Unidad de terapia intensiva pediátrica II: repercusiones en el intercambio asistencial de la Red Pediátrica / Pediatric intensive care unit II: impact on the in-network pediatric health care exchange

INTRODUCCIÓN En el año 2012 como consecuencia de la necesidad asistencial de generar nuevas camas en terapia intensiva pediátrica se creó la Unidad de Cuidados Intensivos pediátricos II (UTIP II) que se dedicó principalmente a la asistencia de pacientes con necesidades especiales de atención médica, con una repercusión en el intercambio asistencial y sus consecuencias indirectas en la red pediátrica no estudiadas hasta la fecha. OBJETIVOS El objetivo de nuestro estudio es analizar las repercusiones en el intercambio asistencial con la red pediátrica en la unidad de terapia intermedia pediátrica (CIPED) como consecuencia de la creación de la UTIP II. METODOS Estudio observacional, retrospectivo realizado en la CIPED del HEC, desde enero de 2009 a diciembre de 2016. Se evaluaron el nᵒ/% de derivaciones aceptadas respecto a las solicitadas, origen de los pacientes (Red/Extrared/HEC), nᵒ de egresos, % de ocupación de camas, giro cama. RESULTADOS Se observa un aumento en los rechazos de solicitudes de ingreso a CIPED a partir de 2013(p de tendencia <0,000001); comparando el período 2009/2012 (pre UTIP 2) con el período 2013/2016 considerando el origen de los pacientes ingresados a CIPED, se observa un aumento en los ingresos directos desde el HEC y un descenso de los ingresos procedentes de los hospitales de la red (p <0,000001) y un porcentaje creciente de pacientes que egresan directamente desde UTIP. El porcentaje de ocupación de cama resulto alto en los tres sectores mientras que el giro cama es bajo, intermedio y alto en la UTIP2, UTIP y CIPED respectivamente. CONCLUSIONES los indicadores evaluados alertan acerca de una disminución en la respuesta a las necesidades asistenciales de la red pediátrica desde la CIPED del HEC y evidencian ineficiencias en el sistema que atentan contra la calidad asistencial y profundización de las relaciones en la red.

INTRODUCTION The Pediatric Intensive Care Unit II (PICU II) was created in 2012,as a result of the health care need to generate new beds in pediatric intensive care. It was devote d mainly to provide care to patients with special health care needs and had an impact on health care exchange and its indirect effects in the pediatric network, which have not been studied to date. Our study aims at examining the impact of creating the PICU II on the health care exchange with the pediatric network in the pediatric intermediate care unit (PIMCU). METHODS Retrospective observational study by the PIMCU of HEC from January 2009 to December 2016. Number/percentage of accepted referrals versus requested referrals, sources of patients' referrals(In-network/ Out-of-network/ HEC), number of discharges, % of bed occupancy and bed turnover rate were evaluated. RESULTS Increased denials in admission requests to the PIMCU are observed from 2013 (P for trend <0.000001). Comparing the 2009/2012 period (pre-PICU 2) with the 2013/2016 period and considering the sources of patients admitted to the PIMCU, increased direct admissions to PIMCU, decreased admissions of patients from in-network hospitals (p <0.000001) and an increased percentage of patients discharged directly from the PICU are observed. Bed occupancy percentage was high in the three sectors while the bed turnover was low, intermediate and high in PICU2, PICU and PIMCU, respectively. CONCLUSIONS Evaluated indicators warn about a diminished response by HEC's PIMCU to pediatric network's healthcare needs and evidence system inefficiencies that target healthcare quality and relationship deepening in the network.

