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.

Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España) / Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)

INTRODUCCIÓN Y OBJETIVOS: Streptococcus pneumoniae (SP) es un patógeno que causa un elevado consumo de antibióticos. OBJETIVOS: conocer la sensibilidad a antibióticos de uso habitual, los factores epidemiológicos asociados y favorecer el uso racional de antibióticos. PACIENTES Y MÉTODOS: En verano del 2009 y el invierno del 2010 realizamos un estudio multicéntrico en Atención Primaria (AP). Se recogió una muestra nasofaríngea y se cumplimentó una encuesta epidemiológica en 1.562 niños de 1 y 4 años. RESULTADOS: El 31,3% (489/1.562) eran portadores nasales (PN). Se realizó un estudio de sensibilidad en 376 aislados, y se serotipificaron 343. El 61,7% (964/1.562) habían recibido al menos una dosis de vacuna antineumocócica conjugada heptavalente (PCV7). El 12,8% (44/343) correspondía a serotipos vacunales (SV). La resistencia a penicilina (criterio meningitis CMI>0,06mg/l) fue del 28%, siendo del 54% para los SV. Para infecciones no meníngeas, el 100% de los aislados eran sensibles a penicilina parenteral (CMI ≤ 2mg/l). Existe un alto nivel de resistencias para eritromicina (45,8%). Fueron factores favorecedores de resistencia haber tomado antibióticos el mes previo y ser portador de SV tanto para penicilina como para cefotaxima y la edad de 4 años un factor de protección. Los serotipos 14, 35B, 19A, 15A y 19F fueron los menos susceptibles a penicilina. CONCLUSIONES: La amoxicilina por vía oral para pacientes ambulatorios y la penicilina o ampicilina por vía intravenosa para pacientes ingresados son excelentes opciones para el tratamiento de infecciones neumocócicas no meníngeas, en entornos como el nuestro, con una baja incidencia de aislados con alto nivel de resistencia a penicilina (CMI ≥ 2mg/l)

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L)

[Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)]. / Sensibilidad de Streptococcus pneumoniae en niños portadores sanos en Murcia (España).

INTRODUCTION AND OBJECTIVES: Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS: In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS: Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 (heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS: Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L).

Características epidemiológicas, clínicas y terapéuticas de lactantes hospitalizados por bronquiolitis / Epidemiology, clinical features and medical interventions in children hospitalized for bronchiolitis

Objetivos: Describir los datos epidemiológicos, clínicos y actitud terapéutica empleada en los lactantes hospitalizados por bronquiolitis en nuestro medio. Material y métodos: Estudio observacional, descriptivo y prospectivo de lactantes menores de 18 meses ingresados en Hospital Virgen de la Arrixaca (Murcia) con el diagnóstico de bronquiolitis, durante el periodo de máxima incidencia (diciembre 2008-abril 2009). Resultados: Ingresaron 235 lactantes, de los que el 78,7% tenía una edad menor o igual a 5 meses de vida. Había una correlación positiva entre el número de cigarrillos consumidos por la madre en la gestación y el número de días de oxigenoterapia y los días de estancia. Los niños cuya madre era fumadora en el momento de su ingreso fueron tratados con oxígeno un mayor número de días. Los lactantes que no habían recibido lactancia materna precisaron oxígeno durante más tiempo. El 23,8% tenía patología de base, siendo la prematuridad la más frecuente, la cual fue un factor de riesgo para la prolongación del tratamiento con oxígeno y de la estancia hospitalaria. La utilización de exploraciones complementarias y el uso de broncodilatadores, corticoides y antibióticos fueron elevados. La aparición de fiebre se asoció a un mayor uso de antibióticos en el medio extra e intrahospitalario y lo mismo sucedía si la radiografía de tórax era patológica o existía una elevación de la proteína C reactiva (PCR). El VRS fue el principal agente etiológico, seguido por rinovirus, bocavirus, adenovirus y metapneumovirus. Conclusiones: La mayoría de los ingresos por bronquiolitis ocurrieron en los primeros meses de la vida. La exposición al tabaco durante la gestación se asoció a una peor evolución clínica. A pesar de las indicaciones de las guías de práctica clínica, en nuestro medio, el uso de exploraciones complementarias y de tratamientos farmacológicos fue elevado(AU)

