[Epidemiology of community-acquired pneumonia in children aged less than 5 years old in the Autonomous Community of Valencia (Spain)]. / Epidemiología de la neumonía adquirida en la comunidad en menores de 5 años en la Comunidad Valenciana.

OBJECTIVE: To assess the incidence of community acquired pneumonia in the Autonomous Community of Valencia in Spain, and describe its treatment and complications. METHODS: A retrospective cohort comprising 654 children born in 1995 and 1996 in Valencia and followed-up during the first 5 years of life by nine pediatricians was studied. The number of cases of pneumonia, treatment, complications and interventions was recorded. RESULTS: Ninety-nine episodes of community-acquired pneumonia in 80 children were recorded (1.24 cases/child). Fifty-one cases (51.1 %) occurred before the child's third birthday and 38 (38.4 %) occurred between the third and the fourth. Of the 99 cases, 51 were diagnosed in primary care and 46 in the emergency room. There was a mean of 2.44 visits per process in primary care (range 1-6). All the children were treated with antibiotics. The most frequently used were amoxicillin-clavulanate (43.3 %) and cefuroxime (26.3 %). Fourteen patients required a change of antibiotic. Twenty-three percent of the children were hospitalized. CONCLUSION: The incidence of community-acquired pneumonia in Valencia was 30.3 cases/1000 children aged less than 5 years/ year (95 % CI: 18.7-46.8), and the incidence of hospitalization was 7.03 cases/1000 children aged less than 5 years/year.

[Survey of the judicious use of antibiotics in primary care]. / Encuesta sobre el uso racional de antibióticos en atención primaria.

OBJECTIVE: To identify pediatricians' antibiotic prescribing habits in acute otitis media and tonsillopharyngitis and to determine the interaction between parents and pediatricians concerning antibiotic use in the Autonomous Community of Valencia (Spain). METHOD: Four hundred members of the Valencian Society of Pediatrics were randomly selected. A semi-structured questionnaire with non-excluding answers was sent by mail and, when responses were not obtained, a second one was sent. The confidentiality of the information was guaranteed. RESULTS: Of 400 questionnaires sent, 143 (35.8 %) were completed; 88.1 % were completed by pediatricians and 51.1 % by primary care workers. A total of 48.3 % of pediatricians used antibiotics in all cases of acute otitis media and 94.5 % prescribed them when fever and otalgia persisted for more than 48 hours. Amoxicillin-clavulanate was the most frequently prescribed antibiotic (63.6 %). Less than 10 % of pediatricians prescribed antibiotics as empirical treatment in tonsillopharyngitis; amoxicillin was the most frequently prescribed antibiotic (54.6 %). Indications for antibiotic treatment were fever, odynophagia and adenomegaly (69.5 %) and tonsillar exudate (62.5 %). Inappropriate antibiotic use was mainly due to excess workload. Providing health education to parents could be the best way of reducing inappropriate use. CONCLUSIONS: Antibiotic use is frequent in the treatment of acute otitis media. Amoxicillin-clavulanate and amoxicillin were the most frequently prescribed antibiotics in tonsillopharyngitis. Providing health education to parents and reducing pediatricians' workload would decrease inappropriate antibiotic use.

[Epidemiology and burden of acute otitis media in Valencia (Spain)]. / Epidemiología e impacto de la otitis media aguda en la Comunidad Valenciana.

OBJECTIVE: To assess the burden (incidence, treatment and complications) of acute otitis media (AOM) and otitis media with effusion (OME) in children younger than 5 years of age from Valencia, Spain. SUBJECT AND METHODS: We performed a retrospective cohort study of 1,399 children followed-up for the first 5 years of life. Seventeen pediatricians reviewed the medical records of their patients born in 1995 and 1996 and followed-up from birth until the age of 5 years. For each child, the number of otitis episodes, treatment, complications, and surgical interventions was obtained. RESULTS: There were 2,961 episodes of AOM in the first 5 years of life (2.23 cases/child). Four hundred seventy-six cases (16.1 %) occurred before 1 year of age and 1,346 between the first and second year of life (45.5 %). By the third year of life, 59.8 % had had at least one episode. In most children (80.9 %), diagnosis was made in primary care and required a median of 1.81 visits/episode for follow-up. A total of 94.5 % were treated with antibiotics (amoxicillin-clavulanate 38.8 %, cefuroxime 14.3 %, clarithromycin 8.2 % and amoxicillin 5.9 %) and 8.5 % required a change of antibiotic therapy. Two hundred seventeen children (15.2 %) had at least one episode of OME. Twenty-six patients (1.8 %, 95 % CI: 1.2-2.7 %) required insertion of ventilation tubes. Twenty-four patients (1.7 %) had secondary hypoacusis. There was one case of meningitis and two cases of chronic otorrhea. No cases of mastoiditis were recorded. CONCLUSIONS: The incidence of AOM in Valencia is 40,014 episodes/100,000 children younger than 5 years/year (95 % CI: 39,700-40,300). It represents a significant burden due to the large number of visits, antibiotic use, associated surgical procedures and need for auditory rehabilitation.

[Urinary excretion of calcium, magnesium, uric acid and oxalic acid in normal children]. / Excreción urinaria de calcio, magnesio, ácido úrico y ácido oxálico en niños normales.

A group of normal children with a free diet was studied. Their first morning urine (n = 176) and their 24-hour-urine (n = 64) was collected, valuing the calciuria, magnesiuria, uricosuria and oxaluria, establishing their relationship with a dietetic survey. Ca/Cr rate value was 0.13 +/- 0.7 mg/mg in the morning urine, and 0.12 +/- 0.06 mg/mg in the 24-hour-urine. Calciuria (mg/kg/day) was 2.46 +/- 1.45, higher to that noticed by other authors. Prevalence of hypercalciuria was 7.8%. We haven't noticed any correlation between the calciuria (mg/kg/day) and the consumption of proteins and carbohydrates. A positive correlation was found between Ca/Cr and Na/Cr rate, together with high natriuria (3.87 +/- 1.35 mEq/kg/day); these findings could justify the elevated calciuria in the children studied. Mean values of magnesium and uric acid were 0.04 +/- 0.02 and 0.30 +/- 0.08 mg/100 ml FG, respectively and the oxaluria was 34.51 +/- 16.35 mg/day/1.73 m2.

[Zinc balance in malnourished children given prolonged total parenteral feeding]. / Balance de zinc en niños desnutridos con alimentación parenteral total prolongada.

Zinc balances were performed in five different occasions in three children receiving prolonged total parenteral nutrition (TPN) for 4 or more weeks. Excessive urinary zinc loss was a constant finding and one patient also presented increased fecal loss. It is concluded that TPN solutions when administered for long periods must be supplemented with zinc in order to obtain positive balances and a retention of zinc between 50-100 micrograms kg/day. In children without abnormal losses supplements recommended by the American Medical Association (100 micrograms/kg/day up to 5 years and from 2.5 to 4 mg/day in old children) seem adequate. In case of deficit in Zn and/or high digestive losses supplement of Zn in TPN must be increased up to 200 to 500 micrograms/kg/day.