Paediatric stroke in the northern Spanish region of Aragon: incidence, clinical characteristics, and outcomes.

BACKGROUND: Recent years have seen considerable changes in the prevention and treatment of acute ischaemic stroke in adult patients. However, the low incidence of paediatric stroke makes the development of specific guidelines more challenging. This study aims to clarify the situation of these children in our region in order to establish a regional protocol to improve the care provided to these patients. METHODS: We performed a regional incidence study of pediatric stroke (≤ 15 years of age) in Aragon, Spain (1308728 population, 15% aged ≤ 15 years) between 2008 and 2019. Data were obtained from hospital discharge records, including deaths, from the regional health service of Aragón, according to ICD codes for cerebrovascular disease. We analysed demographic, clinical, diagnostic/therapeutic, and prognostic variables. RESULTS: A total of 21 events were recorded: 8 ischaemic (38.1%) and 13 haemorrhagic strokes (61.9%). The mean age (SD) was 9.3 years (1.0). The sample included 12 boys and nine girls. No statistically significant differences were found between ischaemic and haemorrhagic strokes, except in the chief complaint (language and motor impairment in ischaemic stroke and headache in haemorrhagic stroke). None of the patients with ischaemic stroke received reperfusion therapies. Including the 3 patients who died during hospitalisation, eight patients (42.1%) had modified Rankin Scale scores > 2 at 12 months. Motor deficits were the most common sequela (n=9). CONCLUSION: Though infrequent, paediatric stroke has an important functional impact. In Spain, Madrid was the first region to adapt the existing code stroke care networks for adult patients. In Aragon, this review has enabled us to work closely with the different stakeholders to offer a care plan for acute paediatric ischaemic stroke. Nevertheless, prospective national registries would be valuable to continue improving the care provided to these patients.

Point-of-care ultrasound after attempted suicidal hanging.

Focused cardiac ultrasound (FoCUS) can provide critical information quickly to determine the etiology after cardiac arrest and may expedite a diagnosis in order to identify underlying treatable causes. We present a case of reversible acute left ventricular dysfunction after cardiopulmonary resuscitation following attempted suicide by hanging presenting with severe hypoxemia. FoCUS revealed findings consistent with severe left ventricular dysfunction, and point-of-care ultrasound (PoCUS) ruled out pneumothorax. These findings, in conjunction with the clinical presentation, facilitated an early identification and rapid evaluation of cardiogenic shock; furthermore, they led to the use of FoCUS, which can provide critical information quickly on site for a patient who is suddenly symptomatic after severe mechanical asphyxia in the pediatric emergency department, pediatric intensive care unit, or the prehospital setting.

Patología neurológica en una unidad de cuidados intensivos pediátricos de tercer nivel. Evolución funcional. Nuestra experiencia / Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience

INTRODUCCIÓN: La enfermedad neurológica representa una parte importante en las unidades de cuidados intensivos pediátricos (UCIP) y es causa de morbimortalidad. El objetivo de este trabajo es analizar la evolución funcional del niño crítico con enfermedad neurológica. MATERIAL Y MÉTODO: Estudio retrospectivo descriptivo, de niños con enfermedad neurológica ingresados en una UCIP durante 3 años (2012-2014), valorando pronóstico vital y funcional, al alta y al año del ingreso, según las Categorías de estado general y cerebral pediátrico (CEGP-CECP) y la Escala de estado funcional (FSS). Los resultados se comparan con nuestros datos previos (años 1990-1999) y con los del estudio multicéntrico internacional PANGEA. RESULTADOS: Se estudió a 266 niños. La mortalidad fue del 3%, sin que los modelos PRISM-II y PIM2 muestren capacidad predictiva. La salud funcional refleja empeoramiento clínicamente significativo al alta de UCIP, en el 30% según CEGP, en el 15% según CECP y en el 5% según FSS. Transcurrido un año, la funcionalidad mejora según CEGP-CECP, pero no según FSS. Los niños sin enfermedad neurológica de base presentan afectación funcional en mayor porcentaje, que se mantiene en el tiempo. Comparada con nuestros datos previos, la mortalidad global y neurocrítica disminuye (5,60 vs. 2,1%; p = 0,0003 y 8,44 vs. 2,63%; p = 0,0014, respectivamente). En relación con el estudio multicéntrico PANGEA, tanto la mortalidad como el empeoramiento funcional cerebral del niño neurocrítico son menores en el estudio actual (1,05 vs. 13,32%; p < 0,0001 y 10,47 vs. 23,79%; p < 0,0001, respectivamente). CONCLUSIONES: Alrededor de un tercio de los niños críticos muestran enfermedad neurológica. Un porcentaje importante, sobre todo de niños sin enfermedad neurológica basal, presenta repercusión funcional clínicamente significativa al alta de UCIP y transcurrido un año. La repercusión en el pronóstico funcional del niño crítico apoya la importancia de la neuromonitorización y neuroprotección, medidas necesarias para mejorar la asistencia del niño crítico y la valoración evolutiva de la salud funcional

