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Introduction Viral infections are associated with pulmonary exacerbations in children with Cystic Fibrosis (cwCF), but after 3 years of SARS-CoV-2 pandemic, whether cwCF are at higher risk of developing COVID-19 or its adverse consequences remains controversial. Methods We conducted an observational, multicenter, cross-sectional study of cwCF infected by SARS-CoV-2 between March 2020 and June 2022, (1 to 6 COVID-19 pandemic waves) in Spain. The study aimed to describe patients’ basal characteristics, SARS-CoV-2 clinical manifestations and outcomes, and whether there were differences across the pandemic waves. Results During study time, 351 SARS-CoV2 infections were reported among 341 cwCF. Median age was 8.5 years (range 0-17) and 51% were female. Cases were unevenly distributed across the pandemic, with most cases (82%) clustered between November 2021 and June 2022 (6 wave, also known as Omicron Wave due to the higher prevalence of this strain in that period in Spain). Most cwCF were asymptomatic (24.8%) or presented with mild Covid-19 symptoms (72.9%). Among symptomatic, most prevalent symptoms were fever (62%) and increased cough (53%). No multisystem inflammatory syndrome (MIS-C), persisting symptoms, long-term sequelae or deaths were reported. Conclusions Spanish current data indicate that cwCF do not experience higher risks of SARS-CoV-2 infection nor worse health outcomes or sequelae. Changes in patients’ basal characteristics, clinical courses and outcomes were detected across waves. While the pandemic continues, and new SARS-CoV-2 variants are being identified, a worldwide monitoring of COVID-19 in pediatric CF patients is needed.

Introduction: Urban air pollution (UAP) is a major threat to child and adolescent health. Children are more vulnerable to its effects, being associated with higher morbidity and mortality due to acute and chronic diseases, especially respiratory ones. A study is performed on the relationship between UAP and the rate of hospital admissions due to acute respiratory diseases. Patients and methods: An ecological study was conducted on young people under 19 years-old in the city of Murcia, who had visited hospital emergency departments due to respiratory diseases (ICD-9) during 2015. A logistic regression was performed on the risk of hospital admission that included consultations in relation to the average daily levels of environmental pollutants (NO2, O3, PM10, SO2) obtained from the Air Quality Surveillance and Control network of the Region of Murcia. Other control variables, such as gender, age, average daily ambient temperature, and season of the year. Results: A total of 12,354 (56% boys and 44% girls) children consulted in the emergency department for respiratory disease. Of those, 3.5% were admitted, with a mean age of 2.54 (95% CI; 2.16−2.91) years. The Odds Ratio (OR) of hospital admission for respiratory diseases: NO2 1.02 (95% CI; 1.01–1.04; P

The aim of this study is to assess, for the first time, the relationship between the volatilome and lung function in healthy infants, which may be of help for the early detection of certain respiratory diseases. Lung function tests are crucial in chronic respiratory diseases diagnosis. Moreover, volatile organic compounds (VOCs) analysis in exhaled breath is a noninvasive technique that enables the monitorization of oxidative stress, typical of some forms of airway inflammation.Lung function was studied in 50 healthy infants of 3-8 months of age and the following parameters were obtained: forced vital capacity (FVC), forced expiratory volume at 0.5 s (FEVA negatively significant relationship has been observed between levels of acetone, tetradecane, and pentadecane in exhaled breath and several of the lung function parameters. Levels of acetone (feature m/z = 58) were significantly negatively associated with FVC and FVEThe findings of this study highlight a significant association between VOCs related to oxidative stress and lung function in healthy infants.

Background Primary prevention strategies for asthma are lacking. Its inception probably starts in utero and/or during the early postnatal period as the developmental origins of health and disease (DOHaD) paradigm suggests. Objectives The main objective of Nutrition in Early Life and Asthma (NELA) cohort study is to unravel whether the following factors contribute causally to the developmental origins of asthma: (1) maternal obesity/adiposity and foetal growth; (2) maternal and child nutrition; (3) outdoor air pollution; (4) endocrine disruptors; and (5) maternal psychological stress. Maternal and offspring biological samples are used to assess changes in offspring microbiome, immune system, epigenome and volatilome as potential mechanisms influencing disease susceptibility. Population Randomly selected pregnant women from three health areas of Murcia, a south-eastern Mediterranean region of Spain, who fulfilled the inclusion criteria were invited to participate at the time of the follow-up visit for routine foetal anatomy scan at 19-22 weeks of gestation, at the Maternal-Fetal Medicine Unit of the "Virgen de la Arrixaca" University Clinical Hospital over a 36-month period, from March 2015 to April 2018. Design Prospective, population-based, maternal-child, birth cohort study. Methods Questionnaires on exposures and outcome variables were administered to mothers at 20-24 gestation week; 32-36 gestation week; and delivery. Children were surveyed at birth, 3 and 18 months of age and currently at 5 years. Furthermore, physical examinations were performed; and different measurements and biological samples were obtained at these time points. Preliminary results Among the 1350 women invited to participate, 738 (54%) were finally enrolled in the study and 720 of their children were eligible at birth. The adherence was high with 612 children (83%) attending the 3 months' visit and 532 children (72%) attending the 18 months' visit. Conclusion The NELA cohort will add original and unique knowledge to the developmental origins of asthma.

OBJECTIVE To know the effect of caffeine therapy on infant lung function in preterm infants with a gestational age less than 31 weeks. MATERIAL AND METHODS Forced vital capacity (FVC), forced expiratory volume at 0.5 seconds (FEV0.5 ), and forced expiratory flows were measured by raised volume rapid thoracoabdominal compression technique; functional residual capacity was measured by plethysmography (FRCpleth ). Compliance of the respiratory system was measured by a single interruption technique (Crs). The Student t test was used to compare lung function measurements between the two groups: treated versus nontreated with caffeine. A multivariate analysis was carried out considering each and every lung function parameter (z-score) as the dependent variable; and gender, gestational age, birth weight (z-score), corrected age, invasive mechanical ventilation (yes/no), and bronchopulmonary dysplasia (BPD) diagnosis (yes/no) as independent ones. Additionally, stratified analyses by BPD diagnosis were performed. RESULTS The multivariate analysis showed significant higher z-scores of FVC and FEV0.5 in preterm infants treated with caffeine (P = .004 and P = .024, respectively). This result only being significant in the group of non-BPD infants (P = .021 and P = .042), after stratifying by BPD diagnosis. Differences were not found in z-scores of FEV0.5/FVC, FEF75, FEF25-75, FRCpleth, nor Crs. CONCLUSION Lung function (FVC and FEV0.5 ) is improved in infants born under 31 weeks of gestation when treated with caffeine. This improvement is driven by the group of infants who did not suffer from BPD. Overall, our results show that there is an early beneficial effect of caffeine treatment in infant lung function.

