Pneumococcal serotypes in children, clinical presentation and antimicrobial susceptibility in the PCV13 era.

The aim was to analyse invasive pneumococcal disease (IPD) serotypes in children aged ⩽17 years according to clinical presentation and antimicrobial susceptibility. We conducted a prospective study (January 2012-June 2016). IPD cases were diagnosed by culture and/or real-time polymerase chain reaction (PCR). Demographic, microbiological and clinical data were analysed. Associations were assessed using the odds ratio (OR) and 95% confidence intervals (CI). Of the 253 cases, 34.4% were aged <2 years, 38.7% 2-4 years and 26.9% 5-17 years. Over 64% were 13-valent pneumococcal conjugate vaccine (PCV13) serotypes. 48% of the cases were diagnosed only by real-time PCR. Serotypes 3 and 1 were associated with complicated pneumonia (P < 0.05) and non-PCV13 serotypes with meningitis (OR 7.32, 95% CI 2.33-22.99) and occult bacteraemia (OR 3.6, 95% CI 1.56-8.76). Serotype 19A was more frequent in children aged <2 years and serotypes 3 and 1 in children aged 2-4 years and 5-17 years, respectively. 36.1% of cases were not susceptible to penicillin and 16.4% were also non-susceptible to cefotaxime. Serotypes 14, 24F and 23B were associated with non-susceptibility to penicillin (P < 0.05) and serotypes 11, 14 and 19A to cefotaxime (P < 0.05). Serotype 19A showed resistance to penicillin (P = 0.002). In conclusion, PCV13 serotypes were most frequent in children aged ⩽17 years, mainly serotypes 3, 1 and 19A. Non-PCV13 serotypes were associated with meningitis and occult bacteraemia and PCV13 serotypes with pneumonia. Non-susceptibility to antibiotics of non-PCV13 serotypes should be monitored.

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report

OBJECTIVES: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. METHODS: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. RESULTS: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. CONCLUSIONS: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation

Patología ocular en adopción internacional: importancia de la región de origen / Eye disease in international adoption: Importance of the region of origin

INTRODUCCIÓN: Los ninos adoptados tienen una mayor prevalencia de patología oftalmológica. El objetivo es estudiar la patología oftalmológica en niños españoles procedentes de adopción internacional, valorando la influencia de la región geográfica de origen y del periodo institucional preadoptivo. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo en 232 niñnos. Se establecieron 4 grupos según la región geográfica de origen: grupo 1: Europa del Este (n = 95); grupo 2: Asia (n = 95); grupo 3: América Central y Sudamérica (n = 26), y grupo 4: África (n = 16). Se realizó un estudio oftalmológico completo. RESULTADOS: El 57,8% (134) de los niños presentaron patología oftalmológica. La prevalencia de ametropía se correlacionó significativamente con la región geográfica de origen, siendo estadísticamente superior en el grupo 3 (65,4%) con respecto a la del resto de grupos. El estrabismo y la hipoplasia del nervio óptico fueron más prevalentes en el grupo 1 (el 15,8 y el 3,2%, respectivamente). El periodo institucional preadoptivo fue significativamente mayor en los niños de los grupos 1 y 3 (24,5 y 27,7 meses, respectivamente). CONCLUSIONES: Los niños procedentes de adopción internacional de América Central y Sudamérica son el grupo con mayor prevalencia de ametropía. A pesar de no existir diferencias estadísticamente significativas, los ninos procedentes de Europa del Este presentaron una mayor tendencia a presentar estrabismo e hipoplasia de nervio óptico. Los padres adoptivos, pediatras y oftalmólogos deben conocer la elevada prevalencia de problemas oftalmológicos y velar por un diagnóstico precoz y un tratamiento adecuado

