Surgical Ligation Versus Percutaneous Closure of Patent Ductus Arteriosus in Very Low-Weight Preterm Infants: Which are the Real Benefits of the Percutaneous Approach?

Percutaneous treatment of patent ductus arteriosus (PDA) in extreme premature infants is technically difficult, and therefore, often not consider as an alternative to surgery. The main objective of our work was to compare respiratory status prior and post ductal closure and morbi-mortality, in our series of preterm infants with percutaneous PDA closure versus surgical ligation in the same time-period. Retrospective review of all premature infants submitted to percutaneous and surgical PDA closure from January 2011 to December 2016. All the antenatal, perinatal, and postnatal characteristics were collected. The main outcome was the assessment of the pulmonary status before and after ductal closure using a pulmonary score. Secondary outcomes included moderate-severe disability in neurodevelopment, death before discharge, moderate-severe chronic lung disease, and morbidity at discharge. 25 patients with a mean weight of 1330 g (± 280) underwent percutaneous closure of PDA with ADO-II-AS, and a total of 53 underwent surgical ligation. 28/53 with similar gestational age, birth weight, and procedure weight to those in the percutaneous group, were selected to perform the comparative study. Ductal closure (percutaneous and surgical) resulted in improved respiratory status. However, percutaneous group achieved a fastest respiratory improvement, than surgical group. The surgical closure group associated higher morbidity among survivors (HIV, number of sepsis, need, and duration of inotropics post-interventionism). The incidence of recurrent laryngeal nerve palsy among the surgical group was 17%. Percutaneous closure of PDA in carefully selected low-weight preterm infants is a safe and reliable alternative to surgical ligation.

El Área del Corazón Infantil del Hospital General Universitario Gregorio Marañón / Area of Pediatric Cardiology of the Hospital General Universitario Gregorio Marañón

La atención integral de las enfermedades cardiovasculares de la infancia y de las cardiopatías congénitas del feto al adulto, se realiza desde hace más de 40 años en el Hospital General Universitario Gregorio Marañón de Madrid, siendo centro nacional de referencia (CSUR) de trasplante cardíaco infantil, cardiopatías congénitas complejas y neonatales, cardiopatías familiares y cardiopatías congénitas del adulto. El Área del Corazón Infantil es la estructura organizativa que engloba Cardiología Pediátrica y Cirugía Cardíaca Infantil, en colaboración con otros servicios del Hospital Infantil y de Adultos. Se incluyen en la cartera de servicios todos los programas asistenciales específicos relacionados, incluso algunos novedosos, como la rehabilitación cardíaca infantil y la telemedicina. Destacar que es el centro con mayor actividad en trasplante cardíaco infantil (serie de 160 pacientes, un 40% del total nacional). En el período 2013 y 2014, con el nuevo equipo quirúrgico se realizaron 645 intervenciones en menores de l 8 años, con alta complejidad (surgical performance de 7) y bajada de la mortalidad del 3,2 al 1,5 %. Entre 2011 y 2014 se realizaron 1.146 cateterismos intervencionistas en menores de 18 años, cerca de 1/3 en menores de 1 año, con una mortalidad menor del 1 por 1.000; se evaluaron en cardiopatías familiares 725 nuevos pacientes (1/4 casos pediátricos) y se realizaron 758 test genéticos. La actividad docente incluye el pregrado de Medicina, Enfermería e Ingeniería Biomédica, residentes de pediatría y cardiología, post MIR y fellows en cardiología pediátrica tanto de España como de otros países, especialmente de Latinoamérica. Destacan los cursos internacionales anuales de actualización en enfermería y medicina (23 ediciones) así como el preceptorship in pediatric cardiology. La actividad investigadora se estructura como grupo dentro del área cardiovascular del Instituto de Investigación Sanitaria Gregorio Marañón, con participación en la red de investigación cardiovascular (RIC), colaboración con el centro nacional de investigaciones cardiológicas (CNIC). Contamos con investigadores de forma continuada así como proyectos de Financiación pública competitiva desde 2010. Las líneas de investigación incluyen la genética de las miocardiopatías, los ensayos clínicos con células madre en Fontan, el uso de vasodilatadores pulmonares y otros fármacos cardiovasculares, así como el impacto de las infecciones respiratorias en niños con cardiopatía y síndrome de Down. Se han iniciado líneas de innovación en el campo de los dispositivos para intervencionismo cardíaco así como en aspectos organizativos y en cooperación internacional al desarrollo con un centro en Nicaragua. La colaboración con los pacientes y sus familias a través de organizaciones como Menudos Corazones han sido claves para obtener los objetivos ñnales del programa: la obtención de la mayor esperanza y calidad de vida de los niños que tienen una condición cardiovascular (AU)

