[Perceived needs regarding school health care]. / Necesidades percibidas sobre atención a la salud escolar.

BACKGROUND AND OBJECTIVE: Changes in infant morbidity require adaptations to preserve their proper development and academic performance. The objective of this study was to know the perceived needs of teachers, pediatricians and pediatric nurses regarding the training of schools to deal with emergences related to chronic pathology and accidents. METHOD: Cross-sectional study using an ad hoc validated questionnaire on digital support (Google Forms) that included sociodemographic variables and a structured survey that collected information on chronic pathology, health care and safety in case of emergency in the school. RESULTS: Data from 266 questionnaires (134 teachers, 132 pediatricians and pediatric nurses) were analyzed. 73.9% of the teachers stated that they have had students with chronic pathology during the last year and 45.5% confirmed the existence of protocols for their assistance, although 68.7% did not receive specific training for their care. 25% of pediatricians and nurses stated that the parents of children with chronic disease always notify the schools and 17.4% stated that they knew about the existence of specific protocols. 35.6% collaborated in training related to specific pathology or emergencies in schools, with a greater predominance of primary health care (P<.001). 50.7% of the pediatricians and 79.7% of the nurses stated as a medium-high priority the need to have a school nurse in the centers. CONCLUSIONS: The health care of students with chronic diseases in schools can be improved for teachers, pediatricians and pediatric nurses, considering the figure of school nurse as the main improvement measure.

Malformaciones ano-rectales: cambios en el manejo neonatal en los últimos 22 años / Anorectal malformations: changes in neonatal management in the last 22 years

Introducción y objetivos. Una inspección perineal alterada o el retraso en la expulsión meconial debe hacernos sospechar una malformación anorrectal. El objetivo de este estudio es conocer la incidencia de estas malformaciones, así como el estudio de las características obstétricas y neonatales, diagnósticas y terapéuticas de estos pacientes, y sus complicaciones en los últimos 22 años. Material y método. Estudio descriptivo y retrospectivo incluyendo pacientes con diagnóstico en periodo neonatal de malformaciones anorrectales, excluyendo enfermedad de Hirschsprung, entre 2000-2021. Se establecieron dos periodos temporales para ver posibles cambios (2000-2010 versus 2011-2021). Resultados. 27 pacientes, 92,6% varones. Incidencia de 1 caso por cada 5.895 recién nacidos en nuestra región. El 88,9% fueron intervenidos con una mediana de edad de 2 días, precisando ingreso todos ellos durante una mediana de 15 días. El 95,8% recibió antibioterapia (mediana de 6 días), siendo la pauta más utilizada la asociación ampicilina, gentamicina y clindamicina; el 25% precisó ventilación mecánica invasiva (mediana de 1 día) y el 25% sedoanalgesia, tras la intervención; y 17 pacientes precisaron nutrición parenteral (media de 7,6 días). El 16,7% presentó complicaciones a corto plazo (75% infecciosas). A mediolargo plazo, el 37,5% precisó reintervención. No hemos encontrado diferencias significativas en las características clínicas ni diagnósticas entre los dos periodos temporales analizados. Conclusiones. Las malformaciones anorrectales son una causa relativamente frecuente de obstrucción intestinal en periodo neonatal que requiere un tratamiento multidisciplinar. En los últimos 22 años no hemos encontrado diferencias en cuanto a su incidencia ni en su manejo y resultado (AU)

Introduction and objectives. An altered perineal inspection or the delay in meconium expulsion should lead us to suspect an anorectal malformation. This study has aimed to know the incidence of these malformations and to study the obstetric and neonatal, diagnostic and therapeutic characteristics of these patients, and their complications in the last 22 years. Material and methods. A descriptive and retrospective study including patients having a diagnosis in the neonatal period of anorectal malformations, excluding Hirschsprung’s disease, between 2000-2021. Two time periods were established to see possible changes (2000-2010 versus 2011-2021). Results. 27 patients, 92.6% males, there being an incidence of one case per 5,895 newborns in our region. 88.9% underwent surgery with a median age of 2 days, admission being required for a median of 15 days. 95.8% received antibiotic therapy (median of 6 days), the regimen used most being the association of ampicillin, gentamicin and clindamycin; 25% required invasive mechanical ventilation (median of 1 day) and 25% sedated analgesia after the intervention. 17 patients required parenteral nutrition (mean 7.6 days). 16.7% had short-term complications (75% infectious). In the medium to long term, 37.5% required reoperation. We did not find any significant differences in the clinical or diagnostic characteristics between the two time periods analyzed. Conclusions. Anorectal malformations are a relatively frequent cause of intestinal obstruction in the neonatal period that requires multidisciplinary treatment. We have not found differences in terms of its incidence or in its management and outcome regarding the last 22 years (AU)

