Persistence of SARS-CoV-2 RNA shedding and infectivity in immunized population: Prospective study along different epidemiological periods in Argentina.

During the pandemic of COVID-19, numerous waves of infections affected the two hemispheres with different impacts on each country. Throughout these waves, and with the emergence of new variants, health systems and scientists have tried to provide real-time responses to the complex biology of SARS-CoV-2, dealing with different clinical presentations, biological characteristics, and clinical impact of these variants. In this context, knowing the extent period in which an infected individual releases infectious viral particles has important implications for public health. This work aimed to investigate viral RNA shedding and infectivity of SARS-CoV-2 beyond 10 days after symptom onset (SO). A prospective multicenter study was performed between July/2021 and February/2022 on 116 immunized strategic personnel with COVID-19 diagnosed by RT-qPCR, with asymptomatic (7%), mild (91%) or moderate disease (2%). At the time of diagnosis, 70% had 2 doses of vaccines, 26% had 2 plus a booster, and 4% had one dose. After day 10 from SO, sequential nasopharyngeal swabs were taken to perform RT-qPCR, viral isolation, and S gene sequencing when possible. Viral sequences were obtained in 98 samples: 43% were Delta, 16% Lambda, 15% Gamma, 25% Omicron (BA.1) and 1% Non-VOC/VOI, in accordance with the main circulating variants at each moment. SARS-CoV-2 RNA was detected 10 days post SO in 57% of the subjects. Omicron was significantly less persistent. Noteworthy, infective viruses could not be isolated in any of the samples. In conclusion, a 10-days isolation period was useful to prevent further infections, and proved valid for the variants studied. Recently, even shorter periods have been applied, as the Omicron variant is prevalent, and worldwide population is largely vaccinated. In the future, facing the possible emergence of new variants and considering immunological status, a return to 10 days may be necessary.

Manejo del estado epiléptico en niños: encuesta en hospitales pediátricos de la Ciudad Autónoma de Buenos Aires / Management of status epilepticus in childhood: a survey conducted at pediatric hospitals in the City of Buenos Aires

Introducción. El estado epiléptico constituye la emergencia neurológica más frecuente. Si bien la mortalidad en niños es baja, su morbilidad puede superar el 20 %. Objetivo. Conocer las pautas de manejo del estado epiléptico referidas por médicos pediatras que atienden esta patología en forma habitual. Población y métodos. Estudio descriptivo, transversal, basado en una encuesta a médicos de tres hospitales pediátricos monovalentes de gestión pública de la Ciudad Autónoma de Buenos Aires. Resultados. Se administraron 292 encuestas (la tasa de respuesta completa alcanzó el 86 %); el 77 % se administró a pediatras y el 16 %, a especialistas en cuidados intensivos. Un 47 % de los participantes refiere indicar la primera benzodiacepina en el tiempo correcto; el 56 % utilizar diazepam intrarrectal en ausencia de un acceso intravenoso; el 95 % elige lorazepam como benzodiacepina inicial en caso de contar con acceso intravenoso; el 58 % refiere iniciar la etapa de fármacos de segunda línea en tiempo adecuado; el 84 % opta por fenitoína como fármaco inicial de segunda línea, un 33 % no cronometra el tiempo durante el tratamiento. La adherencia global a las recomendaciones internacionales fue del 17 %. Conclusiones. Nuestro estudio advierte una baja adherencia referida de los pediatras a las guías internacionales, en particular en las decisiones tiempo-dependientes. También se observó mayor heterogeneidad en las conductas terapéuticas a medida que se avanza en el algoritmo de tratamiento.

Introduction. Status epilepticus is the most common neurological emergency. Although mortality in children is low, morbidity may exceed 20%. Objective. To evaluate the management of status epilepticus by pediatricians who usually treat this condition. Population and methods. Descriptive, cross-sectional study based on a survey administered to physicians from 3 pediatric hospitals in the City of Buenos Aires. Results. A total of 292 surveys were administered (complete response rate as high as 86%); 77% were administered to pediatricians and 16% to intensive care specialists. Forty-seven percent of the participants reported that they administer the first dose of a benzodiazepine within the correct timeframe; 56% use intrarectal diazepam when intravenous access is not available; 95% choose lorazepam as the initial benzodiazepine if an intravenous access is available; 58% initiate the administration of a second-line drug within the correct timeframe; 84% administer phenytoin as the first-choice, second-line drug; and 33% do not measure treatment time. Overall adherence to international recommendations was 17%. Conclusions. Our study highlights poor adherence of pediatricians to international guidelines, particularly in time-dependent decisions. Greater heterogeneity was observed in treatment approaches as the treatment algorithm progressed.

