Nivel asistencial por definir en hospitalización pediátrica / Level of care to be defined in pediatric hospitalization

INTRODUCCIÓN: En muchas plantas de hospitalización pediátrica se atienden pacientes que requieren más cuidados que los que se suponen para estas unidades. El objetivo de este trabajo es tratar de documentar esta situación y proponer mejoras asistenciales. MATERIAL Y MÉTODOS: Se han revisado los ingresos de 2012, 2014 y 2016 de un hospital secundario sin Cuidados Intensivos, buscando criterios de ingreso en Cuidados Intermedios que define la literatura. Se ha realizado una encuesta de opinión en la Sociedad Española de Pediatría Hospitalaria. RESULTADOS: Los pacientes que se adecúan a los criterios de Cuidados Intermedios suponen un 18,2% (2012), 20,8% (2014) y 19,8% (2016) del total de los ingresos pediátricos (médicos) del hospital secundario analizado. Han participado 15 hospitales. La mayoría, el 80% (12), donde se incluyen todos los terciarios con UCIP, contestan que se atienden en planta pacientes con estas características. Los hospitales con UCIP han trasladado desde su planta a intensivos el 1,22% de los ingresos; los hospitales sin UCIP, el 1,23% (p= 0,98); los hospitales secundarios sin UCIP, el 1,01%, y los hospitales comarcales, el 3% (p < 0,001). Los hospitales en los que este problema no se percibe trasladan el 2,41%, frente a los que sí, el 1,12% (p < 0,001). CONCLUSIONES: Existe conciencia de que se atienden pacientes con mayores requerimientos que los que se suponen en este nivel asistencial. Esto se hace con seguridad, pero convierte parte de nuestra asistencia en un nivel no bien definido entre la hospitalización habitual y los cuidados intensivos. Se deben establecer vías de colaboración para definir, regular y abordar esta situación

INTRODUCTION: In many pediatric hospitalization wards, there exist patients who require a higher level of care than routine inpatient pediatric general care. The aim of that study is to document this situation and to propose care improvements. METHODS: Admissions of 2012, 2014 and 2016 in a secondary hospital without a PICU were reviewed. Criteria for the need of Intermediate care were recorded. A survey was carried out in the Spanish Society of Hospital Pediatrics (SEPHO). RESULTS: Patients who met the criteria for Intermediate Care accounted for 18.2% (2012), 20.8% (2014) and 19.8% (2016) of the total pediatric (medical) admissions of the secondary hospital analyzed. 15 hospitals have participated. 80% of them (12), including all tertiary centers with PICU, refer that patients with criteria for intermediate care are admitted in the ward. Hospitals with PICU have transferred from ward to intensive care 1.22% of admitted patients and hospitals without PICU 1.23% (p = 0.98). Secondary hospitals without PICU have transferred 1% and primary hospitals, 3% (p < 0,001). Hospitals with perception of that fact have transferred 1.12% of admitted patients and the hospitals without this perception, 2.45% (p < 0,001). CONCLUSIONS: Patients with a higher level of care than routine inpatient care are admitted in many wards. This is done safely, but it turns part of our care at a level not well defined between the standard hospitalization and intensive care. Collaboration should be established to define, regulate and address this situation

Outbreak of brainstem encephalitis associated with enterovirus-A71 in Catalonia, Spain (2016): a clinical observational study in a children's reference centre in Catalonia.

OBJECTIVES: To describe the characteristics of an outbreak of brainstem encephalitis and encephalomyelitis related to enterovirus (EV) infection in Catalonia (Spain), a setting in which these manifestations were uncommon. METHODS: Clinical and microbiological data were analysed from patients with neurological symptoms associated with EV detection admitted to a reference paediatric hospital between April and June 2016. RESULTS: Fifty-seven patients were included. Median age was 27.7 months (p25-p75 17.1-37.6). Forty-one (72%) were diagnosed with brainstem encephalitis, seven (12%) with aseptic meningitis, six (11%) with encephalitis, and three (5%) with encephalomyelitis (two out of three with cardiopulmonary failure). Fever, lethargy, and myoclonic jerks were the most common symptoms. Age younger than 12 months, higher white-blood-cell count, and higher procalcitonin levels were associated with cardiopulmonary failure. Using a PAN-EV real-time PCR, EV was detected in faeces and/or nasopharyngeal aspirate in all the patients, but it was found in cerebrospinal fluid only in patients with aseptic meningitis. EV was genotyped in 47 out of 57 and EV-A71 was identified in 40 out of 47, being the only EV type found in patients with brainstem symptoms. Most of the detected EV-A71 strains were subgenogroup C1. Intravenous immunoglobulins were used in 34 patients. Eight cases (14%) were admitted to the intensive care unit. All the patients but three, those with encephalomyelitis, showed a good clinical course and had no significant sequelae. No deaths occurred. CONCLUSIONS: The 2016 outbreak of brainstem encephalitis in Catalonia was associated with EV-A71 subgenogroup C1. Despite the clinical manifestations of serious disease, a favourable outcome was observed in the majority of patients.

