Pediatric chest x-ray in covid-19 infection.

BACKGROUND: The outbreak of COVID-19 has become pandemic. Pediatric population has been less studied than adult population and prompt diagnosis is challenging due to asymptomatic or mild episodes. Radiology is an important complement to clinical and epidemiological features. OBJECTIVE: To establish the most common CXR patterns in children with COVID-19, evaluate interobserver correlation and to discuss the role of imaging techniques in the management of children. MATERIALS AND METHODS: Forty-four patients between 0 and 16 years of age with confirmed SARS-Cov-2 infection and CXR were selected. Two paediatric radiologists independently evaluated the images and assessed the type of abnormality, distribution and evolution when available. RESULTS: Median age was 79.8 months (ranging from 2 weeks to 16 years of age). Fever was the most common symptom (43.5 %). 90 % of CXR showed abnormalities. Peribronchial cuffing was the most common finding (86.3 %) followed by GGOs (50 %). In both cases central distribution was more common than peripheral. Consolidations accounted for 18.1 %. Normal CXR, pleural effusion, and altered cardiomediastinal contour were the least common. CONCLUSION: The vast majority of CXR showed abnormalities in children with COVID-19. However, findings are nonspecific. Interobserver correlation was good in describing consolidations, normal x-rays and GGOs. Imaging techniques have a role in the management of children with known or suspected COVID-19, especially in those with moderate or severe symptoms or with underlying risk factors.

Documento de consenso SEIP-AEPap-SEPEAP sobre la etiología, el diagnóstico y el tratamiento de las infecciones cutáneas micóticas de manejo ambulatorio / SEIP-AEPap-SEPEAP consensus document on the etiology, diagnosis, treatment and ambulatory management of fungal skin infections

Entre las infecciones por hongos, las micosis superficiales, adquiridas por contacto directo o indirecto con un animal o con una persona infectados, son las más habituales en la infancia. Los patógenos más frecuentes en el niño inmunocompetente son las levaduras (Candida y Malasezzia) y los dermatofitos. La morbilidad de las micosis superficiales es tan importante como poco considerada, pues existe la falsa impresión de que constituyen un problema menor pese a su gran incidencia en la práctica habitual. En el presente documento de consenso, elaborado por el Grupo de Trabajo de Infecciones de Manejo Ambulatorio de la Sociedad Española de Infectología Pediátrica (SEIP), la Asociación Española de Pediatría de Atención Primaria (AEPap) y la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), se abordan los aspectos esenciales de la infección micótica superficial en el niño inmunocompetente (AU)

Superficial mycoses, acquired by direct or indirect contact with an infected animal or person, are frequent in childhood. The most common pathogens in immunocompetent children are yeasts (Candida and Malasezzia) and dermatophytes. The morbidity of the superficial mycoses is as important as trivialized, which gives the false impression that it constitutes a minor problem despite its high incidence in routine practice. In this consensus document of the Spanish Society of Pediatric Infectious Diseases (SEIP), the Spanish Association of Primary Care Pediatrics (AEPap) and the Spanish Society of Pediatric Outpatient and Primary Care (SEPEAP), the essential aspects of superficial fungal infection in the immunocompetent child are addressed (AU)

Pediamécum: un año de experiencia / Pediamécum: One year of experience

En 2011, la Asociación Española de Pediatría decide apoyar el proyecto más ambicioso de su recién creado Comité de Medicamentos: Pediamécum. Se trata de la primera base de datos on-line, de acceso libre, con información sobre medicamentos de uso pediátrico en España. El 17 de diciembre del 2012 se inaugura http://pediamecum.es/. Un año después, Pediamécum tiene 580 fichas. La web supera durante 2013 el millón de páginas vistas. Con motivo del aniversario de Pediamécum, se realiza una encuesta recabando la opinión de los usuarios. Se obtienen 483 respuestas. Un 95% afirma que es fácil navegar por la web y un 74% que casi siempre resuelve sus dudas sobre el uso de medicamentos en niños. La valoración global de Pediamécum es de 7,5/10. Los objetivos de Pediamécum se están cumpliendo; se refleja fundamentalmente en ser una herramienta útil para todos aquellos profesionales que atienden a niños en su práctica clínica diaria

In 2011, the Spanish Association of Pediatrics decided to support the most ambitious project of its newly created Committee for Medicinal Products: Pediamécum. This is the first free on-line database with information on medicinal products for pediatric use in Spain. The web page http://pediamecum.es/ started on December 17 December 2012. One year later, Pediamécum includes 580 registered drugs. The website achieved more than one million page views by the end of 2013. Because of the first anniversary of Pediamécum, a survey was performed to request the feeling of users. Four hundred eighty-three responses were obtained. Ninety-five percent believed that it is easy to navigate through the web, and 74% said that their doubts about the use of medicines in children were always resolved. The overall rating of Pediamécum is 7.5/10. The aims of Pediamécum are being accomplished; which is reflected essentially due to it becoming a useful tool for all professionals who care for children in their daily clinical practice

[Pediamécum: one year of experience]. / Pediamécum: un año de experiencia.

