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Objetivo: Comparar las variaciones de los ácidos grasos poliinsaturados de cadena larga (LCPUFA) al nacer y al año de edad en niños alimentados con lactancia materna prolongada, lactancia materna de duración media y fórmula artificial. Pacientes: Un total de 77 niños sanos a término con alimentación conocida fueron divididos en grupos: el grupo A (n = 25) había recibido lactancia prolongada (más de 6 meses); el B (n = 26), lactancia media (más de 3 meses y menos de 5), y el C (n = 26), cuyos sujetos fueron alimentados únicamente con fórmula artificial. Se midió la proporción de ácidos grasos plasmáticos al nacer y al primer año de vida. Resultados: No existen diferencias en el momento del nacimiento. Sin embargo, hay una disminución significativa de la proporción de los principales LCPUFA, ácido docosahexaenoico (DHA) y ácido araquidónico (AA), entre el nacimiento y el primer año de vida. Al año, el porcentaje de DHA varía significativamente entre el grupo A y los otros dos: 2,46 ± 0,84 frente a 1,80 ± 0,48 y 1,89 ± 0,75 (p

Introducción: Los broncodilatadores administrados mediante aerosol dosificador presurizado (MDI) con cámara espaciadora son tan eficaces como la nebulización en el tratamiento de las crisis asmáticas en la infancia. No existe consenso sobre cuál es la equivalencia de dosis entre ambos sistemas de inhalación. Objetivo: Determinar la eficacia de diferentes dosis de salbutamol o terbutalina administrados mediante dispositivo MDI con cámara espaciadora, en el tratamiento de la crisis asmática en urgencias. Métodos: Estudio prospectivo, aleatorio y ciego. Fueron incluidos de forma consecutiva, todos los niños entre 2 y 14 años que consultaron por una crisis asmática en el servicio de urgencias entre el 1 de octubre y el 30 de noviembre de 2004. Se establecieron dos grupos de tratamiento: un grupo recibió un número de puffs equivalente a la mitad del peso del niño (1 puff de salbutamol = 100 μg y 1 puff de terbutalina = 250 μg) y el segundo grupo recibió un número de puffs equivalente a un tercio del peso. Resultados: Fueron estudiados 324 episodios; 164 niños en el primer grupo y 160 en el segundo grupo. La edad media de ambos grupos fue similar (58,34 ± 34,72 meses frente a 66,04 ± 36,45 meses), y no se encontraron diferencias significativas en la saturación de oxígeno (95,49 ± 1,93 frente a 95,56 ± 1,97), ni en la puntuación del pulmonary score (PS) (4,04 ± 1,55 frente a 3,97 ± 1,51) en el momento de la llegada a urgencias, ni tras el tratamiento administrado, saturación de oxígeno (96,34 ± 1,60 frente a 96,18 ± 1,77) y puntuación del PS (1,87 ± 1,33 frente a 1,64 ± 1,31). El número de dosis de broncodilatador administradas fue similar en ambos grupos (2,17 ± 0,91 frente a 2,24 ± 1,00). No se observaron diferencias en el porcentaje de niños que precisaron ingreso en la unidad de observación (8,56 % frente a 6,87 %). Conclusiones: Las diferentes dosificaciones de broncodilatadores administradas a través de MDI con espaciador, utilizadas en este estudio, tuvieron una eficacia similar. Estos hallazgos deberían contribuir a reconsiderar el uso de dosis elevadas de broncodilatadores, al menos en la mayoría de las crisis asmáticas en niños. : Introduction: Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage. Objective: To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department. Methods: This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child’s weight (1 puff of salbutamol = 100 μg and 1 puff of terbutaline = 250 μg) and the other group received a number of puffs equivalent to one-third of the child’s weight. Results: Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (± SD) age (58.34 _ 34.72 vs 66.04 ± 36.45 months), arterial oxygen saturation (95.49 ± 1.93 vs 95.56 ± 1.97) or pulmonary score (4.04 ± 1.55 vs 3.97 ± 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 ± 1.60 vs 96.18 ± 1.77], pulmonary score [1.87 ± 1.33 vs 1.64 ± 1.31]). The number of doses administered (2.17 ± 0.91 vs 2.24 ± 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups. Conclusions: The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of igh doses of bronchodilators, at least in most acute asthma exacerbations in children.

