Acta Pediátrica Española

ISSN 2014-2986
Volumen 67 - Número 1 - Enero 2009

Enuresis nocturna: una propuesta para optimizar su manejo (I y II)

La enuresis es un importante problema clínico, familiar y social. Se trata de una condición infradiagnosticada, en la que no se valora de manera suficiente su repercusión emocional y sobre la calidad de vida del niño. En esta monografía, dividida en dos partes, se destacan algunos aspectos clave de esta entidad y la importancia de su detección en las consultas de pediatría de Atención Primaria y su manejo correcto.

Las alteraciones en el sueño en niños y adolescentes, asociadas al uso inadecuado de dispositivos digitales pueden provocar elevadas tasas de depresión y otros problemas de salud como obesidad, disminución del rendimiento académico y otras conductas de riesgo.

Hoy en día existe una amplia variedad de dispositivos digitales cuyo uso inadecuado puede provocar cambios en los hábitos cotidianos de niños, jóvenes y adultos. De hecho, ya se está hablando de insomnio tecnológico, un trastorno del sueño propio de nuestra época vinculado al uso de la tecnología, y que probablemente se convertirá en uno de los principales retos que habrá que afrontar en un futuro.

Por esa razón, Blemil plus Optimum y Blevit Optimum, las marcas de nutrición infantil de Laboratorios Ordesa, han agrupado en la guía Los efectos de las nuevas tecnologías en la salud infantil consejos prácticos y recomendaciones destinadas a pediatras para favorecer un uso adecuado de los dispositivos tecnológicos y unos hábitos saludables de descanso durante la infancia y la adolescencia, además de incluir información científica y rigurosa sobre las principales patologías asociadas como problemas de sueño, dolor de cabeza, alteraciones visuales, trastornos neuropsiquiátricos y psicológicos, molestias musculoesqueléticas u obesidad.

El consumo de todo tipo de dispositivos durante todo el día, especialmente antes de ir a dormir, conlleva consecuencias sobre la salud que es importante conocer para realizar una apropiada prevención. Un 75% de los niños/as y el 60% de los adolescentes utiliza habitualmente pantallas una hora antes de dormir, y el 62,9% de los niños y adolescentes tienen el móvil permanentemente conectado, incluso por la noche.

Entre los principales efectos negativos del uso inadecuado de dispositivos tecnológicos destaca la reducción de horas de sueño, que afecta al 30% de los niños/as en edad preescolar y al 50- 90% de los escolares de más de 6 años y/o adolescentes, provocando que no duerman la cantidad de horas requeridas para un buen desarrollo. Por otro lado, un uso excesivo puede producir molestias como dolor de cabeza, ya que los niños y adolescentes se consideran más vulnerables al efecto negativo de los campos electromagnéticos debido a su inmadurez cerebral. También puede afectar a la salud visual, favoreciendo la aparición de visión borrosa, doble visión, sequedad e irritación visual, que puede degenerar en problemas de salud ocular a largo plazo, así como una merma del rendimiento académico.

Además, se ha comprobado que las alteraciones en el sueño de niños y adolescentes asociadas al uso inadecuado de dispositivos digitales pueden favorecer elevadas tasas de depresión y otros problemas emocionales, obesidad a causa de la inactividad física y el sedentarismo, una disminución del rendimiento académico y la aparición de otras conductas de riesgo.

Novartis ha anunciado que el Comité de Medicamentos de Uso Humano (CHMP) de la Agencia Europea de Medicamentos (EMA) ha adoptado una opinión positiva para Cosentyx® (secukinumab) para el tratamiento de la psoriasis en placas moderada/grave en niños y adolescentes de 6 a <18 años.

Información adicional

  • Num_publicacion 78(3-4)
  • Palabras_clave_ingles
  • Todos_autores Coordinación: Dra. María José Galiano Segovia
  • autores listados Coordinación: Dra. María José Galiano Segovia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e194
  • copyright ©2020 Ediciones Mayo, S.A.
  • Tipo de Artículo Clínico (Microdatos) Abstracts

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: After making some points −not sufficiently clarified in the feeding guides− we have resorted to the traditional Mediterranean diet and we have measured the anthropometric values at the beginning and at the end of the study, in patients who made a reasonably correct compliance with the guidelines, and even so they were overweight and obese.
    Patients and methods: Children aged 2 to 8 years with overweight and obesity were included in a nutritional education program called «Learning to eat from the Mediterranean». To evaluate the quality of the diet, we used the Kidmed test and to measure the new proposals we designed the test Traditional Mediterranean Diet.
    Results: A sample of 92 patients was obtained (42 girls and 50 boys). The average age was 5.3 years. After one year of intervention, 75.7% were no longer obese and 74.3% stopped being overweight. Overall, the BMI percentile fell 12.1 points. An improvement in the quality of the food reflected in a better score of both indices was achieved. The Kidmed test was not appropriate for the control of overweight.
    Conclusions: The application of a traditional Mediterranean diet pattern in the family environment has been very effective in the control of overweight or obese children. We believe that compliance with the Traditional Mediterranean Diet test along with the nutritional program «Learning to eat from the Mediterranean» have been key in the results.

  • Palabras_clave_ingles Childhood obesity child overweight body mass index glycemic index fat mass dietary intervention primary care
  • Todos_autores F. M. Calatayud-Sáez1, B. Calatayud Moscoso del Prado2
  • autores listados F. M. Calatayud-Sáez, B. Calatayud Moscoso del Prado
  • Correspondecia

    Correspondencia: F.M. Calatayud Sáez. Clínica Infanto-Juvenil La Palma. C/Palma, 17, bajo A. 13001 Ciudad Real. Correo electrónico: altayud@gmail.com

  • Titulo_ingles Efficacy of the recommendation of a Mediterranean diet pattern in preschoolers with overweight and obesity
  • Centros_trabajo 1Pediatra. 2Nutricionista. Clínica Infanto-Juvenil La Palma. Ciudad Real
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e101-e110
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 22/10/18
  • Fecha aceptacion 10/12/18
  • Tipo de Artículo Clínico (Microdatos) Evaluation Studies

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Background: Hyperleukocytosis and pulmonary hypertension are risk factors for death in infants with severe pertussis. Treatment options in severe pertussis are not well-established.
    Methods: We designed an ambispective study of children with pertussis admitted to the pediatric intensive care unit (PICU) of a tertiary level hospital in Spain from January 2007 to October 2015. Clinical and demographical variables were compared between the group of children who survived (survivors group or SG) and those children who died (exitus group or EG).
    Results: Thirty-one children were identified. Overall mortality rate was 19% (6/31 patients). Five children had pulmonary hypertension. Five out of 6 infants who eventually died had been placed on ECMO. Eight infants needed exchange transfusion (ET). Median leukocyte count immediately before exchange transfusion was higher (81300 cél./μL) in EG than in SG (57400 cél./μL), p= 0.05. Children who died had higher peak values in white blood cell counts (WBC), lymphocyte count, neutrophil counts and PCR levels than children who survived. The following variables were associated with risk of death: a heart rate above 170 bpm (OR 18, CI 95%: 1.7-192,0), the presence of pneumonia (OR 16.5, CI 95%: 1.7-165) and pulmonary hypertension (OR 179,6 [6,4-5027].
    Conclusion: Early identification of patients at risk for pulmonary hypertension and fatal pertussis using heart rate, WBC and PCR levels would be appropriate so that invasive procedures such as exchange transfusion could be carried out precociously.

