Role of steroids in conservative treatment of parapharyngeal and retropharyngeal abscess in children.

PURPOSE: To characterize the clinical features and outcomes of pediatric patients with retropharyngeal (RPA) or parapharyngeal abscesses (PPA) managed only with medical treatment and showing the importance of early symptoms and imaging studies in the diagnosis of deep neck space infections (DNIs) in children. METHODS: A retrospective analysis of all patients diagnosed with RPA and PPA between 2007 and 2017 was performed in Hospital Universitario Central de Asturias. RESULTS: 30 children were identified, with 11 RPA and 19 PPA. 23 children (76.7%) were under 5 years old, and all were treated with intravenous amoxicillin/clavulanic acid and corticosteroids. Torticollis and fever were present in all patients. The mean length of hospital stay was 7.5 days. There were no complications associated. CONCLUSION: DNIs can be treated in a conservative way, reserving the surgical drainage for cases with a complication associated (airway compromise, lack of response to antibiotic therapy, immunocompromised patients). Treatment with intravenous antibiotics and corticosteroids is a safe option, reducing the duration of symptoms and the length of hospital stay.

Realidad virtual: ¿puede ayudar en la realización de procedimientos invasivos a niños? / Virtual reality: can this help in the performance of invasive procedures on children?

Objetivo. Valorar si el uso de gafas de realidad virtual (RV) es un procedimiento con posible aplicación para disminuir el dolor percibido por los niños al enfrentarse a procedimientos dolorosos. Material y métodos. Se realizó un estudio prospectivo observacional en pacientes pediátricos que acuden al hospital de día de Cuidados Intensivos Pediátricos (CIP) para la realización de procedimientos invasivos que precisan canalizar una vía venosa. Resultados. Participaron en el estudio 22 pacientes (13 niños y 9 niñas) de edades comprendidas entre 5 y 16 años, con una media de edad de 9,7 ± 3,5 años. La medición del dolor se llevó a cabo mediante las escalas de Wong-Baker y la Escala Visual Analógica (EVA), según la edad de los pacientes, obteniéndose una media de dolor de 2,42 ± 2,06 sobre 10 puntos. Además, se recogió el nivel de satisfacción con la intervención, mediante una encuesta no validada valorada del 0 al 4, con una satisfacción de 3,89 puntos en los pacientes; 3,71 en sus padres; 3,94 en el personal médico y 3,50 en el de enfermería. Conclusiones. El uso de RV es fácilmente aplicable a niños sometidos a procedimientos dolorosos, con un alto nivel de satisfacción con la intervención, y podría contribuir a disminuir el dolor percibido por el paciente (AU)

Objective. Evaluate if using Virtual Reality (VR) could be useful to reduce perceived pain between children facing painful procedures. Material and methods. An observational prospective study was performed in paediatric patients who attended the Paediatric ICU’s Day hospital to get invasive procedures done, where a previous venipuncture was needed. Results. 22 patients were included (13 males and 9 females) of ages between 5 and 16 years old, with an average of 9.7 ± 3.5 years old. The most common procedure, performed in 14 patients, was digestive endoscopy. Pain measurement was analyzed with Wong-Baker and visual analog scales, depending on childrens’ ages, getting a final pain average of 2.42 ± 2.06 out of 10 points. What is more, the satisfaction level was studied with a non validate scale going from 0 to 4, getting a result of 3.89 points between patients; 3.71 between their parents; 3.94 between doctors and 3.50 between nurses. Conclusion. Using VR is suitable for children undergoing painful procedures, getting a high satisfaction level with the intervention, and it could contribute to diminish pain level perceived by the patient (AU)

Incidence of enterovirus in patients with acute gastroenteritis.