Caracterización de Cepas de Virus Sincitial Respiratorio en el Gran Buenos Aires y Aspectos de su Diseminación / Characterization of Respiratory Syncytial Virus Strains in the Greater Buenos Aires and Spreading Aspects

INTRODUCCIÓN: El virus sincitial respiratorio (VSR) es el agente viral más frecuente de infecciones respiratorias agudas bajas (IRAB) en la primera infancia y el mayor responsable de las hospitalizaciones en el período invernal. OBJETIVOS: Describir las características de los brotes de VSR en la Zona Sanitaria VI de la provincia de Buenos Aires, establecer la diversidad de las cepas circulantes y realizar el análisis bioinformático y filogeográfico de las secuencias de la glicoproteína G. MÉTODOS: Se estudió a pacientes pediátricos internados con presentación compatible con IRAB durante dos picos epidémicos (2014-2015) en cuatro hospitales. Se recopilaron datos clínicos, demográficos y socio-sanitarios, y se detectaron patógenos virales en aspirados nasofaríngeos de estos pacientes por inmunofluorescencia (IF), obteniéndose la secuencia del gen de la proteína G en los VSR positivos. RESULTADOS: De 1296 casos estudiados, 317 fueron positivos para algún agente viral. De ellos, 266 (84%) fueron VSR positivos. Se hallaron asociaciones significativas entre las poblaciones positivas y negativas para VSR. Una tendencia al hacinamiento y vivienda precaria en los casos VSR positivos fue reflejada en los estudios filogeográficos. CONCLUSIONES: Los datos de firma molecular permitieron trazar orígenes y vías de diseminación del VSR. Esto ayuda a señalar zonas y situaciones de vulnerabilidad, estableciendo la población primaria blanco de planes de vacunación u otras medidas profilácticas.

INTRODUCTION: The respiratory syncytial virus (RSV) is the most frequent viral agent associated to acute lower respiratory infections (ALRIs) in early childhood, being the main responsible for hospitalizations during winter. OBJECTIVES: To describe the characteristics of RSV outbreaks in the Health Area VI of Buenos Aires Province, to establish the diversity of circulating strains and to perform a bioinformatic and phylogeographic analysis of glycoprotein G sequences. METHODS: Pediatric inpatients with ALRI-compatible x|presentation during two epidemic peaks (2014-2015) were studied in four hospitals. Clinical, demographic and socio-sanitary data were collected, viral pathogens were detected by immunofluorescence (IF), and the sequence of the G protein gene was obtained in the positive RSVs. RESULTS: From 1296 cases, 317 were positive for some viral agent and 266 (84%) out of these were RSV positive. Significant associations were found among the positive and negative populations for RSV. A trend towards overcrowding and precarious housing in positive RSV cases was reflected in phylogeographic studies. CONCLUSIONS: The molecular signature data allowed tracing origins and routes of RSV dissemination. This helps identify areas and situations of vulnerability, establishing the primary target population for vaccination plans or other prophylactic measures.

Percepción de clima laboral en la Unidad de Cuidados Intermedios Pediátricos del Hospital Néstor Carlos Kirchner El Cruce. ¿Somos distintos los pediatras? / Perception of Work Climate at the Pediatric Intermediate Care Unit of "El Cruce Nestor Carlos Kirchner" Hospital. Are we pediatricians different?

INTRODUCCIÓN: Un médico satisfecho habrá de desempeñarse en forma más correcta, tanto en el aspecto humano como en el científico académico. Del concepto de motivación en el nivel individual, surge el concepto de clima laboral en el nivel organizacional, aspecto importante en la relación entre personas y organizaciones. El hecho que distintas especialidades reúnan a individuos con características de personalidad y estilos similares hace pensar que éstas características puedan haber incidido no sólo en la elección de la especialidad como ha sido descripto, sino también en la percepción del ambiente laboral en el que se desarrollan. MATERIAL Y MÉTODOS: estudio de corte transversal. A partir de una encuesta de clima laboral realizada a todo el personal del hospital Néstor Carlos Kirchner, El Cruce, (HEC) en el año 2014, quisimos comparar sus resultados, con los observados en la Unidad de Cuidados Intermedios Pediátricos (CIPED) de la misma institución. RESULTADOS: Respondieron la encuesta 593 (48%) trabajadores hospitalarios de un total de 1243 y todos los pediatras de la CIPED (10). En 70 preguntas (78,7%) los pediatras valoraron mejor el clima laboral que el resto del personal hospitalario. El 80% de los pediatras respondieron que su puesto de trabajo contribuye con su realización personal versusel 29% del resto de los trabajadores hospitalarios (p 0,001). CONCLUSIONES: del análisis comparativo de la encuesta de clima laboral, observamos que los pediatras tienen una percepción de clima laboral más positiva que el resto del personal hospitalario, principalmente en dimensiones de liderazgo y comunicación.