In 2011, the Spanish Association of Pediatrics decided to support the most ambitious project of its newly created Committee for Medicinal Products: Pediamécum. This is the first free on-line database with information on medicinal products for pediatric use in Spain. The web page http://pediamecum.es/ started on December 17 December 2012. One year later, Pediamécum includes 580 registered drugs. The website achieved more than one million page views by the end of 2013. Because of the first anniversary of Pediamécum, a survey was performed to request the feeling of users. Four hundred eighty-three responses were obtained. Ninety-five percent believed that it is easy to navigate through the web, and 74% said that their doubts about the use of medicines in children were always resolved. The overall rating of Pediamécum is 7.5/10. The aims of Pediamécum are being accomplished; which is reflected essentially due to it becoming a useful tool for all professionals who care for children in their daily clinical practice.

Documento de consenso sobre etiología, diagnóstico y tratamiento de la sinusitis / Consensus document on the aetiology, diagnosis and treatment of sinusitis

Presentamos el Documento de consenso sobre sinusitis de la Sociedad Española de Infectología Pediátrica, la Asociación Española de Pediatría de Atención Primaria, la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria y la Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. La sinusitis es una enfermedad de diagnóstico difícil, a menudo no reconocida. Se analiza la etiología, la clínica y los criterios diagnósticos más aceptados, y se realizan recomendaciones terapéuticas acordes con la situación epidemiológica actual. Se propone la amoxicilina por vía oral como tratamiento antibiótico de elección, en dosis de 80 mg/kg al día repartidos cada 8 h. Se indican tratamientos alternativos en casos especiales y en ausencia de eficacia de la amoxicilina. Se revisan las principales complicaciones de la enfermedad (AU)

The Spanish National Consensus (Spanish Society of Pediatric Infectious Diseases, Spanish Association of Primary Care Pediatrics, Spanish Society of Pediatric Outpatient and Primary Care, Spanish Society of Otorhinolaryngology and Cervical-Facial Pathology) on Sinusitisis presented. Rhinosinusitis is a difficult to diagnose and often unrecognised disease. The document discusses the aetiology, the clinical signs and symptoms, and the diagnostic criteria. A proposal for treatment is made based on the epidemiological situation in our country. Oral amoxicillin is the treatment of choice (80 mg/kg/day divided every 8 hours). Alternative treatment is proposed in special cases and when amoxicillin is not sufficient. The main complications are reviewed (AU)

Asociación entre la exposición a paracetamol y el asma: estado de la cuestión y recomendaciones prácticas / Association between paracetamol exposure and asthma: update and practice guidelines

La prevalencia del asma ha aumentado en las últimas décadas, especialmente en los países desarrollados, por motivos no bien esclarecidos. En los últimos años se ha observado una asociación entre el uso de paracetamol en distintas etapas de la vida, incluyendo la gestación y la infancia, y la prevalencia de asma. El carácter observacional de los estudios publicados no permite establecer una relación causal. Sería necesario realizar ensayos clínicos para comprobar la naturaleza de la asociación, que podría deberse a la presencia de diversos factores de confusión. Las sociedades pediátricas españolas firmantes de este artículo consideran que los datos disponibles hasta la fecha no son suficientes para desaconsejar el uso de paracetamol durante la gestación ni en niños asmáticos o con riesgo de asma (AU)

Asthma prevalence has increased over the last few decades, especially in developed countries, and possibly due to different reasons. An association between paracetamol use or exposure at different periods of life, including gestation and childhood, and asthma prevalence has been observed in the last few years. Causality can not be established from observational reports, due to the arguable presence of many confounding factors and biases. Randomised trials are needed to elucidate the nature of this association. The Spanish Paediatric societies subscribing to this paper consider that current evidence is insufficient to discourage the use of paracetamol during gestation or in children with or at risk of asthma (AU)

