Boletín médico del Hospital Infantil de México最新文献

Bronchiectasis is characterized by the permanent dilation of bronchi, clinically presenting with chronic cough, sputum production, dyspnea, and recurrent exacerbations. Bronchiectasis can occur due to genetic disorders, congenital malformations, endobronchial obstruction of infectious and inflammatory origin, and chronic aspiration, among other causes. Bronchial dilation leads to impaired mucociliary clearance, trapping particles and microorganisms in the airways. Macrophages and epithelial cells release proinflammatory cytokines that promote neutrophil chemotaxis. Neutrophils release enzymes causing epithelial cell damage, reducing ciliary motility, promoting glandular hyperplasia, and increasing mucus secretion. Persistent infection perpetuates local inflammation in bronchiectasis patients. Diagnosis requires high clinical suspicion and early detection improves clinical outcomes. High-resolution computed tomography is the gold standard for confirmation. A comprehensive medical history, initial assessments with complete blood count, total serum immunoglobulins, iontophoresis, and spirometry help assess the underlying etiology and disease severity. The primary goal is preserving lung function and halting disease progression. This involves adopting healthy lifestyles, expanded vaccination schedules, respiratory therapy, and early antibiotic use for exacerbations and colonization by specific microorganisms.

Background: Invasive medical procedures in children with congenital heart disease (CHD) increase parental anxiety and stress with a negative impact on the disease and children's coping. Parental psychoeducational programs promote their mental health and positive impact on pediatric health. The objective was to evaluate the efficacy of an online psychoeducational program to promote the mental health of parents of children with CHD who are about to undergo an invasive medical procedure.

Methods: Forty-three mothers and fathers of children with CHD about to undergo catheterization or cardiac surgery belonging to the Live Longer Mexico Foundation participated, divided alternately into two groups: 1) online psychoeducational program (n = 22), and 2) control (n = 21). Mental health was evaluated based on three indicators: parental stress, state/trait anxiety and worry before the procedure. The PSI-SF Parental Stress Index, the Parental Worry about Surgery Questionnaire and the Trait-State Anxiety Inventory were used.

Results: The group with the psychoeducational program showed a statistically significant decrease in state anxiety and worry about the medical procedure. Additionally, state anxiety and worry about the medical procedure are significantly lower in the group that received the psychoeducational program compared to the control. Parental stress had no significant intra- and inter-group changes.

Conclusions: The online psychoeducational program is effective in favoring parental mental health, specifically on state/trait anxiety and worry about surgery in parents of children with CC nearing catheterization or cardiac surgery.

El síndrome de abstinencia neonatal (SAN) afecta a los recién nacidos expuestos a opioides o sustancias adictivas durante la gestación. Esta afección ha mostrado un incremento en las últimas décadas, especialmente en países de altos ingresos. El objetivo de este estudio fue identificar las características bibliométricas y visualizar los temas emergentes en la producción científica global sobre el SAN. Se realizó un análisis bibliométrico de documentos recuperados de la base de datos SCOPUS entre 1994 y 2023. Se empleó una estrategia de búsqueda con términos del Medical Subject Headings (MeSH), Emtree y términos libres. Se analizaron el crecimiento anual, las redes de colaboración, las palabras clave más frecuentes y los artículos más citados. Se captaron 1,455 documentos, con un crecimiento anual del 9.57% y un coeficiente de determinación de 0.89. El 37.59% de los estudios se encuentran en acceso abierto. EE.UU. lideró la producción científica con un 52.4% de los documentos, seguido de Canadá (4.9%) y Australia (3.9%). Las palabras clave más frecuentes después de 2020 fueron "sleep", "neonatal opioid withdrawal syndrome" y "neurodevelopment". La producción científica sobre el SAN ha aumentado considerablemente en las últimas décadas, con preponderancia de estudios en EE.UU. y Canadá. Los futuros estudios deberían enfocarse en el diagnóstico, tratamiento y la carga de incidencia y prevalencia en países de ingresos bajos y medianos.

