Promoción de la lectura en etapas precoces desde atención primaria en una zona de exclusión social

IntroductionReading is a tool that stimulates brain activity, increasing its cognitive reserve and providing innumerable benefits such as the stimulation of empathy, concentration or language development. Promoting reading at a very early age helps develop reading skills correctly. However, social inequalities can result in this practice being carried out less in groups of low socioeconomic, social or cultural levels. The purpose of this study was to assess the outcomes of a promoting reading habits intervention in a primary health care center located in a social transformation district by talking to the parents, providing books to families and encouraging books to become a part of children's play preferences.Materials and methodsA non-random intervention study in which children born in 2015 and registered in a particular health center took part. A reading promotion intervention was carried out at the ages of 4, 6, 12 and 18 months and at 24 months their preference for reading activities was assessed in relation to other leisure activities.ResultsThree hundred forty-two subjects were included, 154 allocated in the intervention group and 188 in the control group. The children in the intervention group exhibited a greater preference for reading as a leisure activity as compared to those in the control group (reading ranked in last position of favourite activities in 18.8 vs. 33.9%; p=0.003). The variables found on multivariate analysis to have a greater influence on reading position in the ranking of favorite activities were not having participated in the intervention OR: 2.06 (1.19-3.58) and gipsy ethnicity, OR: 2.37 (1.38-4.09).ConclusionsResults reveal a slight improvement in the preference for reading as an activity in the children that took part in the literacy program.     

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.     

Predictores de éxito y de fracaso en la ventilación no invasiva en la bronquiolitis aguda

IntroductionThe objective was to identify predictive factors for non-invasive ventilation (NIV) failure and to describe its use in bronchiolitis.Patients and methodsProspective observational study that included patients diagnosed with bronchiolitis with a modified Wood's Clinical Asthma Score ?5, or oxygen saturation <92%, or venous CO₂ partial pressure (PCO₂) ?60 mmHg, with no response to medical treatment, who received NIV from December 2005 to May 2008. We collected clinical data before NIV began and at 1, 6, 12, 24 and 48 h. Need for intubation was considered as NIV failure.ResultsNIV was successful in 83% of 47 cases included. Patients in whom NIV failed had lower weight (5.2±2.2 vs. 3.5±0.8 kg, P=.011), lower age [1.8 (0.3–12.3) vs. 0.8 (0.4–4.3) months, P=.038)], lower heart rate (HR) before NIV began (176.3±19.1 vs. 160.4±9.7 beats/minute, P=.010), lower HR decrease at hours 1 (?16.0±17.3 vs.+1.1±11.6, P=.005) and 12 (?31.5±19.7 vs. ?0.75±12.2, P=.002), presence of apnoeas (23.1% vs. 75%; P=.004) and of a predisposing condition (84.6% vs. 50%; P=.029). Multivariate analysis identified the absence of a predisposing condition, and a greater HR decrease during the first hour as success-associated independent factors (OR 0.004; 95% CI 0.000–0.664 and OR 0.896; 95% CI: 0.809–0.993, respectively).ConclusionsNIV has a high success rate in bronchiolitis. The main parameters which can predict NIV success are the absence of a predisposing condition and a higher HR decrease in the first hour.     

Actualización del tratamiento de la tuberculosis en niños

Tuberculosis (TB) is the most important infectious disease all over the world, with a high morbidity and mortality. Pediatric tuberculosis has been a neglected epidemic, due to the difficulties in assessing its global impact, reduced incidence and lower infectivity compared to adults. In 2015, the WHO reported 1 million cases of paediatric TB and 169,000 deaths. In Europe, the emergence of MDR TB is a major concern, representing 16% of the new diagnosis in Eastern Europe. In 2014, it was estimated that about 219,000 children were infected by MDR-TB-strains in Europe, and 2,120 developed the disease. Spain is the Western European country with more paediatric cases, with an incidence 4.3/100,000 inhabitants in 2014. Paediatric tuberculosis mortality in Spain is rare, but extra-pulmonary disease is associated with significant complications. The prevalence of paediatric drug resistant TB in Spain is over 4%, higher than the estimated incidence in adult population, representing mayor difficulties for therapeutic intervention. These data reveal that paediatric TB is still a Public Health priority in our country.The difficulties in diagnosis and the lack of optimal paediatric drug formulations are the major challenges for controlling the childhood's tuberculosis epidemic. A group of national paeditric TB experts has reviewed the international guidelines and the most recent evidences, and has established new recommendations for the management of paediatric TB contacts, latent infection and active TB disease, especially focused in drug resistant cases. This document replaces the former national guidelines from the Spanish Society for Pediatric Infectios Diseases, although the prior recommendations on the diagnosis remain valid.     

