SARS-CoV-2 infection in children requiring hospitalization: the experience of Navarra, Spain.

BACKGROUND: Coronavirus disease 2019 in children, or pediatric COVID-19, initially was described as an acute respiratory syndrome similar to the adult presentation but with less severe manifestations. METHODS: We describe the clinical characteristics, disease presentation, treatments and outcomes of all pediatric cases with COVID-19 admitted to the reference hospitals in Navarra, Spain during the first wave of the COVID-19 outbreak (February-May 2020). RESULTS: We found a low number of hospitalized cases in infants and children compared to adults with a hospitalization ratio of 1:180. Most of these hospitalized cases did not suffer from severe disease. Over 80% of infections reported household contacts, and the mother was the known-contact in 83% of these cases. 72% of hospitalized cases were previously healthy children. We describe how symptoms in pediatric cases are nonspecific and how COVID-19 can be presented with a wide range and variety of symptoms. Respiratory symptoms are not always present, and severe neurological and cardiac features can occur in previously healthy children. CONCLUSION: Epidemiological description and case reports will be key to a better recognition and to adequate treatment of pediatric patients with COVID-19.

Ingesta de yodo durante el embarazo: efectos en la función tiroidea materna y neonatal / Iodine intake during pregnancy: Effects on thyroid function in mother and child

Introduction Recent studies in Spain have shown an inadequate iodine intake in a significant proportion of pregnant women. Pregnancy increases thyroid hormone requirements, and adequate iodine intake is therefore needed. Material and methods One hundred and forty-seven women in their third trimester (week 37) of pregnancy provided a blood sample and a 24-hour urine sample to test serum and urine iodine levels and completed a food frequency questionnaire to assess iodine intake during pregnancy. Serum TSH levels were measured in the babies born to the 140 mothers in the postpartum group. Results Only 10.9% of pregnant women consumed more than 250 μg iodine daily, and 24.4% of them consumed less than 100 μg daily. Mean free T4 levels were 9.37 pmol/L, and 74 women (54.41%) had levels below the hypothyroxinemia threshold. TSH levels were normal in 135 newborns (96.4%), while 5 (3.6%) had levels higher than 5 μU/mL (AU)

Introducción En España, estudios recientes han demostrado que existe una ingesta insuficiente de yodo en un porcentaje importante de mujeres embarazadas. El embarazo supone un aumento en los requerimientos de hormonas tiroideas, para lo que es necesaria una ingesta de yodo adecuada. Material y métodos Se reclutó una muestra de 147 gestantes en el tercer trimestre de embarazo en las que se determinó la ingesta de yodo, la yoduria y la función tiroidea. Las concentraciones de TSH se determinaron en los 140 recién nacidos hijos de dichas mujeres. Resultados Solo el 10,9% de las gestantes consumen más de 250 μg de yodo diarios. La media de T4 libre fue de 9,37 pmol/L y 74 mujeres (54,41%) presentaban valores por debajo del umbral de hipotiroxinemia. Las concentraciones de TSH fueron normales en 135 recién nacidos (96,4%), mientras que en 5 (3,6%) se observaron concentraciones de TSH superiores a 5 μU/mL (AU)

[Iodine intake during pregnancy: effects on thyroid function in mother and child]. / Ingesta de yodo durante el embarazo: efectos en la función tiroidea materna y neonatal.

INTRODUCTION: Recent studies in Spain have shown an inadequate iodine intake in a significant proportion of pregnant women. Pregnancy increases thyroid hormone requirements, and adequate iodine intake is therefore needed. MATERIAL AND METHODS: One hundred and forty-seven women in their third trimester (week 37) of pregnancy provided a blood sample and a 24-hour urine sample to test serum and urine iodine levels and completed a food frequency questionnaire to assess iodine intake during pregnancy. Serum TSH levels were measured in the babies born to the 140 mothers in the postpartum group. RESULTS: Only 10.9% of pregnant women consumed more than 250 µg iodine daily, and 24.4% of them consumed less than 100 µg daily. Mean free T4 levels were 9.37 pmol/L, and 74 women (54.41%) had levels below the hypothyroxinemia threshold. TSH levels were normal in 135 newborns (96.4%), while 5 (3.6%) had levels higher than 5 µU/mL.

