Accompaniment of minors during health care procedures.

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents. We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans. The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.

Acompañamiento a los menores durante los procedimientos asistenciales / Accompaniment of minors during health care procedures

En la práctica clínica no es infrecuente observar situaciones en las cuales se invita a los progenitores y la familia a dejar a los menores en soledad junto al equipo asistencial en estancias repletas de tecnología durante la realización de procedimientos, dando lugar en ocasiones a conflictos, pero sobre todo con consecuencias emocionales en los niños o adolescentes.Se ha realizado una revisión narrativa de la literatura mediante búsqueda bibliográfica en la biblioteca virtual del sistema sanitario público de Andalucía, siendo los criterios de inclusión utilizados, estudios que conciernen a las experiencias de profesionales sanitarios y familiares sobre el acompañamiento de la población pediátrica en los procedimientos asistenciales. El resultado de la búsqueda se limitó a trabajos en humanos en español e inglés.Esta revisión pone de manifiesto la necesidad de humanizar la asistencia sanitaria para mejorar la calidad de la atención. Se justifica la necesidad de acompañamiento de los menores, a través de trabajos que han analizado los factores que intervienen en la permanencia de estas conductas y actitudes tanto por profesionales como padres. Se recomienda la necesidad de políticas institucionales y figuras mediadoras que recojan las declaraciones de algunas sociedades nacionales e internacionales teniendo en cuenta aspectos legales, pero sobre todo los valores en juego desde una ética del cuidado y búsqueda del interés superior del menor.(AU)

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents.We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans.The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.(AU)

Alteraciones electrocardiográficas tras electrocución / Electrocardiographic alterations after electrocution

No disponible

Intracranial arachnoid cysts and epilepsy in children: Should this be treated surgically? Our 29-year experience and review of the literature.

INTRODUCTION AND OBJECTIVE: Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. MATERIAL AND METHODS: The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. RESULTS: After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment. CONCLUSIONS: Although it is necessary to design a prospective study to establish causality, the results of our research and the available literature suggest that there is no causal relationship between the presence of ACs and epilepsy. The study and treatment of these patients should be carried out in a multidisciplinary epilepsy surgery unit, without initially assuming that the AC is the cause of epilepsy.

Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late preterm and term infants.

INTRODUCTION AND OBJECTIVE: Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. METHODS: A prospective cohort study in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. SAMPLE SIZE: 207, 59 neonates developed hypoglycemia. RESULTS: Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. CONCLUSIONS: Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.

Estudio prospectivo de factores perinatales asociados a hipoglucemia precoz en el neonato prematuro tardío y a término / Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late-preterm and term infants

Introducción y objetivos: La hipoglucemia neonatal ofrece múltiples controversias. El objetivo del estudio es valorar los principales factores y circunstancias ambientales implicadas en el desarrollo de la hipoglucemia neonatal precoz. Métodos: Estudio analítico prospectivo de una cohorte de recién nacidos entre 34 + 1 y 40 + 6 semanas de edad gestacional. Se realizó una determinación de glucemia capilar a las dos, cuatro y ocho horas de vida. Tamaño muestral: 207; 59 neonatos desarrollaron hipoglucemia. Resultados: renatalmente, los factores con mayor influencia fueron la diabetes gestacional con mal control glucémico, gemelaridad y edad gestacional. La presencia de líquido amniótico meconial y el nacimiento por cesárea programada se asociaron a mayor probabilidad de hipoglucemia. Postnatalmente, el contacto precoz piel con piel, la succión al pecho, la iluminación tenue y la normotermia fueron factores protectores. El modelo predictivo que combinó tipo de iluminación, temperatura corporal y cifra de exceso de bases clasificó correctamente al 98% de los casos de hipoglucemia grave, con un R2 de Nagelkerke de 0,645 y especificidad del 99,5%. Conclusiones: Los factores postnatales ambientales parecen estar relacionados de forma directa en el desarrollo de la hipoglucemia precoz, por lo que el apoyo a la unión maternofilial y a la lactancia materna es fundamental. Nuestros resultados permiten una mejor identificación de los neonatos que no son subsidiarios de realizar controles de glucemia por tener poco riesgo de desarrollarla. (AU)

Introduction and objective: Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. Methods: A prospective cohort study, in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. Sample size: 207; 59 neonates developed hypoglycemia. Results: Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. Conclusions: Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal–child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.(AU)

[Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late-preterm and term infants]. / Estudio prospectivo de factores perinatales asociados a hipoglucemia precoz en el neonato prematuro tardío y a término.

