Postnatal catch-up growth in term newborns with altered fetal weight patterns. The GROWIN study.

BACKGROUND: Small for gestational age (SGA) perform a postnatal catch-up growth to recover their genetic trajectory. We studied the postnatal catch-up growth pattern of fetuses born with an appropriate-for-gestational-age (AGA) weight but with fetal growth deceleration (FGD) to explore whether they catch up. METHODS: Nine hundred and sixty-six newborns at Villalba University General Hospital (HUGV), were followed from 34 to 37 weeks to birth. Z-scores, adjusted for sex and age, of weight, length, and BMI at 3, 6, 9, and 12 months were calculated. We define catch-up as an increase in z-score greater than 0.67 SD in the growth curves. RESULTS: AGA FGD had lower mean weight and length than AGA non-FGD at all time points; BMI was lower until 3 months. AGA FGD had a lower weight, length, and BMI z-score (until 9, 6 months, and at birth, respectively) than AGA non-FGD. AGA FGD newborns had a significantly increased likelihood of weight catch-up at 3 months (OR 1.79; 95% CI: 1.16, 2.78; p = 0.009) and BMI in all investigated periods (OR 1.90; 95% CI 1.30, 2.78; p < 0.001 at 3 months), compared to AGA non-FGD newborns. CONCLUSIONS: AGA FGD newborns perform catch-up growth, especially in weight and BMI, in the first year of life, compared to AGA non-FGD. IMPACT: Appropriate-for-gestational-age (AGA) newborns with fetal growth deceleration (FGD), between the third trimester of pregnancy and delivery, present a lower weight and height, during the first year of life, compared to AGA non-FGD. Appropriate-for-gestational-age (AGA) newborns with fetal growth deceleration (FGD), between the third trimester of pregnancy and delivery, present a higher likelihood of weight catch-up in the first 3 months of life and of BMI in the first year compared to AGA non-FGD. AGA FGD experienced early weight and BMI catch-up, especially in the first 3 months of life, like SGA. This finding should be considered in the future follow-up.

Publicidad de alimentos no saludables. Posicionamiento del Comité de Nutrición y Lactancia Materna de la Asociación Española de Pediatría / Unhealthy food advertising. A position paper by the AEP Committee on nutrition and breastfeeding

Introducción: Entre los factores más importantes que influyen en la aparición y el mantenimiento de malos hábitos de alimentación están la accesibilidad y publicidad de los productos alimentarios menos saludables. Con el objetivo de elaborar y fundamentar recomendaciones, se ha realizado un análisis de la evidencia disponible sobre el impacto de la publicidad de alimentos en la salud de niños y adolescentes. Métodos: Se ha realizado una revisión bibliográfica de revisiones sistemáticas y metaanálisis publicados hasta enero del 2022 con el término «food advertising», incluyendo aquellas que analizaban el impacto de la publicidad de alimentos sobre el peso, el índice de masa corporal, la adiposidad, la ingesta dietética, la conducta ante el producto anunciado, su compra o su consumo en niños y adolescentes. Resultados: Fueron incluidas 21 revisiones sistemáticas que incluyen un total de 490 artículos, 5 de las cuales contienen además un metaanálisis. La gran mayoría de los estudios primarios evalúan efectos intermedios, relacionados con el comportamiento de niños y adolescentes ante los productos anunciados y su consumo. Existe gran variedad en cuanto al tipo de publicidad y efectos estudiados. La mayoría de los trabajos muestra una asociación entre el tipo de publicidad y el efecto concreto analizado, siendo más evidente en menores de 12 años y en niños obesos. Las revisiones más recientes se centran en la publicidad on-line indicando sus efectos nocivos especialmente en adolescentes. (AU)

Introduction: Some important factors influencing and maintaining unhealthy habits are food advertising and products accessibility. In order to develop and support recommendations, an analysis of the available evidence on the impact of food advertising on the health of children and adolescents has been carried out. Methods: Literature review of systematic reviews and meta-analyses published up to January 2022 for the term «food advertising» that analyzed the impact of food advertising on weight, body mass index, adiposity, dietary intake, behavior toward the advertised product, its purchase or consumption in children and adolescents. Results: Twenty-one systematic reviews fulfilled the inclusion criteria, including a total of 490 primary studies, 5 of which also contained a meta-analysis. The vast majority of the primary studies evaluate intermediate effects, related to the behavior of children and adolescents in relation to advertised products and their consumption. There is great variety in terms of the type of advertising and effects studied. Most of studies agree that there is an association between food advertising and effect analyzed, being more evident in children under 12 years of age and in obese children. Most recent systematic reviews are focused on on-line advertising, noticing the negative effects especially in adolescents. (AU)

El papel clave de la pediatría de atención primaria en el manejo de la obesidad infantil / The key role of primary care pediatrics in the management of childhood obesity

