[Risk factors associated with nosocomial bacteremia in low birth weight neonates. Grady Memorial Hospital, Atlanta]. / Factores de riesgo asociados con bacteriemia nosocomial en recién nacidos de bajo peso al nacimiento. Hospital Grady Memorial, Atlanta.

BACKGROUND: Nosocomial bloodstream infections occur frequently in Neonatal Intensive Care Units and are associated with recognized and unrecognized risk factors. Little has been published regarding risk factors for bloodstream infections in low birth weight neonates. OBJECTIVE: To investigate risk factors for bloodstream infection in neonates < 1,500 g admitted at a Neonatal Intensive Care Unit. METHODS: A prospective study was undertaken in low birth weight neonates (< 1,500g) during a 22 months period. Bivariant, and logistic regresion (stepwise procedure) analysis was used to determine the significance association of bloodstream infection and perinatal and nosocomial risk factors. RESULTS: A total of 72 patiens with nosocomial bacteriemia and 147 non bacteriemic patients were studied. Independent risk factors associated with bloodstream infection were birth weight, persistence of umbilical catheter > 7 days and persistence of peripheral arterial catheter > 1 day. CONCLUSIONS: The uses of umbilical catheter > 7 days, peripheral arterial catheter > 1 day and birth weight < 1,500 g were significant determinants of nosocomial bloodstream infection risk. Because of the importance of invasive procedures as a source of nosocomial bloodstream infections, the lines duration needs to be reviewed with the aim of reducing the incidence of blood stream infection.

[Renal function and functional renal reserve in adolescents who acquired minimal change nephrotic syndrome in childhood]. / Función renal y reserva funcional renal en jóvenes que padecieron síndrome nefrótico a cambios mínimos en la infancia.

OBJECTIVE: The aim of this study was to evaluate glomerular filtration rate (GFR) and renal functional reserve (RR) in young patients after diagnosis of minimal change nephrotic syndrome (MCNS) during childhood. PATIENTS AND METHODS: GFR and RR were evaluated in 15 young patients (10 female) diagnosis of childhood MCNS 18.5 +/- 4 years before. Creatinine clearance (CC) was measured before and after an acute protein load to determine GFR and RR. Based on the tendency towards relapses, the study subjects were divided into two groups: Group A had less than five relapses and group B five or more relapses. Study subjects (groups A and B) and control subjects (group C) were matched for sex and age. RESULTS: Group B showed a higher GFR than groups A and C (group B = 133.9 +/- 16.26 ml/min/1.73 m2, group A = 107.91 +/- 18.19 ml/min/1.73m2; p = 0.014, group C = 113.89 +/- 13.17 ml/min/1.73m2, p = 0.015). RR was significantly lower (absolute and relative) in group B than in group C (group B = 10.9 +/- 15.46 ml/min/1.73m2, group C = 38.58 +/- 21.47 ml/min/1.73m2, p = 0.016 and group B = 8.56 +/- 11.75%, group C = 34.35 +/- 21.43%, p = 0.016, respectively). CONCLUSIONS: After childhood MCNS, young patients who presented more than five relapses showed an increase in GFR and a decrease in RR.

[Pediatricians' opinion on sedation in children]. / Opinión de los pediatras sobre la sedación en los niños.

OBJECTIVE: Our objective was t evaluate the current knowledge and attitudes of pediatricians regarding the issue of pediatric sedation. PATIENTS AND METHODS: In October 1996 we conducted a mail survey of all 686 members of the Asturias, Cantabria and Castilla y Leon Pediatric Society. Physicians were asked to complete and return a confidential 18-item questionnaire. RESULTS: One hundred fifty-seven (23%) of the eligible physicians responded. Of the responding physicians, 90% agreed that they had insufficient training in pain and sedation management. Seventeen percent thought childhood sedation to be very effective, 76% effective and 7% little effective. Fifty-nine percent thought infant sedation was easy and 36% considered it to be difficult. Thirty-six percent of the pediatricians who work in hospitals considered the cooperation of children under 8 to be good versus only 17% of the primary attention pediatricians (p < 0.05). Thirty-nine percent thought that it was only necessary on some occasions that the parents are present when the child is sedated before surgery. Forty-eight percent of the male pediatricians considered that sedation was always or almost always indicated versus 67% of the female pediatricians (p < 0.05). The most used sedative drugs are midazolam (24%), diazepam (23%) and chloral hydrate (14%). Eleven percent indicated that it was necessary to monitor cardiorespiratory function and oxygen saturation during sedation. CONCLUSIONS: Pediatricians in this Society seem to have a lack of knowledge concerning sedation of their patients. Training in childhood sedation is needed.

