Sistema de vigilancia de infecciones respiratorias SiVIRA / SiVIRA respiratory infection surveillance system

El SiVIRA (Sistema de Vigilancia de Infección Respiratoria Aguda) es un sistema de vigilancia de las infecciones por virus de la gripe, virus SARS-CoV-2 y virus respiratorio sincitial (VRS), que permite evaluar la efectividad de las medidas de control y prevención establecidas. Ha sido desarrollado desde el año 2020, siendo sustentado en la experiencia acumulada en el Sistema de Vigilancia de la Gripe en España. La vigilancia, activa durante todo el año, se realiza en el ámbito de la Atención Primaria y en el de la Atención Hospitalaria. Son múltiples las fuentes de información en España, siendo las principales la vigilancia centinela de infección respiratoria aguda leve, en Atención Primaria, y grave, en hospitales, tanto de manera sistemática como de componente sindrómico. Otras fuentes son la investigación de brotes de gripe, la vigilancia virológica no centinela de gripe y VRS, el exceso de mortalidad o la vigilancia internacional. La población centinela en cada comunidad autónoma es aquella atendida por los médicos o centros centinela de Atención Primaria. En el caso de los hospitales centinela, cada uno estima la población de su área de referencia. Han sido publicados informes anuales de las temporadas 2020-2021 y 2021-2022, y disponemos de informes semanales correspondientes a las temporadas 2022-2023 y 2023-2024. En ellos se describen las sucesivas olas pandémicas por COVID-19, así como el comportamiento de las epidemias de gripe y VRS desde el inicio de aquellas.(AU)

SiVIRA is a system for the surveillance of influenza, SARS-CoV-2 and respiratory syncytial viruses (RSV) and the evaluation of established control and prevention measures’ effectiveness. It was developed in 2020, and has been supported by the accumulated experience of the Spanish Influenza Surveillance System. Surveillance, active throughout the year, is carried out in the area of Primary Care and Hospital Care. There are multiple sources of information in Spain, the main ones being sentinel surveillance of mild acute respiratory infection, in Primary Care, and severe, in hospitals, both systematically and with a syndromic component. Other sources are investigation of influenza outbreaks, non-sentinel virological surveillance of influenza and RSV, excess mortality or international surveillance. The sentinel population in each autonomous community are patients attended by Primary Care doctors or sentinel centers. In the case of sentinel hospitals, each one estimates the population of its reference area. Annual reports for the 2020-2021 and 2021-2022 seasons and weekly reports corresponding to the 2022-2023 and 2023-2024 seasons have been published.(AU)

[Impact of COVID-19s alarm states in the care of pediatric patients in Primary Care in a health area in northern Spain]. / Impacto de los estados de alarma por COVID-19 en la atención a pacientes pediátricos en Atención Primaria de un área sanitaria del norte de España.

AIM: The SARS-CoV-2 pandemic has meant a global change in the healthcare model, enhancing telematic assistance, specially at the Health Primary Care (PC). There are few studies that relate the attendance of children at the PC to the pandemic of COVID-19. The aim of our study is to describe the impact of the two Spanish states of alarm on the care of children at de PC level. MATERIAL AND METHODS: Retrospective observational study. The PC visits corresponding to pediatric patients (<14 years) from a health area in northern Spain during the first and second states of alarm were analyzed, and compared with their equivalent periods in 2019. RESULTS: During the first state of alarm, home lockdown and school closure were established, and a large decrease in pediatric visits to the health centres was observed (758 vs. 1381 in 2019) at the expense of health check-ups and infectious diseases. This decrease was not observed in the second state of alarm (1375 vs. 1233 in 2019). In both states of alarm, the percentage of telephone assistance increased significantly. CONCLUSIONS: The implementation of alarm states has meant a decrease on the demand of medical care, especially during the first state of alarm, may be owing to the fear of the families of going to the health center and the decrease in the transmissibility of viruses due to home lockdown. The increase of the telematic assistance has been on account of the need of reorganization of health care, wich has proven to be effective.

