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.

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

No disponible

Espondilodiscitis: diagnóstico y seguimiento a medio-largo plazo de 18 casos / Spondylodiscitis: Diagnosis and medium-long term follow up of 18 cases

Introducción: La espondilodiscitis en niños es poco frecuente. Es habitual un retraso en el diagnóstico y errores en el mismo. Objetivos: Revisar las características clínicas, analíticas y radiológicas de los niños con espondilodiscitis en el Hospital Materno-Infantil Carlos Haya de Málaga. Pacientes y métodos: Estudio retrospectivo de los niños diagnosticados de espondilodiscitis en este hospital, durante un período de 10 años. Resultados: Se estudiaron 18 pacientes. Fue más frecuente en menores de 3 años y mayores de 12. El tiempo medio de retraso en el diagnóstico resultó de 26,9 días, con diagnóstico inicial erróneo en 8 casos. Se presentaron 3 patrones clínicos: en menores de 3 años, rechazo de la marcha y sedestación (100%) e irritabilidad (42%); entre 3 y 12 años, impotencia funcional de extremidades inferiores (EEII) (100%) y dolor abdominal (100%); en adolescentes, molestias de la espalda (75%). Apareció fiebre en el 38% de los casos y febrícula en 8 casos (44%). El 50% presentó leucocitosis moderada, con discreta elevación de la velocidad de sedimentación globular. Las localizaciones más frecuentes fueron L3-L4 y L4-L5. La radiografía al diagnóstico resultó patológica en el 83% de los casos. La RM al ingreso fue diagnóstica en el 100%. Detectó además afectación de raíces nerviosas (5 casos), masas inflamatorias/abscesos paravertebrales (5), absceso epidural (1) y abscesos del psoas (2). Recibió tratamiento antibiótico el 94% de los niños e inmovilización el 100%. Todos experimentaron rápida mejoría tras el inicio del tratamiento, excepto los afectados de abscesos del psoas. El seguimiento radiológico, realizado en 17 pacientes (12 mediante RM), a los 14 meses de media (rango 1–48), mostró disminución o desaparición del espacio discal en el 100% de los niños y mejoría de las masas de partes blandas. En el seguimiento clínico (recogido en 11 pacientes) todos conservaban motilidad normal y el 27% dolor leve-moderado. Conclusión: La espondilodiscitis, cuyo retraso en el diagnóstico es frecuente, no es una entidad banal, ya que puede complicarse con abscesos y daño de raíces nerviosas. La RM es la prueba de elección para determinar su extensión a los tejidos vecinos (AU)

Introduction: Spondylodiscitis is an uncommon disease in children. It is often misdiagnosed or the diagnosis is made late in the course of illness. Objectives: To review the clinical, analytical and radiological characteristics of children with spondylodiscitis in the Materno-Infantil Hospital of Malaga. Patients and methods: Retrospective cohort study on children diagnosed with spondylodiscitis, during a period of 11 years. Results: Eighteen patients were included in the study. Spondylodiscitis was more frequent in patients younger than 3 years old and older than 12 years old. The average time of delay in diagnosis was 26.9 days. In 8 cases the diagnosis was missed initially. Three clinical patterns appeared: in children under 3 years of age, refusing to walk and sit (100%) and irritability (42%); between 3 and 12 years of age, limb (100%) and abdominal pain (100%); in adolescents, back pain (75%). Fever was present in 38% of the cases, and low-grade fever in 8 (44%). A total of 50% of the patients had a moderate leucocytosis, and a slight increase in ESR; the most frequent location was L3-L4. X-ray diagnosis was pathological in 88% of the cases. The initial MRI diagnosed 100% of the cases. In addition, nerve roots damage (5 cases), inflammatory masses/paravertebral abscesses (5), epidural abscess (1) and psoas abscesses (2) were detected. A total of 94% of the children received antibiotics and 100% of the children underwent immobilization. All patients recovered early after the beginning of treatment, with the exception of those affected by psoas abscesses. The radiological follow-up was done in 17 patients (12 by MRI). After a mean of 14 months (rank 1–48), persistent diminution of disc space was seen in 100% of the children, and improvement of soft-tissue inflammation. Clinically (follow-up only in 11 patients) all patients regained normal mobility and only 27% had moderate pain. Conclusion: Spondylodiscitis, whose delay in the diagnosis is frequent, is a serious illness. Complications include abscesses and nerve root damage. MRI is the study of choice to determine the extension to neighbouring tissues (AU)

[Spondylodiscitis: Diagnosis and medium-long term follow up of 18 cases]. / Espondilodiscitis: diagnóstico y seguimiento a medio-largo plazo de 18 casos.