Objetivo: Estudiar la demanda y la asistencia en una Unidad de Urgencias de Pediatría hospitalaria Pacientes y método: Se analiza la evolución del número de episodios registrados en Urgencias de Pediatría entre 1995 y 2002 y se realiza un estudio retrospectivo aleatorio de 540 episodios correspondientes a niños menores de 14 años entre el 1 de octubre de 2001 y el 30 de septiembre de 2002. Se recogen datos sociodemográficos y del episodio, hallazgos exploratorios, pruebas complementarias, tratamiento administrado, destino de los pacientes y reconsulta Resultados: Entre el 1 de enero de 1995 y el 31 de diciembre de 2002, se registraron 337.842 episodios en la Unidad de Urgencias, precisando ingreso en planta o Unidad de Cuidados Intensivos Pediátricos (UCIP) 11.767 (3,48 %). El número de episodios/año registrados pasó de 38.659 en 1995 a 51.933 en 2002 (δ = 34,3 %). La edad media de la muestra estudiada (n = 540) fue 3,5 ± 3,2 años (54,6% menores de 3 años), que se distribuyeron en 306 (56 %) varones. Cerca de un tercio consultó por cuadros de menos de 6 h de evolución. Los motivos de consulta más frecuentes fueron fiebre en 160 (29,6 %), dificultad respiratoria en 78 (14,4 %) y vómitos-diarrea en 65 (12 %). Se practicaron pruebas a 176 (32,6 %), fundamentalmente radiológicas (115; 21,2 %). Recibieron tratamiento en urgencias 153 casos (28,3 %), sobre todo antitérmicos y broncodilatadores. El 65 % permaneció menos de 1 h en Urgencias. Los diagnósticos principales fueron síndrome febril en 66 (12,2 %), diarrea/gastroenteritis aguda en 40 (7,4 %), asma en 35 (6,5 %), laringitis en 27 (5 %). Ingresaron en planta 16 niños (3 %) y 3 (0,6 %) en la UCIP. Se recomendó tratamiento farmacológico domiciliario a 359 (71,8 %). Reconsultaron 59 pacientes (10,9 %), e ingresaron 5 casos Conclusiones: El número de pacientes atendidos entre 1995 y 2002 en la Unidad de Urgencias de Pediatría ha crecido de manera paulatina por lo general por niños pequeños con cuadros febriles recortados o dificultad respiratoria. En la mitad de los casos una correcta anamnesis y exploración física fueron suficientes para manejar a estos niños. La corta evolución de muchos procesos hacen de la observación continuada, ya domiciliaria o intrahospitalaria, una herramienta importante en el correcto seguimiento de nuestros pacientes : Objective: To describe patient demand and management in a hospital pediatric emergency setting Patients and method: We analyzed the number of episodes registered in our pediatric emergency unit between 1995 and 2002 and performed a retrospective, random survey of 540 episodes in children aged less than 14 years admitted between 2001-10-1 and 2002-09-30. Epidemiological details, physical findings, complementary tests, the treatment administered, admissions, and unscheduled return visits were analyzed Results: Between 1995-1-01 and 2002-31-12, a total of 337,842 episodes were registered in our emergency unit, requiring 11,767 (3.48 %) admissions to a ward or the pediatric intensive care unit (PICU). The number of episodes/ year increased from 38,659 in 1995 to 51,933 in 2002 (δ = 34.3 %). The mean age of the sample (n = 540) was 3.5 ± 3.2 years (54.6% were younger than 3 years) and 306 (56%) were boys. Nearly one-third of the children presented with processes of recent onset (less than 6 hours). The most frequent chief complaints were fever in 160 children (29.6 %), respiratory distress in 78 (14.4 %) and vomiting- diarrhea in 65 (12 %). Complementary investigations were performed in 176 patients (32.6 %), mainly radiologic tests (115; 21.2 %). One hundred fifty-three (28.3 %) received treatment in our emergency unit, mainly antipyretics and bronchodilators. Sixty-five percent stayed less than 1 hour in the emergency unit. The most frequent diagnoses were fever without source in 66 patients (12.2 %), diarrhea/acute gastroenteritis in 40 (7.4 %), asthma in 35 (6.5 %), and croup in 27 (5 %). Sixteen children (3 %) were admitted to a ward