[The opinion of pediatricians on childhood pain]. / Opinión de los pediatras sobre el dolor infantil.

OBJECTIVE: The objective of this study was to evaluate the current sensibility and knowledge of pediatricians regarding the issue of pediatric pain assessment and management. PATIENTS AND METHODS: In October 1996 we conducted a mail survey of all 686 members of the Asturias, Cantabria and Castilla y León Pediatric Society. Physicians were asked to complete and return a confidential 95-item questionnaire. RESULTS: One hundred fifty-seven (23%) of eligible physicians responded. Ninety percent of the respondents agreed they had insufficient training in pain management. Sixty-nine percent though their knowledge to deal with acute pain was adequate. Only 12% admitted to having enough background to treat chronic pain. Sixty-five percent of the respondents admitted to know no method at all for pain evaluation, while 82% had never applied any in their clinical practice. About half the respondents (42%) did not know any guidelines for the management of pediatric pain, although 75% considered they would be very useful. A high percentage of pediatricians answered that analgesia was required before performing certain diagnostic or therapeutic procedures (lumbar puncture, venous canalization, arterial puncture and others), but differences in relation to age, sex and clinical setting of the physicians were detected in these responses. The most used drug for the treatment of moderate acute pain is acetaminophen (88%), for severe acute pain metamizol (58%) and for severe chronic pain acetaminophen-codeine (37%). Only 48% admitted to having used opioids. CONCLUSIONS: Pediatricians in this society seem to be too confident about the topic of acute pain management in their patients, even though they report a lack of training which could influence the quality of the care they are offering to their patients. Opioid use is very low. Training in childhood pain management is needed.

[Management of chronic non-terminal renal failure in childhood. Estimation of mean annual cost]. / Manejo del niño en insuficiencia renal crónica no terminal. Una aproximación al coste medio anual.

We have calculated the mean annual cost (MAC) referred to 1,988 pesetas derived from the treatment and surveillance of 15 patients diagnosed of non terminal chronic renal failure (NT-CRF). The patients were aged between 1 month and 12 years at the moment of diagnosis and they were followed-up for five years at least. We have differentiated among costs from hospitalization, pharmacological treatment and outpatient control which were respectively 455,400, 47,798 and 57,917 pesetas/patient year. The costs from hospitalization decreased progressively every year after diagnosis being of 21,211 pesetas/patient year at the 5th year from diagnosis. The 30.1% of pharmacological treatment costs were due to the use of alkalines, 23.4% to phosphorus quelants (calcic carbonate mainly) and 27.3% to the active forms of vitamin D3. The outpatient surveillance costs corresponded 24,000 pesetas/year to staff expenses, 27,492 pesetas/year to laboratory work-up and 6,424 pesetas/year to radiological examination. We conclude that the total MAC for children with NT-CRF eas 561,115 pesetas/patient being the hospitalizations costs the most important concept (81.2%), followed by ambulatory care (10.3% and drug treatment (8.5%).

[Nutritional status assessment in a group of cystic fibrosis patients]. / Valoración del estado nutricional en un grupo de pacientes con fibrosis quística.

