Desenhar, escrever e contar: qualidade de vida da criança e adolescente com condição crônica / Draw, write and tell interview: Quality of life of children and adolescents with chronic condition / Dibujar, escribir y contar: calidad de vida de niños y adolescentes con enfermedades crónicas

Objetivo: compreender por meio da técnica Desenhar, escrever e contar como a condição crônica influencia na qualidade de vida infantojuvenil; e analisar o uso da técnica nessa população. Método: estudo qualitativo, descritivo e exploratório. Participaram onze crianças e adolescentes com condição crônica entre sete e dezessete anos. A coleta de dados ocorreu mediante entrevista semiestruturada, com auxílio da técnica Desenhar, escrever e contar, em um Hospital público. Para análise dos dados utilizou-se a análise de conteúdo temática de Bardin. Resultados: emergiram três categorias que evidenciam diversas alterações na qualidade de vida dessa clientela, com destaque para o comprometimento físico, emocional e social que impacta nas de experiências que compõem a infância e a adolescência. A técnica Desenhar, escrever e contar foi um facilitador e enriqueceu a coleta de dados. Considerações finais: a técnica escolhida possibilitou identificar a qualidade de vida prejudicada da criança e adolescente com condição crônica(AU)

Objective: to understand, through the Draw, Write and Tell interview technique how chronic condition influences pediatric quality of life; To analyze the use of the technique in this population. Method: qualitative, descriptive, exploratory study. Eleven children and adolescents with chronic conditions between seven and seventeen years old participated. Data collection took place through semi-structured interviews, with the aid of the Draw, Write and Tell interview technique, in State University Hospital. For data analysis, thematic content analysis according to Bardin was used. Results: three categories emerged that show several changes in the quality of life of this clientele, with emphasis on the physical, emotional and social impairment that impact on the experiences that make up childhood and adolescence. The Draw, Write and Tell interview technique facilitated and enriched data collection. Final considerations: The chosen technique made it possible to identify the impaired quality of life of children and adolescents with chronic conditions(AU)

Objetivo: comprender, a través de la técnica de entrevista Dibujar, Escribir y Contar, cómo la condición crónica influye en la calidad de vida infantojuvenil; y analizar el uso de la técnica en esta población. Método: estudio cualitativo, descriptivo y exploratorio. Participaron once niños y adolescentes, con condiciones crónicas, de siete a diecisiete años. La recolección de datos ocurrió por medio de entrevistas semiestructuradas, con el auxilio de la técnica de entrevista Dibujar, Escribir y Contar, en un hospital público. En cuanto al análisis de datos, se utilizó el análisis de contenido temático de Bardin. Resultados: surgieron tres categorías que muestran varios cambios en la calidad de vida de esta clientela, con énfasis en el deterioro físico, emocional y social que tiene un gran impacto en las experiencias que componen la infancia y la adolescencia. La técnica Dibujar, Escribir y Contar facilitó y enriqueció la recolección de datos. Consideraciones finales: la técnica elegida permitió identificar la calidad de vida deteriorada de niños y adolescentes con condiciones crónicas(AU)

Compreensão de profissionais sobre o processo de alta hospitalar de crianças dependentes de tecnologias / Understanding of professionals about the process of hospital discharge of children dependent on technologies / Comprensión de los profesionales sobre el proceso de alta hospitalaria de niños dependientes de tecnologías

Objetivo: compreender o processo de alta hospitalar de crianças dependentes de tecnologias por profissionais de unidades pediátricas e neonatais. Método: estudo descritivo com os profissionais da assistência à criança dependente de tecnologias de um Hospital Universitário entre julho e setembro de 2020. Os dados foram obtidos foram exportados para o software Iramuteq e interpretados à luz da teoria de análise de conteúdo. O estudo possui aprovação pelo Comitê de Ética e Pesquisa. Resultados: a nuvem de palavras contextualizou e forneceu subsídios para a identificação de duas categorias: Compreensão da necessidade de trabalho em equipe para planejamento de alta hospitalar e percepção da necessidade de implementação de ferramentas como protocolos e fluxos para o direcionamento do preparo para alta e continuidade do cuidado. Conclusão: os profissionais referem que a alta hospitalar é realizada conforme a rotina assistencial e ainda segue um modelo medicalocêntrico(AU)

Objective: to understand the process of hospital discharge of technology-dependent children by professionals from pediatric and neonatal units. Method: descriptive study with technology-dependent child care professionals at a University Hospital between July and September 2020. The data obtained was exported to the Iramuteq software and interpreted in light of content analysis theory. The study is approved by the Research Ethics Committee. Results: the word cloud contextualized and provided support for the identification of two categories: Understanding the need for teamwork to plan hospital discharge and perception of the need to implement tools such as protocols and flows to guide preparation for discharge and continuity of care. Conclusion: professionals report that hospital discharge is carried out according to the care routine and still follows a medical-centric model(AU)

Objetivo: comprender el proceso de alta hospitalaria de niños dependientes de tecnología por parte de profesionales de unidades de pediatría y neonatología. Método: estudio descriptivo con los profesionales de cuidado al niño que depende de tecnologías en un Hospital Universitario, entre julio y septiembre de 2020. Los datos obtenidos se exportaron al software Iramuteq y se interpretaron a la luz de la teoría del análisis de contenido. El estudio es aprobado por el Comité de Ética en Investigación. Resultados: la nube de palabras contextualizó y trajo subsidios para la identificación de dos categorías: comprensión de la necesidad de trabajo en equipo para planificar el alta hospitalaria y percepción de la necesidad de implementar herramientas como protocolos y flujos para orientar la preparación para el alta y la continuidad de la atención. Conclusión: los profesionales refieren que el alta hospitalaria se realiza según la rutina asistencial y sigue un modelo médico centrado(AU)

ANÁLISIS DE LA ADECUACIÓN DEL APORTE NUTRICIONAL A LA META CALÓRICA Y PROTEICA EN PACIENTES CON NUTRICIÓN ENTERAL EXCLUSIVA INTERNADOS EN UN HOSPITAL PÚBLICO PEDIÁTRICO DE ALTA COMPLEJIDAD / ANALYSIS OF ADEQUACY OF THE NUTRITIONAL CONTRIBUTION TO THE CALORIE GOAL AND PROTEIN IN PATIENTS WITH ENTERAL NUTRITION EXCLUSIVE BOARDING SCHOOLS IN A PUBLIC HOSPITAL PEDIATRIC HIGH COMPLEXITY

La malnutrición en los pacientes hospitalizados representa un importante problema sanitario asociado a una mayor tasa de complicaciones con un incremento de la morbimortalidad

Malnutrition in hospitalized patients represents a significant health problem associated with an increased rate of complications and higher morbidity and mortality

Neumonía bacteriana en niños en Ecuador: una mirada al impacto de las vacunas / Bacterial pneumonia in children in Ecuador: a look at the impact of vaccines

INTRODUCCIÓN: La neumonía adquirida en la comunidad es una de las enfermedades con mayor prevalencia en la comunidad pediátrica en nuestro país. De las diferentes etiologías que pueden causarlas, la neumonía ocasionada por Streptococcus pneumoniae puede ser prevenida con el uso de inmunización. Actualmente se disponen de tres tipos de vacunas antineumocócicas conjugadas autorizadas de uso pediátrico de forma sistemática. OBJETIVO: Identificar la prevalencia de neumonía bacteriana en niños bajo 5 años de edad, que requirieron hospitalización comparando la vacuna neumocócica recibida: 10 valente (PCV10) versus 13 valente (PCV13). PACIENTES Y MÉTODOS: Estudio de descriptivo, retrospectivo. Se incluyeron pacientes hospitalizados bajo 5 años de edad, con diagnóstico de neumonía bacteriana mediante codificación CIE10 en un hospital de tercer nivel de la ciudad de Quito-Ecuador, durante el año 2019. RESULTADOS: Se estudiaron 175 pacientes de los cuales 74 cumplieron con criterios clínicos de neumonía, de estos 46 recibieron PCV10 y 28 recibieron vacuna PCV13. DISCUSIÓN Y CONCLUSIONES: La prevalencia de neumonía bacteriana fue mayor en los pacientes inmunizados con PCV10 lo que sugiere una relación de menor probabilidad de neumonía con el uso de la vacuna PCV13.

