Evaluación de los cursos de simulación médica avanzada para la formación de los médicos residentes de pediatría en situaciones de emergencia

ObjectiveTo analyse the usefulness of simulation courses in paediatric emergencies in a new training program for paediatrics residents.MethodsAn advanced simulation course with practical cases of paediatric emergencies was designed. Assessment of each clinical case was rated from 1 to 5 in the following sections: organization and coordination of team work, physician orders, monitoring, clinical examination, treatments, interpretation of laboratory tests, parent information, and global evaluation. The results were compared by year of residency of the participants. Student satisfaction with the course was assessed through a survey.ResultsThere were six courses of simulation with 55 residents, of whom 29% were second-year residents (R2), 47% third year (R3), and 23% fourth year (R4). The median global score was 3.4 (IR: 3.2 to 3.7). The highest score was the initial monitoring (median: 4; IR: 4 to 4.3) and the initial medical examination (median: 4; IR: 3.4 to 4.2). The worst aspect was the information to the parents (median: 3; IR: 2.3 to 3.4). There were no significant differences in the global score according to the year of residency. The residents felt very positive about simulation courses, emphasizing the realism and practicality.ConclusionsThe inclusion of advanced simulation courses in paediatric emergencies in the training program of paediatric residents is a useful educational method, and is appreciated by residents.     

Evaluación de la alimentación y consumo de nutrientes en menores de 3 años. Estudio piloto ALSALMA

ObjectiveThe present study evaluates energy and nutrient intake in Spanish children under three years of age, and compares the results with the current recommendations in order to identify possible inadequate nutrient intake.Patients and methodsA cross-sectional pilot study. The mothers completed a diet diary for four non-consecutive days, recording the products and amounts consumed by their children. Nutrient intake was calculated, and the results were compared with the dietary reference intakes (DRI) for each age group.ResultsA total of 188 children (93 boys and 95 girls) aged 0-6 (n = 41), 7-12 (n = 24), 13-24 (n = 57), and 25-36 months (n = 66) were included. Statistically significant differences in DRI were observed for most of the nutrients analyzed. Protein intake, in particular was 376% of DRI in children between 1-3 years of age. By age groups, 96% of the children aged 7-12 months, 88% of the children aged 13-24 months, and 97% of the children aged 25-36 months showed protein intakes more than two-fold DRI.ConclusionsNutrient intake differed from the DRI, particularly as regards proteins. A new study is required to determine whether the observed study deviations could be representative of the national population of this age group, as well as the possible effects on child health.     

Exposición prenatal a drogas de abuso a través del análisis de meconio en una población de bajo nivel socioeconómico en Barcelona

IntroductionFor the first time in Europe, the «Meconium Project» aimed to estimate the prevalence of drug use by pregnant women and the subsequent foetal exposure to illicit drugs.Patients and methodBetween October 2002 and February 2004, 1209 mother–infant dyads from the Hospital del Mar, Barcelona, Spain met eligibility criteria and agreed to participate in the study. Data on socio-economic and demographic characteristics and on drug habits during pregnancy were collected using a structured questionnaire. Neonatal meconium was collected within 24 h after birth and analyzed by standardized chromatographic techniques for the presence of opiates, cocaine, cannabinoids and amphetamines.ResultsMeconium analysis showed an overall 10.9% positivity for drugs of abuse, with a specific prevalence of heroin, cocaine and cannabis with foetal exposure of 4.7, 2.6 and 5.3%, respectively. Structured interviews also revealed that 0.3, 1.2 and 1.5% of mothers used heroin, cocaine and cannabis, respectively, while only one mother declared ecstasy consumption, confirmed by meconium analysis. Parental ethnicity and working class was not associated with drug use. Drug consuming mothers were shown to have a higher number of previous abortions when compared to non-consumer mothers, which was probably due to a lack of family planning. Significantly lower birth weight and length was found in newborns from mothers exposed to cocaine alone or in combination with other drugs.ConclusionsThis study, although developed in a low socio-economic-status cohort, may serve as an eye opener for any hidden non-negligible drug consumption during pregnancy. In this sense, meconium analysis can be important to identify neonates with a high suspicion of exposure to drugs of abuse in utero, and provides the basis for appropriate treatment and adequate medical and social follow-up.     

Impacto de la COVID-19 en la forma de presentación y evolución de la apendicitis aguda en pediatría

IntroductionAcute appendicitis (AA) is the most frequent urgent surgical pathology in pediatrics. The COVID-19 pandemic has led to a decrease in emergency department (ED) visits, which can lead to a delay in health care and an increase in the severity of the pathologies. The objective is to analyze the rate of complicated AA during the pandemic, compared to the same period of the previous year.Materials and methodsRetrospective unicenter observational cohort study that included patients under 14 years of age seen in the ED with a diagnosis of AA during the months of March to May 2019 (non-pandemic) and 2020 (pandemic).Results90 patients were included (41 in non-pandemic and 49 in pandemic). No difference was found between the two periods in the time from the clinic onset until the visit to the ED (37 h vs 38 h, p = 0.881), but there was a difference in the time from arrival at the ED until the surgery (7:00 h vs 10:30 h, p = 0.004). The difference was accentuated when comparing the month of March with April-May 2020 (6 h vs 12 h; p = 0.001). No significant differences were observed in the rate of complicated AA in intraoperative diagnosis (35% vs 33%; p = 0.870) or anatomopathology (35% vs 48%; p = 0.222), nor in the number of postoperative complications, length of hospitalization and readmissions. An increase in the anatomopathological diagnosis of AA with periapendicitis was observed (47% vs 81%; p = 0.001)ConclusionDuring the pandemic, a delay from arrival at the ED until the surgery was observed in children diagnosed with AA. This delay resulted in an increase in the diagnosis of histologically evolved AA, but without an increase in the clinical complications of the disease.     

Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2015

IntroductionOverweight and obesity in childhood and adolescence has grown alarmingly in the last twenty years or so in many countries of Europe, including Spain. This study presents the prevalences of overweight and obesity in 6 to 9 year-old schoolchildren in 2015, and their associated characteristics.MethodologyALADINO (Its initials in Spanish for Diet, physical activity, child development and obesity) is a cross-sectional study of a representative sample of 6 to 9 year-old schoolchildren in Spain, in line with the Childhood Obesity Surveillance Initiative (COSI) of the World Health Organisation (WHO). The height and weight of the participants, defining the weight status according to WHO standards, and a questionnaire was given to the parents on lifestyle and sociodemographic characteristics.ResultsAnthropometric measurements were taken on 10,899 schoolchildren for 168 primary education centres. Excess weight was observed in 41.3% (95% CI: 40.0-42.6), overweight in 23.2% (95% CI: 22.1-24.3) and obesity in 18.1% (95% CI: 17.2-19.1), with obesity being more prevalent in boys, overweight in girls. The prevalence of abdominal obesity was 23.2% (95% CI: 21.8-24.6). The prevalence of overweight and obesity increased with age. Excess weight decreased by 3.2% compared to 2011, mainly due to the decrease in overweight in boys, while that of obesity remained stable. Excess weight was more prevalent in schoolchildren from families with a lower socioeconomic level.ConclusionsThe prevalence of excess weight in 6 to 9 year-old schoolchildren in Spain has decreased by 3.2% since 2011, due to the decrease in overweight, whilst obesity remained stable. Action must be taken in the obesogenic environment, by promoting healthy eating habits and physical activity, bearing in mind the inequalities in health.