Andes pediatrica : revista Chilena de pediatria最新文献

Cancer remains one of the most important diseases in public health.

Objective: To estimate 5-year survival in pediatric cancer patients affected by FN, according to clinical-demographic variables.

Patients and method: Survival, prognostic, and analytical study with historical cohort. analytical. Cancer was grouped into leukemias-lymphomas, osteosarcoma, and other solid tumors. Descriptive analysis was performed with Fisher and Kruskal-Wallis tests; prognostic factors like age, type of cancer, and sepsis were analyzed with hazard ratio (HR). The Kaplan-Meier method and the Cox regression model were used for the survival curves.

Results: We studied 116 subjects diagnosed with leukemia-lymphoma (51.7%), osteosarcoma (25.9%), and other solid tumors (22.4%). The median number of days between chemotherapy and the first episode of FN was 5 days [1-7], 7 [7-8], and 7 [58], respectively. Overall survival was 64.7% at 5 years. Protective factors according to Cox Model were post-cancer comorbidity (HR 0.33 CI95% 0.16-0.67) and average educational level of the caregiver (HR 0.36 CI95% 0.18-0.73) and risk factors were the presence of another type of solid organ tumor (HR 3.43 CI95% 1.64-7.19), sepsis (HR 2.89 CI95% 1.47-5.70), delay in chemotherapy (HR 2.94 CI95% 1.17-7.40), and invasive fungal infection (HR 3.36 CI95% 1.22-9.22).

Conclusion: Our study analyzed prognostic factors on survival in children with cancer and FN, finding risk and protective factors consistent with the literature. The presence of a solid organ tumor and sepsis were confirmed as risk factors, while the presence of post-cancer comorbidity and average educational level were protective factors in survival.

Adrenal tumors in children are frequently neoplastic and malignant, and surgical resection is the first management option. Minimally invasive surgery (MIS) has proven to be a safe management alternative and is suggested as a preferred alternative approach.

Objective: To report the surgical outcomes of patients with adrenal tumors treated by MIS.

Patients and method: Retrospective descriptive study of a cohort of pediatric patients with adrenal gland tumors undergoing MIS in the period 2012 - 2023.

Results: 15 MIS of the adrenal gland were performed in 14 patients, 60% were male, mean age 1.8 years (range: 5 days - 7 years). Histological diagnoses included neuroblastoma (n = 7), pheochromocytoma (n = 3), ganglioneuroma (n = 2), extrapulmonary sequestration (n = 1), mature teratoma (n = 1), and adrenal cortical neoplasm of uncertain malignant potential (n = 1). 14 adrenalectomies and one biopsy were performed, all via laparoscopic surgery, with no need for conversion to open surgery. No perioperative complications greater than Clavien-Dindo grade II were recorded; only 2 patients required red blood cell transfusions and there was no perioperative mortality. The mean tumor diameter was 3.7 cm. The median hospital stay was 1 day. The mean follow-up period was 29 months.

Conclusions: The laparoscopic technique has proven to be a safe approach in pediatric patients with adrenal tumors, offering advantages in terms of hospital stay and perioperative complications.

Parenteral nutrition is a high-risk therapy due to some of its components and the exceptional inclusion of drugs. It can contain more than 50 nutrients, with different characteristics of osmolarity, ionic charge, and pH, which can affect its physicochemical stability. In addition, environmental conditions such as light, temperature, and oxygen must be considered. Their prescription and administration represent a challenge for the healthcare team, especially in the pediatric and neonatal setting, due to factors such as the state of metabolic immaturity and greater susceptibility to oxidative damage. This group also requires smaller volumes with higher concentrations of nutrients, which complicates its preparation and risks of incompatibility/interactions. The objective of this article is to review current concepts of parenteral nutrition according to the criteria of the Scale for the Assessment of Narrative Review Articles (SANRA), to make recommendations on physicochemical stability according to clinical relevance. It describes how environmental conditions and inputs can affect the stability of the mixture and provides recommendations and values to reduce the risks of instability, including amino acids, lipids, cations, anions, and different calcium and phosphate salts. Given the variability in the reproduction of the same mixture due to clinical conditions and inputs, this subject constitutes an open area for research due to the methodological diversity used in the reports. Finally, the recommendations from the pediatric/neonatal sphere are the strictest in the literature, so they are valid for adults.

