Revista de la Sociedad Boliviana de Pediatría

The brass haired child syndrome

Neonatal Screening: detection congenital hypothyroidism. Hospital Materno Infantil of Caja Nacional de Salud

Introducción: el hipotiroidismo congénito es una de las endocrinopatías más frecuentes en la edad pediátrica, con secuelas irreversibles cuando no se realiza un diagnóstico y tratamiento tempranos. Objetivo: detección del Hipotiroidismo Congénito a través del tamizaje neonatal en el Hospital Materno Infantil de la C.N.S. Método: se realizó la cuantificación de TSH en recién nacidos (8957), mediante el método de inmunofluorescencia a tiempo retardado (DELFIA), de junio del 2012 a diciembre del 2013. Valores de TSH superiores a 10 uUI/mL se consideran sospechosos, y se solicitó perfil tiroideo completo en sangre venosa para confirmación. Para el diagnóstico etiológico se realizó centellografía tiroidea sin retrasar el tratamiento. Resultados. La cobertura del tamiz fue del 80,3%. Se confirmó hipotiroidismo congénito primario en 3 niños. La centellografía en 2, describió tiroides sublingual. Se inició tratamiento antes de la tercera semana de vida. Conclusiones: la incidencia encontrada fue de 1:2985, similar a la descrita en la bibliografía internacional. La causa más frecuente es la disgenesia tiroidea. La cobertura lograda está aún por debajo de los estándares mundiales.

Introduction: congenital hypothyroidism is one of the most common endocrinopathies in children with irreversible consequences when early diagnosis and treatment isn t performed. Objective: detection of congenital hypothyroidism through newborn screening in the Hospital Materno Infantil of the CNS. Methods: quantification of TSH in newborns (8957) was performed by the method of immunofluorescence to time delayed (DELFIA), since June 2012 to December 2013. TSH levels greater than 10 mIU/ml is considered suspicious, and full thyroid profile in venous blood is requested for confirmation. For etiologic diagnosis thyroid scintigraphy was performed without delay treatment. Results: screen coverage was 80.3%. Primary congenital hypothyroidism in 3 children was confirmed. Scintigraphy in 2 described sublingual thyroid. Treatment was initiated before the third week of life. Conclusions: 1:2985 incidence was found, similarly as described in the international literature. The most common cause is thyroid dysgenesis. The coverage achieved is still below world standards.

Tetralogy of Fallot in a patient with Down syndrome, a case report

Presentamos el caso clínico de un paciente atendido en el Hospital "Roberto Galindo Terán", que corresponde a Tetralogía de Fallot asociado con síndrome de Down confirmado por ecocardiografía.

A case of a patient treated at the "Roberto Galindo Terán" Hospital, with Tetralogy of Fallot confirmed by echocardiography associated with Down syndrome.

Stroke: a dark velum in pediatrics

El actual arsenal de exámenes de laboratorio y de neuroimagen permite afirmar que las enfermedades cerebrovasculares (ECV) en pediatría, desde la etapa prenatal hasta la adolescencia, ya no constituyen una patología inusual, ni idiopática, ni tampoco benigna. Asimismo, los actuales procedimientos en las terapias intensivas, el uso de fármacos neuroprotectores y antiagregantes plaquetarios o las nuevas técnicas de neurorradiología intervencionista, también han modificado favorablemente la morbimortalidad de estos pacientes. A pesar del impacto de las ECV en la salud pública de los niños, todavía no existen guías o protocolos consensuados para tratar las diversas patologías vasculares en estos grupos. Se presenta una sucinta revisión bibliográfica respecto a su presentación clínica, actual abordaje diagnóstico y terapéutico.

