Results after implementation of a sedoanalgesia protocol for procedures in hospital environment. / Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Invasive disease caused by Haemophilus parainfluenzae III in a child with uropathy.

Urinary tract infections (UTIs) caused by Haemophilus parainfluenzae represent a very small percentage of this kind of pathology in children, and it has scarcely been described in the medical literature. According to previous studies of over 800 urine samples in children under 15 years old, a decrease of 50% (from 0.13% to 0.07%) is estimated in its occurrence over the last two decades. This can be explained by the early detection of UTIs and their early empirical treatment, because this micro-organism shows high sensitivity to antibiotics. Also, the culture media in which this bacterium grows are not included in most current protocols. Here we report a case of a UTI caused by H. parainfluenzae in a 4-year-old boy.

Maltrato infantil grave en la unidad de cuidados intensivos pediátricos / Severe child abuse admitted to paediatric ICU

Objetivo: Describir la forma de presentación de maltrato infantil en la unidad de cuidados intensivos pediátricos (UCIP). Pacientes y métodos: Estudio retrospectivo (2000 2008). Se incluyeron los casos diagnosticados de maltrato físico que precisaron atención en la UCIP. Se excluyeron otras formas de malos tratos (negligencia grave, abuso sexual y quemaduras). Resultados: Se recogieron 8 casos (3 varones y 5 mujeres). La mediana de edad fue de 5,2 meses. Seis pacientes tenían menos de 7 meses. El síntoma guía más frecuente fue el neurológico: crisis convulsivas (4 casos), hematoma subdural (2 casos), traumatismo craneoencefálico grave (un caso). Otras formas de presentación fueron hemotórax (un caso) y parada cardiorrespiratoria de origen desconocido (un caso). La tomografía computarizada craneal evidenció hematoma subdural en 5 casos, 3 de ellos necesitaron drenaje quirúrgico. La sospecha de malos tratos pudo confirmarse por la historia social y la presencia de lesiones no fortuitas. Tres pacientes presentaban fracturas de huesos largos (tibia, cúbito y radio y fracturas costales bilaterales) y 4 hemorragias retinianas. Un paciente falleció y 3 quedaron con graves secuelas neurológicas. Conclusión: Los niños gravemente maltratados pueden identificarse falsamente con enfermedad neurológica casual. En la presente serie, la forma más frecuente de aparición es el hematoma subdural, asociado o no a otros signos indicativos de malos tratos. Diagnosticar esta forma de maltrato es decisivo para evitar la repetición de las lesiones (AU)

Objective: To describe cases of severe child abuse admitted to PICU. Methods and patients: It is a retrospective study (2000 2008) in which patients diagnosed with physical child abuse admitted to PICU were included. Other abuse patterns were excluded (severe negligence, sexual abuse or scalding). Results: There were 8 patients included (3 boys and 5 girls). The median age was 5.2 months, with 6 patients were less than 7 months old. The most frequent sign was neurological symptoms: seizures (4 patients), subdural haematoma (2 patients), traumatic brain injury (1 patient). Other: haemothorax (1 patient) and cardiac arrest of no known aetiology (1 patient). The CT showed a subdural haematoma in 5 patients, 3 of which needed surgical drainage. Child abuse was confirmed using the social history and the presence of inflicted injuries. There were long bones fractures (tibia, ulna and radius, bilateral rib fractures) in 3 patients and 4 patients had retinal haemorrhages. There was one death and 3 had severe neurological after effects. Conclusion: Severely abused children can be falsely diagnosed with a casual neurological disease. The most frequent injury is subdural haematoma with or without another injury associated to child abuse. It very important to diagnose child abuse in order to prevent recurrent injuries (AU)

[Severe child abuse admitted to paediatric ICU]. / Maltrato infantil grave en la unidad de cuidados intensivos pediátricos.

OBJECTIVE: To describe cases of severe child abuse admitted to PICU. METHODS AND PATIENTS: It is a retrospective study (2000-2008) in which patients diagnosed with physical child abuse admitted to PICU were included. Other abuse patterns were excluded (severe negligence, sexual abuse or scalding). RESULTS: There were 8 patients included (3 boys and 5 girls). The median age was 5.2 months, with 6 patients were less than 7 months old. The most frequent sign was neurological symptoms: seizures (4 patients), subdural haematoma (2 patients), traumatic brain injury (1 patient). Other: haemothorax (1 patient) and cardiac arrest of no known aetiology (1 patient). The CT showed a subdural haematoma in 5 patients, 3 of which needed surgical drainage. Child abuse was confirmed using the social history and the presence of inflicted injuries. There were long bones fractures (tibia, ulna and radius, bilateral rib fractures) in 3 patients and 4 patients had retinal haemorrhages. There was one death and 3 had severe neurological after effects. CONCLUSION: Severely abused children can be falsely diagnosed with a casual neurological disease. The most frequent injury is subdural haematoma with or without another injury associated to child abuse. It very important to diagnose child abuse in order to prevent recurrent injuries.

Stenotrophomonas maltophilia: ¿un patógeno emergente en la fibrosis quística? / Stenotrophomonas maltophilia: A emergent pathogen in cystic fibrosis?

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