INTRODUCTION: To describe the ophthalmological conditions seen in children adopted internationally by Spanish families, and to assess the influence of the world region of origin and the preadoption period of institutional care on these conditions. MATERIAL AND METHODS: A descriptive, observational, cross-sectional study was conducted on 232 children divided into 4 groups according to world region of origin: Group 1, eastern Europe (n = 95); Group 2, Asia (n = 95); Group 3, Central and South America (n = 26); and Group 4, Africa (n = 16). A complete ophthalmological study was carried out and the groups were compared for the prevalence of ophthalmological conditions. RESULTS: Among the total, 57.8% (134) of children presented ophthalmological abnormalities. The prevalence of ametropia was strongly correlated with the world region of origin, and was significantly higher in Group 3 (65.4%) compared to the remaining groups. Strabismus and optic nerve hypoplasia (15.8% and 3.2%, respectively) were more prevalent in Group 1. The preadoption institutional care period was longer in children in Groups 1 and 3 (24.5 and 27.7 months, respectively). CONCLUSIONS: Children adopted from Central and South America had the highest prevalence of ametropia. Adopted children from eastern Europe showed a weak tendency to present strabismus and optic nerve hypoplasia. Adoptive parents, pediatricians and ophthalmologists should be aware of the high prevalence of ophthalmologic conditions in internationally adopted children and provide the means for a prompt diagnosis and appropriate treatment

Successful Semi-Ambulatory Veno-Arterial Extracorporeal Membrane Oxygenation Bridge to Heart-Lung Transplantation in a Very Small Child.

Lung transplantation (LTx) may be denied for children on extracorporeal membrane oxygenation (ECMO) due to high risk of cerebral hemorrhage. Rarely has successful LTx been reported in children over 10 years of age receiving awake or ambulatory veno-venous ECMO. LTx following support with ambulatory veno-arterial ECMO (VA ECMO) in children has never been reported to our knowledge. We present the case of a 4-year-old, 12-kg child with heritable pulmonary artery hypertension and refractory right ventricular failure. She was successfully bridged to heart-lung transplantation (HLTx) using ambulatory VA ECMO. Initial resuscitation with standard VA ECMO was converted to an ambulatory circuit using Berlin heart cannulae. She was extubated and ambulating around her bed while on VA ECMO for 40 days. She received an HLTx from an oversized marginal lung donor. Despite a cardiac arrest and Grade 3 primary graft dysfunction, she made a full recovery without neurological deficits. She achieved 104% force expiratory volume in 1 s 33 months post-HLTx. Ambulatory VA ECMO may be a useful strategy to bridge very young children to LTx or HLTx. Patient tailored ECMO cannulation, minimization of hemorrhage, and thrombosis risks while on ECMO contributed to a successful HLTx in our patient.

[Eye disease in international adoption: Importance of the region of origin]. / Patología ocular en adopción internacional: importancia de la región de origen.

INTRODUCTION: To describe the ophthalmological conditions seen in children adopted internationally by Spanish families, and to assess the influence of the world region of origin and the preadoption period of institutional care on these conditions. MATERIAL AND METHODS: A descriptive, observational, cross-sectional study was conducted on 232 children divided into 4 groups according to world region of origin: Group 1, eastern Europe (n=95); Group 2, Asia (n=95); Group 3, Central and South America (n=26); and Group 4, Africa (n=16). A complete ophthalmological study was carried out and the groups were compared for the prevalence of ophthalmological conditions. RESULTS: Among the total, 57.8% (134) of children presented ophthalmological abnormalities. The prevalence of ametropia was strongly correlated with the world region of origin, and was significantly higher in Group 3 (65.4%) compared to the remaining groups. Strabismus and optic nerve hypoplasia (15.8% and 3.2%, respectively) were more prevalent in Group 1. The preadoption institutional care period was longer in children in Groups 1 and 3 (24.5 and 27.7 months, respectively). CONCLUSIONS: Children adopted from Central and South America had the highest prevalence of ametropia. Adopted children from eastern Europe showed a weak tendency to present strabismus and optic nerve hypoplasia. Adoptive parents, pediatricians and ophthalmologists should be aware of the high prevalence of ophthalmologic conditions in internationally adopted children and provide the means for a prompt diagnosis and appropriate treatment.

