How can we improve the quality of health care in hospital attendance of medically complex children? / ¿Cómo podemos mejorar la calidad de la atención hospitalaria de los pacientes crónicos complejos en pediatría?

Hospital care of medically complex children (MCC) is increasing, although its real prevalence in Spain is unknown. OBJECTIVE: to analyze hospital admissions and outpatient follow-up of MCC in order to identify strategies to improve the quality of care of MCC. PATIENTS AND METHOD: An analytical, observational, and retrospective study was carried out. We included MCC who were admitted to Pediatric Hospitalization in the last 5 years, in a tertiary hospital without a specific unit for MCC. Clinical data related to their underlying pathology, outpatient visits, and hospital admissions were collected. A multivariate study was carried out to describe risk factors of the need for technological support and to predict prolonged admissions and the hospital consultation rate. RESULTS: 99 MCC (55.6% males) aged 3.9 (2-8) years were included. 41.4% of MCC required technological support at home and presented the highest number of comorbidities, hospital admissions, and care by different specialists (p < 0.01). Older MCC (p < 0.01) with underlying digestive disease (p < 0.04) and respiratory comorbidity (p < 0.04) presented a longer mean hospital stays. Younger patients with more admissions, longer average stay, and a lack of follow-up by the link nurse were associated with a greater number of annual consultations (p < 0.05). CONCLUSIONS: MCC require a high number of annual consultations and have long hospital stays. The creation of specialized consultations for MCC, multidisciplinary care, and the participation of the link nurse are strategies to improve the quality of care for MCC in hospitals without specific MCC units.

Clinical Outcomes of Patients with Chronic Neuropathic Form of Gaucher Disease in the Spanish Real-World Setting: A Retrospective Study.

This was a retrospective, multicenter study that aimed to report the characteristics of type 3 Gaucher disease (GD3) patients in Spain, including the genotype, phenotype, therapeutic options, and treatment responses. A total of 19 patients with GD3 from 10 Spanish hospitals were enrolled in the study (14 men, 5 women). The median age at disease onset and diagnosis was 1 and 1.2 years, respectively, and the mean age at follow-up completion was 12.37 years (range: 1-25 years). Most patients exhibited splenomegaly (18/19) and hepatomegaly (17/19) at the time of diagnosis. The most frequent neurological abnormalities at onset were psychomotor retardation (14/19) and extrinsic muscle disorders (11/19), including oculomotor apraxia, supranuclear palsy, and strabismus. The L444P (c.1448T>C) allele was predominant, with the L444P (c.1448T>C) homozygous genotype mainly associated with visceral manifestations like hepatosplenomegaly, anemia, and thrombocytopenia. All patients received enzyme replacement therapy (ERT); other treatments included miglustat and the chaperone (ambroxol). Visceral manifestations, including hepatosplenomegaly and hematological and bone manifestations, were mostly controlled with ERT, except for kyphosis. The data from this study may help to increase the evidence base on this rare disease and contribute to improving the clinical management of GD3 patients.

Clinical Relevance of RSV and SARS-CoV-2 Coinfections in Infants and Young Children.

We analyzed the frequency, clinical impact and severity of respiratory syncytial virus (RSV) and SARS-CoV-2 coinfections in a single pediatric center between March 2020 and January 2023. Compared to single RSV infections, RSV/SARS-CoV-2 coinfections were uncommon (2.1%), occurred more frequently during circulation of omicron, and were associated with increased disease severity as defined by longer hospitalization and increased need for high-flow nasal cannula.

