Características epidemiológicas de las bronquiolitis causadas por el virus respiratorio sincitial y el metapneumovirus humano en pacientes pediátricos / Epidemiological characteristics of bronchiolitis caused by respiratory sincytial virus and human metapneumovirus in pediatric patients

Introducción: La bronquiolitis es una enfermedad de las vías respiratorias que se produce durante los primeros años de vida. Métodos: Desde febrero de 2008 hasta diciembre de 2009 se estudiaron los casos de bronquiolitis en una población pediátrica de 3 años de edad. Se procesaron 1.012 aspirados nasales para la detección antigénica rápida frente al virus respiratorios incitial (VRS) y 753 para la técnica de amplificación de ácidos nucleicos de metapneumovirus humano (MPVh). Resultados: En las 1.012 muestras recibidas se realizó la detección antigénica de VRS; 195 (19,27%) resultaron positivas, correspondientes a 185 pacientes. En 763 muestras se realizó la detección de MPVh; 60 (7,86%) resultaron positivas, que correspondían a 50 pacientes. El mayor porcentaje de los casos se dieron en pacientes menores de 6 meses. Se observó una distribución estacional de los casos. Conclusión: En nuestro medio, los MPVh presentan una menor incidencia que los VRS; además, la distribución epidemiológica del VRS precede, y con picos más bruscos, a la del MPVh (AU)

Introduction: Bronchiolitis is a disease of the respiratory tract that takes place during the first years of life. Methods: In February 2008- December 2009 the bronchiolitis pediatric population from 0 to 3 years of age was studied. 1,012 nasal aspirates were processed for the rapid antigen detection of RSV and 753 for the technology of amplification of nucleic acids of hMPV. Results: In 1,012 samples the rapid antigen detection of RSV was carried out showing 195 (19.27%) positives, corresponding to185 patients. In 763 samples the detection of hMPV was carried out, showing 60 (7.86%) positives and they corresponded to 50 patients. The major percentage of the cases were given in patients <6 months. A seasonal distribution of the cases was observed. Conclusion: In our environment, the hMPV show a minor incidence than the RSV and the epidemiological distribution of the RSV precedes, and with more sudden sharp point, than to the hMPV (AU)

Análisis del programa de detección precoz de la hipoacusia neonatal en nuestro centro / Analysis of the program of early detection of neonatal hearing loss in our hospital

Objetivos: Conocer los resultados del programa de detección precoz de hipoacusia en recién nacidos (RN) de nuestro hospital durante 2001 y 2004. Pacientes y métodos: Se realizaron otoemisiones acústicas (OEA) a 2.461 (2001) y 2.549 RN (2004); si éstas eran negativas, se repetían antes de un mes. Los RN con la segunda otoemisión negativa eran remitidos al servicio de otorrinolaringología (ORL), completándose su valoración mediante potenciales auditivos troncoencefálicos. Resultados: El 10% (n= 260) y el 5% (n= 145), respectivamente, no pasaron la primera OEA. Continuaron esta primera fase 234 (2001) y 144 (2004), y no pasaron la segunda OEA el 16% (n= 37) y el 24% (n= 35), generándose una remisión al servicio de ORL del 1,51 y el 1,37% cada año; 29 niños no completaron la fase diagnóstica. De los 72 RN con sospecha de hipoacusia, el 59,72% (n= 43) completó el programa, el 30,23%había estado ingresado, el 23,25% presentaba factores de riesgo y el 48,83% tenía OEA negativas bilaterales. En el servicio de ORL se confirmó la hipoacusia en 23 RN (53,48%): en un 57,14% era neurosensorial (un 62% en RN varones sin factores de riesgo; un 75% bilaterales y un 50% profundas) y en un 42,16% era de transmisión. Conclusiones: Nuestra incidencia global de hipoacusia neurosensorial y de transmisión es de 4,54/1.000 RN, y para la neurosensorial profunda de 1,87/1.000 RN. El 71% de los hipoacúsicos eran RN sanos y sin factores de riesgo, predominando los varones. La capacidad de detección de las OEA fue significativamente mayor en 2004; las remisiones a ORL fueron adecuadas, las pérdidas de seguimiento en la primera fase escasas, pero elevadas en la de confirmación (AU)

