¿Se realiza correctamente la punción lumbar en pediatría? Revisión de las recomendaciones actuales y análisis de la realidad / Do paediatricians perform lumbar puncture correctly? Review of recommendations and analysis the technique in Spain

Introducción: La punción lumbar (PL) es una técnica ampliamente utilizada en pediatría. La realización adecuada de la técnica puede evitar la mayoría de las complicaciones asociadas. Objetivo: Evaluar si en España los pediatras y los residentes de pediatría siguen las recomendaciones de la técnica de la PL. Material y métodos: Estudio transversal basado en un cuestionario escrito distribuido por correo electrónico a través de la Sociedad Española de Urgencias Pediátricas, que recogía datos epidemiológicos y preguntas de respuesta múltiple sobre la realización de la PL. Resultados: Se analizaron 206 cuestionarios, 143 (69,5%) respondidos por pediatras y 63 (30,5%) por residentes de pediatría. Hacen la PL sin los padres presentes 128 médicos (62,1%), aplican sedoanalgesia 198 (96,1%); 84 (42%) sólo analgesia local. Colocan al paciente sentado 108 (53,7%). La mayoría utiliza aguja tipo Quincke (126; 62,7%), orienta bien el trocar al hacer la punción 22 (36,1%) residentes y 21 pediatras (15,1%), diferencia estadísticamente significativa (p=0,001). En los neonatos, 63 (46%) pediatras y 19 (30,2%) residentes usan aguja sin fiador tipo «palomilla», diferencia también significativa (p=0,035). Reintroducen el estilete para redirigir el trocar 190 (92,2%) encuestados y para extraerlo 186 (93%). Recomiendan reposo tras la PL 195 (94,7%) médicos. Conclusiones: La mayoría de los pediatras orientan mal el trocar cuando hacen una PL y siguen utilizando aguja tipo «palomilla» en los neonatos a pesar de que está desaconsejado. Los residentes de pediatría y los pediatras con menor experiencia siguen las recomendaciones con mayor frecuencia(AU)

Introduction: Lumbar puncture (LP) is a commonly performed procedure in paediatrics. Performing this technique properly can avoid the most common associated complications. Objective: To assess whether paediatricians and paediatric residents in Spain follow current recommendations for the LP technique. Material and methods: A cross-sectional study was conducted by sending a questionnaire by mail through the Spanish Society of Paediatric Emergencies, collecting demographic information and responses to multiple choice questions about LP technique. Results: A total of 206 questionnaires were analysed, of which 143 (69.5%) were answered by paediatricians, and 63 (30.5%) by paediatric residents. The majority (128; 62.1%) of physicians did not allow parents to be present during LP, 198 (96.1%) routinely use analgesia and sedation; 84 (42%) only used local anaesthesia. The majority of respondents used standard Quincke needles (126; 62.7%). The bevel was correctly positioned when puncturing the dura mater by 22 residents (36.1%) and 21 paediatricians (15.1%), a variation that was statistically significant (P=.001). For neonatal lumbar punctures, 63 paediatricians (46%) and 19 paediatric residents used a butterfly needle which did not contain a stylet, and this difference was also statistically significant (P=.035). Of those surveyed, 190 (92.2%) re-inserted the stylet when re-orientating the needle, and 186 (93%) re-oriented this when removing it. The recommendation of bed rest was made by 195 (94.7%) physicians. Conclusions: The majority of paediatricians orient the bevel wrongly when inserting the needle during LP, and still use "butterfly" needles in newborns, despite warnings to the contrary. Paediatric residents and less experienced paediatricians follow the recommendations more frequently(AU)

[Do paediatricians perform lumbar puncture correctly? Review of recommendations and analysis the technique in Spain]. / ¿Se realiza correctamente la punción lumbar en pediatría? Revisión de las recomendaciones actuales y análisis de la realidad.