BACKGROUND: Community-acquired pneumonia is one of the most prevalent diseases in the pediatric community in our country, of the different etiologies that can cause them, pneumonia caused by Streptococcus pneumoniae can be prevented with the use of immunization. Currently there are three types of authorized pneumococcal conjugate vaccines for pediatric use in a systematic way. AIM: To identify the prevalence of bacterial pneumonia in children under 5 years of age who required hospitalization by comparing the pneumococcal vaccine received: 10 valent (PCV10) versus 13 valent (PCV13). METHODS: Descriptive, retrospective study. Hospitalized patients under 5 years of age with a diagnosis of bacterial pneumonia by ICD10 coding in a third level hospital in the city of Quito - Ecuador during 2019 were included. Results: 175 patients were studied, of which 74 patients met clinical criteria for pneumonia, of these 46 received PCV10 and 28 received PCV13 vaccine. DISCUSSION AND CONCLUSIONS: The prevalence of bacterial pneumonia was higher in patients immunized with PCV10, suggesting a relationship of lower probability of pneumonia with the use of the PCV13 vaccine.

O brincar como estratégia no atendimento fisioterapêutico da criança hospitalizada sob a percepção do acompanhante: um estudo transversal descritivo / Playing as a strategy in physiotherapy care of hospitalized children under the perception of the companion: a descriptive cross-cross study

INTRODUÇÃO: Relatar a percepção familiar e/ou do acompanhante em relação à importância da utilização do brincar como recurso no tratamento fisioterapêutico de crianças hospitalizadas. MÉTODOS: Trata-se de um estudo descritivo de corte transversal. A população do estudo foi composta por acompanhantes das crianças admitidas na Enfermaria Pediátrica do Hospital Geral Roberto Santos e em acompanhamento fisioterapêutico. Foram coletados dados secundários para confirmação do tempo de início do atendimento com a equipe de Fisioterapia e dados primários por meio da aplicação de formulário no período de abril a junho de 2022. O instrumento foi composto por blocos de questões sociodemográficas, atividades sociais da criança anteriormente à hospitalização, comportamento da criança durante a hospitalização. Outrossim, aderência/aceitação ao tratamento, reação emocional e interesse durante e após intervenção utilizando o brincar. RESULTADOS: Foram entrevistados um total de 37 acompanhantes. Em relação às características sociodemográficas das crianças, 64,9% foram do sexo masculino e a idade de maior frequência foi entre dois a cinco anos. No que se caracteriza o humor da criança perante a hospitalização, antes da intervenção 81,1% relataram choro e 64,9% medo. Por fim, 59,5% dos acompanhantes salientaram ótima aderência/aceitação, 75,7% mencionaram melhora do humor, além de 83,8% classificarem como ótimo o interesse e a interação da criança. CONSIDERAÇÕES FINAIS: Constatouse, com base na percepção dos acompanhantes, que o brincar como ferramenta coadjuvante das condutas fisioterapêuticas na enfermaria pediátrica é importante no tratamento da criança hospitalizada, pois melhora o humor, a aceitação, interação/ interesse durante e depois intervenção, o que torna o cuidado mais integral e humanizado.

INTRODUCTION: To report the family and/or companion's point of view regarding the importance of using play as a resource in the physiotherapeutic treatment of hospitalized children. METHODS: This is a descriptive cross-sectional study. The study population consisted of caregivers of children admitted to the Pediatric Ward of the Hospital Geral Roberto Santos and undergoing physiotherapeutic follow-up. Secondary data were collected to confirm the start time of care with the Physiotherapy team and primary data through the application of a form from April to June 2022. The instrument was composed of blocks of sociodemographic questions, social activities of the child previously hospitalization, child's behavior during hospitalization. Furthermore, adherence/acceptance to treatment, emotional reaction and interest during and after intervention using play. RESULTS: A total of 37 companions were interviewed. Regarding the sociodemographic characteristics of the children, 64.9% were male and the most frequent age was between two and five years. In what characterizes the child's mood before the hospitalization before the intervention, 81.1% reported crying and 64.9% fear. Finally, 59.5% of the companions highlighted excellent adherence/ acceptance, 75.7% mentioned improvement in mood, in addition to 83.8% classifying the child's interest and interaction as excellent. FINAL CONSIDERATIONS: It was found, based on the perspective of the companions, that playing as a supporting tool of physiotherapeutic conducts in the pediatric ward is important in the treatment of hospitalized children, as it improves mood, acceptance, interaction/interest during and after the intervention, which makes care more comprehensive and humanized.

Comparison of four different nutritional risk screening tools in hospitalized children / Comparação de quatro ferramentas diferentes de triagem de risco nutricional em crianças hospitalizadas

ABSTRACT Objective: Early detection of malnutrition risk in hospitalized children can improve health outcomes and quality of life; however, the number of studies where the pediatric screening tool is appropriate for Turkish children is limited. Therefore, this article aims to determine the prevalence of malnutrition risk in pediatric patients evaluated with Screening Tool for Risk on Nutritional Status and Growth, Screening Tool for the Assessment of Malnutrition in Pediatrics, Pediatric Yorkhill Malnutrition Score, and Simple Pediatric Nutrition Screening Tool with original and adjusted cutoffs and to evaluate which pediatric screening tool is appropriate for Turkish children. Methods: In this cross-sectional study, four published nutritional risk screening tools (Screening Tool for Risk on Nutritional Status and Growth, Screening Tool for the Assessment of Malnutrition in Pediatrics, Pediatric Yorkhill Malnutrition Score, Pediatric Nutrition Screening Tool) were applied to pediatric inpatients (n=604) aged 1 month to 17 years, admitted to a pediatric ward for at least 24 hours. Results: Pediatric Nutrition Screening Tool with adjusted cutoffs had the greatest recognition rate (94.2%) of acute malnutrition. Having a high nutritional risk by Pediatric Yorkhill Malnutrition Score was associated with an increased risk of acute (OR: 6.57 for Screening Tool for Risk on Nutritional Status and Growth, 5.84 for Screening Tool for the Assessment of Malnutrition in Pediatrics, and 20.35 for Pediatric Yorkhill Malnutrition Score) and chronic malnutrition (OR: 1.27 for Screening Tool for Risk on Nutritional Status and Growth, 3.28 for Screening Tool for the Assessment of Malnutrition in Pediatrics, and 1.72 for Pediatric Yorkhill Malnutrition Score). Classifying the at-risk category by the Pediatric Nutrition Screening Tool was related to raised odds of malnutrition (OR: 2.64 for original and 5.24 for adjusted cutoffs). This positive association was also observed for acute (OR: 4.07 for original cutoffs, and 28.01 for adjusted cutoffs) and chronic malnutrition (OR: 1.14 for original cutoffs, and 1.67 for adjusted cutoffs). Conclusion: Pediatric Nutrition Screening Tool with adjusted cutoffs and Pediatric Yorkhill Malnutrition Score have higher diagnostic accuracy than other screening tools in assessing the nutritional status of hospitalized Turkish children and detecting children, particularly with acute malnutrition.