Objectives: To examine the results of the program of early detection of hearing loss in newborn infants (NB) in our hospital during 2001 and 2004.Patients and methods: Otoacoustic emissions (OAE) were evaluated in 2,461 (2001) and 2,549 NB (2004) and, if the results were negative, the evaluation was repeated before one month had elapsed. The NB with a second negative OAE test were sent to the otorhinolaryngology service (ORL), where their evaluation was completed, including assessment of the auditory brainstem response (ABR). Results: The first OAE test was negative in 260 (10%) and145 (5%) NB, respectively. In all, 234 (2001) and 144 (2004) continued this first stage; 37 (16%) and 35 (24%) NB, respectively, failed to pass the second OAE test, and 1.51% and 1.37%in each year were referred to ORL, whereas 29 children did not complete the diagnostic phase. Of the 72 NB with suspected auditory dysfunction, 59.72% (n= 43) completed the program, 30.23% had been admitted to the hospital, 23.25% had risk factors and 48.83% had bilateral negative results on OAE testing. The ORL service confirmed hearing loss in 23 NB (53.48%): sensorineural in 57.14% (62% were boys with no risk factors, and it was bilateral in 75% and profound in 50%) and conductive in 42.16%. Conclusions: Our overall incidence of sensorineural and conductive hearing loss was 4.54/1,000 NB, and that of deep sensorineural hearing loss was only 1.87/1,000 NB. In all, 71% of the infants with hearing loss were normal and had no risk factors ,and there was a male predominance. The capacity for detection of OAE was significantly greater in 2004; the referrals to ORL were appropriate, the rate of loss to follow-up was low in the first stage and elevated in the confirmation stage (AU)

[Quality control of nosocomial infection in PICU]. / Control de calidad en la infección nosocomial en la UCIP.

INTRODUCTION: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. OBJECTIVE: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. MATERIAL AND METHODS: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. RESULTS: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 (NNISS 7.3 ) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 , with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). CONCLUSIONS: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality.

Control de calidad en la infección nosocomial en la UCIP / Quality control of nosocomial infection in PICU

Introducción: La infección nosocomial representa un problema de salud dada su elevada morbimortalidad y el incremento de costes que ocasiona al sistema sanitario. Objetivo: Analizar la infección nosocomial relacionada con las principales técnicas invasivas realizadas en la unidad de cuidados intensivos pediátricos de nuestro hospital. Material y métodos: Recogida prospectiva de datos epidemiológicos (número de días de ingreso, de colocación de dispositivos, intravasculares y sondaje urinario cerrado y ventilación mecánica) y aparición de infecciones nosocomiales (bacteriemias, neumonías, infecciones de orina) en los pacientes ingresados durante los años 2000-2004. Resultados: Se analizaron un total de 302 pacientes y se encontró una incidencia acumulada de infección nosocomial del 9,76 %. Los microorganismos aislados con mayor frecuencia fueron los gramnegativos (46,60 %), seguidos de Candida sp. (33,30 %) y cocos grampositivos (20,01 %). Su localización predominante fue la bacteriemia, con una incidencia acumulada parcial del 4,09 %, predominando las primarias frente a las relacionadas a dispositivo intravascular (el 2,99 frente al 1,10 %). La tasa media de incidencia de bacteriemias asociadas con dispositivos intravasculares (BADV) fue del 8,92 ‰ (National Nosocomial Infectious Surveillance System [NNISS] 7,3 ‰) con una tasa media de utilización del dispositivo de 0,65 (> Pc90 del NNISS). La neumonía asociada a ventilación mecánica (NAVM) presentó una tasa media de incidencia del 1,80 ‰ partiendo de una tasa media de utilización del 0,27 (< Pc25 del NISS). La infección urinaria asociada con el sondaje urinario cerrado presentó una tasa media de incidencia del 2,63 ‰, con una tasa media de utilización del sondaje del 0,37 (Pc75). Conclusiones: La infección nosocomial representa un problema importante en las UCIP. Los datos obtenidos de este estudio nos permiten conocer la incidencia de la infección nosocomial en nuestra unidad de cuidados intensivos pediátricos (UCIP) y dirigir las estrategias de mejora para disminuir la mortalidad y morbilidad (AU)

Introduction: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. Objective: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. Material and methods: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. Results: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 ‰ (NNISS 7.3 ‰) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 ‰ departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 ‰, with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). Conclusions: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality (AU)

[Neonatal morbidity and mortality according to intrauterine growth pattern]. / Morbilidad y mortalidad de los recién nacidos según el patrón de crecimiento intrauterino.

