Archivos argentinos de pediatria最新文献

Introduction. Dengue is a viral infection that may be asymptomatic or include severe manifestations. This study aims to describe the characteristics of a pediatric population during the epidemic outbreak in 2023. Population and methods. This cross-sectional study included patients with probable or confirmed dengue fever who were seen from March 13, 2023, to May 19, 2023, in a pediatric hospital in the Autonomous City of Buenos Aires. Results. A total of 112 patients were included. The median age was 12 years; 58% were male. Seventy-six percent of them came from the City of Buenos Aires. Twenty-five percent had cohabitants with symptoms compatible with a suspected case. The most frequent clinical manifestations were fever, headache, retro-ocular pain, myalgia, and arthralgia. The most frequent laboratory alterations were leukopenia (65%) and elevated transaminases (60%). Twenty-one percent (24/112) presented alarm signs and required hospitalization. Leukopenia, plateletopenia, and elevated transaminases were associated with the presence of alarm signs. RT-PCR was detected in fifty-three patients; serotype 2 was the most frequent. Twenty-one patients had positive NS1 tests, 18 patients had positive IgM, and 20 patients with clinical and epidemiological links were assumed to be probable dengue cases. There were no cases of severe dengue. Conclusion. Early clinical suspicion and recognition of laboratory parameters associated with alarm signs are essential for an adequate approach to the disease and early supportive treatment during dengue infection.

Introduction. spontaneous breathing trial (SBT) in weaning from pediatric invasive mechanical ventilation (IMV) is an endorsed practice, its positivity is based on clinical parameters; however, its results could be better documented. Objective. To describe the results of the SBT in the IMV weaning process. Population and methods. Retrospective analysis. Patients with ≥48 h in IMV from March 1, 2022 to January 31, 2024. Results. A total of493 SBT were analyzed in 304 patients; 71% (348) were positive, and 87% (302) resulted in successful extubations. The causes of negative SBT were increased work of breathing (70%), respiratory rate (57%), and heart rate (27%). In univariate analysis, respiratory distress as the reason for admission, peak inspiratory pressure before SBT and T-tube use, were predictors of negative SBT. In multivariate analysis, this association persisted for admission for respiratory cause, the higher programmed respiratory rate in IMV, as the T-tube modality. Those with negative SBT stayed more days in IMV (9 [7-12] vs. 7 [4-10]) and in PICU (11 [9-15] vs. 9 [7-12]). Conclusion. Positive SBT predicted successful extubation in a high percentage of cases. Respiratory distress on admission, higher programmed respiratory rate, and a higher proportion of T-tube mode were negative predictors of the test. Negative SBT was associated with more extended stays in IMV and PICU.

Between 1997 and 2012, the diagnoses of ankyloglossia and the indication for frenotomy increased by ˃800%. About 38% of diagnosed cases are surgically treated. Breastfeeding promotion includes evaluating maternal hereditary and personal history of breastfeeding, breast structure, endocrinological physiology, emotional well-being of the mother, breastfeeding technique, quality and quantity of milk, and the newborn's ability to latch on and suckle. Frenotomy would be indicated when restriction of tongue function causes difficulties that have not resolved after thorough evaluation and counseling to correct other causes. Frenotomy can have complications: feeding and respiratory difficulties, pain, weight loss, vascular or nerve damage, and delayed diagnosis of other underlying pathologies. It does not always solve breastfeeding difficulties. Interdisciplinary teamwork reduces the frequency of unnecessary frenotomies.

Esophageal achalasia is an uncommon disease in pediatrics. With an insidious clinical presentation, diagnosis is delayed. Here we describe a case of esophageal achalasia in a 16-year-old girl, with the typical delay in consultation and diagnosis. Although pneumatic balloon dilatation has been described as the best therapeutic option for type II achalasia, it was ineffective in our patient and she required Heller extramucosal myotomy with gastroesophageal fundoplication for reflux.

Primary liver tumors are an increasing indication for pediatric liver transplantation. Here we report the cases of 10 patients who underwent liver transplantation for primary liver tumors in our hospital, from 2001 to date. Up to 2011, 1 transplant due to hepatoblastoma was done out of 117 liver transplants (0.8%). Since 2012, there were 9 patients out of 141 (6.4%) (5 due to hepatoblastoma, 2 due to hepatocellular carcinoma, 1 due to hepatic epithelioid hemangioendothelioma, and 1 due to hepatic mesenchymal hamartoma). Follow-up: 13.2 months (median); age at transplantation: living 4.7 years (median); weight: 17.6 kg (median). Eighty percent of patients received grafts from living donors. No tumor recurrence was observed. Survival was 100% in the follow-up period. In our series, patients with primary liver tumors requiring transplantation showed an adequate course, even in the case of hepatocellular carcinoma, Related living donors liver transplantation shortened the time between the indication and the surgery.

Enteral formulas containing fiber, designed to be administered orally or by gavage, have been used for decades. Although their indication in the pediatric population does not have a global consensus, knowledge about the benefits of using fiber to promote healthier microbiota has grown in recent years. Different fiber types' physicochemical characteristics (solubility, viscosity, fermentability) determine their functions. The impact of fiber use on preventing specific chronic pathologies (cardiovascular disease, cancer, diabetes) has been reported in epidemiological studies. In controlled studies, changes in stool consistency, intestinal transit, and the composition and function of the microbiota have been observed since fiber produces fermentation metabolites such as short-chain fatty acids, which improve metabolic and immunological aspects. Different pediatric pathologies could benefit from the use of fiber.

Introduction. Hypoxic-ischemic encephalopathy (HIE) caused by lack of oxygen and perfusion to the brain can lead to acute neurological damage in newborns. Therapeutic hypothermia (TH) is the most effective and safest treatment. However, mortality remains high with numerous long-term sequelae. Cellular therapies, particularly umbilical cord blood (UCB), are being studied as alternative therapies. The aim of this study is to assess the feasibility and safety of combining autologous cord blood cell infusion with moderate hypothermia. Population and methods. Twelve infants of 36 weeks gestational age or older, diagnosed with moderate or severe HIE and with umbilical cord blood (UCB) collected were included. UCB was volume-reduced, and up to four doses were obtained. These doses were infused within the first 72 postnatal hours. Time to the first infusion and possible adverse reactions to the infusion were evaluated. Results. Between 2014 and 2019, 12 infants were included in the protocol (TH + UCB), 9 with a diagnosis of moderate HIE and 3 with severe HIE. In all cases, at least one dose of UCB was obtained for infusion. In all cases, the first dose was infused within 24 hours in every case, and no adverse reactions attributable to the infusion were observed. Conclusions. The collection, processing, and infusion of fresh autologous umbilical cord blood for use in newborns with HIE are feasible and safe under our conditions.

Western equine encephalitis (WEE) is a zoonotic disease caused by an RNA virus of the genus Alphavirus, and humans are accidental hosts. Although most patients do not develop symptoms upon infection, children are at higher risk for neurological involvement. Here we describe the case of a previously healthy 13-year-old male patient who lived in an urban area in the province of Buenos Aires, Argentina, who was hospitalized and diagnosed with meningoencephalitis. Due to the torpid course of his condition and because none of the most frequent microorganisms were isolated, a test for IgG antibodies for WEE virus in blood and cerebrospinal fluid was requested; both samples were positive. WEE virus is often an underdiagnosed cause of encephalitis and should be taken into consideration in both rural and urban areas.