Clinical relevance of viral codetection in infants with respiratory syncytial virus bronchiolitis.

INTRODUCTION: Respiratory syncytial virus (RSV) is the main cause of severe bronchiolitis, especially in infants. The aim of this study is to assess whether codetection of RSV and other respiratory viruses could affect the severity of this infection comparing with unique RSV detection. METHODS: A prospective study from 2016 to 2019 including children under 2 years who were admitted in the Emergency Service of the Hospital Universitari Arnau de Vilanova de Lleida (Spain) was performed. Nasopharyngeal samples from all patients were sent to the laboratory for RSV real-time PCR detection (GeneXpert®). A multiplex PCR that detects other respiratory viruses was done in all RSV-positive samples. Patients'medical records were checked to collect clinical data (hospital length of stay, BROSJOD score, ICU admission, need for ventilatory support or transfer to a reference hospital). Patients were divided in two groups: infants with unique RSV detection and infants with viral codetection. Bivariant analyses were performed to analyze the data obtained. RESULTS: During the period of study 437 RSV bronchiolitis were diagnosed. In 199 of them (177/437; 45,5%) another respiratory virus was detected concomitantly. Bivariant analyses do not show statistically significant differences between both groups. CONCLUSIONS: Viral codetection in infants with RSV bronchiolitis is frequent. However, it does not seems to affect the severity of this infection.

Evaluación de la madurez del menor en el ámbito sanitario: la perspectiva de padres y pediatras / Assessment of the maturity of the minor in the health field: the perspective of parents and pediatricians

Introducción: el modelo de respeto a la autonomía y de participación progresiva en el contexto pediátrico requiere que el pediatra que atiende al paciente menor sea capaz de evaluar y decidir si este presenta suficiente madurez y es competente para tomar una decisión sanitaria, o en qué grado participa en la misma. El objetivo es determinar la correlación entre la valoración de la madurez del menor realizada por parte de pediatras y de padres de forma subjetiva, con la realizada mediante una prueba objetiva, la Escala de Valoración de la Madurez de Lleida, MadurTest. Material y métodos: estudio prospectivo, observacional y transversal; 199 adolescentes de entre 12 y 16 años, con patología aguda y crónica. Se evaluó la madurez de los pacientes con la escala MadurTest, y los pediatras y los padres valoraron la madurez del menor con preguntas de la escala Likert para madurez. Resultados: la media de la puntuación de MadurTest fue de 6,39, presentando las niñas un nivel de madurez superior a los niños en la mayoría de las franjas de edad. La valoración de madurez por parte de los pediatras fue de 3,18 de media y por parte de los padres de 3,18. No se observa correlación entre la puntuación obtenida en el MadurTest con la valoración por parte de los profesionales ni por parte de los padres. No obstante, se observa una correlación entre las valoraciones efectuadas por los padres y los profesionales (r = 0,73; p <0,00001). Conclusiones: la madurez de los menores valorada de forma subjetiva por pediatras y padres no se correlaciona con la madurez evaluada de forma objetiva mediante el test MadurTest (AU)

Introduction: the model of respect for autonomy and progressive participation in the pediatric context requires that attending pediatricians be able to assess minor maturity, and decide the degree of participation. The objective of this study is to determine the correlation between the assessment made subjectively by paediatricians and parents, with the maturity of the minor carried out by means of an objective test, the Lleida Maturity Assessment Scale, MadurTest.Material and methods: prospective, observational and cross-sectional study. 199 adolescents between 12 and 16 years old, affected by acute and chronic pathology. The maturity of the patients was evaluated with the MadurTest scale and pediatricians and parents assessed the maturity of the minor in the form of the Likert maturity scale.Results: the mean of the MadurTest score is 6.39, girls present a higher level of maturity than boys in most age groups. The maturity assessment by pediatricians is 3.18 on average and by parents 3.18. No correlation is observed between the score obtained with the MadurTest and the assessment by professionals or by parents. However, a correlation is observed between the assessments made by parents and professionals (r = 0.73, p <0.00001)Conclusions: the maturity of minors assessed subjectively by paediatricians and parents does not correlate with the maturity assessed objectively using the MadurTest. (AU)

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Ull vermell I exoftàlmia: a propòsit de dos casos d'inflamació orbitària idiopàtica / Ojo rojo y exoftalmos: a propósito de dos casos de inflamación orbitaria idiopática / Red eye and exophthalmos: report of two cases of idiopathic orbital inflammation

