Bronchiolitis caused by respiratory syncytial virus in an area of portugal: epidemiology, clinical features, and risk factors.

The aim of the present study was to analyse the clinical and epidemiological characteristics of bronchiolitis caused by respiratory syncytial virus (RSV) in 225 children observed in a paediatric hospital in Lisbon, Portugal, and to determine the clinical, epidemiological, or laboratory parameters that correlate with greater severity of the disease. This prospective study included hospitalised and ambulatory children younger than 36 months of age with a diagnosis of bronchiolitis and was conducted during two consecutive RSV epidemiological seasons (November-March 2000/01 and 2001/02). The median age of the patients was 5 months, and the male-to-female ratio was 1.6:1. RSV was isolated in 60.9% of patients, predominantly in the hospitalised group. The subtype A:B ratio was 7.4:1 and was similar in both seasons. RSV-positive patients were younger, had more severe clinical forms of bronchiolitis, and fewer changes in leucocyte total and differential counts. Among infected patients, higher clinical severity scores occurred in association with first wheezing episodes, overcrowded households, attendance at day-care centres, or prematurity (<36 weeks). This first prospective study of RSV epidemiology in Portugal provides a foundation for appropriate surveillance programmes of RSV infection in this country. A multicentre study is desirable in order to delineate optimal prophylactic and therapeutic guidelines for RSV infection in Portugal.

[Importance of J. Brazy's neurobiological index. Prediction of the number and severity of complications in very low birth weight infants]. / Importância do índice neurobiológico de J. Brazy. Predicção do número e gravidade de sequelas dos recém nascidos de muito baixo peso.

The objective of this study was to evaluate the neurodevelopment outcome of Very-Low-Birth-Weight Infants (VLBW), between 1987 and 1993, and correlate these findings with J.Brazy's Neurobiologic Risk Score (NBRS). The minimum corrected age at follow-up was 12 months. The neurodevelopmental assessment was performed using Mary Sheridan and Ruth Griffiths scales, Auditory and Visual Brainstem Evoked Responses and Stycar test. The NBRS was applied to 77 children. According to the score, three groups of risk were defined: Low < or = 4; Intermediate 5-7; High > or = 8. We obtained the following results: children with NBRS < 4, 20% had handicaps (5% of which major); children with NBRS 5-7, 41% had handicaps (23% of which major); in children with NBRS > 8, 95% had handicaps (80% of which major). The incidence of handicaps, (all grades included) was 71.4% for those weighing less than 1000 gr at birth, and 39.2% for those weighing 1000-1499 gr at birth. Major handicaps, mainly motor deficits, occurred in 26.8% of VLBW infants and minor to moderate handicaps were observed in 18.3% of patients in this group. These results were compared to J.Brazy's originals. We concluded that the NBRS, which is simple and objective to perform, is a good predictor of subsquent abnormal development in VLBW infants, allowing the infant's integration as soon as possible in high-risk follow-up programs, to place as soon as possible.

[Acute mastoiditis in children]. / Mastoidites agudas na criança.

We retrospectively studied seventeen cases of acute mastoiditis admitted to the Paediatric Ward of S. Francisco Xavier Hospital during 8 years and 8 months. Seven patients were admitted in 1995. We found no reason for this increase. Eleven children were male and 5 were under 2 years of age. All cases, except one of post-traumatic mastoiditis, occurred after acute otitis media. Only 5 children referred symptoms for more than seven days before admission. Seven patients had surgery. The surgical group of children had a longer period of illness when compared to those only treated medically (7.6 versus 3.9 days). Tympanocentesis was performed in 6 patients, but it did not affect the outcome of the illness. In three children there were complications: Bezold abscess, labyrinthitis and cholesteatoma. The latter was the only patient in our series with permanent hearing loss.

[Clinical and laboratory basis for the diagnosis and understanding of neonatal metabolic diseases]. / Bases clínicas e laboratoriais para o diagnóstico e compreensão das doenças metabólicas neonatais.

