[Satellite center of human milk: Analysis of cost reduction]. / Centro satélite de donación y recepción de leche materna como alternativa a la creación de un banco de leche independiente. Análisis de reducción de costes.

INTRODUCTION: Donor milk is the second best alternative for a newborn after the mother's own milk, especially when the baby is a premature or a sick child since this milk has the advantage of protecting against necrotizing enterocolitis. There are currently 13 milk banks in Spain, however this is not sufficient to supply all Spanish neonatal units with donor milk. In order to bring donor milk to the babies in Neonatal Unit of the Regional University Hospital of Malaga, a Satellite Centre (CS) was created in 2012, depending on the Milk Bank of Virgen de las Nieves Hospital in Granada. AIM: Assessing the efficiency of a SC compared to an independent milk bank. METHOD: A study of cost minimization is used for the analysis. The cost of the implementation of the SC is calculated and compared to the cost of the implementation of the Milk Bank of Virgen de las Nieves of Granada. Additionally, the maintenance cost per year of the 2 models is compared, taking into account the running phase from June, 2012 through August 2015 in the SC. RESULTS: A SC implies savings of 88,852 Euro in equipment, and 24,572 Euro per year in maintenance compared to an independent milk bank. CONCLUSIONS: The efficiency of the SC is due to a better use of resources. A distribution network model of donor human milk, consisting of milk banks and SC, makes it possible to equally supply human milk to premature infants with a reduced cost.

[Complex febrile seizures: study of the associated pathology and practical use of complementary tests]. / Crisis febriles complejas: estudio de la patología asociada y utilidad de las pruebas complementarias.

INTRODUCTION: Although one third of febrile seizures are complex, a consensus has still not been reached on how to manage them, as is the case with simple febrile seizures. The objective of this study is to estimate the usefulness of complementary examinations and the risk of associated serious intracranial pathology. PATIENTS AND METHODS: A retrospective review was conducted from 2003 until 2011 on patients from 6 months to 6 years presenting with a complex febrile seizure admitted to a tertiary care hospital, excluding the cases with previous neurological disease. Epidemiological and clinic variables were collected, as well as complementary tests and complications. RESULTS: We found 65 patients (31 females and 34 males), of whom 44 had repeated seizures in the first 24 hours, with 15 having focal seizures. The vast majority (90%) of the recurrences occurred before 15 hours. The mean age was 20.7 months and temperature was 39.1 ± 0.12°C. None of the patients had severe intracranial pathology. The electroencephalogram gave no helpful information for the diagnosis. Neuroimaging was normal in all studied cases. CONCLUSIONS: The incidence of complications in complex febrile seizure in our series did not justify the systematic admission or the systematic study with complementary tests when the neurological examination was normal. The routine electroencephalogram does not appear to be justified.

Espondilodiscitis: diagnóstico y seguimiento a medio-largo plazo de 18 casos / Spondylodiscitis: Diagnosis and medium-long term follow up of 18 cases

Introducción: La espondilodiscitis en niños es poco frecuente. Es habitual un retraso en el diagnóstico y errores en el mismo. Objetivos: Revisar las características clínicas, analíticas y radiológicas de los niños con espondilodiscitis en el Hospital Materno-Infantil Carlos Haya de Málaga. Pacientes y métodos: Estudio retrospectivo de los niños diagnosticados de espondilodiscitis en este hospital, durante un período de 10 años. Resultados: Se estudiaron 18 pacientes. Fue más frecuente en menores de 3 años y mayores de 12. El tiempo medio de retraso en el diagnóstico resultó de 26,9 días, con diagnóstico inicial erróneo en 8 casos. Se presentaron 3 patrones clínicos: en menores de 3 años, rechazo de la marcha y sedestación (100%) e irritabilidad (42%); entre 3 y 12 años, impotencia funcional de extremidades inferiores (EEII) (100%) y dolor abdominal (100%); en adolescentes, molestias de la espalda (75%). Apareció fiebre en el 38% de los casos y febrícula en 8 casos (44%). El 50% presentó leucocitosis moderada, con discreta elevación de la velocidad de sedimentación globular. Las localizaciones más frecuentes fueron L3-L4 y L4-L5. La radiografía al diagnóstico resultó patológica en el 83% de los casos. La RM al ingreso fue diagnóstica en el 100%. Detectó además afectación de raíces nerviosas (5 casos), masas inflamatorias/abscesos paravertebrales (5), absceso epidural (1) y abscesos del psoas (2). Recibió tratamiento antibiótico el 94% de los niños e inmovilización el 100%. Todos experimentaron rápida mejoría tras el inicio del tratamiento, excepto los afectados de abscesos del psoas. El seguimiento radiológico, realizado en 17 pacientes (12 mediante RM), a los 14 meses de media (rango 1–48), mostró disminución o desaparición del espacio discal en el 100% de los niños y mejoría de las masas de partes blandas. En el seguimiento clínico (recogido en 11 pacientes) todos conservaban motilidad normal y el 27% dolor leve-moderado. Conclusión: La espondilodiscitis, cuyo retraso en el diagnóstico es frecuente, no es una entidad banal, ya que puede complicarse con abscesos y daño de raíces nerviosas. La RM es la prueba de elección para determinar su extensión a los tejidos vecinos (AU)

