Taquipnea en un recién nacido macrosómico. Parálisis diafragmática de causa obstétrica / Macrosomic newborn tachypnea. Diaphragmatic paralysis

La parálisis diafragmática está originada por una lesión del nervio frénico, y su causa predominante en pediatría es el traumatismo durante el parto, especialmente en fetos macrosómicos. La asociación con la parálisis braquial orienta la sospecha diagnóstica, pero hay que tener en cuenta que hasta un 25% de los casos se presentan sin daño en el plexo braquial. Los síntomas pueden ser variables y aparecer inmediatamente tras el parto o durante el periodo neonatal. La radiografía muestra una elevación del hemidiafragma afectado, aunque el diagnóstico de confirmación se realiza con la ecografía en modo M. El manejo habitualmente es conservador, con aportes suplementarios de oxígeno o ventilación no invasiva (CPAP), y los pacientes e recuperan espontáneamente en la mayoría de los casos, aunque en ocasiones es necesario el tratamiento quirúrgico (plicatura) (AU)

The diaphragmatic paralysis is caused by a lesion of the phrenic nerve, being the predominant cause in pediatrics during birth, especially in macrosomic fetus. The relationship with brachial palsy, aids the diagnostic suspicion, but we have to take into account that up to 25% of the cases are shown without brachial plexus injury. Symptoms are variable and may appear immediately after delivery or later in the neonatal period. Chest x-rays show an elevation of the affected hemi-diaphragm. The diagnosis is confirmed by M-mode sonography. The management commonly is conservative (oxygen or CPAP), with spontaneous recovery in most cases, although surgical plication is required in some cases (AU)

Neumotórax recidivante: su relación con el déficit de alfa1-antitripsina / Recurrent pneumothorax: its association with alpha-1 trypsin deficiency

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Ácidos grasos trans, cops y lops: evidencia actual de su influencia sobre la salud infantil / Trans fatty acids, cholesterol oxidation products and lipid oxidation products: current evidence of their influence on the health of children

Una de las preocupaciones del pediatra es la prevención de la enfermedad del adulto a través de la nutrición del niño. La aterosclerosis, una de las principales causas de morbimortalidad actual, se origina ya en la infancia, y uno de sus factores predisponentes es la dieta. En ella, se encuentran algunos productos grasos menos conocidos, como son los ácidos grasos trans, así como los productos de oxidación del colesterol y otros lípidos, que parecen tener efectos nocivos importantes sobre el organismo, y cuyo consumo debería limitarse ya desde la infancia precoz

The prevention of adult disease through childhood nutrition is one of the aims of the paediatrician. It is well known that atherosclerosis is among the major causes of morbidity and mortality, and nutrition is one of its etiologic factors. Our daily diet provides certain lesser known fat products, such as trans fatty acids, cholesterol oxidation products and other lipid oxidation products, that may have detrimental effects on the human body, and their intake through the diet should be limited from early childhood

Addison disease after appendicitis.

A 14-year-old boy manifested acute abdominal pain, vomiting, high temperature and diarrhea. He also underwent increasing hyponatremia and hyperkalemia after appendectomy. Further testing confirmed Addison disease. The serum adrenal antibody test was positive, and other autoimmune diseases were excluded.

Hepatitis C virus infection in children.

The prevalence of hepatitis C virus (HCV) infection is relatively low in childhood, with anti-HCV prevalence rates of 0.1-0.4% in the Western world. To date, blood transfusion has been the principal route of acquisition of HCV in children, but there is evidence that vertical transmission is overtaking it. The overall risk of vertical perinatal transmission of HCV is about 5%, although it increases with HIV co-infection and higher maternal viraemia. The mode of delivery and breastfeeding do not seem to affect the vertical transmission of HCV. Diagnosis of perinatal transmission relies on determination of ALT levels and the presence of HCV after the second month, while maternal anti-HCV antibodies may persist until 18 months of life. After infancy, a variable percentage of perinatally infected children are anti-HCV negative; thus, detection of HCV-RNA is necessary for accurate diagnosis. The natural history of HCV in childhood is not well understood and the outcome depends on host and viral factors. The rate of progression to chronicity is about 60-80% in both post-transfusion and vertically acquired HCV infection. Compared with adult patients, chronic hepatitis C in children is characterized by both low ALT levels and low viral load, as well as by the mildest histological and immunohistochemical forms of chronic hepatitis. The prognosis is usually worse in multitransfused, thalassaemic children and those who have had cancer. Experience of treatment of chronic hepatitis C in children is limited, with about 40% having a sustained response to the interferon therapy. It is necessary to perform long-term follow-up and multicentre treatment studies to improve knowledge of the natural history of HCV in children, as well as that of the efficacy of anti-viral therapy in childhood.

[Usefulness of etiologic studies in children hospitalized for pneumonia]. / Utilidad de los estudios etiológicos en pacientes pediátricos hospitalizados por neumonía.

OBJECTIVE: The aims of this study were: 1) To assess the effectiveness of viral culture and serology. 2) To check if there are clinical differences between patients with viral or bacterial infections. 3) Assessment of treatment, previous to and during the hospital stay. PATIENTS AND METHODS: A prospective study was carried out between January 1994 and June 1995 on 56 inpatients diagnosed of pneumonia. The mean age was 3 years (range: 2 months- 14 years). Viral cultures on cell monolayers was carried out in 46 patients. Serology was carried out in 33 patients older than six months of age. Blood cultures were obtained in 27 patients and a tuberculine reaction was studied in 15 patients. On the basis of microbiological results, three groups were formed (viral, bacterial and unknown) and clinical symptoms, thorax X-rays, and laboratory data were compared. RESULTS: The etiologic agent was detected in 36 patients (64%). The most frequent pathogens detected were adenovirus and respiratory syncytial virus with 11 patients (19%) each, followed by Mycoplasma pneumoniae with 9 patients (16%): Viral cultures were positive in 16 patients (35%) and serology in 22 patients (66%). Viral infection was detected in 20 patients (36%) and bacterial infection in 16 (28%). Mixed infection (bacterial/viral) was found in 5 patients (9%). The patients with viral infections showed significant differences (p < 0.01) for age (younger) and tachypnea compared with those with bacterial infections. Sixty-six percent of the patients had received antibiotic treatment previous to hospital admission and 87% during their hospitalization. CONCLUSIONS: Although the etiologic studies were positive in 64% of the patients, the delay in obtaining the results make them scarcely useful in determining whether to initiate or not antibiotic therapy (87% of inpatients). Clinical data, radiology results and leukocyte counts do not show any difference between viral and bacterial infections.