Neonatal abstinence syndrome (NAS) is a condition that affects newborns exposed to opioids or addictive substances during gestation. The prevalence of this condition has increased significantly in recent decades, particularly in high-income countries. This study aimed to identify the bibliometric characteristics and visualize emerging topics in the global scientific production on NAS. A bibliometric analysis was conducted using documents retrieved from the SCOPUS database between 1994 and 2023. The search strategy incorporated terms from Medical Subject Headings (MeSH), Emtree, and free-text keywords. Annual growth, collaboration networks, the most frequent keywords, and the most cited articles were analyzed. A total of 1,455 documents were retrieved, with an annual growth rate of 9.57% and a coefficient of determination of 0.89. Open-access publications accounted for 37.59% of the studies. The United States led the scientific production with 52.4% of the documents, followed by Canada (4.9%) and Australia (3.9%). The most frequent keywords after 2020 were “sleep,” “neonatal opioid withdrawal syndrome,” and “neurodevelopment.” Scientific production on NAS has increased substantially over the past decades, with a predominance of studies conducted in the United States and Canada. Future research should focus on the diagnosis, treatment, and burden of incidence and prevalence in low- and middle-income countries.

Introducción: La laringomalacia es la principal causa congénita de estridor en pediatría. Su tratamiento depende de la gravedad; los casos graves que cursan con apneas o falta de ganancia ponderal requieren intervención quirúrgica, siendo la supraglotoplastia el tratamiento de elección, logrando generalmente la resolución de síntomas.

Métodos: Se realizó un estudio descriptivo longitudinal mediante una cohorte retrospectiva. Se analizaron los expedientes de pacientes con el diagnóstico de laringomalacia grave a los que se les haya realizado supraglotoplastia, obteniendo datos sociodemográficos, síntomas principales, así como su evolución posquirúrgica, peso prequirúrgico y ganancia ponderal al mes del procedimiento, además de complicaciones quirúrgicas.

Resultados: Se incluyeron 19 pacientes (16 de sexo masculino y 3 de sexo femenino), cuya edad media fue de 3.16 meses. El síntoma principal fue estridor y el 36.9% presentó como enfermedad concomitante reflujo gastroesofágico. La supraglotoplastia tuvo un éxito del 68.4% en el primer mes posquirúrgico y posterior del 100% durante el seguimiento. Todos los pacientes mostraron ganancia de peso y el 15% alcanzó un peso adecuado para su edad.

Conclusiones: La supraglotoplastia se confirma como tratamiento eficaz para la laringomalacia grave, ya que logra resolver síntomas respiratorios y mejora el estado nutricional de los pacientes, aumentando su ganancia ponderal.

Background: Laryngomalacia is the leading congenital cause of stridor in pediatrics. Its management depends on severity; severe cases accompanied by apnea or poor weight gain require surgical intervention, with supraglottoplasty being the treatment of choice, generally resulting in symptom resolution.

Methods: A longitudinal descriptive study was conducted through a retrospective cohort. Medical records of patients diagnosed with severe laryngomalacia who underwent supraglottoplasty were analyzed, collecting sociodemographic data, main symptoms, post-surgical evolution, pre-surgical weight, and weight gain one month after the procedure, as well as surgical complications.

Results: A total of 19 patients (16 males and 3 females) were included, with a mean age of 3.16 months. The main symptom was stridor, and 36.9% had concomitant gastroesophageal reflux disease. Supraglottoplasty had a success rate of 68.4% in the first postoperative month and 100% during follow-up. All patients showed weight gain, with 15% achieving an adequate weight for their age.

Conclusions: Supraglottoplasty is confirmed as an effective treatment for severe laryngomalacia, as it resolves respiratory symptoms and improves the nutritional status of patients by increasing their weight gain.

Background: Monitoring child development requires not only the determination of developmental milestones but also surveillance and continuous monitoring, hence the importance of having valid and reliable evaluation instruments. This research aimed to cross-culturally adapt the Child Development Evaluation (CDE) test for Colombia and determine its validity and reliability.

Methods: The cross-cultural adaptation process was conducted in four phases: I. Adaptation to Colombian Spanish: adjustments of the test to Colombian Spanish and analysis of equivalences; II. Content and face validity: evaluation by five expert judges who performed quantitative and qualitative assessments of the test; III. Review by the original author; IV. Pilot test. Reliability analyses for internal consistency and intra-rater reliability were performed.

Results: For the adaptation to Colombian Spanish, most test items were equivalent to Mexican Spanish, with some requiring minimal conceptual and contextual changes to maintain their meaning; culturally relevant formulations and expressions were adjusted. In the content and face validity assessment, adequate results were found regarding the importance, influence, and observability of the items. Internal consistency reliability was moderate, with Cronbach's α values between 0.41 and 0.57, and intra-rater reliability was very good, with Kappa index values > 0.76.

