Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology / Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

ABSTRACT Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Results: Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2). Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.

RESUMO Introdução: Insuficiência renal aguda (IRA) é uma deterioração abrupta da função renal. A incidência de IRA pediátrica está aumentando em todo o mundo, em ambientes críticos e não críticos. Nosso objetivo foi caracterizar apresentação, etiologia, evolução e desfechos da IRA em pacientes pediátricos internados em um centro de atendimento terciário. Métodos: Realizamos estudo retrospectivo observacional de centro único de pacientes com idade entre 29 dias a 17 anos e 365 dias internados em nossa Unidade de Nefrologia Pediátrica, de janeiro de 2012 a dezembro de 2021, com diagnóstico de IRA. A gravidade da IRA foi categorizada de acordo com os critérios do Kidney Disease Improving Global Outcomes (KDIGO). Os desfechos considerados foram óbito ou sequelas (proteinúria, hipertensão ou alterações na função renal em avaliações de acompanhamento de 3 a 6 meses). Resultados: Incluímos 46 pacientes com idade mediana de 13,0 (3,5-15,5) anos. Cerca de metade (n = 24; 52,2%) apresentou um fator de risco identificável para o desenvolvimento de IRA. Treze pacientes (28,3%) eram anúricos; todos foram classificados como IRA KDIGO 3 (p < 0,001). Quase um quarto (n = 10; 21,7%) dos pacientes necessitaram de terapia renal substitutiva. Aproximadamente 60% (n = 26) apresentou pelo menos uma sequela, sendo proteinúria a mais comum (n = 15; 38,5%; mediana (P25-75) da relação proteína/creatinina urinária 0,30 (0,27-0,44) mg/mg), seguida de taxa de filtração glomerular (TFG) reduzida (n = 11; 27,5%; mediana (P25-75) da TFG 75 (62-83) mL/min/1,73 m2). Conclusões: A IRA pediátrica está associada à morbidade substancial, com potencial para desenvolvimento de proteinúria e comprometimento da função renal e impacto relevante no prognóstico de longo prazo.

Percutaneous kidney biopsies in children: a 24-year review in a tertiary center in northern Portugal / Biópsias renais percutâneas em crianças: uma revisão de 24 anos em um centro terciário no norte de Portugal

Introduction: Percutaneous kidney biopsy (KB) is crucial to the diagnosis and management of several renal pathologies. National data on native KB in pediatric patients are scarce. We aimed to review the demographic and clinical characteristics and histopathological patterns in children who underwent native percutaneous KB over 24 years. Methods: Retrospective observational study of patients undergoing native percutaneous KB in a pediatric nephrology unit between 1998 and 2021, comparing 3 periods: period 1 (1998-2005), period 2 (2006-2013), and period 3 (2014-2021). Results: We found that 228 KB were performed, 78 (34.2%) in period 1, 91 (39.9%) in period 2, and 59 (25.9%) in period 3. The median age at KB was 11 (7-14) years. The main indications for KB were nephrotic syndrome (NS) (42.9%), hematuria and/or non-nephrotic proteinuria (35.5%), and acute kidney injury (13.2%). Primary glomerulopathies were more frequent (67.1%), particularly minimal change disease (MCD) (25.4%), IgA nephropathy (12.7%), and mesangioproliferative glomerulonephritis (GN) (8.8%). Of the secondary glomerulopathies, lupus nephritis (LN) was the most prevalent (11.8%). In group 1, hematuria and/or non-nephrotic proteinuria were the main reasons for KB, as opposed to NS in groups 2 and 3 (p < 0.01). LN showed an increasing trend (period 1-3: 2.6%-5.3%) and focal segmental glomerular sclerosis (FSGS) showed a slight decreasing trend (period 1-3: 3.1%-1.8%), without statistical significance. Conclusions: The main indication for KB was NS, which increased over time, justifying the finding of MCD as main histological diagnosis. LN showed an increase in incidence over time, while FSGS cases did not increase.

RESUMO Introdução: A biópsia renal (BR) percutânea é fundamental para diagnóstico e manejo de diversas patologias renais. Dados nacionais sobre BR nativa em pacientes pediátricos são escassos. Nosso objetivo foi revisar características demográficas, clínicas e padrões histopatológicos em crianças submetidas a BR percutânea nativa ao longo de 24 anos. Métodos: Estudo observacional retrospectivo de pacientes submetidos a BR percutâneas nativas em unidade de nefrologia pediátrica entre 1998 e 2021, comparando três períodos: período 1 (1998-2005), período 2 (2006-2013), período 3 (2014-2021). Resultados: Constatamos que foram realizadas 228 BR, 78 (34,2%) no período 1, 91 (39,9%) no período 2, 59 (25,9%) no período 3. A idade mediana na BR foi 11 (7-14) anos. As principais indicações para BR foram síndrome nefrótica (SN) (42,9%), hematúria e/ou proteinúria não nefrótica (35,5%), lesão renal aguda (13,2%). Glomerulopatias primárias foram mais frequentes (67,1%), principalmente doença de lesão mínima (DLM) (25,4%), nefropatia por IgA (12,7%), glomerulonefrite mesangioproliferativa (GN) (8,8%). Das glomerulopatias secundárias, nefrite lúpica (NL) foi a mais prevalente (11,8%). No grupo 1, hematúria e/ou a proteinúria não nefrótica foram os principais motivos para BR, ao contrário da SN nos grupos 2 e 3 (p < 0,01). A NL apresentou tendência crescente (período 1-3: 2,6%-5,3%) e a glomeruloesclerose segmentar focal (GESF) apresentou leve tendência decrescente (período 1-3: 3,1%-1,8%), sem significância estatística. Conclusões: A principal indicação para BR foi SN, que aumentou ao longo do tempo, justificando o achado de DLM como principal diagnóstico histológico. A NL apresentou aumento na incidência ao longo do tempo, enquanto os casos de GESF não aumentaram.

Shock séptico: complicación atípica de duplicación del tracto alimentario / Septic shock: an atypical complication of alimentary tract duplication

Las duplicaciones del tracto alimentario son un conjunto heterogéneo de anomalías congénitas del tubo digestivo. Su forma de presentación es variada, y pueden desarrollar distintas complicaciones libradas a su evolución natural. La infección es una complicación poco frecuente, pero que no puede desconocerse por la gravedad que implica. Se presenta el caso de una paciente de 2 años de edad, previamente sana, con una complicación atípica de una duplicación del tracto alimentario: un shock séptico. Consultó inicialmente por distensión y dolor abdominal asociado a una masa abdominal palpable. Los estudios imagenológicos evidenciaron una formación líquida parcialmente tabicada en el hemiabdomen derecho. Durante la internación, se presentó una infección intratumoral, que evolucionó al shock séptico. Respondió favorablemente al tratamiento médico del shock, y se realizó la exéresis quirúrgica posteriormente. La anatomía patológica confirmó la duplicación del tracto alimentario.

