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Tras la vorágine que han supuesto los momentos más agudos de la pandemia por SARS-CoV-2, de momento parece que superados, y la espera de los temidos rebrotes dentro de esta "nueva normalidad", la Dra. Mellado, presidenta de la AEP, realiza en esta carta abierta enviada a todos los socios una serie de reflexiones sobre el impacto de dicha pandemia a distintos niveles.
Las situaciones vividas en los pasados meses han puesto a prueba a nuestro sistema sanitario, a los profesionales que trabajamos en él, a los educadores y al as familias. Todos ellos hemos tenido que adaptarnos y aprender cómo manejar esta terrible epidemia. Así mismo, las asociaciones científicas han hecho un esfuerzo enorme para poder servir de guía actualizada y coordinada ante las nuevas evidencias que han ido surgiendo sobre esta nueva enfermedad, desconocida hace apenas 6 meses.
En la carta abierta enviada a los socios, que puedes descargar a continuación, la Dra. Mellado reflexiona sobre estas y...
Nuevas fechas para el European Board of Pediatric Examination: apúntate hasta el 1 de septiembre de 2020.
Después de que el examen de que la convocatoria del primer examen de la Europena Academy of Paedairics (EAP), que iba a tener lugar en Barcelona durante su congreso anual, se suspendiera a causa de la pandemia, por fín se han publicado los detalles de la nueva convocatoria.
Finalmente, se celebrará online el día 16 de octubre de 2020. La nueva fecha límite para apuntarse es el 1 de septiembre de 2020.
Este examen, poco conocido entre los pediatras en formación en España, pretende servir de medida de conocimiento de los aspectos nucleares de la formación en Pediatría. Está abierto a todos los pediatras en formación, tanto en Europa como en...
Los pediatras de Atención Primaria ofrecen una serie de consejos básicos para que las familias puedan disfrutar las vacaciones con seguridad en situación de pandemia
Plan de mejora de la atención neuropediátrica ante posibles rebrotes de la pandemia por SARS-CoV-2 de la Asociación de Neuropediatría de Madrid y Zona Centro
La actual situación de alerta sanitaria por el SARS-Cov2 ha producido un cambio muy importante en la asistencia de nuestros pacientes pediátricos, priorizando la atención de aquellos pacientes con sospecha de enfermedad por coronavirus (Covid19), dejando de lado la asistencia a pacientes con otras enfermedades no relacionadas con la pandemia. En la Asociación de Neuropediatría de Madrid y Zona Centro hemos analizado, mediante reuniones zoom de toda la junta de NPM y de neuropediatras representantes de todos los hospitales terciarios de Madrid, la repercusión que esta situación ha tenido en nuestros niños con enfermedades neurológicas, y hemos elaborado un PLAN DE MEJORA DE LA ATENCIÓN NEUROPEDIÁTRICA ANTE POSIBLES REBROTES DE LA PANDEMIA POR SARS-COV2.
Somos conscientes de lo difícil que ha sido organizar la asistencia sanitaria en esta situación de pandemia. Tras analizar lo...
En los datos recientemente publicado sobre el Factor Impacto (Journal Citation Reports; Clarivate Analytics) correspondiente al año 2019, Anales de Pediatría ha obtenido 1,313 con un incremento significativo respecto al año previo. El factor impacto de 5 años fue de 1,266, el más alto alcanzado, confirmando la progresión favorable de la revista durante los últimos años. En las figuras siguientes detallamos esta evolución.
Desde el Comité Editorial aprovechamos la publicación de estos datos para agradecer a la Junta Directiva de la Asociación Española de Pediatría su apoyo a la revista, así como a los autores y revisores por el trabajo que realizan.
