Inmigración y factores asociados con la lactancia materna. Estudio CALINA / Immigration and factors associated with breastfeeding. CALINA study

OBJETIVO: Identificar las características socioculturales, obstétricas y perinatales asociadas con la lactancia materna completa (LMC) durante 4 meses, en dependencia del origen materno. MATERIAL Y MÉTODOS: Estudio de una cohorte representativa de la población de lactantes aragoneses (n = 1.452). Se han evaluado las variables socioculturales, obstétricas y perinatológicas asociadas a la modalidad de lactancia materna, en dependencia del origen de la madre. RESULTADOS: La prevalencia de LMC en nuestro medio es más alta en las madres inmigrantes que en las de origen español. El 37,2% de las de origen español mantienen la LMC a los 4 meses frente al 43% de las inmigrantes (p = 0,039) (RR españolas/inmigrantes=0,76; IC del 95%, 0,58-0,99); a los 6 meses, esto ocurre en un 13,9% vs. 23,8%, respectivamente (p < 0,001) (RR españolas/inmigrantes=0,52; IC del 95%, 0,37-0,72). Los factores que se asocian a la LMC a los 4 meses son diferentes entre ambos grupos. Las madres de origen español tienen más edad (p = 0,002), nivel educativo (p = 0,001), paridad (p = 0,003) y mayor probabilidad de parto vaginal (p = 0,005), y sus hijos presentan mayores valores antropométricos al nacimiento. Sin embargo, en las madres inmigrantes, el mantenimiento de LMC se asocia a un mayor índice de masa corporal materno y a no trabajar fuera del domicilio. En ambos grupos, la LMC se mantiene con más frecuencia en aquellas madres que no fuman (p = 0,001). CONCLUSIONES: La prevalencia de LMC durante los primeros meses de edad es más alta en las madres inmigrantes que en las madres de origen español y los factores socioculturales, obstétricos y perinatales que se asocian a la misma son distintos en función del origen materno

OBJECTIVE: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin. MATERIAL AND METHODS: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452). RESULTS: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=0.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<0.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=0.002), have higher academic level (P=0.001), greater parity (P=0.003), and a higher probability of vaginal delivery (P=0.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=0.001). CONCLUSIONS: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin

[Immigration and factors associated with breastfeeding. CALINA study]. / Inmigración y factores asociados con la lactancia materna. Estudio CALINA.

OBJECTIVE: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin. MATERIAL AND METHODS: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452). RESULTS: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=.002), have higher academic level (P=.001), greater parity (P=.003), and a higher probability of vaginal delivery (P=.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=.001). CONCLUSIONS: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin.

Hemorragia digestiva alta: Helicobacter pylori e ingesta de ácido acetil salicílico / Upper gastrointetinal bleeding. Helicobacter pylori and intake of acetylsalicylic acid

Introducción. La hemorragia digestiva en niños requiere un adecuado diagnóstico etiológico, que variará en función de la localización, edad del paciente. Ante la presencia de hemorragia digestiva alta, se debe considerar la infección por Helicobacter pylori, ya que se asocia a gastritis crónica y desarrollo de úlcera garoduodenal. Además se deberán tener encuentra otros factores como realización de pruebas invasivas, ingesta de cuerpo extraño o tratamiento con antinflamatorios no esteroideos. Caso clínico. Describimos el caso de un niño de 11 años, que presenta una hemorragia digestiva alta asociada a enfermedad ulceropéptica por helicobacter pylori exacerbada por la ingesta de ácido acetil salicílico. Conclusiones. La infección por Helicobacter pylori puede permanecer asintomática hasta la edad adulta y aunque la primera manifestación suele ser el dolor abdominal, no deberemos olvidarla ante la presencia de hemorragia digestiva, patología poco habitual en la edad pediátrica, peor que se correlaciona con este microrganismo de manera similar a la población adulta. Se deberá descartar la presencia de otros factores de riesgo como la ingesta de ácido acetil salicílico u otros antinflamatorios no esteroideos, que pueden provocar exacerbaciones en una mucosa dañada previamente (AU)