Introduction It remains unclear if prematurity itself can influence post delivery lung development and particularly, the bronchial size. Aim To assess lung function during the first two years of life in healthy preterm infants and compare the measurements to those obtained in healthy term infants during the same time period. Methods This observational longitudinal study assessed lung function in 74 preterm (30 + 0 to 35 + 6 weeks’ gestational age) and 76 healthy term control infants who were recruited between 2011 and 2013. Measurements of tidal breathing, passive respiratory mechanics, tidal and raised volume forced expirations (V’maxFRC and FEF25–75, respectively) were undertaken following administration of oral chloral hydrate sedation according to ATS/ERS recommendations at 6- and 18-months corrected age. Results Lung function measurements were obtained from the preterm infants and full term controls initially at 6 months of age. Preterm infants had lower absolute and adjusted values (for gestational age, postnatal age, sex, body size, and confounding factors) for respiratory compliance and V’maxFRC. At 18 months corrected postnatal age, similar measurements were repeated in 57 preterm infants and 61 term controls. A catch-up in tidal volume, respiratory mechanics parameters, FEV0.5 and forced expiratory flows was seen in preterm infants. Conclusion When compared with term controls, the lower forced expiratory flows observed in the healthy preterm group at 6 months was no longer evident at 18 months corrected age, suggesting a catch-up growth of airway function.

OBJECTIVE To describe a cohort of neonates with left vocal fold motion impairment (LVFMI) and the factors associated to it in the neonatal period; procedures required during LVFMI treatment; and clinical outcomes at the age of 2-years. An additional objective was to study those factors which are likely to be most associated to functional recovery of LVFMI at this age. METHODS A cohort of patients born in a tertiary care hospital with a diagnosis of left VFMI was included. Factors registered were: gender; clinical presentation at the time of examination; diagnosis of other laryngeal defects associated; data related to their neonatal period (gestational age, congenital heart defects corrective surgery required, neurologic disease, bronchopulmonary dysplasia, non-invasive ventilation required, invasive ventilation required, and tracheostomy required); treatment applied for LVFMI (tracheostomy and/or laryngeal surgery); need of language and hearing therapy; and outcomes considered by the pediatric otolaryngologist at the 2 years-old follow-up visit. RESULTS A total of 56 patients with LVFMI diagnosis were included. Only 10 patients (17.9%) showed functional recovery from LVFMI at the age of 2 years. We found significant negative association between this recovery and language and hearing therapy (p = 0.03), which was also associated to psychomotor retardation (p

Background: The aim of the study is to assess whether lung function of infants born preterm predicts wheezing in pre-school age. Methods: A survey of the core wheezing questionnaire of the International Study on Asthma and Allergy in Children was administered to parents of preterm newborns, to whom lung function tests were performed at a corrected age of six months, and who, at the time of the survey, were between three and nine years of age. Results: Low values of all lung function parameters measured, except FVC, were predictors of wheezing at some time in life, (FEV0.5 OR: 0.62 (95%CI 0.39, 0.995), FEV0.5/FVC OR: 0.73 (0.54, 0.99)) FEF75 OR: 0.60 [0.37, 0.93], FEF25-75 OR: 0.57 (0.37, 0.89)), and of wheezing in the past year (FEV0.5 OR: 0.36 (0.17, 0.76), FEV0.5/FVC OR: 0.59 (0.38, 0.93), FEF75 OR: 0.38 [0.19, 0.76], FEF25-75 OR: 0.35 (0.17, 0.70). In addition, FEV0.5/FVC values lower than the lowest limit of normality, were predictive of hospital admissions due to wheezing (OR: 3.07, (1.02, 9.25)). Conclusions: Limited lung function in infancy is predictive of both future wheezing and hospitalization for a wheezing episode.

Resumen: Introducción: La contaminación atmosférica urbana es una amenaza principal para la salud infantojuvenil. Los niños son más vulnerables a sus efectos asociando mayor morbimortalidad de enfermedades agudas y crónicas, especialmente respiratorias. Pretendemos estudiar los efectos de la contaminación atmosférica urbana en la tasa de ingresos hospitalarios por causa aguda respiratoria. Pacientes y métodos: Estudio ecológico durante 2015 de las visitas con patología respiratoria (CIE-9) de urgencias hospitalarias en menores de 17 años en el municipio de la ciudad de Murcia. Regresión logística para el riesgo de ingreso hospitalario entre las consultas en relación con los niveles promedios diarios de contaminantes ambientales (NO2, O3, PM10, SO2) obtenidas de la Red de Vigilancia y Control de la Calidad del Aire de la Región de Murcia. Otras variables de control: sexo, edad, temperatura ambiental media diaria, y estación del año. Resultados: Un total de 12354 niños consultaron en urgencias por patología respiratoria, 56% niños y 44% niñas. Ingresaron el 3,5%, con edad media de 2,54 (IC95% 2,16-2,91) años. Para el riesgo de ingreso hospitalario por enfermedades respiratorias: NO2 1,02 (IC95% 1,01-1,04; p

Objective: To examine the effect of prolonged slow expiration respiratory physiotherapy treatment on the acute bronchiolitis severity scale and O2 saturation at short-time and at medical discharge in infants and the hospital stay. Design: Randomized controlled trial. Setting: Infants’ unit of university hospital. Participants: Infants with acute bronchiolitis ( N = 80). Intervention: Infants were randomized into respiratory treatment (RT) with prolonged slow expiration or treatment as usual (control) for one-week period. Main outcome measures: The primary outcomes were Acute Bronchiolitis Severity Scale score and O2 saturation, recorded shortly after each intervention during the stay and at medical discharge, and the hospital stay. Results: The RT had a significantly lower Acute Bronchiolitis Severity Scale 10-minute after the first intervention (mean difference −1.7 points, 95% confidence interval (CI) −3.0 to −0.38), 2 hours after (–2.0 points, 95% CI −3.2 to −0.86) and the last day before medical discharge (−1.3 points, 95% CI −2.1 to 0.51). No changes were detected in O2 saturation. The survival analysis of time at medical discharge showed decrease in the average number of days to achieve an Acute Bronchiolitis Severity Scale of less than 2 points (RT: 2.6 days, 95% CI 2.1–3.1; Control: 4.4 days, 95% CI 3.6–5.1). Conclusion: A prolonged slow expiration physiotherapy reduces Acute Bronchiolitis Severity Scale scores and does not change O2 saturation. Infants in RT group stay less days in hospital than infants in control group and no adverse events were detected.