Documento de consenso sobre etiología, diagnóstico y tratamiento de la sinusitis / Consensus document on the aetiology, diagnosis and treatment of sinusitis

Presentamos el Documento de consenso sobre sinusitis de la Sociedad de Infectología Pediátrica (SEIP), la Asociación Española de Pediatría de Atención Primaria (AEPap), la Sociedad Española de Pediatría Extrahospitalaria y de Atención Primaria (SEPEAP) y la Sociedad Española de Otrorrinolaringología Pediátrica (SEORL). La sinusitis es una enfermedad de diagnóstico difícil, a menudo no reconocida. Se analiza la etiología, la clínica y los criterios diagnósticos más aceptados, y se realizan recomendaciones terapéuticas acordes con la situación epidemiológica actual. Se propone la amoxicilina por vía oral como tratamiento antibiótico de elección en dosis de 80 mg/kg/día repartidas cada 8 horas. Se indican tratamientos alternativos en casos especiales y en ausencia de eficacia de la amoxicilina. Se revisan las principales complicaciones de esta entidad (AU)

The Spanish National Consensus (Spanish Society of Pediatric Infectious Diseases,Spanish Association of Primary Care Pediatrics, Spanish Society of Pediatric Outpatient and Primary Care, Spanish Society of Otorhinolaryngology and Cervical-Facial Pathology) on Sinusitisis presented. Rhinosinusitis is a difficult to diagnose and often unrecognised disease. The document discusses the aetiology, the clinical signs and symptoms, and the diagnostic criteria. Aproposal for treatment is made based on the epidemiological situation in our country. Oral amoxicillin is the treatment of choice (80 mg/kg/day divided every 8 hours). Alternative treatment is proposed in special cases and when amoxicillin is not sufficient. The main complications are reviewed (AU)

Uso empírico de antibióticos en niños en España. Resultados de una Encuesta Pediátrica Nacional 2012 (Estudio ABES) / Results from the 2012 Paediatric National Survey on Empirical Use of Antibiotics in Children in Spain (ABES Study)

Introducción: Actualmente existen diversas guías nacionales sobre el uso empírico adecuado de antibióticos en niños. Desconocemos si los pediatras españoles emplean dichas guías al seleccionar antimicrobianos. Material y métodos: Estudio transversal de ámbito nacional, mediante encuesta on-line sobre la selección empírica de antibióticos en niños, enviada por correo electrónico a pediatras socios de la Asociación Española de Pediatría o de sus sociedades de especialidades y regionales, entre abril y junio del 2012. Para considerar la adecuación de las respuestas se tuvieron en cuenta las guías, los documentos de consenso y los protocolos recientes. Resultados: Se recibieron 1.214 respuestas. Los tratamientos seleccionados se ajustan en un 85% a las recomendaciones. Los resultados menos adecuados se obtienen en enfermedades infecciosas en las que no existe un documento de consenso nacional en el momento de realizar la encuesta (73% de adecuación en este caso). Conclusiones: La elección empírica de antibióticos por parte de los pediatras españoles es bastante adecuada a las guías recientes. Sin embargo, la interpretación de los datos debe ser crítica, ya que existen aspectos del manejo racional de antibióticos en niños que podrían mejorar en nuestro país. Se plantea como necesidad continuar con la realización e implementación de documentos de consenso nacionales para el manejo de enfermedades infecciosas pediátricas. Proponemos que este tipo de encuestas se realicen periódicamente, así como análisis similares en otras áreas de capacitación específicas, incluyendo estudios de prescripción real, para promover el uso racional de todos los fármacos pediátricos en nuestro país (AU)

Introduction: There are currently several national guidelines on the appropriate empirical use of antibiotics in Spanish children. But, do the Spanish paediatricians use these guidelines when prescribing antimicrobials. Material and methods: A national study from was conducted from April to June 2012 using an on-line questionnaire on the empirical selection of antibiotics in children. An e-mail was sent to paediatrician members of the Spanish Association of Paediatrics (AEP) or its Regional or Paediatric Specialties Societies. Current guidelines and consensus documents were used to determine the appropriateness of the responses. Results: A total of 1214 responses were received. Eighty five per cent of the treatments selected by Spanish paediatricians were adjusted to guidelines. The least appropriate responses were obtained in those infectious diseases with no national consensus document at the time of the survey (73% in this case). Conclusions: Spanish paediatricians mainly select empirical antibiotics in accordance with current guidelines. However, there are features that could be improved in our country. The preparing and implementation of national consensus documents on the management of paediatric infectious diseases should be continued. We propose to regularly perform these kinds of surveys, including real prescription studies, and to also extend it to other paediatric specialities, in order to promote appropriateness of use of all the paediatric drugs in our country (AU)

[Consensus document on the aetiology, diagnosis and treatment of sinusitis]. / Documento de consenso sobre etiología, diagnóstico y tratamiento de la sinusitis.