  • Palabras_clave_ingles Pertussis risk mortality intensive care exchange transfusion
  • Todos_autores E. López Fernández1, J. Ruiz Contreras2, S. Belda Hofheinz3, F. Gómez Sáez4, J.I. Sánchez Díaz3, P. Rojo Conejo2, M.P. Cedena Pilar5, D. Blázquez Gamero2
  • autores listados E. López Fernández, J. Ruiz Contreras, S. Belda Hofheinz, F. Gómez Sáez, J.I. Sánchez Díaz, P. Rojo Conejo, M.P. Cedena Pilar, D. Blázquez Gamero
  • Correspondecia

    Correspondencia: E. López Fernández. Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario 12 de Octubre. Avenida de Córdoba, s/n. 28048 Madrid.
    Correo electrónico: elopezfernandez@salud.madrid.org

  • Titulo_ingles Mortality risk factors in children with severe pertussis
  • Centros_trabajo 1MD. Unidad de Cuidados Intensivos Pediátricos. 2MD, PhD. Departamento de Enfermedades Infecciosas Pediátricas. 3MD, PhD. Unidad de Cuidados Intensivos Pediátricos. Hospital 12 de Octubre. Madrid. 4MD. Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario de Burgos. 5MD. Pediatría General. Hospital 12 de Octubre. Madrid
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e1-e7
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 12/04/19
  • Fecha aceptacion 10/05/20
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: Central line associated bloodstream infections increase mortality in neonates. Chlorhexidine is a wide spectrum antiseptic that decreases bacterial colonization and central line infection in newborns. We compared central line associated bloodstream infection rate in neonates with chlorhexidine wipes and neonates with conventional hygiene measures.
    Methodology: A prospective, nonrandomized experimental study was carried out, including all neonates with intravascular device of central location who were in the intensive and intermediate neonatal care unit of the General Hospital of Medellín. In the experimental group, a disposable towel impregnated with 2% aqueous chlorhexidine was implemented per patient, without removing or rinsing the product; the control group received the traditional bath. The clean-up started after the first day of life and the frequency was inter-day independent of weight or gestational age. The study time was six months, during August 2017 to January 2018; in the first three the bath was carried out with chlorhexidine and in the last the conventional care.
    Results: A total of 133 patients participated, 61 experimental group and 72 control group. In the median birth weight (1960 and 1927 grams) there was no significant difference (p= 0.905) between both groups. The experimental group had more patients with mechanical ventilation (42.6% vs. 15.35) with significant difference (p= 0.001). There was no difference in the median length of hospital stay and the length of the catheter stay (p= 0.189 and 0.246). The rate of infection of the bloodstream was reduced from 5.1 to 3.8 per 1,000 catheter days (p= 1.0); the most commonly isolated germ being methicillin-sensitive Staphylococcus aureus. In the secondary analysis, the intra-abdominal intervention and the multiple central vascular accesses were predictors of infection associated with the catheter.
    Conclusions: Cutaneous cleansing with 2% aqueous chlorhexidine is a measure that can contribute to reduce the rates of catheter-associated infection. It was also safe in neonates older than 25 weeks and weighing more than 650 grams from the second day of life.

  • Palabras_clave_ingles Chlorhexidine neonate central line associated bloodstream infection
  • Todos_autores L.M. Castaño-Jaramillo1, M.I. Saldarriaga-Betancur1, A. Gómez1, L.M. Medina-Escobar1, A. Muñoz-Villa1, A. Díaz-Díaz1, V.M. González-Gómez2, J. Bareño-Silva1, M. Fernández-Laverde1
  • autores listados L.M. Castaño-Jaramillo, M.I. Saldarriaga-Betancur, A. Gómez, L.M. Medina-Escobar, A. Muñoz-Villa, A. Díaz-Díaz, V.M. González-Gómez, J. Bareño-Silva, M. Fernández-Laverde
  • Correspondecia

    Correspondencia: M. Fernández-Laverde. Facultad de Medicina. Universidad CES. c/10 A, 22-04. Medellín (Colombia). Correo electrónico: clorhexidinaneonatos@gmail.com

  • Titulo_ingles Changes in central line associated bloodstream infection rates and related factors in a neonatal unit with the use of chlorhexidine wipes
  • Centros_trabajo 1Universidad CES. 2Hospital General de Medellín. Colombia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e8-e16
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 12/02/19
  • Fecha aceptacion 16/05/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: Achalasia is a rare disease in pediatric patients. Its treatment is based on surgery even though there's no consensus about which the best technique is. The aim of this review is analyze the etiology and management of achalasia regarding to our case series.
    Material and methods: We report a retrospective cohort of younger than 18 years old patients diagnosed with achalasia from 1986 to 2018. Data on epidemiology, clinical signs, etiology, complementary tests, treatment, relapses and monitoring was collected.
    Results: Eight patients with achalasia were identified (incidence of 0,19 cases per 100.000 per year; median age of 13 years old). Seven patients developed dysphagia (87,5%), four vomiting (62,5%), four retrosternal chest pain (62,5%), two gastroesophageal reflux manifestations (25%) and three patients presented cough (37,5%). We found two cases with Allgrove syndrome disease. All patients were diagnosed using esophagography and esophagus manometry (in most cases high resolution manometry), with a median of 6.5 months from the symptoms onset. The first treatment in all cases was laparoscopic Heller myotomy. We used pneumatic dilatation for the two patients that relapsed (25%). A favorable outcome was observed in 87.5% of cases.
    Conclusions: We found a similar incidence as previous reports in literature. According to our series, vomiting is a late onset manifestation of the disease. We have described for the first time two patients with Allgrove syndrome related to c. 655A>T mutation. The diagnosis is based on esophagography and esophagus manometry. Laparoscopic Heller myotomy is currently the first line therapy, being the pneumatic dilatation reserved for refractory cases.

