Características epidemiológicas y factores de riesgo de los episodios aparentemente letales / Epidemiological characteristics and risk factors for apparent life-threatening events

Introducción: Aportar nuestra experiencia en la aplicación de un protocolo en nuestro servicio de urgencias de pediatría (SUP) en los episodios aparentemente letales (EAL), conocer su incidencia, su perfil epidemiológico y el rendimiento de las pruebas complementarias (PC) realizadas. Pacientes y métodos: Estudio prospectivo de casos y controles, de aplicación de un protocolo a lactantes menores de 12 meses que acudieron del 01/06/06 al 31/05/07 con historia de EAL. Se realizaron distintas PC en función de la clínica e historia. Todos ingresaron un mínimo de 12h. Se realizó una entrevista telefónica a los 12 meses. Resultados: Se seleccionaron 50 casos con una incidencia de 5 por cada 1.000 recién nacidos (RN) vivos. La edad fue de 8,46±8,7 semanas. Respecto a los controles hubo significativamente más primogénitos y con antecedentes de alteración del comportamiento. La exploración fue anormal en 13 y 6 presentaron recurrencia en el SUP. Cuarenta y uno (82%) tuvieron alterada alguna PC, pero sólo en 8 contribuyeron al diagnóstico. Veintinueve (58%) fueron idiopáticos y 21 (42%) fueron secundarios. Éstos tuvieron de forma significativa mayor incidencia de tabaquismo materno, edad>12 semanas y exploración alterada. Cuatro recidivaron las semanas posteriores, y uno presentó el síndrome de muerte súbita del lactante (SMSL). A los 12 meses, los casos tuvieron de forma significativa mayor incidencia de vómitos recurrentes, espasmos del sollozo, retraso psicomotor y pondoestatural. Conclusiones: La incidencia fue del 5‰ RN vivos. Fueron más frecuentemente primogénitos o presentaron anomalías en el comportamiento las semanas previas o a los 12 meses. El 42% tuvo un diagnóstico secundario que se asoció a edad >12 semanas, tabaquismo materno y exploración alterada en el SUP. Una lactante presentó un SMSL. Las PC realizadas en el SUP tuvieron un escaso rendimiento (AU)

Introduction: To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) in our pediatric emergency departments (PED), to know their incidence, epidemiological characteristics and the yield of laboratory investigations (LI). Patients and methods: Prospective, case-control study of a guideline approach for infants under age 12 months who suffered an ALTE between 01/06/06 and 31/05/07 and were attended at our PEDs. We ordered LI as a function of the clinical history. All the cases were admitted for a minimum of 12h. We conducted a telephone interview at 12 months. Results: Fifty ALTE were included, corresponding to an incidence of 5‰ live births. The median age was 8.46±8.7 weeks. Compared to controls they had significantly more primogenits and previous behavioral abnormalities. Only 13 presented significant abnormalities at examination, and 6 had recurrent ALTE at the PED. LI were abnormal in 41 (82%), but only in 8 cases did they contribute to a secondary diagnosis. There were 29 idiopathic ALTE (58%). Twenty one (42%) had associated conditions, who had smoked significantly more during pregnancy, age older than 12 weeks and abnormalities at examination. Four had recurrence of the episodes: one suffered a sudden infant death syndrome (SIDS). At 12 months the cases had a significantly higher incidence of recurrent vomiting, breath holding spells and weight-psychomotor retardation. Conclusions: The ALTE incidence was 5‰ live births. Primogenits and/or behavioral abnormalities were most frequent during the first weeks after birth and/or thereafter at 12 months of age. A total of 42% had a related diagnosis: associated with age older than 12 weeks, maternal smoking habits and abnormalities at examination. There was one case of SIDS. Laboratory investigations had a low yield (AU)

[Epidemiological characteristics and risk factors for apparent life-threatening events]. / Características epidemiológicas y factores de riesgo de los episodios aparentemente letales.

INTRODUCTION: To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) in our pediatric emergency departments (PED), to know their incidence, epidemiological characteristics and the yield of laboratory investigations (LI). PATIENTS AND METHODS: Prospective, case-control study of a guideline approach for infants under age 12 months who suffered an ALTE between 01/06/06 and 31/05/07 and were attended at our PEDs. We ordered LI as a function of the clinical history. All the cases were admitted for a minimum of 12h. We conducted a telephone interview at 12 months. RESULTS: Fifty ALTE were included, corresponding to an incidence of 5 per thousand live births. The median age was 8.46+/-8.7 weeks. Compared to controls they had significantly more primogenits and previous behavioral abnormalities. Only 13 presented significant abnormalities at examination, and 6 had recurrent ALTE at the PED. LI were abnormal in 41 (82%), but only in 8 cases did they contribute to a secondary diagnosis. There were 29 idiopathic ALTE (58%). Twenty one (42%) had associated conditions, who had smoked significantly more during pregnancy, age older than 12 weeks and abnormalities at examination. Four had recurrence of the episodes: one suffered a sudden infant death syndrome (SIDS). At 12 months the cases had a significantly higher incidence of recurrent vomiting, breath holding spells and weight-psychomotor retardation. CONCLUSIONS: The ALTE incidence was 5 per thousand live births. Primogenits and/or behavioral abnormalities were most frequent during the first weeks after birth and/or thereafter at 12 months of age. A total of 42% had a related diagnosis: associated with age older than 12 weeks, maternal smoking habits and abnormalities at examination. There was one case of SIDS. Laboratory investigations had a low yield.

