A. Jurado Ortiz

Ahogamientos y casi ahogamientos en niños

Objetivo Los accidentes por sumersion siguen causando importante morbimortalidad en ninos. Se realiza un estudio retrospective para identificar los factores pronosticos asociados a la evolucion clinica de ninos con accidente por sumergimiento, que puedan servir de ayuda para tomar decisiones terapeuticas, comparandolos con otros datos publicados. Pacientes y metodos Estudio retrospectivo mediante revision de las historias clinicas de los casos atendidos por accidente por sumergimiento entre enero de 1995 y abril de 2003. Los datos analizados se refieren al paciente, el accidente, situacion clinica en Urgencias y unidades donde ingresan en el hospital, valorando la evolucion final de cada caso. Resultados Se han incluido 62 pacientes, presentando mala evolucion 12 (7 fallecimientos y 5 secuelas permanentes). Han resultado significativos, como datos de mal pronostico,edad igual o superior a 4 anos, sexo femenino, tiempo inmersion 5 min o mas y, a la llegada al hospital: cianosis inicial que persistia en Urgencias; parada cardiaca, apnea o distres grave, hipotermia (temperatura Conclusiones La evolucion final del paciente esta estrechamente relacionada con la situacion clinica a su llegada al hospital.Aunque disponemos de datos orientativos sobre la evolucion posterior del paciente casi ahogado, se carece de modelos predictivos precoces que permitan vaticinar la evolucion del paciente y, por lo tanto, orientar en la actitud a tomar en las medidas iniciales de reanimacion y mantenimiento posterior.

Influencia del gasto energético en la obesidad infantil

Objetivos Estudiar las diferencias en el gasto energetico en reposo (GER) en funcion de sus determinantes (sexo, peso, masa grasa, masa magra) y la oxidacion de los sustratos energeticos entre ninos obesos y no obesos. Pacientes y metodos Se ha estudiado una muestra de 71 ninos, 39 obesos y 32 controles, con rango de edad entre 4,1 y 13,6 anos, de los cuales 37 eran mujeres y 34 varones, a los que se realiza medida del gasto energetico mediante calorimetria indirecta de circuito abierto. La oxidacion de sustratos se calculo a partir del consumo de oxigeno, produccion de anhidrido carbonico y excrecion de nitrogeno ureico uri-nario. Se determino la composicion corporal por antropometria. Resultados El GER (kcal/dia) ajustado en funcion de los parametros antropometricos y de composicion corporal es superior en ninos que en ninas. El GER en valor absoluto es significativamente superior en los obesos (1.512,82 234,47 frente a 1.172,59 190,20), y al expresarlo en funcion de sus determinantes, sigue siendo mayor en los obesos o se iguala en ambos grupos. Los obesos presentan mayor porcentaje de oxidacion de grasas (57,15 10,68 frente a 51,08 13,61; p 0,04), menor porcentaje de oxidacion dehidratos de carbono (30,10 9,85 frente a 36,34 13,61 p 0,03) y menor cociente respiratorio (0,79 0,03 fren-te a 0,82 0,04; p 0,02). No existen diferencias en los porcentajes de oxidacion de hidratos de carbono, grasas y proteinas segun el sexo. Conclusiones Del estudio se han extraido las siguientes conclusiones: a)el GER ajustado en funcion de los parametros antropometricos y de composicion corporal es significativamente superior en el sexo masculino que en el femenino;b)el GER es superior en los obesos, y sigue siendolo al estan darizarlo en funcion de la masa corporal magra, yc)los ninos obesos presentan mayor porcentaje de oxidacion de grasas, menor porcentaje de oxidacion de hidratos de car-bono y un cociente respiratorio menor que los ninos no obesos. Objectives To study differences in resting energy expenditure (REE) according to its determining factors (sex, weight, body fat mass, lean body mass) and in the oxidation of energy substrates in obese and non obese children. Patients and methods We studied 71 children (39 obese and 32 non-obese) aged from 4.1 to 13.6 years. The male/female ratio was 34/37. Energy expenditure (EE) was measured by usingopen circuit indirect calorimetry. The oxidation of energy substrates was calculated from oxygen consumption, car-bon dioxide production, and urinary nitrogen excretion from urea. Body composition was determined by anthro-pometry.

