Enfermedad neuromuscular: evaluación clínica y seguimiento desde el punto de vista neumológico / Neuromuscular disease: Respiratory clinical assessment and follow-up

Los pacientes con enfermedad neuromuscular constituyen un grupo de riesgo importante para sufrir con frecuencia situaciones de fracaso respiratorio agudo o crónico. Desde que nacen o son diagnosticados requieren un seguimiento por parte del neumopediatra para diagnosticar y tratar las complicaciones respiratorias, que son su principal causa de fallecimiento, dentro de un contexto multidisciplinar. El soporte ventilatorio y la asistencia a la tos han mejorado la calidad de vida y el pronóstico a largo plazo de muchos de estos pacientes. En este artículo los autores repasan la fisiopatología, evaluación de la función respiratoria, trastornos del sueño y complicaciones respiratorias más frecuentes en las enfermedades neuromusculares. En un próximo artículo se analizarán los diversos tratamientos utilizados desde el punto de vista neumológico

Patients with neuromuscular disease are an important group at risk of frequently suffering acute or chronic respiratory failure, which is their main cause of death. They require follow-up by a pediatric respiratory medicine specialist from birth or diagnosis in order to confirm the diagnosis and treat any respiratory complications within a multidisciplinary context. The ventilatory support and the cough assistance have improved the quality of life and long-term survival for many of these patients. In this paper, the authors review the pathophysiology, respiratory function evaluation, sleep disorders, and the most frequent respiratory complications in neuromuscular diseases. The various treatments used, from a respiratory medicine point of view, will be analyzed in a next paper

[Neuromuscular disease: respiratory clinical assessment and follow-up]. / Enfermedad neuromuscular: evaluación clínica y seguimiento desde el punto de vista neumológico.

Patients with neuromuscular disease are an important group at risk of frequently suffering acute or chronic respiratory failure, which is their main cause of death. They require follow-up by a pediatric respiratory medicine specialist from birth or diagnosis in order to confirm the diagnosis and treat any respiratory complications within a multidisciplinary context. The ventilatory support and the cough assistance have improved the quality of life and long-term survival for many of these patients. In this paper, the authors review the pathophysiology, respiratory function evaluation, sleep disorders, and the most frequent respiratory complications in neuromuscular diseases. The various treatments used, from a respiratory medicine point of view, will be analyzed in a next paper.

Derrame pleural paraneumónico / Parapneumonic pleural effusion

La neumonía es la causa más frecuente de derrame pleural en niños. En los últimos años se han observado cambios epidemiológicos con un aumento de la prevalencia de complicaciones y de ingresos por derrame pleural, así como cambios en la etiología (gérmenes y serotipos), pudiendo estar relacionados con el uso más racional de antibióticos y los cambios en la estrategia vacuna. No hay evidencias en Pediatría para algunas de las recomendaciones sobre manejo del derrame pelural paraneumónico. Es por ello que realizamos esta revisión, basándose en las recomendaciones de la Sociedad Española de Neumología Pediátrica y la evidencia científica actual. El tratamiento deberá basarse en el empleo adecuado y precoz de antibioterapia endovenosa. El uso de técnicas complementarias, como la colocación de drenaje pleural (con o sin fibrinolíticos), la realización de toracoscopia y toracotomía, dependerá de la presencia de complicaciones y del estadio evolutivo del derrame (AU)

Pneumonia is the most frequent cause of pleural effusion in children. In recent years, changes in the epidemiological pattern have been observed, with an increase of complications and rate of admissions. Microbiological changes have been also described, such as types of bacteria and serotypes implicated, which can be related to different antibiotic policy and immunization schedule. No conclusive guidelines have been published for pediatric population regarding the management of parapneumonic pleural effusion. Therefore, we reviewed this topic based on Sociedad Española de Neumología Pediátrica (Spanish Society of Pediatric Pulmonology) recommendations and a review of the existing literature. Treatment should be based on early diagnosis and proper intravenous antibiotic use. Pleural effusion management includes different procedures such as pleural drainage (with or without fibirnolytics), thoracoscopy and thoracotomy, depending on the presence of complications and the evolutive stage (AU)

[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)