Boletín médico del Hospital Infantil de México最新文献

Introduction: Lung ultrasound (LU) has proven to be the best method for diagnosing surfactant deficiency (Respiratory Distress Syndrome [RDS]) and continuous positive airway pressure (CPAP) failure; experience in Mexico is limited.

Methods: The objective was to determine the usefulness of a LU program and a lung ultrasound score (LUS) for predicting surfactant need in a perinatal hospital. LUS and FiO₂ of patients who received or did not receive surfactant were compared with Mann-Whitney U test. Using LU as the gold standard, FiO₂ thresholds were tested using receiver operating characteristic curves.

Results: 69 newborns (33 weeks [30, 35]; birth weight 1925 [1470, 2590]) were evaluated for differential diagnosis and to determine surfactant needs. 74 studies were performed: 54 for the first dose (14 administrations, 26%) and 20 for re-surfactant (six administrations, 30%). Among the group evaluated for a first dose, LU diagnoses were RDS 30%, transient tachypnea of the newborn (TTRN) 59%, TTN/air leak 6%, TTRN/pleural effusion 1.6%, congenital pneumonia 1.6%, and meconium aspiration syndrome 1.6%. There was a statistically significant difference between the LUS of patients who received the first (12 [10, 12] vs. 6 [5, 6]) and second dose of surfactant (12 [11, 12] vs. 4 [4, 7]). FiO₂ ≥ 30% was found in 34% of patients with TTN pattern in whom CPAP optimization improved all cases. An optimal FiO₂ threshold of 24% was found with an area under the curve of 0.85.

Conclusions: LU provides very valuable information through pattern recognition and a LUS, allowing differential diagnosis and tailored physiological care.

Background: Pneumothorax (PTX) occurs more frequently in the neonatal period than in any other period of life. Lung ultrasound (LU) is considered the gold standard for diagnosis and treatment.

Clinical case: We describe the case of a term male newborn who developed a tension pneumothorax (tPTX). A quick echocardiographic assessment for post-processing measurements was performed, demonstrating right ventricular failure and elevation of pulmonary vascular resistances as seen in tension physiology, which resolved quickly after drainage.

Conclusions: The right ventricle easily handles varying amounts of preload, but it rapidly decompensates with an acute rise in afterload. LU cannot differentiate PTX from tPTX; however, echocardiographic assessment can.

Background: osteosarcoma is the most common malignant bone tumor, but it is rare before adolescence. The clinical behavior of the tumor that develops in pre-adolescents may differ from that seen during adolescence.

Method: This is a retrospective study of pre-adolescents with osteosarcoma diagnosed in a tertiary-level hospital. The patients were compared with adolescents diagnosed during the same period.

Results: we analyzed 149 patients (forty-four pre-adolescents). The diagnostic interval median was 7 weeks in pre-adolescents and 12 weeks in adolescents (p = 0.002). Forty-four patients had metastases at diagnosis (ten pre-adolescents) (p = 0.23). Limb-salvage surgery was performed on sixteen patients (two pre-adolescents). Fifty-six patients (thirteen pre-adolescents) abandoned the treatment (p = 0.18). Overall survival was 63 months in pre-adolescents and 52 months in adolescents (p = 0.301).

Conclusion: We only found differences in the diagnostic interval, which was shorter in pre-adolescent patients. Studies with a larger number of pre-adolescents are necessary to determine the differences in the characteristics of the disease in adolescent patients.

Background: Childhood obesity (OB) is a growing global concern, reflected in its increasing prevalence, and is one of the main causes of metabolic syndrome (MS) development. Due to the epidemiological relevance and associated complications of MS, it is necessary to conduct studies that provide local prevalence data. Our objective was to determine the prevalence of MS and the association of its components in a pediatric population with overweight (OW), obesity (OB), and severe OB (SOB).

Method: This was a retrospective study. Data were collected from 122 participants, who were divided into three groups: OW, OB, and SOB. Anthropometry, lipid profile, glycemic control, and blood pressure (BP) were analyzed to assess intergroup differences and odds ratios (OR), along with a bivariate analysis.

Results: The prevalence of MS was 40.1%. Triglycerides, high-density lipoprotein (HDL) cholesterol and BP showed differences between the OW and SOB groups. Fasting insulin, homeostatic model assessment (HOMA) index, systolic BP, and diastolic BP showed differences between the OW versus OB and OW versus SOB groups. Differences in ORs for MS occurrence were observed between OW versus OB (4.3), OW versus SOB (25.71), and OB versus SOB (5.7). There was an association between waist circumference, waist-to-height ratio, triglycerides, HDL cholesterol, systolic BP, fasting insulin, and HOMA index with the development of MS.

Conclusion: The results of this study reveal that, locally, MS is characterized by significant differences in metabolic and anthropometric variables depending on the degree of excess weight. In addition, relevant associations were identified between specific MS components and OB severity, reinforcing the need for early diagnostic and preventive strategies in this population.