Hemocultivos en urgencias pediátricas. Guía práctica de recomendaciones: indicaciones, técnica de extracción, procesamiento e interpretación / Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation

El hemocultivo (HC) es el método diagnóstico de elección ante la sospecha de bacteriemia, siendo una de las técnicas microbiológicas más solicitadas en pediatría. Diversos cambios han acontecido en los últimos años como la introducción de nuevas vacunas, el aumento creciente de pacientes portadores de catéteres vasculares centrales, o la irrupción de los sistemas automáticos de procesamiento de los HC. Dichos cambios han propiciado la revisión y la actualización de los distintos aspectos relacionados con esta técnica con el fin de optimizar su uso. Se presenta una guía práctica sobre recomendaciones acerca de la extracción, el procesamiento y la interpretación de los HC elaborada por la Sociedad Española de Urgencias de Pediatría y la Sociedad Española de Infectología Pediátrica. Tras revisar la información científica disponible, se presentan una serie de recomendaciones para cada uno de los siguientes apartados: indicaciones en Urgencias, técnica de extracción, transporte y procesamiento de la muestra, factores a tener en cuenta en situaciones especiales (indicaciones e interpretación de resultados en el paciente inmunodeprimido y/o portador de catéter vascular central, indicaciones de HC para anaerobios), diferenciación entre bacteriemia y contaminación ante un HC con crecimiento bacteriano y actitud a tomar ante un HC positivo en el paciente con fiebre sin foco

Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin

Neumonía adquirida en la comunidad: tratamiento ambulatorio y prevención / Community acquired pneumonia in children: Outpatient treatment and prevention

La neumonía adquirida en la comunidad (NAC) en la edad pediátrica ha sufrido, en la última década, una serie de cambios epidemiológicos, clínicos, etiológicos y de resistencias a antibióticos, que obligan a replantear su abordaje terapéutico. En este documento, dos de las principales sociedades de especialidades pediátricas involucradas en el diagnóstico y tratamiento de esta entidad, como son la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica, así como el Comité Asesor de Vacunas de la AEP, proponen unas pautas consensuadas de tratamiento y prevención, con el fin de proporcionar a todos los pediatras una guía actualizada. En esta primera parte del consenso, se aborda el tratamiento de los pacientes sin enfermedades de base relevantes con NAC que no precisan ingreso hospitalario, así como la prevención global de esta patología con vacunas. En un siguiente documento se expondrá el abordaje terapéutico tanto de aquellos pacientes en situaciones especiales como de las formas complicadas de la enfermedad

There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed

Neumonía adquirida en la comunidad: tratamiento de los casos complicados y en situaciones especiales. Documento de consenso de la Sociedad Española de Infectología Pediátrica (SEIP) y Sociedad Española de Neumología Pediátrica (SENP) / Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP)

Desde hace más de una década, los casos complicados de neumonía adquirida en la comunidad, fundamentalmente con empiema pleural o formas necrosantes, comenzaron a ser más frecuentes en niños, según la amplia documentación procedente de numerosos países. El abordaje terapéutico óptimo de estos casos, tanto desde el punto de vista médico (antibióticos, fibrinolíticos) como técnico-quirúrgico, (drenaje pleural, videotoracoscopia) continúa siendo controvertido. En este documento, la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica revisan la evidencia científica y proponen unas pautas consensuadas de tratamiento de estos casos, fundamentalmente para el abordaje del derrame pleural paraneumónico en niños, así como la actuación en situaciones especiales, sobre todo en la cada vez más frecuente población pediátrica con enfermedades de base o inmumodepresión

The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression

Papel de las exploraciones complementarias y de la monitorización domiciliaria en los pacientes de riesgo de episodio aparentemente letal, apneas y síndrome de muerte súbita del lactante / The role of complementary examinations and home monitoring in patients at risk from apparent life threatening event, apneas and sudden infant death syndrome

