Archivos argentinos de pediatria最新文献

Introduction. Middle-ear ventilation tubes are commonly placed in pediatric patients because of the high frequency of otitis media. Although avoidance of water activity has been recommended to prevent otorrhea, studies indicate that exposure to water does not increase these episodes. However, a survey in the northwestern United States showed low adherence to these guidelines. This study evaluates the current recommendations of otolaryngologists and pediatricians on water exposure in patients with ventilation tubes. Population and methods. We surveyed 235 health professionals from Argentina, Brazil, Chile, and other countries, including general otolaryngologists, pediatric otolaryngologists, otologists, residents, and pediatricians. The questionnaire addressed tubing preferences, swimming recommendations, and depth limits. Results. A total of 87.62% of respondents preferred diabolos as ventilation tubes. Regarding swimming, 54% recommended protection, such as earplugs or caps, while 28.5% prohibited aquatic activity. Permissiveness varied according to age and specialty; residents and pediatricians were the most permissive. One-third allowed only shallow swimming, and 20% imposed no limits. Conclusion. Young professionals and pediatricians were the most permissive concerning water exposure. Within the subspecialties, pediatric otolaryngologists and pediatricians were the respondents who indicated the least restrictions on their patients.

Introduction. The quality improvement cycle in health care requires surveys and measurements. This study, based on data from a Latin American collaborative research project, aimed to describe the situation of pediatric emergency departments (PEDs) in Argentina and identify opportunities for improvement. Methods. Retrospective descriptive study. Data from 2019 were collected in PEDs of public hospitals with pediatric intensive care units (PICU). Continuous variables are presented as median and range, categorical variables as percentages, and productivity/resource ratios as ratios. Bivariate analysis was performed. Results. Out of 66 services, 62 (94%) participated. There was a deficit of isolation and specific pediatric care sectors; 21 (33.9%) PEDs had >70% of the equipment evaluated for the treatment of critical patients. Triage was performed in 34 (54.8%) PEDs. The median number of annual visits/observation beds was 7333 (IQR: 4,998-13,377); the median number of daily visits/consulting rooms was 37.6 (IQR 20.6-60.3). The number of beds increased by 75% at the seasonal peak. The median daily visits were 43/physician and 40.2/nurse. In 32 (51.6%) PEDs, there was 1 physician and 1 referring nurse per shift. Data were electronically recorded in 51 (82.2%) PEDs. Five critical care protocols were used in 44 (71%) PEDs, and 18 (29%) had a quality improvement plan. Five (8%) PEDs followed defined schedules for academic activities. Conclusion. This survey allowed us to know the situation of SEPs in Argentina's public hospitals and to identify opportunities for improvement.

Introduction. Macrocephaly is a phenotypic feature of achondroplasia (ACH), the most common form of disproportionate short stature. In 2011, we published head circumference (HC) references for this population, but due to the scarcity of data about older ages, the centiles were estimated only up to 6 years of age. Objective. To estimated centiles of the HC between birth and 21 years of age for ACH. Population and methods. Data from children with ACH assisted between 1992 an 2024 at a thirdlevel hospital in Argentina were used for its estimation. The growth curves were adjusted using the LMS method. To evaluate the magnitude of the differences between the Argentine references of ACH and those of the general population, the 3, 50, and 97 centiles at different ages were plotted comparatively. Results. The HC of ACH was more significant at all ages than the general population's references. During the first year of life, males and females reach 84% and 86% of adult size, respectively, completing growth after 20 years of age. Conclusions. Due to the difference in cephalic size between the general population and ACH, it is essential to have specific references for this population. This will allow us to detect growth trajectories not attributed to ACH and to suspect deviations that require a rapid interdisciplinary approach.

