Prematuridad tardía: una población de riesgo / Late preterm: A population at risk

Antecedentes: Desde hace una década se pone de manifiesto el riesgo significativamente superior de morbimortalidad del prematuro tardío (RNPT) en relación al nacido a término. Población y método: Estudio prospectivo clínico-epidemiológico de los nacidos entre la 340 y 366 semanas de gestación de 34 hospitales del Grupo SEN34-36 recogidos durante 5años. Análisis de los resultados y comparación con nacidos a término. Resultados: Se obtuvieron datos de 9.121 RNPT, con una tasa de prematuridad tardía del 5,9% (71,8% de los prematuros). Fallecieron el 2,8 por mil . El parto se indujo en el 7%. En el 47,9% se practicó cesárea (44,4% programada), con un 18,8% de causa desconocida o no justificada. Presentaron diagnósticos de patología gestacional el 41,4%, siendo los más frecuentes: rotura prematura de membranas, síndromes hipertensivos, diabetes, amenaza de parto prematuro y crecimiento intrauterino restringido. La causa de prematuridad figuró como desconocida en el 29%, y en el 3,1% como injustificada, con un incremento significativo paralelo al de la edad gestacional. Ingresaron el 58,6% (15% cuidados intensivos). Los diagnósticos más frecuentes fueron hiperbilirrubinemia (43,5%), hipoglucemia (30%) y trastornos respiratorios (28,7%). Conclusiones: La morbimortalidad asociada a la prematuridad tardía justifica la revisión de los protocolos a la hora de finalizar la gestación antes de término y ajustarlos a criterios acordes a la evidencia científica, sin empeorar la morbimortalidad feto-materna. Pediatras y obstetras no debemos desestimar los efectos a corto y a largo plazo de la prematuridad tardía

Background: For the last decade, significant higher rates of morbidity and mortality in late preterm infants (LPI) have been observed when compared with term babies. Population and method: A prospective epidemiological study of late preterm babies registered for 34 hospitals in the SEN34-36 database for a five years period. A comparison with data from term babies was established. Results: 9,121 LPI were enrolled. Late prematurity rate was 5.9% (71.8% of premature infants). Mortality rate was 2.8 per-mille . Labor was induced in 7% of births. A cesarean section was performed in 47.9% of pregnancies, 44.4% of them were planned, and in 18.8% there was not a justified reason to perform it. 41.4% of pregnacies presented diagnoses of gestational pathology, being the most frequent diagnoses: premature rupture of the membranes, hypertensive syndromes, diabetes, preterm labor and restricted intrauterine growth. The reason of prematurity was unknown in 29% of births, and in 3.1% it was considered as unjustified, with a significant increase of this percentage in higher gestational ages. 58.6% of LPI were admitted to the Neonatal Unit (15% to the Neonatal Intensive Care Unit). The most frequent diagnoses were hyperbilirubinemia (43.5%), hypoglycaemia (30%) and respiratory disorders (28.7%). Conclusions: the increased rates of morbidity and mortality in LPI make necessary the revision of obstetrics protocols related to ending gestation before term according to the best evidence, although maternal and fetus morbidity and mortality shouldn't be increased. Pediatricians and obstetricians should not misconsider the effects of late prematurity and create protocols for perinatal care and follow-up for this population at risk

Recomendaciones para el manejo perinatal y seguimiento del recién nacido prematuro tardío / Recommendations for the perinatal management and follow up of late preterm Newborns

La prematuridad es la primera causa de morbimortalidad neonatal e infantil, y constituye uno de los problemas de salud más importantes de la sociedad, especialmente en las más industrializadas. La tasa de prematuridad ha ido incrementándose paulatinamente en los 2 últimos decenios, sobre todo debido al aumento de los denominados prematuros tardíos con edad gestacional entre 34+0 y 36+6 semanas. Las complicaciones, tanto perinatales como a medio y largo plazo, de este grupo de población son considerablemente más frecuentes que las de los recién nacidos a término, y con una incidencia más similar a la de los prematuros de inferiores edades gestacionales. La Sociedad Espa˜nola de Neonatología, a través de su Grupo SEN34-36, ha elaborado unas recomendaciones genéricas para la atención de este grupo de pacientes. Se proponen pautas tanto para la detección precoz como para el manejo de los problemas más habituales en el periodo perinatal más inmediato, incluyendo estrategias de cuidados centrados en el desarrollo y la familia. Asimismo, se insiste en la necesidad de seguimiento a medio y largo plazo, por el mayor riesgo de complicaciones tardía