INTRODUCTION: Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. MATERIAL AND METHODS: Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. RESULTS: A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P = .0003, and 8.44 vs. 2.63%, P = .0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P < .0001, and 10.47% vs. 23.79%, P < .0001, respectively). CONCLUSIONS: Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care

Valoración funcional tras tratamiento neurointensivo pediátrico. Nueva escala de estado funcional (FSS) / Functional assessment of a series of paediatric patients receiving neurointensive treatment: New Functional status scale

INTRODUCCIÓN: La salud funcional, parámetro adecuado de morbilidad, debería constituir un estándar pronóstico de las unidades de cuidados intensivos pediátricos (UCIP), siendo fundamental el desarrollo de escalas para su valoración. Las categorías de estado global y cerebral pediátrico (CEGP-CECP) se han empleado clásicamente en estudios pediátricos; el desarrollo de la nueva Escala de estado funcional (FSS) busca mejorar la objetividad. El objetivo del trabajo es comprobar si la escala FSS es un instrumento válido frente a la clásica CEGP-CECP, y si, incluso, posee mejores cualidades evaluadoras de la funcionalidad neurológica. PACIENTES Y MÉTODO: Estudio retrospectivo descriptivo de los 266 niños con enfermedad neurológica ingresados en la UCIP durante 3 años (2012-2014). Se valora su salud funcional al alta y tras un año del ingreso en UCIP, según las categorías CEGP-CECP y la nueva FSS, comparando ambas escalas mediante análisis de correlación (Rho de Spearman). RESULTADOS: La comparación de varianzas de FSSglobal en cada intervalo de CEGP muestra buena correlación para todas las comparaciones (p < 0,001), excepto en la categoría «5 = coma-vegetativo». La dispersión de FSSglobal aumenta a medida que lo hace la categoría CEGP. La correlación es similar en la versión neurológica de ambas escalas. DISCUSIÓN: La nueva escala FSS parece ser un método útil para evaluar salud funcional en nuestro medio, tras su comparación con las clásicas categorías CEGP-CECP. La dispersión de los valores de la escala FSS indica falta de precisión del sistema CEGP-CECP, comparado con la nueva escala FSS, más desglosada y objetiva

INTRODUCTION: Functional health, a reliable parameter of the impact of disease, should be used systematically to assess prognosis in paediatric intensive care units (PICU). Developing scales for the assessment of functional health is therefore essential. The Paediatric Overall and Cerebral Performance Category (POPC, PCPC) scales have traditionally been used in paediatric studies. The new Functional Status Scale (FSS) was designed to provide more objective results. This study aims to confirm the validity of the FSS compared to the classic POPC and PCPC scales, and to evaluate whether it may also be superior to the latter in assessing of neurological function. PATIENTS AND METHOD: We conducted a retrospective descriptive study of 266 children with neurological diseases admitted to intensive care between 2012 and 2014. Functional health at discharge and at one year after discharge was evaluated using the PCPC and POPC scales and the new FSS. RESULTS: Global FSS scores were found to be well correlated with all POPC scores (P < .001), except in category 5 (coma/vegetative state). Global FSS score dispersion increases with POPC category. The neurological versions of both scales show a similar correlation. DISCUSSION: Comparison with classic POPC and PCPC categories suggests that the new FSS scale is a useful method for evaluating functional health in our setting. The dispersion of FSS values underlines the poor accuracy of POPC-PCPC compared to the new FSS scale, which is more disaggregated and objective

Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience. / Patología neurológica en una unidad de cuidados intensivos pediátricos de tercer nivel. Evolución funcional. Nuestra experiencia.

INTRODUCTION: Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. MATERIAL AND METHODS: Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. RESULTS: A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P=.0003, and 8.44 vs. 2.63%, P=.0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P<.0001, and 10.47% vs. 23.79%, P<.0001, respectively). CONCLUSIONS: Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care.

