[Meningitis by Listeria in children]. / Meningitis por Listeria en niños.

INTRODUCTION: Listeria monocytogenes is a rare cause of bacterial meningoencephalitis in the non-immunocompromised pediatric population. On occasions, the absence of differential characteristics with other bacteria that cause meningitis delays diagnosis and hence treatment, worsening the prognosis. CASE REPORT: We present a case of a previously healthy, non-immunocompromised teenager who was admitted to hospital with meningitis caused by Listeria. DISCUSSION: We review the literature related to this case, noting the increasing incidence of this microorganism in the etiopathogenesis of meningoencephalitis, reason for which it has to be kept in mind in the differential diagnosis at the time of admission.

Meningitis por Listeria en niños / Meningitis by Listeria in children

Introducción. Listeria monocytogenes es una causa de meningoencefalitis bacteriana poco frecuente en la población pediátrica no inmunoafectada. En ocasiones, la ausencia de características diferenciales con otras bacterias causantes de meningitis retrasa el diagnóstico y, con ello, el tratamiento, lo que ensombrece el pronóstico. Caso clínico. Se presenta el caso de un adolescente sano, no inmunodeprimido, que ingresó en nuestro hospital con una meningoencefalitis por Listeria. Discusión. Además, se realiza una revisión de la bibliografía relacionada con el caso, haciendo hincapié en la incidencia ascendente de este microorganismo en la etiopatogenia de la meningoencefalitis, lo que debe tenerse en cuenta en el momento del ingreso, para el diagnóstico diferencial de esta entidad (AU)

Introduction. Listeria monocytogenes is a rare cause of bacterial meningoencephalitis in the non-immunecompromised pediatric population. On occasions, the absence of differential characteristics with other bacteria that cause meningitis delays diagnosis and hence treatment, worsening the prognosis. Case report. We present a case of a previously healthy, non-immunecompromised teenager who was admitted to hospital with meningitis caused by Listeria. Discussion. We review the literature related to this case, noting the increasing incidence of this microorganism in the ethiopathogenesis of meningoencephalitis, reason for which it has to be kept in mind in the differential diagnosis at the time of admission (AU)

[Persistent hyperglycemia and hyperinsulinemia in a newborn infant]. / Recién nacido con hiperglucemia persistente e hiperinsulinemia.

Management of neonatal hyperglycemia is complex, especially in immature newborns. Etiology is diverse, the most frequent cause being iatrogeny. Neonatal diabetes mellitus is a rare cause of hyperglycemia during the first days of life. Insulin treatment is sometimes required to control the condition. When insulin requirements exceed 2I U/kg/day insulin resistance syndrome should be suspected. We present the case of a newborn infant with Donohue syndrome, or leprechaunism, which is a rare, genetically determined dysmorphic syndrome leading to significant insulin resistance.

Recién nacido con hiperglucemia persistente e hiperinsulinemia / Persistent hyperglycemia and hyperinsulinemia in a newborn infant

La hiperglucemia neonatal es un cuadro de complejo tratamiento sobre todo en recién nacidos inmaduros. La etiología es muy variada, aunque la causa más frecuente suele ser la yatrogénica. La diabetes mellitus neonatal es una causa rara de hiperglucemia en los primeros días de vida, que en ocasiones necesita tratamiento insulínico para su control. Cuando los requerimientos de insulina sobrepasan las 2 U/kg/día hay que sospechar un síndrome de resistencia a la insulina. Se presenta el caso de un recién nacido con un síndrome de Donohue o leprechaunismo que es un raro síndrome dismórfico de causa genética y que determina una importante resistencia a la insulina (AU)

[Use of intrapleural urokinase in children]. / Utilización de urocinasa intrapleural en niños.

OBJECTIVE: To present the use of intrapleural urokinase as an alternative to surgical management of complicated pleural effusions in children. To add new cases to the literature and set bases for the development of a standardized protocol. METHOD: Presentation of three cases in children under three years of age treated with intrapleural urokinase. RESULTS: Resolution of the effusions with lack of adverse effects. CONCLUSION: Treatment of pleural effusions when loculations develop. This invasive approach might be avoided in some cases by instillation of a fibrinolytic agent such as urokinase into the pleural space, this being an efficient and safe procedure.

