[Models of care and classification of "Children with special health care needs-CSHCN": Recommendations from the CSHCN Committee, Chilean Paediatric Society]. / Modelo de atención y clasificación de «Niños y adolescentes con necesidades especiales de atención en salud-NANEAS¼: recomendaciones del Comité NANEAS de la Sociedad Chilena de Pediatría.

"Children with special health care needs" (CSHCN) is an emerging and heterogeneous group of paediatric patients, with a wide variety of medical conditions and with different uses of health care services. There is consensus on how to classify and assess these patients according to their needs, but not for their specific diagnosis. Needs are classified into 6 areas: a) specialised medical care; b) use or need of prescription medication; c) special nutrition; d) dependence on technology; e) rehabilitation therapy for functional limitation; and f) special education services. From the evaluation of each area, a classification for CSHCN is proposed according to low, medium, or high complexity health needs, to guide and distribute their care at an appropriate level of the health care system. Low complexity CSHCN should be incorporated into Primary Care services, to improve benefits for patients and families at this level. It is critical to train health care professionals in taking care of CSHCN, promoting a coordinated, dynamic and communicated work between different levels of the health care system. Compliance with these guidelines will achieve a high quality and integrated care for this vulnerable group of children.

Morbimortalidad hospitalaria en niños con síndrome de Down / Hospital morbidity and mortality in children with Down's syndrome: experience in a university hospital in Chile

INTRODUCCIÓN Los niños con síndrome de Down (SD) tienen mayor frecuencia de malformaciones congénitas y de enfermedades con riesgo de hospitalización en comparación con la población general. El objetivo de este trabajo fue caracterizar las estancias hospitalarias de niños con SD. PACIENTES Y MÉTODO Estudio retrospectivo en niños con SD menores de 15 años atendidos en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile, durante los años 2008-2011. RESULTADOS De los 222 egresos hospitalarios de 161 niños con SD, 110 correspondieron a mujeres, con una mediana de edad de 8 meses y una mediana de estancia hospitalaria de 6 días. El 56,7% ingresó en la unidad de pacientes críticos. El 59,4% de los egresos fue por corrección quirúrgica de su cardiopatía congénita. La infección respiratoria aguda baja fue el principal diagnóstico de egreso por causa no cardioquirúrgica. Hubo 3 fallecidos en la serie. CONCLUSIONES Los niños con SD son un grupo relevante para los cuidados hospitalarios, no solo por su alta incidencia en Chile, sino por ser un grupo de riesgo respiratorio y cardiovascular, con hospitalizaciones prolongadas, alta frecuencia de estancia en cuidados críticos y riesgo de mortalidad. Este grupo de niños necesita cuidados complejos y su atención requiere de un equipo multidisciplinario que conozca sus características particulares.

INTRODUCTION Children with Down's syndrome (DS) have a higher risk of congenital malformations and acute diseases, with increased risk of hospital admissions compared with the general population. This study describes patterns of hospital admissions for children and adolescents with DS. PATIENTS AND METHODS A retrospective study of hospital admissions of children with DS, younger than 15 years old, and cared for by the Paediatric Department of the Hospital Clínico Pontificia Universidad Católica de Chile, between 2008 and 2011. RESULTS There were 222 admissions of 161 patients with DS during the study period, of which 110 were girls. The median age was 8 months, and the median hospital stay was 6 days. Just over half (56.7%) of the hospital stays were in the Paediatric Critic Care Unit. Heart surgery was performed on 59.4%, and the principal congenital heart defect attended was atrioventricular canal. The principal diagnosis, other than heart surgery, was lower respiratory tract infection. In this series, 3 children died. CONCLUSIONS Children with DS are a relevant group for inpatient care, because their high incidence in Chile, their respiratory and cardiovascular risk, prolonged hospitalizations, high frequency of critical care days and mortality risk. This group has special and complex needs during their hospitalizations and it is necessary to create a multidisciplinary team with competences to take care the particular characteristics of this vulnerable group.

[Hospital morbidity and mortality in children with Down's syndrome: Experience in a university hospital in Chile]. / Morbimortalidad hospitalaria en niños con síndrome de Down.

INTRODUCTION: Children with Down's syndrome (DS) have a higher risk of congenital malformations and acute diseases, with increased risk of hospital admissions compared with the general population. This study describes patterns of hospital admissions for children and adolescents with DS. PATIENTS AND METHODS: A retrospective study of hospital admissions of children with DS, younger than 15 years old, and cared for by the Paediatric Department of the Hospital Clínico Pontificia Universidad Católica de Chile, between 2008 and 2011. RESULTS: There were 222 admissions of 161 patients with DS during the study period, of which 110 were girls. The median age was 8 months, and the median hospital stay was 6 days. Just over half (56.7%) of the hospital stays were in the Paediatric Critic Care Unit. Heart surgery was performed on 59.4%, and the principal congenital heart defect attended was atrioventricular canal. The principal diagnosis, other than heart surgery, was lower respiratory tract infection. In this series, 3 children died. CONCLUSIONS: Children with DS are a relevant group for inpatient care, because their high incidence in Chile, their respiratory and cardiovascular risk, prolonged hospitalizations, high frequency of critical care days and mortality risk. This group has special and complex needs during their hospitalizations and it is necessary to create a multidisciplinary team with competences to take care the particular characteristics of this vulnerable group.