Enteroviruses (EV) have been linked to lymphocytic meningitis and exanthems, but they may also be involved in acute gastroenteritis (AGE), a condition whose aetiological agent often remains unidentified. In this work 1214 samples from individuals with AGE were studied with the aim of establishing the incidence of EV. The samples were collected between September and December in three different years and subjected to real-time genomic amplification in order to determine the viral load (VL). Of the 1214 samples studied, infection by a single virus was found in 328 cases (27%) and coinfection in 69 (5.7%). While adenoviruses (AdV) were the most frequent (14.8% of total), EV were present in 126 (10.4%) of the individuals tested. Of the 126 EV-positive samples, this virus was found as a single infection and coinfection in 76 (6.3%) and 50 (4.1%) cases, respectively. VL for EV was 5.58±1.51 log copies/ml (range 3.73-9.69) in the former and 6.27±1.75 (range 3.73-10.5) (p=0.02) in the latter. EV were identified in 97 children under 5 (16.9%) and in 29 (4.5%) patients over 5. Patients less than 5 years showed a higher VL that those more than 5 years age [6.08±1.57 (range 3.82-9.69) vs. 5.07±1.53 (range 3.73-10.58); (p=0.002)]. There was a high incidence of EV in AGE patients, and they were more frequent in those under 5, where they were found to replicate more efficiently. These results therefore indicate that testing for EV should be included in the diagnosis of AGE.

Sedoanalgesia para procedimientos en Unidad de Cuidados Intensivos Pediátricos (UCIP). Farmacología, efectos secundarios y control de calidad / Sedoanalgesia for procedures in Pediatric Intensive Care Unit (PICU). Pharmacology, side effects and quality control

OBJETIVOS: Analizar los fármacos más utilizados para sedoanalgesia en procedimientos realizados en una Unidad de Cuidados Intensivos Pediátricos (UCIP), medir su efectividad (nivel de sedación), efectos secundarios y control de calidad. MATERIAL Y MÉTODOS: Estudio prospectivo, observacional y descriptivo. Se recogieron datos epidemiológicos y clínicos, fármaco/s utilizado/s, nivel de sedación alcanzado, incidencias o efectos adversos y escalas de satisfacción, de pacientes de 0 a 18 años sometidos a procedimientos que precisaron sedoanalgesia. RESULTADOS: Se incluyeron 112 pacientes con una edad media de 8,3 años. El fármaco más utilizado fue el propofol (64,3%), seguido de la asociación de ketamina con midazolam (16,1%) y del sevofluorano (12,5%). En el 70,5% de los pacientes se alcanzó un nivel de sedación profunda, sin diferencias estadísticamente significativas entre los distintos fármacos. Se registraron efectos adversos en un 51,8% de pacientes, principalmente desaturación, con una frecuencia mayor al emplear propofol (p< 0,05). La puntuación en la satisfacción alcanzó el valor máximo en todos los padres encuestados, sin hallarse diferencias significativas en función del procedimiento, fármaco, nivel de sedación o efectos adversos. En el 80% de los profesionales la puntuación alcanzó ese mismo valor. CONCLUSIONES: El fármaco más utilizado y con mayor eficacia es el propofol, aunque se asocia más frecuentemente con efectos adversos. El nivel de sedoanalgesia fue adecuado en el momento de iniciar los procedimientos. El grado de satisfacción es óptimo en la mayor parte de los encuestados, aunque fue registrado en menos de la mitad de los procedimientos

OBJECTIVES: To analyze the drugs most used for sedoanalgesia in procedures performed in a Pediatric Intensive Care Unit (PICU), to measure their effectiveness (level of sedation achieved), the main side effects and to carry out a quality control. MATERIAL AND METHODS: Prospective, observational and descriptive study. Epidemiological and clinical data, drug (s) used, level of sedation achieved, incidences or adverse effects, and satisfaction scales were collected from patients from 0 to 18 years of age who underwent procedures that required sedation and analgesia. RESULTS: 112 patients with an average age of 8.3 years were included. The most widely used drug was propofol (64.3%), followed by the association of ketamine with midazolam (16.1%) and sevofluorane (12.5%). In 70.5% of the patients, a level of deep sedation was reached, with no statistically significant differences between the different drugs used. Adverse effects were recorded in 51.8% of patients, mainly desaturation, with a higher frequency when using propofol (p <0.05). Satisfaction score was maximal in all the parents surveyed, without finding significant differences based on the procedure, drug, level of sedation or adverse effects. In 80% of the professionals the score was also maximal. CONCLUSION: The most used and with the highest efficacy in absolute values drug was propofol, although it was more frequently associated with adverse effects. The level of sedoanalgesia was adequate at the time of initiating the procedures. The degree of satisfaction was optimal in most of the respondents, although it was registered in less than half of the procedures