Background: Multiple early childhood development (ECD) screening instruments have been developed in Latin America.

Objective: The objective of this study was to describe ECD screening tests for children under 4 years of age constructed in Latin American countries in the context of healthcare, currently in use.

Methods: A systematic review of literature published until April 2024 was conducted to identify screening tests constructed in Latin America. The search for each test was expanded, and individual records were completed. Authors of the instruments and/or their validations were identified and contacted to corroborate the information. An ECD screening test was defined as one that assesses at least three different domains. Only tests used in the healthcare system were included in the study. Those without publications and/or accessible information were excluded from the study.

Results: Twenty-one tests constructed in nine countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Peru, and Uruguay) were included, many used in different countries of the region. Seven were constructed and/or validated in the past 5 years. They predominantly consist of direct assessment or questions to primary caregivers. Four were validated for online use, and one for virtual use. In the validation, most combined different psychometric analyses, with heterogeneity in methodology and reference patterns. Median summary sensitivity was 0.67 (95% confidence interval [CI] 0.34-1.0), and specificity was 0.71 (95% CI 0.42-1.0).

Conclusions: The ECD screening tests developed in Latin America show thorough validation and ongoing updates, though they exhibit some variability. Direct assessment using paper predominates. The consistency of the instruments, when used in different countries and populations, stands out.

Background: A major dengue epidemic affected Peru in 2023, with more than 246,614 cases with 419 deaths and an approximate of 8,312 pregnant women affected, with risk of transmitting the virus to the fetus.

Clinical case: The case of an 11-day-old newborn is reported, whose mother started dengue fever one day before delivery, who was admitted to the emergency room with a diagnosis of sepsis (fever, jaundice, alteration of sensorium) and a history of cesarean delivery due to acute fetal distress. RT-PCR for dengue serotype 2 was identified in both the mother and neonate, suspending antibiotics and starting controlled hydration therapy, with favorable evolution that allowed the 7 to be discharged from hospitalization.

Conclusions: Congenital dengue should be suspected in any neonate whose mother presents dengue up to 10 days before delivery and who presents a clinical picture of sepsis, and we must monitor the neonate until the 12th day of life.

Introducción: Dentro del estudio etiológico de una hipertransaminasemia en pediatría es posible hallar etiologías de hepatitis infrecuentes, pero si después de completar el diagnóstico diferencial no se encuentra otra posible causa debe asumirse el diagnóstico de dichas afecciones inusuales. Solo en un 7% de los casos Mycoplasma pneumoniae puede afectar al hígado y es excepcional encontrar valores de transaminasas por encima de 500 UI/l.

Caso clínico: Paciente de 5 años con hipertransaminasemia (ALT 723 UI/l, AST 426 UI/l) en contexto de clínica de palidez, astenia y epigastralgia. Antecedentes familiares de enfermedades autoinmunitarias y ligera hipertransaminasemia en analítica de 1 año antes. En el estudio etiológico, serología positiva para M. pneumoniae con estudio de autoinmunidad negativo y ecografía normal. Se diagnostica hepatitis por Mycoplasma y se inicia tratamiento con azitromicina. En la evolución, desaparición de la clínica en los primeros días y descenso paulatino de las transaminasas en los meses posteriores.

Conclusiones: Dada la alta carga de enfermedades autoinmunitarias en los antecedentes familiares, se debe excluir una hepatitis autoinmunitaria. La afectación hepática por M. pneumoniae es poco frecuente y sucede por un mecanismo inmunomediado. Se trata de una afectación benigna y autolimitada, siendo excepcionales unas cifras de transaminasas tan elevadas como en este paciente.

Background: In the etiological study of hypertransaminasemia in pediatrics, we may diagnosis entities little related to hepatitis. After completing the differential diagnosis, if we did not found other possible etiology, we must assume the diagnosis of unusual entities. The incidence of hepatitis in Mycoplasma pneumonia infections is about 7%, being unusual transaminases levels higher than 500 IU/l.

Case report: A 5-year-old patient with hypertransaminasemia (ALT 723 IU/l, AST 426 IU/l) in the context of pallor, asthenia and epigastralgia. The complementary tests showed positive serology for M. pneumoniae with autoimmune and abdominal ultrasound without abnormalities. Acute hepatitis caused by Mycoplasma was the diagnosis. A course of oral azithromycin was received with disappearance of symptoms in the first days, and transaminases levels had a gradual decrease in the following months.

Conclusions: Due to the prominent burden of autoimmune diseases in the family history, autoimmune hepatitis should be excluded. Hepatic involvement by M. pneumoniae is rare, being caused by immuno-mediated phenomenon. Transaminase values as high as that obtained in this patient was exceptional.