Comprehensive care of pediatric cardiovascular disease and congenital heart disease from fetus to adult, has been performed at the Hospital General Universitario Gregorio Marañon de Madrid for the last 40 years. Our hospital is national reference centre (CSUR) for pediatric heart transplant, complex and neonatal congenital heart disease and familia] and adult congenital heart disease. The Children's Heart Area is the organizing structure encompassing pediatric cardiology and pediatric cardiac surgery, in collaboration with the other pediatric and adult hospital services. Our service offers all related specific healthcare including novelties such as pediatric cardiac rehabilitation and telemedicine. Our centre has the highest activity as regards pediatric heart transplant (series of 160 patients, 40% of the national total). During the period from 2013 to 2014, with the new surgical team, 645 interventions were performed in under 185, with high complex surgical interventions (surgical performace 7) with low mortality, from 3.2 to 1.5%. 1,146 interventional catheterism were performed in under 185, between 2011 to 2014, near 1/3 under 1 year of age, with mortality rates less tan 1 per 1,000; 725 new patients were evaluated in the familial cardiopathy clinic (1/4 pediatric cases) and 758 genetic tests were carried out. Teaching activity includes undergraduare medicine, nursing and biomedical engineering, residency in pediatrics and cardiology, post MIR and fellowships in pediatric cardiology in Spain as well as in other countries, especially Latin America. Of interest, are the yearly international courses in updates in nursing and medicine (23 editions) as well as the preceptorship in pediatric cardiology. Research activity is encompassed as the group within the cardiovascular area of the Instituto de Investigación Sanitaria Gregorio Marañón, participating in the Cardiovascular Research Network (RIC), collaboration with the National Centre for Cardiological Research (CNIC). Our research is continuous with competitive publicly funded projects since 2010. Research topics include the genetics of cardiomyopathics, clinical trials with stem cells in Fontan, use of pulmonary vasodilators and other cardiovascular drugs, as well as the impact of respiratory infections in children with heart disease and Down's Syndrome. Innovations in the field of devices in cardiac interventionism have been implemented and also in organizational aspects as well as international cooperation for development with a centre in Nicaragua. Collaboration with patients and families through organizations like ‘Menudos Corazones’ have been key in achieving the goals of our program: the longest life-expectancy and highest quality of life in children who have a cardiovascular condition (AU)

[Clinical guidelines for infantile-onset Pompe disease]. / Guia clinica de la enfermedad de Pompe infantil.

Infantile-onset Pompe disease has a fatal prognosis in the short term unless it is diagnosed at an early stage and enzyme replacement therapy is not started as soon as possible. A group of specialists from different disciplines involved in this disease have reviewed the current scientific evidence and have drawn up an agreed series of recommendations on the diagnosis, treatment and follow-up of patients. We recommend establishing enzyme treatment in any patient with symptomatic Pompe disease with onset within the first year of life, with a clinical and enzymatic diagnosis, and once the CRIM (cross-reactive immunological material) status is known.

