Los cereales en la alimentación del lactante y el niño pequeño / Cereals in infant and toddler feeding

Durante los primeros 6 meses de vida, el lactante se puede alimentar exclusivamente con leche materna o, en su defecto, con una fórmula infantil, que cubre totalmente sus necesidades nutricionales. Sin embargo, el aumento de los requerimientos nutricionales a partir de esta edad, así como la maduración neurológica, digestiva y renal, hacen necesaria la diversificación de la dieta del lactante. Atendiendo a estas razones, así como a otras de tipo sociocultural, los cereales constituyen una fuente nutricional de gran interés en esta etapa, que con frecuencia es el primer alimento distinto a la leche materna o fórmula que se introduce en su alimentación. Representan una importante fuente de energía por su contenido en hidratos de carbono, y también aportan, aunque en menor cantidad, proteínas de bajo valor biológico, minerales, ácidos grasos esenciales y vitaminas. En este trabajo se revisan los principales aspectos relacionados con su origen, uso, composición y regulación, así como su papel en la adquisición de unos hábitos de alimentación saludables en la infancia

Infants can be exclusively breast fed or formula fed for the first 6 months of life and their nutritional requirements are completely fulfilled. However, the increase of nutritional requirements as well as neurological, digestive and renal function maturation from 6 months of age onwards, makes necessary the diversification of infant feeding. According to these factors, and considering sociocultural aspects, cereals have always been a nutritional source of interest during complementary feeding. They have frequently been the first food different from milk to be introduced during this period. Cereals represent a main source of energy due to their content in carbohydrates, but also provide low biological value protein, minerals, essential fatty acids and vitamins. In this article, main aspects related to their origin, use, composition and regulations are reviewed, as well as its importance in healthy nutritional habits acquisition in infancy

Staphylococcus aureus bacteremia in a secondary level Spanish hospital: clinical implications of high vancomycin MIC.

OBJECTIVE: One of the most controversial issues in recent years has been the clinical significance of high vancomycin MIC in Staphylococcus aureus bacteremia. The aim of this study was to elucidate the clinical implication that this parameter has in the staphylococcal bacteremia of a second level hospital. METHODS: Retrospective descriptive study between January 2014 and September 2016 with 138 records from the blood culture Severo Ochoa University Hospital registry. A total of 98 cases were finally analized. Microbiological analysis of vancomycin MIC was performed using micro dilution technique. RESULTS: The mean age was 71.4 ± 12.45 and 63.26% of the patients had a Charlson index ≥6. A 30.61% were carriers of a venous central catheter. The most frequent source was venous central catheter (26.53%). There were 14.24% metastatic events. Global mortality rate at 30 days was 25.51%. The 43.87% of strains had a vancomycin MIC ≥ 2 mg/L. High vancomycin MIC was significantly associated with persistent bacteremia (OR 3.12 [1.13-8.93]), maintaining this statistical significance in methicillin-resistant S. aureus (MRSA) group (p =0.001) but no in methicillin-susceptible S. aureus (MSSA) group (p = 0.13). Persistent bacteremia was also significantly related with permanent catheter carriers (OR 4.18 [1.38-12.61]), peripheric catheter source (OR 5.18 [1.13-8.93]) and metastatic complications (OR 3.82 [1.03- 12.81]). There was no significant association between high vancomycin MIC and mortality. CONCLUSIONS: High vancomycin MIC may be useful in daily clinical practice as a marker of poor clearance of S. aureus bacteremia, specially when is due to MRSA strains.

Diagnóstico de hiperparatiroidismo primario materno a propósito de una hipocalcemia neonatal sintomática / Maternal primary hyperparathyroidism unmasked by a symptomatic neonatal hypocalcemia

Los episodios paroxísticos neonatales pueden deberse a múltiples causas: patología estructural, infección del sistema nervioso central y alteraciones metabólicas. Entre estas últimas, la hipocalcemia es una causa tratable y bien conocida de convulsión en el periodo neonatal. El hiperparatiroidismo primario durante el embarazo puede suprimir la secreción fetal de PTH, produciendo como consecuencia una hipocalcemia por hipoparatiroidismo transitorio tras el nacimiento. Presentamos un caso de hipocalcemia neonatal sintomática, cuyo estudio etiológico permitió diagnosticar a la madre un hiperparatiroidismo primario, y discutimos la trascendencia de la sospecha y tratamiento precoces de ambas entidades (AU)

