Epidemiología de la neumonía adquirida en la comunidad en menores de 5 años en la Comunidad Valenciana / Epidemiology of community-acquired pneumonia in children aged lessthan 5 years old in the Autonomous Community of Valencia (Spain)

Objetivo: Estimar la incidencia, tratamiento y complicaciones de la neumonía adquirida en la Comunidad Valenciana. Métodos: Cohorte retrospectiva de 654 niños nacidos en 1995 y 1996 en Valencia, y seguidos durante los primeros 5 años de vida por 9 pediatras. Se obtuvo el número de neumonías, tratamiento, complicaciones e intervenciones requeridas. Resultados: Se encontraron 99 episodios de neumonía adquirida en la comunidad (NAC) en 80 pacientes (1,24 casos/niño), 51 casos (51,1 %) antes del tercer año y 38 entre el tercer y quinto año (38,4 %): 51 casos (51,5 %) fueron diagnosticados en atención primaria y 46 (46,5 %) en urgencia hospitalaria. En atención primaria, la media de visitas fue de 2,44, con un rango de 1 a 6. Todos fueron tratados con antibiótico. Los más utilizados fueron amoxicilina-ácido clavulánico (43,4 %) y cefuroxima (26,3 %). Catorce casos requirieron cambio a un segundo antibiótico. El 23 % de los casos ingresó en el hospital para tratamiento. Conclusión: La incidencia de NAC en nuestro medio en 30,3 casos/1.000 niños menores de 5 años/año (intervalo de confianza [IC] 95 %: 18,7-46,8). La incidencia de ingreso corresponde a 7,03 casos/1.000 niños menores de 5 años/ año

Objective: To assess the incidence of community acquired pneumonia in the Autonomous Community of Valencia in Spain, and describe its treatment and complications. Methods: A retrospective cohort comprising 654 children born in 1995 and 1996 in Valencia and followed-up during the first 5 years of life by nine pediatricians was studied. The number of cases of pneumonia, treatment, complications and interventions was recorded. Results: Ninety-nine episodes of community-acquired pneumonia in 80 children were recorded (1.24 cases/child). Fifty-one cases (51.1 %) occurred before the child's third birthday and 38 (38.4 %) occurred between the third and the fourth. Of the 99 cases, 51 were diagnosed in primary care and 46 in the emergency room. There was a mean of 2.44 visits per process in primary care (range 1-6). All the children were treated with antibiotics. The most frequently used were amoxicillin-clavulanate (43.3 %) and cefuroxime (26.3 %). Fourteen patients required a change of antibiotic. Twenty-three percent of the children were hospitalized. Conclusion: The incidence of community-acquired pneumonia in Valencia was 30.3 cases/1000 children aged less than 5 years/ year (95 % CI: 18.7-46.8), and the incidence of hospitalization was 7.03 cases/1000 children aged less than 5 years/year

[Epidemiology of community-acquired pneumonia in children aged less than 5 years old in the Autonomous Community of Valencia (Spain)]. / Epidemiología de la neumonía adquirida en la comunidad en menores de 5 años en la Comunidad Valenciana.

OBJECTIVE: To assess the incidence of community acquired pneumonia in the Autonomous Community of Valencia in Spain, and describe its treatment and complications. METHODS: A retrospective cohort comprising 654 children born in 1995 and 1996 in Valencia and followed-up during the first 5 years of life by nine pediatricians was studied. The number of cases of pneumonia, treatment, complications and interventions was recorded. RESULTS: Ninety-nine episodes of community-acquired pneumonia in 80 children were recorded (1.24 cases/child). Fifty-one cases (51.1 %) occurred before the child's third birthday and 38 (38.4 %) occurred between the third and the fourth. Of the 99 cases, 51 were diagnosed in primary care and 46 in the emergency room. There was a mean of 2.44 visits per process in primary care (range 1-6). All the children were treated with antibiotics. The most frequently used were amoxicillin-clavulanate (43.3 %) and cefuroxime (26.3 %). Fourteen patients required a change of antibiotic. Twenty-three percent of the children were hospitalized. CONCLUSION: The incidence of community-acquired pneumonia in Valencia was 30.3 cases/1000 children aged less than 5 years/ year (95 % CI: 18.7-46.8), and the incidence of hospitalization was 7.03 cases/1000 children aged less than 5 years/year.

[Epidemiology and burden of acute otitis media in Valencia (Spain)]. / Epidemiología e impacto de la otitis media aguda en la Comunidad Valenciana.