INTRODUCTION AND OBJECTIVE: Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. METHODS: A prospective cohort study, in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. SAMPLE SIZE: 207; 59 neonates developed hypoglycemia. RESULTS: Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. CONCLUSIONS: Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.

Intracranial arachnoid cysts and epilepsy in children: Should this be treated surgically? Our 29-year experience and review of the literature.

INTRODUCTION AND OBJECTIVE: Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. MATERIAL AND METHODS: The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. RESULTS: After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment. CONCLUSIONS: Although it is necessary to design a prospective study to establish causality, the results of our research and the available literature suggest that there is no causal relationship between the presence of ACs and epilepsy. The study and treatment of these patients should be carried out in a multidisciplinary epilepsy surgery unit, without initially assuming that the AC is the cause of epilepsy.

Encuesta sobre detección de hipoglucemia y uso de glucómetros portátiles: ¿qué glucómetro es el más usado en las unidades neonatales españolas? / Survey on hypoglycaemia diagnosis and glucometer use - which is the most widely used glucometer in Spanish neonatology units?

INTRODUCCIÓN Y OBJETIVOS: la hipoglucemia neonatal sigue ofreciendo múltiples controversias. El objetivo del estudio es presentar la situación actual en torno a la forma de detección de la hipoglucemia neonatal y conocer el glucómetro portátil más utilizado en las unidades neonatales españolas en la actualidad. MÉTODOS: se elaboró un cuestionario "online" sobre el uso de glucómetros en neonatos y los dispositivos más utilizados, que fue enviado a los integrantes de la Sociedad Española de Neonatología. Participaron 75 centros. RESULTADOS: los glucómetros portátiles siguen teniendo un uso generalizado en la población neonatal. Más del 75 % de las unidades realizan un despistaje de la hipoglucemia neonatal en circunstancias clínicas concretas; el 13 % de los centros lo continúan realizando a todos los recién nacidos en las unidades neonatales. A mayor nivel asistencial, mayor es el porcentaje de detección de la hipoglucemia por otros sistemas de análisis (como gasometrías capilares): chi2, p = 0,019. Se usan múltiples modelos de glucómetro actualmente, encontrándose diferencias según el nivel asistencial (chi2, p = 0,01), siendo los modelos de la firma Nova Biomedical, Abbott y Roche Diagnostics los más usados. CONCLUSIONES: se observa que existen diferencias en la realización del despistaje de la hipoglucemia neonatal, por lo que es de gran importancia consensuar los procedimientos y acotar la población neonatal de mayor riesgo, para disminuir la variabilidad en la práctica clínica y mejorar la calidad de la asistencia neonatal

INTRODUCTION AND OBJECTIVE: neonatal hypoglycemia persistently offers multiple diagnostic controversies. This study aims to present the current situation regarding neonatal hypoglycaemia detection, and to gain insight into the most widely used portable glucometers in neonatal units today. METHODS: an online questionnaire was prepared and sent to the members of the Spanish Society of Neonatology; a total of 75 hospitals participated. RESULTS: portable glucometers continue to be widely used in the neonatal population. More than 75 % of units perform neonatal hypoglycemia screening in specific clinical circumstances, and 13 % of units continue to perform protocolized screening on all newborns at neonatal units. The higher the level of care, the higher the percentage of hypoglycaemia detection by other tests (such as blood gas analysis): chi2, p = 0.019. Multiple models of portable glucometers are currently used, with differences according to level of care (chi2, p = 0.01). Nova Biomedical, Abbott, and Roche Diagnostics models are most commonly used. CONCLUSIONS: differences in the performance of neonatal hypoglycaemia screening are observed, so standardised procedures and limiting the neonatal population at risk are important to reduce variability in clinical practice, and to improve the quality of neonatal care

[Survey on hypoglycaemia diagnosis and glucometer use-which is the most widely used glucometer in Spanish neonatology units?] / Encuesta sobre detección de hipoglucemia y uso de glucómetros portátiles: ¿qué glucómetro es el más usado en las unidades neonatales españolas?

