Andes pediatrica : revista Chilena de pediatria最新文献

Pediatric rapid response teams (PRRT) aim to detect the clinical deterioration of a patient and implement timely treatment, avoiding cardiopulmonary arrests (CPA) and in-hospital mortality.

Objective: To describe the experience with PRRT led by the pediatrician in a high-complexity hospital.

Patients and methods: Descriptive, retrospective, longitudinal study. Hospitalized children under 18 years of age who had a PRRT activation between August 2015 and May 2022 were included. Patients who simultaneously had an activation of the emergency system (suspected CPA) were excluded. Demographic and clinical variables were analyzed through a descriptive analysis.

Results: We analyzed 225 PRRT events with an activation rate of 17 per 1,000 admissions. Activations were more common in children under two years of age (50%), oncology patients (35%), general hospitalization (88%), the night shift (44%), and respiratory compromise (48%). Most evaluations occurred within the first five minutes (74%). The most frequent interventions were oxygen administration (45%), fluid bolus (43%), laboratory tests (40%), and X-rays (34%). Admission to the pediatric intensive care unit was 45%. The decrease in inpatient CRP was progressive during the time of the study.

Conclusions: With the implementation of the PRRT, we found a tendency toward fewer CPA events in hospital wards. Most of the therapeutic interventions derived from the PRRT were of low or medium complexity, which supports the pediatrician as the team leader.

Among the restrictive eating and eating disorders, anorexia nervosa (AN) and atypical anorexia nervosa (AAN) are the ones that present the greatest medical complications.

Objective: Describe the characteristics of patients with AN and AAN and their differences in demographic and clinical parameters.

Patients and method: The records of patients <19 years of age with AN admitted to Clinica Santa María between 2013 and 2019 were reviewed. The evolution time, amenorrhea, z-BMI, percentage and speed of weight loss, and complications were recorded. Results were expressed as mean and standard deviation or median and range. Comparisons were made using the Mann-Whitney test, the t-student test, and the chi-square test; Pearson's coefficient was used for correlations.

Results: 76 patients with AN were admitted (64% AAN). The median age was 15.4 years. AN and AAN differed in age at diagnosis (p < 0.03), z-BMI (p < 0.001), bradycardia (p < 0.009), blood pressure (p < 0.003), and cholesterol (p < 0.02), without other differences. The z-BMI correlated with heart rate (r = 0.39 p < 0.002); systolic pressure (r = 0.43 p<0.000), and HDL (r = -0.39 p < 0.005). The percentage of weight loss was correlated with time of amenorrhea (r = 0.27 p < 0.05); alanine aminotransferase (r = 0.0.37 p < 0.031), and HDL (r = 0.47 p < 0.001) and the speed of weight loss with glycemia (r = -0.46 p < 0.001) and urea nitrogen (r = -0.39 p < 0.005).

Conclusion: AAN was the most frequent AN condition in this sample and variables such as the percentage and speed of weight loss were as important as BMI in medical complications.

Palivizumab, a humanized monoclonal antibody against the respiratory syncytial virus (RSV), currently is indicated in groups at higher risk of developing severe RSV disease, such as extreme premature infants and patients with hemodynamically significant heart disease. In Chile, this strategy is guaranteed by Law 20850 (Ricarte Soto Law). Nevertheless, barriers to its administration included the need to transfer these labile patients and exposure to other users, with the risk of contagion in waiting rooms.

Objective: to describe the impact of the palivizumab administration strategy in a home care program for high-risk patients.

Patients and method: retrospective, descriptive, observational cohort study of patients born before 32 weeks of gestation or weighing less than 1500 grams, who received palivizumab between January 2019 and December 2021 at the Hospital Dr. Sótero del Río.

Results: 272 patients were included (median gestational age: 30 weeks). The percentage of doses administered at home was 35.9% (2019) and 37.2% (2021). Each dose of 2020 following the administration in Neonatology, was administered at home during the COVID-19 pandemic. The median interval between doses was as recommended. Adherence was over 90%. The unadjusted incidence of RSV infection was 5.7% (2019), 0% (2020), and 0.9% (2021).

Conclusions: palivizumab administration was adequate and timely; home indication was associated with high adherence rates and an administration interval between doses in line with current recommendations.

In the Chilean pediatric population, to date, there is no validated screening instrument for sleep-related breathing disorders (SRBD).

Objective: to develop and validate a cross-cultural adaptation of the Pediatric Sleep Questionnaire - sleep-related breathing disorder scale (PSQ-SRBD), by creating the Chilean Spanish version (PSQ-CL).