No disponible

Uso de ondansetrón en el manejo de los vómitos asociados a gastroenteritis aguda en Pediatría de Atención Primaria. Posicionamiento del Grupo de Trabajo de Gastroenterología y Nutrición de la AEPap / Use of ondansetron in the management of vomiting associated with acute gastroenteritis in primary care pediatrics. Positioning of the Gastroenterology and Nutrition Working Group of the Spanish Association of Primary Care Pediatrics (AEPap)

Los vómitos incoercibles, asociados o no a gastroenteritis aguda (GEA), son la principal causa de deshidratación en niños, siendo un motivo de consulta frecuente en Atención Primaria (AP). Los posibles efectos secundarios de los antieméticos han dado lugar a una reducción drástica en su uso en las últimas décadas. Desde hace varios años existe experiencia en el uso de ondansetrón con buenos resultados para el tratamiento de los vómitos de repetición asociados a GEA, fundamentalmente en las unidades de urgencia hospitalaria. Su uso en Atención Primaria es mucho más limitado y no se dispone del fármaco en los botiquines de los centros de salud de la mayoría de las comunidades autónomas. El objetivo de esta revisión es analizar la efectividad para esta indicación y los efectos secundarios de ondansetrón y valorar la pertinencia de su uso en Atención Primaria (AU)

Incoercible vomiting associated with acute gastroenteritis (AGE) is the main cause of dehydration in children, being a frequent reason for consultation in primary care. The side effects of antemetics have led to a drastic reduction in their use in recent decades. For several years there has been experience in the use of ondansetron with good results for the treatment of repeated vomiting associated with AGE, mainly in hospital emergency units. Its use in primary care is much more limited and the drug is not available as emergency medication in the majority of the Spanish Primary Care Centers. The objective of this review is to analyze the effectiveness and side effects of ondansetron and assess the relevance of its use in primary care. (AU)

Características nutricionales y composición de las galletas disponibles en el mercado español y de las galletas dirigidas a la población infantil / Nutritional characteristics and composition of the biscuits available in the Spanish market and biscuits marketed to children

INTRODUCCIÓN: en España existe un elevado consumo de galletas en la población infantil. Son productos ultraprocesados de alto contenido energético y densidad calórica, en general con azúcar añadido y grasas poco saludables. MATERIAL Y MÉTODOS: estudio descriptivo transversal sobre características y composición nutricional de galletas disponibles en supermercados españoles y comparativo entre las dirigidas al público infantil y el resto. RESULTADOS: se analizaron 350 galletas: valor energético medio 471,86 ± 35,83 kcal/100 g. El 53,1% contenían grasas saturadas, aceite de palma el 47,1% y azúcar añadido el 90%. Mediana de azúcares 25 g/100 g (rango intercuartílico [RI]: 20-33). Mediana de fibra alimentaria 3,2 g/100 g (RI: 2,4-5,2); 86 galletas mostraban publicidad sobre fibra y 95,34% indicaban la cantidad, mediana de 5,45 g/100 g (RI: 4-7,9). Se analizaron 53 galletas (15,1%) dirigidas al público infantil. Valor energético medio 466,47 ± 19,31 kcal/100 g. El aceite de oliva/girasol alto oleico (GAO) fue la grasa principal en el 67,9%. Aceite de palma presente en el 37,7% y azúcar añadido en 98,1% (media 25,88 ± 6,82 g/100 g). Mediana de fibra alimentaria 2,9 g/100 g (RI: 2,27-3,42). El 75,5% mostraron publicidad de reclamo. Las galletas dirigidas al público infantil contenían azúcar añadido en mayor porcentaje (98,1 frente a 88,6%; p = 0,033), menos fibra (mediana 2,9 g/100 g frente a 3,5 g/100 g; p = 0,005), aceite de oliva/GAO en mayor porcentaje (67,9 frente a 36,7%; p <0,001) y más publicidad de reclamo (75,5 frente a 45,5%; p <0,001). CONCLUSIONES: las galletas dirigidas al público infantil contienen azúcar añadido, elevado contenido calórico, grasas saturadas en más del 37% y publicidad de reclamo en elevado porcentaje. Por otro lado, se observa el uso de grasas monoinsaturadas en más del 50%. La información de este estudio podría facilitar intervenciones de salud pública e incentivar a los fabricantes para reformular sus productos

