Formación online en ecografía pulmonar para residentes de Pediatría / E-learning curriculum on newborn point-of-care lung ultrasound for Paediatric residents

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Three-year prevalence of self-harm behaviors among the reasons for emergency visits of children and adolescents.

Self-harm in the paediatric population is an emerging problem that has been associated with disability and an increased risk of suicide. The objective of the study is to analyse the prevalence of self-harming behaviour as a reason for paediatric emergency consultations.

Respuesta a «Pautas cortas de antibioterapia en neumonías adquiridas en la comunidad en niños» / Reply to "Short-term antibiotic regimens in community-acquired pneumonia in children"

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Documento de consenso sobre la neumonía adquirida en la comunidad en los niños. SENP-SEPAR-SEIP / Consensus Document on Community-Acquired Pneumonia in Children. SENP-SEPAR-SEIP

La neumonía adquirida en la comunidad (NAC) es una enfermedad prevalente en la edad pediátrica y que ofrece frecuentemente dudas tanto diagnósticas como terapéuticas. Se ha realizado un consenso entre SEPAR, SENP y SEIP, con las siguientes conclusiones: 1. La etiología depende fundamentalmente de la edad y de otros factores, como estado inmunitario, presencia de enfermedad de base o estado vacunal y no existe un marcador analítico único con una absoluta fiabilidad diagnóstica. 2. Ante la sospecha clínica de neumonía, no es imprescindible la realización de una radiografía de tórax en los niños sanos. La ecografía torácica se va imponiendo como método de seguimiento, e incluso de diagnóstico. 3. El tratamiento antibiótico empírico de elección en las formas típicas es la amoxicilina oral a una dosis de 80mg/kg/ día generalmente durante 7 días, mientras que en las atípicas en mayores de 5 años son los macrólidos. En las formas típicas graves se recomienda la combinación de cefalosporina de 3.a generación y cloxacilina (o clindamicina o vancomicina) por vía intravenosa. 4. En caso de requerir drenaje pleural, se recomienda la inserción ecoguiada de un catéter de pequeño tamaño. La administración intrapleural de fibrinolíticos (urocinasa) reduce la estancia hospitalaria en comparación con el drenaje pleural simple. 5. En el derrame pleural paraneumónico el tratamiento con antibioticoterapia junto con drenaje pleural y fibrinolíticos se asocia con una estancia hospitalaria y una tasa de complicaciones similar al tratamiento antibiótico más videotoracoscopia asistida. 6. Se recomienda la vacunación antineumocócica conjugada sistemática en menores de 5 años, ya que reduce la incidencia de NAC y de hospitalización por esta causa

Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows: 1. Etiology depends mainly on age and other factors and no single analytical marker offers absolute diagnostic reliability. 2. In the event of clinical suspicion of pneumonia in a healthy child, chest X-ray is not necessary. Chest ultrasound is increasingly implemented as a follow-up method, and even as a diagnostic method. 3. The empirical antibiotic treatment of choice In typical forms of the disease is oral amoxicillin at a dose of 80mg/kg/day for 7 days, while in atypical presentations in children older than 5 years, macrolides should be selected. In severe typical forms, the combination of 3rd generation cephalosporins and cloxacillin (or clindamycin or vancomycin) administered intravenously is recommended. 4. If pleural drainage is required, ultrasound-guided insertion of a small catheter is recommended. Intrapleural administration of fibrinolytics (urokinase) reduces hospital stay compared to simple pleural drainage. 5. In parapneumonic pleural effusion, antibiotic treatment combined with pleural drainage and fibrinolytics is associated with a similar hospital stay and complication rate as antibiotic treatment plus video-assisted thoracoscopy. 6. Systematic pneumococcal conjugate vaccination is recommended in children under 5 years of age, as it reduces the incidence of CAP and hospitalization for this disease

Consensus Document on Community-Acquired Pneumonia in Children. SENP-SEPAR-SEIP. / Documento de consenso sobre la neumonía adquirida en la comunidad en los niños. SENP-SEPAR-SEIP.

Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows.

Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016) / Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016)

Introducción: La información existente sobre el impacto de la gripe en la población infantil española es escasa. El presente trabajo pretende aumentar este conocimiento estudiando aspectos clave como la incidencia de hospitalización, clínica, comorbilidades y el estado vacunal en los niños hospitalizados. Métodos: Estudio retrospectivo, observacional, por revisión de historias clínicas, en menores de 15 años hospitalizados por gripe adquirida en la comunidad, confirmada microbiológicamente, durante 2 temporadas gripales (2014-2015 y 2015-2016). El estudio se realizó en 10 hospitales de 6 ciudades, que atienden aproximadamente al 12% de la población infantil española. Resultados: Fueron hospitalizados 907 niños con diagnóstico principal de gripe (447 < 2 años), con una tasa media anual de incidencia de hospitalización de 0,51 casos/1.000 niños (IC del 95% 0,48-0,55). El 45% presentó enfermedades subyacentes consideradas factores de riesgo para gripe grave, y la mayor parte de ellos (74%) no habían sido vacunados. El porcentaje con enfermedades subyacentes aumentó con la edad, desde el 26% en menores de 6 meses al 74% en mayores de 10 años. El 10% de los casos (n = 92) precisaron cuidados intensivos pediátricos por fallo respiratorio agudo. Conclusión: La gripe es causa importante de hospitalización en la población infantil española. Los menores de 6 meses de edad y los niños con enfermedades subyacentes constituyen una parte mayoritaria (> 50%) de los casos. Una gran parte de las formas graves de gripe en población infantil podrían ser evitada si se cumplieran las indicaciones actuales de vacunación

Introduction: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. Methods: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́ flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. Results: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 < 2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children < 6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. Conclusion: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children < 6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met

[Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014-2016)]. / Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016).