INTRODUCTION: Introduction and objective: neonatal hypoglycemia persistently offers multiple diagnostic controversies. This study aims to present the current situation regarding neonatal hypoglycaemia detection, and to gain insiht into the most widely used portable glucometers in neonatal units today. Methods: an online questionnaire was prepared and sent to the members of the Spanish Society of Neonatology; a total of 75 hospitals participated. Results: portable glucometers continue to be widely used in the neonatal population. More than 75 % of units perform neonatal hypoglycemia screening in specific clinical circumstances, and 13 % of units continue to perform protocolized screening on all newborns at neonatal units. The higher the level of care, the higher the percentage of hypoglycaemia detection by other tests (such as blood gas analysis): chi2, p = 0.019. Multiple models of portable glucometers are currently used, with differences according to level of care (chi2, p = 0.01). Nova Biomedical, Abbott, and Roche Diagnostics models are most commonly used. Conclusions: differences in the performance of neonatal hypoglycaemia screening are observed, so standardised procedures and limiting the neonatal population at risk are important to reduce variability in clinical practice, and to improve the quality of neonatal care.

INTRODUCCIÓN: Introducción y objetivos: la hipoglucemia neonatal sigue ofreciendo múltiples controversias. El objetivo del estudio es presentar la situación actual en torno a la forma de detección de la hipoglucemia neonatal y conocer el glucómetro portátil más utilizado en las unidades neonatales españolas en la actualidad. Métodos: se elaboró un cuestionario "online" sobre el uso de glucómetros en neonatos y los dispositivos más utilizados, que fue enviado a los integrantes de la Sociedad Española de Neonatología. Participaron 75 centros. Resultados: los glucómetros portátiles siguen teniendo un uso generalizado en la población neonatal. Más del 75 % de las unidades realizan un despistaje de la hipoglucemia neonatal en circunstancias clínicas concretas; el 13 % de los centros lo continúan realizando a todos los recién nacidos en las unidades neonatales. A mayor nivel asistencial, mayor es el porcentaje de detección de la hipoglucemia por otros sistemas de análisis (como gasometrías capilares): chi2, p = 0,019. Se usan múltiples modelos de glucómetro actualmente, encontrándose diferencias según el nivel asistencial (chi2, p = 0,01), siendo los modelos de la firma Nova Biomedical, Abbott y Roche Diagnostics los más usados. Conclusiones: se observa que existen diferencias en la realización del despistaje de la hipoglucemia neonatal, por lo que es de gran importancia consensuar los procedimientos y acotar la población neonatal de mayor riesgo, para disminuir la variabilidad en la práctica clínica y mejorar la calidad de la asistencia neonatal.

Trombocitopenia inmune primaria: experiencia de una consulta especializada / Primary immune thrombocytopenia: Experience of a specialised clinic

INTRODUCCIÓN: La trombocitopenia inmune primaria (PTI) es poco frecuente en la infancia, pero es la causa más habitual de trombocitopenia. Se han intentado establecer factores de riesgo para predecir su evolución, con el objetivo de poder optimizar su manejo, que se ha modificado en los últimos años, debido, entre otros factores, a una atención más especializada. MATERIAL Y MÉTODOS: Estudio retrospectivo, observacional y analítico de los pacientes con PTI, en un periodo de 3 años, en una consulta especializada en Hematología Pediátrica. RESULTADOS: Desde el punto de vista epidemiológico, clínico y analítico, las características de esta serie son similares a las de otros grupos. La mayoría de los pacientes (23/31; 74,2%) presentaron una PTI de duración menor de 12 meses, sin complicaciones graves relacionadas con la enfermedad ni con el tratamiento. Se establecieron como factores de riesgo relacionados con una evolución tórpida (supervivencia libre de eventos [SLE] menor), sin alcanzar la significación estadística, el sexo femenino, la edad mayor de 10 años, la leucopenia, la ausencia de trombocitopenia grave inicial y la atención no especializada. La ausencia de antecedente de infección se relacionó significativamente con una SLE menor. CONCLUSIONES: Los factores de riesgo de evolución tórpida de PTI epidemiológicos y analíticos de este estudio coinciden con los descritos en la literatura. Presentaron una SLE menor los pacientes tratados antes del inicio de la atención especializada. Estos datos parecen apoyar la recomendación actual de que las enfermedades poco frecuentes, como esta, se controlen en unidades especializadas

