[Increase in severe acute respiratory infections in children during the last phase of the COVID-19 pandemic]. / Incremento de infecciones respiratorias agudas graves en niños durante la última etapa de la pandemia COVID-19.

OBJECTIVE: The COVID-19 pandemic has caused a variation in the circulation of respiratory pathogens. Our aim was to analyze the epidemiology of severe acute respiratory infections (SARI) in children during 3 years of the COVID-19 pandemic, in comparison with a previous period. METHODS: An observational study was conducted in a tertiary hospital in Spain, which analyzed the frequency and characteristics of patients admitted for SARI in the Pediatric Intensive Care Unit (PICU) during the COVID-19 pandemic (1 March 2020 to 28 February 2023), compared to pre-pandemic period (1 March 2017 to 29 February 2020). RESULTS: A total of 268 patients were included (59.6% males). The median age was 9.6 months (IQR 1.7 - 37). In the pre-pandemic period, there were 126 admissions with an average of 42 admissions/year. During the pandemic, there were 142 admissions, observing a significant reduction in admissions in the first year (12 admissions/year), in contrast to 82 admissions during the third year, which represented an increase of 95% compared to the average of admissions/year in pre-pandemic. In addition, in the last year there was evidence of an increase in viral coinfections in relation to pre-pandemic period (54.9% vs 39.7%; p=0.032). There were no differences in length of hospital stay or PICU stay. CONCLUSIONS: During the last year, coinciding with low rates of hospitalization for COVID in Spain, we observed a notable increase in admissions to the PICU for SARI. Probably, the prolonged period of low exposure to pathogens due to the measures adopted during the pandemic might have caused a decrease in population immunity with a rise in severe respiratory infections.

Antecedentes perinatales y familiares en trastornos del espectro autista / Perinatal and family history in autism spectrum disorders

OBJETIVO: evaluar los factores de riesgo perinatales y las características parentales en los Trastornos del Espectro Autista (TEA). MÉTODO: Se compararon las condiciones obstétricas y las características parentales entre los TEA y dos grupos control sin TEA (unos del servicio de urgencias y el otro de las consultas de psiquiatría del niño y adolescente y del Hospital de Día). RESULTADOS: Hubo 20 pacientes en cada grupo (17 varones y 3 mujeres), con edades de 6-18 años. En el grupo de Trastornos Generalizados del Desarrollo (TGD) hubo 4 Trastorno Autista, 11 Trastorno de Asperger y 5 Trastorno del Espectro Autista no especificado (TGDNE). Técnicas de reproducción asistida en 20% del grupo TGD y 5% en el grupo control B. Todos los del grupo control A fueron gestaciones espontánea (p = 0.039). Hubo diferencias estadísticamente significativas en las enfermedades maternas entre grupo de casos y control A (p = 0.041). Parto fue por cesárea en el 65% del grupo TGD, 35% en el grupo control A y 25% en el grupo control B (p = 0.039). Hubo diferencias estadísticamente significativas en la historia psiquiátrica maternal y familiar entre los 3 grupos (p = 0.008 y p = 0.001). TGD fueron diagnosticados en el 30% de los familiares del grupo de TGD y en ninguno de los grupos controles (p = 0.01). CONCLUSIONES: Este estudio ha encontrado factores de riesgo obstétricos y características parentales relacionadas con TDG de acuerdo con la literatura. Futuro estudios deberían tratar de identificar factores obstétricos y entender su relación con procesos genéticamente influenciados en el desarrollo temprano