Editor jefe de Anales de Pediatría
Children and adolescents who become involved with the justice system often do so with complex medical, mental health, developmental, social, and legal needs. Most have been exposed to childhood trauma or adversity, which both contribute to their involvement with the justice system and negatively impact their health and well-being. Whether youth are held in confinement or in their home communities, pediatricians play a critical role in promoting the health and well-being of justice-involved youth. Having a working knowledge of the juvenile justice system and common issues facing justice-involved youth may help pediatricians enhance their clinical care and advocacy efforts. This policy statement is a revision of the 2011 policy "Health Care for Youth in the Juvenile Justice System." It provides an overview of the juvenile justice system, describes racial bias and overrepresentation of youth of color in the justice system, reviews the health and mental health status of justice-involved youth, and identifies advocacy opportunities for juvenile justice reform.
Clinical documentation has dramatically changed since the implementation and use of electronic health records and electronic provider documentation. The purpose of this report is to review these changes and promote the development of standards and best practices for electronic documentation for pediatric patients. In this report, we evaluate the unique aspects of clinical documentation for pediatric care, including specialized information needs and stakeholders specific to the care of children. Additionally, we explore new models of documentation, such as shared documentation, in which patients may be both authors and consumers, and among care teams while still maintaining the ability to clearly define care and services provided to patients in a given day or encounter. Finally, we describe alternative documentation techniques and newer technologies that could improve provider efficiency and the reuse of clinical data.
Management decisions for patients with gastroenteritis affect resource use within pediatric emergency departments (EDs), and algorithmic care using evidence-based guidelines (EBGs) has become widespread. We aimed to determine if the implementation of a dehydration EBG in a pediatric ED resulted in a reduction in intravenous (IV) fluid administration and the cost of care.METHODS:
In a single-center quality improvement initiative between 2010 and 2016, investigators aimed to decrease the percentage of patients with gastroenteritis who were rehydrated with IV fluids. The EBG assigned the patient a dehydration score with subsequent rehydration strategy on the basis of presenting signs and symptoms. The primary outcome was proportion of patients receiving IV fluid, which was analyzed using statistical process control methods. The secondary outcome was cost of the episode of care. Balancing measures included ED length of stay, admission rate, and return visit rate within 72 hours.RESULTS:
A total of 7145 patients met inclusion criteria with a median age of 17 months. Use of IV fluid decreased from a mean of 15% to 9% postimplementation. Average episode of care–related health care costs decreased from $599 to $410. For our balancing measures, there were improvements in ED length of stay, rate of admission, and rate of return visits.CONCLUSIONS:
Implementation of an EBG for patients with gastroenteritis led to a decrease in frequency of IV administration, shorter lengths of stay, and lower health care costs.
Seven years after its addition to the US Recommended Uniform Screening Panel, newborn screening for critical congenital heart disease (CCHD) using pulse oximetry became mandatory in the United States. Although CCHD newborn screening reduces morbidity and mortality, there remain important opportunities to improve. An expert panel convened for a 1-day meeting in September 2018, including subject matter experts and representatives from stakeholder organizations. Presentations on CCHD outcomes, variations in approach to screening, and data and quality improvement helped identify improvement opportunities. The expert panel concluded that sufficient evidence exists to recommend modifying the current American Academy of Pediatrics algorithm by (1) requiring an oxygen saturation of at least 95% in both (formerly either) the upper and lower extremities to pass and (2) requiring only 1 repeat screen instead of 2 for cases that neither pass nor fail initially. The panel underscored the importance of improving public health reporting by further specifying the targets of screening and criteria for reporting outcomes (false-negative and false-positive cases). The panel also highlighted the need to ensure sufficient public health funding for CCHD newborn screening and opportunities for education and global implementation. Newborn screening for CCHD using pulse oximetry has led to significant improvements in child health outcomes. However, further important work is required to understand and improve the effectiveness and efficiency of screening.