Comparison of Epidemiologic and Clinical COVID-19 Profiles in Children in Argentina, During Circulation of Original and Variant (Alpha, Gamma and Lambda) Strains.

BACKGROUND: Information on the impact of the different variants in children in Latin America is scarce. The objective of this study was to describe epidemiologic and clinical features of COVID-19 infection in children under 18 years of age in Argentina, comparing the periods before and after the circulation of new variants. METHODS: Observational, cross-sectional, multicentric, analytical study. All patients under 18 years of age with confirmed SARS-CoV-2 infection admitted at 22 healthcare centers were included. Two study periods were established: Period 1 (EW10-2020 to EW12-2021) for the Wuhan strain; Period 2 (EW13 to EW35 2021) for Alpha, Gamma, Delta and Lambda variants. FINDINGS: A total of 6330 confirmed cases were included. Period 1: 3575 (56.5%), period 2: 2755 (43.5%). During period 2, a lower number of asymptomatic cases was observed, while general, respiratory and neurologic signs and symptoms increased in all age groups. Oxygen therapy requirement was higher during the first period (36.7% vs 19.1%; P < 0.001). No significant differences were observed in the rates of severe or critical cases (6.3% vs 5,4%; P = 0.102), intensive care admission (2.1% vs 2%; P < 0.656) or case fatality (0.3% vs 0.5 %; P < 0.229). MIS-C cases occurred more frequently during the first period (1.9% vs 1.1%; P = 0.009). INTERPRETATION: The clinical spectrum of COVID-19 in Argentina has evolved. With the emergence of new variants, although the number of asymptomatic cases declined, numbers of severe and critical cases, as well as case fatality rates in children, remained unchanged.

Management of status epilepticus in childhood: a survey conducted at pediatric hospitals in the City of Buenos Aires. / Manejo del estado epiléptico en niños: encuesta en hospitales pediátricos de la Ciudad Autónoma de Buenos Aires.

Introduction. Status epilepticus is the most common neurological emergency. Although mortality in children is low, morbidity may exceed 20%. Objective. To evaluate the management of status epilepticus by pediatricians who usually treat this condition. Population and methods. Descriptive, cross-sectional study based on a survey administered to physicians from 3 pediatric hospitals in the City of Buenos Aires. Results. A total of 292 surveys were administered (complete response rate as high as 86%); 77% were administered to pediatricians and 16% to intensive care specialists. Forty-seven percent of the participants reported that they administer the first dose of a benzodiazepine within the correct timeframe; 56% use intrarectal diazepam when intravenous access is not available; 95% choose lorazepam as the initial benzodiazepine if an intravenous line is available; 58% initiate the administration of a second-line drug within the correct timeframe; 84% administer phenytoin as the first-choice, second-line drug; and 33% do not measure treatment time. Overall adherence to international recommendations was 17%. Conclusions. Our study highlights poor adherence of pediatricians to international guidelines, particularly in time-dependent decisions. Greater heterogeneity was observed in treatment approaches as the treatment algorithm progressed.

Introducción. El estado epiléptico constituye la emergencia neurológica más frecuente. Si bien la mortalidad en niños es baja, su morbilidad puede superar el 20 %. Objetivo. Conocer las pautas de manejo del estado epiléptico referidas por médicos pediatras que atienden esta patología en forma habitual. Población y métodos. Estudio descriptivo, transversal, basado en una encuesta a médicos de tres hospitales pediátricos monovalentes de gestión pública de la Ciudad Autónoma de Buenos Aires. Resultados. Se administraron 292 encuestas (la tasa de respuesta completa alcanzó el 86 %); el 77 % se administró a pediatras y el 16 %, a especialistas en cuidados intensivos. Un 47 % de los participantes refiere indicar la primera benzodiacepina en el tiempo correcto; el 56 % utilizar diazepam intrarrectal en ausencia de un acceso intravenoso; el 95 % elige lorazepam como benzodiacepina inicial en caso de contar con acceso intravenoso; el 58 % refiere iniciar la etapa de fármacos de segunda línea en tiempo adecuado; el 84 % opta por fenitoína como fármaco inicial de segunda línea, un 33 % no cronometra el tiempo durante el tratamiento. La adherencia global a las recomendaciones internacionales fue del 17 %. Conclusiones. Nuestro estudio advierte una baja adherencia referida de los pediatras a las guías internacionales, en particular en las decisiones tiempo-dependientes. También se observó mayor heterogeneidad en las conductas terapéuticas a medida que se avanza en el algoritmo de tratamiento.

Comparison of antigen test and polymerase chain reaction for SARS-CoV-2 in children younger than 12 years. / Comparación del test de antígeno y la reacción en cadena de polimerasa para SARS-CoV-2 en niños menores de 12 años.

