Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study.

Objective: Postoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs in neonates undergoing non-cardiothoracic surgery. Methods: In this retrospective study, all neonates who underwent non-cardiothoracic surgery in a children's hospital from October 2020 to September 2022 were included for analysis. Demographic data and perioperative variables were obtained. The primary outcome was the occurrence of PPCs. Univariate analysis and multivariable logistic regression analysis were used to investigate the effect of patient-related factors on the occurrence of PPCs. Results: Totally, 867 neonatal surgery patients met the inclusion criteria in this study, among which 35.3% (306/867) patients experienced pulmonary complications within 1 week postoperatively. The PPCs observed in this study were 51 exacerbations of pre-existing pneumonia, 198 new patchy shadows, 123 new pulmonary atelectasis, 10 new pneumothorax, and 6 new pleural effusion. Patients were divided into two groups: PPCs (n=306) and non-PPCs (n=561). The multivariate stepwise logistic regression analysis revealed five independent risk factors for PPCs: corrected gestational age (OR=0.938; 95% CI 0.890 to 0.988), preoperative pneumonia (OR=2.139; 95% CI 1.033 to 4.426), length of surgery (> 60 min) (OR=1.699; 95% CI 1.134 to 2.548), preoperative mechanical ventilation (OR=1.857; 95% CI 1.169 to 2.951), and intraoperative albumin infusion (OR=1.456; 95% CI 1.041 to 2.036) in neonates undergoing non-cardiothoracic surgery. Conclusion: Identifying risk factors for neonatal PPCs will allow for the identification of patients who are at higher risk and intervention for any modifiable risk factors identified.

Does time to theater matter in simple gastroschisis?

Objective: A recent publication has suggested that expedited time to theater in gastroschisis results in higher rates of primary closure and decreases the length of stay (LOS). This study primarily aims to assess the impact of time to first management of neonates with gastroschisis on the LOS. Methods: Neonates admitted between August 2013 and August 2020 with gastroschisis were included. Data were collected retrospectively, and neonates with complex gastroschisis were excluded. Variables including gestation, birth weight, time of first management, primary/delayed closure and use of patch were evaluated as possible confounding variables. The outcome measures were time to full feeds, time on parenteral nutrition (PN) and LOS. Univariate and multivariate linear regression analyses were performed. P<0.05 was regarded as significant. Results: Eighty-six neonates were identified, and 16 were then excluded (eight patients with complex gastroschisis, eight patients with time to first management not documented). The median LOS for those who underwent primary closure was 21 days (interquartile range (IQR) =16-29) and for those who underwent silo placement and delayed closure was 59 days (IQR=44-130). The mean time to first management was 473 min (standard deviation (SD) =146 min), with only 20% of these infants being operated on at less than 6 hours of age. Univariate and multivariate analyses demonstrated no relationship between time to first management and LOS (r2=0.00, p=0.82) but did demonstrate a consistent positive association between time to first feed and LOS and delayed closure, resulting in a longer time to full feeds and a longer time on PN. Conclusions: The time to first management was not associated with a change in LOS in these data. Further prospective evaluation of the impact of reducing the time to first feed on the LOS is recommended. Level of evidence: IV.

Survey on surgical treatment of neonatal necrotizing enterocolitis in China 2022.

Objective: The aim of this study was to identify the state of surgical treatment of neonatal necrotizing enterocolitis (NEC) in China. Methods: A total of 246 delegates (88.0% senior surgeons) completed a survey sent by the Neonatal Surgery Group of the Pediatric Surgery Branch of the Chinese Medical Association in 2022. Five centers were eliminated due to lack of experience. Results: Generally, 38.2% of surgeons work in centers where more than 20 cases of surgical NEC are treated per year. A total of 81.3% of surgeons reported the use of ultrasonography; the most used biomarkers were white blood cell count (95.9%), C-reactive protein (93.8%), and procalcitonin (76.3%). Most surgeons (80.9%) used a combination of two (67.2%) antibiotics or single (29.5%) antibiotic for a treatment period of 7-14 days, and most used antibiotics were carbapenems (73.9%), penicillin and cephalosporins (56.0%). Patients are issued the fasting order for 5-7 days by nearly half surgeons (49.8%) for conservative treatment. 70.1% of surgeons deemed that the most difficult decision was to evaluate the optimal timing of surgery. Most surgeons (76.3%) performed diagnostic aspiration of peritoneal fluid. Laparoscopy was performed for the diagnosis and/or treatment of NEC by 40.2% of surgeons. A total of 53.5% of surgeons reported being able to identify localized intestinal necrosis preoperatively. Surgeons relied the most on pneumoperitoneum (94.2%) and failure of conservative treatment (88.8%) to evaluate the surgical indications. At laparotomy, surgical treatments vary according to NEC severity. Infants are fasted for 5-7 days by 55.2% of surgeons postoperatively. Most surgeons (91.7%) followed up with patients with NEC after discharge for up to 5 years (53.8%). Conclusions: The most difficult aspect of surgical NEC is evaluating the timing of surgery, and surgeons in the children's specialized hospitals are experienced. The treatment of NEC totalis is controversial, and the indications for laparoscopy need to be further clarified. More multicenter prospective studies are needed to develop surgical guidelines in the future.