Recuento de neutrófilos asociado al fenotipo Duffy nulo / Neutrophil count associated with the Duffy phenotype null

Introducción. El fenotipo Duffy nulo es una variante de la normalidad de los antígenos de membrana de las células sanguíneas que ocasiona la forma más frecuente de neutropenia congénita a nivel mundial. Los individuos que la poseen, mayoritariamente provenientes de regiones de África subsahariana, presentan de forma persistente recuentos de neutrófilos por debajo del rango normal, sin que esto implique aumento en el riesgo de infecciones. Caso clínico. Presentamos un lactante, seguido en nuestro Servicio de Neonatología, por neutropenia persistente desde el nacimiento, hijo de una madre procedente de Guinea Ecuatorial. Tras varias analíticas se pudo comprobar el diagnóstico de neutropenia congénita asociada a Duffy nulo a través de inmunofenotipo de sangre periférica. La evolución del niño fue satisfactoria y no presentó ninguna complicación por su neutropenia. Conclusiones. Se debe clasificar la Neutropenia Congénita Asociada a Duffy Nulo (DANC, en sus siglas en inglés) como un polimorfismo genético que genera una variante de la normalidad, adecuando los rangos de los recuentos de neutrófilos a la misma. No se ha visto aumento en el riesgo de infecciones o enfermedades autoinmunes, ni alteraciones en la función de los neutrófilos. Considerar a estos pacientes con los rangos normales de la mayoría de la población tiene consecuencias como pruebas innecesarias, exclusión de ensayos clínicos o no administración de tratamientos oncológicos (AU)

Introduction. The Duffy-null phenotype is a variant of normal blood cell membrane antigens that causes the most frequent form of congenital neutropenia worldwide. Individuals who have it, mostly from sub-Saharan Africa, persistently have neutrophil counts below the normal range, without this implying an increased risk of infections. Case report. We present a child, followed in our Neonatology Service, due to persistent neutropenia from birth, son of a mother from Equatorial Guinea. After several tests, the diagnosis of congenital neutropenia associated with Duffy null could be verified through peripheral blood immunophenotyping. The evolution of the child was satisfactory and he did not present any complications due to his neutropenia Conclusions. Duffy-Null Associated Congenital Neutropenia (DANC) should be classified as a genetic polymorphism that generates a variant of normality, adapting the ranges of neutrophil counts to it. There has been no increase in the risk of infections or autoimmune diseases, nor alterations in the function of neutrophils. Considering these patients within the normal ranges of the majority of the population has consequences such as unnecessary tests, exclusion from clinical trials, or non-administration of oncological treatments (AU)

[Variability between health areas in antibiotic consumption among pediatric outpatients of Principado de Asturias, Spain (2005-2018)]. / Variabilidad entre áreas sanitarias en el consumo extrahospitalario de antibióticos de uso sistémico en la población pediátrica del Principado de Asturias, España (2005-2018).