Clinical Phenotype of Respiratory Syncytial Virus Bronchiolitis before and during the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: The main objective of this report was to comprehensively analyze the clinical characteristics of children hospitalized with respiratory syncytial virus (RSV) infections in 2021 during the coronavirus disease 2019 (COVID-19) pandemic and to compare them with those in the five previous RSV seasons. We hypothesized that the clinical and demographic features of children hospitalized with RSV infection in 2021 were different from those hospitalized in previous respiratory seasons. STUDY DESIGN: In this retrospective observational study, children younger than 2 years hospitalized with RSV bronchiolitis from January 1, 2015, to December 31, 2021, at the Department of Pediatrics of the Hospital Gregorio Marañón, Madrid, Spain, were included. We compared the clinical characteristics of children hospitalized with RSV bronchiolitis in the five seasons before the COVID-19 pandemic and during the subsequent off-seasonal surge of RSV infections. RESULTS: We found a significant reduction in hospitalizations for RSV bronchiolitis during the usual winter epidemic period due to the COVID-19 pandemic. Children hospitalized with RSV infection in 2021, during the COVID-19 pandemic, were older than children hospitalized in the prepandemic period (2015-2020; 4.0 [1.6-9.2] vs. 3 [1.5-6.5] months; p < 0.01). We also found shorter duration of oxygen days during the COVID-19 period compared with previous respiratory seasons (3 [2-5] vs. 4 [2-6] days; p = 0.02). CONCLUSION: The COVID-19 pandemic modified the RSV seasonality with a significant reduction in RSV hospitalizations during the expected 2020-2021 season and a reappearance of RSV 7 months later than expected. We also found changes in the median age of children with RSV bronchiolitis during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic compared with the prepandemic RSV seasons and shorter duration of oxygen days suggesting a modest reduction in disease severity. We hypothesize that this observation reflects the lack of RSV circulation in the previous months (April 2020-March 2021), with a larger pool of vulnerable infants that had not been previously infected. KEY POINTS: · The COVID-19 pandemic shifted RSV seasonality.. · RSV children hospitalized during the pandemic were older.. · Modest reduction in disease severity was observed during the pandemic..

¿Sobreestimamos las necesidades de líquidos? Complicaciones del uso de sueros isotónicos de mantenimiento en plantas de hospitalización pediátrica / Do we overestimate intravenous fluid therapy needs? Adverse effects related to isotonic solutions during paediatric hospital admissions

Introducción: La fluidoterapia intravenosa es un tratamiento ampliamente utilizado en pacientes pediátricos hospitalizados. El objetivo del estudio fue analizar las complicaciones asociadas al uso de sueros isotónicos de mantenimiento en pacientes hospitalizados y comparar la frecuencia de aparición de estas complicaciones con distintos ritmos de administración. Materiales y métodos: Se realizó un estudio observacional y prospectivo, en el que se incluyeron pacientes hospitalizados de entre tres meses y 15 años de edad que recibieron tratamiento con fluidoterapia isotónica 0,9% con glucosa al 5% durante las primeras 24 horas de ingreso. Se dividieron en dos cohortes según el ritmo de fluidoterapia: restringido<100% vs. no restringido cercano al 100% necesidades basales (NNBB), calculadas según la regla de Holliday y Segar. Se recogieron variables clínicas y analíticas en dos tiempos de estudio (T0 al ingreso y T1 a las 24 horas de la fluidoterapia). Se realizó un estudio uni y multivariante para identificar factores de riesgo de complicaciones. Resultados: Se incluyeron 84 pacientes, de los cuales 33 recibieron fluidoterapia restringida y 51 pacientes con 100% NNBB. Las principales complicaciones desarrolladas en las primeras 24 horas fueron hipercloremia> 110 mEq/L (16,6%) y edemas (19%). La aparición de edemas fue más frecuente en pacientes de menor edad (p <0,01) y la hipercloremia se asoció con el desarrollo de edemas (OR 1,73 [1,0-3,8]), p=0,06. Conclusiones: La administración de sueros isotónicos no está exenta de complicaciones, probablemente relacionadas con el ritmo de administración y más frecuentes en lactantes. Son necesarios estudios que revisen las necesidades de líquidos en niños hospitalizados. (AU)