Functional assessment of a series of paediatric patients receiving neurointensive treatment: New Functional status scale. / Valoración funcional tras tratamiento neurointensivo pediátrico. Nueva escala de estado funcional (FSS).

INTRODUCTION: Functional health, a reliable parameter of the impact of disease, should be used systematically to assess prognosis in paediatric intensive care units (PICU). Developing scales for the assessment of functional health is therefore essential. The Paediatric Overall and Cerebral Performance Category (POPC, PCPC) scales have traditionally been used in paediatric studies. The new Functional Status Scale (FSS) was designed to provide more objective results. This study aims to confirm the validity of the FSS compared to the classic POPC and PCPC scales, and to evaluate whether it may also be superior to the latter in assessing of neurological function. PATIENTS AND METHOD: We conducted a retrospective descriptive study of 266 children with neurological diseases admitted to intensive care between 2012 and 2014. Functional health at discharge and at one year after discharge was evaluated using the PCPC and POPC scales and the new FSS. RESULTS: Global FSS scores were found to be well correlated with all POPC scores (P<.001), except in category 5 (coma/vegetative state). Global FSS score dispersion increases with POPC category. The neurological versions of both scales show a similar correlation. DISCUSSION: Comparison with classic POPC and PCPC categories suggests that the new FSS scale is a useful method for evaluating functional health in our setting. The dispersion of FSS values underlines the poor accuracy of POPC-PCPC compared to the new FSS scale, which is more disaggregated and objective.

Cerebelitis aguda en Pediatría: nuestra experiencia / Acute cerebellitis in paediatric patients: Our experience

Introducción: La cerebelitis aguda es una rara afección inflamatoria con curso clínico muy variable: desde proceso autolimitado benigno hasta presentación fulminante con riesgo vital por compresión de fosa posterior, hidrocefalia aguda e hipertensión endocraneal. Métodos: Revisión de los hallazgos clínicos, analíticos y radiológicos de niños diagnosticados de cerebelitis aguda en el periodo comprendido entre mayo del 2007 y noviembre del 2016. Se analizan los tratamientos empleados y la evolución clínica y radiológica. Resultados: Nueve niños cumplían criterios de cerebelitis. La cefalea, los vómitos y la somnolencia fueron los síntomas de presentación más frecuentes; la ataxia, la disartria y la dismetría fueron los signos cerebelosos más frecuentes. La resonancia magnética fue el método diagnóstico mostrando afectación cerebelosa (uni o bilateral), mientras que la tomografía computarizada fue normal o solo mostraba signos indirectos como hidrocefalia triventricular por compresión extrínseca del acueducto de Silvio. Los corticoides fueron el tratamiento más empleado, administrados en 6 de los pacientes. Un paciente requirió intervención quirúrgica por hidrocefalia triventricular. Ocho pacientes tuvieron recuperación completa, mientras que uno presenta déficits neurológicos. Conclusiones: La cerebelitis es una urgencia médico-quirúrgica. Precisa un alto índice de sospecha y la realización de resonancia magnética cerebral urgente. Es un síndrome clínico-radiológico: encefalopatía aguda o subaguda, con hipertensión endocraneal y síndrome cerebeloso junto a hiperintensidad en córtex cerebeloso (uni o bilateral) en secuencias T2 y FLAIR y posible dilatación triventricular. El tratamiento es con corticoides a dosis altas y puede precisar derivación ventricular externa y cirugía descompresiva

Introduction: Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. Methods: We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. Results: Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. Conclusions: Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery

Acute cerebellitis in paediatric patients: Our experience. / Cerebelitis aguda en Pediatría: nuestra experiencia.

INTRODUCTION: Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. METHODS: We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. RESULTS: Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. CONCLUSIONS: Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery.