OBJECTIVE: To evaluate perinatal risk factors and parental characteristics in Autistic Spectrum Disorder (ASD). METHOD: Obstetric conditions and parental characteristics were compared between ASD and two control groups without ASD (one from emergency room and the other from psychiatry outpatient service and day-care hospital). RESULT: There were 20 patients in each group (17 boys and 3 girls), ages 6-18. The pervasive developmental disorder (PDD) case group had 4 Autistic, 11 Asperger's and 5 pervasive developmental disorder not otherwise specified (PDD-NOS). Assisted pregnancies in 20% of PDD case group and 5% of control group B. All control group A were spontaneous pregnancies (p = 0.039). Statistically significant differences in maternal disease between PDD case and control group A (p = 0.041). Delivered by cesarean section in 65% of PDD case group, against 35% control A group and 25% of control B group (p = 0.039). Statistically significant differences in family and maternal psychiatry history between three groups (p = 0.008 and p = 0.001). ASD has been diagnosed in 30% of relatives in PDD case group and none in control groups (p = 0.01). CONCLUSION: This study found some obstetric and parental risk factors related with ASD, according to the literature. Future research should attempt to identify obstetric factors and understand their relationship with different genetically influenced processes in early development

[Recommended antibiotic therapy in episodes of urinary tract infection]. / Tratamiento antibiótico recomendado en episodios de infección urinaria.

The present article reviews the scientific evidence available on antibiotic treatment of urinary tract infection in childhood. The information from clinical trials is of little use in decision making, because many of these studies evaluate antibiotics with a high level of resistance in Spain. Although some studies allow certain antibiotics to be identified as sufficiently effective, they do not permit clear hierarchies in the choice of therapy to be established. Nevertheless, data are available from clinical trials and systematic reviews on the efficacy of different routes of administration or regimens and on treatment duration, although this information is of doubtful clinical application in some patient groups. If cystitis in older boys is excluded, the distinction between upper and lower urinary tract infection is of little use. Consequently, differentiating between high- and low-risk infections according to the patient's age and the presence of fever and/or general repercussions is preferable. Finally, the choice of antibiotic will largely depend on the antimicrobial resistances of urinary pathogens in Spain.

Tratamiento antibiótico recomendado en episodios de infección urinaria / Recommended antibiotic therapy in episodes of urinary tract infection

Se presenta una revisión de la evidencia científica disponible sobre el tratamiento antibiótico de la infección urinaria en la infancia. La información procedente de ensayos clínicos resulta poco útil en la toma de decisiones, porque muchos de ellos valoran antibióticos frente a los que existe un alto nivel de resistencia en nuestro país. Aunque algunos estudios permiten etiquetar ciertos antibióticos como suficientemente eficaces, no facilitan el establecimiento de jerarquías claras en la elección terapéutica. Sin embargo, sí que disponemos de información, procedente de ensayos clínicos y revisiones sistemáticas, sobre la eficacia de distintas vías o pautas de administración y sobre la duración del tratamiento, a pesar de que esta información resulta de dudosa aplicación clínica a determinados grupos de pacientes. Si excluimos las cistitis del niño mayor, la diferenciación entre infecciones urinarias de vías altas o bajas resulta poco operativa, por lo que preferimos diferenciarlas como de alto o bajo riesgo, en función de la edad del paciente y la presencia de fiebre y/o repercusión general. Finalmente, la elección de antibiótico dependerá en gran medida de las resistencias a antimicrobianos que tienen los uropatógenos en nuestro país

The present article reviews the scientific evidence available on antibiotic treatment of urinary tract infection in childhood. The information from clinical trials is of little use in decision making, because many of these studies evaluate antibiotics with a high level of resistance in Spain. Although some studies allow certain antibiotics to be identified as sufficiently effective, they do not permit clear hierarchies in the choice of therapy to be established. Nevertheless, data are available from clinical trials and systematic reviews on the efficacy of different routes of administration or regimens and on treatment duration, although this information is of doubtful clinical application in some patient groups. If cystitis in older boys is excluded, the distinction between upper and lower urinary tract infection is of little use. Consequently, differentiating between high- and low-risk infections according to the patient's age and the presence of fever and/or general repercussions is preferable. Finally, the choice of antibiotic will largely depend on the antimicrobial resistances of urinary pathogens in Spain

Ductus arterioso persistente en el recién nacido pretérmino / Patent ductus arteriosus in preterm infants

