Accompaniment of minors during health care procedures.

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents. We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans. The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.

Intracranial arachnoid cysts and epilepsy in children: Should this be treated surgically? Our 29-year experience and review of the literature.

INTRODUCTION AND OBJECTIVE: Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. MATERIAL AND METHODS: The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. RESULTS: After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment. CONCLUSIONS: Although it is necessary to design a prospective study to establish causality, the results of our research and the available literature suggest that there is no causal relationship between the presence of ACs and epilepsy. The study and treatment of these patients should be carried out in a multidisciplinary epilepsy surgery unit, without initially assuming that the AC is the cause of epilepsy.

Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late preterm and term infants.

INTRODUCTION AND OBJECTIVE: Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. METHODS: A prospective cohort study in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. SAMPLE SIZE: 207, 59 neonates developed hypoglycemia. RESULTS: Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. CONCLUSIONS: Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.

Intracranial arachnoid cysts and epilepsy in children: Should this be treated surgically? Our 29-year experience and review of the literature.

INTRODUCTION AND OBJECTIVE: Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. MATERIAL AND METHODS: The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. RESULTS: After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment. CONCLUSIONS: Although it is necessary to design a prospective study to establish causality, the results of our research and the available literature suggest that there is no causal relationship between the presence of ACs and epilepsy. The study and treatment of these patients should be carried out in a multidisciplinary epilepsy surgery unit, without initially assuming that the AC is the cause of epilepsy.

[Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late-preterm and term infants]. / Estudio prospectivo de factores perinatales asociados a hipoglucemia precoz en el neonato prematuro tardío y a término.

INTRODUCTION AND OBJECTIVE: Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. METHODS: A prospective cohort study, in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. SAMPLE SIZE: 207; 59 neonates developed hypoglycemia. RESULTS: Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. CONCLUSIONS: Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.

[Survey on hypoglycaemia diagnosis and glucometer use-which is the most widely used glucometer in Spanish neonatology units?] / Encuesta sobre detección de hipoglucemia y uso de glucómetros portátiles: ¿qué glucómetro es el más usado en las unidades neonatales españolas?

INTRODUCTION: Introduction and objective: neonatal hypoglycemia persistently offers multiple diagnostic controversies. This study aims to present the current situation regarding neonatal hypoglycaemia detection, and to gain insiht into the most widely used portable glucometers in neonatal units today. Methods: an online questionnaire was prepared and sent to the members of the Spanish Society of Neonatology; a total of 75 hospitals participated. Results: portable glucometers continue to be widely used in the neonatal population. More than 75 % of units perform neonatal hypoglycemia screening in specific clinical circumstances, and 13 % of units continue to perform protocolized screening on all newborns at neonatal units. The higher the level of care, the higher the percentage of hypoglycaemia detection by other tests (such as blood gas analysis): chi2, p = 0.019. Multiple models of portable glucometers are currently used, with differences according to level of care (chi2, p = 0.01). Nova Biomedical, Abbott, and Roche Diagnostics models are most commonly used. Conclusions: differences in the performance of neonatal hypoglycaemia screening are observed, so standardised procedures and limiting the neonatal population at risk are important to reduce variability in clinical practice, and to improve the quality of neonatal care.

INTRODUCCIÓN: Introducción y objetivos: la hipoglucemia neonatal sigue ofreciendo múltiples controversias. El objetivo del estudio es presentar la situación actual en torno a la forma de detección de la hipoglucemia neonatal y conocer el glucómetro portátil más utilizado en las unidades neonatales españolas en la actualidad. Métodos: se elaboró un cuestionario "online" sobre el uso de glucómetros en neonatos y los dispositivos más utilizados, que fue enviado a los integrantes de la Sociedad Española de Neonatología. Participaron 75 centros. Resultados: los glucómetros portátiles siguen teniendo un uso generalizado en la población neonatal. Más del 75 % de las unidades realizan un despistaje de la hipoglucemia neonatal en circunstancias clínicas concretas; el 13 % de los centros lo continúan realizando a todos los recién nacidos en las unidades neonatales. A mayor nivel asistencial, mayor es el porcentaje de detección de la hipoglucemia por otros sistemas de análisis (como gasometrías capilares): chi2, p = 0,019. Se usan múltiples modelos de glucómetro actualmente, encontrándose diferencias según el nivel asistencial (chi2, p = 0,01), siendo los modelos de la firma Nova Biomedical, Abbott y Roche Diagnostics los más usados. Conclusiones: se observa que existen diferencias en la realización del despistaje de la hipoglucemia neonatal, por lo que es de gran importancia consensuar los procedimientos y acotar la población neonatal de mayor riesgo, para disminuir la variabilidad en la práctica clínica y mejorar la calidad de la asistencia neonatal.