Alimentary tract duplications are heterogenous congenital anomalies of the digestive tract. Their form of presentation is varied, and they may lead to different complications, depending on their natural course. Infection is a rare complication, but it cannot be ignored because of its severity. Here we describe the case of an otherwise healthy 2-year-old girl with an atypical complication of alimentary tract duplication: septic shock. She initially consulted due to abdominal distension and pain associated with a palpable abdominal mass. The imaging studies showed a partial fluid septation in the right side of the abdomen. During hospitalization, an intratumoral infection developed, which progressed to septic shock. The patient responded favorably to medical treatment for shock, and surgical resection was subsequently performed. The pathology report confirmed the presence of alimentary tract duplication.

Linezolid and vancomycin for nosocomial infections in pediatric patients: a systematic review

Abstract Objective: To investigate the effectiveness of linezolid and vancomycin for the treatment of nosocomial infections in children under 12 years old. Data sources: This is a systematic review in which five randomized clinical trials about the effectiveness of linezolid and vancomycin, involving a total of 429 children with nosocomial infections, were evaluated. They were searched in scientific databases: PubMed, Bvs, and SciELO. Summary of findings: The main nosocomial infections that affected children were bacteremia, skin, and soft tissue infections followed by nosocomial pneumonia. Most infections were caused by Gram-positive bacteria, which all studies showed infections caused by Staphylococcus aureus, with methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci strains being isolated. Both linezolid and vancomycin showed high therapeutic efficacy against different types of nosocomial infections, ranging from 84.4% to 94% for linezolid and 76.9% to 90% for vancomycin. Patients receiving linezolid had lower rates of rash and red man syndrome compared to those receiving vancomycin. However, despite the adverse reactions, antimicrobials can be safely administered to children to treat nosocomial infections caused by resistant Gram-positive bacteria. Conclusion: Both linezolid and vancomycin showed good efficacy in the treatment of bacterial infections caused by resistant Gram-positive bacteria in hospitalized children. However, linezolid stands out regarding its pharmacological safety. Importantly, to strengthen this conclusion, further clinical trials are needed to provide additional evidence.

Validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay / Validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay

Introducción: El dengue es la enfermedad arboviral más común en los seres humanos. Un diagnóstico temprano y preciso del dengue puede respaldar el manejo clínico, la vigilancia y el control de la enfermedad y es fundamental, por ello en el diagnóstico del dengue es importante contar con pautas clínicas y epidemiológicas que permitan la identificación oportuna y una conducta terapéutica adecuada. Objetivos: Evaluar la validez de herramientas diagnósticas en pacientes pediátricos hospitalizados con diagnóstico presuntivo de dengue en un Hospital de Referencia de Paraguay durante los años de 2012 a 2020. Materiales y métodos: Estudio analítico de tipo observacional, retrospectivo correspondientes a pacientes pediátricos (0 a 18 años) internados en el Hospital de Referencia de Paraguay el periodo enero 2012 a julio 2020 con diagnostico presuntivo de dengue al ingreso. Se realizó́ un análisis bivariado relacionando las frecuencias de 20 grupos de criterios diagnósticos combinados y 3 criterios diagnósticos aislados (OMS 2009, nexo epidemiológico y antigenemia NS1 para dengue) con el gold standard de diagnóstico que fue la conversión serológica. Resultados: Participaron del estudio 342 sujetos. EL 44% tenía edad escolar y 70% tenía 5 años o más. El 52,76% (191) fueron masculinos. Se encontraron desnutrición y sobrepeso en el 13% y 2%, respectivamente. La combinación de proteína C reactiva con plaquetopenia se encontró́ en 0.45% de los pacientes sin dengue y en el 6% de los pacientes con diagnóstico final de dengue (p=0.004). Conclusión: Este resultado aporta la alternativa de uso de una combinación sencilla de exámenes de laboratorio que puede replicarse en salas de urgencias como en salas de internación en un primer contacto con pacientes febriles con sospecha de fiebre dengue.

Introduction: Dengue is the most common arboviral disease in humans. An early and accurate diagnosis of dengue can support the clinical management, surveillance and control of the disease and is essential, therefore in the diagnosis of dengue it is important to have clinical and epidemiological guidelines that allow timely identification and appropriate therapeutic conduct. Objectives: To evaluate the validity of diagnostic tools in pediatric patients hospitalized with a presumptive diagnosis of dengue in a Reference Hospital in Paraguay during the years 2012 to 2020. Materials and methods: Analytical study of case and control type, observational, longitudinal, retrospective corresponding to pediatric patients (0 to 18 years) admitted to the Reference Hospital of Paraguay from January 2012 to July 2020 with a presumptive diagnosis of dengue at income. A bivariate analysis was performed relating the frequencies of 20 groups of combined diagnostic criteria and 3 isolated diagnostic criteria (WHO 2009, epidemiological link and NS1 antigenemia for dengue) with the gold standard of diagnosis, which was serological conversion. Results: 342 subjects participated in the study. 44% were school age and 70% were 5 years old or older. 52.76% (191) were male. Malnutrition and overweight were found in 13% and 2%, respectively. The combination of C-reactive protein with thrombocytopenia was found in 0.45% of patients without dengue and in 6% of patients with a final diagnosis of dengue (p=0.004). Conclusion: This result provides the alternative of using a simple combination of laboratory tests that can be replicated in emergency rooms and inpatient wards in a first contact with febrile patients with suspected dengue fever.

Seguimiento de niños con diagnóstico de asma grave antes y durante la pandemia por COVID-19 / Follow-up of children diagnosed with severe asthma before and during the COVID-19 pandemic

En la pandemia por COVID-19 se exploraron estrategias de atención para garantizar el seguimiento de niños con asma grave. Estudio prospectivo, observacional, comparativo. Se incluyeron pacientes del programa de asma grave de un hospital pediátrico de tercer nivel (n 74). Se evaluó el grado de control, exacerbaciones y hospitalizaciones durante un período presencial (PP), marzo 2019-2020, y uno virtual (PV), abril 2020-2021. En el PP, se incluyeron 74 pacientes vs. 68 (92 %) del PV. En el PP, el 68 % (46) de los pacientes presentaron exacerbaciones vs. el 46 % (31) de los pacientes en el PV (p 0,003). En el PP, se registraron 135 exacerbaciones totales vs. 79 en el PV (p 0,001); hubo una reducción del 41 %. En el PP, el 47 % (32) de los pacientes tuvieron exacerbaciones graves vs. el 32 % (22) de los pacientes en el PV (p 0,048). Hubo 91 exacerbaciones graves en el PP vs. 49 en el PV (p 0,029), reducción del 46 %. No hubo diferencias en las hospitalizaciones (PP 10, PV 6; p 0,9). La telemedicina fue efectiva para el seguimiento de pacientes con asma grave

