Anales de pediatria最新文献

英文中文

Clinical response to therapeutic plasma exchange in patients with immune-mediated inflammatory diseases of the central nervous system 免疫介导的中枢神经系统炎症性疾病患者血浆置换治疗的临床反应

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-02-16 DOI: 10.1016/j.anpede.2026.504087

Andrés Rodríguez Galeano , Erika Ruge Joya , Diana Bravo Guerra , Juan Roa Giraldo

Introduction

Inflammatory immune-mediated diseases of the central nervous system, such as autoimmune encephalitis, acute disseminated encephalomyelitis or Guillain-Barré syndrome, pose diagnostic and therapeutic challenges in the pediatric population. Therapeutic plasma exchange has emerged as a useful option in these cases. This study evaluated the clinical response to therapeutic plasma exchange in children with these conditions.

Methods

We conducted a retrospective cohort study at Fundación Hospital Pediátrico La Misericordia in Bogotá (2018–2022), including 50 patients with a confirmed diagnosis of antibody-mediated inflammatory disease of the central nervous system who were managed with therapeutic plasma exchange. We collected data on clinical, therapeutic and outcome variables and performed descriptive, survival, and Cox regression analyses.

Results

The mean age was 10 years, with a uniform sex distribution. The most frequent conditions were autoimmune encephalitis (36%) and acute disseminated encephalomyelitis (14%). At discharge, 56% of patients had persistent neurologic symptoms and 46% had recovered their prior functional status. The mortality was 6%. The use of antiepileptic drugs was significantly associated with a lower risk of relapse (hazard ratio, 0.081; P = .024) and steroid use with increased survival, particularly in patients with autoimmune encephalitis, acute disseminated encephalomyelitis and myasthenia gravis (P < .05).

Conclusion

Therapeutic plasma exchange is a viable and safe treatment strategy for children with immune-mediated inflammatory diseases of the central nervous system. The concomitant use of antiepileptic drugs and steroids showed benefits in reducing relapse and mortality.

中枢神经系统炎症性免疫介导疾病，如自身免疫性脑炎、急性播散性脑脊髓炎或格林-巴罗综合征，对儿科人群的诊断和治疗构成挑战。在这些病例中，治疗性血浆交换已成为一种有用的选择。本研究评估了患有这些疾病的儿童对治疗性血浆置换的临床反应。方法：我们在波哥大Fundación医院Pediátrico进行了一项回顾性队列研究（2018-2022），包括50例确诊为抗体介导的中枢神经系统炎症性疾病的患者，他们接受了治疗性血浆交换。我们收集了临床、治疗和结局变量的数据，并进行了描述性、生存率和Cox回归分析。结果：患者平均年龄10岁，性别分布均匀。最常见的疾病是自身免疫性脑炎（36%）和急性播散性脑脊髓炎（14%）。出院时，56%的患者有持续的神经系统症状，46%的患者恢复了之前的功能状态。死亡率为6%。抗癫痫药物的使用与较低的复发风险显著相关（危险比为0.081;P = 0.024），类固醇的使用与提高生存率显著相关，尤其是自身免疫性脑炎、急性播散性脑脊髓炎和重症肌无力患者（P < 0.05）。结论：治疗性血浆置换是治疗儿童免疫介导性中枢神经系统炎症性疾病的一种安全可行的治疗策略。同时使用抗癫痫药物和类固醇对减少复发和死亡率有好处。

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引用次数: 0

Research and scientific publication in Pediatrics in Spain. The editorial committee’s view 西班牙儿科研究和科学出版物。编辑委员会的观点。

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-02-06 DOI: 10.1016/j.anpede.2026.504126

Montserrat Antón-Gamero , Alejandro Avila-Alvarez , Josep Vicent Balaguer-Martínez , Mercedes Bueno Campaña , Rafael Galera-Martínez

引用次数: 0

Direct view through smart glasses guided vascular cannulation. Is it feasible? Will it be useful? 通过智能眼镜引导血管插管直接观察。这可行吗？它有用吗？

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-02-05 DOI: 10.1016/j.anpede.2026.504104

Carmen Espinosa Pereiro , Rita García Fernández , Miguel A. Rodríguez Vargas , Luis Crego Rodríguez , Antonio Rodríguez Núñez

引用次数: 0

Study of muscle strength using hand-held dynamometry in pediatric patients with obesity 小儿肥胖症患者手持式肌力测定仪的研究。

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-02-10 DOI: 10.1016/j.anpede.2026.504103

Álvaro Martín Rivada , Mercedes Murray Hurtado , Elena Sánchez Camacho , Yolanda Ramallo Fariña

Objective

To evaluate muscle strength based on grip strength in children and adolescents with obesity and comparing it with reference values. To analyse the association with body composition findings obtained by bioelectrical impedance analysis as well as clinical and biochemical variables.