BACKGROUND: A1006E is a Cystic Fibrosis (CF) mutation that is still not widely known. We report phenotypic features and geographic distribution of the largest cohort of people with CF (pwCF) carrying A1006E to date. METHODS: Study of European pwCF carrying A1006E mutation, included in the European CF Society Patient Registry (ECFSPR). Genotype, ancestries and all variables recorded were compared to a cohort of F508del/F508del patients. Rate of decline in percentage-of-predicted FEV(1) (ppFEV(1)) was also analyzed using the 2010-2017 ECFSPR. RESULTS: 44 pwCF carrying A1006E were reported (59% males), median age 33 years old (3-58), 54.5% Spanish and 40.9% Italian, most with ancestry in Murcia (Spain) and Lazio (Italy) regions. Compared to F508del homozygous, A1006E-pwCF were significantly older (75% vs. 52.5% = 18 years old) and diagnosed at later median age (6.98 vs. 0.29 years); showed lower rates of meconium ileus (2.33% vs. 17.7%), pancreatic insufficiency (27.91% vs. 99.26%), diabetes (2.33% vs. 21.98%), liver disease (6.98% vs. 36.72%) and Pseudomonas aeruginosa chronic colonization (30.95% vs. 42.51%); and presented better nutrition (BMI z-score 0.44 vs. -0.43) and ppFEV(1) (90.8% vs. 78.6%), with 18.9% (most >40 years old) having a ppFEV(1)

Background This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial Virus (RSV) infection and its sequelae in preterm infants (32day 1-35day 0weeks of gestational age –wGA-) in Spain. Methods A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs) and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants, 32day 1-35day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average number of injections per RSV season) was analysed. The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection: the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value, number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs. National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs (€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes. Results Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0.0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68 (non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors population subgroups analysed were in line with the total population results. From the societal perspective, the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of the model. Conclusions The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32day 1-35day 0 wGA in Spain. Electronic supplementary material The online version of this article (10.1186/s12879-017-2803-0) contains supplementary material, which is available to authorized users.

Gestational diabetes mellitus (GDM) is a world-wide health challenge, which prevalence is expected to increase in parallel to the epidemic of obesity. Children born from GDM mothers have lower levels of docosahexaenoic acid (DHA) in cord blood, which might influence their neurodevelopment. Recently, the membrane transporter Major Family Super Domain 2a (MFSD2a) was associated with the selective transportation of DHA as lysophospholipids. The expression of the DHA membrane transporter MFSD2a is lower in GDM placentas, which could affect materno-fetal DHA transport. Humans with homozygous inactivating mutations in the MFSD2a gene present severe microcephaly and intellectual impairments. Herein, we intended to identify early blood biomarkers that may be of use during pregnancy to monitor the offspring development and the adequate nutritional interventions, such as nutritional supplementation, that may be selected to improve it. We evaluated MFSD2a expression in maternal blood at the third trimester of pregnancy, and its potential relationship with the expression of placental MFSD2a at delivery and child outcomes. Three groups of pregnant women were recruited: 25 controls, 23 GDM with dietary treatment, and 20 GDM with insulin treatment. Maternal and neonatal anthropometric and biochemical parameters were evaluated. MFSD2a was analyzed in placenta, blood and serum. MFSD2a protein expression in maternal blood was significantly lower in GDM groups and correlated with placental MFSD2a and Z-score neonatal head circumference during the first 6 months of life. The cord/maternal serum ratio of DHA, a solid indicator of materno-fetal DHA transport, was reduced in GDM groups and correlated with MFSD2a in maternal blood at the third trimester and in placenta at delivery. This indicates that altered MFSD2a levels in maternal blood during pregnancy might influence placental nutrient transport and fetal neurodevelopment. Furthermore, MFSD2a levels in maternal blood on the third trimester were inversely correlated to DHA in maternal serum lyso-PL. Thus, the level of MFSD2a in maternal blood could be used as a potential biomarker for the early detection of disturbances of MFSD2a expression during pregnancy and the subsequent consequences for the neurodevelopment of the child, as well as it may help to choose the optimal treatment approach for the affected subjects.

CF-COVID19-Spain Registry Group., [Background] Given the high incidence of confirmed infection by SARS-CoV-2 and mortality by COVID-19 in the Spanish population, its impact was analysed among persons with Cystic Fibrosis (CF) as a group at risk of a worse evolution. The possible causes of the incidence observed in them are explained and how CF Units have faced this health challenge is detailed., [Methods] Retrospective descriptive observational study, for which a Spanish CF Patients with Confirmed COVID-19 Registry is created, requesting information on number of people affected between 8 March–16 May 2020 and their clinical-demographic characteristics from the CF Units participating in the European Cystic Fibrosis Society Patient Registry (ECFSPR). The accumulated incidence is calculated, compared with that of the general population. Additionally, a survey (CF-COVID19-Spain) is carried out on prevention of SARS-CoV-2 infection, workings of CF Units and possible reasons for the incidence observed., [Results] COVID-19 was diagnosed in eight CF patients, one of whom had received a lung transplant. The accumulated incidence was 32/10000 in CF patients and 49/10000 in the general population. General death rate was 5.85/10000 while no CF patients included in the ECFSPR died. The characteristics of those affected and the results of the survey are described., [Conclusions] Despite being considered a disease at high risk of severe COVID-19, the low incidence and mortality in CF patients in Spain contrasts with the figures for the general population. The possible factors that would explain such findings are discussed, with the help of the results of the CF-COVID19-Spain survey.

Aims In current clinical practice, prenatal alcohol exposure is usually assessed by interviewing the pregnant woman by applying questionnaires. An alternative method for detecting alcohol use is to measure the biomarker carbohydrate-deficient transferrin (CDT). However, few studies measure CDT during pregnancy. This study examines the utility of CDT biomarker in the screening of alcohol exposure during early pregnancy. Methods A cohort of 91, first-trimester pregnant women assigned to a public reference maternity hospital, was screened using the Green Page (GP) questionnaire, an environmental exposure tool. CDT levels and other biomarkers of alcohol use were measured and compared with questionnaire data. Results About 70% of the mothers in the study consumed alcohol during early pregnancy and 22% met high-risk criteria for prenatal exposure to alcohol. CDT measurement showed a statistically significant area under the receiver operating characteristic curve with a value of 0.70. For a value of 0.95% of CDT, a specificity of 93% was observed. The most significant predictors of CDT were the number of binge drinking episodes, women’s body mass index and European white race. Conclusion Pregnant women with a CDT value >0.95% would be good candidates for the performance of the GP questionnaire during early pregnancy in order to detect potential high-risk pregnancy due to alcohol exposure.

