[Impact of the use of an early neonatal sepsis calculator]. / Impacto del uso de una calculadora de riesgo de sepsis neonatal temprana.

BACKGROUND: Early onset neonatal sepsis (EOS) is a public health problem; antibiotic treatment is often unnecessary and can increase morbimortality. EOS risk calculator are available that allows limiting the use of antibiotics. OBJECTIVE: To compare the patterns of antibiotic use and hospitalization time in infant newborns (NB) ≥ 34 weeks of gestational age (GA) in a historical cohort attended from November 2017 to April 2018 vs. a prospective cohort from November 2018 to April 2019, before and after implementing the use of an EOS risk calculator, respectively. MATERIAL AND METHODS: Ambispective, observational, longitudinal, analytical study in infants NB ≥ 34 GA attended before and after implementing the use of an EOS risk calculator. The patterns of antibiotic´s use were compared. Simple frequencies and proportions, means and standard deviations or medians with ranges, Mann-Whitney U Test and Chi square test with SPSS V. 20.0 statistical package were used; considering significant values of p < 0.05. RESULTS: Thirty patients were included, 15 NB for each period, the gestational age average was 36.8 ± 2.3 GA. there was no statistically significant difference in the frequency of diagnosis of EOS with blood culture or days of hospital stay. Antibiotics were beginning in all the infants attended before the implementation of the EOS risk calculator, unlike 46.7% of the infants after its implementation (p = 0.001). CONCLUSIONS: The EOS risk calculator is an easy tool to use, and demonstrated to be useful in decreasing unnecessary use of antibiotics.

INTRODUCCIÓN: la sepsis neonatal temprana (SNT) es un problema de salud pública. El tratamiento con antibióticos frecuentemente es innecesario y no inocuo. El uso de calculadoras de riesgo de SNT permite disminuir el uso injustificado de antibióticos. OBJETIVO: comparar el uso de antibióticos y tiempo de hospitalización en recién nacidos (RN) ≥ 34 semanas de gestación (SDG) en una cohorte histórica atendida de noviembre de 2017 a abril de 2018 frente a una cohorte prospectiva de noviembre de 2018 a abril del 2019, antes y después de la implementación del uso de una calculadora de riesgo de SNT. MATERIAL Y MÉTODOS: estudio ambispectivo, observacional, analítico en RN ≥ 34 SDG atendidos antes y después de implementar una calculadora de riesgo de SNT. Se comparó el uso de antibióticos así como el tiempo de hospitalización. Se usaron frecuencias, proporciones, medidas de tendencia central y dispersión, U de Mann-Whitney y Chi cuadrada, con el paquete estadístico SPSS V. 20.0; siendo significativos los valores de p < 0.05. RESULTADOS: se incluyeron 30 pacientes, 15 para cada grupo, de 36.8 ± 2.3 SDG. No hubo diferencia significativa en la frecuencia de diagnóstico de SNT con hemocultivo ni en los días de estancia intrahospitalaria. Se usó antibióticos en el 100% de los RN antes frente al 46.7% después del uso de la calculadora (p = 0.001). CONCLUSIONES: la calculadora de riesgo de SNT es una herramienta de uso sencillo y que demostró ser útil para disminuir el uso innecesario de antibióticos.

Disfunción endotelial en niños con enfermedad renal crónica / Endothelial dysfunction in children with chronic kidney disease

