Impacto clínico de la implantación de la ventilación por alto flujo de oxígeno en el tratamiento de la bronquiolitis en una planta de hospitalización pediátrica

ObjectiveTo analyse the safety and efficacy of high-flow oxygen therapy for treatment of moderate to severe bronchiolitis in children admitted to the paediatric hospital wards.MethodsA prospective observational study was conducted on children < 18 months of age with bronchiolitis admitted to the paediatric ward of a tertiary-care teaching hospital during the 2011-12 respiratory season. Children were treated with a high-flow ventilation system (Fisher & Paykel). Clinical and cardio-respiratory parameters were evaluated every hour for the duration of therapy.ResultsA total of 25 patients, with a median age of 2 months (range: 0.6-11 months) were included. Respiratory syncytial virus (RSV) was positive in 75% of cases. Indications for high-flow therapy included: progressive respiratory distress (Wood-Downes ≥ 8) (88%), apnoea (8%) and desaturation (4%). Median duration of therapy was 4 days (range: 3-7 days), with a median of 9 days in hospital (range: 8-12 days). High flow therapy was associated with a significant decrease in cardio-respiratory parameters, heart rate, respiratory rate, which resulted in a significant improvement of the Wood-Downes Score (from 10±1.21 to 3±0.77, P=.001). No adverse effects were observed. Five patients (20%) were admitted to the Paediatric Intensive Care Unit (PICU), which represents an 80% reduction of PICU admissions compared with historic data of previous years.ConclusionsHigh-flow ventilation therapy achieved a significant improvement in heart rate, respiratory rate, and scale of severity in patients with bronchiolitis. This novel therapeutic strategy allows safe management of bronchiolitis patients in the regular ward, reducing admissions to the PICU.     

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.     

Giardiosis en población pediátrica de la provincia de Castellón: clínica e impacto

IntroductionGiardiasis is a gastrointestinal parasitosis that has a great public health impact.Patients and methodsObservational case study - in children under 15 years old in the Health Department 3 of the Province of Castellon (Spain), during the period 2012-2019.ResultsA total of 190 cases of giardiasis were recorded in children under 15 years old. The number of cases varied significantly according to age group and month of the year. There were 115 males. The most frequent symptoms were diarrhea and abdominal pain. The most commonly used treatment was standard metronidazole (80% of patients). Co-infection occurred in 13% of cases, and comorbidities in 36%, especially atopic dermatitis and lactose/fructose intolerance. Relapses and/or re-infections were recorded in 8%. All cases were diagnosed by conventional parasitological stool tests and complementary immunochromatography (63 cases). Thirty-five samples were positive for Giardia duodenalis by qPCR. The direct health cost per patient was 117€. A disease notification bias was detected between 2012-2016 at a national scale.ConclusionsGiardiasis is a current disease in Castellon, and should be considered as a probable diagnosis of gastrointestinal disease in a child under 4 years-old with diarrhea and abdominal pain. Its correct clinical and therapeutic management could reduce the possibility of worsening of the patient's condition and, additionally, would reduce the economic impact of the disease in terms of direct health costs.     

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.     

Esclerosis tuberosa: caracterización clínica e intento de correlación fenotipo/genotipo

IntroductionTuberous sclerosis (TS) is an inherited disorder with multisystemic involvement and a high phenotypic variability. There are two genes that cause this condition: TSC1 and TSC2.ObjectivesOur goal was to clinically characterize patients with TS followed up in the Pediatric Neurology Clinic of a tertiary hospital during the last 10 years, and correlate the genotype with the severity of neurological manifestations and imaging studies.Patients and methodsRetrospective analysis of patients with TS, including review of medical records and available MRI imaging.ResultsWe studied 35 cases with a median age at diagnosis of ten months. Seizures were the first manifestation in 91.4% of cases, with a predominance of epileptic spasms. Over 50% had cognitive impairment and 49% behavioral disorders.A genetic study was performed on 24 children, and TSC2 mutations identified in 58.3% of them. Of the 11 cases of refractory epilepsy, six had the TSC2 gene mutation. In the group of eight patients with moderate/severe cognitive deficits, five had TSC2 mutations.We reviewed 26 MRI scans, in which it was observed that 76.9% had diffuse involvement of cerebral lobes, which reflects a greater burden of injury. Of the patients who had an MRI scan performed and had TSC2 mutations, all had a high tuber load, and5 of them had refractory epilepsy.DiscussionIn our sample we observe a high percentage of mutations in the TSC2 gene. This mutation carries a worse neurological prognosis, with drug-resistant epilepsy and a more severe cognitive impairment.