Objectives: To describe the epidemiology, clinical characteristics and treatments prescribed in children with bronchiolitis admitted to our hospital. Material and methods: Observational, descriptive and prospective study of children younger than 18 months, admitted to Hospital Virgen de la Arrixaca of Murcia (Spain), with the diagnosis of bronchiolitis, during the season of maximum incidence (December 2008-April 2009). Results: A total of 235 infants were admitted, of whom 78.7% of them were aged 5 months or less. We found a positive correlation between the number of cigarettes smoked by their mothers during pregnancy and the number of hospitalization and oxygen therapy days. Children whose mothers were smokers at the time of their admission needed a greater number of oxygen therapy days. Also infants who were not breastfed needed oxygen therapy during more days. Just under one quarter (23.8%) of them had underlying diseases, with prematurity being the most frequent and a risk factor for the ongoing of oxygen therapy and hospital stay. The use of diagnostic tests, bronchodilators, corticosteroids and antibiotics was high. The onset of high temperature was associated with an increased use of antibiotics in outside and inside the hospital setting. An abnormal chest X-ray or a raised C-reactive protein was associated with a higher use of antibiotics. Respiratory Syncytial virus (RSV) was the main aetiological agent, followed by Rhinovirus, Bocavirus, Adenovirus and Metapneumovirus. Conclusions: The majority of hospital admissions due to bronchiolitis took place during the first months of life. Infants whose mothers smoked during pregnancy had a worse clinical outcome. Despite the availability of clinical practice guidelines in our area, the use of diagnostic tests and pharmacological treatment was high(AU)

[Epidemiology, clinical features and medical interventions in children hospitalized for bronchiolitis]. / Características epidemiológicas, clínicas y terapéuticas de lactantes hospitalizados por bronquiolitis.

OBJECTIVES: To describe the epidemiology, clinical characteristics and treatments prescribed in children with bronchiolitis admitted to our hospital. MATERIAL AND METHODS: Observational, descriptive and prospective study of children younger than 18 months, admitted to Hospital Virgen de la Arrixaca of Murcia (Spain), with the diagnosis of bronchiolitis, during the season of maximum incidence (December 2008-April 2009). RESULTS: A total of 235 infants were admitted, of whom 78.7% of them were aged 5 months or less. We found a positive correlation between the number of cigarettes smoked by their mothers during pregnancy and the number of hospitalization and oxygen therapy days. Children whose mothers were smokers at the time of their admission needed a greater number of oxygen therapy days. Also infants who were not breastfed needed oxygen therapy during more days. Just under one quarter (23.8%) of them had underlying diseases, with prematurity being the most frequent and a risk factor for the ongoing of oxygen therapy and hospital stay. The use of diagnostic tests, bronchodilators, corticosteroids and antibiotics was high. The onset of high temperature was associated with an increased use of antibiotics in outside and inside the hospital setting. An abnormal chest X-ray or a raised C-reactive protein was associated with a higher use of antibiotics. Respiratory Syncytial virus (RSV) was the main aetiological agent, followed by Rhinovirus, Bocavirus, Adenovirus and Metapneumovirus CONCLUSIONS: The majority of hospital admissions due to bronchiolitis took place during the first months of life. Infants whose mothers smoked during pregnancy had a worse clinical outcome. Despite the availability of clinical practice guidelines in our area, the use of diagnostic tests and pharmacological treatment was high.

