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Balance de la consulta por correo electrónico en la pandemia COVID-19 [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
Guillermo Peña Blasco, María Lucía Bartolomé Lalanza, María Jesús Blasco Pérez-Aramendía
An Pediatr (Barc). 2021;95:377-8

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Efecto del confinamiento sobre los nacimientos pretérmino en la Comunidad Valenciana [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
Agustín Molina-Merino, Laura Martínez-Rodríguez, Elena Cubells-García, Verónica Hortelano-Platero, Javier Estañ-Capell
An Pediatr (Barc). 2021;95:379-81

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Pandemia COVID-19. ¿Qué hemos aprendido en este tiempo? [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
Cristina Calvo, Alfredo Tagarro, Ana Méndez Echevarría, Belén Fernández Colomer, María Rosa Albañil Ballesteros, Quique Bassat, Maria José Mellado Peña
An Pediatr (Barc). 2021;95:382.e1-382.e8

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Manejo de la infección por Helicobacter pylori en la edad pediátrica [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
Gonzalo Galicia Poblet, Teresa Alarcón Cavero, Natalia Alonso Pérez, Belén Borrell Martínez, Gonzalo Botija Arcos, Maria Luz Cilleruelo Pascual, Leticia María González Martín, Anselmo Hernández Hernández, Beatriz Martínez Escribano, Xenia Ortola Castells, Jana Rizo Pascual, Pedro Urruzuno Tellería, Ana María Vegas Álvarez
An Pediatr (Barc). 2021;95:383.e1-383.e9

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Trastornos KAT6B: enterrando los síndromes Say-Barber-Biesecker-Young-Simpson y genitopatelar [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
María José Peláez Cantero, Julia Ferrero Turrión, Sara Franco Freire, Aurora Madrid Rodriguez
An Pediatr (Barc). 2021;95:384-6

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Lupus eritematoso neonatal: sospecharlo, para diagnosticarlo [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
Alejandra Méndez Sánchez, Estíbaliz Garrido García, Jonás García Fernández, Agustina Alonso Álvarez
An Pediatr (Barc). 2021;95:387-8

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Luxación congénita de rodilla [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
Ana Elisa Laso Alonso, María Fernández Miaja, Miguel Castro Torre, Agripino Menéndez González
An Pediatr (Barc). 2021;95:389-90

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Infección urinaria febril en el niño con patología nefrourológica [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
Nerea Chamorro Sanz, Paloma Ferreiro-Mazón García-Plata, Laura García Espinosa, José Antonio Ruíz Domínguez, Miguel Ángel Molina Gutiérrez
An Pediatr (Barc). 2021;95:391-2

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Boletín de la Sociedad de Pediatría de Aragón, La Rioja y Soria [Gratuito]

Anales Españoles de Pediatría - Jue, 04/11/2021 - 02:23
Antonio de Arriba-Muñoz, María Gloria Bueno-Lozano
An Pediatr (Barc). 2021;95:393

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Contaminación medioambiental ¿Cómo influye en el asma? AEPaprendemos 2021 (03)

AEPAP - Mié, 03/11/2021 - 11:38

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El Foro de Médicos de Atención Primaria actualiza su decálogo de objetivos

AEPAP - Mié, 03/11/2021 - 11:31
Fuente:  Foro de Médicos de Atención Primaria Fecha de publicación:  3 de Noviembre de 2021 Archivos adjuntos:  Nota de prensa Compartir en...

El diagnóstico de COVID-19 durante el embarazo se asocia a una mayor morbilidad neonatal y morbimortalidad materna

Cuestas Montañés E, Albi Rodríguez MS. El diagnóstico de COVID-19 durante el embarazo se asocia a una mayor morbilidad neonatal y morbimortalidad materna. Evid Pediatr. 2021;17:41.

Los recién nacidos de bajo peso con cuidados inmediatos de madre canguro, tienen menor mortalidad el primer mes de vida

Aizpurua Galdeano MP, Fernández Rodríguez MM. Título Los recién nacidos de bajo peso con cuidados inmediatos de madre canguro, tienen menor mortalidad el primer mes de vida. Evid Pediatr. 2021;17:42.

Interconception Care and Safe Sleep: Adapting the IMPLICIT Toolkit for Pediatrics

Pediatrics - Lun, 01/11/2021 - 09:01
BACKGROUND

A woman’s health in the interconception period has an impact on birth outcomes. Pediatric visits offer a unique opportunity to provide interconception care (ICC). Our aim was to screen and provide interconception and safe sleep screening, counseling, and interventions for 50% of caregivers of children <2 years of age in a pediatric medical setting.

