Cobertura y adherencia a la vacunación frente a la gripe en menores de 15 años con condiciones de riesgo en la Comunidad de Madrid

IntroductionVaccination against influenza is indicated in children at risk of complications or severe disease. The objective of this study was to describe the percentage of children aged less than 15 years with risk conditions vaccinated against influenza in the Community of Madrid, and to analyze the factors associated with adherence to vaccination throughout 3 vaccination campaigns.Materials and methodsPopulation-based cross-sectional observational study of children aged 6 months to 14 years with conditions that indicated influenza vaccination at the beginning of the 2018–2019 campaign. Electronic population registers were used. We described the percentage of children vaccinated in 3 consecutive campaigns, and assessed the association of adherence to vaccination with demographic and socioeconomic variables and risk conditions using bivariate and multivariate analysis.ResultsThe vaccination coverage was 15.6% in the 2018–2019 campaign. The adherence to vaccination was 65.9%. The variables associated with greater adherence were age greater than 2 years, especially in the 6–10 years group (aOR = 1.63; 95% CI: 1.43–1.85) and presenting more than one risk condition, especially 3 or more diseases (aOR = 1.80; 95% CI: 1.00–3.26). Diabetes mellitus was the disease associated most strongly with adherence (aOR = 2.15; 95% CI: 1.74–2.65). Adherence was lower in the immigrant population (aOR = 0.43; 95% CI: 0.36–0.51). We found no association between vaccination adherence and sex or socioeconomic status.ConclusionsVaccination coverage and adherence were suboptimal. Adherence to vaccination against influenza is associated with demographic and clinical conditions. Strategies need to be established to increase vaccination in children, with greater involvement of professionals and education of parents.     

A prospective study of risk factors for neurological complications in childhood bacterial meningitis

ObjectiveTo prospectively analyze the prognostic factors for neurological complications of childhood bacterial meningitis.MethodsThis prospective study enrolled 77 children from 1 month until 16 years of age, treated for bacterial meningitis during the period of January 1, 2009 through December 31, 2010. 16 relevant predictors were chosen to analyze their association with the incidence of neurological complications. p-values < 0.05 were considered statistically significant.ResultsOf the 77 children treated for bacterial meningitis, 33 patients developed neurological complications (43%), and two children died (2.6%). The etiology of bacterial meningitis cases was proven in 57/77 (74%) cases: 32 meningococci, eight pneumococci, six Gram-negative bacilli, five H. influenzae, five staphylococci, and one S. viridans isolates were found. Factors found to be associated with increased risk of development of neurological complications were age < 12 months, altered mental status, seizures prior to admission, initial therapy with two antibiotics, dexamethasone use, presence of focal neurological deficit on admission and increased proteins in cerebrospinal fluid (CSF) (p < 0.05). Initial pleocytosis > 5,000 cells/mm³, pleocytosis > 5,000 cells/mm³ after 48 hours, CSF/blood glucose ratio < 0.20, female gender, previous treatment with antibiotics, community-acquired infection, duration of illness > 48 hours, presence of comorbidity, and primary focus of infection were not associated with increased risk for the development of neurological complications.ConclusionAge < 12 months and severity of clinical presentation at admission were identified as the strongest predictors of neurological complications and may be of value in selecting patients for more intensive care and treatment.     

Real-life study of the role of high-flow nasal cannula for bronchiolitis in children younger than 3 months hospitalised in general pediatric departments