Actitudes, creencias y conocimientos de los pediatras sobre salud medioambiental en Murcia / Pediatrician attitudes, beliefs and knowledge about environmental health in Murcia, Spain

Objetivo: Estudiar las actitudes, las creencias y los conocimientos sobre salud medioambiental pediátrica (SMAP) de los pediatras de la Región de Murcia (RM). Método: Encuesta autocumplimentada, basada en los conocimientos teórico-prácticos sobre SMAP, enviada por correo postal en 2007 a los 293 pediatras que trabajan en la RM. Resultados: Respondieron 164 (56%). El 70% trabaja en atención primaria. El 5% pertenece a alguna organización no gubernamental medioambiental. Según los pediatras, los factores que más afectan a la salud infantil (sobre una puntuación máxima de 10) son: contaminantes del aire interior-tabaco (7,78), lesiones/accidentes (6,64) y contaminación del aire exterior (5,13). El 45% no registra información ambiental en las historias clínicas. Las consultas más frecuentes de los padres (de 1 a 4) son sobre lesiones y accidentes (2,16), radiación ultravioleta (2,06) y contaminación del agua de bebida (2,05). Las enfermedades respiratorias son las más relacionadas con la salud medioambiental. Conclusiones: Se debería asegurar que el contenido de la SMAP sea obligatorio en la enseñanza y la preparación de los futuros pediatras (pregrado, posgrado, formación continuada). Este trabajo podría ayudar a evaluar las necesidades y planificarlas acciones formativas en SMAP(AU)

Objective: To study pediatrician attitudes, beliefs and knowledge about pediatric environmental health (PEH) in the region of Murcia, Spain. Method: Were mailed a self administered survey based on theoretical and practical knowledge about issues related to PEH of 293 paediatricians working in the Region of Murcia. Results: The overall response rate was 56%. About 70% of respondents worked in Primary Care and 5% belonged to anon-governmental organization (NGO). Pediatricians stated that the factors most affecting the health of children (maximum score 10) were: indoor air pollutants (7.78) injuries and accidents (6.64), and outdoor air pollution (5.13). 45% did not systematically record information about the environments in the clinical registry. The most frequently asked questions by parents were (maximum score 4) related to: injuries and accidents (2.16), ultraviolet radiation (2.06) and contamination of drinking water (2.05). Pediatricians considered respiratory diseases to be most strongly related to the environment. Conclusions: Pediatric associations and institutions should include an EH syllabus in the curriculum of pregraduate and graduate students as well as in the continuing education of paediatricians. This work would help needs assessment and planning the training in PEH(AU)

[Review of 22 patients with 22q11.2 deletion syndrome: phenotype spectrum]. / Revisión de 22 casos de deleción 22q11.2: espectro fenotípico.

INTRODUCTION: The 22q11.2 deletion syndrome is a contiguous gene deletion syndrome with an incidence rate of 1/4,000-6,000 live births. The most specific clinical features are: congenital conotruncal heart diseases, palate anomalies, hypocalcaemia, immunity and learning problems, and a characteristic facial phenotype. The objective of this work is to review the presenting phenotype and clinical features of children with 22q11.2 deletion syndrome as a guide for early diagnosis. PATIENTS AND METHODS: Retrospective study of 22 patients with 22q11.2 deletion syndrome diagnosed at our hospital in the time period 2004-2007. Variables analyzed: incidence, sex, age at diagnosis, presenting phenotype, clinical features, positive family history, mortality and natural history. RESULTS: From a total of 22 patients, 63 % were males, and the median age at diagnosis was of 4.5 years. Presenting pheno-type: congenital heart disease, milestones delay, velopharyngeal incompetence, hypocalcaemia, and mental retardation/psychiatric disturbances. CLINICAL FEATURES: congenital heart disease (84 %), velopharyngeal incompetence (47 %), milestones delay and learning disabilities (79 %). All of the deletions were de novo, except in one case where the deletion was present as mosaicism in the father. Three patients died, due to congenital heart disease. CONCLUSIONS: Clinical expression is widely variable, although a characteristic phenotype exists. Patients with heart disease are diagnosed earlier than other patients with unusual presenting phenotype such as congenital dysphagia. It is important to recognize less common phenotypes at early ages in order to provide multidisciplinary monitoring and accurate genetic counselling.