Safety of aerosol therapy in children during noninvasive ventilation with helmet and total face mask / Seguridad de la aerosolterapia durante la ventilación mecánica no invasiva con helmet y mascarilla facial total en población pediátrica

Purpose: To evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet. Design: A descriptive analytical study of a prospective patient cohort was carried out. Ambit: Pediatric intensive care unit (PICU) of a tertiary hospital. Patients: Consecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded. Interventions: Nebulized treatment was added according to medical criteria. Variables of interest: Independent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay. Results: The most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024). Conclusions: The probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients

Objetivo: Evaluar las consecuencias de la medicación nebulizada en pacientes con ventilación no invasiva (VNI) con mascarilla facial total (MFT) y casco. Diseño: Estudio analítico descriptivo sobre una cohorte prospectiva de pacientes. Ámbito: UCIP de hospital de tercer nivel. Pacientes: Todos los pacientes ingresados en UCIP (muestreo consecutivo) con VNI con casco o MFT durante 29 meses. No se excluyeron pacientes. Intervenciones: Se añadió tratamiento nebulizado según criterio médico. Variables de interés: Independientes: edad, sexo, diagnóstico, gravedad, parámetros ventilatorios y medicación nebulizada (si se utilizaba). Secundarias: duración, fallo de VNI y estancia en UCIP. Resultados: Los diagnósticos más frecuentes fueron bronquiolitis (60,5%) y asma (23%). La mediana de conexión a VNI fue de 43 horas. Se administraron nebulizaciones durante la VNI en un 40% sin registrarse efectos adversos. La probabilidad calculada de tener un efecto adverso fue 1,3% con casco y 0,5% con MFT (estadística bayesiana, intervalo de probabilidad 95%). Los pacientes con casco y aerosolterapia tenían mayor gravedad que los que no recibieron nebulizaciones, sin encontrarse diferencias en la necesidad de cambiar a modalidad con doble nivel de presión. En los pacientes con MFT la estancia en UCIP fue menor (p=0,033) a pesar de no existir diferencias en el nivel de gravedad; la tasa de fallo de VNI fue mayor en los que no recibieron nebulizaciones (p=0,024). Conclusiones: La probabilidad de tener un efecto adverso relacionado con la nebulización es baja utilizando casco o MFT. La terapia inhalada con MFT puede disminuir la estancia en UCIP en algunos pacientes

Safety of aerosol therapy in children during noninvasive ventilation with helmet and total face mask.

PURPOSE: To evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet. DESIGN: A descriptive analytical study of a prospective patient cohort was carried out. AMBIT: Pediatric intensive care unit (PICU) of a tertiary hospital. PATIENTS: Consecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded. INTERVENTIONS: Nebulized treatment was added according to medical criteria. VARIABLES OF INTEREST: Independent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay. RESULTS: The most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024). CONCLUSIONS: The probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients.

Confort y nivel de ruido en ventilación no invasiva con interfase helmet en lactantes / Comfort and noise level in infants with helmet interface

OBJETIVOS: Evaluar el grado de bienestar y el nivel de ruido en lactantes que reciben asistencia respiratoria con interfase tipo helmet. Pacientes y método: Estudio analítico, observacional y descriptivo en el que se incluye a todos los lactantes (entre 1 y 12 meses de edad) con helmet ingresados en una UCIP entre el 1 de noviembre del 2013 y el 31 de marzo del 2014. Para la valoración del bienestar se utilizó la Escala de Confort Pediátrica (ECP). Los niveles de ruido fueron medidos con el sonógrafo HIBOK 412. Se realizaron mediciones 3 veces al día. RESULTADOS: Se incluyó a 27 pacientes con bronquiolitis (edad mediana 54 días; rango: 10 - 256). La puntuación mediana de ECP en el primer día fue de 21 puntos (rango: 14-28). Se observó una mejoría en el bienestar objetivado por una disminución progresiva de las puntuaciones, con una reducción máxima del 22% desde las primeras horas (puntuación de 23) al quinto día (puntuación de 18). La cifra mínima de ruido interno fue de 42dB, la máxima fue de 78dB. Las cifras de ruido externo se correlacionan con las de ruido interno tomadas en el mismo momento. No se observaron diferencias en el grado de bienestar del paciente, ni en el ruido en función del tipo de dispositivo de ventilación empleado. CONCLUSIONES: El helmet es una interfase bien tolerada. La puntuación COMFORT obtenida permite mantener a los niños con un grado entre cómodo y muy cómodo. Los niveles de ruido medidos se encuentran dentro del rango máximo de ruido permitido por la Organización Mundial de la Salud