Introduction: Maintenance intravenous fluids are frequently used in hospitalised paediatric patients. The aim of the study was to describe the adverse effects of isotonic fluid therapy in hospitalised patients, and its prevalence based on the rate of infusion. Materials and methods: A prospective clinical observational study was designed. We included hospitalised patients between 3 months-old and 15-years-old were included with 0.9% isotonic solutions with 5% glucose within the first 24h of administration. They were divided into two groups, depending on the quantity of liquid they received (restricted<100% vs. 100% maintenance needs). Clinical data and laboratory findings were recorded in two different times (T0 when they were admitted to hospital and T1 within the first 24h of administration). Results: The study included 84 patients, 33 received <100% maintenance needs and 51 patients received around 100%. The main adverse effects notified in the first 24h of administration were hyperchloremia>110mEq/L (16.6%) and oedema (19%). Oedema was more frequent in patients with lower age (p<0.01). The hyperchloremia at 24h of intravenous fluids was an independent risk factor of developing oedema (OR 1.73 [1.0–3.8], p=0.06). Conclusions: The use of isotonic fluids is not free from adverse effects, probably related to the rate of infusion and more likely to appear in infants. It is necessary more studies that review the correct estimation of intravenous fluid needs in hospitalised children. (AU)

Úlcera duodenal perforada: tratamiento endoscópico-conservador / Perforated duodenal ulcer: Endoscopic-conservative management

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Age and respiratory syncytial virus etiology in bronchiolitis clinical outcomes.

Background: Respiratory syncytial virus (RSV) is the most frequent cause of bronchiolitis. Precise and updated information about demographic characteristics, clinical manifestations, and risk factors for severe disease are needed for optimal implementation of upcoming new therapeutic and preventive interventions. Objectives: The main goals of this study were to define the epidemiology of acute bronchiolitis in hospitalized young children during 5 calendar years in Spain; evaluate the differences in clinical manifestations between children hospitalized with RSV infection and those hospitalized with non-RSV infection; and identify demographic characteristics, clinical parameters, and risk factors associated with disease severity. Methods: We performed a retrospective review of the medical records of children younger than 2 years who were hospitalized with bronchiolitis between January 2015 and December 2019. We constructed multivariable models to identify independent predictors of disease severity defined as length of hospital stay (LOS), pediatric intensive care unit (PICU) admission, and need for a high-flow-nasal canula (HFNC). Results: From January 2015 to December 2019, 1437 children were hospitalized with bronchiolitis and met the inclusion criteria. The proportion of children hospitalized with bronchiolitis caused by RSV increased significantly during the study period, from 60% to 65% (P = .03). The children with RSV bronchiolitis were younger than those with non-RSV bronchiolitis (median age = 3 months [interquartile range = 1.5-6.5 months] vs 4 months [interquartile range = 2-7.5 months], respectively (P < .01). The children younger than 6 months with RSV bronchiolitis had enhanced disease severity compared with those with non-RSV bronchiolitis, as defined by an LOS of more than 4 days, severity scores, need for an HFNC, intravenous fluids, enteral feeding, and PICU admissions (P < .01). Age younger than 6 months and RSV-positive etiology were independently associated with greater odds of PICU admission, need for an HFNC, and longer LOS. Conclusion: This study identified differences in disease severity between young children with RSV bronchiolitis and those with non-RSV bronchiolitis. These differences are particularly significant in children younger than 6 months, who comprise a group of infants with suboptimal innate immunity to RSV and may benefit from new preventive strategies.

Do we overestimate intravenous fluid therapy needs? Adverse effects related to isotonic solutions during pediatric hospital admissions.