Revisión de 22 casos de deleción 22q11.2: espectro fenotípico / Review of 22 patients with 22q11.2 deletion syndrome: phenotype spectrum

Introducción: El síndrome de deleción 22q11.2 es un síndrome de genes contiguos con una incidencia de un caso por cada 4.000-6.000 recién nacidos. Posee una amplia variabilidad clínica y sus características clínicas más frecuentes son cardiopatía conotruncal, anomalías palatinas, hipocalcemia, problemas de inmunidad y de aprendizaje, y un fenotipo facial característico. El objetivo de este estudio es revisar las formas de presentación y las manifestaciones clínicas de los niños con deleción 22q11.2 como guía para su diagnóstico precoz. Pacientes y métodos: Estudio retrospectivo de 22 casos de deleción 22q11.2 diagnosticados en nuestro hospital entre los años 2004 y 2007, en que se analizan las siguientes variables: incidencia, sexo, edad en el momento del diagnóstico, forma de presentación, características clínicas, antecedentes familiares, mortalidad y evolución. Resultados: De los 22 pacientes, el 63 % fueron varones y la edad media en el momento de realizar el diagnóstico fue de 4,5 años. Las formas de presentación fueron cardiopatía, retraso psicomotor, insuficiencia velopalatina, hipocalcemia y retraso mental o alteraciones psiquiátricas. Las principales manifestaciones clínicas fueron cardiopatía (84 %), insuficiencia velopalatina (47 %), retraso psicomotor y problemas de aprendizaje (79 %). Todos los casos fueron deleciones de novo, salvo un caso en el que se identificó la deleción "en mosaico" en el padre. Fallecieron 3 pacientes a causa de cardiopatía. Conclusiones: La expresión clínica es muy variable, aunque existe un fenotipo característico. Los niños con cardiopatía conotruncal son diagnosticados más tempranamente, pero en otras formas de presentación, como la disfagia congénita, el diagnóstico se retrasa más. Es necesario tener en cuenta las formas de presentación menos habituales para identificar en edades tempranas a estos pacientes y proporcionarles una atención multidisciplinaria temprana y un asesoramiento genético familiar adecuado (AU)

Introduction: The 22q11.2 deletion syndrome is a contiguous gene deletion syndrome with an incidence rate of 1/4,000-6,000 live births. The most specific clinical features are: congenital conotruncal heart diseases, palate anomalies, hypocalcaemia, immunity and learning problems, and a characteristic facial phenotype. The objective of this work is to review the presenting phenotype and clinical features of children with 22q11.2 deletion syndrome as a guide for early diagnosis. Patients and methods: Retrospective study of 22 patients with 22q11.2 deletion syndrome diagnosed at our hospital in the time period 2004-2007. Variables analyzed: incidence, sex, age at diagnosis, presenting phenotype, clinical features, positive family history, mortality and natural history. Results: From a total of 22 patients, 63 % were males, and the median age at diagnosis was of 4.5 years. Presenting pheno-type: congenital heart disease, milestones delay, velopharyngeal incompetence, hypocalcaemia, and mental retardation/psychiatric disturbances. Clinical features: congenital heart disease (84 %), velopharyngeal incompetence (47 %), milestones delay and learning disabilities (79 %). All of the deletions were de novo, except in one case where the deletion was present as mosaicism in the father. Three patients died, due to congenital heart disease. Conclusions: Clinical expression is widely variable, although a characteristic phenotype exists. Patients with heart disease are diagnosed earlier than other patients with unusual presenting phenotype such as congenital dysphagia. It is important to recognize less common phenotypes at early ages in order to provide multidisciplinary monitoring and accurate genetic counseling (AU)

[Malama project in the Region of Murcia (Spain): environment and breastfeeding]. / Proyecto Malama en la Región de Murcia (España): medio ambiente y lactancia materna.

