Anales de pediatria最新文献

Introduction

Understanding the variations of abdominal vascular structures is important for preventing complications of abdominal surgical procedures for gastrointestinal disease such as necrotizing enterocolitis or others that may arise in patients with congenital cardiac disease. We analysed the coeliac trunk and its branches in children with congenital heart disease to determine whether there is a greater prevalence of associated vascular abnormalities.

Methods

We retrospectively analysed thoracic computed tomography (CT) angiograms performed in our hospital in paediatric patients with congenital heart disease. We documented the anatomical variations observed in abdominal sections in which the coeliac trunk and hepatic arteries were included in the field of view. We used the Uflacker classification to describe anatomical variants of the coeliac trunk, and the Michels classification and its modified version (Hiatt classification) to describe the anatomy of the hepatic artery system.

Results

Our study included 178 patients with congenital heart disease. We identified coeliac trunk variants in 10.7% of the patients. Gastrosplenic trunk was to the most prevalent variant, amounting to 5.6% of total cases. We found hepatic artery variations in 19.1% of the patients. According to the Michels classification, the prevalence of accessory left hepatic artery arising from the left gastric artery as 4.5%, compared to 6.7% based on the Hiatt classification.

Conclusion

The prevalence of coeliac trunk and hepatic artery variations in patients with congenital heart disease was not greater in our study compared to other series in the literature. Clinicians must be vigilant about the variations detected in multislice CT scans to avoid complications resulting from vascular abnormalities, especially in patients who undergo abdominal surgery.

Introduction

Breastfeeding appears to protect the onset of obesity in infants. The aim is to know whether breastfeeding duration of is associated with the risk of obesity in infants and toddlers aged 12 and 24 months.

Material and methods

Prospective longitudinal study in a cohort of children born in Spain between April 2017 and March 2018 (LAyDI study) in the paediatric primary care system conducted in the framework of the PAPenRed research network. Analysis of breastfeeding duration (group 1: fewer than 6 months; group 2: 6 months or more) and its association with anthropometric variables.

Results

A total of 1495 patients attended the 12 months preventive child health visit and 1073 patients the 24 months visit. We found a statistically significant association between breastfeeding duration and weight-for-age, BMI-for-age and weight-for-length/height at 12 and 24 months; breastfeeding duration of less than 6 months was significantly associated with overweight and obesity (based on BMI-for-age and weight-for-length/height) at ages 12 and 24 months. Maternal pre-pregnancy BMI acted as a modifier on the association between breastfeeding duration and overweight and obesity (based on BMI-for-age).

Conclusions

A breastfeeding duration of less than 6 months is associated with a higher percentage of overweight and obesity at ages 12 and 24 months, although maternal pre-pregnancy BMI modifies this relationship at 24 months.

Introduction

The sharing of research findings through communications at congresses and publications is essential for the dissemination of scientific knowledge. The aim was to determine the percentage of communications presented the biennial meetings of the Sociedad Española de Neonatología (SENeo, Spanish Society of Neonatology) eventually published as full-text articles in indexed peer-reviewed journals and their bibliometric characteristics.

Material and methods

We conducted a cross-sectional study by reviewing the abstracts from the oral communications (OCs) in the 2017, 2019 and 2021 SENeo congresses. Then we searched for the authors in the MEDLINE and Scopus databases. We collected data on the authors, type of OC and bibliometric characteristics.

Results

The sample included 525 OCs, and we found a publication rate of 40.38% corresponding to 212 publications, 78.8% of them in international journals. The most frequent journal of publication was Anales de Pediatría. The median and interquartile range values for the impact factor, quartile and number of citations were 2.86 (1.96-3.98), 2 (1-3) and 3 (0-7), respectively, with a remarkable increase in the impact factor for the most recent congresses. The median time elapsed to publication was 10 months (IQR, 1-23). The proportion published was higher for multicentre studies and those with a respiratory topic.