INTRODUCTION: the consumption of biscuits is high in the Spanish paediatric population. Biscuits are ultra-processed products with a high energy content and energy density and generally contain added sugars and unhealthy fats. METHODS: we conducted a cross-sectional descriptive study on the characteristics and nutritional composition of biscuits available in Spanish supermarkets, and compared biscuits marketed to children to all other biscuits. RESULTS: we analysed a sample of 350 biscuits. The mean energy content was 471.86 ± 35.83 kcal/100 g. Saturated fats were used in 53.1%, palm oil in 47.1% and added sugars in 90% (median content, 25 g/100 g; IQR: 20-33). The median dietary fibre content was 3.2 g/100 g (IQR: 2.4-5.2). The packaging of 86 advertised that the product contained fibre, specifying the total fibre content in 95.34% of cases, with a median value of 5.45 g/100 g (IQR: 4-7.9). Of the total products, 53 (15.1%) were marketed to children, and their mean energy content was 466.47 ± 19.31 kcal/100 g. The main fat was olive oil or high oleic sunflower oil (HOSO) in 67.9%, and palm oil was present in 20 (37.7%). There were added sugars in 98.1% (mean sugar content, 25.88 ± 6.82 g/100 g). The median dietary fibre content was 2.9 g/100 g (IQR 2.27-3.42). The packaging of 75.5% featured some form of advertising. The comparative analysis showed that a greater percentage of biscuits specifically marketed to children had added sugars (98.1% vs 88.6%, p = 0.033) and that these biscuits had a lower fibre content (median, 2.9 g/100 g vs. 3.5 g/100 g, p = 0.005), that a greater percentage contained olive oil or HOSO (67.9% vs 36.7%, p <0.001), and a greater percentage featured promotional advertising in their packaging (75.5% vs 45.5%, p <0.001). CONCLUSIONS: biscuits marketed to the paediatric population had added sugars and a high energy content; more than 37% had saturated fats and a high proportion featured advertising in the packaging. On the other hand, we found that monounsaturated fats were used in more than 50% of these products. The findings of this study could serve as reference to guide the development of public health interventions or product reformulation by manufacturers

Recomendaciones nutricionales y evidencia científica: ¿hay más dudas que certezas? / Nutritional recommendations and scientific evidence. Are there more doubts than certainties?

Cada vez se le da una mayor importancia a la promoción en la población de una alimentación saludable. La edad infantil es una época clave en este sentido. No es fácil la tarea de establecer recomendaciones claras y permanentes, debido a la dificultad para realizar investigación de calidad en nutrición, al carácter cambiante de la evidencia en ocasiones y al influjo que intuimos puede realizar la industria alimentaria. Para evitar la confusión que a veces llega a la población, los profesionales sanitarios deben ser conscientes de estas dificultades y transmitir dichas recomendaciones con la mayor prudencia y rigor posibles

Increasing importance is given to the promotion of healthy nutrition in the population. Childhood is a key time in this regard. The task of establishing clear and permanent recommendations is not easy due to the difficulty to carry out quality research in nutrition, to the changing character of the evidence at times and to the influence that we intuit can make the food industry. To avoid the confusion that sometimes reaches to the population, health professionals should be aware of these difficulties and transmit those recommendations as carefully and rigorously as possible

Manejo conservador de pseudoquiste salival parotídeo postraumático: Reporte de un caso / Conservative management of post-traumatic parotid salivary pseudocyst: A case report

Debido a su compleja anatomía, las lesiones en la región bucal pueden llevar a múltiples complicaciones. Si bien el nervio facial y el conducto parotídeo pueden ser fácilmente heridos por golpes fuertes o traumatismos penetrantes de la mejilla, la lesión del conducto parotídeo es, en general, pasada por alto (especialmente en entornos de múltiples lesiones) y rara vez es reportada en la literatura. El tratamiento de estas lesiones genera controversias, ya que series cortas y estudios de casos anecdóticos reportan su efectividad desde diversos enfoques (el tratamiento no quirúrgico, la ligadura del conducto proximal con o sin medicamentos antisialorreicos, la reparación primaria con microcirugía, la creación de la fístula sialoplastía usando mucosa oral y la sustitución de injerto venoso). Reportamos un método conservador, ideado por los autores, con el objetivo de drenar y mantener funcional al conducto de Stenon en un paciente masculino que presentó pseudoquiste salival derecho como complicación de un desgarro de la parte distal de este conducto por un trauma maxilofacial causado por accidente automovilístico.

Given the complex anatomy of the mouth, injuries occurring in this region can result in multiple complications. The facial nerve and parotid duct can be easily injured by blows or trauma penetrating the cheek. Parotid duct injury is generally overlooked, especially in settings of multiple injuries. Consequently, they are rarely reported in the literature. The treatment of these injuries is very controversial. Short series and anecdotal case studies claim success with various approaches, such as non-surgical treatment, proximal duct glide with or without antisialogogue medication, primary repair with microsurgery, the creation of the fistula sialoplasty using oral mucosa and vein graft replacement. We present a conservative approach devised by the authors, with the aim of draining and maintaining Stenon's duct functional in a male patient who presented right salivary pseudocyst, as a complication from a tear of the distal part of the duct, following maxillofacial trauma caused by a car accident.

