Estudio de la ingesta de yodo en los niños de 6 meses a 3 años de edad de Guipúzcoa / Study of iodine intake in children from 6 months to three years-old in Guipúzcoa

Objetivo: Evaluar si existe deficiencia de yodo en niños sanos con edades comprendidas entre los 6 meses y los 3 años, mediante cuantificación de yoduria. Diseño: Estudio descriptivo transversal, con muestreo intencional de niños que acuden a sus centros de salud para una revisión de salud rutinaria, en 10 centros de salud de Guipúzcoa. Sujetos: Ciento treinta niños de edades comprendidas entre los 6 y los 36 meses, sanos, 61 (46.9%) eran niñas y 69 (53.7%) niños. Mediciones: Edad en meses, procedencia, sexo, encuesta nutricional (en especial ingesta de sal yodada, pescado de mar y lácteos) y yoduria en micción aislada. Resultados: La mediana de yoduria es de 127μg/l. Aproximadamente, un tercio (36.9%) de los niños presentaban yoduria inferior a 100μg/l. No hemos encontrado asociación entre la yoduria y las variables de la encuesta nutricional. Conclusión: La ingesta de yodo en los niños estudiados es adecuada de acuerdo a las recomendaciones de la Organización Mundial de la Salud(AU)

Objective: To assess whether iodine deficiency exists in healthy children aged 6 months to 3 years by measuring urinary iodine. Design: A descriptive, cross-sectional study using purposeful sampling of children who attended 10 Primary Health Care centres in Guipúzcoa for routine health examinations. Subjects: A total of 130 healthy children aged between 6 and 36 months, of whom 61 (46.9%) were girls and 69 (53.1%) boys. Measurements: Age in months, origin, sex, nutritional survey (particularly intake of iodised salt, sea fish and dairy products) and urinary iodine excretion in a random urine sample. Results: The median urinary iodine was 127μg/L. About one third (36.9%) of children had a urinary iodine below 100μg/L. No relationship was found between urinary iodine and nutritional survey variables. Conclusion: Iodine intake in the children studied is adequate according to WHO recommendations(AU)

Uso del chupete y lactancia materna / Use of pacifiers and breastfeeding

El uso del chupete se encuentra muy arraigado en las sociedades desarrolladas, ya que calma el llanto del bebé, ayuda a conciliar el sueño, y reduce el estrés y el dolor en procedimientos desagradables. Su uso se ha relacionado con una menor duración y exclusividad de la lactancia materna, aumento de otitis media, problemas dentales y riesgo de accidentes. Además, estudios recientes relacionan su uso, particularmente durante el sueño, con disminución del riesgo de muerte súbita del lactante. Otros beneficios demostrados son su efecto analgésico y el estímulo de la succión no nutritiva en niños pretérmino y a término. El debate sobre su utilización o no es actualmente motivo de controversia, pero es importante que los profesionales de la salud y los padres conozcan los riesgos y beneficios que conlleva el uso del chupete. Dada la controversia actual, el Comité de Lactancia Materna de la Asociación Española de Pediatría ha realizado, a la luz de las pruebas disponibles actualmente, una revisión del tema en relación con la lactancia materna (AU)

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant is sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breast feeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant (AU)

[Use of pacifiers and breastfeeding]. / Uso del chupete y lactancia materna.

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant́s sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breastfeeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant.

La lactancia materna en la "Estrategia mundial para la alimentación del lactante y del niño pequeño" / Breatfeeding in the "global strategy for infant and young child feeding"

No disponible

[Iodine antiseptics are not harmless]. / Los antisépticos yodados no son inocuos.

The use of iodine-containing antiseptics is still common in obstetrics and neonatology. Topical iodine given both to the mother before delivery and to the neonate causes iodine overload. The absorption of maternal iodine through the skin is so fast that iodine in the blood of the umbilical cord increases by 50% a few minutes before delivery. Iodine overload also occurs in the mother. Urinary and breast-milk iodine are increased more than 10-fold in the days after delivery if providone-iodine is used in episiotomy. The overload in the neonate is even higher if breast-fed. Particularly in iodine-deficient areas, this overload can produce thyroid blockade with undesirable effects in congenital hypothyroidism screening, raising the number of false positives and its consequences: parental anxiety and screening costs. The potential effects that this thyroid blockade can produce in the neonate are even more serious. Attention should be drawn to the undesirable effects of iodine antiseptics and their use in the perinatal period should be avoided.