and three (0.6 %) were admitted to the PICU. Home drug treatment was recommended in 359 patients (71.8 %). Unscheduled return visits were registered in 59 patients (10.9 %), and five were admitted Conclusions: The number of patients attended in our pediatric emergency unit gradually increased between 1995 and 2002, mostly due to young children with fever or respiratory distress. In nearly half of the patients, a thorough anamnesis and physical examination were sufficient for evaluation. Because many of the processes were of recent onset, continuous observation, whether at home or in hospital, was useful to adequately monitor these children

Objetivo: Conocer las características de los pacientes que acuden a urgencias de pediatría de las 0 a las 8 h. Metodología: Estudio retrospectivo de 300 niños atendidos por la noche en urgencias. Resultados: Entre el 1 y el 22 de marzo de 1999 se registraron 300 episodios de 0 a 8 h (1,7 pacientes/h) y 2.350 de las 8 a las 24 h (6,6 pacientes/h). De los 300 episodios nocturnos, 132 correspondían a niños que acudieron de entre las 0.00 a las 2.00 h (44%). Los motivos de consulta más frecuentes fueron: síntomas respiratorios, 116 (38,6%); digestivos, 61 (20,3%), y fiebre 61 (20,3%), practicándose alguna exploración complementaria a 111 pacientes (37,0%). Ingresaron 5 niños (1,7%) de los que se presentaron entre las 0 y las 8 h, y 80 (3,4%) de los que acudieron entre las 8 y las 24 h, (p = 0,15), mientras 25 (8,3%) permanecieron unas horas en la unidad de observación (123 de 8 a 24 h, 5,2%; p = 0,04). Los diagnósticos fueron: infección otorrinolaringológica 91 (30,3%); fiebre sin foco, 38 (12,6%); asma, 29 (9,6%); gastroenteritis aguda, 27 (9%); laringitis, 22 (7,3%); vómitos 14 (4,6%); dolor abdominal, 13 (4,3%); convulsión febril, 6 (2%); neumonía, 5 (1,6%); bronquiolitis 5 (1,6%); bacteriemia, 1 (0,3%), y otros, 49 (16,3%). Conclusiones: La presión asistencial en urgencias de pediatría disminuye por la noche, especialmente de 2 a 8 h. La tasa de ingresos nocturna es menor a la diurna, sin que la diferencia sea estadísticamente significativa, existiendo una mayor tendencia a dejar más pacientes en la unidad de evolución. El porcentaje de pacientes con enfermedad respiratoria se incrementa por la noche. : Objective: To determine the characteristics of children younger than 14 years visiting our pediatric emergency department between 0:00 and 8:00 hours. Patients and methods: Retrospective review of 300 children visiting our emergency department at night. Results: Between March 1 and 22 1999 we recorded 300 episodes from 0:00-8:00 hours (1.7 patients/hour) and 2350 episodes from 8:00-24:00 hours (6.6 patients/hour). Of the 300 episodes registered at night, 132 children (44%) came between 0:00 and 2:00. The most common complaints were: respiratory symptoms in 116 patients (38.6%), fever in 61 (20.3%) and digestive symptoms in 61 (20.3%). We carried out at least one complementary test in 111 patients (37.0%). Five children (1.7%) were admitted to the hospital (80 between 8:00 and 24:00, 3.4%, p = 0.15) and 25 (8.3%) were admitted for a few hours to the observation ward (123 of the 2350 who came between 8:00 and 24:00, 5.2%, p = 0.06). Final diagnoses were: ear nose and throat infection in 91 (30.3%), fever without source in 38 (12.6%), asthma in 29 (9.6%), acute gastroenteritis in 27 (9%), croup in 22 (7.3%), vomiting in 14 (4.6%), abdominal pain in 13 (4.3%), febrile convulsion in 6 (2%), pneumonia in 5 (1.6%), bronchiolitis in 5 (1.6%), bacteremia in 1 (0.3%), and other diagnoses in 46 (16.3%). Conclusions: The number of visits to our emergency department diminished at night, particularly between 0:00 and 2:00. The night-time admission rate was less than the daytime rate, although this difference was not statistically significant. Admission for a few hours to the observation ward was more common at night. The percentage of patients with respiratory illnesses was higher during the night.