RESUMO Objetivo: A detecção precoce do risco de desnutrição em crianças hospitalizadas pode melhorar a saúde e a qualidade de vida, porém o número de estudos em que a ferramenta de triagem pediátrica é apropriada para crianças turcas é limitado. O objetivo deste estudo foi determinar a prevalência do risco de desnutrição em pacientes pediátricos avaliados com Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria, Escore de Malnutrição Pediátrica de Yorkhill e Ferramenta de Triagem de Nutrição Pediátrica Simples com pontos de corte originais e ajustados para avaliar qual ferramenta de triagem pediátrica é apropriada para crianças turcas. Métodos: Neste estudo transversal, quatro ferramentas de triagem de risco nutricional publicadas (Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria, Escore de Malnutrição Pediátrica de Yorkhill, Ferramenta de Triagem de Nutrição Pediátrica) foram aplicadas a pacientes pediátricos (n=604) com idades entre 1 mês e 17 anos, internados em uma enfermaria pediátrica por pelo menos 24 horas. Resultados: A Ferramenta de Triagem de Nutrição Pediátrica com pontos de corte ajustados obteve a maior taxa de reconhecimento de desnutrição aguda (94,2%), enquanto a Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria teve a maior taxa na identificação da desnutrição crônica (67,4%). Essas associações positivas foram mais notáveis para desnutrição aguda (OR: 6,57 para Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, 5,84 para Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria e 20,35 para Escore de Malnutrição Pediátrica de Yorkhill) do que para desnutrição crônica (OR: 1,27 para Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, 3,28 para Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria e 1,72 para Escore de Malnutrição Pediátrica de Yorkhill). A classificação da categoria de risco pela Ferramenta de Triagem de Nutrição Pediátrica foi relacionada a maiores chances de desnutrição (OR: 2,64 para pontos de corte originais e 5,24 para pontos de corte ajustados). Essa associação positiva também foi observada para desnutrição aguda (OR: 4,07 para pontos de corte originais e 28,01 para pontos de corte ajustados) e crônica (OR: 1,14 para pontos de corte originais e 1,67 para pontos de corte ajustados). Conclusão: A Ferramenta de Triagem de Nutrição Pediátrica com pontos de corte ajustados e Escore de Malnutrição Pediátrica de Yorkhill têm maior precisão diagnóstica do que outras ferramentas de triagem na avaliação do estado nutricional de crianças turcas hospitalizadas e na detecção da desnutrição aguda em particular.

From theory to practice: the inclusion of hospitalized children's families in painful procedures / De la teoría a la práctica: la inclusión de familiares de niños hospitalizados en procedimientos dolorosos / Da teoria à prática: a inclusão da família de crianças hospitalizadas nos procedimentos dolorosos

ABSTRACT Objective: To understand nursing team professionals' strategies to include the family in painful procedures performed on hospitalized children. Method: An exploratory-descriptive, qualitative study, carried out with nursing professionals. Data were collected through semi-structured interviews, guided by a script of topics, transcribed and submitted to thematic content analysis, in the light of Symbolic Interactionism, discussed considering the Family-Centered Care philosophy assumptions. Results: Two central categories emerged, "Theoretical perspective: the family as a care agent in painful procedures" and "Practical perspective: experiences, challenges and strategies in painful procedures for family inclusion", with their respective subcategories. Conclusion: Nursing professionals have theoretical knowledge about family inclusion in painful procedures based on the assumptions: Family-Centered Care: dignity and respect; information sharing; joint participation; and family collaboration. However, knowledge is not applied in clinical practice; consequence of the interaction between beliefs and attitudes unfavorable to family presence.

RESUMEN Objetivo: Comprender las estrategias de los profesionales del equipo de enfermería para incluir a la familia en los procedimientos dolorosos realizados en niños hospitalizados. Método: Estudio exploratorio-descriptivo, cualitativo, realizado con profesionales de enfermería. Los datos fueron recolectados a través de entrevistas semiestructuradas, guiadas por un guión de temas, transcritas y sometidas al análisis de contenido temático, a la luz del Interaccionismo Simbólico, discutido frente a los presupuestos de la filosofía del Cuidado Centrado en la Familia. Resultados: Surgieron dos categorías centrales, "Perspectiva teórica: la familia como agente de cuidado en los procedimientos dolorosos" y "Perspectiva práctica: experiencias, desafíos y estrategias en los procedimientos dolorosos para la inclusión familiar", con sus respectivas subcategorías. Conclusión: Los profesionales de enfermería poseen conocimientos teóricos sobre la inclusión de la familia en el procedimiento doloroso a partir de los supuestos: Cuidado Centrado en la Familia: dignidad y respeto; el intercambio de información; participación conjunta; y colaboración familiar. Sin embargo, el conocimiento no se aplica en la práctica clínica; consecuencia de la interacción entre creencias y actitudes desfavorables a la presencia de la familia.

RESUMO Objetivo: Compreender as estratégias dos profissionais da equipe de enfermagem para a inclusão da família nos procedimentos dolorosos realizados em crianças hospitalizadas. Método: Estudo exploratório-descritivo, qualitativo, realizado com profissionais de enfermagem. Os dados foram coletados por meio de entrevistas semiestruturadas, guiadas por um roteiro de tópicos, transcritas e submetidas à análise temática de conteúdo, à luz do Interacionismo Simbólico, discutidas frente aos pressupostos da filosofia do Cuidado Centrado na Família. Resultados: Emergiram-se duas categorias centrais, "Perspectiva teórica: a família como agente de cuidado nos procedimentos dolorosos" e "Perspectiva prática: vivências, desafios e estratégias nos procedimentos dolorosos para inserção da família", com suas respectivas subcategorias. Conclusão: Os profissionais de enfermagem possuem conhecimento teórico sobre a inclusão da família no procedimento doloroso com base nos pressupostos: Cuidado Centrado na Família: dignidade e respeito; compartilhamento de informações; participação conjunta; e colaboração da família. No entanto, os conhecimentos não são aplicados na prática clínica; consequência da interação entre as crenças e atitudes desfavoráveis à presença da família.

Uso de antiepilépticos en niños hospitalizados en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell / Use of antiepileptic drugs in children hospitalized at the Pereira Rossell Pediatric Hospital / Uso de drogas antiepilépticas em crianças internadas no Hospital Pediátrico Pereira Rossell

Introducción: indicaciones off label, estrecho margen terapéutico, variabilidad farmacocinética, interacciones farmacológicas constituyen algunos de los problemas a abordar en el uso crónico de antiepilépticos (AE). Caracterizar su perfil de uso es necesario para promover su prescripción racional. Objetivo: Describir el perfil de uso de AE en menores de 15 años hospitalizados en el Centro Hospitalario Pereira Rossell entre 1/07/2020 y 31/12/2020. Material y método: estudio descriptivo, de menores de 15 años hospitalizados en cuidados moderados en tratamiento con AE. Variables: tipo y número de AE, motivo de la indicación, vía de administración, dosis, uso asociado con psicofármacos, adherencia. Resultados: recibían AE 113 pacientes, mediana edad 7 años, 50,4% sexo femenino. Motivo de la indicación: epilepsia (grupo A) 50,4% y otras patologías (grupo B) 49,6%. Mediana de edad: 2,7 años grupo A vs. 11,5 años grupo B. El AE más indicado fue levetiracetam en el grupo A (35%) y ácido valproico en el grupo B (35,7%). La asociación con psicofármacos se registró en 8,7% grupo A vs. 44,6% en el grupo B. Conclusiones: predominó el uso de levetiracetam en pacientes epilépticos. La mitad de los pacientes recibieron AE para patologías diferentes a la epilepsia, mayoritariamente psiquiátricas. En este grupo predominó el uso de ácido valproico. El análisis de esta serie permite una aproximación al conocimiento del perfil de uso de AE en los niños asistidos en este centro, y por tanto de los principales problemas a abordar. Futuros estudios multicéntricos con población ambulatoria son necesarios para mejorar el conocimiento y contribuir al uso racional de los mismos.

Introduction: off-label prescription, narrow therapeutic margin, pharmacokinetic variability, drug interaction, are some of the problems to consider in the chronic use of antiepileptic drugs (AEDs). It is necessary to characterize their utilization profile in order to promote rational prescription. Objective: to describe the utilization profile of AEDs in children under 15 years of age hospitalized at the Pereira Rossell Pediatric Hospital from 7/01/2020 to 12/31/2020. Material and Methods: descriptive study of children under 15 years of age hospitalized in moderate care units receiving treatment with AEDs. Variables: type and number of AEDs, reason for the prescription, dose, associated use of psychotropic drugs, compliance. Results: 113 patients received AEDs, median age 7 years, 50.4% females. Reason for prescription; epi- lepsy (group A) 50.4%, other pathologies (group B) 49.6%. Median age in group A 2.7 years, versus 1.1.5 years in group B. Most frequently prescribed AEDs was levetiracetam in group A (35%) and valproic acid in group B (37,7%). Association with psychotropic drugs was present in 8.7% of group A versus 44.6% of group B. Conclusions: levetiracem use was predominant in epileptic patients. Half of the patients received AEDs for pathologies other than epilepsy, mostly psychiatric. In this group the use of valproic acid was predominant. Analysis of this series enables an approximation to the understanding of the profile of AEDs use in children assisted at this Hospital, and there- fore an approximation to the problems to be considered. Future multicenter studies with an outpatient population are necessary to expand our knowledge and to contribute to a rational use of these drugs.

