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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 333, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 225, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 134, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
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Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
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Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
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Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
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Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
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Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
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Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 5)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 345, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 310, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 408, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 187, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 9)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 164, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 158, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Anales de Pediatría (English Edition)
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   ISSN (Print) 2341-2879
   Published by Elsevier Homepage  [3043 journals]
  • Idiopathic intracranial hypertension: Experience over 25 years and a
           management protocol
    • Authors: Lorena Monge Galindo; Ruth Fernando Martínez; Cristina Fuertes Rodrigo; David Fustero de Miguel; Victoria Pueyo Royo; Juan Pablo García Iñiguez; Javier López-Pisón; José Luis Peña-Segura
      Pages: 78 - 86
      Abstract: Publication date: August 2017
      Source:Anales de Pediatría (English Edition), Volume 87, Issue 2
      Author(s): Lorena Monge Galindo, Ruth Fernando Martínez, Cristina Fuertes Rodrigo, David Fustero de Miguel, Victoria Pueyo Royo, Juan Pablo García Iñiguez, Javier López-Pisón, José Luis Peña-Segura
      Introduction We present our experience on idiopathic intracranial hypertension (IIH), before and after the introduction of a specific diagnosis and management protocol. Method A descriptive retrospective study was conducted on patients with IIH over a 25 year period (1990–2015), comparing the last 7 years (after introduction of the protocol) with the previous 18 years. Results Among the 18,865 patients evaluated, there were 54 cases of IIH (29 infants and 25 children). A comparison was made between the two time periods: 32 cases in 1990–2008—published in An Pediatr (Barc). 2009;71:400-6—, and 23 cases in 2008–2015. In post-protocol period, there were 13 patients aged between 3–10 months (62% males) with transient bulging fontanelle, and 10 aged between 2 and 14 years (50% males), with papilloedema. A total of 54% of infants had recently finished corticosteroid treatment for bronchitis. In the older children, there was one case associated with venous thrombosis caused by otomastoiditis, one case on corticosteroid treatment for angioma, and another case treated with growth hormone. Transfontanelle ultrasound was performed on all infants, and CT, MRI and angio-MRI was performed on every child. Lumbar puncture was performed on 2 infants in whom meningitis was suspected, and in all children. All patients progressed favourably, with treatment being started in 3 of them. One patient relapsed. Discussion Characteristics and outcomes of patients overlap every year. IIH usually has a favourable outcome, although it may be longer in children than in infants. It can cause serious visual disturbances, so close ophthalmological control is necessary. The protocol is useful to ease diagnostic decisions, monitoring, and treatment.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.09.009
  • Cord blood procalcitonin in the assessment of early-onset neonatal sepsis
    • Authors: Olivia Oria de Rueda Salguero; José Beceiro Mosquera; Marta Barrionuevo González; María Jesús Ripalda Crespo; Cristina Olivas López de Soria
      Pages: 87 - 94
      Abstract: Publication date: August 2017
      Source:Anales de Pediatría (English Edition), Volume 87, Issue 2
      Author(s): Olivia Oria de Rueda Salguero, José Beceiro Mosquera, Marta Barrionuevo González, María Jesús Ripalda Crespo, Cristina Olivas López de Soria
