ABSTRACT
La neumonía adquirida en la comunidad (NAC) en la edad pediátrica ha sufrido, en la última década, una serie de cambios epidemiológicos, clínicos, etiológicos y de resistencias a antibióticos, que obligan a replantear su abordaje terapéutico. En este documento, dos de las principales sociedades de especialidades pediátricas involucradas en el diagnóstico y tratamiento de esta entidad, como son la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica, así como el Comité Asesor de Vacunas de la AEP, proponen unas pautas consensuadas de tratamiento y prevención, con el fin de proporcionar a todos los pediatras una guía actualizada. En esta primera parte del consenso, se aborda el tratamiento de los pacientes sin enfermedades de base relevantes con NAC que no precisan ingreso hospitalario, así como la prevención global de esta patología con vacunas. En un siguiente documento se expondrá el abordaje terapéutico tanto de aquellos pacientes en situaciones especiales como de las formas complicadas de la enfermedad
There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed
Subject(s)
Child , Female , Humans , Male , Pneumonia/mortality , Pneumonia/etiology , Pneumonia/drug therapy , Pneumonia/prevention & control , Community-Acquired Infections/epidemiology , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Drug Resistance, Microbial , Epidemiological Monitoring/trends , Haemophilus influenzae type b/pathogenicity , Streptococcus pneumoniae/pathogenicity , Staphylococcus aureus/pathogenicity , Streptococcus pyogenes/pathogenicity , Pneumococcal Vaccines , Vaccines, Conjugate , Haemophilus Vaccines , Influenza Vaccines , Spain/epidemiologyABSTRACT
Desde hace más de una década, los casos complicados de neumonía adquirida en la comunidad, fundamentalmente con empiema pleural o formas necrosantes, comenzaron a ser más frecuentes en niños, según la amplia documentación procedente de numerosos países. El abordaje terapéutico óptimo de estos casos, tanto desde el punto de vista médico (antibióticos, fibrinolíticos) como técnico-quirúrgico, (drenaje pleural, videotoracoscopia) continúa siendo controvertido. En este documento, la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica revisan la evidencia científica y proponen unas pautas consensuadas de tratamiento de estos casos, fundamentalmente para el abordaje del derrame pleural paraneumónico en niños, así como la actuación en situaciones especiales, sobre todo en la cada vez más frecuente población pediátrica con enfermedades de base o inmumodepresión
The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression
Subject(s)
Child , Female , Humans , Infant , Male , Pneumonia/drug therapy , Pneumonia/therapy , Pneumonia/prevention & control , Pneumonia/complications , Pleural Effusion/drug therapy , Pleural Effusion/therapy , Anti-Bacterial Agents/therapeutic use , Thoracoscopy/methods , Community-Acquired Infections , Epidemiological Monitoring/trends , Empyema, Pleural , Hyponatremia , Oxygen Inhalation Therapy , Oximetry , Energy Drinks , Respiration, Artificial , Noninvasive Ventilation , Immunocompromised Host , Treatment Failure , Spain/epidemiologyABSTRACT
Non-cystic fibrosis bronchiectasis (nCFb) is an acquired condition of variable etiology. An impaired mucociliary clearance seems to be one of the mechanisms behind nCFb, and treatment involves antibiotics, mucoactive agents, and airway clearance techniques (ACTs). Traditional ACTs have four components: postural drainage, percussion, vibration of the chest wall, and coughing. Reviewing the international medical literature on the use of ACTs for patients with nCFb from 1989 to the present day, we retrieved 93 articles, of which 35 met our selection criteria for this analysis. We reviewed active cycle of breathing techniques (ACBT), forced expiration techniques (FET), autogenic drainage, postural drainage, oscillating positive expiratory pressure (OPep), high frequency chest wall oscillation (HFCWO), and exercise or pulmonary rehabilitation. Overall, ACTs appear to be safe for individuals (adults and children) with stable bronchiectasis; where there may be improvements in sputum expectoration, selected measures of lung function, and health-related quality of life. Unfortunately, there is a lack of RCTs in nCFb patients, especially in children. Moreover, none of the studies describes long-term effects of ACTs. It should be noted that a single intervention might not reflect the longer-term outcome and there is no evidence to recommend or contest any type of ACTs in nCFb management. Multicenter RCTs are necessary to evaluate the different techniques of ACTs especially in children with nCFb.
Subject(s)
Bronchiectasis/physiopathology , Bronchiectasis/therapy , Mucociliary Clearance/physiology , Cystic Fibrosis/physiopathology , Drainage, Postural/methods , Humans , Quality of Life , Respiratory Therapy/methodsABSTRACT
The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression.