To evaluate parent-child agreement on postconcussion symptom severity within 48 hours of injury and examine the comparative predictive power of a clinical prediction rule when using parent or child symptom reporting.METHODS:
Both patients and parents quantified preinjury and current symptoms using the Postconcussion Symptom Inventory (PCSI) in the pediatric emergency department. Two-way mixed, absolute measure intraclass correlation coefficients were calculated to evaluate the agreement between patient and parent reports. A multiple logistic regression was run with 9 items to determine the predictive power of the Predicting and Preventing Postconcussive Problems in Pediatrics clinical prediction rule when using the child-reported PCSI. Delong’s receiver operating characteristic curve analysis was used to compare the area under the curve (AUC) for the child-report models versus previously published parent-report models.RESULTS:
Overall parent-child agreement for the total PCSI score was fair (intraclass correlation coefficient = 0.66). Parent-child agreement was greater for (1) postinjury (versus preinjury) ratings, (2) physical (versus emotional) symptoms, and (3) older (versus younger) children. Applying the clinical prediction rule by using the child-reported PCSI maintained similar predictive power to parent-reported PCSI (child AUC = 0.70 [95% confidence interval: 0.67–0.72]; parent AUC = 0.71 [95% confidence interval: 0.68–0.74]; P = .23).CONCLUSIONS:
Overall parent-child agreement on postconcussion symptoms is fair but varies according to several factors. The findings for physical symptoms and the clinical prediction rule have high agreement; information in these domains are likely to be similar regardless of whether they are provided by either the parent or child. Younger children and emotional symptoms show poorer agreement; interviewing both the child and the parent would provide more comprehensive information in these instances.
An 8-year-old boy with no significant past medical history presented to his pediatrician with 5 days of fever, diffuse abdominal pain, and pallor. The pediatrician referred the patient to the emergency department (ED), out of concern for possible malignancy. Initial vital signs indicated fever, tachypnea, and tachycardia. Physical examination was significant for marked abdominal distension, hepatosplenomegaly, and abdominal tenderness in the right upper and lower quadrants. Initial laboratory studies were notable for pancytopenia as well as an elevated erythrocyte sedimentation rate and C-reactive protein. Computed tomography (CT) of the abdomen and pelvis showed massive splenomegaly. The only significant history of travel was immigration from Albania 10 months before admission. The patient was admitted to a tertiary care children’s hospital and was evaluated by hematology–oncology, infectious disease, genetics, and rheumatology subspecialty teams. Our multidisciplinary panel of experts will discuss the evaluation of pancytopenia with apparent multiorgan involvement and the diagnosis and appropriate management of a rare disease.
To estimate the risk of neonatal outcomes from patterns of prenatal antidepressant use.METHODS:
From the OptumLabs Data Warehouse, 226 932 singleton deliveries were identified. Antidepressant claims with coverage between the last menstrual period and 35 weeks’ gestation were converted to fluoxetine equivalents, and a longitudinal cluster analysis was performed. Outcomes included major cardiac malformations (11.7 of 1000 births), preterm birth (75.7 of 1000 births), and newborn respiratory distress (54.2 of 1000 births). The lowest trajectory was the primary reference group, and depression and anxiety with no antidepressant claims served as secondary reference groups.RESULTS:
From 15 041 (6.6%) pregnancies exposed to an antidepressant, use patterns were best described as (1) low use (~10 mg/day) with first-trimester reduction, (2) low sustained use (~20 mg/day), (3) moderate use (~40 mg/day) with first-trimester reduction, (4) moderate sustained use (~40 mg/day), and (5) high sustained use (~75 mg/day). Moderate sustained use increased the risk of major cardiac malformations, although results included the null when compared with depression or anxiety reference groups. Moderate sustained (adjusted risk ratio [RR] 1.31; 95% confidence interval [CI] 1.16–1.49) and high sustained (adjusted RR 1.78; 95% CI 1.48–2.14) trajectories were associated with an increased risk of preterm birth. All 4 trajectories increased the risk of neonatal respiratory distress in a dose-response fashion (adjusted RRs 1.36 [95% CI 1.20–1.50] to 2.23 [95% CI 1.83–2.77]).CONCLUSIONS:
Although findings support continuation of the lowest effective dose to treat depression or anxiety, which benefits the mother, they also highlight an increased risk for newborn respiratory distress in all groups and preterm birth at moderate to high sustained doses.
