Short report - Usefulness of point-of-care ultrasound in pediatric SARS-CoV-2 infection.

SARS-CoV-2 infection in children is uncommon compared to adult population. However, some children required hospital and/or PICU admission. The aim of this short communication is to share our experience with Point-of-Care Ultrasound (POCUS) when managing these patients. Remarkably, all cases presented pleural and pericardial effusions, detected by POCUS, despite showing an adequate urinary output and prior to receiving any kind of fluid resuscitation. Effusions have been described as rare among SARS-CoV-2 infection in adult population. By performing portable chest X-Ray they would have gone unnoticed in our patients. Other POCUS findings consisted of all types of consolidations and coalescent B-line patterns. POCUS was also performed in order to optimize PEEP, checking adequate endotracheal intubation positioning (avoiding the risk of contagiousness related to auscultation in this framework), and to assess volemia status, cardiac performance, and brain neuro-monitoring. There was not cross-infection. In pediatric SARS-CoV-19 effusions are frequent but easily unnoticed unless lung and echo POCUS are performed.

Manejo de la pancreatitis aguda grave en niños. Serie de 3 casos / Management of severe acute pancreatitis in children. A series of 3 cases

La pancreatitis aguda es una entidad poco frecuente en la población pediátrica, cuya incidencia ha aumentado en las últimas dos décadas. Sin embargo, existen pocos estudios sobre esta afección, por lo que su manejo terapéutico resulta muy variable, especialmente en los casos graves. En este trabajo describimos nuestra experiencia sobre el manejo en una unidad de cuidados intensivos pediátrica de 3 casos clínicos con esta afección en los últimos meses. En ellos se aplicaron las directrices extraídas de las guías clínicas sobre el manejo de la pancreatitis aguda en pacientes adultos basadas en la optimización de la analgesia, la administración de fluidoterapia i.v. agresiva y el reposo pancreático inicial con reintroducción precoz de la nutrición enteral, con lo que mostraron una buena evolución clínica posterior. Nuestro objetivo principal, dado el aumento en la incidencia de esta entidad, es destacar la importancia de un alto nivel de sospecha clínica ante un cuadro de dolor abdominal que permita un diagnóstico precoz y la rápida instauración de un tratamiento adecuado en estos casos, así como incidir en los puntos más importantes de su manejo

Acute pancreatitis is a rare entity among pediatric population, whose incidence has increased in the last two decades. However, there are few studies on this condition, so its therapeutic management is unsteady, especially in severe cases. In this article, we describe our experience in a pediatric intensive care unit in the management of 3 clinical cases with pancreatitis occured in the last months. We applied the guidelines extracted from the clinical guides about management of acute pancreatitis in adult patients, based on improving analgesia, administration of intensive fluid therapy and initial pancreatic rest with early reintroduction of enteral nutrition, which showed a good subsequent clinical evolution. Our main purpose, given the increase in the incidence of this entity, is to emphasize the importance of a high level of clinical suspicion when facing a case of abdominal pain that may allow an early diagnosis and a quick establishment of a proper treatment in these cases, as well as to highlight the most important facts of its management

La Unidad de Cuidados Intensivos Pediátricos en el Hospital Universitario Ramón y Cajal en el año 2015 / The Pediatric Intensive Care unit in the Hospital Ramón y Cajal in the year 2015

Este documento esquematiza la organización y principales características de la Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Ramón y Cajal de Madrid, catalogada del máximo nivel asistencial (nivel III) en el último informe técnico de la SECIP. Tras una breve reseña histórica, se señalan sus principales valores describiéndose, a continuación, sus características físicas (su reciente reubicación ha permitido un moderno diseño arquitectónico, con boxes individualizados donde el acompañamiento de los enfermitos por sus padres goza de un importante grado de confortabilidad). También se presentan los principales recursos humanos y materiales con los que ha sido dotada, situados al frente de la mayor vanguardia asistencial y tecnológica. A continuación mostramos su cartera de servicios, una sucinta memoria asistencial, y los objetivos de gestión (basados en una cultura de excelencia, calidad y seguridad del paciente). Finalmente, integrada en un hospital docente de la mayor complejidad asistencial, se resalta la actividad formadora e investigadora de la misma (AU)

This paper summarizes the organization and the main charateristics of the Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Ramón y Cajal de Madrid, scored as level III (the major level) by the SECÏIP. After a brief historic background, their values as organization are presented. Secondly, we describe their modern archithetonic design which allows an individualized care in medical boxes as a comfortable presence of parents with their children. Human and material resources, having the best technologies currently available, are also shared. Following, portfolio services with a brief attending report, and the managing objectives (based on strategies concerned about the highest quality) are also shown. Finally, due to the PICU is integrated in an University Hospital, where highly complex patients are treated, it must be emphasized the wide PICU teaching and researching activities (AU)

Utilidad de la ecografía pulmonar a pie de cama en cuidados intensivos pediátricos / Bedside lung ultrasound in paediatric intensive care

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¿Es prudente seguir utilizando los enemas fosfato? / Is it wise to continue using phosphate enemas?

