Percutaneous catheter use in newborn infants with parenteral nutrition.

The well known negative effect of infection on nutrition causes the cycle 'infection-malnutrition-infection'. Prolonged parenteral nutrition requires central venous catheterization. Due to the possibility of 'catheter related sepsis' (CRS) catheters should be used correctly to avoid septic complications. A very high percentage of central venous catheters (CVC) removed because of presumed infections are not infected when culture is done. In some patients infections are successfully treated with antibiotics without catheter removal. Removal of the line is recommended when catheter-associated sepsis is suspected or proven, but not for the extremely ill preterm infant or when such removal may be impractical. A therapeutic protocol is suggested to avoid future canalizations in the neonate, sometimes in a critical situation. Current literature referring to CRS in the newborn infant is reviewed.

[Endoscopic evaluation of endobronchial tuberculosis in children]. / Valoración endoscópica de la tuberculosis endobronquial infantil.

The aim of this study was to determine the role of fiberoptic bronchoscopy (FB) in pulmonary tuberculosis in children. We assessed bronchoscopic findings of 36 procedures performed in 30 children who presented the following abnormalities on chest films: lobular or segmentary atelectasis (17), paratracheal or parahilar adenopathies (14), parenchymatous consolidation (9) and localized hyperinflation (5). Premedication for FB included intravenous atropine and diazepam plus ketamine for sedation, as well as lidocaine 2 and 5% in aerosol form for topical anesthesia. FB results showed that involvement was endobronchial in 29 patients. In the 18 patients with X-rays suggestive of endobronchial tuberculosis (EBT), the diagnosis was confirmed by FB. Significantly, EBT was found by FB in 11 (36.6%) patients with no clinical or radiological signs of such involvement. EBT was in the early stages in 3 (10%) patients and was advanced in 8 (26.6%). M. tuberculosis was isolated in 9 (30%) of the 30 patients. Culture was of bronchoalveolar lavage in three, of gastric lavage in four and of endobronchial biopsy in two. We conclude that FB is a safe, important tool for the confirmation of EBT in the management of pulmonary tuberculosis in children. It serves as a guide for the start of steroid treatment, especially in children with no radiological suggestion of EBT.

[Usefulness of fiberoptic bronchoscopy in critical pediatric care]. / Utilidad de la fibrobroncoscopia en el paciente crítico pediátrico.

UNLABELLED: Fiberoptic bronchoscopy (FB) is being applied increasingly in pediatrics as a therapeutic and diagnostic technique. OBJECTIVE: To analyze the contribution of FB to the diagnosis and treatment of respiratory disease in patients admitted to the pediatric intensive care unit (PICU). PATIENTS AND METHOD: We reviewed FB performed with 3.5 and 2.2 mm external diameter instruments between January 1989 and October 1998 in patients admitted to the PICU. Underlying disease and purpose of and indications for FB were analyzed. We also analyzed route of insertion, findings of airway inspection and bronco-alveolar lavage (BAL), complications and the contribution of FB to patient management. RESULTS: A total of 51 procedures in 47 patients aged between ten days and 12 years old were performed. Twenty-one children (41%) were under one year old. The initial indications for FB were diagnostic in 73% and therapeutic in 27%. Airway inspection showed abnormality in 65%. BAL was performed in 18 cases, with microbiological findings in 8 of the 18. The patients benefited directly from the technique in 75% of cases. CONCLUSIONS: FB is useful diagnostic and therapeutic procedure in PICU patients and is generally well tolerated.

[Carbohydrate metabolic changes in cystic fibrosis]. / Alteraciones del metabolismo hidrocarbonado en la fibrosis quística.