[Use of antibiotics, in a pediatric hospital, for respiratory infection and diarrheal disease]. / Uso de antibióticos, en hospital pediátrico, para infección respiratoria y enfermedad diarreica.

Background: The World Health Organization (WHO) reports an increasing unjustified use of antibiotics in the treatment of Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) in children under five years of age. This has generated problems such as polypharmacy and the inappropriate use of antibiotics; characterized by incorrect dosage, use in viral infections, prescription inconsistent with clinical guidelines. Objective: To analyze the prescription of antibiotics, their diagnostic-therapeutic congruence, as well as the correct filling of the medical prescription, in a tertiary level hospital in Mexico. Material and methods: Observational, descriptive cross-sectional study. The electronic medical prescriptions made during the period January-December 2017 with a clinical diagnosis of ARI and EDA were analyzed. Results: Of a total of 21,446 boys and girls under five years of age, 10,233 prescriptions were issued for the treatment of ARI and ADD diagnoses. 80% of the prescriptions complied with the items indicated in the electronic file. Conclusions: The prescription of antibiotics showed a prudent use of antibiotics both in the management of acute diarrheal diseases and in the management of acute respiratory diseases. Diagnostic-therapeutic congruence was found in most of the cases in the prescriptions analyzed.

Introducción: la Organización Mundial de Salud (OMS) reporta un creciente uso injustificado de antibióticos en el tratamiento de las infecciones respiratorias agudas (IRA) y las enfermedades diarreicas agudas (EDA) en menores de cinco años de edad. Lo anterior ha generado problemas como la polifarmacia y el uso inapropiado de antibióticos, caracterizado por dosis incorrectas, uso en infecciones virales y prescripción incongruente con las directrices clínicas. Objetivo: analizar la prescripción de antibióticos, su congruencia diagnóstico-terapéutica, así como el correcto llenado de la receta médica, en un hospital de tercer nivel de México. Material y métodos: estudio transversal observacional, descriptivo. Se analizó las recetas médicas electrónicas realizadas durante el periodo enero-diciembre de 2017 con diagnóstico clínico de IRA y EDA. Resultados: de un total de 21,446 niños y niñas menores de cinco años se otorgaron 10, 233 recetas para el tratamiento de los diagnósticos de IRA y EDA. El 80% de las recetas cumplieron con de los rubros indicados en el expediente electrónico. Conclusiones: la prescripción de antibióticos mostró un uso prudente de antibióticos tanto en el manejo de las enferdades diarreicas agudas como en el manejo de las enfermedades respiratorias agudas. Se encontró, en la mayoría de los casos, congruencia diagnóstico-terapéutica en las prescripciones analizadas.

Dual ultrasound-guided totally implantable venous access ports via the right internal jugular vein in pediatric patients with cancer: a preliminary experience in a single institution.

Objective: To assess the efficacy and safety of dual ultrasound-guided (DUG) totally implantable venous access port (TIVAP) implantation (namely, using ultrasound-guided percutaneous puncture with transesophageal echocardiography-guided catheterization) via the right internal jugular vein (IJV) in pediatric patients with cancer. Methods: Fifty-five children with cancer requiring chemotherapy underwent DUG-TIVAP implantation via the right IJV. Clinical data were recorded, including the procedure success rate, first attempt success rate, and perioperative and postoperative complications. Results: All 55 cases were successfully operated on. The first puncture success rate was 100%. The operation time was 22-41 min, with a mean time of 30.8±5.5 min. The mean TIVAP implantation time was 253±145 days (range 42-520 days). There were no perioperative complications. The postoperative complication rate was 5.4% (3/55), including skin infections around the port in one case, catheter-related infection in one case, and fibrin sheath formation in one case. The ports were all preserved after anti-infection or thrombolytic therapy. No unplanned port withdrawal was recorded in this study. Conclusions: DUG-TIVAP implantation is a technique with a high success rate and a low complication rate; therefore, it provides an alternative for children with cancer. Further randomized controlled studies are needed to confirm the efficacy and safety of DUG-TIVAP via the right IJV in children.