Introdução: indicações off-label, margem terapêutica estreita, variabilidade farmacocinética, interações farmacológicas são alguns dos problemas a serem abordados no uso crônico de drogas antiepilépticas (EA). Caracterizar seu perfil de uso é necessário para promover sua prescrição racional. Objetivo: descrever o perfil de utilização da AE em crianças menores de 15 anos internadas no Centro Hospitalar Pereira Rossell entre 01/07/2020 e 31/12/2020. Material e Métodos: estudo descritivo de crianças menores de 15 anos internadas em cuidados moderados em tratamento de EA. Variáveis: tipo e número de EAs, motivo da indicação, via de administração, dose, uso associado a psicotrópicos, adesão. Resultados: 113 pacientes receberam EA, com meia idade de 7 anos, 50,4% do sexo feminino. Motivo da indicação: epilepsia (grupo A) 50,4% e outras patologias (grupo B) 49,6%. Mediana de idade: 2,7 anos grupo A vs. 11,5 anos grupo B. O EA mais indicado foi Levetiracetam no grupo A (35%) e ácido valpróico no grupo B (35,7%). A associação com psicotrópicos foi registrada em 8,7% do grupo A vs. 44,6% no grupo B. Conclusões: o uso de Levetiracetam em pacientes epilépticos predominou. A metade dos pacientes recebeu AE por outras patologias que não foram a epilepsia, principalmente psiquiátricas. Nesse grupo, predominou o uso do ácido valpróico. A análise desta série permite aproximar o conhecimento do perfil de uso da AE nas crianças atendidas nesse centro e, portanto, a aproximação aos principais problemas a serem abordados. Futuros estudos multicêntricos com população ambulatorial são necessários para aprimorar o conhecimento e contribuir para sua utilização racional.

Infecciones fúngicas invasivas en niños hospitalizados en un centro de referencia de Uruguay / Invasive fungal infections in children hospitalized at a pediatric reference hospital in Uruguay / Infecções fúngicas invasivas em crianças internadas em um centro hospitalar de referência no Uruguai

Introducción: las infecciones fúngicas invasivas (IFI) son un problema de salud en creciente aumento. Objetivo: describir las características epidemiológicas, microbiológicas y clínicas de los menores de 15 años con IFI hospitalizados en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell entre 2010- 2019. Metodología: estudio retrospectivo, mediante revisión de historias clínicas. Variables: edad, sexo, comorbilidades, factores de riesgo, clínica, patógenos, tratamiento y evolución. Resultados: se registraron 26 casos de IFI en 23 niños. La mediana de edad fue 8 años, de sexo femenino 17, con comorbilidades 17: infección por VIH 5, enfermedad hematooncológica 4. Todos presentaban factores de riesgo para IFI. Las manifestaciones clínicas de sospecha fueron: fiebre en 19, síntomas neurológicos 11, respiratorios 9, gastrointestinales 6, urinarios 2, sepsis/shock en 3. Los agentes identificados fueron: Candida spp en 14, Cryptococcus neoformans complex 8 y Aspergillus fumigatus complex 4. Tratamiento: se indicó fluconazol en 15, asociado a anfotericina B 11. Todas las infecciones por candida fueron sensibles a los azoles. Fallecieron 7 niños, la mediana de edad fue 1 año. En 4 se identificó Candida spp, Aspergillus fumigatus complex 2 y Cryptococcus neoformans complex 1. Conclusiones: las IFI son poco frecuentes, afectan en su mayoría a niños inmunocomprometidos asociando elevada mortalidad. El diagnóstico requiere alto índice de sospecha. Candida spp y Cryptococcus spp fueron los agentes más involucrados. El inicio precoz del tratamiento acorde a la susceptibilidad disponible se asocia a menor mortalidad.

Summary: Introduction: invasive fungal infections (IFI) are an increasing health problem. Objective: describe the epidemiological, microbiological and clinical characteristics of children under 15 years of age with IFI hospitalized at the Pereira Rossell Hospital Center between 2010-2019. Methodology: retrospective study, review of medical records. Variables: age, sex, comorbidities, risk factors, symptoms, pathogens, treatment and evolution. Results: 26 cases of IFI were recorded involving 23 children. Median age 8 years, female 17, comorbidities 17, HIV infection 5, hematological-oncological disease 4. All with risk factors. Suspicion symptoms: fever 19, neurological symptoms 11, respiratory 9, gastrointestinal 6, urinary 2, sepsis / shock 3. Identified agents: Candida spp 14, Cryptococcus neoformans complex 8 and Aspergillus fumigatus complex 4. Treatment: fluconazole 15, associated with amphotericin B 11. All candida infections were sensitive to azoles. 7 died, median age 1 year. In 4, Candida spp was isolated, Aspergillus fumigatus complex in 2 and Cryptococcus neoformans complex in 1. Conclusions: IFI are rare, mostly affecting immunocompromised children, associated with high mortality. The diagnosis requires a high index of suspicion. Candida spp and Cryptococcus spp were the most involved agents. Early treatment according to available susceptibility is associated with lower mortality.

Introdução: as infecções fúngicas invasivas (IFI) são um problema de saúde crescente. Objetivo: descrever as características epidemiológicas, microbiológicas e clínicas de crianças menores de 15 anos com IFI internadas no Centro Hospitalar Pereira Rossell entre 2010 e 2019. Metodologia: estudo retrospectivo, revisão de prontuários. Variáveis: idade, sexo, comorbidades, fatores de risco, sintomas, patógenos, tratamento e evolução. Resultados: foram registrados 26 casos de IFI em 23 crianças. Idade mediana 8 anos, sexo feminino 17, comorbidades 17, infecção por HIV 5, doença hemato-oncológica 4. Todos com fatores de risco. Suspeita clínica: febre 19, sintomas neurológicos 11, respiratórios 9, gastrointestinais 6, urinários 2, sepse/choque 3. Agentes identificados: Candida spp 14, Cryptococcus neoformans complexo 8 e Aspergillus fumigatus complexo 4. Tratamento: fluconazol 15, associado à anfotericina B 11. Todas as infecções por cândida foram sensíveis aos azóis. 7 morreram, idade média de 1 ano. Em 4 das crianças Cândida spp foi isolada, Aspergillus fumigatus complexo em 2 e Cryptococcus neoformans complexo em 1. Conclusões: IFIs são raras, afetando principalmente crianças imunocomprometidas, associadas a alta mortalidade. O diagnóstico requer alto índice de suspeita. Cândida spp e Cryptococcus spp são os agentes mais envolvidos. O tratamento precoce de acordo com a suscetibilidade disponível está associado a menor mortalidade.

Incidencia de endocarditis infecciosa en un servicio de neonatología centro de referencia nacional en el período 2009-2019 / Incidence of infective endocarditis in a national reference neonatology department in 2009-2019 / Incidência de endocardite infecciosa no departamento de neonatologia de referência nacional no período 2009-2019

La endocarditis infecciosa es una enfermedad rara en pediatría, principalmente en la etapa neonatal pero con una importante morbimortalidad. Existen factores de riesgo definidos, sin embargo el diagnóstico, principalmente en recién nacidos, continúa siendo un desafío. En este trabajo se presenta un relevamiento en 10 años, 5 casos de endocarditis infecciosa confirmada en recién nacidos y se analizan las características clínicas, estudios paraclínicos, agentes infeccioso, tratamiento realizado y asociación con factores de riesgo en esta población.