Seizures during the neonatal period have a broad differential diagnosis such as intracranial infections, structural pathology and metabolic disorders. Among them, hypocalcemia is a treatable and well-known cause of neonatal seizures. Maternal hyperparathyroidism during pregnancy suppresses parathyroid activity in the fetus resulting in transient hypoparathyroidism and hypocalcemia after birth. We report a case of neonatal symptomatic hypocalcemia leading to a diagnosis of maternal hyperparathyroidism. The relevance of early suspicion and treatment of both entities is also discussed (AU)

Herpes zóster en inmunocompetente vacunada frente a varicela / Herpes zoster in a varicella-vaccinated immunocompetent patient

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Imagen de esofagitis en el inmunocompetente: posibilidades diagnósticas / Esophagitis imaging in the immunocompetent: Diagnostic possibilities

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Metahemoglobinemia inducida por rasburicasa en un paciente con recidiva de leucemia / Rasburicase-induced methemoglobinemia in a patient with leukemia recurrence

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Ascitis urinosa en el periodo neonatal secundaria a válvulas de uretra posterior / Neonatal urinary ascites caused by posterior urethral valves

La causa más frecuente de obstrucción del tracto urinario inferior en los niños son las válvulas de uretra posterior. A pesar de que se relaciona con una importante morbilidad, su pronóstico ha mejorado en los últimos años debido a un diagnóstico de sospecha más precoz, al detectar oligohidramnios, dilatación vesical e hidronefrosis durante el seguimiento ecográfico prenatal. El propósito de esta nota clínica es describir la forma de presentación, el tratamiento proporcionado y la respuesta a éste, en un caso recientemente diagnosticado en nuestro centro (AU)

The most common cause of lower urinary obstruccion in male infants is posterior urethral valves. Although it is related to significant morbidity, prognosis has improved in recent years due to an earlier diagnosis when detecting oligohydramnios, bladder dilatation and hydronephrosis during the prenatal ultrasound evaluation. The aim of this note is to describe the presentation, treatment provided and the clinical course, in a case recently diagnosed in our center (AU)

Manejo del traumatismo alvéolo-dentario infantil en el Servicio de Urgencias de un hospital terciario / Management of pediatric dental injury in the Emergency Department of a tertiary hospital

Introducción: el traumatismo alvéolo-dentario es muy frecuente en la infancia y supone un motivo habitual de consulta en los Servicios de Urgencias pediátricos. Objetivo: estudiar el manejo de los traumatismos dentales en un hospital terciario. Material y métodos: estudio descriptivo retrospectivo. Se incluyeron todos los menores de 15 años que consultaron por traumatismo dental en la Urgencia Pediátrica del Hospital 12 de Octubre (Madrid, España) entre septiembre de 2008 y agosto de 2010. Durante este periodo se puso en marcha un protocolo de manejo de estos pacientes en nuestro centro. Resultados: en el periodo de estudio fueron atendidos 374 pacientes, el 63% varones, con una media de edad de 4,45 años. En el 84% de los casos, la etiología fue casual, seguido de un 3% relacionado con accidentes deportivos. El 32% de los pacientes fue derivado desde otros centros para valoración por Cirugía Maxilofacial. El 60% fue atendido exclusivamente por pediatras. Las causas más frecuentes de atención por parte de Cirugía Maxilofacial fueron: sutura de laceración gingival (6,4%), extracción dental (3%) y ferulización (1,3%). El 83,4% requirió solamente tratamiento médico. Conclusiones: el trauma dental es una causa frecuente de consulta en los Servicios de Urgencias y de derivación a hospitales de referencia. La mayoría de los pacientes presenta lesiones menores que no precisan la realización de pruebas complementarias ni requieren tratamiento quirúrgico, y pueden ser manejadas por un pediatra siguiendo protocolos consensuados con especialistas en Cirugía Maxilofacial (AU)