Antecedentes y objetivo: La enfermedad cardiovascular es la principal causa de muerte en niños con enfermedad renal crónica. La inflamación y la disfunción endotelial se presenta en la mayoría de estos pacientes y son factores asociados a enfermedad cardiovascular. La dilatación mediada por flujo (DMF)<7% es un marcador subrogado validado en la evaluación de la disfunción endotelial. Nuestro objetivo fue identificar los factores de riesgo asociados a disfunción endotelial en niños con enfermedad renal crónica. Materiales y métodos: Se estudió a niños de 2-16 años de edad. Se recopiló su información clínica y variables bioquímicas, incluidos hormona paratiroidea intacta (iPTH), interleucinas 6 y 1β, proteína C reactiva de alta sensibilidad (hsCRP), glutatión reducido, óxido nítrico, malondialdehído y homocisteína. Se consideró DMF alterada<7%. Resultados: Se incluyó a 129 pacientes con edad de 13,1±2,6 años. Tuvieron DMF<7% 69 (52,7%). Los pacientes con DMF<7% tuvieron niveles más altos de triglicéridos y de hsCRP que aquellos con DMF≥7% (145,5 vs. 120,0mg/dl, p=0,042, y 1,24 vs. 0,55U/l, p=0,007, respectivamente), así como una mayor frecuencia de iPTH baja (19,1 vs. 4,9%, p=0,036). Los niveles de hsCRP se correlacionaron significativamente con la DMF (Rho=−0,28, p=0,003). Los pacientes con iPTH baja (OR 4,41, IC 95% 1,13-17,27, p=0,033) y con hsCRP incrementada (OR 2,89, IC 95% 1,16-7,17, p=0,022) tuvieron un riesgo ajustado mayor de DMF<7%. Conclusiones: La hipertrigliceridemia, la inflamación y una iPTH baja se asociaron significativamente a una DMF alterada. Son factores de riesgo de enfermedad cardiovascular frecuentes y tratables. (AU)

Background and objective: Cardiovascular disease is the main cause of death in children with chronic kidney disease. Inflammation and endothelial dysfunction are found in the majority of these patients and are factors associated to cardiovascular disease. Flow mediated dilatation (FMD) is a surrogate marker validated for evaluating endothelial dysfunction. Our objective was to identify risk factors associated to endothelial dysfunction in children with chronic kidney disease. Materials and methods: Children 2-16 years of age were studied. Clinical information and biochemical variables were gathered, including intact parathyroid hormone (iPTH), interleukins 6 and 1β, high sensitivity C reactive protein (hsCRP), reduced glutathione, nitric oxide, malondialdehyde and homocysteine. FMD was measured, and considered altered if<7%. Results: Included were 129 patients aged 13.1±2.6 years. FMD<7% was found in 69 (52.7%). Patients with altered FMD had higher levels of triglycerides and hsCRP than those with normal FMD (145.5 vs. 120.0mg/dL, P=.042, and 1.24 vs. 0.55U/L, P=.007, respectively), as well as higher frequency of low iPTH (19.1 vs. 4.9%, P=.036). Levels of hsCRP correlated significantly with FMD (Rho=−0.28, P=.003). Patients with low iPTH (OR 4.41, 95% CI 1.13-17.27, P=.033) and increased hsCRP (OR 2.89, 95% CI 1.16-7.17, P=.022) had higher adjusted risk of having FMD<7%. Conclusions: Hypertriglyceridemia, inflammation and low iPTH associated significantly with altered FMD. They are frequent, treatable risk factors for cardiovascular disease. (AU)

Endothelial dysfunction in children with chronic kidney disease.

BACKGROUND AND OBJECTIVE: Cardiovascular disease (CVD) is the main cause of death in children with chronic kidney disease (CKD). Inflammation and endothelial dysfunction (ED) are found in the majority of these patients and are factors associated to CVD. Flow mediated dilatation (FMD) is a surrogate marker validated for evaluating ED. Our objective was to identify risk factors associated to ED in children with CKD. MATERIALS AND METHODS: Children 2-16 years of age were studied. Clinical information and biochemical variables were gathered, including intact parathyroid hormone (iPTH), interleukins 6 and 1b, high sensitivity C reactive protein (hsCRP), reduced glutathione, nitric oxide, malondialdehyde and homocysteine. FMD was measured, and considered altered if <7%. RESULTS: Included were 129 patients aged 13.1 ±â€¯2.6 years. FMD < 7% was found in 69 (52.7%). Patients with altered FMD had higher levels of triglycerides and hsCRP than those with normal FMD (145.5 mg/dl vs. 120.0 mg/dl, P = .042, y 1.24 U/L vs. 0.55 U/L, P = .007, respectively), as well as higher frequency of low iPTH (19.1% vs. 4.9%, P = .036). Levels of hsCRP correlated significantly with FMD (Rho = -0.28, P = .003). Patients with low iPTH (OR = 4.41, 95%CI 1.13-17.27, P = .033) and increased hsCRP (OR = 2.89, 95%CI 1.16-7.17, P = .022) had higher adjusted risk of having FMD < 7%. CONCLUSIONS: Hypertriglyceridemia, inflammation and low iPTH associated significantly with altered FMD. They are frequent, treatable risk factors for CVD.