Subject(s)
Pneumonia, Bacterial/therapy , Pneumonia, Viral/therapy , Child , Community-Acquired Infections/therapy , Humans , Pneumonia, Bacterial/complications , Pneumonia, Viral/complications , RiskABSTRACT
There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed.
Subject(s)
Community-Acquired Infections/prevention & control , Community-Acquired Infections/therapy , Pneumonia, Bacterial/prevention & control , Pneumonia, Bacterial/therapy , Anti-Bacterial Agents/therapeutic use , Child , Drug Resistance, Bacterial , Humans , Outpatients , Practice Guidelines as Topic , Societies, Medical , SpainABSTRACT
El asma es una enfermedad difícil de diagnosticar en el lactante y prescolar, ya que a esa edad sus manifestaciones clínicas, tos sibilancias, taquipnea pueden darse también en otros procesos y no se cuenta con marcadores objetivos que permitan diferenciados. Se hace, por tanto, necesario valorar la respuesta al tratamiento broncodilatador y/o antinflamatorio y, si no es efectivo, derivar al niño a neumología y plantear un diagnóstico diferencial con otras enfermedades "sibilantes". La catalogación del niño en un determinado fenotipo puede servir de ayuda, aunque los fenotipos no son excluyentes entre sí y se definen mejor retrospectivamente; por eso, otra opción es la clasificación evolutiva de las sibilancias, como virales episódicas o a múltiples estímulos, con un pronóstico y tratamiento distintos. La aplicación de índices predictivos de asma (IPA) permite diferencia a los probables asmáticos y plantear tratamientos más selectivos. El inhalador presurizado aplicado con cámara pequeña con mascarilla facial es el método de elección para la administración de fármacos. Montelukast es el fármaco de elección para las sibilancias inducidas por virus y los corticoides inhalados, a dosis bajas, la opción terapéutica en los niños con sibilancias recurrentes a múltiples estímulos con IPA positivo (AU)
Asthma is a difficult disease to diagnose in infants and preschool because, at that age, their clinical manifestations (cough, wheezing, tachypnea), may also occur in other processes, and there is no objective markers that allow then apart. It is therefore necessary to assess response to treatment, bronchodilators and/or anti-inflammatory, and if not effective, refer the child to pediatric pulmonology and rise a differential diagnosis with other diseases "wheezing". The cataloging of the child in a particular phenotype may be helpful, although the phenotype may be helpful, although the phenotypes are not mutually exclusive and are best defined retrospectively; so, another options is the evolutionary classification of wheezing, as episodic viral or multiple stimuli, with a different prognosis at treatment. Application of asthma predictive index (API) differentiating the probable asthmatics and raise more selective treatments. The MDI applied with a small camera with face mask is the method of choice for drug delivery. Montelukast is the drug of choice for virus-induced wheezing and inhaled corticosteroids at low doses, the therapeutic option in children with recurrent wheezing to multiple stimuli with positive API (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Airway Obstruction/drug therapy , Asthma/drug therapy , Asthma/epidemiology , Environmental Pollution/adverse effects , Risk Factors , Respiratory Sounds/diagnosis , Dyspnea/diagnosis , Bronchodilator Agents/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Diagnosis, Differential , Phenotype , Virus Diseases/diagnosisABSTRACT
La tuberculosis continúa siendo uno de los problemas sanitarios más importantes en el mundo. En países desarrollados se está asistiendo a un aumento de casos, incluidos los niños, por diferentes motivos. El más determinante parece ser la inmigración procedente de zonas con elevada endemia de tuberculosis. Es prioritario que se establezcan las medidas necesarias para optimizar el diagnóstico precoz y adecuado de las distintas formas clínicas de tuberculosis en niños. Para ello, la Sociedad Española de Infectología Pediátrica (SEIP) y la Sociedad Española de Neumología Pediátrica (SENP), ambas pertenecientes Asociación Española de Pediatría, han decidido realizar el presente documento de consenso con el objetivo de unificar los criterios de actuación diagnóstica en la edad pediátrica (AU)
Tuberculosis is one of the most important health problems worldwide. There are an increased number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration coming from high endemic areas. Measures to optimize early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Pediatric Association (Spanish Society of Pediatric Infectology and Spanish Society of Pediatric Pneumology) have agreed this Consensus Document in order to homogenize diagnostic criteria in pediatric patients (AU)
Subject(s)
