Risk Factors Associated with Intensive Care Admission in Children with Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome (MIS-C) in Latin America: A Multicenter Observational Study of the REKAMLATINA Network.

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. Study Design: An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. Results: A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; P < 0.01) with no difference in the frequency of coronary abnormalities (P = 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%; P = 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%. Conclusions: Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.

Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network.

OBJECTIVES: To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA). STUDY DESIGN: An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG). RESULTS: Of 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88). CONCLUSION: From our Latin American population, coronary artery z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD.

Clinical and Epidemiological Characteristics of Paediatric Patients Diagnosed with COVID-19 in a Tertiary Hospital in Mexico City.

COVID-19 affects the paediatric population less frequently than adults. A retrospective study was performed in a tertiary paediatric hospital in Mexico City in children <18 years of age who were hospitalized with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2. Included in the study were 86 patients with a median age of 10 years old (IQR 2.6-14.3 years), who were classified in three groups: previously healthy, with chronic disease and immunosuppressed patients. The principal signs and symptoms were fever (81%), cough (51%) and headache (35%). A total of 20 patients (23%) required management in the paediatric intensive care unit (PICU) and 17% needed mechanical ventilation for an average of 12.7 days (IQR 2-29 days). There was no statistically significant difference between the three clinical classification groups in those patients admitted to the PICU, most of which were previously healthy patients. The mortality rate was 5% (four patients). Given that the paediatric population is susceptible to infection, potential transmitters and to clinical presentations with variable degrees of severity, it is important to continue reinforcing social distancing measures.

Kawasaki disease presenting with hoarseness: A multinational study of the REKAMLATINA network.

BACKGROUND: Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki disease (KD). The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America. METHODS: We used prospective data from the multinational Red de Enfermedad de Kawasaki en America Latina (REKAMLATINA) network. A total of 865 patients from 20 countries were enrolled during the 3 year study period. Data on hoarseness were available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared. RESULTS: Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger than those with KD without hoarseness (median age 18 vs 26 months; P = 0.002) and presented with lower hemoglobin (10.7 g/dL vs 11.3 g/dL; P = 0.040) and hematocrit levels (32% vs 33%, P = 0.048). CONCLUSIONS: Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.

Use of Adjunctive Therapy in Acute Kawasaki Disease in Latin America.

Objective: To characterize the use of adjunctive therapy in Kawasaki disease (KD) in Latin America. Methods: The study included 1,418 patients from the Latin American KD Network (REKAMLATINA) treated for KD between January 1, 2009, and May 31, 2017. Results: Of these patients, 1,152 received only a single dose of IVIG, and 266 received additional treatment. Age at onset was similar in both groups (median 2 vs. 2.2 years, respectively). The majority of patients were male (58 vs. 63.9%) and were hospitalized with the first 10 days of fever (85.1 vs. 84.2%). The most common adjunctive therapy administered was steroids for IVIG-resistance, followed by additional doses of IVIG. The use of biologics such as infliximab was limited. KD patients who received adjunctive therapy were more likely to have a lower platelet count and albumin level as well as a higher Z score of the coronary arteries. Conclusion: This is the first report of adjunctive therapies for KD across Latin America. IVIG continues to be the initial and resistance treatment, however, steroids are also used and to a lesser extent, biological therapy such as infliximab. Future studies should address the barriers to therapy in children with acute KD throughout Latin America.

Presentation and Outcomes of Kawasaki Disease in Latin American Infants Younger Than 6 Months of Age: A Multinational Multicenter Study of the REKAMLATINA Network.

Objective: To characterize the clinical presentation and outcomes of Kawasaki disease (KD) in infants <6 months of age as compared to those ≥6 months in Latin America. Methods: We evaluated 36 infants <6 months old and 940 infants ≥6 months old diagnosed with KD in Latin America. We compared differences in laboratory data, clinical presentation, treatment response, and coronary artery outcomes between the two cohorts. Results: The majority (78.1%) of infants and children ≥6 months of age were initially diagnosed with KD, as compared to only 38.2% of infants <6 months. Clinical features of KD were more commonly observed in the older cohort: oral changes (92 vs. 75%, P = 0.0023), extremity changes (74.6 vs. 57.1%, P = 0.029), and cervical lymphadenopathy (67.6 vs. 37.1%, P = 0.0004). Whether treated in the first 10 days of illness or after the 10th day, infants <6 months were at greater risk of developing a coronary artery aneurysm compared to KD patients ≥6 months treated at the same point in the course of illness [ ≤ 10 days (53.8 vs. 9.4%, P = 0.00012); >10 days (50 vs. 7.4%, P = 0.043)]. Conclusion: Our data show that despite treatment in the first 10 days of illness, infants <6 months of age in Latin America have a higher risk of developing a coronary artery aneurysm. Delay in the diagnosis leads to larger coronary artery aneurysms disproportionately in these infants. Thus, suspicion for KD should be high in this vulnerable population.

