Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)
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Practice Guideline
[Consensus conference on acute bronchiolitis (I): methodology and recommendations].
The recommendations of the Consensus Conference "Diagnostic and Therapeutic Management of Acute Bronchiolitis" are presented. Evidence on the frequency of bronchiolitis in the general population and risk groups, risk factors and markers of severe forms, severity scores and the clinical-etiological profile is summarized. The commonly used diagnostic tests are ineffective in the management of the disease; oxygen saturation measurement is considered necessary only in the initial assessment or to monitor changes in patients with respiratory distress. ⋯ Heliox and non-invasive ventilation techniques could be used in cases with respiratory failure, methylxanthine in patients with apnea and surfactant in intubated critically ill patients. No treatment has proved effective in preventing persistence or recurrence of post-bronchiolitis symptoms. As for prevention of bronchiolitis, only palivizumab slightly reduces the risk of admissions for lower respiratory infections by respiratory syncytial virus, although its high cost justifies its use only in a small group of high-risk patients.
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Multicenter Study
[Study of variability in the management of acute bronchiolitis in Spain in relation to age of patients. National multicenter study (aBREVIADo project)].
There are many studies on the controversial issues involved in the management of acute bronchiolitis (AB). The aim of this multicenter nationwide study in Spain was to find out the variability in the management of AB in various areas of clinical care (primary care, emergency and hospitalization) and to analyze the impact of patient age on diagnostic and therapeutic management. ⋯ There are discrepancies between routine practice and evidence-based management of AB in Spain (both inpatient and outpatient). There is a high percentage of cases in which diagnostic tests and therapeutic interventions (of unproven effectiveness and usefulness in the BA) are performed, where the use is higher in younger infants.
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During the Influenza A H1N1 pandemic an aggressive manifestation of the disease was observed in children and some cases required admittance to intensive care unit. We describe the initial presentation and clinical behavior of critical pediatric patients treated in our unit. ⋯ We observed severe respiratory disease that required mechanical ventilation in confirmed cases admitted to the PICU and a mortality rate of 50%.
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Multicenter Study
[Epidemiological characteristics and risk factors for apparent life-threatening events].
To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) in our pediatric emergency departments (PED), to know their incidence, epidemiological characteristics and the yield of laboratory investigations (LI). ⋯ The ALTE incidence was 5 per thousand live births. Primogenits and/or behavioral abnormalities were most frequent during the first weeks after birth and/or thereafter at 12 months of age. A total of 42% had a related diagnosis: associated with age older than 12 weeks, maternal smoking habits and abnormalities at examination. There was one case of SIDS. Laboratory investigations had a low yield.