OBJECTIVE: Antibiotics in Spain are mainly prescribed in the community sector, remarking a high variability between areas. The aim of this study is to describe the variability between health areas in the antibiotic consumption in the pediatric population of Asturias during 2005-2018 period. METHODS: Retrospective and comparative study using data about consumption of antibacterial agents for systemic use (J01C group in ATC, Anatomical Therapeutic Chemical, classification) in the pediatric outpatients of the eight health areas of Principado de Asturias between 2005 and 2018, based on defined daily dose (DDD) per 1000 inhabitants and day (DID). RESULTS: Mean antibiotic consumption in pediatric outpatients in Principado de Asturias (2005-2018) was 14 DID (CI95% 13.4 - 14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). ß-lactam penicillins was the most consumed therapeutic group (10.7 DID). There were statistically significant differences among the areas with the highest and the lowest consumption rates (Avilés, 19 DID; Oviedo, 11.5 DID). A high variability between health areas was observed when analysing data temporally (difference of 11.8 DID in 2011) and therapeutic groups. The consumption of macrolides in Langreo health area and quinolones in Jarrio health area were 2.3 and 4.1 times higher, respectively, comparing to Gijón health area. CONCLUSIONS: There is a wide quantitative and qualitative variability of antibiotic consumption in the pediatric outpatients among the different health areas of Asturias.

Características de los neonatos trasladados al hospital de referencia regional en Asturias / Characteristics of the newborns transferred to the regional reference hospital in Asturias

INTRODUCCIÓN: La regionalización de la asistencia neonatal es un punto importante de la asistencia pediátrica de calidad. Los traslados interhospitalarios neonatales forman parte de esta regionalización. OBJETIVO: Analizar las características de los neonatos trasladados al hospital de referencia en Asturias. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo y descriptivo de los pacientes neonatales trasladados al Servicio de Neonatología del hospital regional de referencia, entre enero de 2017 y diciembre de 2018 en Asturias. RESULTADOS: Se incluyeron 136 pacientes (56 mujeres y 80 varones), lo que supone un traslado cada 5 días, el 1,8% de los neonatos nacidos en los hospitales emisores y el 14,4% de los ingresos en el hospital receptor. El 63,2% ingresaron en la unidad de cuidados intensivos y el 36,7% en la sala de cuidados intermedios, con un tiempo de ingreso medio de 9,5 días. El 20,7% eran prematuros. El peso medio al nacimiento fue de 2.983 g. La edad media al traslado fue de 5 días y el 46,3% de los traslados se realizaron durante las primeras 24 horas de vida. Las causas más frecuentes de traslado fueron: respiratorias (25%), neurológicas (14,7%), digestivas (13,2%) e infecciosas (12,5%). El 38% de los pacientes precisó soporte ventilatorio y el 1,4% falleció durante el ingreso. CONCLUSIONES: Los traslados neonatales interhospitalarios son relativamente frecuentes en nuestra región, siendo el distrés respiratorio y los problemas neurológicos las causas más comunes. El análisis de la regionalización de la asistencia neonatal resulta especialmente importante en regiones con escasa natalidad debido a la crisis demográfica

INTRODUCTION: Regionalization of neonatal care is an important point of quality in pediatric care. Neonatal interhospital transfers between regional hospitals and referral centers are part of this regionalization. OBJECTIVE: To analyze characteristics of newborns transferred from the different regional and private hospitals to theregional reference hospital in Asturias during 2017 and 2018. MATERIALS AND METHODS: An observational, descriptive and retrospective study was conducted, including all neonatal patients transferred fron other Asturian hospital to Neonatology Service of HUCA between January 2017 and December 2018, in Asturias. RESULTS: 136 patients were included (56 female and 80 male), which represents a transfer every 5 days, 1.8% of the 7,563 neonates born in the sending hospitals and 14.4% of the neonatal admissions in the receiving hospital. 63.2% of patients were admitted to the neonatal Intensive Care Unit and 36.7% to the neonatal Intermiediate care room with a mean admission time of 9.5 days. 20.7% were preterm newborns. The average born weight was 2,983 g. 20.6% were less than 2,500 g. Average age at transfer was 5 days, being the 46.3% made during first 24 hours of life. The most frequent causes of transfer were: respiratory (25%) neurological (14.7%), digestive (13.2%) and infectous (12.5%). 38% required ventilatory support and 1,4% died during admission. CONCLUSIONS: Neonatal inter-hospital transfers are relatively frequent in our region, with respiratory distress and neurological problems being the most common causes. The analysis of neonatal care regionalization is especially important in regions with low birth rates due to demographic crisis

Ética en investigación en pediatría: principios y problemas / Ethics in research in pediatrics: principles and problems

