Influencia de la asistencia a guarderías en la frecuentación en Urgencias y Atención Primaria / Influence of nursery attendance in Emergency and Primary Care frequentation

Introducción: las guarderías surgen para atender una necesidad social, pero no están exentas de influir sobre la salud infantil. Pacientes y métodos: estudio longitudinal prospectivo de dos cohortes de niños entre 0 y 24 meses (se diferencian en asistencia o no a guardería) que acuden a las consultas de 33 pediatras del Servicio Público de Salud del Principado de Asturias. Los datos se obtuvieron de la historia clínica informatizada y entrevistas programadas (6, 12, 18 y 24 meses). Se compararon: número medio de visitas a Servicios de Urgencias y Pediatría e influencia de diferentes variables recogidas. Se analizaron: la morbilidad registrada (infecciones agudas y sibilancias recurrentes) entre hiperfrecuentadores (HF) y no HF. Resultados: el número medio de visitas a las consultas pediátricas es significativamente mayor para los niños que acuden a guardería en todos los tramos de edad estudiados. Hay mayor porcentaje de HF entre los que acuden a guardería: los niños de entre 0 y 6 meses que acuden tienen un riesgo relativo de ser HF a Servicios de Urgencias de hasta seis veces mayor que los que no acuden y cuatro veces mayor de ser HF en las consultas de Pediatría. Conclusiones: 1) la asistencia a guardería se asocia con mayor probabilidad de ser HF en Urgencias y en la consulta de Pediatría de Atención Primaria (AP); 2) los niños HF padecen más enfermedades respiratorias e infecciosas, que no son explicadas por su asistencia a guardería, y 3) lo anterior conlleva un mayor consumo de fármacos (AU)

Introduction: nurseries arise to attend a social need, but are not without influence on children’s health. Patients and methods: prospective longitudinal study of two cohorts of children aged 0-24 months (they differ in nursery assistance or not) who come to the consultations of 33 pediatricians at the Public Health Service of Asturias. The data were obtained from the clinical history and interviews scheduled (6, 12, 18 and 24 months). They were compared: average number of visits to Emergency and Paediatrics Services, and influence of different variables collected. We analyzed: the registered morbidity (acute infections and recurrent wheezing) between frequent attenders (HF) and not HF. Results: the average number of visits to pediatric visits is significantly higher for children attending kindergarten in all age groups studied. There is a higher percentage of HF among those attending nursery: children between 0 and 6 months that have a relative risk of HF to Emergency Services up to 6 times higher than those not attending and four times higher of being HF in consultations of a Primary Care center. Conclusions: 1) attendance at kindergarten is associated with increased probability of being HF in Emergency departments and Paediatrics Primary Care services; 2) the HF children suffer more respiratory and infectious diseases, which are not explained by their attendance at a nursery, y 3) the above carries a higher drug consumption (AU)

Uso de anticatarrales en menores de 14 años en consultas de Atención Primaria / Use of cold and cough medications prescribed in Primary Care clinics for children less than 14 years

OBJETIVO: Conocer el perfil de prescripción de anticatarrales en las consultas de Pediatría de Atención Primaria en el Área V del Servicio de Salud del Principado de Asturias y valorar su idoneidad. Material y métodos; Estudio transversal, descriptivo y retrospectivo. Se analizaron las prescripciones para el tratamiento de los procesos respiratorios en 6 consultas de Pediatría de Atención Primaria en el Área Sanitaria V del Servicio de Salud del Principado de Asturias en el año 2011. Se valoraron la idoneidad de los tratamientos prescritos mediante las fichas técnicas de los fármacos y las indicaciones clínicas según el diagnóstico, siguiendo las recomendaciones de guías clínicas, protocolos o en su defecto la bibliografía disponible más actual. RESULTADOS: Se analizaron 424 anticatarrales: 249 antitusígenos, 155 mucolíticos y 20 clasificados en otros. La media de edad de los pacientes es de 5 años. Un 85,1% de las prescripciones se consideran inadecuadas. El 11,6% de ellos fueron prescritos fuera de ficha técnica. Se consideraron inadecuados el 82,8% de los asociados al diagnóstico R74 y el 73% al R05. Todos los fármacos de los menores de 6 años se consideraron inadecuados. El 99,4% de los mucolíticos/otros y el 75,1% de los antitusígenos se consideraron inadecuados. CONCLUSIONES: Se observa un alto porcentaje de prescripción de fármacos anticatarrales en menores de 14 años en nuestro medio, encontrándose un 85% de las prescripciones inadecuadas. Los niños deberían recibir solo medicamentos con una relación beneficio-riesgo favorable; para ello es necesario mejorar la información sobre el uso pediátrico y promover acciones formativas dirigidas a los padres y a los profesionales sanitarios