Bacteriemia neumocócica durante el año 2009 en un hospital pediátrico de nivel 2: características clínicas y microbiológicas / Bacteremia pneumococcal throughout 2009 in a level 2 children's hospital: clinical and microbiological characteristics

Objetivo: Estudiar las características clínicas y microbiológicas de los pacientes con hemocultivo positivo a Streptococcus pneumoniae durante el año 2009 en un hospital pediátrico de nivel 2. Material y métodos: Estudio observacional descriptivo de los pacientes pediátricos con hemocultivo positivo a neumococo desde el 1 de enero hasta el 31 de diciembre de 2009. Se analizaron las siguientes variables: edad, vacunación antineumocócica conjugada heptavalente, antibioterapia previa, diagnóstico clínico, serotipo y sensibilidad antibiótica, así como la necesidad de ingreso hospitalario. Resultados: Se detectaron 15 pacientes con hemocultivo positivo a S. pneumoniae. El 60% de los aislamientos se obtuvo en niños entre 3 y 36 meses de edad. El diagnóstico clínico más frecuente fue neumonía, con o sin derrame pleural (67%). El serotipo aislado más frecuentemente fue el 1 (40%). Todos los pacientes infectados por el serotipo 1 presentaban como manifestaciónclínica la neumonía. Todas las cepas aisladas fueronsensibles a penicilina y cefotaxima según los nuevos criterios del Clinical Laboratory Standards Institute (2008). El 80%de los serotipos aislados están incluidos en la vacuna antineumocócica conjugada 13-valente, el 67% en la 10-valente y ninguno en la 7-valente.Conclusión: Los serotipos más frecuentemente aislados productores de enfermedad neumocócica invasiva durante el año2009 en nuestro centro son serotipos no incluidos en la vacuna antineumocócica conjugada heptavalente. Todos los serotipos aislados fueron sensibles a penicilina y cefotaxima(AU)

Objective: To study the clinical and microbiological characteristics of patients with positive blood culture for Streptococcus pneumoniae in 2009 in a pediatric level 2 hospital. Material and methods: Retrospective observational study of pediatric patients with positive blood culture for Streptococcus pneumoniae from January 1st to December 31st 2009. We analyzed the following variables: age, heptavalent pneumococcal conjugate vaccine (PCV7), previous antibiotic therapy, clinical diagnosis, serotype and antibiotic sensitivity and need for hospitalization. Results: We identified 15 patients with positive blood culture for S. pneumoniae (60%) and were obtained in children aged between 3 and 36 months of age. The most common clinical diagnosis was pneumonia with or without pleural effusion(67%). Serotype 1 was the most frequently isolated serotype(40%). All serotype 1-infected patients had pneumonia as a clinical manifestation. All isolates were susceptible to penicillin and cefotaxime under the new criteria of the Clinical Laboratory Standards Institute (2008). 80% of the isolated serotypes are included in pneumococcal conjugate vaccine13-valent, 67% in 10-valent and none in 7-valent.Conclusion: The most frequently isolated invasive pneumococcal disease producing serotypes in our center in 2009 were serotypes not included in PCV7 and were sensitive to penicillin and cefotaxime(AU)

Dos episodios de secuestro esplénico en un lactante con drepanocitosis homozigota / Two splenic sequestrations in an infant with homozygous sickle cell anemia

No disponible

Anemia megaloblástica por déficit nutricional / Cobalamin deficiency causing megaloblastic anemia

No disponible

Masa abdominal y eosinofilia en un niño de origen etíope / Abdominal mass and eosinophilia in an Ethiopian boy

No disponible

Otomastoiditis tuberculosa en un paciente de origen magrebí / Tuberculous otomastoiditis in a magrebian patient

No disponible

[Chronic and recurrent immune thrombocytopenic purpura]. / Púrpura trombocitopénica inmune crónica y recurrente.

