ 3) a 298 (74,5%), y en éstos se analizó la relación entre SAHOS y obesidad. La distribución antropométrica (expresada en media ± desviación estándar) fue la siguiente: z-peso de 0,37 ± 1,31; z-talla de 0,23 ± 1,19; IMC de 17,063 ± 2,51 kg/m², y z-IMC de 0,39 ± 1,36. Los resultados de la poligrafía respiratoria durante el sueño mostraron un IAH/h de 6,56 ± 7,56. Conclusiones: No se han encontrado diferencias entre z-talla, z-peso, z-IMC, edad e IAH/h. En esta serie la obesidad no se asocia a SAHOS. Sin embargo, se requieren estudios en poblaciones más amplias y no preseleccionadas para evaluar si la obesidad actúa o no como factor de riesgo para desarrollar SAHOS en niños

Objective: The prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) in the general pediatric population ranges from 1% to 3%. However, its prevalence in an unselected population of obese children is unknown. We studied the association between obesity and OSAHS in children diagnosed with the syndrome in a cohort of boys and girls (age range, 2-14 years) referred to the pediatric respiratory medicine outpatient clinic at our hospital for suspected apnea, snoring, or both over the past 5 years. Patients and methods: The medical history of each patient was recorded and all patients underwent a physical examination, chest and nasal cavities radiography, and 8-channel respiratory polygraphy during sleep. The following variables were evaluated: sex, reason for consultation, source of referral, findings during upper airway examination, age, weight z-score (reflecting how much a finding differs from the mean and in what direction in a normally distributed sample), height z-score, body mass index (BMI) z-score, number of apneas, number of hypopneas, apnea index, hypopnea index, apnea-hypopnea index (AHI), oxygen saturation (mean and minimum) measured by pulse oximetry, number of snores, and snore index. Results: Of the 400 patients studied, 242 (60.5%) were male and 157 (39.5%) female. The mean age was 4.95 years. OSAHS (AHI≥3) was diagnosed in 298 cases (74.5%) and these patients were then studied to determine the relation between OSAHS and obesity. The anthropometric distribution (expressed as mean [SD]) was as follows: weight z-score, 0.38 (1.31); height z-score, 0.23 (1.19); BMI, 17.063 kg/m² (2.51); and BMI z-score, 0.39 (1.36). The respiratory polygraph during sleep recorded an AHI of 6.56 (7.56). Conclusions: No differences were observed between the height z-score, weight z-score, BMI z-score, age, and AHI. No association between obesity and OSAHS was found in this series. However, studies of larger, unselected populations are needed to determine if obesity is a risk factor for OSAHS in children

Realidades y deseos / Realities and desires

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Efecto de los glucocorticoides inhalados en la composición corporal del niño con asma moderada / Inhalated glucocorticoids effects on the body composition in children with moderate asthma

FUNDAMENTO: Valorar la composición corporal en niños con asma moderada. POBLACIÓN Y MÉTODO: Estudio transversal, dos cohortes homogéneas: grupo 1, niños con asma moderada tratados con budesonida inhalada durante al menos 12 meses ininterrumpidos; grupo 2, niños sanos. Se estudió la composición corporal mediante impedancia bioeléctrica. RESULTADOS: Los varones asmáticos presentan valores inferiores de masa libre de grasa, y de agua corporal total. Analizadas como porcentaje del peso, las diferencias no son significativas. CONCLUSIONES: Los niños con asma moderada presentan un menor componente magro (AU)