Paciente de 10 años con cuadro confusional y desorientación temporospacial / Confusional state and spatiotemporal disorientation in a 10-year-old girl

Las intoxicaciones son una causa frecuente de consulta en los servicios de urgencias pediátricos. El inicio brusco de sintomatología de tipo neurológico constituye una posible forma de manifestación de esta patología, lo que conlleva un estrés adicional por las posibilidades diagnósticas que se barajan en dichos casos (infecciones del sistema nervioso central, lesiones ocupantes de espacio, etcétera). Presentamos un caso de intoxicación por anticolinérgicos con sintomatología neurológica llamativa (AU)

Utilización de urocinasa intrapleural en niños / Use of intrapleural urokinase in children

Objetivo: Presentar la utilización de urocinasa (UC) intrapleural como tratamiento alternativo a la decorticación quirúrgica en los derrames pleurales complicados durante la infancia. Aportar nuevos casos a la escasa casuística pediátrica existente y sentar bases para el futuro desarrollo de un protocolo estandarizado para su utilización. Método Presentación de tres casos de niños menores de tres años en los que se ha utilizado dicha técnica. Resultados Evolución favorable en los tres casos, con ausencia de efectos secundarios. Conclusión El tratamiento del derrame pleural en ocasiones requiere la inserción de un tubo torácico e incluso en algunos casos la realización de una toracotomía y decorticación cuando se desarrollan empiemas tabicados. Este procedimiento invasivo puede ser evitado en algunos casos mediante la instilación de fibrinolíticos como la urocinasa en la cavidad pleural, siendo éste un procedimiento eficaz y seguro (AU)

[High rate of early hospitalization in healthy newborns]. / Alta hospitalaria temprana en recién nacidos a término sanos.

OBJECTIVE: The length of hospital stay of healthy term newborns and their mothers varies in different developed countries. The American Academy of Pediatrics defines early postpartum discharge (EPD) as a discharge occurring within 48 hours of postpartum. EPD has been advocated by patients as part of the humanization of care after delivery and by health services as a more efficient management of resources. Controversies in relation to EPD focus on its impact on initiation and maintenance of breastfeeding, the possible increase of readmissions of newborns with jaundice and the influence on newborn screening for endocrine and metabolic disorders. PATIENTS AND METHODS: Five years ago we started an EPD program for healthy term newborns. We present a descriptive observational study including a series of 2798 consecutive live newborns over a period of 19 months (April 1996 to October 1997). Data about breastfeeding at the time of discharge, coverage of hypothyroidism and phenylketonuria screening and readmissions for newborn jaundice were collected during this period. RESULTS: During the defined period of time, 2798 live newborns were registered. Of these, 2109 (75.38%) were included in the EPD group, the majority of them (75.86%) between 24 and 40 hours postpartum. Breastfeeding was implemented in 95.82% of the newborns, 3.56% of the mothers decided to use artificial formulas and 0.52% were prescribed artificial formulas due to health problems in the mother. In relation to newborn screening of endocrine and metabolic diseases, we found similar coverage of hypothyroid screening compared to the other 7 maternities in our province (public and private) and of phenylketonuria screening compared to the other 5 primary care districts. Regarding newborn jaundice, we detected 47 readmissions, which is 2.23% of the total EPD. These newborns were treated with phototherapy and none required exchange transfusion. The mean value of total serum bilirubin at the time of readmission was 18.7 mg/dl, with a range between 15.1 and 22.6 mg/dl. CONCLUSIONS: In our experience, 75.38% of live newborns were included in a EPD program that has been shown to be safe in relation to controversial subjects, although the limitations of an observational study must be taken into consideration. The safety of this program is inferred by the high proportion of breastfeeding on EPD (95.82%), coverage of endocrine and metabolic screening comparable to other surrounding hospitals and adequate control of hyperbilirubinemia in the newborn period.

[Effectiveness of brain imaging in children with headache]. / Efectividad de los estudios de neuroimagen en niños con cefalea.

OBJECTIVE: Headache is a common complaint in children and brain imaging has become widely used to evaluate this clinical condition. We studied the value of neuroimaging in children with chronic headaches. PATIENTS AND METHODS: A retrospective chart review was conducted of all children referred to the pediatric outpatient clinic for evaluation of headache over a 3-year period. The charts were reviewed for headache characteristics, clinical indications for performing neuroimaging, and imaging results. Special attention was paid to evidence of space-occupying lesions. RESULTS: A total of 160 records were studied, with subjects ranging in age from 4 to 14 years. Most patients were diagnosed as having migraine headaches (60%) or chronic tension headaches (29.5%). Other diagnoses were post-traumatic (6%) and unclassified (4%). Sixty-six patients (41%) had computed tomography imaging performed. In most cases, brain imaging studies were performed because of clinical data (41%) like atypical pattern, sleep-related headache or increase of headache, because of the parents' concerns about brain lesions (38%) and because of an age less than 5 years (14%). Structural changes were found on brain imaging in 4 patients, but none indicated the presence of a treatable space-occupying lesion and all were deemed unrelated to the headache. Our findings of no relevant abnormalities in a series of 66 neuroimaging studies indicate that the maximal rate at which such abnormalities might appear in this population is 4.4%. CONCLUSIONS: These results indicate that neuroimaging studies have very limited value in the clinical evaluation of pediatric patients with chronic headache and should be reserved for those patients with clinical evidence suggestive of underlying structural lesion.