TITLE: Guia clinica de la enfermedad de Pompe infantil.La enfermedad de Pompe infantil tiene un pronostico fatal a corto plazo si no se diagnostica precozmente ni se inicia un tratamiento enzimatico sustitutivo lo antes posible. Un grupo de especialistas de las diferentes disciplinas involucradas en esta enfermedad ha revisado la evidencia cientifica actual y ha elaborado por consenso una serie de recomendaciones para el diagnostico, el tratamiento y el seguimiento de los pacientes. Se recomienda instaurar tratamiento enzimatico en todo paciente con enfermedad de Pompe sintomatica de comienzo en el primer año de vida, con diagnostico clinico y enzimatico, y una vez conocido el estado CRIM (material inmunologico con reactividad cruzada).

Acidemia propiónica y síndrome QT largo: una asociación potencialmente grave / Propionic acidemia and long QT syndrome: a potentially serious combination

No disponible

Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica / Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology

Antecedentes: Tras la finalización y análisis de resultados del estudio CIVIC, la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC) plantea la necesidad de revisar sus recomendaciones para la prevención del VRS en niños con cardiopatías congénitas. Para considerar tanto la valoración de las nuevas evidencias disponibles como la experiencia preventiva acumulada por los cardiólogos infantiles, se propone efectuar dicha actualización mediante un método estructurado de consenso profesional. Objetivos: Desarrollar un consenso clínico español sobre la prevención de la infección por virus respiratorio sincitial, bajo el auspicio de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Métodos: Consenso Delphi modificado en 2 rondas. El estudio se efectuó en 4 fases: 1) constitución de un comité científico, impulsor del proyecto y responsable de la revisión bibliográfica y de la formulación de las recomendaciones a debate; 2) constitución de un panel experto multicéntrico con 75 representantes de la especialidad; 3) encuesta postal en 2 rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Cincuenta y cinco expertos consultados completaron las 2 rondas de evaluación del cuestionario. En la primera ronda se lograron consensuar 44 de las 70 cuestiones analizadas. Tras la interacción del panel, se aumentó el consenso hasta un total de 54 ítems de la encuesta (el 77% de los contenidos propuestos). En las 16 cuestiones restantes no se consiguió un consenso suficientemente unánime, bien por disparidad de opiniones entre los profesionales, bien por falta de criterio establecido en la mayoría de los expertos. Conclusiones: Se presenta y actualiza una lista de recomendaciones profilácticas frente al virus respiratorio sincitial, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que justifique su revisión (AU)

Background: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. Objectives: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Methods: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. Results: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Conclusions: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review (AU)

[Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology.]. / Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica.

BACKGROUND: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. OBJECTIVES: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. METHODS: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. RESULTS: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. CONCLUSIONS: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review.

Infecciones respiratorias, síndrome de Down y cardiopatías congénitas: Estudio CIVIC 21 / Respiratory infections, Down's syndrome and congenital heart disease: The CIVIC 21 study

Introducción: Se comparan las tasas de hospitalización por infección respiratoria aguda en niños con cardiopatías congénitas significativas sin síndrome de Down y en niños con síndrome de Down, con y sin cardiopatías, menores de 24 meses. Material y métodos: Estudio epidemiológico, multicéntrico (53 hospitales), observacional y prospectivo, de octubre de 2006 a abril de 2007. Se siguió a 1.085 pacientes; 806 sin síndrome de Down y con cardiopatía significativa y 279 con síndrome de Down: 135 con cardiopatía significativa, 38 con cardiopatías leves y 105 sin cardiopatía. Resultados: Ingresaron 147 (13,1%) pacientes (intervalo de confianza del 95%, 11,2 15,2%) por infecciones respiratorias. Las tasas en niños sin y con síndrome de Down fueron del 11 frente al 19,1%. Entre los últimos, el 26,3%, con cardiopatías no significativas; el 23%, con cardiopatías significativas, y el 11,4%, sin cardiopatía. El diagnóstico principal (59,4%) fue bronquiolitis. Se identificó algún germen en el 36,2%. La tasa de ingreso específica por virus respiratorio sincitial fue del 4,4%, con diferencias entre los niños sin y con síndrome de Down (el 3,2 frente al 7,8%) y entre los grupos con síndrome de Down con cardiopatías no significativas (15,8%), cardiopatías significativas (9,3%) y sin cardiopatía (3%). Había recibido profilaxis contra el virus respiratorio sincitial el 83,4 frente al 39,9% de los niños sin y con síndrome de Down. No hubo diferencias en el tiempo ni en la gravedad de las estancias. Conclusiones: Las hospitalizaciones por infecciones respiratorias y específicamente por virus respiratorio sincitial predominan en los niños con síndrome de Down, y entre ellos, en los que tienen cardiopatías leves y escasa inmunoprofilaxis frente al virus respiratorio sincitial (AU)