Stopping the spread of coronavirus disease 2019 (COVID-19) is critical and can be achieved through rapid and effective detection techniques. Our objective was to compare the diagnostic accuracy of rapid antigen tests (RAgT) and reverse transcriptionquantitative polymerase chain reaction (RT-qPCR) and to describe amplification cycle thresholds (Cts). Participants were children aged 1 month to 11 years with symptoms for less than 7 days, who did not have a detectable result in the past 90 days, and were immunocompetent. A total of 1855 patients were included; the prevalence of COVID-19 was 4.7%. For the RAgT, overall sensitivity was 60.2% and specificity, 99.8%; in children older than 5 years, values were 69.8% and 99.8%, respectively. Ct values for discordant samples were higher. To conclude, the diagnostic accuracy indicated that the specificity of RAgT is similar to that of RT-qPCR, but its sensitivity is notably lower, especially in children younger than 5 years.

Frenar la propagación de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) es fundamental, y se puede realizar mediante técnicas de detección rápidas y efectivas. El objetivo fue comparar la precisión diagnóstica de un test rápido de antígeno (TRAg,) con la reacción en cadena de polimerasa con retrotranscripción (RT-qPCR, por su sigla en inglés) y describir los umbrales de amplificación (Ct, por su sigla en inglés). Participaron niños de 1 mes a 11 años que tuvieran menos de 7 días de síntomas, sin resultado detectable en los últimos 90 días, e inmunocompetentes. Se incluyeron 1855 pacientes con una prevalencia de COVID-19 del 4,7 %. La sensibilidad global del TRAg fue del 60,2 % y su especificidad, del 99,8 %; en niños mayores de 5 años los valores fueron de 69,8 % y 99,8 %, respectivamente. Los valores de Ct de las muestras discordantes fueron más altos. En conclusión, la precisión diagnóstica muestra que TRAg tiene una especificidad similar a la RT-qPCR, pero una sensibilidad considerablemente menor, sobre todo en niños de menos de 5 años.

Comparación del test de antígeno y la reacción en cadena de polimerasa para SARS-CoV-2 en niños menores de 12 años / Comparison of antigen test and polymerase chain reaction for SARS-CoV-2 in children younger than 12 years

Frenar la propagación de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) es fundamental, y se puede realizar mediante técnicas de detección rápidas y efectivas. El objetivo fue comparar la precisión diagnóstica de un test rápido de antígeno (TRAg,) con la reacción en cadena de polimerasa con retrotranscripción (RT-qPCR, por su sigla en inglés) y describir los umbrales de amplificación (Ct, por su sigla en inglés). Participaron niños de 1 mes a 11 años que tuvieran menos de 7 días de síntomas, sin resultado detectable en los últimos 90 días, e inmunocompetentes. Se incluyeron 1855 pacientes con una prevalencia de COVID-19 del 4,7 %. La sensibilidad global del TRAg fue del 60,2 % y su especificidad, del 99,8 %; en niños mayores de 5 años los valores fueron de 69,8 % y 99,8 %, respectivamente. Los valores de Ct de las muestras discordantes fueron más altos. En conclusión, la precisión diagnóstica muestra que TRAg tiene una especificidad similar a la RT-qPCR, pero una sensibilidad considerablemente menor, sobre todo en niños de menos de 5 años.

Stopping the spread of coronavirus disease 2019 (COVID-19) is critical and can be achieved through rapid and effective detection techniques. Our objective was to compare the diagnostic accuracy of rapid antigen tests (RAgT) and reverse transcription quantitative polymerase chain reaction (RT-qPCR) and to describe amplification cycle thresholds (Cts). Participants were children aged 1 month to 11 years with symptoms for less than 7 days, who did not have a detectable result in the past 90 days, and were immunocompetent. A total of 1855 patients were included; the prevalence of COVID-19 was 4.7%. For the RAgT, overall sensitivity was 60.2% and specificity, 99.8%; in children older than 5 years, values were 69.8% and 99.8%, respectively. Ct values for discordant samples were higher. To conclude, the diagnostic accuracy indicated that the specificity of RAgT is similar to that of RT-qPCR, but its sensitivity is notably lower,especially in children younger than 5 years.