During the COVID-19 pandemic, health care strategies were explored to ensure the follow-up of children with severe asthma. This was a prospective, observational, and comparative study. Patients in the severe asthma program of a tertiary care children's hospital were included (n: 74). The extent of control, exacerbations, and hospitalizations during an in-person period (IPP) (March 2019­2020) and an online period (OP) (April 2020­2021) was assessed. A total of 74 patients were enrolled in the IPP compared to 68 (92%) in the OP. During the IPP, 68% (46) of patients had exacerbations versus 46% (31) during the OP (p = 0.003). During the IPP, 135 total exacerbations were recorded compared to 79 during the OP (p = 0.001); this accounted for a 41% reduction. During the IPP, 47% (32) of patients had severe exacerbations versus 32% (22) during the OP (p = 0.048). A total of 91 severe exacerbations were recorded during the IPP compared to 49 during the OP (p = 0.029); the reduction was 46%. No differences were observed in terms of hospitalization (IPP: 10, OP: 6; p = 0,9). Telemedicine was effective for the follow-up of patients with severe asthma.

Lineamientos para la prevención y el tratamiento de la osteoporosis inducida por glucocorticoides en pediatría / Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis in pediatrics

Objetivo. Proporcionar un marco para profesionales de la salud que tratan a pacientes pediátricos bajo terapia con glucocorticoides (GC) y desarrollar recomendaciones para la prevención y el tratamiento de la osteoporosis inducida por GC en la población pediátrica. Métodos. Un panel de expertos en enfermedades óseas y pediátricas generó una serie de preguntas PICO que abordan aspectos relacionados con la prevención y el tratamiento de osteoporosis en pacientes bajo tratamiento con GC. Siguiendo la metodología GRADE, se realizó una revisión sistemática de la literatura, se resumieron las estimaciones del efecto y se calificó la calidad de la evidencia. Luego se procedió a la votación y a la formulación de las recomendaciones. Resultados. Se desarrollaron 7 recomendaciones y 6 principios generales para osteoporosis inducida por GC en población pediátrica. Conclusión. Estas recomendaciones proporcionan orientación para los médicos que deben tomar decisiones en pacientes pediátricos bajo tratamiento con GC.

Objective. To provide a framework for healthcare professionals managing pediatric patients who are on active glucocorticoid (GC) therapy and to develop recommendations for the prevention and treatment of GC-induced osteoporosis in the pediatric population. Methods. A panel of experts on bone and pediatric diseases developed a series of PICO questions that address issues related to the prevention and treatment of osteoporosis in patients on GC therapy. In accordance with the GRADE approach, we conducted a systematic review of the literature, summarized effect estimations, and classified the quality of the evidence. Then, voting and the formulation of recommendations followed. Results. Seven recommendations and six general principles were developed for GC-induced osteoporosis in the pediatric population. Conclusion. These recommendations provide guidance for clinicians who must make decisions concerning pediatric patients undergoing treatment with GC.

Tuberculosis abdominal en pediatría: presentación de un caso / Abdominal tuberculosis in pediatrics: A case report

La tuberculosis es una enfermedad infectocontagiosa cuya forma de presentación más frecuente es la pulmonar; la afectación abdominal es poco frecuente, por lo que su diagnóstico continúa siendo un desafío. Las manifestaciones clínicas de la tuberculosis abdominal así como sus hallazgos en el examen físico suelen ser inespecíficos y, en muchas ocasiones, similares a los de otras patologías, por lo que es fundamental considerarla entre los diagnósticos diferenciales. Se presenta el caso clínico de un paciente de sexo masculino, de 15 años de edad, hospitalizado por un síndrome febril prolongado asociado a dolor abdominal, diarrea, sudoración nocturna y pérdida de peso

Tuberculosis is an infectious disease which most commonly compromises the respiratory system, whereas abdominal involvement is rare, thus its diagnosis is a challenge. The clinical manifestations of abdominal tuberculosis as well as its physical examination findings are usually non-specific and, frequently, similar to those of other diseases, so it is critical to consider abdominal tuberculosis among the differential diagnoses. Here we report the clinical case of a 15-year-old male patient hospitalized for a prolonged febrile syndrome associated with abdominal pain, diarrhea, night sweats, and weight loss.

Feocromocitoma y paraganglioma en un hospital pediátrico de Argentina. Serie de casos / Pheochromocytoma and paraganglioma at a children's hospital in Argentina. A case series

El feocromocitoma y el paraganglioma son tumores neuroendocrinos secretores de catecolaminas. Los feocromocitomas se originan en la médula suprarrenal, mientras que los paragangliomas son extraadrenales. Se describe una serie de casos de niños con diagnóstico anatomopatológico de feocromocitoma o paraganglioma que consultaron en un hospital pediátrico de alta complejidad de Argentina. Se incluyeron 21 pacientes, 14 varones, con una mediana de edad de 11,4 años; 8 casos con feocromocitoma y 13 casos con paraganglioma. Se presentaron con hipertensión arterial 14/21. La mayoría de los paragangliomas tuvieron localización paraaórtica (9/13). Debido a que representan una causa potencialmente curable de hipertensión arterial, la sospecha clínica es muy importante. El diagnóstico temprano y la instauración de un tratamiento antihipertensivo adecuado, que permita afrontar la cirugía con normotensión arterial, aseguran la curación en la mayoría de los casos si la resección tumoral es completa.

Pheochromocytomas and paragangliomas are neuroendocrine tumors producing catecholamines. Pheochromocytomas occur in the adrenal medulla, while paragangliomas are those that occur outside the adrenal gland. Here we describe a case series of children with a pathological diagnosis of pheochromocytoma or paraganglioma who consulted at a tertiary care children's hospital in Argentina. A total of 21 patients (14 males) were included; their median age was 11.4 years; 8 children had pheochromocytoma and 13, paraganglioma. Arterial hypertension was observed in 14/21. Most paragangliomas were para-aortic (9/13). Since they are a potentially curable cause of hypertension, clinical suspicion is very important. An early diagnosis and the initiation of an adequate antihypertensive treatment, which allows the patient to undergo surgery with normal blood pressure, ensure a cure in most cases if tumor resection is complete.