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Spinal surgery in the univentricular heart--is it viable?

INTRODUCTION: The management of patients with Fontan physiology who undergo scoliosis surgery is difficult. The purpose of this article was to describe our experience in the management of patients with Fontan circulation undergoing spinal surgery for correction of scoliosis. MATERIALS AND METHODS: This was a retrospective study including patients with Fontan physiology who underwent spinal orthopaedic surgery. Anaesthetic management, post-operative complications, paediatric intensive care unit and total hospital stay, and the need for blood transfusions were analysed. RESULTS: We identified eight children with Fontan physiology who had undergone spinal surgery from 2000 to 2010. All patients were receiving cardiac medications at the time of spinal surgery. The mean age at surgery was 14.8 years (range 12-21). In all, three patients needed inotropic support with dopamine (3, 5, and 8 µg/kg/min), which was started during surgery. During the immediate post-operative period, one patient died because of hypovolaemic shock caused by massive bleeding and dysrythmia. Mean blood loss during the post-operative period was 22.2 cc/kg (7.8-44.6). Surgical drainages were maintained for a mean time of 3 days (range 1-7). The mean hospital stay was 9.2 days (range 6-19). Pleural effusions developed in two patients. On follow-up, one patient presented with thoracic pseudarthrosis and another with a serohaematoma of the surgical wound. CONCLUSIONS: Spinal surgery in patients with Fontan circulation is a high-risk operation. These patients must be managed by a specialised team.

Agenesia de la vena cava inferior / Agenesis of the inferior vena cava

La agenesia de la vena cava inferior, especialmente de su segmento infrarrenal, es una patología excepcional, diagnosticándose normalmente de forma casual. Se ha postulado su origen en relación con una trombosis en el periodo intrauterino más que con una verdadera malformación congénita. La sintomatología depende de la formación de colaterales que, a su vez, se relaciona con una trombosis venosa profunda. Presentamos el caso de una niña de 13 años que consulta por dolor y tumefacción de miembros inferiores de 4 días de evolución, con edema bilateral que deja fóvea en ambas extremidades inferiores. Se realizó ecografía doppler, visualizándose trombosis venosa profunda bilateral, tras lo cual se completó el estudio de imagen mediante TAC observándose una ausencia de vena cava inferior con formación de abundantes colaterales. Se inició tratamiento anticoagulante con mejoría de la sintomatología, manteniéndose dicho tratamiento en el momento actual tres meses después (AU)

Agenesis of the inferior vena cava, especially of the infrarenal segment, is exceptional. Is commonly reported as a fortuitous finding. This condition is thought to result from thrombosis during gestation rather than from a true congenital malformation. Agenesis of the inferior vena cava can be associated with symptoms resulting from the formation of collaterals, which in turn relates to venous thrombosis deep. In young patients with thrombosis idiopathic deep vein should be CT or angiography to rule out anatomical abnormalities of the vena cava. We present a case of a girl of 13 years of age with a 4-day history of pain and swelling of lower limbs associated with dilated abdominal wall veins. Doppler ultrasound is performed and demonstrated bilateral deep venous thrombosis. The study of image was broader and observed the absence of interior vena cava with formation of abundant collateral. We started on anticoagulant treatment that stands up to the present time (AU)

Miocarditis aguda fulminante: a propósito de dos casos / Acute fulminant myocarditis: based on two cases

La miocarditis es un proceso inflamatorio del músculo cardíaco. Afecta a cualquier grupo de edad. La mayoría de los casos son subclínicos, aunque puede manifestarse como una insuficiencia cardiaca crónica o fulminante. La inflamación es habitualmente consecuencia de un proceso infeccioso, aunque existen formas idiopáticas o autoinmunes. La mayoría de los virus patógenos para el hombre pueden producir miocarditis, siendo lo más frecuentes los enterovirus y los adenovirus. Se desconoce si el origen de la gravedad de la lesión es producido por el virus o por la respuesta inflamatoria postinfecciosa o por una combinación de ambos factores. Presentamos dos casos que presentaron una miocarditis aguda con una evolución fatal fulminante. En ninguno se pudo identificar el agente etiológico (AU)

Myocarditis is an inflammatory process of cardiac muscle. It affects equally all the age groups. Most of the cases are subclinical even though it can present as chronic or fatal heart failure. Inflammation is usually a consequence of an infectious process although idiopacthic and inmunitary cases have also been described. The majority of human virus can cause myocarditis, among them enterovirus and adenovirus are the most common. It is not known whether the virus causes the severity of the process itself, the post-infectious inflammatory response or a combination of both factors. We present two cases of acute myocarditis with a fatal outcome. We were unable to identify the pathogenic agent in neither of them (AU)

[Early postoperative complications of thoracoscopy versus thoracotomy in pediatric idiopathic scoliosis]. / Estudio comparativo de las complicaciones postoperatorias inmediatas de la toracoscopia frente a la toracotomía en la escoliosis idiopática infantil.

