Empyema and bacteremic pneumococcal pneumonia in children under five years of age.

We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.

La enseñanza de la salud infantil en las escuelas y facultades de enfermería de América Latina

Presenta guía acerca de la enseñanza de la salud infantil en las escuelas y facultades de enfermería de América Latina. Presenta un conocimiento basal que permitirá generar y orientar la educación y la práctica de la enfermería en la Región. A través deello se intenta fortalecer lineamientos de acción en salud pública y atención primaria, dos campos de acción que siempre han constituido un componente esencial en las preocupaciones de las enfermeras. Document in PDF format, required Acrobat Reader.

[Evaluation of two standardized methods for chest radiographs interpretation in children with pneumonia]. / Evaluación de dos métodos estandarizados de interpretación de radiografías de tórax en niños con neumonía.

OBJECTIVE: To evaluate the accuracy of World Health Organization (WHO) method of interpreting chest radiographs on identifying young children with bacterial pneumonia, and to compare its accuracy with other method. METHODS: Chest radiographs from children aged under 5 years old hospitalized for pneumonia, with microbiological evidence of bacterial or viral infection, were evaluated by 3 observers blinded to other data (pediatrician [P], pulmonologist [N], radiologist [R]) according to WHO and Khamapirad scores. A WHO score=1 and a Khamapirad score >2 were selected as the thresholds suggesting bacterial pneumonia. The relationship between radiographic scores and etiology was evaluated using chi square. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values for predicting bacterial pneumonia were calculated. Interobserver agreement (P vs. N vs. R) was calculated (kappa). RESULTS: 108 chest radiographs were evaluated (87 viral, 21 bacterial). WHO score= 1 was associated with bacterial pneumonia (p <0.001; OR= 6.4; CI 95%= 1.629.7), achieving a Se= 85%, Sp= 51%, PPV= 30%, NPV= 93%. Khamapirad score >2, evaluated by P, was also associated with bacterial pneumonia (p <0.0008; OR= 6.31; CI 95%= 1.8-24.4), achieving a Se= 80%, Sp= 59%, PPV= 32% NPV= 92%. Interobserver agreement was slightly better using WHO score (P vs. N= 0.82, P vs. R= 0.69, N vs. R= 0.85) than Khamapirad score (P vs. N= 0.48, P vs. R= 0.69, N vs. R= 0.82). CONCLUSIONS: Both methods showed similar accuracy in order to identify bacterial pneumonia. WHO score is simpler than Khamapirad score and showed a better interobserver agreement.

Evaluación de dos métodos estandarizados de interpretación de radiografías de tórax en niños con neumonía / Evaluation of two standarized methods for chest radiographs interpretation in children with pneumonia

Objetivos. Evaluar la capacidad diagnóstica del método de interpretación radiográfico de la Organización Mundial de la Salud (OMS) para identificar neumonía bacteriana en niños y comparar su desempeño con otro método similar. Población, material y métodos. Radiografías de tórax de pacientes menores de 5 años de edad hospitalizados por neumonía con etiología confirmada (bacteriana o viral), fueron evaluadas por 3 observadores (pediatra [P], neumonólogo [N] y radiólogo[R]) según los métodos de OMS y Khamapirad. Se seleccionaron un puntaje OMS= 1 y un Khamapirad ≥2 para definir neumonía radiológica, presumiblemente bacteriana. Se evaluó asociación entre cada puntaje y etiología por χ2. Se calculó sensibilidad(S), especificidad (E) y valores predictivos positivo (VPP) y negativo (VPN) para predecir neumonía deetiología bacteriana confirmada. Se calculó el acuerdo interobservador (coeficiente kappa).Resultados. Se evaluaron 108 radiografías (87 neumonías virales y 21 bacterianas). Un puntaje OMS= 1,en la evaluación de P, se asoció con etiología bacteriana (p <0,001; OR= 6,4; IC 95 por ciento= 1,6-29,7), alcanzando S= 85 por ciento, E= 51 por ciento, VPP= 30 por ciento, VPN= 93 por ciento. Un puntaje Khamapirad ≥2, se asoció con etiología bacteriana(p= 0,0008; OR= 6,31; IC95 por ciento= 1,8-24,4), alcanzando S= 80 por ciento, E= 59 por ciento, VPP= 32 por ciento, VPN= 92 por ciento. Al evaluar las con etiología bacteriana confirmada, el acuerdo interobservador fue ligeramente superior con métodoOMS (P contra N= 0,82, P contra R= 0,69, N contra R= 0,85) que con Khamapirad (P contra N= 0,48, Pcontra R= 0,69, N contra R= 0,82).Conclusiones. Ambos métodos mostraron similar capacidad diagnóstica para identificar neumonía bacteriana. El método OMS es más simple y mostrómejor acuerdo interobservador.

Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia.