Objective: to know the effect of caffeine therapy on infant lung function in preterm infants with a gestational age Material and Methods: Preterm infants were classified as having BPD when their oxygen dependency persisted at 36 weeks postmenstrual age. FVC, FEV0.5, FEF75 and FEF25-75 were obtained by means of the raised volume rapid thoraco-abdominal compression technique (RVRTC); and FRC was measured by plethysmography. A t-Student test was used to compare lung function measurements between the two groups of preterm newborns: treated vs. non-treated with caffeine. A multivariate regression analysis was carried out considering each and every lung function parameter (z-score) as the dependent variable; and gender, gestational age, birth weight (z-score), corrected age, invasive mechanical ventilation (IMV) (yes/no) and BPD diagnosis (yes/no) as independent ones. Results were stratified by BDP diagnosis. Results: The multivariate analysis showed significant higher z-scores of FVC and FEV0.5 in preterm infants treated with caffeine (β=0.3; 95%CI: 0.10 to 0.51; p=0.04 and β=0.33; 95%CI: 0.04 to 0.62; p=0.024 respectively), being this result more clearly significant in the group of non-BPD infants (p=0.021 and p=0.042). We did not find differences in the rest of lung parameters. Conclusion: FVC and FEV0.5 were higher in infants born under 31 weeks of gestational age that received caffeine therapy as compared to those not-treated, the effect being higher and significant in non-BPD infants. The effect of caffeine in infant lung function is independent of receiving IMV in the newborn period.

Objective: to know the effect of weight gain on infant lung function in preterm infants with a gestational age Methods: Preterm infants were classified as having BPD when their oxygen dependency persisted at 36 weeks postmenstrual age. FVC and FEV0.5 were measured by means of the raised volume rapid thoraco-abdominal compression technique . A linear regression analysis was carried out considering z-score of lung function parameters (FVC, FEV0.5 and FEV0.5/FVC rate) and weight gain in grams per day. A logistic analysis was then performed including values of FEV0.5/FVC rate below lower limit of normality (LLN) and weight gain. These analysis were controlled by gender, gestational age, caffeine therapy, birth weight (z-score), corrected age and mother smoked during pregnancy (yes/no). Results: We found significant association between weight gain and increased z-score of FVC (β 0.028; 95%CI: 0.0035 to 0.052; p=0.025); and therefore significant association between weight gain and decreased z-score of FEV0.5/FVC rate (β -0.077; 95%CI: -0.132 to -0.022; p=0.006). We did not find this association in z-score of FEV0.5. The logistic analysis showed a significant increased proportion of z-scores of FEV0.5/FVC values below LLN in those preterm infants with higher weight gain (OR 1.16; 95%CI, 1.05-1.28; p=0.004). Conclusion: Increased weight gain in preterm infants below 31 weeks of gestational age and BPD diagnosis shows significant association with higher FVC values and lower FEV0.5/FVC rate. There is a risk effect of rapid weight gain in this group of preterm infants that could be causing dysanaptic lung growth.

The 5-year overall survival (OS) in childhood acute lymphoblastic leukemia (ALL) has reached 90% in high-income countries, levels that can no be longer overcome with strategies based on intensification of treatment. Other approaches in the search for new and modifiable prognostic factors are necessary to continue to improve these rates. The importance of environmental factors in the etiopathogenesis of childhood ALL has been regaining interest but its role in the prognosis and survival of this disease is not well explored. We aim to investigate the association between secondhand smoke (SHS) and survival in children diagnosed with ALL.We analyzed survival rates in 146 patients under the age of 15 years diagnosed with ALL between January 1998 and May 2016 in the Region of Murcia, Spain. Evaluation of parental SHS and other known prognostic factors (sex, age, white blood cell count at diagnosis, cytogenetics, NCI/Rome Criteria, early response to therapy, and relapse) were assessed for impact on OS, event-free survival (EFS), cumulative incidence of relapse (CIR), and treatment-related mortality (CITRM) using Kaplan-Meier analysis, Cox regression, and Fine-Gray model.The mean follow-up time was 105.3 months (±66.5). Prenatal exposure to SHS due to parental smoking was highly prevalent. Of the mothers, 44.4% and 55.5% of the fathers smoked at some point during pregnancy. After the child's diagnosis of ALL 39.7% of mothers and 45.9% of fathers reported smoking. The Cox proportional hazards model showed that maternal smoking during pregnancy and after diagnosis (HR = 4.396, 95% CI: 1.173-16.474, p = 0.028); and relapse (HR = 7.919; 95% CI: 2.683-21.868; p 0.001) are independent prognostic factors in determining survival. The Fine-Gray model showed that maternal smoking during pregnancy and after diagnosis (HR = 14.525, 95% CI: 4.228-49.90, p 0.001) is an independent prognostic factor in CITRM.Persistent SHS worsens OS and TRM in children with ALL. This negative impact contributes to a different prognosis and may possibly provide an exceptional insight into new therapeutic approaches, including environmental aspects such as prevention and smoking cessation to improve survival outcomes.

Background: Obesity is a major public health crisis among both children and adults and contributes to significant physical, psychological, and economic burden. We aim to investigate the effect of duration of breastfeeding on excessive weight and obesity at 6 years of age. Subjects/Methods: Data on breastfeeding and child anthropometric measurements were collected in a birth-cohort study in Murcia, Spain (n = 350). Breastfeeding status and body mass index (BMI) were established according to WHO definitions. Other factors potentially related to children's weight were considered. Multiple log-linear and ordinal regressions were used to analyze the effects of breastfeeding on overweight and obesity when considering potential confounders. Results: 33% and 17.3% of children in the study were of excess weight and obesity, respectively. Univariate predictors of BMI in children aged 6 were as follows: pregestational maternal BMI (kg/m2) (R2 = 0.127, p

Summary Objectives The aim of our study was to determine whether the development of lung function, during the first 2 years of life, is different in preterm infants who suffered or did not suffer from Bronchopulmonary dysplasia (BPD). We also assessed the role of nutritional status and growth in that development. Methods Lung function tests were performed in 71 preterm infants at two time points: 6 months of corrected age and 1 year after. FVC, FEV0.5, FEF75, and FEF25–75 were obtained from maximal expiratory volume curves by means of the raised volume rapid thoraco-abdominal compression technique. Results When comparing lung function measurements, we found that FVC (P = 0.033) FEV0.5 (P = 0.044), FEF75 (P = 0.014), and FEF25–75 (P = 0.036) were significantly lower in BPD infants. We did not find any catch-up of lung function during the study time, in neither the whole group of children nor within the BPD or non-BPD groups. The increase in lung function was directly proportional to the increase in weight and length. The multivariate analysis showed that the increase in z-score of FVC (P = 0.043), FEV0.5 (P = 0.015), and FEF75 (P = 0.042), was related with the height velocity during the study period. Conclusions Infants who suffered from BPD have lower lung function (FVC, FEV0.5, FEF75, and FEF25–75), than those non-BPD, at two different time points 1 year apart. During the study period, there was no lung function catch-up in either BPD or non-BPD infants. The increase in length is closely associated to the increase in lung function. Pediatr Pulmonol. © 2016 Wiley Periodicals, Inc.

