[Paediatric neurology health care activity in a tertiary hospital. A study comparing it with adult neurology and non-neurological paediatrics]. / Actividad asistencial de la neurología pediátrica en un hospital de nivel 3. Estudio comparativo con la neurología de adultos y la pediatría no neurológica.

INTRODUCTION: Paediatric neurology (PN) remains 'hidden' somewhere between paediatrics and neurology in almost all health care centres and this makes it difficult to allocate resources in a proper manner. AIMS: Our objective in this study was to analyse PN health care activity and compare it with adult neurology (AN) and with non-neurological paediatrics (NNP). MATERIAL AND METHODS: PN health care activity registry for the year 2002. AN and NNP data were collected from the hospital's Computer Service. RESULTS: In all, 1300 PN visits were made, 428 of which were new and 872 successive, which represent 16.2% of paediatric visits (30% new, 13.3% successive) and 10.3% of neurological visits (12.4% new, 10.2% successive). The rates of new and successive visits in PN are: 32.6, 10.7 and 21.9 per 1000 children, and in AN: 44.2, 12.5 and 31.7 per 1000 adults. A total number of 94 hospitalised children were attended, 3.3% of all paediatric admissions and 9.2% of the total neurological attention in inpatients. The rates are 2.36 per 1000 children in PN and 3.9 per 1000 adults in AN. There is greater demand among smaller children. The most frequent pathologies are headaches in clinical visits and epilepsy in hospitalised patients. CONCLUSIONS: PN is essentially a service used by outpatients. It accounts for a high percentage of hospital paediatric visits. The activity rates per 1000 children and per 1000 adults are similar. The increased birth rate raises PN activity to a level that is higher than would normally be desirable, due to the growth in the population.

Actividad asistencial de la neurología pediátrica en un hospital de nivel 3. Estudio comparativo con la neurología de adultos y la pediatría no neurológica / Paediatric neurology health care activity in a tertiary hospital. A study comparing it with adult neurology and non-neurological paediatrics

Introducción. La neurología pediátrica (NP) queda 'oculta' entre la pediatría y la neurología en casi todos los centros, lo que dificulta el correcto reparto de los recursos. Objetivo. Analizar la actividad asistencial de la NP y compararla con la neurología de adultos (NA) y con la pediatría no neurológica (PNN). Pacientes y métodos. Registro de la actividad asistencial de NP durante el año 2002. Los datos de NA y de PNN se obtuvieron del Servicio de Informática del hospital. Resultados. Se realizaron 1.300 consultas de NP, 428 nuevas y 872 sucesivas, que suponen el 16,2 por ciento de las pediátricas (30 por ciento nuevas, 13,3 por ciento sucesivas) y el 10,3 por ciento de las neurológicas (12,4 por ciento nuevas, 10,2 por ciento sucesivas). Las tasas de consultas, nuevas y sucesivas en NP son: 32,6, 10,7 y 21,9 por 1.000 niños, y en NA: 44,2, 12,5 y 31,7 por 1.000 adultos. Se atendieron 94 niños hospitalizados, un 3,3 por ciento del total de ingresos pediátricos y un 9,2 por ciento de la atención neurológica total en hospitalización. Las tasas son de 2,36 por 1.000 niños en NP y de 3,9 por 1.000 adultos en NA. Existe una mayor demanda en los niños más pequeños. Las patologías más frecuentes son las cefaleas en consultas y las epilepsias en hospitalización. Conclusiones. La NP es fundamentalmente ambulatoria. Supone un alto porcentaje de las consultas pediátricas hospitalarias. Las tasas de actividad por 1.000 niños y por 1.000 adultos son parecidas. El aumento de la natalidad incrementa la actividad de la NP más de lo esperable debido al incremento demográfico (AU)

Introduction. Paediatric neurology (PN) remains ‘hidden’ somewhere between paediatrics and neurology in almost all health care centres and this makes it difficult to allocate resources in a proper manner. Aims. Our objective in this study was to analyse PN health care activity and compare it with adult neurology (AN) and with non-neurological paediatrics (NNP). Pacients and methods. PN health care activity registry for the year 2002. AN and NNP data were collected from the hospital’s Computer Service. Results. In all, 1300 PN visits were made, 428 of which were new and 872 successive, which represent 16.2% of paediatric visits (30% new, 13.3% successive) and 10.3% of neurological visits (12.4% new, 10.2% successive). The rates of new and successive visits in PN are: 32.6, 10.7 and 21.9 per 1000 children, and in AN: 44.2, 12.5 and 31.7 per 1000 adults. A total number of 94 hospitalised children were attended, 3.3% of all paediatric admissions and 9.2% of the total neurological attention in inpatients. The rates are 2.36 per 1000 children in PN and 3.9 per 1000 adults in AN. There is greater demand among smaller children. The most frequent pathologies are headaches in clinical visits and epilepsy in hospitalised patients. Conclusions. PN is essentially a service used by outpatients. It accounts for a high percentage of hospital paediatric visits. The activity rates per 1000 children and per 1000 adults are similar. The increased birth rate raises PN activity to a level that is higher than would normally be desirable, due to the growth in the population (AU)

[Prediction of complications in children of hypertensive mothers]. / Predicción de complicaciones en el hijo de madre hipertensa.

The hypertensive disorders of pregnancy are a frequent cause of neonatal morbidity and mortality. 259 newborns of hypertensive women were study to establish the relationship between some maternal findings and the subsequent neonatal complications. The severity, early onset of hypertension, proteinuria and the gestation of 32 week or less, are related with special risk of small-for-date, anoxia, seizures and neutropenia. Preeclampsia was related with foetus more compromised. Also hyperuricemia, thrombocytopenia and cesarean section were light predictors of neonatal trouble. These findings can orientate the neonatologist to select the newborns prone to complications, watching them closely to start the treatment, if necessary, as soon as possible.

[Neonatal lactic acidosis caused by severe pyruvate carboxylase deficiency]. / Acidosis láctica neonatal debida a deficiencia aislada de piruvato carboxilasa.

A new patient with neonatal lactic acidosis due to pyruvate carboxylase deficiency is described. Since birth he developed vomiting, hypothermia, lethargy, irritability, hypoglycemia and severe metabolic acidosis. During admission a progressive deterioration was observed. Despite different attempted therapies patient died at 4 1/2 months of age. High levels of plasma and urine lactate and pyruvate were detected. Enzymatic studies in cultures skin fibroblasts and postmortem tissues showed a severe deficiency of pyruvate carboxylase.

[3 patients with maple syrup urine disease]. / Estudio de tres pacientes con la enfermedad de jarabe de arce.

Clinical manifestations, biochemistry and treatment of three patients with the inherited alteration of the so called maple syrup urine disease are presented. Diagnosis was based upon both detection of high concentrations of leucine, isoleucine, valine and their corresponding alpha-ketoacids in plasma and urine, and existence of a peculiar odor as well as an intense, progressive, neurological alteration. Considering the early onset of clinical symptoms, low protein tolerance and very reduced rate of leucine decarboxylation in cultured fibroblasts, the three patients exhibited grade I, classical type of this disease. None of them responded favorably to suprapharmacological doses of thiamine. Treatment of the patients is discussed and compared with that recommended in the literature.