The Spanish National Consensus (Spanish Society of Pediatric Infectious Diseases, Spanish Association of Primary Care Pediatrics, Spanish Society of Pediatric Outpatient and Primary Care, Spanish Society of Otorhinolaryngology and Cervical-Facial Pathology) on Sinusitis is presented. Rhinosinusitis is a difficult to diagnose and often unrecognised disease. The document discusses the aetiology, the clinical signs and symptoms, and the diagnostic criteria. A proposal for treatment is made based on the epidemiological situation in our country. Oral amoxicillin is the treatment of choice (80mg/kg/day divided every 8hours). Alternative treatment is proposed in special cases and when amoxicillin is not sufficient. The main complications are reviewed.

[Association between paracetamol exposure and asthma: update and practice guidelines]. / Asociación entre la exposición a paracetamol y el asma: estado de la cuestión y recomendaciones prácticas.

Asthma prevalence has increased over the last few decades, especially in developed countries, and possibly due to different reasons. An association between paracetamol use or exposure at different periods of life, including gestation and childhood, and asthma prevalence has been observed in the last few years. Causality can not be established from observational reports, due to the arguable presence of many confounding factors and biases. Randomised trials are needed to elucidate the nature of this association. The Spanish Paediatric societies subscribing to this paper consider that current evidence is insufficient to discourage the use of paracetamol during gestation or in children with or at risk of asthma.

[Results from the 2012 Paediatric National Survey on Empirical Use of Antibiotics in Children in Spain (ABES Study)]. / Uso empírico de antibióticos en niños en España. Resultados de una Encuesta Pediátrica Nacional 2012 (Estudio ABES).

INTRODUCTION: There are currently several national guidelines on the appropriate empirical use of antibiotics in Spanish children. But, do the Spanish paediatricians use these guidelines when prescribing antimicrobials? MATERIAL AND METHODS: A national study from was conducted from April to June 2012 using an on-line questionnaire on the empirical selection of antibiotics in children. An e-mail was sent to paediatrician members of the Spanish Association of Paediatrics (AEP) or its Regional or Paediatric Specialties Societies. Current guidelines and consensus documents were used to determine the appropriateness of the responses. RESULTS: A total of 1214 responses were received. Eighty five per cent of the treatments selected by Spanish paediatricians were adjusted to guidelines. The least appropriate responses were obtained in those infectious diseases with no national consensus document at the time of the survey (73% in this case). CONCLUSIONS: Spanish paediatricians mainly select empirical antibiotics in accordance with current guidelines. However, there are features that could be improved in our country. The preparing and implementation of national consensus documents on the management of paediatric infectious diseases should be continued. We propose to regularly perform these kinds of surveys, including real prescription studies, and to also extend it to other paediatric specialities, in order to promote appropriateness of use of all the paediatric drugs in our country.

Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda / Consensus document on the aetiology, diagnosis and treatment of acute otitis media

Se presenta el documento de consenso sobre otitis media aguda (OMA) de la Sociedad de Española Infectología Pediátrica (SEIP), Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Sociedad Española de Urgencias Pediátricas (SEUP) y de la Asociación Española de Pediatría de Atención Primaria (AEPAP).Se analizan la etiología de la enfermedad y los posibles cambios de esta después de la introducción de la vacunas antineumocócicas 7-valente, 10-valente y 13-valente. Se hace una propuesta diagnóstica basada en la clasificación de la otitis media aguda en confirmada o probable. Se considera OMA confirmada si hay coincidencia de 3 criterios: comienzo agudo, signos de ocupación del oído medio (u otorrea) y signos o síntomas inflamatorios, como otalgia o intensa hiperemia timpánica y OMA probable cuando existan solo 2 criterios. Se propone como tratamiento antibiótico de elección la amoxicilina oral a 80mg/kg/día repartido cada 8 h. El tratamiento con amoxicilina-ácido clavulánico a dosis de 80mg/kg/día se indica si el niño es menor de 6 meses, en lactantes con clínica grave (fiebre>39°C o dolor muy intenso), cuando haya historia familiar de secuelas óticas por OMA o un fracaso terapéutico de la amoxicilina(AU)