Asistencia a población infantil en una unidad de pediatría de atención primaria durante el estado de alarma por COVID-19. Eficacia de la asistencia telefónica y los circuitos específicos / Assistance to children in a Primary Care Pediatric Unit during the COVID-19 state of alarm. Effectiveness of telephone assistance and specific circuits

No disponible

Valoración de fuerza isométrica en extremidades inferiores y composición corporal en prematuros / Evaluation of isometric force in lower limbs and body composition in preterm infants

INTRODUCCIÓN: La fuerza es una cualidad con clara influencia sobre la calidad de vida. Está condicionada por la estructura del aparato locomotor y es directamente dependiente de la estructura muscular. Se ha descrito que ambas cualidades están condicionadas por la prematuridad. Son objetivos del estudio conocer si la prematuridad está relacionada con la fuerza o la composición corporal durante la infancia y valorar la relación entre prematuridad, fuerza y masa muscular. MATERIAL Y MÉTODOS: Estudio de casos y controles realizado en niños de entre 7 y 11 años con desarrollo normal y controles a término de la misma edad. Se incluyó a 89 sujetos: 30 prematuros con peso al nacimiento ≤ 1.500g, 29 prematuros con peso al nacimiento > 1.500g y 30 controles. Se analizaron antropometría, composición corporal mediante absorciometría de rayos X de energía dual y fuerza isométrica mediante banco inclinado y galga. RESULTADOS: El peso y el IMC fueron menores en los niños que pesaron ≤ 1.500g. No se observaron diferencias en composición corporal ni fuerza. Se estableció una razón entre fuerza y masa muscular, resultando esta de un peso desplazado 4 veces superior al peso corporal, no encontrándose diferencias entre grupos ni relación con el peso al nacimiento. CONCLUSIONES: Entre los 7 y los 11 años de edad, los niños que fueron grandes prematuros tienen un peso y un IMC menores al resto de los niños. No se encontraron diferencias entre prematuros y controles en cuanto a composición corporal y fuerza muscular

INTRODUCTION: Strength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and evaluate the relationship between prematurity, strength and muscle mass. MATERIAL AND METHODS: Case-control study. Participants were premature 7-to-11 year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X-ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth-weight ≤ 1500g, 29 prematures with birth-weight 1500-2000g, and 30 controls. RESULTS: Weight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth-weight. CONCLUSIONS: Between 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls

Trastorno del desarrollo de la coordinación / Developmental coordination disorder

Durante varios años, muchos niños sin comorbilidad neurológica grave que presentaban un desarrollo motor subóptimo o con dificultades motrices en áreas específicas como la coordinación visomotora o el equilibrio eran etiquetados como 'torpes', con 'dispraxia' o 'trastornos motores menores'. En 1994, este tipo de trastornos se unificaron bajo el término único de 'trastorno del desarrollo de la coordinación'; sin embargo, actualmente sigue constituyendo una patología poco conocida y a menudo infradiagnosticada. Se estima que entre un 5-8% de niños en la etapa escolar podrían tener trastorno del desarrollo de la coordinación, con un mayor predominio en el sexo masculino. Este riesgo es significativamente superior en los niños prematuros, incluso en aquellos sin secuelas neurológicas aparentes. Las manifestaciones clínicas vienen determinadas por la combinación de una alteración en la propiocepción, la programación motora y la actividad motora secuencial, lo que conlleva dificultades en diferentes áreas motrices, que repercuten en las actividades de la vida diaria, el rendimiento académico y la autoestima. Existen herramientas diagnósticas específicas para su detección. La evolución clínica sin tratamiento específico suele ser la cronificación de las disabilidades motrices, por lo que el diagnóstico y el tratamiento precoz resultan de especial interés en estos niños

Over several years, many children without severe neurological comorbidity having suboptimal motor development or motor difficulties in specific areas such as visomotor coordination or balance were labels as 'clumsy,' with 'dyspraxia' or 'minor motor disorders.' In 1994, this type of disorder was unified under the term 'developmental coordination disorder.' However, it continues to be a little known condition and is often underdiagnosed. It is estimated that 5-8% of school age children could have developmental coordination disorder, with a greater predominance in the male gender. This risk is significantly greater in premature children, even in those without apparent neurological sequels. The clinical manifestations are determined by the combination of an alteration in propioception, motor programming and sequential motor activity. This entails difficulties in different motor areas that affect the daily life activities, academic performance and self esteem. There are specific diagnostic tools for their detection. The clinical course without specific treatment generally leads to the chronification of the motor disabilities, so that the early diagnosis and treatment is of special importance in these children

Colestasis y pancreatitis como forma de presentación de quiste de colédoco forma frustra / A forme fruste choledochal cyst presenting as cholestasis and pancreatitis

No disponible

[Evaluation of isometric force in lower limbs and body composition in preterm infants]. / Valoración de fuerza isométrica en extremidades inferiores y composición corporal en prematuros.