Competências para o atendimento multiprofissional da PCR em pediatria: percepções da equipe de enfermagem / Skills for multiprofissional care for cardiorespiratory arrests in pediatrics: perceptions of the nursing team / Habilidades para el cuidadod multiprofesional de las paradas cardiorrespiratorias en pediatria: percepciones del equipo de enfermería

Estudo exploratório descritivo, quantitativo, realizado em um hospital pediátrico filantrópico, com objetivo de compreender as competências profissionais da enfermagem no atendimento da parada cardiorrespiratória em pediatria, além de investigar suas percepções. Participaram 30 profissionais da equipe de enfermagem e a coleta de dados foi realizada por meio de um questionário fechado. Os resultados, analisados por meio de estatística descritiva, mostraram que os profissionais de enfermagem, em sua maioria, apresentaram conhecimento sobre o atendimento da emergência investigada. Em relação às suas percepções sobre as habilidades técnicas necessárias, notou-se que a maioria dos participantes se perceberam seguros para as manobras de ressuscitação e para a administração de medicações durante o atendimento; contudo, ao abordar o manuseio do desfibrilador e a realização de punção venosa, a maior parte da amostra afirmou não se sentir totalmente segura para estas atividades. Concluiu-se que a maioria dos participantes apresentam conhecimento teórico-prático para a execução do atendimento.

Descriptive, quantitative exploratory study, carried out in a philanthropic pediatric hospital, with the objective of understanding the nursing professional competencies in the care of cardiorespiratory arrests in pediatrics, besides investigating. 30 professionals from the nursing team participated and data was collected using a closed questionnaire. The results, analyzed using descriptive statistics, showed that the majority of nursing professionals had knowledge about the care of the investigated emergency. In relation to their perceptions about the necessary technical skills, the majority of participants perceived themselves to be confident in resuscitation maneuvers and the administration of medications during care. However, when approaching the handling of the defibrillator and performing a venipuncture, most of the sample stated that they did not feel complete confidence for these activities. Study concluded that the majority of participants had theoretical-practical knowledge to perform the service.

Estudio exploratorio descriptivo, cuantitativo, realizado en un hospital pediátrico filantrópico, con el objetivo de comprender las competencias profesionales de enfermería en el cuidado de la parada cardiorrespiratoria en pediatría, además de investigar sus percepciones. Participaron 30 profesionales del equipo de enfermería y la recolección de datos se realizó mediante cuestionario cerrado. Los resultados, analizados mediante estadística descriptiva, mostraron que la mayoría de los profesionales de enfermeira tenían conocimiento sobre la atención de la emergencia investigada. En relación a sus percepciones sobre las habilidades técnicas necesarias, se observa que la mayoría de los participantes se observó que la mayoría de los participantes se percibió confiada en las maniobras de reanimación y la administración de medicamentos durante la atención. Sin embargo, al abordar el manejo del desfibrilador y realizar una punción venosa, la mayoría de la muestra manifestó no sentirse completamente segura para estas actividades. Estudio concluyó que la mayoría de los participantes presentó conocimientos teórico-prácticos para realizar el servicio.

A prática psicológica e a ludicidade na hospitalização pediátrica: relato de experiência / Psychological practice and playing in pediatric hospitalization: experience report / La práctica psicológica y la ludicidad en la hospitalización pediátrica: informe de experiencia

INTRODUÇÃO: A inserção da psicologia e o método lúdico de intervenção na esfera hospitalar surge para promover bem-estar frente às vivências das crianças em condição de internação. O enfrentamento de uma hospitalização no período da infância pode provocar impactos significativos do ponto de vista orgânico, psíquico e ambiental, por ser um momento de estruturação do indivíduo enquanto sujeito psíquico. OBJETIVO: Posto isso, o presente artigo objetiva refletir sobre a relação da família e da equipe de saúde com crianças hospitalizadas e a relevância da utilização dos recursos lúdicos, a partir de um relato de experiência de estagiários de um curso de graduação em psicologia. MÉTODO: Logo, trata-se de um relato de experiência, de abordagem qualitativa e de natureza descritiva, realizado de março de 2022 a junho de 2023, em uma Unidade Pediátrica de um Hospital Público Brasileiro. RESULTADOS E DISCUSSÃO: A partir disso, observaram-se na prática reações de estranhamento dos pacientes ao se depararem com a permanência no hospital, o adoecimento e os procedimentos das equipes multiprofissionais de saúde; bem como evidenciou-se a importância da transmissão das informações e do preparo verbal ante intervenções, visando a participação ativa do paciente em seu tratamento. Também observou-se a significância do uso de ferramentas lúdicas nas intervenções com as crianças, que facilitam a adaptação ao contexto e proporcionam âncora para estas elaborarem suas vivências. CONCLUSÃO: Portanto, conclui-se que a utilização de recursos lúdicos favorece o atendimento psicológico na infância e período de hospitalização.

INTRODUCTION: The integration of psychology and the playing method of intervention in the hospital setting emerges to promote wellbeing in the face of children's experiences during hospitalization. Confronting hospitalization during childhood can lead to significant impacts from organic, psychological, and environmental standpoints, as it represents a pivotal moment in the individual's psychological development. OBJECTIVE: With this in mind, the present article aims to reflect on the relationship between families and healthcare teams with hospitalized children and the relevance of using playful resources, based on an experience report from interns of an undergraduate psychology course. METHOD: Therefore, it constitutes an experiential account, employing a qualitative and descriptive approach, conducted from March 2022 to June 2023, in a Pediatric Unit of a Brazilian Public Hospital. RESULTS AND DISCUSSION: From this perspective, practical observations revealed patients' feelings of unfamiliarity upon facing hospital stays, illness, and procedures performed by multidisciplinary healthcare teams; as well as the significance of conveying information and verbal preparation before interventions was highlighted, aiming to actively involve the patient in their treatment. It was also observed the significance of using playful tools in interventions with children, which facilitates adaptation to the context and provides an anchor for them to elaborate on their experiences. CONCLUSION: Thus, it can be concluded that the use of playful resources enhances psychological care during childhood and the hospitalization period.

INTRODUCCIÓN: La inserción de la psicología y el método lúdico de intervención en el ámbito hospitalario surge con el propósito de promover el bienestar frente a las experiencias de los niños en condiciones de hospitalización. Enfrentar la hospitalización durante la infancia puede generar impactos significativos desde un punto de vista orgánico, psicológico y ambiental, ya que representa un momento de estructuración del individuo como sujeto psíquico. OBJETIVO: En este sentido, el presente artículo tiene como objetivo reflexionar sobre la relación de la familia y el equipo de salud con niños hospitalizados y la relevancia de utilizar recursos lúdicos, a partir de un relato de experiencia de practicantes de un curso de grado en psicología. MÉTODO: Por lo tanto, se trata de un informe de experiencia con enfoque cualitativo y de naturaleza descriptiva, llevado a cabo desde marzo de 2022 hasta junio de 2023 en una Unidad Pediátrica de un Hospital Público Brasileño. RESULTADOS Y DISCUSIÓN: A partir de esto, se observaron reacciones de desconcierto por parte de los pacientes al enfrentar la permanencia en el hospital, la enfermedad y los procedimientos realizados por los equipos de salud multidisciplinarios; así como también se resaltó la importancia de la transmisión de información y la preparación verbal antes de las intervenciones, con el objetivo de involucrar activamente al paciente en su tratamiento. También se observó la importancia del uso de herramientas lúdicas en las intervenciones con niños, ya que facilitan la adaptación al contexto y brindan un punto de referencia para que estos niños elaboren sus experiencias. CONCLUSIÓN: Por lo tanto, se concluye que el uso de recursos lúdicos favorece la atención psicológica durante la infancia y el período de hospitalización.