We aimed to describe the real-life role of high-flow nasal cannula (HFNC) for bronchiolitis in infants under 3 months of age admitted to three general pediatric departments during the 2017–2018 epidemic period. We retrospectively assessed the clinical severity (Wang score) for every 24-h period of treatment (H0–H24 and H24–H48) according to the initiated medical care (HFNC, oxygen via nasal cannula, or supportive treatments only), the child's discomfort (EDIN score), and transfer to the pediatric intensive care unit (PICU). A total of 138 infants were included: 47 ± 53 days old, 4661 ± 851.9 g, 70 boys (50.7%), 58 with hypoxemia (42%), Wang score of 6.67 ± 2.58, 110 (79.7%) staying for 48 consecutive hours in the same ward. During the H0–H24 period, only patients treated with HFNC had a statistically significant decrease in the severity score (n = 21/110; ?2 points, P = 0.002) and an improvement in the discomfort score (n = 15/63; ?3.8 points, P < 0.0001). There was no difference between groups during the H24–H48 period. The rate of admission to the PICU was 2.9% for patients treated for at least 24 h with HFNC (n = 34/138, 44% with oxygen) versus 16.3% for the others (P = 0.033). Early use of HFNC improves both clinical status and discomfort in infants younger than 3 months admitted for moderately severe bronchiolitis, whatever their oxygen status.     

Severe and fatal forms of COVID-19 in children

ObjectivesThe aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging findings, as well as the disease management and outcomes.MethodsThis was a retrospective, single-center, observational study conducted in a pediatric intensive and high-dependency care unit (PICU, HDU) in an urban hospital in Paris. All patients, aged from 1 month to 18 years, admitted for confirmed or highly suspected SARS-CoV-2 were included.ResultsWe analyzed the data of 27 children. Comorbidities (n = 19, 70%) were mainly neurological (n = 7), respiratory, (n = 4), or sickle cell disease (n = 4). SARS-CoV-2 PCR results were positive in 24 children (nasopharyngeal swabs). The three remaining children had a chest CT scan consistent with COVID-19. Respiratory involvement was observed in 24 patients (89%). Supportive treatments were invasive mechanical ventilation (n = 9), catecholamine (n = 4), erythropheresis (n = 4), renal replacement therapy (n = 1), and extracorporeal membrane oxygenation (n = 1). Five children died, of whom three were without past medical history.ConclusionThis study highlighted the large spectrum of clinical presentation and time course of disease progression as well as the non-negligible occurrence of pediatric life-threatening and fatal cases of COVID-19 mostly in patients with comorbidities. Additional laboratory investigations are needed to further analyze the mechanism underlying the variability of SARS-Cov-2 pathogenicity in children.     

Vitamin D deficiency and low hemoglobin level as risk factors for severity of acute lower respiratory tract infections in Egyptian children: A case-control study

ObjectiveAcute lower respiratory tract infection (ALRTI) is an important cause of morbidity in the developed world, and both morbidity and mortality in the developing world. Vitamin D has a major role in both acquired and innate immunity. Anemic children have less oxygen carrying capacity of blood. This study was done to determine the relation between vitamin D deficiency, anemia and the severity of ALRTIs in hospitalized children.MethodsThis study included 96 hospitalized infants with ALRTI, 48 diagnosed with pneumonia and 48 with bronchiolitis. Mean age was 10.67 ± 3.143 months. Matched age and sex infants with no respiratory illness were included. Serum 25 hydroxy vitamin D was measured in all cases and controls by Radio-immune assay. Hemoglobin level was measured by Coulter.ResultsVitamin D deficiency and low hemoglobin level were positively correlated with the severity of ALRTIs (r = 0.798 and P = 0.001) and (r = 0.708, P = 0.028), respectively. Low vitamin D level was significantly correlated with low hemoglobin level (r = 0.708, P = 0.028).ConclusionVitamin D deficiency was associated with severity of ALRTIs. Low hemoglobin level was more prevalent in those children. Improving the nutritional status in children by preventing vitamin D deficiency and low hemoglobin might influence the outcome of children with ALRTI.     

