Survey of Impediments to Prevention of Mother-to-infant Transmission of Hepatitis B Virus by International Societies.

OBJECTIVE: Mother-to-infant transmission (MIT) is the leading cause of hepatitis B virus (HBV) infections globally. The aim of this international study was to assess the impediments to prevention of (MIT) of HBV. METHODS: A cross-sectional survey was developed by the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition. (FISPGHAN) The survey was sent to HBV experts of the 5-member societies of FISPGHAN, and 63 of 91 countries/regions responded. Main outcome measures include percentage of countries having vaccine programs, timing of the first dose of HBV vaccine, availability of HBV vaccine for outborn neonates, payment of HBV vaccine and hepatitis B immune globulin, screening HBV markers during pregnancy, and antivirals to highly infectious pregnant mothers. RESULTS: Among the participating countries/regions, 11% did not implement infant HBV immunization programs. The first dose of vaccine was given >24 hours in 36% of the total countries and 100% of African countries. The recommended birth dose was unavailable for outborn neonates in 45% of the total countries, including 92% of African and 50% of Latin American countries/regions. During pregnancy, 44% countries do not screen maternal viral markers, and 46% do not provide third trimester antiviral therapy for highly viremic pregnant mothers. CONCLUSIONS: Our study demonstrated multiple obstacles to achieving the goal of preventing MIT of HBV. Comprehensive public health programs to enhance vaccine coverage rate, supply HBV vaccine for out-born neonates, screening maternal HBV markers, treating highly viremic pregnant mothers are proposed to overcome these obstacles and achieve the goal of preventing MIT of HBV.

Síndrome de Dumping en pediatría / Dumping syndrome in pediatrics

Se describen 2 pacientes con síndrome de dumping como complicación de la cirugía antirreflujo gastroesofágico. El diagnóstico se sospechó por la presencia de síntomas postprandiales inmediatos y tardíos junto con el antecedente quirúrgico. La detección de hiperglucemia seguida de hipoglucemia durante la prueba oral de tolerancia a la glucosa, junto a una evacuación gástrica acelerada demostrada por seriada gastroduodenal y cámara gamma con Tc 99, permitió la confirmación diagnóstica. Los pediatras deberán estar alerta sobre esta complicación en el postoperatorio inmediato y mediato de la cirugía antirreflujo gastroesofágico