Boletín médico del Hospital Infantil de México最新文献

Background: Human metapneumovirus (hMPV) is a leading cause of acute respiratory infection in children, particularly early in life. Despite this, there are few prospective hMPV studies in Latin American children and this is the only of that kind in Costa Rica.

Methods: We conducted an observational descriptive prospective study at the only national tertiary referral pediatric hospital of the country. We included children < 13 years of age with a laboratory-confirmed hMPV episode of acute respiratory tract infection requiring hospitalization from September 1, 2015, to September 30, 2017. Diagnosis was confirmed by direct immunofluorescence assay and/or polymerase-chain reaction.

Results: One hundred and eighty-eight patients were analyzed. One hundred and sixteen (62%) were male. About 65% were < 15 months of age; median age was 12 months (interquartile range [IQR] = 6-23). Median hospital stay was 5 days (IQR = 3-8). The most common underlying conditions were prematurity (21.8%;41), recurrent wheeze-asthma (22,8%;43), and low birth weight (17%;32). About 52.6% patients received intravenous antibiotics. Complications occurred in 37.5%, among which, ventilatory failure occurred in 17% (32), shock 4.2% (8), and pleural effusion 1.6% (3). Forty-five (23.9%) patients needed high-flow nasal cannula (average of 3.4 days [standard deviation (SD) = 2.08]). Fifty-four (28.7%) children required pediatric intensive care unit admission. Twenty-eight (14.8%) of them were on assisted mechanical ventilation for a mean duration of 6.3 days (SD = 6.03). Ten patients went home with requiring supplementary oxygen; no deaths occurred.

Conclusions: hMPV-associated hospitalizations in Costa Rican children are associated with significant morbidity. A concerning finding in our study was the high proportion of patients requiring antibiotic therapy, either on admission or during hospitalization. This should prompt us to antimicrobial stewardship interventions.

Background: Septic shock is a common cause of admission to pediatric intensive care units (PICU) and is associated with significant mortality. Our objective was to analyze the association between septic shock diagnosis at PICU admission and mortality during hospitalization.

Method: This retrospective cohort study was conducted in the PICU of Hospital Nacional Edgardo Rebagliati Martins (HNERM) in Lima, Peru, from January 2018 to December 2021. The sample size was determined based on annual mortality rates, and randomization was used to create two groups: patients with and without septic shock. To evaluate mortality risk, we performed a Poisson regression with robust variances and 95% confidence intervals (CI) using both crude and adjusted models.

Results: Of 1,341 patients admitted to the PICU during the study period, 358 were included in the analysis. The study population was 51.9% female, with a median age of 3.7 years. The largest age group was children under 1 year, comprising 29.6% of participants. The septic shock group showed higher rates of mechanical ventilation requirement, longer hospital stays, and increased mortality. The risk of mortality was 2.73 times higher in patients admitted with septic shock compared to those admitted with other diagnoses (relative risks: 2.73; 95% CI: 1.36-5.46).

Conclusion: Patients admitted to the PICU with septic shock demonstrated a 2.73 times higher risk of death compared to those admitted for other reasons.

The Mexican Association of Hepatology held this Consensus on Autoimmune Hepatitis in the Pediatric Population with the aim of providing physicians with useful information for diagnosis and treatment. A group of pediatric and hepatology gastroenterologists and a transplant surgeon reviewed the medical literature. The Delphi method was applied sending the statements to the participants to be analyzed and voted on the level of agreement and discussed during virtual sessions, 46 statements were approved with the recommendations for the autoimmune hepatitis diagnosis, early management to prevent disease progression, cirrhosis complications, and for the treatment failure, adverse events detection, alternative therapy and liver transplant indications. Autoimmune hepatitis is a rare entity in pediatrics diagnostic and therapeutic challenge. Updated recommendations for diagnosis and treatment with pediatric doses are presented.

Background: Early childhood development is crucial. The objective of this study was to evaluate, on a national scale, the level of development of children enrolled in the federal childcare program, according to the length of stay in the childcare centers and by geographic area.

Methods: A national cross-sectional study was conducted. The study population comprised 231,058 children aged between 13 and 48 months, enrolled in 9200-day care centers across the 32 states of Mexico. The developmental level was measured using the Child Development Evaluation test. The effect of length of stay was analyzed by logistic regression, using odds ratio of prevalence and 95% confidence intervals.

Results: Of the total number of participants, 53% were male, and the 37-48 month-old group was the largest (45%, n = 103,976). The length of stay ranged from 1 to > 24 months. The proportion of children with normal developmental outcomes increased alongside the length of stay, from 72.3% for children with < 6 months of stay to 88.7% for those who attended centers for > 24 months. By geographical region, Guerrero and Oaxaca, two low-income states, showed the best results, along with the highest-income states. The distribution for each area of development and geographic area are shown.

Conclusion: At the national level, long-term enrollment in daycare centers favors normal development. Particularly important is the high result in low-income regions, and it could be an equalizing strategy as a public policy. The different results among areas could help to improve the curricula.

Background: Early childhood is a critical period for child development. The Child Development Evaluation Test (EDI in Spanish), developed and validated in Mexico, is a screening tool for developmental problems in children from 1 month to 4 years and 11 months.

Objective: To validate group 15 of the EDI test for children aged 60-71 months, comparing sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using the Battelle Developmental Inventory 2^nd edition (BDI-2) in Spanish as the gold standard.