INTRODUCTION: Lumbar puncture (LP) is a commonly performed procedure in paediatrics. Performing this technique properly can avoid the most common associated complications. OBJECTIVE: To assess whether paediatricians and paediatric residents in Spain follow current recommendations for the LP technique. MATERIAL AND METHODS: A cross-sectional study was conducted by sending a questionnaire by mail through the Spanish Society of Paediatric Emergencies, collecting demographic information and responses to multiple choice questions about LP technique. RESULTS: A total of 206 questionnaires were analysed, of which 143 (69.5%) were answered by paediatricians, and 63 (30.5%) by paediatric residents. The majority (128; 62.1%) of physicians did not allow parents to be present during LP, 198 (96.1%) routinely use analgesia and sedation; 84 (42%) only used local anaesthesia. The majority of respondents used standard Quincke needles (126; 62.7%). The bevel was correctly positioned when puncturing the dura mater by 22 residents (36.1%) and 21 paediatricians (15.1%), a variation that was statistically significant (P=.001). For neonatal lumbar punctures, 63 paediatricians (46%) and 19 paediatric residents used a butterfly needle which did not contain a stylet, and this difference was also statistically significant (P=.035). Of those surveyed, 190 (92.2%) re-inserted the stylet when re-orientating the needle, and 186 (93%) re-oriented this when removing it. The recommendation of bed rest was made by 195 (94.7%) physicians. CONCLUSIONS: The majority of paediatricians orient the bevel wrongly when inserting the needle during LP, and still use "butterfly" needles in newborns, despite warnings to the contrary. Paediatric residents and less experienced paediatricians follow the recommendations more frequently.

[Complications of bladder catheterization to obtain a urine sample in the emergency department]. / Complicaciones del cateterismo vesical realizado en un servicio de urgencias para obtener una muestra de orina.

INTRODUCTION: Bladder catheterization (BC) is frequently performed to diagnose urinary tract infection (UTI) (the most common serious bacterial infection among young children). The purposes of this study were to evaluate performance and complications of BC to obtain a urine specimen. MATERIAL AND METHODS: This was a prospective study conducted in an urban children's hospital on patients who had a urine specimen obtained in the emergency department (ED) by BC between November 1, 2009 and December 15, 2009. Epidemiological data and the medical reasons why the BC was performed were reviewed. Finally, to determine the complications we contacted the family by telephone at least one month after the BC. RESULTS: A total of 126 BC were performed in 124 patients, 45 males (35.7%) and 81 female (64.3%). A urine sample was obtained in all cases. The median age was 7 months (5 days-35 months). Of the 126 urine cultures collected, 34 were positive (26.98%) and 1 was considered contaminated (0.8%). Escherichia coli was the most common pathogen (27, 79.41%). Fever (76.2%) was the main reason why BC was performed in children. Of the 116 patients contacted by telephone, only 5 mentioned complications: genital pain (3), unconfirmed hematuria (1) and UTI 12 days after (1). CONCLUSIONS: BC performed in ED to obtain a urine sample in non toilet-trained children is effective and safe. BC is an invasive method which needs to be quality controlled.

Miositis secundaria a tratamiento antitiroideo / Myositis secondary to antithyroid treatment

No disponible

[Triptorelin therapy in girls with central precocious puberty increases body mass index]. / El tratamiento con triptorelina en las niñas con pubertad precoz central provoca incremento del índice de masa corporal.

INTRODUCTION: The most important complications of central precocious puberty (CPP) in girls are loss of height and multiple psychosocial problems. OBJECTIVES: To study the effect of triptorelin therapy in a cohort of girls with CPP. PATIENTS AND METHODS: Thirty-four girls diagnosed with organic or idiopathic CPP and treated with monthly triptorelin were studied. Age, height in standard deviation (SD), bone age (Greulich and Pyle), height prediction (Bayle-Pinneau), body mass index (BMI) in SD, uterine size (pelvic ultrasound), target height, cranial magnetic resonance imaging, triptorelin dose, and treatment duration were studied. RESULTS: Triptorelin produced a statistically significant reduction in growth velocity and an increase in BMI after 1 year of therapy and these changes were maintained after discontinuation of therapy. Adult height in these patients was in accordance with their target genetic height, as well as with their predicted height according to the method of Bayley-Pinneau. No significant differences were found between age of menarche in our patients and in controls. Adult height in patients with organic CPP was significantly lower than that in patients with idiopathic CPP. CONCLUSIONS: 1. Triptorelin can increase BMI in girls with CPP. 2. The presence of an organic cause in patients with CPP worsens the prognosis for adult height. 3. The Bayley-Pinneau prediction method for "average" bone age is useful for establishing a prognosis of adult height in girls with CPP treated with triptorelin.

[Central precocious puberty is associated with a high prevalence of organic disease]. / La pubertad precoz central en niños está asociada a una elevada prevalencia de patología orgánica.