  • Palabras_clave_ingles Achalasia dysphagia Allgrove syndrome esophagus manometry Heller myotomy
  • Todos_autores . Francia Güil1, M. Oviedo Gutiérrez2, A. Manzanares Quintela2, J. Serra Pueyo3, I. Blanco Guillermo4, M.M. Montraveta Querol1,3
  • autores listados I. Francia Güil, M. Oviedo Gutiérrez, A. Manzanares Quintela, J. Serra Pueyo, I. Blanco Guillermo, M.M. Montraveta Querol
  • Correspondecia

    Correspondencia: I. Francia Güil. Hospital Universitari Germans Trias i Pujol. Carretera de Canyet, s/n. 08916 Badalona (Barcelona).
    Correo electrónico: ifrancia.germanstrias@gencat.cat

  • Titulo_ingles Pediatric achalasia review: a case series in a third-level hospital
  • Centros_trabajo 1Departamento de Pediatría. 2Departamento de Cirugía Pediátrica. 3Departamento de Digestología Pediátrica. 4Departamento de Genética Clínica. Hospital Universitari Germans Trias i Pujol. Badalona (Barcelona)
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e17-e24
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 22/01/19
  • Fecha aceptacion 29/06/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: The detection of inborn errors of metabolism (IEM), endocrinopathies, hemoglobinopathies, and other disorders through newborn screening (NBS) is a global health initiative that began until 1973 in Mexico. The national incidence of this group of diseases is uncertain due to the lack of NBS programs and related publications. For the present manuscript, the incidence of a specific group of IEM, endocrinopathies, hemoglobinopathies, and other disorders in newborns was estimated from an NBS program implemented in a private group of hospitals part of Grupo Christus Muguerza located northeast of Mexico.
    Material and methods: This retrospective study included the examination of 19,768 newborns’ results obtained from the NBS program from March 2006 to February 2017.
    Results: The NBS program found 60 newborns with an IEM or other disorder and 104 were identified as carriers, with an incidence of 30.4 and 52.7 per 10,000 newborns, respectively. The most frequent diagnosis was glucose-6-phosphate dehydrogenase deficiency (G6PD); and in the case of carriers, were hemoglobinopathies. The combination of screening technologies showed a specificity of 99.95%, a sensitivity close to 100%, and a positive predictive value of 86.96%.
    Conclusions: The benefit of an NBS program is to stablish an early diagnosis to offer prompt treatment and proper genetic counseling. Furthermore, these results provide an estimation of IEM, endocrinopathies, hemoglobinopathies, and other disorders incidence in a group of private hospitals in Mexico.

  • Palabras_clave_ingles Neonatal screening incidence Mexico inborn errors of metabolism
  • Todos_autores H. Cruz-Camino1,5, E.A. Martínez Cervantes1-3, C. Cantú-Reyna1,4, D.L. Vázquez-Cantu1,4, A. Zea-Rey1, R. Gómez Gutiérrez1,2, J.A. Vera Delgado2
  • autores listados H. Cruz-Camino, E.A. Martínez Cervantes, C. Cantú-Reyna, D.L. Vázquez-Cantu, A. Zea-Rey, R. Gómez Gutiérrez, J.A. Vera Delgado
  • Correspondecia

    Correspondencia: C. Cantú-Reyna. Av. Cerro de las Mitras, 2411. Colonia Obispado, Monterrey. Nuevo León, México. CP 64060.
    Correo electrónico: cocantu@genomi-k.com

  • Titulo_ingles Incidence of inborn errors of metabolism and other diseases detected in a newborn screening program within a group of Mexican private hospitals
  • Centros_trabajo 1Genomi-k S.A.P.I. de C.V., Monterrey. Nuevo León. México. 2Christus Muguerza Sistemas Hospitalarios. México. 3Universidad de Monterrey. Monterrey. Nuevo León. México. 4Tecnológico de Monterrey. Escuela de Medicina y Ciencias de la Salud. Monterrey. Nuevo León. México. 5Tecnológico de Monterrey. Escuela de Ingeniería y Ciencias. Monterrey. Nuevo León. México
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e25-e32
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 01/07/19
  • Fecha aceptacion 02/10/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Erythema nodosum is a delayed-type hipersensitivity reaction that presents as erythematous and painful nodules on the shins. It can appear as an uncommon complication of cat scratch disease produced by Bartonella henselae.
    A rare case of erythema nodosum associated to cat scratch disease was diagnosed in our hospital. Its diagnostic, therapeutic management and evolution is reported.
    We have found in previous literature just a single case of association between erythema nodosum and cat scratch disease in a pediatric patient.

  • Palabras_clave_ingles Erythema nodosum Bartonella henselae cat scratch disease
  • Todos_autores D. Bernad Mechó, R. Pina Pérez, A. Piqueras Arenas, M. Oltra Benavent
  • autores listados D. Bernad Mechó, R. Pina Pérez, A. Piqueras Arenas, M. Oltra Benavent
  • Titulo_ingles Erythema nodosum as an atypical presentation of cat scratch disease: presentation of a clinical case and bibliographic review
  • Centros_trabajo Departamento de Pediatría Infecciosa. Hospital Universitari i Politècnic La Fe. Valencia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e190-e193
  • copyright ©2020 Ediciones Mayo, S.A.
  • Tipo de Artículo Clínico (Microdatos) Case Reports

Enuresis nocturna: una propuesta para optimizar su manejo (I y II)

La enuresis es un importante problema clínico, familiar y social. Se trata de una condición infradiagnosticada, en la que no se valora de manera suficiente su repercusión emocional y sobre la calidad de vida del niño. En esta monografía, dividida en dos partes, se destacan algunos aspectos clave de esta entidad y la importancia de su detección en las consultas de pediatría de Atención Primaria y su manejo correcto.

Las alteraciones en el sueño en niños y adolescentes, asociadas al uso inadecuado de dispositivos digitales pueden provocar elevadas tasas de depresión y otros problemas de salud como obesidad, disminución del rendimiento académico y otras conductas de riesgo.

Hoy en día existe una amplia variedad de dispositivos digitales cuyo uso inadecuado puede provocar cambios en los hábitos cotidianos de niños, jóvenes y adultos. De hecho, ya se está hablando de insomnio tecnológico, un trastorno del sueño propio de nuestra época vinculado al uso de la tecnología, y que probablemente se convertirá en uno de los principales retos que habrá que afrontar en un futuro.

Por esa razón, Blemil plus Optimum y Blevit Optimum, las marcas de nutrición infantil de Laboratorios Ordesa, han agrupado en la guía Los efectos de las nuevas tecnologías en la salud infantil consejos prácticos y recomendaciones destinadas a pediatras para favorecer un uso adecuado de los dispositivos tecnológicos y unos hábitos saludables de descanso durante la infancia y la adolescencia, además de incluir información científica y rigurosa sobre las principales patologías asociadas como problemas de sueño, dolor de cabeza, alteraciones visuales, trastornos neuropsiquiátricos y psicológicos, molestias musculoesqueléticas u obesidad.

El consumo de todo tipo de dispositivos durante todo el día, especialmente antes de ir a dormir, conlleva consecuencias sobre la salud que es importante conocer para realizar una apropiada prevención. Un 75% de los niños/as y el 60% de los adolescentes utiliza habitualmente pantallas una hora antes de dormir, y el 62,9% de los niños y adolescentes tienen el móvil permanentemente conectado, incluso por la noche.

