Dispositivo de presión positiva continua en la vía aérea de Boussignac durante el transporte interhospitalario en lactantes menores de tres meses / Boussignac continuous positive airway pressure device during inter-hospital transportation in infants aged less than three months

Fundamento: El objetivo del presente estudio es evaluar la seguridad y efectividad del dispositivo de generación de presión positiva continua en la vía aérea de Boussignac(R) (CPAPB) durante su uso en el transporte en lactantes menores de tres meses con bronquiolitis. Material y métodos: Estudio observacional analítico transversal de cuatro años de duración. Se recogieron datos de 25 lactantes que precisaron trasladado interhospitalario a la Unidad de Cuidados Intensivos Pediátrica (UCIP) de referencia con CPAPB e interfase tipo Helmet. Se registraron las caracteristicas epidemiológicas, del traslado y de la evolución en UCIP, además de los parámetros cardiorrespiratorios y gasométricos previos al traslado y a su llegada a UCIP. Resultados: La mediana del nivel de presión contínua en la vía aérea (CPAP) utilizada durante el traslado fue de 7 cm H2O (6-7,25). Ningún paciente precisó de intubación endotraqueal durante el traslado y un paciente la precisó durante las primeras seis horas de ingreso en UCIP. Los siguientes parámetros cardiorrespiratorios presentaron una mejoría estadisticamente significativa a su llegada a UCIP: score de Wood-Downes modificado [8,40 (2,1) vs 5,29 (1,68)], frecuencia respiratoria [60,72 (12,73) vs 47,28 (10,31)], frecuencia cardiaca [167,28 (22,60) vs 154,48 (24,83)] y saturación de oxígeno [92,08 (5,63) vs 97,64 (2,27)]. Conclusiones: La aplicación de CPAPB resultó ser un método de soporte respiratorio seguro en lactantes menores de tres meses. Su uso durante el transporte suposo una mejoría en los parámetros cardiorrespiratoriosl

Background: The present study aims to evaluate the safety and effectiveness of the Boussignac continuous positive airway pressure device (CPAPB) when used during the transportation of infants under three months of age with bronchiolitis. Methods: Transversal analytical observational study of four years duration. Data was collected on 25 infants who needed inter-hospital transportation to the reference Paediatric Intensive Care Unit (PICU), with CPAPB and Helmet interface. The epidemiological characteristics of the transportation and evolution in the PICU were registered, as well as the cardiorespiratory gastronomic parameters prior to transfer and on arrival at the PICU. Results: The median level of continuous airway pressure (CPAP) used during the transfer was 7 cm H2O (6-7.25). No patient required endotracheal intubation during transportation, while one patient required this during the first six hours of admission in the PICU. The following cardiorespiratory parameters presented a statistically significant improvement on arrival at the PICU: modified Wood-Downes score [8.40 (2.1) vs 5.29 (1.68)], respiratory frequency [60.72 (12.73) vs 47.28 (10.31)], cardiac frequency [167.28 (22.60) vs 154.48 (24.83)] and oxygen saturation [92.08 (5.63) vs 97.64 (2.27)]. Conclusions: Application of CPAPB proved to be a safe method of respiratory support in infants under three months of age. Its use during transportation brought an improvement in cardiorespiratory parameters

[Boussignac continuous positive airway pressure device during inter-hospital transportation in infants aged less than three months]. / Dispositivo de presión positiva continua en la vía aérea de Boussignac durante el transporte interhospitalario en lactantes menores de tres meses.

BACKGROUND: The present study aims to evaluate the safety and effectiveness of the Boussignac continuous positive airway pressure device (CPAPB) when used during the transportation of infants under three months of age with bronchiolitis. METHODS: Transversal analytical observational study of four years duration. Data was collected on 25 infants who needed inter-hospital transportation to the reference Paediatric Intensive Care Unit (PICU), with CPAPB and Helmet interface. The epidemiological characteristics of the transportation and evolution in the PICU were registered, as well as the cardiorespiratory gastronomic parameters prior to transfer and on arrival at the PICU. RESULTS: The median level of continuous airway pressure (CPAP) used during the transfer was 7 cm H2O (6-7.25). No patient required endotracheal intubation during transportation, while one patient required this during the first six hours of admission in the PICU. The following cardiorespiratory parameters presented a statistically significant improvement on arrival at the PICU: modified Wood-Downes score [8.40 (2.1) vs 5.29 (1.68)], respiratory frequency [60.72 (12.73) vs 47.28 (10.31)], cardiac frequency [167.28 (22.60) vs 154.48 (24.83)] and oxygen saturation [92.08 (5.63) vs 97.64 (2.27)]. CONCLUSIONS: Application of CPAPB proved to be a safe method of respiratory support in infants under three months of age. Its use during transportation brought an improvement in cardiorespiratory parameters.