Asociación entre el estado nutricional y las capacidades físicas en niños de 6 a 18 años de Medellín (Colombia)

IntroductionNutritional disorders in childhood may cause a decline in motor abilities and increased morbidity and mortality in adulthood.ObjectiveTo assess the association between nutritional status and motor abilities.Materials and methodsA cross-sectional study was performed that included 12,872 children aged between 6 and 18 years who underwent a clinical evaluation and various physical tests.ResultsAmong the children, 66% had a Tanner maturation stage 1 and 2, 6% were under-nourished, and 12.2% were at risk of overweight and obesity. The obese children had a decrease in aerobic power (in 2.72 mL O2 kg^–1·min^–1; 95% CI: 1.89 to 3.56; P < .001), speed (0.14 m·sec; 95% CI: 0.06 to 0.22; P < .001), explosive strength (0.10 m; 95% CI: 0.06 to 0.13; P < .001), agility, strength endurance and balance. Under-nourished children showed a decrease in speed (0.13 m·sec; 95% CI: 0.06 to 0.20; P < .001), explosive strength (0.04 m; 95% CI: 0.01 to 0 07; P < .004), and strength endurance.ConclusionsThere was an association between nutritional status and motor abilities in the children included in this study. Obese children showed the worst results in physical tests, and the under-nourished ones showed a decrease in speed, explosive strength and strength endurance.     

Severity of parechovirus infections in infants under 3 months of age and comparison with enterovirus infections: A French retrospective study

While enteroviruses (EV) are a well-recognized cause of aseptic meningitis in children, human parechoviruses (HPeV), especially genotype 3, have been increasingly reported as a frequent cause of sepsis-like illness and meningitis among young infants. The aim of this study was to describe the epidemiological, clinical, and laboratory characteristics of HPeV infections in infants and to compare them with those of well-known EV infections. This monocentric retrospective study was carried out at the pediatric unit of Nantes University Hospital from January 2015 to August 2018. All patients under 18 years of age with diagnosis codes referring to fever, for whom viral infection was suspected and cerebrospinal fluid (CSF) specimens were collected, were included. All CSF specimens were screened by duplex real-time polymerase chain reaction (PCR) assay that allows for the simultaneous detection of EV and HPeV in clinical samples. During the study period, 1373 CSF specimens from patients under 18 were included. A total of 312 CSF samples were positive for HPeV (n = 34) or EV (n = 278). Among the 34 HPeV-positive patients, 97% (33/34) were under 3 months of age, whereas the rate was 54% (149/278) for EV-positive patients (P < 0.001); thus, patients under 3 months of age were defined as the study population for the rest of this work. A review of the medical records was carried out for the positive cases. In this population, the HPeV detection rate was 5.6% versus 25.3% (P < 0.001) for EV. All but one of the HPeV samples available for genotyping were HPeV-3. No seasonality was observed for HPeV infections. Length of hospital stay tended to be longer for children infected with HPeV compared with those infected by EV (3 days vs. 2 days, P = 0.05). Clinicians reported more severe illness presentations among HPeV-infected infants, with more frequent administration of fluid bolus (P < 0.02). Regarding laboratory characteristics, a significant lack of cellular reaction in the CSF (P = 0.004) as well as lower C-reactive protein (CRP) levels (P = 0.006) and neutrophil counts (P < 0.001) were noted for HPeV infections compared with EV infections. Our results confirm the early onset of HPeV infections (more than 95% of patients aged under 3 months). The clinical presentation and laboratory characteristics of the two infections was similar. However, some higher clinical severity criteria and a lack of CSF pleocytosis were regularly observed in patients with HPeV infections. Considering the significant proportion (5.6%; 95% CI, 3.7–7.5) of all CSF samples in our series, HPeV detection should be systematically included in the microbiological diagnosis of febrile children under 3 months of age.     

Mortality of children aged 5–15 years in a tertiary care center in Yaoundé, Cameroon

IntroductionAlthough sub-Saharan Africa accounts for only 21% of the global population of children and adolescents aged 5–15 years, 55% of deaths among children in this age group occur in this region. This seems to be related to infectious diseases. We hypothesized that besides infectious diseases, in our context, a chronic underlying condition increases mortality. Our goal was to describe the leading causes of mortality among this age group.Patients and methodsWe conducted a retrospective study in a tertiary care center in Yaoundé. We included the medical files of children who died between January 2013 and December 2017.ResultsThe in-hospital mortality rate was 10.3 per 1000. Coma and/or convulsion was the main cause of death (70.6%), followed by severe anemia (64.7%) and respiratory distress (56.8%). We identified a chronic illness in 62.2% of cases: HIV infection (39.2%) and sickle cell disease (24.5%) were the most prevalent. The main diagnoses were severe malaria, severe sepsis, and meningitis (Cryptococcus sp. included) in 25 (n = 35), 16.4 (n = 27), and 10.3% (n = 17) of cases, respectively.ConclusionHIV infection and sickle cell disease are the most prevalent chronic diseases related to the patients’ death in the age group studied. Specific interventions focusing on this age group are recommended including intensification of impregnated bednet usage as well as HIV and sickle cell disease management.     