INTRODUCTION: Although primary immune thrombocytopenia (ITP) is rare in childhood, it is the most frequent cause of thrombocytopenia. There have been attempts to establish risk factors to predict the progression of the disease in order to optimise its management, which has changed in recent years due to, among other reasons, specialised care. MATERIAL AND METHODS: A retrospective, observational and analytical study was conducted on patients diagnosed with ITP over a 3-year period in a Paediatric Haematology specialist clinic. RESULTS: From the epidemiological, clinical and analytical point of view, the characteristics of this group are similar to others. Most of the patients (23/31, 74.2%) had ITP for less than 12 months, with there being no serious complications related to the disease or the treatment received. It was established that risk factors were related to being slowly evolving (lower event-free survival (EFS)) with no statistical significance, female gender, age over 10 years, leukopenia absence of initial severe thrombocytopenia, and non-specialised care. The absence of a history of infection was significantly related to a lower EFS. CONCLUSIONS: The epidemiological and analytical risk factors for a slowly evolving ITP are the same that described in the literature. Patients treated before the beginning of specialised care also had a lower EFS. These data seem to support the current recommendation that rare diseases should be managed in specialised units

Malformación congénita grave de la columna cervical / Severe congenital malformation of the cervical spine

No disponible

[Primary immune thrombocytopenia: Experience of a specialised clinic]. / Trombocitopenia inmune primaria: experiencia de una consulta especializada.

INTRODUCTION: Although primary immune thrombocytopenia (ITP) is rare in childhood, it is the most frequent cause of thrombocytopenia. There have been attempts to establish risk factors to predict the progression of the disease in order to optimise its management, which has changed in recent years due to, among other reasons, specialised care. MATERIAL AND METHODS: A retrospective, observational and analytical study was conducted on patients diagnosed with ITP over a 3-year period in a Paediatric Haematology specialist clinic. RESULTS: From the epidemiological, clinical and analytical point of view, the characteristics of this group are similar to others. Most of the patients (23/31, 74.2%) had ITP for less than 12 months, with there being no serious complications related to the disease or the treatment received. It was established that risk factors were related to being slowly evolving (lower event-free survival (EFS)) with no statistical significance, female gender, age over 10 years, leukopenia absence of initial severe thrombocytopenia, and non-specialised care. The absence of a history of infection was significantly related to a lower EFS. CONCLUSIONS: The epidemiological and analytical risk factors for a slowly evolving ITP are the same that described in the literature. Patients treated before the beginning of specialised care also had a lower EFS. These data seem to support the current recommendation that rare diseases should be managed in specialised units.

Metahemoglobinemia en lactantes mayores de un año / Metahemoglobinemia in infants over one year

Antecedentes y objetivo: La metahemoglobinemia es un cuadro de intoxicación aguda típico de niños menores de un año. Se produce por un exceso de nitratos que producen la oxidación del hierro de la hemoglobina impidiendo su adecuada unión al oxígeno. Es más frecuente en lactantes debido a su inferior actividad enzimática. Pacientes: Dos casos de lactantes de 15 meses con cuadros de metahemoglobinemia tras ingesta de verduras, atípicos por la edad de los pacientes y por la severidad inicial en el primer caso, que llegó a simular un cuadro séptico. En ambos casos se logró la resolución del cuadro con adecuada oxigenoterapia. Conclusiones: Aunque la clínica más frecuente es cianosis asociada a dificultad respiratoria, la metahemoglobinemia puede presentarse con cuadros más severos y confusos y en mayores de un año. El tratamiento de elección es oxigenoterapia a altas concentraciones y azul de metileno como antídoto por vía intravenosa únicamente en casos seleccionados. La ingesta de vegetales es el principal causante de este cuadro, por lo que es importante dar la información adecuada a los padres sobre el consumo y la conservación de estos alimentos

Background and objectives: Methaemoglobinaemia is a typical acute intoxication disorder in children under one year old. It is produced by excess nitrates which induce the haemoglobin's iron oxidation, preventing its adequate binding to oxygen. It is more frequent in infants due to its lower enzymatic activity. Patients: Two cases of 15-month-old infants with methaemoglobinaemia after the intake of vegetables, atypical by the age of the patients and the initial severity in the first case that simulated a septic syndrome. Both cases evolved well with adequate oxygen therapy. Conclusions: Although the most frequent clinical manifestation is cyanosis associated with respiratory distress, methaemoglobinaemia can present with more severe and confusing symptoms. The main treatment is oxygen therapy at high concentrations and methylene blue as an intravenous antidote only in selected cases. The intake of vegetables is the main cause of this in infants, so it is important to give adequate information to parents about the consumption and preservation of these foods during the first year of life

Metahemoglobinemia in infants over one year. / Metahemoglobinemia en lactantes mayores de un año.