Background Infections by respiratory syncytial virus (RSV) are more severe in patients with cystic fibrosis (CF), and many CF units use palivizumab as prophylaxis; however, information about palivizumab efficacy in CF patients is almost lacking. Methods A literature search up to December 2012 on the morbidity of RSV bronchiolitis in CF patients and on the safety and efficacy of palivizumab in those patients was performed. A random-effects meta-analysis was conducted for those studies meeting pre-specified search criteria. Historical controls were allowed. Results The number of patients who received palivizumab was 354 and the hospital admission rate was 0.018 (95% CI 0.0077–0.048). The corresponding number in the non-treated groups was 463 patients with an admission rate of 0.126 (95% CI 0.086–0.182) (Q = 13.9; p Conclusion Palivizumab may have a role in the prevention of severe lower airway infection by RSV in CF patients.

Background: The relationship between pneumonia and recurrent wheezing (RW) and the factors associated to pneumonia in wheezing and non-wheezing infants have not been compared between affluent and non-affluent populations. Methods: The International Study of Wheezing in Infants (EISL) is a large population-based cross-sectional study carried out in Latin America (LA) and Europe (EU). We used a validated questionnaire for identifying wheeze in the first year of life. The questionnaire also inquired about pneumonia diagnosis, together with other potentially related factors. Associations between both conditions and between potential risk/protective factors for pneumonia were tested by random-effects logit model and adjusting for all factors found previously associated to RW in this cohort. Results: Pneumonia and RW were strongly associated to each other in LA and EU (aOR 5.42; 95% CI: 4.87-6.04 and aOR 13.99; 95% CI: 9.61-20.36, respectively). Infant eczema was the most consistent risk factor of pneumonia in both continents, in the whole population and also among wheezers and non-wheezers (aOR ranging from 1.30; 95% CI: 1.11-1.52 to 2.65; 95% CI: 1.68-4.18); while breast feeding for at least 3 months was the most consistent protective factor (aOR ranging from 0.60; 95% CI: 0.51-0.71 to 0.76; 95% CI: 0.69-0.84). Factors associated to pneumonia were similar between continents among wheezers, but differed considerably among non-wheezers. Conclusion: Pneumonia and RW are associated conditions sharing many risk/protective factors in EU and LA among wheezing infants, but not among non-wheezing infants. The association between pneumonia and RW could be due to shared pathophysiology or by diagnostic confusion between the two conditions. (C) 2015 Wiley Periodicals, Inc.

Resumen Introduccion y objetivos Streptococcus pneumoniae es un patogeno para el ser humano que precisa de colonizacion nasofaringea previa para causar enfermedad. Realizamos un estudio epidemiologico de portadores nasofaringeos de neumococo en ninos sanos en Murcia, tras la introduccion de la vacuna neumococica conjugada heptavalente (VCN7) y ante la inmediata comercializacion de las nuevas vacunas con el objetivo de conocer, en nuestro ambito geografico, la influencia de la vacunacion y de otros factores sobre el estado de portador y los diferentes serotipos circulantes. Metodos En verano de 2009 e invierno de 2010 realizamos un estudio multicentrico en 60 consultas de atencion primaria, recogiendose una muestra nasofaringea y cumplimentandose una encuesta epidemiologica en 1.562 ninos de 1 y 4 anos. De las 1.562 muestras nasofaringeas se obtuvieron 489 neumococos, habiendose podido serotipar 343 (72% de los aislados). Resultados El 31,3% (489/1.562) de los ninos eran portadores. El 61,7% (964/1.562) de los pacientes incluidos habian recibido al menos una dosis de la VCN7. El 12,8% (44/343) de los serotipos identificados eran serotipos vacunales. Fueron factores protectores independientes de colonizacion: el periodo de verano en todas las edades, la vacunacion en el total de los ninos (OR: 0,73; IC 95%: 0,56–0,93; p = 0,010) y en ninos de 1 ano (OR: 0,6; IC 95%: 0,42–0,84; p = 0,002) y haber tomado antibioticos en el ultimo mes en el total de la poblacion (OR: 0,69; IC 95%: 0,50–0,96). Por el contrario, para todo el grupo, la escolarizacion (OR: 1,85; IC 95%: 1,27–2,18; p = 0,001), el numero de hermanos (OR: 1,31; IC 95%: 1,01–0,91) y la exposicion al tabaco (OR: 1,33; IC 95%: 1,02–1,73) fueron factores de riesgo. Los serotipos 6 A, 19A, 23B, 15A/B, 11A, 14, 23A/F, 3 y 19F fueron los mas prevalentes. Conclusiones La proporcion de serotipos vacunales encontrados fue baja, persistiendo el 14, el 23F y el 19F. Hallamos una alta prevalencia de serotipos 6 A y 19A. El periodo estival, la vacunacion y la administracion previa de antibioticos demostraron ser protectores de la colonizacion; y la escolarizacion, el habito tabaquico y el numero de hermanos, facilitadores de la misma.

Objective To analyse the circadian rhythm maturation of temperature, activity and sleep during the first year of life in offspring of diabetic mothers (ODM) and its relationship with obesity markers. Methods A prospective analysis of the children of 63 pregnant women (23 controls, 21 gestational diabetes mellitus (GDM) controlled with diet and 19 GDM with insulin). Fetal abdominal circumference was evaluated ecographically during gestation. Skin temperature and rest-activity rhythms were monitored for 3 consecutive days in children at 15 days and 1, 3 and 6 months. Anthropometrical parameters of the children were evaluated during the first year of life. Results Children from the GDM groups tended to higher fetal abdominal circumference z-score than controls at the beginning of the last trimester (p = 0.077) and at delivery (p = 0.078). Mean skin temperature or activity was not different among the groups. The I