OBJECTIVES: To assess the prevalence of impaired glucose tolerance and diabetes mellitus in a group of patients with cystic fibrosis and to compare insulin secretion, haemoglobin A1c, age, gender, genotype, and clinical status related variables between the groups with abnormal (impaired glucose tolerance and diabetes mellitus) and normal carbohydrate metabolism. PATIENTS AND METHODS: 66 patients with cystic fibrosis (age 1-38 years). Plasma glucose, insulin and C peptide determinations during an oral glucose tolerance test (OGTT) in 65 patients (one was previously known as diabetic). Based on the Expert Committee from the American Diabetes Association (1997), patients were classified as having impaired glucose tolerance and diabetes mellitus. Haemoglobin A1c, presence of delta F508 mutation, date of diagnosis and first sputum colonization, scores of National Institutes of Health, Schwachman and Chrispin-Norman, pancreatic enzyme intake, weight, body mass index, forced expiratory volume in one second and forced vital capacity determinations in every patient. Comparative analysis of these variables in both groups of patients was performed by Student test. RESULTS: Nine patients (13.6%) showed impaired tolerance glucose and one diabetes mellitus following OGTT, so we have two diabetics in our cystic fibrosis group (3.0%). When compared to cystic fibrosis patients with normal glucose tolerance, tolerance glucose and diabetes mellitus patients had significantly reduced basal insulin levels (8.6 [3.8] vs 15.0 [22.2] microU/ml; p < 0.0001), increased glucose stimulated insulin and C peptide levels (50.2 [19.3] vs 21.4 [19.3] microU/ml; p < 0.0001, and 9.0 [5.9] vs 4.4 [3.2] ng/ml; p < 0.0001), they were older (18.0 [7.5] vs 12.7 [7.3] years old; p < 0.05) and had longer time since diagnosis and since first sputum colonization. The remaining variables did not differ between the two groups. All patients with exocrine pancreatic sufficiency showed normal glucose tolerance. CONCLUSIONS: Abnormalities in carbohydrate metabolism were present in 16.6% of cystic fibrosis patients. These patients had reduced basal but increased glucose stimulated insulin levels. Age, time since diagnosis of cystic fibrosis, time since first sputum colonization and exocrine pancreatic insufficiency are the variables being associated with carbohydrate metabolism abnormalities.

[Effects of childhood nutrition on adult health]. / Repercusión de la nutrición infantil en la salud del adulto.

Nutrition and health occupy a long period from the fetal age to adolescence. The interaction between genes and nutrients is one of the most interesting aspects. Health depends on genetic and environmental factors, the most important of which is nutrition. There is a need to define mechanisms and evaluate specific hypotheses in controlled animal experiments and clinical trials in humans. The effects must be permanent, remaining long after the nutritional deficiency or excess has disappeared. This presupposes the existence of critical periods in organ development and biochemical or physiological maturation, during which stimuli leave a permanent imprint. Nutrients can affect the structural development of certain organs during critical periods, both in the fetal and neonatal periods, and can contribute to the development of a different organ structure during these critical periods, leaving permanent effects.The role of folic acid as the prime example of the interaction between genes and nutrients is well known. Folates play an important role in DNA synthesis because of their intervention in deoxyuridine and deoxythymidine methylation and their absence provokes severe disorders in DNA replication and synthesis, which can be precancerous. Periconceptional administration of folic acid is essential to prevent dysraphias (spina bifida). Equally, this nutrient is also important to homocysteine metabolism, which is derived from methionine metabolism and which is an important endothelial toxin. Pediatrics should carefully redefine the criteria for adapting feeding and nutrition not only to childhood health but also to adult well being and disease-free survival. The advent of molecular genetics and the possibility of identifying at-risk individuals and the risks to which they are exposed at an early age, even before birth, provides pediatricians with unique opportunities. However, the growth of knowledge and techniques makes it impossible to keep up to date with all the scientific findings concerning children's health. Nevertheless, as doctors, pediatricians need I would say they are obliged to keep up to date in order to serve as a bridge between science and the practical needs of children and their families. Pediatricians will continue to focus on children's health, although the emphasis will increasingly be placed on prevention rather than cure, and must be ever more aware that the child is the father of the man and that the future is in his hands.

Protein composition of human milk in relation to mothers' weight and socioeconomic status.

In the past few years there has been a resurgence of interest in the protein composition of human milk. Up to now the influence of maternal diet and of the mothers' nutritional status on the protein composition of human milk have not been fully clarified. We have evaluated the relationship between the mothers' socioeconomic status and weight and the protein composition of human milk. Protein fractions were determined by a polyacrylamide gel electrophoresis method in 181 samples of human milk obtained from voluntary donors. Samples were classified according to the time of lactation and in relation to the socioeconomic status and to the weight of the lactating women. Total protein and non-protein nitrogen decreased with advancing lactation but there were no differences among the socioeconomic and weight groups of mothers who were considered. beta- and kappa-caseins fell during lactation and beta-casein was significantly increased in the milk of the upper socioeconomic class with respect to that of the low one. alpha-lactalbumin increased from transitional to mature milk (16-30 d) and then declined. The milk from the low socioeconomic group presented the lowest levels of this protein. Lysozyme increased during lactation, whereas lactoferrin decreased. Both proteins were significantly influenced by the mothers' socioeconomic status; the highest concentrations for these proteins were found in the milk of the low socioeconomic group. Deficit or excess of mothers' weight did not influence the levels of the different protein fractions of human milk.

Successful administration of cytarabine after a previous anaphylactic reaction.