      Introduction Early diagnosis of early-onset neonatal sepsis (EONS) is essential to reduce morbidity and mortality. Procalcitonin (PCT) in cord blood could provide a diagnosis of infected patients from birth. Objective To study the usefulness and safety of a procedure for the evaluation of newborns at risk of EONS, based on the determination of PCT in cord blood. Patients and methods Neonates with infectious risk factors, born in our hospital from October 2013 to January 2015 were included. They were processed according to an algorithm based on the values of cord blood procalcitonin (<0.6ng/mL versus ≥0.6ng/mL). They were later classified as proved infection, probable, or no infection. Results and conclusions Of the 2.519 infants born in the study period, 136 met inclusion criteria. None of 120 cases with PCT <0.6ng/mL in cord blood developed EONS (100% negative predictive value). On the other hand, of the 16 cases with PCT ≥0.6ng/mL, 10 were proven or probably infected (62.5% positive predictive value). The sensitivity of the PCT against infection was 100%, with a specificity of 95.2% (area under the receiver operator curve 0.969). The incidence of infection in the study group was 7.4%, and 26.1% in cases with maternal chorioamnionitis. 21 newborn (15.4%) received antibiotic therapy. The studied protocol has shown to be effective and safe to differentiate between patients with increased risk of developing an EONS, in those where the diagnostic and therapeutic approach was more interventionist, versus those with less likelihood of sepsis, who would benefit from a more conservative management.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.09.008
  • Urinary iodine levels and dairy consumption in pre-school children in
           Southwest Asturias (Spain)
    • Authors: Esther Arbesú Fernández; María Haydee Serrano Peraza; Hans Abdón Eguia Angeles; César Oliver Sotelo García; Claude Henrry Saint Jean; Nache Ismael Musa Martín
      Pages: 18 - 25
      Abstract: Publication date: July 2017
      Source:Anales de Pediatría (English Edition), Volume 87, Issue 1
      Author(s): Esther Arbesú Fernández, María Haydee Serrano Peraza, Hans Abdón Eguia Angeles, César Oliver Sotelo García, Claude Henrry Saint Jean, Nache Ismael Musa Martín
      Introduction For decades dairy products have been a major source of iodine. The purpose of this study was to determine the iodine nutritional status and its relationship with dairy consumption in pre-schooler children between 2 and 5 years old in a rural area with 27847 inhabitants. Patients and methods It was planned to study 200 participants, selected by random sampling, proportional to the size of the municipality, age, and sex. Parents provided urine samples to analyse urinary iodine, as well as the nutritional information through an interview. A glass of milk or a slice of cheese was considered as a ration, and a portion of other milk derivatives were considered as half rations. The nutritional status of iodine was interpreted with the median (P[percentile]50) of the urinary iodine levels, and iodine intake was estimated using the mean of ration/day of milk and dairy products, fish, and eggs. Results Of the total of 198 subjects that took part, 193 provided urine specimens for the determination of iodine levels. The mean dairy ration/day was 3.8 (SD:1.4). More than two-thirds (69.9%) drank ≥2 glasses of milk/day, and 88.1% consumed a dairy ration of another dairy product. The median urinary iodine level was 184μg/L, but was dependent on glasses of milk/day (282.5μg/L ≥ 4 glasses) and/or the type of milk (233.0μg/L in semi-skimmed). An intake of 117.4μg/day to 178.6μg/day of iodine was estimated, and that milk was the food which provided more iodine (89.9μg/day). Conclusions Iodine intake was adequate, although higher than necessary when four or more glasses of milk were consumed, and/or when the milk was skimmed. The consumption of dairy products should be monitored to prevent both excessive and deficient intake of iodine.

      PubDate: 2017-06-27T02:08:21Z
      DOI: 10.1016/j.anpede.2016.03.009
  • Five steps to decreasing nosocomial infections in very preterm newborns: A
           quasi-experimental study
    • Authors: Ana García González; José Luis Leante Castellanos; Carmen Fuentes Gutiérrez; José María Lloreda García; José Ramón Fernández Fructuoso; Elisabet Gómez Santos; Verónica García González
      Pages: 26 - 33
      Abstract: Publication date: July 2017
      Source:Anales de Pediatría (English Edition), Volume 87, Issue 1
      Author(s): Ana García González, José Luis Leante Castellanos, Carmen Fuentes Gutiérrez, José María Lloreda García, José Ramón Fernández Fructuoso, Elisabet Gómez Santos, Verónica García González
