[Increase in severe acute respiratory infections in children during the last phase of the COVID-19 pandemic]. / Incremento de infecciones respiratorias agudas graves en niños durante la última etapa de la pandemia COVID-19.

OBJECTIVE: The COVID-19 pandemic has caused a variation in the circulation of respiratory pathogens. Our aim was to analyze the epidemiology of severe acute respiratory infections (SARI) in children during 3 years of the COVID-19 pandemic, in comparison with a previous period. METHODS: An observational study was conducted in a tertiary hospital in Spain, which analyzed the frequency and characteristics of patients admitted for SARI in the Pediatric Intensive Care Unit (PICU) during the COVID-19 pandemic (1 March 2020 to 28 February 2023), compared to pre-pandemic period (1 March 2017 to 29 February 2020). RESULTS: A total of 268 patients were included (59.6% males). The median age was 9.6 months (IQR 1.7 - 37). In the pre-pandemic period, there were 126 admissions with an average of 42 admissions/year. During the pandemic, there were 142 admissions, observing a significant reduction in admissions in the first year (12 admissions/year), in contrast to 82 admissions during the third year, which represented an increase of 95% compared to the average of admissions/year in pre-pandemic. In addition, in the last year there was evidence of an increase in viral coinfections in relation to pre-pandemic period (54.9% vs 39.7%; p=0.032). There were no differences in length of hospital stay or PICU stay. CONCLUSIONS: During the last year, coinciding with low rates of hospitalization for COVID in Spain, we observed a notable increase in admissions to the PICU for SARI. Probably, the prolonged period of low exposure to pathogens due to the measures adopted during the pandemic might have caused a decrease in population immunity with a rise in severe respiratory infections.

Acute liver failure after sevoflurane anesthesia in a pediatric patient. / Fallo hepático agudo tras anestesia con sevoflurano en un paciente pediátrico.

Sevoflurane is a volatile anesthetic characterized by low toxicity and is the most used in pediatric age. Unlike other halogenated anesthetic, sevoflurane is not metabolized to reactive intermediates that lead to the formation of hepatotoxic proteins. However, a few cases of hepatotoxicity have been associated with its use. We report a case of an 11-year-old boy who developed acute liver failure after neurosurgical intervention, resection of a posterior fossa mass, under sevoflurane anesthesia and other drugs. Postoperatively, he presented abdominal pain and the laboratory tests showed markedly elevated aminotransferase levels, coagulopathy and thrombocytopenia. He had no fever, hypoglycemia or evidence of encephalopathy. The clinical evolution was favorable and after 7 days, laboratory values were completely normalized. All the possible causes of acute liver failure were evaluated and the differential diagnosis is exposed.

Prevalencia de lactancia materna y factores asociados a su abandono en un área del centro-norte de España / Prevalence of breastfeeding and factors associated with cessation in an area of north-central Spain

Introducción. La lactancia materna (LM) es el alimento idóneo para el recién nacido y el lactante. El objetivo del estudio fue estimar la prevalencia y duración de la LM e identificar los factores relacionados con su abandono. Pacientes y métodos. Estudio observacional prospectivo, realizado en el Área de Salud Valladolid-Este, situada en el norte de España, que incluyó recién nacidos atendidos en la maternidad de un hospital de tercer nivel entre octubre de 2015 y febrero de 2016. Se excluyeron aquellos recién nacidos que precisaron ingreso hospitalario. Se llevaron a cabo encuestas a las madres al alta de maternidad y seguimiento mediante entrevistas telefónicas durante 2 años, realizadas a los 6, 12, 18 y 24 meses postparto, recogiéndose información sobre el tipo de alimentación de los recién nacidos, datos sociodemográficos, gestacionales y perinatales. Se realizó análisis de regresión de Cox, univariante y multivariante. Resultados. Se incluyeron 223 recién nacidos, 201 (90,1%) recibían LM al alta de maternidad (71,3% LM exclusiva y 18,8% lactancia mixta). La prevalencia de LM fue del 51,7% a los 6 meses, del 21,4% a los 12 meses y del 3% a los 24 meses. Los factores de riesgo relacionados con el abandono de la LM fueron: no haber amamantado previamente (HR 1,65; IC95% 1,13-2,42) o haber amamantado menos de 3 meses (HR 4,81; IC95% 2,32-9,25), tabaquismo materno gestacional (HR 2,57; IC95% 1,59-4,1), cesárea programada (HR 1,79; IC95% 1,08-2,98) y peso del recién nacido menor de 2.800 g (HR 1,57; IC95% 1,02-2,43). Conclusiones. La tasa de LM al alta de maternidad es similar a la de otros estudios nacionales. Se identificaron varios factores implicados en su abandono, hallazgos relevantes para diseñar estrategias de apoyo que permitan incentivar su continuidad (AU)

