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a está disponible un nuevo número de Pediatría Hospitalaria (volumen 1, nº 6)

Pincha aquí para acceder al número 6 de la revista Pediatría Hospitalaria, publicación oficial de la SEPHO, con unas selección de artículos comentados, recursos y noticias de interés sobre la Pediatría Interna Hospitalaria. 

La bronquiolitis alcanza esta semana su pico máximo de incidencia en España

Según informa la Sociedad Española de Urgencias de Pediatría (SEUP), integrada en la Asociación Española de Pediatría (AEP), desde la semana pasada España está viviendo el pico de máxima incidencia de bronquiolitis aguda y está previsto que se prolongue, al menos, 6 semanas más. Según explica el presidente de SEUP, el doctor Francisco Javier Benito Fernández, “estamos ante el inicio de lo que llamamos la epidemia de los niños más pequeños, ya que esta enfermedad afecta principalmente a los niños menores de 2 años. Y es que hay unincremento importante del número de casos atendidos en las consultas de atención primaria y en los servicios de urgencias hospitalarios”.

La bronquiolitis aguda afecta a los niños menores de 2 años y los síntomas son tos, mucosidad nasal, fiebre y dificultad respiratoria que puede durar entre dos y tres semanas. Se estima que aproximadamente un 20% de los niños tendrá un episodio de bronquiolitis en su...

Participación de la AEP en el proyecto MOCHA (Models of Child Health Appraised)

Este Proyecto tiene como meta la identificación y evaluación de los diferentes modelos de Atención Primaria de Salud para la Infancia y Adolescencia (IA) en 30 países de Europa (UE /EEE). 

La metodología de investigación, reconoce la relevancia de una APS accesible y eficaz, para la Salud de la IA. En consecuencia, tiene un enfoque de ciclo vital, centrado en el niño/a y sus necesidades, la familia y los Derechos de la Infancia, junto con una aproximación integral / interrelación de la APS con otros niveles asistenciales (atención hospitalaria y especializada, en particular Salud Mental) y con aquellos sectores relacionados con la Salud y el Bienestar de la Infancia-Adolescencia (servicios sociales, educación).

Asimismo, considera la importancia de los cuidados de salud integrales (biopsicosociales) e integrados (interdisciplinariedad y coordinación intersectorial), especialmente en los niños /as y adolescentes con enfermedad crónica y/o discapacidad y sus...

Semana mundial de la Lactancia Materna 2019: ¡Hagamos posible la lactancia!

La semana mundial de la lactancia materna, instaurada oficialmente por la Organización Mundial de la Saludy UNICEF en 1992, es actualmente el movimiento social más extendido en defensa de la lactancia materna. Se celebra en más de 120 países, del 1 al 7 de agosto, aniversario de la Declaración de Innocenti, firmada por la OMS y el ...

Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices

Pediatrics - Lun, 02/12/2019 - 10:01

Severe obesity among youth is an "epidemic within an epidemic" and portends a shortened life expectancy for today’s children compared with those of their parents’ generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple comorbid states, including increased cardiometabolic risk resulting in end-organ damage in adulthood. Lifestyle modification treatment has achieved moderate short-term success among young children and those with less severe forms of obesity, but no studies to date demonstrate significant and durable weight loss among youth with severe obesity. Metabolic and bariatric surgery has emerged as an important treatment for adults with severe obesity and, more recently, has been shown to be a safe and effective strategy for groups of youth with severe obesity. However, current data suggest that youth with severe obesity may not have adequate access to metabolic and bariatric surgery, especially among underserved populations. This report outlines the current evidence regarding adolescent bariatric surgery, provides recommendations for practitioners and policy makers, and serves as a companion to an accompanying technical report, "Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity," which provides details and supporting evidence.

Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity

Pediatrics - Lun, 02/12/2019 - 10:01

Severe obesity affects the health and well-being of millions of children and adolescents in the United States and is widely considered to be an "epidemic within an epidemic" that poses a major public health crisis. Currently, few effective treatments for severe obesity exist. Metabolic and bariatric surgery are existing but underuse treatment options for pediatric patients with severe obesity. Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the most commonly performed metabolic and bariatric procedures in the United States and have been shown to result in sustained short-, mid-, and long-term weight loss, with associated resolution of multiple obesity-related comorbid diseases. Substantial evidence supports the safety and effectiveness of surgical weight loss for children and adolescents, and robust best practice guidelines for these procedures exist.

Neonatal Provider Workforce

Pediatrics - Lun, 02/12/2019 - 10:01

This technical report reviews education, training, competency requirements, and scopes of practice of the different neonatal care providers who work to meet the special needs of neonatal patients and their families in the NICU. Additionally, this report examines the current workforce issues of NICU providers, offers suggestions for establishing and monitoring quality and safety of care, and suggests potential solutions to the NICU provider workforce shortages now and in the future.

