[Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital]. / Terapia con surfactante con técnica mínimamente invasiva: experiencia en un hospital terciario.

INTRODUCTION: Surfactant delivered using a minimally invasive technique, known as MIST (Minimally Invasive Surfactant Therapy) is a method which allows surfactant to be administered to a patient connected to non-invasive respiratory support. This is an increasingly used therapy in Neonatal Units that reduces the intubation rate and the pathology associated with intubation and allows the surfactant to be administered to the patients who clinically need it. PATIENTS AND METHODS: In years 2013 and 2014 in the Hospital General Universitario de Elche surfactant was delivered using this method to 19 patients, five of whom were 28 or less weeks of gestation age at birth. A comparison is made with a historical cohort consisting of 28 patients with Respiratory Distress Syndrome treated initially with non-invasive respiratory support. RESULTS: No incidents were recorded that caused the interruption of the administration. A reduction in the fraction of inspired oxygen was observed in all cases after surfactant administration. Fewer intubations in the first 72 hours of life were found in the treatment group compared to the control group (42% vs. 54%). DISCUSSION: The experience recorded in the Hospital General Universitario de Elche shows that the administration of surfactant using a MIST technique is a reproducible method of treatment, which allows the surfactant distribution during spontaneous breathing with non invasive respiratory support.

[Neonatal jaundice: Clinical evaluation of a transcutaneous bilirubinometer]. / Ictericia neonatal: evaluación clínica de un bilirrubinómetro transcutáneo.

BACKGROUND: Transcutaneous bilirubinometers provide non-invasive data on newborn jaundice. The aim of this study is to evaluate whether the measurement of transcutaneous bilirubin can be correlated with serum bilirubin, and to find out whether gestational age, weight birth, race or hours of life affect those measurements. METHOD: Descriptive observational cross-sectional study on a sample of 65 simultaneous measurement of transcutaneous (TcB) and serum bilirubin (TSB). RESULTS: The correlation coefficient between both methods was 0.923. Race, gestational age and birth weight tends to not have any effects on the levels of transcutaneous bilirubin. CONCLUSION: Although bilirubinometer measurements tend to underestimate serum bilirubin, especially in patients with high levels, it is a useful technique as a screening tool in the evaluation of hyperbilirubinaemia.

[Neisseria meningitidis strains with decreased susceptibility to penicillin and ampicillin]. / Neisseria meningitidis con moderada sensibilidad frente a penicilina y ampicilina.

Thirty-eight patients (31 children and 7 adults) with meningococcal infection (sepsis and/or meningitis) were studied. The strain most frequently isolated was B (44.7%), followed by C (31.6%). Of the strains isolated, 52.6% were moderately resistant to penicillin (91.6% if only strain C was considered). No resistance to cephotaxime or chloramphenicol was found. Even though patients with moderately resistant strains treated with penicillin G evolved satisfactorily (minimum inhibitory concentrations 0.12-0.50 microgram/ml), the possible appearance of more resistant strains and/or of strains that produce beta-lactamase leads us to the conclusion that cephotaxime is the treatment of choice until an antibiogram is available.

[Tuberculosis outbreak at a public school]. / Brote epidémico de tuberculosis en un colegio público.

BACKGROUND: At school there are special circumstances of living together and a particular susceptibility, which favour the emergence of tuberculosis microepidemics. We report here the microepidemic occurred at a school among 9-year old children. METHODS: After ruling out a possible familiar source in a child with pulmonary tuberculosis, we detected a case with high bacillar shedding in a female teacher and conducted a tuberculin search among children and teachers, initially outlining the theoretical groups at risk. Tuberculin positive children underwent chest-X-ray and when abnormalities were found, children were derived to the pediatrician for chemotherapy. All converters received secondary chemoprophylaxis and all non-respondents primary chemoprophylaxis. RESULTS: The classroom where the teacher spent most of het time had a higher rate of converters (70%) than other classroom, where the index teacher spent only a partial time (40%; RR: 1.75; CI: 1.06-2.88) or the collective of teachers (45.4%; RR: 1.45; CI: 0.94-2.23). Three additional cases of secondary disease were detected, all of them children. The initial compliance with chemoprophylaxis was greater among (for) children (97.0%) than among teachers (41.6%). Among children there was one case of tuberculin conversion compared with three cases among teachers. No additional cases were detected; also, an abnormal rate of reactors outside the initially studied groups was also not detected. CONCLUSIONS: Our results somehow agree with those reported from other school outbreaks. To note the anergy and lack of symptoms in the index case and the suggestion to delineate the degree of spending hours together to identify groups with a higher theoretical risk of being infected. Thus, an unnecessary expense of resources and a social alarm would be avoided.

[The determination of IgG subclasses in healthy children by ELISA with monoclonal antibodies]. / Determinación de subclases de IgG en niños sanos mediante ELISA con anticuerpos monoclonales.

The age at which the different IgG subclasses reach stable values has not been uniformly established to date. In this study the concentration of IgG1, IgG2, IgG3 and IgG4 has been determined in the serum of 164 children (from 1 to 14 years of age) and 20 healthy adults, by using a monoclonal antibody enzyme immunoassay. The geometric mean, standard deviation and coefficient of correlation were obtained. Results showed a gradual increase in the levels of the different subclasses throughout age. The time at which the adult concentrations were obtained varied and these adult levels were not necessarily the highest values. During the first year of life, the level of IgG1 is already high and by 6-7 years its serum concentration represented 90% of the adult IgG concentration. IgG2, IgG3 and IgG4 were initially detected at low levels. IgG2 increased rapidly until it reached a stable value at 9-10 years of age. Adult values were obtained at 10-11 years of age for IgG3 and 7-8 years of age for IgG4.

[Alkaline phosphatase in the intestinal mucosa of children with the malabsorption syndrome]. / Fosfatasa alcalina en la mucosa intestinal en niños con síndrome de malabsorción.

110 children suffering from malabsorption underwent several biopsies of the gut to confirm coeliac disease (CD) following the ESPGAN criteria. We studied the values for alkaline phosphatase (AP) in the intestinal mucosa after gluten challenge. In 42 patients the after challenge biopsy was normal, thus excluding coeliac disease. In 68 children the mucosa was severely damaged confirming CD. In all biopsy specimens lactase, invertase, maltase and alkaline phosphatase were measured. We found a good correlation between PA values and severity of mucosal damage, showing that measurement of PA in the mucosa is helpful in assessing the degree of mucosal atrophy in children suffering from malabsorption.