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

[The role of complementary examinations and home monitoring in patient at risk from apparent life threatening event, apneas and sudden infant death syndrome]. / 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.

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 in a 20.5% 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.

Clinical features of influenza disease in admitted children during the first postpandemic season and risk factors for hospitalization: a multicentre Spanish experience.

The main objectives of this study were to describe the characteristics of children with influenza infection during the postpandemic outbreak, and to compare sociodemographic and clinical data between patients who required hospitalization and those managed on an outpatient basis with a matched case-control study design. This is a multicentre paediatric study in Spain that included patients aged 6 month to 18 years in whom influenza infection was confirmed by real-time reverse transcription-polymerase chain reaction between December 2010 and March 2011. Among the 143 admitted patients, the main reason for admission was respiratory failure (123/143). In 55 there was some previously known disease. The median age was lower in patients without comorbidity (1.8 years: interquartile range 1.0-3.0 versus 5.3 years: interquartile range 1.3-10.7); p <0.01). The lag time from onset of symptoms to starting antiviral treatment was correlated with the length of hospital stay (Rho Spearman = + 0.32; p 0.01). Twenty patients required admission to the paediatric intensive care units, all due to respiratory failure. Children with chest X-ray opacities in more than one quadrant more frequently required admission to intensive care. Having a neurological disease conferred the highest risk of requiring hospitalization (OR 17.18) in a multivariate analysis. This study concludes that influenza in the paediatric population requiring hospitalization during the postpandemic season affected mainly children with neurological or pulmonary comorbidities and children of parents with a lower educational level. Most of the influenza infections caused respiratory symptoms, although neurological manifestations were also observed. Early initiation of oseltamivir was associated with a shorter length of hospital stay.

Low prevalence of invasive bacterial infection in febrile infants under 3 months of age with enterovirus infection.

Infants under 3 months of age with fever without source (FWS) generally undergo a full, invasive septic evaluation to exclude invasive bacterial infection (IBI). Enterovirus (EV) infections are mostly banal and self-limiting and show a high prevalence rate at this age. We aimed to investigate the prevalence of IBI in EV-infected and uninfected infants under 3 months of age with FWS. This was a prospective observational cohort study of infants aged <90 days who were admitted because of FWS. As per protocol, blood and urine analysis and culture were obtained in all cases, and RNA EV from blood and/or cerebrospinal fluid samples was determined by real-time PCR. Three hundred and eighty-one previously healthy infants with FWS were included. EV infection was diagnosed in 64 children (16.8%; 95% confidence interval, 13.2-20.9%) and showed an uneventful evolution in all cases. Laboratory markers of infection were consistently lower in EV-infected patients; only one case of IBI (1.6%) was observed in an EV-infected patient as compared with 25.2% in EV-negative infants (p <0.001). Intravenous antibiotic use and length of stay were no different in EV-infected and uninfected patients. In our study, febrile infants (<90 days) diagnosed with EV infection showed a low risk of IBI when compared with uninfected patients. The systematic investigation of EV infection in young infants with FWS may allow a more conservative approach to the management of these patients. Further studies on this diagnostic approach are needed.

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.

Halitosis en el niño y el adolescente / Halitosis in children and adolescents

La halitosis es el olor desagradable procedente de la boca, la nariz o las vías respiratorias. No suele ser un motivo de consulta directa en pediatría, pero con frecuencia es mencionada por la familia del paciente. En muchas ocasiones, los profesionales sanitarios no están suficientemente sensibilizados ante este tipo de molestia, y además la información sobre el tema es escasa. Sin embargo, este síntoma debe tenerse en cuenta, ya que puede ser la manifestación de diversos trastornos médico-odontológicos, además de la implicación social, económica y psicológica que puede tener, sobre todo en el adolescente. En este artículo se pretende revisar la bibliografía referente a la etiología, la fisiopatología, el diagnóstico y las diferentes opciones terapéuticas, incluidas las más novedosas, para facilitar su manejo en la práctica diaria pediátrica. Es necesaria la educación del paciente afectado y de sus familiares, de modo que sean ellos mismos quienes adopten unos hábitos higiénicos saludables y efectivos (AU)

Halitosis is an unpleasant odour emanating from mouth, nose or airway. This is not a usual reason for a direct consultation in pediatrics but is frequently mentioned by the patient´s family. On many occasions, health professionals are not concerned about this type of discomfort. Information about this problem is scarce. This symptom should be taken into account as it can be the manifestation of several medical and odontological disorders and for the social, economical and psychological implications, mostly in adolescents. The intention of this work is to revise bibliography about etiology, physiopathology, diagnosis and different therapeutic options of halitosis including the newest ones, in order to facilitate the daily practice at a pediatric level. The education of the affected patient is necessary in order to acquire healthy and effective hygienic habits to cope with the halitosis (AU)

Tortícolis e hiperextensión espinal. Presentación inusual del síndrome de Guillain-Barré / Torticollis and hyperextended spine: unusual presentation of Guillain-Barré syndrome

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[Violence and adolescence. A perspective from and Emergency Department]. / Violencia y adolescencia. Perspectiva desde un servicio de urgencias.