Prematurity is the main reason for neonatal morbidity and mortality, and has become one of the greatest problems in public health, especially in developed countries. Prematurity rate has increased during the last 2 decades. This increase may be attributed to late preterm babies, that is, those with a gestational age between 34+0 and 36+6 weeks. Perinatal morbidities, as well as long term complications, are more frequent in this population than in term babies. The incidence is more similar to the one observed in earlier premature babies. The SEN34-36 group of the Spanish Society of Neonatology suggests these recommendations for the management of late preterm babies. Strategies are offered not only for the early detection of possible complications, but also for the correction of these morbidities, and from the point of view of a family and development centered care. Follow up is strongly recommended due to the high rate of late morbidities

[Recommendations for the perinatal management and follow up of late preterm newborns]. / Recomendaciones para el manejo perinatal y seguimiento del recién nacido prematuro tardío.

Prematurity is the main reason for neonatal morbidity and mortality, and has become one of the greatest problems in public health, especially in developed countries. Prematurity rate has increased during the last 2 decades. This increase may be attributed to late preterm babies, that is, those with a gestational age between 34(+0) and 36(+6) weeks. Perinatal morbidities, as well as long term complications, are more frequent in this population than in term babies. The incidence is more similar to the one observed in earlier premature babies. The SEN34-36 group of the Spanish Society of Neonatology suggests these recommendations for the management of late preterm babies. Strategies are offered not only for the early detection of possible complications, but also for the correction of these morbidities, and from the point of view of a family and development centered care. Follow up is strongly recommended due to the high rate of late morbidities.

Lupus eritematoso sistémico. A propósito de un caso clínico con presentación cutánea / Systemic lupus erythematosus. A case report with cutaneous presentation

El lupus eritematoso sistémico pediátrico es una enfermedad autoinmunitaria crónica multisistémica con manifestaciones clínicas complejas. Presentación clínica de carácter cíclico. Los síntomas iniciales son inespecíficos. Afecta a múltiples órganos con síntomas específicos según su localización. Su manifestación cutánea puede presentarse junto con la manifestación sistémica o no. Es el gran imitador que puede simular otras enfermedades. La naturaleza heterogénea del lupus hace que sea un reto médico diagnóstico. Debido a que no existe un síntoma o hallazgo exclusivo para hacer el diagnóstico de la enfermedad, la American College of Rheumatology ha establecido unos criterios para su evaluación ante la sospecha de lupus. Su tratamiento depende de las manifestaciones clínicas, de la presencia/ausencia de afectación de órganos vitales y su abordaje debe ser multidisciplinar. Su supervivencia ha mejorado en la última década gracias a su diagnóstico y tratamiento precoz. Sin embargo, su pronóstico continúa siendo grave. Presentamos el caso clínico de una niña de diez años, diagnosticada de esta enfermedad (AU)

Pediatric Systemic lupus erythematosus is a multisystem chronic autoimmune disease with complex clinical manifestations. The clinical presentation has a cyclic nature. The initial symptoms are nonspecific. It affects multiple organs with specific symptoms depending on their location. Its skin manifestation may or may not occur with systemic manifestation. It is the great mimic that can simulate other diseases. The heterogeneous nature of lupus makes it a diagnosis medical challenge. Since there is not an only symptom or finding leading to the diagnosis of the disease, the American College of Rheumatology has established some criteria for the evaluation of suspicion of lupus. Treatment depends on the clinical manifestations, on the presence/absence of vital organs affectation and its approach must be multidisciplinary. The survival has improved in the last decade due to its early diagnosis and treatment. However, his prognosis continues to be serious. We present the clinical case of a 10 year old diagnosed girl with this condition (AU)