Introduction: dental injury is very common in childhood and a frequent reason for consultation in pediatric emergency departments. Objectives: to study the management of dental injury in a tertiary hospital. Material and methods: retrospective descriptive study. All patients under 15 years old consulting for dental injury in the Pediatric Emergency Department of Hospital 12 de Octubre between September 2008 and August 2010 were included. During this period of time a specific management protocol of these patients was started. Results: a total of 374 patients were treated, 63% being males, with a median age of 4.45 years. In 84% of cases the etiology was casual, followed by a 3% sports-related accident. Thirty-two percent of the patients were referred from other centers for Maxillofacial Surgery evaluation. In 60% of cases, children were treated exclusively by pediatricians. The most common reasons for maxillofacial surgery evaluation were: suture of gingival laceration (6.4%), dental extraction (3%) and ferulization (1.3%); 83.4% required only medical treatment. Conclusions: dental injury is a common reason for consultation in the pediatric emergency department and referral to other centers. Most patients have mild lesions so they need neither complementary studies nor surgery treatment and should be managed by pediatricians following agreed protocols (AU)

[Evaluation of the anal position in newborns and children with chronic constipation. Incidence of anterior ectopic anus]. / Valoración de la posición del ano en recién nacidos y en niños con estreñimiento crónico. Incidencia del ano anterior ectópico.

INTRODUCTION: Anterior ectopic anus (AEA), continues to be a controversial issue. The objective is to determine the normal position of the anus or anal ano-genital index (AGI) in newborns (NB) and in a group of infants with chronic constipation, know the incidence of AEA in both groups, and its relationship with constipation. METHODS: A prospective aleatory study is performed in where the AGI is determined in 529 NB and 64 older patients with chronic constipation. The AGI is obtained by dividing the distances (cm): vulvar fornix-anus/fornix-coccyx in females and scrotum-anus/scrotum-coccyx in males. The NB group is further studied for gestational age, weight, number of meconium discharges and anal calibration. The newborns with AEA are then controlled to exclude constipation. In patients with chronic constipation, their age, sex and AGI are evaluated. The statistical comparisons are made by a Student's t test and Welch's t test for independent samples. RESULTS: 49.5% of NB are male. The average gestational age is 38.95 +/- 2.08/w in NB females and 38.54 +/- 2.26/w in NB males. The average weight is 3101.91 +/- 511.41/g in newborn females and 3145.14 +/- 573.36/g in newborn males. The average AGI of NB females is 0.40 +/- 0.05 and NB males 0.53 +/- 0.06. AEA is considered with AGI < 0.30 in females and < 0.41 in males. 2.2% of NB females (6/267) and 1.1% of NB males (3/262) have AEA. There is a significant difference between the AGI of NB females and NB males (p < 0.0001). 98% of NB discharge meconium in the first 24 hours. 2 NB females with AGI 0,21 and 0,26 had severe constipation in the first months of life. In group with chronic constipation (64 pacients), 59.4% are female. The AGI is 0.36 +/- 0.1 in females and 0.47 +/- 0.1 in males (p < 0.0001). Concerning of AEA in the NB group (AGI < 0.30 in females and 0.41 in males) incidence of AEA in group with chronic constipation is 35% in males and 47% in females. CONCLUSIONS: The position of the anus in the perineal floor is anterior in females, with significant differences (p < 0.0001) to the AGI in males. AEA has more incidence in females (2.2%). In the constipated group 47% of females had AEA and it is considered the probable reason for this disorder in these patients. To conclude, each NB evaluation protocol should include determination of the AGI in the neonatal period to exclude AEA and to prevent clinical consequences.

Determination of the anal position in newborns and in children with chronic constipation: comparative study in two European healthcare centres.