La investigación en Pediatría es esencial para el bienestar de la población infantil y de su futuro como adultos. Su importancia está fuera de toda duda y debemos abogar por una investigación ética y legalmente intachable que proporcione conocimientos y evidencia científica de calidad. En todas las sociedades científicas pediátricas se busca fomentar esta investigación entre sus socios, sobre todo los más jóvenes, y nuestra Sociedad de Pediatría de Asturias, Cantabria, Castilla y León no debería quedarse al margen. En los últimos años se ha producido gran cantidad de textos y legislación en el tema de la ética en investigación en clínica humana, tanto a nivel internacional como nacional. En este artículo de revisión intentaré ordenar y poner al día los aspectos más importantes de este problema y discutir concretamente los referentes a la edad pediátrica, como población vulnerable. Por último, plantearé el problema de la confidencialidad de los datos en los estudios observacionales y otros aspectos a tener en cuenta de cara al futuro de la ética en la investigación pediátrica

Pediatric research is essential for the well-being of children and their future as adults. The importance of this research is beyond doubt and we must advocate for an ethically and legally flawless research that provides knowledge and quality scientific evidence. In all the pediatric scientific societies it is sought to promote this research among its partners, especially the youngest, and our Pediatric Society of Asturias, Cantabria, Castilla y León should not be left out. In recent years there has been a large number of texts and legislation on the subject of ethics in human clinical research, both internationally and nationally. In this review article I will try to organize and update the most important aspects of this problem and specifically discuss those referring to pediatric age, as a vulnerable population. Finally, I will raise the problem of confidentiality of data in observational studies and other aspects to consider in the future of ethics in pediatric research

Use of anti-allergic drugs in children

Allergic rhinitis is one of the most frequent chronic diseases in children. We have analysed the prescriptions habits of anti-allergic medications in children (<14 years old) in 2011. We calculated the DHD (N°DDD/1000 children/day) for oral antihistamines and intranasal therapies (corticoids and antihistamines) in the region (sanitary districts I–VIII) and specifically in sanitary district V (health centres 1–15). We also reviewed the clinical records in six health centres in sanitary district V to know more details about age and diagnosis and to value if these prescriptions are adequate. We observed a use of 8.78 DHD in the group of oral antihistamines, with a predominance of desloratadine (3.48 DHD), a 3rd generation drug of this group, and in second place the intranasal therapy with a preference of corticoids (budesonide 3.5 DHD and mometasone 2.25 DHD). We think that it is necessary to improve the knowledge of anti-allergic drugs in children (AU)

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[Resistance rates and phenotypic characterization of Streptococcus pyogenes in a paediatric population in Northern Spain (2005-2015)]. / Cambios evolutivos en las tasas y fenotipos de resistencia de Streptococcus pyogenes en una población pediátrica de Asturias, España (2005-2015).

OBJECTIVE: Streptococcus pyogenes is a significant cause of bacterial infections in children. The aim of the study is to analyse resistance rates and phenotypes of S. pyogenes isolates in a paediatric population in Northern Spain over the last 11 years. METHODS: Descriptive retrospective study of S. pyogenes isolates from paediatric patients between 2005 and 2015 in a region of Asturias (Spain). Resistance rates and changes in erythromycin resistance phenotypes in two time periods (2005-2009 and 2010-2015) were studied. RESULTS: A total of 1,794 S. pyogenes isolates were registered (70% from 2005 to 2009). 87.5% were obtained from pharyngeal swabs and 0.2% from blood cultures. Resistance rates to tetracycline (8.8% to 4.3%, p=0.02), erythromycin (22% to 9.3%, p<0.01) and clindamycin (6% to 1.7%, p<0.01) decreased between the two study periods. A reduction in erythromycin-resistant isolates with the MLSB phenotype was observed. CONCLUSIONS: A decrease in S. pyogenes resistance rates to erythromycin and clindamycin and a change in the erythromycin resistance phenotype were observed along the study period.

Use of anti-allergic drugs in children.

