ABSTRACT
Resumen Introducción: la bronquiolitis aguda se define como el primer episodio bronco-obstructivo en menores de dos años, precedida por signos de infección de las vías aéreas superiores. Su importancia radica en la alta prevalencia de la enfermedad, puesto que en Colombia es la primera causa de hospitalización en menores de un año. Si bien es una enfermedad con baja letalidad, hay grupos de pacientes que pueden desarrollar complicaciones graves. Objetivo: describir la frecuencia de hospitalización y complicaciones, así como el manejo terapéutico de menores de dos años con bronquiolitis aguda en una institución de alta complejidad. Métodos: se hizo un estudio observacional descriptivo retrospectivo. La población estudiada estuvo compuesta por lactantes con diagnóstico de bronquiolitis que ingresaron a la institución durante el 2017 y 2018. La información fue consignada en una base de datos y analizada utilizando el programa SPSS-24.0. Resultados: se incluyeron 427 pacientes, de los cuales 266 eran mujeres (62,3 %); la mediana de edad fue de 2 meses (1-5 meses). Las retracciones estuvieron presentes en 242 de los lactantes (56,7 %). Requirieron hospitalización 268 (62,8 %), con una mediana de estancia de 4 días (2-7 días). Entre los hospitalizados, 32 (11,9 %) fueron ingresados a UCIP. El lavado nasal fue la terapia más usada, aplicada a 365 pacientes (85,5 %). A 259 (60,6 %) se les realizó panel viral, donde el VRS fue el principal agente encontrado. Conclusiones: aunque más de la mitad de los pacientes requirieron hospitalización, la mayoría tuvo un curso benigno. Si bien el manejo fue diverso, el sintomático fue el predominante.
Abstract Introduction: Acute bronchiolitis is defined as the first broncho-obstructive episode in children under two years of age, preceded by signs of upper respiratory tract infection. Its significance lies in its high prevalence, as it is the leading cause of hospitalization in children under one year in Colombia. While it is a disease with low fatality, there are patient groups that may develop severe complications. Objective: This study aimed to describe the frequency of hospitalization and complications, as well as the treatment, of children under two years of age with acute bronchiolitis in a high-complexity institution. Methods: A retrospective descriptive observational study was conducted. The study population consisted of infants diagnosed with bronchiolitis who were admitted to the institution during 2017 and 2018. The information was recorded in a database and analyzed with SPSS-24.0. Results: A total of 427 patients were included, of whom 266 were females (62.3%). The median age was 2 months (1-5 months). Retractions were present in 242 infants (56.7%). Hospitalization was required for 268 patients (62.8%), with a median length of stay of 4 days (2-7 days). Among the hospitalized patients, 32 (11.9%) were admitted to the Intensive Care Unit (ICU). Nasal lavage was the most commonly used therapy, applied to 365 patients (85.5%). Viral panel testing was performed in 259 patients (60.6%), with respiratory syncytial virus (RSV) being the primary agent detected. Conclusions: Although more than half of the patients required hospitalization, the majority had a benign course. While management approaches varied, symptomatic treatment was predominant
ABSTRACT
STUDY OBJECTIVES: The aim of this study was to determine the impact of apneas on oxygen saturation and the presence of intermittent hypoxia, during sleep of preterm infants (PTIs) born at high altitudes and compare with full-term infants (FTIs) at the same altitude. METHODS: PTIs and FTIs from 3 to 18 months were included. They were divided into three age groups: 3-4 months (Group 1); 6-7 months (Group 2), and 10-18 months (Group 3). Polysomnography parameters and oxygenation indices were evaluated. Intermittent hypoxia was defined as brief, repetitive cycles of decreased oxygen saturation. Kruskal-Wallis test for multiple comparisons, t-test or Mann-Whitney U-test were used. RESULTS: 127 PTI and 175 FTI were included. Total apnea-hypopnea index (AHI) was higher in PTI that FTI in all age groups (Group 1: 33.5/h vs. 12.8/h, p = 0.042; Group 2: 27.0/h vs. 7.4/h, p < 0.001; and Group 3: 11.6/h vs. 3.1/h, p < 0.001). In Group 3, central-AHI (8.0/h vs. 2.3/h, p < 0.001) and obstructive-AHI (1.8/h vs. 0.6/h, p < 0.008) were higher in PTI than FTI. T90 (7.0% vs. 0.5, p < 0.001), oxygen desaturation index (39.8/h vs. 11.3, p < 0.001) were higher in PTI than FTI, nadir SpO2 (70.0% vs. 80.0, p<0.001) was lower in PTI. CONCLUSION: At high altitude, compared to FTI, PTI have a higher rate of respiratory events, greater desaturation, and a delayed resolution of these conditions, suggesting the persistence of intermittent hypoxia during the first 18 months of life. This indicates the need for follow-up of these infants for timely diagnosis and treatment of respiratory disturbances during sleep.