Entre los principales efectos negativos del uso inadecuado de dispositivos tecnológicos destaca la reducción de horas de sueño, que afecta al 30% de los niños/as en edad preescolar y al 50- 90% de los escolares de más de 6 años y/o adolescentes, provocando que no duerman la cantidad de horas requeridas para un buen desarrollo. Por otro lado, un uso excesivo puede producir molestias como dolor de cabeza, ya que los niños y adolescentes se consideran más vulnerables al efecto negativo de los campos electromagnéticos debido a su inmadurez cerebral. También puede afectar a la salud visual, favoreciendo la aparición de visión borrosa, doble visión, sequedad e irritación visual, que puede degenerar en problemas de salud ocular a largo plazo, así como una merma del rendimiento académico.

Además, se ha comprobado que las alteraciones en el sueño de niños y adolescentes asociadas al uso inadecuado de dispositivos digitales pueden favorecer elevadas tasas de depresión y otros problemas emocionales, obesidad a causa de la inactividad física y el sedentarismo, una disminución del rendimiento académico y la aparición de otras conductas de riesgo.

Novartis ha anunciado que el Comité de Medicamentos de Uso Humano (CHMP) de la Agencia Europea de Medicamentos (EMA) ha adoptado una opinión positiva para Cosentyx® (secukinumab) para el tratamiento de la psoriasis en placas moderada/grave en niños y adolescentes de 6 a <18 años.

Información adicional

  • Num_publicacion 78(3-4)
  • Palabras_clave_ingles
  • Todos_autores Coordinación: Dra. María José Galiano Segovia
  • autores listados Coordinación: Dra. María José Galiano Segovia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e194
  • copyright ©2020 Ediciones Mayo, S.A.
  • Tipo de Artículo Clínico (Microdatos) Abstracts

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: After making some points −not sufficiently clarified in the feeding guides− we have resorted to the traditional Mediterranean diet and we have measured the anthropometric values at the beginning and at the end of the study, in patients who made a reasonably correct compliance with the guidelines, and even so they were overweight and obese.
    Patients and methods: Children aged 2 to 8 years with overweight and obesity were included in a nutritional education program called «Learning to eat from the Mediterranean». To evaluate the quality of the diet, we used the Kidmed test and to measure the new proposals we designed the test Traditional Mediterranean Diet.
    Results: A sample of 92 patients was obtained (42 girls and 50 boys). The average age was 5.3 years. After one year of intervention, 75.7% were no longer obese and 74.3% stopped being overweight. Overall, the BMI percentile fell 12.1 points. An improvement in the quality of the food reflected in a better score of both indices was achieved. The Kidmed test was not appropriate for the control of overweight.
    Conclusions: The application of a traditional Mediterranean diet pattern in the family environment has been very effective in the control of overweight or obese children. We believe that compliance with the Traditional Mediterranean Diet test along with the nutritional program «Learning to eat from the Mediterranean» have been key in the results.

  • Palabras_clave_ingles Childhood obesity child overweight body mass index glycemic index fat mass dietary intervention primary care
  • Todos_autores F. M. Calatayud-Sáez1, B. Calatayud Moscoso del Prado2
  • autores listados F. M. Calatayud-Sáez, B. Calatayud Moscoso del Prado
  • Correspondecia

    Correspondencia: F.M. Calatayud Sáez. Clínica Infanto-Juvenil La Palma. C/Palma, 17, bajo A. 13001 Ciudad Real. Correo electrónico: altayud@gmail.com

  • Titulo_ingles Efficacy of the recommendation of a Mediterranean diet pattern in preschoolers with overweight and obesity
  • Centros_trabajo 1Pediatra. 2Nutricionista. Clínica Infanto-Juvenil La Palma. Ciudad Real
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e101-e110
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 22/10/18
  • Fecha aceptacion 10/12/18
  • Tipo de Artículo Clínico (Microdatos) Evaluation Studies

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Background: Hyperleukocytosis and pulmonary hypertension are risk factors for death in infants with severe pertussis. Treatment options in severe pertussis are not well-established.
    Methods: We designed an ambispective study of children with pertussis admitted to the pediatric intensive care unit (PICU) of a tertiary level hospital in Spain from January 2007 to October 2015. Clinical and demographical variables were compared between the group of children who survived (survivors group or SG) and those children who died (exitus group or EG).
    Results: Thirty-one children were identified. Overall mortality rate was 19% (6/31 patients). Five children had pulmonary hypertension. Five out of 6 infants who eventually died had been placed on ECMO. Eight infants needed exchange transfusion (ET). Median leukocyte count immediately before exchange transfusion was higher (81300 cél./μL) in EG than in SG (57400 cél./μL), p= 0.05. Children who died had higher peak values in white blood cell counts (WBC), lymphocyte count, neutrophil counts and PCR levels than children who survived. The following variables were associated with risk of death: a heart rate above 170 bpm (OR 18, CI 95%: 1.7-192,0), the presence of pneumonia (OR 16.5, CI 95%: 1.7-165) and pulmonary hypertension (OR 179,6 [6,4-5027].
    Conclusion: Early identification of patients at risk for pulmonary hypertension and fatal pertussis using heart rate, WBC and PCR levels would be appropriate so that invasive procedures such as exchange transfusion could be carried out precociously.

  • Palabras_clave_ingles Pertussis risk mortality intensive care exchange transfusion
  • Todos_autores E. López Fernández1, J. Ruiz Contreras2, S. Belda Hofheinz3, F. Gómez Sáez4, J.I. Sánchez Díaz3, P. Rojo Conejo2, M.P. Cedena Pilar5, D. Blázquez Gamero2
  • autores listados E. López Fernández, J. Ruiz Contreras, S. Belda Hofheinz, F. Gómez Sáez, J.I. Sánchez Díaz, P. Rojo Conejo, M.P. Cedena Pilar, D. Blázquez Gamero
  • Correspondecia

    Correspondencia: E. López Fernández. Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario 12 de Octubre. Avenida de Córdoba, s/n. 28048 Madrid.
    Correo electrónico: elopezfernandez@salud.madrid.org

  • Titulo_ingles Mortality risk factors in children with severe pertussis
  • Centros_trabajo 1MD. Unidad de Cuidados Intensivos Pediátricos. 2MD, PhD. Departamento de Enfermedades Infecciosas Pediátricas. 3MD, PhD. Unidad de Cuidados Intensivos Pediátricos. Hospital 12 de Octubre. Madrid. 4MD. Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario de Burgos. 5MD. Pediatría General. Hospital 12 de Octubre. Madrid
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e1-e7
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 12/04/19
  • Fecha aceptacion 10/05/20
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: Central line associated bloodstream infections increase mortality in neonates. Chlorhexidine is a wide spectrum antiseptic that decreases bacterial colonization and central line infection in newborns. We compared central line associated bloodstream infection rate in neonates with chlorhexidine wipes and neonates with conventional hygiene measures.
    Methodology: A prospective, nonrandomized experimental study was carried out, including all neonates with intravascular device of central location who were in the intensive and intermediate neonatal care unit of the General Hospital of Medellín. In the experimental group, a disposable towel impregnated with 2% aqueous chlorhexidine was implemented per patient, without removing or rinsing the product; the control group received the traditional bath. The clean-up started after the first day of life and the frequency was inter-day independent of weight or gestational age. The study time was six months, during August 2017 to January 2018; in the first three the bath was carried out with chlorhexidine and in the last the conventional care.
    Results: A total of 133 patients participated, 61 experimental group and 72 control group. In the median birth weight (1960 and 1927 grams) there was no significant difference (p= 0.905) between both groups. The experimental group had more patients with mechanical ventilation (42.6% vs. 15.35) with significant difference (p= 0.001). There was no difference in the median length of hospital stay and the length of the catheter stay (p= 0.189 and 0.246). The rate of infection of the bloodstream was reduced from 5.1 to 3.8 per 1,000 catheter days (p= 1.0); the most commonly isolated germ being methicillin-sensitive Staphylococcus aureus. In the secondary analysis, the intra-abdominal intervention and the multiple central vascular accesses were predictors of infection associated with the catheter.
    Conclusions: Cutaneous cleansing with 2% aqueous chlorhexidine is a measure that can contribute to reduce the rates of catheter-associated infection. It was also safe in neonates older than 25 weeks and weighing more than 650 grams from the second day of life.