OBJECTIVE:To evaluate cold and cough medications and their suitability in children in Primary Health Care in Area V of the Asturian Health Service. MATERIAL AND METHODS: A cross-sectional, descriptive and retrospective study was conducted in which an analysis was performed of the respiratory diseases and the prescriptions of 6 Primary Health Care paediatricians who worked in Area V of the Asturian Health Service in 2011. An evaluation was made on the suitability of these medications. An analysis was also made of the drug datasheet and clinical recommendations (clinical guidelines, protocols or reports). RESULTS: A total of 424 cold and cough drugs: 249 antitussives, 155 mucolytics, and 20 'others' were analyzed. The mean age was 5 years old. There was a total of 85.1% unsuitable prescriptions. Off-label drugs were used in 11.6%. The prescribing was considered unsuitable in 82.8% of prescriptions associated with R74, and 73% of R05. All of the prescription drugs in children under 6 years old were unsuitable. Mucolytics/'others' were not suitable in 99.4%, nor antitussives in 75.1%. CONCLUSIONS: There is a high level of cold and cough drugs being prescribed in children, with 85% of these being unsuitable. Children should only receive drugs with a good risk and benefit ratio. Pediatricians should try to improve the information about pediatric drug use and spread this information to parents, doctors and nurses

[Use of cold and cough medications prescribed in Primary Care clinics for children less than 14 years]. / Uso de anticatarrales en menores de 14 años en consultas de Atención Primaria.

OBJECTIVE: To evaluate cold and cough medications and their suitability in children in Primary Health Care in Area V of the Asturian Health Service. MATERIAL AND METHODS: A cross-sectional, descriptive and retrospective study was conducted in which an analysis was performed of the respiratory diseases and the prescriptions of 6 Primary Health Care paediatricians who worked in Area V of the Asturian Health Service in 2011. An evaluation was made on the suitability of these medications. An analysis was also made of the drug datasheet and clinical recommendations (clinical guidelines, protocols or reports). RESULTS: A total of 424 cold and cough drugs: 249 antitussives, 155 mucolytics, and 20 "others" were analyzed. The mean age was 5 years old. There was a total of 85.1% unsuitable prescriptions. Off-label drugs were used in 11.6%. The prescribing was considered unsuitable in 82.8% of prescriptions associated with R74, and 73% of R05. All of the prescription drugs in children under 6 years old were unsuitable. Mucolytics/"others" were not suitable in 99.4%, nor antitussives in 75.1%. CONCLUSIONS: There is a high level of cold and cough drugs being prescribed in children, with 85% of these being unsuitable. Children should only receive drugs with a good risk and benefit ratio. Pediatricians should try to improve the information about pediatric drug use and spread this information to parents, doctors and nurses.