Introduction. Gastrointestinal hemorrhage in children requires an adequate etiologic diagnosis, which depends on the location and the age of the patient. In upper gastrointestinal bleeding, Helicobacter pylori infection should be considered, because it is associated with chronic gastritis an peptic ulcer. In addition other factors such invasive techniques, foreign body ingestion or AINES therapy should be investigated. Clinical case. We report the case of a child under 11 years, who presents an upper gastrointestinal bleeding, associated with Helicobacter pylori peptic ulcer disease which was exacerbated by aspirin ingestion. Conclusions. Helicobacter pylori infection can remain asymptomatic until adulthood, and although the first manifestation is usually abdominal pain, we shouldn´t forget it in the presence of gastro intestinal bleeding, unusual disease in children, but with similar correlation that in the adult people. We should investigate other risk factors such as the ingestion of aspirin or other AINES, which cause exacerbation in a previously damaged mucosa (AU)

Trastornos paroxísticos no epilépticos en niños de 0 a 15 meses: Revisión de dos años / Non epileptic paroxismal disorders in children from 0 to 15 months. A two-year review

Introducción. Los trastornos paroxísticos no epilépticos son manifestaciones de origen brusco y breve duración. Se originan por una disfunción cerebral y tiene en común el carácter excluyente de no ser epilépticas. Objetivo. Analizar los datos epidemiológicos, clínica y evolución de estos episodios en nuestra serie. Material y métodos. Se revisaron las historias de 139 pacientes de 0 a 15 meses valorados en nuestro Servicio de Pediatría en 2007 y 2008 que presentaron al menos un episodio paroxístico y se registraron las características epidemiológicas, clínicas, actitud diagnóstico-terapéutica y evolución. Resultados. El 94,3% de los pacientes con trastornos paroxísticos fueron no epilépticos. El 67% fueron crisis febriles y el 28% afebriles. Este último grupo se clasificó en: crisis anóxicas (59%), trastornos motores (8%), trastornos secundarios a tóxicos (7,7%) o relacionados con el sueño (2,6%). El desarrollo psicomotor fue normal en todos excepto en uno. Precisaron tratamiento farmacológico (2 síndrome de Sandifer y 1 síndrome de abstinencia). Conclusiones. Los trastornos paroxísticos no epilépticos son 10 veces más frecuentes que los epilépticos, no precisan tratamiento farmacológico, pero sí normas de actuación ante las crisis, ya que a pesar de su naturaleza benigna y mejor pronóstico, causan gran angustia familiar y generan consultas frecuentes (AU)

Introduction. Non epileptic paroxismal events are clinical disorders with sudden appearance, short duration and caused by a cerebral dysfunction with the common feature to be not epileptic. Objective. Our aim was to analyze the epidemiological, clinical and evolution of these events in our series. Methods. We included 139 patients from 0 to 15 months studied in our department in 2007 and 2008 who had at least one paroxysmal event and registered the epidemiological, clinical, diagnostic, therapeutic and developmental data. Results. 94.3% of patients were non-epileptic paroxysmal events. Of these, 67% were febrile seizures and 28% were afebrile. The latter group was classified as: Anoxic events (59%), motor disorders (8%), toxic secondry disorders (7.7%) or sleep-related (2.6%), among others. Psychomotro development was normal in all cases except one. Only three patients were treated 82 Sandifer Syndrome and 1 withdrawal). Conclusion. It is estimated that non-epileptic paroxysmal disorders are 10 times more common that epilepsy, not usually require drug treatment, but a proper performance is needed because despite its benign nature and better prognosis cause great distress and generate family frequent consultations (AU)

Linfangioma quístico de localización inusual / Cystic lymphangioma in unusual location

Se describe el caso de una paciente con una masa tumoral benigna congénita, que fue detectada tras un cuadro febril agudo. La masa, de 7 cm de diámetro, estaba localizada en la región pectoral derecha y fue diagnosticada mediante resonancia magnética. Tras su extirpación, se observaba una masa quística de paredes gruesas y cubierta de tejido graso. El estudio anatomopatológico constató la existencia de quistes con contenido linfático, lo que confirmaba que se trataba de un linfangioma quístico (AU)

We report the case of a patient with a congenital benign tumor, which was incidentally discovered after acute fever. The tumor had a diameter of 7 centimetres, located in the right pectoral region and was diagnosed by MRI. The cyst was totally excised. The lesion consisted of a thick-wall cystic mass covered with fatty tissue. Histopathological examination revealed lymphatic cysts, which lead to the diagnosis of cystic lymphangioma (AU)