The absence of one or both testicles in the scrotal position is defined as cryptorchidism. It occurs in 1 - 8 % of full-term newborns and up to 45 % of preterm newborns. Its detection is of great importance due to its association with fertility disorders and the risk of malignancy. The National Endocrinology Committee of the Sociedad Argentina de Pediatría decided to prepare an update document on advances in the diagnosis and treatment of cryptorchidism that contributes to the performance of pediatric practice and allows recognition of conditions that may be accompanied by cryptorchidism, but need more evaluation and referral to a specialist, such as alterations/differences in sexual development, anorchia, genetic syndromes, among others. The first-line treatment is early orchiopexy before 12 to 18 months, always in the hands of pediatric surgeons.

Inborn errors of immunity (IEI) are a heterogeneous group of hereditary disorders that affect in number and/or function different components of the immune system, resulting in an increased risk and severity of infections, autoimmune diseases, allergic manifestations, autoinflammation and malignancy. Inactivated vaccines are generally safe in these patients, but may be ineffective in some cases, due to difference in immunogenicity. However, live viral and bacterial vaccines may lead to disease, with high morbidity and mortality, so it is essential a previous immunological work-out. In this document, the Pediatric Immunology Work Group of the Sociedad Argentina de Pediatría summarizes recommendations about immunizations in patients with IEI, their household contacts, as well as in patients under immunosuppressive treatment and hematopoietic stem cell transplant recipients.

Kabuki syndrome is a rare genetic disorder characterized by distinctive facial features, intellectual disability, skeletal abnormalities, short stature, and dermatological disorders, among other clinical manifestations. There is an increased risk of associated autoimmune diseases (such as thrombocytopenic purpura, hemolytic anemia, vitiligo, and type 1 diabetes). Type 1 diabetes is caused by autoimmune destruction of the beta cells of the pancreas and is the most common form of diabetes in children and adolescents. We present three pediatric patients with a diagnosis of Kabuki syndrome and type 1 diabetes, two of whom have an associated second autoimmune disease.

Introduction. Sleep-disordered breathing (RBD), from habitual snoring to obstructive sleep apnea syndrome (OSAS), can influence brain functioning by affecting executive functions such as attention and inhibitory control. Objective. To analyze the association between snoring and executive functions, specifically attention, impulsivity/inhibitory control in Argentine adolescents. Population and methods. In 2018, a cross-sectional study was conducted on 831 adolescents attending public and private schools in La Pampa. Sleep duration, snoring, and the risk of OSAS were assessed using the pediatric sleep questionnaire (PSQ) and executive functions (attention and inhibitory control) using the Go/No-Go test. The association between SRT and executive functions was performed using a robust regression model adjusted for body mass index, hours of sleep, and physical activity. Results. About 10% of the participants were habitual snorers, and about 7% were at risk of OSA (positive PSQ), with no significant differences between sexes. Errors of commission (No-Go errors) (β= 2.06; -3.20, -0.92) and errors of omission (Go errors) (β= -0.66; -1.31, -0.01) were significantly higher in snorers vs.non-snorers. In addition, individuals at risk for OSAS showed significantly more commission errors (NoGo errors) than those without OSAS risk (β= -1.98; -3.31, -0.66). Conclusions. The associations between snoring and inattention and impulsivity, and between the risk of sleep apnea and lower inhibitory control found in the present study suggest alterations in executive functions due to sleep disorders.

Advances in molecular biology achieved during the last years have allowed us to know the genes involved in biliary secretion and the mutations capable of generating cholestasis. The mechanisms involved in forming bile and its circulation have been clarified. According to the biology of biliary secretion, we classify the genetic causes of cholestasis as follows: 1) transport abnormalities in canalicular or basolateral membranes, 2) alterations in intracellular vesicle transit, 3) increased paracellular permeability, 4) mutations in nuclear receptors, 5) cholangiopathies, and 6) hepatocellular diseases, due to disturbance of the function of intracellular organelles or errors of metabolism. This physiopathological classification of chronic cholestasis in childhood will facilitate pediatricians' diagnostic guidance and timely specialized referrals, as patients should receive early and appropriate treatment for its complications.