OBJECTIVE: To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin. DESIGN: Multicentre, prospective, observational study. SETTING: 12 tertiary-care centres in three countries in Latin America. PATIENTS: 240 children aged 3-59 months, hospitalised with severe pneumonia and known in vitro susceptibility of S pneumoniae. INTERVENTION: Patients were treated with intravenous penicillin/ampicillin after collection of blood and, when possible, pleural fluid for culture. The minimal inhibitory concentration (MIC) test was used to determine penicillin susceptibility of the pneumococcal strains isolated. Children were continuously monitored until discharge. MAIN OUTCOME MEASURES: The primary outcome was treatment failure (using clinical criteria). RESULTS: Overall treatment failure was 21%. After allowing for different potential confounders, there was no evidence of association between treatment failure and in vitro resistance of S pneumoniae to penicillin according to the Clinical Laboratory Standards Institute (CLSI)/National Committee for Clinical Laboratory Standards (NCCLS) interpretative standards ((adj)RR = 1.03; 95%CI: 0.49-1.90 for resistant S pneumoniae). CONCLUSIONS: Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 microg/ml.

Manual de tratamiento de la diarrea en niños

La reducción de la mortalidad en menores de cinco años en la Región de las Américas es fundamental para disminuir las grandes brechas entre países, áreas y grupos humanos, y lograr la equidad en el acceso a estrategias disponibles para la prevención y el tratamiento de las enfermedades, así como la promoción del crecimiento y el desarrollo saludable de la niñez. El Objetivo de Desarrollo del Milenio número 4 está relacionado con reducir la mortalidad en menores de cinco años en dos terceras partes entre 1990 y 2015... El componente comunitario de la Estrategia AIEPI contiene orientaciones preventivas de salud para que las familias las incorporen en sus hábitos y se constituya así en practices de buena salud para un desarrollo saludable de los niños, orientaciones sobre cuidados adecuados en el hogar en caso de enfermedad y, lo más importante, orientaciones para detectar oportunamente los signos cuando se requiera traslado urgente a un servicio de salud. Este material realizado por el Área de Salud Familiar y Comunitaria/Unidad de Salud del Niño y del Adolescente de la Organización Panamericana de la Salud, fue elaborado como parte de un esfuerzo para mejorar la detección de signos de peligro durante la enfermedad diarreica y contribuir de esta manera a la reducción de la morbilidad y mortalidad en niños y niñas menores de cinco años en la Región de las Américas.

Integrated management of childhood illness: an emphasis on the management of infectious diseases.

The Integrated Management of Childhood Illness (IMCI) strategy has helped strengthen the application and expand coverage of key child survival interventions aimed at preventing deaths from infectious disease, respiratory illness, and malnutrition, whether at the health services, in the community, or at home. IMCI covers the prevention, treatment, and follow-up of the leading causes of mortality, which are responsible for at least two-thirds of deaths of children younger than 5 years in the countries of the Americas. The IMCI clinical guidelines take an evidence-based, syndrome approach to case managment that supports the rational, effective, and affordable use of drugs and diagnostic tools. When clinical resources are limited, the syndrome approach is a more realistic and cost-effective way to manage patients. Careful and systematic assessment of common symptoms and well-selected clinical signs provide sufficient information to guide effective actions.

Atenção integrada às doenças: prevalentes na infância; implantação e avaliação no Brasil

O livro traz uma série de textos de profissionais da área da saúde materno-infantil que oferecem um panorama da atenção integrada às doenças prevalentes na infância, estratégia reconhecida pelo Ministério da Saúde.

Operations research on Integrated Management of Childhood Illness (IMCI) / Investigaciones operativas sobre Atención Integrada a las Enfermedades

[Preface]. The commitment assumed by the countries during the Millennium Summit to reduce mortality in children under 5 by two-thirds over 1990 figures by the year 2015 restores the priority and importance accorded to child survival for improving the health of the population. In the Region of the Americas, meeting this target will require the continued strengthening of interventions for the prevention and effective treatment of infectious diseases, respiratory illnesses, and malnutrition, which are still responsible for roughly 30% of the deaths each year in children under 5. However, since these diseases and health problems no longer cause most of the deaths in this age group, attaining the Millennium Development Goals (MDG) will require the prevention and control of other health problems, such as peri-neonatal disorders, which account for 40% of the mortality in children under 5 and 60% of infant mortality. Ensuring that more and more children survive the first years of life cannot be the sole objective of action to improve the health of the population. It must be complemented with interventions designed to provide all children with the proper conditions for growth and development. This is the only way to help boys and girls grow into healthy adolescents, young adults, and adults who can contribute to the development and growth of their families and communities...Thus, the IMCI operations research projects are presented as a tool to support the ongoing identification of problems and actions to solve them and to assess the impact of these actions. Within this context, these protocols are expected not only to demonstrate the impact of the strategy on child health, but to provide more in-depth knowledge about the health situation of children, in addition to boosting local capacity to identify and solve problems. In light of all this, it is hoped that just as the benefits of the IMCI strategy extend beyond child health, improving the ability of families to prevent disease and promote health, the application of these protocols will also extend beyond actions in child health, upgrading the skills of all people working in local health services and the community to improve the health of the population.