OBJECTIVES: To evaluate comfort and noise intensity using the COMFORT scale in infants who receive respiratory support with a helmet interface. PATIENTS AND METHODS: An observational descriptive study was conducted on all infants (1 to 12 months of age) admitted to a PICU from November 1st 2013 to March 31th 2014 and who received non-invasive ventilation with a helmet interface. Tolerance to the interface was assessed by use of the COMFORT scale. The intensity of the noise to which the infants were exposed was measured with a TES1350A HIBOK 412 sound-level meter. Three measurements were made every day. RESULTS: Twenty seven patients with bronchiolitis (median age: 54 days; range: 10 to 256) were included. Median COMFORT score in the first day was 21 points (14 - 28). An increase in patient comfort was found with a gradual decrease in the scores, with a maximum reduction of 22% from the first hours (score of 22) to the fifth day (score of 18). The minimum sound intensity registered was 42dB, and the maximum was 78dB. Background noise intensity was associated with noise intensity in the helmet. No differences were observed in COMFORT score and noise intensity between ventilator devices. CONCLUSIONS: Helmet interface was well tolerated by infants. COMFORT score results are an indicator that infants were comfortable or very comfortable. The measured noise intensity was in the safe range permitted by World Health Organization

[Comfort and noise level in infants with helmet interface]. / Confort y nivel de ruido en ventilación no invasiva con interfase helmet en lactantes.

OBJECTIVES: To evaluate comfort and noise intensity using the COMFORT scale in infants who receive respiratory support with a helmet interface. PATIENTS AND METHODS: An observational descriptive study was conducted on all infants (1 to 12 months of age) admitted to a PICU from November 1st 2013 to March 31st 2014 and who received non-invasive ventilation with a helmet interface. Tolerance to the interface was assessed by use of the COMFORT scale. The intensity of the noise to which the infants were exposed was measured with a TES1350A HIBOK 412 sound-level meter. Three measurements were made every day. RESULTS: Twenty seven patients with bronchiolitis (median age: 54 days; range: 10 to 256) were included. Median COMFORT score in the first day was 21 points (14 - 28). An increase in patient comfort was found with a gradual decrease in the scores, with a maximum reduction of 22% from the first hours (score of 22) to the fifth day (score of 18). The minimum sound intensity registered was 42dB, and the maximum was 78dB. Background noise intensity was associated with noise intensity in the helmet. No differences were observed in COMFORT score and noise intensity between ventilator devices. CONCLUSIONS: Helmet interface was well tolerated by infants. COMFORT score results are an indicator that infants were comfortable or very comfortable. The measured noise intensity was in the safe range permitted by World Health Organization.

Parkour: una nueva causa de lesiones internas graves / Parkour: a new cause of serious internal injury

No disponible

Trombosis y obstrucción asociadas a vías venosas centrales. Incidencia y factores de riesgo / Thrombosis and obstruction associated with central venous lines. Incidence and risk factors