El conducto arterioso persistente (DAP) complicala evolución de los niños prematuros. La incidenciade DAP es inversamente proporcional a la edad degestación. La clínica permite hacer un diagnósticode DAP pero por lo general de forma tardía, especialmenteen niños de peso extremadamente bajo alnacer, por lo que actualmente se utiliza la ecografíapara hacer un diagnóstico precoz. El tratamientoprecoz del ductus aumenta el porcentaje de éxitosde cierre y disminuye la morbilidad pulmonar. Tantoindometacina como ibuprofeno son válidos para eltratamiento médico. La cirugía está indicada en casode fracaso o contraindicación del tratamiento médico

A patent ductus arteriosus (PDA) complicates theclinical course of preterm infants. The incidence ofPDA is inversely proportional to the age of gestation.Symtomatic PDA is in general a late diagnosis, especiallyin infants of extremely low birth weight(ELBW), that is why nowadays we can use echocardiographicmarkers for an early diagnostic. Early treatmentimproves the outcome and decreases therisk of pulmonary morbidity. Indomethacin and ibuprofenboth are effective treatment to close a PDA.Surgical ligation of PDA is only preferred in case offailure or no possible medical treatment

¿Se debe formar el residente de Pediatría en Atención Primaria? ¿Por qué? Encuesta a pediatras y residentes de Valencia / No disponible

Introducción y objetivos: considerando que el residente de Pediatría no se forma en puericulturani en prevención y promoción de salud del niño sano en centros de Atención PediátricaPrimaria, ni para el tratamiento del niño que no precisa atención hospitalaria, se intentasaber si el residente debe formarse en Atención Primaria.Material y métodos: para ello se distribuyó una encuesta anónima dirigida a todos lospediatras que prestan la Atención Primaria en la ciudad de Valencia, a todos los pediatras delHospital La Fe y a todos los residentes de Pediatría de dicho hospital. Se preguntó: ¿Creesque el residente de Pediatría debe rotar –también– por un centro de Atención Primaria acreditadopara completar su formación? Y ¿por qué?Resultados: se obtuvo un porcentaje de respuesta del 44,7%. El 86% respondió sí, el13% no y el 1% en blanco. Dijeron sí el 90% de los pediatras (95% de Primaria y 83% dehospital) y el 50% de los residentes. Los encuestados respondieron a la segunda parte de lapregunta y aportaron su opinión respecto a los motivos a favor de la rotación en AtenciónPediátrica Primaria; el 29% aportó ideas respecto al programa de formación del residente. El13% que opinó que no debe rotar justificó su opinión y aportó ideas para la formación delresidente. Conclusiones: el 86% de encuestados opina que el residente de Pediatría debe rotar porAtención Primaria para completar su formación y el 17% reclama alargar a más de cuatro añosla especialidad de Pediatría

Introduction and objectives: considering that the resident physician in the specialty ofpaediatrics in Valencia never trains in Paediatric Primary Care centres and that he does notreceive any preparation in child care nor in aspects as preventive care and promotion of goodhabits in healthy children or the treatment of ill children who do not need hospitalization,our intention is to find out if residents should be trained in Paediatric Primary Care, accordingto the opinion of paediatricians and residents in paediatrics.Material and methods: for this reason, an anonymous survey was carried out directed toall paediatricians in Primary Care in the city of Valencia and to all paediatricians and residentsin paediatrics who practise hospital care in the Hospital La Fe. The questions were: Doyou think that a paediatric resident should train –additionally– in an accredited primary healthcare center in order to complete his training? Why?Results: a percentage of 44.7% answered. Eighty-six per cent answered yes, 13% no and1% blank. Affirmative responses were from 90% of the paediatricians (95% primary carepaediatricians and 85% hospital care paediatricians) and 50% of the residents. Those surveyedresponded to the second part of the question giving their opinion on the motives in favourof Paediatric Primary Care training. 29% offered ideas for the resident training program,the 13% against Paediatric Primary Care training, that justified with their opinions.Conclusions: 86% say the resident should be trained in Paediatric Primary Care and17% demand more than four years’ training in Paediatrics