METHODS

Two pediatric clinics implemented the March of Dimes’ Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques (IMPLICIT) toolkit, in addition to standardized safe sleep assessments. A quality improvement learning collaborative was formed with a local "infant mortality champion" leading quality improvement efforts. Monthly webinars with the clinic teams reviewed project successes and challenges. Framework for Reporting Adaptations and Modifications was used to document adaptations.

RESULTS

For each individual IMPLICIT domain, clinics screened and provided needed interventions for ICC and safe sleep in >50% of eligible encounters. Over the course of the quality improvement learning collaborative, the number of caregivers screened for at least 4 of the 5 IMPLICIT domains increased from 0% to 95%.

CONCLUSIONS

To successfully implement the IMPLICIT toolkit in pediatrics, adaptations were made to the existing model, which had previously been used in family medicine clinics. Pediatricians should consider providing ICC as an innovative way to impact infant mortality rates in their community. Framework for Reporting Adaptations and Modifications can be used to systematically describe the adaptations needed to improve the fit of IMPLICIT in the pediatric clinic, understand the process of change and potential application to local context.

An Intervention to Improve Chlamydia and Gonorrhea Testing Among Adolescents in Primary Care

Pediatrics - Lun, 01/11/2021 - 09:01
BACKGROUND AND OBJECTIVES

Rates of chlamydia and gonorrhea among adolescents continue to rise. We aimed to evaluate if a universal testing program for chlamydia and gonorrhea improved testing rates in an urban general pediatric clinic and an urban family medicine clinic within a system of federally qualified health care centers and evaluated the feasibility, cost, and logistic challenges of expanding implementation across 28 primary care clinics within a federally qualified health care centers system.

METHODS

A universal testing quality improvement program for male and female patient 14 to 18 years old was implemented in a general pediatrics and family medicine clinic in Denver, Colorado. The intervention was evaluated by using a controlled pre-post quasi-experimental design. The difference in testing rates due to the intervention was assessed by using a difference-in-differences regression model weighted with the inverse probability of treatment.

RESULTS

In total, 15 541 pediatric encounters and 5420 family medicine encounters were included in the analyses. In pediatrics, the unadjusted testing rates increased from 32.0% to 66.7% in the intervention group and from 20.9% to 28.9% in the comparison group. For family medicine, the rates increased from 38.5% to 49.9% in the intervention group and decreased from 26.3% to 24.8% in the comparison group. The intervention resulted in an adjusted increase in screening rates of 25.2% (P < .01) in pediatrics and 11.8% (P < .01) in family medicine. The intervention was well received and cost neutral to the clinic.

CONCLUSIONS

Universal testing for chlamydia and gonorrhea in primary care pediatrics and family medicine is a feasible approach to improving testing rates .

Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial

Pediatrics - Lun, 01/11/2021 - 09:01
OBJECTIVES

With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT).

METHODS

CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures.

RESULTS

Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O’Brien’s rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment).

CONCLUSIONS

CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.

Corticosteroids in the Treatment of Pediatric Retropharyngeal and Parapharyngeal Abscesses

Pediatrics - Lun, 01/11/2021 - 09:01
BACKGROUND AND OBJECTIVES

Treatment of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) includes antibiotics, with possible surgical drainage. Although corticosteroids may decrease inflammation, their role in the management of RPAs and PPAs is unclear. We evaluated the association of corticosteroid administration as part of initial medical management on drainage rates and length of stay for children admitted with RPAs and PPAs.

METHODS

We conducted a retrospective study using administrative data of children aged 2 months to 8 years discharged with RPAs and PPAs from 2016 to 2019. Exposure was defined as systemic corticosteroids administered as part of initial management. Primary outcome was surgical drainage. Bivariate comparisons were made between patients in the corticosteroid and noncorticosteroid groups by using Wilcoxon rank or 2 tests. Outcomes were modeled by using generalized linear mixed-effects models.

RESULTS

Of the 2259 patients with RPAs and PPAs, 1677 (74.2%) were in the noncorticosteroid group and 582 (25.8%) were in the corticosteroid group. There were no significant differences in age, sex, or insurance status. There was a lower rate of drainage in the corticosteroid cohort (odds ratio: 0.28; confidence interval: 0.22–0.36). Patients in this group were more likely to have repeat computed tomography imaging performed, had lower hospital costs, and were less likely to have opioid medications administered. The corticosteroid cohort had a higher 7-day emergency department revisit rate, but there was no difference in length of stay (rate ratio 0.97; confidence interval: 0.92–1.02).

CONCLUSIONS

Corticosteroids were associated with lower odds of surgical drainage among children with RPAs and PPAs.