  • Palabras_clave_ingles Chlorhexidine neonate central line associated bloodstream infection
  • Todos_autores L.M. Castaño-Jaramillo1, M.I. Saldarriaga-Betancur1, A. Gómez1, L.M. Medina-Escobar1, A. Muñoz-Villa1, A. Díaz-Díaz1, V.M. González-Gómez2, J. Bareño-Silva1, M. Fernández-Laverde1
  • autores listados L.M. Castaño-Jaramillo, M.I. Saldarriaga-Betancur, A. Gómez, L.M. Medina-Escobar, A. Muñoz-Villa, A. Díaz-Díaz, V.M. González-Gómez, J. Bareño-Silva, M. Fernández-Laverde
  • Correspondecia

    Correspondencia: M. Fernández-Laverde. Facultad de Medicina. Universidad CES. c/10 A, 22-04. Medellín (Colombia). Correo electrónico: clorhexidinaneonatos@gmail.com

  • Titulo_ingles Changes in central line associated bloodstream infection rates and related factors in a neonatal unit with the use of chlorhexidine wipes
  • Centros_trabajo 1Universidad CES. 2Hospital General de Medellín. Colombia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e8-e16
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 12/02/19
  • Fecha aceptacion 16/05/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: Achalasia is a rare disease in pediatric patients. Its treatment is based on surgery even though there's no consensus about which the best technique is. The aim of this review is analyze the etiology and management of achalasia regarding to our case series.
    Material and methods: We report a retrospective cohort of younger than 18 years old patients diagnosed with achalasia from 1986 to 2018. Data on epidemiology, clinical signs, etiology, complementary tests, treatment, relapses and monitoring was collected.
    Results: Eight patients with achalasia were identified (incidence of 0,19 cases per 100.000 per year; median age of 13 years old). Seven patients developed dysphagia (87,5%), four vomiting (62,5%), four retrosternal chest pain (62,5%), two gastroesophageal reflux manifestations (25%) and three patients presented cough (37,5%). We found two cases with Allgrove syndrome disease. All patients were diagnosed using esophagography and esophagus manometry (in most cases high resolution manometry), with a median of 6.5 months from the symptoms onset. The first treatment in all cases was laparoscopic Heller myotomy. We used pneumatic dilatation for the two patients that relapsed (25%). A favorable outcome was observed in 87.5% of cases.
    Conclusions: We found a similar incidence as previous reports in literature. According to our series, vomiting is a late onset manifestation of the disease. We have described for the first time two patients with Allgrove syndrome related to c. 655A>T mutation. The diagnosis is based on esophagography and esophagus manometry. Laparoscopic Heller myotomy is currently the first line therapy, being the pneumatic dilatation reserved for refractory cases.

  • Palabras_clave_ingles Achalasia dysphagia Allgrove syndrome esophagus manometry Heller myotomy
  • Todos_autores . Francia Güil1, M. Oviedo Gutiérrez2, A. Manzanares Quintela2, J. Serra Pueyo3, I. Blanco Guillermo4, M.M. Montraveta Querol1,3
  • autores listados I. Francia Güil, M. Oviedo Gutiérrez, A. Manzanares Quintela, J. Serra Pueyo, I. Blanco Guillermo, M.M. Montraveta Querol
  • Correspondecia

    Correspondencia: I. Francia Güil. Hospital Universitari Germans Trias i Pujol. Carretera de Canyet, s/n. 08916 Badalona (Barcelona).
    Correo electrónico: ifrancia.germanstrias@gencat.cat

  • Titulo_ingles Pediatric achalasia review: a case series in a third-level hospital
  • Centros_trabajo 1Departamento de Pediatría. 2Departamento de Cirugía Pediátrica. 3Departamento de Digestología Pediátrica. 4Departamento de Genética Clínica. Hospital Universitari Germans Trias i Pujol. Badalona (Barcelona)
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e17-e24
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 22/01/19
  • Fecha aceptacion 29/06/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: The detection of inborn errors of metabolism (IEM), endocrinopathies, hemoglobinopathies, and other disorders through newborn screening (NBS) is a global health initiative that began until 1973 in Mexico. The national incidence of this group of diseases is uncertain due to the lack of NBS programs and related publications. For the present manuscript, the incidence of a specific group of IEM, endocrinopathies, hemoglobinopathies, and other disorders in newborns was estimated from an NBS program implemented in a private group of hospitals part of Grupo Christus Muguerza located northeast of Mexico.
    Material and methods: This retrospective study included the examination of 19,768 newborns’ results obtained from the NBS program from March 2006 to February 2017.
    Results: The NBS program found 60 newborns with an IEM or other disorder and 104 were identified as carriers, with an incidence of 30.4 and 52.7 per 10,000 newborns, respectively. The most frequent diagnosis was glucose-6-phosphate dehydrogenase deficiency (G6PD); and in the case of carriers, were hemoglobinopathies. The combination of screening technologies showed a specificity of 99.95%, a sensitivity close to 100%, and a positive predictive value of 86.96%.
    Conclusions: The benefit of an NBS program is to stablish an early diagnosis to offer prompt treatment and proper genetic counseling. Furthermore, these results provide an estimation of IEM, endocrinopathies, hemoglobinopathies, and other disorders incidence in a group of private hospitals in Mexico.