Flecainide acetate is a Vaughan-Williams class IC antiarrhythmic drug prescribed for the treatment of supraventricular arrhythmias. It has a narrow therapeutic index and proarrhythmic effects even at therapeutic doses. Flecainide is metabolized by a CYP2D6 enzyme that exhibits polymorphism. In this case report, we present, to our best knowledge, the first case of toxicity contributed by genetic polymorphism in an infant. Our patient with recurrent supraventricular tachycardia was treated with a therapeutic dose of flecainide but developed heart block requiring extracorporeal membrane oxygenation support and subsequent treatment with lipid emulsion therapy. He was found to have supratherapeutic serum flecainide concentration, and gene testing revealed the patient to be an intermediate metabolizer. With this case report, we reinforce the importance of evaluating the CYP2D6 genotype before drug initiation in the neonatal population and recommend regular monitoring of serum flecainide levels and electrocardiograms in these patients.
Estimates of children and adolescents with disabilities worldwide are needed to inform global intervention under the disability-inclusive provisions of the Sustainable Development Goals. We sought to update the most widely reported estimate of 93 million children <15 years with disabilities from the Global Burden of Disease Study 2004.METHODS:
We analyzed Global Burden of Disease Study 2017 data on the prevalence of childhood epilepsy, intellectual disability, and vision or hearing loss and on years lived with disability (YLD) derived from systematic reviews, health surveys, hospital and claims databases, cohort studies, and disease-specific registries. Point estimates of the prevalence and YLD and the 95% uncertainty intervals (UIs) around the estimates were assessed.RESULTS:
Globally, 291.2 million (11.2%) of the 2.6 billion children and adolescents (95% UI: 249.9–335.4 million) were estimated to have 1 of the 4 specified disabilities in 2017. The prevalence of these disabilities increased with age from 6.1% among children aged <1 year to 13.9% among adolescents aged 15 to 19 years. A total of 275.2 million (94.5%) lived in low- and middle-income countries, predominantly in South Asia and sub-Saharan Africa. The top 10 countries accounted for 62.3% of all children and adolescents with disabilities. These disabilities accounted for 28.9 million YLD or 19.9% of the overall 145.3 million (95% UI: 106.9–189.7) YLD from all causes among children and adolescents.CONCLUSIONS:
The number of children and adolescents with these 4 disabilities is far higher than the 2004 estimate, increases from infancy to adolescence, and accounts for a substantial proportion of all-cause YLD.
To evaluate the effectiveness of a stepped-wedge randomized trial of Development of Systems and Education for Human Papillomavirus Vaccination (DOSE HPV), a multilevel intervention.METHODS:
DOSE HPV is a 7-session program that includes interprofessional provider education, communication training, data feedback, and tailored systems change. Five primary care pediatric and/or family medicine practices completed interventions between 2016 and 2018; all chose to initiate vaccination at ages 9 to 10. We compared vaccination rates in the preintervention, intervention, and postintervention periods among 9- to 17-year-olds using random-effects generalized linear regression models appropriate for stepped-wedge design, accounting for calendar time and clustering of patients by providers and clinic. Outcomes included (1) the likelihood that eligible patients would receive vaccination during clinic visits; (2) the likelihood that adolescents would complete the series by age 13; and (3) the cumulative effect on population-level vaccine initiation and completion rates. Postintervention periods ranged from 6 to 18 months.RESULTS:
In the intervention and postintervention periods, the adjusted likelihood of vaccination at an eligible visit increased by >10 percentage points for ages 9 to 10 and 11 to 12, and completion of the vaccine series by age 13 increased by 4 percentage points (P < .001 for all comparisons). Population-level vaccine initiation coverage increased from 75% (preintervention) to 84% (intervention) to 90% (postintervention), and completion increased from 60% (preintervention) to 63% (intervention) to 69% (postintervention).CONCLUSIONS:
Multilevel interventions that include provider education, data feedback, tailored systems changes, and early initiation of the human papillomavirus vaccine series may improve vaccine series initiation and completion beyond the conclusion of the intervention period.