The authors divide neonatal metabolic diseases into two major groups: intoxication and energy deficiency. The main signs which allow for the suspicion of the diagnosis are indicated for each group. The complementary examinations to be carried out by the Clinical Pathology Service of the Central Hospital and those which must be carried out by the metabolic diseases Reference Centre are reviewed. Based on the clinical framework and on the examination results, the authors establish five syndromatic groups to orientate diagnosis. The authors conclude by presenting differential diagnosis tables based on the original systematic classification by Jean-Marie Saudubray, with up-dated modifications from their own experience.

[Extra-lobar pulmonary sequestration with broncho-esophageal fistula]. / Sequestro pulmonar extra-lobar com fístula bronco-esofágica.

We describe a case of extra-lobar pulmonary sequestration with broncho-esophageal fistula in a newborn male who presented respiratory distress, cyanosis and feeding difficulties. The diagnosis was made with a swallowed contrast examination, nuclear magnetic resonance, digital subtraction angiography and confirmed by gross and histologic examination. The work of a multidisciplinary team was essential for an early diagnosis and the correct and effective treatment of this Cuncommon condition.

The kinetic profile of vancomycin in neonates.

The pharmacokinetic parameters of vancomycin in a neonatal population have been characterized to enable development of optimum dosage guidelines for neonatal intensive-care units and to examine the relationship between these pharmacokinetic parameters and various demographic, developmental and clinical factors which might be associated with changes in the kinetic profile of vancomycin. Forty-four infants (twenty-five males and nineteen females) with suspected or proven Gram-positive infection and who received intravenous vancomycin between October 1993 and December 1996 were included in this retrospective analysis. Gestational age ranged from 25 to 40 weeks and postconceptional age at the time of the study ranged from 28 to 45 weeks. Sixty case-studies were obtained from the forty-four patients, with one period of study corresponding to one week or one cycle of therapy. Vancomycin pharmacokinetic parameters were determined by use of a one-compartment model. By regression analysis the current weight (g) was shown to be the stronger covariate, and both vancomycin clearance (L h(-1)) and volume of distribution (L) had to be normalized. The vancomycin volume of distribution depended on the postconceptional age with a cut-off at 32 weeks, whereas vancomycin clearance depended on the presence or absence of concomitant treatment with indomethacin or of mechanical ventilation, or both. On the basis of the pharmacokinetic parameters obtained we suggest initial dosage guidelines for vancomycin ranging from 10 mg kg(-1) every 8 h to 10 mg kg(-1) every 12 h, depending on the demographic and clinical characteristics of the patients. The results obtained enabled application of better a priori and a posteriori dosage schedules to infants in neonatal intensive-care units by use of the Bayesian approach, although further prospective study is recommended before direct extrapolation to patients in other settings.

[Health care delivered to Portuguese children. The past, present and new challenges]. / Cuidados de saúde prestados às crianças portuguesas. O passado, o presente e os novos desafios.

The socio-economic development of a country as well as the state of its health, its communications network, cultural level and health care organisation together affect what is known as the health indicators. Portugal belongs to the group of UNICEF countries with the best indicators in what concerns infant mortality and death below the age of five. It is still, however, 25th and 28th respectively at world level. The authors review some of the factors which have most contributed towards the progress of the indicators over the last twenty years, namely, the role played by general practitioners, the creation of health centers, the development of a maternal-infant assistance programme and the activity of Central and District Hospitals. They analyse the recent maternal-infant programme and discuss the main short and mid-term problems in the perinatal and paediatric age groups. The socio-economic changes seen in Portuguese society, together with sociological changes and those observed in the field of pathology, call for a new approach in the organisation of care which includes the need for a new dialogue between the different health structures of a society, namely, through maintaining the functional coordinating maternal-infant units, the creation of the same units for paediatrics, new efforts by the general paediatrician, the community paediatrician and the sub-specialised paediatrician together with the general practitioners within a specific action programme of a Health Unit.