Land Rights and Health Outcomes in American Indian/Alaska Native Children

Pediatrics - Lun, 01/11/2021 - 09:01

American Indian and Alaska Native (AI/AN) land rights, sovereignty conflicts, and health outcomes have been significantly influenced by settler colonialism. This principle has driven the numerous relocations and forced assimilation of AI/AN children as well as the claiming of AI/AN lands across the United States. As tribes across the country begin to reclaim these lands and others continue to struggle for sovereignty, it is imperative to recognize that land rights are a determinant of health in AI/AN children. Aside from the demonstrated biological risks of environmental health injustices including exposure to air pollution, heavy metals, and lack of running water, AI/AN children must also face the challenges of historical trauma, the Missing and Murdered Indigenous Peoples crisis, and health care inequity based on land allocation. Although there is an undeniable relationship between land rights and the health of AI/AN children, there is a need for extensive research into the impacts of land rights and recognition of sovereignty on the health of AI/AN children. In this article we aim to summarize existing evidence describing the impact of these factors on the health of AI/AN children and provide strateg ies that can help pediatricians care and advocate for this population.

Reducing Benzodiazepine Exposure by Instituting a Guideline for Dexmedetomidine Usage in the NICU

Pediatrics - Lun, 01/11/2021 - 09:01
BACKGROUND

Midazolam is a benzodiazepine sedative used in NICUs. Because benzodiazepine’s effects include respiratory depression and potential detrimental developmental effects, minimizing exposure could benefit neonates. Dexmedetomidine is routinely used for sedation in older pediatric populations. We implemented a quality improvement initiative with the aim of decreasing midazolam infusions by 20% through use of dexmedetomidine.

METHODS

A multidisciplinary committee created a sedation guideline that included standardized dexmedetomidine dosing escalation and weaning. Baseline data collection occurred from January 2015 to February 2018, with intervention from March 2018 to December 2019. Percentage of sedation episodes with dexmedetomidine initiated was followed as a process measure. Outcomes measures were percentage of eligible infants receiving midazolam infusions and midazolam-free days per sedation episode. Bradycardia with dexmedetomidine, unplanned extubation rates, and morphine dosage were monitored as balancing measures.

RESULTS

Our study included 434 episodes of sedation in 386 patients. Dexmedetomidine initiation increased from 18% to 49%. The intervention was associated with a significant reduction in midazolam initiation by 30%, from 95% to 65%, with special cause variation on statistical process control chart analysis. Midazolam-free days per sedation episode increased from 0.3 to 2.2 days, and patients receiving dexmedetomidine had lower midazolam doses (1.3 mg/kg per day versus 2.2 mg/kg per day, P = 5.97 x 10–04). Bradycardia requiring discontinuation of dexmedetomidine, unplanned extubation rates, and morphine doses were unchanged.

CONCLUSIONS

Implementation of a quality improvement initiative was successful in reducing the percentage of patients receiving midazolam infusions and increased midazolam-free days per sedation episode, revealing an overall reduction in benzodiazepine exposure while maintaining adequate sedation.

Neonatal MIS-C: Managing the Cytokine Storm

Pediatrics - Lun, 01/11/2021 - 09:01

A term infant girl with uneventful antenatal history had an erythematous rash followed by fever from day 8. She was diagnosed with late-onset sepsis and was treated accordingly. She received immunoglobulin for persistent thrombocytopenia, after which there was transient improvement. The patient was transferred to our hospital on day 25 after recurrence of fever, watery diarrhea, and a generalized maculopapular rash. On admission, she had tachycardia, tachypnoea, anemia, thrombocytopenia, hypoalbuminemia, and generalized edema. Reverse transcriptase–polymerase chain reaction results for coronavirus disease 2019 (COVID-19) was positive. Within 12 hours of admission, she developed cardiogenic shock with pulmonary edema and needed invasive ventilation. Echocardiography revealed ejection fraction of 40% with mild pericardial effusion. N-terminal pro–brain natriuretic peptide was 33000 g/L, D-dimer 16500 µg/L, and ferritin 16000 ng/mL. Methylprednisolone, immunoglobulin, and enoxaparin was started, with a diagnosis of multisystem inflammatory syndrome in children, associated with COVID-19. She developed seizures, pulmonary hemorrhage, and cardiac arrest the following day, along with acute kidney injury. She was extubated after 5 days. Steroid was stopped after 5 days because she developed hypertension and echocardiography had normalized. Five days after extubation, she again developed respiratory distress and was ventilated again for 2 days. Echocardiography revealed moderate left ventricular dysfunction, along with secondary elevation of ferritin. Methylprednisolone was restarted and continued for 5 days followed by tapering dose of oral prednisolone, on which she was finally discharged. Although mild myocarditis with COVID-19 has been reported, multisystem inflammatory syndrome in children in a newborn with refractory myocarditis, along with gastrointestinal and renal manifestations, is a rare entity. Dermatologic manifestation of neonatal COVID-19 is also unique.

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