[Primary immune thrombocytopenia: Experience of a specialised clinic]. / Trombocitopenia inmune primaria: experiencia de una consulta especializada.

INTRODUCTION: Although primary immune thrombocytopenia (ITP) is rare in childhood, it is the most frequent cause of thrombocytopenia. There have been attempts to establish risk factors to predict the progression of the disease in order to optimise its management, which has changed in recent years due to, among other reasons, specialised care. MATERIAL AND METHODS: A retrospective, observational and analytical study was conducted on patients diagnosed with ITP over a 3-year period in a Paediatric Haematology specialist clinic. RESULTS: From the epidemiological, clinical and analytical point of view, the characteristics of this group are similar to others. Most of the patients (23/31, 74.2%) had ITP for less than 12 months, with there being no serious complications related to the disease or the treatment received. It was established that risk factors were related to being slowly evolving (lower event-free survival (EFS)) with no statistical significance, female gender, age over 10 years, leukopenia absence of initial severe thrombocytopenia, and non-specialised care. The absence of a history of infection was significantly related to a lower EFS. CONCLUSIONS: The epidemiological and analytical risk factors for a slowly evolving ITP are the same that described in the literature. Patients treated before the beginning of specialised care also had a lower EFS. These data seem to support the current recommendation that rare diseases should be managed in specialised units.

Metahemoglobinemia in infants over one year. / Metahemoglobinemia en lactantes mayores de un año.

BACKGROUND AND OBJECTIVES: Methaemoglobinaemia is a typical acute intoxication disorder in children under one year old. It is produced by excess nitrates which induce the haemoglobin's iron oxidation, preventing its adequate binding to oxygen. It is more frequent in infants due to its lower enzymatic activity. PATIENTS: Two cases of 15-month-old infants with methaemoglobinaemia after the intake of vegetables, atypical by the age of the patients and the initial severity in the first case that simulated a septic syndrome. Both cases evolved well with adequate oxygen therapy. CONCLUSIONS: Although the most frequent clinical manifestation is cyanosis associated with respiratory distress, methaemoglobinaemia can present with more severe and confusing symptoms. The main treatment is oxygen therapy at high concentrations and methylene blue as an intravenous antidote only in selected cases. The intake of vegetables is the main cause of this in infants, so it is important to give adequate information to parents about the consumption and preservation of these foods during the first year of life.

First Cases of Severe Flaccid Paralysis Associated With Enterovirus D68 Infection in Spain, 2015-2016.

Enterovirus D68 was known to be the cause of mild to severe respiratory infections, but in the last few years, it has also been associated with myelitis and paralysis. This report describes the first Enterovirus D68 detections in acute flaccid paralysis cases occurring between December 2015 and March 2016 in Spain.

[Idiopathic intracranial hypertension: Experience over 25 years and a management protocol]. / Hipertensión intracraneal idiopática: experiencia en 25 años y protocolo de actuación.