INTRODUCTION AND AIM: The acts of violence between adolescents are becoming increasingly more common, generating problems of a diverse nature. The knowledge of the circumstances that surround this violence is important to implement measures to decrease their incidence. The aim of this study was to describe the epidemiology of violent assault in teenagers from the perspective of an Emergency Department. MATERIAL AND METHOD: Retrospective analysis of information recorded on adolescent victims of assault, who attended our Emergency Department over a 1 year period (2006), was performed. RESULTS: Of the 105 patients included, the mean age of the assault victims was 15.9 (SD: 1.4) years. Of those, 73.3 % were male. They were seen at holidays (58.1 %) and predominantly between the hours of 8 pm and 4 am (55.2 %). Forty-nine (46.7 %) of the events were classified as fights, 44 (41.9 %) as assaults, 7 (6.7 %) as physical abuse and 5 (4.8 %) as sexual abuse. Overall, 20 (19 %) patients reported that there was a weapon at the scene: in 13.3 % a blunt object and in 5.7 % a knife/piercing object. Bruises or haematomas were present in 93.3 % of patients; lacerations in 19 % and fractures in 11.4 %. Sixty-two (59 %) patients needed an X-ray, 10 (9.5 %) a urineanalysis and 7 (6.7 %) a blood test. Seven (6.7 %) patients were hospitalised and 6 (5.7 %) were evaluated by Social Work. CONCLUSIONS: The knowledge of the epidemiology of this problem and awareness by the professionals involved in handling this, must promote the coordinated creation of protocols and actions that can decrease its impact among adolescents, and in turn, society.

Violencia y adolescencia. Perspectiva desde un servicio de urgencias / Violence and adolescence. A perspective from and Emergency Department

Introducción y objetivo: Los actos de violencia entre adolescentes son cada vez más frecuentes y generan problemas de índole diversa. El conocimiento de las circunstancias que los rodean es importante para instaurar medidas que disminuyan su incidencia. El objetivo de este trabajo es analizar las características de las víctimas de agresiones atendidas en nuestro servicio de urgencias. Material y método: Estudio retrospectivo de los informes de urgencias de los adolescentes que fueron visitados en el año 2006 por haber sido agredidos y en los que se emitió un parte de lesiones. Resultados: Fueron 105 pacientes, con una edad media de 15,9 años (DE: 1,4 años) y predominio masculino (77 casos, 73,3 %). El 55,2 % de las visitas se produjeron entre las 20.00 y las 4.00 h; el 58,1 % en día festivo. El motivo de la consulta estaba relacionado con una pelea en 49 casos (46,7 %), con una agresión sin pelea en 44 (41,9 %), con maltrato físico en 7 (6,7 %) y con abuso sexual en 5 (4,8 %). En el 85,1 % se había usado la fuerza física; en el 13,3 %, instrumentos no cortantes, y en el 5,7 %, armas blancas. Las contusiones fueron las lesiones más frecuentes, en 98 pacientes (93,3 %), seguidas de heridas abiertas y fracturas, en 20 (19 %) y 12 casos (11,4 %), respectivamente. Requirieron pruebas de radiodiagnóstico 62 adolescentes (59 %), análisis de orina 10 (9,5 %) y hemograma 7 (6,7 %). Ingresaron 7 pacientes (6,7 %) y 6 (5,7 %) fueron valorados por Trabajo Social. Conclusiones: El conocimiento de la epidemiología de este problema y su difusión entre los profesionales implicados en su manejo debe promover la creación de protocolos y acciones coordinadas que puedan minimizar su impacto entre los adolescentes y, por lo tanto, en la sociedad

Introduction and aim: The acts of violence between adolescents are becoming increasingly more common, generating problems of a diverse nature. The knowledge of the circumstances that surround this violence is important to implement measures to decrease their incidence. The aim of this study was to describe the epidemiology of violent assault in teenagers from the perspective of an Emergency Department. Material and method: Retrospective analysis of information recorded on adolescent victims of assault, who attended our Emergency Department over a 1 year period (2006), was performed. Results: Of the 105 patients included, the mean age of the assault victims was 15.9 (SD: 1.4) years. Of those, 73.3 % were male. They were seen at holidays (58.1 %) and predominantly between the hours of 8 pm and 4 am (55.2 %). Forty-nine (46.7 %) of the events were classified as fights, 44 (41.9 %) as assaults, 7 (6.7 %) as physical abuse and 5 (4.8 %) as sexual abuse. Overall, 20 (19 %) patients reported that there was a weapon at the scene: in 13.3 % a blunt object and in 5.7 % a knife/piercing object. Bruises or haematomas were present in 93.3 % of patients; lacerations in 19 % and fractures in 11.4 %. Sixty-two (59 %) patients needed an X-ray, 10 (9.5 %) a urineanalysis and 7 (6.7 %) a blood test. Seven (6.7 %) patients were hospitalised and 6 (5.7 %) were evaluated by Social Work. Conclusions: The knowledge of the epidemiology of this problem and awareness by the professionals involved in handling this, must promote the coordinated creation of protocols and actions that can decrease its impact among adolescents, and in turn, society