INTRODUCTION: Spondylodiscitis is an uncommon disease in children. It is often misdiagnosed or the diagnosis is made late in the course of illness. OBJECTIVES: To review the clinical, analytical and radiological characteristics of children with spondylodiscitis in the Materno-Infantil Hospital of Malaga. PATIENTS AND METHODS: Retrospective cohort study on children diagnosed with spondylodiscitis, during a period of 11 years. RESULTS: Eighteen patients were included in the study. Spondylodiscitis was more frequent in patients younger than 3 years old and older than 12 years old. The average time of delay in diagnosis was 26.9 days. In 8 cases the diagnosis was missed initially. Three clinical patterns appeared: in children under 3 years of age, refusing to walk and sit (100%) and irritability (42%); between 3 and 12 years of age, limb (100%) and abdominal pain (100%); in adolescents, back pain (75%). Fever was present in 38% of the cases, and low-grade fever in 8 (44%). A total of 50% of the patients had a moderate leucocytosis, and a slight increase in ESR; the most frequent location was L3-L4. X-ray diagnosis was pathological in 88% of the cases. The initial MRI diagnosed 100% of the cases. In addition, nerve roots damage (5 cases), inflammatory masses/paravertebral abscesses (5), epidural abscess (1) and psoas abscesses (2) were detected. A total of 94% of the children received antibiotics and 100% of the children underwent immobilization. All patients recovered early after the beginning of treatment, with the exception of those affected by psoas abscesses. The radiological follow-up was done in 17 patients (12 by MRI). After a mean of 14 months (rank 1-48), persistent diminution of disc space was seen in 100% of the children, and improvement of soft-tissue inflammation. Clinically (follow-up only in 11 patients) all patients regained normal mobility and only 27% had moderate pain. CONCLUSION: Spondylodiscitis, whose delay in the diagnosis is frequent, is a serious illness. Complications include abscesses and nerve root damage. MRI is the study of choice to determine the extension to neighbouring tissues.

[End-of-life care in a Spanish Pediatric Intensive Care Unit: staff and parental evaluation]. / Cuidados al final de la vida en una unidad de cuidados intensivos pediátricos: evaluación por parte del personal y de los padres.

OBJECTIVES: To evaluate end-of-life care in a Paediatric Intensive Care Unit (PICU). METHODS: Retrospective study developed in a PICU. SUBJECTS: 41 workers from the PICU and parents of 26 deceased children (from 2001 to 2005). A questionnaire was designed to investigate end-of-life care. RESULTS: An age < 1-year old and a chronic or congenital disease correlated with a perceived lack of consistency in information. Nearly 38 % parents were with their children at the time of death; 64 % of all parents consider this "positive", and 13 % consider it "negative". Forty per cent of staff stated that it is "positive" for parents to be by the side of their child at the time of death, and 52 % do not know. Seventy-three per cent of staff, but only 29 % of parents want further professional psychological support for parents. Twenty per cent of children died following withdrawal of life support. The most important factors for this decision were the possibility of survival and quality of life. The majority (73 %) of caregivers express the view that often, this decision should be taken earlier. CONCLUSIONS: Analysis of staff opinions underlines the importance of the way news is communicated, the timing of withdrawal of life support, and the need for psychological support. Parents emphasized the role of the family during time spent in a PICU and during the last moments.

Cuidados al final de la vida en una unidad de cuidados intensivos pediátricos: evaluación por parte del personal y de los padres / End-of-life care in a Spanish Pediatric Intensive Care Unit: staff and Parental Evaluation

Objetivos: Evaluar los cuidados al final de la vida en una unidad de cuidados intensivos pediátricos (UCIP). Métodos: Estudio retrospectivo desarrollado en una UCIP. Los sujetos fueron 41 trabajadores de la UCIP y los padres de 26 niños fallecidos entre 2001 y 2005. Se diseñó un cuestionario para evaluar los cuidados al final de la vida proporcionados en este período. Resultados: La edad inferior a 1 año y las enfermedades crónicas o congénitas son las variables que se correlacionaron con una mayor percepción de incoherencia en la información. Cerca del 38 % de los padres estuvieron junto a sus hijos en el momento del fallecimiento; el 64 % de ellos consideran estar presentes algo positivo, y el 13 %, algo negativo. El 40 % del personal declaró que es positivo para los padres estar al lado de sus hijos en el momento del fallecimiento, y el 52 % no sabía si era positivo o negativo. El 73 % del personal, pero sólo el 29 % de los padres, desearía apoyo psicológico profesional para los padres. El 20 % de los niños fallecieron tras la retirada del soporte vital. Los factores más importantes para esta decisión fueron la posibilidad de supervivencia y la calidad de vida. La mayoría de los sanitarios expresaron que, a menudo, esta decisión debería haber sido tomada antes. Conclusiones: El análisis del personal subraya la importancia del cómo las noticias son comunicadas, del momento de retirada del soporte vital y la necesidad del apoyo psicológico. Los padres enfatizan más el papel de la familia en la UCIP y durante los últimos momentos (AU)