INTRODUCTION: The objective of this study was to determine the normal anal position index (API) in neonates and in a group of older children with chronic constipation, and to identify the incidence of anterior ectopic anus (AEA) in the two groups. MATERIALS AND METHODS: A prospective random study was carried out in two European hospitals determining the API in 1,012 neonates (529 in Group A, and 483 in Group B) and in 64 children suffering chronic constipation of ages between 3 months and 12 years (Group C). The API is defined as the ratio between the fourchette-anal and fourchette-coccygeal distances in girls and the scroto-anal and scroto-coccygeal distances in boys. The gestational age, weight, meconium evacuation and anal calibre were recorded in Groups A and B, and age, sex, and API in Group C. Statistical comparisons were made using Student's t test and Welch's t test for independent sample groups. RESULTS: The mean API in Group A was 0.53 ± 0.06 in males and 0.40 ± 0.05 in females, and in Group B 0.51 ± 0.06 in males and 0.39 ± 0.08 in females, with significant differences between the sexes (p < 0.0001) in both groups; 1.7% of the neonates in Group A and 2.4% of Group B presented AEA. 4/13 newborns females with AEA presented with severe constipation during their first months of life. For the 64 patients in Group C: 59.3% were female; the mean API was 0.47 ± 0.1 in males and 0.36 ± 0.1 in females (p < 0.0001). The incidence of AEA was 47% in females and 35% in males. CONCLUSIONS: In the neonates (Groups A and B), the position of the anus in the perineum was more anterior in females than in males (p < 0.0001); 31% of the newborns females with AEA presented with constipation in their first months of life. In the Group C patients, there was a high incidence of AEA, especially in the females, and we consider it to be the probable cause of this defecation disorder.

Valoración de la posición del ano en recién nacidos y en niños con estreñimiento crónico. Incidenciadel ano anterior ectópico / Evaluation of the anal position in newborns and children with chronic constipation. incidence of anterior ectopic anus

Introducción. El ano anterior ectópico (AAE) continúa siendo una entidad controvertida. El objeto es determinar la posición normal del ano o índice anogenital (IAG) en recién nacidos (RN) y en un grupo de niños con estreñimiento crónico, conocer la incidencia del AAE en ambos grupos, y la relación de éste con el estreñimiento. Material y métodos. Se realiza un estudio prospectivo y aleatorio en el que se determina el IAG en 529 RN y en 64 pacientes de más edad con estreñimiento crónico. El IAG se obtiene dividiendo las distancias(cm): horquilla vulvar-ano/horquilla-coxis en niñas y escrotoano/escroto-coxis en niños. En el grupo de RN se estudian, además, la edad gestacional, peso, evacuación meconial y calibre anal. Los RN con AAE son controlados para el despistaje de estreñimiento. En los paciente scon constipación crónica se valora la edad, sexo e IAG. Las comparaciones estadísticas se efectúan mediante los tests de t-Student y elde Welch para muestras independientes .Resultados. De los 529 RN, el 49,5% son hombres. La edad gestacional media en RN niñas es 38,95 ± 2,08/s y 38,54 ± 2,26/s en RN niños. El peso es 3.101,91 ± 511,41/g en RN niñas y 3.145,14 ± 573,36/gen RN niños. El IAG medio en RN niñas es 0,40 ± 0,05 y en niños 0,53± 0,06. Se considera AAE los IAG de menos 2 DS por debajo de la (..) (AU)

Introduction. Anterior ectopic anus (AEA), continues to be a controversial issue. The objective is to determine the normal position of theanus or anal ano-genital index (AGI) in newborns (NB) and in a group of infants with chronic constipation, know the incidence of AEA in both groups, and its relationship with constipation. Methods. A prospective aleatory study is performed in where the AGI is determined in 529 NB and 64 older patients with chronic constipation. The AGI is obtained by dividing the distances (cm): vulvarfornix-anus/fornix-coccyx in females and scrotum-anus/scrotum-coccyx in males. The NB group is further studied for gestational age, weight, number of meconium discharges and anal calibration. The newborns with AEA are then controlled to exclude constipation. In patients with chronic constipation, their age, sex and AGI are evaluated. The statistical comparisons are made by a Student’s t test and Welch’s t test for independent samples. Results. 49.5% of NB are male. The average gestational age is38.95 ± 2.08/w in NB females and 38.54 ± 2.26/w in NB males. The average weight is 3101.91 ± 511.41/g in newborn females and 3145.14± 573.36/g in newborn males. The average AGI of NB females is 0.40± 0.05 and NB males 0.53 ± 0.06. AEA is considered with AGI < 0.30in females and < 0.41 in males. 2.2% of NB females (6/267) and 1.1%of NB males (3/262) have AEA. There is a significant difference between (..) (AU)