Background: Although the association between latitude and asthma prevalence has been studied to a certain extent, its influence on the magnitude of the association of risk/protective factors with recurrent wheeze in infants has never been reported.Methods: The adjusted odd ratios (aOR) of various risk/protective factors for recurrent wheeze from 31 920 infants from 19 centres of the "Estudio Internacional de Sibilacias en Lactantes" (EISL) in very different parts of the world were used to build a meta-regression using the strength of the aOR of each factor as dependent variable and centre latitude as explanatory variable. The meta-regression was further adjusted for continent.Results: There was a positive significant correlation between latitude and the magnitude of the aOR between recurrent wheeze and having cold(s) during the first three months of life (p = 0.004); attending a nursery school (p = 0.011); and having additional siblings (p = 0.003). Furthermore, there was a negative correlation for having been breastfed for at Least three months (p = 0.044). Heterogeneity (as measured by I-2) of the magnitude of aORs between centres was quite high except for breast feeding: 73.1% for colds; 66.9% for nursery school; 52.6% for additional siblings; and 18.1% for breast feeding. Latitude explained a considerable amount of that heterogeneity: 63.8% for colds; 52.8% for nursery school; 86.6% for additional siblings; and 100% for breast feeding, probably as a consequence of its low heterogeneity.Conclusion: The magnitude in which some risk/protective factors are associated to recurrent wheeze during the first year of life varies significantly with latitude. (C) 2013 Elsevier Ltd. All rights reserved.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity pulmonary disease that affects both patients with cystic fibrosis (CF) and those with asthma. HLA-DRB1 alleles have previously been associated with ABPA–CF susceptibility; however, HLA-DQB1 allele associations have not been clearly established. The aim of the present study was to investigate HLA class II associations in patients with ABPA–CF and determine their roles in susceptibility or protection. Patients with ABPA–CF, patients with CF without ABPA, patients with asthma without ABPA (AST), and healthy controls were included in this study. DNA was extracted by automatic extractor. HLA-DRB1 and -DQB1 genotyping was performed by the Luminex PCR-SSOP method (One Lambda, Canoga Park, CA, USA). Allele specific PCR-SSP was also performed by high-resolution analysis (One Lambda). Statistical analysis was performed with SSPS and Arlequin software. Both HLA-DRB1*5:01 and -DRB1*11:04 alleles occurred with greater frequency in patients with ABPA–CF than in those with AST and CF and control subjects, corroborating previously published data. On the other hand, analysis of haplotypes revealed that almost all patients with ABPA–CF lacking DRB1*15:01 or DRB1*11:04 carry either DRB1*04, DRB1*11:01, or DRB1*07:01 alleles. In the HLA-DQB1 region, the HLA-DQB1*06:02 allele occurred more frequently in patients with ABPA–CF than in those with AST and CF and healthy controls, whereas HLA-DQB1*02:01 occurred less frequently in patients with ABPA–CF. These data confirm that there is a correlation between HLA-DRB1*15:01, –DRB1*11:04, DRB1*11:01, –DRB1*04 and –DRB1*07:01 alleles and ABPA–CF susceptibility and suggest that HLA-DQB1*02:01 is an ABPA–CF resistance allele.

This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (plt; 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p =lt;0.01). Cotinine was significantly correlated with both active and passive exposure (plt;0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (plt;0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF.Este estudio evalúa el impacto en el tiempo de una intervención telefónica de prevención y cesación tabáquica dirigida a pacientes con fibrosis quística (FQ) en la Región de Murcia, España. Estudio prospectivo experimental en una cohorte de pacientes con FQ utilizando un programa integrativo de cesación tabáquica, entre 2008 y 2013. La población diana incluye a pacientes y familiares de la unidad regional de FQ. El estudio incluyó un cuestionario inicial de exposición al tabaco, medición de la función pulmonar, niveles de cotinina en orina, medidas antropomórficas y la intervención realizada en intervalos de tiempo.De los 88 pacientes seguidos, la tasa de fumadores activos se redujo de 10,23% a 4,55% (p = 0,06). La exposición al humo ambiental de tabaco se redujo en los pacientes no fumadores de 62,03% a 36,90% (plt; 0,01) durante los cinco años de seguimiento. Se observaron reducciones significativas en la exposición al humo ambiental de tabaco en los hogares, de 31,65% (n = 25/79) a 19,05% (n = 16/84) en 2013 (p =lt;0,01). La cotinina se correlacionó significativamente con la exposición al tabaco activa y pasiva (plt; 0,01) con una reducción significativa de los niveles de cotinina de 63,13 (28,58-97,69) a 20,56 (0,86-40,27) ng/ml (plt; 0,01). La intervención para aumentar significativamente la probabilidad de abandono familiar (hogar libre de humo) fue de 1,26 (1,05-1,54). La intervención telefónica mantenida en el tiempo es una herramienta útil para la prevención y cesación tabáquica. Profesionales entrenados en este modelo de intervención con enfoque en salud medioambiental son necesarios para mejorar el tratamiento de FQ.

Background There is very limited information on how the risk of persistent asthma in recurrent wheezing (RW) infants modifies their lung function early in life. The aim of this study is to compare lung function of RW infants and young children with a positive or negative asthma predictive index (API), an index previously used to anticipate asthma persistence into childhood and adolescence. Methods Two groups of RW infants and young children were recruited in two centres in Spain (Palma de Mallorca and Murcia). Lung function was measured according to the thoracho-abdominal compression technique (RCT), and values of the maximal flow at functional residual capacity were expressed as Z-scores. Other variables included in the study, as independent factors, were: gender, age, length, weight, and parental smoking habits together with information regarding API. Results Expressed as mean ± SD, API+ RW infants (n = 50; age in months 11.9 ± 4.9) had a lower Z-score than API− RW ones (n = 41; age in months 12.3 ± 6.2; −2.01 ± 0.79 vs. −1.64 ± 0.77, P = 0.026, respectively). Centre and tobacco exposition did not have an effect on lung function. Conclusion Among RW infants and young children, those having a positive API have a significant lower lung function as measured by at an early age. Pediatr. Pulmonol. 2010; 45:914–918. © 2010 Wiley-Liss, Inc.

Objective To test the hypothesis that consuming Mediterranean diet and using olive oil for cooking/dressing salads during pregnancy might be associated with less wheezing during the first year of the offspring's life. Methods A study was conducted in 1,409 infants (mean age, 16.6 ± 2.5 months) attending healthy infant clinics in Spain. Dietary data of mothers' intake during pregnancy was collected by means of a parental food frequency questionnaire. Demographic information and data on wheezing during the first year of the offspring's life were also recorded. Infants were stratified according to any wheezing (42.2%) during the first year of life. Results In the univariate analysis, adherence to a Mediterranean diet and using olive oil for cooking/dressing salads during pregnancy were both significantly associated with less wheezing during the first year of life. However, after multivariate analysis, only olive oil consumption during pregnancy remained associated with less wheezing in the studied period (aOR = 0.57 [95% CI = 0.4–0.9]); whereas male gender (1.8 [1.4–2.3]), day care attendance (2.15 [1.5–3.1]), maternal asthma (2.16 [1.3–3.6]), maternal smoking during pregnancy (1.83 [1.3–2.2]), infant eczema (1.95 [1.3–2.9]), and mould stains on the household walls (1.72 [1.2–2.5]) remained associated with wheezing. Conclusion Our findings suggest a protective effect (primary prevention) of olive oil use during pregnancy on wheezing during the first year of the offspring's life. Pediatr Pulmonol. 2010; 45:395–402. © 2010 Wiley-Liss, Inc.