Objetivo: Comparar la tinción de Gram y la tira reactiva en orina, como métodos para el diagnóstico de la infección del tracto urinario (ITU), en el lactante con fiebre Pacientes y métodos: Estudio prospectivo de 175 lactantes con fiebre, con edades comprendidas entre 1 y 24 meses, en los que se analizó la orina para descartar la presencia de ITU. Además del análisis de orina mediante tira reactiva para detectar la presencia de leucocitos y nitritos, se envió una muestra para tinción de Gram y urocultivo. La orina se recogió mediante sondaje uretral. Se consideró urocultivo positivo al crecimiento de más de 50.000 col./ml del mismo germen Resultados: La edad media de los pacientes fue de 9,8 meses. El uro-cultivo resultó positivo en 87 pacientes (49,5 %). El diagnóstico de ITU se estableció en 91 pacientes (51,9%) siendo hospitalizados 74 de ellos con sospecha clínica de pielonefritis (81,3%). La prueba más sensible fue la leuco-cituria (90,8%) y la más específica la tinción de Gram (98,9 %). Destacó como prueba de mayor rendimiento global la suma de aplicar como método diagnóstico la leuco-cituria más la tinción de Gram: sensibilidad, 93,1 %; especificidad, 98,4%; valor predictivo positivo (VPP), 98,5%, y valor predictivo negativo (VPN), 92,5 % Conclusión: La tinción de Gram en orina es un método diagnóstico de mayor rendimiento que la tira reactiva para detectar ITU en el lactante febril pero debe interpretarse conjuntamente con los resultados de esta última : Objetive: To compare urinary Gram staining and dipstick for the detection of urinary tract infection (UTI) in febrile infants Methods: Prospective study of 175 febrile infants aged 1-24 months. In all infants, a urine specimen was analyzed to detect UTI. The dipstick test was used to detect leukocytes and nitrites and samples were taken for Gram staining and urine culture. Urine was obtained by urethral catheterization. Positive urine results were defined as > 50.000 colony-forming units per millimeter of urinary tract pathogen Results: The mean age was 9.8 months (SD: 6.64). Urine culture was positive in 87 patients (49.5 %). Diagnosis of UTI was confirmed in 91 patients (51.9 %), of whom 74 were admitted for clinically suspected pyelonephritis (81.3%). Gram stain had the highest specificity (98.9%) and pyuria the highest sensitivity (90.8%). Better results were obtained using the combination of dipstick and Gram stain with a sensitivity of 93.1%, specificity of 98.4%, positive predictive value of 98.5 % and negative predictive value of 92.5% Conclusion: Urinary Gram stain appears to be more reliable than dipstick in detecting UTI in febrile infants but the results of both tests should be interpreted together

Compare the variations of long-chain polyunsaturated fatty acids (LCPUFA) levels at birth and at the first year of age in children on extended breast-feeding, medium term breast-feeding and formula feeding.77 healthy term infants divided in three groups: A (N=25): extended breast-feeding (more than 6 months), B (N=26): medium term breast-feeding (more than 3 and less than 5 months) and C (N=26): exclusive formula feeding. Fatty acids in plasma were measured at birth and at the first year of age.There were no differences in the levels at birth. However, there is a significant decrease in the proportion of the main LCPUFA, docosahexaenoic acid (DHA) and arachidonic acid (AA), between birth and the first year of age. At one year of age, the percentage of DHA in Group A differs significantly between the other two: 2.46+/-0.84 vs. 1.80+/-0.48 and 1.89+/-0.75 (p0.01).1. At birth, there are no differences in LCPUFA. 2. A significant decrease in the main LCPUFA is observed with age. 3. The extended breast-feeding group shows higher DHA levels than the other two. Therefore, breast-feeding for more than 6 months is required to achieve higher plasma DHA values.

Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage.To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department.This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child's weight (1 puff of salbutamol = 100 microg and 1 puff of terbutaline = 250 microg) and the other group received a number of puffs equivalent to one-third of the child's weight.Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (6 SD) age (58.34 +/- 34.72 vs 66.04 +/- 36.45 months), arterial oxygen saturation (95.49 +/- 1.93 vs 95.56 +/- 1.97) or pulmonary score (4.04 +/- 1.55 vs 3.97 +/- 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 +/- 1.60 vs 96.18 +/- 1.77], pulmonary score [1.87 +/- 1.33 vs 1.64 +/- 1.31]). The number of doses administered (2.17 +/- 0.91 vs 2.24 +/- 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups.The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children.

To describe patient demand and management in a hospital pediatric emergency setting.We analyzed the number of episodes registered in our pediatric emergency unit between 1995 and 2002 and performed a retrospective, random survey of 540 episodes in children aged less than 14 years admitted between 2001-10-1 and 2002-09-30. Epidemiological details, physical findings, complementary tests, the treatment administered, admissions, and unscheduled return visits were analyzed.Between 1995-1-01 and 2002-31-12, a total of 337,842 episodes were registered in our emergency unit, requiring 11,767 (3.48 %) admissions to a ward or the pediatric intensive care unit (PICU). The number of episodes/ year increased from 38,659 in 1995 to 51,933 in 2002 (Delta = 34.3 %). The mean age of the sample (n = 540) was 3.5 6 3.2 years (54.6 % were younger than 3 years) and 306 (56 %) were boys. Nearly one-third of the children presented with processes of recent onset (less than 6 hours). The most frequent chief complaints were fever in 160 children (29.6 %), respiratory distress in 78 (14.4 %) and vomiting-diarrhea in 65 (12 %). Complementary investigations were performed in 176 patients (32.6 %), mainly radiologic tests (115; 21.2 %). One hundred fifty-three (28.3 %) received treatment in our emergency unit, mainly antipyretics and bronchodilators. Sixty-five percent stayed less than 1 hour in the emergency unit. The most frequent diagnoses were fever without source in 66 patients (12.2 %), diarrhea/acute gastroenteritis in 40 (7.4 %), asthma in 35 (6.5 %), and croup in 27 (5 %). Sixteen children (3 %) were admitted to a ward and three (0.6 %) were admitted to the PICU. Home drug treatment was recommended in 359 patients (71.8 %). Unscheduled return visits were registered in 59 patients (10.9 %), and five were admitted.The number of patients attended in our pediatric emergency unit gradually increased between 1995 and 2002, mostly due to young children with fever or respiratory distress. In nearly half of the patients, a thorough anamnesis and physical examination were sufficient for evaluation. Because many of the processes were of recent onset, continuous observation, whether at home or in hospital, was useful to adequately monitor these children.

To determine the characteristics of children younger than 14 years visiting our pediatric emergency department between 0:00 and 8:00 hours.Retrospective review of 300 children visiting our emergency department at night.Between March 1 and 22 1999 we recorded 300 episodes from 0:00-8:00 hours (1.7 patients/hour) and 2350 episodes from 8:00-24:00 hours (6. 6 patients/hour). Of the 300 episodes registered at night, 132 children (44%) came between 0:00 and 2:00. The most common complaints were: respiratory symptoms in 116 patients (38.6%), fever in 61 (20.3%) and digestive symptoms in 61 (20.3%). We carried out at least one complementary test in 111 patients (37.0%). Five children (1.7%) were admitted to the hospital (80 between 8:00 and 24:00, 3.4%, p = 0.15) and 25 (8.3%) were admitted for a few hours to the observation ward (123 of the 2350 who came between 8:00 and 24:00, 5.2%, p = 0.06). Final diagnoses were: ear nose and throat infection in 91 (30.3%), fever without source in 38 (12.6%), asthma in 29 (9.6%), acute gastroenteritis in 27 (9%), croup in 22 (7.3%), vomiting in 14 (4.6%), abdominal pain in 13 (4.3%), febrile convulsion in 6 (2%), pneumonia in 5 (1.6%), bronchiolitis in 5 (1. 6%), bacteremia in 1 (0.3%), and other diagnoses in 46 (16.3%).The number of visits to our emergency department diminished at night, particularly between 0:00 and 2:00. The night-time admission rate was less than the daytime rate, although this difference was not statistically significant. Admission for a few hours to the observation ward was more common at night. The percentage of patients with respiratory illnesses was higher during the night.