Introduction. Asthma is a major economic burden to families and public healthcare since it leads to a large number of emergency room (ER) visits and hospital admissions. Whereas healthcare programs for children with asthma have proved to be very effective to improve the course of the disease, there is less information about programs for children with severe asthma. Objective. To comparatively analyze the impact of the Healthcare Program for Children with Severe Asthma (Programa de Atención de Niños con Asma Grave, PANAG). Methods. This was a longitudinal, pre- and postintervention study. Two approaches were used to compare the frequency of asthma exacerbations and hospital admissions due to severe asthma in a group of patients: regular follow-up in a public hospital (pre-intervention period, 18 months) and follow-up while participating in PANAG (post-intervention period, 18 months). During the Program, patients received preventive treatment free of charge; educational activities were also organized. Results. Twenty children were included, 16 (80%) out of the 20 were females, and the mean age was 13.3 years (SD 3.8). During the pre-intervention period 59 asthma attacks were recorded; after PANAG was implemented, they decreased to 26. This accounts for a significant reduction of 55% of asthma attacks (p= 0.0002). During the period previous to PANAG implementation, there were 4 asthma-related hospital admissions. In the period after the program implementation, there was only one hospital admission. Conclusions. The Healthcare Program for Patients with Severe Asthma is an effective strategy to manage this disease. This healthcare program is affordable to be used in a public hospital.

Introducción. El asma tiene un alto impacto en la salud pública pues causa un gran número de consultas a los servicios de emergencias y de internaciones. Si bien los programas de atención de niños con asma han demostrado ser muy eficaces para mejorar la evolución de la enfermedad, existe menos información sobre programas para niños con asma grave. Objetivo. Evaluar en forma comparativa el impacto del Programa de Atención de Niños con Asma Grave (PANAG). Métodos. Estudio longitudinal, pre-posintervención. Se comparó el número de exacerbaciones y de internaciones por asma grave en un grupo de pacientes bajo dos estrategias: seguimiento regular en un hospital público (período preintervención, 18 meses) y seguimiento bajo el PANAG (período posintervención, 18 meses). Durante el PANAG los pacientes recibieron en forma gratuita la medicación preventiva y se organizaron actividades educativas. Resultados. Se incluyeron 20 niños, 16 mujeres (80%) con un promedio de edad de 13,3 años (DE 3,8). Durante el período pre-intervención se observaron 59 crisis asmáticas y luego de la implementación del PANAG hubo 26. Esto representa una reducción significativa del 55% en el número de crisis asmáticas (p= 0,0002). Durante el período previo al PANAG se observaron 4 internaciones por asma. En el período posterior solo hubo una hospitalización. Conclusiones. El programa de atención de pacientes con asma grave es una estrategia eficaz para el control de esta patología. Es un modelo de atención factible en un hospital público.

OBJETIVO: A malformação adenomatoide cística congênita (MACC) é a malformação pulmonar ressecada cirurgicamente mais comum em crianças. Este estudo retrospectivo foi realizado para apresentar a experiência de 172 casos de MACC em um hospital pediátrico. MÉTODOS: Séries publicadas com um pequeno número de pacientes relatam detalhes de lesões, evolução e tratamento. Como este estudo lida com características clínicas, evolução e procedimentos cirúrgicos em 172 crianças com diagnóstico de MACC, a população inclui casos tratados e acompanhados em um hospital pediátrico ao longo de 25 anos (1986-2011). RESULTADOS: A idade média ao diagnóstico foi de 48 meses (r = 0,03-213), 52% (n = 90) eram do sexo masculino. Os sintomas de apresentação mais comuns foram dificuldade respiratória em crianças com menos de 6 meses de idade (40%) e pneumonia recorrente nas que tinham mais idade (75%; p = 0.001). Lobectomia foi o procedimento de escolha na maioria dos casos. Todos os tipos histológicos foram encontrados: 1 (70%), 2 (24%), 4 (4%) e 0 e 3 (n = 1). Foi observado um padrão misto em nove pacientes. Foram encontradas anomalias associadas em 47% das crianças. A mais frequente foi sequestro (71%), mais presente na MACC tipo 2 (p = 0,001). As anomalias mais graves se relacionaram principalmente com o tipo 2 (p = 0,008). Também foram observados um blastoma pleuropulmonar e um carcinoma broncoalveolar. A mortalidade foi de 5% (n = 9). Os fatores de risco para mortalidade foram falência respiratória (OR = 25,7 [IC95% 3,2-221]; p = 0,03), sepse (OR = 9,9 [IC95% 8,2-12]; p = 0,002), necessidade de assistência respiratória (OR = 9,5 [IC95% 2,3-37]; p = 0,04) e diversas comorbidades associadas (OR = 3,3 [IC95% 1,2-22]; p = 0,008). CONCLUSÕES: Foram observadas anomalias relacionadas em quase metade da população. Devido à possibilidade de infecção recorrente ou desenvolvimento de neoplasias, deve-se considerar a ressecção cirúrgica quando MACC for diagnosticada. O desfecho cirúrgico é favorável e apresenta complicações tratáveis.

