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.     

Función renal basal en pediatría: correlación de métodos que dependen de la recogida de orina de 24 h con otros más sencillos que no requieren orina minutada

IntroductionIn daily clinical practice a quick, easy and accessible method is needed to adequately assess renal function. The objectives of this study were: 1. To quantify the relationship and concordance of the glomerular filtration rate (GF) calculated by the clearance of creatinine in 24 h urine (CCr) and the original and modified Schwartz equation (SE); and 2. To correlate urine elimination of substances that depends on the volume of excreted urine in a unit of time with other parameters that are calculated measuring the concentration of these substances in blood and urine.Material and methodsThe study included 401 healthy children with ages between 3 to 14 years (187 male and 214 female). The analysis between the variables was carried out using Pearson's correlation coefficient and the intraclass correlation coefficient (ICC).ResultsThe correlation between values of CCr and the original SE (non-standardised creatinine measurement) was r = 0.58 (P < 0.001) and the concordance, ICC = 0.74. The correlation between CCr values and the modified SE (standardised creatinine measurement) was r = 0.68 (P < .001), and the concordance ICC = 0.78. There was a very significant correlation between the elimination of sodium in a 24 h urine (mEq/kg/24 h) and the Na-Fractional-Excretion (EFNa): r = 0.8 (P < .001). There was a correlation between the potassium elimination in 24 h (mEq/kg/24 h) and EFK: r = 0.85 (P < .001). Between volume/min/1.73 m² and the urine volume percent of GF was: r = 0.88 (P < .001).ConclusionsThese equations provide valuable information of the state of the basal renal function without having to use a timed urine.     

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.     

Cateterización venosa umbilical guiada por ultrasonografía: un análisis de coste-efectividad

IntroductionAlthough the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital.Patients and methodsA retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24 hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis.ResultsCatheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p = .04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p < .0001). The cost-effectiveness ratio of the guided catheterisation was €153.9, and €484.6 for the conventional one. The incremental cost-effectiveness ratio was €45.5. The sensitivity analysis showed a €2.6 increase in the cost-effectiveness ratio of the guided catheterisation and €47 in the conventional one.ConclusionsThe use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness.     

Diez años de vacunación frente al virus del papiloma humano. De la dermatología a la oncología a través de la infectología

Human papillomavirus (HPV) was first identified in dermatology, and it was subsequently demonstrated that is was required for the development of uterine cervical cancer and other tumours, after a persistent infection by any of its oncogenic genotypes. Ten years ago, the most common infections and cancers associated with HPV could be prevented by immunisation with 2 vaccines, one bivalent, and another tetravalent, and having just marketed a nonavalent one. During the period 2007-2008, the HPV vaccine was included in the Autonomous Communities vaccination calendar, and it is the second vaccine, after that of Hepatitis B, that prevents cancer. In these 10 years that these vaccines have been available the knowledge has progressed and there have been significant advances in vaccination strategies, as well as in the indications and recommendations. These include, lowering the age in the vaccination schedule, prescribing of 2 doses at 9 years and at 13-14 years, systematic vaccination of the male in some countries, immunisation of the woman after adolescence, implementation of vaccination programmes in developed countries, prevention of other cancers, recommendations for vaccinations for populations at high risk of HPV infection, scientific evidence on the impact and effectiveness of vaccination, and confirmation of the safety of these vaccines, with more than 270 million doses administered, as has already been observed in clinical trials. The role of health professionals is essential to achieve and maintain high vaccine coverage.     

Recomendaciones para la informatización de los servicios de neonatología

The aim is to provide a framework for data collection in the health area of newborn infants allowing harmonization of their care. This requires knowing the population served, and the greatest difficulty is the absence of a data collection system and standards of care for all conditions of the newborn infant. It is essential to have a single record with the main perinatal and neonatal data of all newborn infants. The Spanish Society of Neonatology (SEN) should be responsible for the database, which must meet all legal requirements of privacy and confidentiality. It is possible to determine the relative weight of the pathology treated using Diagnostic Related Groups (DRG) and the results from a quality care perspective. Guidelines for diagnosis and treatment may be established by comparative analysis (benchmarking studies…).Conclusion and Recommendation. It is necessary to know the newborn population served, and define criteria for diagnosis and treatment to improve quality of care. The SEN wishes to address those responsible for the care in hospitals, and to ask for their support and cooperation in the implementation of these recommendations.     

Versión española del NAKQ. Adaptación transcultural y análisis de fiabilidad y validez

IntroductionThe Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ) has proven to be a valid instrument for asthma knowledge assessment of patients and their parents. The widespread use of the SRS-22 in non-English-speaking countries requires its transcultural adaptation. Our objective was to obtain a version of the NAKQ questionnaire adapted to Spanish and to analyze its validity and reliability.Material and methodsThe Spanish version was obtained by using the forward/back-translation method with expert, bilingual translators. The questionnaire was administered to 157 parents with high knowledge (n=78) and low knowledge (n=79) of asthma. The differences in the number of answers between both groups were analyzed with the χ² test. Internal consistency was determined with Cronbach's alpha coefficient and test–retest reliability with the tau-b of Kendall correlation coefficient, and kappa statistics.ResultsAt the end of the process, 23 of the 31 items were classified as of total equivalence and eight ase of moderate equivalence. The mean score of parents high knowledge was 23±2.94 and the mean score of parents low knowledge was 16.84±2.56. The difference between the two groups was statistically significant (p<0.001). The overall Cronbach's alpha coefficient of the questionnaire was 0.72, the Kendall's tau-b 0,8573 was significant (p=0.01) and the kappa index showed good or very good consistency in more than half of the items.ConclusionsThe Spanish version of the NAKQ has proven to be acceptable and culturally equivalent to the original version and it has a good degree of consistency, validity and reliability.     

Influencia de los cambios demográficos en la frecuentación de urgencias hospitalarias: 13 años de experiencia

Objective

The aim of the present study is to describe the trend in volume and age-specific rates in visits to the Paediatric Emergency Department of a university teaching hospital in Cantabria (Spain) from January 2001 to December 2013, and evaluate the influence of population growth on Emergency Department use.