Falta de adherencia al control médico en pacientes pediátricos con antecedente de glomerulonefritis infecciosa

Introducción: La glomerulonefritis pos infecciosa (GNPI) en la infancia es un factor de riesgo para el desarrollo de enfermedad renal crónica a largo plazo. La adherencia al control médico permite realizar la nefroprevención secundaria. Objetivo: evaluar la relación entre los factores de riesgo relacionados a la falta de adherencia al control médico de pacientes con GNPI en una cohorte pediátrica. Metodología: estudio descriptivo de asociación cruzada de cohorte retrospectiva de pacientes internados entre enero de 2000 a diciembre de 2018 en un hospital de referencia. Se analizó la relación entre: hacinamiento, colecho, escolaridad materna y paterna, número de hermanos, de convivientes y procedencia, con la falta de adherencia al control médico. Se utilizaron la prueba de chi cuadrado y regresión logística a un nivel de significancia de 0,05. Resultados: Se incluyeron 148 pacientes (103 niños y 45 niñas) entre 2 a 16 años (edad promedio: 8,5± 3,4 años). La falta de adherencia fue encontrada en 73 pacientes (49,3%) que se asoció a procedencia rural (p= 0,012, RR: 1,50, IC95%: 1,10-2,06), baja escolaridad materna (p= 0,046, IC95%: 1,54:1,14-2,08), baja escolaridad paterna (p= 0,02; RR: 1,483, IC95%: 1,09-2,01), >3 convivientes (p=0,007, RR: 1,630, IC95%: 1,21-2,19), colecho (p=0,026; RR: 1,52, IC95%: 1,02-2,27) y hacinamiento (p<0,0001; RR: 1,92, IC95%: 1,39-2,65). Por regresión logística, el hacinamiento (p=0,005; OR= 4,8) y procedencia rural (p=0,022; OR: 2,4) se mantuvieron asociados a la falta de adherencia. Discusión: El hacinamiento y la procedencia rural se asociaron en forma independiente con la pérdida de seguimiento. Se recomienda mayor intervención de la atención primaria de salud.

Introduction: Post-infectious glomerulonephritis (PIGN) in childhood is a risk factor for the development of long-term chronic kidney disease. Adherence to medical control allows secondary nephroprevention to be carried out. Objective: to evaluate the relationship between risk factors related to non-adherence to medical control of patients with IPGN in a pediatric cohort. Methods: descriptive study, with an analytical component of a retrospective cohort of patients hospitalized between January 2000 and December 2018 in a reference hospital. The relationship between: overcrowding, co-sleeping, maternal and paternal education, number of siblings, cohabitants and origin, with lack of adherence to medical control was analyzed. The chi-square test and logistic regression were used at a significance level of 0.05. Results: a total of 148 patients (103 boys y 45 girls) between 2 and 16 years old (mean age: 8.5± 3.4 years) were included. The lack of adherence was found in 73 patients (49.3%) that was associated with rural origin (p= 0.012, RR: 1.50, 95% CI: 1.10-2.06), low maternal education (p= 0.046, 95%CI: 1.54:1.14-2.08), low paternal education (p= 0.02; RR: 1.483, 95%CI: 1.09-2.01), >3 cohabitants (p=0.007, RR: 1.630, 95% CI: 1.21-2.19), co-sleeping (p=0.026; RR: 1.52, 95% CI: 1.02-2.27) and overcrowding (p<0.0001; RR: 1.92, 95% CI: 1.39-2.65). By logistic regression, overcrowding (p=0.005; OR= 4.8) and rural origin (p=0.022; OR: 2.4) remained associated with lack of adherence. Discussion: Overcrowding and rural origin were independently associated with loss to follow-up. Greater intervention by primary health care is recommended.

Hidden hunger - a narrative review

Abstract Objective Malnutrition is characterized by situations of undernutrition and obesity resulting from the lack of micronutrients with the greatest impact on children. The objective of this review was to highlight inadequate food consumption, food security, and nutritional inadequacy leading to hidden hunger and the prevention and treatment of the main micronutrient deficiencies in Brazil. Data source Literature review carried out through a bibliographic survey in PubMed (National Library of Medicine, United States), Lilacs (Latin American and Caribbean Literature in Health Sciences), and SciELO (Scientific Electronic Library Online) databases. The search used the terms Occult hunger, (hidden hunger), and Child, in articles published between 2013 and 2023 in Portuguese, English and Spanish. The search was performed on 06/25/2023. Data synthesis The lack of micronutrients can occur insidiously and without clinical manifestations, being called hidden hunger. The prevention of nutritional deficiencies is part of the recommended actions in childcare, with healthy eating. Studies were cited related to macro and micronutrient intake deficiencies, both national and international, and strategies to improve micronutrient intake, including routine supplementation of iron, and vitamins D and A. The diagnosis, prevention, and treatment of the main deficiencies in Brazil (iron, vitamin A, vitamin D, zinc), currently adopted, concluded the topic. Conclusion Zero hunger and zero obesity must be part of the same policy, together with a nutritional education program.

