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BACKGROUND Severe Pediatric Allergic Asthma (SPAA) induces a huge economic burden in terms of direct, indirect and intangible costs. The use of omalizumab for the treatment of these patients has produced a significant improvement in several clinical outcomes, but at the same time, the cost for the management of the disease has also increased. The aim of this report was to evaluate whether the use of omalizumab is cost-effective. METHODS A sample of 426 children with SPAA from the ANCHORS study was used to calculate the Incremental Cost Effectiveness Ratio (ICER) for the avoidance of Moderate to Severe Exacerbations (MSE), and also for the improvement in childhood Asthma Control Test (c-ACT) or the Asthma Control Questionnaire (ACQ5). We retrospectively collected data of health encounters and drug consumption before and up to six years after the beginning of the treatment with omalizumab. RESULTS The ICER per avoided MSE was \euro2,107 after one year, and it consistently decreased to \euro656 in those followed up to six years. Similarly, the ICER for the Minimally Important Difference in control tests showed a decrease from \euro2,059 to \euro380 per each 0.5 points of improvement in ACQ5, and from \euro3,141 to \euro2,322 per each 3 points improvement in c-ACT, at years 1 and 6 respectively. CONCLUSION The use of OMZ is a cost-effective option for most children with uncontrolled SPAA, mainly those who have frequent exacerbations, showing progressively reduced costs in successive years of treatment.

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 Hospitalde 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.

Introduction: Isotonic fluids, in most cases, are the safest way to dispense fluids intravenously. The aim of this study was to determine the prescription of maintenance intravenous fluids and to study possible associated factors. Material and method: A descriptive, cross-sectional, multi-centre study was performed. A questionnaire was sent nationwide to several healthcare providers via an online survey, sent by email through different Medical Scientific Societies, and the Official Spanish Medical Association, between December 2016 and December 2017. Results: A total of 487 questionnaires were received, of which 456 were submitted by paediatricians. More than one quarter (28.95%) (95% CI; 24.77–33.13) of the paediatricians usually dispense hypotonic fluids and 81.14% (95% CI; 77.54–84.74) prescribe infusion rates based on the Holliday and Segar protocol. The general profile of paediatricians who prescribe hypotonic fluids intravenously in Spain are medical residents, paediatricians working in paediatric non-intensive care units, in private hospitals, and those who recognise that no consensus exists among their direct work colleagues regarding this subject. Conclusions: More than twenty-five per cent of all paediatricians in our country continue to use hypotonic fluids as maintenance intravenous fluid therapy. There might be several potential factors associated to this. These kind of studies provide evidence of the great difficulties in transferring scientific knowledge to clinical practice. Resumen: Introducción: Los fluidos isotónicos, en la mayoría de los casos, constituyen la forma más segura de administración de líquidos por vía intravenosa. Los objetivos de nuestro trabajo han sido describir las prácticas de prescripción de los fluidos intravenosos de mantenimiento y estudiar los posibles factores asociados. Material y método: Estudio transversal, descriptivo, multicéntrico de ámbito nacional, mediante encuesta on-line, difundida a través de sociedades científicas médicas y la Organización Médica Colegial, entre diciembre de 2016 y diciembre de 2017. Resultados: Un total de 487 encuestas fueron recibidas, 456 de pediatras. El 28,95% (IC 95%: 24,77-33,13) de ellos prescribían habitualmente fluidos hipotónicos y el 81,14% (IC 95%: 77,54-84,74) se basaba en la regla de Holliday y Segar para calcular el volumen total a infundir. El perfil del pediatra en España que utiliza fluidos hipotónicos intravenosos es el de médico residente de pediatría, pediatra que trabaja en áreas diferentes a las unidades de cuidados intensivos pediátricos, en hospitales privados, y aquellos que reconocen que no existe un consenso al respecto en su grupo de trabajo. Conclusiones: Más de una cuarta parte de los pediatras en nuestro país sigue utilizando los fluidos hipotónicos como fluidoterapia intravenosa de mantenimiento. Diferentes factores podrían estar asociados a este hecho. Estos estudios son prueba de las grandes dificultades existentes para trasladar el conocimiento a la práctica.

