[Hospital management of pediatric patients referred from primary care centers]. / Actuación hospitalaria con las interconsultas procedentes de atención primaria.

OBJECTIVE: To describe the hospital management of patients referred from primary care pediatricians, as well as final diagnosis and other epidemiological data. PATIENTS AND METHODS: We performed a descriptive study of 737 patients referred to hospital for the first time by pediatricians from 13 primary care centers in the public health system. Physicians completed a 20-item report on each patient at the end of each hospital consultation. The statistical analysis included the mean and standard deviation. The Chi-square test for tendencies was performed through an R-Sigma program. RESULTS: The mean age of the patients was 5.43 6 4.39 years. Immigration populations accounted for 14 % of patients. Fifty-three percent of the children were referred to other specialties or subspecialties, mainly cardiology (9 %), endocrinology (8 %) and pediatric surgery (5 %). The most frequent diagnoses were cardiac murmur (10 %), asthma (6.4 %) and food allergy (5.5 %). The 30 most frequent problems accounted for 71 % of all referrals. Psychosomatic problems were found in 20 % of the patients. At the end of the study, 34 % of the patients were discharged. In our study, children were followed-up for a mean of 23.9 6 20 days. CONCLUSIONS: Approximately half the patients referred to hospital are sent to subspecialists. Training should concentrate on the 30 most commonly referred conditions. Education concerning the referral process should focus on the respective roles of physicians in the different healthcare settings, which in the hospital setting includes undergraduate and postgraduate teaching. Psychosomatic problems are frequent.

[Assessment of overweight from prepuberty to adolescence]. / Valoración de la evolución temporal del sobrepeso desde la edad prepuberal hasta la adolescencia.

OBJECTIVE: To examine whether prepubertal overweight continues into adolescence, and to evaluate if this progression over time differs by sex. METHODS: The sample population consisted of 179 healthy boys and 206 girls on whom anthropometric data were assessed at 6-8 years and 13-16 years of age. The assessment of overweight was performed according to the cut-offs points of the International Obesity Task Force. RESULTS: From baseline to follow-up, the percentage of participants who were overweight increased from 23% to 29.2% in males, and decreased from 32.6% to 21.4% in females. Baseline weight was significantly correlated (P<.01) with follow-up weight in both males (r=0.78) and females (r=0.68). Weight and BMI at 6-to-8 years- old explained percentages of variation of weight and BMI at 13-to-16 years-old, higher in boys than in girls (64.1% and 44.1%, respectively, for weight; 53.5% and 39.9%, respectively, for BMI). A total of 75% of the participants remained in the same weight category. CONCLUSION: The prevalence of overweight in adolescence decreased in girls. The weight and BMI at prepubertal age account for a significant percentage of the variation in weight and BMI in adolescence. This percentage is higher in males than in females.

[Intensive care in a pediatrics service. Epidemiologic study]. / Atención intensiva en un servicio de pediatría. Estudio epidemiológico.

During the past 10 years, there has been an increase in the number of pediatric services with intensive care units (ICUs). An epidemiological study based in the experience of two years in a ICU is presented. During the study period, 213 patients, accounting for the 6% of total admitted in the pediatric ward (2,898) and 1.8% of newborn (2,091), were admitted in the ICU. The average length of stay was 3.74 days. Regarding the degree of severity two groups of patients were considered: The first group were 104 (48.8%) and they were admitted for close nursing care and observation, while 109 (51%) were to receive an active treatment respiratory problems were the more frequent accounting for the 41% of patients. The total mortality rate was 5.6% and this rate raised until 20% if only newborn patients are considered. The results of this study can be helping in order to planing the organization in this units facing with many problems sometimes difficult to resolve.

[Antibiotic prescribing patterns for pediatric inpatients with acute respiratory tract infection]. / Uso de antibióticos en niños hospitalizados por infección respiratoria aguda.

