Comparison of two methods for cleaning breast pump milk collection kits in human milk banks.

BACKGROUND: Appropriate decontamination of breast pump milk collection kits (BPKs) is critical to obtain safe milk for infants and to avoid discarding donor human milk (DHM). AIM: To evaluate two strategies for BPK decontamination by assessing microbial cultures and the proportion of discarded DHM, according to the criteria of the National Institute for Health and Care Excellence for pre-pasteurization cultures. METHODS: Prospective comparative study, allocation ratio 1:1, microbiologist-blind. PARTICIPANTS: 47 new donors in a human milk bank in Madrid. INTERVENTIONS: Study group (N=21): BPKs washed with water and detergent after each use and further steam decontamination within a microwavable bag. Control group (N=26): washing, rinsing and drying only. Five samples: first sample by hand expression and four samples (one per week) collected using the same pump and method. OUTCOMES: Primary: proportion of DHM discarded due to contamination. Secondary: comparison of the microbiota between samples obtained by hand expression and breast pump in both groups. FINDINGS: In total, 217 milk samples were collected: 47 by hand expression and 170 by pump expression (78 from study group). Steam decontamination of BPKs using a microwavable bag after washing resulted in a lower proportion of discarded DHM samples (1.3% vs 18.5%, P<0.001) and samples contaminated with Enterobacteriaceae (1.3% vs 22.8%, P<0.001) and Candida spp. (1.3% vs 14.1%, P<0.05) compared with samples collected with BPKs that were washed but not steam decontaminated. There were no differences in bacterial contamination between samples obtained using steam decontaminated BPKs and those obtained by hand expression. CONCLUSIONS: Steam decontamination of BPKs using a microwavable bag after washing decreases the amount of discarded DHM and the number of samples with potentially pathogenic bacteria.

Aspectos prácticos de la extracción, conservación y administración de leche materna en el hogar / Practical aspects of expressing, storing and handling breast milk in the home

El amamantamiento proporciona leche materna no deteriorada al lactante en condiciones naturales. Cuando es necesaria la administración de leche materna extraída, hay riesgo de contaminación y deterioro de la leche. La extracción cuidadosa, el mantenimiento de la cadena de frío en la conservación y el transporte y la manipulación adecuada son esenciales para no alterar sus propiedades (AU)

Breast feeding provides the infant with fresh mother’s milk in natural condition. When expressed breast milk has to be used, there is a risk of contamination and deterioration of the milk. Careful expressing, assuring the cold chain during storage and transport and proper handling are essential if its properties are to be maintained (AU)

XV Congreso SEINAP. Cómo se pone en marcha y cómo funciona un banco de leche. Experiencia del Hospital 12 de Octubre / XV Congreso SEINAP. How a milk bank is initiated and how it works. Experience of the Hospital 12 de Octubre

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Incoherencia entre el nivel asistencial de las Unidades Neonatales y los pacientes atendidos / Inconsistency between the level of care in Neonatal Units and the patients in care

No disponible

¿Nos formamos los pediatras para publicar artículos médicos? Encuesta piloto / How are pediatricians trained to write biomedical articles? A pilot study

Introducción: Redactar y publicar requiere una metodología, una organización y una sistemática que los pediatras deben conocer. Objetivo: Evaluar la formación en publicaciones biomédicas entre los pediatras y especialistas médicos que trabajan en nuestra área de pediatría, así como su experiencia personal respecto a la publicación de artículos. Material y métodos: Se realizó una encuesta de oportunidad con 13 preguntas cerradas y una mixta sobre formación, experiencia y motivación para publicar. La muestra estuvo constituida por los asistentes a una sesión sobre «Cómo publicar artículos » de un curso dirigido a pediatras, médicos de familia, residentes de pediatría (MIR-pediatría) y residentes de medicina familiar. La estadística descriptiva se llevó a cabo con el programa SPSS versión 15. Resultados: La población diana estuvo formada por 53 médicos; cumplimentaron el cuestionario 34 (64,1%). Sólo 13 de los 34 respondedores (38%) refirieron haber asistido a cursos o seminarios sobre cómo realizar una publicación: 9 de 21 pediatras (42,8%), 2 de 6 MIR-pediatría (33,3%) y 2 de 7 MIR-medicina de familia (28,6%). Respecto a la experiencia, 18 pediatras (85,7%) publicaron al menos 1 artículo en los últimos 5 años; publicaron más de 5 artículos 5 pediatras (23,8%), 2 MIR-pediatría (ambos menos de 6 artículos) y 5 MIR-medicina de familia. Respecto a la motivación, publicar les resultó «demasiado difícil» a 5 (un 20% de los que publicaron). El motivo principal para publicar fue el currículum personal (un 94,1% de 34). Discusión: Este estudio piloto nos sirvió para conocer la realidad y la necesidad formativa para escribir artículos biomédicos en nuestra muestra local. Es una propuesta para extender este tipo de estudios a otros distritos o áreas sanitarias. Un porcentaje importante señaló que no le resultó emocionalmente positivo publicar, antes al contrario, que tuvo «demasiadas dificultades». Conclusiones: En nuestra muestra se observa una falta de formación percibida en escritura científica. Para conocer, promover y orientar las necesidades de formación en docencia sobre escritura biomédica, creemos recomendable potenciar herramientas como este tipo de encuestas (AU)

