ABSTRACT
In asthmatic patients the bronchodilator response (BDR) reflects airway obstruction reversibility. BDR commonly used definition of 12 percent or greater change in FEV1 from baseline offers poor sensitivity as an adjunct test in the diagnosis of asthma in children. A cutoff of 8 percent - 10 percent has significantly better sensitivity, although more research studies are needed to recommend this lower BDR value in children. A positive BDR is associated with biomarkers of inflammation, future lung function, inhaled corticosteroids response, and poor asthma control and could provide a useful tool for better monitoring asthmatic children, particularly when pre bronchodilator spirometry is in normal range.
En pacientes asmáticos la respuesta broncodilatadora (RBD) refleja la reversibilidad de la obstrucción de la vía aérea. La definición de 12 por ciento o mayor cambio en VEF1 con respecto a su basal tiene baja sensibilidad y podría llevar a un subdiagnóstico y subtratamiento de asma. La utilización de un punto de corte menor, de 8 por ciento a 10 por ciento, mejora significativamente la sensibilidad para el diagnóstico de asma en niños y podría considerarse en casos individuales, requiriéndose más estudios para recomendar su uso en niños. Una RBD positiva en niños se ha asociado con biomarcadores de inflamación, función pulmonar futura, respuesta a corticoides inhalatorios y pobre control del asma, por lo tanto podría entregar al médico una herramienta más para una mejor evaluación de los niños con asma sobre todo cuando su espirometría basal es normal.
Subject(s)
Humans , Child , Asthma/diagnosis , Asthma/physiopathology , Bronchodilator Agents , Spirometry , Forced Expiratory Volume/physiologyABSTRACT
Esophageal atresia (EA) and tracheoesophageal fistula are congenital anomalies associated with respiratory and gastrointestinal morbidity. Objective: The aim of this study was to describe clinical characteristics of patients with EA and TEF during childhood, specially focused on respiratory and gastrointestinal complications. Methods: We reviewed the clinical charts from fifteen patients admitted to our hospital and who were followed locally between 1995 and 2007. Results: Gross classification distribution was: A: 0, B: 0, C: 12, D: 2, E: 1. Waterston distribution was Al: 6, B1: 1, B2: 4y C2: 4. Associated malformations to EA and TEF were 7/15. Main morbidity during the follow up period was: Recurrent pneumonia: 6/15, recurrent wheezing 12/15, tracheomalacia in 9/15 and apnea in one patient. Fistula re-opening in 3/15, Gastro esophageal reflux in 15/15 esophagic stenosis in 7/15. All patients were admitted to the hospital at least once during the follow up and in 12/15 of this were due to respiratory causes. Conclusions: EA and TEF after surgical repair have significant respiratory and gastrointestinal morbidity and frequent admission to the hospital during the first years of life.
La Atresia esofágica (AE) con o sin fístula traqueoesofágica (FTE) es una malformación congénita que se asocia a complicaciones respiratorias y digestivas. Objetivo: Describir las características de estos pacientes, su morbilidad respiratoria, digestiva y hospitalizaciones en su evolución a largo plazo. Materiales y Métodos: Se revisaron en forma retrospectiva 15 fichas de pacientes con diagnóstico de FTE evaluados por el equipo de Neumología Pediátrica de la Universidad Católica de Chile entre 1995 y 2007. Resultados: N = 15 pacientes, sexo masculino 9 diagnóstico el primer día de vida 13/15 pacientes. Clasificación de Gross: A= 0, B= 0, C= 12, D= 2, E= 1. Clasificación de Waterston Al: 6, Bl: 1, B2: 4 y C2: 4 Malformaciones asociadas: en 7/15. Complicaciones respiratorias: Neumonía recurrente 8/15, sibilancias recurrentes 12/15, Recurrencia de fístula: 3 /15 pacientes, Apnea: 1 paciente, Traqueomalacia (TM) (9/15). Complicaciones digestivas: Reflujo gastroesofágico 15/15, Estenosis esofágica: II15. Un paciente requirió cirugía de Nissen. Todos los pacientes se hospitalizaron en al menos una oportunidad y en el 12/15 la causa fue respiratoria. Conclusión: La FTE es una enfermedad de resolución quirúrgica con alta morbilidad respiratoria, digestiva y frecuentes hospitalizaciones en los primeros años de vida.
