Effect of Protein Intake Early in Life on Kidney Volume and Blood Pressure at 11 Years of Age.

High protein intake has been associated with kidney hypertrophy, which is usually reversible; however, when it occurs early in life, it could lead to cell programming with a long-lasting effect. This study aimed to assess whether higher protein ingestion early in life has a persistent effect on kidney volume at 11 years of age, as well as its influence on blood pressure. This is a secondary analysis of a randomized control trial that compared the growth of infants fed with a higher-protein formula versus those fed with a lower-protein formula, with a control group of breastfed infants. Renal ultrasound and anthropometric measurements were assessed at 6 months and 11 years of age. At 11 years, urinary protein, albumin and creatinine, and blood pressure were measured in 232 children. Feeding with a higher-protein formula was associated with a larger kidney volume (ß = 8.71, 95%CI 0.09-17.33, p = 0.048) and higher systolic blood pressure (ß = 3.43, 95%CI 0.78-6.08, p = 0.011) at 11 years of age. Microalbuminuria was detected in 7% of the patients, with no differences among groups (p = 0.56). The effect of increased protein ingestion early in life may condition kidney volume and blood pressure in later childhood.

Lactant amb estancament ponderal I alteració hidroelectrolítica / No disponible

No disponible

[Treatment for children and adolescents with pain in Spain: data from a survey on current specialized programs]. / El tratamiento del dolor en población infantojuvenil en España: Datos de una encuesta sobre los programas especializados existentes.

OBJECTIVE: The treatment of children and adolescents with pain has improved considerably in the last 30 years. In Spain, progress is also evident, and specialized units or programs have emerged as part of the care provided for this population. However, there are no studies on the characteristics or activities of these specialized units or programs. This lack of information prevents an adequate evaluation of the current procedures, and hinders an adequate administration and management of these resources. The objective of this work was to study the characteristics of these units and programs for the treatment of children and adolescents with pain in Spain. METHODS: A total of 10 specialized units or specific treatment programs for pediatric pain in Spain were identified, and the person responsible was contacted. Through a self-administered online survey, information was collected on the organization of the program, the involvement in relevant fields such as research, training of professionals and the raising of awareness and visibility of the problem, the specialties involved, the type of treatments offered, the evaluation of results and the services provided. RESULTS: Of the ten units or programs contacted, eight answered the survey (80%). Pain programs for children and adolescents proved to be primarily pharmacological, also for chronic pain. They reported to promote awareness about the problem (88%), to contribute to the training of specialists (88%) and to a lesser extent to research and knowledge generation (75%). CONCLUSIONS: This survey provides valuable information on the current characteristics of specialized programs and units for the treatment of children and adolescents with pain in Spain, and can be used to propose actions that improve its current management and administration.

OBJETIVO: El tratamiento de la población infantojuvenil con dolor ha mejorado considerablemente en los últimos 30 años. En España, el progreso también es evidente, y han surgido unidades o programas especializados como parte de la atención a esta población, aunque no existen estudios sobre las características o la actividad de estas unidades o programas especializados. Esta falta de información impide una evaluación adecuada de los procedimientos vigentes y dificulta una adecuada administración y gestión de estos recursos. El objetivo de este trabajo fue conocer las características de estas unidades y programas para el tratamiento de la población infantojuvenil con dolor en España. METODOS: Se identificaron un total de 10 unidades especializadas o programas de tratamiento específicos del dolor infantil en España y se contactó con la persona responsable. A través de una encuesta autoadministrada online se recogió información sobre la organización del programa, su implicación en ámbitos relevantes como la investigación, la formación de los profesionales, la sensibilización y visibilidad del problema en la sociedad y entre los profesionales, las especialidades implicadas, el tipo de tratamientos que se ofrecen, la evaluación de resultados y los servicios prestados. Se han utilizado medias y porcentajes para describir los resultados. RESULTADOS: De las diez unidades o programas contactados, ocho contestaron a la encuesta (80%). Los programas de tratamiento del dolor infantojuvenil demostraron ser fundamentalmente farmacológicos, también en los casos de dolor crónico. Informaban de que se preocupaban por impulsar la sensibilización de los especialistas y la sociedad sobre el problema (88%), de contribuir también a la formación de especialistas (88%) y, en menor medida, de investigar y generar conocimiento (75%). CONCLUSIONES: Esta encuesta proporciona información valiosa sobre las características actuales de los programas y unidades especializadas para el tratamiento de la población infantojuvenil con dolor en España. Puede servir para proponer acciones que mejoren la gestión y administración actual.