Los antisépticos yodados no son inocuos / Iodine antiseptics are not harmless

El uso de antisépticos yodados es una práctica aún extendida en nuestras maternidades. La aplicación de antisépticos yodados tanto a la madre en los momentos previos al parto como al recién nacido provoca una sobrecarga yodada incontrolada. La absorción del yodo a través de la piel de la madre es tan rápida que la yodemia en sangre de cordón aumenta en un 50 por ciento tras la aplicación en los momentos previos al expulsivo de antisépticos yodados a la madre. La sobrecarga yodada en la madre se manifiesta con aumento de la yoduria y del contenido de yodo en la leche hasta 10 veces en los días inmediatamente posteriores al parto, si las curas de la episiotomía se realizan con povidona yodada. La elevada concentración de yodo en la leche agrava la sobrecarga al recién nacido. Especialmente en zonas con déficit nutricional de yodo, esta sobrecarga yodada puede provocar un bloqueo transitorio del tiroides neonatal que tiene repercusiones negativas sobre el programa de detección del hipotiroidismo congénito, aumentando el número de falsos positivos, y sus inmediatas consecuencias: ansiedad de los padres y un importante aumento de los costes del programa. Más graves son las consecuencias que este bloqueo puede producir en el desarrollo del recién nacido. Parece ineludible realizar una llamada de atención sobre las alteraciones que provocan los antisépticos yodados y desaconsejar su uso en el período perinatal (AU)

[Congenital chylothorax]. / Quilotórax congénito.

OBJECTIVE: The aim of this study was to study the prenatal diagnosis, clinical manifestations and karyotype results in congenital chylothorax. PATIENTS AND METHODS: A retrospective survey of a 20 year period was carried out. The prenatal diagnosis, maneuvers following delivery, malformations and clinical outcome were studied. RESULTS: We found 10 cases of congenital chylothorax. Four were diagnosed by prenatal ultrasound with pleural effusion and no other signs of hydrops and six were diagnosed postnatally. Of the later, five had respiratory distress and one was diagnosed by radiological procedures. In all 10 cases, postnatal thoracocentesis was performed for diagnosis and therapy, five infants required mechanical ventilation and four parenteral nutrition. One patient died 72 hours after birth and three within 24 hours of birth. The clinical outcome of the rest was successful and were placed on a medium-chain triglyceride formula that was given orally. Of the eight karyotypes studied, six trisomy 21 were found. CONCLUSIONS: The prenatal diagnosis of pleural effusion permits prompt recognition of congenital chylothorax and allow for appropriate treatment upon birth. Medical therapy including pleural drainage and total parenteral nutrition and medium-chain triglyceride formula for oral feedings is successful in the majority of cases. Down's syndrome should be considered in fetuses or newborns with pleural effusion.

[Iodine overload in newborn infants caused by the use of PVP-iodine for perineal preparation of the mother in vaginal delivery]. / Sobrecarga iodada al recién nacido por utilizar PVP-iodada para la preparación perineal materna en el parto vaginal.

The high incidence of transient thyroid dysfunction in newborns from our hospital (0.6%), led us to investigate whether povidone perineal prep. during delivery and daily postpartum antisepsis, induced iodine overload in the newborn, and whether breast milk was the vehiccle. In a controlled randomized trial we used either povidone-iodine or clorhexidine in 36 mothers, and we investigated in them and in their newborns iodine levels and thyroid function. Iodine levels in cord blood, maternal urine and newborn urine were significantly higher in povidone treated group (p less than 0.001) up to the 4th postpartum day. These levels were also significantly higher in breast fed than in formula-fed babies within the group of povidone-iodine-treated mothers. Maternal prepartum urine iodine, and thyroid function in mothers and newborns were not significantly different in both groups.

[Spontaneous neonatal chylothorax. Apropos of 5 cases]. / Quilotórax espontáneo neonatal. A propósito de cinco observaciones.

Authors report five consecutive cases of spontaneous neonatal chylothorax (SNC). Three patients had also Down's syndrome, one a VSD and the remaining one was a premature. Two infants with bilateral pleural effusions started with severe neonatal asphyxia in absence of previous fetal alteration. Two right-side chylothoraces made a satisfactory recovery. Fith patient died a few hours after birth because of prematurity. Special mention is made of difficulties for an accurate etiologic diagnostic in the majority of SNC. Interest of association with Down's syndrome, of which only two cases have been previously reported, is pointed out. Finally, the presence of polihydramnios is interpreted as an expression of a lymphatic anomaly and/or an alteration of reabsorption of amniotic fluid at pulmonary level.