INTRODUCTION: A satisfied physician will certainly work more appropriately, both in the humane and the scientific academic aspects. The concept of work climate at the organization level, an important aspect of the person-organization relationship, arises from the concept of motivation at the individual level. The fact that different specializations gather individuals with similar traits and styles suggests that these characteristics might have had an impact not only on the choice of specialization, as said before, but also on the perception of the work climate where they are developing. MATERIALS AND METHODS: a cross-sectional study. After a survey on work climate was administered to all the staff at the Hospital El Cruce Néstor Carlos Kirchner in 2014, we wanted to compare its results with those found in the Pediatric Intermediate Care Unit (CIPED) at this hospital. RESULTS: All the pediatricians of the CIPED and 593 (48%) hospital workers out of a total of 1243 answered the survey (10). Through 70 (78,7%) questions, pediatricians gave a higher value to the work atmosphere than the hospital staff. Eighty percent of pediatricians, compared to 29% of the other hospital staff, answered that their work position contributes to personal fulfillment (p 0.001). CONCLUSIONS: the comparative analysis of the survey on work climate shows that pediatricians have a more positive perception of work climate than the other hospital staff, mainly in terms of leadership and communication.

Unravelling respiratory syncytial virus outbreaks in Buenos Aires, Argentina: Molecular basis of the spatio-temporal transmission.

Respiratory syncytial virus (RSV) is the main viral cause of hospitalization due to acute lower respiratory tract infections in infants worldwide. Several vaccines against RSV are under research and development, which are about to be approved. We evaluated transmission patterns in different settings to determine age-specific vaccination targets from a viral perspective. We sequenced the G glycoprotein's ectodomain of a constant clinical sampling between two epidemic outbreaks in a limited geographical region and performed phylogeographic analyses. We described a spatio-temporal transmission between local strains, which were originated in the center of the analyzed area and then spread to others. Interestingly, that central area reported the highest population density of the region and also showed overcrowding. This information should be considered by public health systems to evaluate vaccination at all ages in those areas to decrease viral transmission and in lower density populations only susceptible children should be vaccinated.

[Cerebrovascular disease in childhood. Case series]. / Enfermedad cerebrovascular en la infancia: presentación de casos clínicos.

Stroke in childhood is considered rare. It may be ischemic or hemorrhagic. Its presentation is often acute and it is a leading cause of mortality in pediatrics. The aim of our work is to present the general features of stroke of 18 patients under 15 years of age admitted to the Hospital El Cruce, between July 2009 and June 2014, and their clinical outcome a year later. We observed a predominance of male patients and the median age of 5 years. The main clinical features were hemiparesis, seizures, headache and vomiting and sensory impairment. The most frequent type was ischemic and the middle cerebral artery territory was the most commonly involved. Twelve patients had no sequelae. The signs and symptoms were guiding stroke, neuroimaging studies were essential for diagnosis and patients evolved favorably with low number of recurrence and death.

La enfermedad cerebrovascular en la infancia es poco frecuente. Su presentación es aguda y constituye una de las 10 causas de mortalidad en pediatría. El objetivo de nuestro estudio es presentar las características de la enfermedad de 18 pacientes menores de 15 años ingresados en el Hospital El Cruce entre julio de 2009 y junio de 2014, y su evolución clínica al año del evento. Observamos un predominio de sexo masculino y una mediana de edad de 5 años. La forma de presentación en orden de frecuencia fue hemiparesia, convulsiones, cefalea y vómitos, y deterioro del sensorio. La forma isquémica fue la más frecuente y el territorio más afectado fue el de la arteria cerebral media. Doce pacientes no presentaron secuelas. Los signos y síntomas fueron orientadores de enfermedad cerebrovascular; los estudios de neuroimágenes, esenciales para su diagnóstico; y los pacientes evolucionaron favorablemente con bajo número de recurrencia y fallecidos.