This is the consensus document on acute otitis media (AOM) of the Sociedad Española de Infectología Pediatrica (SEIP), Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Sociedad Española de Urgencias Pediátricas (SEUP) and Asociación Española de Pediatría de Atención Primaria (AEPAP). It discusses the aetiology of the disease and its potential changes after the introduction of the pneumococcal 7-valent, 10-valent and 13-valent vaccines. A proposal is made based on diagnostic classification of otitis media as either confirmed or likely. AOM is considered confirmed if 3 criteria are fulfilled: acute onset, signs of occupation of the middle ear (or otorrhea) and inflammatory signs or symptoms, such as otalgia or severe tympanic hyperaemia. Oral amoxicillin is the antibiotic treatment of choice (80mg/kg/day divided every 8hours). Amoxicillin-clavulanate (80mg/kg/day) is indicated in the following cases: when the child is under 6 months, in infants with severe clinical manifestations (fever>39°C or severe pain), there is family history of AOM sequels, and after amoxiciline treatment failure(AU)

Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda / Consensus document on the aetiology, diagnosis and treatment of acute otitis media

Se presenta el documento de consenso sobre otitis media aguda (OMA) de la Sociedad Española de Infectología Pediátrica (SEIP), la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), la Sociedad Española de Urgencias Pediátricas (SEUP) y la Asociación Española de Pediatría de Atención Primaria (AEPap). Se analizan la etiología de la enfermedad y los posibles cambios de esta después de la introducción de la vacunas antineumocócicas 7-valente, 10-valente y 13-valente. Se hace una propuesta diagnóstica basada en la clasificación de la OMA en confirmada o probable. Se considera OMA confirmada si hay coincidencia de tres criterios: comienzo agudo, signos de ocupación del oído medio (u otorrea) y signos o síntomas inflamatorios, como otalgia o intensa hiperemia timpánica, y OMA probable cuando existan solo dos criterios. Se propone como tratamiento antibiótico de elección la amoxicilina oral en dosis de 80 mg/kg/día repartidas cada ocho horas. El tratamiento con amoxicilina-ácido clavulánico en dosis de 80 mg/kg/día se indica si el niño es menor de seis meses, en lactantes con clínica grave (fiebre >39 ºC o dolor muy intenso), cuando haya historia familiar de secuelas óticas por OMA o un fracaso terapéutico de la amoxicilina(AU)

We present the consensus document on acute otitis media (AOM) written by the Spanish Society of Pediatric Infectology (SEIP), the Spanish Society of Outpatient and Primary Care Pediatrics (SEPEAP), the Spanish Society of Pediatric Emergency Care (SEUP) and the Spanish Association of Primary Care Pediatrics (AEPAP). The document analyses the etiology of the disease and the possible shifts in it following the introduction of the 7-valent, 10-valent, and 13-valent pneumococcal vaccines. The document proposes diagnosing AOM as confirmed or probable. The AOM diagnosis is considered confirmed if three criteria are met: acute onset, signs of fluid in the middle ear (or otorrhea), and symptoms of inflammation, such as otalgia or marked erythema in the middle ear, and considered probable when only two of these criteria are met. The proposed first choice for antibiotic treatment is 80 mg/kg/day of amoxicillin administered orally in doses at eight hour intervals. Treatment with amoxicillin-clavulanic acid in doses of 80 mg/kg/day are indicated in children younger than six months, in infants with a severe presentation (fever >39 °C or acute pain), when there is a family history of AOM sequelae, or in cases of amoxicillin treatment failure(AU)

[Consensus document on the aetiology, diagnosis and treatment of acute otitis media]. / Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda.

This is the consensus document on acute otitis media (AOM) of the Sociedad Española de Infectología Pediatrica (SEIP), Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Sociedad Española de Urgencias Pediátricas (SEUP) and Asociación Española de Pediatría de Atención Primaria (AEPAP). It discusses the aetiology of the disease and its potential changes after the introduction of the pneumococcal 7-valent, 10-valent and 13-valent vaccines. A proposal is made based on diagnostic classification of otitis media as either confirmed or likely. AOM is considered confirmed if 3 criteria are fulfilled: acute onset, signs of occupation of the middle ear (or otorrhea) and inflammatory signs or symptoms, such as otalgia or severe tympanic hyperaemia. Oral amoxicillin is the antibiotic treatment of choice (80mg/kg/day divided every 8hours). Amoxicillin-clavulanate (80mg/kg/day) is indicated in the following cases: when the child is under 6 months, in infants with severe clinical manifestations (fever>39°C or severe pain), there is family history of AOM sequels, and after amoxiciline treatment failure.