INTRODUCTION: Maintenance intravenous fluids are frequently used in hospitalised pediatric patients. The aim of the study was to describe the adverse effects of isotonic fluid therapy in hospitalised patients, and its prevalence based on the rate of infusion. MATERIALS AND METHODS: A prospective clinical observational study was designed. We included hospitalised patients between 3 months-old and 15-years-old were included with 0,9% isotonic solutions with 5% glucose within the first 24 h of administration. They were divided into two groups, depending on the quantity of liquid they received (restricted <100% vs 100% maintenance needs). Clinical data and laboratory findings were recorded in two different times (T0 when they were admitted to hospital and T1 within the first 24 h of administration). RESULTS: The study included 84 patients, 33 received <100% maintenance needs and 51 patients received around 100%. The main adverse effects notified in the first 24 h of administration were hyperchloremia >110 mEq/L (16.6%) and oedema (19%). Oedema was more frequent in patients with lower age (p < 0,01). The hyperchloremia at 24 h of intravenous fluids was an independent risk factor of developing oedema (OR 1,73 (1,0-3,8), p = 0,06). CONCLUSION: The use of isotonic fluids is not free from adverse effects, probably related to the rate of infusion and more likely to appear in infants. It`s necessary more studies that review the correct estimation of intravenous fluid needs in hospitalized children.

Nasal and Fecal Microbiota and Immunoprofiling of Infants With and Without RSV Bronchiolitis.

Bronchiolitis associated with the respiratory syncytial virus (RSV) is the leading cause of hospitalization among infants aged < 1 year. The main objective of this work was to assess the nasal and fecal microbiota and immune profiles in infants with RSV bronchiolitis, and to compare them with those of healthy infants. For this purpose, a total of 58 infants with RSV-positive bronchiolitis and 17 healthy infants (aged < 18 months) were recruited in this case-control study, which was approved by the Ethics Committee of the Hospital Gregorio Marañón. Nasal and fecal samples were obtained and submitted to bacterial microbiota analysis by 16S rDNA sequencing and to analysis of several immune factors related to inflammatory processes. Nasal samples in which Haemophilus and/or Moraxella accounted for > 20% of the total sequences were exclusively detected among infants of the bronchiolitis group. In this group, the relative abundances of Staphylococcus and Corynebacterium were significantly lower than in nasal samples from the control group while the opposite was observed for those of Haemophilus and Mannheimia. Fecal bacterial microbiota of infants with bronchiolitis was similar to that of healthy infants. Significant differences were obtained between bronchiolitis and control groups for both the frequency of detection and concentration of BAFF/TNFSF13B and sTNF.R1 in nasal samples. The concentration of BAFF/TNFSF13B was also significantly higher in fecal samples from the bronchiolitis group. In conclusion, signatures of RSV-associated bronchiolitis have been found in this study, including dominance of Haemophilus and a high concentration of BAFF/TNFSF13B, IL-8 and sTNF.R1 in nasal samples, and a high fecal concentration of BAFF/TNFSF13B.

La oxigenoterapia de alto flujo sí tiene un papel en el tratamiento de la bronquiolitis en las plantas de pediatría / High-flow oxygen therapy does have a role in the treatment of bronchiolitis on the paediatric wards

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Detección de factores de riesgo de reingreso prevenible en la hospitalización pediátrica / Detection of risk factors for preventable paediatric hospital readmissions

Introducción y objetivos: La tasa de reingresos hospitalarios es un indicador de calidad de la asistencia hospitalaria. El objetivo de este trabajo es describir factores de riesgo de reingreso prevenible en la hospitalización pediátrica. Material y métodos: Estudio analítico, retrospectivo, unicéntrico realizado en las plantas de Pediatría de un hospital terciario (junio de 2012 a noviembre de 2015). Se definió reingreso al que acontecía en los primeros 30 días del ingreso previo: muy precoz (en menos de 48 h), precoz (2-7 días) y tardío (a partir de 7 días). Se definió reingreso prevenible al que ocurrió en los primeros 15 días y por la misma causa del primer ingreso. Se analizaron variables epidemiológicas y clínicas. Se realizó un estudio univariante y posteriormente multivariante. Resultados: En el período de estudio ingresaron en las plantas de Pediatría General Hospitalaria 5.459 pacientes y reingresaron 226 (tasa de reingreso del 4,1%). Cuando la tasa de ocupación hospitalaria es mayor del 70%, el porcentaje global de reingresos es significativamente mayor (8,5 vs. 2,5%), p < 0,001. En el análisis de regresión de Cox se objetivó que la presencia de enfermedad de base y el número de visitas a urgencias desde el alta son factores de predicción de reingreso prevenible. Conclusiones: La tasa de reingresos es mayor en los períodos de mayor presión asistencial. El reingreso de los pacientes con patología crónica de base es prevenible, y por lo tanto hay que diseñar estrategias para intentar evitarlo

