Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure.

Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.

Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. / Sumario de las recomendaciones y puntos clave del Consenso de las Sociedades Científicas Españolas (SEPAR, SEMICYUC, SEMES; SECIP, SENeo, SEDAR, SENP) para la utilización de la ventilación no invasiva y terapia de alto flujo con cánulas nasales en el paciente adulto, pediátrico y neonatal con insuficiencia respiratoria aguda grave.

Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.

Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer.

OBJECTIVE: Determine the suitability of transcutaneous bilirubin (TCB) as a tool to assess the effectiveness of phototherapy on patched skin. STUDY DESIGN: A prospective observational study was conducted. We covered a fragment of skin (sternum) with a photo-opaque patch. Several simultaneous TCB and TSB measurements were performed with the JM-105 bilirubinometer. Bland and Altman test evaluated the agreement between bilirubin levels. RESULT: A total of 217 patients were studied, 48.8% were preterm. The mean difference between TSB and TCB before the start of treatment was 1.07 mg/dL. During phototherapy, differences on covered skin were 0.52, 0.27, and 0.39 mg/dL at 24, 48, and 72 h of therapy respectively. The best correlation was observed at 48 h in preterm infants. CONCLUSION: The measurement of TCB on patched skin (PTCB) is useful for monitoring the response to phototherapy in term and preterm infants. We use a patch with a removable flap that eases successive measures without disturbing the patients.

Nutrición parenteral en neonatos: individualización de la prescripción / Parenteral nutrition in neonates: Individualization of the prescription

Introducción: El parto prematuro suprime radicalmente la energía fácilmente asimilable que proporciona el transporte placentario, planteando una emergencia médica nutricional, ya que el aparato digestivo del recién nacido pretérmino es incapaz de manejar y absorber la energía que requiere la vida extrauterina y el crecimiento posnatal. Por sus características de inmadurez y la morbilidad propia del recién nacido pretérmino y/o pequeño para su edad gestacional, es necesario individualizar la composición de la nutrición parenteral, adaptándola a las necesidades y a la tolerancia de cada neonato. Objetivo: El objetivo de nuestro trabajo es diseñar un programa que permita el cálculo de la nutrición parenteral del recién nacido de forma individualizada. Métodos: Se revisan las recomendaciones actuales de macro/micronutrientes, y con las variables edad gestacional, peso, días de vida y parámetros analíticos se establecen unas ecuaciones matemáticas. Resultados: Se obtiene una serie de funciones continuas que relacionan los requerimientos basados en la evidencia científica ac-tual con la edad, el peso y el día de la nutrición, simplificando la prescripción individualizada y la elaboración de la nutrición parenteral. Conclusiones: Este método de cálculo permite disminuir los errores en la estimación de la nutrición parenteral en recién nacidos pretérmino, ya que, al simplificar las operaciones, el riesgo de error disminuye, lo que permite realizar el cálculo de una nutrición parenteral individualizada de forma sencilla, rápida y segura (AU)

Introduction: Preterm birth suppresses radically easily assimilable energy that provides placental transport, posing a nutritional medical emergency, because the digestive tract of preterm infant is unable to manage and absorb the energy required by extrauterine life and postnatal growth. Because of the characteristics of immaturity and own morbidity of newborn preterm and/or small for gestational age, it’s necessary to individualize the composition of parenteral nutrition, adapting it to the needs and tolerance of each newborn. Objective: The aim of our work is to design a program that allows the calculations of parenteral nutrition of the newborn individually. Methods: Current recommendations of macro and micronutrients are reviewed, and with the variables gestational age, weight, days of life and laboratory parameters, some mathematical equations are established. Results: We obtain a series of continuous functions relating requirements based on current scientific evidence with age, weight and nutrition day, simplifying the individualized prescription and the development of parenteral nutrition. Conclusions: This calculation method allow us to reduce errors in the calculation of parenteral nutrition in preterm infants, because simplifying operations the risk of error decreases, allowing the calculation of an individual parenteral nutrition easily, quickly and safely (AU)

Prenatal Therapy with Magnesium Sulfate and Its Correlation with Neonatal Serum Magnesium Concentration.

INTRODUCTION: Antenatal magnesium sulfate (MgSO4) administration has shown to be effective in minimizing cerebral palsy and severe motor dysfunction at the age of 2 years. The aim of this study is to determine the relationship between the magnesium dose delivered to the mother and the magnesium concentration in the neonates. MATERIALS AND METHODS: A prospective cohort study was conducted on neonates of less than 32 weeks' gestation admitted to the neonatal intensive care unit of University Hospital Complex of Vigo from December 2012 to July 2015. Comparative analysis of magnesium levels between the groups of neonates exposed to MgSO4 and the control group. RESULTS: A total of 118 neonates were included in the study. The mothers of 62 of them had received MgSO4 as a neuroprotective agent. There was a significant correlation between the full dose of MgSO4 received by the mother and the levels of magnesium in the neonate in the first 24 hours of life (r2 = 0.397; p < 0.001). CONCLUSION: The MgSO4 dose received by the mother has a linear relationship with the magnesium levels obtained in neonates.