A Measles Outbreak in a Local Children's Hospital in Korea, 2019.

A measles outbreak with 20 confirmed cases occurred at a local children's hospital in Daejeon from March 28 to April 21, 2019. The index patient was a 7-month-old girl with a recent history of travel to Vietnam. Contact tracing, active surveillance, and post-exposure prophylaxis were conducted by health authorities. Among the 20 patients, 11 (55%) were infants (0-11 months of age), three (15%) were aged 1-3 years, one (5%) was aged 4 years, and five (25%) were adults. Fifteen (75%) patients did not have a history of measles vaccination, and five (25%) had received only one vaccine dose. This study described the importance of prompt application of infection control measures in susceptible environments, including hospitals. Age-appropriate vaccination and providing information on infectious diseases to international travelers and multicultural families in Korea is vital.

Prevalencia y factores de riesgo asociados a infección por virus SARS-CoV-2 en trabajadores del Instituto Nacional de Salud del Niño de Perú, abril 2020 a marzo 2021

Objetivo: Determinar la prevalencia y factores de riesgo asociados a la infección por virus SARS-CoV-2 en trabajadores del Instituto Nacional de Salud del Niño (INSN), en el periodo de abril 2020 a marzo 2021. Materiales y métodos: Estudio no experimental, descriptivo, transversal. La muestra corresponde a 608 trabajadores de salud que resultaron positivos a la prueba serológica rápida. Se revisaron las fichas de investigación clínica epidemiológica COVID-19 elaboradas por el Ministerio de Salud de Perú, que fueron autoadministradas por los trabajadores de salud, y el personal de Epidemiología del INSN verificó el llenado de la ficha. Los datos se introdujeron en una base de datos que sirvió para el análisis estadístico respectivo. El estudio fue aprobado por el Comité Institucional de Ética en Investigación del INSN (código de registro: PI-17/21). Resultados: La prevalencia fue de 7,24 % de COVID-19 en trabajadores del INSN entre abril del 2020 y marzo del 2021. El 71,4 % fueron mujeres, los participantes presentaron una media de edad de 44,71 años, mayoritariamente en el rango de los 30 a 59 años (83,4 %); el 65,6 % fueron asistenciales, de los cuales la mayoría fueron técnicos en enfermería. El 56,9 % de los trabajadores presentaron síntomas, principalmente fiebre/escalofríos (12,2 %), tos (8,9 %), malestar general (7,7 %), dolor de garganta (6,7 %), congestión nasal (2,5 %) y cefalea (1,3 %) . La mayoría de trabajadores residían en los distritos de Lima . Se encontró asociación significativa por sexo y grupos de edad, tipo de trabajador y perfil del trabajador. Conclusiones: La prevalencia de COVID-19 entre los trabajadores del INSN fue del 7,24 %; las características más frecuentes que mostraron diferencias significativas con el resto de los factores fueron el ser mujer, trabajador asistencial y técnica de enfermería. El 56,9 % de los trabajadores presentó síntomas, solo el 20,9 %, signos clínicos y el 10,9 % tuvo comorbilidades.

Objective: To determine the prevalence and risk factors associated with SARS-CoV-2 infection among workers of Instituto Nacional de Salud del Niño (INSN) from April 2020 to March 2021. Materials and methods: A non-experimental, descriptive, cross-sectional study. The sample consisted of 608 workers who tested positive for COVID-19 using a rapid antigen test. The COVID-19 clinical-epidemiological research sheets prepared by the Ministry of Health of Peru and self-administered by the workers were reviewed. The INSN Department of Epidemiology staff verified the completion of the sheets. The data was entered into a database, which was used for the respective statistical analysis. The study was approved by the INSN Institutional Research Ethics Committee (registration code: PI-17/21). Results: COVID-19 prevalence among INSN workers was 7.24 % from April 2020 to March 2021. Out of the workers with COVID-19, 71.4 % were women; 83.4 % were in the 30 to 59 age range with an average age of 44.71 years; 65.6 % were healthcare workers, most of whom were nursing technicians; and 56.9 % experienced symptoms, mainly fever/chills (12.2 %), cough (8.9 %), malaise (7.7 %), sore throat (6.7 %), stuffy nose (2.5 %) and headache (1.3 %). Most workers lived in Lima Centro districts (33.2 %). A significant association between sex, age groups, worker type and worker profile was found. Conclusions: COVID-19 prevalence among INSN workers was 7.24 %; the most frequent characteristics, which showed significant differences with the rest of the factors, were being a woman, healthcare worker and nursing technician. A total of 56.9 % of the workers experienced symptoms, only 20.9 % developed clinical signs and 10.9 % had comorbidities.