Subject(s)
Altitude , Infant, Premature , Humans , Hypoxia/therapy , Infant , Infant, Newborn , Oxygen , Polysomnography , SleepABSTRACT
AIM: This study aims to assess rates of antibiotic prescriptions and its determinants in in children with COVID-19 or Multisystem Inflammatory Syndrome (MIS-C). METHODS: Children <18 years-old assessed in five Latin Americas countries with a diagnosis of COVID-19 or MIS-C were enrolled. Antibiotic prescriptions and factors associated with their use were assessed. RESULTS: A total of 990 children were included: 921 (93%) with COVID-19, 69 (7.0%) with MIS-C. The prevalence of antibiotic use was 24.5% (n = 243). MIS-C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X-rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. There was significant variation in antibiotic use across the hospitals. CONCLUSION: Our study showed a high rate of antibiotic prescriptions in children with COVID-19, in particular in those with severe disease or MIS-C. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID-19 children.
Subject(s)
COVID-19 , Adolescent , Anti-Bacterial Agents/therapeutic use , Child , Female , Humans , Latin America/epidemiology , Prescriptions , Prospective Studies , SARS-CoV-2 , Systemic Inflammatory Response SyndromeABSTRACT
Thrombosis of the inferior vena cava represents a significant percentage of all venous thrombosis that take place during the neonatal period, generally associated with risk factors such as the use of central venous catheter. The incidence of bacterial endocarditis in preterm infants is low. Objectives: To characterize the case of a preterm neonate with both conditions and to detail the disease changing spectrum in the neonatal population and its therapeutic possibilities. Case report: Premature newborn, 31 + 5 weeks of gestation who presented Enterococcus faecalis bacteremia, developed progressive thrombosis of the inferior vena cava and right atrium secondary to the use of umbilical venous catheter, with subsequent diagnosis of endocarditis. He was treated with anticoagulation with subcutaneous low molecular weight heparin. Given a favorable evolution, it was decided to continue the anticoagulation therapy for 4-6 weeks, and at the time of discharge, aspirin treatment was given. Conclusions: The preterm infant with infective endocarditis and intracardiac thrombus presents an interesting management dilemma. Treatment should be individualized according to the clinical evolution and safety profile of thrombolytic and/or anticoagulant agents. Availability and advantages of low molecular weight heparin have led to its use as an alternative treatment in neonates and infants with deep venous thrombosis.
La trombosis de la vena cava inferior corresponde a un porcentaje importante de las trombosis venosas en la etapa neonatal, generalmente asociado a factores de riesgo como el uso de catéter venoso central. La incidencia de endocarditis bacteriana en recién nacidos prematuros es baja. Objetivos: Caracterizar el caso de un neonato pretérmino en que se asociaron ambas patologías y detallar el espectro cambiante de esta enfermedad en la población neonatal y sus posibilidades terapéuticas. Caso clínico: Recién nacido prematuro de 31 + 5 semanas de gestación, que presentó bacteriemia por Enterococo faecalis, evolucionó con trombosis progresiva de la vena cava inferior y aurícula derecha secundaria al uso de catéter venoso umbilical, con posterior diagnóstico de endocarditis. Se manejó con anticoagulación con heparina de bajo peso molecular en forma subcutánea, dada evolución favorable, se decidió continuar manejo médico con terapia anticoagulante por 4-6 semanas, y al alta manejo con aspirina. Conclusiones: El neonato pretérmino con endocarditis infecciosa y trombo intracardiaco presentan un dilema interesante de manejo, por lo cual se debe individualizar el tratamiento según la evolución clínica y el perfil de seguridad de los agentes trombolíticos y/o anticoagulantes. La disponibilidad y las ventajas de la heparina de bajo peso molecular ha dado lugar a su uso como una alternativa de tratamiento en neonatos y niños con trombosis venosa profunda.
Subject(s)
Female , Humans , Infant, Newborn , Endocarditis, Bacterial/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Vena Cava, Inferior/pathology , Venous Thrombosis/pathology , Anticoagulants/therapeutic use , Bacteremia/microbiology , Endocarditis, Bacterial/microbiology , Enterococcus faecalis/isolation & purification , Gram-Positive Bacterial Infections/microbiology , Heparin, Low-Molecular-Weight/therapeutic use , Infant, Premature , Venous Thrombosis/drug therapyABSTRACT
UNLABELLED: Thrombosis of the inferior vena cava represents a significant percentage of all venous thrombosis that take place during the neonatal period, generally associated with risk factors such as the use of central venous catheter. The incidence of bacterial endocarditis in preterm infants is low. OBJECTIVES: To characterize the case of a preterm neonate with both conditions and to detail the disease changing spectrum in the neonatal population and its therapeutic possibilities. CASE REPORT: Premature newborn, 31 + 5 weeks of gestation who presented Enterococcus faecalis bacteremia, developed progressive thrombosis of the inferior vena cava and right atrium secondary to the use of umbilical venous catheter, with subsequent diagnosis of endocarditis. He was treated with anticoagulation with subcutaneous low molecular weight heparin. Given a favorable evolution, it was decided to continue the anticoagulation therapy for 4-6 weeks, and at the time of discharge, aspirin treatment was given. CONCLUSIONS: The preterm infant with infective endocarditis and intracardiac thrombus presents an interesting management dilemma. Treatment should be individualized according to the clinical evolution and safety profile of thrombolytic and/or anticoagulant agents. Availability and advantages of low molecular weight heparin have led to its use as an alternative treatment in neonates and infants with deep venous thrombosis.