El colecho favorece la práctica de la lactancia materna y no aumenta el riesgo de muerte súbita del lactante. Dormir con los padres / Bed-sharing favours the practice of breastfeeding and does not increase the risk of sudden infant death syndrome. Sleeping with parents

La práctica de los padres de dormir junto a sus hijos ha sido una constante en la humanidad. Con el aumento en la prevalencia y duración de la lactancia materna, se ha observado paralelamente un aumento de esa práctica, que posiblemente se dé con más frecuencia que la reconocida en las encuestas. Los estudios han demostrado interrelación y mutua potenciación entre lactancia materna y colecho. Las asociaciones y organizaciones pediátricas recomiendan evitar el colecho, por relacionarlo con la muerte súbita del lactante. Se basan, sin embargo, en estudios en su mayoría no controlados, bajo la influencia de factores de riesgo no tenidos en cuenta. Los autores, tras una revisión exhaustiva sobre colecho, lactancia y muerte súbita del lactante, encuentran el colecho como una práctica beneficiosa para la lactancia y concluyen que, bien practicado, evitando factores de riesgo, no guarda relación con la muerte súbita del lactante (AU)

The practice of bed-sharing by parents and their offspring has been a common behaviour among humans. In parallel with the increase of breastfeeding rates, a higher frequency of bed-sharing has been observed worldwide. And, it is probable that it occurs more frequently than what appears reflected in surveys. There seems to be an interrelated and mutually enhanced effect between breastfeeding and bed-sharing. Pediatric associations and health organizations have warned against the practice of bed-sharing based on studies that describe a link between this practice and Sudden Infant Death Syndrome (SIDS). However, many were non-controlled studies that did not include other potentially risky circumstances. After a thoroughly review of the available literature, the authors have found the practice of bed-sharing to be of benefit on the basis of a warm and close-up infant care approach and calls for recognition and avoidance of risky situations that could represent a threat for infant life (AU)

Uso del chupete y lactancia materna / Use of pacifiers and breastfeeding

El uso del chupete se encuentra muy arraigado en las sociedades desarrolladas, ya que calma el llanto del bebé, ayuda a conciliar el sueño, y reduce el estrés y el dolor en procedimientos desagradables. Su uso se ha relacionado con una menor duración y exclusividad de la lactancia materna, aumento de otitis media, problemas dentales y riesgo de accidentes. Además, estudios recientes relacionan su uso, particularmente durante el sueño, con disminución del riesgo de muerte súbita del lactante. Otros beneficios demostrados son su efecto analgésico y el estímulo de la succión no nutritiva en niños pretérmino y a término. El debate sobre su utilización o no es actualmente motivo de controversia, pero es importante que los profesionales de la salud y los padres conozcan los riesgos y beneficios que conlleva el uso del chupete. Dada la controversia actual, el Comité de Lactancia Materna de la Asociación Española de Pediatría ha realizado, a la luz de las pruebas disponibles actualmente, una revisión del tema en relación con la lactancia materna (AU)

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant is sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breast feeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant (AU)

[Use of pacifiers and breastfeeding]. / Uso del chupete y lactancia materna.

Pacifiers are widely used in developed societies. They are used for soothing infants, reducing their stress and pain during procedures and to help them sleep. The use of pacifiers has been associated, however, with a shorter duration and exclusivity of breastfeeding, with higher rates of otitis media and dental problems, as well as a higher risk of accidents during infancy. Recent studies have also described a relationship between pacifier use and SIDS, especially when used during infant́s sleep. Other described benefits are analgesia and stimulation of non-nutritive sucking in preterm and term infants. There is, at present, wide debate and controversy on whether or not to recommend its use; thus it seems important for professionals and parents to be aware of the risks and benefits associated to its use, particularly related to breastfeeding. Due to the existing controversy of scientific findings, the Committee on Breastfeeding of the Spanish Paediatrics Society, publishes this review, trying to summarise present evidence with the objective of, after analysing scientific results and recommendations, making recommendations regarding the use of the pacifier in the breastfed infant.