  • Palabras_clave_ingles Neonatal screening incidence Mexico inborn errors of metabolism
  • Todos_autores H. Cruz-Camino1,5, E.A. Martínez Cervantes1-3, C. Cantú-Reyna1,4, D.L. Vázquez-Cantu1,4, A. Zea-Rey1, R. Gómez Gutiérrez1,2, J.A. Vera Delgado2
  • autores listados H. Cruz-Camino, E.A. Martínez Cervantes, C. Cantú-Reyna, D.L. Vázquez-Cantu, A. Zea-Rey, R. Gómez Gutiérrez, J.A. Vera Delgado
  • Correspondecia

    Correspondencia: C. Cantú-Reyna. Av. Cerro de las Mitras, 2411. Colonia Obispado, Monterrey. Nuevo León, México. CP 64060.
    Correo electrónico: cocantu@genomi-k.com

  • Titulo_ingles Incidence of inborn errors of metabolism and other diseases detected in a newborn screening program within a group of Mexican private hospitals
  • Centros_trabajo 1Genomi-k S.A.P.I. de C.V., Monterrey. Nuevo León. México. 2Christus Muguerza Sistemas Hospitalarios. México. 3Universidad de Monterrey. Monterrey. Nuevo León. México. 4Tecnológico de Monterrey. Escuela de Medicina y Ciencias de la Salud. Monterrey. Nuevo León. México. 5Tecnológico de Monterrey. Escuela de Ingeniería y Ciencias. Monterrey. Nuevo León. México
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e25-e32
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 01/07/19
  • Fecha aceptacion 02/10/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Erythema nodosum is a delayed-type hipersensitivity reaction that presents as erythematous and painful nodules on the shins. It can appear as an uncommon complication of cat scratch disease produced by Bartonella henselae.
    A rare case of erythema nodosum associated to cat scratch disease was diagnosed in our hospital. Its diagnostic, therapeutic management and evolution is reported.
    We have found in previous literature just a single case of association between erythema nodosum and cat scratch disease in a pediatric patient.

  • Palabras_clave_ingles Erythema nodosum Bartonella henselae cat scratch disease
  • Todos_autores D. Bernad Mechó, R. Pina Pérez, A. Piqueras Arenas, M. Oltra Benavent
  • autores listados D. Bernad Mechó, R. Pina Pérez, A. Piqueras Arenas, M. Oltra Benavent
  • Titulo_ingles Erythema nodosum as an atypical presentation of cat scratch disease: presentation of a clinical case and bibliographic review
  • Centros_trabajo Departamento de Pediatría Infecciosa. Hospital Universitari i Politècnic La Fe. Valencia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e190-e193
  • copyright ©2020 Ediciones Mayo, S.A.
  • Tipo de Artículo Clínico (Microdatos) Case Reports

Enuresis nocturna: una propuesta para optimizar su manejo (I y II)

La enuresis es un importante problema clínico, familiar y social. Se trata de una condición infradiagnosticada, en la que no se valora de manera suficiente su repercusión emocional y sobre la calidad de vida del niño. En esta monografía, dividida en dos partes, se destacan algunos aspectos clave de esta entidad y la importancia de su detección en las consultas de pediatría de Atención Primaria y su manejo correcto.

Las alteraciones en el sueño en niños y adolescentes, asociadas al uso inadecuado de dispositivos digitales pueden provocar elevadas tasas de depresión y otros problemas de salud como obesidad, disminución del rendimiento académico y otras conductas de riesgo.

Hoy en día existe una amplia variedad de dispositivos digitales cuyo uso inadecuado puede provocar cambios en los hábitos cotidianos de niños, jóvenes y adultos. De hecho, ya se está hablando de insomnio tecnológico, un trastorno del sueño propio de nuestra época vinculado al uso de la tecnología, y que probablemente se convertirá en uno de los principales retos que habrá que afrontar en un futuro.

Por esa razón, Blemil plus Optimum y Blevit Optimum, las marcas de nutrición infantil de Laboratorios Ordesa, han agrupado en la guía Los efectos de las nuevas tecnologías en la salud infantil consejos prácticos y recomendaciones destinadas a pediatras para favorecer un uso adecuado de los dispositivos tecnológicos y unos hábitos saludables de descanso durante la infancia y la adolescencia, además de incluir información científica y rigurosa sobre las principales patologías asociadas como problemas de sueño, dolor de cabeza, alteraciones visuales, trastornos neuropsiquiátricos y psicológicos, molestias musculoesqueléticas u obesidad.

El consumo de todo tipo de dispositivos durante todo el día, especialmente antes de ir a dormir, conlleva consecuencias sobre la salud que es importante conocer para realizar una apropiada prevención. Un 75% de los niños/as y el 60% de los adolescentes utiliza habitualmente pantallas una hora antes de dormir, y el 62,9% de los niños y adolescentes tienen el móvil permanentemente conectado, incluso por la noche.

Entre los principales efectos negativos del uso inadecuado de dispositivos tecnológicos destaca la reducción de horas de sueño, que afecta al 30% de los niños/as en edad preescolar y al 50- 90% de los escolares de más de 6 años y/o adolescentes, provocando que no duerman la cantidad de horas requeridas para un buen desarrollo. Por otro lado, un uso excesivo puede producir molestias como dolor de cabeza, ya que los niños y adolescentes se consideran más vulnerables al efecto negativo de los campos electromagnéticos debido a su inmadurez cerebral. También puede afectar a la salud visual, favoreciendo la aparición de visión borrosa, doble visión, sequedad e irritación visual, que puede degenerar en problemas de salud ocular a largo plazo, así como una merma del rendimiento académico.

Además, se ha comprobado que las alteraciones en el sueño de niños y adolescentes asociadas al uso inadecuado de dispositivos digitales pueden favorecer elevadas tasas de depresión y otros problemas emocionales, obesidad a causa de la inactividad física y el sedentarismo, una disminución del rendimiento académico y la aparición de otras conductas de riesgo.

Novartis ha anunciado que el Comité de Medicamentos de Uso Humano (CHMP) de la Agencia Europea de Medicamentos (EMA) ha adoptado una opinión positiva para Cosentyx® (secukinumab) para el tratamiento de la psoriasis en placas moderada/grave en niños y adolescentes de 6 a <18 años.

Información adicional

  • Num_publicacion 78(3-4)
  • Palabras_clave_ingles
  • Todos_autores Coordinación: Dra. María José Galiano Segovia
  • autores listados Coordinación: Dra. María José Galiano Segovia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e194
  • copyright ©2020 Ediciones Mayo, S.A.
  • Tipo de Artículo Clínico (Microdatos) Abstracts

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: After making some points −not sufficiently clarified in the feeding guides− we have resorted to the traditional Mediterranean diet and we have measured the anthropometric values at the beginning and at the end of the study, in patients who made a reasonably correct compliance with the guidelines, and even so they were overweight and obese.
    Patients and methods: Children aged 2 to 8 years with overweight and obesity were included in a nutritional education program called «Learning to eat from the Mediterranean». To evaluate the quality of the diet, we used the Kidmed test and to measure the new proposals we designed the test Traditional Mediterranean Diet.
    Results: A sample of 92 patients was obtained (42 girls and 50 boys). The average age was 5.3 years. After one year of intervention, 75.7% were no longer obese and 74.3% stopped being overweight. Overall, the BMI percentile fell 12.1 points. An improvement in the quality of the food reflected in a better score of both indices was achieved. The Kidmed test was not appropriate for the control of overweight.
    Conclusions: The application of a traditional Mediterranean diet pattern in the family environment has been very effective in the control of overweight or obese children. We believe that compliance with the Traditional Mediterranean Diet test along with the nutritional program «Learning to eat from the Mediterranean» have been key in the results.