Management of eosinophilic esophagitis in children according to atopic status: A retrospective cohort in northeast of France

IntroductionMost children with eosinophilic esophagitis (EoE) are atopic, but the impact of atopy on the remission and development of EoE is still unclear. The aim of our study was to determine the impact of atopy on remission of EoE and to describe allergy tests and the choice of treatment for a cohort of EoE children in France.MethodsAll children diagnosed with EoE between January 2013 and June 2018 in the five pediatric centers in the northeast of France were included. Children were divided into two groups according to personal atopic disorders. Histological remission was defined on the basis of an eosinophilic count below 15 eosinophils per high-power field.ResultsAmong the 49 children included, 38 (78%) were atopic. Allergy tests were performed for 45 children (92%). Rates of sensitization were similar in both groups: 64% had food sensitization and 64% had aeroallergen sensitization. The most commonly attempted first-line therapy was with proton pump inhibitors (63%), followed by swallowed topical steroids (STS) (18%). First-line therapy was not associated with atopic status (P = 0.88). Atopic children had a nonsignificant tendency for a higher remission rate after STS (55% vs. 0%, P = 0.24) and a higher global remission rate (54% vs. 33%, P = 0.18) compared with non-atopic children.ConclusionAllergy testing is relevant in the majority of children with EoE whether or not they have atopic disorders. Atopy seems to be associated with better response to STS. Further studies are needed to determine whether atopic status determines histological response.     

Pediatric ocular trauma: Characteristics and outcomes among a French cohort (2007–2016)

Pediatric ocular trauma is a major cause of acquired monocular blindness. Post-traumatic visual impairment can lead to significant handicap. In France, recent data on the epidemiology of pediatric ocular trauma are lacking.AimTo describe the characteristics of a pediatric cohort with ocular trauma and to analyse patient outcomes.Material and methodsThis was a retrospective observational study of pediatric ocular trauma (age < 15 years) presenting to pediatric and ophthalmology emergency units of our tertiary university hospital between January 1, 2007 and December 31, 2016. Data were collected on: age, sex, time and circumstances of trauma, injury type and location, trauma mechanism, other associated injuries, hospitalisation rate and length of stay, treatment, and sequelae (visual impairment). Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system and the Ocular Trauma Score (OTS).ResultsA total of 337 children were included (247 males). The global mean age was 8.4 ± 4.1 years (range 6 months to 14.9 years). The trauma occurred at home (51%) or in a public area (21%). Blunt objects (22%) and direct trauma (17%) were the main mechanisms. According to the BETT, 23% of ocular traumas were open-globe traumas (OGT): penetrating (n = 39), perforating (n = 12), with intraocular foreign body (n = 24). Among closed-globe injuries (CGT), hyphema was the most frequent lesion (22%). Associated injuries were recorded in 32 patients. In all, 63% of patients had an OTS of 5 (good visual prognosis) while 39 children (12%) had an OTS of ≤ 3. In 47 patients, there was an initial surgery; 62% of children were hospitalised. By the end of the ophthalmic follow-up, 32 patients (9.5%) had sequelae. Children aged between 2 and 5 years had the greatest proportion of sequelae (15%). Compared with female patients, male patients were older (P = 0.0007) and were more frequently injured by projectiles (P = 0.036). Compared with CGT, OGT were more frequent among younger children (P = 0.0015). Ocular injuries secondary to a projectile and spring-summer accidents were associated more frequently with a poor visual prognosis (OTS ≤ 3; P = 0.036, OR = 2.5 [1.1–5.8] and P < 0.0001, OR = 5.8 [3.2–10.7] respectively).CommentsThe annual admission for pediatric ocular trauma was stable during the study period (200 cases per 100,000 annual trauma admissions in the first period [2007–2011] and 195 cases per 100,000 during the most recent period [2012–2016]). Projectiles such as Airsoft gun bullets and paintball are still the cause of severe injuries while reports on ocular injuries secondary to blaster or Nerf guns use are starting to be published.ConclusionThe great majority of ocular traumas could be prevented, especially by wearing protective goggles during at-risk activities. French legislation should be stricter about the sale of any Airsoft gun to children under 18 years old. Parents must repeat educational warnings to their children handling sharp objects. The social and psychological burden of relative visual impairment is of importance: One in ten children will have a permanent visual defect.     