OBJECTIVE: To evaluate the influence of intrauterine growth on neonatal morbidity and mortality in live neonates born in a regional tertiary care center. PATIENTS AND METHODS: A retrospective cohort study was performed. Data from 12,311 live neonates (LN) born in our hospital (from January 1999 to December 2003) were reviewed to analyze neonatal morbidity and mortality according to whether the LN were appropriate (AGA), small (SGA) or large (LGA) for gestational age. The variables collected from birth to hospital discharge were: gestational abnormalities, gender, delivery type, Apgar score, respiratory distress, presentation of obstetric trauma (including cephalohematomas), hypoglycemia, hypocalcemia, hyperbilirubinemia, congenital malformations, heart disease, and type of hospital discharge. Differences were examined among groups. We used the chi-squared test to compare the frequency of these variables in each group. RESULTS: Data from 12,311 LN were entered into the database; 11,182 (90.8%) were AGA, 743 (6.1%) were LGA and 386 (3.1%) were SGA. There were 52.58% boys and 47.42% girls, and 5.5% of LN had macrosomia (birth weight > 4,000 g). A total of 0.39% of LN died before hospital discharge. Among LN, there were 1,215 preterm infants, representing 9.89% of all LN and 2.63% died (SGA 25% and AGA 75%). There was a prevalence of boys in the LGA group and of girls in the SGA group (p = 0.000). The presence of maternal diabetes (pregestational or gestational) was significantly higher (p = 0.000) in the LGA group. Maternal hypertension, smoking and drug addiction were significantly higher in the SGA group. The finding of obstetric trauma was significantly higher in the LGA group (p = 0.000). The proportion of congenital malformations, hypocalcemia and hypoglycemia was higher in the SGA group than in the AGA and LGA groups (p = 0.000). Neonatal mortality was significantly higher (p = 0.000) in the SGA group and preterm infants. CONCLUSIONS: Neonates with deviations in the pattern of intra-uterine growth had worse outcome. Prognosis was worse in SGA neonates, followed by LGA neonates, than in AGA neonates.

Morbilidad y mortalidad de los recién nacidos según el patrón de crecimiento intrauterino / Neonatal morbidity and mortality according to intrauterine growth pattern