      Objectives An evaluation is made of the impact of a series of five interventions on the incidence of hospital-related infections in a level iii neonatal unit. Material and methods Quasi-experimental, pre-post intervention study, which included preterm infants weighing 1500g at birth or delivered at <32 weeks gestation, admitted in the 12 months before and after the measures were implemented (January 2014). The measures consisted of: optimising hand washing, following a protocol for insertion and handling of central intravenous catheters, encouraging breastfeeding; applying a protocol for rational antibiotic use, and establishing a surveillance system for multi-resistant bacteria. The primary endpoint was to assess the incidence of hospital-acquired infections before and after implementing the interventions. Results Thirty-three matched patients were included in each period. There was an incidence of 8.7 and 2.7 hospital-related infections/1000 hospital stay days in the pre- and post-intervention periods, respectively (P <.05). Additionally, patients in the treatment group showed a statistically-significant decrease in days on mechanical ventilation, use of blood products, and vasoactive drugs. Conclusions The strategy, based on implementing five specific measures in a unit with a high rate of hospital-related infections, proved effective in reducing their incidence. This reduction could contribute to lowering the use of mechanical ventilation, blood products, and vasoactive drugs.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.06.009
  • Aetiology and outcomes of potentially serious infections in febrile
           infants less than 3 months old
    • Authors: Mercedes de la Torre; Nieves de Lucas; Roberto Velasco; Borja Gómez; Santiago Mintegi
      Pages: 42 - 49
      Abstract: Publication date: July 2017
      Source:Anales de Pediatría (English Edition), Volume 87, Issue 1
      Author(s): Mercedes de la Torre, Nieves de Lucas, Roberto Velasco, Borja Gómez, Santiago Mintegi
      Background Recent studies have shown changes in the aetiology of serious bacterial infections in febrile infants ≤90 days of age. The aim of this study was to describe the current microbiology and outcomes of these infections in Spain. Material and methods Sub-analysis of a prospective multicentre study focusing on febrile infants of less than 91 days of life, admitted between October 2011 and September 2013 to Emergency Departments of 19 Spanish hospitals, members of the Spanish Paediatric Emergency Research Group of the Spanish Society of Paediatric Emergencies (RISeuP/SPERG). Results The analysis included 3401 febrile infants ≤90 days of age with fever without source. There were 896 positive cultures: 766 urine (85.5%), 100 blood (11.2%), 18 cerebrospinal fluid (2%), 10 stool, and 2 umbilical cultures. Among the 3401 infants included, 784 (23%) were diagnosed with a serious bacterial infection, and 107 of them (3.1%) with an invasive infection. E. coli was the most common pathogen isolated from urine (628; 82%), blood (46; 46%), and cerebrospinal fluid cultures (7; 38.9%), followed by S. agalactiae that was isolated from 24 (24%) blood cultures and 3 (16.7%) cerebrospinal fluid cultures. There were only 2 L. monocytogenes infections. Four children died, and seven had severe complications. Conclusions Among infants ≤90 days of age with fever without source, E. coli was the most common pathogen isolated from urine, blood, and cerebrospinal fluid cultures.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.07.004
  • Spanish funded paediatric research: Contribution of Anales de
           Pediatría to its dissemination
    • Authors: María Francisca Abad-García; Aurora González-Teruel; Gonzalo Solís Sánchez
      Pages: 306 - 313
      Abstract: Publication date: June 2017
      Source:Anales de Pediatría (English Edition), Volume 86, Issue 6
      Author(s): María Francisca Abad-García, Aurora González-Teruel, Gonzalo Solís Sánchez
      Objective To identify Spanish funded paediatric research published in general paediatric journals included in the Web of Science (WoS) from 2010 to 2014 and those published in Anales de Pediatría. To examine the relationship between funding and the prestige of the journals. To describe the journal conditions to meet the open access criteria. Material and method Spanish funded paediatric articles (FA) were identified by using the WoS Funding Agency field, and by reviewing the original documents for Anales de Pediatria (AP). For the FA published in AP the number and kind of funding agencies were identified. The possible differences in citations between FA and non-funded was assessed for articles published in this journal using the Kruskal–Wallis non-parametric test. For general