[What can we expect of Collaborative Review Groups of Cochrane Collaboration in neuropaediatrics?]. / Qué podemos esperar de los Grupos Colaboradores de Revisión de la Colaboración Cochrane en neuropediatría?

INTRODUCTION: Cochrane Collaboration (CC) contains detailed, critical and up-to-date systematic reviews (SR) of the best scientific evidence available. AIM: To analyse the bibliometric characteristics of the SR related to paediatric neurology published in the 50 Collaborative Review Groups (CRG) of the CC. MATERIALS AND METHODS: Bibliometric analysis of the Database of Systematic Reviews in Cochrane Library, Issue 2, 2005 (n = 2.231 SR). The variables recorded were: number of SR and protocols in any CRG, authors and clusters of secondary research, dates (late review and update), type of study, critical review of the SR and conclusions. RESULTS: Nine published SR about neuropaediatrics: the Epilepsy Group (24 SR), the Neuromuscular Disease Group (16), the Neonatal Group (16), the Developmental, Psychosocial and Learning Problems Group (10), the Pain, Palliative Care and Supportive Care Group (4), the Movement Disorders Group (3), the Injuries Group (3), the Infectious Disease Group (3) and the Acute Respiratory Infections Group (2). The three main thematic areas were treatment of epilepsy (pharmacologic and non-pharmacologic), neonatal neurology (mainly intraventricular haemorrhage and perinatal asphyxia) and miscellanea (autism spectrum disorder, headache, cerebral palsy, myasthenia gravis, Guillain-Barre syndrome, Bell's palsy and bacterial meningitis). All the SR were about treatment interventions. CONCLUSIONS: Paediatric neurology SR are infrequent (3.6% of the 2.231 SR published in CC), and helps an evidence-based decision-making in a few areas: pharmacologic treatment of epilepsy, management of intraventricular haemorrhage of preterm infants and bacterial meningitis. Many therapies in paediatric neurology persist with no supporting evidence, and we detected no SR about important neurological issues in childhood as attention-deficit hyperactivity disorder, mental retardation and hypotonia.

¿Qué podemos esperar de los Grupos Colaboradores de Revisión de la Colaboración Cochrane en neuropediatría? / What can we expect of Collaborative Review Groups of Cochrane collaboration in Neuropaediatrics?

Introducción. La Colaboración Cochrane (CC) se fundamentaen revisiones sistemáticas (RS) exhaustivas, críticas y actualizadasde la mejor evidencia científica disponible. Objetivo.Analizar las características bibliométricas de las RS relacionadascon la neuropediatría publicadas en los 50 Grupos Colaboradoresde Revisión (GCR) de la CC. Materiales y métodos. Análisis bibliométricode la Base de Datos de RS en la Cochrane Library, Issue 2,2005 (n = 2.231 RS). Variables analizadas: número de RS y protocolosen cada GCR, autores y grupos de investigación secundaria,fechas (última revisión y actualización), tipo de estudio, valoracióncrítica de la RS y conclusiones. Resultados. Nueve GCR presentanRS sobre neuropediatría: 24 en Epilepsy Group, 16 en NeuromuscularDisease Group, 16 en Neonatal Group, 10 en Developmental,Psychosocial and Learning Problems Group, cuatro RS en CochranePain, Palliative Care and Supportive Care Group, tres en MovementDisorders Group, tres en Injuries Group, tres en Cochrane InfectiousDisease Group y dos en Cochrane Acute Respiratory InfectionsGroup. Las tres áreas temáticas principales detectadas fuerontratamiento de la epilepsia (farmacológico y no farmacológico),patología neurológica neonatal (principalmente hemorragia intraventriculary asfixia perinatal) y miscelánea (espectro autista, cefalea,parálisis cerebral infantil, miastenia grave, síndrome de Guillain-Barré, parálisis facial de Bell y meningitis bacteriana). Todaslas RS versan sobre intervenciones terapéuticas. Conclusiones. LasRS sobre neuropediatría son escasas (3,6% del total de 2.231 RSpublicadas en CC) y sólo permiten una toma de decisiones basadaen pruebas en algunos temas: tratamiento farmacológico de la epilepsia,manejo de la hemorragia intraventricular del prematuro ymeningitis bacteriana. Muchos tratamientos en neurología pediátricapermanecen sin un soporte de evidencia científica y no se encuentranRS acerca de áreas importantes de la neurología pediátricacomo trastorno por déficit de atención/hiperactividad, retrasomental e hipotonía

Introduction. Cochrane Collaboration (CC) contains detailed, critical and up-to-date systematic reviews (SR) of thebest scientific evidence available. Aim. To analyse the bibliometric characteristics of the SR related to paediatric neurologypublished in the 50 Collaborative Review Groups (CRG) of the CC. Materials and methods. Bibliometric analysis of the Databaseof Systematic Reviews in Cochrane Library, Issue 2, 2005 (n = 2.231 SR). The variables recorded were: number of SR andprotocols in any CRG, authors and clusters of secondary research, dates (late review and update), type of study, critical reviewof the SR and conclusions. Results. Nine published SR about neuropaediatrics: the Epilepsy Group (24 SR), the NeuromuscularDisease Group (16), the Neonatal Group (16), the Developmental, Psychosocial and Learning Problems Group (10), the Pain,Palliative Care and Supportive Care Group (4), the Movement Disorders Group (3), the Injuries Group (3), the InfectiousDisease Group (3) and the Acute Respiratory Infections Group (2). The three main thematic areas were treatment of epilepsy(pharmacologic and non-pharmacologic), neonatal neurology (mainly intraventricular haemorrhage and perinatal asphyxia)and miscellanea (autism spectrum disorder, headache, cerebral palsy, myasthenia gravis, Guillain-Barré syndrome, Bell’s palsyand bacterial meningitis). All the SR were about treatment interventions. Conclusions. Paediatric neurology SR are infrequent(3.6% of the 2.231 SR published in CC), and helps an evidence-based decision-making in a few areas: pharmacologic treatmentof epilepsy, management of intraventricular haemorrhage of preterm infants and bacterial meningitis. Many therapies inpaediatric neurology persist with no supporting evidence, and we detected no SR about important neurological issues in childhoodas attention-deficit hyperactivity disorder, mental retardation and hypotonia

[Usefulness of a software package to reduce medication errors in neonatal care]. / Utilidad de una aplicación informática para disminuir errores de tratamiento en neonatología.