OBJECTIVE: To assess the burden (incidence, treatment and complications) of acute otitis media (AOM) and otitis media with effusion (OME) in children younger than 5 years of age from Valencia, Spain. SUBJECT AND METHODS: We performed a retrospective cohort study of 1,399 children followed-up for the first 5 years of life. Seventeen pediatricians reviewed the medical records of their patients born in 1995 and 1996 and followed-up from birth until the age of 5 years. For each child, the number of otitis episodes, treatment, complications, and surgical interventions was obtained. RESULTS: There were 2,961 episodes of AOM in the first 5 years of life (2.23 cases/child). Four hundred seventy-six cases (16.1 %) occurred before 1 year of age and 1,346 between the first and second year of life (45.5 %). By the third year of life, 59.8 % had had at least one episode. In most children (80.9 %), diagnosis was made in primary care and required a median of 1.81 visits/episode for follow-up. A total of 94.5 % were treated with antibiotics (amoxicillin-clavulanate 38.8 %, cefuroxime 14.3 %, clarithromycin 8.2 % and amoxicillin 5.9 %) and 8.5 % required a change of antibiotic therapy. Two hundred seventeen children (15.2 %) had at least one episode of OME. Twenty-six patients (1.8 %, 95 % CI: 1.2-2.7 %) required insertion of ventilation tubes. Twenty-four patients (1.7 %) had secondary hypoacusis. There was one case of meningitis and two cases of chronic otorrhea. No cases of mastoiditis were recorded. CONCLUSIONS: The incidence of AOM in Valencia is 40,014 episodes/100,000 children younger than 5 years/year (95 % CI: 39,700-40,300). It represents a significant burden due to the large number of visits, antibiotic use, associated surgical procedures and need for auditory rehabilitation.

Epidemiología e impacto de la otitis media aguda en la Comunidad Valenciana / Epidemiology and burden of acute otitis media in Valencia (Spain)

Objetivo: Estimar el impacto (incidencia, tratamiento y complicaciones) de la otitis media aguda (OMA) y la otitis media serosa (OMS) en los niños menores de 5 años de la Comunidad Valenciana (España). Sujetos y métodos: Cohorte retrospectiva de 1.399 niños seguidos durante los primeros 5 años de vida. Diecisiete pediatras revisaron las historias clínicas de sus pacientes nacidos en 1995 y 1996, controlados desde su nacimiento hasta los 5 años. Se obtuvo de cada niño el número de episodios de otitis, tratamiento, complicaciones e intervenciones quirúrgicas requeridas. Resultados: Hubo 2.961 episodios de OMA en los primeros 5 años de vida (2,23 casos/niño), 476 casos (16,1 por ciento) antes del año y 1.346 entre el primer y segundo año (45,5 por ciento). Al tercer año, el 59,8 por ciento habían presentado al menos un episodio. La mayoría de casos (80,9 por ciento) se diagnosticaron en atención primaria, con 1,81 visitas/episodio de media para su seguimiento. El 94,5 por ciento de los episodios fueron tratados con antibiótico (amoxicilina-ácido clavulánico 38,8 por ciento, cefuroxima-axetilo, 14,3 por ciento; claritromicina, 8,2 por ciento, y amoxicilina 5,9 por ciento). El 8,5 por ciento requirió cambio a un segundo antibiótico. Presentaron al menos un episodio de OMS 217 niños (15,2 por ciento). Necesitaron implantación de tubos de ventilación 26 pacientes (1,8 por ciento, intervalo de confianza del 95 por ciento (IC 95 por ciento), 1,2-2,7). Presentaron hipoacusia secundaria 24 niños (1,7 por ciento). Hubo un caso de meningitis y dos de otorrea crónica. No hubo mastoiditis. Conclusiones: La incidencia de OMA en la Comunidad Valenciana es de 40.014 episodios/100.000 niños menores de 5 años/año (IC 95 por ciento, 39.700-40.300). Supone un gran impacto sanitario por el elevado número de visitas, uso antibiótico, cirugía asociada y necesidad de rehabilitación auditiva (AU)

[Survey of the judicious use of antibiotics in primary care]. / Encuesta sobre el uso racional de antibióticos en atención primaria.

OBJECTIVE: To identify pediatricians' antibiotic prescribing habits in acute otitis media and tonsillopharyngitis and to determine the interaction between parents and pediatricians concerning antibiotic use in the Autonomous Community of Valencia (Spain). METHOD: Four hundred members of the Valencian Society of Pediatrics were randomly selected. A semi-structured questionnaire with non-excluding answers was sent by mail and, when responses were not obtained, a second one was sent. The confidentiality of the information was guaranteed. RESULTS: Of 400 questionnaires sent, 143 (35.8 %) were completed; 88.1 % were completed by pediatricians and 51.1 % by primary care workers. A total of 48.3 % of pediatricians used antibiotics in all cases of acute otitis media and 94.5 % prescribed them when fever and otalgia persisted for more than 48 hours. Amoxicillin-clavulanate was the most frequently prescribed antibiotic (63.6 %). Less than 10 % of pediatricians prescribed antibiotics as empirical treatment in tonsillopharyngitis; amoxicillin was the most frequently prescribed antibiotic (54.6 %). Indications for antibiotic treatment were fever, odynophagia and adenomegaly (69.5 %) and tonsillar exudate (62.5 %). Inappropriate antibiotic use was mainly due to excess workload. Providing health education to parents could be the best way of reducing inappropriate use. CONCLUSIONS: Antibiotic use is frequent in the treatment of acute otitis media. Amoxicillin-clavulanate and amoxicillin were the most frequently prescribed antibiotics in tonsillopharyngitis. Providing health education to parents and reducing pediatricians' workload would decrease inappropriate antibiotic use.