Exposition des enfants à la violence conjugale : troubles mentaux et facteurs de résilience. Étude transversale tunisienne

Conjugal violence is a social problem whose impact extends beyond the couple, to the children who are exposed.ObjectiveTo study the psychological impact of exposure to conjugal violence in children and adolescents in child psychiatry consultation and the factors associated with their capacity for resilience.Patients and methodsWe conducted a cross-sectional study on a sample of 30 children and adolescents, aged between 6 and 18 years and exposed to conjugal violence. Patients were recruited from the child psychiatry unit of the Hospital University of HediChaker of Sfax. We conducted clinical interviews to identify the psychological impact of conjugal violence on children. The resilience evaluation was done by self or hetero passation of the Child and Youth Resilience Measure (CYRM).ResultsChildren and adolescents exposed to conjugal violence suffered from trauma-related disorders and stressors in 40% of cases, mood disorders in 33.3% of cases and externalized disorders in 6.6% of cases. We found that children were more resilient than adolescents in the area of emotional care provided by their parents (12.66 ± 2.02 vs. 9.46 ± 2.69 among adolescents; P = 0.001). In contrast, adolescents were significantly more resilient than children in the area of contextual factors including spirituality (6.46 ± 1.4 vs. 4.53 ± 1.06; P = 0.000), education (11.13 ± 2.13 vs. 8.4 ± 1.54; P = 0.000) and culture (11.13 ± 2.13 vs. 8.4 ± 1.54; P = 0.000). The child's education and good mental health for the mother were associated with better resilience in the children. The child's exposure to conjugal violence by being both a witness and a victim was associated with a reduced capacity for resilience.ConclusionExposure to conjugal violence has a significant impact on the mental health of children exposed. The study of resilience and associated factors could thus be useful in order to limit the deleterious repercussions on children and provide them with harmonious development both on the somatic and psychological levels.     

Diagnostic evaluation and management of seizures and status epilepticus in children with known epilepsy or new-onset seizures: A retrospective and comparative analysis

ObjectivesThe purpose of this study was to describe and compare the initial management, including clinical/biological investigation and treatment, of new-onset seizures and status epilepticus (SE) in children versus seizures and SE in those with known epilepsy.MethodsThis was a retrospective, single-center, observational study conducted in an urban pediatric hospital in Paris. All patients, aged from 1 month to 18 years, admitted to the pediatric intensive care unit, the high-dependency care unit, and those who required hospitalization in the short-term unit of the emergency department between January 1 and December 31, 2014 for seizures and/or SE were included.ResultsWe analyzed the data of 190 children: new-onset seizures (N = 118; group A) versus those with known epilepsy (N = 72; group B). At least one diagnostic test was performed on 156 patients (82.1%) (group A, N = 104, 88.1%; group B, N = 52, 72.2%; P = 0.05). In group B, blood levels of antiepileptic drugs were measured in 14 of the 38 patients with SE, of whom six were under dosed. Treatments were: first line, diazepam (group A, 80%; group B, 46%; P < 0.001); second line, diazepam (group A, 56%; group B, 34%; P = 0.02) or clonazepam (group A, 24%; group B, 46%; P = 0.001); third line, phenytoin (group A, 54%; group B, 22%; P < 0.001) or clonazepam (group A, 18%; group B, 61%; P < 0.001).ConclusionDiagnostic evaluation and treatment should be individualized for children with known epilepsy.     