Enfermedad cerebrovascular en la infancia: presentación de casos clínicos / Cerebrovascular disease in childhood: Case series

La enfermedad cerebrovascular en la infancia es poco frecuente. Su presentación es aguda y constituye una de las 10 causas de mortalidad en pediatría. El objetivo de nuestro estudio es presentar las características de la enfermedad de 18 pacientes menores de 15 años ingresados en el Hospital El Cruce entre julio de 2009 y junio de 2014, y su evolución clínica al año del evento. Observamos un predominio de sexo masculino y una mediana de edad de 5 años. La forma de presentación en orden de frecuencia fue hemiparesia, convulsiones, cefalea y vómitos, y deterioro del sensorio. La forma isquémica fue la más frecuente y el territorio más afectado fue el de la arteria cerebral media. Doce pacientes no presentaron secuelas. Los signos y síntomas fueron orientadores de enfermedad cerebrovascular; los estudios de neuroimágenes, esenciales para su diagnóstico; y los pacientes evolucionaron favorablemente con bajo número de recurrencia y fallecidos.

Stroke in childhood is considered rare. It may be ischemic or hemorrhagic. Its presentation is often acute and it is a leading cause of mortality in pediatrics. The aim of our work is to present the general features of stroke of 18 patients under 15 years of age admitted to the Hospital El Cruce, between July 2009 and June 2014, and their clinical outcome a year later. We observed a predominance of male patients and the median age of 5 years. The main clinical features were hemiparesis, seizures, headache and vomiting and sensory impairment. The most frequent type was ischemic and the middle cerebral artery territory was the most commonly involved. Twelve patients had no sequelae. The signs and symptoms were guiding stroke, neuroimaging studies were essential for diagnosis and patients evolved favorably with low number of recurrence and death.

Cumplimiento de criterios de admisión y alta complejidad en la Unidad de Cuidados Intermedios Pediátricos del Hospital El Cruce / Compliance with admission criteria and high complexity in the Pediatric Intermediate Care Unit of El Cruce Hospital

El objetivo fue evaluar si los pacientes admitidos en la Unidad de Cuidados intermedios pediátricos (CIPED) reunieron los criterios de admisión a la misma, cumplieron con criterios de alta complejidad definidos ad-hoc y pudieron ser incluidos dentro de los "centros de referencia nacional" del plan estratégico del Hospital. Como también identificar las barreras que impidieron la contrarreferencia de estos pacientes y cuantificar la necesidad de anestesista pediátrico como único criterio de asistencia al HEC. Se concluye que la mayoría de los pacientes internados en CIPED cumplieron con los criterios de admisión y de alta complejidad. Debido al alto porcentaje de pacientes no contrarreferidos al segundo nivel de atención, trabajar desde la gestión en la integración del intercambio asistencial entre el tercer y primer nivel de atención resultará determinante para una adecuada continuidad asistencial.

Abdomen agudo como manifestación inicial de enfermedad de Kawasaki incompleta y atípica: Caso clínico / Acute abdomen at onset of incomplete and atypical Kawasaki disease: Case report

La enfermedad de Kawasaki es una de las vasculitis más frecuentes en niños y la causa más común de cardiopatía adquirida en países desarrollados. El diagnóstico se basa en criterios clínicos y no existe, hasta el momento, un test específico. El diagnóstico y las decisiones terapéuticas resultan difíciles para el pediatra en los casos incompletos o atípicos e indefectiblemente surgen interrogantes durante la atención de estos pacientes. En niños con forma atípica o incompleta, la opción en favor de instaurar el tratamiento con gammaglobulina parece, al momento, la más aconsejable. Se presenta un paciente con abdomen agudo como forma de inicio de enfermedad de Kawasaki.

Kawasaki disease is one of the most common systemic vasculitis in children and the most common cause of acquired heart disease in developed countries. Diagnosis relies on clinical findings and there is no specific test. Diagnosis and treatment decisions are very difficult in incomplete or atypical cases and questions inevitably arise during the care of these patients. In children with atypical or incomplete disease, the option in favor of therapy with gamma globulin seems currently to be the most suitable one. A patient with acute abdomen is presented as the initial symptom of Kawasaki disease.