INTRODUCTION: Thoracoscopic surgery has been used for anterior release, discectomy, and fusion in severe scoliosis or kyphosis. The indications of thoracoscopy for the treatment of pediatric spinal deformity are similar to those of thoracotomy-based spinal surgery. OBJECTIVE: We designed a comparative study to observe the immediate complications in the postoperative period after thoracoscopy or thoracotomy for scoliosis in the pediatric population. MATERIAL AND METHODS: The postsurgical complications of 63 interventions for idiopathic scoliosis over a 10-year period were analyzed. Conventional thoracotomy was used in 37 interventions (59 %) and thoracoscopy was used in 26 (41 %). RESULTS: In patients treated with the thoracolumbar endoscopic procedure, oral nutrition was resumed earlier, the mean length of hospital stay was lower, and debit drainage or requirement of surgical drainage were lower. CONCLUSIONS: Fewer immediate postsurgical complications were observed in scoliosis surgery when thoracoscopy was used.

Estudio comparativo de las complicaciones postoperatorias inmediatas de la toracoscopia frente a la toracotomía en la escoliosis idiopática infantil / Early postoperative complications of thoracoscopy versus thoracotomy in pediatric idiopathic scoliosis

Introducción La toracoscopia es una técnica quirúrgica que se utiliza en cirugía anterior, discectomía y fusión vertebral en pacientes con escoliosis o cifosis graves. Las indicaciones de la toracoscopia para el tratamiento de la deformidad espinal son similares a las de la toracotomía. Objetivo Nos planteamos el estudio comparativo de las complicaciones postoperatorias inmediatas de la toracoscopia frente a la toracotomía en escoliosis infantil. Material y métodos Se analizó, en un período de 10 años, el postoperatorio de 63 intervenciones quirúrgicas de escoliosis idiopática, de las cuales 37 (59 %) se realizaron mediante toracotomía convencional y 26 (41 %) mediante abordaje endoscópico toracolumbar. Resultados En el grupo de pacientes a los que se les practicó un abordaje endoscópico toracolumbar la tolerancia oral fue más precoz y el tiempo de estancia media, así como el débito y requerimiento de los drenajes quirúrgicos fue menor. Conclusiones Las complicaciones de la cirugía de escoliosis en el postoperatorio inmediato son menores cuando la técnica quirúrgica empleada es la toracoscopia

Introduction Thoracoscopic surgery has been used for anterior release, discectomy, and fusion in severe scoliosis or kyphosis. The indications of thoracoscopy for the treatment of pediatric spinal deformity are similar to those of thoracotomy-based spinal surgery. Objective We designed a comparative study to observe the immediate complications in the postoperative period after thoracoscopy or thoracotomy for scoliosis in the pediatric population. Material and methods The postsurgical complications of 63 interventions for idiopathic scoliosis over a 10-year period were analyzed. Conventional thoracotomy was used in 37 interventions (59 %) and thoracoscopy was used in 26 (41 %). Results In patients treated with the thoracolumbar endoscopic procedure, oral nutrition was resumed earlier, the mean length of hospital stay was lower, and debit drainage or requirement of surgical drainage were lower. Conclusions Fewer immediate postsurgical complications were observed in scoliosis surgery when thoracoscopy was used

Diabetes insípida central secundaria a meningitis neonatal por Escherichia coli / Central insipid diabetes secondary to neonatal meningitis due to EScherichia coli

Los criterios de diabetes insípida incluyen una osmolaridad en sagre elevada y unosniveles altos de sodio en sangre acompañados de una orina hipotónica. La respuesta a la administración intranasal de arginina-vasopresina es satisfactoria, normalizándose los niveles séricos de sodio e incrementándose la osmolaridad urinaria, seguidos de un mejor balance hídrico. El neonatólogo debe pensar en esta entidad en neonatos coninfección del sistema nervioso central. Estudios de imagen donde se observe una hemorragia en la región posterior del hipotálamo debe ser un signo de que ha ocurrido esta complicación. Este artículo describe el primer caso clínico de un neonato que desarrolló una diabetes insípida central secundaria a una meningitis por Escherichia coli

The criteria for diabetes insipidus reaching high levels of serum sodium and osmolarity, along with hypotonic urine. The response to intranasal arginine-vasopressin were prompt, normalizing the serum levels of sodium and increasing urinary osmolality, allowing a better metabolic balance. The neonatologist must be aware of the possibility of this kind of complication even in a normal child with central nervous system. Infection. Imaging studies showing hemorrhage in the region of the posterior hypothalamus must be a sign that this type of complication is able to occur. This report describes the first case of central diabetes insipidus secondary to Escherichia coli meningitis in a neonate

[Early postoperative complications after scoliosis surgery]. / Complicaciones médicas precoces en el postoperatorio de cirugía de escoliosis.