Title: How are pediatricians trained to write biomedical articles? A pilot study Introduction: Writing and publishing require a methodology, organization, and systematics that all pediatricians should know. Objective: To evaluate the level of training on biomedical publications among pediatricians and other medical specialists who work in pediatrics in our area, as well as their personal experience in publishing. Material and methods: An opportunity survey with 13 closed questions and another mixed question on training, experience, and motivation to publish. Sample: physicians attending to a lecture about «How to publish articles» from a course aimed to pediatricians, family physicians, pediatrics residents (MIR-pediatrics), and residents in family medicine (MIR-family physicians). Descriptive statistics: SPSS version 15. Results: The target population was 53 physicians. Thirty four (64.1%) fulfilled the questionnaire. Only 13 (38.2%) from the people who answered were trained in publication techniques (through courses and seminars): pediatricians 9 out of 21 (42.8%), MIR-pediatrics 2 out of 6 (33.3%), MIR-family physicians 2 out of 7 (28.6%). Experience: a) published at least one article in the last 5 years: pediatricians 18 (85.7%); b) more than 5 articles: pediatricians 5 (23.8%), MIR-pediatrics 2 (33%, both <6 articles), MIR-family physicians 5. Motivation: publishing was experienced as «too difficult» for 5 (20% of those who had published). The main reason for publishing was personal curriculum (94.1% of 34). Discussion: This pilot study offers a glance at reality and let us know the necessity to train on how to write biomedical article. This work is a proposal to extend this kind of studies to other districts or sanitary areas. A considerable percentage of people didn't remark publishing as emotionally positive, instead, they found it «too difficult». Conclusions: In our sample, a lack of training in scientific writing has been proven. We recommend enhancing tools such as these surveys, in order to discover, promote, and guide through training skills to teach biomedical writing (AU)

En lactantes, ¿es más útil la ecografía universal que la selectiva para detectar la displasia del desarrollo de la cadera? / In infants, is the universal ultrasound screening more useful than the selective one to detect the developmental dysplasia of the hip?

Conclusiones de los autores de los estudios: ninguna estrategia ecográfica demuestra mejorar los resultados, incluido el diagnóstico tardío de la displasia del desarrollo de la cadera y la cirugía, pero los estudios tienen poco poder estadístico para detectar diferencias significativas en estos eventos tan poco frecuentes. Comentario de los revisores: por lo infrecuente de la displasia del desarrollo de la cadera y sus consecuencias (necesidad de cirugía, necrosis avascular de la cabeza del fémur, osteoartritis...), no existen estudios de suficiente tamaño y calidad metodológica para responder la pregunta. Algunos estudios recientes de baja calidad metodológica informan del beneficio del cribado universal para disminuir la necesidad de cirugía, sin descartar que con esto aumente la necesidad de tratamientos muchas veces innecesarios (más del 90% de las displasias leves se resuelven espontáneamente entre las seis semanas y los seis meses de edad) y no exentos de complicaciones (AU)

Authors’ conclusion: none of the ultrasound strategies have shown to improve clinical outcomes, including late diagnosis of developmental dysplasia of the hip and surgery, as the studies are substantially underpowered to detect significant differences in these uncommon events. Reviewers’ commentary: due to the low incidence of developmental dysplasia of the hip and its consequences (surgery, avascular necrosis of the femoral head, osteoarthritis ...), currently there are not studies with sufficient size and methodological quality to answer the question. Recent studies of low methodological quality report the benefit of universal screening to reduce the need for surgery, but do not rule out the possibility that this measure could increase the need for treatments that in many cases are unnecessary (mild dysplasia resolves spontaneously between 6 weeks and 6 months in >90% of untreated hips) and not without complications (AU)

[Congenital adrenal hyperplasia: an association with increased fetal nuchal translucency]. / Hiperplasia suprarrenal congénita: asociación con translucencia nucal fetal aumentada.

A neonate with increased nuchal translucency and congenital adrenal hyperplasia is described. The possible interferences in hormone assays when values are much higher than the average assay range are also discussed.

Hiperplasia suprarrenal congénita: asociación con translucencia nucal fetal aumentada / Congenital adrenal hyperplasia: an association with increased fetal nuchal translucency

Se presenta el caso de un recién nacido con hiperplasia suprarrenal congénita y aumento de la translucencia nucal fetal. También se describen las posibles interferencias que pueden encontrarse en las determinaciones hormonales cuando los valores de la misma superan ampliamente el rango habitual de los ensayos (AU)

[Transcutaneous bilirubin measurement in neonates]. / Bilirrubina transcutánea en neonatos.

