Introducción En España la alergia a las proteínas de leche de vaca (APLV) supone la segunda causa de alergia alimentaria tras el huevo. Actualmente la prevención primaria no está bien establecida. Algunos estudios han demostrado que el uso de fórmulas extensamente hidrolizadas (FHe) en los primeros días de vida disminuye el riesgo de desarrollarla. Objetivos Determinar si la exposición precoz a las FHe reduce el riesgo de APLV frente al uso de fórmulas de inicio (FI). Material y métodos Estudio cuasiexperimental de intervención antes-después durante los periodos 2013 y 2018. En el 2018 se sustituyó el protocolo de suplementación cambiando las FI por FHe. Tras seguimiento clínico durante 2 años se recogieron los datos de los pacientes que participaron voluntariamente: antecedentes personales y familiares de alergia, antecedentes perinatales, tipo de alimentación y suplementación. Resultados Se observó una reducción significativa del 67% del riesgo de APLV en los recién nacidos (RN) expuestos a FHe frente a los expuestos a FI (OR 0,334; IC 95%: 0,174-0,643) y un aumento multiplicado por 15,75 en los expuestos a suplementos de fórmula frente a lactancia materna exclusiva (OR 15,75; IC 95%: 3,81-65,03). La posibilidad de APLV aumentaba cuando el paciente asociaba antecedentes maternos de alergia (OR 3,56; p<0,001) domicilio familiar en un área rural (OR 0,30; p<0,001) o presentaba alergia al huevo (p<0,001). Conclusiones En aquellos RN que pertenezcan a poblaciones de riesgo y que reciban lactancia materna parece razonable el uso de suplementos con FHe durante los primeros días de vida.
Objective: To evaluate the efficacy and safety of second-line therapies in pediatric patients with chronic nonbacterial osteomyelitis (CNO) that responded poorly to nonsteroidal antiinflammatory drugs (NSAIDs) Methods: A systematic review of observational studies, cohort studies, and case series (n = 13) involving patients aged less than 15 years with a diagnosis of CNO. We analyzed clinical and radiological remission rates, safety profiles, and the incidence of adverse events for the different therapeutic regimens. Results: The efficacy of NSAIDs in monotherapy was limited (18-57%). Among second-line therapies, bisphosphonates (particularly pamidronate) and tumor necrosis factor-a inhibitors (TNF inhibitors) achieved the highest response rates, with remission levels between 70% and 91%. Pamidronate proved highly effective for spinal lesions, achieving rapid pain resolution. TNF inhibitors were particularly effective in refractory cases and for the prevention of long-term relapses. The efficacy of disease-modifying antirheumatic drugs (DMARDs) was lower and inconsistent (12-50%). No seriou adverse effects were reported; the most frequent event was flu-like syndrome following the first pamidronate infusion. Conclusions: Bisphosphonates and TNF inhibitors constitute the most effective and safe second-line strategies for the treatment of refractory CNO. Early diagnosis and appropriate therapeutic scaling are essential to achieve complete remission and prevent permanent bone sequelae, such as spinal fractures or deformities. (c) 2026 Published by Elsevier Espana, S.L.U. on behalf of Asociacion Espanola de Pediatr & imath;a. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
Neonatal mechanical ventilation is a cornerstone in the management of respiratory failure in newborns (NBs), particularly in preterm infants, in whom pulmonary and neurologic increases their vulnerability to ventilation-induced lung injury. At present, the primary objective of respiratory support is to ensure adequate ventilation while minimizing lung and brain injury through lung-protective strategies and careful oxygen titration. Noninvasive ventilation (NIV) is currently the first-line approach for both initial respiratory support and post-extubation care, as it reduces the need for invasive ventilation and the incidence of ventilator-induced lung injury. Multiple modalities and devices are available, and their selection should be individualized according to the underlying disease, gestational age, and clinical response. The selection of the appropriate interface and ventilatory settings and patient-ventilator synchronization are of utmost importance. Noninvasive ventilation failure should be preceded by systematic optimization and requires well-defined criteria for timely therapeutic escalation. Conventional mechanical ventilation continues to be necessary in more severe cases. Its use should be synchronized and volume-targeted whenever possible, as this strategy has been shown to reduce major complications such as pneumothorax, intraventricular hemorrhage, and the composite outcome of death or bronchopulmonary dysplasia. High-frequency oscillatory ventilation serves as a rescue strategy in refractory cases and selected clinical condition, relying on the maintenance of lung recruitment with extremely low tidal volumes. Finally, ventilatory management of the most common neonatal respiratory conditions-such as respiratory distress syndrome, meconium aspiration syndrome, air leak syndrome, and bronchopulmonary dysplasia--requires a dynamic, individualized approach focused on lung protection from the earliest hours of life. (c) 2026 Asociacion Espanola de Pediatr & imath;a. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
