Archivos argentinos de pediatria最新文献

Exclusive breastfeeding during the first six months of life, and prolonged with complementary feeding until 2 years of age or more, is the best nutritional approach in the first stage of life. Mastitis is a pathology that can jeopardize the continuity of breastfeeding. Different methods have been proposed for the prevention and treatment of mastitis, including probiotics. This narrative review aims to describe the problem of mastitis during lactation and the role of probiotics in its prevention. Mastitis should not be confused with the physiological phenomenon known as milk coming in. In persistent pain, timely medical consultation is key to avoiding complications. The administration of specific probiotics in the perinatal period has shown efficacy in reducing the incidence of mastitis.

Introduction. Child development is a complex process influenced by genetic and environmental factors. An enriching linguistic environment is fundamental for cognitive development and language learning in the first years of life. Objective. To describe caregivers' knowledge of cognitive and language development of children under 5 years of age. Population and methods. Cross-sectional, analytical study. Caregivers of children under the age of 5 years who attended the offices of a pediatric hospital during January-March. A self-administered survey, the Survey of Parent/Provider Expectations and Knowledge (SPEAK), probes caregivers' knowledge of cognitive and language development. Demographic characteristics were explored. A univariate descriptiveanalysis was performed for each variable, and a bivariate analysis was conducted using demographic data as predictor variables and the total survey score as the outcome variable. Results. The median global score obtained in the SPEAK survey was 31 (interquartile range 26-34), out of a maximum possible 54 points. The analysis revealed a significant association between the caregiver's educational level and their knowledge of child development (r = 0.211; p = 0.012). Conclusion. The population studied presented an intermediate level of knowledge about language and cognitive development in early childhood. An association was found between a higher level of education and greater knowledge of development.

Introduction. In Pediatrics, communication involves children and their families. Students with the highest interaction with children can approach this subject with greater confidence. Objective. To assess the interaction with children of medical students in their daily lives and its correlation with confidence at the start of the Pediatrics course. Methods. A self-administered survey study of pediatric students of the School of Medicine of the Universidad de Buenos Aires inquired about the frequency of interaction with children under 12 years of age and confidence in this interaction. Results. A total of 286/450 responses were obtained. Only 27 students lived with children, and 14 were parents. Most had little interaction (1-2 times a year or less) with children (64% infants, 64.3% preschoolers, 54.6% schoolchildren). A positive correlation was found between interaction level and confidence (p < 0.01). Conclusion. Medical students have limited interaction with minors in their daily lives, which affects their confidence in taking a Pediatrics course.

In recent years, access to high-performance genetic techniques has allowed new diagnoses to become evident, allowing us to say today that genetic causes represent more than one-third of the etiologies of cholestasis in newborns and infants. When faced with a pediatric patient with cholestasis, with similar clinical and biochemical findings, an early genetic diagnosis will facilitate specific treatment, delay or exclude invasive diagnostic procedures (for example, liver biopsy), and offer genetic counseling to the family. We recently published a classification of genetic cholestasis, considering how the molecular defect affects biliary secretion. In this opportunity, we briefly summarize each of them to facilitate their identification by the pediatrician, who is the first professional to detect them and promptly refer them to a high-complexity center.

Introduction. Acute lower respiratory infections (ALRI) due to respiratory syncytial virus (RSV) are a significant cause of disease. Most of them are treated outpatient without etiological investigation, making it difficult to estimate the disease burden. In 2020, an algorithm was developed to identify consultations for ALRI in electronic health records. We evaluated the algorithm's behavior in patients with RSV ALRI. Methods. The cross-sectional study included children under 5 years of age who consulted for ALRI with viral screening. The algorithm was applied to their health records, calculating diagnostic capacity to identify RSV ALRI. Results. We included 133 patients (age 4.9 ± 4.1 years). RSV was identified in 21.8%. The algorithm identified ALRI in 33.8% (95%CI: 26.3-42.2) and showed a limited ability to identify RSV infection (sensitivity: 55.2%, specificity: 72.1%). Conclusion. An algorithm for identifying ALRI consultations in electronic health records does not adequately distinguish those caused by RSV.

Invasive mechanical ventilation (IMV) is widely used in pediatric intensive care units. Acute lower respiratory infection is its primary indication; it is characterized by increased inspiratory and expiratory resistance, as well as decreased lung compliance. It can progress to acute respiratory distress syndrome, which poses a challenge in optimizing IMV. Although different ventilatory modes are not presumed to generate significant clinical differences, there is a marked preference for the pressure control mode in pediatrics. In predominantly obstructive conditions, volume control mode ensures ventilation regardless of the degree of inspiratory resistance, allowing for extended expiratory time and preventing hyperinflation. In restrictive conditions, pressure control enables ventilation to be adjusted to protective parameters, albeit with the potential risk of inducing damage due to higher flow rates. The physiological basis of the different ventilation modes and their clinical application are reviewed.

Acute suppurative thyroiditis (AST) is a rare endocrinological emergency in pediatrics that may require immediate infectious disease and surgical intervention. It is generally associated with bacterial infections and, in some cases, congenital malformations of the branchial arch. We present the case of a 7-year-old girl with recurrent AST, in both episodes with cervical abscess formation, requiring intravenous antibiotics and surgical drainage. From the outset, a piriform sinus fistula was suspected, which was confirmed by direct laryngoscopy in the operating room during the hospitalization for the second episode. Chemical sclerosis of the fistulous tract was performed, with favorable evolution and no recurrence at follow-up. Although rare, this case highlights the importance of considering AST in the differential diagnosis of cervical masses in the pediatric population. It also encourages investigation of underlying causes such as congenital anomalies, which allows for early diagnosis and definitive treatment.

Biosimilars are highly similar versions of already authorized biological drugs. A notable benefit of these is their significantly lower price compared to innovator drugs, which frees up healthcare resources and improves affordability. Leading regulatory agencies approve biosimilars after rigorous comparability studies, ensuring that there are no significant differences in quality, safety, and effectiveness. Currently, the structural and functional equivalence of biosimilars to originators may be sufficient evidence, together with post-marketing experience, to support their safe and effective use in pediatrics. Although the extrapolation of indications and interchangeability continues to be debated, research continues to support the use of biosimilars. However, challenges remain, such as regulatory heterogeneity and mistrust due to misinformation. Continuing education and clear public policies are essential to maximize their adoption and access to vulnerable populations such as children.