Introduction and objectives: Readmission rate is an indicator of the quality of hospital care. The aim of the study is to identify potential preventable factors for paediatric readmission. Material and methods: A descriptive, analytical, longitudinal, and single centre study was carried out in the Paediatric Hospitalisation ward of a tertiary hospital during the period from June 2012 to November 2015. Readmission was defined as the one that occurs in the first 30 days of previous admission, as very early readmission if it occurs in the first 48 hours, early readmission in the 2-7 days, and late readmission if occurs after 7 days. Preventable readmission is defined as one that takes place in the first 15 days and for the same reason as the first admission. Epidemiological and clinical variables were analysed. A univariate and multivariate study was carried out. Results: In the study period, 5,459 patients were admitted to the paediatric hospital, of which 226 of them were readmissions (rate of readmission: 4.1%). When the hospital occupation rate was greater than 70%, the overall percentage of readmissions was significantly higher (8.5% vs 2.5%; P < .001). In the multivariate analysis, it was found that having a chronic disease and the number of visits to emergency care units before admission, are predictive factors of preventable readmission. Conclusions: The rate of readmissions is greater in the periods of higher care pressure. The readmission of patients with chronic condition is preventable, and therefore strategies must be designed to try to avoid them

Influencia del estado nutricional en la evolución clínica del niño hospitalizado / Influence of nutritional status on clinical outcomes in hospitalised children

Introducción: La desnutrición en el paciente pediátrico hospitalizado es una comorbilidad prevalente que puede influir en la evolución clínica y se estima en un 31,4% en nuestro medio. Objetivo: Nuestro objetivo fue describir el riesgo de desnutrición de los pacientes que ingresan en nuestro centro, mediante la herramienta Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), así como analizar su asociación con la evolución del ingreso hospitalario. Métodos: Se realizó un estudio prospectivo, unicéntrico y analítico desde octubre hasta diciembre de 2017 en pacientes hospitalizados, de edades entre 1 mes y 15 años. Se recogieron variables clínicas y datos antropométricos (peso, talla, peso según Waterlow al ingreso (T0), a las 48 h (T1) y al alta (T2). Se construyeron modelos multivariantes para identificar variables predictoras de gravedad. Resultados: Analizamos a 200 pacientes (55% varones) con una mediana de edad de 15,8 meses (RIQ 2,5-42,8) y una estancia media de 3 días (RIQ 1-18 días). El 48,3% presentaba alto riesgo de desnutrición en T0 (STAMP ≥ 4) y un 48,2% riesgo moderado (STAMP = 2-3). En el análisis bivariante, una mayor puntuación de STAMP se asoció a mayor estancia media (p < 0,01) y a mayor gravedad (p < 0,01). En el análisis multivariante, el STAMP en T0 fue predictor de gravedad (OR 1,48; IC 95%: 1,18-1,86; p < 0,01). Conclusiones: Casi el 50% de los pacientes ingresados tenían un elevado riesgo de desnutrición durante el ingreso. El riesgo de desnutrición al ingreso medido según el cribado nutricional STAMP se asoció con una mayor estancia media y mayor gravedad. Es importante evaluar el riesgo de desnutrición al ingreso dada su influencia en la evolución de la enfermedad