El tratamiento del dolor en población infantojuvenil en España: Datos de una encuesta sobre los programas especializados existentes / Treatment for children and adolescents with pain in Spain: data from a survey on current specialized programs

OBJETIVO: El tratamiento de la población infantojuvenil con dolor ha mejorado considerablemente en los últimos 30 años. En España, el progreso también es evidente, y han surgido unidades o programas especializados como parte de la atención a esta población, aunque no existen estudios sobre las características o la actividad de estas unidades o programas especializados. Esta falta de información impide una evaluación adecuada de los procedimientos vigentes y dificulta una adecuada administración y gestión de estos recursos. El objetivo de este trabajo fue conocer las características de estas unidades y programas para el tratamiento de la población infantojuvenil con dolor en España. MÉTODOS: Se identificaron un total de 10 unidades especializadas o programas de tratamiento específicos del dolor infantil en España y se contactó con la persona responsable. A través de una encuesta autoadministrada online se recogió información sobre la organización del programa, su implicación en ámbitos relevantes como la investigación, la formación de los profesionales, la sensibilización y visibilidad del problema en la sociedad y entre los profesionales, las especialidades implicadas, el tipo de tratamientos que se ofrecen, la evaluación de resultados y los servicios prestados. Se han utilizado medias y porcentajes para describir los resultados. RESULTADOS: De las diez unidades o programas contactados, ocho contestaron a la encuesta (80%). Los programas de tratamiento del dolor infantojuvenil demostraron ser fundamentalmente farmacológicos, también en los casos de dolor crónico. Informaban de que se preocupaban por impulsar la sensibilización de los especialistas y la sociedad sobre el problema (88%), de contribuir también a la formación de especialistas (88%) y, en menor medida, de investigar y generar conocimiento (75%). CONCLUSIONES: Esta encuesta proporciona información valiosa sobre las características actuales de los programas y unidades especializadas para el tratamiento de la población infantojuvenil con dolor en España. Puede servir para proponer acciones que mejoren la gestión y administración actual

OBJECTIVE: The treatment of children and adolescents with pain has improved considerably in the last 30 years. In Spain, progress is also evident, and specialized units or programs have emerged as part of the care provided for this population. However, there are no studies on the characteristics or activities of these specialized units or programs. This lack of information prevents an adequate evaluation of the current procedures, and hinders an adequate administration and management of these resources. The objective of this work was to study the characteristics of these units and programs for the treatment of children and adolescents with pain in Spain. METHODS: A total of 10 specialized units or specific treatment programs for pediatric pain in Spain were identified, and the person responsible was contacted. Through a self-administered online survey, information was collected on the organization of the program, the involvement in relevant fields such as research, training of professionals and the raising of awareness and visibility of the problem, the specialties involved, the type of treatments offered, the evaluation of results and the services provided. RESULTS: Of the ten units or programs contacted, eight answered the survey (80%). Pain programs for children and adolescents proved to be primarily pharmacological, also for chronic pain. They reported to promote awareness about the problem (88%), to contribute to the training of specialists (88%) and to a lesser extent to research and knowledge generation (75%). CONCLUSIONS: This survey provides valuable information on the current characteristics of specialized programs and units for the treatment of children and adolescents with pain in Spain, and can be used to propose actions that improve its current management and administration

Rickettsiosis tras la picadura de una garrapata: una clínica sutil en muchas ocasiones, debemos estar atentos / Rickettsiosis after tick bite: A subtle clinic picture on many occasions, we must be vigilant