INTRODUCTION: Strength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and evaluate the relationship between prematurity, strength and muscle mass. MATERIAL AND METHODS: Case-control study. Participants were premature 7-to-11 year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X-ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth-weight ≤ 1500g, 29 prematures with birth-weight 1500-2000g, and 30 controls. RESULTS: Weight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth-weight. CONCLUSIONS: Between 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls.

Cuantificación del sueño y presencia de alteraciones en la duración del sueño en niños menores de 2 años / Amount of sleep and changes in its patterns in children less than two years old

OBJETIVOS: Conocer si en nuestro medio la duración del sueño y el patrón de distribución del sueño a lo largo del día en < 2 años son similares a los publicados. Obtener información sobre la prevalencia de las alteraciones de la duración del sueño y sobre la influencia de la edad en dicha prevalencia. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, transversal realizado en niños < 2 años de 3 centros de salud de León y Asturias. Mediante la cumplimentación por sus padres del cuestionario de sueño Brief Infant Sleep Questionnaire (BISQ) se analizó la duración del sueño. Para evaluar alteraciones en la duración del sueño se utilizaron percentiles de duración del sueño. Los resultados fueron valorados en el conjunto de niños encuestados y en los 2 grupos creados para su comparación (niños > y < 6 meses) (niños de León y Asturias). RESULTADOS: Se incluyeron 125 niños < 2 años (73 varones). El sueño nocturno aumentó desde 8,28 ± 2,06 h en < 6 meses hasta 10,43 ± 1,21 en > 6 meses (p = 0,0001), disminuyendo el sueño diurno desde 4,61 ± 2,66 a 1,96 ± 0,79 h (p = 0,0001). Los niños leoneses duermen durante el día más horas que los asturianos (3,91 ± 2,67 vs 3,00 ± 2,09 h, p = 0,041). Diecinueve niños tuvieron una duración total de sueño < percentil 2, siendo más frecuente en niños < 6 meses (14/72 vs 5/53, p = 0,006). CONCLUSIONES: Los niños sustituyen el sueño diurno por el sueño nocturno según van creciendo. Aproximadamente el 15% de niños < 2 años podría tener trastornos en la duración del sueño, siendo este hallazgo más frecuente en < 6 meses

OBJECTIVES: The aim is to study the sleep duration and the 24-hour sleep distribution pattern in children under 2 years-old from two different areas of Spain, as well as to determine the prevalence of abnormal sleep duration and the influence of age on this prevalence, and compare them with the already published data. MATERIAL AND METHODS: An observational, descriptive and cross-sectional study on children from two health centers: one in Castilla y León and the other in Asturias. Their parents completed the Brief Infant Sleep Questionnaire (BISQ). Daytime and nighttime sleep duration was assessed, with percentiles being used to evaluate the results. Two groups were created: one according to the age (children under or above 6 months), and the other according to the area. RESULTS: A total of 125 children were studied (73 males). The nighttime sleep duration increased from 8.28 ± 2.06 hours to 10.43 ± 1.21 hours (P = .0001) and the daytime sleep decreased from 4.61 ± 2.66 to 1.96 ± 0.79 hours (P = .0001) for children under 6 months and above 6 months, respectively. The children from Castilla y León slept more during daytime than those from Asturias (3.91 ± 2.67 vs 3.00 ± 2.09 hours, P = .041). Nineteen children had a total sleep duration below the 2 nd percentile. A sleep duration below normal percentiles was observed in children under 6 months (14/72 vs 5/53, P = .006). CONCLUSIONS: As children grow older, they substitute daytime sleep for nighttime sleep. Approximately 15% of the children under 2 years-old may have changes in sleep duration, and is more common in children under 6 months

[Amount of sleep and changes in its patterns in children less than two years old]. / Cuantificación del sueño y presencia de alteraciones en la duración del sueño en niños menores de 2 años.