[Intellectual development in the second year of life in healthy breast-fed children compared with formula-fed children]. / Desarrollo intelectual en el segundo año de vida en niños sanos lactados de forma natural frente a los lactados artificialmente.

BACKGROUND: The role of breast milk with regard to W3 long-chain polyunsaturated fatty acids and infant intellectual development remains controversial. PATIENTS AND METHODS: Thirty-nine children born at term and from homogeneous sociocultural status were enrolled in a blind-prospective trial. Children were divided in two non-randomized groups: a breast-fed group and a standard formula-fed group. Red blood cell phospholipid fatty acids were analyzed at 7 and 60 days of life. Cognitive development was evaluated at the end of the second year of life through Bailey s test. RESULTS: Concentrations of phosphatidylethanolamine and phosphatidylcholine docosahexaenoic acid were significantly lower in the formula-fed group. No statistically significant differences between groups were found in cognitive function. Brain development index was significantly correlated with infant head circumference and educational status of the mother. CONCLUSIONS: Maternal nutrition provides higher red blood cell docosahexaenoic acid, but is not related to a higher developmental quotient at the age of 2 years. However, infant head circumference and maternal educational status were correlated with developmental cognition.

Desarrollo intelectual en el segundo año de vida en niños sanos lactados de forma natural frente a los lactados artificialmente / Intellectual development in the second year of life in healthy breast-fed children vs. Formula-fed children

FUNDAMENTO: El papel que desempeña la leche materna, en especial los ácidos grasos poliinsaturados de cadena larga n-3, en el desarrollo intelectual del niño sano a término sigue suscitando polémica en la actualidad. PACIENTES Y MÉTODOS: Se realizó un estudio prospectivo y ciego con 39 niños sanos a término pertenecientes a familias de nivel sociocultural homogéneo. Se dividieron de forma no aleatorizada en dos grupos alimentados con leche materna o leche infantil convencional. A los 7 y 60 días se midieron las concentraciones de ácidos grasos poliinsaturados de cadena larga en fosfolípidos de membrana de los hematíes en 12 niños con lactancia natural y 6 niños con lactancia artificial. Al final del segundo año se evaluó el desarrollo intelectual del total de niños mediante el test de Bayley. RESULTADOS: La concentración de ácido docosahexaenoico en los fosfolípidos fosfatidilcolina y fosfatidiletanolamina de la membrana del hematíe fue significativamente inferior en el grupo de niños con lactancia artificial. No se encontraron diferencias significativas en el desarrollo intelectual entre los grupos. Se halló una asociación significativa entre el índice de desarrollo mental y las variables perímetro cefálico del niño y grado de educación materno. CONCLUSIÓN: El tipo de lactancia recibida y, como consecuencia, las diferencias en el perfil de ácidos grasos poliinsaturados de cadena larga en la membrana del hematíe, no se han relacionado con el desarrollo intelectual alcanzado al segundo año de vida. Sin embargo, el perímetro cefálico del niño y la educación y trabajo materno sí han resultado relevantes (AU)

[Pertussis. Study of an epidemic]. / Tosferina. Estudio de una epidemia.

Forty-six children seen during 1989 with the clinical diagnosis of Pertussis are reviewed in this study. In 64.5% of the cases the Bordet-Gengou medium nasopharyngeal culture was positive for B. pertussis. Two age groups showed more susceptibility to B. pertussis, children under one year of age (70%) and of more than five years of age (20%). The disease was of more severity among infants younger than two months of age (apnea, choking spells, etc.). Most infants needed to be admitted to the hospital. All patients received therapy with erythromycin, salbutamol (80%) and general supportive medical care. No deaths or other medical sequelae were observed.

[Migraine in a pediatric emergency service]. / Migraña en un servicio de urgencias pediátrico.

105 patients were studied, during a one year period, who had attended the Pediatric Emergency Room, because of a migraine or migraine-like attack. In 8 patients, a different final diagnosis was accomplished during the acute episode: cerebral tumor, subaracnoid bleeding, epilepsy and meningitis. The clinical features are described. Aura symptoms and/or neurologic deficit were necessarily more frequent in these patients than those attending a pediatric out-patient clinic. Neurodiagnostic procedures (EEG, lumbar puncture, CT-Scan) were done in 20%; a third part of the patients were observed at the hospital during several hours before discharge, but only 5% required to be admitted. 30% had attended the Emergency Room in previous occasions for the same purpose. Half of the children did not have a history of migraine, therefore a definite diagnostic of migraine would depend of posterior evolution.

[Evaluation of epidemiologic aspects of poisoning cases at a pediatric emergency service]. / Valoración sobre aspectos epidemiológicos de las intoxicaciones en un servicio de urgencias pediátrico.

An epidemiologic interview was carried out in 279 children between 2-5 years represented the highest risk group. Male children were more frequently affected (57.7%). Most poisoning happened at home. Medicines and cleaning products were the most relevant poisons. Only 81 children (29%) were admitted, generally for 26 hours. Deaths serious sequels were not observed.

[Intestinal invagination: clinico-therapeutic study in a pediatric emergency service]. / Invaginación intestinal: estudio clinicoterapéutico en un servicio de urgencias de pediatría.

Sixty four infants with intussusception diagnosed in one year period are reviewed. The atypical form of presentation with only neurological signs, observed in six patients, is emphasized. These children consulted at an earlier time than those with the classic clinical picture. So that, a high degree of awareness is necessary. There was a significant association between bloody stools and need of surgery (p less than 0.05). We think that barium enema hydrostatic reduction is the primary form of diagnostic and treatment. Only 14 patients (22%) eventually required surgery.