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country.

Objective: Assessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management of pediatric subclavian vein catheters (SVCs) and to investigate the main risk factors for complications. Methods: In this prospective observational study, we included children aged 3 months to 14 years who underwent infraclavicular subclavian vein catheterization consecutively using the anatomic landmark technique. Patients were divided into two groups: group 1 included complicated catheters and group 2 included non-complicated catheters. The management protocol was standardized for all patients. After comparing the two groups, univariate and multivariate logistic regression were used to investigate the risk factors for complications. Results: In this study, we included 134 pediatric patients. The rate of complications was 32.8%. The main complications were central line-associated bloodstream infection (63.6%), bleeding and/or hematoma (22.7%), mechanical complications (13.6%), and vein thrombosis (13.6%). After adjustment for confounding factors, predictors of catheter-related complications were difficult insertion procedure (adjusted odds ratio (aOR)=9.4; 95% confidential interval (CI): 2.32 to 38.4), thrombocytopenia (aOR=4.43; 95% CI: 1.16 to 16.86), comorbidities (aOR=2.93; 95% CI: 0.58 to 14.7), and neutropenia (aOR=5.45; 95% CI: 2.29 to 13.0). Conclusions: High rates of complications were associated with difficult catheter placement and patients with comorbidities and severe thrombocytopenia. To reduce catheter-related morbidity, we suggest an ultrasound-guided approach, a multidisciplinary teaching program to improve nursing skills, and the use of less invasive devices for patients with cancer.

Caracterización del dolor abdominal crónico en pacientes del Hospital Pediátrico Provincial Eduardo Agramonte Piña

Introducción: El dolor abdominal recurrente es un síntoma común en los niños y causa gran ansiedad a la familia. Representa hasta el 10 % de las consultas en pediatría, con frecuencia entre escolares y adolescentes, del 85 al 90 % de los casos la causa obedece a un trastorno de tipo funcional. Objetivo: Caracterizar el dolor abdominal recurrente en niños ingresados en el hospital pediátrico Eduardo Agramonte Piña de la provincia Camagüey. Métodos: Se realizó un estudio observacional, descriptivo, transversal, retrospectivo, cuyo universo de trabajo estuvo constituido por 122 pacientes ingresados con diagnóstico de dolor abdominal recurrente, durante el período de estudio. Para la obtención de la información se utilizó el análisis de documentos al revisar las historias clínicas del total de pacientes atendidos y los materiales bibliográficos. Resultados: De 122 pacientes estudiados el grupo más afectado correspondió al de 13-18 años de edad, seguido del grupo escolar de 7-12 años para un total de 73 y 45 casos, respectivamente. Entre los factores que aumentó la frecuencia estuvo la exposición mantenida a situaciones estresantes relacionadas con la disfunción del medio ambiente familiar y social del niño, expresados en los resultados, de 122 pacientes, 91 proceden de medios socio-ambientales disfuncionales, con predominio en las etapas escolares y de la adolescencia. Conclusiones: El número de pacientes con resultados de laboratorio negativos fue mayor que el de los positivos, por lo cual el dolor abdominal de origen funcional superó al de tipo orgánico.

Introduction: Recurrent abdominal pain (RAP) is a common symptom in children and causes great anxiety to the family. It represents up to 10% of pediatric consultations. It occurs frequently among schoolchildren and adolescents and in 85 to 90% of cases the cause is due to a functional disorder. Objective: To characterize the behavior of recurrent abdominal pain in children admitted to the Eduardo Agramonte Piña pediatric hospital in the province of Camagüey. Methods: An observational, descriptive, cross-sectional, retrospective study was carried out, whose universe of work consisted of 122 patients admitted with a diagnosis of recurrent abdominal pain, during the study period. To obtain the information, document analysis was used by reviewing the clinical histories of the total number of patients treated and the bibliographic materials. Results: Of a total of 122 patients studied, the most affected group corresponded to 13 to 18 years of age, followed by the school group of 7 to 12 years for a total of 73 and 45 cases, respectively. Among the factors that increased the frequency was sustained exposure to stressful situations related to the dysfunction of the child's family and social environment, expressed in the results: of 122 patients, 91 come from dysfunctional socio-environmental environments, with predominance in the schoolchildren and adolescents stages. Conclusions: The number of patients with negative laboratory results was greater than that of positive ones, that is why abdominal pain of functional origin exceeded that of organic origin.