Humans , Male , Female , Child , Tuberculosis/epidemiology , Immunologic Tests/methods , Tuberculosis/diagnosis , Consensus , Practice Patterns, Physicians' , Tuberculin Test/methods , Microbiological Techniques/methods , Radiography/methods , Endoscopy/methods , BCG Vaccine/administration & dosageABSTRACT
BACKGROUND: Leukotrienes and isoprostanes are biomarkers of airway inflammation and oxidative stress that can be detected in exhaled breath condensate (EBC). The aim of this study was to evaluate leukotriene B4 (LTB4) and 8-isoprostane levels in EBC of healthy and asthmatic children with episodic and moderate persistent asthma. METHODS: EBC was collected from 62 children aged 6 to 14 years: 22 healthy children, 30 patients with episodic asthma, and 10 patients with moderate persistent asthma, without preventive treatment at the time of enrolment. RESULTS: LTB concentrations were higher in children with asthma than in healthy controls (50.7 pg/mL vs. 13.68 pg/mL, P < .011). The same was true for children with moderate persistent asthma compared to children with episodic asthma (146.9 pg/mL vs. 18.85 pg/mL, P < .0001), children with moderate persistent asthma compared to healthy controls (146.9 pg/mL vs. 13.68 pg/mL, P < .0001), and children with episodic asthma compared to healthy controls (P, nonsignificant). EBC concentrations of 8-isoprostane were higher in asthmatic than in healthy children (18.3 pg/mL vs. 6.59 pg/mL, P < .026). They were also increased in children with moderate persistent asthma compared to those with episodic asthma (36.25 pg/mL and 12.28 pg/mL, P < .012), and in children with moderate persistent asthma and episodic asthma compared to healthy controls (36.25 pg/mL vs. 6.59 pg/mL [P < .0001] and 12.28 pg/mL versus 6.59 pg/mL [P < .0001], respectively). CONCLUSION: LTB4 and 8-isoprostane concentrations were increased in asthmatic children compared to healthy individuals, with differences detected for 2 degrees of asthma severity. Our findings suggest that EBC is a noninvasive method for airway inflammation and oxidative stress assessment.
Subject(s)
Asthma/metabolism , Dinoprost/analogs & derivatives , Leukotriene B4/metabolism , Adolescent , Asthma/immunology , Breath Tests , Child , Dinoprost/immunology , Dinoprost/metabolism , Female , Humans , Leukotriene B4/immunology , Male , Nitric Oxide/immunology , Nitric Oxide/metabolism , Oxidative Stress/immunology , Respiratory Function Tests , Statistics, NonparametricABSTRACT
La tuberculosis continúa siendo uno de los problemas sanitarios más importantes en el mundo. En países desarrollados se está asistiendo a un aumento de casos, incluidos los niños, por diferentes motivos. El más determinante parece ser la inmigración procedente de zonas con elevada endemia de tuberculosis. Es prioritario que se establezcan las medidas necesarias para optimizar el diagnóstico precoz y adecuado de las distintas formas clínicas de tuberculosis en niños. Para ello, la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica ambas pertenecientes a la Asociación Española de Pediatría, han decidido realizar el presente documento de consenso, con el objetivo de unificar los criterios de actuación diagnóstica en la edad pediátrica (AU)
Tuberculosis is one of the most important health problems worldwide. There are an increasing number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration from highly endemic areas. Measures to optimise early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Paediatric Association (Spanish Society of Paediatric Infectology and Spanish Society of Paediatric Pneumology) have agreed this Consensus Document in order to homogenise diagnostic criteria in paediatric patients (AU)
Subject(s)
Humans , Child , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Medical History Taking/methods , Immunologic Tests/methods , Radiography, Thoracic , Bacteriological Techniques/methodsABSTRACT
Tuberculosis is one of the most important health problems worldwide. There are an increased number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration coming from high endemic areas. Measures to optimize early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Pediatric Association (Spanish Society of Pediatric Infectology and Spanish Society of Pediatric Pneumology) have agreed this Consensus Document in order to homogenize diagnostic criteria in pediatric patients.
ABSTRACT
Tuberculosis is one of the most important health problems worldwide. There are an increasing number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration from highly endemic areas. Measures to optimise early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Paediatric Association (Spanish Society of Paediatric Infectology and Spanish Society of Paediatric Pneumology) have agreed this Consensus Document in order to homogenise diagnostic criteria in paediatric patients.