Hidrocución secundaria a urticaria a frigore en una niña de 9 años / Hydrocution secondary to urticaria a frigore in a 9 year old child

Las urticarias inducidas por frío (UIF) engloban una serie de entidades caracterizadas por enrojecimiento, prurito, ampollas y edema en la piel expuesta al frío. Las lesiones se pueden limitar sólo a la zona expuesta o incluso llegar a producir síntomas sistémicos tales como shock anafiláctico si el estímulo es intenso y el sujeto, sensible. Presentamos el caso de una niña de 9 años con riesgo de anafilaxias severa por urticaria inducida por frío, dada su excepcional presentación en la infancia (AU)

[Acute infantile hemiplegia caused by Coxsackie B virus]. / Hemiplejía aguda infantil por virus Coxsackie B.

INTRODUCTION: Acute infantile hemiplegia (AIH) is a syndrome that appears, typically, in infants without any underlying neurological damage. It can be due to a number of causes, in which viral infections play an important role. We report a case of AIH caused by Coxsackie B virus. CASE REPORT: A 20-month-old female who visited because of fever, vomiting and progressive left hemiparesis. Clinical exploration did not reveal any alteration in the level of consciousness and the only striking feature was the left hemiparesis, with weak deep muscle reflexes. Of the complementary examinations carried out, the most important were: LCR with 80 leukocytes/mm3 (predominance of mononuclear cells), EEG with a persistent focus in the right temporal region (which had become normal at four days) and a positive Coxsackie B virus serology. Progression was completely normal. CONCLUSIONS: AIH is produced as a complication of focal encephalitis which gives rise to a vasculitic phenomenon. Among the infectious causes, one important aetiological agent is the herpes simplex virus. Enterovirus, however, are infrequent. Therefore, until the exact aetiology has been established, it appears wise to begin empirical therapy with acyclovir. When the germs involved in this entity are enterovirus, prognosis is good, although there are reports of cases involving neurological sequelae in the literature.

Niño de 6 años con dificultad respiratoria postextubación / Six-year-old boy with post-extubacion respiratory insufficiency

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Eritema vulvar y perianal / Vulvar and periana erythema

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[Neuropediatric healthcare demand in a general hospital]. / Demanda asistencial neuropediátrica en un hospital general.

INTRODUCTION: The few existing studies on the demand for neuropediatric care in Spain offer information of enormous value, contributing to our knowledge of this specialty and of the needs of specialists and their training, as well as to the correct planning and use of economic and human resources. AIM: To determine the real demand, predominant disorders and usefulness of complementary examinations with a view to determining the need for neuropediatric care in a general hospital. MATERIALS AND METHODS: Descriptive, retrospective study of patients attending the neuropediatric department for the first time during a 7-year period and for follow-up visits during a 4-year period. The periods were randomly selected. RESULTS: During this period 1130 children, generating 5033 consultations, were assessed. The total number of visits amounted to 25% of all consultations in the Pediatric Department, involving 31% of the children under 14 years of age in the pediatric population of Segovia. The overall rate of reexaminations/new patients was 3.4. The most frequent diagnosis was headache (32%), followed by non-epileptic paroxysms, febrile convulsions and epilepsy. The disorders requiring the greatest number of follow-up consultations were epilepsy (20%), headache (9%) and febrile convulsions (5%). The rate of reexamination/new patients was significantly higher in pediatric cerebral palsy and epilepsy. Electroencephalogram was the most frequently requested complementary examination, followed by neuroradiological studies. CONCLUSIONS: Demand for neuropediatric care mainly involves headaches, epilepsy, convulsions, non-epileptic paroxysmal disorders, and neonatal neurology in the first years of life. Pressure on neuropediatric departments is great due to the number of patients attending consulting rooms because of functional or self-limiting disorders. This pressure could be reduced by appropriate neurological training of general pediatricians or family doctors.

Trombosis de seno sigmoide como complicación de otitis media / Sigmoid sinus thrombosis as a complication of otitis media

Las complicaciones de la otitis media son relativamente infrecuentes, en particular desde el empleo de antimicrobianos eficaces y la introducción de técnicas quirúrgicas específicas. Se presenta un caso de seudotumor cerebral por trombosis del seno sigmoide izquierdo como complicación intracraneal de una otitis media, revisando las diferentes formas clínicas de trombosis del seno sigmoide y sus opciones terapéuticas (AU)