The etiological spectrum of bowel obstruction and early postoperative outcome among neonates at a tertiary hospital in Uganda.

Background: Bowel obstruction is a common surgical emergency in newborns. One-fourth of neonates with obstruction suffer postoperative complications, with high mortality, especially in low-income countries. Factors attributed to mortality include prematurity, late presentation and associated multiple congenital anomalies. The prevalence and the predictors of mortality in our setting have not been well studied. We aimed to describe the early postoperative outcomes and to determine the predictors of mortality among neonates with bowel obstruction. Methods: We conducted a prospective cohort study during 4 months, when we recruited postoperative neonates from the pediatric surgery unit of Mulago Hospital. We collected data on demographics, clinical presentations, maternal characteristics, the surgical procedure performed, postoperative outcomes, etc. After follow-up for 2 weeks, we analyzed the data using Cox proportional hazards regression models of predictors of mortality. Results: A total of 76 neonates were recruited, with a male-to-female ratio of 2.2:1. The age ranged from 1 to 26 days, a median of 3 [interquartile range (IQR): 2, 7]. About 67.1% had birth weights ranging between 2.5 kg and 3.5 kg, a mean of 2.8 [standard deviation(SD)=0.64]; 76.3% were termed; with anorectal malformation (ARM), 31.6% as the leading cause, followed by jejunoileal atresia (JIA), 25%. Nearly 55.3% of neonates developed complications; 53.9% with post-operative fever, 15.8% had wound sepsis. The mortality rate was 44.7% (34/76) and was highest among cases of JIA, 41.2%. The predictors of mortality included prematurity, fever at admission, breastfeeding status, and mother's parity as well as the cadre of healthcare providers (p<0.005). Conclusions: ARM is the predominant cause of bowel obstruction among neonates, followed by JIA. The morbidity and mortality due to bowel obstruction among neonates are unacceptably high. The major predictors of mortality were prematurity, fever at admission, and the cadre of the healthcare providers.

Readmissions to a Pediatric Ward: An Eleven-Year Experience in a Portuguese Hospital.

INTRODUCTION: Pediatric readmissions have received increased attention in the past few years. Distinguishing between planned and unplanned readmissions and between preventable and unpreventable ones constitutes an important target to better understand this thematic. The aim of this study was to analyze the readmission rate and characterize the population readmitted within a 30-day period after discharge in the pediatric ward of a level II hospital. MATERIAL AND METHODS: Observational retrospective single center study of the pediatric patients who were discharged from a level II hospital, between 2009 and 2019, and had at least one readmission within 30 days after discharge. Clinical and demographic data were obtained from the analysis of the patient's medical records. We considered as potentially preventable all the unplanned readmissions that were related with the index admission. RESULTS: From the 6879 admissions during the study period, 4.8% resulted in readmissions within the next 30 days. Excluding the planned readmissions, the seven, 15 and 30-day readmission rates were respectively 1.7%, 2.7% and 3.9%. Most of the unplanned readmissions (77%) were considered as potentially preventable. Patients reevaluated in the Pediatric Day Hospital after discharge had shorter intervals to readmission. Readmissions due to decompensation of chronic disease were more likely related with the index admission. Patients with chronic disease, as well as patients with neurological impairment were more likely to have multiple readmissions. CONCLUSION: We found a low overall readmission rate, but a higher percentage of potentially preventable readmissions, when compared with the available literature.