Las rickettsiosis constituyen un grupo de enfermedades transmitidas por la picadura de garrapatas, clasificándose en 2 grandes grupos: fiebres manchadas y fiebres tifíticas. Además, recientemente se ha descrito una nueva entidad conocida como linfadenopatía por picadura de garrapata. Presentamos una serie retrospectiva de casos pediátricos diagnosticados de rickettsiosis durante los años 2013-2014. Se incluyeron un total de 8 pacientes, 2 de ellos diagnosticados de fiebre botonosa mediterránea y 6 de linfadenopatía por picadura de garrapata, identificándose en 3 de ellos Rickettsia slovaca, Rickettsia sibirica mongolitimonae y Rickettsia massiliae. Se describen la etiología, las características clínicas y el tratamiento realizado en cada uno de ellos. El interés de estos casos radica en que aunque mayoritariamente presentan un curso benigno, la elevada sospecha diagnóstica y el inicio precoz del tratamiento parecen ser beneficiosos en su evolución

Rickettsia diseases are a group of tick-borne transmitted diseases, classified into 2 large groups: spotted fevers and typhus fevers. In addition, a new condition has been described recently, known as tick-borne lymphadenopathy. A retrospective series is presented of paediatric cases of rickettsia diseases diagnosed in 2013 and 2014. A total of 8 patients were included, of which 2 of them were diagnosed as Mediterranean spotted fever, and 6 as tick-borne lymphadenopathy. Rickettsia slovaca, Rickettsia sibirica mongolitimonae, and Rickettsia massiliae were identified in 3 of them. Aetiology, clinical features and treatment carried out in each of them are described. The interest of these cases is that, although most have a benign course, the high diagnostic suspicion and early treatment seem to be beneficial for its outcome

[Rickettsiosis after tick bite: A subtle clinic picture on many occasions, we must be vigilant]. / Rickettsiosis tras la picadura de una garrapata: una clínica sutil en muchas ocasiones, debemos estar atentos.

Rickettsia diseases are a group of tick-borne transmitted diseases, classified into 2 large groups: spotted fevers and typhus fevers. In addition, a new condition has been described recently, known as tick-borne lymphadenopathy. A retrospective series is presented of paediatric cases of rickettsia diseases diagnosed in 2013 and 2014. A total of 8 patients were included, of which 2 of them were diagnosed as Mediterranean spotted fever, and 6 as tick-borne lymphadenopathy. Rickettsia slovaca, Rickettsia sibirica mongolitimonae, and Rickettsia massiliae were identified in 3 of them. Aetiology, clinical features and treatment carried out in each of them are described. The interest of these cases is that, although most have a benign course, the high diagnostic suspicion and early treatment seem to be beneficial for its outcome.

Agenesia renal unilateral. Nuevos argumentos acerca de la relación genética entre la urolitiasis y las malformaciones renales / Unilateral renal agenesis. New arguments about the genetic relationship between kidney malformations and urolithiasis

ANTECEDENTES: En escasos trabajos previos, se ha comunicado que puede observarse la presencia de hipercalciuria en pacientes portadores de algunos tipos de CAKUT como estenosis pieloureteral, reflujo vesicoureteral o quistes renales simples. Además, se ha descrito una prevalencia mayor de hipercalciuria y/o urolitiasis en los miembros de las familias de esos niños con algunos tipos de CAKUT, en comparación con la población en general. El presente estudio se llevó a cabo para averiguar si los niños con agenesia renal unilateral (ARU) tienen las características descritas anteriormente en otros tipos de CAKUT. MÉTODOS: En un estudio descriptivo y multicéntrico se determinó la prevalencia de hipercalciuria, hipocitraturia y urolitiasis en 67 niños (43 hombres y 24 mujeres) con ARU y sus familias. RESULTADOS: En 26 niños (38,8%) se observaron las dos anomalías metabólicas que favorecen la formación de cálculos renales distribuidos de la siguiente manera: hipercalciuria en 16, hipocitraturia en 9 y tanto hipercalciuria como hipocitraturia en 1. Ocho niños (11,9%) padecieron un cólico renal durante el tiempo total de seguimiento. Una historia familiar de litiasis urinaria se encontró en 42/67 de los niños (62,7%): en familiares de primer grado en 12 de ellos, en familiares de segundo grado en 15 y en ambos grados de familiares en los otros 15. En contraste, en el grupo de control histórico, solamente en 28,1% de las familias, al menos, un miembro había tenido urolitiasis. CONCLUSIÓN: Nuestros resultados muestran que la prevalencia de la hipercalciuria y/o hipocitraturia en pacientes pediátricos con ARU es mayor que en la población general. Asimismo, la prevalencia de urolitiasis en las familias de estos niños es también mayor que en la población general

