Terapia miofuncional para mejorar eficiencia en la succión en recién nacidos pretérmino

Resumen: Objetivo: Comparar las características de los neonatos pretérmino que recibieron terapia miofuncional con los que no la recibieron, y analizar el tiempo que cada grupo toma en llegar desde la primera succión a la mayor eficiencia en la succión (ES) de su estancia. Métodos: Estudio de cohorte retrospectivo que incluyó 442 neonatos de entre 28 y 36.6 semanas de gestación (SG) al nacimiento ingresados a la Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital Español de México entre marzo de 2014 y octubre de 2016. Los pacientes se dividieron en dos grupos: 1) los que recibieron terapia miofuncional por parte de un especialista, y 2) los que no la recibieron. Se registraron antecedentes; se midió el tiempo en días desde la primera succión hasta la mayor ES según SG y peso. Resultados: Un total de 123 neonatos recibieron terapia miofuncional. Se observaron diferencias entre grupos, siendo el grupo intervenido el de menor SG y peso al nacimiento, con más comorbilidades y días de estancia intrahospitalaria. El grupo que no recibió terapia logró alcanzar la mayor ES significativamente en menos días que el grupo que la recibió, ajustando por SG y peso a la primera succión (diferencia de medias de 2.18 a 6.15 días; p = 0.06 a p < 0.001). Conclusión: El bajo peso, la edad gestacional al nacimiento, un mayor número de comorbilidades y días de estancia intrahospitalaria son factores que podrían retrasar la obtención de una adecuada ES. La terapia miofuncional debería comenzarse antes de iniciarse la succión nutritiva. Abstract: Objective: Compare the characteristics of the preterm newborns who received myofunctional therapy with those who didn’t received it, and to analyze the time each group takes to reach effective sucking since the first sucking to the best one during their intrahospital stay. Methods: Retrospective cohort study which included 442 preterm newborns between 28 to 36.6 weeks of gestational age admitted to the Neonatal Intensive Care Unit of Hospital Español de México between March 2014 to October 2016. The patients were divided in two groups: 1) the ones that received myofunctional therapy carried out by two people specialized in early intervention of the premature, and 2) the ones that did not. We registered perinatal history and measure the time it was taken to achieve an efficient sucking since the first sucking according to gestational age and weight. Results: 123 were exposed to myofunctional therapy. We observed a significant difference between both groups, being the exposed group the patients with lower gestational age and weight at birth and the ones presenting more comorbidities and days in hospital. The group that did not received myofunctional therapy achieved an earlier effective sucking than the one that received myofunctional therapy adjusted by gestational age and weight presented in the first sucking (mean 2.18 to 6.15 days; p = 0.06 to p < 0.001). Conclusion: Small for gestational age, lower gestational weight at birth, more comorbidities and longer length of stay are factors that may delay the acquisition of efficiency in sucking. The myofunctional therapy should be started before starting nutritive sucking. Palabras clave: Succión, Recién nacido pretérmino, Terapia miofuncional, Keywords: Sucking, Preterm newborn, Myofunctional therap

Airway inflammation and dysbiosis in antibody deficiency despite the presence of IgG

Background: Patients with antibody deficiency suffer chronic respiratory symptoms, recurrent exacerbations, and progressive airways disease despite systemic replacement of IgG. Little is known about the respiratory tract biology of these patients. Objective: We sought to measure immunoglobulin levels, inflammatory cytokines, and mediators of tissue damage in serum and sputum from patients with antibody deficiency and healthy controls; to analyze the respiratory microbiome in the same cohorts. Methods: We obtained paired sputum and serum samples from 31 immunocompetent subjects and 67 antibody-deficient patients, the latter divided on computed tomography scan appearance into “abnormal airways” (bronchiectasis or airway thickening) or “normal airways.” We measured inflammatory cytokines, immunoglobulin levels, neutrophil elastase, matrix-metalloproteinase-9, urea, albumin, and total protein levels using standard assays. We used V3-V4 region 16S sequencing for microbiome analysis. Results: Immunodeficient patients had markedly reduced IgA in sputum but higher concentrations of IgG compared with healthy controls. Inflammatory cytokines and tissue damage markers were higher in immunodeficient patients, who also exhibited dysbiosis with overrepresentation of pathogenic taxa and significantly reduced alpha diversity compared with immunocompetent individuals. These differences were seen regardless of airway morphology. Sputum matrix-metalloproteinase-9 and elastase correlated inversely with alpha diversity in the antibody-deficient group, as did sputum IgG, which correlated positively with several inflammatory markers, even after correction for albumin levels. Conclusions: Patients with antibody deficiency, even with normal lung imaging, exhibit inflammation and dysbiosis in their airways despite higher levels of IgG compared with healthy controls