Experiencia con la hoja de información de «epilepsia en la infancia» / Experience with the information sheet of «epilepsy in infancy»

Introducción. En la sección de neuropediatría, se trabaja con hojas de información que pretenden explicar de forma rigurosa los problemas y su seguimiento. La de «la epilepsia en la infancia» se entrega cuando existe sospecha o diagnóstico certero de epilepsia. Método. Se analiza, a través de unas encuestas, el grado de satisfacción y las percepciones de los padres o tutores que recibieron dicha hoja. Resultados. 658 pacientes recibieron la hoja de información desde febrero de 2012 hasta diciembre de 2014. La tasa de respuesta es del 56,8%. El 63,10% de los pacientes que recibieron la hoja de información tenían un diagnóstico definitivo de epilepsia. Un 92,7% está satisfecho de haber recibido la hoja. Solo un 0,3% de los pacientes hubiera preferido no recibir la hoja de información. Conclusiones. La mayoría de padres o tutores de los pacientes con sospecha o diagnóstico de epilepsia se mostraron satisfechos por recibir la hoja de información. La hoja de información de «epilepsia en la infancia» mejora la información y la satisfacción percibida y su evaluación para corregir y mejorar, es necesaria en el proceso de mejora que no tiene punto final (AU)

Introduction. In the Pediatric Neurology service, we work with fact sheets that aim to rigorously explain the problems and their follow—up. The «epilepsy in childhood» fact sheet is given when there is suspicion or accurate diagnosis of epilepsy. Methods. The degree of satisfaction and the perceptions of the parents or guardians who received this sheet were analyzed through surveys. Results. 658 patients received the fact sheet from February 2012 to December 2014. The response rate was 56.8%. 63.10% of the patients who received the information sheet had a definitive diagnosis of epilepsy. 92.7% are satisfied to have received the sheet. Only 0.3% of the patients would have preferred not to receive the fact sheet. Conclusion. The majority of parents or guardians of patients with suspected or diagnosed epilepsy were satisfied by receiving the fact sheet. The «epilepsy in childhood» fact sheet improves information and perceived satisfaction, and its evaluation (to correct and improve it) is necessary in the continua] improvement process (AU)

La Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Miguel Servet de Zaragoza en el año 2015 / The pediatric intensive care unit of the Hospital Universitario Miguel Servet of Zaragoza in the year 2015

El presente documento representa un resumen de la organización actual de la Unidad de Cuidados Intensivos Pediatricos (UCIP). Describiremos la historia y actividad asistencial de nuestra Unidad así como la actividad docente de grado, la formación especializada en Pediatría y la formacion continuada. Se comentaran los proyectos de investigación y los de mejora de calidad y las actividades para fomentar la humanizacion dc nuestra asistencia (AU)

This document represents a summary of the current organization of the Pediatric Intensive Care Unit (PICU). We will describe the history, and clinical and grade educational activities, pediatric specialized formation and continuous training. We will comment research projects, healthcare quality improvement and activities to encourage humanization of our assistance (AU)

Taponamiento cardíaco: valor de la ecocardiografía en una Unidad de Cuidados Intensivos Pediátricos / Cardiac tamponade: Role of echocardiography in a Pediatric Intensive Care Unit

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Paracetamol y fallo hepático agudo, ¿la gota que colma el vaso? / Acetaminophen and acute liver failure, was it the last thing needed?

El fallo hepático agudo (FHA) es una patología poco frecuente, pero fatal en pediatría. Su segunda causa más habitual es la tóxica, y el paracetamol es el agente más frecuente en esta edad, incluso en una dosis adecuada. Presentamos 2 casos de FHA sin etiología clara, en los que el paracetamol pudo ser determinante. El primer caso corresponde una lactante con bronquiolitis complicada con sobreinfección bacteriana, que presenta un fallo hepático agudo atribuido a una posible idiosincrasia del paracetamol, favorecida por una hipoperfusión hepática, desestimando la inestabilidad hemodinámica como única causa, dado su carácter leve y tardío. El segundo caso corresponde a otra lactante que desarrolló un FHA en el contexto de una deshidratación hipernatrémica por una gastroenteritis aguda; su estudio metabólico era compatible con un déficit de 3-OH metilglutaril-CoA liasa (no confirmado en el estudio molecular), considerándose una posible inhibición de la betaoxidación agravada por paracetamol (idiosincrasia) y favorecida por una hipoperfusión hepática ante una deshidratación severa. En ambos casos se empleó N-acetilcisteína (NAC) como parte del tratamiento del FHA y la evolución fue favorable. La acumulación del metabolito tóxico del paracetamol en un hígado previamente dañado, puede empeorar su función. Se deben solicitar sus niveles ante un FHA en los pacientes que han recibido este fármaco, considerando su toxicidad en función del tiempo transcurrido tras la administración. El tratamiento con NAC puede ser beneficioso en todo paciente con FHA (AU)