Resumen: Introducción: Los fluidos isotónicos, en la mayoría de los casos, constituyen la forma más segura de administración de líquidos por vía intravenosa. Los objetivos de nuestro trabajo han sido describir las prácticas de prescripción de los fluidos intravenosos de mantenimiento y estudiar los posibles factores asociados. Material y método: Estudio transversal, descriptivo, multicéntrico de ámbito nacional, mediante encuesta on-line, difundida a través de sociedades científicas médicas y la Organización Médica Colegial, entre diciembre de 2016 y diciembre de 2017. Resultados: Un total de 487 encuestas fueron recibidas, 456 de pediatras. El 28,95% (IC 95%: 24,77-33,13) de ellos prescribían habitualmente fluidos hipotónicos y el 81,14% (IC 95%: 77,54-84,74) se basaba en la regla de Holliday y Segar para calcular el volumen total a infundir. El perfil del pediatra en España que utiliza fluidos hipotónicos intravenosos es el de médico residente de pediatría, pediatra que trabaja en áreas diferentes a las unidades de cuidados intensivos pediátricos, en hospitales privados, y aquellos que reconocen que no existe un consenso al respecto en su grupo de trabajo. Conclusiones: Más de una cuarta parte de los pediatras en nuestro país sigue utilizando los fluidos hipotónicos como fluidoterapia intravenosa de mantenimiento. Diferentes factores podrían estar asociados a este hecho. Estos estudios son prueba de las grandes dificultades existentes para trasladar el conocimiento a la práctica. Abstract: Introduction: Isotonic fluids, in most cases, are the safest way to dispense fluids intravenously. The aim of this study was to determine the prescription of maintenance intravenous fluids and to study possible associated factors. Material and method: A descriptive, cross-sectional, multi-centre study was performed. A questionnaire was sent nationwide to several healthcare providers via an on-line survey, sent by email through different Medical Scientific Societies, and the Official Spanish Medical Association, between December 2016 and December 2017. Results: A total of 487 questionnaires were received, of which 456 were submitted by paediatricians. More than one quarter (28.95%) (95% CI; 24.77-33.13) of the paediatricians usually dispense hypotonic fluids and 81.14% (95% CI; 77.54-84.74) prescribe infusion rates based on the Holliday and Segar protocol. The general profile of paediatricians who prescribe hypotonic fluids intravenously in Spain are medical residents, paediatricians working in paediatric non-intensive care units, in private hospitals, and those who recognise that no consensus exists among their direct work colleagues regarding this subject. Conclusions: More than twenty-five per cent of all paediatricians in our country continue to use hypotonic fluids as maintenance intravenous fluid therapy. There might be several potential factors associated to this. These kind of studies provide evidence of the great difficulties in transferring scientific knowledge to clinical practice.

Resumen: Introducción: La bronquiolitis vírica aguda (BA) es una de las enfermedades respiratorias más frecuentes en los lactantes. Sin embargo, los criterios utilizados para su diagnóstico son heterogéneos e insuficientemente conocidos. Objetivo: Identificar los criterios de diagnóstico de BA empleados en España, tanto por expertos como por pediatras clínicos. Métodos: Estudio de metodología Delphi con expertos españoles en BA, buscando los puntos de consenso sobre el diagnóstico de BA. Posteriormente se realizó un estudio transversal mediante encuesta on-line dirigida a todos los pediatras españoles, contactados a través de mensajes de correo electrónico enviados por nueve sociedades científicas pediátricas. Se hizo análisis descriptivo y análisis factorial de los resultados de la encuesta, buscando si los criterios diagnósticos empleados se relacionaban con variables demográficas, geográficas o con la subespecialidad pediátrica. Resultados: Los 40 expertos participantes alcanzaron un consenso en muchos aspectos (primer episodio de dificultad respiratoria y aumento de la frecuencia respiratoria, diagnóstico en cualquier estación del año, y utilidad de la identificación de virus para el diagnóstico), pero manteniendo opiniones enfrentadas en cuestiones importantes como la edad máxima aceptable para el diagnóstico. A la encuesta on-line respondieron 1297 pediatras. Los criterios diagnósticos que aplican son heterogéneos y están fuertemente asociados con la subespecialidad pediátrica. Su acuerdo con el consenso de expertos y con estándares internacionales es muy bajo. Conclusiones: Los criterios usados en España para el diagnóstico de BA son heterogéneos. Esas diferencias pueden causar variabilidad en la práctica clínica en pacientes con BA. Abstract: Introduction: Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. Objective: To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. Methods: Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an on-line questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. Results: Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics such as the maximum age for diagnosis. The on-line questionnaire was completed by 1297 paediatricians. Their diagnostic criteria were heterogeneous and strongly associated with their paediatric sub-specialty. Their agreement with the Spanish expert consensus and with international standards was very poor. Conclusions: Diagnostic criteria for AB in Spain are heterogeneous. These differences could cause variability in clinical practice with AB patients.