Background. Breastfeeding (BF) is the optimal way to nourish newborns and infants, due to the multiple benefits it offers. The aim of this study was to estimate the prevalence and incidence of breastfeeding and identify the risk factors related with breastfeeding weaning. Methods. A prospective, observational study was performed on healthy newborns in the area of Valladolid-East, Spain, between October 2015 and February 2016. Questionnaires were completed by mothers at discharge from maternity and and follow-up through telephone interviews for 2 years, carried out at 6, 12, 18 and 24 months postpartum. Sociodemographic variables, gestational, perinatal and breastfeeding data were collected. Univariate and multivariate Cox regression analysis were performed. Results. A total of 223 newborns were included. At hospital discharge, 201 newborns (90.1%) received breastfeeding (71.3% exclusive breastfeeding and 18.8% partial breastfeeding). At 6 months, prevalence of breastfeeding was 51.7%, 21.4% at 12 months and 3% at 24 months. Risk factors for stopping breastfeeding were: not having previously breastfed (HR 1.65; IC95% 1.13-2.42) or previous breastfeeding less than 3 months (HR 4.81; IC95% 2.32-9.25), tobacco consumption during gestation (HR 2.57; IC95% 1.59-4.1), C-section without delivery work (HR 1.79; IC95% 1.08-2.98) and birthweight below 2,800 g (HR 1.57; IC95% 1.02-2.43). Conclusions. The rate of initiation of breastfeeding is similar to that of other national studies. Several risk factors related to the cessation of breastfeeding were identified. This is an important finding so as to design support strategies that will promote the maintenance of breastfeeding (AU)

Fallo hepático agudo tras anestesia con sevoflurano en un paciente pediátrico / Acute liver failure after sevoflurane anesthesia in a pediatric patient

El sevoflurano es un anestésico volátil que se caracteriza por su baja toxicidad siendo el más utilizado en edad pediátrica. A diferencia de otros anestésicos inhalados halogenados, el sevoflurano no se metaboliza a productos intermedios que conducen a la formación de proteínas hepatotóxicas; sin embargo, algunos casos de hepatotoxicidad han sido atribuidos a su uso. Describimos el caso de un niño de 11 años que presentó fallo hepático agudo tras la intervención neuroquirúrgica de un tumor de fosa posterior, realizada bajo anestesia con sevoflurano asociado a otros fármacos. Durante el postoperatorio manifestó dolor abdominal y en la analítica sanguínea se observó marcada elevación de enzimas hepáticas, coagulopatía y trombocitopenia. Permaneció afebril, sin presentar hipoglucemia ni signos de encefalopatía. Su evolución fue favorable, con normalización de los parámetros analíticos al séptimo día de postoperatorio. Se evaluaron todas las posibles causas de fallo hepático agudo y se expone el diagnóstico diferencial realizado

Sevoflurane is a volatile anesthetic characterized by low toxicity and is the most used in pediatric age. Unlike other halogenated anesthetic, sevoflurane is not metabolized to reactive intermediates that lead to the formation of hepatotoxic proteins. However, a few cases of hepatotoxicity have been associated with its use. We report a case of an 11-year-old boy who developed acute liver failure after neurosurgical intervention, resection of a posterior fossa mass, under sevoflurane anesthesia and other drugs. Postoperatively, he presented abdominal pain and the laboratory tests showed markedly elevated aminotransferase levels, coagulopathy and thrombocytopenia. He had no fever, hypoglycemia or evidence of encephalopathy. The clinical evolution was favorable and after 7 days, laboratory values were completely normalized. All the possible causes of acute liver failure were evaluated and the differential diagnosis is exposed