Cytarabine (Cyt) is an antimetabolite used primarily in the treatment of leukemia, and both immediate and delayed hypersensitivity reactions have been reported. We studied a 9-year-old girl with lymphoblastic leukemia, who developed three anaphylactoid reactions during Cyt treatment courses over a 1-year period. Three years later, Cyt was required again. Although a skin test was negative to Cyt at the concentration of 4 micrograms/ml, we decided on placebo-controlled administration of the drug. The Cyt was well tolerated, and urine values of N-methylhistamine showed no important variations throughout this period compared to those during the placebo administration. Skin tests carried out 14 days after the study were positive at the concentration of 4 micrograms/ml. The history of different episodes of allergic reactions to Cyt, the last one being the most severe, indicated the possible participation of an immediate hypersensitivity phenomenon, but because no studies had been carried out initially, we could not establish the presence of IgE antibodies. These results indicate that good tolerance existed after the control administration procedure. The long interval, 3 years, between the allergic episode and our protocol and the appearance of a positive skin test 14 days after the protocol indicated that the subject had lost sensitivity and become resensitized after the controlled administration procedure.

Diagnosis and treatment of pertussis.

A review of the diagnostic methods of pertussis (clinical, radiological, laboratoryy: 42 case reports in a period of 2 1/2 years, being all hospitalized children with pertussis, aged from 23 days to 7 years. A review of the treatment with hyperimmune globulin, antibiotics, symptomatic treatment, and the results obtained, is presented.

Early onset neonatal sepsis due to Neisseria meningitidis B.

The onset of meningococcal infection in the first 72 hours after birth has only been reported on a few occasions; The authors describe a case where it was confirmed that the bacteria responsible, Neisseria meningitidis group B, grew in the newborn's blood and in the mother's lochia. The transmission mechanisms are also reviewed.

[Pediatric fiberoptic bronchoscopy. Analysis of a decade]. / Fibrobroncoscopia pediátrica. Análisis de una década.

OBJECTIVE: To review the contribution of new advances in flexible bronchoscopy to the management of respiratory problems in children. METHODS: Over a 10-year-period, 536 flexible bronchoscopies were performed under sedation and local anesthesia in 433 children aged from 5 days to 14 years. Data on symptomatology, underlying diseases, indications, sedation, instrumentation, findings and complications were prospectively collected and stored in a database for later analysis. RESULTS: Underlying disease was found in 300 children (69.3 %). The most common indications for flexible bronchoscopy were persistent atelectasis (n 166), stridor (n 134), tuberculosis (n 66), suspected foreign body (n 61), persistent wheezing (n 55), middle lobe syndrome (n 47) and opportunistic pneumonias (n 41). In 178 patients the procedures were performed on an outpatient basis. One hundred forty-seven bronchoalveolar lavages, 10 bronchial biopsies, and 8 selective bronchographies were performed. Airway anomalies were found in 447 procedures (83.4 %) and 32 pathogenic organisms were identified. In 13 patients cytological study of the samples obtained guided the diagnosis of noninfectious lung disease. Therapeutic interventions were performed in 54 (10.1 %) flexible bronchoscopies. The most important of these were aspiration of bronchial secretions (n 31), removal of foreign bodies (n 6), selective intubation (n 5), and balloon dilatation of bronchial stenosis (n 2). The procedure was diagnostically or therapeutically useful in 391 procedures (79.2 %). CONCLUSION: Although rigid bronchoscopy is currently the procedure of choice in most therapeutic interventions, flexible bronchoscopy is very useful in improving airway exploration and understanding of respiratory disorders in children.

Dietary nucleotides might influence the humoral immune response against cow's milk proteins in preterm neonates.

The objective of this study was to evaluate the influence of dietary nucleotide supplementation in preterm infants during the first month of life on the intestinal permeability to lactulose, mannitol and to beta-lactoglobulin and on the development of circulating antibodies to beta-lactoglobulin and alpha-casein. Twenty-seven preterm infants were enrolled in the study; 11 of them were fed a standard low-birth weight milk formula and 16 infants were fed the same formula supplemented with nucleotides at similar levels to those found in human milk. Blood and urine samples were obtained at 1, 7 and 30 days of age. Serum beta-lactoglobulin, serum IgG antibody to alpha-casein and serum IgG antibody to beta-lactoglobulin were measured by ELISA. The lactulose/mannitol urinary excretion rate was measured by gas liquid chromatography. Neither the intestinal permeability to saccharides nor the intestinal absorption of beta-lactoglobulin were affected by the nucleotide supplementation. However, serum concentrations of IgG antibody to beta-lactoglobulin were higher in preterm neonates fed the supplemented formula than in those fed the standard formula. According to these results, dietary nucleotides might influence the maturation of the humoral immune response in preterm newborn infants.

Changes in the fatty acids pattern of red blood cell phospholipids induced by type of milk, dietary nucleotide supplementation, and postnatal age in preterm infants.