Objectives: To evaluate end-of-life care in a Paediatric Intensive Care Unit (PICU). Methods: Retrospective study developed in a PICU. Subjects: 41 workers from the PICU and parents of 26 deceased children (from 2001 to 2005). A questionnaire was designed to investigate end-of-life care. Results: An age < 1-year old and a chronic or congenital disease correlated with a perceived lack of consistency in information. Nearly 38 % parents were with their children at the time of death; 64 % of all parents consider this "positive", and 13 % consider it "negative". Forty per cent of staff stated that it is "positive" for parents to be by the side of their child at the time of death, and 52 % do not know. Seventy-three per cent of staff, but only 29 % of parents want further professional psychological support for parents. Twenty per cent of children died following withdrawal of life support. The most important factors for this decision were the possibility of survival and quality of life. The majority (73 %) of caregivers express the view that often, this decision should be taken earlier. Conclusions: Analysis of staff opinions underlines the importance of the way news is communicated, the timing of withdrawal of life support, and the need for psychological support. Parents emphasized the role of the family during time spent in a PICU and during the last moments (AU)

[Uveitis and juvenile idiopathic arthritis]. / Uveítis y artritis idiopática juvenil.

OBJECTIVE: Anterior uveitis is one of the most important extra-articular manifestations of juvenile idiopathic arthritis (JIA). The objective was to analyze the frequency of uveitis in patients with JIA and to describe its clinical and evolutive characteristics. PATIENTS AND METHOD: Among the 234 children diagnosed with JIA in our hospital, those presenting uveitis were studied. RESULTS: Seventeen children, 16 girls and 1 boy, presented uveitis in 28 eyes, representing a prevalence of 7.3%. Among patients with pauci- or oligo-articular forms of the disease, the percentage increased to 13.3%; polyarticular forms accounted for 10%. Only one of the 12 patients with psoriatic arthritis developed uveitis. Mean age at diagnosis of the ocular condition was 4.5 years and the interval between diagnosis of arthritis to detection of uveitis was 661.5 months. In two patients uveitis was diagnosed before arthritis. Thirty-seven episodes of uveitic activity were identified, of which 27 were asymptomatic. Fifty-three percent of the affected eyes developed complications (posterior synechias in 43%, cataracts in 25%, in-band keratopathy in 18% and glaucoma in 7%). Surgery was required in six eyes. A marked loss of vision occurred in four eyes, despite ophthalmologic treatment. Conclusions Anterior uveitis is a cause of morbidity in JIA. Periodic ophthalmologic explorations are essential for early diagnosis and treatment.

Uveítis y artritis idiopática juvenil / Uveitis and juvenile idiopathic arthritis

Objetivo: La uveítis anterior es una de las manifestaciones extraarticulares más importantes de la artritis idiopática juvenil (AIJ). El objetivo de este estudio ha sido analizar la frecuencia de uveítis en pacientes con AIJ y describir sus características clínicas y evolutivas. Pacientes y métodos: Se analizaron los pacientes que presentaron uveítis entre los 234 niños con AIJ diagnosticados en nuestro hospital. Resultados: Presentaron uveítis 17 pacientes, 16 niñas y un niño, en 28 ojos, lo que supone una prevalencia de 7,3% en el total de niños con AIJ. Entre los pacientes con una forma pauciarticular u oligoarticular de la enfermedad el porcentaje se elevó hasta el 13,3% y fue del 10% en las formas poliarticulares. Sólo 1 de los 12 pacientes con artritis psoriásica desarrolló uveítis. La media de edad al diagnóstico de la afectación ocular fue de 4,5 años y el tiempo transcurrido entre el diagnóstico de la artritis y el de la uveítis fue de 661,5 meses. En 2 casos el diagnóstico de uveítis precedió al de artritis. Se objetivaron 37 episodios de actividad de la uveítis de los que 27 fueron asintomáticos. En el 53% de los ojos afectados aparecieron complicaciones (sinequias posteriores 43%, cataratas 25%, queratopatía en banda 18% y glaucoma 7%). Requirieron cirugía 6 ojos y 4 ojos presentaron una pérdida grave de visión a pesar del tratamiento oftalmológico. Conclusiones: La uveítis anterior es una causa de morbilidad en la AIJ. La exploración oftalmológica periódica en estos pacientes es obligada para establecer el diagnóstico y tratamiento precoces (AU)