Consenso para las prácticas de alimentación complementaria en lactantes sanos / Guidelines for complementary feeding in healthy infants

Resumen: La nutrición adecuada durante los primeros dos años de vida es fundamental para el desarrollo pleno del potencial de cada ser humano; actualmente se reconoce que este periodo es una ventana crítica para la promoción de un crecimiento y desarrollo óptimos y un buen estado de salud. Por tanto, cumplir con una alimentación adecuada en esta etapa de la vida tiene impacto sobre la salud, estado de nutrición, crecimiento y desarrollo de los niños; no sólo en el corto plazo, sino en el mediano y largo plazo. El presente trabajo ofrece recomendaciones de alimentación complementaria (AC) que se presentan en forma de preguntas o enunciados que consideran temas importantes para quienes atienden niños durante esta etapa de la vida; por ejemplo: inicio de la alimentación complementaria a los 4 o 6 meses de edad; exposición a alimentos potencialmente alergénicos; introducción de bebidas azucaradas; uso de edulcorantes artificiales y productos light; secuencia de introducción de alimentos; modificaciones de consistencia de alimentos de acuerdo a la maduración neurológica; número de días para probar aceptación y tolerancia a los alimentos nuevos; cantidades por cada tiempo de comida; prácticas inadecuadas de alimentación complementaria; mitos y realidades de la alimentación complementaria; hitos del desarrollo; práctica del "Baby Led Weaning" y práctica de vegetarianismo.

Abstract: A proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of "Baby Led Weaning" and practice of vegetarianism.

[Guidelines for complementary feeding in healthy infants]. / Consenso para las prácticas de alimentación complementaria en lactantes sanos.

A proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of "Baby Led Weaning" and practice of vegetarianism.

[Kawasaki's disease: must fever be obligatory criteria?]. / Enfermedad de Kawasaki. La fiebre debe ser un criterio obligatorio?

Kawasaki disease (KD) is one of the most common vasculitic disorders in children. The diagnosis is made based on the presence of clinical criteria. We present an exceptional case that fulfilled the clinical criteria of KD except the presence of fever. We consider that the criteria should be revised, with fever not to be considered as an obligate criterion. The similarities of KD with recurrent toxin-mediated perineal erythema are discussed, the latter being a possible attenuated form of KD.

Cefalotina amikacina vs. cefalotina isepamicina en el tratamiento inicial del paciente neutropénico febril / Cephalotine-amikacin vs. cephalotine isepamicine in the initial treatment of neutropenic patient febrile

Para evaluar la eficacia y seguridad de isepamicina y cefalotina vs. amikacina cefalotina en el tratamiento del paciente neutropénico febril, se realizó un estudio prospectivo longitudinal, aleatorizado, en donde se incluyeron 60 episodios de neutropenia y fiebre, en 58 pacientes menores de 18 años con diagnóstico de base hemato-oncológico, hospitalizados en el Instituto Nacional de Pediatría durante el periodo de abril de 1996 a febrero de 1997. Treinta y seis fueron asignados al grupo 1 (cefalotina + amikacina) y 24 en el grupo 2 (cefalotina isepamicina). No se encontraron diferencias estadísticamente significativas en relación con la edad, género, padecimiento hematooncológico de base y cuenta de neutrófilos absolutos al ingreso. Treinta y nueve pacientes (65 por ciento) tenían diagnóstico de leucemia aguda o linfoma, mientras que 21 niños (35 por ciento) tenían diagnóstico de tumor sólido. Se documentó clínicamente foco infeccioso aparente en 37 episodios (61 por ciento) y hubo documentación bacterilógica sólo en 2/60 (3.3 por ciento), el resto presentó fiebre de origen oscuro. La curación clínica fue similar en ambos grupos: 29/36 pacientes en el grupo 1 (80 por ciento) y 19/24 en el grupo 2 (79 por ciento) (Z=0.1311 y P 0.8966). Se modificó el tratamiento antimicrobiano en 7 pacientes del grupo 1 y cinco del grupo 2 por persistencia de la fiebre; dos pacientes fallecieron, uno en cada grupo, sin evidencia microbiológica de infección. En un solo paciente del grupo 1 se documentó en audiometría hipoacusia leve. Con esto podemos concluir que el tratamiento con isepamicina y cefalotina es una alternativa eficaz y segura en el tratamiento empírico inicial del paciente neutropénico febril

Tratamiento antibacteriano de la meningitis neonatal (metaanálisis) (primera parte) / Antibacterial treatment of Neonatal Meningitis (metaanalysis) (part one)

Objetivo: Identificar los criterios de tratamiento antimicrobiano para meningitis bacteriana neonatal, publicados de 1967 a 1997. Diseño: metaanálisis. Material y método: revisión bibliográfica. Resultados: el tratamiento antimicrobiano empírico inicial debe estar dirigido contra organismos entéricos y no entéricos. La meta del tratamiento antimicrobiano para la meningitis neonatal (MN) es alcanzar concentraciones elevadas del antibiótico en LCR en comparación con la concentración mínima inhibitoria (CMI) del patógeno. Se debe repetir la punción lumbar 24 a 36 horas después del inicio del antibiótico hasta que se negativice el frotis. La administración intraventricular de aminoglucósido no siempre se asocia con una buena respuesta clínica o bacteriológica. En pacientes con válvula de derivación ventrículo-peritoneal se debe incluir tratamiento para S. aureus y S. epidermidis, además de un antibiótico que cubra a organismos gram-negativos. Las cefalosporinas de tercera generación son útiles cuando el agente causal es la Klebsiella u otro gram-negativo. En la última década son dos los esquemas antimicrobianos útiles en el tratamiento empírico inicial de la MN: uno incluye la asociación de ampicilina con un aminoglucósido y otro, la asociación de ampicilina con una cefalosporina de tercera generación (cefotaxima). La cefotaxima parece ser ideal; por su actividad antimicrobiana, su habilidad para cruzar la barrera hematoencefálica y su buena tolerancia, entre otras