Pesquisa de virus respiratorios habituales en pacientes pediátricos ambulatorios, a dos años de la pandemia por COVID-19 / Screening for common respiratory viruses in pediatric outpatients 2 years after the onset of the COVID-19 pandemic

Introducción. Durante el 2020, la circulación de otros virus respiratorios fue inferior a lo acostumbrado. Es probable que, almodificarse las medidas de mitigación para la infección por el coronavirus 2019, dicha prevalencia haya aumentado en 2021. Objetivo. Estimar la prevalencia de virus respiratorioshabituales en pacientes de 0 a 5 años asistidos en Departamento de Urgencias de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Métodos. Estudio transversal con 348 pacientes que consultaronpor sospecha de enfermedad por el coronavirus 2019(COVID-19), en quienes se descartó dicha enfermedad y se realizó la pesquisa sistemática de virus respiratorios habitualesResultados. En el 40 % de los pacientes se identificó el virus sincicial respiratorio (VSR), un virus respiratorio habitual. La edad menor de 2 años se mostró como predictor independiente de VSR (razón de momios [OR]: 4,15; intervalos de confianza del 95 % [IC95 %]: 2,46-6,99). Conclusión. En la población estudiada, 40 % de los pacientes con sospecha de COVID-19 en quienes se descartó infección por SARS-CoV-2 presentaban infección por VSR.

Introduction. During 2020, circulation of other respiratory viruses was lower than usual. Most likely, as mitigation measures for coronavirus disease 2019 (COVID-19) were modified, their prevalence in 2021 may have increased. Objective. To estimate the prevalence of common respiratory viruses among patients aged 0­5 years seen at the Emergency Department of a children's hospital in the City of Buenos Aires. Methods. Cross-sectional study of 348 patients consulting for suspected COVID-19 in whom SARS-CoV-2 infection was ruled out and routine screening for common respiratory viruses was performed. Results. Respiratory syncytial virus (RSV), a common respiratory virus, was identified in 40% of patients. Age younger than 2 years was an independent predictor of RSV (odds ratio [OR]: 4.15; 95% confidence interval [CI]: 2.46­6.99). Conclusion. In the study population, 40% of patients suspected of COVID-19 in whom SARS-CoV-2 infection was ruled out had RSV infection.

Screening for common respiratory viruses in pediatric outpatients 2 years after the onset of the COVID-19 pandemic. / Pesquisa de virus respiratorios habituales en pacientes pediátricos ambulatorios, a dos años de la pandemia por COVID-19.

INTRODUCTION: During 2020, circulation of other respiratory viruses was lower than usual. Most likely, as mitigation measures for coronavirus disease 2019 (COVID-19) were modified, their prevalence in 2021 may have increased. OBJECTIVE: To estimate the prevalence of common respiratory viruses among patients aged 0-5 years seen at the Emergency Department of a children's hospital in the City of Buenos Aires. METHODS: Cross-sectional study of 348 patients consulting for suspected COVID-19 in whom SARS-CoV-2 infection was ruled out and routine screening for common respiratory viruses was performed. RESULTS: Respiratory syncytial virus (RSV), a common respiratory virus, was identified in 40% of patients. Age younger than 2 years was an independent predictor of RSV (odds ratio [OR]: 4.15; 95% confidence interval [CI]: 2.46-6.99). CONCLUSIONS: . In the study population, 40% of patients suspected of COVID-19 in whom SARS-CoV-2 infection was ruled out had RSV infection.

Introducción. Durante el 2020, la circulación de otros virus respiratorios fue inferior a lo acostumbrado. Es probable que, al modificarse las medidas de mitigación para la infección por el coronavirus 2019, dicha prevalencia haya aumentado en 2021. Objetivo. Estimar la prevalencia de virus respiratorios habituales en pacientes de 0 a 5 años asistidos en Departamento de Urgencias de un hospital pediátrico de la Ciudad Autónoma de Buenos Aires. Métodos. Estudio transversal con 348 pacientes que consultaron por sospecha de enfermedad por el coronavirus 2019 (COVID-19), en quienes se descartó dicha enfermedad y se realizó la pesquisa sistemática de virus respiratorios habituales. Resultados. En el 40 % de los pacientes se identificó el virus sincicial respiratorio (VSR), un virus respiratorio habitual. La edad menor de 2 años se mostró como predictor independiente de VSR (razón de momios [OR]: 4,15; intervalos de confianza del 95 % [IC95 %]: 2,46-6,99). Conclusión. En la población estudiada, 40 % de los pacientes con sospecha de COVID-19 en quienes se descartó infección por SARS-CoV-2 presentaban infección por VSR.

Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments: A Multicenter Study in Latin America.

OBJECTIVE: Sepsis is one of the most urgent health care issues worldwide. Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour. METHODS: A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated. RESULTS: We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [ P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001). CONCLUSIONS: We found poor adherence to the international recommendations for the treatment of PSS in the first hour at the PED in third-level hospitals in Latin America.

OBJECTIVE: Sepsis is one of the most urgent health care issues worldwide. Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour. METHODS: A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated. RESULTS: We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20­60 minutes) and 40 minutes (IQR, 20­60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30­135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59­278 minutes] vs 42 minutes [30­70 minutes], respectively [ P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001). CONCLUSIONS: We found poor adherence to the international recommendations for the treatment of PSS in the first hour at the PED in third-level hospitals in Latin America.