INTRODUCCIÓ: La inflamació orbitària idiopàtica (IOI), o pseudotumor orbitari idiopàtic, forma part del diagnòstic diferencial d'ull vermell I exoftàlmia. És una malaltia inflamatòria, benigna I sense causa identificable, que respon majoritàriament a corticoteràpia. L'interès de tots dos casos recau en la variabilitat de la resposta al tractament de primera línia I el maneig complex en casos d'evolució atípica. OBSERVACIÓ CLÍNICA: Cas 1. Nen de 12 anys amb ull vermell d'evolució tòrpida, associat posteriorment a exoftàlmia, quemosi I dolor ocular. Es va diagnosticar d'IOI, amb una resposta excel·lent a la corticoteràpia, però amb corticodependència a la retirada progressiva del fàrmac. Va necessitar biòpsia per l'evolució atípica I tractament immunosupressor. Cas 2. Nena de 6 anys amb cefalea frontal I rinorrea, orientada inicialment com a sinusitis. Posteriorment va presentar ull vermell, dolor ocular, exoftàlmia, diplopia I altres signes inflamatoris locals. Es va diagnosticar d'IOI I es va iniciar la corticoteràpia, amb resposta excel·lent I remissió. COMENTARIS: La IOI requereix un exhaustiu diagnòstic diferencial, amb un diagnòstic final d'exclusió que descarti l'associació de malalties sistèmiques. N'és característica la ràpida resposta a glucocorticoides. La corticodependència observada en el primer cas és poc freqüent, I va caldre un esglaó terapèutic superior per aconseguir el control dels símptomes

INTRODUCCIÓN: La inflamación orbitaria idiopática (IOI), o pseudotumor orbitario inflamatorio, forma parte del diagnóstico diferencial de ojo rojo y exoftalmos. Es una enfermedad inflamatoria, benigna y sin causa identificable, que responde mayoritariamente a corticoterapia. El interés de ambos casos recae en la variabilidad de la respuesta al tratamiento de primera línea y el manejo complejo en casos de evolución atípica. OBSERVACIÓN CLÍNICA: Caso 1. Niño de 12 años con ojo rojo de evolución tórpida, asociado posteriormente a exoftalmos, quemosis y dolor ocular. Se diagnosticó de IOI con excelente respuesta a corticoterapia, pero presentando corticodependencia a la retirada progresiva del fármaco. Precisó biopsia por la evolución atípica, y tratamiento inmunosupresor. Caso 2. Niña de 6 años con cefalea frontal y rinorrea, orientada inicialmente como sinusitis. Posteriormente presentó ojo rojo, dolor ocular, exoftalmos, diplopía y otros signos inflamatorios locales. Se diagnosticó de IOI y se inició corticoterapia, con excelente respuesta y remisión. COMENTARIOS: La IOI requiere un exhaustivo diagnóstico diferencial, con un diagnóstico final de exclusión descartando la asociación a enfermedades sistémicas. Es característica la rápida respuesta a glucocorticoides. La corticodependencia apreciada en el primer caso es poco frecuente, y se requirió un escalón terapéutico superior para conseguir el control de los síntomas

INTRODUCTION: Idiopathic orbital inflammation (IOI) or orbital inflammatory pseudotumor is within the differential diagnosis of red eye and exophthalmos, and it is defined as a benign inflammatory disease without identifiable cause that responds to corticosteroid therapy. The two cases reported here highlight the variability of the response to the first line treatment, and the complex management in cases of atypical evolution. Case 1: A 12-year-old boy presented with a red eye with indolent evolution associated with exophthalmos, chemosis and eye pain. He was diagnosed with IOI and had an excellent initial response to corticosteroid therapy. However, the disease was corticosteroiddependent requiring a biopsy for confirmation, and initiation of immunosuppressive therapy. Case 2: A 6-year-old girl presented with frontal headache and rhinorrhea and was initially diagnosed with sinusitis. She later presented with painful red eye, exophthalmos, diplopia and other local inflammatory signs. She was diagnosed with IOI and had an excellent response and long-term remission to corticosteroid therapy. COMMENTS: IOI requires a comprehensive differential diagnosis, with a final diagnosis of exclusion ruling out the association with systemic diseases. The rapid response to glucocorticoids is characteristic of IOI. Corticosteroid dependence is rare and requires an increment in immunosuppressive therapy for disease control

Reflexions al voltant de la pediatria territorial. Com es pot aplicar en un territori perifèric? / No disponible

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Reanimació neonatal: comentaris als canvis apareguts a les recomanacions internacionals 2015 / No disponible

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Effectiveness of a Multi-Component Intervention for Overweight and Obese Children (Nereu Program): A Randomized Controlled Trial.

INTRODUCTION: Treatment of childhood obesity is a complex challenge for primary health care professionals. OBJECTIVES: To evaluate the effectiveness of the Nereu Program in improving anthropometric parameters, physical activity and sedentary behaviours, and dietary intake. METHODS: Randomized, controlled, multicentre clinical trial comparing Nereu Program and usual counselling group interventions in primary care settings. The 8-month study recruited 113 children aged 6 to 12 years with overweight/obesity. Before recruitment, eligible participants were randomly allocated to an intensive, family-based multi-component behavioural intervention (Nereu Program group) or usual advice from their paediatrician on healthy eating and physical activity. Anthropometric parameters, objectively measured sedentary and physical activity behaviours, and dietary intake were evaluated pre- and post-intervention. RESULTS: At the end of the study period, both groups achieved a similar decrease in body mass index (BMIsd) compared to baseline. Nereu Program participants (n = 54) showed greater increases in moderate-intense physical activity (+6.27% vs. -0.61%, p<0.001) and daily fruit servings (+0.62 vs. +0.13, p<0.026), and decreased daily soft drinks consumption (-0.26 vs. -0.02, p<0.047), respectively, compared to the counselling group (n = 59). CONCLUSIONS: At the end of the 8-month intervention, participants in the Nereu Program group showed improvement in physical activity and dietary behaviours, compared to the counselling group. TRIAL REGISTRATION: ClinicalTrials.gov NCT01878994.

