Pacientes con diagnóstico de "BRUE" atendidos en hospital pediátrico chileno. Aplicando nueva terminología / Patients with diagnosis of "Sids" treated in chilean pediatric hospital. Applying new terminology

La posible relación entre apneas durante la infancia temprana y Síndrome de Muerte Súbita del Lactante (SMSL) nunca ha sido demostrada, existiendo evidencias de que ambas condiciones podrían no estar relacionadas. La Academia Americana de Pediatría (AAP) define ALTE (Acute Life Threatening Event), como un evento brusco e inesperado que incluye manifestaciones de apnea junto con cambios de coloración cutánea y de tono muscular, donde el observador cree que el niño ha muerto. La AAP ha propuesto recientemente la sustitución del término ALTE por Brief Resolved Unexplained Events (BRUE). El nuevo concepto permite categorizar eventos breves, resueltos e inexplicados, para optimizar mejor el recurso en salud, a través de objetivar el evento y entregando estrategias de manejo categorizando el riesgo. Objetivo: Describir las características clínicas y letalidad de los pacientes menores de 12 meses que consultan por BRUE en un hospital de referencia. Materiales y métodos: Estudio transversal descriptivo con revisión de ficha de 46 pacientes de la Unidad de Lactantes y Nutrición del Hospital Dr. Luis Calvo Mackenna, con diagnóstico de BRUE, entre enero a diciembre de 2017. Resultados: Del total de pacientes con BRUE, 45% fueron hombres y 55% mujeres. La edad promedio fue de 1,37 + 0,51 meses. En 70% se demostró una etiología, de estas 31% con enfermedad por reflujo gastroesofágico (ERGE), siendo ésta la causa más frecuente seguida de un 19% con infecciones respiratorias agudas (IRA) y 9% causas neurológicas. En el 30% fueron causas idiopáticas. Conclusión: En nuestro estudio las causas más frecuentes de BRUE fueron ERGE e infecciones respiratorias. Durante el período de estudio ningún paciente estudiado falleció, por lo que no encontramos relación entre apneas del lactante y síndrome de muerte súbita.

The possible relationship between apneas during early childhood and Sudden Infant Death Syndrome (SIDS) has never been demonstrated, and there is evidence that the two conditions may not be related. The American Academy of Pediatrics (AAP) defines ALTE (Acute Life Threatening Event), as an abrupt and unexpected event that includes manifestations of apnea along with changes in skin color and muscle tone, where the observer believes that the child has died. The AAP has recently proposed replacing the term ALTE with Brief Resolved Unexplained Events (BRUE). The new concept makes it possible to categorize brief, resolved and unexplained events, to better optimize the health resource, through objectifying the event and delivering management strategies by categorizing the risk. Objective: To describe the clinical characteristics and lethality of patients younger than 12 months who consult for BRUE in a referral hospital. Materials and methods: Descriptive cross-sectional study with revision of the file of 46 patients from the Infant and Nutrition Unit of the Dr. Luis Calvo Mackenna Hospital, with a diagnosis of BRUE, between January and December 2017. Results: Of the total number of patients with BRUE, 45% were men and 55% women. The average age was 1.37 + 0.51 months. An etiology was demonstrated in 70%, of these 31% with gastroesophageal reflux disease (GERD), this being the most frequent cause, followed by 19% with acute respiratory infections (ARI) and 9% with neurological causes. In 30% they were idiopathic causes. Conclusion: In our study, the most frequent causes of BRUE were GERD and respiratory infections. During the study period, no patient studied died, so we found no relationship between apnea in the infant and sudden death syndrome.

Fatores associados ao óbito em lactentes após eventos com aparente risco de morte (apparent life-threatening event, ALTE) / Factors associated with infant death after apparent life-threatening event (ALTE)

OBJETIVO: Identificar, na admissão dos lactentes com após eventos com aparente risco de morte (apparent life-threatening event, ALTE), fatores que possam indicar maior risco de evolução para o óbito. MÉTODOS: Estudo transversal retrospectivo, descritivo e analítico com lactentes menores de 12 meses, com evento súbito de cianose, palidez, hipotonia e/ou apneia, atendidos na unidade de emergência de hospital universitário de nível terciário. Para avaliação da associação, determinaram-se os valores de odds ratio bruto e ajustado por regressão logística (método stepwise forward Wald). RESULTADOS: Foram avaliados 145 pacientes com idade média de 105 dias (mediana = 65 dias). Onze (7,6 por cento) evoluíram para óbito, com idade média de 189 dias (mediana = 218 dias), enquanto que a idade média dos sobreviventes foi de 98 dias (mediana = 62 dias) (p = 0,003). Atividades que precederam o evento, antecedente de prematuridade e número de episódios não apresentaram associação com o óbito. Apresentou relação significativa o relato de palidez pelos observadores. Entre os 11 lactentes, 3 apresentaram melhora imediata e espontânea; já 8 pacientes [27,6 por cento; p < 0,001; OR = 14,3 (IC95 por cento 3,51-58,3)] não tiveram melhora espontânea. Os diagnósticos de doença do trato respiratório e do sistema cardiocirculatório também foram significantes. Na análise multivariada, mostraram significância estatística: não melhora imediata e espontânea [p = 0,015; OR = 6,06 (IC95 por cento 1,02-35,94)] e diagnóstico de doença do sistema cardiocirculatório [p = 0,047; OR = 164,27 (IC95 por cento 7,34-3.673,78)]. CONCLUSÃO: Os lactentes que apresentaram ALTE tiveram maior risco de óbito quando presentes na faixa etária acima dos 6 meses e quando os eventos tiveram duração prolongada, principalmente quando ocorreram como manifestação de doenças do sistema cardiocirculatório.

OBJECTIVE: To detect factors associated with greater risk of death in infants after an apparent life-threatening event (ALTE). METHODS: This cross-sectional, retrospective, descriptive and analytic study evaluated infants younger than 12 months who had a sudden event of cyanosis, pallor, hypotonia or apnea and were seen in the emergency department of a tertiary university hospital. Forward stepwise logistic regression (Wald) was used to calculate and adjust odds ratios to evaluate associations. RESULTS: Mean age of the 145 patients included in the study was 105 days (median = 65 days). Eleven (7.6 percent) died, and their mean age was 189 days (median = 218 days). Mean age of survivors was 98 days (median = 62 days) (p = 0.003). Activity before the event, prematurity and number of events were not associated with death. A significant association was found with pallor. Of the 11 infants, 3 had spontaneous resolution of ALTE, whereas 8 patients [27.6 percent; p < 0.001; OR = 14.3 (95 percentCI 3.51-58.3)] did not. The associations with respiratory or cardiovascular disease were also significant. In multivariate analysis, immediate spontaneous resolution [p = 0.015; OR = 6.06 (95 percentCI 1.02-35.94)] and diagnosis of cardiovascular disease [p = 0.047; OR = 164.27 (95 percentCI 7.34-3.673.78)] remained statistically significant. CONCLUSION: Infants who experienced an ALTE had a higher risk of subsequent death when their age was greater than 6 months and the event had a long duration, particularly when ALTE was associated with cardiovascular disease.