OBJECTIVE: Congenital cystic adenomatoid malformation (CCAM) is the most common surgically resected pulmonary malformation in children. This retrospective study was undertaken to present the experience of 172 CCAM cases in a pediatric hospital. METHODS: Published series with a small number of patients reports details of lesions, progress and management. As this study addresses clinical characteristics, progress and surgical procedures in 172 children with CCAM diagnosis, the population includes cases treated and followed up in a pediatric hospital throughout 25 years (1986-2011). RESULTS: Mean age at diagnosis was 48 months (r = 0.03-213), 52% (n = 90) were male. The most common presenting symptoms were respiratory distress in children under 6 months of age (40%) and recurrent pneumonia in older ones (75%; p = 0.001). Lobectomy was the procedure of choice in the majority. All histological types were found: 1 (70%), 2 (24%), 4 (4%), and 0 and 3 (n = 1). A mixed pattern was observed in nine patients. Associated anomalies were found in 47% of children. The most frequent was sequestration (71%), mostly present in CCAM type 2 (p = 0.001). Severe anomalies were mostly related to type 2 (p = 0.008). A pleuropulmonary blastoma and a bronchioloalveolar carcinoma were also observed. Mortality was 5% (n = 9). Risk factors for mortality were respiratory failure (OR = 25.7 [95%CI 3.2-221]; p = 0.03), sepsis (OR = 9.9 [95%CI 8.2-12]; p = 0.002), respiratory assistance requirements (OR = 9.5 [95%CI 2.3-37]; p = 0.04), and severe associated comorbidities (OR = 3.3 [95%CI 1.2-22]; p = 0.008). CONCLUSIONS: Related anomalies were observed in almost half of the population. Due to the possibility of recurrent infection or development of malignancies, surgical resection should be considered when CCAM is diagnosed. Surgical outcome is favorable with manageable complications.

Introduction. Cystic fibrosis is a genetic autosomal recessive disease that affects approximately 1:6000 live births in our country. Chronic infection with Pseudomonas aeruginosa (PA) is associated with higher morbidity and-mortality, and deterioration of lung function. Treatment of initial infection is important to prevent or delay chronic infection. The primary aim was to determine the effectiveness and freetime of PA in bronchial secretions after eradication treatment. The secondary objective was to determine changes in the weight and lung function. Materials and methods. Prospective, observational study, of patients with cystic fibrosis (CF) and recent PA infection. After initial infection by PA patients received oral ciprofoxacin and nebulized colistin. We studied effectiveness of treatment to eradicate PA, and changes in the weight measured in Z score and in the respiratory functional tests, pre-infection, during, and after the eradication of PA. Results. We included 24 patients (11 male) with confirmed CF. Seven of them had two PA infections, and received 2 treatment courses. PA was eradicated in 24 (80.5%) out of 31 infections. The value of weight measured in Z score, and functional tests measures through the FVC and FEV1 decreased during the infection by PA, returning to the baseline after eradication. The free-time of PA during the follow-up to these patients was 23.75 (95% CI 14.38-32.86) months. Conclusion. Treatment of initial infection by PA has a high degree of response. Weight and functional values improved after treatment.

Introducción. La fibrosis quística (FQ) es una enfermedad genética autosómica recesiva que afecta a 1:6000 recién nacidos vivos en nuestro país. La infección crónica por Pseudomonas aeruginosa (PA) se asocia con mayor morbimortalidad y deterioro de la función pulmonar. El tratamiento de la infección inicial puede evitar o posponer la infección crónica. El objetivo primario fue determinar la eficacia y el tiempo libre de PA luego del tratamiento. El objetivo secundario fue determinar cambios en el peso y la función pulmonar. Material y métodos. Estudio prospectivo, observacional, con intervención, no aleatorizado, en pacientes con FQ e infección reciente por PA. Los pacientes con infección por PA recibieron ciprofoxacina oral más colistina aerosolizada. Las variables estudiadas fueron eficacia del tratamiento, tiempo libre de PA, cambios en el peso medido en puntaje Z y en las pruebas funcionales respiratorias, preinfección, durante la infección y luego de la erradicación de PA. Resultados. Se incluyeron 24 pacientes (11 varones). Siete presentaron dos infecciones por PA y recibieron 2 tratamientos. En los 31 tratamientos realizados, 24 (80,5%) pacientes se negativizaron y 7 persistieron con PA. El valor de peso medido en puntaje Z y las pruebas funcionales disminuyeron durante la infección por PA y regresaron a los valores previos luego de ser erradicada El tiempo libre de PA durante el seguimiento fue de 23,75 meses (IC95% 14,38-32,86). Conclusión. El tratamiento de la infección inicial por PA es muy eficaz. Luego del tratamiento se produce una mejoría del peso y de los valores funcionales.