Valoración de la sedación en el niño crítico con ventilación mecánica durante la aspiración endotraqueal

ObjectivesTo compare the changes in clinical sedation scales, bispectral index (BIS) and physiological variables occurring during tracheal suction in critically ill children.DesignProspective, observational study in critically ill children on mechanical ventilation. BIS value, heart rate (HR), systolic blood pressure (SPB), diastolic blood pressure (DBP), modified Ramsay sedation scale score and the dose of sedative drugs were recorded before and 3 minutes after every tracheal suction.ResultsA total of 83 tracheal suctions were analyzed from 46 children, 1 month to 15 years of age. Most of the children (92%) were receiving continuous infusions of fentanyl and midazolam, and 45.7% of them were receiving vecuronium. The increase in BIS, SPB and DBP values were small but statistically significant (BIS, from 51.8 to 57.3; SBP, from 92.9 to 103.1 mmHg; DBP, from 51.8 to 58.9 mmHg). There was poor correlation between the BIS, HR, SBP and DBP values before and after suction. A total of 87% of patients maintained the same Ramsay score values.ConclusionsTracheal suction produces a slight increase in the BIS and the BP in critically ill children who are receiving sedation by continuous infusion. Most children with adequate sedation do not need any other drugs before the tracheal suction. Physiological variables have no correlation with sedation scales or BIS values during the tracheal suction.     

Canalización arterial ecoguiada o por palpación del pulso en la unidad de cuidados intensivos

IntroductionUltrasound (US) guidance increases the success rate and decreases complications during central venous catheterisation (CVC). The benefits of US guidance in arterial catheterisation are less clear. The aim of this study is to compare the outcomes of US-guided arterial catheterisation with the traditional landmark (LM) technique in critically ill children.MethodsA prospective multicentre study was carried out in 18 Paediatric Intensive Care units in Spain during a 6-months period. Ultrasound guided and landmark techniques were compared in terms of cannulation technical success and immediate mechanical complications.ResultsA total of 161 procedures were performed on 128 patients (78 procedures in the US group and 83 in the LM groups). The median (interquartile range) age and weight of the cohort was 11 months (2-52), and 10 kg (4-17), respectively. More than half (59.6%) were male. US was used mainly in big (number of beds 11 [8-16] vs 6 [4-10], p < 0,001) and high complexity intensive care units (cardiac surgery program 76.9% vs. 25.6%, P < .001) as well as in smaller children [weight 5.7 kg (3.8-13) vs 11.5 kg (4.9-22.7), P < .001]. Almost half (49.7%) of the procedures were performed by an inexperienced operator (paediatric resident, or staff with less than 5 years of clinical experience in the PICU), and only 24.4% had performed more than 50 US-guided vascular access procedures before the study. There were no significant differences between US and LM techniques in terms of first-attempt success (35.8% vs 33.7%, P = .773), overall success (75.6% vs 71.1%, P = .514), number of puncture attempts [2 (1-4) vs 2 (1-3), P = .667] and complications (16.6% vs 25.6%, P = .243). Adjustment by potential confounders using multivariate regression models did not modify these results. Subgroup analyses showed that US outperformed LM technique in terms of overall success (83.7% vs 62.7%, P = .036) and complications (10,8% vs 32.5%, P = .020) only when procedures where performed by less-experienced operators.ConclusionsIn this prospective observational multicentre study, US did not improve arterial cannulation outcomes compared to the traditional LM technique in critically ill children. US-guided arterial cannulation may offer advantages when cannulation is performed by inexperienced operators.     

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.