OBJECTIVES: The aim is to study the sleep duration and the 24-hour sleep distribution pattern in children under 2 years-old from two different areas of Spain, as well as to determine the prevalence of abnormal sleep duration and the influence of age on this prevalence, and compare them with the already published data. MATERIAL AND METHODS: An observational, descriptive and cross-sectional study on children from two health centers: one in Castilla y León and the other in Asturias. Their parents completed the Brief Infant Sleep Questionnaire (BISQ). Daytime and nighttime sleep duration was assessed, with percentiles being used to evaluate the results. Two groups were created: one according to the age (children under or above 6 months), and the other according to the area. RESULTS: A total of 125 children were studied (73 males). The nighttime sleep duration increased from 8.28±2.06 hours to 10.43±1.21 hours (P=.0001) and the daytime sleep decreased from 4.61±2.66 to 1.96±0.79 hours (P=.0001) for children under 6 months and above 6 months, respectively. The children from Castilla y León slept more during daytime than those from Asturias (3.91±2.67 vs 3.00±2.09 hours, P=.041). Nineteen children had a total sleep duration below the 2nd percentile. A sleep duration below normal percentiles was observed in children under 6 months (14/72 vs 5/53, P=.006). CONCLUSIONS: As children grow older, they substitute daytime sleep for nighttime sleep. Approximately 15% of the children under 2 years-old may have changes in sleep duration, and is more common in children under 6 months.

Alteraciones hidroelectrolíticas en paciente con traumatismo craneoencefálico grave: Secreción inadecuada de ADH, diabetes insípida y síndrome pierde sal cerebral / Hydroelectrolytic alterations in patients with severe cranioencephalic trauma: Inappropriate antidiuretic hormone secretion, diabetes insipidus and cerebral salt wasting syndrome

Entre las complicaciones descritas tras un daño neurológico destacan los trastornos hidroelectrolíticos tales como la diabetes insípida central (DIC), el síndrome pierde sal cerebral (SPSC) y el síndrome de secreción inadecuada de hormona antidiurética (SIADH). La hiponatremia es la complicación electrolítica más frecuente en estos pacientes y su principal manifestación es el edema cerebral, lo que ocasiona un empeoramiento de la clínica neurológica. Este trastorno electrolítico puede ser debido a alteraciones distintas, SPSC o SIADH. Las manifestaciones clínicas de ambos trastornos son similares, pero su patogénesis y su manejo es muy diferente. Es imprescindible la monitorización estrecha de estos pacientes durante su estancia en la unidad de cuidados intensivos pediátricos (UCIP) para realizar un diagnóstico y tratamiento precoz. Presentamos el caso de una niña de 9 años que tras un traumatismo craneoencefálico grave y tras una intervención por una fístula de líquido cefalorraquídeo (LCR), presentó diversas alteraciones a nivel hidroelectrolítico. Inicialmente fue diagnosticada de SPSC corrigiéndose con SSH3% y fludrocortisona, posteriormente de DIC que precisó desmopresina y finalmente un SIADH corregido con restricción hídrica

Fluid and electrolyte disturbances such as central diabetes insipidus (CDI), cerebral salt wasting syndrome (CSWS) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) are frequent after acute brain damage. The most common electrolyte complication in these patients is hyponatremia. Cerebral edema is the main manifestation and may produce a worsening of the neurological status. Hyponatremia may be due to SPSC or SIADH, both with similar clinical manifestations but different pathogenesis and management. We report a 9 year old girl who had fluid and electrolyte disturbances after severe traumatic head injury and cerebrospinal fluid fistula surgery. First developed CSWS corrected with SSH3% and fludrocortisone, then a CDI, corrected with desmopresin and finally SIADH, corrected with fluid restriction. The monitoring of these patients in a pediatric intensive care unit is necessary for an early diagnosis and treatment

Hiperfrecuentación en Pediatría: ¿Se trata de una verdadera necesidad? / Frequent users in Pediatrics: Is this a real need?

Introducción: Frecuentemente detectamos que una pequeña parte de la población genera un gran número de consultas. Esto supone un importante consumo de recursos. Objetivos: 1) Describir la importancia de la hiperfrecuentación y su impacto económico. 2) Indagar las características de aquellos más hiperfrecuentadores. 3) Averiguar si existía alguna causa relacionada con su salud. Material y métodos. Estudio observacional, descriptivo, transversal. Se incluyeron los menores de 14 años. Se registró número total de visitas y número de pacientes que realizaron cada número de visitas. Se definió hiperfrecuentación como la media de visitas más una desviación estándar. El coste por consulta está valorado en 20,89 Euros. En aquellos con ≥ 20 visitas revisamos el historial. Resultados: Incluimos 875 pacientes (5.206 visitas; 5,95 ± 5,55 visitas/paciente). Hiperfrecuentador fue aquel con más de 12 visitas. Hubo 125 hiperfrecuentadores (14%), realizando 2.098 visitas (40%). Acudieron ≥ 20 veces 26 sujetos (3%), generando 637 visitas (12%). La edad media fue 26,5 ± 18,9 meses. Se encontró correlación negativa entre edad y visitas a hospital (coeficiente -0,26). Padecían ESRL 13. Acudieron a urgencias 1,46 ± 1,5 veces e ingresaron 0,42 ± 0,7 veces. Hubo 6 prematuros (EG 27,8 ± 0,5 semanas; PRN 825,0 ± 253,6 g). Realizaron 29,3 ± 7,0 visitas (21-38). Se encontró correlación negativa entre EG y visitas (coeficiente -0,3), urgencias hospitalarias (-0,27) e ingresos (-0,37). Conclusiones: 1) Los sujetos hiperfrecuentadores son un 14% de la población y ocupan el 40% de las consultas. El ahorro potencial anual que supondría una asistencia similar a la media sería 31.721 Euros. 2) Asimismo sobrecargan los Servicios de Urgencias. 3) Presentan similar morbilidad que el resto de la población. La prematuridad parece influir, aunque no justifica el fenómeno

