Fallo de medro en Pediatría de Atención Primaria: recomendaciones para su abordaje y seguimiento / Failure to Thrive in Primary Care pediatrics: recommendations for its approach and follow-up

El fallo de medro representa la dificultad para mantener un ritmo de crecimiento adecuado, tanto en peso como en talla, en menores de tres años. Se trata de una entidad actualmente infradiagnosticada que puede repercutir en el desarrollo físico, intelectual, emocional y social de los niños. El pediatra de Atención Primaria es clave en la identificación precoz y en la prevención de su morbilidad. Este documento representa una herramienta útil para el desarrollo de la labor conjunta del pediatra y la enfermería pediátrica, realizando una intervención precoz, individualizada y eficiente en estos niños. (AU)

Failure to thrive is poor physical growth, both in weight and height, in children under three years of age. This underdiagnosed entity can affect children’s physical, intellectual, emotional and social development. Paediatric Primary Care is crucial in early diagnosis and prevention of their morbidity. This document represents a useful tool for the teamwork between paediatricians and paediatric nursing. Its objective is to carry out an early, individualized and efficient approach in these children. (AU)

Longitudinal study of the newborn small for gestational age. Growth recovery and conditioning factors.

Introduction: Background: small-for-gestational-age (SGA) newborns present a higher morbidity and mortality rate when compared to infants born appropriate for gestational age (AGA), as well as insufficient growth, with height far from their target and in some cases a low final height (< -2 SDs). Objective: the aim of this study was to determine when catch-up growth (CUG) in height occurs in these children, and which factors are associated with lack of CUG. Material and methods: this is a retrospective study of SGAs born between 2011 and 2015 in a secondary hospital. Anthropometric measurements were taken consecutively until CUG was reached, and fetal, placental, parental, newborn, and postnatal variables were studied. Results: a total of 358 SGAs were included from a total of 5,585 live newborns. At 6 and 48 months of life, 93.6 % and 96.4 % of SGAs achieved CUG, respectively. By subgroups, symmetric SGAs performed worse than asymmetric SGAs with CUG in 84 % and 92 % at 6 and 48 months of life, respectively. The same occurred in the subgroup of preterm SGAs with respect to term SGAs, with worse CUGs of 88.2 % and 91.2 % at 6 and 48 months of life, respectively. Prematurity, symmetrical SGA, intrauterine growth retardation (IUGR), preeclampsia, previous child SGA, perinatal morbidity, and comorbidity during follow-up were associated with absence of CUG. Conclusions: the majority of SGAs had CUG in the first months of life. The worst outcomes were for preterm and symmetric SGAs.

Introducción: Antecedentes: el recién nacido pequeño para la edad gestacional (PEG) presenta mayor morbimortalidad que el recién nacido con peso adecuado (PAEG), así como un crecimiento insuficiente con talla alejada de la talla diana y, en algunos casos, talla final baja (< -2 DE). Objetivo: el objetivo de este estudio fue determinar en qué momento se produce el crecimiento compensador (CUG) de la talla en estos niños y conocer qué factores se asocian a la falta de dicho crecimiento compensador. Material y métodos: estudio retrospectivo de los recién nacidos PEG entre los años 2011 y 2015 en un hospital secundario. Se tomaron medidas antropométricas de forma consecutiva hasta alcanzar el CUG y se estudiaron las variables fetales, placentarias, parentales, neonatales y posnatales. Resultados: se incluyeron 358 PEG de un total de 5585 recién nacidos vivos. A los 6 y 48 meses de vida alcanzaron el CUG el 93,6 % y 96,4 % de los PEG, respectivamente. Por subgrupos, los PEG simétricos obtuvieron peores resultados que los PEG asimétricos, con CUG del 84 % y 92 % a los 6 y 48 meses de vida, respectivamente. Lo mismo ocurrió en el subgrupo de PEG prematuros respecto de los PEG a término, con CUG peores del 88,2 % y 91,2 % a los 6 y 48 meses de vida, respectivamente. La prematuridad, el PEG simétrico, la restricción del crecimiento intrauterino, la preeclampsia, tener un hijo previo PEG, la morbilidad perinatal y la comorbilidad durante el seguimiento se asociaron a la ausencia de CUG. Conclusiones: la mayoría de los PEG alcanzaron el CUG en los primeros meses de vida. Los peores resultados fueron para los PEG prematuros y simétricos.