Introduction: Paediatric malnutrition during hospital admission is a prevalent comorbidity, which it is estimated around 31.4% in our environment, and could influence the clinical outcomes of paediatric patients. Objective: The aim of this study was to describe the malnutrition risk in hospitalised children using STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics), and to study its relationship with clinical outcomes. Methods: A single-centre, analytical and prospective study was conducted on children aged 1 month to 15 years hospitalised in a tertiary hospital between October and December 2017. An analysis was made of the clinical data and anthropometric measurements (weight, height, Waterlow weight classification). Patients were classified according to STAMP, which is a validated screening tool used to classify the risk of paediatric malnutrition during hospital admission. Multivariate statistical analysis was used to identify predictive variables of illness severity. Results: An analysis was made on a total of 200 patients (55% male), with a median age of 15.8 months (IQR 2.5-42.8), and a median length of stay of 3 days (IQR 1-18 days). Almost half (48.3%) of them had high risk of malnutrition at admission (STAMP ≥ 4), and 48.2% showed medium risk (STAMP 2-3). A higher STAMP score was associated with longer length of hospital stay (P < .01) and greater severity (P < .01). Multivariable analysis showed that STAMP could be a predictor of illness severity (OR 1.48, 95% CI: 1.18-1.86, P < .01). Conclusions: Nearly 50% of hospitalised children have a high risk of malnutrition at admission according to the STAMP screening tool. Risk of malnutrition at admission measured according to STAMP nutritional screening was associated with a longer length of stay and greater severity of illness. It is important to evaluate the risk of malnutrition as this could be related to illness severity

[Influence of nutritional status on clinical outcomes in hospitalised children]. / Influencia del estado nutricional en la evolución clínica del niño hospitalizado.

INTRODUCTION: Paediatric malnutrition during hospital admission is a prevalent comorbidity, which it is estimated around 31.4% in our environment, and could influence the clinical outcomes of paediatric patients. OBJECTIVE: The aim of this study was to describe the malnutrition risk in hospitalised children using STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics), and to study its relationship with clinical outcomes. METHODS: A single-centre, analytical and prospective study was conducted on children aged 1 month to 15 years hospitalised in a tertiary hospital between October and December 2017. An analysis was made of the clinical data and anthropometric measurements (weight, height, Waterlow weight classification). Patients were classified according to STAMP, which is a validated screening tool used to classify the risk of paediatric malnutrition during hospital admission. Multivariate statistical analysis was used to identify predictive variables of illness severity. RESULTS: An analysis was made on a total of 200 patients (55% male), with a median age of 15.8 months (IQR 2.5-42.8), and a median length of stay of 3 days (IQR 1-18 days). Almost half (48.3%) of them had high risk of malnutrition at admission (STAMP ≥4), and 48.2% showed medium risk (STAMP 2-3). A higher STAMP score was associated with longer length of hospital stay (P<.01) and greater severity (P<.01). Multivariable analysis showed that STAMP could be a predictor of illness severity (OR 1.48, 95% CI: 1.18-1.86, P<.01). CONCLUSIONS: Nearly 50% of hospitalised children have a high risk of malnutrition at admission according to the STAMP screening tool. Risk of malnutrition at admission measured according to STAMP nutritional screening was associated with a longer length of stay and greater severity of illness. It is important to evaluate the risk of malnutrition as this could be related to illness severity.

¿Cuál es el flujo inicial idóneo en la oxigenoterapia de alto flujo para el tratamiento de la bronquiolitis en las plantas de hospitalización? / What is the optimal flow on starting high-flow oxygen therapy for bronchiolitis treatment in paediatric wards?