BACKGROUND: In few previous studies, it has been reported that hypercalciuria is associated with some types of congenital anomalies of the kidney and urinary tract (CAKUT), namely ureteropelvic junction obstruction, vesicoureteral reflux or simple renal cysts. In addition, one higher prevalence of hypercalciuria and/or urolithiasis has been described in their family members compared to the general population. This study was carried out to find out whether children with unilateral renal agenesis (URA) have these features previously described in other CAKUT types. METHODS: In a descriptive and multicenter study we studied the prevalence of hypercalciuria, hypocitraturia and urolithiasis in 67 children (43 males and 24 females) with URA and their families. RESULTS: The two metabolic anomalies that promote stone formation were observed in 26 children (38.8%), distributed as follows: hypercalciuria in 16, hypocitraturia in 9, and both hypercalciuria and hypocitraturia in 1. Eight children (11.9%) suffered renal colic during follow-up. Familial history of urolithiasis was found in 42/67 children (62.7%): in 12 of the first-degree relatives, in 15 of the second degree relatives and in 15 patients both in the first-degree as in their second degree relatives. In contrast, in historic control group, only in 28.1% of families at least one member had urolithiasis. CONCLUSION: Our results show that the prevalence of hypercalciuria and/or hypocitraturia is greater in pediatric patients with URA than in the general population. Likewise, the prevalence of urolithiasis in the families of these children is also higher than that in the general population

[Unilateral renal agenesis. New arguments about the genetic relationship between kidney malformations and urolithiasis]. / Agenesia renal unilateral. Nuevos argumentos acerca de la relación genética entre la urolitiasis y las malformaciones renales.

BACKGROUND: In few previous works, it has been reported that hypercalciuria is associated with some types of CAKUT, namely ureteropelvic junction obstruction, vesicoureteral reflux or simple renal cysts. In addition, one higher prevalence of hypercalciuria and/or urolithiasis has been described in their family members compared to the general population. This study was carried out to find out whether children with unilateral renal agenesis (URA) have these features previously described in other CAKUT types. METHODS: In a descriptive and multicenter study we studied the prevalence of hypercalciuria, hypocitraturia and urolithiasis in 67 children (43 males and 24 females) with URA and their families. RESULTS: The two metabolic anomalies that promote stone formation were observed in 26 children (38.8%), distributed as follows: hypercalciuria in 16, hypocitraturia in 9, and both hypercalciuria and hypocitraturia in 1. Eight children (11.9%) suffered renal colic during follow-up. Familial history of urolithiasis was found in 42/67 children (62.7%): in 12 of the first-degree relatives, in 15 of the second degree relatives and in 15 patients both in the first-degree as in their second degree relatives. In contrast, in historic control group, only in 28.1% of families at least one member had urolithiasis. CONCLUSION: Our results show that the prevalence of hypercalciuria and/or hypocitraturia is greater in pediatric patients with URA than in the general population. Likewise, the prevalence of urolithiasis in the families of these children is also higher than that in the general population.

