Pediatric thyroidectomy in a "low volume" institution without protocolization: results and future horizons. / Tiroidectomía pediátrica en un centro de "bajo volumen" y sin protocolización: resultados y horizontes.

OBJECTIVE: Pediatric thyroidectomy is an infrequent, complex surgery, with high risk of complications. Complication rates and oncological results of non-protocolized thyroidectomy in a secondary pediatric hospital were compared with those from reference institutions. MATERIALS AND METHODS: A retrospective study of patients under 15 years old undergoing thyroidectomy ± cervical lymphadenectomy by low volume pediatric surgeons (<30 cervical endocrine surgeries annually) in a pediatric hospital from January 2010 to January 2020 was carried out. RESULTS: 11 patients undergoing 12 surgeries (mean age: 9.8 years; 63% female) were analyzed. Thyroid nodules were the main surgical indication (50%), and prevalence of genetic mutations was 45%. 1 patient had transient hypocalcemia, and there were 2 cases of transient recurrent laryngeal nerve neuropraxia (16.6%). No permanent complications were noted. 66.6% of pathological reports showed malignancy. Mean hospital stay was 2.35 days (range: 1.25-5), with an overall complication rate of 25%, similar to that reported by high-volume institutions. After a mean follow-up of 4 years, tumor recurrence has not been observed in any patient. CONCLUSIONS: In our view, an experienced pediatric surgeon specialized in pediatric and neonatal general surgery - even if below the high volume threshold - acquires the skills required in pediatric thyroid surgery without an increase in morbidity and mortality. Perioperative management should be agreed and protocolized by the various specialists involved to improve results.

OBJETIVOS: La tiroidectomía pediátrica es una intervención infrecuente, compleja y con un riesgo elevado de complicaciones. Se evalúa la tasa de complicaciones y resultados oncológicos de la tiroidectomía no protocolizada en un hospital infantil de segundo nivel en comparación con los centros de referencia. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes menores de 15 años sometidos a tiroidectomía ± disección ganglionar cervical por cirujanos pediátricos de bajo volumen (< 30 cirugías endocrinas cervicales/año) entre enero de 2010 y enero de 2020 en un hospital infantil. RESULTADOS: Se analizaron once pacientes sometidos a 12 procedimientos quirúrgicos (edad media 9,8 años, 63% niñas). Los nódulos tiroideos fueron la principal indicación quirúrgica (50%) y la prevalencia de mutaciones genéticas en la serie fue del 45%. Un paciente presentó hipocalcemia transitoria y hubo 2 casos de neuropraxia transitoria del nervio laríngeo recurrente (16,6%). No hubo complicaciones permanentes. El 66,6% de los informes anatomopatológicos mostraron malignidad. La estancia hospitalaria media fue de 2,35 días (rango 1,25-5) con una tasa global de complicaciones del 25%, similar a la reportada por centros de alto volumen. Después de un seguimiento medio de 4 años, ningún paciente ha presentado recidiva tumoral. CONCLUSIONES: Sugerimos que un cirujano infantil con experiencia en cirugía pediátrica general y neonatal, a pesar de no superar el umbral de alto volumen, adquiere las facultades para realizar la cirugía tiroidea pediátrica sin aumento de morbilidad y mortalidad. El manejo perioperatorio debe ser consensuado entre los diversos especialistas involucrados y protocolizado para mejorar los resultados.

Tiroidectomía pediátrica en un centro de “bajo volumen” y sin protocolización: resultados y horizontes / Pediatric thyroidectomy in a “low volume” institution without protocolization: results and future horizons

Objetivos: La tiroidectomía pediátrica es una intervención infre-cuente, compleja y con un riesgo elevado de complicaciones. Se evalúala tasa de complicaciones y resultados oncológicos de la tiroidectomía noprotocolizada en un hospital infantil de segundo nivel en comparacióncon los centros de referencia. Material y métodos: Estudio retrospectivo de los pacientes menoresde 15 años sometidos a tiroidectomía ± disección ganglionar cervical porcirujanos pediátricos de bajo volumen (< 30 cirugías endocrinas cervi-cales/año) entre enero de 2010 y enero de 2020 en un hospital infantil. Resultados: Se analizaron once pacientes sometidos a 12 proce-dimientos quirúrgicos (edad media 9,8 años, 63% niñas). Los nódulostiroideos fueron la principal indicación quirúrgica (50%) y la prevalenciade mutaciones genéticas en la serie fue del 45%. Un paciente presentóhipocalcemia transitoria y hubo 2 casos de neuropraxia transitoria delnervio laríngeo recurrente (16,6%). No hubo complicaciones permanen-tes. El 66,6% de los informes anatomopatológicos mostraron malignidad.La estancia hospitalaria media fue de 2,35 días (rango 1,25-5) con unatasa global de complicaciones del 25%, similar a la reportada por centrosde alto volumen. Después de un seguimiento medio de 4 años, ningúnpaciente ha presentado recidiva tumoral. Conclusiones: Sugerimos que un cirujano infantil con experienciaen cirugía pediátrica general y neonatal, a pesar de no superar el umbralde alto volumen, adquiere las facultades para realizar la cirugía tiroideapediátrica sin aumento de morbilidad y mortalidad. El manejo periopera-torio debe ser consensuado entre los diversos especialistas involucradosy protocolizado para mejorar los resultados.(AU)