Allergic rhinitis is one of the most frequent chronic diseases in children. We have analysed the prescriptions habits of anti-allergic medications in children (<14 years old) in 2011. We calculated the DHD (N°DDD/1000 children/day) for oral antihistamines and intranasal therapies (corticoids and antihistamines) in the region (sanitary districts I-VIII) and specifically in sanitary district V (health centres 1-15). We also reviewed the clinical records in six health centres in sanitary district V to know more details about age and diagnosis and to value if these prescriptions are adequate. We observed a use of 8.78 DHD in the group of oral antihistamines, with a predominance of desloratadine (3.48 DHD), a 3rd generation drug of this group, and in second place the intranasal therapy with a preference of corticoids (budesonide 3.5 DHD and mometasone 2.25 DHD). We think that it is necessary to improve the knowledge of anti-allergic drugs in children.

Deshidratación hipernatrémica asociada a la alimentación con lactancia materna en el periodo neonatal / Hypernatremic dehydration associated with breast-feeding in the neonatal period

Introducción: La deshidratación hipernatrémica en el neonato se asocia de forma característica a la alimentación con lactancia materna exclusiva en madres primigestas por una mala técnica de amamantamiento. Pese a los avances en los cuidados perinatológicos, continúa siendo una patología habitual en nuestros días. Población y métodos: Estudio descriptivo retrospectivo de los neonatos alimentados con lactancia materna exclusiva y natremia ≥150 mmol/L, que precisaron ingreso en el Hospital Universitario Central de Asturias en los últimos 14 años. Resultados: Serie de 26 casos (0,54 por cada 1.000 recién nacidos vivos). La pérdida media de peso hasta el ingreso fue del 17,9%, con una natremia media de 162 mmol/L. Se observó una relación lineal entre el sodio sérico y la pérdida de peso. El 73% de las madres eran primigestas. El 34% de los casos procedían de la maternidad de nuestro hospital, el 34% habían acudido al servicio de urgencias de nuestro centro y el 30,6% acudían remitidos por sus pediatras de referencia. Todos los casos evolucionaron satisfactoriamente. Se constató un aumento de la incidencia en los últimos años. Conclusiones: La deshidratación hipernatrémica asociada a la lactancia materna exclusiva aparece, en la mayoría de los casos, en madres primigestas. La formación del personal sanitario, la intensificación de los cuidados del neonato durante su estancia en la maternidad y el control precoz del mismo tras el alta hospitalaria pueden considerarse medidas útiles para evitar esta patología, cuya existencia pone de manifiesto una carencia en el sistema sanitario (AU)

Introduction: Hypernatremic dehydration in newborns is associated to exclusive breastfeeding in primiparous mothers with wrong breastfeeding technique. Despite advances in perinatological care, hypernatremic dehydration remains common today. Subjects and methods: Retrospective study of exclusive breastfeeding neonates with serum sodium concentrations equal to or greater than 150 mmol/L requiring admission in the Hospital Universitario Central de Asturias in the last 14 years. Results: Twenty-six newborn were included in the study (0.54 per 1,000 live births). At admission, the mean percentage of weight loss was 17.9% and mean serum sodium value 162 mmol/L. A linear relationship between serum sodium and weight loss was observed. 73% of the mothers were primiparous. 34% of the sample were admitted directly from the maternity, 34% came from the emergency department and 30,6% were referred to the hospital by their reference pediatrician. All cases evolved satisfactorily. An increase in incidence in recent years was objectively. Conclusions: Hypernatremic dehydration in exclusively breastfed neonates appears in most cases in primiparous. Breastfeeding training for health professionals, to intensify the care of the newborn during their stay in the maternity and to implement an early visit after postnatal discharge may be considered useful measures to prevent this pathology. Nowadays, this disease reflects a lack of support for breast-feeding mothers in health system (AU)

Uso de anticatarrales en menores de 14 años en consultas de Atención Primaria / Use of cold and cough medications prescribed in Primary Care clinics for children less than 14 years