Agentes etiológicos de la sepsis neonatal temprana y tardía en el Hospital Infantil Privado / Etiological agents of early and late neonatal sepsis at the Hospital Infantil Privado

Se realizó un estudio retrospectivo, transversal, observacional y descriptivo en el que se incluyeron 49 recién nacidos con diagnóstico de sepsis neonatal, atendidos en el Hospital Infantil Privado del 10 de enero de 1993 al 31 de diciembre de 1997. El objetivo fue conocer los agentes etiológicos de sepsis neonatal temprana y tardís. Se encontró que los agentes etiológicos tanto de sepsis neonatal temprana y tardía fueron S. aureus en 19 casos (38.7 por ciento), de los cuales 12(63.1 por ciento) correspondieron a sepsis temprana y 7 (36.9 por ciento) a sepsis tardía. Seguido de Klebsiella pneumoniae en 9 casos (18.3 por ciento), de los cuales cinco correspondieron a sepsis tardía y cuatro a sepsis temprana. No se encontró relación entre el sexo y la presencia de sepsis. RR = 1.33, IC 95 por ciento (0.55-3.22)

Complicaiones de la varicela en niños inmunocompetentes / Varicella complications in immunocompromised children

El objetivo de este estudio fue conocer la evolución y tipo de complicaciones de la varicela en niños inmunocompetentes del Hospital Infantil Privado. Se revisaron los expedientes de 100 pacientes con diagnóstico de egreso de varicela. Se analizó el tiempo de duración de la fase vesicular, la duración e intensidad de la fiebre, la biometría hemática, la presencia y tipo de complicaciones, así como su evolución. Se realizaron pruebas estadísticas de tendencia central y para la correlación de variables la prueba de chi cuadrada (p < 0.05). Ocho pacientes presentaron más de una complicación, 54 por ciento correspondieron al sexo masculino y 46 por ciento al femenino. La mediana de edad fue 65 meses, (límites 1 a 207 meses). Sólo se reportó una defunción (1 por ciento). Se concluye que la varicela puede condicionar complicaciones graves, independientemente del estado de inmunidad. Las complicaciones supurativas, infecciones de piel y tejidos blandos son más frecuentes que las complicaciones no supurativas. La linfopenia y/o neutropenia no influyen en la presencia de complicaciones ni en la severidad de las mismas en niños inmunocompetentes con varicela

Comparación de olor, cuerpo, sabor y sensación posterior a la ingesta que producen cinco ampicilinas y dos trimetoprim-sulfametoxazol en presentaciones líquidas con sabor distinto / Comparison of the smell, body, taste and sensibility produced by five oral ampicillins and two trimetoprim-sulfametoxazol liquid formulations with different taste

Una de las características para el cumplimiento adecuado del tratamiento con un antibiótico líquido en la edad pediátrica es que el gusto y la sensación posterior a la ingestión sean acetables al paladar del niño. Se comparan siete suspensiones de antimicrobianos (cinco ampicilinas y dos trimetoprim-sulfametoxazol) de uso común en pediatría en un estudio doble ciego con 50 médicos pediatras voluntarios a determinar diferencias en la aceptabilidad del olor, textura, gusto, sensación posterior a la ingestión y el total de los antibióticos orales. en el recuento total el mejor es Pentrexyl, con diferencias significativas (p< 0.05), seguidos de omnipen, Binotal y pembritin sin diferencias significativas entre ellos, seguido de Lampicin y al final se encuentran Septrin y Bactrim. En el gusto el mejor fue Pentrexyl con diferenias significativa al resto. Muchos clínicos pueden considerar lo resultados del presente estudio, para seleccionar una suspensión antimicrobiana y así obtener un mejor cumplimiento del tratamiento

Cólera. Conceptos actuales / Cholera. Currents concepts

Bosquejo histórico del cólera, situación actual y análisis del proceso de transmisión y del tratamiento. El contenido del libro está organizado por capítulos: I) Antecedentes históricos del cólera; II) Epidemiología, contiene datos epidemiológicos actuales; III) Etiología, características biológicas, clínicas y taxonómicas del bacilo; IV) Patogenia, el agente y el proceso de transmisión; V) Cuadro clínico, síntomas del padecimiento; VI) Diagnóstico de laboratorio; VII) Diagnóstico diferencial, procedimiento para detección; VIII) Profilaxis, medidas de prevención y atención y acciones de salud pública y vigilancia epidemiológica: IX) Tratamiento de la deshidratación; X) Tratamiento antimicrobiano.