Documento de consenso sobre el diagnóstico y tratamiento de la faringoamigdalitis aguda / Consensus document on the diagnosis and treatment of acute tonsillopharyngitis

La faringoamigdalitis aguda (FAA) es una de las enfermedades más comunes en la infancia. La etiología más frecuente es vírica. Entre las causas bacterianas, el principal agente responsable es Streptococcus pyogenes o estreptococo beta hemolítico del grupo A (EbhGA). Las escalas de valoración clínica son una buena ayuda para seleccionar a qué niños se deben practicar las técnicas de detección rápida de antígeno estreptocócico (TDR) y/o el cultivo de muestras faringoamigdalares. Sin su empleo, se tiende al sobrediagnóstico de FAA estreptocócica, con la consiguiente prescripción innecesaria de antibióticos, muchas veces de amplio espectro. Los objetivos del tratamiento son: acelerar la resolución de los síntomas, reducir el tiempo de contagio y prevenir las complicaciones supurativas locales y no supurativas. Idealmente, solo deben tratarse los casos confirmados. En caso de no disponibilidad de la TDR, o en algunos casos, ante un resultado negativo, se recomienda obtener cultivo e iniciar tratamiento a la espera de los resultados, solo si la sospecha clínica es alta. Los antibióticos de elección para el tratamiento de la FAA estreptocócica son penicilina y amoxicilina. Amoxicilina-clavulánico no está indicado de forma empírica en la infección aguda. Los macrólidos tampoco son un tratamiento de primera elección; su uso debe reservarse para pacientes con alergia inmediata a penicilina o como tratamiento erradicador, en los casos indicados. Es urgente y prioritario en nuestro país adecuar la prescripción de antibióticos a la evidencia científica disponible (AU)

Acute tonsillopharyngitis is one of the most common childhood diseases. Viruses are the most frequent origin. Group A Streptococcus (Streptococcus pyogenes) is the main bacterial cause. A culture or a rapid antigen-detection test of a throat-swab specimen should only be done on the basis of clinical scores, in order to avoid over-diagnosis of bacterial origin and unnecessary antibiotic prescription. The objectives of treatment are: the reduction of symptoms, reduce the contagious period, and prevent local suppurative and systemic complications. Ideally, only confirmed cases should receive antibiotics. If there is no possibility to perform a rapid antigen-detection test, or in some cases if the result is negative, it is recommended to perform a culture and, if there is high suspicious index, to prescribe antibiotics. Penicillin is the treatment of choice, although amoxicillin is also accepted as the first option. Amoxicillin/clavulanate is not indicated in any case as empirical treatment. Macrolides are not a first choice antibiotic, and should be reserved for those patients with immediate penicillin allergy reaction or for the treatment of streptococcal carriers. It is of primordial importance to adapt the prescribing of antibiotics to the scientific evidence (AU)

[Consensus document on the diagnosis and treatment of acute tonsillopharyngitis]. / Documento de consenso sobre el diagnóstico y tratamiento de la faringoamigdalitis aguda.

Acute tonsillopharyngitis is one of the most common childhood diseases. Viruses are the most frequent origin. Group A Streptococcus (Streptococcus pyogenes) is the main bacterial cause. A culture or a rapid antigen-detection test of a throat-swab specimen should only be done on the basis of clinical scores, in order to avoid over-diagnosis of bacterial origin and unnecessary antibiotic prescription. The objectives of treatment are: the reduction of symptoms, reduce the contagious period, and prevent local suppurative and systemic complications. Ideally, only confirmed cases should receive antibiotics. If there is no possibility to perform a rapid antigen-detection test, or in some cases if the result is negative, it is recommended to perform a culture and, if there is high suspicious index, to prescribe antibiotics. Penicillin is the treatment of choice, although amoxicillin is also accepted as the first option. Amoxicillin/clavulanate is not indicated in any case as empirical treatment. Macrolides are not a first choice antibiotic, and should be reserved for those patients with immediate penicillin allergy reaction or for the treatment of streptococcal carriers. It is of primordial importance to adapt the prescribing of antibiotics to the scientific evidence.