Methods: A cross-sectional analytic study with 46 children aged 60-71 months was conducted at the Hospital Infantil de México Federico Gómez. Children were evaluated using group 15 of the EDI test and BDI-2. The sample was non-probabilistic by convenience. Diagnostic metrics and comparisons were performed globally and in the developmental domain.

Results: The sensitivity and specificity of group 15 for the EDI test were 93.8% (95% confidence interval [CI]: 81.8%-100%) and 73.3% (95%CI: 57.5%-89.1%), respectively. The PPV was 65.2%, and the NPV 95.5%. The highest percentage of false negatives was in the cognitive domain, followed by the adaptive domain.

Conclusion: In this first study, group 15 of the EDI test shows high sensitivity and NPV, allowing early detection in an age group previously not covered, thus facilitating interventions in this group.

Acute diarrhea (AD) is one of the leading causes of child mortality, particularly in children under 5 years old. Dysentery, a severe form of AD characterized by blood and mucus in the stool, raises controversies regarding the appropriate use of antibiotics. The objective of this manuscript is to synthesize the available information on the indications, risks, and benefits of antibiotics used in infectious dysentery during early childhood. A scoping systematic review was conducted using international reference documents and the databases PubMed, Scopus, and Google Scholar, following the PRISMA-ScR guidelines. Studies from 2014 onwards that addressed antibiotic management in children under 5 years old with bacterial or parasitic dysentery were included. Among the 39 selected studies, the evidence shows limited benefits and significant risks associated with antibiotic use, with recommendations varying based on specific etiology and the patient's clinical conditions, where it is evident that the rational use of antibiotics in pediatric dysentery is crucial to avoid bacterial resistance and adverse effects. There is a need for future research to establish guidelines based on robust clinical trials, to optimize targeted treatment and improve clinical outcomes in this population.

Background: Tuberous sclerosis complex (TSC) is an autosomal dominant disease that can affect any organ with hamartomas. It is characterized by early-onset seizures and is associated with intellectual disability. The main dermatological findings include hypopigmented macules, shagreen patches, and angiofibromas, which appear in 81-96% of patients.

Method: We conducted a quasi-experimental, before-and-after, open-label study in 10 patients with TSC and facial angiofibromas, aged 8-17 years, who were treated at the dermatology service of the Instituto Nacional de Pediatría in 2019 and 2020. All patients agreed to participate in the study and signed both consent and assent forms. All patients received treatment with 1% topical sirolimus for 6 months on the right side of the face, followed by 6 months on the left side of the face to assess recurrence. Each patient served as their own control. Measurements of baseline lesions were taken and followed monthly for 6 months. The changes in lesion size, measured in millimeters at each time point, were compared using repeated measures analysis of variance.

Results: All children showed a decrease in the size and number of angiofibromas, as well as reduced erythema, from the 3^rd month of treatment. Few recurrences were observed beginning at 4 months after discontinuation of the medication.

Conclusion: Topical sirolimus is effective and safe for treating patients with angiofibromas and TSC.

Background: Waugh syndrome is named to intestinal obstruction caused by intestinal invagination and malrotation, being a pathology rarely reported. The objective is to present the clinical case of a male infant with multiple intestinal obstruction secondary to Waugh Syndrome, having as a guide point a colonic intestinal duplication.

Case report: A 4-month-old male patient, with no previous history of importance, previously healthy, with clinical picture of mechanical intestinal obstruction, who underwent emergency exploratory laparotomy, finding colonic-colonic intestinal invagination at the level of the ascending colon, as head of invagination or guide point a cystic intestinal duplication of ascending colon and intestinal malrotation, exvagination by cabs, ileocecocolic resection was performed, which included cystic intestinal duplication, ileotransversoanastomosis and finally Ladd's procedure. His postoperative evolution was satisfactory. Currently with good evolution at 6 months of follow up.

Conclusions: Waugh's syndrome is a rare entity; despite having been described more than a century ago, its incidence continues to be rare. Colo-colonic invagination is infrequent, occurring in 2.5% of cases, generally associated with a guide point, as in our case, being extremely rare to cystic duplication of the colon, since there is no case reported in the literature.

Background: Residents endure psychosocial and work-related situations associated with an increased risk of developing mental health problems. Mental health is often affected during epidemics. Knowledge about the mental health state of residents before and after the onset of the COVID-19 pandemic is scarce.

Method: In this cohort study, demographic features, psychosocial characteristics, and mental health disorders were examined before and after one year of training. The second evaluation assessed burnout syndrome (BS) and individual experiences with the pandemic. Non-parametric tests and logistic regression were used to evaluate differences after 1 year and to analyze the relationship between mental health outcomes and the independent variables. Models were adjusted on a priori supposition of confounding variables.

Results: A total of 49 pediatric residents were included; none were lost to follow-up. Overall, mental health disorders prevalence increased by 30.6%. The prevalence of depressive episodes and generalized anxiety disorder also increased significantly. The prevalence of BS was 57.1%. The main risk factor for developing a mental health disorder was having a family history of mental health disorders.

Conclusions: The increase in the prevalence of mental health disorders after 1 year during the COVID-19 pandemic was more significant than the one observed in pre-pandemic studies. Further research is needed to find strategies to protect mental health among residents, especially during health crises.