Garcia-Marcos L, Ruiz TR, Garcia-Hernandez G, Suarez-Varela MM, Valverde-Molina J, Sanchez-Solis M. Asthma and rhinoconjunctivitis comorbidity: United airway disease or inherited target organs? Pediatr Allergy Immunol 2010: 21: e142–e148. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard The idea of a united airway disease for asthma and rhinoconjunctivitis is supported by clinical and epidemiological data. However, many asthmatics do not have rhinoconjunctivitis and vice versa. The aim of this study was to investigate if the family history of a specific organ involvement is associated with the implication of the same organ in the allergic child. According to the organ involvement in either or both parents, the family history of 739 children who were skin prick positive to either Dermatophagoides pteronyssinus or D. farinae or both was defined as: asthma and rhinoconjunctivitis positive; asthma and rhinoconjunctivitis negative; asthma negative and rhinoconjunctivitis positive; and asthma positive and rhinoconjunctivitis negative. Asthma and rhinoconjunctivitis in the children were defined according to the International Study of Asthma and Allergies in Childhood questionnaire. Associations between each type of family history and the presence of asthma and/or rhinoconjunctivitis in the children were calculated and adjusted for usual confounders. Adjusted odds ratio of children having asthma, when family history included asthma, was 2.48 (1.38–4.45) when it also included rhinoconjunctivitis; and 2.13 (1.12–4.05) when it did not. However, family history of rhinoconjunctivitis was not associated with asthma in the child. Conversely, the odds ratio of children having rhinoconjunctivitis when family history included rhinoconjunctivitis was 1.84 (1.05–3.21) when it also included asthma; and 1.89 (1.23–2.89) when it did not. Family history of asthma was not associated with rhinoconjunctivitis in the child. In a population of children sensitized to mites, the organ or organs (nose and/or lung) which are implicated in parents tend to be also involved in their children.

Resumen Introduccion y objetivo no hay datos publicados sobre la evolucion de la mortalidad por asma en Espana en el periodo 1960–2005. El objetivo de este estudio ha sido describir la evolucion de la tasa de mortalidad debida al asma en Espana entre 1960 y 2005, tanto en el total de la poblacion como en el grupo de edad de 5 a 34 anos. Material y metodos los datos necesarios para calcular la tasa de mortalidad, esto es, numero de defunciones debidas al asma y poblacion, proceden del Instituto Nacional de Estadistica. En cada caso se obtuvieron los valores totales, por grupo de edad y sexo. A partir de estos datos se calculo la tasa de mortalidad por asma, por 100.000 habitantes. Resultados la tasa de mortalidad por asma para todas las edades era en 1960 de 9,36, y en 2005 de 2,22, con una reduccion en los varones de 12,26 a 0,96 y en las mujeres de 6,58 a 3,44. En el grupo de edad de 5 a 34 anos, los valores de la tasa de mortalidad para ambos sexos oscilan entre 0,4 y 0,1, y se observa una gran variabilidad en su evolucion a lo largo de los anos. Conclusiones la mortalidad por asma ha disminuido a lo largo del periodo analizado, si bien de forma diferente en varones y mujeres, entre las que el descenso es mucho menor. La tendencia y las tasas de Espana son similares a las de la mayoria de los paises de los que se dispone de datos.

Background and objective: No data have been published on trends in asthma mortality in Spain between 1960 and 2005. The aim of this study was to trace these trends for both the general population and the 5- to 34-year age group in Spain. Material and methods: The data on asthma mortality for the general population and by age and sex were obtained from the Spanish National Institute of Statistics and used to calculate the asthma mortality rates per 100 000 inhabitants. Results: The overall asthma mortality rate per 100 000 inhabitants was 9.36 in 1960 and 2.22 in 2005, showing a reduction from 12.26 to 0.96 in males and from 6.58 to 3.44 in females. In the 5- to 34-year age group, the mortality rate for both sexes ranged from 0.4 to 0.1, showing great variability over time. Conclusions: Asthma mortality decreased in the period analyzed, but less in women than in men. The trend and rates in Spain are similar to those of most countries for which data are available.

Objetivo: La hiperreactividad bronquial (HRB) es un hallazgo comun en la fibrosis quistica (FQ), que no se ha relacionado de forma concluyente con la atopia. El objetivo del estudio ha sido investigar la relacion existente entre la colonizacion-infeccion cronica por Pseudomonas aeruginosa y la HRB en un grupo de pacientes con FQ. Pacientes y metodos: Se realizo la prueba de broncoprovocacion inespecifica con histamina a un grupo de 32 pacientes con FQ cuya edad media ± desviacion estandar era de 11,25 ± 3,7 anos. Ademas se investigo en estos pacientes la existencia de atopia y colonizacion-infeccion cronica por P. aeruginosa. Resultados: De los 32 pacientes estudiados, se encontro HRB en 9 (28,1%), cuya situacion clinica era significativamente peor. Estos 9 pacientes con HRB presentaron todos colonizacion-infeccion cronica por P. aeruginosa. Tenian atopia 17 pacientes (53,1%) de la muestra estudiada, pero solo 3 (33,3%) de los 9 con HRB. La HRB se asocio significativamente con la colonizacion-infeccion cronica por P. aeruginosa (p < 0,001), pero no con la atopia (p = 0,12). Entre los pacientes sin atopia, la colonizacion se asocio significativamente con HRB (p = 0,017). Ademas, en el grupo de pacientes con funcion pulmonar normal (volumen espiratorio forzado en el primer segundo ? 80%) esta asociacion fue tambien significativa (p = 0,044), mientras que la asociacion entre HRB y atopia no lo fue (p = 0,11). Conclusiones: Los resultados del presente estudio indican que en pacientes con FQ la HRB podria estar relacionada con la colonizacion-infeccion cronica por P. aeruginosa, que podria ser un factor de riesgo de HRB mas importante que la atopia.

Spanish 'Fondo de Investigacion Sanitaria' 'Secretaria de Estado para la Cooperacion Internacional' Regional Government of Murcia, Spain Foundation to Combat Asthma (Stichting Astmabestrijding), Amsterdam, The Netherlands Male gender, asthmatic heredity, perinatal tobacco smoke exposure and respiratory infections have been associated with wheeze in the first years of life, among other risk factors. However, information about what factors modify the time to the first episode of wheeze in infants is lacking. The present study analyses which factors are associated with shorter time to the first episode of wheeze in infants. Parents of 11- to 24-month-old children were surveyed when attending their health-care centres for a control visit. They answered a questionnaire including the age in months when a first wheeze episode (if any) had occurred (outcome variable). The study was performed in 14 centres in Latin America (LA) and in 8 centres in Europe (EU) (at least 1,000 infants per centre). Factors known to be associated with wheezing in the cohort were included in a survival analysis (Cox proportional hazards model). Summary hazard ratios adjusted for all risk factors (aHR) were calculated using the meta-analysis approach with random effects. A total of 15,067 infants had experienced wheezing at least once, out of 35,049 surveyed. Male gender in LA (aHR 1.05, 95% confidence interval (CI) 1.00-1.10, P = 0.047), parental asthma in LA and EU (aHR 1.05, 95% CI 1.00-1.11, P = 0.037), infant eczema in EU (aHR 1.25, 95% CI 1.12-1.39, P < 0.001) and having a cold during the first 3 months in LA and EU (aHR 1.97, 95% CI 1.90-2.04, P < 0.001), in LA (aHR 1.98, 95% CI 1.90-2.06, P < 0.001) and in EU (aHR 1.91, 95% CI 1.75-2.09, P < 0.001) were associated with a shorter period of time to the first episode. Breast feeding for at least 3 months was associated with a longer period, only in LA (aHR 0.91, 95% CI 0.86-0.96, P < 0.001). Cold symptoms during the first 3 months is the most consistent factor shortening the time to the first episode of wheezing; breast feeding for >= 3 months delays it only in LA, whereas eczema shortens it only in EU. Avoiding a common cold in the first months of life could be a good strategy to delay the first wheeze episode; however, cohort studies will help to elucidate this association. Univ Murcia, Virgen de la Arrixaca Univ Childrens Hosp, Pediat Resp & Allergy Unit, Murcia, Spain Univ Santiago Chile USACH, Dept Pediat Resp Med, Hosp El Pino, Santiago, Chile Fed Univ Sao Paulo UNIFESP, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, Sao Paulo, Brazil Isala Klin, Princess Amalia Childrens Clin, Zwolle, Netherlands Univ Med Ctr Groningen, UMCG Postgrad Sch Med, NL-9713 AV Groningen, Netherlands Univ Murcia, Dept Pediat, Murcia, Spain IMIB Biores Inst, Murcia, Spain Fed Univ Sao Paulo UNIFESP, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, Sao Paulo, Brazil Spanish 'Fondo de Investigacion Sanitaria': PI050480 'Secretaria de Estado para la Cooperacion Internacional': A/3069/05 'Secretaria de Estado para la Cooperacion Internacional': A/5189/06 Web of Science