A study was performed to determine, in our population, the relationship between transcutaneous, visual and serum bilirubin values. This was done in attempts to reduce the number of serum bilirubin determinations to be performed in the future. We did a correlation coefficient between serum bilirubin and five measurements of transcutaneous bilirubin levels in a group of 60 term newborns and 60 preterm newborns, obtaining a value of 0.84 in both groups. The results were also considered from an analytical point of view where the ability of the test to predict an alteration in serum bilirubin levels, for example > or = 12 mg/dl in preterm and > or = 13 mg/dl in term newborns, was assessed. For values of 18 in preterm and 17 in term infants, the transcutaneous method was found to be both sensitive and specific. If Kramer's test is also evaluated the results improve.

[Adenovirus infections in an emergency department]. / Infecciones por adenovirus en un servicio de urgencias.

We have reviewed 108 emergency ward reports of patients with adenoviral positive cultures in "Doce de Octubre" Hospital in Madrid. Our aim was to know the most frequent symptoms of the infection so that identification and treatment could be managed more efficiently in our department. Cellular cultures were negative for other viruses such as CMV, enterovirus and herpesvirus. No bacteria were found in the throat cultures. Of the children who were evaluated, 78% were younger than 3 years old. The most frequent symptom was high fever with an otherwise good state of health. During the physical examination, a reddened throat with an exudate was found in half of the patients. A white blood cell count of over 15,000 was found in 33% of the patients with a left shift in 20%. The clinical findings overlapped with throat bacterial infections in 66%, lower respiratory infections in 14%, and more unusual, gastroenteritis, hematuria, intestinal invagination or exanthemas. Only 15% were not given antibiotic therapy.

[Treatment of acute epiglottitis]. / Tratamiento de la epiglotitis aguda.

We analyze 13 children between 1 and 3 years old (mean: 24.6 +/- 6.5 months), who were diagnosed (by direct or radiological examination) of epiglottitis. Seven were male. All of them had fever and respiratory distress. Six blood cultures (46%) were positive for Hemophilus Influenzae, and in 5 cases were resistant to beta-lactamases. Diagnose was made by radiology (70%) or by direct examination (30%). Five patients were not intubated (38%), with a favorable outcome. One died after a cardiorespiratory arrest due to self-extubation. We describe in this study our experience in the conservative treatment of epiglotitis, although initial nasotracheal intubation is the safest method for the management of this entity.

[Urolithiasis in childhood]. / Urolitiasis en la infancia.

We report a retrospective study of 51 children who presented urolithiasis between 1980 and 1989 in our Hospital. Mean age was 7 years and the male:female ratio was 2. 1:1. A positive family history was found in 60% of cases. It was done metabolic evaluation in every case: hypercalciuria was found in 34% of cases. In 6% of cases there were hyperuricosuria. None of our patients presented hyperoxaluria, cystinuria or hypocitraturia. Abdominal echography was the most sensible an specific imaging technique of diagnosis. In 16 cases it was necessary a surgical procedure although most cases received only medical management. Four patients were treated with extracorporeal shock-wave lithotripsy. We emphasize the importance of metabolic evaluation. We report our own protocol of study and results.

[Hemodynamic study in meningococcal septic shock]. / Estudio hemodinámico en el shock séptico meningocócico.

We analyzed 8 cases of meningococcal septic shock diagnosed in a three year period. The age varied from 20 months to 10 years (mean: 4.8 years). Two patients died. Every child was monitored with a Swan-Ganz catheter 5 F or 7F, placed on by puncture of internal jugular or subclavicular veins. Of this hemodynamic study, we can conclude that in septic shock, there is a myocardial depression, that persist for several days, and improves with dopamine and dobutamine. In addition to this, in sepsis exists a pulmonary hypertension that makes worse the prognosis.

[Renal function in meningococcal infection. Analysis of 116 cases]. / Función renal en la sepsis meningocócica. Estudio de 116 casos.

We study the renal function in meningococcal sepsis in other to get prognostic data in disease evolution. We include 116 patients of whom we take data of anamnesis; physical examination; blood, urine and cerebrospinal fluid biochemical and microbiologic studies and TISS and APS score. We analyze qualitative and quantitative data of renal function statistical and we compare with another prognostic data of disease. We find that renal failure in meningococcal sepsis gets worse the prognostic of the disease.

[Neonatal systemic candidiasis]. / Candidiasis sistémica neonatal.

We analysed 7 cases of systemic candida sp. infection diagnosed between 1986 to 1989. Clinical presentation was of sepsis. Evolution was favorable in all, excepting two cases that died due to a candidiasic meningitis and a candidiasic aortic thrombosis, respectively. Almost all patients were treated with amphotericin B only. A newborn had signs of toxicity (thrombocytopenia). We emphasize the importance of a prompt diagnosis and treatment and the effectivity of amphotericin B for systemic candidiasis, besides of its rare toxicity in newborns.