Abdomen agudo como manifestación inicial de enfermedad de Kawasaki incompleta y atípica: Caso clínico / Acute abdomen at onset of incomplete and atypical Kawasaki disease: Case report

La enfermedad de Kawasaki es una de las vasculitis más frecuentes en niños y la causa más común de cardiopatía adquirida en países desarrollados. El diagnóstico se basa en criterios clínicos y no existe, hasta el momento, un test específico. El diagnóstico y las decisiones terapéuticas resultan difíciles para el pediatra en los casos incompletos o atípicos e indefectiblemente surgen interrogantes durante la atención de estos pacientes. En niños con forma atípica o incompleta, la opción en favor de instaurar el tratamiento con gammaglobulina parece, al momento, la más aconsejable. Se presenta un paciente con abdomen agudo como forma de inicio de enfermedad de Kawasaki.(AU)

Kawasaki disease is one of the most common systemic vasculitis in children and the most common cause of acquired heart disease in developed countries. Diagnosis relies on clinical findings and there is no specific test. Diagnosis and treatment decisions are very difficult in incomplete or atypical cases and questions inevitably arise during the care of these patients. In children with atypical or incomplete disease, the option in favor of therapy with gamma globulin seems currently to be the most suitable one. A patient with acute abdomen is presented as the initial symptom of Kawasaki disease.(AU)

[Acute abdomen at onset of incomplete and atypical Kawasaki disease: case report]. / Abdomen agudo como manifestación inicial de enfermedad de Kawasaki incompleta y atípica: caso clínico.

Kawasaki disease is one of the most common systemic vasculitis in children and the most common cause of acquired heart disease in developed countries. Diagnosis relies on clinical findings and there is no specific test. Diagnosis and treatment decisions are very difficult in incomplete or atypical cases and questions inevitably arise during the care of these patients. In children with atypical or incomplete disease, the option in favor of therapy with gamma globulin seems currently to be the most suitable one. A patient with acute abdomen is presented as the initial symptom of Kawasaki disease.

Abdomen agudo como manifestación inicial de enfermedad de Kawasaki incompleta y atípica: Caso clínico. / [Acute abdomen at onset of incomplete and atypical Kawasaki disease: Case report].

Kawasaki disease is one of the most common systemic vasculitis in children and the most common cause of acquired heart disease in developed countries. Diagnosis relies on clinical findings and there is no specific test. Diagnosis and treatment decisions are very difficult in incomplete or atypical cases and questions inevitably arise during the care of these patients. In children with atypical or incomplete disease, the option in favor of therapy with gamma globulin seems currently to be the most suitable one. A patient with acute abdomen is presented as the initial symptom of Kawasaki disease.

Infecciones graves por Staphylococcus aureus: características clínicas, sensibilidad antibiótica y uso de antimicrobianos. Serie de casos / Severe Staphylococcus aureus infections: clinical characteristics, antibiotic susceptibility and use of antimicrobials. Case series

La aparición de infecciones por Staphylococcus aureus (SA) meticilino-resistente (MR) de la comunidad es un problema de salud pública de variable magnitud en diferentes áreas geográficas del mundo. El debate acerca del tratamiento antibiótico empírico inicial permanece abierto. Nuestro objetivo es presentar una serie de pacientes hospitalizados con infecciones graves por Staphyloccocus aureus en la Unidad de Cuidados Intermedios Pediátricos del Hospital El Cruce. Entre mayo de 2008 y diciembre de 2010, se internaron 43 pacientes. El 69,8% de los SA aislados fueron MR. Aunque la diferencia no fue estadísticamente significativa, las infecciones por SAMR requirieron mayor cantidad de días de internación en terapia intensiva y desarrollaron más focos secundarios de infección. Vancomicina, rifampicina y clindamicina fueron los antibióticos más comúnmente prescritos. Existió una alta resistencia de los SA a los ß-lactámicos en la serie estudiada

Infectious due to methicillin-resistant community acquired Staphylococcus aureus is a public health problem of varying magnitude in different geographical areas of the world, representing a major burden on health systems. The debate on the initial empiric antibiotic therapy remains open. We present a case series of hospitalized patients with severe Staphylococcus aureus infections admitted to the pediatric intermediate care unit of Hospital El Cruce. Between May 2008 and December 2010, 43 patients were admitted. Sixty nine percent of isolated Staphylococcus aureus were methicillin-resistant. Although the difference was not statistically significant, methicillin-resistant Staphylococcus aureus infections required more days of hospitalization in critical care unit and developed more secondary sites of infection. Vancomycin, rifampicin and clindamycin were the most commonly prescribed antibiotics. There was a high resistance of Staphylococcus aureus to p-lactams in the series.