Diagnósticos retrasados y administración de ondansetron en el tratamiento de los vómitos en urgencias pediátricas

Introducción : El ondasentrón es un agente farmacológico de uso frecuente para el tratamiento sintomático de los vómitos originados por gastroenteritis. Sin embargo, podría enmascarar patologías más graves que ameriten reconsultas y hospitalización. Objetivo: Indagar si la administración del ondansetrón como tratamiento sintomático de los vómitos en el departamento de emergencias pediátricas (DEP) retrasó el diagnóstico de patologías graves. Materiales y métodos: Estudio observacional, descriptivo de corte transverso retrospectivo. Fueron elegibles pacientes que consultaron en el DEP, recibieron tratamiento con ondansetron, y reconsultaron dentro de las 24 horas. Los datos fueron recolectados de la base de datos de consultas del DEP, el comando reconsultas y entrevista telefónica a los padres. Las variables fueron edad, sexo, procedencia, motivo de la segunda consulta, diagnósticos finales en la segunda consulta. Los datos fueron analizados en SPSS utilizando estadística descriptiva. Resultados En el periodo de estudio consultaron por vómitos y recibieron ondasentrón 2018 pacientes. Reconsultaron dentro de las 24 horas 212, cumpliendo con los criterios de inclusión 205 pacientes. Se constató un 24,8% nuevos diagnósticos durante la reconsulta, de los cuales 35% requirieron hospitalización. Los diagnósticos fueron fiebre sin foco 2,9%, neumonía 2,4%, infección de vías urinarias 1%, sospecha de chikunguya 1,5%, adenitis mesentérica 0,5%, abdomen agudo quirúrgico 0,5%. Conclusión: Se identificó diagnósticos diferentes a la primera consulta en pacientes que recibieron ondansetrón como tratamiento sintomático de los vómitos en urgencias pediátricas, requiriendo hospitalización el 35% de los mismos.

Introduction: Ondansetron is a pharmacological agent frequently used for the symptomatic treatment of vomiting caused by gastroenteritis. However, it could mask more serious pathologies that require repeat consultations and hospitalization. Objective: To investigate whether the administration of ondansetron as a symptomatic treatment of vomiting in the pediatric emergency department (PED) delayed the diagnosis of serious pathologies. Materials and methods: This was an observational, descriptive, retrospective and cross-sectional study. Patients who consulted at the PED, received treatment with ondansetron, and returned for consultation within 24 hours were eligible. Data were collected from the PED consultation database, the follow-up consultation request, and a telephone interview with parents. The variables were age, sex, origin, reason for the second consultation, and final diagnoses in the second consultation. The data were analyzed in SPSS using descriptive statistics. Results: During the study period, 2018 patients consulted for vomiting and received ondansetron. 212 were consulted again within 24 hours, with 205 patients meeting the inclusion criteria. There were 24.8% new diagnoses during the follow-up consultation, of which 35% required hospitalization. The diagnoses were fever without source 2.9%, pneumonia 2.4%, urinary tract infection 1%, suspected chikunguya 1.5%, mesenteric adenitis 0.5%, and surgical acute abdomen 0.5%. Conclusion: Diagnoses different from the first consultation were identified in patients who received ondansetron for symptomatic treatment of vomiting in pediatric emergencies, with 35% requiring hospitalization.

Trastornos psicopatológicos de los pacientes de un hospital pediátrico durante la pandemia por el SARS COV-2

Introducción: La pandemia del COVID-19 alteró la vida de la población infantil. Según UNICEF, 1 de cada 7 niños se ha visto directamente afectado por los confinamientos en todo el mundo. Objetivo: Describir las características de la consulta y los diagnósticos de los pacientes que acudieron al departamento de salud mental del Hospital General Pediátrico Niños de Acosta Ñu, durante la pandemia COVID-19. Materiales y Métodos: Estudio observacional descriptivo transversal, retrospectivo. Se incluyeron a los pacientes que acudieron al Departamento de Salud Mental del Hospital General Pediátrico Niños de Acosta Ñu con diagnósticos psicopatológicos durante la pandemia COVID-19 en el periodo de marzo 2020 a marzo 2021. Las variables fueron: edad, sexo, procedencia, áreas de reclutamiento, tipo de consulta, modalidad de consulta, motivo de evaluación en salud mental, diagnóstico, tratamiento, hospitalización. Los datos se analizaron en IBM SPSS v.21 (demo) utilizando estadística descriptiva. El protocolo fue aprobado por el comité de ética. Resultados: Fueron incluidos 130 participantes, la mediana de edad fue de 13.5 años. El 81.5% procedían del Departamento Central y el 53.8% eran de sexo femenino. El 87.7% eran pacientes en seguimiento y el 69.2% realizaron la consulta de manera presencial. Los diagnósticos más frecuentes fueron, la depresión en un 51.5% y la negligencia o abandono en 27.7%. Se observó asociación de diagnósticos en 58.1%. El 70.8% requirió tratamiento y 10.8% requirió internación. Conclusión: Consultaron con mayor frecuencia adolescentes de sexo femenino. El diagnóstico más frecuente fue la depresión, acompañados de antecedentes de abuso sexual y/o de negligencia o abandono.

Introduction: The COVID-19 pandemic altered the lives of the children's population. According to UNICEF, 1 in 7 children has been directly affected by lockdowns around the world. Objective: Describe the characteristics of the consultation and the diagnoses of the patients who attended the Mental Health Department of the Children General Pediatric Hospital "Acosta Ñu", during the COVID-19 pandemic. Materials and methods: Observational, descriptive, cross-sectional, retrospective study that included those patients who attended the Mental Health Department of the Children Pediatric Hospital "Acosta Ñu" with psychopathological diagnoses during the COVID-19 pandemic in the period from March 2020 to March 2021. The variables were: age, sex, origin, recruitment areas, type of consultation, mode of consultation, reason for mental health evaluation, diagnosis, treatment, hospitalization. Data were analyzed in IBM SPSS v.21 (demo) using descriptive statistics. The protocol was approved by the ethics committee. Results: 130 participants were included with a median age of 13.5 years. 81.5% came from the Central Department and 53.8% were female. 87.7% were patients in follow-up and 69.2% had the consultation in person. The most frequent diagnoses were depression in 51.5% and neglect or abandonment in 27.7%. Association of diagnoses was observed in 58.1%. 70.8% required treatment and 10.8% required hospitalization. Conclusion: Female adolescents consulted more frequently. The most frequent diagnosis was depression, accompanied by a history of sexual abuse or neglect or abandonment.

Cambios en Mecánica Respiratoria en Usuarios Pediátricos en Ventilación Mecánica Post Cirugía de Cardiopatía Congénita Sometidos a Kinesiología Respiratoria versus Succión Endotraqueal. Revisión Estructurada / Changes in Respiratory Mechanics in Pediatric Users on Mechanical Ventilation Post Congenital Heart Disease Surgery Undergoing Respiratory Kinesiology versus Endotracheal Suction. Structured Review

Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.

Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.

Hiperandrogenismo por tumor ovárico de células esteroideas en paciente pediátrico / Hyperandrogenism due to ovarian steroid cell tumor in a pediatric patient

RESUMEN Los tumores de ovario son raros en pediatría. En este grupo, los tumores de células esteroideas representan el 0,1% de los casos y existen escasos reportes en la literatura. Presentamos el caso de una niña de 11 años con síntomas de engrosamiento de la voz, hirsutismo, acné y clitoromegalia. El análisis de laboratorio mostró niveles elevados de testosterona total y libre, niveles normales de 17-hidroxiprogesterona. La evaluación ecográfica reveló un agrandamiento significativo del ovario izquierdo. La paciente fue sometida a salpingooforectomía izquierda. Este hallazgo fue consistente con un tumor de células esteroideas de ovario. A esto le siguió la reducción gradual de los andrógenos y la mejoría clínica. Los tumores de células esteroideas son raros en pediatría, sin embargo, deben considerarse como diagnóstico diferencial al estudiar pacientes con síntomas de hiperandrogenismo.