Introduction: Spondylodiscitis is an uncommon disease in children. It is often misdiagnosed or the diagnosis is made late in the course of illness. Objectives: To review the clinical, analytical and radiological characteristics of children with spondylodiscitis in the Materno-Infantil Hospital of Malaga. Patients and methods: Retrospective cohort study on children diagnosed with spondylodiscitis, during a period of 11 years. Results: Eighteen patients were included in the study. Spondylodiscitis was more frequent in patients younger than 3 years old and older than 12 years old. The average time of delay in diagnosis was 26.9 days. In 8 cases the diagnosis was missed initially. Three clinical patterns appeared: in children under 3 years of age, refusing to walk and sit (100%) and irritability (42%); between 3 and 12 years of age, limb (100%) and abdominal pain (100%); in adolescents, back pain (75%). Fever was present in 38% of the cases, and low-grade fever in 8 (44%). A total of 50% of the patients had a moderate leucocytosis, and a slight increase in ESR; the most frequent location was L3-L4. X-ray diagnosis was pathological in 88% of the cases. The initial MRI diagnosed 100% of the cases. In addition, nerve roots damage (5 cases), inflammatory masses/paravertebral abscesses (5), epidural abscess (1) and psoas abscesses (2) were detected. A total of 94% of the children received antibiotics and 100% of the children underwent immobilization. All patients recovered early after the beginning of treatment, with the exception of those affected by psoas abscesses. The radiological follow-up was done in 17 patients (12 by MRI). After a mean of 14 months (rank 1–48), persistent diminution of disc space was seen in 100% of the children, and improvement of soft-tissue inflammation. Clinically (follow-up only in 11 patients) all patients regained normal mobility and only 27% had moderate pain. Conclusion: Spondylodiscitis, whose delay in the diagnosis is frequent, is a serious illness. Complications include abscesses and nerve root damage. MRI is the study of choice to determine the extension to neighbouring tissues (AU)

[Spondylodiscitis: Diagnosis and medium-long term follow up of 18 cases]. / Espondilodiscitis: diagnóstico y seguimiento a medio-largo plazo de 18 casos.

INTRODUCTION: Spondylodiscitis is an uncommon disease in children. It is often misdiagnosed or the diagnosis is made late in the course of illness. OBJECTIVES: To review the clinical, analytical and radiological characteristics of children with spondylodiscitis in the Materno-Infantil Hospital of Malaga. PATIENTS AND METHODS: Retrospective cohort study on children diagnosed with spondylodiscitis, during a period of 11 years. RESULTS: Eighteen patients were included in the study. Spondylodiscitis was more frequent in patients younger than 3 years old and older than 12 years old. The average time of delay in diagnosis was 26.9 days. In 8 cases the diagnosis was missed initially. Three clinical patterns appeared: in children under 3 years of age, refusing to walk and sit (100%) and irritability (42%); between 3 and 12 years of age, limb (100%) and abdominal pain (100%); in adolescents, back pain (75%). Fever was present in 38% of the cases, and low-grade fever in 8 (44%). A total of 50% of the patients had a moderate leucocytosis, and a slight increase in ESR; the most frequent location was L3-L4. X-ray diagnosis was pathological in 88% of the cases. The initial MRI diagnosed 100% of the cases. In addition, nerve roots damage (5 cases), inflammatory masses/paravertebral abscesses (5), epidural abscess (1) and psoas abscesses (2) were detected. A total of 94% of the children received antibiotics and 100% of the children underwent immobilization. All patients recovered early after the beginning of treatment, with the exception of those affected by psoas abscesses. The radiological follow-up was done in 17 patients (12 by MRI). After a mean of 14 months (rank 1-48), persistent diminution of disc space was seen in 100% of the children, and improvement of soft-tissue inflammation. Clinically (follow-up only in 11 patients) all patients regained normal mobility and only 27% had moderate pain. CONCLUSION: Spondylodiscitis, whose delay in the diagnosis is frequent, is a serious illness. Complications include abscesses and nerve root damage. MRI is the study of choice to determine the extension to neighbouring tissues.