INTRODUCTION: There are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. METHODS: A retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́flu seasons (2014-2015 and 2015-2016). The study was carried out in 10 hospitals of 6cities, which represent approximately 12% of the Spanish child population. RESULTS: A total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 <2 years), estimating an average annual rate of hospitalisation incidence of 0.51 cases / 1,000 children (95% CI; 0.48-0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children <6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. CONCLUSION: Influenza continues to be an important cause of hospitalisation in the Spanish child population. Children <6 months of age and children with underlying diseases make up the majority (> 50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met.

The decline of the incidence of meningococcal disease in Barcelona between 1988 and 2015: the influence of the vaccine against serogroup C. / El declive de la incidencia de enfermedad meningocócica en Barcelona entre 1988 y 2015: la influencia de la vacunación frente al serogrupo C.

INTRODUCTION AND OBJECTIVE: The purpose of this study was to describe the evolution of meningococcal disease (MD) in the city of Barcelona between 1988 and 2015 and to assess the impact of the vaccine against serogroup C. MATERIALS AND METHODOLOGY: The evolution of MD and by serogroup was analysed using the information included in the mandatory notification diseases registry. Incidences of all serogroups between the periods of before and after the implementation of the serogroup C vaccine in 2000 were compared. Vaccination coverage among cases, serogroup among vaccinated cases and mortality and case fatality rates were analysed. RESULTS: MD has evolved from an incidence rate in children aged under 1 of 63.09 cases per 100,000 in 1997-2000 to 15.44 per 100,000 in 2001-2015. All MD serogroups incidences decreased after the implementation of the vaccine, especially for serogroup C among children aged between 1 and 4. Since 2000 vaccine coverage in MD cases by this serogroup was 7.6% while in those affected by serogroup B it was 35.0% (p<.01). Among those vaccinated, 66.4% of cases were serogroup B and 5.2% were C (p<.01). Mortality and case fatality rates were 7.7% and 0.19/100,000 respectively, without significant changes in time regarding case fatality. CONCLUSIONS: Incidence caused by serogroups B and C has decreased after the systematic vaccination against serogroup C. Vaccination against serogroup B could further reduce the impact of this lethal disease which has not decreased during this period.

Calendario vacunal / Vaccinal calendar

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El neumococo y el teatro de la Grecia clásica / Neumooccus and the theatre of classic Greece

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Three-year multicenter surveillance of community-acquired Listeria monocytogenes meningitis in adults.

BACKGROUND: Listeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series. METHODS: A descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI) over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM) were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF) culture or blood culture. The patients were followed up until death or discharge from hospital. RESULTS: Two hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042), immunosuppression (OR 2.520; 95% CI 1.05-6.00; p = 0.037), and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002) were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49%) patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68%) patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79%) of 43 patients, in 11 (32%) of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024) and a higher mortality (67% vs 32%; p = 0.040).The mortality rate was 28% (12 of 43 patients) and 5 of 31 (16.1%) surviving patients developed adverse clinical outcome. CONCLUSIONS: Elderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients' outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.

[Trends of HIV mother-to-child transmission in Catalonia, Spain, between 1987 and 2003]. / Evolución de la transmisión vertical del VIH en Cataluña durante el período 1987-2003.

BACKGROUND AND OBJECTIVE: To describe and to analyze the evolution of the mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV), the clinical and epidemiological characteristics and the use of antiretrovirals (ARV) in the HIV infected pregnant women and their new-borns alive between 1987 and 2003 in Catalonia. MATERIAL AND METHOD: The available clinical-epidemiological and treatment data were obtained from 4 reference hospitals that take care of most of the children born to HIV infected mothers in Catalonia. Two of the hospitals had a data base designed to the follow up of their patients, whereas in the other 2 data were gathered by reviewing clinical registries. For the analysis, 3 periods, based on the recommendations of treatment ARV during pregnancy, were settled down: 1987-1993; 1994-1996, and 1997-2003. RESULTS: 1,105 mother-infant pairs were studied. HIV MTCT was reduced from 20.4% to 3.5% from first to third period of study (p < 0.001). The median age of the mothers increased from 24.6 to 30.5 years of age (p < 0.001). The proportion of women infected by sexual transmission increased from 17.2% to 58.8% (p < 0.001), whereas that of parenteral transmission decreased from the 79.2% to 43.5% (p < 0.001). In the last period, 74.1% of mother-child pairs received complete ARV prophylaxis regimens and 21.6% partial ones. The rate of elective caesarean-section went up from 32.2% to 58.2% (p < 0.001). CONCLUSIONS: The rates of MTCT in our setting have followed the same trend as in other countries of our surroundings. The observed changes reflect the variations in the characteristics of the epidemic in the general population. The implementation of the recommendations on ARV prophylaxis has begun early and it has extended progressively without getting to be total. Additional strategies for the universal coverage of the screening test during pregnancy are still needed.