Infección perinatal por VIH-1 no esperada

598 An Pediatr (Barc) 2005;62(6):591-604 tan sólo 9 pacientes habrían recibido quimioprofilaxis secundaria. A pesar de que el cribado en niños sanos no está actualmente indicado6-9, las recomendaciones basadas en la prevalencia de infección tuberculosa en una población determinada obligan en cierto modo a realizar cribados periódicamente. La decisión de establecer quimioprofilaxis secundaria es individualizada, pero deberían consensuarse unas recomendaciones con ámbito nacional y mantenerse hasta que nuevas evidencias científicas o cambios epidemiológicos aconsejen su modificación. Sería interesante el seguimiento de este grupo, con un elevado índice de inmigración pero baja prevalencia de infección tuberculosa, al final de la etapa escolar para conocer la incidencia real de infección y poder determinar si estamos ante una población de riesgo.

Tratamiento antimicrobiano parenteral domiciliario: análisis prospectivo de los últimos 12 años

OBJETIVES Parenteral antibiotic treatment has been classically developed in hospitals and is considered as a hospital procedure. The development of Hospital at Home Units (HHU) has led to an increase in outpatient parenteral antibiotic therapy (OPAT) in paediatrics patients. The objective of this study is to describe our experience, as an HHU integrated within a Paediatric Department, in home antimicrobial therapy over a period of 12 years. PATIENTS AND METHODS This prospective and descriptive study included every patient with a disease requiring parenteral antimicrobial therapy who was admitted to our HHU from January 2000 to December 2012. RESULTS During the study there were 163 cases on OPAT. The mean age of the patients was 11.1 years, and the sample group was comprised of 33 males and 22 feamales. The main sources of the treated infections were respiratory tract (76%), catheter-related bloodstream (9.2%), and urinary tract infections (5.5%). Amikacin was the most widely used antibiotic. Almost all treatments (96.6%) were via an intravenous route. Catheter-associated complications were more common than drug-associated complications. Successful at-home treatment was observed in 90.2% of cases. CONCLUSIONS OPAT is a good and safe alternative in many paediatric diseases.

88 Use of Statins in Children

Introduction Referring to the use of statins for hyperlipemia in children, it is not yet clearly defined who must be treated (recent recommendations focused on older than 8 years) and also the frequency of short and long-term toxicity. Methods Retrospective, descriptive study of patients, 10 year-old or younger, under statin treatment, followed in our Unit. Epidemiology, treatment and side-effects data were analized. Results Twelve children met inclusion criteria; 7/12 female and 11/12 caucasian. Main diagnosis was familiar hypercholesterolemia (10/12); 1/12 hypertriglyceridemia and 1/12 nefrotic syndrome. Positive family history of cardiovascular events: 5/12 (no death among first degree relatives). Mean age at diagnosis was 5.3 years. All of them were asymptomatic. 8/12 had been treated previously (7/12 resins, 1/12 cholesterol absorption inhibitor). Statin treatment starting age was 8.6 years, 4/12 younger than 8 year-old (minimum age: 5.2 years). Atorvastatin used in 10/12, lovastatin 1/12, simvastatin 1/12; initial dose was always 10 mg/day. The average levels before treatment were: LDL 235 mg/dL, total cholesterol 324.7 mg/dL. In one 10 year-old patient (40 mg/day lovastatin) muscular pain was reported with a CPK increase; side-effects stopped once the statin dose was reduced to 20mg/day. Besides, no adverse effect was reported. The highest dose achieved was 40 mg/day. Patients follow-up varies from 9 months to 4 years. Conclusions It remains unclear whether statins could be started before 8 year-old. From our experience, no adverse effects were found in that group. Dose had to be increased to 20–40 mg/day in order to achieve objectives.