Infective endocarditis is a rare disease in pediatrics, mainly in neonates, even though it involves significant morbidity and mortality. There are defined risk factors; however, regarding diagnosis and mainly for the case of newborns, it continues to be a challenge. In this paper, we present a 10-year research and follow-up of 5 confirmed cases of infective endocarditis in newborns and their clinical characteristics, paraclinical studies, infectious agents, treatment and association with risk factors in this population

A endocardite infecciosa é uma doença rara em pediatria, principalmente na fase neonatal, mas apresenta significativa morbidade e mortalidade. Existem fatores de risco definidos, porém o diagnóstico, principalmente em recém-nascidos, continua sendo um desafio. Este paper apresenta uma pesquisa de 10 anos de 5 casos de endocardite infecciosa confirmada em recém-nascidos e analisa as suas características clínicas, estudos para clínicos, agentes infecciosos, tratamento e associação com fatores de risco nesta população.

The impact of the COVID-19 pandemic on theatre use at the rahima moosa mother and child hospital

SARS-COV-2, the viral pathogen that resulted in the COVID-19 pandemic, was first identified by the World Health Organization (WHO) on 31 December 2019. Efforts to curb the spread of this virus, as well as the effects of viral infections and resulting complications thereof, have placed immense strain on healthcare systems throughout the world. In South Africa, a nationwide lockdown was instituted on 27 March 2020 which resulted in the suspension of all elective surgical services. The effect of this suspension of services has not been fully elucidated, but it has been postulated that a significant surgical backlog may have been created due to limited resources and massive pre-existing patient loads. Methods: We conducted a retrospective descriptive review of theatre records at the Rahima Moosa Mother and Child Hospital (RMMCH) for the time period 1 March 2019 to 28 February 2021. Results: A total of 8 176 cases amounting to 9 656 hours and 20 minutes of theatre time occurred from 1 March 2019 to 29 February 2020 (pre-COVID-19). From 1 March 2020 to 28 February 2021 (post-COVID-19), a total of 7 717 cases amounting to 9 148 hours and 2 minutes were conducted. This calculated to a 5.61% reduction in cases and a 5.26% reduction in theatre hours. There was a statistically significant reduction in theatre use both in terms of cases done and hours of theatre time after the onset of the COVID-19 pandemic. Conclusion: The onset of the COVID-19 pandemic significantly reduced the number of cases completed at the RMMCH. It also led to a significant reduction in total theatre use. Both of these findings were most pronounced in elective gynaecology and paediatric surgery services. There was, however, no statistically significant increase in intensive care unit (ICU) and high care (HC) admissions as well as mortalities for the period studied

Poisonous substances and geographical distribution of poisoning in hospitalized children based on data from 25 hospitals in China from 2016 to 2020 / 中华儿科杂志

Objective: To investigate the poisonous substances and geographical distribution of poisoning in children in China. Methods: A cross-sectional study. The clinical data of 8 385 hospitalized children from January 2016 to December 2020 were extracted from the FUTang Updating Medical Records database. These children aged 0 to 18 years and were admitted due to poisoning. They were grouped according to age (newborns and infants, toddlers, preschoolers, school-age children, adolescents), place of residence (Northeast China, North China, Central China, East China, South China, Southwest China, Northwest China), and mode of discharge (discharge under medical advice, transfer to another hospital under medical advice, discharge without medical advice, death, other). The poisonous substance and causes of poisoning in different groups were analyzed. Results: Among these 8 385 children, 4 734 (56.5%) were male and 3 651 (43.5%) female, with a male-to-female ratio of 1.3∶1. The age was 3 (2, 7) years. The prevalence of poisoning was 51.8% (4 343/8 385) in toddlers, 16.5% (1 380/8 385) in adolescents, 14.8% (1 242/8 385) in preschoolers, 14.4% (1 206/8 385) in school-age children, and 2.5% (214/8 385) in newborns and infants. Drug poisoning accounted for 43.5% (3 649/8 385) and pesticide accounted for 26.8% (2 249/8 385). Drug poisoning was more common in adolescents (684/1 380, 49.6%) and toddlers (2 041/4 343, 47.0%); non-drug poisoning was more common in school-age children (891/1 206, 73.9%), of which carbon monoxide was mainly in newborns and infants (41/214, 19.2%) and food poisoning in children of school age (241/1 206, 20.0%). Regarding regional characteristics, drug poisoning was more frequent in South China (188/246, 64.2%) and non-drug poisoning was more frequent in Southwest China (815/1 123, 72.5%). For drugs, anti-epileptic drugs, sedative-hypnotic drugs and anti-Parkinson's disease drugs had a higher proportion of poisoning in North China (138/1 034, 13.0%) than that in other regions. For non-drug poisoning, pesticides (375/1 123, 33.3%), food poisoning (209/1 123, 18.6%) and contact with poisonous animals (86/1 123, 7.7%) were more common in Southwest China than in other regions; carbon monoxide poisoning was more common in North China (81/1 034, 7.6%) and Northwest China (65/1 064, 6.3%). In Central China, poisoning happened more in toddlers (792/1 295, 61.2%) and less in adolescents (115/1 295, 8.8%) than in other regions. Regarding different age groups, poisoning in adolescent happened more in Northeast China (121/457, 26.5%), North China (240/1 034, 23.2%), and Northwest China (245/1 064, 23.0%). The rate of discharge under medical advice, discharge without medical advice, and mortality rate within the 5 years were 77.0% (6 458/8 385), 20.8% (1 743/8 385), 0.5% (40/8 385), respectively. Conclusions: Poisoning is more common in male and toddlers. Poisonous substances show a regional characteristic and vary in different age groups, with drugs and insecticides as the most common substances.

Etiology composition and prognosis of pediatric chronic critical illness in a pediatric intensive care unit / 中国当代儿科杂志

OBJECTIVES@#To explore the etiology composition and outcomes of pediatric chronic critical illness (PCCI) in the pediatric intensive care unit (PICU).@*METHODS@#The children who were hospitalized in the PICU of Dongguan Children's Hospital Affiliated to Guangdong Medical University and met the diagnostic criteria for PCCI from January 2017 to December 2022 were included in the study. The etiology of the children was classified based on their medical records and discharge diagnoses. Relevant clinical data during hospitalization were collected and analyzed.@*RESULTS@#Among the 3 955 hospitalized children in the PICU from January 2017 to December 2022, 321 cases (8.12%) met the diagnostic criteria for PCCI. Among the 321 cases, the most common etiology was infection (71.3%, 229 cases), followed by unintentional injury (12.8%, 41 cases), postoperation (5.9%, 19 cases), tumors/immune system diseases (5.0%, 16 cases), and genetic and chromosomal diseases (5.0%, 16 cases). Among the 321 cases, 249 cases (77.6%) were discharged after improvement, 37 cases (11.5%) were discharged at the request of the family, and 35 cases (10.9%) died in the hospital. Among the deaths, infection accounted for 74% (26/35), unintentional injury accounted for 17% (6/35), tumors/immune system diseases accounted for 6% (2/35), and genetic and chromosomal diseases accounted for 3% (1/35). From 2017 to 2022, the proportion of PCCI in PICU diseases showed an increasing trend year by year (P<0.05). Among the 321 children with PCCI, there were 148 infants and young children (46.1%), 57 preschool children (17.8%), 54 school-aged children (16.8%), and 62 adolescents (19.3%), with the highest proportion in the infant and young children group (P<0.05). The in-hospital mortality rates of the four age groups were 14.9% (22/148), 8.8% (5/57), 5.6% (3/54), and 8.1% (5/62), respectively. The infant and young children group had the highest mortality rate, but there was no statistically significant difference among the four groups (P>0.05).@*CONCLUSIONS@#The proportion of PCCI in PICU diseases is increasing, and the main causes are infection and unintentional injury. The most common cause of death in children with PCCI is infection. The PCCI patient population is mainly infants and young children, and the in-hospital mortality rate of infant and young children with PCCI is relatively high.