Introduction: We frequently detect that a small part of the population generates a large number of visits. This accounts for a significant use of resources. Objectives: 1) Describe the importance of frequent users and its economic impact. 2) Investigate the characteristics of those having the most frequent visits. 3) Discover if there is any health-related cause. Material and methods: Cross-sectional, descriptive and observational study. Children under 14 years of age were included. Total number of visits and number of patients who made each number of visits were recorded. Frequent use was defined as the mean visits plus one standard deviation. Cost per visit is calculated at 20.89 Euros. We reviewed the clinical record for those having ≥ 20 visits. Results: We included 875 patients (5,206 visits; 5.95 ± 5.55 visits/patient). High level of visitors were those with more than 12 visits. There were 125 high level visitors (14%), who made 2,098 visits (40%). A total of 26 subjects (3%) came ≥ 20 time, generating 637 visits (12%). Mean age was 26.5 ± 18.9 months. There was a negative correlation between age and visits to the hospital (coefficient -0.26). Thirteen had recurrent wheezing episodes in early childhood (RWE-infancy). They came to the emergency service 1.46 ± 1.5 times and were hospitalized 0.42 ± 0.7 times. There were 6 premature babies (gestational age 27.8 ± 0.5 weeks; PRN 825.0 ± 253.6 g). They made 29.3 ± 7.0 visits (21-38). Negative correlation was found between GA and visits (coefficient -0.3), hospital emergencies (-0.27) and admissions (-0.37). Conclusions: 1) Subjects with high frequency of visits accounts for 14% of the population and use 40% of the visits. The potential annual saving that would be obtained with care similar to the mean would be 31,721 Euros. 2) In addition, they overload the Emergency Service. 3) They have similar morbidity as the rest of the population. Prematurity may play a role, although it does not justify the phenomenon

Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal / Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal Intubation

OBJETIVOS: Evaluar la utilidad de la ecografía frente a la capnografía y la radiografía en la intubación traqueal (IT) en niños y neonatos. MATERIAL Y MÉTODOS: Se incluyó a pacientes hemodinámicamente estables intubados en la UCIP y UCIN. Se verificó la posición del tubo endotraqueal (TET) tras cada intubación mediante ecografía traqueal y capnografía. Posteriormente, se comprobó la profundidad del TET por ecografía mediante la visualización de la punta del mismo y el deslizamiento pleural y, posteriormente, con radiografía de tórax. Se cronometraron los tiempos de realización de las técnicas. RESULTADOS: Se incluyó a 31 intubaciones en 26 pacientes (15 en UCIP y 16 en UCIN). No hubo diferencias significativas entre la ecografía y la capnografía ni entre la ecografía y la radiografía en la detección de la IT ni en la comprobación de la profundidad del TET. La sensibilidad y la especificidad de la ecografía comparada con la capnografía y la radiografía fueron del 92 y el 100%, y del 100 y el 75%, respectivamente. La ecografía fue significativamente más lenta que la capnografía (12 [4-16] vs. 6 [3-12] s; p < 0,001) y más rápida que la radiografía (0,22 [0,17-0,40] vs. 20 [17-25] min; p < 0,001). CONCLUSIONES: La ecografía parece tan efectiva como la capnografía, aunque más lenta en la comprobación de la IT. Podría ser de utilidad en situaciones donde la capnografía no sea fiable. La ecografía es tan efectiva y más rápida que la radiografía en la evaluación de la profundidad del TET, por lo que podría disminuir la utilización rutinaria de la radiografía

OBJECTIVES: The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns. MATERIALS AND METHODS: Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded. RESULTS: The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001]. CONCLUSIONS: Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation

Hipertiroidismo neonatal e hipertensión pulmonar / Neonatal hyperthyroidism and pulmonary hypertension

No disponible

[Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal intubation]. / Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal.