Introduction: Accurate identification of paediatric patients with severe asthma is essential for an adequate management of the disease. However, criteria for defining severe asthma and recommendations for control vary among different guidelines. Material and methods: An online survey was conducted to explore expert opinions about the definition and management of severe paediatric asthma. To reach a consensus agreement, a modified Delphi technique was used, and practice guidelines were prepared after the analysis of the results. Results: Eleven paediatric pulmonologists and allergists with wide expertise in severe asthma responded to the survey. Consensus was reached in 50 out of 65 questions (76.92%). It was considered that a patient has severe asthma if during the previous year they had required 2 or more cycles of oral steroids, required daily treatment with medium doses of inhaled corticosteroids (with other controller medication) or high doses (with or without other controller medication), did not respond to optimised conventional treatment, or if the disease threatened the life of the patient or seriously impaired their quality of life. The definition of severe asthma may also include patients who justifiably use health resources on a regular basis, or have psychosocial or environmental factors impeding control. For monitoring, the use of questionnaires designed specifically for paediatric population, such as CAN or ACT, is recommended. As regards treatment, the use of omalizumab should be considered prior to the use of oral corticosteroids. Conclusions: This paper provides consensus recommendations that may be useful in the management of severe paediatric asthma. Resumen: Introducción: La identificación adecuada del paciente pediátrico con asma grave es esencial para su correcto manejo. Sin embargo, los criterios para definir el asma grave y las recomendaciones para su control varían mucho entre las distintas guías. Material y métodos: Se elaboró una encuesta telemática para analizar las opiniones relativas a la definición y control del asma grave pediátrica. Para lograr un consenso se siguió una metodología Delphi modificada. Con los resultados se elaboraron recomendaciones prácticas. Resultados: El cuestionario fue respondido por 11 neumólogos y alergólogos pediátricos expertos en asma grave. Hubo consenso en 50 de los 65 ítems planteados (76,92%). Se consideró que un paciente tiene asma grave si en el último año ha requerido 2 o más ciclos de corticoides orales, si requiere tratamiento diario con corticoides inhalados a dosis medias (con otra medicación controladora) o dosis altas (con o sin otra medicación controladora), si no responde a un tratamiento convencional optimizado, o si la enfermedad pone en riesgo su vida o deteriora gravemente su calidad de vida. La definición de asma grave también podría incluir a los pacientes que consumen recursos sanitarios de manera regular y justificada, o tienen factores psicosociales o ambientales que impiden su control. Para la monitorización, se recomienda usar cuestionarios específicos de población pediátrica (CAN o ACT). Respecto al tratamiento, se debería considerar el uso de omalizumab en un escalón anterior al de los corticoides orales. Conclusiones: El presente trabajo ofrece recomendaciones consensuadas que pueden ser de utilidad en el manejo del asma grave pediátrica.

Even in the absence of overt respiratory disease during the neonatal period, reduced lung function (LF) has been reported in preterm infants. We have previously found significantly lower Crs, V9maxFRC, FEV0.5 and FEF25-75 in “healthy” preterm infants when compared to term controls (ERS de Mir, 2014) Objectives: To assess LF at 6 and 18 months of age in preterm infants without neonatal respiratory disease, and compare the measurements to those obtained in healthy fullterm infants. Methods: LF was measured under chloral sedation in 9healthy9 preterm (30-35.8 w) and fullterm Spanish White babies, using the CareFusionTM Masterscreen BabyBody equipment. Results were expressed as z scores to adjust for sex, age and body size (Lum, Ped Pulm 2010; Nguyen, Ped Pulm 2013). Results: 156 infants were initially studied at mean (SD) corrected postnatal age (cPNA) of 5.9 (1.0) months. 112 (57 term and 55 preterm) were followed up at 18.3 and 18.2 months respectively. At 18 months cPNA, results were similar between the groups Conclusions: The differences observed in our cohort between term controls and 9healthy9 preterm infants at 6 months cPNA in Crs, V9maxFRC, FEV 0,5 and FEF 25-75% was no longer evident at 18 months corrected age, suggesting a catch-up of lung function in this group of preterm infants.

The aim of our study was to determine whether the development of lung function, during the first 2 years of life, is different in preterm infants who suffered or did not suffer from Bronchopulmonary dysplasia (BPD). We also assessed the role of nutritional status and growth in that development.Lung function tests were performed in 71 preterm infants at two time points: 6 months of corrected age and 1 year after. FVC, FEV0.5, FEF75 , and FEF25-75 were obtained from maximal expiratory volume curves by means of the raised volume rapid thoraco-abdominal compression technique.When comparing lung function measurements, we found that FVC (P = 0.033) FEV0.5 (P = 0.044), FEF75 (P = 0.014), and FEF25-75 (P = 0.036) were significantly lower in BPD infants. We did not find any catch-up of lung function during the study time, in neither the whole group of children nor within the BPD or non-BPD groups. The increase in lung function was directly proportional to the increase in weight and length. The multivariate analysis showed that the increase in z-score of FVC (P = 0.043), FEV0.5 (P = 0.015), and FEF75 (P = 0.042), was related with the height velocity during the study period.Infants who suffered from BPD have lower lung function (FVC, FEV0.5 , FEF75 , and FEF25-75 ), than those non-BPD, at two different time points 1 year apart. During the study period, there was no lung function catch-up in either BPD or non-BPD infants. The increase in length is closely associated to the increase in lung function. Pediatr Pulmonol. 2016; 51:936-942. © 2016 Wiley Periodicals, Inc.