[Severe Staphylococcus aureus infections: clinical characteristics, antibiotic susceptibility and use of antimicrobials. Case series]. / Infecciones graves por Staphylococcus aureus: características clínicas, sensibilidad antibiótica y uso de antimicrobianos. Serie de casos.

Infectious due to methicillin-resistant community acquired Staphylococcus aureus is a public health problem of varying magnitude in different geographical areas of the world, representing a major burden on health systems. The debate on the initial empiric antibiotic therapy remains open. We present a case series of hospitalized patients with severe Staphylococcus aureus infections admitted to the pediatric intermediate care unit of Hospital El Cruce. Between May 2008 and December 2010, 43 patients were admitted. Sixty nine percent of isolated Staphylococcus aureus were methicillin-resistant. Although the difference was not statistically significant, methicillin-resistant Staphylococcus aureus infections required more days of hospitalization in critical care unit and developed more secondary sites of infection. Vancomycin, rifampicin and clindamycin were the most commonly prescribed antibiotics. There was a high resistance of Staphylococcus aureus to p-lactams in the series.

Infecciones graves por Staphylococcus aureus: características clínicas, sensibilidad antibiótica y uso de antimicrobianos. Serie de casos. / [Severe Staphylococcus aureus infections: clinical characteristics, antibiotic susceptibility and use of antimicrobials. Case series].

Infectious due to methicillin-resistant community acquired Staphylococcus aureus is a public health problem of varying magnitude in different geographical areas of the world, representing a major burden on health systems. The debate on the initial empiric antibiotic therapy remains open. We present a case series of hospitalized patients with severe Staphylococcus aureus infections admitted to the pediatric intermediate care unit of Hospital El Cruce. Between May 2008 and December 2010, 43 patients were admitted. Sixty nine percent of isolated Staphylococcus aureus were methicillin-resistant. Although the difference was not statistically significant, methicillin-resistant Staphylococcus aureus infections required more days of hospitalization in critical care unit and developed more secondary sites of infection. Vancomycin, rifampicin and clindamycin were the most commonly prescribed antibiotics. There was a high resistance of Staphylococcus aureus to p-lactams in the series.

Referral and counter-referral system between secondary and tertiary care facilities in a children's hospital network of Greater Buenos Aires.

INTRODUCTION: Hospital El Cruce is a tertiary care facility which is part of a healthcare network that has been operating since July 2008 and includes health centers from five municipalities of the South of Greater Buenos Aires. The objective of the study was to describe the referral and counter-referral system at the pediatric intermediate medical care unit of the Hospital El Cruce, the tertiary level care of the network, and secondly to identify the critical points that could go against the consolidation of the network and to analyze the level of knowledge about it. POPULATION AND METHODS: This was a cross-sectional, prospective study conducted at the pediatric intermediate medical care unit of Hospital El Cruce between July 2008 and December 2010. Indicators related to patient admission and discharge were analyzed. A survey was administered to all the heads of the network's pediatric departments in order to assess the level of knowledge they had about it. RESULTS: A total of1677patients were hospitalized; 83.9% were referred from the network. Of all referrals made, 71.1% were accepted. There were 156 patients (9.4%) who were counter-referred to the referring facility. The survey results showed that 70% of heads of pediatric departments were unaware of the range of services provided by the network. CONCLUSIONS: Health care exchange was predominantly based on accepting patients referred from secondary care facilities to Hospital El Cruce and a minimum number of counter-referrals to referring facilities, with a radial pattern dynamics. There was scarce knowledge about the availability of the network health service delivery.