[Out-of-hospital care setting in a Febrile Emergency Unit of suspected Covid 19 patients]. / Atención extrahospitalaria en una Unidad Febril de Urgencia de pacientes sospechosos de Covid 19.

INTRODUCTION: In 2019, a new infection was reported in China. This coronavirus was named SARS-COV-2, causative of the 21st-century pandemic, COVID-19. Health systems adopted different strategies to cope with it. OBJECTIVE: to describe the clinical-epidemiological characteristics of COVID-19 in children seen at an Emergency Febril Unit (UFU). PATIENTS AND METHOD: Cross-sectional study in patients under 18 years of age tested for SARS-COV-2 between April 1 and June 30, 2020. All epidemiological re cords made at the time of consultation and the result of the Polymerase Chain Reaction (PCR) test of these patients, either by suspicion of COVID-19 or epidemiological isolation criteria, were inclu ded. Patients whose samples had been taken for SARS-COV-2 determination outside the initial time of consultation or whose epidemiological records were incomplete or did not meet the established inclusion criteria were excluded. The diagnosis of COVID-19 was made using the PCR technique for SARS-COV-2 in nasopharyngeal secretions obtained by nasopharyngeal swab or aspirate. The following variables were recorded: age, gender, place of residence, history of close contact, history of history of close contacts, travel history and comorbidities, history of institutionalization and PCR result. RESULTS: 1,104 patients were admitted to the UFU and tested due to suspected COVID-19. 152 patients had to be excluded due to insufficient data. Of the 952 patients tested, 22.6% had a detec table result, and 71.2% of them reported close contact with confirmed cases. The mean age was 5.9 years. The 55.4% were male and 99.3% lived in the Metropolitan Area of Buenos Aires. 72.8% of the patients tested had symptoms. The time of delay in consultation was 2.17 days. 25% of the children had comorbidities. CONCLUSIONS: The availability of the UFU facilitated access and optimized the care circuit in response to demand. Children with a history of close contact and those symptomatic showed more frequently a detectable result for SARS-COV-2.

Impacto de una intervención de mejora de calidad de atención para prevenir las úlceras por presión en una Unidad de Cuidados Intensivos Pediátricos / Impact of a health care quality improvement intervention to prevent pressure ulcers in a Pediatric Intensive Care Unit

Introducción. En los niños internados en las unidades de cuidados intensivos, más del 50% de las úlceras por presión (UPP) se relacionan con la presión sostenida de los equipos y dispositivos. las UPP son un indicador indirecto de la calidad de atención. Objetivo. Evaluar el impacto de la implementación de una intervención de mejora de la calidad de atención sobre el desarrollo de UPP en una Unidad de Cuidados Intensivos Pediátricos. Material y métodos. Estudio antes-después, no controlado. Preintervención: medición de UPP; posintervención: se aplicó un paquete de medidas (educación del personal, identificación de los pacientes de riesgo y disminución de la presión mediante el uso de colchones antiescaras y posicionadores de gel de polímero), con iguales mediciones. Resultados. Se incluyeron 152 pacientes, 74 preintervención y 78 posintervención. Se observó una disminución significativa de la incidencia de UPP (pre-: 50,60%; pos-: 23,08%; p = 0,001). Mayor puntaje de riesgo en el grupo posintervención (pre-: 12,4 ± 1,9; pos-: 13,7 ± 2,1; p= 0,001). Sin diferencias en el puntaje de riesgo al día de aparición de la UPP y la cantidad de UPP. El análisis estratificado por riesgo mantuvo la diferencia significativa en la incidencia de UPP (PIM2 < 5: 47,37%; 19,23%; p= 0,004; y PIM2 > 5:55,56%; 30,77%; p= 0,053). Conclusión. Hubo un menor desarrollo de UPP luego de la implementación de una intervención de mejora de la calidad. No se observaron cambios en la cantidad ni en su estadio de mayor gravedad.

Introduction. Among children hospitalized in the intensive care unit who have pressure ulcers (PUs), more than 50% are related to the sustained pressure from a device or equipment. PUs are an indirect indicator of the quality of health care. Objective. To assess the impact of a health care quality improvement intervention on the development of PUs at the pediatric intensive care unit. Materials and methods. Uncontrolled, before and after study. Pre-intervention: measurement of PUs; post-intervention: implementation of a bundle of measures (staff training, identification of patients at risk, and pressure relief by using antibedsore mattresses and polymer gel positioners) and the same measurements. Results. A total of 152 patients were included: 74 before the intervention and 78 after the intervention. A significant reduction was observed in the incidence of PUs (preintervention: 50.60%; post-intervention: 23.08%; p= 0.001). A higher risk score was seen in the post-intervention group (pre-intervention: 12.4 ± 1.9; post-intervention: 13.7 ± 2.1; p= 0.001). No differences were observed in the risk score on the day of PU onset and the number of PUs. The risk-stratified analysis maintained the significant difference in the incidence of PUs (PIM2 < 5: 47.37%; 19.23%; p= 0.004; and PIM2 > 5: 55.56%; 30.77%; p= 0.053). Conclusion. A lower incidence of PUs was observed after the implementation of the health care quality improvement intervention. No changes were detected in the number of PUs or the severity staging.

