Subject(s)
Bronchiolitis Obliterans , Glucocorticoids , Methylprednisolone , Humans , Bronchiolitis Obliterans/drug therapy , Bronchiolitis Obliterans/etiology , Methylprednisolone/administration & dosage , Methylprednisolone/therapeutic use , Child , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Pulse Therapy, Drug , Administration, Intravenous , Treatment OutcomeABSTRACT
Bronchiolitis obliterans (BO) is a rare but severe disease, characterized by inflammation and fibrosis of the terminal bronchioles. BO in children usually occurs after a severe lung viral infection. Diagnosis is based on clinical history of acute bronchiolitis followed by persistent obstruction of the airways and characteristic findings in HRCT. There is no consensus on treatment beyond supportive measures, but bronchodilators and corticosteroids are often used. This review describes the clinical and radiological characteristics and outcomes of BO in pediatric patients, with an emphasis on current research in Brazil.
ABSTRACT
BACKGROUND: Bronchiolitis obliterans (BO) is a rare but severe disease in children. Currently, there is no consensus on the treatment for BO with respect to the systemic use of corticosteroids. Here we report on the follow-up of children with a diagnosis of BO who were treated with corticosteroid pulse therapy. METHODS: Forty patients fulfilling the BO diagnosis criteria were treated with methylprednisolone pulse therapy in monthly cycles until clinical improvement. After the pulse therapy began, we analyzed the clinical and laboratory data at intervals. Statistical analyses were performed using non-parametric tests to compare repeated measures (Friedman, Wilcoxon) or paired nominal data (McNemar) (α = 5%). RESULTS: The frequency of wheezing exacerbations and hospitalizations was reduced (p = 0.0042 and p < 0.0001, respectively) and oxygen saturation improved (p = 0.0002) in the pulse therapy-treated patients. Prolonged oral corticosteroid therapy was discontinued in 83% of these patients. The mean Z-score length for age improved from -1.08 to -0.63, and the mean Z-score weight for age improved from -0.91 to -0.59. The adverse effects during the infusion were temporary and none were serious. CONCLUSIONS: Our data suggest that pulse corticotherapy could be a safe alternative to prolonged systemic oral corticotherapy in children with BO, thus minimizing the adverse effects of the oral therapy. New prospective controlled studies are required to confirm this proposition.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Bronchiolitis Obliterans/drug therapy , Bronchiolitis Obliterans/physiopathology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , MaleABSTRACT
Ressaltar a dificuldade diagnostica da doenca de Kawasaki...
Subject(s)
Humans , Female , Infant , Coronary Aneurysm , Exanthema , Mucocutaneous Lymph Node Syndrome/diagnosis , Child , Echocardiography , Hyperemia , VomitingABSTRACT
Objetivos: avaliar o aleitamento materno, ressaltando os fatores que levaram ao desmame precoce conforme as condições socioeconômico-culturais. Métodos: analisou-se uma amostra de 599 crianças e seus responsáveis que procuraram o Pronto Socorro do Instituto da Criança, São Paulo, de agosto a dezembro de 1998. Utilizou-se um questionário incluindo: idade, profissão e escolaridade dos pais, condições de moradia, renda familiar, trabalho materno, duração da amamentação exclusiva, introdução de novos alimentos, causas de desmame e importância do leite materno. Resultados: 86,1 por cento das mães amamentaram e 92 por cento referiram saber a importância do leite materno. A idade média do desmame foi de 3,3 meses, sendo que 75,9 por cento das mães suspenderam a amamentação sem orientação médica. 38,9 por cento referiram que o leite era "fraco", ou "secou" ou que a criança "largou" o peito. Maior escolaridade da mãe e presença de rede de esgoto mostraram relação com maior tempo de aleitamento (p = 0,016 e p= 0,011 respectivamente). Não houve associação entre acompanhamento da criança no posto de saúde e tempo de aleitamento materno. Conclusões: embora a grande maioria das mães saiba a importância do leite materno e tenha amamentado seu filho, a duração do aleitamento materno exclusivo é menor do que o preconizado pela Organização Mundial da Saúde, sendo a baixa escolaridade um fator para o desmame precoce.
