Flexible fiberoptic bronchoscopy in children with heart diseases: a twelve years experience.

In children, cardiac diseases and respiratory disorders are tightly linked entities whose evaluation should be performed integrally. Flexible fiberoptic bronchoscopy (FB) presents a diagnostic and therapeutic role by assessing the airway anatomically, dynamically, and through the performance of several procedures. The present study describes our experience on FB assessment in children with congenital and acquired cardiac diseases, providing a characterization of the principal demographic and clinical features. Records of 72 patients under 14 years (mean age 21 months) with heart diseases, corresponding to 104 FB performed between January 1993 and October 2004 were reviewed. The principal cardiac diseases were left-to-right shunt (51.9%), followed by right-to-left shunt (17.3%) and miscellaneous cardiopathies (8.7%). The main indications for FB assessment were study of atelectasis (35%), stridor (14%), and pneumonia (14%). Airway malacias, as a group, were the commonest finding, represented mainly by left main bronchus malacia (24%). The second most common finding was stenosis by extrinsic compression, and among these, 75% corresponded to left main bronchus compression. Sixteen different types of clinically meaningful utilities were obtained. No mortality was reported and in only one procedure was there a major complication, which was easily managed. We concluded that FB is an important and safe diagnostic-therapeutic tool in the health care of neonates, infants, and children with a variety of cardiac diseases.

Urine microscopy as screen for urinary tract infections in a pediatric emergency unit in Chile.

OBJECTIVE: To evaluate the accuracy of urine microscopy as a predictor of urinary tract infections (UTIs), taking the urine culture as a criterion standard in a pediatric emergency unit. METHODS: Retrospective study in which all medical charts were analyzed for children younger than 15 years who underwent urine culture and sediment tests. Urine microscopy test was considered positive for leukocyturia when there were more than 10 leukocytes per microliter, and bacteriuria test was considered positive when any presence of bacteria was detected at x40 magnification. The method of sample taking was also recorded. RESULTS: Of 18,302 consultations of children younger than 15 years, 1173 (6.4%) needed both a urine culture and a urine microscopy. Urine cultures demonstrated that 20.9% of the samples were consistent with the diagnosis of UTI. Bacteriuria and leukocyturia tests had a sensitivity of 87.4% (95% CI, 82.7%-91.0%), a specificity of 94.8% (95% CI, 93.2%-96.1%), a likelihood ratio for a positive test of 16.7 (95% CI, 16.18-17.61), and a likelihood ratio for a negative test of 0.13 (95% CI, 0.12-0.14). Samples taken by sterile methods (suprapubic aspiration and bladder catheterization) had a better positive predictive value than those taken by nonsterile methods (urine bag and midstream clean-catch) without having an adverse impact on the negative predictive value. CONCLUSIONS: Urine microscopy without Gram stain is a good test for predicting the presence of UTIs in children, which supports the use of this screening method in pediatric emergency units.

Neutropenia en la infancia / Neutropenia in childhood

Neutropenia se define como la disminución en el número absoluto de neutrófilos circulantes, describiéndose etiologías y cursos clínicos diversos. Los casos más severos debutan con infecciones graves de riesgo vital, sin embargo, la mayoría se diagnostica en forma casual como hallazgo en exámenes de laboratorio en pacientes con escasa sintomatología. En esta revisión se presentan los conceptos generales y principales etiologías de las neutropenias en la infancia, así como las características clínicas y de laboratorio de las distintas entidades. Se describen además, las líneas generales del enfrentamiento diagnóstico, manejo del paciente y tratamiento de las principales etiologías.