INTRODUCTION: We present our experience on idiopathic intracranial hypertension (IIH), before and after the introduction of a specific diagnosis and management protocol. METHOD: A descriptive retrospective study was conducted on patients with IIH over a 25year period (1990-2015), comparing the last 7years (after introduction of the protocol) with the previous 18years. RESULTS: Among the 18,865 patients evaluated, there were 54 cases of IIH (29 infants and 25 children). A comparison was made between the two time periods: 32 cases in 1990-2008 -published in An Pediatr (Barc). 2009;71:400-6-, and 23 cases in 2008-2015. In post-protocol period, there were 13 patients aged between 3-10months (62% males) with transient bulging fontanelle, and 10 aged between 2-14years (50% males), with papilloedema. A total of 54% of infants had recently finished corticosteroid treatment for bronchitis. In the older children, there was one case associated with venous thrombosis caused by otomastoiditis, one case on corticosteroid treatment for angioma, and another case treated with growth hormone. Transfontanelle ultrasound was performed on all infants, and CT, MRI and angio-MRI was performed on every child. Lumbar puncture was performed on 2 infants in whom meningitis was suspected, and in all children. All patients progressed favourably, with treatment being started in 3 of them. One patient relapsed. DISCUSSION: Characteristics and outcomes of patients overlap every year. IIH usually has a favourable outcome, although it may be longer in children than in infants. It can cause serious visual disturbances, so close ophthalmological control is necessary. The protocol is useful to ease diagnostic decisions, monitoring, and treatment.

[Cerebrovascular accidents in paediatric care. Our experience gained over an 18-year period]. / Accidente cerebrovascular en pediatría. Nuestra experiencia de 18 años.

PATIENTS AND METHODS: This study reviews our experience over the last 18 years with paediatric patients diagnosed with non-haemorrhagic cerebrovascular accidents (CVA) after the perinatal period. Data were collected for the period between May 1990 and May 2008 (n = 10 270 children) and special attention was given to cases with no previous pathology. RESULTS: We found 41 cases that were diagnosed with post-natal non-haemorrhagic CVA, of which 13 did not present any known pathology at the onset of the symptoms. Nine patients were diagnosed as having ischaemic CVA (ICVA), three cases had thrombosis of the venous sinuses and there was one case of haemorrhagic infarction (HI). No causation was found in five cases, three of which were heterozygotic for the C677T mutation of methylenetetrahydrofolate reductase. ICVA was caused by fibromuscular dysplasia, aneurysm of the auricular septum and patent foramen ovale, homocystinuria and chickenpox. A recent ear infection and diminished levels of protein C were noted in two cases of venous thrombosis. Five patients with ICVA and the case of HI were treated with oral antiaggregants, anticoagulants were administered in two of the thromboses, and the remaining cases did not receive any treatment. Seven patients (four ICVA, two thromboses and the HI) did not present any kind of sequelae, four ICVA presented different degrees of hemiparesis and two died (one ICVA and one thrombosis). CONCLUSIONS: The scarcity of studies and therapeutic clinical trials in the paediatric age makes it difficult to lay down clear guidelines of conduct, especially from the therapeutic point of view. The different specialists involved must collaborate with each other.

Diagnóstico retrospectivo de la infección congénita por citomegalovirus / Retrospective diagnosis of citomegalovirus congenital infection

La infección por citomegalovirus (CMV) es la infección viral congénita más frecuente. Es causa de múltiples anomalías que involucran al sistema nervioso central. Debido a que es principalmente asintomática, dos tercios de las secuelas se producen en niños asintomáticos al nacimiento. Pasadas las primeras 2 a 3 semanas de vida, se ha propuesto como método ideal y único de certeza para el diagnóstico retrospectivo la detección del ADN viral en la muestra de sangre seca procedente de la pesquisa neonatal. La técnica se lleva a cabo mediante dilución, amplificación y extracción, con resultado en menos de 48 horas. Se han publicado en la bibliografía numerosos protocolos, que refieren variadas sensibilidades in vitro que dependen fundamentalmente del método de extracción, desde la prueba del talón y de la amplificación, que son muy heterogéneas (entre 35% y 98%). La sensibilidad es mayor si es secundaria a primoinfección, en pacientes seleccionados, si se utiliza un buen método de extracción y amplificación, y una amplificación duplicada o, incluso, triplicada. La especificidad en todos ellos es concordante y alcanzaca si el 100%. La carga viral de la prueba del talón está subestimada, pero altamente relacionada con la de sangre fresca y, aunque puede no haber viremia al nacimiento, los neonatos virémicos son los que tienen mayor riesgo de presentar secuelas neurosensoriales, por lo que los índices de detección clínica en pacientes seleccionados son altos. Se ha descrito la viabilidad de otras alternativas, como el cordón umbilical en Japón y, en los últimos años, el uso de orina seca en papel de filtro, y se comunicaron buenos resultados...