Patients and method: The PSQ-SRBD was translated from English into Chilean Spanish, obtaining the PSQ-CL, which was subsequently validated. Internal consistency was determined through Cronbach's alpha coefficient in 26 children with obstructive sleep apnea confirmed by polysomnography and in 112 controls. Reliability was obtained through the test-retest method.

Results: In the pilot group, the overall internal consistency of the PSQ- CL through Cronbach's alpha was 0.71 and the internal consistency was 0.653, 0.566, and 0.808 in subscales A, B, and C, respectively. The discrimination capacity of the PSQ-CL questionnaire established through ROC analysis was 81%, determining a cut-off score of 0.227 with a sensitivity of 73.08% and a specificity of 77.68%.

Conclusions: The PSQ-CL is a suitable instrument for screening sleep-disordered breathing in Chilean children. This instrument may be useful in clinical practice and epidemiological research in the Chilean pediatric population and could be used for multicenter studies.

Cardiorespiratory fitness can be assessed by direct, indirect, maximal, and moderate effort, running, cycling, or walking methods.

Objective: To predict maximum oxygen consumption (V O2max) from the six-minute walk test in schoolchildren.

Patients and method: 459 students were included, 215 were male and 244 were female, aged 11.9 ± 1.3 years. Basic anthropometry and cardiorespiratory fitness were measured using field tests. Multivariate equations were developed to predict the V O2max using the R® Commander v. 4.2.2 software (p < 0.05).

Results: The best model predicting V O2max include distance walked in the six-minute walk test, heart rate recovery, age, height, body weight (V O2max [L-min-1] = - 0.0902 + (- 0.0464 x age) + (0.0002 x distance) + (- 0.0019 x HR) + (0.5843 x height) + (0.0353 x weight), R2 = 0.76; error = 0.25 L-min-1)), and also body mass index (V O2max [L-min-1] = - 0.6152 + (0.0399 x age) + (0.0933 x BMI) + (0.0005 x distance) + (- 0.0022 x HR), R2 = 0.57; error = 0.34 L-min-1)), both with p < 0.001.

Conclusions: Cardiorespiratory fitness can be estimated based on basic anthropometry and performance on the six-minute walk test.

Transmesenteric hernia is an internal hernia without a sac caused by a congenital defect of the mesentery. It is a rare cause of intestinal atresia, usually diagnosed intraoperatively, therefore, its prognosis is variable and may be associated with high morbidity and mortality.

Objective: To report a case of transmesenteric hernia with multiple intestinal atresia of late diagnosis.

Clinical case: Male newborn, born at term, referred due to vomiting, scanty bowel movements, and abdominal distention. At 8 days of age and after excluding various causes of abdominal distention, the patient underwent exploratory laparotomy, identifying a transmesenteric hernia and two sites of intestinal atresia. Resection of the atretic segment and primary anastomosis were performed, with good evolution.

Conclusions: In the presence of neonatal intestinal obstruction, an appropriate differential diagnosis should be made, excluding the most frequent causes of intestinal obstruction, without leaving aside those unusual but potentially serious conditions, such as transmesenteric hernia associated or not with intestinal atresia.

In Latin America, scales have been built to assess Early Child Development (EChD), most of them for direct evaluations. In Chile, the Psychomotor Development Evaluation Scale (EEDP) and the Test of Psychomotor Development (TEPSI) were developed in the 70's and 80's and are still used in different Spanish-speaking countries, but have not been updated or revalidated. In response to the need for a new instrument built in Chile for the evaluation of EChD on a large scale, the Test of Early Learning and Development (TADI-2, for its acronym in Spanish) was built and standardized between 2009 and 2012. This was updated and strengthened between 2018 and 2023 as TADI-2.

Objective: To describe the main methodological requirements considered in the construction of a health measurement instrument and, in this context, to analyze the validity of the TADI-2.

Development: The rigorous validation process of the TADI-2 stands out, complying with the standards of content selection, standardization, reliability, validity in different sociocultural and ethnic environments, low cost, easy application and open use. Sensitivity for the global score in 4- and 5-year-olds was very good and, in younger children, moderate.

Conclusions: The gathered evidence shows that the TADI-2 may be implemented for EChD screening through direct assessment of children under 6 years of age in Chile and the rest of the continent. It is recommended to continue studying the instrument in larger samples to know the consistency of the results in complementary and population-based studies.