Introducción: La oxigenoterapia de alto flujo (OAF) es un tratamiento seguro y eficaz de la bronquiolitis en las plantas de hospitalización. Se desconoce cuál es el flujo óptimo para iniciar esta terapia. Nuestro objetivo es analizar si hay diferencias en la evolución de los pacientes según el flujo inicial empleado. Métodos: Durante el periodo 2014-2016 se realizó un estudio clínico observacional y analítico de cohortes prospectivas en lactantes ingresados por bronquiolitis que precisaron OAF. Se establecieron dos cohortes en función del flujo inicial: cohorte 1: flujo 15 l/min (OAF-15); cohorte 2: flujo 10l/min (OAF-10). El fracaso terapéutico se definió como la presentación de pausas de apnea o a la ausencia de mejoría clínica en las siguientes 12-24 h. Se construyeron modelos probabilísticos multivariantes para identificar variables predictivas de fracaso terapéutico. Resultados: Se incluyeron 57 pacientes. Mediana de edad, 4 meses (RIQ2-13). Recibieron tratamiento con OAF-10 el 54% y con OAF-15 el 46%. En la cohorte OAF-15 la frecuencia respiratoria empezó a disminuir en la primera hora y en la cohorte OAF-10 a partir de las 6 primeras horas (p = 0,03). En la cohorte OAF-10 ocurrió fracaso terapéutico en el 71%, frente al 15% de la OAF-15 (p < 0,01). Precisaron ingreso en la UCIP el 35%, en la cohorte OAF-10 vs el 18% en la OAF-15 (p = 0,11). No se encontraron efectos adversos en ninguna de las cohortes. Conclusiones: La OAF a 15l/min en el tratamiento de la bronquiolitis es segura y eficaz, consigue una mejoría precoz de la frecuencia respiratoria y tiene un menor porcentaje de fracaso terapéutico

Introduction: High-flow nasal cannula (HFNC) is a safe and effective treatment in bronchiolitis in paediatric wards. The optimal flow on starting HFNC is still unknown. The main aim of this study was to determine if there were differences in clinical outcome of patients according the initial flow. Methods: A prospective, observational and analytical study was conducted between 2014 and 2016 on infants admitted with bronchiolitis and who required HFNC. Two cohorts were established according to the initial flow: cohort 1: flow 15 L/min (HFNC-15), and cohort 2: flow 10 L/min (HFNC-10). Treatment failure was defined as the presentation of apnoea or the absence of clinical improvement in the first 12-24 hours. Multivariate probabilistic models were built to identify predictive variables of treatment failure. Results: A total of 57 patients were included. The median age was 4 months (IQR 2-13), and 54% received treatment with HFNC-10 and 46% with HFNC-15. In HFNC-15 cohort, respiratory rate (RR) decreased in the first hour, and in the HFNC-10 cohort in the first 6hours (P = .03). In HFNC-10 cohort, treatment failure rate was 71%, compared to 15% of HFNC-15 (P < .01). Admission to PICU was required in 35% of the HFNC-10 group vs 18% in HFNC-15 (P = .11). No adverse effects were found. Conclusions: The use of HFNC 15L/min in bronchiolitis treatment in paediatric wards is safe and effective, achieves a faster improvement of respiratory rate and has a lower treatment failure rate

[Detection of risk factors for preventable paediatric hospital readmissions]. / Detección de factores de riesgo de reingreso prevenible en la hospitalización pediátrica.