¿Qué variables influyen en el cumplimiento de las recomendaciones de actividad física en preescolares?

IntroductionThere are established European guidelines for physical activity in childhood. The main goal of our study was to determine the factors that may influence compliance with European recommendations for physical activity in young children.MethodsWe included 136 children (aged 2-8 years) classified by weight status, calculated based on the body mass index z-score using the growth standards of the World Health Organization. We measured physical activity over 5 consecutive days with accelerometers and recorded the food intake.ResultsA greater level of physical activity was associated with a lower weight status category (B = −1.55; 95% CI: −2.02 to −1.08; P < .001), lower age (B = −1.33; 95% CI: −1.72 to −0.93; P < .001) and greater energy expenditure (B = 0.02; 95% CI: 0.02 to 0.03; P < .001). The overall physical activity in the sample was light (mean = 589 cpm/day). Children with overweight and obesity spent less time engaged in moderate to vigorous physical activity (P = .005) and more time engaged in sedentary activities (P = .005) compared to children with normal weight. All groups spent between 90 and 130 minutes a day in sedentary activities, with a mean time spent that amounted to 15.5% of their time (excluding time spent sleeping). The adherence to European recommendations varied in association with sex (P = .010) and weight status (P = .038).ConclusionYoung children spent more than 100 minutes a day engaged in sedentary activities. Most of the sample met the European recommendations for daily moderate to vigorous physical activity. However, the degree of adherence depended on sex and weight status.     

Opsoclonus–myoclonus in children associated or not with neuroblastoma

ObjectiveTo compare the clinical data at diagnosis, treatment and neurological outcome in 34 children with opsoclonus–myoclonus syndrome (OMS) associated with a detected neuroblastoma or not.Study designThis is a multicentric retrospective study of 34 children presenting with OMS from four pediatric centers diagnosed between 1988 and 2008.ResultsTwenty-two patients had OMS associated with a neuroblastoma. These patients all had neuroblastomas with favourable prognostic features; all underwent surgery, six received chemotherapy. Twelve children had OMS without a detected neuroblastoma. For OMS, the main treatment in all children was corticotherapy (n = 33), but immunoglobulins (n = 13), cyclophosphamide (n = 4) and rituximab (n = 4) were also given. In the 27 OMS patients with or without neuroblastoma whose follow up was greater than two years, the neurological outcome was evaluated: 59.3% had neurological sequelae, including motor, praxic and/or language sequelae (n = 9), persistent ataxia (n = 6) and moderate motor deficit (n = 3). No significant difference in neurological outcome was noted between the two patient groups.ConclusionOur retrospective study provides further evidence that OMS with or without a detected neuroblastoma is the same disease, whose major challenges are the neurological sequelae. An international collaboration is required to improve the knowledge about OMS, the treatment and the outcome in this rare disorder.     

Dramatic impact of morbid obesity on child lung development

ObjectiveTo assess the respiratory function and sleep characteristics of obese adults and children.MethodsAll patients with non-syndromic, severe obesity (BMI ≥ 3 z-scores for children and ≥ 40.00 kg/m² for adults), referred for pulmonary function tests at Lille University Hospital, were retrospectively included.ResultsA total of 69 children (mean ± SD BMI 36.8 ± 6.7 and mean BMI z-score 4.7 ± 1.0) and 70 adults were included (mean BMI 45.7 ± 6.2). Metabolic syndrome was diagnosed in 13 children (26%) and 40 adults (80%). Reduced lung volumes were observed in 34 children (50.0%) and 16 adults (24.0%) and both the mean functional residual capacity (FRC) and the mean residual volume (RV) were lower in children than in adults (FRC: ?1.7 ± 2.1 z-score in children vs. ?1.0 ± 1.1 in adults, P = 0.026; and RV: ?0.8 ± 1.2 z-score in children vs. ?0.1 ± 1.1 in adults, P = 0.002). The prevalence of severe obstructive sleep apnea syndrome was greater in adults (40.7% vs. 18.8%, P = 0.007). Children had a higher average oxygen saturation (median of 96.0% [91.0–98.0] vs. 93.0% [76.0–97.0] in adults, P < 0.0001).ConclusionObesity has consequences for lung volumes in children; however, a longitudinal study is needed to determine the impact on pulmonary expansion and growth.     