Referral and counter-referral system between secondary and tertiary care facilities in a children's hospital network of Greater Buenos Aires / Sistema de referencia-contrarreferencia entre el segundo y el tercer nivel de salud en una red hospitalaria pediátrica en el conurbano bonaerense

Introduction. Hospital El Cruce is a tertiary care facility which is part of a healthcare network that has been operating since July 2008 and includes health centers from five municipalities of the South of Greater Buenos Aires. The objective of the study was to describe the referral and counter-referral system at the pediatric intermediate medical care unit of the Hospital El Cruce, the tertiary level care of the network, and secondly to identify the critical points that could go against the consolidation of the network and to analyze the level of knowledge about it. Population and Methods. This was a cross-sectional, prospective study conducted at the pediatric intermediate medical care unit of Hospital El Cruce between July 2008 and December 2010. Indicators related to patient admission and discharge were analyzed. A survey was administered to all the heads of the network's pediatric departments in order to assess the level of knowledge they had about it. Results. A total of1677patients were hospitalized; 83.9% were referred from the network. Of all referrals made, 71.1% were accepted. There were 156 patients (9.4%) who were counter-referred to the referring facility. The survey results showed that 70% of heads of pediatric departments were unaware of the range of services provided by the network. Conclusions. Health care exchange was predominantly based on accepting patients referred from secondary care facilities to Hospital El Cruce and a minimum number of counter-referrals to referring facilities, with a radial pattern dynamics. There was scarce knowledge about the availability of the network health service delivery.

Introducción. El Hospital El Cruce es un centro de alta complejidad de una red asistencial que funciona desde julio de 2008 y abarca centros sanitarios de cinco municipios del conurbano sur bonaerense. El objetivo del estudio fue describir el sistema de referencia y contrarreferencia a la unidad de cuidados intermedios pediátricos del Hospital de Alta Complejidad en Red El Cruce, y secundariamente identifcar los puntos críticos que podrían conspirar contra la consolidación de la red y analizar el nivel de autoconocimiento sobre ésta. Población y métodos. Estudio observacional, prospectivo, realizado en la unidad de cuidados intermedios pediátricos del Hospital El Cruce, entre julio de 2008 y diciembre de 2010. Se analizaron los indicadores vinculados al ingreso y egreso del paciente. Se realizó una encuesta a todos los jefes de servicios pediátricos de la red para evaluar el nivel de conocimiento sobre ésta. Resultados. Se internaron 1677 pacientes; 83,9% fueron derivados desde la red. Se aceptaron 71,1% de las derivaciones solicitadas. El 9,4% (156 pacientes) fueron contrarreferidos al centro de origen. En la encuesta, 70% de las respuestas de los jefes de servicios pediátricos expresaron desconocimiento del menú prestacional de la red. Conclusiones. El intercambio asistencial se basó predominantemente en la aceptación de pacientes derivados desde centros de segundo nivel de atención hacia el Hospital El Cruce y escasa contrarreferencia hacia los centros derivadores, con una dinámica de funcionamiento radiada. Hubo escaso conocimiento de la disponibilidad de prestaciones de la red.

Referral and counter-referral system between secondary and tertiary care facilities in a childrens hospital network of Greater Buenos Aires / Sistema de referencia-contrarreferencia entre el segundo y el tercer nivel de salud en una red hospitalaria pediátrica en el conurbano bonaerense

Introduction. Hospital El Cruce is a tertiary care facility which is part of a healthcare network that has been operating since July 2008 and includes health centers from five municipalities of the South of Greater Buenos Aires. The objective of the study was to describe the referral and counter-referral system at the pediatric intermediate medical care unit of the Hospital El Cruce, the tertiary level care of the network, and secondly to identify the critical points that could go against the consolidation of the network and to analyze the level of knowledge about it. Population and Methods. This was a cross-sectional, prospective study conducted at the pediatric intermediate medical care unit of Hospital El Cruce between July 2008 and December 2010. Indicators related to patient admission and discharge were analyzed. A survey was administered to all the heads of the networks pediatric departments in order to assess the level of knowledge they had about it. Results. A total of1677patients were hospitalized; 83.9% were referred from the network. Of all referrals made, 71.1% were accepted. There were 156 patients (9.4%) who were counter-referred to the referring facility. The survey results showed that 70% of heads of pediatric departments were unaware of the range of services provided by the network. Conclusions. Health care exchange was predominantly based on accepting patients referred from secondary care facilities to Hospital El Cruce and a minimum number of counter-referrals to referring facilities, with a radial pattern dynamics. There was scarce knowledge about the availability of the network health service delivery.(AU)

