[Immigrant pregnancy and neonatal morbidity]. / Gestante inmigrante y morbilidad neonatal.

INTRODUCTION: Over the past few years immigration has become an important growth issue in Spain, with the subsequent social, economic and health impact it produces. OBJECTIVE: To analyze the characteristics of immigrant pregnancy and its neonatal morbidity. METHOD: Prospective, descriptive, and cross-sectional study, which includes live-born infants born in the Hospital de Sabadell, from the 1st of September until the 31st of December, 2004. All demographic data were collected, together with details of the pregnancy, the labour, the infant and its associated morbidity. RESULTS: There were 902 births during this period, of which 159 (17.6%) were immigrant pregnancies, with Latin Americans and Moroccans predominant. About 83.3% of immigrant pregnancies where of mothers who have lived in Spain for less than 5 years. The average age of immigrant pregnancies was 27 years (p<0.001), multiparous is more frequent (p<0.001) and have a lower control of pregnancy than non-immigrant (p=0.001). The average gestational age is similar between both groups, nevertheless, the average weight is significantly higher in immigrant women newborns (p<0.05). About 36.5% of the newborns are admitted with their mother o in the neonatal unit, with the main reason for admission being the risk of infection with a predominance between the newborns of immigrant pregnancies (p=0.05). The number of newborns admitted in the neonatal unit is similar in both groups. CONCLUSIONS: This study allowed us to look at characteristics of immigrant pregnancies and draw conclusions in providing the necessary medical assistance for this new and growing population.

Gestante inmigrante y morbilidad neonatal / Immigrant pregnancy and neonatal morbidity

Introducción: Durante estos últimos años, la inmigración ha tenido un crecimiento muy importante en el Estado español, con el consecuente impacto social, económico y sanitario que genera. Objetivo: Analizar las características de la gestante inmigrante y su morbilidad neonatal. Método: Estudio prospectivo, descriptivo y transversal, que incluye a todos los recién nacidos vivos del Hospital de Sabadell, entre el 1 de septiembre y el 31 de diciembre de 2004. Se recogen datos demográficos, de la gestación, del parto, del recién nacido y de su morbilidad asociada. Resultados: Durante el período de estudio ha habido un total de 902 nacimientos, 159 (17,6 %) son de madres inmigrantes, con un predominio de latinoamericanas y marroquíes. El 83,3 % de las gestantes inmigrantes hace 5 años o menos que viven en nuestro país. La edad media de las mujeres inmigrantes es de 27 años (p < 0,001), es más frecuente la multiparidad (p < 0,001) y presentan menor control de la gestación (p = 0,001). La edad gestacional media es similar en ambos grupos; no obstante, la media de peso es significativamente superior entre los hijos de mujeres inmigrantes (p < 0,05). El 36,5 % de los recién nacidos son ingresados junto a la madre o en la unidad de neonatos, y el motivo de ingreso más frecuente es el riesgo infeccioso con un predominio entre los hijos de mujeres inmigrantes (p = 0,05). El número de neonatos ingresados en la unidad neonatal es similar en ambos grupos. Conclusiones: Este estudio nos permite conocer las características de las gestantes inmigrantes y proporcionar elementos necesarios para adecuar la asistencia sanitaria a las necesidades que esta nueva población genera (AU)

Introduction: Over the past few years immigration has become an important growth issue in Spain, with the subsequent social, economic and health impact it produces. Objective: To analyze the characteristics of immigrant pregnancy and its neonatal morbidity. Method: Prospective, descriptive, and cross-sectional study, which includes live-born infants born in the Hospital de Sabadell, from the 1st of September until the 31th of December, 2004. All demographic data were collected, together with details of the pregnancy, the labour, the infant and its associated morbidity. Results: There were 902 births during this period, of which 159 (17.6 %) were immigrant pregnancies, with Latin Americans and Moroccans predominant. About 83.3 % of immigrant pregnancies where of mothers who have lived in Spain for less than 5 years. The average age of immigrant pregnancies was 27 years (p < 0.001), multiparous is more frequent (p < 0.001) and have a lower control of pregnancy than non-immigrant (p = 0,001). The average gestational age is similar between both groups, nevertheless, the average weight is significantly higher in immigrant women newborns (p < 0.05). About 36.5 % of the newborns are admitted with their mother o in the neonatal unit, with the main reason for admission being the risk of infection with a predominance between the newborns of immigrant pregnancies (p = 0.05). The number of newborns admitted in the neonatal unit is similar in both groups. Conclusions: This study allowed us to look at characteristics of immigrant pregnancies and draw conclusions in providing the necessary medical assistance for this new and growing population (AU)

[Bacteremic pneumococcal pneumonia]. / Neumonía neumocócica bacteriémica.