Oxidative and antioxidative status of children with acute bronchiolitis

ObjectiveOxidative stress has been shown to contribute to the pathogenesis of acute and chronic lung inflammatory diseases. This article aimed to evaluate the oxidant/antioxidant status of children with acute bronchiolitis through the measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index.MethodsChildren with acute bronchiolitis admitted to the pediatric emergency department of a university hospital between January and April of 2012 were compared with age-matched healthy controls. Patients with acute bronchiolitis were classified as mild and moderate bronchiolitis. Oxidative and antioxidative status were assessed by measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index.ResultsThirty-one children with acute bronchiolitis aged between 3 months and 2 years, and 39 healthy children were included. Total oxidative status (TOS) was higher in patients with acute bronchiolitis than the control group (5.16 ± 1.99 μmol H₂O₂ versus 3.78 ± 1.78 μmol H₂O₂ [p = 0.004]). Total antioxidant capacity (TAC) was lower in children with bronchiolitis than the control group (2.51 ± 0.37 μmol Trolox eqv/L versus 2.75 ± 0.39 μmol Trolox eqv/L [p = 0.013]). Patients with moderate bronchiolitis presented higher TOS levels than those with mild bronchiolitis and the control group (p = 0.03, p < 0.001, respectively). Patients with moderate bronchiolitis had higher oxidative stress index levels than the control group (p = 0.015). Oxygen saturation level of bronchiolitis patients was inversely correlated with TOS (r = ?0.476, p < 0.05).ConclusionThe balance between oxidant and antioxidant systems is disrupted in children with moderate bronchiolitis, which indicates that this stress factor may have a role in the pathogenesis of the disease.     

Influencia étnica en la prevalencia de síndrome metabólico en población pediátrica obesa

IntroductionObesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population.ObjectiveTo analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population.Patients and methodsA retrospective study of 616 obese children and adolescents (BMI ≥ 2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity + 2 or more of the following components: HDL-cholesterol < 40 mg/dl, triglycerides > 110 mg/dl, systolic and/or diastolic blood pressure > p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed.ResultsAlmost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR = 2.4 [CI 95%: 1.5-3.8]), P<.005] and OR = 2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment.ConclusionThere is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood     

Botulinum toxin type A treatment in children with cerebral palsy: Evaluation of treatment success or failure by means of goal attainment scaling

BackgroundThere is considerable variability in the amount of response to BTX-A treatment between and within patients with cerebral palsy (CP).AimsThe purpose of this retrospective cohort study was to evaluate the clinical responsiveness of Botulinum toxin type A (BTX-A) treatment in children with CP and specifically delineate features of treatment success and failure.MethodsFour hundred and thirty-eight children (251 boys, 187 girls; mean age 8 years 2 months, SD 4 years) were included into the study. Goal Attainment Scaling (GAS) was used to classify and evaluate treatment efficacy. Two study groups were defined: one group with an excellent response (GAS ≥ 60.0) and one group with a lack of response (GAS ≤ 40.0) to BTX-A.ResultsSeventy-five patients (17.1%) had an excellent response and treatment was found to be unsuccessful for 31 patients (7.1%). Children with a lack of response to BTX-A were significantly older compared to children with a high responsiveness (p = 0.0013). In the latter group, more children received multi-level injections and fewer children had injections in proximal parts of the lower limb compared to the low responsiveness group (p = 0.0024). Moreover, there was a significant difference in the use of different types of casts between both study groups (p = 0.0263).ConclusionAge, level of treatment and casting seem to be crucial features of BTX-A treatment success or failure in children with CP.