Low mortality in necrotizing enterocolitis associated with coagulase-negative Staphylococcus infection.

The aim of this study was to correlate the clinical course of necrotizing enterocolitis (NEC) with infection by coagulase-negative Staphylococcus at the onset of the illness. Records of all newborn infants developing NEC between January 1998 and December 2001 were reviewed. NEC was classified according to the criteria of Bell et al. Numeric variables were described by standard statistical methods. Comparisons between subgroups were performed by parametric statistical tests. Forty-four patients developed NEC stage II (n = 25) or III (n = 19). The incidence was 0.024% of live births in the hospital, and the mortality rate was 9%. The main risk factor was prematurity (84%). Only one-fourth of the patients had gastric residuals. A platelet count of <100,000 cells/mm3 occurred only in grade III NEC. Blood cultures were positive in 34% of the patients. The predominant organism (73%) was coagulase-negative Staphylococcus (CoNS). Neither Clostridium nor Bacteroides species were isolated. Stage II patients were maintained nothing per os (NPO) for 9 +/- 3 days and received antibiotics for 10 +/- 3 days. All of the stage III patients required an operation. In one-third of them, primary peritoneal drainage was initially performed but all required further operative procedures. We report a low incidence and mortality rate of necrotizing enterocolitis. Thrombocytopenia is confirmed as a marker of severity. Positive blood cultures for CoNS may explain, at least in part, the low mortality reported.

Nefroblastoma extrarrenal: presentación de caso / Extrarenal nephroblastoma: clinical case

Tipo de Estudio: Observación directa de caso clínicoObjetivo: Es dar a conocer la poca frecuencia de la presentación del Tumor de Wilms en su variedad extrarrenal, ya que hasta el año 2002 sólo 56 casos han sido reportados en la Literatura mundial. Presentamos el caso de un niño con una tumoración retroperitoneal, diagnosticada al inicio como nefroblastoma renal, que luego de su investigación clínica y de varios exámenes complementarios, se determinó que se trataba de un caso de nefroblastoma extrarrenal, una presentación clínica pocas veces observada.Conclusión:El tumor de Wilms o Nefroblastoma es el tumor maligno de origen renal en pacientes pediátricos que se presenta con más frecuencia, existen pocos reportes en la literatura mundial de este tipo de tumor, cuando su localización es extrarrenal.

Type of study: Direct observation of clinic case.Objective: To show the very little frequently of Wilms´ tumour presentation in a variety of extrarenal, until the year 2002, only 56 cases were been reported in the worldwide literature.We present a case of a little boy with a retroperitoneal tumour diagnosticaded in the beginning like renal nephroblastoma, and then in the clinic investigation and many complementary examans, we established that was of a case of extrarenal nephroblastoma, a clinic presentation not very often observed.Conclusion: Wilms´ tumour or Nephroblastoma is a malignant tumour of the kidney, found in children that present with more frequency, exist few reports in the worldwide literature of this kind of tumour when his location is extrarenal.

Estimulación temprana en niños con minusvalías / Early stimulation in children with a handicap

Estudio prospectivo en la institución “María Buitrón de Zumárraga”, de la ciudad de Portoviejo, con un universo de 22 niños con minusvalías, que asistieron al programa de estimulación temprana; entre estos estaban niños con síndrome de Down, hipoacúsicos e invidentes multimpedidos.Objetivo: Determinar si la estimulación temprana incrementa el desarrollo en los niños con minusvalías.Resultados: El tiempo de estimulación recibido fue de 3 meses a 1 año.El desarrollo físico en los no videntes multimpedidos tuvo una evolución del 50%, del 45% en los afectados con síndrome de Down y del 40% en los hipoacúsicos.En el desarrollo social y del lenguaje la evolución fue del 60% para los niños no videntes multimpedidos, 40% con síndrome de Down y del 22.90% para los hipoacúsicos.En conclusión, observamos que la estimulación temprana si favorece el desarrollo de los niños con minusvalías

A prospective study in the Institution of "María Buitrón of Zumárraga", of the city of Portoviejo, with an universe of 22 children with handicaps who attended for the program of early stimulation. Among these they were children with Down syndrome, deafness and blindness.Objective: To determine if the early stimulation increases the development in children with a handicap.Results: The time of stimulation that they received went from 3 months to 1 year. The psychomotor development in the children that were blind had an evolution of 50%, of 45%, in those affected with Down syndrome and of 40% in children that were deaf. In the social and language development the evolution was of 60% for the blind children, 40% with Down syndrome and of 22.90% with deafness. In conclusion, we observe that the early stimulation favors the development of the children with handicaps.