Enfermedad infecciosa y consumo de recursos sanitarios en menores de 2 años que acuden a guarderías / Infectious diseases and use of health care resources in children less than 2 years-old who attend kindergarten

INTRODUCCIÓN Y OBJETIVOS: Los padres con frecuencia solicitan a los pediatras consejo acerca del mejor sistema para el cuidado de sus hijos. En la literatura existen discrepancias al respecto. El objetivo de este estudio es evaluar la influencia de la asistencia a la guardería sobre el riesgo de infecciones agudas y la utilización de recursos sanitarios en los niños menores de 24 meses. Población y métodos: Estudio longitudinal prospectivo de 2 cohortes de niños de 0-24 meses que se diferencian por la asistencia o no a la guardería, nacidos entre el 1 de enero y el 30 de septiembre de 2010 y que acuden habitualmente a las consultas de 33 pediatras del Servicio Público de Salud del Principado de Asturias. RESULTADOS Y CONCLUSIONES: Se estudiaron 975 niños. A los 24 meses acuden a la guardería el 43,7%. Asistir a guardería incrementa el riesgo de padecer neumonía en un 131%, el de sibilancias recurrentes en un 69%, el de bronquitis un 57% y el de otitis media en un 64%. La exposición temprana a la guardería incrementa el riesgo de neumonías de 2,31 a 2,81 y la media de visitas a urgencias desde 1 a 2,3. La media de ciclos de antibióticos es de 1,7 para los que no van a la guardería, de 3,4 si la inician en los 6 primeros meses y de 2 si comienzan a partir de los 18 meses. La asistencia a guarderías es un factor de riesgo de padecer enfermedades infecciosas que aumenta si asisten desde edades tempranas

INTRODUCTION AND OBJECTIVES: Parents often ask paediatricians for advice about the best way to care for their children. There are discrepancies in the literature on this subject. The objective of this study is to evaluate the influence of attending kindergartens on the risk of acute infections and the use of health care resources in children less than 24 months. Population and methods: A prospective longitudinal study was conducted on two cohorts of children 0-24 months (born between 1 January and 30 September 2010), who were grouped according to whether they attended kindergarten or not, and were usually seen in 33 pediatric clinics of the Principality of Asturias Public Health Service. RESULTS AND CONCLUSIONS: A total of 975 children were studied, of whom 43.7% attended a kindergarten at 24 months. Attending kindergarten increases the risk of pneumonia by 131%, recurrent wheezing by 69%, bronchitis by 57%, and otitis media by 64%. Early exposure to kindergarten increases the risk of pneumonia from 2.31 to 2.81, and the mean emergency room visits from 1 to 2.3. The mean antibiotic cycle is 1.7 in children who do not go to kindergarten, 3.4 if started within the first 6 months, and 2 if they start at 18 months. Day-care attendance is a risk factor of infectious diseases that increases if attending kindergartens from an early age

[Infectious diseases and use of health care resources in children less than 2 years-old who attend kindergarten]. / Enfermedad infecciosa y consumo de recursos sanitarios en menores de 2 años que acuden a guarderías.

INTRODUCTION AND OBJECTIVES: Parents often ask paediatricians for advice about the best way to care for their children. There are discrepancies in the literature on this subject. The objective of this study is to evaluate the influence of attending kindergartens on the risk of acute infections and the use of health care resources in children less than 24 months. POPULATION AND METHODS: A prospective longitudinal study was conducted on two cohorts of children 0-24 months (born between 1 January and 30 September 2010), who were grouped according to whether they attended kindergarten or not, and were usually seen in 33 pediatric clinics of the Principality of Asturias Public Health Service. RESULTS AND CONCLUSIONS: A total of 975 children were studied, of whom 43.7% attended a kindergarten at 24 months. Attending kindergarten increases the risk of pneumonia by 131%, recurrent wheezing by 69%, bronchitis by 57%, and otitis media by 64%. Early exposure to kindergarten increases the risk of pneumonia from 2.31 to 2.81, and the mean emergency room visits from 1 to 2.3. The mean antibiotic cycle is 1.7 in children who do not go to kindergarten, 3.4 if started within the first 6 months, and 2 if they start at 18 months. Day-care attendance is a risk factor of infectious diseases that increases if attending kindergartens from an early age.

