Andes pediatrica : revista Chilena de pediatria最新文献

Retinoblastoma (Rb) is the most common intraocular cancer in children and, along with its treatment, can negatively impact the Quality of Life (QoL). Few studies have explored this subject in these patients; none in Latin America.

Objective: To evaluate the general, physical, emotional, social, and school quality of life of patients treated for Rb and to analyze which patient, disease, or treatment factors are associated with worse outcomes.

Patients and method: Descriptive, cross-sectional, analytical study in 59 cases aged between 2 and 18 years treated between 2007-2021, in remission and at least one year of follow-up. The PedsQL 4.0™ scale, which measures QoL in the pediatric population in four dimensions, was applied to children and one caregiver. Non-parametric (Kruskal-Wallis and median) and parametric (Chi-square) tests were used to study differences. The study was approved by the Institutional Ethics Committee.

Results: QoL reported by patients was medium for the general and school dimensions (73.8 and 70, respectively), high for physical and social health (83.1 and 80), and low for the emotional dimension (65). The quality of life reported by parents was high for general and physical and social health (78, 87.5, and 80, respectively), and medium for emotional and school dimensions (70 and 75). No significant differences were found regarding sex, disease stage at diagnosis, Rb laterality, or treatment received. Age at diagnosis > 18 months was associated with worse QoL in general and in all dimensions and was significant in parents.

Conclusion: Children treated for Rb had their QoL affected, particularly in emotional and school dimensions.

Urinary tract infections (UTIs) are one of the most frequent bacterial conditions in children, being enterobacteria the predominant etiologic agents. Streptococcus pneumoniae is an exceptional cause of UTI in the pediatric population.

Objective: To report the case of a UTI caused by Streptococcus pneumoniae, and to discuss the need for urinary tract imaging studies based on a literature review.

Clinical case: A 2-year-old girl with megaureter and left hydronephrosis diagnosed in the context of a recurrent UTI, with poor adherence to prophylactic treatment, was hospitalized due to a new episode of febrile UTI without response to outpatient treatment with a broad-spectrum antibiotic. Streptococcus pneumoniae was isolated in the urine culture. She received parenteral therapy with ceftriaxone with good clinical course and, due to UTI caused by an atypical germ added to her history of renal malformation, prophylaxis was reinitiated and imaging studies were completed. Voiding cystourethrogram showed left grade V vesicoureteral reflux. Renal scintigraphy showed severe functional compromise of the left kidney, thus, surgical indication was considered. This case, along with 16 additional cases identified in a literature review, revealed that 12 of them (70%) showed concomitant renal-urological conditions.

Conclusion: UTIs caused by Streptococcus pneumoniae are frequently associated with renal-urological alterations, which suggest the need to study the urinary tract in these patients.

Migration is a phenomenon with an impact on the health of adolescents. Barriers to accessing health services expose them to risks such as sexual violence, unwanted pregnancies, and sexually transmitted infections/HIV.

Objective: To analyze variables of sexual and reproductive health in migrant and Chilean adolescents.

Patients and method: Cross-sectional and analytical study with a sample of 3 375 adolescents aged 19 or younger, both Chilean and foreign, from the 10th National Youth Survey. Sociodemographic and sexual and reproductive health variables were analyzed. Descriptive analysis, Rao-Scott statistical test, and adjusted Odds Ratio calculation were performed using STATA v 12 software.

Results: 6.4% of the adolescents were foreigners, mainly from Venezuela (36.98%). Differences were found in health insurance coverage, sexual behaviors, contraceptive use, and children between Chilean and foreign adolescents.

Conclusions: It is concerning that one-third of migrant adolescents are not registered in the health insurance system. Differences in sexual behaviors and reproductive variables may reflect cultural and social influences, as well as inequities in access to healthcare.

The use of latent construct measurement scales is widespread in the medical literature. An essential condition is that the instrument be validated, in addition to being highly reliable.

Objective: To evaluate the level of compliance with various methodological and statistical premises of validation studies of psychometric instruments in pediatrics, which are necessary to ensure adequate interpretation of the results, in order to offer recommendations for future research.

Methods: Articles published in two of the most prestigious journals in Spanish (Andes Pediatrica and Anales de Pediatría) were identified between December 2000 and December 2023, where factor analysis was performed on the items of measurement scales, and in which the reliability and validity of these scales were studied. Twenty-five articles that met the selection criteria were selected and compared with the analysis procedure recommendations.

Results: Five key points were identified to improve: 1) Reflective and formative indicators; 2) Determination of the best reflective indicator; 3) Validity of a scale linked to the fit of the theoretical model; 4) Reliability using Cronbach's alpha; 5) Factor analysis versus principal components. Factor rotation.

Conclusions: The analysis processes of measurement instruments in pediatrics must be improved, especially regarding the selection and specification of indicators, the use of factor analysis, and the fit of the proposed models.

Observational studies have described an increase in the duration of oxygen therapy, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) in relation to the use of high-flow nasal cannula (HFNC, 2013-2016).

Objective: to analyze changes in the evolution of very preterm newborns with the use of HFNC.

Patients and method: The incidence of neonatal pathologies between 2013 and 2021 was analyzed with a statistical process control. An analysis of cases (with HFNC, 2017-2021) and controls (without HFNC, 2013-2016) was performed, 1:2, matched by weight and gestational age, comparing the main neonatal morbidities and respiratory support. Univariate analysis and logistic regression were performed with the variables associated with BPD and ROP.

Results: 59 cases and 116 controls. The statistical process control revealed an increase in BPD and ROP over time, which coincides with the incorporation of the HFNC and with the increase in days of oxygen therapy. The case-control analysis showed an increase in respiratory support and oxygen therapy measures and greater severity at birth, according to the Apgar and Neocosur score, in the group with HFNC. Logistic regression showed a significant association between the use of the HFNC and the risk of BPD and ROP. In addition, a longer duration of mechanical ventilation, lower birth weight, and more late sepsis were associated with BPD, and lower weight and gestational age at birth and longer duration of mechanical ventilation were associated with ROP.

Conclusions: These findings require a quality improvement program to reduce BPD and ROP, seeking an adequate use of HFNC.

L-asparaginase (L-asp) is an antineoplastic drug used in Leukemia and Lymphoma treatment protocols. Alterations in lipid metabolism have been reported in 10-50% of children treated with L-Asp.

Objective: To report an unusual complication of lipid metabolism associated with the use of L-Asp.

Clinical case: We describe the clinical picture of an adolescent who, during treatment for Lymphoblastic Non-Hodgkin Lymphoma (NHL), presented pseudohyponatremia and hypertriglyceridemia, suspecting an adverse drug reaction (ADR). This suspicion was evaluated according to the modified causality algorithm (Karch and Lasagna), resulting in a "definitive" ADR for the L-asparaginase and corticosteroids association. He received treatment with a low-fat diet and lipid-modifying drugs; L-asparaginase and prednisone were not suspended since the protocol ended. Hypertriglyceridemia recovered without complications after 14 days of treatment.

Conclusion: Although the magnitude of the hypertriglyceridemia did not result in clinical pancreatitis, it seems advisable to include ADR suspicion to L-asp among the differential diagnoses, to highlight the need to detect these complications, and to know their prognosis and management in order not to affect the treatment of the patients.