Objetivo: Analizar la incidencia de trombosis y obstrucción asociada a las vías centrales implantadas a niños críticamente enfermos y la determinación de sus factores de riesgo. Diseño: Estudio prospectivo observacional, desarrollado en una unidad de cuidados intensivos pediátrica de un hospital universitario. Material y método: Se analizaron 825 catéteres venosos centrales (CVC) insertados en 546 pacientes. Se recogieron la edad, el sexo, el peso, el tipo de catéter (luces, tamaño, marca), la localización final del catéter, la existencia de ventilación mecánica, el tipo de sedación y analgesia utilizado, el médico que realizó la técnica, el fallo inicial del residente con posterior canalización por el adjunto, el número de intentos, la indicación, la enfermedad de base, el diagnóstico de ingreso, el tipo de cateterización (urgente, programada o recanalización) y las complicaciones mecánicas tardías (CMT). Se determinaron los factores de riesgo para estas complicaciones mediante un análisis de regresión múltiple. Resultados: Se registraron 52 CMT (6,14%), 42 obstrucciones y 10 trombosis. Las tasas de obstrucción y trombosis fueron de 4,96 y 1,18 por cada 100 CVC, respectivamente. El único factor de riesgo asociado de forma independiente a la obstrucción fue el tiempo de duración del CVC (OR = 1,05, IC del 95%, 1,00-1,10). Respecto a la trombosis, tanto el número de luces (OR = 4,88, IC del 95%, 1,26-18,90) como la nutrición parenteral (OR = 4,17, IC del 95%, 1,06-16,31) alcanzaron significación estadística en el análisis bivariante. Sin embargo, no se objetivaron factores de riesgo para trombosis en el análisis multivariante. Conclusiones: La obstrucción y la trombosis de los CVC insertados en una unidad de cuidados intensivos pediátrica de un hospital universitario son relativamente frecuentes. El tiempo de duración de la vía central es un factor de riesgo independiente para la obstrucción de alguna de sus luces (AU)

Objective: To analyse the incidence of thrombosis and obstruction associated with central venous lines (CVL) inserted in critically ill children, and to determine their risk factors. Design: Prospective observational study in a Pediatric Intensive Care Unit in a University Hospital. Material and method: An analysis was made of 825 CVL placed in 546 patients. Age, gender, weight, type of catheter (lines, size, and brand), final location of the catheter, mechanical ventilation, type of sedation and analgesia used, initial failure by the doctor to perform CVL catheterization, number of attempts, CVL indication, admission diagnosis, emergency or scheduled procedure, and delayed mechanical complications (DMC). Risk factors for these complications were determined by a multiple regression analysis. Results: A total of 52 cases of DMC, 42 cases of obstruction, and 10 of thrombosis were registered. Obstruction and thrombosis rates were 4.96 and 1.18 per 100 CVL, respectively. The only risk factor independently linked to obstruction was the duration of the CVL (OR 1.05; 95% CI; 1.00-1.10). The number of lines with thrombosis (OR 4.88; 95% CI; 1.26-18.0), as well as parenteral nutrition (OR 4.17; 95% CI; 1.06-16.31) was statistically significant according to bivariate analysis. However, no risk factors for thrombosis were found in the multivariate analysis. Conclusions: Obstruction and thrombosis of CVL inserted in a Pediatric Intensive Care Unit are relatively common complications. CVL duration is an independent risk factor for any line obstruction (AU)

[Thrombosis and obstruction associated with central venous lines. Incidence and risk factors]. / Trombosis y obstrucción asociadas a vías venosas centrales. Incidencia y factores de riesgo.

OBJECTIVE: To analyse the incidence of thrombosis and obstruction associated with central venous lines (CVL) inserted in critically ill children, and to determine their risk factors. DESIGN: Prospective observational study in a Pediatric Intensive Care Unit in a University Hospital. MATERIAL AND METHOD: An analysis was made of 825 CVL placed in 546 patients. Age, gender, weight, type of catheter (lines, size, and brand), final location of the catheter, mechanical ventilation, type of sedation and analgesia used, initial failure by the doctor to perform CVL catheterization, number of attempts, CVL indication, admission diagnosis, emergency or scheduled procedure, and delayed mechanical complications (DMC). Risk factors for these complications were determined by a multiple regression analysis. RESULTS: A total of 52 cases of DMC, 42 cases of obstruction, and 10 of thrombosis were registered. Obstruction and thrombosis rates were 4.96 and 1.18 per 100 CVL, respectively. The only risk factor independently linked to obstruction was the duration of the CVL (OR 1.05; 95% CI; 1.00-1.10). The number of lines with thrombosis (OR 4.88; 95% CI; 1.26-18.0), as well as parenteral nutrition (OR 4.17; 95% CI; 1.06-16.31) was statistically significant according to bivariate analysis. However, no risk factors for thrombosis were found in the multivariate analysis. CONCLUSIONS: Obstruction and thrombosis of CVL inserted in a Pediatric Intensive Care Unit are relatively common complications. CVL duration is an independent risk factor for any line obstruction.