Introduction: Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. Objective: To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. Methods: Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an online questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. Results: Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics such as the maximum age for diagnosis. The online questionnaire was completed by 1297 paediatricians. Their diagnostic criteria were heterogeneous and strongly associated with their paediatric sub-specialty. Their agreement with the Spanish expert consensus and with international standards was very poor. Conclusions: Diagnostic criteria for AB in Spain are heterogeneous. These differences could cause variability in clinical practice with AB patients. Resumen: Introducción: La bronquiolitis vírica aguda (BA) es una de las enfermedades respiratorias más frecuentes en los lactantes. Sin embargo, los criterios utilizados para su diagnóstico son heterogéneos e insuficientemente conocidos. Objetivo: Identificar los criterios de diagnóstico de BA empleados en España, tanto por expertos como por pediatras clínicos. Métodos: Estudio de metodología Delphi con expertos españoles en BA, buscando los puntos de consenso sobre el diagnóstico de BA. Posteriormente se realizó un estudio transversal mediante encuesta online dirigida a todos los pediatras españoles, contactados a través de mensajes de correo electrónico enviados por nueve sociedades científicas pediátricas. Se hizo análisis descriptivo y análisis factorial de los resultados de la encuesta, buscando si los criterios diagnósticos empleados se relacionaban con variables demográficas, geográficas o con la subespecialidad pediátrica. Resultados: Los 40 expertos participantes alcanzaron un consenso en muchos aspectos (primer episodio de dificultad respiratoria y aumento de la frecuencia respiratoria, diagnóstico en cualquier estación del año, y utilidad de la identificación de virus para el diagnóstico), pero manteniendo opiniones enfrentadas en cuestiones importantes como la edad máxima aceptable para el diagnóstico. A la encuesta online respondieron 1297 pediatras. Los criterios diagnósticos que aplican son heterogéneos y están fuertemente asociados con la subespecialidad pediátrica. Su acuerdo con el consenso de expertos y con estándares internacionales es muy bajo. Conclusiones: Los criterios usados en España para el diagnóstico de BA son heterogéneos. Esas diferencias pueden causar variabilidad en la práctica clínica en pacientes con BA.

Introduction: Clinical practice guidelines have been shown to be valuable tools for guiding medical decisions. However, their mere publication has not reduced the variability of practice in terms of the way acute bronchiolitis is managed. Method: A before-and-after study design was used to analyse the effectiveness of a method of disseminating diagnostic recommendations among physicians regarding the management of infants, hospitalised due to bronchiolitis. Patients with comorbidities, ex-premature patients, and patients transferred to other hospitals were excluded. The diagnostic resources studied were: chest X-ray, full blood count, C-reactive protein, blood culture, venous blood gas, and determination of the respiratory syncytial virus. Eleven epidemic periods were analysed. Results: A total of 259 patients were studied including 98 in the pre-intervention group (2006–2010), and 131 in the post-intervention group (2011–2017). The intervention took place in October of 2010 and 2011. A comparison of the two periods showed that the use of chest X-rays dropped from 73.5% to 16% (P

Resumen: Introducción: Las Guías de Práctica Clínica han demostrado ser herramientas valiosas para orientar las decisiones de los médicos. Su mera publicación no ha reducido la variabilidad en el manejo de la bronquiolitis aguda, y se siguen utilizando de forma excesiva determinados recursos para su atención. Método: Mediante una investigación con un diseño antes-después, se estudió la efectividad de un método de difusión de recomendaciones diagnósticas para el manejo de lactantes hospitalizados por bronquiolitis. Pacientes con comorbilidades, exprematuros y los que fueron trasladados a otros centros sanitarios fueron excluidos. Los recursos diagnósticos estudiados fueron: radiografía de tórax, hemograma, proteína C reactiva, hemocultivo, gasometría venosa y determinación de virus respiratorio sincitial. Se analizaron un total de 11 temporadas epidémicas. Resultados: Se estudiaron 259 pacientes, 98 en el periodo preintervención (2006-10) y 131 en el posintervención (2011-17). La intervención se llevó a cabo en octubre de 2010 y 2011. Comparando los dos periodos, disminuyó el uso de radiografía de tórax, 73,5 a 16% (p < 0,01); hemograma 51 a 21,4% (p < 0,01), PCR 48 a 22,1% (p < 0,01) y hemocultivo 23,5 a 7,6% (p < 0,01). La duración de la hospitalización disminuyó 0,6 (DE = 1) días y no hubo diferencias en los reingresos. Conclusiones: La difusión organizada y sistematizada, mediante un método multimodal, de las recomendaciones diagnósticas contenidas en una guía de práctica clínica sobre bronquiolitis, es capaz de transformar la práctica médica, reduciendo el uso de recursos diagnósticos, sin incrementarse los reingresos. Abstract: Introduction: Clinical Practice Guidelines have been shown to be valuable tools for guiding medical decisions. However, their mere publication has not reduced the variability of practice in terms of the way acute bronchiolitis is managed. Method: A before-and-after study design was used to analyse the effectiveness of a method of disseminating diagnostic recommendations among physicians regarding the management of infants, hospitalised due to bronchiolitis. Patients with comorbidities, ex-premature patients, and patients transferred to other hospitals were excluded. The diagnostic resources studied were: chest X-ray, full blood count, C-reactive protein, blood culture, venous blood gas, and determination of the respiratory syncytial virus. Eleven epidemic periods were analysed. Results: A total of 259 patients were studied including 98 in the pre-intervention group (2006-2010), and 131 in the post-intervention group (2011-2017). The intervention took place in October of 2010 and 2011. A comparison of the two periods showed that the use of chest X-rays dropped from 73.5% to 16% (p