Aluminum Effects in Infants and Children

Pediatrics - Lun, 02/12/2019 - 10:01

Aluminum has no known biological function; however, it is a contaminant present in most foods and medications. Aluminum is excreted by the renal system, and patients with renal diseases should avoid aluminum-containing medications. Studies demonstrating long-term toxicity from the aluminum content in parenteral nutrition components led the US Food and Drug Administration to implement rules for these solutions. Large-volume ingredients were required to reduce the aluminum concentration, and small-volume components were required to be labeled with the aluminum concentration. Despite these rules, the total aluminum concentration from some components continues to be above the recommended final concentration. The concerns about toxicity from the aluminum present in infant formulas and antiperspirants have not been substantiated but require more research. Aluminum is one of the most effective adjuvants used in vaccines, and a large number of studies have documented minimal adverse effects from this use. Long-term, high-concentration exposure to aluminum has been linked in meta-analyses with the development of Alzheimer disease.

Emergency Contraception

Pediatrics - Lun, 02/12/2019 - 10:01

Despite significant declines over the past 2 decades, the United States continues to experience birth rates among teenagers that are significantly higher than other high-income nations. Use of emergency contraception (EC) within 120 hours after unprotected or underprotected intercourse can reduce the risk of pregnancy. Emergency contraceptive methods include oral medications labeled and dedicated for use as EC by the US Food and Drug Administration (ulipristal and levonorgestrel), the "off-label" use of combined oral contraceptives, and insertion of a copper intrauterine device. Indications for the use of EC include intercourse without use of contraception; condom breakage or slippage; missed or late doses of contraceptives, including the oral contraceptive pill, contraceptive patch, contraceptive ring, and injectable contraception; vomiting after use of oral contraceptives; and sexual assault. Our aim in this updated policy statement is to (1) educate pediatricians and other physicians on available emergency contraceptive methods; (2) provide current data on the safety, efficacy, and use of EC in teenagers; and (3) encourage routine counseling and advance EC prescription as 1 public health strategy to reduce teenaged pregnancy.

Unique Needs of the Adolescent

Pediatrics - Lun, 02/12/2019 - 10:01

Adolescence is the transitional bridge between childhood and adulthood; it encompasses developmental milestones that are unique to this age group. Healthy cognitive, physical, sexual, and psychosocial development is both a right and a responsibility that must be guaranteed for all adolescents to successfully enter adulthood. There is consensus among national and international organizations that the unique needs of adolescents must be addressed and promoted to ensure the health of all adolescents. This policy statement outlines the special health challenges that adolescents face on their journey and transition to adulthood and provides recommendations for those who care for adolescents, their families, and the communities in which they live.

Dealing With the Caretaker Whose Judgment Is Impaired by Alcohol or Drugs: Legal and Ethical Considerations

Pediatrics - Lun, 02/12/2019 - 10:01

An estimated 8.7 million children live in a household with a substance-using parent or guardian. Substance-using caretakers may have impaired judgment that can negatively affect their child’s well-being, including his or her ability to receive appropriate medical care. Although the physician-patient relationship exists between the pediatrician and the child, obligations related to safety and confidentiality should be considered as well. In managing encounters with impaired caretakers who may become disruptive or dangerous, pediatricians should be aware of their responsibilities before acting. In addition to fulfilling the duty involved with an established physician-patient relationship, the pediatrician should take reasonable care to safeguard patient confidentiality; protect the safety of their patient, other patients in the facility, visitors, and employees; and comply with reporting mandates. This clinical report identifies and discusses the legal and ethical concepts related to these circumstances. The report offers implementation suggestions when establishing anticipatory procedures and training programs for staff in such situations to maximize the patient’s well-being and safety and minimize the liability of the pediatrician.

Chronic, Gross Hematuria Caused by Idiopathic Ureteric Stricture

Pediatrics - Lun, 02/12/2019 - 10:01

An otherwise healthy, 10-year-old boy presented with chronic, gross hematuria. This persisted daily for 5 years despite extensive multidisciplinary workup with renal biopsy and resulted in severe iron deficiency anemia. The extensive workup and requirement for routine follow-up, investigations, and procedures led to significant psychosocial distress for the patient. Initially, it was thought the patient had a nutcracker phenomenon, but on closer inspection of his ureters, an idiopathic, unilateral ureteric stricture was discovered and, after 8 weeks of stenting, resulted in complete resolution of the hematuria. Importantly, the patient’s psychosocial distress resolved after resolution of the hematuria and with the closure that came with a diagnosis.

Trends in Bronchiolitis Hospitalizations in the United States: 2000-2016

Pediatrics - Lun, 02/12/2019 - 10:01
OBJECTIVES:

To investigate the temporal trend in the national incidence of bronchiolitis hospitalizations, their characteristics, inpatient resource use, and hospital cost from 2000 through 2016.