Influencia de la asistencia a guarderías sobre la morbilidad en niños menores de 12 meses de edad / Influence of day care attendance on morbidity in children under 12 months of age

Introducción: la estructura actual de la sociedad española favorece la asistencia de los niños a guarderías infantiles a edades cada vez más tempranas. Esto es un factor de riesgo por sí solo para el padecimiento de infecciones del tracto respiratorio superior e inferior, otitis media aguda, infecciones gastrointestinales y otras infecciones. Objetivo: evaluar la influencia de la asistencia a la guardería sobre el riesgo de padecer infecciones en los niños menores de 12 meses de edad. Población y métodos: estudio longitudinal prospectivo. Se incluyeron en el estudio los niños nacidos entre el 1 de enero y el 30 de septiembre de 2010 que acuden a consulta de Pediatría de Atención Primaria. Se excluyeron los niños que presentaban patología respiratoria o cardiaca grave o inmunodeficiencias graves. Los datos se obtuvieron de la historia clínica informatizada y de las entrevistas en visitas programadas a los padres a los 6 y a los 12 meses. Para el análisis estadístico de los datos se utilizó el programa estadístico R® (R Development Core Team, 2011). Resultados: los niños que acuden a la guardería presentan más episodios infecciosos que los que no lo hacen, siendo estadísticamente significativas (p-valor <0,05) las diferencias respecto a bronquiolitis, bronquitis, conjuntivitis, faringoamigdalitis, gastroenteritis aguda, laringitis, neumonía, otitis media aguda, resfriado común, sibilancias, sinusitis y para el total de patologías. Los niños que asisten a guarderías tienen un riesgo dos o más veces mayor de padecer bronquiolitis, bronquitis, faringoamigdalitis y otitis media, que los que no acuden. Conclusión: teniendo en cuenta estos resultados, parece aconsejable intentar otras fórmulas diferentes para el cuidado de los niños en edades tempranas (AU)

Introduction: the current structure of Spanish society favors the attendance of children at day care to increasingly early ages. This is a risk factor in itself to the condition of infection of the upper and lower respiratory tract, as well as acute otitis media, gastrointestinal infections and other infections. Objective: to evaluate the influence of day care attendance on the risk of infections in children under 12 months of age. Population and methods: prospective longitudinal study. Children born between 1 January and 30 September 2010, attending primary care pediatrics’ offices, were included. We excluded children who had severe respiratory or cardiac disease or severe immune deficiency. The data were obtained from computerized medical records and interviews with parents in scheduled visits at 6 and 12 months. In the statistical analysis of the data the statistical software R© (R Development Core Team, 2011) was used. Results: children who attend day care have one or more infectious episodes in higher percentages with statistically significant (p-value <0.05) differences for bronchiolitis, bronchitis, conjunctivitis, tonsillopharyngitis, acute gastroenteritis, laryngitis, pneumonia, acute otitis media, common cold, wheezing, sinusitis and for total pathologies. Attendance at nursery could be responsible for between 35% and 50% of the acute otitis, gastroenteritis, bronchiolitis and bronchitis. Conclusion: taking into account these results, it seems advisable to try other different ways for the care of children in early ages (AU)

Consultas dermatológicas en pediatría de atención primaria / Dermatology consultations in primary care pediatrics

Las consultas por problemas dermatológicos son muy frecuentes en pediatría.Material y métodos: mediante un estudio descriptivo observacional realizado durantetodo el año 2008, que analiza las consultas pediátricas por causas dermatológicas, se obtuvieronlos motivos principales de las consultas, se cuantificó la tasa de resolución de éstas enel ámbito de la Atención Primaria y se elaboró un listado de procesos dermatológicos comoguía para futuras actividades formativas en dermatología pediátrica.Resultados: de un total de 21.748 consultas, 1.323 se debieron a procesos dermatológicos(6,1%). La categoría con mayor número de diagnósticos correspondió al grupo dermatitis/eczema con 438 consultas (33%), seguida de las infecciones víricas con 352 (26%), lasinfecciones bacterianas con 128 (10%) y las zoonosis con 118 (9%). Fueron derivados 75 niños(5,7% de las consultas) al servicio de dermatología.Conclusiones: concluimos que la mayoría de procesos dermatológicos de la infancia puedenser manejados en Atención Primaria, manteniendo una estrecha colaboración con los especialistasen dermatología para aquellas situaciones precisadas por el escenario clínico (AU)