BACKGROUND: Streptococcus pneumonia is the most common bacterial cause of community-acquired pneumonia in children. The reference standard for etiological diagnosis is isolation of S. pneumoniae from blood Since the advent of conjugate vaccines, disease caused by this organism can now be prevented. Many studies have been performed of the global incidence of invasive pneumococcal infections and of pneumococcal meningitis but few studies investigated bacteremic pneumococcal pneumonia and its complications in children. OBJECTIVES: To determine the incidence, patient characteristics, clinical signs, laboratory data, percentage and days of hospitalization, response to antibiotic treatment, antibiotic resistance, complications and causal serogroups of bacteremic pneumococcal pneumonia in our environment in order to estimate requirements for systematic vaccination programs. MATERIAL AND METHODS: From January 1990 to May 2001, data on all pediatric cases of invasive pneumococcal infections diagnosed in our hospital were collected. Several characteristics of patients with bacteremic pneumococcal pneumonia were analyzed. Bacteremic pneumococcal pneumonia was diagnosed in patients with positive blood or pleural fluid cultures for S. pneumoniae and radiographically evident pulmonary infiltrate. The incidence of both types of pneumonia were determined according to population census data. All S. pneumonia strains were sent to the Pneumococci Reference Laboratory of the Instituto Carlos III in Madrid for serotyping. We estimated the serotype coverage of the pneumococcal 7-valent conjugate vaccine according to the serotypes included in this vaccine and their distribution. RESULTS: Forty cases of bacteremic pneumococcal pneumonia were diagnosed, yielding an incidence of 17,10 and 5 cases per 10(5) children aged less than 2, 4 and 15 years old respectively. The mean age was 50 months and 43% were aged less than 4 years. Peaks occurred in January, March, April and May. A total of 77.5% of the patients were admitted to hospital and the mean length of stay was 9.2 days. The mean duration of fever was 2 days and was 4.2 days in patients with pleural empyema. All patients presented fever and its mean duration before admission was 4 days. Fifty-eight percent of the patients had cough. Thirty-nine percent appeared generally unwell, vomiting was present in 47% and abdominal pain in 28%. Respiratory auscultation detected rales in 30% of the patients, hypophonesis in 28% and polypnea or dyspnea in 35%. Most patients showed alveolar bilateral infiltrations and 20% had pleural empyema. Seventy-eight percent had WBC counts > 15,000 and 93% showed neutrophilia of > 60%. Erythrocyte sedimentation rate and C-reactive protein were elevated in 77% and 85% of the patients, respectively. Overall, 40% of the isolates showed intermediate susceptibility to penicillin and 5% were resistant. Eighteen percent showed intermediate susceptibility to cefotaxime and 18% were resistant to erythromycin. Thirty-four strains were resistant to erythromycin. Thirty-four strains were serogroups and in children < or = 59 months, 34% of the serogroups were included in the pneumococcal 7-valent pneumococcal conjugate vaccine. CONCLUSION: The significant morbidity of bacteremic pneumococcal pneumonia and the implicated serogroups supports the use of the new heptavalent vaccine in the pediatric age group.

Neumonía neumocócica bacteriémica / Bacteremic pneumococcal pneumonia

Antecedentes: Streptococcus pneumoniae es el primer agente causal de neumonía bacteriana adquirida en la comunidad en la infancia. Para su diagnóstico el aislamiento en sangre de S. pneumoniae es el único método válido. Con la aparición de las nuevas vacunas conjugadas antineumocócicas se pueden prevenir estas infecciones. Existen estudios sobre la incidencia global de la enfermedad invasiva neumocócica (EIN) y sobre sus formas más graves como la meningitis, pero muy pocos la neumonía neumocócica bacteriémica (NNB) y sus complicaciones en la infancia. Objetivos: Conocer la incidencia, forma de presentación clínica y analítica, porcentaje y días de ingreso, respuesta al tratamiento antibiótico y resistencia a éstos, complicaciones y serogrupos causales de la NNB en nuestros medio para estimar la necesidad de una vacunación sistemática. Material y métodos: Desde enero de 1990 hasta mayo de 2002 se han recogido todos los casos pediátricos de EIN diagnosticados en nuestro hospital. Del total de estos casos se analizaron diversas características en los pacientes con NNB. Se consideraron NNB los casos con radiología torácica compatible con neumonía y hemocultivo o cultivo de líquido pleural positivo para S. pneumoniae. Se calculó la incidencia, tanto de la EIN como de la NNB, según los datos de población censales. Todas las cepas de S. pneumoniae fueron enviadas para serotipificación al Laboratorio de Referencia de Neumococos del Instituto de Salud Carlos III en Majadahonda (Madrid). Se estimó la cobertura vacunal de la nueva vacuna antineumocócica conjugada heptavalente según los serotipos incluidos en ella y la distribución de los serotipos. Resultados: Se diagnosticaron 40 casos de NNB, lo que representa una incidencia de 17, 10 y 5 casos por 105 niños menores de 2, 4 y 15 años, respectivamente. La edad media fue de 50 meses, siendo el 43% menores de 4 años. El mayor número de casos se dio en enero, marzo, abril y mayo. Ingresaron el 77,5% de los casos y la estancia media fue de 9,2 días. La duración media de la fiebre fue de 2 días y en los pacientes con derrame pleural fue de 4,2 días. Presentaron fiebre todos los casos, siendo su duración media antes del ingreso de 4 días. El 58% de los pacientes tenían tos. El 39% presentaban afectación de su estado general, vómitos el 47% y dolor abdominal el 28%. En la auscultación respiratoria se detectaron estertores en el 30% de los casos, hipofonesis en el 28% y polipnea o disnea en el 35%. En la mayoría de los pacientes se observó un infiltrado alveolar unilateral y el 20% de los casos tenían un derrame pleural. El 78% de los casos tenían una leucocitosis superior a 15.000 y el 93% una neutrofilia mayores de 60%. La velocidad de sedimentación globular y la proteína C reactiva fueron elevadas en el 77 y 85% de los casos, respectivamente. El 40% de las cepas tenían una sensibilidad disminuida a la penicilina y el 5% eran resistentes. El 18% tenían una sensibilidad disminuida a cefotaxima y el 18% eran resistentes a eritromicina. Se serogruparon 34 cepas y en los menores de 59 meses, el 84% de los serogrupos eran los incluidos en la vacuna heptavalente. Conclusión: La importante morbilidad de la NNB y la distribución de los serogrupos implicados apoyaría la utilización de la nueva vacuna heptavalente en esta edad (AU)