Material and methods

Retrospective observational cohort study in pediatric patients with obesity (6–16 years) followed up in an outpatient clinic in a tertiary care hospital. We collected data on physical activity and anthropometric, biochemical, sonographic, bioimpedance and dynamometry parameters.

Results

The sample included 125 patients (mean age, 12.06 years; 50.4% female; body mass index [BMI] Z-score, 3.87 [SD, 1.46]). Male participants were less severely obese and had a healthier body composition. Prepubertal patients were less physically active and had a higher fat mass (FM) percentage. The prevalence of metabolic comorbidities, such as hyperuricemia and insulin resistance, increased with the degree of obesity. Children with obesity had a mean muscle strength Z-score of +0.71 in the dominant hand, with differences based on sex and stage of pubertal development. We found dynapenia in 4.8%, with a greater prevalence in prepubertal children. Muscle strength was positively correlated to physical activity, fat-free mass and phase angle and negatively correlated to FM percentage. Fat-free mass was the strongest predictor of muscle strength.

Conclusions

In this sample of children with obesity, muscle strength was not decreased compared to the healthy reference population. Fat-free mass is the strongest predictor of muscle strength. The findings highlight the positive influence of physical activity and the amount of lean mass on strength in children and adolescents with obesity.

目的：评价儿童和青少年肥胖患者以握力为指标的肌肉力量，并与参考值进行比较。目的：分析生物电阻抗分析结果与身体成分、临床及生化指标的关系。材料和方法：对某三级医院门诊6-16岁儿童肥胖患者进行回顾性观察队列研究。我们收集了身体活动和人体测量、生化、超声、生物阻抗和动力学参数的数据。结果：共纳入125例患者，平均年龄12.06岁，女性50.4%，身体质量指数（BMI） Z-score 3.87 [SD, 1.46]。男性参与者的肥胖程度较轻，身体成分也更健康。青春期前患者体力活动较少，脂肪质量（FM）百分比较高。代谢合并症的患病率，如高尿酸血症和胰岛素抵抗，随着肥胖程度的增加而增加。肥胖儿童的优势手肌肉力量Z-score平均值为+0.71，存在性别和青春期发育阶段的差异。我们发现动力不足的发生率为4.8%，在青春期前儿童中发病率更高。肌力与体力活动、无脂质量、相位角呈正相关，与FM百分比呈负相关。无脂肪量是肌肉力量的最强预测指标。结论：在这个肥胖儿童样本中，与健康参考人群相比，肌肉力量没有下降。无脂肪量是肌肉力量的最强预测指标。研究结果强调了体育活动和瘦肉量对肥胖儿童和青少年力量的积极影响。

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引用次数: 0

Integrating the best available evidence: A methodological roadmap for the practicing paediatrician 整合最好的现有证据：为执业儿科医生的方法学路线图。

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-02-16 DOI: 10.1016/j.anpede.2026.504129

Paz González Rodríguez , María Aparicio Rodrigo , Josep Vicent Balaguer-Martínez

引用次数: 0

Consensus document on the treatment of insomnia in patients with autism spectrum disorder under 18 years of age 18岁以下自闭症谱系障碍患者失眠治疗的共识文件。

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-02-16 DOI: 10.1016/j.anpede.2026.504064

Gonzalo Pin Arboledas , Milagros Merino Andreu , Pedro Javier Rodríguez Hernández , Marta Furones García , Lucia Monfort Belenguer , Teresa de la Calle Cabrera , Guillermo Benito Ruiz , Óscar Sans Capdevila , Carlos Javier Egea Santaolalla

Introduction and objectives

The prevalence of sleep problems in people with ASD is high, affecting their quality of life and social skills. To date, there is no guideline for the treatment of insomnia in people with ASD at the national level in Spain or the European level. With the aim to guide the comprehensive management of insomnia, this consensus document was created under the leadership of the Spanish Association of Pediatrics (AEP) and the Spanish Sleep Society (SES).