OBJECTIVES: The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns. MATERIALS AND METHODS: Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded. RESULTS: The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001]. CONCLUSIONS: Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation.

Uso de la ecografía en la comprobación de la intubación traquealurgente en Pediatría: experiencia preliminar / Use of ultrasonograph in the verification of urgent tracheal intubation in pediatrics: preliminary experience

Introducción y objetivos. El método estándar para la confirmación de la intubación traqueal es la laringoscopia directa; siendo el método secundario más recomendado la capnografía. Por otro lado, existe un interés creciente en el uso de la ecografía como técnica alternativa y complementaria, con la ventaja añadida de permitir comprobar los movimientos respiratorios, sin embargo, su uso es aún limitado. Exponemos nuestra experiencia preliminar con el uso de la ecografía para este fin, describiendo e ilustrando la técnica en una pequeña serie de pacientes. Material y métodos. Se comprobó la intubación correcta en los planos longitudinal y transversal así como la ausencia de intubación bronquial selectiva mediante ecografía. Posteriormente un segundo investigador revisó y analizó las imágenes obtenidas para evaluar la concordancia entre ambos. Casos clínicos. Fueron incluidas 7 intubaciones en 5 pacientes, sin producirse en ningún caso intubación esofágica. La mediana del tiempo de comprobación fue 63,5 (28- 97,5) segundos. La posición del tubo fue considerada como correcta ecográficamente en 6 de los casos, según el signo del lung sliding y la motilidad diafragmática; sin embargo, por radiografía convencional sólo se consideró correcta en 5. En 27 de las 28 imágenes registradas hubo concordancia entre ambos investigadores. Comentarios. La ecografía parece ser un método alternativo útil y rápido para la confirmación de la intubación traqueal. En comparación con los métodos convencionales se trata de una técnica no invasiva, que permite descartar la intubación selectiva del bronquio derecho de forma rápida y podría contribuir a evitar la realización de radiografías (AU)

Introduction and objectives. Direct laringoscopy is the standard method to confirm proper endotracheal tube placement; capnography represents the second most recommended method. Nowadays, ultrasound is gaining interest as an alternative and complementary technique, which also allows the comprobation of respiratory movements. Unfortunately this use is still limited. This study aimed to show our experience with the use of ultrasound for this purpose, describing and illustrating the technique in a small series of patients. Material and methods. Proper intubation in longitudinal and transverse plane, as well as the absence of selective bronchial intubation was verified by ultrasound. Subsequently the obtained images were reviewed and analyzed by a second researcher to evaluate the correlation between them. Clinical cases. Seven intubations in five patients were included, none of them were esophagical. The average time to verify was 63.5 (28-97.5) seconds. Correct tube position was considered by ultrasound lung sliding and diaphragmatic motility in 6 cases, in contrast with 5 cases by conventional radiography. In 27 of 28 recorded images there was an agreement between both researchers. Comments. Ultrasound appears to be a useful and fast alternative technique to confirm tracheal intubation. Compared with conventional methods it is a noninvasive technique that allows to dismiss selective right bronchial intubation in a fast way and can contribute to avoid excessive use of radiography (AU)

Persistent cerebral blood flow by transcranial Doppler ultrasonography in an asphyxiated newborn meeting brain death diagnosis: case report and review of the literature.

We want to illustrate the difficulty of establishing a brain death diagnosis in newborn children and how an easy and useful tool, the transcranial Doppler ultrasonography, can leave an unexpected result that complicates the process despite the rest of the diagnostic tests. We describe a 36-week gestation newborn male who was diagnosed of brain death after asphyxiated and offered for donation. After initial stabilization at admission, we established brain death diagnosis by checking and meeting every criterion. The donation process was complicated because of persistent blood flow on transcranial Doppler ultrasonography. Transcranial Doppler ultrasonography is a very useful method to assess cerebral blood flow. However, caution and individualization are needed when interpreting this complementary exam, especially in highly conflictive situations like brain death diagnosis.

Tos ferina y parada cardiorrespiratoria secundaria a bradicardia durante accesos de tos / Whooping cough and cardiorespiratory arrest secondary to a bradycardia during coughing spells

No disponible