Automedicación,autoprescripción y medicación «por poderes» en pediatría

Introduction

Self-prescribing or medicating ‘by proxy’ is not an autonomous, free and voluntary decision in the case of children. On the contrary, in this case it is based on the subjective interpretation of symptoms made by the mother or by a third person who is legally responsible for the minor. In our opinion, to analyse this situation is of great importance in order to know the determining factors, perceptions, and realities related to this problem.

Revisión y recomendaciones sobre la prevención,diagnóstico y tratamiento de la infección posnatal por citomegalovirus

Postnatal cytomegalovirus (CMV) infection in the newborn can occur from exposure to maternal cervical secretions during birth, ingestion of breast milk, transfusion of blood products or transmission by body fluids of infected people. Breast milk is the main source of infection, given the high rate of CMV-positive mothers excreting CMV in milk. Freezing reduces the risk of CMV transmission by breastfeeding, although it does not eliminate it completely. Pasteurisation prevents such transmission, but it can alter the immunological properties of breast milk.Postnatal CMV infection is usually asymptomatic, as it normally results from viral reactivation in the mother, and the neonate is born with protective antibodies. However, in the very low birth weight premature infant the amount of transferred antibodies is smaller and a symptomatic infection can occur. Symptomatic posnatal CMV infection in the newborn typically causes hepatitis, neutropenia, thrombocytopenia or sepsis-like syndrome. Pneumonitis and enteritis are less common, but very characteristic. Diagnosis is based on urine virus detection at the time of onset of symptoms. Postnatal CMV infection in the newborn generally resolves spontaneously without antiviral treatment. Ganciclovir should be reserved for severe cases. Unlike congenital CMV disease, posnatal CMV infection in the preterm infant does not seem to be associated with hearing loss or abnormal neuro-development in long term follow-up.     

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.