Conclusions

The frequency of publication for OCs submitted to SENeo congresses was similar to the frequency of publication for other paediatric congresses, with an impact factor that was above the mean of the congresses under study. The proportion of publication was higher for studies with a multicentre design or a respiratory topic.

Objective

The aim of the study was to describe how physical exercise affects metabolic control, insulin requirements and carbohydrate intake in children who use hybrid closed-loop systems.

Methods

Cross-sectional study design. The sample included 21 children and adolescents diagnosed with type 1 diabetes. During the study, participants were monitored for a period of 7 days to gather comprehensive data on these factors.

Results

Nine participants (42.9%) had switched to exercise mode to raise the target glucose temporarily to 150 mg/dL. The HbA1c values ranged from 5.5% to 7.9% (median, 6.5%; IQR, 0.75). The percentage of time within the target range of 70-180 mg/dL was similar; however, there was an increased duration of hyperglycaemia and more autocorrections on exercise days. The time spent in severe hyperglycaemia (> 250 mg/dL) increased by 2.7% in exercise compared to non-exercise days (P = .02). It is worth noting that hypoglycaemic episodes did not increase during the exercise days compared with non-exercise days.

Conclusion

The hybrid closed-loop system was effective and safe in children and adolescents with type 1 diabetes during the performance of competitive sports in real life.

Introduction

Currently, kangaroo mother care (KMC) is an intervention whose implementation in clinical practice varies widely. The aim of this document is to gather the latest evidence-based recommendations in an attempt to reduce interprofessional variation and increase the quality of neonatal care.

Methods

The document was developed following the guidelines provided in the Methodological Manual for the Development of Clinical Practice Guidelines of the National Health System: formulation and prioritization of clinical questions, literature search, critical reading, development of the document and external review. The target population was preterm (PT) and/or low birth weight (LBW) newborn infants admitted to a neonatal unit.

Recommendations

Based on the current evidence, recommendations have been issued to address 18 clinical questions regarding the impact of KMC (morbidity and mortality, physiological stability, neurodevelopment, feeding, pain, families), including infants with vascular access or respiratory support devices. It also describes the KMC procedure (transfer, positioning), the facilitators and barriers related to the implementation of KMC and how to implement KMC in extremely preterm newborns (less than 28 weeks of postmenstrual age in the first days of life).

Conclusions

The kangaroo mother care is a beneficial practice for PT infants, LBW infants and their families. The implementation of these recommendations may be useful in everyday clinical practice and may improve KMC outcomes and the quality of care provided to neonatal patients.

Therapeutic monitoring of antibiotics and antifungals based on pharmacokinetic and pharmacodynamic param- eters, is a strategy increasingly used for the optimization of therapy to improve efficacy, reduce the occurrence of toxicities, and prevent the selection of antimicrobial resistance, particularly in vulnerable patients including neonates and the critical or immunocompromised host.

In neonates and children, infections account for a high percentage of hospital admissions and anti-infectives are the most used drugs. However, pediatric pharmacokinetic and pharmacodynamic studies and the evidence regarding the efficacy and safety of some newly marketed antibiotics and antifungals -usually used off-label in pediatrics- to determine the optimal drug dosage regimens are limited. It is widely known that this population presents important differences in the pharmacokinetic parameters (especially in drug clearance and volume of distribution) in comparison with adults that may alter antimicrobial exposure and, therefore, compromise treat- ment success. In addition, pediatric patients are more susceptible to potential adverse drug effects and they need closer monitoring.

The aim of this document, developed jointly between the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Pediatric Infectious Diseases (SEIP), is to describe the available evidence on the indications for therapeutic drug monitoring of antibiotics and antifungals in newborn and pediatric patients and to provide prac- tical recommendations for therapeutic drug monitoring in routine clinical practice to optimize pharmacokinetic and pharmacodynamic parameters, efficacy and safety of antibiotics and antifungals in the pediatric population.