Impact of a health care quality improvement intervention to prevent pressure ulcers in a Pediatric Intensive Care Unit. / Impacto de una intervención de mejora de calidad de atención para prevenir las úlceras por presión en una Unidad de Cuidados Intensivos Pediátricos.

INTRODUCTION: Among children hospitalized in the intensive care unit who have pressure ulcers (PUs), more than 50% are related to the sustained pressure from a device or equipment. PUs are an indirect indicator of the quality of health care. Objective. To assess the impact of a health care quality improvement intervention on the development of PUs at the pediatric intensive care unit. Materials and methods. Uncontrolled, before and after study. Pre-intervention: measurement of PUs; post-intervention: implementation of a bundle of measures (staff training, identification of patients at risk, and pressure relief by using antibedsore mattresses and polymer gel positioners) and the same measurements. RESULTS: A total of 152 patients were included: 74 before the intervention and 78 after the intervention. A significant reduction was observed in the incidence of PUs (preintervention: 50.60%; post-intervention: 23.08%; p= 0.001). A higher risk score was seen in the post-intervention group (pre-intervention: 12.4 ± 1.9; post-intervention: 13.7 ± 2.1; p= 0.001). No differences were observed in the risk score on the day of PU onset and the number of PUs. The risk-stratified analysis maintained the significant difference in the incidence of PUs (PIM2 < 5: 47.37%; 19.23%; p= 0.004; and PIM2 ≥ 5: 55.56%; 30.77%; p= 0.053). CONCLUSION: A lower incidence of PUs was observed after the implementation of the health care quality improvement intervention. No changes were detected in the number of PUs or the severity staging.

Introducción. En los niños internados en las unidades de cuidados intensivos, más del 50% de las úlceras por presión (UPP) se relacionan con la presión sostenida de los equipos y dispositivos. las UPP son un indicador indirecto de la calidad de atención. Objetivo. Evaluar el impacto de la implementación de una intervención de mejora de la calidad de atención sobre el desarrollo de UPP en una Unidad de Cuidados Intensivos Pediátricos. Material y métodos. Estudio antes-después, no controlado. Preintervención: medición de UPP; posintervención: se aplicó un paquete de medidas (educación del personal, identificación de los pacientes de riesgo y disminución de la presión mediante el uso de colchones antiescaras y posicionadores de gel de polímero), con iguales mediciones. Resultados. Se incluyeron 152 pacientes, 74 preintervención y 78 posintervención. Se observó una disminución significativa de la incidencia de UPP (pre-: 50,60%; pos-: 23,08%; p = 0,001). Mayor puntaje de riesgo en el grupo posintervención (pre-: 12,4 ± 1,9; pos-: 13,7 ± 2,1; p= 0,001). Sin diferencias en el puntaje de riesgo al día de aparición de la UPP y la cantidad de UPP. El análisis estratificado por riesgo mantuvo la diferencia significativa en la incidencia de UPP (PIM2 < 5: 47,37%; 19,23%; p= 0,004; y PIM2 ≥ 5:55,56%; 30,77%; p= 0,053). Conclusión. Hubo un menor desarrollo de UPP luego de la implementación de una intervención de mejora de la calidad. No se observaron cambios en la cantidad ni en su estadio de mayor gravedad.

Acute kidney injury in critically ill children: incidence and risk factors for mortality.