Consultations for dermatological problems are very common in pediatrics.Material and methods: descriptive observational study along 2008, that analyzes dermatologicalcauses of visits in Primary Care pediatrics; the main reasons for consultations wereobtained, the rate of resolution in Primary Care was quantified and a list of dermatologicalprocesses was obtained as a guide oriented to pediatric dermatological formation.Results: of 21,748 visits, 1,323 were due to dermatological conditions (6.1%). The diagnosticgroups were: skin infections, dermatitis-eczema, urticaria, zoonosis, hair and nail disorders,pigmentation disorders and miscellaneous. The main causes of consultation were:dermatitis/eczema (33%), viral skin infections (26%), bacterial skin infections (10%) andzoonosis (9%); 75 children (5.7%) were referred to dermatologists Conclusions: most of pediatric dermatological conditions can be assessed in Primary Careas far as close collaboration with the dermatologist is provided for those situations that theclinical scenario demands (AU)

Síndrome auriculotemporal (síndrome de Frey) en dos lactantes con presentación bilateral / Auriculotemporal nerve syndrome (Frey syndrome) in two infants with bilateral presentation

El síndrome auriculotemporal (síndrome de Frey) se caracteriza por episodios de enrojecimiento facial, sudoración o ambos, localizados en el territorio de distribución del nervio auriculotemporal, y que ocurren como respuesta a estímulos gustativos. Cuando se manifiesta en la infancia y coincide con la introducción de nuevos alimentos en lactantes, se puede llegar al diagnóstico erróneo de alergia alimentaria. Presentamos dos lactantes (de 5 y 6 meses) con enrojecimiento facial bilateral en el área temporal, extendiéndose hasta el borde oral; ambos manifestaron los síntomas inmediatamente a la toma de fruta (y posteriormente tras un tipo de golosina en uno de los niños) con desaparición de cuadro instantes después del cese de la toma. Los dos niños eran fruto de un parto eutócico. En uno de ellos, los síntomas desaparecieron antes del año, mientras que el segundo aún tiene 7 meses y presenta episodios de intensidad variable. Es conveniente reconocer este síndrome para evitar exploraciones innecesarias y restricciones dietéticas improcedentes (AU)

Patients with auriculotemporal nerve syndrome (Frey syndrome) have facial flushing, sweating, or both located along the distribution of the auriculotemporal nerve, and that occurs in response to gustatory stimuli. As the condition usually manifests during infancy with the introduction of solid food, it can lead to the misdiagnosis of food allergy by physicians unfamiliar with this syndrome. Two boys (5 and 6 months old) presented with a history of bilateral facial flushing extending from the corner of the mouth to the temporal area. Symptoms began at the moment of fruit introduction (orange, pear, apple and banana) and also with some type of candy in the first. Symptoms appeared immediate to fruit mastication and cutaneous erythema spontaneously disappeared in a few minutes after finishing fruit. Both cases had been born without instrumental delivery. In one case the symptoms disappeared before the end of the first year of age, and the second (he?s now 7 months old) has symptoms discontinuously. The recognition of this entity might avoid unnecessary referral and laboratory evaluation (AU)

[Nemaline myopathy: apropos of a case]. / Miopatía nemalínica: A propósito de una observación.

Authors present a girl without familiar antecedents of consanguinity with mild motor deficiency, hypotonicity and obesity during infancy, with progressive posterior healing. The girl did not present Marfan's habit or special phenotype, and had small hypertrophy of calfs. There was not recurrent respiratory infections. EMG was myopathic and muscle dependent seric enzymes (CPK, ALD, LDH...) were normal. Radiographically films showed increased relationship fat-muscle and pathology by MO and ME confirmed the presence of small sticks in muscle fibers. After evaluating the case as a neomutation, the genetic counseling is made.