Pediatric Pulmonology

Texto completo: acesso restrito. p. 244–248Two different socioeconomic groups of children with pneumonia were studied, and their clinical and demographic aspects were evaluated. The diagnosis of pneumonia was based on findings of cough and tachypnea, or on crackles on auscultation or on radiologically confirmed infiltrate. This was a prospective cross-sectional study conducted at the Professor Hosannah de Oliveira Pediatric Center, which cares for children of lower socioeconomic status (PHOPC), and at one private hospital which cares for children from middle to high socioeconomic status (Aliança Hospital, AH). Demographics and clinical differences were assessed by the Pearson chi-square test or Fisher's exact test as appropriate; means of continuous variables were compared by Mann-Whitney U-test. In a 26-month period, 3,431 cases were recruited. The 2,476 cases identified at the PHOPC were younger than the 955 identified at AH (2.2 ± 2.3 vs. 4.5 ± 3.1 years, P < 0.0001) and had higher scores for severity (3.5 ± 1.5 vs. 2.7 ± 1.7, P < 0.0001), duration of hospitalization (days) (10.9 ± 12.1 vs. 6.2 ± 7, P < 0.0001), frequency of tobacco smoker in the household (48% vs. 31%, P < 0.0001), cardiopathy (15.3% vs. 5.9%, P = 0.003), fever (44.4% vs. 36.3%, P = 0.0001), tachypnea (67.6% vs. 32.3%, P < 0.0001), crackles (69.5% vs. 64.9%, P = 0.02), somnolence (19.9% vs. 10.4%, P < 0.0001), malnutrition (13.7% vs. 5%, P < 0.0001), hospitalization rate (27.4% vs. 22.5%, P = 0.003), and death (0.9% vs. 0.1%, P = 0.009). However, other features were more frequent among AH cases: parent's university level of education (38.2% vs. 1.0%, P < 0.0001), underlying chronic illness (40.6% vs. 28.5%, P < 0.0001), asthma (62.7% vs. 50.8%, P = 0.01), rhinitis (9.2% vs. 0.4%, P < 0.0001), previous use of antibiotics (34.3% vs. 27.1%, P = 0.001), and wheezing (53.1% vs. 42.2%, P < 0.0001). Children of lower socioeconomic status have more serious lower respiratory tract disease, whereas children with pneumonia of middle to high socioeconomic status have more allergic diseases (rhinitis, asthma) and wheezing. Pediatr Pulmonol. 2002; 33:244–248. © 2002 Wiley-Liss, Inc

Atenção integrada às doenças prevalentes na infância : implantação e avaliação no Brasil

O livro traz uma série de textos de profissionais da área da saúde materno-infantil. Oferece um panorama da atenção integrada às doenças prevalentes na infância, estratégia reconhecida pelo Ministério da Saúde

Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia

Objective: To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin. Design: Multicentre, prospective, observational study. Setting: 12 tertiary-care centres in three countries in Latin America. Patients: 240 children aged 3-59 months, hospitalised with severe pneumonia and known in vitro susceptibility of S pneumoniae. Intervention: Patients were treated with intravenous penicillin/ampicillin after collection of blood and, when possible, pleural fluid for culture. The minimal inhibitory concentration (MIC) test was used to determine penicillin susceptibility of the pneumococcal strains isolated. Children were continuously monitored until discharge. Main outcome measures: The primary outcome was treatment failure (using clinical criteria). Results: Overall treatment failure was 21%. After allowing for different potential confounders, there was no evidence of association between treatment failure and in vitro resistance of S pneumoniae to penicillin according to the Clinical Laboratory Standards Institute (CLSI)/National Committee for Clinical Laboratory Standards (NCCLS) interpretative standards ((adj)RR = 1.03; 95%Cl: 0.49-1.90 for resistant S pneumoniae). Conclusions: Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 mu g/ml

Empiema e pneumonia pneumocócica bacterêmica em menores de cinco anos de idade

We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.Canadian International Development Agency (CIDA)Pan American Health OrganizationWorld Health Organization Department of Child and Adolescent Health and DevelopmentBoston University Applied Research on Child Health (ARCH) Project (United States Agency for International Development)Univ Sao Paulo, Sch Publ Hlth, Dept Epidemiol, Sao Paulo, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Sao Paulo, BrazilPedro Elizalde Childrens Hosp, Buenos Aires, DF, ArgentinaSanta Casa Sch Med Sci Sao Paulo, Dept Pediat, Sao Paulo, BrazilDurand Municipal Hosp, Dept Maternal & Child Hlth, Buenos Aires, DF, ArgentinaUniv Fed Rio de Janeiro, Sch Med, Dept Pediat, Rio De Janeiro, BrazilAdolfo Lutz Inst, Sao Paulo, BrazilUniv Fed Fluminense, Niteroi, RJ, BrazilFernando Figueira Inst Integrat Med, Recife, PE, BrazilDr Robert Reid Cabral Childrens Hosp, Dept Infect Dis, Santo Domingo, Dominican RepWHO, Pan Amer Hlth Org, Washington, DC USAUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilUniv Fed Sao Paulo, Paulista Sch Med, Sao Paulo, BrazilBoston University Applied Research on Child Health (ARCH) Project (United States Agency for International Development): HRN-A-00-960010-00Web of Scienc