Objetivo: Analizar la influencia del patrón de crecimiento intrauterino sobre la morbilidad y mortalidad de los recién nacidos vivos en un hospital regional terciario. Pacientes y métodos: Se revisaron de forma retrospectiva, mediante un estudio de cohortes, a 12.311 recién nacidos vivos nacidos en nuestro hospital (entre enero de 1999 y diciembre de 2003), para analizar la morbilidad y la mortalidad neonatal, según fueran adecuados (AEG), pequeños (PEG) o grandes (GEG) para la edad gestacional. Las variables recogidas desde su nacimiento hasta el momento de su alta hospitalaria fueron: patología gestacional, sexo, tipo de parto, valoración de Apgar, existencia de dificultad respiratoria, traumatismo obstétrico (incluyendo cefalohematoma), malformaciones congénitas, hipoglucemia, hipocalcemia, hiperbilirrubinemia, cardiopatía y el tipo de alta hospitalaria. La incidencia de estas variables en los tres grupos se comparó aplicando el test de la ji cuadrado (χ 2). Resultados: De los 12.311 recién nacidos vivos recogidos en la base de datos, el 90,8 % (n = 11.182) fueron AEG, el 6,1 % (n = 743) GEG y el 3,1 % (n = 386) fueron PEG. El 52,58 % era niños y el 47,42 % niñas. Fueron macrosómicos (peso al nacer ≥ 4.000 g) el 5,5 % de los recién nacidos. Fallecieron el 0,39 % de los recién nacidos vivos. Del total de recién nacidos vivos 1.215 fueron pretérmino, lo que supone el 9,89 % del total y fallecieron el 2,63 % (PEG el 25 % y AEG el 75 %). Existió un predominio de niños en el grupo de GEG y de niñas en el grupo de PEG (p 5 0,000). La existencia de diabetes materna (pregestacional o gestacional) fue significativamente más alta (p 5 0,000) en el grupo de GEG y los antecedentes de hipertensión materna, madre fumadora o drogadicta en el grupo de PEG (p = 0,000). La existencia de trauma obstétrico fue significativamente mayor en los GEG (p = 0,000). La tasa de malformaciones congénitas, hipocalcemia e hipoglucemia (p 5 0,000) fue más elevada en los PEG respecto a los otros grupos. La mortalidad neonatal fue significativamente mayor en los PEG y en los prematuros (p = 0,000). Conclusiones: Existe una peor evolución de los recién nacidos que presentan una desviación del patrón de crecimiento intrauterino, teniendo un peor pronóstico los PEG y en menor cuantía los GEG, respecto a los AEG

Objective: To evaluate the influence of intrauterine growth on neonatal morbidity and mortality in live neonates born in a regional tertiary care center. Patients and methods: A retrospective cohort study was performed. Data from 12,311 live neonates (LN) born in our hospital (from January 1999 to December 2003) were reviewed to analyze neonatal morbidity and mortality according to whether the LN were appropriate (AGA), small (SGA) or large (LGA) for gestational age. The variables collected from birth to hospital discharge were: gestational abnormalities, gender, delivery type, Apgar score, respiratory distress, presentation of obstetric trauma (including cephalohematomas), hypoglycemia, hypocalcemia, hyperbilirubinemia, congenital malformations, heart disease, and type of hospital discharge. Differences were examined among groups. We used the chi-squared test to compare the frequency of these variables in each group. Results: Data from 12,311 LN were entered into the database; 11,182 (90.8 %) were AGA, 743 (6.1 %) were LGA and 386 (3.1 %) were SGA. There were 52.58 % boys and 47.42 % girls, and 5.5 % of LN had macrosomia (birth weight > 4,000 g). A total of 0.39 % of LN died before hospital discharge. Among LN, there were 1,215 preterm infants, representing 9.89 % of all LN and 2.63 % died (SGA 25 % and AGA 75 %). There was a prevalence of boys in the LGA group and of girls in the SGA group (p = 0.000). The presence of maternal diabetes (pregestational or gestational) was significantly higher (p = 0.000) in the LGA group. Maternal hypertension, smoking and drug addiction were significantly higher in the SGA group. The finding of obstetric trauma was significantly higher in the LGA group (p = 0.000). The proportion of congenital malformations, hypocalcemia and hypoglycemia was higher in the SGA group than in the AGA and LGA groups (p = 0.000). Neonatal mortality was significantly higher (p = 0.000) in the SGA group and preterm infants. Conclusions: Neonates with deviations in the pattern of intra-uterine growth had worse outcome. Prognosis was worse in SGA neonates, followed by LGA neonates, than in AGA neonates

[Prognosis of perinatal asphyxia in full-term neonates]. / Pronóstico de la asfixia perinatal en el recién nacido a término.

We have performed a prospective study in 65 asphyxiated term newborns to evaluate the prognostic value of three different methods: 1) Neurological examination, 2) Electroencephalographic tracings (EEGs) and 3) Transfontanellar sonography, carried out periodically from birth until discharged from the neonatal unit. The neurological status of surviving infants was assessed at one year of age. We found a statistically significant (p < 0.0001) association between the neurological examination, electroencephalographic tracings and transfontanellar sonography during the neonatal period and the neurological development. The prognostic value, as a function of sensibility, specificity and predictive value of the three methods was very high. No differences were found among them, although the EEGs and neurological examinations showed the highest predictive values.