OBJETIVO: Conocer el perfil de prescripción de anticatarrales en las consultas de Pediatría de Atención Primaria en el Área V del Servicio de Salud del Principado de Asturias y valorar su idoneidad. Material y métodos; Estudio transversal, descriptivo y retrospectivo. Se analizaron las prescripciones para el tratamiento de los procesos respiratorios en 6 consultas de Pediatría de Atención Primaria en el Área Sanitaria V del Servicio de Salud del Principado de Asturias en el año 2011. Se valoraron la idoneidad de los tratamientos prescritos mediante las fichas técnicas de los fármacos y las indicaciones clínicas según el diagnóstico, siguiendo las recomendaciones de guías clínicas, protocolos o en su defecto la bibliografía disponible más actual. RESULTADOS: Se analizaron 424 anticatarrales: 249 antitusígenos, 155 mucolíticos y 20 clasificados en otros. La media de edad de los pacientes es de 5 años. Un 85,1% de las prescripciones se consideran inadecuadas. El 11,6% de ellos fueron prescritos fuera de ficha técnica. Se consideraron inadecuados el 82,8% de los asociados al diagnóstico R74 y el 73% al R05. Todos los fármacos de los menores de 6 años se consideraron inadecuados. El 99,4% de los mucolíticos/otros y el 75,1% de los antitusígenos se consideraron inadecuados. CONCLUSIONES: Se observa un alto porcentaje de prescripción de fármacos anticatarrales en menores de 14 años en nuestro medio, encontrándose un 85% de las prescripciones inadecuadas. Los niños deberían recibir solo medicamentos con una relación beneficio-riesgo favorable; para ello es necesario mejorar la información sobre el uso pediátrico y promover acciones formativas dirigidas a los padres y a los profesionales sanitarios

OBJECTIVE:To evaluate cold and cough medications and their suitability in children in Primary Health Care in Area V of the Asturian Health Service. MATERIAL AND METHODS: A cross-sectional, descriptive and retrospective study was conducted in which an analysis was performed of the respiratory diseases and the prescriptions of 6 Primary Health Care paediatricians who worked in Area V of the Asturian Health Service in 2011. An evaluation was made on the suitability of these medications. An analysis was also made of the drug datasheet and clinical recommendations (clinical guidelines, protocols or reports). RESULTS: A total of 424 cold and cough drugs: 249 antitussives, 155 mucolytics, and 20 'others' were analyzed. The mean age was 5 years old. There was a total of 85.1% unsuitable prescriptions. Off-label drugs were used in 11.6%. The prescribing was considered unsuitable in 82.8% of prescriptions associated with R74, and 73% of R05. All of the prescription drugs in children under 6 years old were unsuitable. Mucolytics/'others' were not suitable in 99.4%, nor antitussives in 75.1%. CONCLUSIONS: There is a high level of cold and cough drugs being prescribed in children, with 85% of these being unsuitable. Children should only receive drugs with a good risk and benefit ratio. Pediatricians should try to improve the information about pediatric drug use and spread this information to parents, doctors and nurses

[Use of cold and cough medications prescribed in Primary Care clinics for children less than 14 years]. / Uso de anticatarrales en menores de 14 años en consultas de Atención Primaria.

OBJECTIVE: To evaluate cold and cough medications and their suitability in children in Primary Health Care in Area V of the Asturian Health Service. MATERIAL AND METHODS: A cross-sectional, descriptive and retrospective study was conducted in which an analysis was performed of the respiratory diseases and the prescriptions of 6 Primary Health Care paediatricians who worked in Area V of the Asturian Health Service in 2011. An evaluation was made on the suitability of these medications. An analysis was also made of the drug datasheet and clinical recommendations (clinical guidelines, protocols or reports). RESULTS: A total of 424 cold and cough drugs: 249 antitussives, 155 mucolytics, and 20 "others" were analyzed. The mean age was 5 years old. There was a total of 85.1% unsuitable prescriptions. Off-label drugs were used in 11.6%. The prescribing was considered unsuitable in 82.8% of prescriptions associated with R74, and 73% of R05. All of the prescription drugs in children under 6 years old were unsuitable. Mucolytics/"others" were not suitable in 99.4%, nor antitussives in 75.1%. CONCLUSIONS: There is a high level of cold and cough drugs being prescribed in children, with 85% of these being unsuitable. Children should only receive drugs with a good risk and benefit ratio. Pediatricians should try to improve the information about pediatric drug use and spread this information to parents, doctors and nurses.