INTRODUCTION: Acute kidney injury is a common complication associated with an increase in mortality in children who require intensive care. The objective of this study was to determine the incidence of acute kidney injury and identify risk factors for mortality in critically ill patients hospitalized in our facility. PATIENTS AND METHODS: This was a prospective and observational study conducted at the Intensive Care Unit (ICU) of Hospital Pedro de Elizalde between 2005 and 2009. All patients with acute kidney injury were included, and those with chronic renal failure, prerenal acute kidney injury, hepatorenal syndrome, newborn infants, and postoperative cardiovascular surgery patients were excluded. The sample was divided into survivors and deceased patients so as to identify risk factors for mortality using univariate and multivariate analyses, taking their clinical characteristics as predictive variable, and death at the ICU as the outcome variable. RESULTS: Out of 1496 patients, 66 developed acute kidney injury (4.4%). The cause was secondary in 72.8% of cases, and due to primary kidney disease in 27.2% of cases. Mortality rate was 44% (29 patients). The univariate analysis showed that the presence of anuria (p= 0.0003; OR: 7.01; 95% CI: 2.3-21.35) and the need of dialysis (p= 0.0009; OR: 6.35; 95% CI: 2.03-9.88) were signifcantly higher in deceased patients. The multiple regression analysis identifed that the need of dialysis (p = 0.0002; OR: 5.94; 95% CI: 1.85-19.04) was an independent risk factor for mortality. CONCLUSIONS: The incidence of acute kidney injury in critically ill children was 4.4%, and the need of dialysis was an independent predictor of mortality.

Acute kidney injury in critically ill children: incidence and risk factors for mortality / Daño renal agudo en niños críticos: incidencia y factores de riesgo de mortalidad

Introduction. Acute kidney injury is a common complication associated with an increase in mortality in children who require intensive care. The objective of this study was to determine the incidence of acute kidney injury and identify risk factors for mortality in critically ill patients hospitalized in our facility. Patients and Methods. This was a prospective and observational study conducted at the Intensive Care Unit (ICU) of Hospital Pedro de Elizalde between 2005 and 2009. All patients with acute kidney injury were included, and those with chronic renal failure, prerenal acute kidney injury, hepatorenal syndrome, newborn infants, and postoperative cardiovascular surgery patients were excluded. The sample was divided into survivors and deceased patients so as to identify risk factors for mortality using univariate and multivariate analyses, taking their clinical characteristics as predictive variable, and death at the ICU as the outcome variable. Results. Out of 1496 patients, 66 developed acute kidney injury (4.4%). The cause was secondary in 72.8% of cases, and due to primary kidney disease in 27.2% of cases. Mortality rate was 44% (29 patients). The univariate analysis showed that the presence of anuria (p= 0.0003; OR: 7.01; 95% CI: 2.3-21.35) and the need of dialysis (p= 0.0009; OR: 6.35; 95% CI: 2.03-9.88) were signifcantly higher in deceased patients. The multiple regression analysis identifed that the need of dialysis (p = 0.0002; OR: 5.94; 95% CI: 1.85-19.04) was an independent risk factor for mortality. Conclusions. The incidence of acute kidney injury in critically ill children was 4.4%, and the need of dialysis was an independent predictor of mortality.(AU)

Introducción. El daño renal agudo es una complicación frecuente que se asocia a un aumento de la mortalidad en los niños que requieren cuidados intensivos. El objetivo de este estudio fue determinar su incidencia e identifcar los factores de riesgo de mortalidad en los pacientes críticos internados en nuestra institución. Pacientes y métodos. Estudio prospectivo y observacional realizado en la unidad de terapia intensiva (UTI) del Hospital Pedro de Elizalde entre 2005 y 2009. Se incluyeron todos los pacientes con daño renal agudo, exceptuando a aquellos con insufciencia renal crónica, daño agudo prerrenal, síndrome hepatorrenal, recién nacidos y posquirúrgicos cardiovasculares. La muestra se dividió en sobrevivientes y fallecidos para identifcar los factores de riesgo de mortalidad mediante un análisis univariado y multivariado, considerando como variable de predicción sus características clínicas, y de resultado, la muerte en la UTI. Resultados. De 1496 pacientes, 66 presentaron daño renal agudo (4,4%). En el 72,8% de los casos fue de causa secundaria y en el 27,2%, por enfermedad renal primaria. La mortalidad fue de 44% (29 pacientes). En el análisis univariado la presencia de anuria (p= 0,0003; OR 7,01; IC 95% 2,3 a 21,35) y la necesidad de diálisis (p= 0,0009; OR 6,35; IC 95% 2,03 a 9,88) fueron signifcativamente mayores en los fallecidos. Por regresión múltiple se identifcó la necesidad de diálisis (p= 0,0002; OR 5,94; IC 95% 1,85 a 19,04) como factor de riesgo independiente de mortalidad. Conclusiones. La incidencia de daño renal agudo en los niños críticos fue de 4,4% y el requerimiento de diálisis fue un predictor independiente de mortalidad.(AU)

Acute kidney injury in critically ill children: incidence and risk factors for mortality / Daño renal agudo en niños críticos: incidencia y factores de riesgo de mortalidad