INTRODUCTION: The incidence of central precocious puberty (CPP) is lower in boys than in girls; however, the presence of organic disease is more common in boys. OBJECTIVES: To investigate the percentage of CPP secondary to organic disease in boys and to analyze their clinical and biological characteristics at diagnosis, during follow-up, and at the end of therapy. PATIENTS AND METHODS: Eight boys with a diagnosis of CPP treated with triptorelin every 28 days were included. Age, height in standard deviation (SD), body mass index (BMI) in SD, growth velocity in SD, bone age (Greulich and Pyle), predicted height (Bayle-Pinneau), and target height were analyzed. Testicular volume was measured (according to Prader standards) and peak lutein hormone (LH) values and testosterone levels were determined after gonadotropin-releasing hormone (GnRH) stimulus. RESULTS: Seventy-five percent of the patients with CPP had organic disease. After treatment with triptorelin, growth reduction significantly decreased. In contrast, no changes were seen in the difference between bone age and chronological age, due to the slight difference found at diagnosis. Likewise, during treatment, there was no LH peak and testosterone levels were lower than 0.5 ng/ml in response to GnRH stimulus. No changes were observed in weight or BMI. Three patients reached an adult height similar to their genetic height and their predicted height, as estimated by the Bayle-Pinneau method. CONCLUSIONS: 1. Among boys with CPP we found a substantial number of patients with organic disease. 2. Adult height after treatment with triptorelin can reach the normal range. 3. Determination of testosterone levels can be useful in the follow-up of these children during treatment.

El tratamiento con triptorelina en las niñas con pubertad precoz central provoca incremento del índice de masa corporal / Triptorelin therapy in girls with central precocious puberty increases body mass index

Introducción Las complicaciones más relevantes asociadas a la pubertad precoz central (PPC) en las niñas son una talla adulta baja respecto a la talla genética y desarrollar trastornos psicosociales. Objetivos Estudiar los efectos del tratamiento con triptorelina en un grupo de niñas con PPC. Pacientes y métodos Un total de 34 niñas diagnosticadas de PPC, orgánica o idiopática, tratadas con triptorelina mensual. Se estudian: edad, talla en desviaciones estándar (DE), edad ósea (Greulich y Pyle), predicción de talla (Bayle-Pinneau), índice de masa corporal (IMC) (DE), tamaño uterino (ecografía pélvica), talla diana, resonancia magnética (RM) craneal, así como la dosis de triptorelina y la duración del tratamiento. Resultados El tratamiento con triptorelina produce una disminución de la velocidad de crecimiento y un aumento del IMC a partir del primer año de tratamiento, mantenidos tras la retirada del mismo, de manera estadísticamente significativa. La talla adulta es acorde con la talla genética, y con la predicción de talla mediante el método de Bayley-Pinneau. La menarquia aparece a la misma edad que en la población general. La talla adulta de las pacientes con PPC orgánica es significativamente menor que la de las pacientes con PPC idiopática. Conclusiones 1. El tratamiento de la PPC en niñas con triptorelina puede producir aumento del IMC. 2. La existencia de una causa orgánica de la PPC es un factor que empeora el pronóstico de talla. 3. El método de predicción de talla Bayley-Pinneau, para edad ósea acorde a la edad cronológica es adecuado para hacer un pronóstico de talla final en estas pacientes

Introduction The most important complications of central precocious puberty (CPP) in girls are loss of height and multiple psychosocial problems. Objectives To study the effect of triptorelin therapy in a cohort of girls with CPP. Patients and methods Thirty-four girls diagnosed with organic or idiopathic CPP and treated with monthly triptorelin were studied. Age, height in standard deviation (SD), bone age (Greulich and Pyle), height prediction (Bayle-Pinneau), body mass index (BMI) in SD, uterine size (pelvic ultrasound), target height, cranial magnetic resonance imaging, triptorelin dose, and treatment duration were studied. Results Triptorelin produced a statistically significant reduction in growth velocity and an increase in BMI after 1 year of therapy and these changes were maintained after discontinuation of therapy. Adult height in these patients was in accordance with their target genetic height, as well as with their predicted height according to the method of Bayley-Pinneau. No significant differences were found between age of menarche in our patients and in controls. Adult height in patients with organic CPP was significantly lower than that in patients with idiopathic CPP. Conclusions 1. Triptorelin can increase BMI in girls with CPP. 2. The presence of an organic cause in patients with CPP worsens the prognosis for adult height. 3. The Bayley-Pinneau prediction method for "average" bone age is useful for establishing a prognosis of adult height in girls with CPP treated with triptorelin

La pubertad precoz central en niños está asociada a una elevada prevalencia de patología orgánica / Central precocious puberty is associated with a high prevalence of organic disease