Viral infections are the main cause of acute respiratory failure in infants, which can progress to acute respiratory distress syndrome (ARDS), with high morbidity and mortality, so it is essential to imple ment strategies that prevent this progression. Recently, it has been proposed that increased work of breathing would not only be a warning symptom during the evolution of acute respiratory failure, but also a mechanism for the progression of injury, both lungs and diaphragm, coining the concept of patient self-inflicted lung injury. Since the first reports of ARDS, the usefulness of the use of con tinuous positive airway pressure (CPAP) has been raised, a non-invasive respiratory support therapy with wide access and low cost, capable of improving oxygenation and work of breathing. In this re view, we summarize the current concepts of physiological bases, preclinical and clinical studies that support the theoretical capacity of CPAP to prevent ARDS progression, and the clinical experience of early implementation of bubble CPAP in the Pediatric Ward of the Hospital Dr. Franco Ravera Zunino, allowing a marked reduction in pediatric ICU admissions and the use of invasive mechanical ventilation.

Congenital myotonic dystrophy type 1 (DM1) is a rare entity that can pose a diagnostic challenge, especially if other processes such as prematurity coexist.

Objective: to describe the typical presentation of congenital DM1 and thus increase diagnostic suspicion.

Clinical case: A 29-week preterm female newborn who required non-invasive mechanical ventilation until 41 weeks postmenstrual age; she presented with apnea requiring manual ventilation with a self-inflating bag and cardiac massage. Initially, it was attributed to prematurity, but on physical examination, hypotonia, hyporeflexia, bilateral Achilles tendon retraction, facial diplegia, and weak sucking were confirmed. These characteristics, together with the respiratory compromise, suggested a possible congenital neuromuscular disease. The patient's history included infertility in the mother and polyhydramnios during gestation. The examination of the mother showed clinical myotonia, later confirmed by electromyogram, which suggested congenital myotonic dystrophy. This was confirmed genetically, finding 2000 CTG copies in the newborn and 833 in her mother.

Conclusions: Apneas and respiratory compromise in a hypotonic and weak newborn are a frequent manifestation of this disease. The presence of myotonia in the mother of a newborn with suspected neuromuscular disease should lead us to think of congenital DM1. This case highlights the importance of an exhaustive anamnesis and physical examination of the patient and her mother as key elements in the etiological diagnostic orientation.

The Ketogenic Diet (KD) is a non-pharmacological strategy for drug-resistant epilepsy (DRE) and inborn errors of metabolism (Glut-1 deficiency) management. KD is characterized by being restrictive, affecting micronutrient intake. There are different modalities of KD in which food intake and nutritional deficiencies vary.

Objective: To determine the micronutrient intake in different KD modalities.

Patients and method: Observational, cross-sectional study with patients diagnosed with DRE and Glut-1 deficiency. The dietary intake of 21 micronutrients was evaluated, and analyzed according to KD modality [Classic, Modified Atkins Diet (MAD)], use of special formula, and adequacy of recommended dietary intake (RDI) according to age and sex, defining < 75% as deficient.

Results: 19 patients were evaluated, median age 62 months (IQR: 20.5-79), 12/19 (63.2%) male, 13/19 (68.4%) eutrophic, 5/19 (26.3%) gastrostomy users, 10 (52.6%) MAD modality, use of special formula 7/19 (36.8%). Micronutrient deficiencies were found in 16/21 (76.2%) in the classic diet and 9/16 (42.9%) in the MAD. The intake of vitamin D, B2, B12, sodium, phosphorus, zinc, and selenium was significantly lower in the classic diet than in DMA, the median intake adequacy of vitamins A, C, D, E, and K was > 100%. The use of special formula manages to complete the requirements in MAD.

Conclusions: The micronutrient intake in the different KD modalities is low for most of them, being the MAD with formula the one that presented a more adequate micronutrient intake. These results should be considered in nutritional follow-up and supplementation planning.