Introduction: We compare hospitalisation rates for acute respiratory tract infection in children youngerth an 24 months with significant congenital heart disease without Down’s syndrome with those with Down’s syndrome with or without congenital heart disease. Material and methods: This was an epidemiological, multicentre (53 Spanish hospitals), observation al and prospective study, from October 2006 to April 2007. A total of 1085 patients were followed-up, of which 806 did not have Down’s syndrome and 279 with Down’s syndrome: 135 with significant, 38 with non significant and 105 without congenital heart disease. Results: A total of 147 patients (13.1%; 95% CI, 11.2–15.2%) required hospitalisation due to respiratory infection. Rates in patients without and with Down’s syndrome were 11% vs 19.1%. In the Down’s group, 26.3%had no significant, a 23% had significant and 11.4% had no congenital heart disease. The main diagnosis was bronchiolitis (59.4%). An infectious agent was found in 36.2% cases. The specificad mission rate due to respiratory syncytial virus was 4.4%, with differences in children without vs with Down’s syndrome (3.2% vs 7.8%). In the Down’s patients we found rates of 15.8%, 9.3% and 3% in the non-significant, significant and no congenital heart disease. Immunoprophylaxis against respiratory syncytial virus rates were 83.4%vs 39.9%in no Down’s versus Down’s syndrome patients. No differences were found in hospital stay or the severity. Conclusions: Hospital admission rates due to respiratory infection, and specifically respiratory syncytial virus, were higher in the Down’s patients, particularly in the group with no significant congenital heart disease and low immunoprophylaxis against respiratory syncytial virus (AU)

[Respiratory infections, Down's syndrome and congenital heart disease: the CIVIC 21 study]. / Infecciones respiratorias, síndrome de Down y cardiopatías congénitas: Estudio CIVIC 21.

INTRODUCTION: We compare hospitalisation rates for acute respiratory tract infection in children younger than 24 months with significant congenital heart disease without Down's syndrome with those with Down's syndrome with or without congenital heart disease. MATERIAL AND METHODS: This was an epidemiological, multicentre (53 Spanish hospitals), observational and prospective study, from October 2006 to April 2007. A total of 1085 patients were followed-up, of which 806 did not have Down's syndrome and 279 with Down's syndrome: 135 with significant, 38 with non significant and 105 without congenital heart disease. RESULTS: A total of 147 patients (13.1%; 95% CI, 11.2-15.2%) required hospitalisation due to respiratory infection. Rates in patients without and with Down's syndrome were 11% vs 19.1%. In the Down's group, 26.3% had no significant, a 23% had significant and 11.4% had no congenital heart disease. The main diagnosis was bronchiolitis (59.4%). An infectious agent was found in 36.2% cases. The specific admission rate due to respiratory syncytial virus was 4.4%, with differences in children without vs with Down's syndrome (3.2% vs 7.8%). In the Down's patients we found rates of 15.8%, 9.3% and 3% in the non-significant, significant and no congenital heart disease. Immunoprophylaxis against respiratory syncytial virus rates were 83.4% vs 39.9% in no Down's versus Down's syndrome patients. No differences were found in hospital stay or the severity. CONCLUSIONS: Hospital admission rates due to respiratory infection, and specifically respiratory syncytial virus, were higher in the Down's patients, particularly in the group with no significant congenital heart disease and low immunoprophylaxis against respiratory syncytial virus.

[Spanish multidisciplinary consensus on the prevention of respiratory syncytial virus infection in children]. / Consenso multidisciplinar español sobre la profilaxis de la infección respiratoria pediátrica por virus respiratorio sincitialConsenso.