BACKGROUND AND OBJECTIVES: Methaemoglobinaemia is a typical acute intoxication disorder in children under one year old. It is produced by excess nitrates which induce the haemoglobin's iron oxidation, preventing its adequate binding to oxygen. It is more frequent in infants due to its lower enzymatic activity. PATIENTS: Two cases of 15-month-old infants with methaemoglobinaemia after the intake of vegetables, atypical by the age of the patients and the initial severity in the first case that simulated a septic syndrome. Both cases evolved well with adequate oxygen therapy. CONCLUSIONS: Although the most frequent clinical manifestation is cyanosis associated with respiratory distress, methaemoglobinaemia can present with more severe and confusing symptoms. The main treatment is oxygen therapy at high concentrations and methylene blue as an intravenous antidote only in selected cases. The intake of vegetables is the main cause of this in infants, so it is important to give adequate information to parents about the consumption and preservation of these foods during the first year of life.

Hipertensión intracraneal idiopática: experiencia en 25 años y protocolo de actuación / Idiopathic intracranial hypertension: Experience over 25 years and a management protocol

Introducción y objetivos: Se presenta nuestra experiencia en hipertensión intracraneal idiopática (HII) preimplantación y postimplantación de un protocolo específico de actuación. Material y métodos: Estudio descriptivo retrospectivo de los pacientes con diagnóstico de HII en 25 años (1990-2015), comparando los últimos 7 años (tras implantar protocolo) con los 18 previos. Resultados: De 18.865 pacientes valorados en 25 años, hay 54 casos de HII (29 lactantes y 25 niños mayores). Se comparan ambos periodos: 32 casos de 1990-2008 -publicados en An Pediatr (Barc). 2009;71:400-6- y 23 de 2008-2015. En el periodo posprotocolo, hubo 13 pacientes entre 3 y 10 meses (62% varones) con abombamiento transitorio de fontanela y 10 entre 2 y 14 años (50% varones) con papiledema. El 54% de los lactantes habían finalizado recientemente tratamiento corticoideo por bronquitis. En los mayores, un caso asoció trombosis de senos venosos por otomastoiditis, otro tratamiento corticoideo por angioma y otro tratamiento con hormona de crecimiento. Se hizo ecografía transfontanelar a todos los lactantes; TAC, RM y angioRM a todos los mayores, y punción lumbar a 2 lactantes (por sospecha de meningitis) y a todos los mayores. Todos los pacientes evolucionaron favorablemente; solo en 3 se instauró tratamiento. Una paciente recidivó. Discusión: Las características y la evolución de los pacientes son superponibles en todos los años. La HII suele tener un curso favorable, aunque puede tardar en resolverse en niños mayores y presentar graves repercusiones visuales, por lo que precisa estrecho control oftalmológico. Destacamos la utilidad del protocolo para facilitar la toma de decisiones diagnósticas, de seguimiento y tratamiento (AU)

Introduction: We present our experience on idiopathic intracranial hypertension (IIH), before and after the introduction of a specific diagnosis and management protocol. Method: A descriptive retrospective study was conducted on patients with IIH over a 25 year period (1990-2015), comparing the last 7 years (after introduction of the protocol) with the previous 18 years. Results: Among the 18,865 patients evaluated, there were 54 cases of IIH (29 infants and 25 children). A comparison was made between the two time periods: 32 cases in 1990-2008 -published in An Pediatr (Barc). 2009;71:400-6-, and 23 cases in 2008-2015. In post-protocol period, there were 13 patients aged between 3-10 months (62% males) with transient bulging fontanelle, and 10 aged between 2-14 years (50% males), with papilloedema. A total of 54% of infants had recently finished corticosteroid treatment for bronchitis. In the older children, there was one case associated with venous thrombosis caused by otomastoiditis, one case on corticosteroid treatment for angioma, and another case treated with growth hormone. Transfontanelle ultrasound was performed on all infants, and CT, MRI and angio-MRI was performed on every child. Lumbar puncture was performed on 2 infants in whom meningitis was suspected, and in all children. All patients progressed favourably, with treatment being started in 3 of them. One patient relapsed. Discussion: Characteristics and outcomes of patients overlap every year. IIH usually has a favourable outcome, although it may be longer in children than in infants. It can cause serious visual disturbances, so close ophthalmological control is necessary. The protocol is useful to ease diagnostic decisions, monitoring, and treatment (AU)

First Cases of Severe Flaccid Paralysis Associated With Enterovirus D68 Infection in Spain, 2015-2016.

Enterovirus D68 was known to be the cause of mild to severe respiratory infections, but in the last few years, it has also been associated with myelitis and paralysis. This report describes the first Enterovirus D68 detections in acute flaccid paralysis cases occurring between December 2015 and March 2016 in Spain.