  • Palabras_clave_ingles Childhood obesity child overweight body mass index glycemic index fat mass dietary intervention primary care
  • Todos_autores F. M. Calatayud-Sáez1, B. Calatayud Moscoso del Prado2
  • autores listados F. M. Calatayud-Sáez, B. Calatayud Moscoso del Prado
  • Correspondecia

    Correspondencia: F.M. Calatayud Sáez. Clínica Infanto-Juvenil La Palma. C/Palma, 17, bajo A. 13001 Ciudad Real. Correo electrónico: altayud@gmail.com

  • Titulo_ingles Efficacy of the recommendation of a Mediterranean diet pattern in preschoolers with overweight and obesity
  • Centros_trabajo 1Pediatra. 2Nutricionista. Clínica Infanto-Juvenil La Palma. Ciudad Real
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e101-e110
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 22/10/18
  • Fecha aceptacion 10/12/18
  • Tipo de Artículo Clínico (Microdatos) Evaluation Studies

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Background: Hyperleukocytosis and pulmonary hypertension are risk factors for death in infants with severe pertussis. Treatment options in severe pertussis are not well-established.
    Methods: We designed an ambispective study of children with pertussis admitted to the pediatric intensive care unit (PICU) of a tertiary level hospital in Spain from January 2007 to October 2015. Clinical and demographical variables were compared between the group of children who survived (survivors group or SG) and those children who died (exitus group or EG).
    Results: Thirty-one children were identified. Overall mortality rate was 19% (6/31 patients). Five children had pulmonary hypertension. Five out of 6 infants who eventually died had been placed on ECMO. Eight infants needed exchange transfusion (ET). Median leukocyte count immediately before exchange transfusion was higher (81300 cél./μL) in EG than in SG (57400 cél./μL), p= 0.05. Children who died had higher peak values in white blood cell counts (WBC), lymphocyte count, neutrophil counts and PCR levels than children who survived. The following variables were associated with risk of death: a heart rate above 170 bpm (OR 18, CI 95%: 1.7-192,0), the presence of pneumonia (OR 16.5, CI 95%: 1.7-165) and pulmonary hypertension (OR 179,6 [6,4-5027].
    Conclusion: Early identification of patients at risk for pulmonary hypertension and fatal pertussis using heart rate, WBC and PCR levels would be appropriate so that invasive procedures such as exchange transfusion could be carried out precociously.

  • Palabras_clave_ingles Pertussis risk mortality intensive care exchange transfusion
  • Todos_autores E. López Fernández1, J. Ruiz Contreras2, S. Belda Hofheinz3, F. Gómez Sáez4, J.I. Sánchez Díaz3, P. Rojo Conejo2, M.P. Cedena Pilar5, D. Blázquez Gamero2
  • autores listados E. López Fernández, J. Ruiz Contreras, S. Belda Hofheinz, F. Gómez Sáez, J.I. Sánchez Díaz, P. Rojo Conejo, M.P. Cedena Pilar, D. Blázquez Gamero
  • Correspondecia

    Correspondencia: E. López Fernández. Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario 12 de Octubre. Avenida de Córdoba, s/n. 28048 Madrid.
    Correo electrónico: elopezfernandez@salud.madrid.org

  • Titulo_ingles Mortality risk factors in children with severe pertussis
  • Centros_trabajo 1MD. Unidad de Cuidados Intensivos Pediátricos. 2MD, PhD. Departamento de Enfermedades Infecciosas Pediátricas. 3MD, PhD. Unidad de Cuidados Intensivos Pediátricos. Hospital 12 de Octubre. Madrid. 4MD. Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario de Burgos. 5MD. Pediatría General. Hospital 12 de Octubre. Madrid
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e1-e7
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 12/04/19
  • Fecha aceptacion 10/05/20
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: Central line associated bloodstream infections increase mortality in neonates. Chlorhexidine is a wide spectrum antiseptic that decreases bacterial colonization and central line infection in newborns. We compared central line associated bloodstream infection rate in neonates with chlorhexidine wipes and neonates with conventional hygiene measures.
    Methodology: A prospective, nonrandomized experimental study was carried out, including all neonates with intravascular device of central location who were in the intensive and intermediate neonatal care unit of the General Hospital of Medellín. In the experimental group, a disposable towel impregnated with 2% aqueous chlorhexidine was implemented per patient, without removing or rinsing the product; the control group received the traditional bath. The clean-up started after the first day of life and the frequency was inter-day independent of weight or gestational age. The study time was six months, during August 2017 to January 2018; in the first three the bath was carried out with chlorhexidine and in the last the conventional care.
    Results: A total of 133 patients participated, 61 experimental group and 72 control group. In the median birth weight (1960 and 1927 grams) there was no significant difference (p= 0.905) between both groups. The experimental group had more patients with mechanical ventilation (42.6% vs. 15.35) with significant difference (p= 0.001). There was no difference in the median length of hospital stay and the length of the catheter stay (p= 0.189 and 0.246). The rate of infection of the bloodstream was reduced from 5.1 to 3.8 per 1,000 catheter days (p= 1.0); the most commonly isolated germ being methicillin-sensitive Staphylococcus aureus. In the secondary analysis, the intra-abdominal intervention and the multiple central vascular accesses were predictors of infection associated with the catheter.
    Conclusions: Cutaneous cleansing with 2% aqueous chlorhexidine is a measure that can contribute to reduce the rates of catheter-associated infection. It was also safe in neonates older than 25 weeks and weighing more than 650 grams from the second day of life.

  • Palabras_clave_ingles Chlorhexidine neonate central line associated bloodstream infection
  • Todos_autores L.M. Castaño-Jaramillo1, M.I. Saldarriaga-Betancur1, A. Gómez1, L.M. Medina-Escobar1, A. Muñoz-Villa1, A. Díaz-Díaz1, V.M. González-Gómez2, J. Bareño-Silva1, M. Fernández-Laverde1
  • autores listados L.M. Castaño-Jaramillo, M.I. Saldarriaga-Betancur, A. Gómez, L.M. Medina-Escobar, A. Muñoz-Villa, A. Díaz-Díaz, V.M. González-Gómez, J. Bareño-Silva, M. Fernández-Laverde
  • Correspondecia

    Correspondencia: M. Fernández-Laverde. Facultad de Medicina. Universidad CES. c/10 A, 22-04. Medellín (Colombia). Correo electrónico: clorhexidinaneonatos@gmail.com