journals, the patterns of distribution of FA and non-FA were investigated according to the quartile of the journal. The journal's self-archiving conditions were described using Sherpa/romeo database. Results Funding was received for 27.5%, being 16.6% for those published in AP. In these, 105 funding agencies were identified, with 80% being national. The FA published in AP did not receive significantly more citations. In general journals, the presence of FA is greater in Q1 and Q2 journals. More than half (56%) of the articles were published in subscription journals. All journals that publish FA allow self-archiving in repositories, but with embargos of at least 12 months. Conclusions The role of AP in the dissemination of FA is still limited. Embargos in self-archiving permits compliance of Spanish open access mandate, but may hinder compliance in Europe.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.04.009
  • Vaccination counselling: The meeting point is possible
    • Authors: Roi Piñeiro Pérez; Diego Hernández Martín; Miguel Ángel Carro Rodríguez; María de la Parte Cancho; Esther Casado Verrier; Sonsoles Galán Arévalo; Iván Carabaño Aguado
      Pages: 314 - 320
      Abstract: Publication date: June 2017
      Source:Anales de Pediatría (English Edition), Volume 86, Issue 6
      Author(s): Roi Piñeiro Pérez, Diego Hernández Martín, Miguel Ángel Carro Rodríguez, María de la Parte Cancho, Esther Casado Verrier, Sonsoles Galán Arévalo, Iván Carabaño Aguado
      Introduction There are recommendations for decision-making as regards parents who do not vaccinate their children, but there are few publications analysing this problem. In November 2014, a pioneer medical clinic opened in Spain, for counselling on immunisation practices. The aim of this study is to determine the success of the recommendations of the American and Spanish Paediatrics Associations according to the number of parents who finally accept vaccination. Patients and methods A descriptive, cross-sectional, prospective and single-centre study was conducted from November 2014 to March 2016. Children under the age of 16 not properly vaccinated, according to the immunisation schedule of the region where the study was conducted, were included after signing informed consent. Results A total of 20 families were counselled. The median age of the children was 2 years, and 80% of them received no vaccine. Absolute non-acceptance of vaccination was practiced by 45% of parents. The main reasons for not vaccinating were: 100% thimerosal-containing, 90% risk of autism, 85% aluminium-containing, 70% presence of other stabilisers and preservatives, and 65% risk of anaphylaxis. The immunisation advice was said to be helpful by 90% of parents. Vaccination was accepted by 90% of parents (45% completely). Conclusions Anti-vaccination ideologies are strong and hard to change. Paediatricians not denying medical care to parents who endanger the lives of their own children are also hard to find. The meeting point is possible, and society needs it. Active listening, empathy, and good quality information were the keys to our results.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.06.006
  • Epidemiology and risk factors in injuries due to fall in infants under one
    • Authors: Ana Jiménez de Domingo; Elena Rubio García; Rafael Marañon Pardillo; Vanessa Arias Constanti; Luis Alberto Frontado Haiek; Marta Soriano Arola; Francesc Ripoll Oliveras; Cristina Remón García; Gloria Estopiña Ferrer; Jorge Lorente Romero
      Pages: 337 - 343
      Abstract: Publication date: June 2017
      Source:Anales de Pediatría (English Edition), Volume 86, Issue 6
      Author(s): Ana Jiménez de Domingo, Elena Rubio García, Rafael Marañon Pardillo, Vanessa Arias Constanti, Luis Alberto Frontado Haiek, Marta Soriano Arola, Francesc Ripoll Oliveras, Cristina Remón García, Gloria Estopiña Ferrer, Jorge Lorente Romero
      Objectives To describe the epidemiological characteristics of unintentional injuries due to falls in children under one year and to analyse the risk factors associated with severe injuries. Patients and methods This multicentre, observational and cross-sectional study included all children less than one year treated for unintentional fall in the Emergency Departments of 8 Spanish Hospitals, belonging to the “Unintentional Paediatric Injury Workshop” of the Spanish Paediatric Emergency Society, between March 1st, 2014 and February 28th, 2015. Results Out of 289,887 emergency department cases, 1022 were due to unintentional falls. The median age was 8 months and 52.5% were males. Fall injuries were more frequent among children aged 9–12 months (37.6%), and 