Short report - Usefulness of point-of-care ultrasound in pediatric SARS-CoV-2 infection.

SARS-CoV-2 infection in children is uncommon compared to adult population. However, some children required hospital and/or PICU admission. The aim of this short communication is to share our experience with Point-of-Care Ultrasound (POCUS) when managing these patients. Remarkably, all cases presented pleural and pericardial effusions, detected by POCUS, despite showing an adequate urinary output and prior to receiving any kind of fluid resuscitation. Effusions have been described as rare among SARS-CoV-2 infection in adult population. By performing portable chest X-Ray they would have gone unnoticed in our patients. Other POCUS findings consisted of all types of consolidations and coalescent B-line patterns. POCUS was also performed in order to optimize PEEP, checking adequate endotracheal intubation positioning (avoiding the risk of contagiousness related to auscultation in this framework), and to assess volemia status, cardiac performance, and brain neuro-monitoring. There was not cross-infection. In pediatric SARS-CoV-19 effusions are frequent but easily unnoticed unless lung and echo POCUS are performed.

Manejo de la pancreatitis aguda grave en niños. Serie de 3 casos / Management of severe acute pancreatitis in children. A series of 3 cases

La pancreatitis aguda es una entidad poco frecuente en la población pediátrica, cuya incidencia ha aumentado en las últimas dos décadas. Sin embargo, existen pocos estudios sobre esta afección, por lo que su manejo terapéutico resulta muy variable, especialmente en los casos graves. En este trabajo describimos nuestra experiencia sobre el manejo en una unidad de cuidados intensivos pediátrica de 3 casos clínicos con esta afección en los últimos meses. En ellos se aplicaron las directrices extraídas de las guías clínicas sobre el manejo de la pancreatitis aguda en pacientes adultos basadas en la optimización de la analgesia, la administración de fluidoterapia i.v. agresiva y el reposo pancreático inicial con reintroducción precoz de la nutrición enteral, con lo que mostraron una buena evolución clínica posterior. Nuestro objetivo principal, dado el aumento en la incidencia de esta entidad, es destacar la importancia de un alto nivel de sospecha clínica ante un cuadro de dolor abdominal que permita un diagnóstico precoz y la rápida instauración de un tratamiento adecuado en estos casos, así como incidir en los puntos más importantes de su manejo

Acute pancreatitis is a rare entity among pediatric population, whose incidence has increased in the last two decades. However, there are few studies on this condition, so its therapeutic management is unsteady, especially in severe cases. In this article, we describe our experience in a pediatric intensive care unit in the management of 3 clinical cases with pancreatitis occured in the last months. We applied the guidelines extracted from the clinical guides about management of acute pancreatitis in adult patients, based on improving analgesia, administration of intensive fluid therapy and initial pancreatic rest with early reintroduction of enteral nutrition, which showed a good subsequent clinical evolution. Our main purpose, given the increase in the incidence of this entity, is to emphasize the importance of a high level of clinical suspicion when facing a case of abdominal pain that may allow an early diagnosis and a quick establishment of a proper treatment in these cases, as well as to highlight the most important facts of its management

La Unidad de Cuidados Intensivos Pediátricos en el Hospital Universitario Ramón y Cajal en el año 2015 / The Pediatric Intensive Care unit in the Hospital Ramón y Cajal in the year 2015

Este documento esquematiza la organización y principales características de la Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Ramón y Cajal de Madrid, catalogada del máximo nivel asistencial (nivel III) en el último informe técnico de la SECIP. Tras una breve reseña histórica, se señalan sus principales valores describiéndose, a continuación, sus características físicas (su reciente reubicación ha permitido un moderno diseño arquitectónico, con boxes individualizados donde el acompañamiento de los enfermitos por sus padres goza de un importante grado de confortabilidad). También se presentan los principales recursos humanos y materiales con los que ha sido dotada, situados al frente de la mayor vanguardia asistencial y tecnológica. A continuación mostramos su cartera de servicios, una sucinta memoria asistencial, y los objetivos de gestión (basados en una cultura de excelencia, calidad y seguridad del paciente). Finalmente, integrada en un hospital docente de la mayor complejidad asistencial, se resalta la actividad formadora e investigadora de la misma (AU)