The current arsenal of laboratory tests and neuroimaging suggests that pediatric cerebrovascular disease, from prenatal through adolescence, are not an unusual, or idiopathic disease, nor benign pathology. Moreover, the current procedures in intensive care, the use of neuroprotective therapy or antiplatelet drugs, also have changed favorably the morbidity and mortality of these patients. Despite the impact of cerebrovascular diseases on children, guidelines or consensus for treating them in this age group have not been developed yet. In addition, this study encouraged us to make a brief literature review regarding clinical presentation, diagnostic and therapeutic approach.

Variability of antibiotic treatment in paediatric acute pharyngotonsillitis in Asturias, Spain

Introducción. Las faringoamigdalitis agudas suponen un importante porcentaje de las consultas pediátricas y una de las principales causas de prescripción antibiótica. Nuestro objetivo fue analizar los hábitos de prescripción antimicrobiana en niños diagnosticados con faringoamigdalitis aguda en servicios de urgencias hospitalarios y consultas pediátricas de atención primaria en Asturias (España). Métodos. Estudio descriptivo multicéntrico que evalúa pacientes pediátricos diagnosticados con faringoamigdalitis aguda en los servicios de urgencias de 5 hospitales y en 80 consultas pediátricas de atención primaria. La idoneidad de las prescripciones se estableció por comparación con estándares de referencia. Resultados. Se incluyeron 563 niños con faringoamigdalitis agudas, 49,7% en atención primaria (IC 95% 45,6-53,8%), a los largo de 30 días no consecutivos (6,8% de las consultas pediátricas). Se prescribieron antibióticos en el 75,5% de las faringoamigdalitis (IC 95% 71,9-79,0%) [(78,3% en los menores de 3 años (IC 95% 71,8-84,8%)]. El antibiótico más indicado fue la amoxicilina [39,1% de los casos que recibieron antibioterapia (IC 95% 34,4-43,7%)]. Se encontraron diferencias significativas en el porcentaje de prescripción antibiótica entre atención primaria y urgencias hospitalarias (70,0% contra 80,9%, p= 0,003). El tratamiento prescrito se consideró de primera elección en el 43,3% de los tratados (IC 95% 38,6-48,0%) e inadecuado en el 56,0% (IC 95% 51,3-60,7%). Conclusiones. Pese a que la mayoría de las faringoamigdalitis agudas pediátricas son de probable etiología vírica, tres cuartas partes de ellas reciben tratamiento antibiótico en nuestro medio, siendo la elección inapropiada en más de la mitad de los casos.

Introduction. Acute pharyngotonsillitis accounts for a large portion of antibiotic prescriptions in pediatric offices. Our aim was to analyze the antimicrobial prescription habits for acute pharyngotonsillitis in children from hospital emergency departments and primary care pediatric clinics in Asturias (Spain). Methods. Multicenter descriptive study evaluating pediatric patients with a diagnosis of acute pharyngotonsillitis in 5 hospital emergency departments and 80 pediatric primary care clinics. Appropriateness of prescription was established by comparing with reference standards. Results. Five hundred sixty-three children with acute pharyngotonsillitis [49.7% in primary care CI 95% 45.6-53.8%)] were included along 30 nonconsecutive days. Antibiotics were prescribed in 75.5% of cases (95% CI 71.9-79.0%) [78.3% in children under 3 years of age (95% CI 71.8-84.8%)]. Amoxicillin was the antibiotic most frequently prescribed [39.1% (95% CI 34.4-43.7%)]. Significant differences in the frequency or antibiotic prescription were found between primary care and hospital emergency departments (70% vs. 80.9%, p= 0.003). The treatment prescribed was considered first choice in 43.3% (95% CI 38.6-48.0%) and inappropriate in 56.0% (95% CI 51.3-60.7%). Conclusions. Although in most cases pediatric acute pharyngotonsillitis is viral in origin, three out of four are treated with antibiotics. Treatment was inappropriate in more than half of the cases in our study.

