Is palivizumab effective as a prophylaxis of respiratory syncytial virus infections in cystic fibrosis patients? A meta-analysis

BACKGROUND: Infections by respiratory syncytial virus (RSV) are more severe in patients with cystic fibrosis (CF), and many CF units use palivizumab as prophylaxis; however, information about palivizumab efficacy in CF patients is almost lacking. METHODS: A literature search up to December 2012 on the morbidity of RSV bronchiolitis in CF patients and on the safety and efficacy of palivizumab in those patients was performed. A random-effects meta-analysis was conducted for those studies meeting pre-specified search criteria. Historical controls were allowed. RESULTS: The number of patients who received palivizumab was 354 and the hospital admission rate was 0.018 (95% CI 0.0077-0.048). The corresponding number in the non-treated groups was 463 patients with an admission rate of 0.126 (95% CI 0.086-0.182) (Q = 13.9; p < 0.001). CONCLUSION: Palivizumab may have a role in the prevention of severe lower airway infection by RSV in CF patients

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Is palivizumab effective as a prophylaxis of respiratory syncytial virus infections in cystic fibrosis patients? A meta-analysis.

BACKGROUND: Infections by respiratory syncytial virus (RSV) are more severe in patients with cystic fibrosis (CF), and many CF units use palivizumab as prophylaxis; however, information about palivizumab efficacy in CF patients is almost lacking. METHODS: A literature search up to December 2012 on the morbidity of RSV bronchiolitis in CF patients and on the safety and efficacy of palivizumab in those patients was performed. A random-effects meta-analysis was conducted for those studies meeting pre-specified search criteria. Historical controls were allowed. RESULTS: The number of patients who received palivizumab was 354 and the hospital admission rate was 0.018 (95% CI 0.0077-0.048). The corresponding number in the non-treated groups was 463 patients with an admission rate of 0.126 (95% CI 0.086-0.182) (Q=13.9; p<0.001). CONCLUSION: Palivizumab may have a role in the prevention of severe lower airway infection by RSV in CF patients.

[Malama project in the Region of Murcia (Spain): environment and breastfeeding]. / Proyecto Malama en la Región de Murcia (España): medio ambiente y lactancia materna.

OBJECTIVES: To identify protective factors and risk factors for the initiation and length of breastfeeding and full breastfeeding, in the Region of Murcia (Spain). PATIENTS AND METHODS: The Malama study (Medio Ambiente y Lactancia Materna) is a follow up study from birth up to years of 1,000 mother-child pairs. A description of breastfeeding practices are presented here, the survival curve of breastfeeding and a Cox regression model of the pilot study that includes 101 mother-child pairs and 6 months of follow-up. RESULTS: After six months the prevalence of breastfeeding was 35 %. The mean duration of full breastfeeding was 63 days (median 45 days) with six months prevalence of 8 %. Hazard ratios (HR) for full breastfeeding were, to be a smoker (1.89; 95 % CI: 1.18-3.02), older than 35 years of age (2.04; 95 % CI: 1.22-3.42), caesarean birth (1.63; 95 % CI: 1.00-2.66). As well as those previously mentioned risks for breastfeeding, there were also hazard ratios for primary school education or less (1.63; 95 % CI: 0.98-2.82); to have breastfed an earlier child for at least 16 weeks (0.33; 95 % CI: 0.13-0.79), and to be the first birth (0.50; 95 % CI: 0.27-0.95). The length of both breastfeeding and full breastfeeding increased with the length of the maternal leave (0.96; 95 % CI: 0.94-0.99). Pregestational occupational exposure to endocrine disruptors did not seem to interfere with the duration of breastfeeding. CONCLUSIONS: In order to improve quality and duration of breastfeeding programmes, paediatric research and training on breastfeeding practice should be encouraged, to reduce unnecessary caesarean sections, promote tobacco cessation, focus human and economic resources to women with less education, and include legal mechanisms to ensure longer maternal leave.

Proyecto Malama en la Región de Murcia (España): medio ambiente y lactancia materna / Malama project in the Region of Murcia (Spain): environment and breastfeeding

Objetivo: Estudiar los factores protectores y de riesgo de la calidad y duración de la lactancia materna completa (LMC) y total (LMT) en la Región de Murcia. Pacientes y métodos: El estudio Malama (medio ambiente y lactancia materna) realiza un seguimiento de 1.000 parejas madre-hijo desde el nacimiento hasta los 2 años. Aquí presentamos la descripción, supervivencia de la lactancia y regresión de Cox del estudio piloto con 101 parejas y 6 meses de seguimiento. Resultados: La duración media de la LMC fue de 63 días (mediana de 45) y prevalencia a los 6 meses del 8 %. La prevalencia de LMT fue del 35 %. Riesgo relativo (RR) para LMC eran ser madre fumadora (1,89; intervalo de confianza del 95 % [IC 95 %]: 1,18-3,02), mayor de 35 años (2,04; IC 95 %: 1,22-3,42), con parto por cesárea (1,63; IC 95 %: 1,00-2,66); y para LMT, además de las anteriores el tener sólo estudios primarios (1,63; IC 95 %: 0,98-2,82); haber lactado antes al menos 16 semanas (0,33; IC 95 %: 0,13-0,79); primer hijo/a (0,50; IC 95 %: 0,27-0,95). La duración de LMC y LMT crecían con la mayor duración de la baja maternal (0,96; IC 95 %: 0,94-0,99). La exposición laboral pregestacional a disruptores endocrinos no parece interferir con la duración de la lactancia. Conclusiones: Los programas de protección-promoción de la LM deberían aumentar la investigación y formación pediátrica en LM, disminuir las cesáreas innecesarias, fomentar la deshabituación tabáquica, dedicar más recursos a las mujeres con menos estudios e incluir mecanismos legales que prolonguen la baja por maternidad para conseguir una lactancia más duradera y de mejor calidad (AU)