Recomendaciones para la asistencia respiratoria en el recién nacido (III). Surfactante y óxido nítrico / Recommendations for respiratory support in the newborn (III). Surfactant and nitric oxide

Las recomendaciones incluidas en este documento forman parte de una revisión actualizada de la asistencia respiratoria en el recién nacido. Están estructuradas en 12 módulos y en este trabajo se presenta el módulo 7. El contenido de cada módulo es el resultado del consenso de los miembros del Grupo Respiratorio y Surfactante de la Sociedad Española de Neonatología. Representan una síntesis de los trabajos publicados y de la experiencia clínica de cada uno de los miembros del grupo (AU)

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group (AU)

[Recommendations for respiratory support in the newborn (iii). Surfactant and nitric oxide]. / Recomendaciones para la asistencia respiratoria en el recién nacido (iii). Surfactante y óxido nítrico.

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group.

Retención aguda de orina / Acute urinary retention

No disponible

Encuesta Framingham de Seguridad: conocimientos y actitudes de las familias frente a los accidentes infantiles / Framingham safety survey in children injury

Introdución: Antes de diseñar un programa deprevención es útil conocer la valoración subjetiva delos padres sobre su actitud frente a los accidentesinfantiles.Pacientes y métodos: Encuesta a un grupo aleatoriode familias seleccionadas. Cuestionario Framinghamde Seguridad (Asociación Americana dePediatría) y encuesta complementaria.Resultados: Se recogen 65 encuestas. La encuestareferida a los menores de 1 año presentó unnúmero mayor de items correctos. Se detectan respuestasincorrectas respecto a la actuación frente alfuego, la protección frente a precipitaciones y la faltade seguridad en el automóvil. Las actitudes correctasmás generalizadas son la vigilancia a los máspequeños y el control de objetos peligrosos. Noexiste relación significativa en cuanto a sexo, profesión,número ni edad de los hijos del encuestado ymayor número de respuestas correctas. Un 33% refiereconocer la reanimación cardio-pulmonar básica.Un 57% opinan que la mayoría de los accidentesson evitables (la edad media de los hijos de estegrupo fue mayor).Conclusiones: La protección de los padres frentea los accidentes parece disminuir a medida que elniño gana autonomía. Los padres con más edad,mayor preparación profesional o más experiencia nopor ello realizan prácticas más adecuadas

Background: Before designing a prevention programfor children injury it is useful to know what familiesthink about their attitude about unintentionalaccident.Patients and methods: A randomised selectedgroup of families completed the questionnaire of theFramingham Safety Survey (American Academy ofPediatrics) and another questionnaire designed byus.Results: 65 parents were interviewed. Surveysdesigned for the first year of age group accountedfor more right answers than the other groups of age.Wrong answers were detected in relation to fire injury,prevention of falls from a height and traffic security.Main right answers concerned surveillance ofthe youngest ones and protection against dangerousproducts. There was no correlation between sex,age, job, number and age of children of the interviewedand the number of right answers they got. Resuscitationmanoeuvres and emergency call phonenumbers were known by 33% and 87% respectively.More than a half of parents (57%) agreed that mostaccidents could be helped (this group owed olderchildren than the others).Conclusion: Protection against injury dismissesas children becomes autonomous. Older, educatedand trained parents showed no differences with therest concerning a safer behaviour

Accidentes infantiles: diseño y aplicación de un registro hospitalario del niño accidentado / Hospital record of the injured child

Introducción: Los accidentes infantiles constituyen un serio problema socio-sanitario. Los pediatras tenemos un papel clave en su prevención a través de la elaboración de registros de trauma pediátrico. Objetivo: Diseñar y aplicar un registro hospitalario del niño accidentado a fin de conocer la situación epidemiológica del trauma pediátrico en nuestro medio. Métodos: Se incluyen los pacientes ingresados por un motivo accidental en nuestro centro en el período de un año. Se valoran de modo prospectivo más de 50 variables referentes a: filiación, circunstancias del accidente y factores de riesgo implicados, asistencia sanitaria y diagnóstico-gravedad de las lesiones. Resultados: Son 1127 pacientes. Existe un predominio del sexo masculino. La vía pública y el domicilio son los escenarios más comunes. Se detectan circunstancias de riesgo en un 80% casos. Las caídas y los accidentes de circulación son los tipos más frecuentes. Destacan en nuestra serie las intoxicaciones por monóxido de carbono, la bronco- aspiración por frutos secos y las quemaduras por líquidos calientes. Objetos de uso cotidiano (andador, cambiador...) se encuentran frecuentemente relacionados. Un 12% de los pacientes cumplían criterios de gravedad, precisando ingreso en cuidados intensivos un 10% de los mismos. El traumatismo craneoencefálico es el diagnóstico más frecuente. Conclusiones: Se presenta el perfil epidemiológico del niño accidentado en nuestro medio. El control de ciertos factores de riesgo evitaría o atenuaría los accidentes detectados. La necesidad de intervención se justifica por el importante número de casos que presentan factores de riesgo (AU)