BACKGROUND: Immune thrombocytopenic purpura (ITP) is characterized by a drop in platelet count usually accompanied by hemorrhagic diathesis. In chronic forms the platelet count remains low for six months after diagnosis and in recurrent forms the drop in platelet count appears after a period of normality. OBJECTIVES: To asses outcome and treatment response in patients with chronic or recurrent ITP. METHODS: We performed a retrospective, descriptive study of patients attended in the pediatric hematology outpatient clinic between January 1999 and December 2001. RESULTS: Of 38 patients with chronic ITP, 16 (42 %) presented chronic forms and 22 (58 %) presented recurrent forms. No significant differences were found between the two groups in age, sex, diagnosis, duration of follow-up, previous viral infection, or antiplatelet antibodies. In recurrent forms, the most effective treatment was intravenous immune gamma-globulin (77 % favorable responses) but response time was short (mean: 22.1 weeks). Splenectomy produced complete remission in 63 % of the chronic forms. Good results were obtained in six patients from both groups treated with intravenous anti-D immune globulin. During the study period, 4.5 % of patients with recurrent forms and 31.5 % of those with chronic forms showed spontaneous remission without treatment. CONCLUSIONS: In our experience, the most effective treatment for recurrent forms of ITP was intravenous immune globulin, but none of the treatments achieved long-term responses. In chronic forms, splenectomy is an effective alternative when the risk of hemorrhage is high, while a watchful attitude seems to be the best option when this risk is absent. Although the number of patients treated with intravenous anti-D immune globulin was low, good results were achieved.

Púrpura trombocitopénica inmune crónica y recurrente / Chronic and recurrent immune thrombocytopenic purpura

Antecedentes: La púrpura trombocitopénica inmune es un trastorno autoinmune caracterizado por un descenso de la cifra de plaquetas acompañado habitualmente de diátesis hemorrágica. Las formas crónicas son aquellas en las que la trombocitopenia persiste a los 6 meses del diagnóstico y las formas recurrentes son las que, tras un período de normalidad, experimentan un descenso en la cifra de plaquetas. Objetivos Valorar la evolución, así como la respuesta al tratamiento, de los pacientes afectados de púrpura trombocitopénica inmune crónica persistente y recurrente. Métodos Estudio retrospectivo y descriptivo de los pacientes asistidos en consultas externas en un período de 3 años, desde enero de 1999 hasta diciembre de 2001.Resultados De 38 pacientes afectados de púrpura trombocitopénica inmune crónica, 16 (42 por ciento) correspondieron a formas crónicas y 22 (58 por ciento) se consideraron formas recurrentes. No se encontraron diferencias significativas entre ambos grupos en cuanto a sexo, edad al diagnóstico, tiempo de seguimiento, infección viral previa, así como presencia de anticuerpos antiplaquetarios. En las formas recurrentes, el tratamiento médico más eficaz fue la gammaglobulina por vía intravenosa (77 por ciento de respuestas favorables), pero la duración de la respuesta fue corta (media, 22,1 semanas).El 63 por ciento de las formas crónicas persistentes obtuvieron una remisión completa mediante esplenectomía. Seis pacientes de ambos grupos, tratados con gammaglobulina anti-D, obtuvieron resultados favorables. El 4,5 por ciento de las formas recurrentes y el 31,5 por ciento de las persistentes remitieron de forma espontánea durante el período de estudio. Conclusiones Con los resultados obtenidos y en nuestra experiencia, el tratamiento más eficaz en las formas recurrentes fue la gammaglobulina intravenosa, pero ningún tratamiento consiguió respuestas duraderas a largo plazo. En las formas persistentes la esplenectomía sería una alternativa eficaz en situaciones de riesgo hemorrágico, mientras que una conducta expectante parece la mejor opción cuando éste no exista. Aunque el número de pacientes tratados es limitado es de señalar el elevado número de respuestas favorables obtenidas con la gammaglobulina anti-D (AU)

Tumoración indolora en el brazo / Non-painful arm sweelling

No disponible

Exantema petequial generalizado / Generalized potechial exanthema

No disponible