Epidemiological characteristics of human adenovirus 2, 3 and 7 genetypes in hospitalized children with respiratory infection in a hospital of pediatric in Hebei Province from 2018 to 2020 / 中华预防医学杂志

Objective: To investigate the epidemiological characteristics of human adenovirus (HADV) 2, 3 and 7 in hospitalized children with respiratory infection. Methods: A total of 25 686 children with respiratory infection hospitalized at Children's Hospital of Hebei Province from January 2018 to December 2020 were retrospectively included.Deep sputum or nasopharyngeal aspirates of those children were collected. Then thirteen common respiratory pathogens were detected by multiplex PCR. 510 HADV positive specimens were randomly selected via random number and classified for type 2, 3 and 7 using a multiplex real-time quantitative PCR. SPSS 21.0 software was used to perform all of the statistical analyses. Enumeration data were expressed by frequency and percentage. χ2 test was used for comparison between groups. Results: The HADV-positive rate was 7.99% (2 052/25 686). Children at age 3-<6 years had the highest HADV-positive rate (11.44%). The HADV-positive rate in 2019 was highest (10.64%). Among the 510 HADV-positive specimens, the proportion of type 3 was the highest (31.16%), followed by type 7 (21.37%) and type 2 (11.18%). The rate of type 2 in 2019 was significantly lower than that in 2018 and 2020 (χ2=8.954 and 16.354; P=0.003 and <0.01), while the rate of type 3 was significantly higher than that in 2018 and 2020 (χ2=5.248 and 4.811; P=0.022 and 0.028). The rate of type 2, type 3 and type 7 were lowest in winter, spring and autumn, respectively. The rate of type 2 increased significantly in autumn and the rate of type 3 and type 7 increased significantly in winter.The co-detection rate of HADV with other respiratory pathogens was 43.33%(221/510). Among, the co-detection rate of type 3 was highest (47.32%), and the co-detection rate of type 2, 3 and 7 was significantly higher than the alone detection rate (χ2=20.438, P<0.01; χ2=42.105, P<0.01; χ2=27.573, P<0.01).The proportion of severe pneumonia in children with type 7 positive (15.89%) was higher than that in children with non-type 7 positive (8.23%) (χ2=5.260, P=0.022). Conclusion: HADV is one of the important pathogens of children with respiratory infection in Children's Hospital of Hebei Province. The susceptible population of HADV is preschool children aged 3 to 6 years. HADV often co-detects with other respiratory pathogens. Type 3 and 7 is likely to be the dominant genotypes in this region, and type 7 may be one of the risk factors of severe pneumonia in children.

La madre acompañante en los servicios pediátricos, ejemplo del pensamiento humanista de Fidel / The Accompanying Mother in Pediatric Services, An Example of Fidel's Humanist Thought

Introducción: El desarrollo de la pediatría en Villa Clara tiene una rica historia e importantes contribuciones de grandes personalidades. Una de ellas, fue la incorporación de la madre acompañante en los servicios pediátricos, controversial decisión inicialmente no bien comprendida, que se desarrolló en la provincia en 1968. Objetivo: Explicar el surgimiento de la madre acompañante en los servicios pediátricos de Villa Clara. Métodos: Para analizar el objeto de estudio se realizó una investigación histórica durante el año 2019 mediante el método teórico, que se sustenta en la interacción de lo histórico y lo lógico desde las dimensiones temporal y espacial; y el empírico, consistente en la revisión de fuentes primarias (análisis documental) y secundarias (incluido entrevistas con informantes clave), seguidos por la triangulación metodológica para arribar a consideraciones integradoras. Resultados: Se identificaron destacadas figuras de la especialidad de Pediatría en Villa Clara, y su contribución a la incorporación de la madre acompañante en los hospitales pediátricos. Conclusiones: Los servicios pediátricos de Villa Clara fueron pioneros en la incorporación del modelo de la madre acompañante y su generalización contó con el apoyo del líder histórico de la Revolución, Fidel Castro Ruz(AU)

Introduction: The development of pediatrics in Villa Clara has a rich history and important contributions from great personalities. One of them was the incorporation of the accompanying mother in the pediatric services, a controversial decision initially not well understood, which was developed in the province in 1968. Objective: To explain the emergence of the accompanying mother modality in the pediatric services of Villa Clara. Methods: To analyze the object of study, a historical research was carried out during 2019 using the theoretical method, which is based on the interaction of the historical and the logical from the temporal and spatial dimensions; and the empirical one, consisting in the review of primary sources (documentary analysis) and secondary sources (including interviews with key informants), followed by methodological triangulation to arrive at integrative considerations. Results: Outstanding figures of the specialty of Pediatrics in Villa Clara were identified, and their contribution to the incorporation of the accompanying mother modality in pediatric hospitals. Conclusions: The pediatric services of Villa Clara were pioneers in the incorporation of the accompanying mother model and its generalization had the support of the historical leader of the Revolution, Fidel Castro Ruz(AU)

A experiência vivenciada pelo cuidador da criança/adolescente que enfrenta uma doença limitante da vida / The lived experience of the caregiver of a child/adolescent facing a life-limiting illness / La experiencia vivida por el cuidador de un niño/adolescente que se enfrenta a una enfermedad que limita su vida

Este estudo qualitativo teve como objetivo compreender a experiência vivenciada pelo cuidador da criança/adolescente que enfrenta uma doença limitante da vida. Para tanto, foram entrevistados seis pais de crianças e adolescentes que se encontravam hospitalizados, com diagnósticos variados, em sua maior parte por doenças onco-hematológicas. Os dados foram coletados por meio de entrevista semiestruturada aplicada individualmente. A análise mostrou que, ao receber o diagnóstico da doença grave de um(a) filho(a) predominaram reações de surpresa, tristeza, desespero e relutância inicial em aceitar o diagnóstico. Sentimentos de medo, desconforto e vivências de culpa permearam a trajetória dos pais no adoecer do(a) filho(a). Crianças e adolescentes com diagnósticos limitantes da vida exigem tratamento intensivo e de alta complexidade tecnológica. A hospitalização aparece como um momento especialmente difícil para os pais, gerando fadiga crônica, esgotamento físico e emocional. Na percepção dos pais, a comunicação com os profissionais foi satisfatória, sendo vista como um fator positivo que contribui para amenizar as dificuldades de enfrentar as situações críticas. A experiência paterna frente à doença limitante da vida foi considerada um fator de mudança de vida. Esses resultados mostram a necessidade de intervenções psicológicas de apoio para auxiliarem os pais e demais familiares a enfrentarem os desafios encontrados.

This qualitative study aimed to understand the lived experience of the caregiver of a child/adolescent facing a life-limiting illness. To this end, six parents of children and adolescents who were hospitalized, with varied diagnoses, mostly due to onco-hematological diseases, were interviewed. The data were collected through semi-structured interviews applied individually. The analysis showed that, upon receiving the diagnosis of a child's serious disease, there were predominant reactions of surprise, sadness, despair, and initial reluctance to accept the diagnosis. Feelings of fear, discomfort, and experiences of guilt permeated the parents' trajectory in their child's illness. Children and adolescents with life-limiting diagnoses require intensive treatment and high technological complexity. Hospitalization appears as an especially difficult time for parents, generating chronic fatigue, physical and emotional exhaustion. In the perception of parents, communication with professionals was satisfactory, being seen as a positive factor that contributes to ease the difficulties of facing critical situations. The father's experience facing life limiting illness was considered a life changing factor. These results show the need for psychological support interventions to help parents and other family members to face the challenges encountered.