The fatty acid profile of red blood cell phospholipids and the total phospholipid and cholesterol contents of erythrocyte membrane in preterm infants in the first month of life were studied. Influences of human milk and adapted formula and dietary nucleotides supplementation at a level similar to that found in human milk were evaluated. Nineteen preterm newborn infants with adequate weight for gestational age were fed their own mother's preterm human milk, 18 with a standard milk formula and 18 with the same formula supplemented with nucleotides. Blood samples were obtained at birth from cord blood, and at 30 days of age. At 1 month of life, linoleic acid rose in formula fed infants compared to those fed human milk (p less than 0.05) and relative amounts of 20:3w6, 20:4w6, 22:4w6, 22:5w6, and total polyunsaturates of the w6 series greater than 18 carbon atoms were significantly decreased in standard milk formula fed infants (p less than 0.05-0.01). No significant differences for these fatty acids were found between human milk and nucleotide milk formula infants. Docosahexaenoic acid (22:6w3) decreased from birth to 1 month of age in formula fed infants (p less than 0.01) but not in human milk fed infants. Infants fed nucleotide milk formula showed intermediate values for 20:3w6 and 20:4w6 (p less than 0.1) between infants fed human milk and those fed standard milk formula.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anorexia nervosa in adolescence]. / Anorexia nerviosa en la adolescencia.

A study and bibliographic revision is made on Anorexia Nervosa. The definition, classificiation, epidemiology and the different etiopathogenic factors are appraised. A detailed analysis of de clinical, functional, biochemical and endocrinological symptoms are made. Models for treatment are given on insulation therapeutics, on biological and psycho-therapeutics.

Circulating CLA+ lymphocytes from children with atopic dermatitis contain an increased percentage of cells bearing staphylococcal-related T-cell receptor variable segments.

BACKGROUND: Atopic dermatitis is an allergic T-cell mediated skin inflammation. Staphylococcus aureus colonization is very common in cutaneous atopic dermatitis lesions. The cutaneous lymphocyte-associated antigen (CLA) is a T cell skin homing receptor that defines T lymphocytes associated with the cutaneous immune response. OBJECTIVE: To study whether CLA+ T cells from atopic dermatitis children present a selective expression for Staphylococcus aureus-related TCR Vbeta segments. METHODS: Peripheral blood T cells were stained with HECA-452 (anti-CLA) and a panel of TCR Vbeta specific monoclonal antibodies and analysed by flow cytometry. RESULTS: Atopic dermatitis patients have a higher percentage of circulating CLA+ CD3+ lymphocytes compared with healthy controls. Patients with active atopic dermatitis during the study expressed a higher percentage of cells positive for the TCR Vbeta2 and Vbeta5.1 segments in the CLA+ but not in the CLA- subset. These TCR Vbetas are recognized by staphylococcal superantigens. Moreover, there was an increased percentage of HLA-DR+ expression by CLA+ Vbeta5.1+ T cells in patients with active atopic dermatitis, but those patients whose eczema was inactive had very similar values to healthy controls regarding TCR Vbeta and HLA-DR phenotype in circulating CLA+ T lymphocytes. CONCLUSION: Our data indicate that circulating skin-homing T cells of patients with active atopic dermatitis contain an increased percentage of cells bearing TCR Vbeta segments related with Staphylococcus aureus. Staphylococcus superantigens may therefore trigger expansion or at least circulation of appropriate CLA+ T cells.

[Hepatic tumors]. / Tumores hepáticos.

This article show our group of liver neoplasm. We studied the presentation way in the benign and malignant tumors. Moreover we compared the therapeutics results between both groups. In our population was more frequent the malignant neoplasm. The first symptom was more frequent the malignant neoplasm. The first symptom was abdominal mass but with more general complaints in the last one. We checked the increase survival with therapeutics as ADR or CDDP.

[Incidence of IDDM in children (age 0-14 yrs) in Málaga 1982-1988]. / Incidencia de IDDM en niños (0-14 a.) en Málaga, 1982-1988.

The annual incidence of diabetes mellitus in children 0 to 14 years of age in the province of Malaga (Spain) between 1982 and 1988 was 11.4 cases per 100,000 inhabitants (range = 9.7-13.1). There was an inverse relationship with seasonal temperature; the onset of the disease occurred more frequently during the colder months. The highest incidence was found among children between 5 and 9 years of age, with 13.88 cases per 100,000. The male/female ratio was 1.3 in children between 0 and 5 years and in children between 5 and 9 years of age and 0.97 in children between 10-14 years. The onset of the disease as ketoacidosis remained constant at 25% and was independent of age. When compared with other European epidemiological studies, we found a higher incidence of diabetes mellitus than that in Central European or Mediterranean Countries.