INTRODUCTION AND OBJECTIVES: Readmission rate is an indicator of the quality of hospital care. The aim of the study is to identify potential preventable factors for paediatric readmission. MATERIAL AND METHODS: A descriptive, analytical, longitudinal, and single centre study was carried out in the Paediatric Hospitalisation ward of a tertiary hospital during the period from June 2012 to November 2015. Readmission was defined as the one that occurs in the first 30 days of previous admission, as very early readmission if it occurs in the first 48hours, early readmission in the 2-7 days, and late readmission if occurs after 7 days. Preventable readmission is defined as one that takes place in the first 15 days and for the same reason as the first admission. Epidemiological and clinical variables were analysed. A univariate and multivariate study was carried out. RESULTS: In the study period, 5,459 patients were admitted to the paediatric hospital, of which 226 of them were readmissions (rate of readmission: 4.1%). When the hospital occupation rate was greater than 70%, the overall percentage of readmissions was significantly higher (8.5% vs 2.5%; P<.001). In the multivariate analysis, it was found that having a chronic disease and the number of visits to emergency care units before admission, are predictive factors of preventable readmission. CONCLUSIONS: The rate of readmissions is greater in the periods of higher care pressure. The readmission of patients with chronic condition is preventable, and therefore strategies must be designed to try to avoid them.

Strengthening the Chain of Survival: Cardiopulmonary Resuscitation Workshop for Caregivers of Children at Risk.

BACKGROUND: Parents and caregivers should receive training regarding pediatric cardiopulmonary resuscitation (CPR) because this knowledge improves survival. We conducted a study as part of a Patient Safety Project to improve caregivers' CPR knowledge and skills. We also aimed to improve the quality of patient care. METHODS: We performed a prospective, longitudinal study in 2013-2014 in a pediatric hospital. We enrolled the caregivers of all patients admitted with a diagnosis of an acute life-threatening event, apnea, or choking. We provided a 45-minute CPR workshop for parents at discharge and evaluated the results using a test before, immediately after, and at 1 and 3 months after the workshop. Participants also completed an evaluation survey about the CPR workshop. RESULTS: We admitted 62 patients [median age, 1 mo (0.5-2 mo)]. We provided 62 pediatric CPR workshops to 106 enrolled relatives. The median score was 5 (CI, 3-6) out of 10 at baseline, which increased to 8 (CI, 7-10) immediately after the workshop (P < 0.01). After 1 and 3 months, the median score was 8 (CI, 6-9; P < 0.01). The severity of the acute life-threatening event episode correlated with a better score (P = 0.02). The utility of the workshop scored 9.9 out of 10. CONCLUSIONS: This CPR workshop significantly increased CPR knowledge and confidence, and this was maintained up to 3 months post-training. Caregiver satisfaction was high.

[What is the optimal flow on starting high-flow oxygen therapy for bronchiolitis treatment in paediatric wards?] / ¿Cuál es el flujo inicial idóneo en la oxigenoterapia de alto flujo para el tratamiento de la bronquiolitis en las plantas de hospitalización?

INTRODUCTION: High-flow nasal cannula (HFNC) is a safe and effective treatment in bronchiolitis in paediatric wards. The optimal flow on starting HFNC is still unknown. The main aim of this study was to determine if there were differences in clinical outcome of patients according the initial flow. METHODS: A prospective, observational and analytical study was conducted between 2014 and 2016 on infants admitted with bronchiolitis and who required HFNC. Two cohorts were established according to the initial flow: cohort1: flow 15L/min (HFNC-15), and cohort2: flow 10L/min (HFNC-10). Treatment failure was defined as the presentation of apnoea or the absence of clinical improvement in the first 12-24hours. Multivariate probabilistic models were built to identify predictive variables of treatment failure. RESULTS: A total of 57 patients were included. The median age was 4months (IQR 2-13), and 54% received treatment with HFNC-10 and 46% with HFNC-15. In HFNC-15 cohort, respiratory rate (RR) decreased in the first hour, and in the HFNC-10 cohort in the first 6hours (P=.03). In HFNC-10 cohort, treatment failure rate was 71%, compared to 15% of HFNC-15 (P<.01). Admission to PICU was required in 35% of the HFNC-10 group vs 18% in HFNC-15 (P=.11). No adverse effects were found. CONCLUSIONS: The use of HFNC 15L/min in bronchiolitis treatment in paediatric wards is safe and effective, achieves a faster improvement of respiratory rate and has a lower treatment failure rate.