This paper summarizes the organization and the main charateristics of the Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Ramón y Cajal de Madrid, scored as level III (the major level) by the SECÏIP. After a brief historic background, their values as organization are presented. Secondly, we describe their modern archithetonic design which allows an individualized care in medical boxes as a comfortable presence of parents with their children. Human and material resources, having the best technologies currently available, are also shared. Following, portfolio services with a brief attending report, and the managing objectives (based on strategies concerned about the highest quality) are also shown. Finally, due to the PICU is integrated in an University Hospital, where highly complex patients are treated, it must be emphasized the wide PICU teaching and researching activities (AU)

Utilidad de la ecografía pulmonar a pie de cama en cuidados intensivos pediátricos / Bedside lung ultrasound in paediatric intensive care

No disponible

Spinal surgery in the univentricular heart--is it viable?

INTRODUCTION: The management of patients with Fontan physiology who undergo scoliosis surgery is difficult. The purpose of this article was to describe our experience in the management of patients with Fontan circulation undergoing spinal surgery for correction of scoliosis. MATERIALS AND METHODS: This was a retrospective study including patients with Fontan physiology who underwent spinal orthopaedic surgery. Anaesthetic management, post-operative complications, paediatric intensive care unit and total hospital stay, and the need for blood transfusions were analysed. RESULTS: We identified eight children with Fontan physiology who had undergone spinal surgery from 2000 to 2010. All patients were receiving cardiac medications at the time of spinal surgery. The mean age at surgery was 14.8 years (range 12-21). In all, three patients needed inotropic support with dopamine (3, 5, and 8 µg/kg/min), which was started during surgery. During the immediate post-operative period, one patient died because of hypovolaemic shock caused by massive bleeding and dysrythmia. Mean blood loss during the post-operative period was 22.2 cc/kg (7.8-44.6). Surgical drainages were maintained for a mean time of 3 days (range 1-7). The mean hospital stay was 9.2 days (range 6-19). Pleural effusions developed in two patients. On follow-up, one patient presented with thoracic pseudarthrosis and another with a serohaematoma of the surgical wound. CONCLUSIONS: Spinal surgery in patients with Fontan circulation is a high-risk operation. These patients must be managed by a specialised team.

Agenesia de la vena cava inferior / Agenesis of the inferior vena cava

La agenesia de la vena cava inferior, especialmente de su segmento infrarrenal, es una patología excepcional, diagnosticándose normalmente de forma casual. Se ha postulado su origen en relación con una trombosis en el periodo intrauterino más que con una verdadera malformación congénita. La sintomatología depende de la formación de colaterales que, a su vez, se relaciona con una trombosis venosa profunda. Presentamos el caso de una niña de 13 años que consulta por dolor y tumefacción de miembros inferiores de 4 días de evolución, con edema bilateral que deja fóvea en ambas extremidades inferiores. Se realizó ecografía doppler, visualizándose trombosis venosa profunda bilateral, tras lo cual se completó el estudio de imagen mediante TAC observándose una ausencia de vena cava inferior con formación de abundantes colaterales. Se inició tratamiento anticoagulante con mejoría de la sintomatología, manteniéndose dicho tratamiento en el momento actual tres meses después (AU)

Agenesis of the inferior vena cava, especially of the infrarenal segment, is exceptional. Is commonly reported as a fortuitous finding. This condition is thought to result from thrombosis during gestation rather than from a true congenital malformation. Agenesis of the inferior vena cava can be associated with symptoms resulting from the formation of collaterals, which in turn relates to venous thrombosis deep. In young patients with thrombosis idiopathic deep vein should be CT or angiography to rule out anatomical abnormalities of the vena cava. We present a case of a girl of 13 years of age with a 4-day history of pain and swelling of lower limbs associated with dilated abdominal wall veins. Doppler ultrasound is performed and demonstrated bilateral deep venous thrombosis. The study of image was broader and observed the absence of interior vena cava with formation of abundant collateral. We started on anticoagulant treatment that stands up to the present time (AU)

Gingivoestomatitis complicada / Complicated gingivoestomatitis

No disponible

Relación de la enfermedad mínima residual postinducción con el pronóstico a largo plazo en la leucemia linfoblástica aguda en la edad pediátrica / Relationship of the post-induction residual disease with long term prognosis in acute lymphoblastic leukemia in the pediatric age

No disponible

[Graves' disease in preschool children]. / Enfermedad de Graves-Basedow en el niño preescolar.