Acute liver failure (ALF) in children is a rare but often fatal condition. Drugs are the second most common identified cause in most of the series in children. Acetaminophen is the most frequent agent in these patients, even when it is administered in correct dosage. We present two acute liver failure cases without evident cause, in which acetaminophene could be a determinant agent. An infant with bronchiolitis complicated with bacterial sobreinfection, who presents ALF. ALF is attributed to possible acetominophen idiosyncrasy, enhanced by hepatic hypoperfusion; rejecting hemodynamic instability as the only cause because its mild and late nature. Another infant who presents ALF in context of hypernatremic dehidratation secondary to acute gastroenteritis. Metabolic study is compatible with a deficit of 3-OH methyl-glutaryl-CoA lyase (not confirmed by molecular study). It is considered possible b-oxidation inhibition exacerbated by acetaminophen (idiosyncrasy) and enhanced by liver hypoperfusion due to severe dehydration. In both cases, we use N-acetylcysteine (NAC) as part of ALF treatment; the course is favorable, normalizing liver function. The accumulation of acetaminophen toxic metabolite in a previously damaged liver can worsen its function. We must request its level in every patient with ALF who have received this drug, given its toxicity based on the time after administration. The administration of NAC to children with ALF not caused by acetaminophen toxicity appeared to be safe and may be associated with a better outcome (AU)

Hidrocefalia obstructiva transitoria como complicación de traumatismo craneoencefálico / Transient obstructive hydrocephalus following traumatic brain injury

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Tromboembolismo pulmonar en paciente afectado de nefropatía lúpica / Pulmonary thromboembolism in a child with lupus nephropathy

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Síndrome neuroléptico maligno y reacción a oxcarbazepina en un paciente pediátrico / Neuroleptic malignant syndrome and adverse reaction to oxcarbazepine in a pediatric patient

Puesto que la prescripción de antipsicóticos o neurolépticos está siendo cada vez más frecuente en la población pediátrica con trastornos neurológicos en politerapia, es interesante tener presente un cuadro tan infrecuente y potencialmente grave como el síndrome neuroléptico maligno, así como otras posibles reacciones adversas a medicamentos. Describimos el caso de un paciente pediátrico que desarrolló un síndrome neuroléptico maligno secundario a haloperidol y/o risperidona, al que pudo sumarse una reacción adversa medicamentosa a oxcarbazepina, con una evolución favorable(AU)

Since the prescription of antipsychotic or neuroleptic medications are becoming more common in the pediatric population under polytherapy with neurological disorders is interesting to take into account this rare and potentially serious neuroleptic malignant syndrome and other possible adverse reactions to drugs. We describe a pediatric patient who developed neuroleptic malignant syndrome secondary to haloperidol/risperidone and a possible adverse reaction to oxcarbazepine(AU)

Estudio retrospectivo de factores de riesgo de transmisión vertical de infección por virus hepatitis C / Retrospective study of risk factors of vertical transmission of hepatitis C virus

Introducción: A pesar de la baja prevalencia infantil de infección por virus hepatitis C (VHC) y su leve clínica inicial, la infección crónica puede evolucionar a cirrosis y/o hepatocarcinoma. Es fundamental controlar su transmisión vertical. Los últimos estudios describen hasta 50% de transmisiones intraútero. Material y métodos: Estudiamos retrospectivamente 17 casos de infección por VHC en 8 años, analizando los factores de riesgo de transmisión vertical, para aplicar prevención primaria. Resultados: Solo la adicción a drogas vía parenteral muestra riesgo significativo, sin ser la coinfección VIH factor de confusión. La carga viral, la coinfección por VIH, la disfunción hepática y el tiempo de evolución de infección no muestran mayor riesgo. La cesárea, la amniocentesis y la monitorización interna pueden ser factores de riesgo (sin significación estadística), pero no las horas de amniorrexis. La lactancia materna muestra protección. Conclusiones: Pese a la importancia frecuentemente atribuida, el efecto de la carga viral sobre el riesgo de transmisión no está claramente establecido: la ausencia de viremia no descarta el riesgo de transmisión, ya que la detección de ARN viral puede ser intermitente, y por tanto, los datos al respecto deben interpretarse con cautela. La inmunosupresión secundaria a la coinfección por VIH supone mayor riesgo de transmisión, pero dicho efecto disminuye al mejorar la capacidad inmune gracias al tratamiento antirretroviral. Respecto a las características del parto, el tiempo transcurrido tras la rotura de membranas no ha mostrado ser factor de riesgo; y se desestima la cesárea como forma óptima y electiva de finalizar la gestación de estas mujeres. La lactancia materna, lejos de suponer mayor riesgo de transmisión, puede ser protectora. La escasa carga viral en la leche, su inactivación por el pH ácido gástrico y sus beneficios inmunológicos justificarían este resultado. Dadas las limitaciones de los estudios retrospectivos, es necesario plantear análisis prospectivos para conocer mejor el papel de los posibles factores de riesgo y establecer pautas claras de prevención; de momento, es fundamental el control evolutivo de todos los hijos de madres con infección por el VHC (AU)