BACKGROUND: Various studies have assessed omalizumab outcomes in the clinical practice setting but follow-up and/or number of patients included were limited. We aim to describe the long-term outcomes of pediatric patients with severe persistent allergic asthma receiving omalizumab in the largest real-life cohort reported to date. METHODS: ANCHORS was a multicenter, observational, retrospective cohort study conducted in 25 Pediatric Allergy and Pulmonology units in Spain. We collected data of patients

Background: There are a number of clinical scores for bronchiolitis but none of them are firmly recommended in the guidelines. Method: We designed a study to compare two scales of bronchiolitis (ESBA and Wood Downes Ferres) and determine which of them better predicts the severity. A multicentre prospective study with patients

There is an increase in the child neurology attention and, specially in attention deficit hyperactivity disorder (ADHD). It's been proposed that the birth date affects the diagnosis of ADHD, so the youngest children more susceptible of being diagnosed.To analyse if there is a relationship between the birth date and the suspicion of ADHD, and to investigate the health demand of child neurology and its evolution regarding diagnostic categories.Retrospective study of patients been attended in a child neurology clinic between 1992 and 2012. Different diagnostic groups were compared considering epidemiologic variables and trimester and semester of birth to determine whether exists a seasonal pattern.3469 patients were included, 58.5% were male with a median age of 6 years old. The first reason of consultation was the headache, and the ADHD has experienced an increase of 350% in the last 10 years of the study. 61.6% of patients with ADHD suspicion were born in the second semester of the year. The difference was higher for girls. This pattern was not observed in other neurologic diseases when a comparative analysis was done.There is an increase of child neurologic demand within the last years, mainly of ADHD patients. Children born in the last semester of the year have a higher risk of being sent to a neurology clinic for evaluation.Influencia del mes de nacimiento en la demanda asistencial por trastorno por deficit de atencion/hiperactividad. Resultados de un estudio retrospectivo realizado en una consulta de neuropediatria.Introduccion. Las consultas de neuropediatria se han incrementado en los ultimos años, especialmente por trastorno por deficit de atencion/hiperactividad (TDAH). Se postula que los niños mas jovenes del curso tienen mas riesgo de ser diagnosticados de TDAH. Objetivos. Analizar la demanda asistencial de neuropediatria, comparar su evolucion por grupos diagnosticos y determinar si existe una relacion entre la fecha de nacimiento de los pacientes y la sospecha de TDAH. Pacientes y metodos. Estudio retrospectivo de los pacientes remitidos a neuropediatria entre 1992 y 2012. Se compararon las distintas categorias diagnosticas segun variables epidemiologicas y se exploro si existia un factor relativo a la edad. Resultados. Se incluyeron 3.469 pacientes, un 58,5% varones, con una mediana de edad de 6 años. El principal motivo de consulta fue la cefalea, y todos los grupos diagnosticos sufrieron un incremento de las consultas. El TDAH experimento un aumento del 350% en los ultimos 10 años. El 61,6% de los niños con sospecha de TDAH nacio en el segundo semestre del año, y la diferencia es mas notable en las niñas. Se objetiva un incremento de sospecha de TDAH en los niños nacidos antes de la fecha de corte del curso escolar que no aparece en ninguna de las otras patologias en el analisis comparativo. Conclusiones. Existe un incremento de la demanda asistencial de neuropediatria en los ultimos años, principalmente por TDAH. Los niños nacidos el ultimo semestre del año tienen un riesgo mayor de ser remitidos por sospecha de esta enfermedad.