Indicadores de riesgo de hipoacusia neurosensorial infantil / Risk factors for sensorineural hearing loss in children

En la última década hemos asistido a un rápido y tremendo progreso en el desarrollo de los sistemas de diagnóstico y tratamiento precoz de la hipoacusia infantil dentro de programas de salud pública. El porcentaje de niños cribados anualmente en España se ha incrementado significativamente al haberse extendido los programas de atención al déficit auditivo infantil a todas las autonomías. Históricamente, los indicadores de alto riesgo han sido empleados para la identificación de los niños que debían ser evaluados audiológicamente por vivir en áreas remotas donde los programas de cribado no existían, para ayudar a identificar aquellos niños que, aunque hayan pasado el cribado, siguen presentando riesgo de desarrollar una hipoacusia diferida y para identificar los niños que presentan hipoacusias permanentes leves no detectadas en el cribado. En esta revisión se analizan los indicadores de riesgo de hipoacusia y se identifican los factores que se asocian a sus formas de presentación diferida. La recomendación establecida es que se lleve a cabo al menos una revisión audiológica entre los 24 y los 30 meses de edad en los niños con un indicador de bajo riesgo. Sin embargo, para aquellos que presenten factores de alto riesgo como la infección por citomegalovirus o antecedentes familiares de hipoacusia es apropiado realizar un seguimiento más frecuente y temprano. Para todos los niños, incluidos los que carecen de indicadores de riesgo, se debería comprobar su desarrollo global con una herramienta validada a los 8, 18, 24 y 30 meses de edad o antes si existe preocupación de los padres o cuidadores(AU)

In the last decade, tremendous progress has been made very rapidly in the development of Early Hearing Detection and Intervention (EHDI) systems as a major public health initiative. The percentage of infants screened annually in Spain has increased significantly since the EHDI systems have expanded to all autonomic regions. Historically, high risk indicators have been used for the identification of infants who should receive audio logical evaluation but who live in geographic locations where universal hearing screening is not yet available, to help identify infants who pass neonatal screening but are at risk of developing delayed-onset hearing loss and to identify infants who may have passed neonatal screening but have mild forms of permanent hearing loss. In this review, the standard risk factors for hearing loss are analysed and the risk factors known to be associated with late onset or progressive hearing loss are identified. The recommendation for infants with a risk factor that may be considered as low risk is to perform at least one audiology assessment by 24-30 months. In contrast, for an infant with risk factors known to be associated with late onset or progressive hearing loss (such as cytomegalovirus infection or family history), early and more frequent assessment is appropriate. All infants should have an objective standardised screening of global development with a validated assessment tool at 9, 18 and 24-30 months of age or at any time if the health care professional or the family is concerned(AU)

Hypothyroxinemia during pregnancy: the effect on neurodevelopment in the child.

CONTEXT: Experimental studies have shown that maternal hypothyroxinemia during early pregnancy is associated with poor neurodevelopment in affected offspring. OBJECTIVE: The aim of this study was to assess the impact of maternal serum free T4 on psychomotor development of offspring. MATERIALS AND METHODS: The study involved 147 women in the third trimester (week 37) of pregnancy. TSH and free T4 serum levels were measured at 37 week gestation. The children were evaluated between 38 and 60 months of age by the McCarthy Scales of Children's Abilities. RESULTS: 54.4% of the women had a free T4 below the threshold of hypothyroxinemia. We find a significant effect of maternal hypothyroxinemia on the general cognitive index, and on perceptual-manipulative and memory coefficients.