ABSTRACT Ovarian tumors are rare in pediatrics. In this group, steroid cell tumors represent 0.1% of total cases and there are few reports in the literature. We present the case of an 11-year-old girl who suffered from deeper voice, hirsutism, acne and clitoromegaly. Analysis showed elevated levels of total and free testosterone, normal levels of 17-hydroxyprogesterone. Ultrasound evaluation revealed significant enlargement of the left ovary. The patient underwent left salpingo-oophorectomy. This finding is consistent with an ovarian steroid cell tumor. This is followed by gradual reduction of androgens and clinical improvement. Steroid cell tumors are rare in pediatrics, however, they should be considered as a differential diagnosis when studying patients with symptoms of hyperandrogenism.

Manejo del tracto de salida del ventrículo derecho con implante percutáneo de válvula Melody en pacientes pediátricos: experiencia en un centro de alta complejidad en Colombia / Management of right ventricular outflow tract with percutaneous Melody valve implantation in pediatric patients: experience in a high complexity center in Colombia

Resumen Antecedentes: Las cardiopatías congénitas plantean un desafío terapéutico, específicamente la estenosis de la válvula pulmonar. Esta ha sido tratada durante muchos años con procedimientos invasivos e inserción de bioprótesis, que con el tiempo se vuelven disfuncionales y pueden reestenosarse por acumulación de tejido fibroso y calcificación. Debido a las complicaciones generadas por la injuria quirúrgica, se han descrito medidas menos invasivas para el manejo de la estenosis residual e inicial por medios endovasculares en adultos y más recientemente en población pediátrica. Objetivo: El objetivo de este reporte es describir la misma en el manejo endovascular del tracto de salida del ventrículo derecho, como el inicio de un trabajo continuo para la mejoría de los resultados pediátricos en países en vía de desarrollo. Métodos: Se presentan siete casos pediátricos de manejo endovascular del tracto de salida derecho; tres de ellos sometidos a valvuloplastia quirúrgica con persistencia de la estenosis pulmonar, por lo cual se decidió inserción percutánea de una válvula pulmonar (IVPP) transcatéter con válvula Melody utilizando la técnica valve-in-valve, con lo que se consiguió una resolución del 100% de la estenosis y no se presentó ningún tipo de complicación asociada al procedimiento. Resultados: En cuatro pacientes se logró una implantación exitosa de la válvula por vía percutánea en diferentes cardiopatías congénitas, siendo uno de ellos en tracto nativo; además, destaca el caso de un paciente en quien se realizó fractura intencional de la válvula pulmonar, procedimiento innovador en el manejo endovascular pediátrico en Colombia. Conclusiones: En estos pacientes el procedimiento resultó ser poco invasivo, seguro y efectivo. La técnica IVPP podría ser considerada una opción viable en Colombia (y en otros países en desarrollo) para el manejo de implantes valvulares primarios fallidos o incluso en tractos nativos.

Abstract Background: Congenital heart disease poses a therapeutic challenge, specifically pulmonary valve stenosis. This has been treated for many years with invasive procedures and bioprostheses, which over time, become dysfunctional due to the accumulation of fibrous tissue and calcification. Objective: The aim of this study is to describe the use of endovascular management in the right ventricular outflow tract, as the beginning of an ongoing effot to improve pediatric outcomes in developing countries. Methods: Seven pediatric patients with endovascular management of the right outflow tract are presented. Three of them underwent surgical valvuloplasty with persistent pulmonary stenosis. They decided to insert a percutaneous transcatheter pulmonary valve (PPVI) with a Melody valve using the valve-in-valve technique, with 100% stenosis and no complications associated with the procedure. Results: Four patients with successful percutaneous valve implantation had different congenital heart diseases. In addition, the case of a patient in whom an intentional pulmonary valve fracture was performed, an innovative procedure in pediatric endovascular management in the country, is highlighted. Conclusions: The procedure was minimally invasive, safe, and effective. The IVPP technique could be a viable option in our country for managing failed primary valve implantations or even in native tracts.

Epidemiología y resultados del paro cardiorrespiratorio pediátrico en la unidad de recuperación cardiovascular de un hospital público en Argentina / Epidemiology and outcomes of pediatric cardiac arrest in a cardiovascular unit at a public hospital in Argentina

Resumen Antecedentes: Los niños con cardiopatías congénitas experimentan paro cardiorrespiratorio (PCR) con mayor frecuencia que la población pediátrica general. Se desconoce la epidemiología exacta del PCR en nuestro medio, al igual que el riesgo de mortalidad y los factores que influyen en la evolución neurológica. Objetivo: Describir la epidemiología y los resultados asociados con la reanimación cardiopulmonar pediátrica en una unidad de recuperación cardiovascular. El criterio de valoración primario fue la supervivencia al momento del alta hospitalaria; los secundarios fueron el retorno de la circulación espontánea, la supervivencia a las 24 horas y la condición neurológica en el largo plazo. Método: Estudio de cohorte longitudinal, descriptivo, prospectivo, en menores de 18 años que requirieron reanimación cardiopulmonar entre 2016 y 2019. Se analizaron las variables demográficas y las características del paro cardiorrespiratorio y de la reanimación, así como su resultado. Se realizaron análisis de una y múltiples variables para comparar a los pacientes sobrevivientes con los fallecidos. Resultados: De los 1,842 pacientes internados, el 4.1% experimentó PCR. Se analizaron 50 pacientes con expedientes completos. Se logró el retorno de la circulación espontánea en el 78% (39), con una supervivencia alta del 46%. La reanimación > 6 min y el uso de fármacos vasoactivos fueron factores predictivos de mortalidad; se realizó el seguimiento de 16/23 pacientes, 10 de ellos con desarrollo normal para la edad luego de seis meses, seis tenían trastorno generalizado del desarrollo. Conclusiones: El 4.1% de los pacientes presentó un PCR, con una tasa de 3.4 PCR por 1,000 días-paciente. La supervivencia al egreso hospitalario (n = 50) fue del 46%. La reanimación > 6 min y la utilización de fármacos vasoactivos fueron factores predictivos independientes de mortalidad. Luego de seis meses, el 63% tenía desarrollo neurológico normal para la edad.