Adolescentes con normopeso y obesidad: análisis de las diferencias en la actividad física, resistencia cardiovascular, características familiares y autoevaluación personal / Adolescents with normal weight and obesity: analysis of differences in physical activity, cardiovascular endurance, in family characteristics and in a personal self-assessment

Introducción: La obesidad en edades pediátricas representa un grave problema de salud pública, siendo una de las causas más importantes de morbilidad prematura evitable. En la prevención y tratamiento de la obesidad juegan un papel importante factores como la actividad física. Dicha actividad física puede estar limitada por la propia condición física, el nivel de motivación o autoestima y por otros factores a nivel familiar. El presente trabajo pretende analizar si existen diferencias entre niños con normopeso y obesos respecto a dichos factores. Material y método: Se estudiaron a 146 adolescentes entre 9 y 14 años (110 obesos y 36 con normopeso). Se analizaron los antecedentes familiares (antropometría y nivel socioeconómico de los padres) y personales, el nivel de autoestima y antropometría de los niños (peso, talla, perímetros y pliegues cutáneos), el nivel de actividad física realizada (test PAQ-A) y la condición física (Test de banco de Astrand). Se compararon los resultados de ambos grupos. Resultados: Los niños obesos son más sedentarios y dedican 62, 6 minutos/semana a actividades deportivas, mientras el grupo con normopeso dedica un 50% más de tiempo a dichas actividades (94,5 minutos/semana). Los adolescentes obesos tienen una peor condición física y menor adaptación cardiovascular al esfuerzo así como una peor opinión sobre si mismos a nivel físico pero también como personas. El IMC y peso de los progenitores es signifi cativamente superior en el grupo de obesos y su nivel socioeconómico y educativo es menor en los padres de dicho grupo. Conclusiones: La menor actividad física de los adolescentes obesos hace prioritaria su promoción en este grupo. Dicha promoción debería estructurarse en programas que tengan en cuenta los aspectos diferenciales de estos adolescentes, que tienen una peor condición física, una menor autoestima y pertenecen a familias con niveles socioeconómicos y formativos más bajos, y unos patrones familiares de obesidad característicos

Introduction: The obesity in paediatric ages represents a serious public health problem, being one of the main causes of avoidable premature morbidity. In preventing of overweight, things like practice of physical activity, the physical fi tness, the motivation, the esteem and the family history, play an important role. This paper pretends to analyze if there are diff erences between kids with normal weight and obese children in those listed things. Material and method: 146 teenagers were studied, between 9 and 14 years old. 110 were obese and 36 were normal weight. The family history was analyzed (anthropometry and parents socioeconomic status), the esteem status and the kids anthropometry (weight, height, perimeters and skinfold) the kids, the physical activity made (PAQ-A test), the physical fi tness (Astrand step test). The results from all the groups were compared. Results: The obese children are more sedentary and they spend 62.6 minutes/week for sport activities, while normal weight ones spend fi fty per cent more to do these activities (94.5 minutes/week). The obese children have a worse physical fitness and also a worse cardiovascular adaptation to physical stress, aboveall, they have a worse opinion about themselves, as well as physical conditions like a persons. The progenitor IMC and weight is over in the overweight kids and the socioeconomic and educational status is lower in obese group. Conclusion: The lower practice of physical activities in the obese group, makes prioritary to promote these group. These promotions should be structured as intervention programs which take care of the diff erences of the obese kids. who present worse esteem, worse physical condition, have a lower socioeconomic and educational level families and have a obesity familiy patterns

A longitudinal study on the effects of maternal smoking and secondhand smoke exposure during pregnancy on neonatal neurobehavior.

Maternal smoking during pregnancy is one of the most modifiable causes of morbidity and mortality for both pregnant women and their fetuses. The long-term effects of prenatal exposure to smoke on child behavior and development have been the subject of more extensive research than have the short-term effects. Therefore, the aim of this work is to examine the effects of smoke exposure during pregnancy on neonatal behavior, including in our study a group of mothers exposed to secondhand smoke. The behavior of 282 healthy full-term newborns was assessed using the Neonatal Behavior Assessment Scale (NBAS) at 48-72 h of life. Sixty-two mothers smoked during pregnancy (no mother smoked more than 15 cig/day) and 17 were exposed to secondhand smoke. After adjusting for socio-demographic and obstetric factors, both newborns whose mothers smoked and those whose mothers were exposed to secondhand smoke showed significantly lower scores in the habituation cluster than non-smoking mothers. Exposure to secondhand smoke was also related to lower motor system cluster scores as well as some supplementary items and the newborns of smoking mothers showed significantly lower scores in the state regulation cluster and in some items of the state organization cluster than the newborns of non-smoking mothers. We conclude that active and passive smoking during pregnancy affects several aspects of neurobehavioral development, regardless of socio-demographic, obstetric and pediatric factors.

