Situación actual de la infección pediátrica por virus de la inmunodeficiencia humana en España / Current situation of paediatric human immunodeficiency virus infection in Spain

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Exposición a drogas de abuso en pediatría / Exposure to drugs of abuse in paediatrics

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Simplificación a monoterapia con lopinavir/ritonavir en niños infectados por el virus de la inmunodeficiencia humana / Simplification to lopinavir/ritonavir monotherapy in HIV-infected children

La monoterapia con lopinavir/ritonavir como estrategia de simplificación tiene el potencial de minimizar la toxicidad del tratamiento antirretroviral sin perder eficacia en casos seleccionados según estudios realizados en adultos; sin embargo, existen pocos datos en niños. Describimos una serie de 5 casos pediátricos tratados con este régimen durante una mediana de 112 semanas. Un niño con problemas de adhesión requirió intensificación de tratamiento por fallo virológico, presentando nuevamente carga viral indetectable. Ensayos clínicos aleatorizados controlados son necesarios para evaluar la eficacia de esta estrategia en niños y establecerlas recomendaciones apropiadas (AU)

Lopinavir/ritonavir monotherapy as a simplification strategy has the potential to minimize antiretroviral treatment toxicity without losing efficacy in selected cases, according to studies in adults, but little is known in paediatric patients. We report 5 children on this regimen for a median time of 112 weeks. One child with suboptimal adherence required intensification therapy to re-suppress viral load. Randomised controlled trials are needed to evaluate the efficacy of this strategy in children in order to make appropriate recommendations (AU)

[Simplification to lopinavir/ritonavir monotherapy in HIV-infected children]. / Simplificación a monoterapia con lopinavir/ritonavir en niños infectados por el virus de la inmunodeficiencia humana.

Lopinavir/ritonavir monotherapy as a simplification strategy has the potential to minimize antiretroviral treatment toxicity without losing efficacy in selected cases, according to studies in adults, but little is known in paediatric patients. We report 5 children on this regimen for a median time of 112 weeks. One child with suboptimal adherence required intensification therapy to re-suppress viral load. Randomised controlled trials are needed to evaluate the efficacy of this strategy in children in order to make appropriate recommendations.

[Prenatal exposure to drugs of abuse using meconium analysis in a low socioeconomic population in Barcelona]. / Exposición prenatal a drogas de abuso a través del análisis de meconio en una población de bajo nivel socioeconómico en Barcelona.

INTRODUCTION: For the first time in Europe, the <> aimed to estimate the prevalence of drug use by pregnant women and the subsequent foetal exposure to illicit drugs. PATIENTS AND METHOD: Between October 2002 and February 2004, 1209 mother-infant dyads from the Hospital del Mar, Barcelona, Spain met eligibility criteria and agreed to participate in the study. Data on socio-economic and demographic characteristics and on drug habits during pregnancy were collected using a structured questionnaire. Neonatal meconium was collected within 24h after birth and analyzed by standardized chromatographic techniques for the presence of opiates, cocaine, cannabinoids and amphetamines. RESULTS: Meconium analysis showed an overall 10.9% positivity for drugs of abuse, with a specific prevalence of heroin, cocaine and cannabis with foetal exposure of 4.7, 2.6 and 5.3%, respectively. Structured interviews also revealed that 0.3, 1.2 and 1.5% of mothers used heroin, cocaine and cannabis, respectively, while only one mother declared ecstasy consumption, confirmed by meconium analysis. Parental ethnicity and working class was not associated with drug use. Drug consuming mothers were shown to have a higher number of previous abortions when compared to non-consumer mothers, which was probably due to a lack of family planning. Significantly lower birth weight and length was found in newborns from mothers exposed to cocaine alone or in combination with other drugs. CONCLUSIONS: This study, although developed in a low socio-economic-status cohort, may serve as an eye opener for any hidden non-negligible drug consumption during pregnancy. In this sense, meconium analysis can be important to identify neonates with a high suspicion of exposure to drugs of abuse in utero, and provides the basis for appropriate treatment and adequate medical and social follow-up.