BACKGROUND: Many treatment errors in neonatal intensive care units are caused by the need to carry out a sequence of calculations to determine the dose and dilution of the drugs used. OBJECTIVES: To help in this task, we designed a spreadsheet (Neodosis) that helps clinicians and nurses to calculate the doses and standardize the dilutions of some of the drugs most commonly used in resuscitation and neonatal intensive care units. The aim of this study was to verify the usefulness and reliability of this software package. METHODS: A randomized, cross-over, controlled trial was conducted through simulated clinical cases in which the number of errors in the prescription data and the amount of time spent in making calculations, with and without the program, were evaluated. Fifty-four tests were performed by pediatricians, third- and fourth-year pediatric residents, and nurses. RESULTS: Without computer support, all three groups made errors (residents, pediatricians and nurses in descending order). When Neodosis was used, all the medical staff made significantly fewer errors. The greatest reduction was found in errors made by pediatric residents: minor errors decreased from 16 % to 2 % and major errors from 1.6 % to zero. When using the spreadsheet, the time spent by all groups in making the calculations was reduced by between one-third and one-half. CONCLUSIONS: The tests performed with simulated clinical cases revealed that the number of errors made by the healthcare personnel who participated in this study was not inconsiderable. The use of Neodosis helped physicians and nurses to make markedly fewer errors and also saved them time.

Utilidad de una aplicación informática para disminuir errores de tratamiento en neonatología / Usefulness of a software package to reduce medication errors in neonatal care

Antecedentes: Muchos de los errores de tratamiento producidos en las unidades de cuidados intensivos neonatales (UCIN) tienen su origen en la necesidad de efectuar secuencias de cálculos para determinar dosis y diluciones de fármacos. Objetivos: Para ayudar en estas tareas se diseñó una hoja de cálculo (neodosis) que facilita los cálculos y estandariza las diluciones de algunas de las terapias más usadas en reanimación y UCIN. Para evaluar su utilidad se diseñó este trabajo. Métodos: Se efectuó un estudio controlado, cruzado y aleatorizado mediante simulaciones clínicas en las que se evaluó el número de errores y tiempo utilizado en su resolución, con y sin el programa. Fueron realizadas un total de 54 pruebas en las que intervinieron médicos (residentes de tercer y cuarto año y pediatras) y personal de enfermería. Resultados: Sin ayuda de ordenador todos los estamentos cometieron errores (en orden decreciente: residentes, pediatras y enfermería). El conjunto del estamento médico experimentó una reducción significativa de errores con la ayuda informática. El grupo de residentes fue el más beneficiado con su utilización: su porcentaje de errores "menores" pasó del 16 al 2% y el de errores "mayores" del 1,6% a 0. El tiempo empleado por todos los grupos se redujo entre un tercio y la mitad. Conclusiones: El personal asistencial probado cometió un número no insignificante de errores en pruebas de simulación sobre cálculos típicos de UCIN. Neodosis ayudó a médicos y enfermeras a reducir muy sensiblemente estos errores y a emplear menos tiempo en su resolución (AU)

[Episodic benign unilateral mydriasis. Clinical case in a girl]. / Midriasis unilateral benigna episódica. Caso clínico en una niña.

INTRODUCTION: Pupil asymmetry is an alarm signal which should lead to investigation to rule out severe underlying neurological disorders. Among its causes are tumors, aneurysms and hernia of the uncus. The differential diagnosis should also include other conditions such as Adie's tonic pupil, the Pourfour de Petit syndrome and local disorders such as closed angle glaucoma or segmental spasm of the iris dilator muscle. In practice however, exposure to mydriatic substance is one of the commonest causes. Another cause of this sign is benign episodic unilateral mydriasis. This uncommon condition has been defined as an isolated benign cause of pupil asymmetry. The underlying physiopathology is not always clear and may involve either parasympathetic deficiency or sympathetic hyperactivity affecting the iris. Usually related to migraine, some authors classify it as a limited form of ophthalmoplegic migraine, although some cases have been described with no accompanying headache. CLINICAL CASE: We describe a case of benign episodic unilateral mydriasis in a six-year-old girl who presented with intermittent episodes of pupil asymmetry with no other neurological symptoms. CONCLUSION: We underline the rarity of this condition in children with no simultaneous headache.

Hipoglucemia hiperinsulinémica persistente en recién nacido asociada al tratamiento con glimepiride al inicio del embarazo

No disponible

[Cardiac tamponade in children as a complication of central venous catheterization. Report of four cases]. / Taponamiento cardiaco en niños como complicación de la cateterización venosa céntral. Presentación de cuatro casos.

Very few cases of children with cardiac tamponade from central venous catheterization have been reported. Four cases are described. In 3 patients the diagnosis was suspected, a pericardiocentesis was performed and they survived. The other patient died and, at autopsy, diagnosis was made. The available literature on cardiac tamponade from central venous catheters in children is reviewed, preventive measures are considered in detail and the need for a high index of suspicion is highlighted.