Methods

Modified and adapted Delphi process.

Results and conclusions

The document describes diagnostic tools for use before treatment initiation and provides recommendations for comprehensive management. The treatment of insomnia begins with sleep hygiene measures and personalized cognitive-behavioral therapies. In maintenance insomnia, if these are not sufficient, pediatric prolonged-release melatonin (PedPRM) is recommended as the first-line drug, starting with a dose of 2 mg/day and adjusting it to up to 10 mg/day as needed. If the problems persist, alimemazine, risperidone or clonidine can be added, in that order, in a stepwise fashion. For early insomnia, immediate-release melatonin (IRM) is recommended, starting with a dose of 5 mg/day and reducing it to up to 2 mg/day if it is effective or increasing it to up to 7 mg/day otherwise, or else PedPRM. The dosage should be reevaluated periodically in regular follow-up visits using sleep diaries.

简介和目的：ASD患者的睡眠问题患病率很高，影响了他们的生活质量和社交技能。迄今为止，在西班牙或欧洲，还没有针对ASD患者失眠的治疗指南。为了指导失眠的全面管理，这份共识文件是在西班牙儿科协会（AEP）和西班牙睡眠协会（SES）的领导下创建的。方法：对德尔菲法进行改进和改编。结果和结论：该文件描述了治疗开始前使用的诊断工具，并提供了综合管理的建议。失眠的治疗从睡眠卫生措施和个性化的认知行为疗法开始。对于维护性失眠，如果这些还不够，建议将儿童缓释褪黑激素（PedPRM）作为一线药物，开始剂量为2mg/天，并根据需要调整至10mg/天。如果问题仍然存在，可以按顺序逐步添加alimemazine，利培酮或可乐定。对于早期失眠，建议立即释放褪黑激素（IRM），从5mg/天开始，如果有效，将其减少到2mg/天，否则增加到7mg/天，或者PedPRM。在定期随访中，应使用睡眠日记重新评估剂量。

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引用次数: 0

Neurodegeneration in Langerhans Cell Histiocytosis: beyond a Sequela 朗格汉斯细胞组织细胞增多症的神经退行性变：超出后遗症。

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-02-05 DOI: 10.1016/j.anpede.2026.504058

Vicente Santa-María López , Ignacio Gutiérrez-Carrasco , Antonio Pérez-Martínez , Carmen Rodríguez-Vigil Iturrate , Susana García-Obregón , Mikael Lorite Reggiori , Thais Murciano Carrillo , Lorena Valero-Arrese , Montse Torrent , Itziar Astigarraga , en representación del Grupo de Histiocitosis de la Sociedad Española de Hematología y Oncología Pediátricas (SEHOP)

Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasm with heterogeneous organ and system involvement. Neurodegenerative LCH (ND-LDH) is an uncommon late manifestation with progressive clinical and radiological features, substantial morbidity and an unpredictable course. Historically it was considered a paraneoplastic sequela for which treatment was largely ineffective. Multisystemic disease, central diabetes and orbital and/or skull base bone lesions are risk factors associated with the development of ND-LCH. Early diagnosis, guided by clinical, radiological, electrophysiological and neurocognitive evaluations, may enable timely treatment to halt or slow its progression. Recent identification of activating mutations in the mitogen-activated protein kinase (MAPK) pathway and the development of murine models have redefined ND-LCH as an active neuroinflammatory and neurodegenerative form of LCH, changing our understanding of its etiopathogenesis and identifying novel risk factors and targets for therapy.