Introduction. Acute lower respiratory infection in children usually causes Bronchial Obstructive Syndrome, which could include hipoxemia. Although pulse oximetry (SaO2) is the gold standard to evaluate hipoxemia, it is usually estimated from a clinical score not yet validated. We aimed to validate the respiratory distress score used in Argentina and to compare its performance with the one used in Chile. Methods. We included 200 children aged under 2 years, with Bronchial Obstructive Syndrome. On admission SaO2 and, Argentinean and Chilean scores components (respiratory rate, heart rate, wheezing, chest indrawing, cyanosis) were assessed. We evaluated the score components ability to predict hipoxemia (SaO2 ≤95 and SaO2 ≤91) by logistic regression. Correlation between Argentinean score and SaO2 was estimated. The best threshold of both scores to predict hipoxemia was calculated by ROC curve. Sensitivity, specifcity, predictive values and likelihood ratios of both scores to predict hipoxemia were calculated. Results. Chest indrawing was an independent predictor of hipoxemia (SaO2 ≤95 and SaO2 ≤91) (OR: 3.1 IC95%:1.6-5.9 and OR: 13.8 IC95%:1.8-105.4, respectively). The Argentinean score showed acceptable correlation with SaO2 (Spearman: -0,492; p< 0,0001). On SaO2 ≤91 the Argentinean score showed the best diagnostic performance (auc= 0.904). An Argentinean score ≥5 was the best threshold to predict hipoxemia (Sensitivity= 100%, specifcity= 54.3%). The Chilean score was also evaluated, showing a performance slightly worst than the Argentinean. Conclusion. An Argentinean score ≥5 points was sensitive enough to predict hipoxemia (SaO2 ≤91). This score only allowed identifying children who does not beneft from supplementary oxygen.

Introducción. El síndrome bronquial obstructivo en niños puede acompañarse de diversos grados de hipoxemia. La saturación arterial de oxígeno (SaO2) es el mejor medio para valorar hipoxemia, pero suele inferirse por una escala para valorar difcultad respiratoria, aún no validada. El objetivo fue validar la escala de difcultad respiratoria utilizada en la Argentina y compararla con la utilizada en Chile. Población, material y métodos. Se incluyeron 200 niños menores de 2 años con síndrome bronquial obstructivo y se registraron SaO2 y componentes de ambas escalas (frecuencia respiratoria, frecuencia cardíaca, tiraje, sibilancias, cianosis). Se evaluó la capacidad de los componentes para predecir hipoxemia (SaO2 ≤95 y SaO2 ≤91) por regresión logística. Se estimó la correlación entre la escala argentina y la SaO2. Se determinó el mejor punto de ambas escalas para predecir hipoxemia (curvas ROC). Se calculó sensibilidad, especifcidad, valores predictivos y razones de verosimilitud de ambas escalas para predecir hipoxemia. Resultados. Sólo el tiraje fue predictor independiente de hipoxemia (SaO2 ≤95 y ≤91) (OR: 3,1 IC95%:1,6-5,9 y OR: 13,8 IC95%:1,8-105,4, respectivamente). La escala argentina mostró aceptable correlación con la SaO2 (Spearman: -0,492; p< 0,0001) en SaO2 ≤91, la escala argentina mostró la mejor capacidad diagnóstica (abc= 0,904). Un puntaje ≥5 fue el mejor punto para predecir hipoxemia (sensibilidad= 100%, especifcidad= 54,3%). La escala chilena mostró una sensibilidad sensiblemente inferior. Conclusión. La escala argentina fue sufcientemente sensible para predecir hipoxemia (SaO2 ≤91) en un puntaje ≥5, pero no mostró especifcidad que permita una correcta discriminación por encima de este punto. Esta escala sólo permite identifcar niños que no se benefciarían con el uso de O2.