Risk factors for sensorineural hearing loss in children.

In the last decade, tremendous progress has been made very rapidly in the development of Early Hearing Detection and Intervention (EHDI) systems as a major public health initiative. The percentage of infants screened annually in Spain has increased significantly since the EHDI systems have expanded to all autonomic regions. Historically, high risk indicators have been used for the identification of infants who should receive audiological evaluation but who live in geographic locations where universal hearing screening is not yet available, to help identify infants who pass neonatal screening but are at risk of developing delayed-onset hearing loss and to identify infants who may have passed neonatal screening but have mild forms of permanent hearing loss. In this review, the standard risk factors for hearing loss are analysed and the risk factors known to be associated with late onset or progressive hearing loss are identified. The recommendation for infants with a risk factor that may be considered as low risk is to perform at least one audiology assessment by 24-30 months. In contrast, for an infant with risk factors known to be associated with late onset or progressive hearing loss (such as cytomegalovirus infection or family history), early and more frequent assessment is appropriate. All infants should have an objective standardised screening of global development with a validated assessment tool at 9, 18 and 24-30 months of age or at any time if the health care professional or the family is concerned.

Recomendaciones de la Comisión para la Detección Precoz de la Hipoacusia (CODEPEH) para 2010 / Early hearing detection and intervention: 2010 CODEPEH recommendation

Actualmente, el cribado auditivo neonatal se lleva a cabo de forma rutinaria en muchos de los sistemas de salud autonómicos en España. A pesar de la importante expansión del cribado de la hipoacusia desde 2000, su viabilidad y los beneficios de la identificación e intervención tempranas, aún existen importantes retos. En este artículo, la CODEPEH actualiza las recomendaciones que se consideran importantes para el futuro desarrollo de los sistemas de detección e intervención precoz en los siguientes puntos: 1. Protocolos de cribado: se recomienda seguir distintos protocolos para los niños ingresados en cuidados intensivos neonatales y los procedentes de maternidad. 2. Evaluación audiológica: se precisa contar con profesionales con experiencia en evaluación de recién nacidos y niños pequeños para completar tanto el diagnóstico como para la selección y adaptación de audioprótesis. 3. Evaluación médica: los factores de riesgo para la hipoacusia neonatal y adquirida se recogen en una única lista en lugar de estar agrupados por el momento de su aparición. Un protocolo de diagnóstico paso a paso es más eficiente y de coste efectivo que efectuar todas las pruebas simultáneamente. 4. Intervención temprana y seguimiento: todos los profesionales que atienden a niños con hipoacusia deberían contar con un entrenamiento especializado y experiencia en la audición, el habla y el lenguaje. Debe realizarse un control periódico del desarrollo de las habilidades auditivas, si existen sospechas paternas y del estado del oído medio. 5. Control de calidad: la gestión de la información como parte integral del sistema es importante para monitorizar y mejorar la calidad del servicio (AU)

Newborn hearing screening is currently performed routinely in many regional health-care systems in Spain. Despite the remarkable expansion in newborn hearing screening since 2000, its feasibility and the benefits of early identification and intervention, many major challenges still remain. In this article, the Committee for the Early Detection of Hearing Loss (Comisión para la Detección Precoz de la Hipoacusia, CODEPEH) updates the recommendations that are considered important for the future development of early hearing detection and intervention (EDHI) systems in the following points: 1. Screening protocols: Separate protocols are recommended for NICU (Neonatal Intensive Care Units) and well-infant nurseries. 2. Diagnostic audiology evaluation. Professionals with skills and expertise in evaluating newborn and young infants should provide diagnosis, selection and fitting of amplification devices. 3. Medical evaluation. Risk factors for congenital and acquired hearing loss have been combined in a single list rather than grouped by time of onset. A stepwise diagnostic paradigm is diagnostically more efficient and cost-effective than a simultaneous testing approach. 4. Early intervention and surveillance. All individuals providing services to infants with hearing loss should have specialized training and expertise in the development of audition, speech and language. Regular surveillance should be performed on developmental milestones, auditory skills, parental concerns, and middle ear status. 5. Quality control. Data management as part of an integrated system is important to monitor and improve the quality of EDHI services (AU)

[Incidence of congenital heart disease in navarra (1989-1998)]. / Incidencia de las cardiopatías congénitas en Navarra (1989-1998).