Background: Accidental injury in children has became a serious social and health problem. Paediatricians play an important role in injury control by the creation of hospital records on the injured child. They are the first step in the way of developing a prevention program. Methods: We record prospectively a randomised selected trial of patients visited in our hospital for an unintentional accident. We record more than 50 items for each one by interview about: patient characteristics, injury circumstances and risk factors, medical care and main diagnoses and severity. Results: There are 1127 patients. Male sex was more frequent. Home and public road were the main sceneries detected. We found risk situations in 80% of all cases. Falls and traffic injuries are the main accidents registered. It is important the incidence of monoxide carbon poisoning, chocking by dry fruits or burns by hot fluids. 12% of patients had severity criteria and 10% were admitted to intensive care unit. Mild head injury was the most common diagnosis. Conclusions: We present the epidemiological profile of children injury in our area. We demonstrate that the control of risk situations will help or at least reduce injury. The need for intervention is justified by the fact of a high number of cases with risk factors (AU)

Iloprost inhalado: una alternativa terapéutica para la hipertensión pulmonar persistente del recién nacido / Inhaled iloprost: a therapeutic alternative for persistent pulmonary hypertension of the newborn

No disponible

Una curiosa asociación: síndrome nefrótico y enfermedad celíaca / A curious association: nephorotic syndrome and celiac disease

No hemos encontrado ningún caso descrito en la literatura de síndrome nefrótico y enfermedad celíaca. Presentamos 5 pacientes diagnosticados de síndrome nefrótico durante los últimos cinco años a 4 de los cuales se les había diagnosticado previamente una enfermedad celíaca, siendo el último de ellos diagnosticado al solicitarse los marcadores de celiaquía en el momento del debut del síndrome nefrótico. La enfermedad celíaca no influyó en el pronóstico ni en la evolución del síndrome nefrótico. No hemos encontrado explicación para el aumento de la asociación de las dos enfermedades en nuestra serie Destacamos la necesidad de incluir los marcadores de celiaquía en el estudio de los pacientes afectos de síndrome nefrótico (AU)

[Coronary ischemia secondary to congenital anomaly of the left coronary artery]. / Isquemia coronaria secundaria a anomalías congénitas de las arterias coronarias.

Coronary artery anomalies constitute 2.2 % of congenital malformations of the heart. The most common abnormality is anomalous origin of the left coronary artery from the pulmonary trunk, also known as Bland-White-Garland syndrome. Clinical manifestations are due to myocardial ischemia caused by the creation of an arteriovenous shunt. The childhood type of this anomaly presents high mortality from heart failure. The adult type develops myocardial infarction, arrhythmias, sudden cardiac death or signs of congestive heart failure. Surgical repair is essential. Various surgical approaches are available and the treatment of choice is direct left coronary artery reimplantation in the aorta. An alternative technique is to create an aortopulmonary tunnel (Takeuchi technique). Marked improvement is usually observed after surgical repair. We report two cases of myocardial ischemia due to coronary anomalies.

Isquemia coronaria secundaria a anomalías congénitas de las arterias coronarias / Coronary ischemia secondary to congenital anomaly of the left coronary artery

Las anomalías de las arterias coronarias constituyen el 2,2 per cent de las cardiopatías congénitas. De ellas, la más frecuente es el origen anómalo de la arteria coronaria izquierda a partir del tronco de la arteria pulmonar, también conocido como síndrome de Bland-White-Garland. Las manifestaciones clínicas se derivan de la isquemia miocárdica secundaria a la creación de una derivación arteriovenosa. Existen formas infantiles con una tasa de mortalidad elevada por insuficiencia cardíaca grave. En edades posteriores de la infancia o en la edad adulta suelen presentarse como infarto miocárdico, arritmias, muerte súbita o signos de insuficiencia cardíaca progresiva. Existen varias estrategias de abordaje quirúrgico, siendo de elección la reimplantación directa de la arteria coronaria izquierda en la aorta. Una técnica alternativa es la creación de un túnel intrapulmonar (intervención de Takeuchi). La evolución posterior a la reparación quirúrgica suele ser favorable. Se presentan 2 casos clínicos de isquemia miocárdica secundaria a anomalías coronarias (AU)