Subject(s)
Tuberculosis/diagnosis , Adolescent , Algorithms , Child , Humans , Radiography , Tuberculosis/microbiology , Tuberculosis, Pulmonary/diagnostic imagingSubject(s)
Asthma/therapy , Disease Management , Adolescent , Age Factors , Anti-Asthmatic Agents/administration & dosage , Anti-Asthmatic Agents/classification , Anti-Asthmatic Agents/therapeutic use , Asthma/classification , Asthma/epidemiology , Asthma/prevention & control , Child , Child, Preschool , Combined Modality Therapy , Desensitization, Immunologic/methods , Female , Hospitalization , Humans , Infant , Infant, Newborn , Male , Nebulizers and Vaporizers , Oxygen Inhalation Therapy , Patient Discharge , Patient Education as Topic , Respiratory Sounds , Severity of Illness Index , SpainABSTRACT
No disponible
No disponible
Subject(s)
Child , Humans , Asthma/therapy , Immunotherapy/methods , Asthma/diagnosis , Asthma/epidemiology , Asthma/genetics , Primary Health Care , Spain/epidemiology , Diagnosis, Differential , Adrenergic Agonists/pharmacology , Adrenal Cortex Hormones/therapeutic useSubject(s)
Asthma/diagnosis , Asthma/therapy , Consensus , Acute Disease , Algorithms , Child , Child, Preschool , Humans , Respiratory SoundsABSTRACT
OBJECTIVE: To study the effect of seasons on the health-related quality of life (HRQL) of asthmatic children. METHODS: Four groups of asthmatic children 7 to 14 years old were recruited by pediatricians during each season of the year. Their HRQL was assessed by means of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ). Other factors surveyed were asthma severity, atopy, medical treatment, immunotherapy, obesity, parental smoking, and anti-allergic measures. RESULTS: The mean (SD) overall PAQLQ score was highest in summer at 6.2 (1.0) and lowest in autumn at 5.5 (1.2). The same trend was found for domains in summer and autumn, respectively: symptoms, 6.2 (1.0) vs 5.4 (1.4); emotions, 6.5 (0.8) vs 6.0 (1.0); and activities, 5.9 (1.4) vs. 5.0 (1.5). Factors such as male gender (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.41-0.87), being on immunotherapy (OR, 0.59; 95% CI, 0.38-0.92), living in an urban environment (OR, 0.56; 0.33-0.93), and residing on the northern coast of Spain along the Bay of Biscay (OR, 0.56; 0.36-0.89) were independent protective factors against having a total PAQLQ score in the lower tertile. Conversely, being recruited in a primary care setting (OR, 1.55; 1.01-2.38) and having more severe asthma were risks for being in the lower tertile. CONCLUSIONS: Irrespective of the severity of the disease, season has a significant influence on the HRQL of asthmatic children.
Subject(s)
Asthma/complications , Health Status , Quality of Life , Seasons , Child , Female , Humans , Male , Outpatient Clinics, Hospital , Physicians , Residence Characteristics , Severity of Illness Index , Sex Factors , SpainABSTRACT
No disponible
No disponible
Subject(s)
Male , Female , Child , Humans , Consensus Development Conferences as Topic , Asthma/diagnosis , Asthma/epidemiology , Asthma/therapy , Phenotype , Risk Factors , Bronchodilator Agents/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Immunotherapy/methods , Nebulizers and Vaporizers , Societies, Medical/trends , Societies, Medical , Immunologic TechniquesABSTRACT
No disponible
Subject(s)
Child , Adolescent , Child, Preschool , Humans , Asthma/therapy , Anti-Asthmatic Agents/therapeutic useABSTRACT
BACKGROUND: Although the treatment of asthma has been addressed in several guidelines, the management of the first acute wheezing episode in infants has not often been evaluated. We surveyed practicing pediatricians in Spain about the treatment they would provide in a simulated case. MATERIAL AND METHODS: A random sample of 3000 pediatricians and physicians who normally treated children was surveyed. The questionnaire inquired about how they would treat a first mild-to-moderate wheezing attack in a 5-month-old boy with a personal and family history of allergy. Pediatricians were asked about their professional background. RESULTS: A total of 2347 questionnaires were returned with useful data (78.2%). Most (90.4%) of the pediatricians would use a short-acting beta2 agonist (SABA) via a metered-dose inhaler with a spacer and a face mask or nebulizer. However, only 34.5% chose a SABA alone: 31.3% added an oral steroid and 27.6% added an inhaled corticosteroid (ICS). The factors associated with the use of ICS in the acute attack were: (1) lack of specific training in pediatrics (OR 1.45; 1.12-1.85) and (2) primary care health center setting (OR 1.31; 1.01-1.69) or rural setting (OR 1.28; 1.01-1.66). Forty-four percent did not recommend any follow-up treatment while 20.7% prescribed ICS as maintenance therapy. The factors related to this decision were the same as those described above. CONCLUSIONS: The management of a first wheezing episode seems to meet published guidelines among Spanish pediatricians with formal training in pediatrics and in those who work in a hospital setting or in urban areas.