Longitud renal y aclaramiento de la creatinina en pacientes embarazadas con enfermedad renal crónica / Renal length and creatinine clearance in pregnant patients with chronic kidney disease

Resumen: OBJETIVO: Medir, con ultrasonido, la longitud renal y el aclaramiento de creatinina para evaluar su correlación en pacientes embarazadas con enfermedad renal crónica. MATERIALES Y MÉTODOS: Estudio transversal, analítico y retrospectivo efectuado en pacientes embarazadas con enfermedad renal crónica a quienes se midió, con ultrasonido, la longitud renal derecha, izquierda, total y el aclaramiento de creatinina calculado con la ecuación Modification of Diet in Renal Disease (MDRD) para evaluar su correlación como grupo y por trimestres del embarazo. Se utilizó estadística descriptiva, prueba de ANOVA de una vía y el coeficiente de correlación de Pearson (r) con el programa estadístico SPSS versión 20. Los valores p < 0.05 y r > 0.1 se consideraron significativos. RESULTADOS: Se estudiaron 50 pacientes. La longitud renal derecha fue 75.52 ± 16.14 mm, izquierda 84.46 ± 16.51 mm y total 159.96 ± 28.59 mm. La media del aclaramiento de creatinina fue 34.17 ± 25.63 mL/min/1.73 m2 área de superficie corporal. La correlación resultó positiva para la longitud renal izquierda vs aclaramiento de creatinina (r = 0.362) y longitud renal total vs aclaramiento de creatinina (r = 0.346) con mayor evidencia en pacientes en el segundo trimestre del embarazo. Las pacientes en el primer trimestre del embarazo fueron de mayor edad (p = 0.004), con riñones más pequeños (p = 0.008), menor aclaramiento de creatinina (p = 0.001) y mayor frecuencia de enfermedad renal crónica terminal (18%). CONCLUSIONES: Se encontró incremento de la longitud renal izquierda, longitud renal total y aclaramiento de creatinina con correlación positiva. Los cambios fueron evidentes solo en pacientes en el segundo trimestre del embarazo.

Abstract OBJECTIVE: To measure renal length by ultrasound and creatinine clearance to assess its correlation in pregnant patients with chronic kidney disease (CKD). MATERIALS AND METHODS: Cross-sectional, analytical and retrospective study in pregnant patients with CKD whose right, left and total renal length was measured by ultrasound and the creatinine clearance calculated with the Modification of Diet in Renal Disease (MDRD) equation to evaluate its correlation. as a group and by gestational trimesters. Descriptive statistics, one-way ANOVA test and Pearson's correlation coefficient (r) were used with the SPSS version 20 statistical program. The p < 0.05 and r > 0.1 value was considered significant, respectively. RESULTS: 50 patients were studied. The right renal length was 75.52 ± 16.14 mm, left 84.46 ± 16.51 mm and total 159.96 ± 28.59 mm. The mean creatinine clearance was 34.17 ± 25.63 mL/min/1.73 m2 body surface area. The correlation was positive for the left renal length vs creatinine clearance (r = 0.362) and total renal length vs creatinine clearance (r = 0.346) with more evidence in second trimester patients. The first trimester patients were older (p = 0.004), smaller kidneys (p = 0.008), reduced creatinine clearance (p = 0.001) and higher frequency of terminal chronic kidney disease (18%). CONCLUSIONS: An increase in left kidney length, total kidney length and ACr was found, whose correlation was positive. The changes were evident in second trimester pregnant patients.

Carotid intima media thickness, oxidative stress, and inflammation in children with chronic kidney disease.