Resistencias antibióticas y tasas de erradicación en infección por Helicobacter pylori / Antibiotic resistances and eradication rates in Helicobacter pylori infection

Introducción: Las resistencias antibióticas de Helicobacter pylori(H. pylori) son el principal factor que afecta a la eficacia de los regímenes terapéuticos actuales. El objetivo principal del estudio es describir el patrón de resistencias antibióticas en niños con infección por H. pylori.Pacientes y métodos: Estudio observacional retrospectivo de 2014 a 2019 en el que se incluyen pacientes entre 5-17 años a los que se realizó gastroscopia, con cultivo de biopsia gástrica positivo para H. pylori y estudio de sensibilidad a antibióticos. Los estudios de sensibilidad antibiótica se realizaron mediante E-test. Los puntos de corte para definir las resistencias fueron los propuestos por el EUCAST. El estudio de erradicación se realizó con test del aliento con urea marcada con C 13 o test monoclonal de antígeno de H. pylori en heces a las 6-8 semanas de finalizar el tratamiento.Resultados: Ochenta pacientes (63,8% mujeres). Media de edad 11,9 años (±2,7DS). Un 38,8% habían recibido tratamiento previo para H. pylori. Un 10% presentaron en la endoscopia lesiones ulcerosas pépticas. El 67,5% presentaba resistencia al menos a un fármaco. Un 16,3% presentaron doble resistencia. Las resistencias primarias fueron: claritromicina 44,9%, metronidazol 16,3%, levofloxacino 7,9% y amoxicilina 2%. Los pacientes que recibieron tratamiento acorde a las nuevas guías ESPGHAN 2017 presentaron tasas de erradicación significativamente superiores en comparación con los que recibieron tratamiento acorde a las guías previas (80% vs. 55,8% p=0,04). (AU)

Introduction: The resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori.Patients and methods: An observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing – EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6-8 weeks after finalising the treatment.Results: The study included 80 patients (63.8% females), with a mean age of 11.9 years (SD±2.7DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P=.04). (AU)

Antibiotic resistances and eradication rates in Helicobacter pylori infection.

INTRODUCTION: The resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori. PATIENTS AND METHODS: An observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing - EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6-8 weeks after finalising the treatment. RESULTS: The study included 80 patients (63.8% females), with a mean age of 11.9 years (SD ±â€¯2.7 DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P = 0.04). CONCLUSIONS: The high rate of H. pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate.

Síndrome de ACNES: no todo dolor abdominal es visceral / ACNES syndrome, not all abdominal pain is visceral

El anterior cutaneous nerve entrapment syndrome (ACNES) es un tipo de dolor abdominal crónico originado en la pared abdominal. Su diagnóstico inicialmente es clínico, basado en historia clínica y exploración física compatibles, con signos de Carnett, pinch test o disestesias positivos. El diagnóstico definitivo se realiza a través de la mejoría clínica tras infiltración con anestésico tópico en el punto de máximo dolor. Este síndrome es poco conocido y por consiguiente infradiagnosticado, suponiendo un exceso de pruebas complementarias innecesarias e invasivas

The anterior cutaneous nerve entrapment syndrome (ACNES) is a type of chronic neuropathic pain felt in the abdominal wall. Initially, its diagnosis is clinical, based on a compatible clinical history and physical examination, with Carnett signs, Pinch test and/or positive dysesthesias. The definitive diagnosis is made through clinical improvement after infiltration with topical anesthetic at the point of maximum pain. This syndrome is frequently overlooked and therefore underdiagnosed, involving an excess of unnecessary and invasive complementary tests

[Antibiotic resistances and eradication rates in Helicobacter pylori infection]. / Resistencias antibióticas y tasas de erradicación en infección por Helicobacter pylori.

