Maternal smoking during pregnancy and asthma during the first year of life: a comparative study between smokers and nonsmoker mothers

Background: We investigated the relationship between maternal smoking in pregnancy and health care problems in the offspring during the first year of life, particularly asthma. Material and Methods: A cohort of 648 consecutive infants born at term and alive at Hospital de Sagunto (Valencia, Spain) over one year period was followed for 12 months. Clinical data of the infants were prospectively collected from the database of ambulatory medical records (ABUCASIS) of the Valencia health system. Results: Smoking during pregnancy was recorded in 164 (25.3%) mothers. During the first year of life, asthma was diagnosed in 101 infants, with an incidence of 15.7%. The diagnoses of asthma (25.6% vs. 12.3%; P < 0.0001) and bronchiolitis (44.5% vs. 28.6%; P = 0.0002) during the first year of life were more common among infants in the smoking group. The probability of developing asthma during the first year of life was two-fold higher for the male gender and 2.5 times higher when mothers smoked while pregnant. Up to 52% of asthma cases could have been avoided in infants born to smoking mothers if they did not smoke during pregnancy. Infants in the smoking group showed a lower weight and length at birth than infants in the nonsmoking group differences almost disappeared at 6 months and 12 months. Conclusion: Asthma during the first year of life showed a clear relationship with maternal smoking in pregnancy. Pregnant women should be advised of the significant perinatal risk for respiratory diseases associated with tobacco use (AU)

Tratamiento hospitalario de la bronquiolitis moderada-grave: ¿suero salino hipertónico o fisiológico? Análisis de factores de riesgo asociados al reingreso / Hospital treatment of moderate-severe bronchiolitis, hypertonic or physiological saline? Analysis of risk factors associated with readmission

Introducción: a pesar de los numerosos estudios publicados hasta la fecha sobre el tratamiento hospitalario de la bronquiolitis y de la prometedora eficacia del suero salino hipertónico, lo cierto es que existe controversia al respecto. Material y métodos: estudio observacional prospectivo que evalúa la eficacia del suero salino hipertónico al 3% frente al suero fisiológico en el tratamiento hospitalario de la bronquiolitis, en términos de reducción de estancia y de puntuación de escala clínica de gravedad; en una segunda fase se analizan factores de riesgo asociados al reingreso por broncoespasmo de los mismos pacientes. Resultados: se analizan 67 de los 73 pacientes ingresados por bronquiolitis, de los cuales 9 recibieron fisiológico y 58 hipertónico, con o sin broncodilatador asociado. La estancia hospitalaria fue de 6,07 ± 3,12 días para el grupo fisiológico, y de 6,67 ± 4,36 días para el grupo con hipertónico. La media de la puntuación (Wood-Downes modificado por Ferrés) para el grupo con fisiológico fue de 3,67 ± 1,1 y de 3,16 ± 1,1 para los que recibieron hipertónico. Para la segunda fase se obtiene una tasa de reingresos del 8,2%. Conclusiones: no encontramos diferencias significativas entre ambos grupos en tiempo de hospitalización ni en mejoría de escala clínica y días de oxigenoterapia. Pese al reducido tamaño muestral no observamos ninguna tendencia a favor de diferencias significativas en nuestra muestra. Los factores más relacionados con el reingreso han sido la edad menor a 6 meses, el sexo masculino, el tener hermanos mayores y el tabaquismo familiar

Introduction: although numerous studies have been published to date on the subject of inpatient management of bronchiolitis and the promising outcomes obtained with hypertonic saline, this subject remains controversial. Materials and methods: we conducted a prospective observational study to assess the effectiveness of 3% hypertonic saline compared to physiological saline in the inpatient management of bronchiolitis, understood as the achieved reductions in length of stay and clinical severity scores. In a second phase, we analysed the risk factors associated with readmission due to bronchospasm in the same sample of patients. Results: we included 67 out of the 73 patients admitted with bronchiolitis in the analysis, of who 9 received physiological saline and 58 hypertonic saline, with or without an added bronchodilator. The mean length of stay was 6.07 ± 3.12 days in the physiological saline group and 6.67 ± 4.36 days in the hypertonic saline group. The mean severity score (Wood-Downes scale modified by Ferrés) was 3.67 ± 1.1 in the physiological saline group versus 3.16 ± 1.1 in the hypertonic saline group. In the second phase of the study, we found a readmission rate of 8.2%. Conclusion: we did not find statistically significant differences between the two groups in the length of stay or in the improvement in the clinical severity score or duration of oxygen therapy. Although the sample size was small, we did not find any trends in our sample suggesting the actual presence of significant differences. The factors associated most strongly with readmission were age of less than 6 months, male sex, having older siblings and exposure to smoke in the household