INTRODUCCIÓN: Los monitores de apneas detectan anomalías en la frecuencia cardíaca y respiratoria, sin utilidad demostrada para el diagnóstico de alteraciones respiratorias relacionadas con el sueño en los niños como se pensaba en su origen. OBJETIVO: Describir el tipo de pacientes que se monitorizan, durante cuánto tiempo y la evolución de los mismos. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo de los pacientes con monitorización cardiorrespiratoria domiciliaria controlados, desde octubre del 2008 hasta septiembre del 2012, en consultas externas de un hospital materno-infantil de tercer nivel. RESULTADOS: Durante el periodo de estudio fueron incluidos 88 pacientes, el 58% de ellos de sexo masculino, con una mediana de edad de 15,5 días y durante un periodo de 4,7 meses. El motivo de monitorización fue en un 20,5% por antecedente de muerte súbita, sin encontrar patología subyacente; un 25% por apnea de la prematuridad; un 20,5% por episodio aparentemente letal, y un 14.8% por atragantamiento. Otras causas suponen el 19,3% (apnea/hipopnea, desaturaciones y respiración periódica). De estos 3 últimos grupos, en el 50% se registraron eventos patológicos: reflujo patológico (9), apneas de la prematuridad (2), causa neurológica (3) y apneas de causa desconocida (10). CONCLUSIONES: La sospecha de apnea del lactante es un motivo de consulta que crea gran preocupación tanto a la familia como al pediatra. La monitorización domiciliaria es útil en la detección de alteraciones en la frecuencia cardíaca y respiratoria pero es necesario limitar sus indicaciones y realizar un buen seguimiento de estos pacientes, evitando el abuso de otras pruebas complementarias o tratamientos

INTRODUCTION: Home apnea monitors detect abnormalities in cardiac and respiratory frequency, but their use in the diagnosis of respiratory -related sleep disturbances in children has not been demonstrated, as was originally thought. OBJECTIVE: To describe the type of patients being monitored, for how long and their outcome. MATERIAL AND METHODS: A retrospective descriptive study was conducted on patients with controlled home cardiorespiratory monitoring from October 2008 to September 2012 in the Outpatient department of a Maternity tertiary hospital. RESULTS: During the study period 88 patients were included, 58% of them were male, with a median age of 15.5 days, and followed up for a period of 4.7 months. The reason for monitoring was due to a history of sudden death without finding underlying pathology in 20.5%, 25% due to apnea of prematurity, 20.5% due to apparent life-threatening event, and 14.8% due to choking. Other causes accounted for 19.3% (apnea/hypopnea, desaturation and periodic breathing). Of these last three groups, pathological events were observed in 50% of them: reflux disease (9), apnea of prematurity (2), neurological causes (3), and apnea of unknown cause (10). CONCLUSIONS: Suspected infant apnea is a cause for consultation that creates a great deal of concern to the family and the pediatrician. Home monitoring is useful in detecting changes in cardiac and respiratory frequency, but is necessary to limit its indications and ensure proper monitoring of these patients, avoiding the abuse of other tests or treatments

Situación de la pediatría hospitalaria en España: informe de la Sociedad Española de Pediatría Hospitalaria (SEPHO) / Status of pediatric hospital medicine in Spain: A report by the Spanish Pediatric Hospital Medicine Society (SEPHO)

Son pocos los informes sobre la situación de la pediatría hospitalaria en España. Desde la Sociedad Española de Pediatría Hospitalaria (SEPHO) se ha impulsado la realización de un estudio para conocer el estado en que se dispensa la atención hospitalaria pediátrica. Para ello se han consultado los datos publicados por el Ministerio de Sanidad y el Instituto Nacional de Estadística, y se han analizado los resultados de una encuesta informática diseñada y elaborada por la SEPHO disponible en Internet para su cumplimentación desde noviembre de 2011 hasta diciembre de 2012 entre hospitales españoles. Los resultados de esta encuesta forman parte del inicio de nuestra andadura como asociación, en la necesidad de conocer el estado actual de la asistencia al niño y su familia durante su hospitalización, con el objetivo de poder estudiar y, en su caso, proponer recomendaciones de mejora y homogenización de la asistencia. Se trata de un estudio, inédito hasta la fecha, del estado de la atención hospitalaria pediátrica por cuanto es vista y analizada desde la perspectiva directa de los profesionales implicados en la hospitalización general pediátrica. Se han incluido hospitales de distinto tamaño y complejidad asistencial. El objetivo del presente informe es presentar los resultados de la encuesta y contrastarlos con los datos demográficos y asistenciales de fuentes oficiales

Few reports are available on the status of Pediatrics Hospital Medicine in Spain. This has prompted the Spanish Society of Hospital Pediatrics (SEPHO) to conduct a study to determine the status of pediatric hospital care received. Data released by the Ministry of Health, the National Institute of Statistics have been used in the study, and an analysis was made of the results of a computerized survey designed and developed by SEPHO and available on the Internet for completion from November 2011 to December 2012 among Spanish hospitals. The results of this survey are part of the beginning of our journey as an association, and the current status of child and family welfare during hospitalization needs to be determined in order to consider and, where appropriate, make recommendations for improvement and standardization of care. The study, still unpublished, is to determine the state of pediatric hospital care as seen and analyzed from the perspective of the professionals directly involved in pediatric general hospital care. We included hospitals of different size and complexity of care. The aim of this report is to present the results of the survey and relate it to demographic and health care data from official sources

Respiratory viruses, such as 2009 H1N1 influenza virus, could trigger temporal trends in serotypes causing pneumococcal disease.