[Successful medical treatment of spinal epidural abscess]. / Abceso Epidural espinal resuelto con tratamiento médico.

Spinal epidural abscess is rare in children. We describe the case of a 5 year old girl with vertebral osteomyelitis and spinal epidural abscess. Diagnosis was made by magnetic resonance imaging and scintigraphic study with HMDP99Tc. Treatment with intravenous cefotaxime (200mg/kg/day) and cloxacillin (200mg/kg/day) for 15 days followed by oral cloxacillin (100mg/kg/day) for a further 15 days produced a satisfactory clinical outcome.

Abceso Epidural espinal resuelto con tratamiento médico / Successful medical treatment of spinal epidural abscess

El absceso epidural espinal es una entidad rara en el niño. Se presenta el caso de una niña de 5 años con osteomielitis vertebral y absceso epidural espinal. El diagnóstico se realizó por resonancia magnética y gammagrafía con 99mTcHMDP. Se realizó tratamiento con cefotaxima (200mg/kg/día) y cloxacilina (200mg/kg/día) por vía intravenosa durante 15 días seguidos de cloxacilina oral (100mg/kg/día) con buena evolución clínica (AU)

Teratoma sacrococcígeo asociado a lipomielomeningocele / Sacrococcygeal teratoma associated with lipomyelomeningocele

El teratoma sacrococcígeo (TSC) es el tumor más frecuentemente encontrado en el periodo neonatal, con una incidencia estimada de 1/40.000 nacimientos 1,2. z. Un porcentaje de estos TSC tiene un carácter maligno o premaligno, lo que va a condicionar el tratamiento y posterior seguimiento de estos pacientes. Hasta en un 20 por ciento de los casos el TSC se asocia con alteraciones regionales como mieloceles, mielomeningoceles, hamartomas, linfangiomas o lipomielomeningocele (LMM), por lo que plantea la necesidad de un diagnóstico diferencial con estas entidades 3,4. Presentamos un caso de asociación de TSC y LMM. Se trata de un niño con una masa en la región sacra compatible con un TSC, pero en el que era evidente una alteración del tono de las extremidades inferiores junto con un esfínter anal incompetente, lo que llevó a la sospecha de que existiera alguna afectación medular asociada al TSC. La ecografía de la masa sugirió la comunicación de ésta con el canal medular. Posteriormente, la resonancia magnética nuclear (RMN) confirmó la existencia de un LMM asociado al TSC. Ambos diagnósticos condicionan tanto el manejo quirúrgico como el pronóstico funcional del niño. El seguimiento postoperatorio de estos enfermos es imprescindible y los niveles de alfafetoproteína en suero constituyen un buen marcador para descartar posibles recurrencias de carácter maligno (AU)

[Neonatal sepsis caused by Streptococcus agalactiae. What should be done?]. / Sepsis neonatal por Streptococcus agalactiae. Qué hacer?

OBJECTIVE: Within the common pathogenic flora responsible for neonatal sepsis, streptococci group B (SGB) is the most frequently found etiological agent. The fact that it is a frequent colonizer of the female perigenital area has resulted in a whole host of detection and eradication strategies via preventative measures applied to the pregnant woman to eliminate vertical transmission to the newborn. PATIENTS AND METHODS: We present a revision of SGB sepsis and our protocol based on the intrapartum treatment of those pregnant women with risk factors and the study in the newborn at risk of infection with early detection of particles of Latex in urine for SGB (Slidex Strepto B bioMerieux), as well as the customary analytical and bacteriological tests. We have also revised the different strategies in medical scientific publications and several neonatal units for the management of this infection and compare this with our protocol. RESULTS: During the period 1986-1996 the incidence of SGB sepsis was 0.9/1,000 (19 cases), with an incidence of neonatal sepsis of 4.08/1,000. The incidence of sepsis caused by Streptococcus agalactiae in our environment is low, although it has increased from 15.9% to 28% comparing the first five years with the following six years, with a fatality rate of 10.5%. We believe that the most effective strategy for this problem is intrapartum identification and treatment of the pregnant woman at risk and early diagnosis of the newborn resulting from this pregnancy. CONCLUSIONS: We based our strategy on two vias, intrapartum treatment of mothers included in the high risk infection group and in the neonatal unit by early routine detection of SGB in urine. We have obtained a low incidence rate, low mortality rate and avoid false negatives of carrier mothers.