朗格汉斯细胞组织细胞增生症（LCH）是一种罕见的炎性髓系肿瘤，累及多器官和系统。神经退行性LCH （ND-LDH）是一种罕见的晚期表现，具有进行性临床和放射学特征，发病率高，病程不可预测。从历史上看，它被认为是一种治疗基本上无效的副肿瘤后遗症。多系统疾病、中枢性糖尿病、眼眶和/或颅底骨病变是ND-LCH发生的危险因素。在临床、放射学、电生理和神经认知评估的指导下进行早期诊断，可以及时治疗，阻止或减缓其进展。最近发现的丝裂原活化蛋白激酶（MAPK）通路的激活突变和小鼠模型的发展将ND-LCH重新定义为LCH的活动性神经炎症和神经退行性形式，改变了我们对其发病机制的理解，并确定了新的危险因素和治疗靶点。

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引用次数: 0

One artery, two circulations: diagnostic challenges of anomalous origin of unilateral pulmonary artery from the ascending aorta in neonates 一条动脉，两条循环：新生儿升主动脉单侧肺动脉异常起源的诊断挑战。

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2025-12-30 DOI: 10.1016/j.anpede.2025.504109

Laia Brunet-Garcia , Flavio Zuccarino , Juan Manuel Carretero Bellon

引用次数: 0

Lower limb muscle herniation in an adolescent 青少年下肢肌肉突出症。

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-01-30 DOI: 10.1016/j.anpede.2026.504062

Lidia Jiménez García, Javier Vicente Hernández, Jorge Andrés López-Torrijos Florez, Gabriela Valentina Cattabriga León

引用次数: 0

Adverse events after COVID-19 vaccination in the pediatric population in Spain 西班牙儿童COVID-19疫苗接种后的不良事件

Anales de pediatria

Pub Date : 2026-02-01 Epub Date: 2026-02-07 DOI: 10.1016/j.anpede.2026.504088

M. Ángeles Rivas Paterna , Carla Pérez Ingidua , Ana B. Rivas Paterna , David Ortega Martínez , Esther Aleo Luján , Emilio Vargas Castrillón

Introduction

In December 2021, Spain launched its COVID-19 vaccination campaign for children aged 5–11 years. Although the Comirnaty® vaccine exhibited a favorable safety profile in premarketing trials, its rapid deployment and novel mRNA technology raised concerns among the public, leading to parental hesitancy. Real-world postmarketing data are limited but crucial for guiding clinical and public health policy decisions.

Objective

To assess the incidence and nature of adverse drug reactions (ADRs) following pediatric COVID-19 vaccination.

Methods

Prospective, observational and descriptive study cconducted at a tertiary care hospital in Spain. The sample consisted of a total of 2126 children aged 5–11 years. Data on ADRs were collected through telephone interviews, health record reviews and institutional registries. An expert committee evaluated each ADR using predefined criteria for causality and severity.

Results

Overall, 35.6% of participants reported at least one ADR, totaling 1437 reactions. Most were mild (99.5%) and resolved spontaneously. Only one case was classified as severe. The most common ADRs were injection site pain (57.1%), fever (11.1%) and headache (5.7%). There was no evidence of increased reactogenicity after the second dose. Of all ADRs, 65.1% were considered «definite» or «probable.»

Conclusions

The Comirnaty® vaccine maintains a favorable safety profile in children under real-world conditions, with predominantly mild, self-limiting reactions and minimal need for medical care.

2021年12月，西班牙启动了针对5-11岁儿童的COVID-19疫苗接种运动。尽管Comirnaty®疫苗在上市前试验中显示出良好的安全性，但其快速部署和新型mRNA技术引起了公众的担忧，导致家长犹豫不决。真实的上市后数据有限，但对指导临床和公共卫生政策决策至关重要。目的：了解小儿COVID-19疫苗接种后药物不良反应（adr）的发生率和性质。方法：在西班牙一家三级医院进行前瞻性、观察性和描述性研究。样本包括2126名5-11岁的儿童。通过电话访谈、健康记录审查和机构登记收集有关不良反应的数据。专家委员会使用预先确定的因果关系和严重程度标准对每个ADR进行评估。结果：总体而言，35.6%的参与者报告了至少一个不良反应，总计1437个反应。大多数为轻度（99.5%），自行消退。只有一例被列为严重病例。最常见的不良反应是注射部位疼痛（57.1%）、发热（11.1%）和头痛（5.7%）。没有证据表明第二次注射后反应性增加。在所有不良反应中，65.1%被认为是“确定的”或“可能的”。»结论：Comirnaty®疫苗在现实条件下的儿童中保持良好的安全性，主要是轻微的、自限性的反应，并且对医疗护理的需求最小。

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