Maltrato físico grave con ingreso en Cuidados Intensivos Pediátricos / Severe physical abuse with admission to Pediatric Intensive Care Unit

Introducción. El maltrato infantil es un problema de salud pública. Varios estudios han señalado que este diagnóstico se incrementa de forma alarmante. El objetivo de este estudio es describir la forma de presentación de los casos de maltrato físico infantil que precisaron ingreso en una Unidad de Cuidados Intensivos Pediátricos (UCIP).Métodos. studio descriptivo retrospectivo (1995-2011). Se incluyeron los casos de maltrato físico grave que precisaron ingreso en la UCIP. Se analizaron datos epidemiológicos, clínicos, resultados de las pruebas complementarias y tipos de tratamientos requeridos. Resultados. Se analizaron ocho casos con una mediana de edad de 7 meses. El síntoma guía principal fue neurológico. Los hallazgos patológicos más frecuentes encontrados en las pruebas complementarias fueron hematomas subdurales (6 pacientes), hemorragias retinianas (4 pacientes), sufrimiento cerebral difuso (3 pacientes), fractura craneal (3 pacientes), fracturas óseas en otras localizaciones (2 pacientes). Finalmente, un paciente falleció y dos presentaron secuelas neurológicas graves. Conclusión. La clínica de los malos tratos físicos puede interpretarse erróneamente como una enfermedad neurológica. Es importante considerar este diagnóstico para identificar precozmente casos de maltrato y realizar las pruebas complementarias necesarias. El riesgo de secuelas graves o muerte es elevado, por lo que el diagnóstico precoz es fundamental (AU)

Introduction. Child abuse is a problem of public health. Several reports have demonstrated an increasing tendency for this problem. The objective of this study is to describe cases of severe child abuse admitted to paediatric intensive care unit (PICU).Methods. It is a retrospective study (1995-2011) in which patients diagnosed with physical child abuse admitted to PICU were included. Epidemiological and clinical findings, diagnostic procedures and therapy were analyzed. Results. Eight patients were included with a median age of 7 months. The most frequent sign was neurological. The more frequent injuries associated were subdural haematoma (6 patients), retinal haemorrhages (4 patients), severe abnormality in electroencephalogram (3 patients), skull fracture (3 patients), other fractures (2 patients). Finally, there was one death and two cases of severe neurological damage. Conclusion.C hild abuse can be falsely diagnosed as a neurological disease. Pediatricians should be aware of this pathology in order to identify cases of abuse as soon as possible. The relevance of early diagnosis is based on the fact that an early intervention could prevent severe sequelae or death (AU)

Ventilación no invasiva en Pediatría / Non-invasive ventilation in Pediatrics

La ventilación no invasiva (VNI) se ha ido posicionando en los últimos años, como un arma terapéutica de probada eficacia en la población pediátrica y neonatal, tanto en pacientes agudos como crónicos, con una clara disminución de los efectos secundarios ocasionados por técnicas más invasivas, como la ventilación mecánica convencional. Aunque las contraindicaciones para la aplicación de la VNI no son muy numerosas, es necesario conocerlas para evitar posibles errores en la indicación de tratamiento así como falsos fracasos de dicha técnica. Dependiendo del tipo depatología del paciente, elegiremos tanto el material necesario adecuado como la metodología de aplicación de la VNI. La utilización de la VNI en el fracaso respiratorio tipo II (en el que predomina la hipoventilación) está documentada yes en la que se han obtenido mejores resultados, aunque existen casos especiales del fracaso respiratorio tipo I o hipoxémico (edema agudo de pulmón) en los que existe una importante evidencia científica de indicación. En el resto de patologías englobadas dentro del fallo respiratorio tipo I se podría aplicar esta técnica, siempre teniendo en cuenta una serie de recomendaciones y limitaciones. Durante las primeras horas de conexión a la VNI es cuando debemos objetivar una serie de cambios clínicos que se relacionarán con el éxito o fracaso de nuestro tratamiento. Presentamos una revisión de los conceptos básicos, indicaciones, contraindicaciones y metodología de aplicación de VNI en pacientes pediátricos (AU)