Introducción. El Hospital El Cruce es un centro de alta complejidad de una red asistencial que funciona desde julio de 2008 y abarca centros sanitarios de cinco municipios del conurbano sur bonaerense. El objetivo del estudio fue describir el sistema de referencia y contrarreferencia a la unidad de cuidados intermedios pediátricos del Hospital de Alta Complejidad en Red El Cruce, y secundariamente identifcar los puntos críticos que podrían conspirar contra la consolidación de la red y analizar el nivel de autoconocimiento sobre ésta. Población y métodos. Estudio observacional, prospectivo, realizado en la unidad de cuidados intermedios pediátricos del Hospital El Cruce, entre julio de 2008 y diciembre de 2010. Se analizaron los indicadores vinculados al ingreso y egreso del paciente. Se realizó una encuesta a todos los jefes de servicios pediátricos de la red para evaluar el nivel de conocimiento sobre ésta. Resultados. Se internaron 1677 pacientes; 83,9% fueron derivados desde la red. Se aceptaron 71,1% de las derivaciones solicitadas. El 9,4% (156 pacientes) fueron contrarreferidos al centro de origen. En la encuesta, 70% de las respuestas de los jefes de servicios pediátricos expresaron desconocimiento del menú prestacional de la red. Conclusiones. El intercambio asistencial se basó predominantemente en la aceptación de pacientes derivados desde centros de segundo nivel de atención hacia el Hospital El Cruce y escasa contrarreferencia hacia los centros derivadores, con una dinámica de funcionamiento radiada. Hubo escaso conocimiento de la disponibilidad de prestaciones de la red.(AU)

Referral and counter-referral system between secondary and tertiary care facilities in a childrens hospital network of Greater Buenos Aires. / Referral and counter-referral system between secondary and tertiary care facilities in a childrens hospital network of Greater Buenos Aires.

INTRODUCTION: Hospital El Cruce is a tertiary care facility which is part of a healthcare network that has been operating since July 2008 and includes health centers from five municipalities of the South of Greater Buenos Aires. The objective of the study was to describe the referral and counter-referral system at the pediatric intermediate medical care unit of the Hospital El Cruce, the tertiary level care of the network, and secondly to identify the critical points that could go against the consolidation of the network and to analyze the level of knowledge about it. POPULATION AND METHODS: This was a cross-sectional, prospective study conducted at the pediatric intermediate medical care unit of Hospital El Cruce between July 2008 and December 2010. Indicators related to patient admission and discharge were analyzed. A survey was administered to all the heads of the networks pediatric departments in order to assess the level of knowledge they had about it. RESULTS: A total of1677patients were hospitalized; 83.9

were referred from the network. Of all referrals made, 71.1

were accepted. There were 156 patients (9.4

) who were counter-referred to the referring facility. The survey results showed that 70

of heads of pediatric departments were unaware of the range of services provided by the network. CONCLUSIONS: Health care exchange was predominantly based on accepting patients referred from secondary care facilities to Hospital El Cruce and a minimum number of counter-referrals to referring facilities, with a radial pattern dynamics. There was scarce knowledge about the availability of the network health service delivery.

Lactante sibilante atípico: consideraciones diagnósticas. Hendidura laríngea / Atypical sibilant lactate: diagnostic considerations. Laryngeal cleft

El síndrome bronquial obstructivo es un motivo de consulta frecuente en la edad pediátrica. En este trabajo se presenta el caso de un paciente con antecedentes de internaciones recurrentes por infecciones respiratorias agudas bajas y trastorno de deglución con diagnóstico de hendidura laríngea. Se realiza una breve descripción de la hendidura laríngea, sus características clínicas, diagnóstico y tratamiento. Se enumeran los diagnósticos diferenciales de los niños con sibilancias atípicas, sus signos y síntomas y su evaluación inicial.