Objectives: To identify protective factors and risk factors for the initiation and length of breastfeeding and full breastfeeding, in the Region of Murcia (Spain). Patients and methods: The Malama study (Medio Ambiente y Lactancia Materna) is a follow up study from birth up to years of 1,000 mother-child pairs. A description of breastfeeding practices are presented here, the survival curve of breastfeeding and a Cox regression model of the pilot study that includes 101 mother-child pairs and 6 months of follow-up. Results: After six months the prevalence of breastfeeding was 35 %. The mean duration of full breastfeeding was 63 days (median 45 days) with six months prevalence of 8 %. Hazard ratios (HR) for full breastfeeding were, to be a smoker (1.89; 95 % CI: 1.18-3.02), older than 35 years of age (2.04; 95 % CI: 1.22-3.42), caesarean birth (1.63; 95 % CI: 1.00-2.66). As well as those previously mentioned risks for breastfeeding, there were also hazard ratios for primary school education or less (1.63; 95 % CI: 0.98-2.82); to have breastfed an earlier child for at least 16 weeks (0.33; 95 % CI: 0.13-0.79), and to be the first birth (0.50; 95 % CI: 0.27-0.95). The length of both breastfeeding and full breastfeeding increased with the length of the maternal leave (0.96; 95 % CI: 0.94-0.99). Pregestational occupational exposure to endocrine disruptors did not seem to interfere with the duration of breastfeeding. Conclusions: In order to improve quality and duration of breastfeeding programmes, paediatric research and training on breastfeeding practice should be encouraged, to reduce unnecessary caesarean sections, promote tobacco cessation, focus human and economic resources to women with less education, and include legal mechanisms to ensure longer maternal leave (AU)

[Longitudinal study of the growth of preterm newborn infants]. / Estudio longitudinal de crecimiento de recién nacidos pretérmino.

BACKGROUND: The growth and nutrition of premature infants should be accurately assessed. To do this, reference values of normality, obtained from population to be studied, are required. OBJECTIVES: To study the postnatal growth of premature infants in our environment and to compare their growth with intrauterine growth (Lubchenco et al). PATIENTS: A total of 103 premature infants born at 28-36 weeks of gestation in the Virgen de la Arrixaca University Children's Hospital in Murcia (Spain) from April 1994 to June 1995 were studied. Children who received medical care during the first 24 hours of life and who had no prenatal condition that could affect their growth were selected. Those who suffered from serious disease were excluded. The study was carried out from birth to a postconceptional age of 48-52 weeks. The 2-step regression model was used to calculate the percentile graphs. RESULTS: Percentile growth graphs were drawn up for the following variables: weight, length, arm circumference, head circumference, subscapular fold, and tricipital fold. In premature infants, postnatal growth in weight and length was uniform, progressive, and practically linear and did not show the flattening that is characteristic of intrauterine growth. Other corporal segments such as the head and arm circumference showed a certain slowing down at a postconceptional age of 42 or 43 weeks, and the folds showed a moderate dispersion of values as the study progressed. CONCLUSIONS: Intrauterine growth charts do not accurately assess postnatal growth in premature infants.

Estudio longitudinal de crecimiento de recién nacidos pretérmino / Longitudinal study of the growth of preterm newborn infants

Antecedentes. Es importante la valoración adecuada del crecimiento y nutrición de los recién nacidos pretérmino. Es preciso para ello disponer de valores de referencia de normalidad, obtenidos de la población que se va a estudiar. Objetivos. Estudiar el crecimiento posnatal de nuestros recién nacidos pretérmino, y comparar este crecimiento con el crecimiento intrauterino. Pacientes. Se incluyen 103 recién nacidos pretérmino de 28 a 36 semanas de gestación, ingresados en el Hospital Universitario Infantil Virgen de la Arrixaca de Murcia en el período comprendido entre abril de 1994 y junio de 1995. Se seleccionaron niños captados en las primeras 24 h de vida, sin condiciones prenatales que afectaran al crecimiento. Se excluyeron aquellos que sufrían enfermedad grave. Se realizó el estudio desde el nacimiento hasta las semanas 48 a 52 de edad posconcepcional. Se utilizó el modelo de regresión en dos etapas como método estadístico para el cálculo de las gráficas de percentiles. Resultados. Se construyeron gráficas de crecimiento de percentiles para los siguientes parámetros: peso, longitud, perímetro de brazo, perímetro cefálico, pliegue subescapular y pliegue tricipital. El crecimiento posnatal de los recién nacidos pretérmino en peso y longitud es uniforme, progresivo, prácticamente lineal, y no muestra el aplanamiento característico del crecimiento intrauterino. Otros segmentos corporales como perímetro cefálico, perímetro de brazo, experimentan una cierta disminución de la velocidad de crecimiento a las 42 o 43 semanas de edad posconcepcional, los pliegues muestran moderada dispersión de valores al avanzar el período de estudio. Conclusiones. Las gráficas de crecimiento intrauterino no son adecuadas para valorar el crecimiento posnatal del recién nacido pretérmino (AU)