INTRODUCTION: The resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori. PATIENTS AND METHODS: An observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing - EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6-8 weeks after finalising the treatment. RESULTS: The study included 80 patients (63.8% females), with a mean age of 11.9 years (SD±2.7DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P=.04). CONCLUSIONS: The high rate of H.pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate.

Colitis eosinofílica: hay que pensar en ella / Eosinophilic colitis: think about it

La colitis eosinofílica es un trastorno gastrointestinal primario de etiología desconocida y ligada a procesos alérgicos. Se define por la presencia de un número anormal de eosinófilos en la mucosa colónica junto con síntomas de disfunción intestinal. Su incidencia ha aumentado en los últimos años debido a un mayor reconocimiento. El diagnóstico es endoscópico y requiere la exclusión de otras causas de eosinofilia colónica, como la enfermedad inflamatoria intestinal entre otras. Los criterios diagnósticos no están bien establecidos ya que no se conoce con certeza el número normal de eosinófilos en los distintos tramos del tubo digestivo. El tratamiento, de la misma manera, se basa en la opinión de expertos. Se presentan dos casos de colitis eosinofílica en la edad infantil con el objetivo de mejorar el conocimiento de esta enfermedad y poner de manifiesto la necesidad de realizar estudios que permitan homogeneizar el manejo de esta patología

Eosinophilic colitis is a primary gastrointestinal disease of unknown etiology and related to allergic processes. It is defined by the presence of an abnormal number of eosinophils in the colonic mucosa together with symptoms of intestinal dysfunction. Its incidence has increased in the last years due to a growing recognition. Diagnosis is endoscopic and requires the exclusion of other colonic eosinophilia causes, such as the inflammatory bowel disease, among others. Diagnosis criteria are not well stablished since there is no certainty about the normal number of eosinophilic cells in the different sections of the gastrointestinal tract. Likewise, treatment is based on expert opinion. Two cases of eosinophilic colitis in childhood are presented with the aim of improving the disease awareness as well as highlighting the need to carry out investigations that allow the homogenization of the management of this pathology

Detección precoz y manejo de la enfermedad de Kawasaki: la inadvertida enfermedad de Kawasaki incompleta / Early detection and management of Kawasaki disease: the undetected incomplete Kawasaki disease

La enfermedad de Kawasaki (EK) incompleta supone el no cumplimiento de todos los criterios diagnósticos del Kawasaki completo o síndrome mucocutáneo linfonodular, siendo necesario un hallazgo de fiebre de al menos cinco días de evolución y dos o tres criterios clínicos, así como una serie de criterios de laboratorio. Las complicaciones no difieren del síndrome completo, por lo que estos pacientes tienen el mismo riesgo de desarrollar alteraciones cardiovasculares tales como aneurismas y arteritis coronarias, disminución de la fracción de eyección del ventrículo izquierdo o derrame pericárdico. Diversos estudios constatan un diagnóstico ineficaz de la EK incompleta, y consecuentemente una mayor frecuencia de alteraciones ecocardiográficas. Se presenta el caso de un paciente con fiebre de cinco días de evolución y exantema generalizado que posteriormente presenta dolor testicular, eritema perineal, enantema e inyección conjuntival que finalmente fue diagnosticado de EK incompleta (AU)

Incomplete Kawasaki disease (KD) means the non-compliance with all diagnostic criteria of complete Kawasaki, or mucocutaneous lymph node syndrome, with the presence of fever lasting at least five days and two or three clinical criteria, as well as a series of laboratory criteria. Complications do not differ from the complete syndrome, which is why these patients are subject to the same risk of developing cardiovascular disorders such as aneurysms, coronary arteritis, decreased ejection fraction in the left ventricle or pericardial effusion. Several studies have shown an inefficient diagnosis of incomplete KD and consequently, a greater frequency of echocardiographic alterations. The case of a patient with a fever lasting five days and a generalized rash is reported, who subsequently develops testicular pain, perineal erythema, enanthema and a bloodshot appearance, who was finally diagnosed with incomplete KD (AU)