Este estudio cualitativo tenía como objetivo comprender la experiencia vivida por el cuidador de un niño/adolescente con una enfermedad que limita su vida. Se entrevistó a seis padres de niños y adolescentes hospitalizados, con diversos diagnósticos, en su mayoría debidos a enfermedades oncohematológicas. Los datos se recogieron mediante entrevistas semiestructuradas aplicadas individualmente. El análisis mostró que, al recibir el diagnóstico de una enfermedad grave del niño, predominaron las reacciones de sorpresa, tristeza, desesperación y reticencia inicial a aceptar el diagnóstico. Los sentimientos de miedo, malestar y experiencias de culpa impregnaron la trayectoria de los padres en la enfermedad de su hijo. Los niños y adolescentes con diagnósticos que limitan su vida requieren un tratamiento intensivo y una alta complejidad tecnológica. La hospitalización aparece como un momento especialmente difícil para los padres, generando fatiga crónica y agotamiento físico y emocional. En la percepción de los padres, la comunicación con los profesionales fue satisfactoria, siendo vista como un factor positivo que contribuyó a mitigar las dificultades para enfrentar situaciones críticas. La experiencia paterna de enfrentarse a una enfermedad que limita la vida se consideró un factor de cambio de vida. Estos resultados ponen de manifiesto la necesidad de realizar intervenciones de apoyo psicológico para ayudar a los padres y a otros miembros de la familia a enfrentarse a los retos encontrados.

Características clínicas y epidemiológicas asociadas con internación en niños con COVID-19 en un hospital pediátrico de alta complejidad: Estudio de cohorte enero-marzo 2022 / Clinical and epidemiologic characteristics associated with hospital admission in children with COVID19 in a tertiary-care pediatric hospital: A January-March 2022 cohort study

Introducción: La proporción de casos reportados de niños y adolescentes con COVID-19 aumenta progresivamente. La hospitalización relacionada con COVID-19 en niños es infrecuente, pero causa morbilidad y sobrecarga al sistema de salud. Objetivos: Describir las características clínicas y evolutivas de los niños con diagnóstico de COVID-19 en un hospital pediátrico de alta complejidad. Comparar los pacientes que requirieron internación y los que no. Material y métodos: Cohorte prospectiva. Se incluyeron todos los pacientes con diagnóstico virológico de COVID-19 desde 1.1.2022 a 1.3.22 en un hospital pediátrico de alta complejidad. Se compararon los antecedentes, características clínicas y evolutivas de los pacientes según requirieran o no internación. Se utilizó STATA 16. Resultados: n: 1764 pacientes, de ellos 958 eran varones (54%). La mediana de edad fue 56 meses (RIC 17-116). Tenían enfermedad de base 789 pacientes (46%). Las más frecuentes fueron: enfermedad oncohematológica 215 (12%), neurológica 103 pacientes (6%) , enfermedad pulmonar crónica 68 (4%), cardiopatías congénitas 65 (4%) y síndrome genético 57 pacientes (3%). Eran inmunosuprimidos: 292 (17%). Presentaron síntomas relacionados con COVID-19 1319 pacientes (79%). Requirieron internación 591 (34%). Tuvieron coinfección con otros virus respiratorios 33 pacientes (2%). Ingresaron a Cuidados intensivos en relación a la COVID-19 22 pacientes (1.3%) y fallecieron en relación con la infección 8 (0.5%). En el análisis univariado, la presencia de comorbilidades, la coinfección viral y la inmunosupresión se asociaron estadísticamente con el requerimiento de internación. El antecedente de 2 o más dosis de vacuna para SARS-CoV-2 fue un factor protector para la internación en los mayores de 3 años. En el modelo multivariado, los pacientes menores de 3 años (OR 6.5, IC95% 1.2-36.8, p 0.03), con comorbilidades (OR 2.04, IC 95% 1.7- 3.3, p 0.00) y los huéspedes inmunocomprometidos (OR 2.89, IC95% 2.1-4.1, p 0.00) tuvieron más riesgo de internación. Ajustado por el resto de las variables, haber recibido dos o más dosis de vacuna fue un factor protector para la internación (OR 0.65, IC 95% 0.49-0.87, p<0.01). Conclusiones: En este estudio de cohorte prospectivo de niños con diagnóstico confirmado de COVID-19 predominó la enfermedad sintomática. Fueron admitidos en relación con el COVID-19, 34% de los pacientes. La vacunación con dos o más dosis fue un factor protector para la internación en el modelo multivariado. Además, se asociaron estadísticamente con la hospitalización, la edad menor de 3 años, las comorbilidades previas y la inmunosupresión (AU)

Introduction: The rate of reported cases of children and adolescents with COVID-19 is progressively increasing. COVID-19-related hospital admission in children is uncommon, but leads to morbidity and places a burden on the healthcare system. Objectives: To describe the clinical characteristics and outcome of children diagnosed with COVID-19 in a pediatric tertiary-care hospital and to compare patients who required hospital admission with those who did not. Material and methods: A prospective cohort study. All patients with a virological diagnosis of COVID-19 seen between 1.1.2022 and 1.3.22 in a tertiary-care pediatric hospital were included. We compared patient history, clinical characteristics, and outcome according to whether or not they required hospital admission. STATA 16 was used. Results: n: 1764 patients, 958 of whom were male (54%). The median age was 56 months (IQR, 17- 116). Overall, 789 patients had an underlying disease (46%), the most frequent of which were hematology-oncology disease in 215 patients (12%), neurological disease in 103 (6%), chronic lung disease in 68 (4%), congenital heart disease in 65 (4%), and a genetic syndrome in 57 (3%); 292 were immunosuppressed (17%). Overall, 1319 patients (79%) had COVID-19-related symptoms and 591 (34%) required hospital admission. A coinfection with other respiratory viruses was observed in 33 patients (2%). Intensive care admission due to COVID-19 was required in 22 patients (1.3%) and 8 (0.5%) died with COVID-19. In univariate analysis, the presence of comorbidities, viral coinfecton, and immunosuppression were statistically significantly associated with the need for hospitalization. A history of two or more doses of the SARSCoV2 vaccine was a protective factor against hospital admission in children older than 3 years. In the multivariate model, patients younger than 3 years (OR 6.5, 95% CI 1.2-36.8, p 0.03), with comorbidities (OR 2.04, 95%CI 1.7-3.3, p 0.00) and immunocompromised hosts (OR 2.89, 95% CI 2.1-4.1, p 0.00) had a higher risk of hospital admission. When adjusting for the remaining variables, having received two or more doses of the vaccine was found to be a protective factor against hospital admission (OR 0.65, 95% CI 0.49-0.87, p<0.01). Conclusions: In this prospective cohort study of children with a confirmed diagnosis of COVID-19, symptomatic disease predominated. Thirty-four percent of the patients were admitted for COVID-19. Vaccination with two or more doses was a protective factor against hospitalization in the multivariate model. In addition, age younger than 3 years, previous comorbidities, and immunosuppression were statistically associated with hospital admission (AU)

Rol de enfermería en el área COVID en un hospital pediátrico de alta complejidad / The role of nurses in the COVID area in a pediatric tertiary-care hospital

Introducción: la pandemia por SARS-CoV-2 planteó un desafío para todo el equipo de salud. Fue necesario analizar y pensar en este contexto el rol de enfermería en la atención y cuidados del paciente y su familia. Los procesos asistenciales debieron adaptarse a nuevas y diversas situaciones que generaron la atención de pacientes en su mayoría con comorbilidades asociadas. El objetivo del trabajo fue describir el rol de enfermería y la implementación de diversos protocolos y procesos de atención de pacientes en salas de internación pediátrica del área COVID de un hospital de alta complejidad. Material y métodos: se realizó un estudio retrospectivo y descriptivo sobre el personal de enfermería que participó en la atención de casos sospechosos o confirmados de COVID-19 durante la pandemia y los protocolos implementados para los cuidados de enfermería. Resultados: solo el 52.5% (n 79) del personal tenía experiencia mayor a tres años, el 75% (n: 113) pertenecían al género femenino, el 47% (n: 71) eran licenciados en enfermería. Conclusiones: Los profesionales enfermeros han logrado mediante sus fortalezas disciplinares dar respuesta a las necesidades del paciente pediátrico y su familia frente a la crisis sanitaria. Las competencias desarrolladas en la administración de los recursos disponibles, la adaptación, flexibilidad a los procesos y líneas estratégicas en tiempo real, posicionan al enfermero como un valor fundamental en el cuidado asistencial (AU)