Exposición prenatal a drogas de abuso a través del análisis de meconio en una población de bajo nivel socioeconómico en Barcelona / Prenatal exposure to drugs of abuse using meconium analysis in a low socioeconomic population in Barcelona

Introducción: por primera vez en Europa, el «Proyecto Meconio» ha estimado la prevalencia del consumo de drogas ilegales por mujeres embarazadas y la consiguiente exposición fetal. Pacientes y método: entre octubre de 2002 y febrero de 2004, se incluyó en el estudio a 1.209 parejas madre-recién nacido del Hospital del Mar, Barcelona. Se recogieron datos sobre las características socioeconómicas y demográficas y los hábitos tóxicos durante el embarazo empleando un cuestionario. Se recogió el meconio neonatal antes de 24 horas después del nacimiento y se analizó empleando técnicas cromatográficas estandarizadas para detectar opiáceos, cocaína, cannabinoides y anfetaminas. Resultados: el análisis del meconio demostró una positividad para las drogas de abuso del 10,9% del total, con una prevalencia específica de exposición fetal a heroína, cocaína y cannabis del 4,7, el 2,6 y el 5,3%, respectivamente. El cuestionario estructurado detectó que el 0,3, el 1,2 y el 1,5% de las madres habían consumido heroína, cocaína y cannabis, y sólo una madre declaró el consumo de éxtasis, confirmado mediante el análisis del meconio. La etnia de los padres y la clase laboral no se asociaron con el consumo de drogas. Las madres consumidoras de drogas mostraron un número de abortos previos más elevado que las madres no consumidoras. Se encontró que el peso y la talla al nacimiento eran significativamente más bajos en los recién nacidos de las madres expuestas a cocaína sola o en combinación con otras drogas. Conclusiones: este estudio puede servir como aviso de un consumo de drogas durante el embarazo oculto y significativo. En este sentido, el análisis del meconio puede ser importante para identificar a recién nacidos en elevada sospecha de exposición intrauterina a drogas de abuso y proporciona la base para un tratamiento médico y un seguimiento social apropiados (AU)

Introduction: For the first time in Europe, the «Meconium Project» aimed to estimate the prevalence of drug use by pregnant women and the subsequent foetal exposure to illicit drugs. Patients and method: Between October 2002 and February 2004, 1209 mother–infant dyads from the Hospital del Mar, Barcelona, Spain met eligibility criteria and agreed to participate in the study. Data on socio-economic and demographic characteristics and on drug habits during pregnancy were collected using a structured questionnaire. Neonatal meconium was collected within 24h after birth and analyzed by standardized chromatographic techniques for the presence of opiates, cocaine, cannabinoids and amphetamines. Results: Meconium analysis showed an overall 10.9% positivity for drugs of abuse, with a specific prevalence of heroin, cocaine and cannabis with foetal exposure of 4.7, 2.6 and 5.3%, respectively. Structured interviews also revealed that 0.3, 1.2 and 1.5% of mothers used heroin, cocaine and cannabis, respectively, while only one mother declared ecstasy consumption, confirmed by meconium analysis. Parental ethnicity and working class was not associated with drug use. Drug consuming mothers were shown to have a higher number of previous abortions when compared to non-consumer mothers, which was probably due to a lack of family planning. Significantly lower birth weight and length was found in newborns from mothers exposed to cocaine alone or in combination with other drugs. Conclusions: This study, although developed in a low socio-economic-status cohort, may serve as an eye opener for any hidden non-negligible drug consumption during pregnancy. In this sense, meconium analysis can be important to identify neonates with a high suspicion of exposure to drugs of abuse in utero, and provides the basis for appropriate treatment and adequate medical and social follow-up (AU)

Attempt to normalize simulated exhaled nitric oxide according to ventilatory settings.

BACKGROUND: Simulated exhaled nitric oxide (eNO) depends on ventilatory settings used in different experimental conditions. OBJECTIVES: To normalize the simulated minute exhaled nitric oxide according to different ventilatory settings. WORKING HYPOTHESIS: Different ventilatory settings influence the concentrations of exhaled nitric oxide and these results can be normalized. METHODOLOGY AND STUDY DESIGN: We used a rubber lung model (50 ml) with an orifice through which a 3 mm endotracheal tube was introduced. The NO, which simulated that of endogenous production, was delivered through the base of the lung using a unidirectional rotameter and obtaining a concentration of around 25 ppb. The sample of gas was recorded through a 6 F arterial catheter introduced into the endotracheal tube to its tip. The ventilator used was a Babylog 8000. Air delivered was compressed and filtered and had an NO content of under 0.3 ppb. The NO level assessed was the plateau value given by the software of the Sievers NOA apparatus. Each experiment involved sampling during 1 min, three times. Normalization was done using a multiple cubic regression formula. RESULTS: An increase in respiratory frequency or in peak of inspiratory pressure were accompanied by a decrease in eNO (ppb). Minute volume was adjusted for the percentage of leakage given by the ventilator. Normalization was obtained analyzing 518 respirations with different ventilatory settings. The coefficient of variation fell from 15.5% to 0.27%. Validation of the normalization formula was performed in other three groups (320, 372, and 372 respirations) with different simulated NO concentrations (25, 16, and 50 ppb), resulting in reduction of the coefficient of variation from 42.7% to 9.3%, from 42.3% to 10.6% and from 45.2% to 9.6%, respectively. CONCLUSIONS: Normalization of simulated minute eNO according to ventilatory settings is possible using the equipment and experimental set-up reported. Extrapolation to patients is not possible without constraints.