Child safety seat usage errors in under-4s

Objetivo: Analisar erros de utilização de assentos de segurança infantil por crianças matriculadas em creches e fatores relacionados. Métodos: Estudo observacional transversal de coleta de dados prospectiva e eixo analítico retrospectivo. Resultados: Um total de 42,7% das crianças apresentava erros de utilização. O modelo de regressão logística evidenciou maiores chances de erros na presença de duas ou mais crianças no veículo (odds ratio = 5,10, p = 0,007) e menores níveis de escolaridade e renda dos pais (renda e escolaridade médias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). Conclusão: Os dados são coerentes com publicações internacionais.

Objective: To analyze child safety seat usage errors among children enrolled at daycare. Methods: This was a cross-sectional, observational study with prospective data collection and a retrospective analytical axis. Results: Overall, 42.7% of the children studied were in incorrectly used seats. A logistic regression model showed that the likelihood of usage errors was higher if there were two or more children in the vehicle (odds ratio = 5.10, p = 0.007) and was dependent on parents' educational level and income (medium income and educational level: odds ratio = 7.00, p = 0.003; low income and educational level: odds ratio = 3.40, p = 0.03). Conclusion: The results of this study are in line with findings reported in international publications.

Asthma mortality among Brazilian children up to 19 years old between 1980 and 2007

Objetivo: Avaliar a tendência de mortalidade por asma em crianças brasileiras de até 19 anos de idade no período de 1980 a 2007. Métodos: Foi realizado um estudo ecológico, de séries temporais, baseado em banco de dados do Departamento de Informática do Sistema Único de Saúde, do qual foi extraído o número de óbitos por asma e a popuação residente de até 19 anos de idade no país como um todo. O coeficiente de mortalidade foi calculado pelo número de óbitos por asma dividido pela população, multiplicando por 100.000. Utilizou-se o teste de regressão linear para avaliar a tendência temporal de mortalidade. Para a análise, estudaram-se separadamente três grupos etários: 1 a 4 anos, 5 a 9 anos e 10 a 19 anos. Resultados: No período estudado, ocorreram 9.051 óbitos por asma no Brasil em menores de 19 anos. Destes, 69% (6.270 registros) foram de menores de 5 anos. Observou-se um decréscimo significativo de mortalidade por asma no período em todos os grupos etários. A redução média anual do coeficiente de mortalidade por asma em crianças foi de 0,022 (p < 0,0001). De 1 a 4 anos foi de 0,076, de 5 a 9 anos foi de 0,005, e de 10 a 19 anos foi de 0,004 (p< 0,0001). Conclusão: A mortalidade por asma em crianças é baixa e mantém a tendência de queda no período estudado em todas as faixas etárias pediátricas.

Objective: To evaluate asthma mortality among Brazilian children up to 19 years old in 1980 to 2007 . Methods: This ecological time-series study used the database of the Brazilian Unified Health System, from which data were collected about the number of asthma deaths and the population under 19 years of age in Brazil. Mortality rates were calculated as the number of asthma deaths divided by population and multiplied by 100,000. Linear regression was used to assess the trend of mortality. For the analysis, participants were assigned to three separate age groups: 1-4 years, 5-9 years and 10-19 years. Results: During the study period, there were 9,051 deaths due to asthma in children under 19 years of age. Of these, 69% (6,270 records) of the children were younger than 5 years. There was a significant decrease in asthma mortality during the study in all age groups. The mean annual reduction of asthma mortality rates among children was 0.022 (p < 0.0001). The reduction was 0.076, 0.005 and 0.004 for the 1 to 4, 5 to 9 and 10 to 19 year-old age groups (p < 0.0001). Conclusion: Asthma mortality among Brazilian children is low and has kept a downward trend during the study in all pediatric age groups.

Early diagnosis of childhood cancer

CUESTIONARIO NÚMERO 52, PREGUNTAS CORRESPONDIENTES AL TEMA: DIAGNÓSTICO TEMPRANO DEL CÁNCER EN LA INFANCIA