INTRODUCTION AND OBJECTIVES: Congenital cardiopathies are the most common forms of congenital malformation. They occur in between 5.2 and 12.5 in every thousand live births. The aim of this study was to describe the incidence and nature of congenital heart disease in the Spanish region of Navarra during a specified time period (1989-1998). PATIENTS AND METHOD: The study involved all children with congenital heart disease among the 47 783 born in the region in the specified time period. RESULTS: The incidence was 8.96 per thousand live births, with 90% having one of the 10 most common types of cardiac malformation. The accumulative percentage diagnosed was 25.3% in the first 24 hours of life, 45% in the first week, 65% in the first month, and 83.1% during the first year. Some 30.8% of cases of congenital heart disease required invasive treatment: 25.4% underwent surgery and 6.4%, cardiac catheterization. CONCLUSIONS: The incidence of congenital heart disease in Navarra falls within the range reported for developed countries. The level of care provided in this region is good, as demonstrated by existing diagnostic capabilities and treatment provision.

Incidencia de las cardiopatías congénitas en Navarra (1989-1998) / Incidence of congenital heart disease in Navarra (1989-1998)

Introducción y objetivos. Las cardiopatías congénitas son las malformaciones congénitas más frecuentes. Se detectan entre el 5,2 y el 12,5‰ de los recién nacidos vivos. El objetivo del presente trabajo es conocer la incidencia y la evolución de las cardiopatías congénitas en una región concreta de España (Navarra) y en un período determinado (1989-1998). Pacientes y método. Se estudian los casos de cardiopatía congénita detectados entre los 47.783 niños nacidos en dicha comunidad durante el período indicado. Resultados. Se detecta una incidencia de cardiopatías congénitas del 8,96‰ en recién nacidos vivos, el 90% de las cuales corresponde a las 10 malformaciones cardíacas más frecuentes. El porcentaje acumulado de diagnóstico es del 25,3% en las primeras 24 h de vida, del 45% en la primera semana, del 65% en el primer mes y del 83,1% durante el primer año de vida. El 30,8% de las cardiopatías congénitas requiere tratamiento invasivo: un 25,4% necesita cirugía y un 6,4% cateterismo terapéutico. Conclusiones. La incidencia obtenida en Navarra está dentro del intervalo obtenido en los países desarrollados. Tanto la capacidad diagnóstica como el manejo evolutivo de las cardiopatías congénitas hacen de Navarra una comunidad con un nivel asistencial adecuado para dicha enfermedad

Introduction and objectives. Congenital cardiopathies are the most common forms of congenital malformation. They occur in between 5.2 and 12.5 in every thousand live births. The aim of this study was to describe the incidence and nature of congenital heart disease in the Spanish region of Navarra during a specified time period (1989-1998). Patients and method. The study involved all children with congenital heart disease among the 47 783 born in the region in the specified time period. Results. The incidence was 8.96 per thousand live births, with 90% having one of the 10 most common types of cardiac malformation. The accumulative percentage diagnosed was 25.3% in the first 24 hours of life, 45% in the first week, 65% in the first month, and 83.1% during the first year. Some 30.8% of cases of congenital heart disease required invasive treatment: 25.4% underwent surgery and 6.4%, cardiac catheterization. Conclusions. The incidence of congenital heart disease in Navarra falls within the range reported for developed countries. The level of care provided in this region is good, as demonstrated by existing diagnostic capabilities and treatment provision