[Pattern of the distribution of total cholesterol and cHDL cholesterol Spanish children and adolescents: RICARDIN Study]. / Patrón de la distribución de colesterol total y cHDL en niños y adolescentes españoles: estudio RICARDIN.

BACKGROUND: The RICARDIN Study multicenter study of cardiovascular risk factors in children and adolescents has described the standards of normality of blood cholesterol levels in the Spanish school population. The objective of the present study was to compare mean values of cholesterol between different regions of Spain, and to compare the global mean with a pool international study. Also, the pattern of total cholesterol and cHDL by age and sex using mathematical model is described, and comparison with two international studies carried out in USA and Japan is performed. SUBJECTS AND METHODS: 10,683 children aged 6 to 18 were selected from 7 different Spanish provinces (Madrid, Vizcaya, Lugo, Badajoz, Murcia, Asturias and Barcelona). Blood samples were obtained by capilar puncture (Reflotron). RESULTS: Mean values of total cholesterol was different among provinces, and globally, were lower than the international pooled population, although the pattern observed in each population was very similar. Total cholesterol curve for Spanish boys showed a curvilinear trend that can be estimated through a cubic function that explains 89% of observed data, while for girls the best estimate was obtained through an inverse function (R2 = 0.40). cHDL for boys showed a cubic function as the best estimate (R2 = 0.90), while for girls the best estimate was obtained through a quadratic function (R2 = 0.59). CONCLUSIONS: There are important physiological variations of total cholesterol level by age and sex in children and adolescents. The pattern of cholesterol does not follow a linear model but a curvilinear one, that need to be considered in clinically assessing individual determinations of cholesterol, since highest percentiles can vary by age and sex.

[Arterial pressure in 1- to 4-year-old school children]. / Tensión arterial en niños de uno a cuatro años escolarizados.

Systolic and diastolic blood pressures have been evaluated in 645 school children aged 1 to 4 years old. Mercury-gravity manometer was used, and diastolic pressure was assessed taking Korotkoff is fifth phase. Blood pressure with sex, age, body height and body weight was correlated. There was no significant difference of tension values between both sexes. Diastolic blood pressure increased progressively and notoriously for each age interval (12 months) in both sexes. Systolic blood pressure increased notoriously only in the 3 and 4 years girls group. The partial correlation and stepwise regression analyses of variables age, body height and body weight with blood pressure showed that body weight was the only variable significantly related to systolic in both sexes, while body weight and age in boys and none of them in girls with the diastolic.

[Arterial blood pressure in the term neonate in the first month of life]. / Tensión arterial del recién nacido a término en el primer mes de la vida.

Systolic blood pressure was valued by Doppler method, in 162 healthy full-term newborn at 48 hours of live, repeated in 134 in the second week and in 120 at the end of first month. A significant increase of systolic blood pressure along all the period with a strong increment in the first week was observed. Authors studied influences on blood pressure of the variabilities: weight, height, gestational age and heart rate. At 48 hours variability with a rate of correlation, weight was higher at birth (r = 0.324, p less than 0.001). There was not evident and significant relation with gestational age. Systolic blood pressure codes were lower when sleeping than when awake. Empirical percentiles of blood pressure are shown during first month of life.

[Arterial pressure in the school-age child; distribution and correlation with chronological and anthropometric variables]. / Estudios de la tensión arterial en la edad escolar; distribución y correlación con variables cronológicas y antropométricas.

The aim of the present study is to establish the normal patterns of blood pressure and the correlations with chronologic and anthropometric variables (age, body, weight, body height and body surface) in childhood. Blood pressures were taken in 1,310 children (727 male, 583 female) ages 4-14 years employing mercury sphygmomanometer, and taking for assessment of diastolic pressure Korotkoff's fifth phase. Study of single correlations showed significant increase of systolic blood pressure with every variable (p less than 0.001); the more predictable was body weight, and the less one, age. There were not significant relationships between diastolic pressure and any other variable; in the same way, there were not significant differences of blood pressures between both sexes. Multiple correlations established the following predictive order: Body weight, age and height. Authors show empirical and theoretical percentiles of blood pressure in relationship with variables: Age, body height and body weight.