1031 Aminoacidopathies: Review and Data of 12 Years Experience from a Spanish Tertiary Care Center

Background/Aims Range and severity of symptoms hugely variable in aminoacidopathies, mainly diagnosed during acute episodes. Tandem Mass spectrometry (Ms/Ms) used in our unit since 2010 for diagnosing asymptomatic infants (very important for prognosis). Methods Retrospective, descriptive study in which field data were collected from clinical histories of patients diagnosed of aminoacidopathies (excluding phenylcetonuria) since 2000 till 2012. Results 30 children detected. 22/30 male; 24/30 caucasians. 10/30 diagnosed by newborn screening, all of them asymptomatic: 1 methylmalonic acidemia (MMA), 3 glutaric aciduria type 1, 2 homocystinuria, 2 methylcrotonylglycinuria, 1 hipermetioninemia and 1 maple syrup urine disease. 20/30 diagnosed because of clinical symptoms, 2/20 since MS/MS newborn screening was performed. Mean age of clinical debut in intoxication type aminoacidopathies was 64.5 days (median 8 days). Most frequent symptoms were clouding of consciousness (9/20), convulsions (2/20) and apnoea (2/20). Laboratory results showed metabolic acidosis (6/20), hyperammonemia (8/20), coagulation defects (4/20) and hipoglycemia. Main complications were: shock (9/20), multiple organ failure (5/20), coagulopathy (4/20), brain injury (1/20), liver failure (1/20) and seizures (2/20). The final diagnosis was: 5 OTC-defficiency, 2 citrullinemia, 3 methylmalonic acidemia, 1 3-OH-metilglutaric aciduria, 1 glutaric aciduria type 1, 1 metilglutaconic acidemia, 1 trimethylaminuria, 1 propionic acidemia, 2 tyrosinemia and 3 homocystinuria. Ventilatory support needed in 13/20, vasoactive agents 11/20, peritoneal dialysis 8/20, continuous veno-venous haemofiltration 4/20. 8 patients died; among survivors, 2/12 madurative failure, 3/12 serious neurological sequelae, 1/12 liver failure, needing transplantation. Conclusions Aminoacidopathies diagnosed by Ms/Ms start early with treatment. Wide range of presentation symptoms and findings.

Trombosis venosa profunda como manifestación precoz de la enfermedad de Behçet en la infancia

Behcets disease is a multisystemic vasculitis of unknown origin whose classical triad is oral and genital ulcers and uveitis. Deep venous thrombosis may sometimes be the first manifestation of this disease but is very rare in children. We report the case of a 14-year-old boy with deep venous thrombosis of the leg and a history of severe aphthous gingivostomatitis, perianal ulcers, Henoch-Schonlein purpura, ecchymotic lesions on the lower limbs and intermittent swelling of the left ankle. Complementary tests ruled out the main causes of thrombosis in children. HLA-B5 and B-51 study proved positive, which, together with the patients history, suggested a diagnosis of Behcets disease. This disease usually presents around the third decade of life and is very unusual in children. This case is exceptional because thrombosis as an early manifestation of Behcets disease is very rare in children and because it led to the diagnosis of Behcets disease in our patient.

Anemia intensa en la primera infancia

CASO CLINICO Nino de 1 ano y 10 meses de edad, previamente sano, que acude al servicio de urgencias por aparicion progresiva en un periodo de 2-3 semanas de astenia, anorexia, perdida de 1 kg de peso aproximadamente, palidez, irritabilidad y cambio del caracter. Simultaneamente, ha presentado aumento en el numero de deposiciones, de consistencia pastosa, amarillentas, malolientes y sin productos patologicos. Antecedentes personales: Periodo neonatal sin incidencias; lactancia materna durante 4 meses e introduccion de la alimentacion complementaria de forma correcta. Destaca la ingesta abundante de productos lacteos. No tomaba medicacion ni habia estado en contacto con productos toxicos. Sin enfermedades previas. Antecedentes familiares: Sin interes clinico. Exploracion fisica: Buen estado general, buena hidratacion, no habito malnutritivo ni malabsortivo. Afebril. Peso de 11,8 kg (percentil 40) y talla de 90 cm (percentil 45). Tenia palidez intensa de piel y mucosas, sin otras lesiones cutaneas destacables. Taquicardia sinusal de 140 lat./min sin soplos, sin polipnea ni distres respiratorio. No hepatoesplenomegalia, no adenopatias. Resto de la exploracion dentro de limites normales. Pruebas complementarias: El hemograma inicial evidencio intensa anemia con hemoglobina de 7,1 g/dl, hematocrito de 22,6 %, con VCM de 79,6 fl y HCM de 25,0 pg. Las series leucocitaria y plaquetaria eran normales. El sedimento urinario no presentaba productos de degradacion de hemoglobina ni hematuria microscopica. Sideremia: 111 mg/dl; ferritina: 78 ng/ml; transferrina: 216 mg/dl. La bilirrubina total y la haptoglobina eran normales, con LDH plasmatica de 218 U/l. Perfil hepatico y renal sin alteraciones. Los reticulocitos en los primeros dias se mantenian persistentemente descendidos (0,1%). Ante la continuidad de la anemia arregenerativa, y descartandose cualquier tipo de anemia de causa periferica, se decidio realizar biopsia y aspirado de medula osea.