OBJECTIVE: We evaluated the association between inflammation and oxidative stress with carotid intima media thickness (cIMT) and elasticity increment module (E(inc)) in pediatric patients with chronic kidney disease (CKD). METHODS: This analytical, cross-sectional study assessed 134 children aged 6-17 years with CKD. Anthropometric measurements and biochemistry of intact parathyroid hormone (iPTH), high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, IL-1ß, reduced glutathione (GSH), malondialdehyde, nitric oxide, and homocysteine were recorded. Bilateral carotid ultrasound (US) was taken. Patients were compared with controls for cIMT and E(inc) using ≥ 75 percentile (PC). RESULTS: Mean cIMT was 0.528 ± 0.089 mm; E(inc) was 0.174 ± 0.121 kPa × 10(3); cIMT negatively correlated with phosphorus (r -0.19, p =0.028) and the calcium × phosphorus (Ca × P) product (r -0.26, p =0.002), and positively with iPTH (r 0.19,p =0.024). After adjusting for potential confounders, hemodialysis (HD) (ß=0.111, p =<0.001), automated peritoneal dialysis (APD) (ß=0.064, p =0.026), and Ca x P product(ß=-0.002, p =0.015) predicted cIMT (R(2)=0.296). In patients on dialysis, HD (ß=0.068, p =0.010), low-density lipoprotein cholesterol (LDL-C) (ß=0.001, p =0.048), and GSH(ß=-0.0001, p=0.041) independently predicted cIMT (R(2)=0.204); HD, hypoalbuminemia, and high iPTH increased the risk of increased cIMT. In dialysis, E(inc) was inversely associated with GSH, and in predialysis, Ca × P correlated with/predicted E(inc) (ß=0.001, p =0.009). CONCLUSIONS: cIMT and E(inc) strongly associate with several biochemical parameters and GSH but not with other oxidative stress or inflammation markers.

Metabolic syndrome in children with chronic kidney disease: PON1 and treatment modality.

BACKGROUND AND AIMS: We undertook this study to evaluate the relationship between PON1, SOD and metabolic syndrome (MetS) in pediatric patients undergoing peritoneal dialysis, hemodialysis and patients in early stages of CKD. METHODS: We carried out an analytical cross-sectional study of 134 children 6-17 years old. We registered anthropometric variables, vital signs, basic biochemical parameters, intact PTH (iPTH), high sensitivity CRP (hs-CRP), paraoxonase-1; SOD; PON1/HDL-cholesterol and homocysteine. For statistical analyses we used t test, Mann Whitney U test, χ(2), Fisher exact test, linear or logistic regression models, using SPSS v.16.0. p values <0.05 were considered as significant. RESULTS: There were 66 (49.3%) females; 39 (29.1%) had CKD stages 2-4 (predialysis), 42 (31.3%) on hemodialysis (HD) and 53 (39.6%) on automated peritoneal dialysis (PD). Time from diagnosis was 26 months. Significant differences were observed in mean, systolic and diastolic blood pressure, C-peptide, triglycerides, and HDL-cholesterol as well as PON1/HDL-cholesterol ratio and SOD. CONCLUSIONS: This study demonstrates that PON1 and SOD may be predictors for the presence of MetS in pediatric patients under treatment with peritoneal dialysis. The positive correlation observed in PON1/HDL-cholesterol ratio may reflect the protector effect of HDL-cholesterol in patients with CKD according with the modality of treatment.

Riesgo de atelectasia postextubación en neonatos tratados con ambroxol / The effect of ambroxol in the newborn with post-extubation atelectasia

Se valora el efecto del ambroxol en recién nacidos con atelectasia postextubación. Se estudiaron 66 neonatos que requerían asistencia ventilatoria, divididos en dos grupos. El grupo I (n=36) tratado con ambroxol intravenoso, administrado desde inicio del destete hasta tres días después de la postextubación; el grupo II (control) fue integrado con 30 niños que recibieron tratamiento convencional. Ambos grupos fueron similares en semanas de edad gestacional, peso, Apgar y días de asistencia ventilatoria. Al valorar la evolución postextubación, al término del segundo día, la atelectasia postextubación fue menor frecuente en el grupo I (p<0.001); y al tercer día, la frecuencia de atelectasia fue de cero casos en el grupo I. Se concluye que el ambroxol facilita el drenaje de secreciones y disminuye el riesgo de presentación de atelectasia postextubación en el neonato que se recupera de patología pulmonar