BACKGROUND: A certain degree of feasibility exists in Spanish clinical practice with respect to interventions performed to prevent paediatric respiratory infection by RSV, including hygienic measures and intramuscular immunoprophylaxis with palivizumab. This task involves different paediatric specialties that may have a different perception of the magnitude of the problem and different professional criteria regarding the most appropriate actions. OBJECTIVES: To develop Spanish multidisciplinary consensus on preventing infection by RSV with the participation of the paediatric scientific societies involved (SNS, SSPC, SSPP and SSHPO). METHODS: Delphi Consensus modified in two rounds was used. The study was conducted in four phases: 1) constitution of a multidisciplinary Scientific Committee at the recommendation of the scientific entities participating in the study, for bibliographic review and submission of the recommendations to discussion; 2) constitution of an Expert Panel with 77 speciality representatives; 3) postal survey organised in two rounds and intermediate processing of opinions and issuing of a report for the panellists, and 4) discussion of the results in a meeting of the Scientific Committee. RESULTS: Consensus was reached on 48 of the 57 preventive recommendations analysed. With respect to the 9 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Only in 3 recommendations was the opinion of the experts associated with the speciality of origin. CONCLUSIONS: A list of anti-RSV prophylactic recommendations was submitted, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a review thereof.

Consenso multidisciplinar español sobre la profilaxis de la infección respiratoria pediátrica por virus respiratorio sincitial. Consenso / Spanish multidisciplinary consensus on the prevention of respiratory syncytial virus infection in children

Antecedentes: Existe cierta variabilidad de práctica clínica en España sobre las intervenciones preventivas para evitar la infección respiratoria infantil por el virus respiratorio sincitial (VRS), entre las que se incluyen medidas higiénicas e inmunoprofilaxis intramuscular con palivizumab. Esta tarea implica varias especialidades pediátricas, que pueden tener distinta percepción de la magnitud del problema y distinto criterio profesional sobre las actuaciones apropiadas. Objetivos: Desarrollar un consenso multidisciplinar español sobre la prevención de la infección por VRS, con participación de las sociedades científicas pediátricas implicadas: Sociedad Española de Neonatología (SEN), Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC), Sociedad Española de Neumología Pediátrica (SENP) y Sociedad Española de Hematología y Oncología Pediátrica (SEHOP). Métodos: Consenso Delphi modificado en dos rondas. El estudio se efectuó en cuatro fases: 1) constitución de un comité científico multidisciplinar, a propuesta de las sociedades científicas participantes, para la revisión bibliográfica y formulación de las recomendaciones a debate; 2) constitución de un panel experto con 77 representantes de las especialidades; 3) encuesta postal en dos rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Se consensúan 48 de las 57 recomendaciones preventivas analizadas. En las nueve cuestiones restantes no se consigue acuerdo, bien por disparidad de opinión profesional, bien por falta de criterio establecido en la mayoría de los expertos. Sólo en tres recomendaciones, la opinión de los expertos se asocia a la especialidad de procedencia. Conclusiones: Se presenta una lista de recomendaciones profilácticas anti-VRS, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que indique su revisión (AU)

Background: A certain degree of feasibility exists in Spanish clinical practice with respect to interventions performed to prevent paediatric respiratory infection by RSV, including hygienic measures and intramuscular immunoprophylaxis with palivizumab. This task involves different paediatric specialties that may have a different perception of the magnitude of the problem and different professional criteria regarding the most appropriate actions. Objectives: To develop Spanish multidisciplinary consensus on preventing infection by RSV with the participation of the paediatric scientific societies involved (SNS, SSPC, SSPP and SSHPO). Methods: Delphi Consensus modified in two rounds was used. The study was conducted in four phases: 1) constitution of a multidisciplinary Scientific Committee at the recommendation of the scientific entities participating in the study, for bibliographic review and submission of the recommendations to discussion; 2) constitution of an Expert Panel with 77 speciality representatives; 3) postal survey organised in two rounds and intermediate processing of opinions and issuing of a report for the panellists, and 4) discussion of the results in a meeting of the Scientific Committee. Results: Consensus was reached on 48 of the 57 preventive recommendations analysed. With respect to the 9 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Only in 3 recommendations was the opinion of the experts associated with the speciality of origin. Conclusions: A list of anti-RSV prophylactic recommendations was submitted, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a review there of (AU)

[Respiratory infections and congenital heart disease: two seasons of the CIVIC study]. / Infecciones respiratorias y cardiopatías congénitas: dos estaciones del estudio CIVIC.