[Perinatal outcomes in immigrant women]. / Resultados perinatales de las gestantes inmigrantes.

OBJECTIVES: To describe the characteristics of immigrant women's newborns in our environment, and to compare them with those of native women's newborns. PATIENTS AND METHODS: All newborns attended in the Neonatology Section of Hospital del Mar in Barcelona, Spain, in 2003 and 2004 were included (n 5 2,735). Data were prospectively collected in a database. Pregnant immigrant women were classified in 6 regions (Eastern Europe, the rest of Europe, Africa, Asia, Latin America and other countries). Twelve diagnoses were defined and compared between native newborns and those of immigrant parents, and their relative risks were calculated. RESULTS: There were 1,296 native newborns (47.8 %) and 1,416 of immigrant origin (52.2 %). Immigrant women showed a higher rate of HBsAg carrier status (2.0 % versus 1.0 %) and a lower rate of hepatitis C virus infection (0.8 % vs 2.0 %; p < 0.01). There was only one HIV-positive pregnant immigrant woman compared with 14 Spanish women (p < 0.01), and drug use was lower in the immigrant group (0.4 % vs 4.0 %; p < 0.01). Immigrant newborns had a lower rate of prematurity (6.0 % vs 7.6 %) and of low birthweight (2.3 % vs 4.6 %; p < 0.01). There were no significant differences in the rate of respiratory distress or fetal acidosis. The incidence of neonatal infection risk was higher in immigrant newborns (49.9 % vs 40.6 %; p < 0.01). CONCLUSIONS: In our environment, immigrant mothers' newborns have better perinatal outcomes than native newborns. The most frequent complications are secondary to an inadequate.

Resultados perinatales de las gestantes inmigrantes / Perinatal outcomes in immigrant women

Objetivos Conocer las características de los recién nacidos de las gestantes inmigrantes atendidas en nuestro medio y compararlas con las de los recién nacidos de madre autóctona. Pacientes y métodos Se incluyen los recién nacidos atendidos en la Sección de Neonatología del Hospital del Mar de Barcelona en los años 2003 y 2004 (n 5 2.735). Los datos eran recogidos de forma prospectiva en una base de datos. Las gestantes inmigrantes se clasificaron en 6 regiones (Europa del Este, resto de Europa, África, Asia, América Latina y otras). Se establecieron 12 diagnósticos que se compararon entre recién nacidos autóctonos e inmigrantes, y se calculó el riesgo relativo de éstos. Resultados Hubo 1.296 recién nacidos autóctonos (47,8 %) y 1.416 inmigrantes (52,2 %). Las gestantes inmigrantes presentaban mayor incidencia de estado portador de antígeno de superficie de la hepatitis B (HBsAg) (2,0 % frente al 1,0 %) y menor de anticuerpos contra el virus de la hepatitis C (AcVHC) (0,8 % frente al 2,0 %; p < 0,01). Sólo hubo una gestante inmigrante positiva al virus de la inmunodeficiencia humana (VIH), frente a 14 españolas (p < 0,01), y el consumo de drogas era menor en las inmigrantes (0,4 % frente al 4,0 %; p < 0,01). Los recién nacidos inmigrantes tenían menos incidencia de prematuridad (6,0 % frente al 7,6 %) y de bajo peso (2,3 % frente al 4,6 %; p < 0,01). No hubo diferencias significativas de distrés respiratorio ni de acidosis fetal. La incidencia de riesgo de infección neonatal era mayor en los recién nacidos inmigrantes (49,9 % frente al 40,6 %; p < 0,01). Conclusiones Los recién nacidos de madre inmigrante presentan en nuestro medio mejores resultados perinatales que los autóctonos, siendo las complicaciones más frecuentes secundarias a un control prenatal inadecuado