Introdução: Nos últimos anos, os reinternamentos pediátricos têm sido alvo de atenção crescente. Distinguir reinternamentos programados de não programados, e os que podem ou não ser evitados constituem aspetos importantes para a melhor compreensão desta temática. O objetivo deste estudo foi analisar a taxa de reinternamentos e caracterizar a população reinternada até 30 dias após a alta numa enfermaria de Pediatria de um hospital de nível II. Material e Métodos: Estudo observacional retrospetivo dos doentes com alta da enfermaria de Pediatria de um hospital de nível II, entre 2009 e 2019, e que tiveram pelo menos um reinternamento até 30 dias após a alta. Dados clínicos e demográficos foram obtidos a partir da análise dos processos clínicos. Considerámos potencialmente evitáveis os reinternamentos não programados relacionadas com o internamento índex. Resultados: Das 6879 admissões durante o período de estudo, 4,8% resultaram em reinternamento até 30 dias. Excluindo os reinternamentos programados, a taxa de reinternamento até sete, 15 e 30 dias foi, respetivamente, 1,7%, 2,7% e 3,9%. A maioria dos reinternamentos não programadas (77%) foi considerada potencialmente evitável. Os doentes reavaliados em Hospital de Dia após a alta apresentaram um menor intervalo até ao reinternamento. Os reinternamentos devido à descompensação de doença crónica apresentaram maior probabilidade de estarem relacionados com o internamento índex. Doentes com doença crónica e com compromisso neurológico apresentaram maior probabilidade de terem múltiplos reinternamentos. Conclusão: Em comparação com a literatura disponível, foi identificada uma baixa taxa global de reinternamentos, mas uma percentagem superior de reinternamentos potencialmente evitáveis.

Costos de hospitalización de menores de cinco años por gastroenteritis a causa de rotavirus. Hospital Pediátrico de Cienfuegos, 2018

RESUMEN Fundamento El estudio de los costos de la hospitalización por gastroenteritis por rotavirus es un tema estratégico ante la disyuntiva de introducir o no una vacuna contra rotavirus en Cuba. Objetivo estimar el costo institucional de hospitalización de pacientes menores de cinco años de edad por gastroenteritis a causa de rotavirus. Métodos estudio descriptivo, específicamente una evaluación económica parcial del tipo descripción de costos. Se utilizó el costo modelado por protocolo de atención ajustado a la práctica habitual. Fueron revisados los documentos normativos y se aplicó un ejercicio de ajuste a la práctica de rutina mediante consulta a expertos. El costo fue expresado en CUP de 2018. Resultados se estimó el ingreso en sala de Gastroenterología para el 93,1 % de los pacientes, de los cuales el 99,4 % resolvería el problema de salud. El salario resultó la partida de mayor aporte al gasto, aunque en la sala de Gastroenterología lo fueron los exámenes complementarios. El costo de hospitalización promedio modelado para la gastroenteritis por rotavirus fue de 435,13 CUP; este varió según la condición clínica con que arribe el paciente, entre 415,72 CUP y 1057,60 CUP. El costo fue sensible a la variación de la estadía en los servicios. Conclusión La hospitalización de un paciente menor de cinco años por gastroenteritis a causa de rotavirus representa altos gastos para el hospital. El servicio de atención a pacientes críticos y el ingreso previo en una sala clínica distinta a la de gastroenterología incrementan el costo de la atención.

ABSTRACT Background The study of the hospitalization costs for rotavirus gastroenteritis is a strategic issue given the dilemma of introducing or not a rotavirus vaccine in Cuba. Objective to estimate the institutional cost of hospitalization of patients younger than five years of age because of gastroenteritis due to rotavirus. Methods descriptive study, specifically a partial economic evaluation of the costs description type. Modeled cost per care protocol adjusted to standard practice was used. The normative documents were reviewed and an adjustment exercise was applied to routine practice by consulting experts. The cost was expressed in 2018 Cuban pesos. Results admission to the Gastroenterology ward was estimated for 93.1% of the patients, of which 99.4% would solve the health problem. The salary was the item with the highest contribution to spending, although in the Gastroenterology ward it was the complementary examinations. The average cost of hospitalization modeled for rotavirus gastroenteritis was 435.13 Cuban pesos; this varied according to the clinical condition with which the patient arrives, between 415.72 pesos and 1057.60 pesos. The cost was sensitive to the variation of the stay in the services. Conclusion Hospitalization of a patient younger than five years of age for gastroenteritis due to rotavirus represents high costs for the hospital. The attention service to critical patients and the previous admission to a clinical room other than that of Gastroenterology, increase the cost of care.

Changes in pediatric hospital care during the COVID-19 pandemic: a national qualitative study.

BACKGROUND: The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children's and community hospitals. METHODS: We purposefully sampled participants from both community and children's hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2-3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes. RESULTS: We interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians' mental health, and they stressed the importance of mental health resources and wellness activities/spaces. CONCLUSIONS: We identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians' expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians' mental health and well-being, re-evaluating trainees' skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises.

Hemorrhage Expansion After Pediatric Intracerebral Hemorrhage.