Objective: Pediatric thyroidectomy is an infrequent, complex sur-gery, with high risk of complications. Complication rates and oncolog-ical results of non-protocolized thyroidectomy in a secondary pediatrichospital were compared with those from reference institutions. Materials and methods: A retrospective study of patients under15 years old undergoing thyroidectomy ± cervical lymphadenectomyby low volume pediatric surgeons (<30 cervical endocrine surgeriesannually) in a pediatric hospital from January 2010 to January 2020was carried out. Results: 11 patients undergoing 12 surgeries (mean age: 9.8 years;63% female) were analyzed. Thyroid nodules were the main surgical in-dication (50%), and prevalence of genetic mutations was 45%. 1 patienthad transient hypocalcemia, and there were 2 cases of transient recurrentlaryngeal nerve neuropraxia (16.6%). No permanent complications werenoted. 66.6% of pathological reports showed malignancy. Mean hospitalstay was 2.35 days (range: 1.25-5), with an overall complication rateof 25%, similar to that reported by high-volume institutions. After amean follow-up of 4 years, tumor recurrence has not been observedin any patient. Conclusions: In our view, an experienced pediatric surgeon spe-cialized in pediatric and neonatal general surgery – even if below thehigh volume threshold – acquires the skills required in pediatric thyroidsurgery without an increase in morbidity and mortality. Perioperative management should be agreed and protocolized by the various specialistsinvolved to improve results.(AU)

Vitamin D status and response to growth hormone treatment in prepubertal children with growth hormone deficiency.

PURPOSE: To analyze whether vitamin D deficiency could condition the growth response to GH therapy, as well as to analyze if GH treatment modifies both seasonal variations and vitamin D levels in these patients. METHODS: Retrospective study in 98 prepubertal children with GH deficiency (GHD), aged 4.1-8.9 years treated with GH. Growth rate and blood testing (calcium, phosphorus, IGF-I, 25(0H)D and PTH) were monitored at diagnostic and every six months until 24 months of treatment. A control group was recruited (247 healthy children, aged 3.8-9.7 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: There were no significant differences in vitamin D deficiency among control (12.5%) and GHD groups (15.3%) before starting treatment. Growth rate and IGF-1 and PTH increased (p < 0.05) during GH treatment, but there were no significant differences in calcium, phosphorus and 25(OH)D. There were no significant differences in growth rate and IGF-1, calcium and phosphorus levels in relation to the seasons along GH treatment. There was no correlation between 25(OH)D and IGF-1 during GH therapy. In every programmed control, patients with vitamin D deficiency showed lower growth rate (p < 0.05) compared to patients with vitamin D insufficiency or sufficiency. CONCLUSION: GH treatment, at least during the first two years, does not modify the vitamin D levels. Vitamin D deficiency could condition the response to GH therapy so vitamin D monitoring should be considered as part of the routine evaluation of children with GH treatment.

Prevalence of hypovitaminosis D and associated factors in obese Spanish children.

BACKGROUND/OBJECTIVES: Vitamin D deficiency may contribute to endocrine health and disease (diabetes, autoimmune thyroid diseases, polycystic ovarian syndrome, etc.). The aim of this study was to determine the prevalence and specific factors for hypovitaminosis D among children stratified by body mass index (BMI) in Northern Spain. SUBJECTS/METHODS: A cross-sectional clinical (sex, age, season of study visit, place of residence and BMI) and blood testing (calcium, phosphorous, calcidiol and parathyroid hormone (PTH)) were accomplished in 546 Caucasian individuals (aged 3.2-15.8 years). The BMI (Z-score) allowed establishing four groups: normal, overweight, obesity and severe obesity. The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. RESULTS: Calcidiol levels were significantly higher in normal and overweight groups (P=0.001), whereas PTH levels were significantly higher in obesity and severe obesity groups (P=0.001). Hypovitaminosis D prevalence was significantly higher in severe obesity (81.1%) and obesity (68.2%) groups, whereas was lowest in overweight (55%) and normal (58.1%) groups (P=0.001). There was a negative correlation between calcidiol and PTH levels (P<0.01). Female (90.9%), adolescent group (88,2%), winter (100%) and autumn (82.4%) time and urban residence (94.1%) imply a higher prevalence of hypovitaminosis D in subjects with severe obesity (P<0.001). Female, puberal age, autumn, winter and spring time, urban residence and severe obesity were found to be independent predictors for hypovitaminosis D. CONCLUSIONS: Severe obesity could be considered as an associated factor for vitamin D deficiency, and, owing to its high prevalence, the implementation of systematic screening and hypovitaminosis treatment programs would be particularly useful.

Hipotiroidismo subclínico / No disponible

No disponible

[Change of position and the decrease in the cases of sudden infant death syndrome in Navarra]. / Cambio de postura y disminución de la tasa de mortalidad por muerte súbita infantil en Navarra.

The prone position during sleep has been described as the most important risk factor in relationship to sudden infant death syndrome (SIDS). The prevalence of infants that sleep in the prone position and its relationship with SIDS has not been studied in our country. A survey was performed in a population of children born in Navarra between February 1, 1992 and February 1, 1993. We found that 86.5% of these children sleep in the prone position, 5.6% in the supine position and 3.5% on their side. In March 1993 a campaign was begun that recommended that the prone position not be used for infants from the time of birth until 6 months of age. After this campaign, in a sample of 441 children, born between May 1, 1993 and May 1, 1994, only 38.3% of the infants continued to sleep in the prone position, while 46% did so supine and 9% slept on their side. The number of deaths in Navarra as a result of SIDS during the period of 1985 through 1993 was 1.3% of live births with a mean of 6.3 deaths/year. The number of infant deaths after the change of sleeping position, in 1994, was 0.42% of live births, with 2 deaths as a result of SIDS during this year. In Navarra, the decrease in the number of infants sleeping in the prone position has been accompanied by a significant decline in the number of deaths due to SIDS.