BACKGROUND: Children with acute respiratory tract infection (ARTI) represent an important target group for efforts aimed at reducing unnecessary antibiotic use. OBJECTIVE: To present the epidemiological data and evaluate the effect of clinical, laboratory, radiological and microbiological data on the decision to prescribe antibiotics to pediatric patients with ARTI as well as to seek criteria that would justify antibiotic use. PATIENTS AND METHODS: A retrospective review was made of the clinical histories of 147 previously healthy children, consecutively admitted to our hospital with ARTI for 1 year (May 1996-April 1997). Patients were divided in two groups: those not treated with antibiotics (n = 92) and those treated (n = 55). Data from the two groups were compared with a statistical computer program (R-Sigma). RESULTS: Of the 147 patients studied, mean age was 2.5 years (range 0-14 years) and 85 (58%) males. One-hundred-and-five patients (72%) had previously been attended to in the emergency room, and 45 patients (30%) had been treated with antibiotics. Upper respiratory tract infection was diagnosed in 81 patients (54%), bronchitis in 28 (18%), bronchiolitis in 23 (15%) and pneumonia in 15 (10%). Ninety-seven patients (66%) had viral infection and only two (1%) had bacterial infection. Syncytial respiratory virus was isolated in 41 patients (28%) and adenovirus in 30 (20%). In the untreated group, the longer duration of symptoms before admission, lymphocytosis, clinical diagnosis of bronchiolitis and normal thorax X-ray, were statistically significant. In the treated group, fever, leukocytosis, neutrophilia and a diagnosis of pneumonia were statistically significant. Length of stay was longer in this group than in the untreated group. CONCLUSIONS: It is difficult to prescribe antibiotics on the basis of bacteriologic data. Laboratory, analytic and radiological data can be helpful in the rational use of antibiotics.

[Usefulness of etiologic studies in children hospitalized for pneumonia]. / Utilidad de los estudios etiológicos en pacientes pediátricos hospitalizados por neumonía.

OBJECTIVE: The aims of this study were: 1) To assess the effectiveness of viral culture and serology. 2) To check if there are clinical differences between patients with viral or bacterial infections. 3) Assessment of treatment, previous to and during the hospital stay. PATIENTS AND METHODS: A prospective study was carried out between January 1994 and June 1995 on 56 inpatients diagnosed of pneumonia. The mean age was 3 years (range: 2 months- 14 years). Viral cultures on cell monolayers was carried out in 46 patients. Serology was carried out in 33 patients older than six months of age. Blood cultures were obtained in 27 patients and a tuberculine reaction was studied in 15 patients. On the basis of microbiological results, three groups were formed (viral, bacterial and unknown) and clinical symptoms, thorax X-rays, and laboratory data were compared. RESULTS: The etiologic agent was detected in 36 patients (64%). The most frequent pathogens detected were adenovirus and respiratory syncytial virus with 11 patients (19%) each, followed by Mycoplasma pneumoniae with 9 patients (16%): Viral cultures were positive in 16 patients (35%) and serology in 22 patients (66%). Viral infection was detected in 20 patients (36%) and bacterial infection in 16 (28%). Mixed infection (bacterial/viral) was found in 5 patients (9%). The patients with viral infections showed significant differences (p < 0.01) for age (younger) and tachypnea compared with those with bacterial infections. Sixty-six percent of the patients had received antibiotic treatment previous to hospital admission and 87% during their hospitalization. CONCLUSIONS: Although the etiologic studies were positive in 64% of the patients, the delay in obtaining the results make them scarcely useful in determining whether to initiate or not antibiotic therapy (87% of inpatients). Clinical data, radiology results and leukocyte counts do not show any difference between viral and bacterial infections.

[Neonatal care in a primary health care center]. / Atención neonatal en un centro primario.

Small Madrid community hospitals (less than 100 deliveries annually) were the site of approximately 14% of the hospital births in 1990. The quality and quantity of services provided by our unit, considered to be of the first of primary level, are presented. The study period was 2.5 years long and 1,339 newborns were attended. The mean stay in the neonatal unit was 4.44 days (+/- 3.8 days). The cesarean section rate was 17%. The incidence of newborns with a weight less than 2,000 g was 1.5%, while those with a weight of more than 4,000 g was 5.47%. Almost 25% of the newborns were transferred to the neonatal ward and 1.79% were transferred to a third level hospital (neonatal intensive care), where three of them died. The mortality rate in our hospital was null. With rational guidelines, the primary centers can provide valuable services in a community perinatal care system.