[Conservative versus interventional treatment of primary vesicoureteral reflux in children]. / Tratamiento médico-conservador versus intervencionista del reflujo vesicoureteral primario en el niño.

OBJECTIVES: To assess the efficacy of medical and surgical treatment of vesicoureteral reflux (VUR) in children using recurrence of urinary tract infections, renal scarring and renal function as end-points. METHODS/RESULTS: We performed a MEDLINE search for articles. We selected only randomized clinical trials and meta-analysis that analyzed medical versus surgical treatment of VUR in children. A total of 820 patients were included in all studies. We found no statistatically significant differences between surgically and medically treated patients in terms of scarring, kidney function or recurrence of urinary tract infections. There was only a significant decrease in the frequency of febrile UTI in patients who were surgically corrected, compared with those receiving antibiotics alone (RR 0.43). CONCLUSIONS: We found no clinically significant differences between surgical and medical treatment for VUR in terms of kidney function or renal scarring. We suggest that a child with UTI and VUR should be treated conservatively at first.

[Current status of antibiotic prophylaxis in primary vesicoureteral reflux in children]. / Situación actual de la profilaxis antibiótica en el reflujo vesicoureteral primario en el niño.

OBJECTIVES: To assess the efficacy of antibiotic prophylaxis for prevention of urinary infections and renal parenchymal damage in children with primary vesicoureteral reflux (VUR). METHODS/RESULTS: A search based on MEDLINE and The Cochrane Library was performed selecting those clinical trials and meta-analysis which compared antibiotic prophylaxis (either continuous or intermittent) and placebo or no treatment at all in children with primary VUR. Three systematic reviews were chosen for assessing the efficacy of prophylaxis of urinary infections including trials with a predominant paediatric population without known VUR. Results showed that the use of antibiotics decreased the risk of urinary infection. The quality of the trials was, however, insufficient and therefore of questionable results. We also selected two randomized controlled trials in children with reflux: one had limited information as the degree of reflux was not stated; the second assessed the results in a population of 113 children with VUR grade I to III (55 receiving prophylaxis and 58 not) following acute pyelonephritis. There were no differences with regard to the risk of urinary infection or the risk of renal parenchymal damage. CONCLUSIONS: There is not enough evidence supporting generalized use of antibiotics to prevent urinary infections. No benefit in prophylaxis has been proven for VUR grades I to III. There is no data for high grade VUR. It will be necessary to perform more trials in order to establish more accurate recommendations on prevention of urinary infections in the presence of VUR.

Tratamiento médico-conservador versus intervencionista del reflujo vesicoureteral primario en el niño / Conservative versus interventional treatment of primary vesicoureteral reflux in children

Objetivo: Valorar la estrategia de tratamiento del reflujo vesico-ureteral primario (RVU) en el niño, teniendo en cuenta su repercusión sobre la aparición de infecciones urinarias, daño parenquimatoso renal y alteración de la función renal. Métodos/Resultado: Se realiza una búsqueda en MEDLINE de la literatura, seleccionando ensayos clínicos y metaanálisis que comparen el tratamiento intervencionista (quirúrgico o endoscópico) y conservador (profilaxis antibiótica o medidas higiénicas) del RVU en el niño. Los ECA seleccionados agrupan un total de 820 niños afectos de RVU y aleatorizados a recibir tratamiento médico o quirúrgico. Los resultados muestran que no existen diferencias en el número global de infecciones urinarias, aunque los niños operados padecen menos pielonefritis (RR 0.43). Ambos grupos presentaron igual número de nuevas cicatrices renales y de progresión de las ya existentes. No se encontraron diferencias en la afectación de la función renal, valorada como aparición de hipertensión arterial o disminución del filtrado glomerular. Conclusiones. El tratamiento quirúrgico del RVU no aporta ventajas sobre el conservador en cuanto a preservación del funcionalismo renal o aparición de nuevas cicatrices. El tratamiento conservador sería la elección inicial prioritaria (AU)