Subject(s)
Humans , Male , Infant , Child, Preschool , Child , Esophageal Atresia/surgery , Postoperative Complications/epidemiology , Respiratory Tract Diseases/etiology , Digestive System Diseases/etiology , Tracheoesophageal Fistula/surgery , Esophageal Atresia/complications , Clinical Evolution , Respiratory Tract Diseases/epidemiology , Digestive System Diseases/epidemiology , Tracheoesophageal Fistula/complications , Hospitalization , Recurrence , Retrospective Studies , Severity of Illness IndexABSTRACT
Introducción: el estridor es un signo de obstrucción de la vía aérea superior localizado a nivel supraglótico, glótico o infraglótico. En lactantes la laringomalacia explica alrededor del 60 por ciento de los casos de estridor. Existen causas poco frecuentes pero potencialmente de riesgo vital frente a las cuales hay que mantener una alta sospecha clínica para hacer un diagnóstico precoz. Objetivo: dar a conocer nuestra experiencia en el manejo de tres pacientes con estridor atípico en el primer mes de vida. Casos clínicos: 1) Recién nacido de término, con síndrome velocardiofacial, delección 22q11, con estridor, cianosis, disfonia y dificultad respiratoria severa a las 48 horas de vida, fibrobroncoscopía (FB) a los 14 días revela membrana laríngea tipo 3. 2) RN prematuro que al mes de vida presentó estridor de intensidad rápidamente progresiva asociado a dificultad respiratoria, laringoscopía directa a los 45 días reveló hemangioma subglótico, se trató con corticoides sistémicos con mala respuesta y síndrome de Cushing, a los 84 días la FB mostró hemangioma subglótico que ocluía más del 50 por ciento del lumen. 3) RNT con estridor desde los 3 días, a los 60 días rinolaringoscopía mostró laringomalacia, a los 7 meses aumentó el estridor y aparecieron crisis de cianosis y apnea, FB reveló compresión extrínseca tercio distal de tráquea, esófagograma y resonancia nuclear magnética: anillo vascular (doble arco aórtico). Conclusiones: es importante realizar un diagnóstico específico y precoz en los casos de estridor asociado a dificultad respiratoria progresiva, crisis de cianosis, apneas y disfonía, siendo la FB un examen de alto rendimiento. La visualización de la vía aérea debe incluir la porción central y distal ya que la presencia de laringomalacia puede asociarse a otras alteraciones de la vía aérea
Subject(s)
Humans , Male , Female , Infant, Newborn , Laryngeal Diseases , Larynx , Respiratory Sounds , Bronchoscopy , Cyanosis , Respiratory InsufficiencyABSTRACT
Background: Complicated pleural empyema has a torpid and longer clinical evolution, requiring in some patients surgical management. The predictive factors for surgical treatment are not well known. Aim: To search for clinical, laboratory or radiological predictors for the requirement of surgical treatment in pediatric patients with empyema. Patients and methods: A retrospective review of the charts of 108 patients hospitalized for pneumonia plus pleural effusion at the Pediatric Service of the Catholic University Hospital between January 1985 and July 2000. Results: Eighty one patients had complete radiological evaluation and pleural fluid biochemical analysis. Forty nine (60 percent) fulfilled the criteria for empyema and 32 (40 percent) for an exudate. Thirteen patients with empyema required surgery and 36 were treated medically. The mean age was 3 years (range 9 months-6 years) for the surgically treated and 4 years (range 12 months-14 years) for the non-surgical group. The male/female ratio was 5:1 in the surgical group and 1:1 for the non-surgical group. Pleural fluid cultures were positive in 21 of 79 patients. Streptococcus pneumonia was the most frequently isolated agent. No significant differences were found between groups for the average days of fever prior to the diagnosis or total days of fever, days of hospital stay, pleural fluid pH (6.8 and 7.0 respectively) and glucose (21 and 31 mg/dl respectively). No differences were either observed for pleural fluid risk factors (pH < 7 and glucose <20mgdl), the presence of extensive pleural effusions, pleural loculations or bands on pleural ultrasonography and positive Gram stain or cultures in the pleural fluid. Surgical patients required oxygen for more days than medical patients (7.7 and 5.1 days; p=0.037). Conclusions: This study failed to find predictive clinical, radiological or pleural fluid parameters, for the requirement of surgical treatment of empyema
Subject(s)
Humans , Male , Female , Pleural Effusion , Empyema, Pleural , Nutritional Status , Risk Factors , Empyema, Pleural , Prognosis , Radiography, Thoracic/methodsABSTRACT
Background: Home care of tracheostomized children is considered a safe and low-cost alternative. Aim: To report the experience with tracheostomized children at the Pediatric Respiratory Unit of the Catholic University Hospital. Patients and methods: The records of 16 children (9 male) with tracheostomy (TQ) in home care between 1992 and 1998 were reviewed. Results: The average age at the moment of TQ was 9 months (range 1-30 months) and the postoperative hospital management period was 5 months (range 1-11 months). The average age at discharge was 13 months (range 3 to 30 months). Surgical indication were upper airway obstruction (congenital or acquired subglotic stenosis in three, upper airway malformations in one, vocal cord palsy in one and tracheobronchomalacia in one) and chronic assisted ventilation (severe tracheobronchomalacia in four, pulmonary hypoplasia in two, myopathy in one, central nervous injury in one and bronchopulmonary displasia in one). Overall rate complications were 2 per 100 tracheostomy months during home care and 8 per 100 tracheostomy months during hospital care. No tracheostomy-related deaths were observed. A parenteral education program to teach about tracheostomy management and cardiopulmonary resuscitation was carried out. Conclusions: Tracheostomized children can be safely managed at home