Mycophenolate mofetil for autoimmune cytopenias in children: high rates of response in inborn errors of immunity.

Second-line treatments of autoimmune cytopenias (AC) are not well-defined in children. Mycophenolate mofetil (MMF) is an immunosuppressant agent that has been demonstrated to be safe and effective in this setting. A retrospective observational study was conducted in 18 children with prolonged AC who received MMF, in order to describe clinical and biological markers of response. The overall response rate of MMF at 20-30 mg/kg per day was 73.3%. All patients with Evans syndrome (n = 9) achieved complete response. Among the patients with monolineage AC (n = 9), those with an underlying inborn errors of immunity (IEI), tended to respond better to MMF. No biological markers related to treatment response were found. Rather, lymphocyte subpopulations proved useful for patient selection as a marker suggestive of IEI along with immunoglobulin-level determination.

Niños con traumatismo craneal leve en urgencias: ¿es necesaria la radiografía de cráneo en pacientes menores de 2 años? / Children with minor head injury in the emergency department: Is skull radiography necessary for children under 2 years?

INTRODUCCIÓN: La mayoría de publicaciones actuales sobre el manejo del traumatismo craneoencefálico (TCE) leve ya no tienen en cuenta la presencia de una fractura craneal para determinar el riesgo del lesión intracraneal (LIC). Sin embargo, en nuestro medio sigue siendo habitual la realización de radiografías de cráneo en los niños pequeños para descartar su presencia. OBJETIVO Determinar la prevalencia de LIC clínicamente importante (LICCI) en los niños menores de 2 años con TCE leve atendidos en urgencias. PACIENTES Y MÉTODOS: Revisión retrospectiva de los informes de urgencias de los niños menores de 2 años atendidos por TCE leve (Glasgow ≥ 14 puntos) durante un año. Se define LICCI aquella LIC que tiene como consecuencia la muerte, una intervención neuroquirúrgica, ventilación mecánica o soporte inotrópico. RESULTADOS: Se incluyen 854 niños, con una mediana de edad de 11,0 meses (P25-75: 7,5-17,0 meses). Cuatrocientos cincuenta y siete (53,5%) eran varones. En 741 casos (86,8%) el mecanismo del TCE fue una caída. En 438 (51,3%) se realizó una radiografía craneal. En 11 casos (1,3%) se diagnosticó una LIC, ninguna clínicamente importante (prevalencia de LICCI en niños menores de 2 años con TCE leve: 0%; IC 95% 0-0,4%). CONCLUSIONES: Los niños menores de 2 años con TCE leve tienen un riesgo muy bajo de LICCI. La observación clínica puede considerarse como una alternativa válida a la realización de radiografías de cráneo

BACKGROUND: Current guidelines on the management of mild head trauma (traumatic braininjury/TBI) do not include the presence of a skull fracture in determining the risk of intracranial injury. However, in our setting cranial radiography is still performed frequently to rule out the presence of skull fracture. OBJECTIVE: To estimate the prevalence of clinically-important traumatic brain injuries (ciTBI)in children younger than two years of age with mild TBI. PATIENTS AND METHODS: Descriptive observational study. All children attended in emergency department with mild TBI (Glasgow ≥ 14 points) for a year were included. We defined ciTBIas intracranial injuries that caused death or required neurosurgery, intubation for morethan 24hours, inotropic drugs or mechanical ventilation. RESULTS: The study included 854 children, of which 457 (53.5%) were male. The median patient age was 11.0 months (P25-75: 7.5-17.0 months). In 741 cases (86.8%) the mechanism of TBI was a fall. In 438 cases (51.3%) skull radiography was performed. Eleven children (1.3%) had intracranial injury, but none met the criteria for ciTBI (estimated prevalence of ciTBI was0%; CI 95%: 0%-0.4%). CONCLUSION: Children younger than two years of age with mild TBI have low prevalence of ciTBI. Consequently, it is possible to monitor children younger than two years with a TBI without performing skull radiography

[Children with minor head injury in the emergency department: Is skull radiography necessary for children under 2 years?]. / Niños con traumatismo craneal leve en urgencias: ¿es necesaria la radiografía de cráneo en pacientes menores de 2 años?

BACKGROUND: Current guidelines on the management of mild head trauma (traumatic brain injury/TBI) do not include the presence of a skull fracture in determining the risk of intracranial injury. However, in our setting cranial radiography is still performed frequently to rule out the presence of skull fracture. OBJECTIVE: To estimate the prevalence of clinically-important traumatic brain injuries (ciTBI) in children younger than two years of age with mild TBI. PATIENTS AND METHODS: Descriptive observational study. All children attended in emergency department with mild TBI (Glasgow ≥14 points) for a year were included. We defined ciTBI as intracranial injuries that caused death or required neurosurgery, intubation for more than 24 hours, inotropic drugs or mechanical ventilation. RESULTS: The study included 854 children, of which 457 (53.5%) were male. The median patient age was 11.0 months (P25-75: 7.5-17.0 months). In 741 cases (86.8%) the mechanism of TBI was a fall. In 438 cases (51.3%) skull radiography was performed. Eleven children (1.3%) had intracranial injury, but none met the criteria for ciTBI (estimated prevalence of ciTBI was 0%; CI 95%: 0%-0.4%). CONCLUSION: Children younger than two years of age with mild TBI have low prevalence of ciTBI. Consequently, it is possible to monitor children younger than two years with a TBI without performing skull radiography.