Objectives: To assess the efficacy of medical and surgical treatment of vesicoureteral reflux (VUR) in children using recurrence of urinary tract infections, renal scarring and renal function as end-points. Methods/Results: We performed a MEDLINE search for articles. We selected only randomized clinical trials and meta-analysis that analyzed medical versus surgical treatment of VUR in children. A total of 820 patients were included in all studies. We found no statistatically significant differences between surgically and medically treated patients in terms of scarring, kidney function or recurrence of urinary tract infections. There was only a significant decrease in the frequency of febrile UTI in patients who were surgically corrected, compared with those receiving antibiotics alone (RR 0.43). Conclusions: We found no clinically significant differences between surgical and medical treatment for VUR in terms of kidney function or renal scarring. We suggest that a child with UTI and VUR should be treated conservatively at first (AU)

Situación actual de la profilaxis antibiótica en el reflujo vesicoureteral primario en el niño / Current status of antibiotic prophylaxix in primary vesicoureteral reflux in children

Objetivo: Valorar la eficacia de la profilaxis antibiótica en la prevención de las infecciones urinarias y del daño parenquimatoso renal en niños con Reflujo Vesicoureteral primario (RVU). Métodos/Resultado. Se realiza una búsqueda de la literatura en MEDLINE y The Cochrane Library seleccionando ensayos clínicos y metaanálisis que comparen la profilaxis antibiótica (continua ó discontinua) y placebo ó ningún tratamiento en niños con RVU primario. Seleccionamos 3 revisiones sistemáticas que evalúan la eficacia de la profilaxis para prevenir las infecciones de orina y que incluyen estudios en los cuales predomina una población de niños sin RVU conocido. Los resultados mostraron que los antibióticos redujeron el riesgo de infección urinaria. La calidad de los estudios fue deficiente y por lo tanto los resultados son cuestionables. Seleccionamos además dos ensayos clínicos en niños con reflujo, uno con información limitada pues se desconoce el grado de RVU y otro que evalúa los resultados en una población de 113 niños con RVU grado I a III (55 con profilaxis y 58 sin profilaxis) después de una pielonefritis aguda. No existen diferencias en el riesgo de infección urinaria ni tampoco en el riesgo de lesión en el parénquima renal. Conclusiones. Las pruebas que apoyan el uso generalizado de antibióticos para prevenir las infecciones urinarias son débiles. No se ha demostrado un beneficio de la profilaxis en los RVU grado I a III. No se dispone de información en RVU de alto grado. Se requieren estudios adicionales para poder establecer unas recomendaciones más precisas con el objetivo de prevenir las infecciones de orina en niños con RVU (AU)

Objectives: To assess the efficacy of antibiotic prophylaxis for prevention of urinary infections and renal parenchymal damage in children with primary vesicoureteral reflux (VUR). Methods/Results. A search based on MEDLINE and The Cochrane Library was performed selecting those clinical trials and meta-analysis which compared antibiotic prophylaxis (either continuous or intermittent) and placebo or no treatment at all in children with primary VUR. Three systematic reviews were chosen for assessing the efficacy of prophylaxis of urinary infections including trials with a predominant paediatric population without known VUR. Results showed that the use of antibiotics decreased the risk of urinary infection. The quality of the trials was, however, insufficient and therefore of questionable results. We also selected two randomized controlled trials in children with reflux: one had limited information as the degree of reflux was not stated; the second assessed the results in a population of 113 children with VUR grade I to III (55 receiving prophylaxis and 58 not) following acute pyelonephritis. There were no differences with regard to the risk of urinary infection or the risk of renal parenchymal damage. Conclusions. There is not enough evidence supporting generalized use of antibiotics to prevent urinary infections. No benefit in prophylaxis has been proven for VUR grades I to III. There is no data for high grade VUR. It will be necessary to perform more trials in order to establish more accurate recommendations on prevention of urinary infections in the presence of VUR (AU)