Lactancia materna y protección contra las infecciones respiratorias en los primeros meses de vida / Breastfeeding and the protection against respiratory infections in the first months of life

Introducción: entre las ventajas de la lactancia materna (LM) se incluye su papel protector ante infecciones respiratorias (IR). Objetivos: describir el patrón de LM de una cohorte de recién nacidos (RN) y su protección contra las IR en el lactante. Material y métodos: estudio prospectivo de 316 RN, de las áreas 8 y 9 de Madrid, desde el nacimiento mediante llamadas telefónicas quincenales durante el invierno, registrando datos clínicos y epidemiológicos. Si presentaban sintomatología compatible con IR se recogió aspirado nasofaríngeo. Resultados: mil ochocientas sesenta y cinco llamadas (mediana: 4,2 [1-11]) y 106 visitas programadas. Al mes, el 56,1% recibía LM exclusiva; a los tres meses, el 39,4%, y a los cinco meses, el 31,9%. La LM exclusiva se mantuvo 65,1 días (desviación estándar: 43,49) y ningún factor se asoció a una mayor duración. Hubo 89 episodios de IR aguda. Los hermanos escolares multiplican por 1,74 (intervalo de confianza del 95% [IC 95%]: 1,12-2,72) el riesgo de IR en todos los estratos de duración de LM exclusiva. El riesgo de infección se multiplica por cinco (IC 95%: 2,07-12,19) si la LM exclusiva dura menos de un mes, por 9,8 (IC 95%: 4,06-23,66) si dura entre 30 y 60 días y por 3,4 (IC 95%: 1,28-9,19) si dura entre 60 y 90 días. Conclusiones: aunque muchos RN inician LM exclusiva, solo la tercera parte la mantiene a los cinco meses. Ningún factor se asoció a mayor duración de la misma. La LM es un factor protector de IR cuando dura más de 90 días. Se debe fomentar el mantenimiento de la LM más allá del tercer mes, especialmente en aquellos con hermanos escolares (AU)

Background: the protective role against respiratory infections is included among the advantages of breastfeeding (BF). Objective: to describe the pattern of BF in a cohort of newborns and its protective role against respiratory infections (RI) in the infant. Material and methods: a cohort of 316 newborns (NB) from Madrid Health Districts 8 and 9 was followed by telephone calls every fortnight during the winter season recording clinical and epidemiological data. Nasopharyngeal aspirate was obtained in every patient with symptoms compatible with RI. Results: one thousand, eight hundred and sixty-five phone calls [median: 4.2 (1-11)], and 106 scheduled visits were conducted. At the age of 1 month 56.1% of the infants were exclusively breastfed, at 3 months 39.4% and at 5 months 31.9%. The duration of BF was 65.1 days (SD: 43.49) and no factors were associated to a longer duration. Eighty nine acute RI were registered. The presence of siblings in school age increased the risk of RI by 1.74 (CI 95%: 1.12-2.72) in all the strata of duration of exclusive BF. The risk of RI increased by 5 (CI 95%: 2.07-12.19) if breastfeeding lasted less than 1 month, by 9,8 (CI 95%: 4,06-23,66) between 30-60 days and by 3,4 (CI 95%: 1.28-9,19) if it lasted 60-90 days. Conclusions: though many NB begin BF, only a third part of them go on with it at the age of 5 months. No covariant was associated with a longer duration. BF is a protector factor against RI when it lasts more than 90 days. So it must be promoted specially in those infants with siblings in school age (AU)

Documento de Consenso de la Sociedad de Infectología Pediatrica y la Sociedad de Reumatología Pediatrica sobre el diagnóstico diferencial y el abordaje terapéutico de la fiebre recurrente / Consensus Document on the differential diagnosis and therapeutic approach to recurrent fever by the Paediatric Infectology Society and the Paediatric Rheumatology Society

La fiebre recurrente es un problema relativamente frecuente en la infancia. En la mayoría de las ocasiones es sencillo establecer su etiología generalmente asociada a episodios infecciosos banales. No obstante, en un pequeño porcentaje de casos estos episodios se deben a procesos de causa no infecciosa a menudo de complejo diagnóstico. En este documento se analiza el diagnóstico diferencial de la fiebre recurrente o periódica frente a otros procesos, con especial atención a las enfermedades autoinflamatorias (EA). Las EA son alteraciones de la inmunidad innata recientemente incluidas dentro de las inmunodeficiencias, sin embargo no se caracterizan por presentar infecciones lo que las diferencia de las inmunodeficiencias clásicas. Un importante número de las EA tienen una base genética conocida. La sintomatología que ocasionan se deriva de una inflamación sistémica que puede dar clínica y procesos muy variados. Uno de los grupos mejor conocidos es el formado por los síndromes hereditarios de fiebre periódica. Este grupo se caracteriza por presentar fiebre recurrente, asociada a diversos síntomas, con una relativa periodicidad y con intervalos libres o casi libres de síntomas. Para algunas de las entidades más frecuentes se dispone de criterios diagnósticos que son aquí recogidos, así como las características que deben hacernos iniciar el estudio genético. El tratamiento debe ser individualizado dada la complejidad de estos cuadros si bien se pueden dar algunas recomendaciones generales (AU)