Objectives To describe the characteristics of immigrant women's newborns in our environment, and to compare them with those of native women's newborns. Patients and methods All newborns attended in the Neonatology Section of Hospital del Mar in Barcelona, Spain, in 2003 and 2004 were included (n 5 2,735). Data were prospectively collected in a database. Pregnant immigrant women were classified in 6 regions (Eastern Europe, the rest of Europe, Africa, Asia, Latin America and other countries). Twelve diagnoses were defined and compared between native newborns and those of immigrant parents, and their relative risks were calculated. Results There were 1,296 native newborns (47.8 %) and 1,416 of immigrant origin (52.2 %). Immigrant women showed a higher rate of HBsAg carrier status (2.0 % versus 1.0 %) and a lower rate of hepatitis C virus infection (0.8 % vs 2.0 %; p < 0.01). There was only one HIV-positive pregnant immigrant woman compared with 14 Spanish women (p < 0.01), and drug use was lower in the immigrant group (0.4 % vs 4.0 %; p < 0.01). Immigrant newborns had a lower rate of prematurity (6.0 % vs 7.6 %) and of low birthweight (2.3 % vs 4.6 %; p < 0.01). There were no significant differences in the rate of respiratory distress or fetal acidosis. The incidence of neonatal infection risk was higher in immigrant newborns (49.9 % vs 40.6 %; p < 0.01). Conclusions In our environment, immigrant mothers' newborns have better perinatal outcomes than native newborns. The most frequent complications are secondary to an inadequate

Intoxicación por ingesta accidental de cannabis / Poisoning by accidental cannabis ingestion

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[Neonatal endocarditis due to staphylococcus aureus as a complication of neonatal sepsis]. / Endocarditis neonatal por Staphylococcus aureus como complicación de sepsis neonatal.

We present the case of a newborn with bacterial endocarditis with mitral valve involvement as a complication of late-onset sepsis due to Staphylococcus aureus with associated pyelonephritis and meningitis. The diagnosis was confirmed by echocardiogram and blood culture with growth of S. aureus. Treatment was medical and surgical. Neonatal bacterial endocarditis is extremely difficult to diagnose. The signs and symptoms are usually nonspecific and cannot be distinguished from those of sepsis or congenital heart disease. Consequently, a high degree of suspicion is needed for the early diagnosis of this condition. Echocardiography should be performed in children who present sepsis and heart murmur and even in those with staphylococcemia (sepsis due to S. aureus) without associated heart murmur. This investigation enables an early diagnosis of endocarditis to be made and appropriate treatment to be given without having to wait for the development of signs and symptoms that frequently go undetected.

[Transient neonatal diabetes associated with uniparental isodisomy of chromosome 6]. / Diabetes mellitus neonatal transitoria asociada a isodisomía uniparental del cromosoma 6.

A female neonate was born after a 37.4-week pregnancy to a healthy primipara. There was a family history of diabetes on the father's side. The neonate's birth weight was 1,955 g and she was 43 cm long. Physical examination showed bilateral palpebral edema, macroglossia, umbilical hernia and abdominal distension. At 29 hours of life she presented hyperglycemia without acidosis or ketosis. Insulin treatment was started and maintained intermittently until 38 days of life. The patient presented anemia from the second day of life, which required iron therapy and blood transfusion one month after birth. The karyotype was 46, XX with paternal uniparental isodisomy of chromosome 6. Paternal uniparental isodisomy of chromosome 6 has been described as the pathogenic mechanism of transient neonatal diabetes, which provides evidence for an imprinted gene exclusively of paternal expression. In paternal isodisomy (as in regional duplications) there is overexpression due to the existence of two functional copies of the gene, which is responsible for transient neonatal diabetes mellitus. Transient neonatal diabetes associated with macroglossia, umbilical hernia and anemia has been described in only a few cases.

Endocarditis neonatal por Staphylococcus aureus como complicación de sepsis neonatal / Neonatal endocarditis due to staphylococcus aureus as a complication of neonatal sepsis

Se presenta el caso de un recién nacido con una endocarditis de la válvula mitral en el contexto de una sepsis de inicio tardío por Staphylococcus aureus, con pielonefritis y meningitis por el mismo patógeno. La confirmación diagnóstica se realizó por ecocardiografía y hemocultivo positivo, y el tratamiento fue médico y quirúrgico. La presentación clínica de la endocarditis neonatal suele ser muy poco expresiva y los signos y los síntomas suelen ser inespecíficos e indistinguibles de los de una sepsis o una cardiopatía congénita, por lo que hay que tener un índice de sospecha elevado para diagnosticarla precozmente. Hay que destacar la importancia de la práctica de ecocardiograma en aquellos recién nacidos que presentan sepsis y soplo cardíaco, e incluso en los casos de sepsis por S. aureus sin soplo asociado. Con esta exploración es posible establecer el diagnóstico precoz de la endocarditis y proceder a un tratamiento adecuado sin esperar a la aparición de una sintomatología que a menudo pasará desapercibida (AU)