Abstract Background: Children with congenital heart disease present a higher frequency of cardiorespiratory arrest (CRA) than the general pediatric population. The epidemiology of CRA is not exactly known in our setting, nor are the mortality risk or the neurological evolution factors. Objective: To describe the epidemiology and outcomes associated with pediatric cardiopulmonary resuscitation in a cardiovascular recovery unit. The primary endpoint was the survival to discharge and the secondary endpoints were the return to spontaneous circulation, the survival at 24 hours and the remote neurological condition. Methods: Descriptive, prospective, longitudinal cohort study in children under 18 years of age who required cardiopulmonary resuscitation between 2016 and 2019. Demographic variables, characteristics of cardiopulmonary arrest, resuscitation and outcome were analyzed. An uni- and multivariate analysis was performed comparing survivors and deceased. Results: Out of 1,842 hospitalized patients, 4.1% presented CRA. Fifty patients with complete records were analyzed. Seventy-eight percent (39) returned to spontaneous circulation with a high survival rate of 46%. Resuscitation > 6 min and the use of vasoactive drugs were predictors of mortality; 16/23 patients were followed up, 10 of them with normal development for age at 6 months, six had pervasive developmental disorder. Conclusions: 4.1% of patients presented CRA, with a rate of 3.4 CRA per 1,000 patient-days. Survival at hospital discharge (n = 50) was 46%. Resuscitation > 6 min and the use of vasoactive drugs were independent predictors of mortality. At six months, 63% had normal neurological development for age.

Descentralización en la formación de especialistas en Pediatría en la Facultad de Medicina, Universidad de la República. Uruguay

Introducción: centralizar estudios superiores en Montevideo implica para las familias del interior del país gastos económicos, desarraigo familiar y pérdida de recursos humanos. La formación de especialistas en Pediatría en el interior comenzó en la década de 1980. En los últimos años se ha fortalecido, agregando escenarios de aprendizaje, docentes, recursos didácticos y evaluaciones. Objetivo: describir la experiencia en la descentralización de la docencia de especialistas en Pediatría entre 2007 y 2021 en los departamentos de Maldonado, Paysandú, Rivera y Salto. Metodología: estudio descriptivo, incluyendo estudiantes del posgrado de especialistas en Pediatría que realizaron su formación en Maldonado, Paysandú, Rivera y Salto, entre 2007 y 2021. Se describe el número de especialistas formados, las características personales o familiares que incidieron en la decisión de realizar el curso en el interior, desempeño curricular, lugar de ejercicio profesional, recursos humanos docentes disponibles. Resultados: en el período analizado 88 estudiantes cursaron el posgrado en las ciudades evaluadas, 33 en régimen de residencia. Eran oriundos/residentes del lugar, 78. Egresaron 57; 19 se encontraban cursando, 4 abandonaron. Un porcentaje variable de las instancias obligatorias del curso se realizaron en el interior. El tiempo promedio para realizar todas las actividades obligatorias fue de 3,3 años. Ejercen en el lugar de formación o en ciudades cercanas, 60. Paysandú y Salto cuentan con 34 horas docentes/semana. Maldonado con 6 horas docentes/semana y docentes honorarios. Rivera cuenta con docentes/tutores honorarios. Conclusiones: la descentralización de la docencia de Pediatría es un gran logro para las ciudades del interior, que forman sus propios recursos humanos, permitiendo que se radiquen en estas ciudades. Es necesario mejorar la oferta de actividades curriculares y horas docentes.

Introduction: Centralizing higher education studies in Montevideo entails economic expenses, family uprooting, and loss of human resources for families living in the interior of Uruguay. The training of pediatric specialists outside the capital city began in the 1980s. In recent years, this innovations has been reinforced by adding learning scenarios, teachers, didactic resources, and evaluations. Objective: to describe the experience of decentralizing the teaching of pediatric specialists between 2007 and 2021 in Maldonado, Paysandú, Rivera, and Salto. Method: Descriptive study, including postgraduate students of pediatris who completed their training in Maldonado, Paysandú, Rivera, and Salto between 2007 and 2021. The study describes the number of specialists trained, personal or family characteristics that influenced the decision to take the course in the interior, academic performance, place of professional practice, and available teaching staff. Results: during the study period, 88 students undertook postgraduate studies in the evaluated cities, 33 of which studied in a residency program. Of these, 78 were native to or residents of the area. Fifty six pediatricians graduated, 18 were still enrolled, and 4 dropped out. A variable percentage of the course's mandatory components were conducted in the interior. Average time to complete all mandatory activities was 3.3 years. Sixty graduates practice in the place of training or in nearby cities. Paysandú and Salto have 34 hours of teaching per week; Maldonado has 6 hours per week and honorary teachers. Rivera has honorary teachers/tutors. Conclusions: the decentralization of pediatric teaching is a significant achievement for inland cities in the interior of the country, as it allows them to train their own human resources, enabling them to settle in these cities. There is a need to improve the offer of curricular activities and teaching hours.

Introdução: a centralização do ensino superior em Montevidéu implica custos econômicos para as famílias do interior do país, o desenraizamento familiar e a perda de recursos humanos. A formação de especialistas em Pediatria no interior do país começou na década de 1980. Nos últimos anos foi fortalecida acrescentando cenários de aprendizagem, professores, recursos didáticos e avaliações. Objetivo: descrever a experiência de descentralização do ensino de especialistas em Pediatria entre 2007 e 2021 nos departamentos de Maldonado, Paysandú, Rivera e Salto. Metodologia: estudo descritivo, incluindo estudantes de pós-graduação em Pediatria que se formaram em Maldonado, Paysandú, Rivera e Salto, no período 2007-2021. Descrevemos o número de especialistas formados, as características pessoais ou familiares que influenciaram a decisão de fazer o curso no interior do país, o desempenho curricular, o local de prática profissional e recursos humanos docentes disponíveis. Resultados: no período analisado, 88 alunos fizeram a pós-graduação nas cidades avaliadas, 33 deles em regime de residência. Eram nativos/residentes no local, 78. 57 terminaram a pós-graduação, 19 ainda estavam em formação e 4 desistiram. Uma porcentagem variável das disciplinas obrigatórias do curso foi cursada no interior do país. O tempo médio para a realização das atividades obrigatórias foi de 3,3 anos. Sessenta trabalham no lugar de pós-graduação ou en cidades próximas. Paysandú y Salto tem 34 horas docentes/semana, Maldonado 6 horas docentes/semana e docentes honorários. Rivera tem docentes/tutores honorários. Conclusões: a descentralização do ensino de Pediatria é uma grande conquista para as cidades do interior, que formam seus próprios recursos humanos, permitindo que se estabeleçam nessas cidades. É necessário melhorar a oferta de atividades curriculares e a carga horária de ensino.