Introduction. Acute kidney injury is a common complication associated with an increase in mortality in children who require intensive care. The objective of this study was to determine the incidence of acute kidney injury and identify risk factors for mortality in critically ill patients hospitalized in our facility. Patients and Methods. This was a prospective and observational study conducted at the Intensive Care Unit (ICU) of Hospital Pedro de Elizalde between 2005 and 2009. All patients with acute kidney injury were included, and those with chronic renal failure, prerenal acute kidney injury, hepatorenal syndrome, newborn infants, and postoperative cardiovascular surgery patients were excluded. The sample was divided into survivors and deceased patients so as to identify risk factors for mortality using univariate and multivariate analyses, taking their clinical characteristics as predictive variable, and death at the ICU as the outcome variable. Results. Out of 1496 patients, 66 developed acute kidney injury (4.4%). The cause was secondary in 72.8% of cases, and due to primary kidney disease in 27.2% of cases. Mortality rate was 44% (29 patients). The univariate analysis showed that the presence of anuria (p= 0.0003; OR: 7.01; 95% CI: 2.3-21.35) and the need of dialysis (p= 0.0009; OR: 6.35; 95% CI: 2.03-9.88) were signifcantly higher in deceased patients. The multiple regression analysis identifed that the need of dialysis (p = 0.0002; OR: 5.94; 95% CI: 1.85-19.04) was an independent risk factor for mortality. Conclusions. The incidence of acute kidney injury in critically ill children was 4.4%, and the need of dialysis was an independent predictor of mortality.

Introducción. El daño renal agudo es una complicación frecuente que se asocia a un aumento de la mortalidad en los niños que requieren cuidados intensivos. El objetivo de este estudio fue determinar su incidencia e identifcar los factores de riesgo de mortalidad en los pacientes críticos internados en nuestra institución. Pacientes y métodos. Estudio prospectivo y observacional realizado en la unidad de terapia intensiva (UTI) del Hospital Pedro de Elizalde entre 2005 y 2009. Se incluyeron todos los pacientes con daño renal agudo, exceptuando a aquellos con insufciencia renal crónica, daño agudo prerrenal, síndrome hepatorrenal, recién nacidos y posquirúrgicos cardiovasculares. La muestra se dividió en sobrevivientes y fallecidos para identifcar los factores de riesgo de mortalidad mediante un análisis univariado y multivariado, considerando como variable de predicción sus características clínicas, y de resultado, la muerte en la UTI. Resultados. De 1496 pacientes, 66 presentaron daño renal agudo (4,4%). En el 72,8% de los casos fue de causa secundaria y en el 27,2%, por enfermedad renal primaria. La mortalidad fue de 44% (29 pacientes). En el análisis univariado la presencia de anuria (p= 0,0003; OR 7,01; IC 95% 2,3 a 21,35) y la necesidad de diálisis (p= 0,0009; OR 6,35; IC 95% 2,03 a 9,88) fueron signifcativamente mayores en los fallecidos. Por regresión múltiple se identifcó la necesidad de diálisis (p= 0,0002; OR 5,94; IC 95% 1,85 a 19,04) como factor de riesgo independiente de mortalidad. Conclusiones. La incidencia de daño renal agudo en los niños críticos fue de 4,4% y el requerimiento de diálisis fue un predictor independiente de mortalidad.

Acute kidney injury in critically ill children: incidence and risk factors for mortality. / Acute kidney injury in critically ill children: incidence and risk factors for mortality.

INTRODUCTION: Acute kidney injury is a common complication associated with an increase in mortality in children who require intensive care. The objective of this study was to determine the incidence of acute kidney injury and identify risk factors for mortality in critically ill patients hospitalized in our facility. PATIENTS AND METHODS: This was a prospective and observational study conducted at the Intensive Care Unit (ICU) of Hospital Pedro de Elizalde between 2005 and 2009. All patients with acute kidney injury were included, and those with chronic renal failure, prerenal acute kidney injury, hepatorenal syndrome, newborn infants, and postoperative cardiovascular surgery patients were excluded. The sample was divided into survivors and deceased patients so as to identify risk factors for mortality using univariate and multivariate analyses, taking their clinical characteristics as predictive variable, and death at the ICU as the outcome variable. RESULTS: Out of 1496 patients, 66 developed acute kidney injury (4.4

). The cause was secondary in 72.8

of cases, and due to primary kidney disease in 27.2

of cases. Mortality rate was 44

(29 patients). The univariate analysis showed that the presence of anuria (p= 0.0003; OR: 7.01; 95

CI: 2.3-21.35) and the need of dialysis (p= 0.0009; OR: 6.35; 95

CI: 2.03-9.88) were signifcantly higher in deceased patients. The multiple regression analysis identifed that the need of dialysis (p = 0.0002; OR: 5.94; 95

CI: 1.85-19.04) was an independent risk factor for mortality. CONCLUSIONS: The incidence of acute kidney injury in critically ill children was 4.4

, and the need of dialysis was an independent predictor of mortality.