METHODS:

We performed a serial, cross-sectional analysis of nationally representative samples (the 2000, 2003, 2006, 2009, 2012, and 2016 Kids’ Inpatient Databases) of children (age <2 years) hospitalized for bronchiolitis. We identified all children hospitalized with bronchiolitis by using International Classification of Diseases, Ninth Revision, Clinical Modification 466.1 and International Classification of Diseases, 10th Revision, Clinical Modification J21. Complex chronic conditions were defined by the pediatric complex chronic conditions classification by using inpatient data. The primary outcomes were the incidence of bronchiolitis hospitalizations, mechanical ventilation use, and hospital direct cost. We examined the trends accounting for sampling weights.

RESULTS:

From 2000 to 2016, the incidence of bronchiolitis hospitalization decreased from 17.9 to 13.5 per 1000 person-years in US children (25% decrease; Ptrend < .001). In contrast, the proportion of bronchiolitis hospitalizations among overall hospitalizations increased from 16% to 18% (Ptrend < .001). There was an increase in the proportion of children with a complex chronic condition (6%–13%; 117% increase), hospitalization to children’s hospital (15%–29%; 93% increase), and mechanical ventilation use (2%–5%; 184% increase; all Ptrend < .001). Likewise, the hospital cost increased from $449 million to $734 million (63% increase) nationally (with an increase in geometric mean of cost per hospitalization [from $3267 to $4086; 25% increase; Ptrend < .001] adjusted for inflation) from 2003 to 2016.

CONCLUSIONS:

From 2000 through 2016, the incidence of bronchiolitis hospitalizations among US children declined. In contrast, mechanical ventilation use and nationwide hospital direct cost substantially increased.

Religious Vaccine Exemptions in Kindergartners: 2011-2018

Pediatrics - Lun, 02/12/2019 - 10:01
BACKGROUND:

Forty-five states permit religious exemptions to school immunization laws; 15 allow personal belief exemptions. Updated religious exemption estimates are lacking, and it is unclear if personal belief exemption availability impacts religious exemption rates. We aimed to (1) update religious exemption trends in kindergartners, (2) compare states’ proportions of kindergartners with religious exemptions by personal belief exemption availability, and (3) describe whether the proportion of kindergartners with religious exemptions changed in Vermont after it eliminated personal belief exemptions in 2016.

METHODS:

We analyzed Centers for Disease Control and Prevention data on exemptions for children entering kindergarten from 2011 to 2018, including 295 state-years in our final analysis. Using a quasi-binomial regression analysis, we compared mean proportions of kindergartners with religious exemptions in states allowing both nonmedical exemptions against states with religious exemptions only, adjusting for policy strength and school year.

RESULTS:

States with religious and personal belief exemptions were one-fourth as likely to have kindergartners with religious exemptions as states with religious exemptions only (risk ratio 0.25; 95% confidence interval 0.16–0.38). After Vermont’s policy change, the mean proportion of kindergartners with a religious exemption increased from 0.5% to 3.7%. States were significantly more likely to have kindergartners with religious exemptions during the 2017–2018 school year compared with the 2011–2012 school year (P = .04).

CONCLUSIONS:

Religious exemption rates appear to be associated with personal belief exemption availability, may be subject to a replacement effect on personal belief exemption elimination, and are increasing. Researchers and policy makers should confirm findings with individual-level studies and reconsider the purpose and nature of religious exemption laws.

Nonpowder Firearm Injuries to Children Treated in Emergency Departments

Pediatrics - Lun, 02/12/2019 - 10:01
OBJECTIVES:

To investigate nonpowder firearm injuries treated in US emergency departments among children <18 years old.

METHODS:

National Electronic Injury Surveillance System data from 1990 through 2016 were analyzed.

RESULTS:

An estimated 364 133 (95% confidence interval 314 540–413 727) children <18 years old were treated in US emergency departments for injuries related to nonpowder firearms from 1990 to 2016, averaging 13 486 children annually. From 1990 to 2016, the number and rate of nonpowder firearm injuries decreased by 47.8% (P < .001) and 54.5% (P < .001), respectively. Most injuries occurred among 6- to 12-year-olds (47.4%) and 13- to 17-year-olds (47.0%). Boys accounted for 87.1% of injured children, the most common diagnosis was foreign body (46.3%), and 7.1% of children were admitted. BB guns accounted for 80.8% of injuries, followed by pellet guns (15.5%), paintball guns (3.0%), and airsoft guns (0.6%). The rate of eye injuries increased by 30.3% during the study period. Eye injuries accounted for 14.8% of all injuries and the most common diagnoses were corneal abrasion (35.1%), hyphema (12.5%), globe rupture (10.4%), and foreign body (8.6%).

CONCLUSIONS:

Although the number and rate of nonpowder firearm injuries declined during the study period, nonpowder firearms remain a frequent and important source of preventable and often serious injury to children. The severity and increasing rate of eye injuries related to nonpowder firearms is especially concerning. Increased prevention efforts are needed in the form of stricter and more consistent safety legislation at the state level, as well as child and parental education regarding proper supervision, firearm handling, and use of protective eyewear.

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