  • Titulo_ingles Changes in central line associated bloodstream infection rates and related factors in a neonatal unit with the use of chlorhexidine wipes
  • Centros_trabajo 1Universidad CES. 2Hospital General de Medellín. Colombia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e8-e16
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 12/02/19
  • Fecha aceptacion 16/05/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: Achalasia is a rare disease in pediatric patients. Its treatment is based on surgery even though there's no consensus about which the best technique is. The aim of this review is analyze the etiology and management of achalasia regarding to our case series.
    Material and methods: We report a retrospective cohort of younger than 18 years old patients diagnosed with achalasia from 1986 to 2018. Data on epidemiology, clinical signs, etiology, complementary tests, treatment, relapses and monitoring was collected.
    Results: Eight patients with achalasia were identified (incidence of 0,19 cases per 100.000 per year; median age of 13 years old). Seven patients developed dysphagia (87,5%), four vomiting (62,5%), four retrosternal chest pain (62,5%), two gastroesophageal reflux manifestations (25%) and three patients presented cough (37,5%). We found two cases with Allgrove syndrome disease. All patients were diagnosed using esophagography and esophagus manometry (in most cases high resolution manometry), with a median of 6.5 months from the symptoms onset. The first treatment in all cases was laparoscopic Heller myotomy. We used pneumatic dilatation for the two patients that relapsed (25%). A favorable outcome was observed in 87.5% of cases.
    Conclusions: We found a similar incidence as previous reports in literature. According to our series, vomiting is a late onset manifestation of the disease. We have described for the first time two patients with Allgrove syndrome related to c. 655A>T mutation. The diagnosis is based on esophagography and esophagus manometry. Laparoscopic Heller myotomy is currently the first line therapy, being the pneumatic dilatation reserved for refractory cases.

  • Palabras_clave_ingles Achalasia dysphagia Allgrove syndrome esophagus manometry Heller myotomy
  • Todos_autores . Francia Güil1, M. Oviedo Gutiérrez2, A. Manzanares Quintela2, J. Serra Pueyo3, I. Blanco Guillermo4, M.M. Montraveta Querol1,3
  • autores listados I. Francia Güil, M. Oviedo Gutiérrez, A. Manzanares Quintela, J. Serra Pueyo, I. Blanco Guillermo, M.M. Montraveta Querol
  • Correspondecia

    Correspondencia: I. Francia Güil. Hospital Universitari Germans Trias i Pujol. Carretera de Canyet, s/n. 08916 Badalona (Barcelona).
    Correo electrónico: ifrancia.germanstrias@gencat.cat

  • Titulo_ingles Pediatric achalasia review: a case series in a third-level hospital
  • Centros_trabajo 1Departamento de Pediatría. 2Departamento de Cirugía Pediátrica. 3Departamento de Digestología Pediátrica. 4Departamento de Genética Clínica. Hospital Universitari Germans Trias i Pujol. Badalona (Barcelona)
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e17-e24
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 22/01/19
  • Fecha aceptacion 29/06/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Introduction: The detection of inborn errors of metabolism (IEM), endocrinopathies, hemoglobinopathies, and other disorders through newborn screening (NBS) is a global health initiative that began until 1973 in Mexico. The national incidence of this group of diseases is uncertain due to the lack of NBS programs and related publications. For the present manuscript, the incidence of a specific group of IEM, endocrinopathies, hemoglobinopathies, and other disorders in newborns was estimated from an NBS program implemented in a private group of hospitals part of Grupo Christus Muguerza located northeast of Mexico.
    Material and methods: This retrospective study included the examination of 19,768 newborns’ results obtained from the NBS program from March 2006 to February 2017.
    Results: The NBS program found 60 newborns with an IEM or other disorder and 104 were identified as carriers, with an incidence of 30.4 and 52.7 per 10,000 newborns, respectively. The most frequent diagnosis was glucose-6-phosphate dehydrogenase deficiency (G6PD); and in the case of carriers, were hemoglobinopathies. The combination of screening technologies showed a specificity of 99.95%, a sensitivity close to 100%, and a positive predictive value of 86.96%.
    Conclusions: The benefit of an NBS program is to stablish an early diagnosis to offer prompt treatment and proper genetic counseling. Furthermore, these results provide an estimation of IEM, endocrinopathies, hemoglobinopathies, and other disorders incidence in a group of private hospitals in Mexico.

  • Palabras_clave_ingles Neonatal screening incidence Mexico inborn errors of metabolism
  • Todos_autores H. Cruz-Camino1,5, E.A. Martínez Cervantes1-3, C. Cantú-Reyna1,4, D.L. Vázquez-Cantu1,4, A. Zea-Rey1, R. Gómez Gutiérrez1,2, J.A. Vera Delgado2
  • autores listados H. Cruz-Camino, E.A. Martínez Cervantes, C. Cantú-Reyna, D.L. Vázquez-Cantu, A. Zea-Rey, R. Gómez Gutiérrez, J.A. Vera Delgado
  • Correspondecia

    Correspondencia: C. Cantú-Reyna. Av. Cerro de las Mitras, 2411. Colonia Obispado, Monterrey. Nuevo León, México. CP 64060.
    Correo electrónico: cocantu@genomi-k.com

  • Titulo_ingles Incidence of inborn errors of metabolism and other diseases detected in a newborn screening program within a group of Mexican private hospitals
  • Centros_trabajo 1Genomi-k S.A.P.I. de C.V., Monterrey. Nuevo León. México. 2Christus Muguerza Sistemas Hospitalarios. México. 3Universidad de Monterrey. Monterrey. Nuevo León. México. 4Tecnológico de Monterrey. Escuela de Medicina y Ciencias de la Salud. Monterrey. Nuevo León. México. 5Tecnológico de Monterrey. Escuela de Ingeniería y Ciencias. Monterrey. Nuevo León. México
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e25-e32
  • copyright ©2020 Ediciones Mayo, S.A.
  • Fecha recepcion 01/07/19
  • Fecha aceptacion 02/10/19
  • Tipo de Artículo Clínico (Microdatos) Observational Study

Información adicional

  • Num_publicacion 78(3-4)
  • Resumen_ingles

    Erythema nodosum is a delayed-type hipersensitivity reaction that presents as erythematous and painful nodules on the shins. It can appear as an uncommon complication of cat scratch disease produced by Bartonella henselae.
    A rare case of erythema nodosum associated to cat scratch disease was diagnosed in our hospital. Its diagnostic, therapeutic management and evolution is reported.
    We have found in previous literature just a single case of association between erythema nodosum and cat scratch disease in a pediatric patient.

  • Palabras_clave_ingles Erythema nodosum Bartonella henselae cat scratch disease
  • Todos_autores D. Bernad Mechó, R. Pina Pérez, A. Piqueras Arenas, M. Oltra Benavent
  • autores listados D. Bernad Mechó, R. Pina Pérez, A. Piqueras Arenas, M. Oltra Benavent
  • Titulo_ingles Erythema nodosum as an atypical presentation of cat scratch disease: presentation of a clinical case and bibliographic review
  • Centros_trabajo Departamento de Pediatría Infecciosa. Hospital Universitari i Politècnic La Fe. Valencia
  • Publicado en Acta Pediatr Esp. 2020; 78(3-4): e190-e193
  • copyright ©2020 Ediciones Mayo, S.A.
  • Tipo de Artículo Clínico (Microdatos) Case Reports
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