Non-invasive ventilation (NIV) has been developing during the last years and has become a proven therapeutic weapon in neonatal and pediatric population, in acute and chronic patients, with an important decrease of side-effects produced by conventional ventilation. Even though contraindications for the application of NIV are not so numerous, it is necessary to know them all in order to avoid any mistake in the indication of NIV or fake failures of the technique. Material and NIV methodology must be chosen depending on the patient's type of disease. The application of NIV in type II acute respiratory insufficiency (ARF) is well documented and promising results have been obtained. There are special indications in type I ARF (acute pulmonary edema) in which NIV has proved to be a great option. Also NIV could be an interesting therapeutic option in other pathologies involved in type I ARF, without forgetting some recommendations. The first hours after the NIV initiation, clinical monitoring must be practiced in order to detect clinical changes which may relate with the success of our actions. We present a review of basic concepts, indications, contra-indications and methodology of NIV in pediatric patients (AU)

Helmet-delivered heliox-CPAP in severe upper airway obstruction caused by PHACES syndrome.

We present the case of a 4-month-old girl with PHACES syndrome and severe upper respiratory airway obstruction secondary to multiple subglottic and tracheal hemangiomas effectively treated with heliox-CPAP delivered by helmet (HH-CPAP).

Hiposmia, rinorrea fétida y algias faciales por aspergiloma maxilar / Hyposmia, fetid rhinorrhea and facial pain caused by a maxillary aspergilloma

En los últimos años se ha observado un aumento de la incidencia de sinusitis fúngicas en sujetos inmunocompetentes. Presentamos un caso de sinusitis micótica en una paciente de 12 años, en el que concurren varios aspectos que podían dificultar su diagnóstico, produciendo un retraso en su tratamiento definitivo. Este caso ilustra cómo, para llegar a un diagnóstico correcto de esta patología, es necesario basarse en los estudios histológicos y radiológicos, pero siempre sin olvidar un aspecto clave como es la sospecha diagnóstica. El tratamiento de la sinusitis fúngica es quirúrgico, y en el momento actual la técnica de elección es la cirugía endoscópica nasal. Se exponen las características clínicas de esta patología y los métodos diagnósticos necesarios (AU)

In the last few years an increase has been observed in the incidence of fungal sinusitis in immunocompetent subjects. We present a case of mycotic sinusitis in a 12-year-old patient, in which there were several aspects that could have made the diagnosis more difficult, thus delaying her definitive treatment. This case illustrates how to arrive at a correct diagnosis of this pathology. It must be based on the histological and radiological studies, but always without forgetting a key aspect as it is a suspected diagnosis. The treatment of fungal sinusitis is surgical, and currently, endoscopic sinus surgery is the choice. We describe the clinical characteristics of this pathology and the diagnostic methods required (AU)

[Hyposmia, fetid rhinorrhea and facial pain caused by a maxillary aspergilloma]. / Hiposmia, rinorrea fétida y algias faciales por aspergiloma maxilar.

In the last few years an increase has been observed in the incidence of fungal sinusitis in immunocompetent subjects. We present a case of mycotic sinusitis in a 12-year-old patient, in which there were several aspects that could have made the diagnosis more difficult, thus delaying her definitive treatment. This case illustrates how to arrive at a correct diagnosis of this pathology. It must be based on the histological and radiological studies, but always without forgetting a key aspect as it is a suspected diagnosis. The treatment of fungal sinusitis is surgical, and currently, endoscopic sinus surgery is the choice. We describe the clinical characteristics of this pathology and the diagnostic methods required.