Several medical complications can occur after scoliosis surgery in children and adolescents. New surgical techniques have allowed greater degrees of scoliosis correction but have also increased the possibility of postsurgical deficit due to their greater aggressivity. We analyzed the early postsurgical complications of scoliosis surgery in a pediatric intensive care unit over a 10-year period. Seventy-six surgical procedures were performed. Of these, no complications occurred in 55 (73%). Chest X-ray revealed pulmonary atelectasia in 8 patients (10%) and pleural effusion in 7 patients (9%). Symptoms and signs of infection related to surgery were observed in only 6 children (8%). The absence of severe medical complications may be related to new surgical techniques and an experienced team.

Complicaciones médicas precoces en el postoperatorio de cirugía de escoliosis / Early postoperative complications after scoliosis surgery

Diversas complicaciones médicas pueden ocurrir tras la cirugía de columna. Las técnicas quirúrgicas actuales han permitido mayor grado de corrección de la escoliosis, pero al mismo tiempo ha aumentado la posibilidad de déficit postoperatorio debido a su mayor agresividad. Se analizaron las complicaciones precoces en el postoperatorio de cirugía de escoliosis en una unidad de cuidados intensivos a lo largo de 10 años. Se realizaron 76 intervenciones quirúrgicas, de las cuales en 55 (73 %) no hubo ningún tipo de complicaciones. En 8 pacientes (10 %) se observó en la radiografía de tórax una atelectasia pulmonar, siete (9 %) desarrollaron derrames pleurales y únicamente en 6 niños (8 %) se pudo constatar síntomas y signos infecciosos relacionados con la intervención quirúrgica. La ausencia de complicaciones médicas graves se debió, posiblemente, a la asociación de nuevas técnicas con un equipo experimentado

Several medical complications can occur after scoliosis surgery in children and adolescents. New surgical techniques have allowed greater degrees of scoliosis correction but have also increased the possibility of postsurgical deficit due to their greater aggressivity. We analyzed the early postsurgical complications of scoliosis surgery in a pediatric intensive care unit over a 10-year period. Seventy-six surgical procedures were performed. Of these, no complications occurred in 55 (73 %). Chest X-ray revealed pulmonary atelectasia in 8 patients (10 %) and pleural effusion in 7 patients (9 %). Symptoms and signs of infection related to surgery were observed in only 6 children (8 %). The absence of severe medical complications may be related to new surgical techniques and an experienced team

Probable metahemoglobinemia tras administración de EMLA® / Probable methemoglobinemia following EMLA® administration

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Hipernatremia como causa de corea y rabdomiólisis / Hypernatremia as cause of chorea and rhabdomyolysis

La hipernatremia severa asocia un estado de hiperosmolaridad que puede producir rabdomiólisis y consecuentemente desencadenar un fracaso renal agudo. La aparición de corea transitoria es una rara complicación de la hipernatremia. Presentamos un caso de un lactante de nueve meses con hipernatremia por una intoxicación salina que presentó rabdomiólisis con fracaso renal agudo y corea transitoria (AU)

[Cohen's syndrome: non-causal association with vascular rings]. / Síndrome de Cohen: asociación no casual con anillos vasculares.

Cohen syndrome is an autosomal recessive disorder characterized by hypotonia, mental retardation, microcephalia, typical craniofacial features, myopia and chorioretinal dystrophy. The responsible gene has been mapped to chromosome 8q 22 (COH 1). Since it was described more than 100 patients have been reported. However, none of them has been associated with vascular rings. Our hospital has studied eight pediatric cases and 25% of them were related with vascular rings.

Síndrome de Cohen: asociación no casual con anillos vasculares / Cohen's syndrome non-causal association with vascular rings

El síndrome de Cohen es un trastorno autosómico recesivo que se caracteriza por la asociación de obesidad, hipotonía, retraso mental, microcefalia, dismorfia craneofacial típica, miopía y distrofia coriorretiniana. Se ha localizado el locus para el síndrome de Cohen en el cromosoma 8q 22 (COH 1). Desde su descripción más de cien pacientes han sido comunicados, no presentando ninguno de ellos asociación con anillos vasculares. Presentamos ocho casos pediátricos diagnosticados en nuestro hospital, la mayor serie publicada en España, de las cuales un 25 por ciento se asociaron con anillos vasculares (AU)