Graves' disease, which is the main cause of hyperthyroidism in the pediatric age group, is very rare in pre-school children. We describe the cases of four girls, aged less than 6 years old, out of a total of 30 patients diagnosed with Graves' disease between 1985 and 2004. Investigations were motivated by tachycardia, chronic diarrhea, language development delay or thyroid nodules detected by cervical ultrasonography. In three of the four patients height and bone age were advanced. In all patients goiter was small or absent. None of the patients had ophthalmic disease. In all patients free T3 and T4 were elevated and thyroid-stimulating hormone was suppressed. Three patients were positive for thyroid-stimulating immunoglobulins (the method was not available for the oldest case). Two patients showed complete resolution after 5 years of treatment with carbimazole. The remaining two patients are still under treatment and no adverse effects have been documented.

Enfermedad de Graves-Basedow en el niño preescolar / Grave´s disease in preschool children

Introducción. La enfermedad de Graves-Basedow, que es la causa más frecuente de hipertiroidismo en la edad pediátrica, es muy infrecuente en el niño preescolar. Se describen los casos de 4 niñas menores de 6 años de un total de 30 pacientes diagnosticados de enfermedad de Graves-Basedow entre 1985 y 2004. El motivo del estudio fue taquicardia, diarrea, retraso del lenguaje y estudio fortuito por alteraciones ecográficas tiroideas. La talla y la maduración ósea estaban avanzadas en 3 de las 4 pacientes. El bocio estuvo ausente o fue de muy pequeño tamaño, y en ningún caso existió oftalmopatía. Todas presentaron elevación de T4 y T3 con hormona tiroestimulante (TSH) suprimida y en 3 casos los anticuerpos estimulantes del tiroides fueron positivos (en el caso más antiguo la técnica no estaba disponible). Dos de las pacientes están curadas tras 5 años de tratamiento con carbimazol, y las otras dos están aún en tratamiento, sin haberse evidenciado ningún efecto secundario

Introduction. Graves' disease, which is the main cause of hyperthyroidism in the pediatric age group, is very rare in pre-school children. We describe the cases of four girls, aged less than 6 years old, out of a total of 30 patients diagnosed with Graves' disease between 1985 and 2004. Investigations were motivated by tachycardia, chronic diarrhea, language development delay or thyroid nodules detected by cervical ultrasonography. In three of the four patients height and bone age were advanced. In all patients goiter was small or absent. None of the patients had ophthalmic disease. In all patients free T3 and T4 were elevated and thyroid-stimulating hormone was suppressed. Three patients were positive for thyroid-stimulating immunoglobulins (the method was not available for the oldest case). Two patients showed complete resolution after 5 years of treatment with carbimazole. The remaining two patients are still under treatment and no adverse effects have been documented

Neurofibromatosis tipo 1: escoliosis distrófica y tumor paravertebral / Type I neurofibromatosis: dystrophic scoliosis and paravertebral tumor

La neurofibromatosis tipo 1 es el más frecuente de los síndromes neurocutáneos. Es una enfermedad heterogénea y progresiva, en la que existe una gran tendencia a desarrollar tumores. Los del sistema nervioso periférico constituyen la complicación más numerosa de la enfermedad. Los neurofibromas espinales pueden causar deformidades vertebrales. La escoliosis es el trastorno óseo más frecuentemente encontrado. Se describe el caso de una niño con neurofibromatosis tipo 1 que desarrolló una escoliosis dorso-lumbar progresiva de tipo distrófico que necesitó intrevención quirúrgica, asociada a un tumor paravertebral en "reloj de arena" que histológicamente fue un neurofibroma plexiforme (AU)