Encuesta sobre el uso racional de antibióticos en atención primaria / Survey of the judicious use of antibiotics in primary care

Objetivo: Conocer los hábitos de prescripción de antibióticos de los pediatras de la Comunidad Valenciana en la otitis media aguda (OMA) y la faringoamigdalitis y la relación padres-pediatra respecto a los antimicrobianos. Método: Se seleccionaron al azar 400 miembros de la Sociedad Valenciana de Pediatría. Cuestionario semiestructurado de respuestas no excluyentes remitido por correo y nuevo envío si no se obtuvo respuesta. Se garantizó la confidencialidad de la información. Resultados De las 400 encuestas remitidas, 143 (35,8 per cent) fueron cumplimentadas. El 88,1 per cent eran pediatras y el 51,1 per cent trabajaban en un equipo de atención primaria. En la OMA, el 48,3 per cent indicaba antibiótico en todos los casos, recetándolo el 94,5 per cent si la fiebre y la otalgia persistían más de 48 h. La amoxicilina-ácido clavulánico fue el antibiótico más prescrito (63,6 per cent). En la faringoamigdalitis, menos del 10 per cent administraban tratamiento empírico, siendo la amoxicilina el antibiótico más utilizado (54,6 per cent). La fiebre, la odinofagia y las adenopatías (69,5 per cent) o el exudado amigdalar (62,5 per cent) fueron los criterios para indicar la antibioticoterapia. El aspecto que más contribuye al uso inapropiado de antibióticos es la presión asistencial y el educar a los padres el que más ayudaría a reducir este uso inapropiado. Conclusiones La utilización de antibióticos en el tratamiento de la OMA es una práctica frecuente. La amoxicilina-ácido clavulánico para la otitis y la amoxicilina en la faringoamigdalitis fueron los antibióticos más prescritos. La educación sanitaria de los padres y reducir la presión asistencial disminuirían el consumo inadecuado de antibióticos (AU)

[Urinary excretion of calcium, magnesium, uric acid and oxalic acid in normal children]. / Excreción urinaria de calcio, magnesio, ácido úrico y ácido oxálico en niños normales.

A group of normal children with a free diet was studied. Their first morning urine (n = 176) and their 24-hour-urine (n = 64) was collected, valuing the calciuria, magnesiuria, uricosuria and oxaluria, establishing their relationship with a dietetic survey. Ca/Cr rate value was 0.13 +/- 0.7 mg/mg in the morning urine, and 0.12 +/- 0.06 mg/mg in the 24-hour-urine. Calciuria (mg/kg/day) was 2.46 +/- 1.45, higher to that noticed by other authors. Prevalence of hypercalciuria was 7.8%. We haven't noticed any correlation between the calciuria (mg/kg/day) and the consumption of proteins and carbohydrates. A positive correlation was found between Ca/Cr and Na/Cr rate, together with high natriuria (3.87 +/- 1.35 mEq/kg/day); these findings could justify the elevated calciuria in the children studied. Mean values of magnesium and uric acid were 0.04 +/- 0.02 and 0.30 +/- 0.08 mg/100 ml FG, respectively and the oxaluria was 34.51 +/- 16.35 mg/day/1.73 m2.

[Zinc balance in malnourished children given prolonged total parenteral feeding]. / Balance de zinc en niños desnutridos con alimentación parenteral total prolongada.

Zinc balances were performed in five different occasions in three children receiving prolonged total parenteral nutrition (TPN) for 4 or more weeks. Excessive urinary zinc loss was a constant finding and one patient also presented increased fecal loss. It is concluded that TPN solutions when administered for long periods must be supplemented with zinc in order to obtain positive balances and a retention of zinc between 50-100 micrograms kg/day. In children without abnormal losses supplements recommended by the American Medical Association (100 micrograms/kg/day up to 5 years and from 2.5 to 4 mg/day in old children) seem adequate. In case of deficit in Zn and/or high digestive losses supplement of Zn in TPN must be increased up to 200 to 500 micrograms/kg/day.