Estreptococo del grupo B que «atraviesa la barrera» del Protocolo de Atlanta / Streptococcus agalactiae, or group B, that «crosses the barrier» of Atlanta’s Protocolo

Se presenta el caso de un recién nacido de 6 días de vida, atendido en el centro de salud, cuya madre estaba contaminada por el estreptococo grupo B (SGB), o Agalactiae, durante la gestación y que había recibido 4 dosis de ampicilina intraparto. En los informes no se mencionó la presencia de SGB ni nada relativo al tratamiento antibiótico profiláctico intraparto. El recién nacido presentaba ictericia, por lo que se remitió al hospital e ingresó en el servicio de neonatología para realizar fototerapia, ya que presentaba una bilirrubinemia de 23,1 mg/dL. Fue dado de alta con una bilirrubinemia de 10 mg/dL, una exploración física y una analítica normales, y alimentación con lactancia materna bien instaurada. Tras el alta, a los 13 días de vida, se realizó un urocultivo para descartar una contaminación por SGB, que se confirmó a los 15 días de vida, por lo que se diagnosticó como recién nacido contaminado por SGB y se inició tratamiento con amoxicilina oral durante 10 días, con controles clínicos y urocultivos posteriores normales(AU)

We present a case of a 6-day newborn attended at the health center, whose mother was contaminated with Streptococcus agalactiae or group B (GBS) during pregnancy and had received four doses of ampicillin intrapartum. The reports did not mention the presence of GBS or anything regarding intrapartum antibiotic prophylaxis. The newborn had jaundice so we sent him to the hospital and he was admitted to neonatal service for phototherarapy with bilirubin of 23.1 mg/dL and was discharged with bilirubin of 10 mg/dL and normal physical examination and laboratory and breast feeding well established. After discharge, at 13 days old, we took urine culture to discard contamination by SGB and the 15th day of age was confirmed and diagnosed as a newborn contaminated by SGB and began treatment with oral amoxicillin for 10 days, and good health controls and normal subsequent urine cultures(AU)

¿Se debe formar el residente de Pediatría en Atención Primaria? ¿Por qué? Encuesta a pediatras y residentes de Valencia / No disponible

Introducción y objetivos: considerando que el residente de Pediatría no se forma en puericulturani en prevención y promoción de salud del niño sano en centros de Atención PediátricaPrimaria, ni para el tratamiento del niño que no precisa atención hospitalaria, se intentasaber si el residente debe formarse en Atención Primaria.Material y métodos: para ello se distribuyó una encuesta anónima dirigida a todos lospediatras que prestan la Atención Primaria en la ciudad de Valencia, a todos los pediatras delHospital La Fe y a todos los residentes de Pediatría de dicho hospital. Se preguntó: ¿Creesque el residente de Pediatría debe rotar –también– por un centro de Atención Primaria acreditadopara completar su formación? Y ¿por qué?Resultados: se obtuvo un porcentaje de respuesta del 44,7%. El 86% respondió sí, el13% no y el 1% en blanco. Dijeron sí el 90% de los pediatras (95% de Primaria y 83% dehospital) y el 50% de los residentes. Los encuestados respondieron a la segunda parte de lapregunta y aportaron su opinión respecto a los motivos a favor de la rotación en AtenciónPediátrica Primaria; el 29% aportó ideas respecto al programa de formación del residente. El13% que opinó que no debe rotar justificó su opinión y aportó ideas para la formación delresidente. Conclusiones: el 86% de encuestados opina que el residente de Pediatría debe rotar porAtención Primaria para completar su formación y el 17% reclama alargar a más de cuatro añosla especialidad de Pediatría

Introduction and objectives: considering that the resident physician in the specialty ofpaediatrics in Valencia never trains in Paediatric Primary Care centres and that he does notreceive any preparation in child care nor in aspects as preventive care and promotion of goodhabits in healthy children or the treatment of ill children who do not need hospitalization,our intention is to find out if residents should be trained in Paediatric Primary Care, accordingto the opinion of paediatricians and residents in paediatrics.Material and methods: for this reason, an anonymous survey was carried out directed toall paediatricians in Primary Care in the city of Valencia and to all paediatricians and residentsin paediatrics who practise hospital care in the Hospital La Fe. The questions were: Doyou think that a paediatric resident should train –additionally– in an accredited primary healthcare center in order to complete his training? Why?Results: a percentage of 44.7% answered. Eighty-six per cent answered yes, 13% no and1% blank. Affirmative responses were from 90% of the paediatricians (95% primary carepaediatricians and 85% hospital care paediatricians) and 50% of the residents. Those surveyedresponded to the second part of the question giving their opinion on the motives in favourof Paediatric Primary Care training. 29% offered ideas for the resident training program,the 13% against Paediatric Primary Care training, that justified with their opinions.Conclusions: 86% say the resident should be trained in Paediatric Primary Care and17% demand more than four years’ training in Paediatrics

[Is the pediatric service coordinated? Survey of pediatricians in Valencia and solutions]. / Está coordinado el Servicio de Pediatría? Encuesta a pediatras de Valencia y soluciones.

OBJECTIVE: The objective of this study was to identify existing problems in the coordination between the different levels of the pediatric care system and suggest possible solutions. PATIENTS AND METHODS: A poll of 66% of the health center pediatricians (HCP) of the greater metropolitan area of Valencia (city + 30 km) on the problems in the coordination between HCP and hospital pediatricians (HP), possible solutions and the number of patients per HCP per day, including the average and range, was performed. RESULTS: Answers were received from 54% of the HCP (n = 51), which represented 81% of the sample. Problems were identified in coordination (100%), institutional organization (98%), communication (96%), access to reports from outpatient clinics (84%), lack of time and mobility of the HCP (33%), and in the structure of the emergency service for primary child care (ESPCC; 4%). The suggested solutions were; None (6%), global institutional organization (94%) by creating a hierarchy in the HP and HCP, meetings and protocols by consensus, rotation of HP, HCP and pediatric residents between health centers and hospitals, institutionalized intercommunication, allotting time and work mobility to HCP, limiting patients per day and planning ESPCC in hospitals. The average number of patients per day was 32 +/- 8 patients/day (pd), range: 5-100 pd, with 92% of the HCP seeing > 20 pd, 63% > 30 pd, 17% > 40 pd and 2% > 50 pd. At > 6 km from the city there is no coordination and the number of patients/day is greater (p < 0.02). CONCLUSIONS: There is no institutionalized coordination between HP and NCP. The greater the distance from the city, the greater the overload and the lower the coordination. There is a lack of institutional organization.