OBJECTIVES: To identify protective factors and risk factors for the initiation and length of breastfeeding and full breastfeeding, in the Region of Murcia (Spain). PATIENTS AND METHODS: The Malama study (Medio Ambiente y Lactancia Materna) is a follow up study from birth up to years of 1,000 mother-child pairs. A description of breastfeeding practices are presented here, the survival curve of breastfeeding and a Cox regression model of the pilot study that includes 101 mother-child pairs and 6 months of follow-up. RESULTS: After six months the prevalence of breastfeeding was 35 %. The mean duration of full breastfeeding was 63 days (median 45 days) with six months prevalence of 8 %. Hazard ratios (HR) for full breastfeeding were, to be a smoker (1.89; 95 % CI: 1.18-3.02), older than 35 years of age (2.04; 95 % CI: 1.22-3.42), caesarean birth (1.63; 95 % CI: 1.00-2.66). As well as those previously mentioned risks for breastfeeding, there were also hazard ratios for primary school education or less (1.63; 95 % CI: 0.98-2.82); to have breastfed an earlier child for at least 16 weeks (0.33; 95 % CI: 0.13-0.79), and to be the first birth (0.50; 95 % CI: 0.27-0.95). The length of both breastfeeding and full breastfeeding increased with the length of the maternal leave (0.96; 95 % CI: 0.94-0.99). Pregestational occupational exposure to endocrine disruptors did not seem to interfere with the duration of breastfeeding. CONCLUSIONS: In order to improve quality and duration of breastfeeding programmes, paediatric research and training on breastfeeding practice should be encouraged, to reduce unnecessary caesarean sections, promote tobacco cessation, focus human and economic resources to women with less education, and include legal mechanisms to ensure longer maternal leave.

Proyecto Malama en la Región de Murcia (España): medio ambiente y lactancia materna / Malama project in the Region of Murcia (Spain): environment and breastfeeding

Objetivo: Estudiar los factores protectores y de riesgo de la calidad y duración de la lactancia materna completa (LMC) y total (LMT) en la Región de Murcia. Pacientes y métodos: El estudio Malama (medio ambiente y lactancia materna) realiza un seguimiento de 1.000 parejas madre-hijo desde el nacimiento hasta los 2 años. Aquí presentamos la descripción, supervivencia de la lactancia y regresión de Cox del estudio piloto con 101 parejas y 6 meses de seguimiento. Resultados: La duración media de la LMC fue de 63 días (mediana de 45) y prevalencia a los 6 meses del 8 %. La prevalencia de LMT fue del 35 %. Riesgo relativo (RR) para LMC eran ser madre fumadora (1,89; intervalo de confianza del 95 % [IC 95 %]: 1,18-3,02), mayor de 35 años (2,04; IC 95 %: 1,22-3,42), con parto por cesárea (1,63; IC 95 %: 1,00-2,66); y para LMT, además de las anteriores el tener sólo estudios primarios (1,63; IC 95 %: 0,98-2,82); haber lactado antes al menos 16 semanas (0,33; IC 95 %: 0,13-0,79); primer hijo/a (0,50; IC 95 %: 0,27-0,95). La duración de LMC y LMT crecían con la mayor duración de la baja maternal (0,96; IC 95 %: 0,94-0,99). La exposición laboral pregestacional a disruptores endocrinos no parece interferir con la duración de la lactancia. Conclusiones: Los programas de protección-promoción de la LM deberían aumentar la investigación y formación pediátrica en LM, disminuir las cesáreas innecesarias, fomentar la deshabituación tabáquica, dedicar más recursos a las mujeres con menos estudios e incluir mecanismos legales que prolonguen la baja por maternidad para conseguir una lactancia más duradera y de mejor calidad (AU)

Objectives: To identify protective factors and risk factors for the initiation and length of breastfeeding and full breastfeeding, in the Region of Murcia (Spain). Patients and methods: The Malama study (Medio Ambiente y Lactancia Materna) is a follow up study from birth up to years of 1,000 mother-child pairs. A description of breastfeeding practices are presented here, the survival curve of breastfeeding and a Cox regression model of the pilot study that includes 101 mother-child pairs and 6 months of follow-up. Results: After six months the prevalence of breastfeeding was 35 %. The mean duration of full breastfeeding was 63 days (median 45 days) with six months prevalence of 8 %. Hazard ratios (HR) for full breastfeeding were, to be a smoker (1.89; 95 % CI: 1.18-3.02), older than 35 years of age (2.04; 95 % CI: 1.22-3.42), caesarean birth (1.63; 95 % CI: 1.00-2.66). As well as those previously mentioned risks for breastfeeding, there were also hazard ratios for primary school education or less (1.63; 95 % CI: 0.98-2.82); to have breastfed an earlier child for at least 16 weeks (0.33; 95 % CI: 0.13-0.79), and to be the first birth (0.50; 95 % CI: 0.27-0.95). The length of both breastfeeding and full breastfeeding increased with the length of the maternal leave (0.96; 95 % CI: 0.94-0.99). Pregestational occupational exposure to endocrine disruptors did not seem to interfere with the duration of breastfeeding. Conclusions: In order to improve quality and duration of breastfeeding programmes, paediatric research and training on breastfeeding practice should be encouraged, to reduce unnecessary caesarean sections, promote tobacco cessation, focus human and economic resources to women with less education, and include legal mechanisms to ensure longer maternal leave (AU)