Introduction: The SARS CoV-2 pandemic posed a challenge for the entire healthcare team. It was necessary to analyze and reflect on the role of nursing in the care of patients and their families in this context. Care processes had to be adapted to new and diverse situations that were generated by the care for patients who usually had associated comorbidities. The aim of the study was to describe the nursing role and the implementation of different protocols and processes for patient care in pediatric inpatient wards in the COVID area of a tertiary-care hospital. Material and methods: a retrospective descriptive study was conducted in the nursing personnel involved in the care of suspected or confirmed cases of COVID-19 during the pandemic and the protocols implemented for nursing care. Results: only 52.5% (n: 79) of the personnel had more than three years of experience, 75% (n: 113) were female, and 47% (n: 71) had a nursing degree. Conclusions: Through their disciplinary strengths, nursing professionals have been able to respond to the needs of pediatric patients and their families in the face of the health crisis. The skills developed in the management of available resources, adaptation, and flexibility to processes and real-time strategies, have positioned nurses as a fundamental factor in healthcare (AU)

Enfermedades invasoras por Streptococcus pyogenes en población pediátrica. Caracterización clínico-molecular 2014-2020 / Invasive diseases due to Streptococcus pyogenes in the pediatric population. Clinical-molecular characterization 2014-2020

INTRODUCCIÓN: Streptococcuspyogenes (EGA) es agente de enfermedad invasora (EI); su alta morbimortalidad exige vigilancia epidemiológica. OBJETIVO: Describir características clínicas y epidemiológicas de niños hospitalizados con EI por EGA en un centro de referencia de Uruguay del 1/1/2014 al 31/12/2020 incluyendo el estudio de los factores de virulencia encontrados en las cepas aisladas. MATERIALES Y MÉTODOS: Descriptivo y retrospectivo. Definición de caso: aislamiento de EGA. en sitios estériles. Variables: epidemiológicas, clínicas, laboratorio, tratamiento y evolución. Se tipificó por secuenciación del gen emm. Se obtuvieron perfiles cromosómicos por digestión del ADN con la enzima SmaI. Presencia de los genes que codifican SpeB, SpeA, SpeC y Ssa, y susceptibilidad a antimicrobianos. RESULTADOS: Tasa de admisiones: 3,98/10.000. Se incluyeron 22 pacientes; infección osteoarticular (n = 11), infección pleuropulmonar (n = 6), absceso no cutáneo (n = 4) y aislamiento en sangre (n = 1). Media de edad: 44 meses; 8 fueron graves, siendo su media de edad menor (16 meses) Todas los casos con neumonías fueron graves y un paciente falleció. Se secuenciaron 12 cepas: 5 emm1 (4 emm 1.29 y 1 emm 1) y 1 de cada uno de los siguientes: emm 6.4, emm 81, emm12, emm28, emm 22, emm 87, emm 11. Todas eran SpeB+. Perfiles de toxinas: SpeA+SpeC-Ssa-(5), SpeA-SpeC+Ssa-(4) SpeA-SpeC-Ssa-(2) y SpeA-SpeC+Ssa+ (2). CONCLUSIONES: Este estudio permite dar continuidad a un estudio previo. Se logró mayor tipificación de EGA. que puede contribuir a su conocimiento clínico molecular. No hubo registro de pacientes con diagnóstico de SST ni de fascitis necrosante, a diferencia de la serie anterior.

BACKGROUND: Streptococcus pyogenes (GAS) is an agent of invasive disease (ID); its high morbidity and mortality requires epidemiological surveillance. AIM: To describe the clinical and epidemiological characteristics of children hospitalized with ID due to GAS in a reference center in Uruguay from January 1-2014 to December 31-2020, including a study of virulence factors. METHODS: Descriptive and retrospective. Case definition: Isolation of GAS in sterile sites. Variables: epidemiological, clinical, laboratory, treatment and evolution. Strains were typified by sequencing of the emm gene. Chromosomal profiles were obtained by digestion of the DNA. with the Smal enzyme. Presence of SpeB, SpeA and SpeC genes and susceptibility to antibiotics were performed. RESULTS: Admissions rate: 3.98/10,000. 22 patients were included; osteoarticular infection (n = 11), pleuropulmonary infection (n = 6), non-cutaneous abscess (n = 4) and blood isolation (n = 1). Mean age: 44 months; 8 cases were severe, their mean age was lower (16 months). All pneumonia cases were severe and one patient died. Twelve strains were sequenced: 5 emm1 (4 emm1.29 and 1 emm1) and 1 of each: emm6.4, emm81, emm 12, emm28, emm 22, emm 87, emm 11. All were SpeB+. Toxin profiles: SpeA+SpeC-Ssa-(5), SpeA-SpeC+Ssa-(4) SpeA-SpeC-Ssa-(2) and SpeA-SpeC+Ssa+(2). CONCLUSIONS: This study allows to give continuity to a previous study. Greater typing of GAS was achieved, which may contribute to its molecular clinical knowledge. There was no record of patients diagnosed with TSS or necrotizing fascitis, unlike the previous series.

El papel del padre en el cuidado del neonato en una unidad de cuidados intensivos durante la pandemia del COVID-19: una mirada desde las nuevas masculinidades / The role of the father in the care of the newborn in an intensive care unit during the COVID-19 pandemic: a perspective from the new masculinities / O papel do pai no cuidado do recém-nascido em uma unidade de terapia intensiva durante a pandemia da COVID-19: uma visão das novas masculinidades

Resumen: Objetivo: Analizar el papel del padre en el cuidado del neonato hospitalizado en una unidad de cuidados intensivos neonatal. Metodología: Se trata de un estudio de enfoque cualitativo con selección de muestreo abierto, saturación por conveniencia, entrevistas a 10 padres y 4 de ellas analizadas a través del programa Atlas Ti 8.0®, por medio de categorías y análisis de contenido. Resultados: Para hacer frente a la situación estresante de tener a su hijo en unidad de cuidados intensivos, los padres requieren capacitarse y aprender respecto de la condición de salud del niño, realizar constantemente introyección y autoanálisis reflexivo, profundizar en el componente espiritual y, como responsables económicos, enfocarse también en el trabajo. Conclusión: Se identificaron las habilidades del padre en el cuidado del neonato hospitalizado, tales como paciencia y pasión para realizar papel de padre. Se evidencia que el hombre tiene un papel fundamental en el cuidado del neonato.

Abstract: Goal. To analyze the role of the father in the care of the newborn hospitalized in a neonatal intensive care unit. Methodology. This is a qualitative approach study. The selection of open sampling, convenience saturation, interviewing 10 parents where at the end 4 were analyzed where the interviews were conducted in the Neonatal Intensive Care Units (NICU). The data was analyzed using the Atlas Ti 8.0® program through categories and content analysis. Results. Parents need to face the stressful situation of having their child in an intensive care unit, train and learn about the baby's health condition, constantly carry out introjection and reflective self-analysis, delve into the spiritual component and also focus on the I work as financial manager. Conclusion. The father's skills in the care of the hospitalized newborn were identified, such as patience and passion to perform the role of father. It is evident that man has a fundamental role in the care of the newborn.

Resumo: Objetivo: Analisar o papel do pai no cuidado do recém-nascido hospitalizado em uma unidade de terapia intensiva neonatal. Metodologia: Este é um estudo de abordagem qualitativa com seleção aberta de amostras, saturação por conveniência, entrevistas com 10 pais e 4 deles analisados através do programa Atlas Ti 8.0®, por meio de categorias e análise de conteúdo. Resultados: Para lidar com a situação estressante de ter seu filho na unidade de terapia intensiva, os pais precisam treinar e aprender sobre a condição de saúde da criança, realizar constantemente introjeção e auto-análise reflexiva, aprofundar o componente espiritual e também focar em seu trabalho como financeiramente responsável. Conclusão: As habilidades do pai no cuidado do recém-nascido hospitalizado foram identificadas, tais como a paciência e a paixão para desempenhar o papel de pai. É evidente que os homens têm um papel fundamental no cuidado do recém-nascido.