In order to determine if the novel influenza A(H1N1)pdm09 was associated with temporal trends of main serotypes causing invasive pneumococcal disease (IPD), we studied 384 episodes of IPD in <18-year-old patients from 2007 to 2012. The number of IPD episodes diagnosed during the 2009 pandemic period meant almost one-third of all the episodes diagnosed in the five included influenza periods (51/156). The number of IPD episodes diagnosed during the 2009 pandemic period meant almost one-third of all the episodes diagnosed in the five included influenza periods. Most of them occurred in <5-year-old children. Serotype 1 was the main serotype detected over the period, except for the 2009 pandemic, when it practically disappeared. Seasonality and viral infections could trigger temporal trends of serotypes causing IPD.

Utilidad de la procalcitonina para la prescripción antibiótica y la sospecha de bacteriemia en urgencias. Respuesta de los autores / Usefulness of procalcitonin for prescribing of antibiotics and suspicion of bacteremia in theemergency department. Author’s reply

No disponible

Comparison of an in-house real-time RT-PCR assay with a commercial assay for detection of enterovirus RNA in clinical samples.

Molecular detection of enterovirus (EV) RNA based on PCR methods is a quicker and more sensitive approach than culture methods. At present, different PCR-based methods for EV RNA detection are available, but comparisons of results obtained according to the different approaches are limited. We evaluated an in-house real-time RT-PCR assay with a commercialized TaqMan real-time RT-PCR kit for detection of EV. Consecutive clinical specimens from paediatric patients less than 6 years old with clinical suspicion of EV infection were analyzed between July and November 2010. After RNA extraction, samples were amplified both by the real-time RT-PCR commercial assay and the in-house assay. A total of 19 of 132 patients (14.4%) involving 20 samples (14 plasma samples and 6 CSF) were positive in at least one of the two assays. The sensitivity of the in-house assay when the MutaPLATE® assay was used as a reference was 90% (IC 95%; 74.35-100) and the specificity was 100% (IC 95%; 99.63-100). Cts results of two methods were statistically correlated (r = 0.774; P = 0.01). In conclusion, these two real-time RT-PCR assays are rapid and easy methods for detection of EV.

Infección invasiva por «Staphylococcus aureus» resistente a meticilina de origen comunitario en pacientes pediátricos sanos / Invasive infection caused by community acquired methicillin resistant Staphylococcus aureus on healthy pediatric patients

Staphylococcus aureus resistente a meticilina de adquisición comunitaria (SARM-AC) es una bacteria implicada en infecciones de diversa gravedad y localización. En este trabajo exponemos la actualidad de las infecciones por SARM-AC en pediatría, y lo ilustramos con dos ejemplos de infección virulenta en pacientes pediátricos sanos. El primer caso corresponde a una paciente con artritis séptica y neumonía necrosante por SARM-AC, y el segundo a un lactante con pleuroneumonía por SARM-AC. Ambos casos son un claro ejemplo de la relevancia de esta infección emergente en pediatría (AU)

The community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is a bacterium that is frequently involved in severe infections and various locations. In this article we describe the actual state of CA-MRSA infections in pediatrics, and we illustrate it with two examples of virulent infection in healthy pediatric patients. The first case is in a patient with septic arthritis and necrotizing pneumonia caused by CA-MRSA, and the second one is in an unweaned baby with pleuropneumonia caused by CA-MRSA. Both cases are a clear example of the importance of this emerging infection in pediatrics (AU)

Novel influenza A (H1N1) encephalitis in a 3-month-old infant.

Seasonal influenza virus infection has been associated with a variety of neurologic complications. We report a case of novel influenza A (H1N1) encephalitis in an infant aged 3 months with an upper respiratory infection, who presented seizures. The infection was confirmed in nasopharyngeal aspirate and cerebrospinal fluid. Treatment with oseltamivir was started. He was discharged without any neurologic sequelae.

Espondilitis atlantoaxoidea. Una causa infrecuente de tortícolis / Atloaxoid spondylitis. An infrequent cause of torticolis

No disponible