Introduction: Despite the low prevalence of paediatric HCV infection and its initial mild clinical expressiveness, chronic infection could progress into cirrhosis and/or hepatocarcinoma. It is essential to control vertical transmission. Recent studies show that up to 50% of transmissions occur within the uterus. Material y methods: A retrospective study was conducted on 17 cases of (Hepatitis C virus) HCV infection registered over a period of 8 years. Vertical transmission risk factors were analysed, in order to introduce primary prevention. Results: Only parenteral drug addiction significantly increased the rate of HCV transmission; HIV co-infection was not a confounding factor. HCV viremia, HIV co-infection, liver dysfunction and/or duration of the infection did not appear to affect the rate of transmission. Caesarean section, amniocentesis and internal monitoring may be risk factors (not statistically significant), but not prolonged vaginal delivery after amniotic membrane rupture. Breastfeeding showed protection. Conclusions: The effect of viremia on the risk of transmission is not clearly established, despite the importance usually attributed. Lack of viremia does not discount the risk of transmission, due to viral RNA detection can be intermittent, so it should be interpreted cautiously. Immunosuppression secondary to HIV co-infection implies a higher risk of transmission, but this effect decreases by improving immune competence by antiretroviral treatment. With regard to the birth characteristics, time after the rupture of membranes has not shown being a risk factor; being the caesarean not advisable as a good alternative to finish the pregnancy. Breastfeeding does not increase the risk, even it can be protective. This results would be justified by the low viral content of milk, its inactivation by gastric pH and its immunological benefits. Given that retrospective studies results are limited, prospective studies need to be carried out in order to improve the understanding of the role of possible risk factors and to provide a clear preventive guidelines. At the moment it is essential to control all the children born of mothers with HCV infection (AU)

[Retrospective study of risk factors of vertical transmission of hepatitis C virus]. / Estudio retrospectivo de factores de riesgo de transmisión vertical de infección por virus hepatitis C.

INTRODUCTION: Despite the low prevalence of paediatric HCV infection and its initial mild clinical expressiveness, chronic infection could progress into cirrhosis and/or hepatocarcinoma. It is essential to control vertical transmission. Recent studies show that up to 50% of transmissions occur within the uterus. MATERIAL AND METHODS: [corrected] A retrospective study was conducted on 17 cases of (Hepatitis C virus) HCV infection registered over a period of 8 years. Vertical transmission risk factors were analysed, in order to introduce primary prevention. RESULTS: Only parenteral drug addiction significantly increased the rate of HCV transmission; HIV co-infection was not a confounding factor. HCV viremia, HIV co-infection, liver dysfunction and/or duration of the infection did not appear to affect the rate of transmission. Caesarean section, amniocentesis and internal monitoring may be risk factors (not statistically significant), but not prolonged vaginal delivery after amniotic membrane rupture. Breastfeeding showed protection. CONCLUSIONS: The effect of viremia on the risk of transmission is not clearly established, despite the importance usually attributed. Lack of viremia does not discount the risk of transmission, due to viral RNA detection can be intermittent, so it should be interpreted cautiously. Immunosuppression secondary to HIV co-infection implies a higher risk of transmission, but this effect decreases by improving immune competence by antiretroviral treatment. With regard to the birth characteristics, time after the rupture of membranes has not shown being a risk factor; being the caesarean not advisable as a good alternative to finish the pregnancy. Breastfeeding does not increase the risk, even it can be protective. This results would be justified by the low viral content of milk, its inactivation by gastric pH and its immunological benefits. Given that retrospective studies results are limited, prospective studies need to be carried out in order to improve the understanding of the role of possible risk factors and to provide a clear preventive guidelines. At the moment it is essential to control all the children born of mothers with HCV infection.