BACKGROUND AND PURPOSE: Significant hemorrhage expansion (sHE) is a known predictor of poor outcome after an intracerebral hemorrhage (ICH) in adults but remains poorly reported in children. In a large inception cohort, we aimed to explore the prevalence of sHE, its associations with clinical outcomes, and its clinical-imaging predictors in children. METHODS: Children admitted between January 2000 and March 2020 at a quaternary care pediatric hospital were screened for inclusion. Sample was restricted to children with 2 computed tomography scans within 72 hours of ICH onset, and a minimal clinical follow-up of months. sHE was defined as an increase from baseline ICH volume by 6 cc or 33% on follow-up computed tomography. Clinical outcome was assessed at 12 months with the King's Outcome Scale for Childhood Head Injury score and defined as favorable for scores ≥5. RESULTS: Fifty-two children met inclusion criteria, among which 8 (15%) demonstrated sHE, and 18 (34.6%) any degree of expansion. Children with sHE had more frequent coagulation disorders (25.0% versus 2.3%; P=0.022). After multivariable adjustment, only the presence of coagulation disorders at baseline remained independently associated with sHE (adjusted odds ratio, 14.4 [95% CI, 1.04-217]; P=0.048). sHE was independently associated with poor outcome (King's Outcome Scale for Childhood Head Injury <5A, odds ratio, 5.77 [95% CI, 1.01-38.95]; P=0.043). CONCLUSIONS: sHE is a frequent phenomenon after admission for a pediatric ICH and more so in children with coagulation defects. As sHE was strongly associated with poorer clinical outcomes, these data mandate a baseline coagulation work up and questions the need for protocolized repeat head computed tomography in children admitted for pediatric ICH.

Dolor abdominal como motivo de consulta pediátrica durante la pandemia del SARSCoV- 2 (COVID-19) en Guayaquil, Ecuador / Abdominal pain as a reason for pediatric visiting during the SARS-CoV-2 (COVID-19) pandemic in Guayaquil, Ecuador

Objetivo: el objetivo de este estudio fue describir los casos de pacientes con dolor abdominal y diagnóstico confirmado de COVID-19. En países de Latinoamérica la pandemia ha tenido un gran impacto por el alto índice de mortalidad. Ecuador es el quinto país más afectado en la región en número de casos confirmados con una tasa de 223 fallecidos por cada millón de habitantes, ubicándose en el primer lugar de letalidad. En la población pediátrica el comportamiento del COVID-19 sigue siendo inespecífico. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo en el cual se incluyó a todos los pacientes menores de 18 años exceptuando neonatos, que ingresaron por dolor abdominal a un hospital pediátrico de la ciudad de Guayaquil entre los meses de abril y mayo de 2020 y obtuvieron diagnóstico confirmado COVID-19. Resultados: fueron incluidos 30 pacientes con diagnóstico confirmado de COVID-19 y dolor abdominal. La edad promedio fue 8,46 años a predomino del sexo masculino (70%). En la valoración del dolor 19 (63%) tuvieron un EVA moderado-severo y 11 (37%) EVA leve. 7 pacientes (23.33%) requirieron intervención quirúrgica, 21 (70%) necesitaron de unidad de cuidados críticos, y 1 (3.33%) falleció.Conclusiones: el dolor abdominal constituye un desafío diagnóstico en este tiempo de pandemia y debería ser considerado dentro de las posibles manifestaciones clínicas de COVID-19 en la población pediátrica..Au

Objective: the objective of this study was to describe the cases of paediatric patients with abdominal pain and confirmed diagnosis of COVID-19. In Latin American countries the pandemic has had a major impact from the high mortality rate. Ecuador is the fifth most affected country with a rate of 223 deaths per million inhabitants, ranking at the top of the fatality. In the paediatric population, the behavior of COVID-19 remains nonspecific. Materials and methods: an observational, descriptive and retrospective study was conducted, in which patients under the age of 18 were included except for newborns, admitted by abdominal pain and who obtained a confirmed diagnosis COVID-19. Results: 30 patients with confirmed diagnosis of COVID-19 and abdominal pain were included. The average age was 8.46 years at the predomin of the male sex (70%). In the pain assessment 19 (63%) had a moderate-severe EVA and 11 (37%) Mild EVA. 7 (23.33%) required surgery, 21 (70%) needed a critical care unit, and 1 (3.33%) Died. Conclusions: abdominal pain is a diagnostic challenge in this time of pandemic and should be considered within the possible clinical manifestations of COVID-19 in the paediatric population..Au

Congenital thymoma.