Evaluación de la implementación de un protocolo de hipotermia terapéutica en la encefalopatía hipóxico-isquémica neonatal / Evaluation of the implementation of therapeutic hypothermia protocol in the newborn with hypoxic-ischaemic encephalopathy

Introducción; La seguridad de la hipotermia moderada activa (HMA) en la encefalopatía hipóxico-isquémica (EHI) junto con los resultados esperanzadores sobre el pronóstico neurológico ha contribuido a la proliferación de centros donde se oferta esta técnica. Objetivos: Evaluar la experiencia inicial en la implantación de un nuevo programa de HMA: condiciones en las que llegan los neonatos al hospital de referencia, dificultades para llevar a cabo este tratamiento y seguridad de esta intervención. Población: Estudio observacional de una cohorte de pacientes formada por los 15 neonatos nacidos en nuestro hospital o remitidos desde otros centros sanitarios tras presentar una EHI moderada-severa entre el 1 de julio de 2012 y el 1 de enero de 2015. Resultados:. El 60% de los neonatos procedía de otros hospitales de la provincia. Todos requirieron una reanimación avanzada (duración: 10-50 minutos). Se registró el inicio de la hipotermia pasiva en el 73,3% de los casos. En el 40% se esperó, al menos, 6 horas para iniciar HMA. Al ingreso en UCIN: 33,3% presentaron temperatura dentro del rango considerado adecuado y 20% temperatura < 33°C, el 80% ventilación mecánica (40% con FiO2 > 40%), 60% hipotensión arterial, 33,3% glucemia < 60 mg/dl. Todos los neonatos tuvieron clínica multisistémica y 53,3% convulsiones. El 35,7% presentaron algún tipo de alteración en su desarrollo neurológico y la mortalidad fue del 6,6%. Conclusiones: El manejo de los neonatos asfícticos es mejorable optimizando la formación del personal que asiste y traslada a estos pacientes. Con el debido entrenamiento, la HMA ha demostrado ser una técnica segura

Introduction: Therapeutic hypothermia (TH) as the standard therapy in neonates with neurological injury because of hypoxic-ischemic encephalopathy (HIE), provides safe and encouraging results. Because of this, many centers where this technique is offered have multiplied in recent years. Objective: To evaluate the initial experience in the implementation of a new TH program: clinical conditions of newborns once they arrive at referring hospitals, difficulties to start this treatment and safety of this intervention. Material and methods: Observational study of a cohort of patients formed by 15 neonates undergoing therapeutic hypothermia due to moderate or severe HIE in our hospital between July 1, 2012 and January 1, 2015. Results: 60% of the patients came from other hospitals. All of them required advanced resuscitation (from 10 to 50 minutes). The time when passive hypothermia started were recorded in 73.3% of the patients and in 40% were expected at least six hours to start TH. At the admission to neona tal intensive care unit (NICU): only 33.3% of infants were within the target temperature range at arrival and in 20% a temperature lower than 33°C were registered, 80% were in mechanical ventilation (40% with FiO2 > 40%). In 60% of the sample arterial hypothension were recorded and 33,3% of the infants had blood glucose less than 60 mg/dl. The whole sample had multisystemic symptoms and 53,3% had seizures. Had any alteration in their neurological development 35.7% and 6.6% of the neonates died. Conclusions: The management of neonatal asphyxia can be improved by optimizing the training of the staff who attends these neonates and the transport teams who transfer the newborn to the referral hospitals. With the proper training, TH has proven to be a safe technique

Necesidad de la perspectiva de género en el anuario de ANALES DE PEDIATRÍA. Respuesta de los autores / Need for the gender perspective in the Anales de Pediatría yearbook. Author's response

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El espacio de los editores: anuario de Anales de Pediatría / Editors' Corner: anales de Pediatria Annual Report

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[Use of probiotics in the prevention of necrotizing enterocolitis in premature newborns]. / Empleo de probióticos en la prevención de la enterocolitis necrotizante en recién nacidos prematuros.