Grupo de Investigación HERMES: evaluación de la exposición dietética a metilmercurio en poblaciones vulnerables de la Región de Murcia (España) / The Hermes Research Group: Evaluation of dietary exposure to methylmercury in vulnerable populations in the region of Murcia (Spain)

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[The behavior of FEV1 and PEFR in the free running test for the detection of exercise-induced asthma in childhood]. / Comportamiento del FEV1 y del PEFR en la prueba de carrera libre para la detección del asma inducida por ejercicio en la infancia.

OBJECTIVE: Our aim was to study the behavior and validity of PEFR and FEV1 in the free-running exercise test in order to diagnose exercise-induced asthma during childhood. PATIENTS AND METHODS: We studied 30 asthmatic children and 30 healthy children as controls. A provocation test was performed by means of free-running exercise in an indoor sports center. Environmental temperature and humidity were equal in both groups. Forced breathing spirometry and the "Mini-Wright peak flow meter" test were recorded before and two, five, fifteen and twenty minutes after the exercise challenge. The spirometric values representing two standard deviations below the mean for each variable studied in the control group were considered as reference values (FEV1 > or = 83.5% and PEFR > or = 81.5%). RESULTS: There was a decrease in FEV1 in 17 asthmatic children (56.7%) and a decrease in PEFR occurred in 14 children (46.7%). No statistically significant differences were found in either test. Specificity was 100% for FEV1 and 96.7% for PEFR. The greatest decrease in both spirometric parameters occurred at five minutes. CONCLUSIONS: According to our results, in a free-running provocation test if we maintain previously controlled environmental conditions and exercise intensity "forced breathing spirometry" and "Mini-Wright peak flow" can be used interchangeably in order to diagnose exercise-induced asthma.

[Ribavirin in the treatment of bronchiolitis caused by syncytial respiratory virus]. / Ribavirina como tratamiento de la bronquiolitis por virus respiratorio sincitial.

OBJECTIVE: The aim of this study was to evaluate ribavirin therapy for acute bronchiolitis caused by viral syncytial respiratory infection. PATIENTS AND METHODS: Ninety-seven patients with acute bronchiolitis in which respiratory syncytial virus was identified by direct immunofluorescence and admitted to the hospital between October 1990 and May 1995 were studied. Data pertaining to age, sex, weight, respiratory frequency at admission, respiratory frequency on the fourth day, day in which respiratory ausculation was normal, day in which there were no thoracic retractions, number of days that the infants needed oxygen, duration of hospital stay, and whether or not they were treated with ribavirin were collected retrospectively. RESULTS: At admission there were no statistically significant differences in patients treated or not with ribavirin or in age, sex or weight, but the respiratory frequency was higher in those patients treated with ribavirin than in those who were not. The number of days of oxygen therapy was statistically different between these groups, with infants treated with ribavirin requiring oxygen for 2.7 days and the nontreated group requiring 1.7 days. However, we think that this difference is not clinically relevant. CONCLUSIONS: We did not find any difference of clinical relevance between patients treated or not with ribavirin.

[Breast feeding promotion: is health education effective?]. / Promoción de la lactancia materna. Es efectiva la educación sanitaria?

A program founded on health education, habitually realized in the national health centers to increase the breast-feeding practice, was evaluated. In 1990, in order to know social and economic characteristics and alimentation practices associated to the incidence and duration of breast-feeding, mothers answered a questionnaire at the first week and sixth month of their child's life. Some aspects about breast-feeding promotion in our country are discussed.