Introducción La incidencia de pubertad precoz central (PPC) en los niños es inferior a la presentada por las niñas; sin embargo, la posibilidad de presentar patología orgánica cerebral es mayor. Objetivos Conocer el porcentaje de PPC secundaria a patología orgánica en niños, y estudiar las características clínico-biológicas al diagnóstico, durante y al final del tratamiento. Pacientes y métodos Se estudian 8 niños diagnosticados de PPC, en tratamiento con triptorelina mensual. Se valoraron: edad, talla en desviaciones estándar (DE), índice de masa corporal (IMC) en DE, velocidad de crecimiento (DE), edad ósea (Greulich y Pyle), predicción de talla (Bayle-Pinneau) y talla diana. Se determinó el volumen testicular, el pico de la hormona luteinizante (LH) tras estimulación con la hormona estimuladora de gonadotropinas (GnRH) y las concentraciones plasmáticas de testosterona. Resultados El 75 % de los niños presentaron patología orgánica. Tras el tratamiento con triptorelina, se evidenció una disminución significativa de la velocidad de crecimiento, sin cambios en la diferencia entre la edad ósea menos la edad cronológica, debido a la escasa diferencia existente al diagnóstico. Durante el tratamiento presentaron un test de GnRH frenado junto con concentraciones de testosterona inferiores a 0,5 ng/ml, sin alteraciones del peso ni del IMC. Tres pacientes alcanzan una talla adulta acorde con su talla genética y con la predicción de talla según el método de Bayley-Pinneau. Conclusiones 1. En niños afectados de PPC el elevado porcentaje de patología orgánica es elevado. 2. La talla adulta tras tratamiento con análogos de GnRH se encontró dentro de la normalidad. 3. La determinación de los niveles de testosterona puede ser de utilidad en el control terapéutico de estos niños

Introduction The incidence of central precocious puberty (CPP) is lower in boys than in girls; however, the presence of organic disease is more common in boys. Objectives To investigate the percentage of CPP secondary to organic disease in boys and to analyze their clinical and biological characteristics at diagnosis, during follow-up, and at the end of therapy. Patients and methods Eight boys with a diagnosis of CPP treated with triptorelin every 28 days were included. Age, height in standard deviation (SD), body mass index (BMI) in SD, growth velocity in SD, bone age (Greulich and Pyle), predicted height (Bayle-Pinneau), and target height were analyzed. Testicular volume was measured (according to Prader standards) and peak lutein hormone (LH) values and testosterone levels were determined after gonadotropin-releasing hormone (GnRH) stimulus. Results Seventy-five percent of the patients with CPP had organic disease. After treatment with triptorelin, growth reduction significantly decreased. In contrast, no changes were seen in the difference between bone age and chronological age, due to the slight difference found at diagnosis. Likewise, during treatment, there was no LH peak and testosterone levels were lower than 0.5 ng/ml in response to GnRH stimulus. No changes were observed in weight or BMI. Three patients reached an adult height similar to their genetic height and their predicted height, as estimated by the Bayle-Pinneau method. Conclusions 1. Among boys with CPP we found a substantial number of patients with organic disease. 2. Adult height after treatment with triptorelin can reach the normal range. 3. Determination of testosterone levels can be useful in the follow-up of these children during treatment

[Transitory neonatal diabetes mellitus and pericentric chromosome 9 inversion]. / Diabetes mellitus neonatal transitoria e inversión pericéntrica del cromosoma 9.

Neonatal diabetes mellitus is an infrequent carbohydrate metabolism disorder with an estimated incidence of approximately one case every 400,000 to 600,000 live newborns. We present the case of a 1-month-old girl with irritability, polyuria, and a 24-h history of eagerness to feed, without fever or other associated symptoms. The patient's karyotype, obtained by amniocentesis, was 46XX with a pericentric chromosome 9 inversion. Her birth weight and length were 2,230 g (-2.65 SD) and 46 cm (-1.8 SD), respectively. Glycemic determinations during the first 72 h of extrauterine life oscillated between 90 and 157 mg/dl. Physical examination revealed general involvement, skin and mucosal pallor, evident signs of dehydration, and impaired awareness. Laboratory tests revealed glycemia: 1552 mg/dL, pH 7.16, pCO2: 23.7 mmHg; bicarbonate: 8.1 mEq/L, base excess: -19.1, and positive ketonemia. After initial stabilization, the patient was treated with intravenous fluids and continuous intravenous regular insulin infusion (initial dose 0.03-0.05 IU/kg/h). After intensive treatment, breast feeding was restored and a short-acting insulin analog was administered subcutaneously after every feed (0.1 to 0.3 IU according to capillary glycemic determinations). Insulin requirements decreased and were discontinued when the infant was 5 months old. Currently, the patient is 2 years and 7 months old and her glycemia and glycosylated hemoglobin levels are normal. Anti-islet (ICA and GAD) and anti-tyrosin phosphatase (IA2) antibodies were absent, as were mutations in the glucokinase gene (GCK).