INTRODUCTION: In younger than 24 month with significant congenital heart disease we evaluate the hospitalisation rate for acute respiratory tract infection, the associated risk factors, compliance of preventive measures, aetiology and clinical course. MATERIAL AND METHODS: Ours was an epidemiological, multicentric (53 Spanish hospitals), observational and prospective study, in two seasons from October to April from 2004 to 2006. 1248 patients were follow-up. RESULTS: 167 patients (13.4 %, 95 % CI: 11.6-15.4 %) required 210 hospitalizations for respiratory infection. Significant risk factors were with Odds ratio: Delection 22q11 4.31, sibilances 4.25, incomplete prophylaxis against respiratory syncytial virus 2.10, sibblings less than 11 years old 2.06, trisomy 21 1.89, second season 1.74, prematurity 1.54. Protective factors were: weight over third percentile 0.57, female 0.65 and age in months 0.94. The main diagnosis were bronchiolitis (41.7 %), upper respiratory airway infection (28,1 %) and pneumoniae (17.6 %). An infectious agent was found in 32.5 % cases. Respiratory syncytial virus was the principal agent founded with a 3.4 % specific rate. Median stay was 6 days. In 18.1 % episodes admission in intensive care unit was required. 4 patients (0.32 %) died from respiratory infection. CONCLUSIONS: We found 13.4 % in hospital admissions for respiratory infection. Significant risk factors are mainly associated (syndromes, malnutrition, siblings, incomplete respiratory syncytial virus prophylaxis). Bronchiolitis and respiratory syncytial virus was the most common clinical picture and identified infectious agent. In some cases they are morbidity and mortality.

[Diaphragmatic paralysis in the postoperative period after heart surgery in children]. / Parálisis diafragmática en el postoperatorio de cirugía cardíaca en la infancia.

OBJECTIVE: The purpose of our study was to determine the incidence, pathological features, clinical relevance and treatment of diaphragmatic paralysis (DP) after pediatric cardiac surgery. PATIENTS AND METHODS: Five hundred fifty-six children who had undergone cardiac surgery between 1990 and 1994 were retrospectively analyzed. Persistent raising of one or both hemidiaphragms on chest x-ray films lead to the diagnosis in all cases. RESULTS: Diaphragmatic paralysis was diagnosed in 13 patients (2.3%) ranging from 3 days to 13 years of age. Atrial septal defect closure (3 cases) and systemic-pulmonary shunt derivations (3 cases) were the type of operations most frequently involved. The other cases included, 2 arterial switch in transposition of the great vessels, 1 repair of total anomalous pulmonary venous drainage, 1 tetralogy of Fallot repair, 1 coarctation and aortic stenosis repair, 1 resection of subpulmonary stenosis of transposition of the great vessels and 1 pacemaker implantation. There was no significant association with the use of extracorporeal circulation. There were seven cases of right hemidiaphragmatic paralysis, but no bilateral paralysis was found. Ipsilateral thoracotomy section concordance was found in all patients and no relation with central venous line placement was found. Diagnosis was made by chest x-ray in all cases, and further confirmation was done using fluoroscopy in 6 patients and ultrasound studies in 2. Prolonged mechanical ventilation was needed in 3 patients, and one patient required diaphragmatic plication. No long term complications were found. CONCLUSIONS: Diaphragmatic paralysis is a rare complication of pediatric cardiac surgery which must be suspected when failed attempts of respiratory weaning, not attributable to cardiac or pulmonary problems, are present.