Recurrent fever is a relatively common problem during childhood. Diagnosis is often easy and related to mild viral infections. However a small proportion of these cases originate from an underlying non-infectious process that is generally difficult to diagnose. In this paper we describe the differential diagnosis of recurrent or periodic fever versus other processes, with especial attention to autoinflammatory disorders (AD). AD are alterations of innate immunity, and they have been recently classified as an immunodeficiency. Anyhow, since infections are not present, these processes are different to the classic primary immunodeficiency. An important part of AD is of known genetic aetiology. The symptoms originate from an underlying inflammatory process and can have different clinical expressions. One of the most relevant groups is the hereditary syndromes of periodic fever. This group of diseases associates recurrent fever and several clinical symptoms with a relative periodicity, separated by intervals free or almost free of symptoms. We include the diagnostic criteria for some processes as well as the characteristics that should, eventually, lead to a genetic study. Although treatment should be individualised, we also include some general recommendations (AU)

[Consensus Document on the differential diagnosis and therapeutic approach to recurrent fever by the Paediatric Infectology Society and the Paediatric Rheumatology Society]. / Documento de Consenso de la Sociedad de Infectología Pediatrica y la Sociedad de Reumatología Pediatrica sobre el diagnóstico diferencial y el abordaje terapéutico de la fiebre recurrente.

Recurrent fever is a relatively common problem during childhood. Diagnosis is often easy and related to mild viral infections. However a small proportion of these cases originate from an underlying non-infectious process that is generally difficult to diagnose. In this paper we describe the differential diagnosis of recurrent or periodic fever versus other processes, with especial attention to autoinflammatory disorders (AD). AD are alterations of innate immunity, and they have been recently classified as an immunodeficiency. Anyhow, since infections are not present, these processes are different to the classic primary immunodeficiency. An important part of AD is of known genetic aetiology. The symptoms originate from an underlying inflammatory process and can have different clinical expressions. One of the most relevant groups is the hereditary syndromes of periodic fever. This group of diseases associates recurrent fever and several clinical symptoms with a relative periodicity, separated by intervals free or almost free of symptoms. We include the diagnostic criteria for some processes as well as the characteristics that should, eventually, lead to a genetic study. Although treatment should be individualised, we also include some general recommendations.

Asma grave. Tratamiento farmacológico y asistencia respiratoria / Severe asthma. Drug treatment and respiratory assistance

El asma es la enfermedad crónica más frecuente en la infancia y su incidencia está aumentando. Con el diagnóstico y tratamiento precoz de las crisis asmáticas en Atención Primaria y en los Servicio de Urgencia hospitalarios el número de niños con crisis asmáticas que requieren ingreso en el hospital y sobre todo ingreso en las Unidades de Cuidados Intensivos Pediátricos (UCI), ha disminuido sensiblemente. En la UCIP el tratamiento intensivo con broncodilatadores β2 inhalados y/o intravenosos y corticoides y la utilización precoz de ventilación no invasiva ha permitido disminuir el número de pacientes que requieren intubación y acortar el tiempo de estancia en la UCIP. El sulfato de magnesio, el heliox, la teofilina, la ketamina y el óxido nítrico también pueden ser eficaces como tratamientos complementarios. En los pacientes que requieren ventilación mecánica invasiva la utilización de parámetros moderados tolerando una hipercapnia contralada ha logrado reducir mucho la morbimortalidad (AU)

Asthma is the more common chronic disease in children, and its incidence is increasing. The number of children with acute asthma who need admittance in the Hospital and the Pediatric Intensive Care Units (PICU) has decreased because the early diagnosis and treatment in primary health services and Urgency Departments. The intensive treatment with inhaled and/or intravenous β2, bronchodilators and corticosteroids in the PICU and the early use of non-invasive ventilation has permitted diminishing the number of patients who need intubation and reducing the length of PICU stay. Magnesium sulphate, heliox, theophilline, ketamine and nitric oxide can also be useful as complementary treatment . The use of mechanical ventilation with moderate parameters and controlled permissive hypercapnia has diminished the morbimortality (AU)