Necrotizing enterocolitis is the most frequent and life threatening pathology of the neonatal period and causes high morbi-mortality. According to the most recent metaanalyses, prophylactic treatment of premature newborns with probiotics significantly lowers the risk of suffering from severe necrotizing enterocolitis (stages II and III). This treatment also reduces the mortality, the hospitalization period and the days after which exclusive enteral nutrition is reached. Based in these facts, the Nutrition and Neonatal Metabolism Group of the Spanish Society of Neonatology considers that probiotics should be taken into consideration for use on less than 32 weeks- gestation premature newborns and/or those born with a weight lower than 1,500 g, although their use has to be submitted to close monitoring.

La enterocolitis necrotizante es la patologia digestiva adquirida mas frecuente y grave en el periodo neonatal, que ocasiona una importante morbi-mortalidad. Segun los ultimos metaanalisis, el tratamiento profilactico con probioticos en el recien nacido prematuro disminuye de manera significativa el riesgo de padecer una enterocolitis necrotizante severa (estadios II o III). Dicho tratamiento tambien ha demostrado una disminucion de la mortalidad, de los dias de hospitalizacion y de los dias tras los que se alcanza la nutricion enteral exclusiva. Por todo ello, el Grupo de Nutricion y Metabolismo Neonatal de la Sociedad Espanola de Neonatologia considera que el uso de probioticos deberia tenerse en cuenta en el recien nacido prematuro ≤ 32 semanas de gestacion y/o < 1500 g, si bien su uso debe someterse a una estrecha monitorizacion.

Cambios en la presentación y evolución de la atresia esofágica en los últimos 20 años / Changes in the presentation and evolution of esophageal atresia in the last 20 years

Objetivo: Conocer los cambios ocurridos en las dos últimas décadas en las formas de presentación clínica, malformaciones asociadas, tratamiento y evolución de la atresia esofágica, comparando una serie actual con otra histórica de nuestro mismo centro. Métodos: Estudio descriptivo retrospectivo. Revisión de las historias clínicas de todos los casos codificados como atresia de esófago al alta desde 1/1/2003 a 31/12/2013. Comparación con la serie histórica de nuestro centro de 1/1/1980 a 31/12/1990 publicada en 1992. Resultados: Al comparar la serie ya publicada con la revisión actual no encontramos diferencias estadísticamente significativas en la incidencia de atresia esofágica (2,29 frente a 2,61 casos por cada 10.000 neonatos vivos), ni en el porcentaje de prematuridad (25,9 frente a 45%), ni en el porcentaje de casos con ecografía intraútero patológica (65 frente a 50%), ni en el porcentaje de casos con otras malformaciones asociadas (59,2 frente a 68,1%). Encontramos diferencias estadísticamente significativas en el porcentaje de cirugía en el primer día de vida (40,7 frente a 9%), en el porcentaje de sepsis nosocomial postquirúrgica (44,4 frente a 86%) y en la mortalidad (40,7 frente a 4,5%). Conclusiones: La atresia de esófago es una patología con una importante morbilidad asociada. En los últimos veinte años no hemos encontrado diferencias en su forma de presentación, pero si en su evolución, con un descenso muy importante en la mortalidad

Objective: To know the changes in the last two decades in clinical presentation, associated malformations, treatment and outcome of esophageal atresia, comparing this current series with another historical of our own hospital. Methods: A retrospective descriptive study. Review of medical records of all cases coded as esophageal atresia at discharge from 1/1/2003 to 12/31/2013. Comparison with our historical series from 1/1/1980 to 12/31/1990, published in 1992. Results: No statistically significant differences in the incidence of esophageal atresia (2.29 versus 2.61 cases per 10,000 live infants), or the percentage of prematurity (25.9 vs. 45%), or the percentage of cases with pathological intrauterine ultrasound (65 vs. 50%), or the percentage of cases with associated malformations (59.2 vs. 68.1%). Found significant differences in percentage of surgery on the first day of life (40.7 vs. 9%), the percentage of nosocomial postsurgical sepsis (44.4 vs. 86%) and mortality (40.7 vs 4.5%). Conclusions: Esophageal atresia is a condition associated with significant morbidity. In the last twenty years we have not found differences in their presentation, but we had found differences in its evolution, with a significant decrease in mortality