Conclusion: The CDE test demonstrates cross-cultural adaptation, content and face validity, and reliability for its application and use in Colombia.

Background: The Health Ministry has incorporated the Child Development Evaluation test (CDE test) as the national screening tool for children < 5 years old. The aim of this study is to analyze the cost-effectiveness of the CDE test compared to standard medical consultation in Mexico.

Methods: The study was conducted with information available until 2020. A cost-effectiveness analysis was conducted from perspective of the public/social sectors in Mexico with a decision tree model to evaluate the strategies. The time horizon was set at 1 year, no discounting applied. Costs were calculated in Mexican pesos (MXN) at 2019 prices and included both direct/indirect costs. Direct costs encompassed CDE test administration, specialist consultations, and rehabilitation sessions. Indirect costs considered transportation expenses and lost wages related to caregiving. To account for variability and uncertainty, a Monte Carlo simulation with 10,000 iterations was performed. Probabilistic sensitivity analysis was conducted to test robustness of the results.

Results: The results confirm that the CDE test consistently outperforms the standard approach, delivering improved outcomes at reduced costs in the majority of scenarios. The incremental net monetary benefit of implementing CDE screening was $44,608 MXN (2019 value), providing additional evidence of its cost-effectiveness.

Conclusion: This study suggests that the CDE test is cost-saving from the public and social sector perspective, generating a net increase in both monetary benefits and health outcomes. Furthermore, its implementation is feasible within the Mexican healthcare system, particularly considering its potential to enhance long-term efficiency.

Background: An online tool for national monitoring of pediatric intensive care unit (PICU) bed occupancy was developed and implemented for 12 weeks in the winter of 2023 in Uruguay.

Methods: Using a daily 5-minute survey in each PICU, operational bed capacity, occupancy rates, invasive mechanical ventilation demand, and the number of children admitted for acute lower respiratory infections (ALRI) were collected. The REDCap software platform was used for data capture.

Results: Data were collected from 100% (n = 20) of Uruguayan PICUs, 68% located in Montevideo, with 2.72 PICU beds per 10,000 children under 18 years of age, and 32% in the rest of the country, with 0.86 PICU beds per 10,000 children under 18 years of age. The national average bed occupancy rate was 55.5%, with marked variability between centers (32% to 86%). During epidemiological week (SEPI) 28, the system expanded by 36% compared to the initial value of operational beds. The highest percentage of bed occupancy was observed between SEPIs 25 and 28, when the average was above 70%. This peak reached 78% during SEPI 26, coinciding with the epidemiological peak of cumulative incidence of LRTI in children under 15 years of age.

Conclusions: In Uruguay, a national ICU bed monitoring tool was implemented, which showed that occupancy rates did not reach critical levels. However, regional and inter-center differences were found that warrant further study to optimize system management.

Background: Congenital diaphragmatic hernia (CDH) is a severe condition associated with high morbidity and mortality. Its severity correlates with the degree of pulmonary hypoplasia. Recent literature has emphasized the importance of identifying distinct hemodynamic phenotypes (HP) to guide physiology-based management.

Method: We included all CDH patients evaluated by targeted neonatal echocardiography from January 2017 to April 2022. HPs were classified into three groups: HP1 (mild pulmonary hypertension [PH] without ventricular dysfunction), HP2 (pre-capillary PH), and HP3 (post-capillary PH). We compared differences between survivors and non-survivors using the Mann-Whitney U-test, analyzed baseline and pre/post-surgical echocardiographic parameters using the Wilcoxon test, estimated survival curves using Kaplan-Meier analysis, and compared length of stay using the Kruskal-Wallis test.

Results: Among 28 included neonates, 24 survived (86%). HP distribution was: HP1 9 patients (32%), HP2 8 patients (29%), and HP3 11 patients (39%). Four patients died, two post-surgery and two without surgical intervention. Mortality-associated factors included higher pCO₂, lower left ventricular (LV) output, decreased LV compliance, and elevated pulmonary vascular resistance (PVR). Survival analysis revealed a non-significant trend toward higher mortality in HP2 (one death) and HP3 (three deaths). Follow-up demonstrated progressive increases in biventricular output, PVR reduction, and compensatory cerebral vasodilation.

Conclusion: HP correlated with patient mortality, particularly in cases with greater pulmonary hypoplasia (higher CO₂) and compromised ventricular performance. Echocardiographic monitoring revealed improvements in biventricular performance, decreased PVR facilitating surgical intervention, and cerebral perfusion adaptation.