Thymomas are a heterogeneous group of tumors arising from the epithelium of the thymus. They are categorized by the proportion of neoplastic epithelia to lymphocytes and by the degree of cytologic atypia. Thymomas constitute 0.2-1.5% of all malignancies and nearly all occur in patients over 20 years. We reviewed the available literature and found less than 50 cases of thymoma reported in children (<18 years of age), the youngest being 4 years old, and no cases in newborns. They represent less than 1% of all mediastinal tumors in children. Due to the limited number of cases in the pediatric population, the diagnosis and treatment in this population is extremely challenging. Thymomas in all age groups may be associated with paraneoplastic syndromes, being myasthenia gravis the most common, which is associated with a worse prognosis in the pediatric population. We present the first case of a newborn infant with congenital thymoma. This case demonstrates a rare tumor in an unusual age group and emphasizes the importance of multidisciplinary teamwork in the decision-making and management of this condition.

Congenital thymoma

Thymomas are a heterogeneous group of tumors arising from the epithelium of the thymus. They are categorized by the proportion of neoplastic epithelia to lymphocytes and by the degree of cytologic atypia. Thymomas constitute 0.2-1.5% of all malignancies and nearly all occur in patients over 20 years. We reviewed the available literature and found less than 50 cases of thymoma reported in children (<18 years of age), the youngest being 4 years old, and no cases in newborns. They represent less than 1% of all mediastinal tumors in children. Due to the limited number of cases in the pediatric population, the diagnosis and treatment in this population is extremely challenging. Thymomas in all age groups may be associated with paraneoplastic syndromes, being myasthenia gravis the most common, which is associated with a worse prognosis in the pediatric population. We present the first case of a newborn infant with congenital thymoma. This case demonstrates a rare tumor in an unusual age group and emphasizes the importance of multidisciplinary teamwork in the decision-making and management of this condition.

Manejo de la bronquiolitis aguda en el servicio de neumología pediátrica de Pinar del Río / Management of acute bronchiolitis in the pediatric pulmonology service in Pinar del Río

RESUMEN Introducción: la bronquiolitis aguda es la infección de vías respiratorias inferiores más frecuente en niños menores de un año, y supone el 18 % de todas las hospitalizaciones pediátricas. Objetivo: caracterizar el manejo de la bronquiolitis aguda en los pacientes ingresados en el servicio de neumología del Hospital Pediátrico Provincial Docente "Pepe Portilla" durante el año 2019. Métodos: se realizó un estudio observacional, descriptivo y de corte transversal. El universo estuvo constituido por los 612 pacientes con diagnóstico de bronquiolitis y la muestra fue de 482 pacientes. Resultados: predominaron los pacientes ingresados por cuadros ligeros de bronquiolitis (75,9 %), con estadía hospitalaria promedio menor de cinco días. Se realizaron hemograma, eritrosedimentación y radiografía de tórax en el 100 % de los pacientes, con bajo porcentaje de positividad. La ecografía de precordio se reportó en el 15,6 % por auscultación transitoria de soplos cardíacos. La oxigenoterapia fue prescrita en el 98,9 % de los casos, sin evidencia clínica de hipoxemia. Conclusiones: existió un exceso en la indicación de exámenes complementarios y prescripción de medicamentos. Se encontró prescripción irracional de broncodilatadores inhalados, esteroides sistémicos y antihistamínicos. Existe dependencia de los medios diagnósticos, lo cual refleja la necesidad de un mayor empleo del método clínico.

ABSTRACT Introduction: acute bronchiolitis is the most frequent lower respiratory tract infection in children under one year of old and accounts for 18% of all pediatric hospitalizations. Objective: to characterize the management of acute bronchiolitis in patients admitted to the pulmonology service at Pepe Portilla Pediatric Teaching Hospital during 2019. Methods: an observational, descriptive and cross-sectional study was carried out. The target group comprised 612 patients diagnosed with bronchiolitis and the sample included 482 patients who met the inclusion criteria: moderate, mild cases with risk factors and clinical history with complete data. Descriptive statistical techniques were applied to process the information collected. Results: patients were admitted for mild bronchiolitis (75.9%), with an average stay of less than 5 days. Complete Blood Count (CBC), erythrocyte sedimentation and chest radiography was performed in 100% of patients, with low percentage of positivity. Prechordal ultrasound was reported in 15.6% by transitory auscultation of cardiac murmurs. Oxygen therapy was prescribed in 98.9% of cases, with no clinical evidence of hypoxemia. Conclusions: there was an excess in the indication of complementary examinations and medication prescription. There was found an irrational prescription of inhaled bronchodilators, systemic steroids and antihistamines. There is dependence on diagnostic means, which reflects the need for a better application of the clinical method.