[Effectiveness of an early discharge program after normal childbirth]. / Efectividad de un programa de alta precoz tras parto normal.

OBJECTIVE: To implement a program of early hospital discharge after an uncomplicated birth, in order to improve the effectiveness, as well as ensuring clinical safety and patient acceptability. MATERIAL AND METHODS: Descriptive study of the effectiveness of an early discharge program after uncomplicated delivery between February 2012 and September 2013. The populations are post-partum women and newborns admitted to the University Hospital of Fuenlabrada, with a duration of less than 24h after uncomplicated delivery that met the defined inclusion criteria. Satisfaction was assessed using a Likert scale. The effectiveness of the program was monitored by safety indicators, productivity, adaptation, and continuity of care. RESULTS: A total of 20% of cases capable of early discharge from Fuenlabrada University Hospital completed the program. Almost all (94%) were normal deliveries. The 188 cases included were from 911 patients with uncomplicated childbirth, accounting for 6.5% of the 2,857 total births. The mean stay of patients included showed a decrease of 50% (2.4 to 1.2 days). All patients received continuity of care after hospital discharge. The review consultation was reprogrammed for 4.8% of cases, with 2% of patients re-admitted within 96h. with no serious problems. Four newborns (2%) required attention in the emergency department (mother or newborn) before 96h. The assessment of patient satisfaction achieved a score of 4.5 out of 5. CONCLUSIONS: The program achieved a decrease in the average stay by 50%, favouring the autonomy of midwives. This acceptance level is in line with similar interventions. The deployment of the program may be useful for other changes in care processes.

[Cluster headache in pediatric population: four case reports and review of the literature]. / Cefalea en racimos en edad pediatrica: descripcion de cuatro casos y revision de la bibliografia.

INTRODUCTION: Cluster headache is a rare cause of primary headache in children. We report four cases with a mean age of onset of 8.6, ranged from 2 to 13 years. CASE REPORTS: Three males and one female with onset at 2, 7, 13, and 12 years-old, respectively, were included. The symptoms of all patients fulfill the criteria for the diagnosis of cluster headache according to the International Society of Headache. CONCLUSIONS: Despite being rare during childhood, cluster headache should be part of the differential diagnosis of headache in childhood. This report highlights the variable features of this disorder in children, often misdiagnosed. It can be useful in making a quick diagnosis and starting the appropriate treatment early. Verapamil was more effective than flunarizine in terminating the headache in our patients. Oxygen treatment and triptans resulted the treatments with the best response in acute cluster headache.

TITLE: Cefalea en racimos en edad pediatrica: descripcion de cuatro casos y revision de la bibliografia.Introduccion. La cefalea en racimos es una cefalea primaria de origen trigeminoautonomico cuyo inicio en la infancia es infrecuente. Se presentan cuatro casos en los que el inicio de la sintomatologia se produjo entre los 2 y los 13 años. Casos clinicos. Se incluyen tres varones y una niña con inicio a los 2, 7, 13 y 12 años, respectivamente. Los cuatro pacientes cumplen los criterios propuestos por la tercera edicion de la Clasificacion Internacional de las Cefaleas ICHD-III (beta). Conclusiones. A pesar de ser poco frecuente durante la edad pediatrica, la cefalea en racimos debe formar parte del diagnostico diferencial de un niño que consulta por cefalea. Subrayamos la importancia de conocer sus criterios diagnosticos para evitar el retraso diagnostico que se ha descrito con frecuencia. En nuestros pacientes, el tratamiento con verapamilo resulto mas eficaz que el tratamiento con flunaricina. Los tratamientos con mejor respuesta en fase aguda fueron la oxigenoterapia y los triptanes.

[Neurofibromatosis in children. Our experience]. / Neurofibromatosis en niños. Nuestra experiencia.

INTRODUCTION: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with a high index of spontaneous mutations and extremely varied and unpredictable clinical manifestations. It is diagnosed by the existence of certain clinical criteria which cannot appear until adulthood. PATIENTS AND METHODS: The clinical histories of the confirmed or possible cases of neurofibromatosis (NF) in the neuropaediatric databases at the Hospital Miguel Servet in Zaragoza and at the Hospital General in Guadalajara were analysed retrospectively. RESULTS: Cases were distributed in 46 NF1, six compatible with NF1, 11 with just marks, five with marks and a family history of marks, and two cases of segmentary NF. Among the confirmed cases of NF1, the following alterations were found: optic glioma (OG) in eight, and one of them developed a glioblastoma multiforme, multiple radicular neurofibromas in one, mental retardation in one and learning disorders in 13 of the 29 school aged children, afebrile seizures in three, precocious puberty in two and scoliosis in nine. Brain areas with hypersignals were found in 71% of the cases submitted to magnetic resonance imaging (MRI) (20 out of 28), including seven of the eight patients suffering from OG. DISCUSSION: Our case mix, like all the others, exemplifies the clinical heterogeneity and unpredictable progression of children with NF1 or who are suspected of suffering from it. We followed the most widely used method of clinical and ophthalmological control, and complementary examinations were performed according to the clinical features. If neuroimaging is used, it must be MRI.

[Chiari type II malformation with brain stem paroxystic dysfunction. What can we do?]. / Malformación de Chiari tipo II con disfunción paroxística de tronco. ¿Qué se puede hacer?

The Chiari type II malformation is the main cause of death in children with myelomeningocele, usually due to respiratory dysfunction, and unfortunately there is no effective cure. Episodic symptoms of brain stem dysfunction are frequent. We report a child with Chiari type II malformation and brain stem dysfunction who required tracheotomy and who was fed through a nasogastric tube from the age of 1.5 months. He first presented episodic symptoms at the age of 8 months and died at 9 months due to respiratory dysfunction despite intensive care. We also report our experience in the last 12 years with four patients with Chiari type II malformation and episodic symptoms of brain stem dysfunction. Both patients who required mechanical ventilation died. Neither surgical decompression nor intensive care prevented the fatal outcome, which was unpredictable and inevitable. Prognosis may be more positive in less severe cases, because the two patients that did not require mechanical ventilation show favorable outcome to date.