Evaluation of a family intervention programme for the treatment of overweight and obese children (Nereu Programme): a randomized clinical trial study protocol.

BACKGROUND: Obesity is mainly attributed to environmental factors. In developed countries, the time spent on physical activity tasks is decreasing, whereas sedentary behaviour patterns are increasing.The purpose of the intervention is to evaluate the effectiveness of an intensive family-based behavioural multi-component intervention (Nereu programme) and compared it to counselling intervention such as a health centre intervention programme for the management of children's obesity. METHODS/DESIGN: The study design is a randomized controlled multicenter clinical trial using two types of interventions: Nereu and Counselling. The Nereu programme is an 8-month intensive family-based multi-component behavioural intervention. This programme is based on a multidisciplinary intervention consisting of 4 components: physical activity sessions for children, family theoretical and practical sessions for parents, behaviour strategy sessions involving both, parents and children, and lastly, weekend extra activities for all. Counselling is offered to the family in the form of a monthly physical health and eating habits session. Participants will be recruited according the following criteria: 6 to 12 year-old-children, referred from their paediatricians due to overweight or obesity according the International Obesity Task Force criteria and with a sedentary profile (less than 2 hours per week of physical activity), they must live in or near the municipality of Lleida (Spain) and their healthcare paediatric unit must have previously accepted to cooperate with this study. The following variables will be evaluated: a) cardiovascular risk factors (anthropometric parameters, blood test and blood pressure), b) sedentary and physical activity behaviour and dietary intake, c) psychological aspects d) health related quality of life (HRQOL), e) cost-effectiveness of the intervention in relation to HRQOL. These variables will be then be evaluated 4 times longitudinally: at baseline, at the end of the intervention (8 months later), 6 and 12 months after the intervention. We have considered necessary to recruit 100 children and divide them in 2 groups of 50 to detect the differences between the groups. DISCUSSION: This trial will provide new evidence for the long-term effects of childhood obesity management, as well as help to know the impact of the present intervention as a health intervention tool for healthcare centres. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01878994.

Alletament matern en la unitat neonatal. Donem tots la mateixa informació? / No disponible

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Síndrome de celulitis-adenitis inguinal por Streptococcus agalactiae / Cellulitis-adenitis syndrome inguinal Streptococcus agalactiae

Las infecciones de tejidos blandos en la infancia son producidas habitualmente por el Staphylococcus aureus pero, en los primeros meses de vida, el Streptococcus agalactiae (SGB) puede ser responsable de celulitis con afectación sistémica. El síndrome de celulitis-adenitis por SGB constituye una presentación infrecuente de la infección tardía causada por este germen. Las manifestaciones clínicas consisten en fiebre, mal estado general y signos inflamatorios locales. La localización más frecuente es la submaxilar, siendo excepcional la inguinal. Aportamos el caso de un paciente de 30 días de vida con fiebre, con una placa eritematosa y adenopatías en la zona inguinal derecha. En el hemocultivo se aisló SGB. El tratamiento inicial fue cloxacilina y cefotaxima parenterales cambiándose a las 48 horas, tras la recepción del hemocultivo, por cefotaxima y ampicilina. La evolución fue favorable. En niños menores de 3 meses, ante la presencia de celulitis y adenitis regional, debemos considerar al SGB como posible agente etiológico y contemplar la posibilidad de bacteriemia y afectación del sistema nervioso central para no diferir el tratamiento adecuado.

Soft-tissue infections in children are most often caused by Staphylococcus aureus but, in the first months of life, group B streptococcus (GBS) can be the etiologic agent of cellulitis with systemic involvement. Group B streptococcus cellulitis-adenitis syndrome is a rare form of late-onset disease for this germen. Clinical manifestations include fever and local inflammatory signs. Typical localization is submandibular but the inguinal form is exceptional. We present a case of a 30-day-old infant with fever, an erythematous plaque and lymphadenopathy in the right inguinal area. Blood culture was positive for GBS. Evolution was good with initial parenteral therapy with oxacylin and cefotaxime that was changed at 48 hours of treatment, after the blood culture reception, to ampicilin and cefotaxime. In cases of cellulitis and adenitis in infants during the first 3 months of life, GBS has to be considered the probable etiologic agent, and severe invasive disease has to be ruled-out in order to establish the appropriate antimicrobial therapy.