The objectives of this study were to evaluate the nutritional status and the efficiency of high density oral supplements in patients with cystic fibrosis. Twenty patients with cystic fibrosis (10 boys and 10 girls) with a mean age of 11.63 years (SD:6.3) were studied. Sixty percent of these patients were receiving high density oral supplements. A clinical and nutritional evaluation, including a three day evaluation of food intake, were performed. Patients were separated into two groups according to oral supplement intake and the presence or not of pulmonary colonization. We found the patients to have a mild to moderate clinical status. Anthropometric values were lower than ideal. Intake of calories, macronutrients and micronutrients were similar (except for folic acid) in both groups of patients and were close or above the established dietetic recommendations for cystic fibrosis. Patients with pulmonary colonization scored lower in the Shwachman and Brasfield tests, had lower weights, subscapular skinfolds and nutritional indices, and higher plasma immunoglobulin A concentrations. We conclude that a free hypercaloric diet allows cystic fibrosis patients to maintain an adequate nutritional status. Oral supplements should be prescribed on an individual basis according to the results of periodic food records and clinical and anthropometric status evaluation.

[Influence of diet in idiopathic hypercalciuria]. / Influencia de la dieta en la hipercalciuria idiopática.

OBJECTIVES: To find out if differences in diet may justify the presence of idiopathic hypercalciuria (IH) and to verify if the calcium-restricted diet, often recommended for treatment of IH, is nutritionally appropriate. PATIENTS AND METHODS: Dietary intake and mineral and electrolyte urinary excretion were studied twice in 10 children diagnosed of IH and in 9 controls. First, while being on a free diet. Second, after a week of suppression of milk and dairy products. RESULTS: Intakes of calories, proteins, carbohydrates, fats, and minerals were similar in IH patients and controls. Withdrawal of dairy products of diet resulted in an important reduction in the intakes of calcium (71.1%), phosphorus (63.5%) and fats (30.1%), although only calcium intake was remarkably below international recommendations (33.6 +/- 10.4%). CONCLUSIONS: Spontaneous diet of this group of hypercalciuric children was no different from that of control children. Suppression of milk and dairy products causes a nutritionally inappropriate diet.

[Urinary concentration capacity in neonatal hydronephrosis]. / Capacidad de concentración urinaria en la hidronefrosis neonatal.

In order to determine the renal concentration capacity in neonatal hydronephrosis, 10 micrograms of DDAVP were administered intranasally to 18 infants with hydronephrosis. Fluid intake was restricted to 50% of normal for 3 hours before and 6 hours after the administration of DDAVP. Maximal urine osmolality (mean +/- SD) was 348 +/- 180 mOsm/kg in 7 newborns younger than 21 days and 420 +/- mOsm/kg in 11 neonates between 22-50 days of age. Both osmolarities were inferior to the standard response to DDAVP reported in normal neonates. After 24 hours of clinical observation, we did not notice any secondary effects caused by this test.

[Reduction in the number of hospitalizations for asthma. Quality assurance program for the management of asthma crises in a district hospital]. / Reducción de ingresos por asma. Programa de mejora de la calidad de la atención a la crisis asmática en un hospital de área.

OBJECTIVE: The purpose of this study was to analyze the impact of a quality assurance program intended to improve the care of children with acute asthma in the emergency ward of a first level hospital. PATIENTS AND METHODS: New guidelines for acute asthma management in children were developed and applied beginning 1-1-1997. The ways to deal with an asthma crisis in 1996 and 1997 were compared. The quality guarantee cycle was the method for application of the guidelines, health workers being aware of the starting point (1996) and which areas could be improved. The quality of the clinical assessment of the asthma crisis, the adequacy of treatment, and the final destination of the patients (discharge or admission) were evaluated. RESULTS: Seventy-seven and 68 asthma crises were attended to during 1996 and 1997, respectively. We noticed significant improvements in the clinical assessment of the crisis (p < 0.001), in the correct usage of the term "asthma crisis" (p < 0.001) and in the description of the crisis severity (p < 0.001). The number of improper therapeutic procedures was reduced (p < 0.0001). Children with a mild crisis, except for those associated with risk factors (14% in 1996 and 6% in 1997), were discharged from the hospital. All children with severe crises were admitted to the hospital. Of the children with moderate crises, 75% need hospitalization in 1996, while only 45.1% did during 1997 (p = 0.05). CONCLUSIONS: Following appropriate guidelines during acute asthma attacks implies better care of the asthmatic child and reduces the number of hospital admissions. The quality guarantee cycle is a proper way to achieve these goals.