Acute appendicitis (AA) is the most frequent cause of acute surgical abdomen in pediatrics. During the COVID-19 pandemic, lockdown slowed surgical processes, delaying medical consultations.

Objective: To analyze the impact of the pandemic on the presentation and management of acute appendicitis.

Patients and method: Retrospective cohort, which included patients under 15 years of age seen in the emergency department (ED) with a diagnosis of acute appendicitis, from March to December of the pre-pandemic period of 2018 and the pandemic period in 2020. Demographic data, symptoms, treatment, and complications were analyzed. Patients were divided into groups based on the severity of the condition. A statistically significant difference of p < 0.05 was demonstrated.

Results: 629 patients with AA from both periods were included. The evolution time from the onset of symptoms to the consultation of all patients with AA in the pandemic was longer, with 41.2 hours versus 35.5 hours in the pre-pandemic period (p < 0.05), and in the subgroup of complicated acute appendicitis (CAA), it was 59.5 hours versus 45.4 hours in the pandemic and pre-pandemic periods (p < 0.01), respectively. Admission to the intensive care unit was higher in the pandemic, with 3.9% versus 0.6% in the pre-pandemic period (p < 0.05). In the case of appendicular phlegmon, it had greater hospital stay in the pandemic with 11.6 days versus 7.8 days in the pre-pandemic period (p < 0.05) and longer antibiotic treatment with 17 days in the pandemic versus 11.1 days in the prepandemic period (p < 0.05). The surgical approach in the pandemic was mainly laparoscopic with 62.4% (p < 0.001).

Conclusion: During the pandemic, there was a delay in consultation and a greater requirement for intensive management in patients with acute appendicitis. The hospital stays and antibiotic treatment of appendiceal phlegmon were longer and the laparoscopic technique was the surgical approach of choice.

There is evidence of the benefits that breastfeeding (BF) provides to full-term and premature newborns who are hospitalized. In the latter, maintaining BF during and after hospitalization is difficult.

Objective: To determine the factors associated with BF cessation in preterm infants one month after discharge from a neonatology unit.

Patients and method: Historical cohort of 218 newborns from the Very Low Birth Weight Newborn Follow-up Program of the Hospital Base Valdivia, hospitalized between January 2016 and June 2022 and who maintained BF at discharge. Biodemographic and clinical data were collected from available records and their relationship with BF cessation was evaluated one month after discharge.

Results: One month after discharge, 35.8% of the infants abandoned BF (N = 78). The bivariate analysis highlighted a significantly lower median gestational age and lower mean birth weight in those who abandoned BF. Neonates born to married mothers, with a shorter median hospital stay and without requiring invasive mechanical ventilation had a lower proportion of BF abandonment. In the adjusted analysis, the educational level of maternal higher education was significantly associated with a lower probability of abandoning BF (adjusted OR: 0.3; 95% CI 0.11 - 0.85).

Conclusions: One month after discharge, over a third of the children stopped BF which was significantly associated with the mother's educational level. Support and educational interventions during hospitalization must consider the mother's educational background.

High-frequency oscillatory ventilation with volume guarantee (HFOV-VG) is a ventilatory mode that controls small tidal volumes at supraphysiological frequencies, potentially beneficial for preterm infants with respiratory distress syndrome (RDS).

Objective: To identify the physiological and clinical effects of HFOV-VG in preterm newborns with RDS, compared with conventional HFOV.

Method: Exploratory review of studies published between 2019 and 2023 of preterm newborns from 23 to 36 weeks of gestation with RDS, weighing ≥ 450g, with invasive HFOV support, using PRISMA flow diagram. For their critical evaluation, the MINORS and PEDro scales were used.

Results: 1,386 articles were initially identified, of which 7 articles were selected. Compared with conventional HFOV, the use of lower tidal volumes (VThf) and higher respiratory rate stands out, as well as better and more stable gas exchange, both as an elective or early rescue strategy in preterm newborns with RDS. Furthermore, an inverse relationship is observed between VThf and respiratory rate.

Conclusion: HFOV-VG, used in preterm neonates with RDS, consistently improves oxygenation and ventilation compared with conventional HFOV. Control and reduction of VThf could provide additional lung protection.