83.5% occurred at home. The most common mechanism was fall from nursery equipment (69.4%), and 47.8% occurred from a height under 50cm. More than two-thirds (68%) of falls were witnessed, but in half of the cases (329) the caregiver was not in area. Serious injuries were seen in 12% of cases. In this study, a fall height greater than 50cm, falls in the street, from the arms of the carer, and from the stairs were identified as independent risk factors for worse outcomes. Conclusions The most serious injuries occur in children <3 months and from a height of >50cm, though not related to unwitnessed falls. Because the most common serious injury mechanism is the fall from the arms of the carer, from stairs and falls in the street, these facts should be highlighted in order to avoid morbidity.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2015.12.007
  • Spanish patients with central hypoventilation syndrome included in the
           European Registry. The 2015 data
    • Authors: María Angeles García Teresa; Raquel Porto Abal; Silvia Rodríguez Torres; Diego García Urabayen; Silvia García Martínez; Ha Trang; Angel Campos Barros
      Pages: 255 - 263
      Abstract: Publication date: May 2017
      Source:Anales de Pediatría (English Edition), Volume 86, Issue 5
      Author(s): María Angeles García Teresa, Raquel Porto Abal, Silvia Rodríguez Torres, Diego García Urabayen, Silvia García Martínez, Ha Trang, Angel Campos Barros
      Introduction Congenital central hypoventilation syndrome (CCHS) is a very rare genetic disease. In 2012 the European Central Hypoventilation Syndrome (EuCHS) Consortium created an online patient registry in order to improve care. Aim To determine the characteristics and outcomes of Spanish patients with CCHS, and detect clinical areas for improvement. Materials and method An assessment was made on the data from Spanish patients in the European Registry, updated on December 2015. Results The Registry contained 38 patients, born between 1987 and 2013, in 18 hospitals. Thirteen (34.2%) were older than 18 years. Three patients had died. Genetic analysis identified PHOX2B mutations in 32 (86.5%) out of 37 patients assessed. The 20/25, 20/26 and 20/27 polyalanine repeat mutations (PARMs) represented 84.3% of all mutations. Longer PARMs had more, as well as more severe, autonomic dysfunctions. Eye diseases were present in 47%, with 16% having Hirschsprung disease, 13% with hypoglycaemia, and 5% with tumours. Thirty patients (79%) required ventilation from the neonatal period onwards, and 8 (21%) later on in life (late onset/presentation). Eight children (21%) were using mask ventilation at the first home discharge. Five of them were infants with neonatal onset, two of them, both having a severe mutation, were switched to tracheostomy after cardiorespiratory arrest at home. Approximately one-third (34.3%) of patients were de-cannulated and switched to mask ventilation at a mean age of 13.7 years. Educational reinforcement was required in 29.4% of children attending school. Conclusion The implementation of the EuCHS Registry in Spain has identified some relevant issues for optimising healthcare, such as the importance of genetic study for diagnosis and assessment of severity, the high frequency of eye disease and educational reinforcement, as well as some limitations in ventilatory techniques.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.05.006
  • Real-time safety audits in a neonatal unit
    • Authors: Elena Bergon-Sendin; María del Carmen Perez-Grande; David Lora-Pablos; Ana Melgar-Bonis; Noelia Ureta-Velasco; María Teresa Moral-Pumarega; Carmen Rosa Pallas-Alonso
      Abstract: Publication date: Available online 17 August 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Elena Bergon-Sendin, María del Carmen Perez-Grande, David Lora-Pablos, Ana Melgar-Bonis, Noelia Ureta-Velasco, María Teresa Moral-Pumarega, Carmen Rosa Pallas-Alonso
      Background Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations. Material and methods Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure. Results A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P =.001). Significant differences were found with improved usage during weekends vs. working-day (73.97 vs. 58.74%, P =.01), and the rest of the year vs. 3rd quarter (66.06 vs. 52%, P =.02). Conclusions Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits.

      PubDate: 2017-08-20T19:45:40Z
      DOI: 10.1016/j.anpede.2016.08.010
  • Drugs use in pregnancy in the Valencia Region and the risk of congenital
    • Authors: Clara Cavero-Carbonell; Silvia Gimeno-Martos; Lucía Páramo-Rodríguez; María José Rabanaque-Hernández; Carmen Martos-Jiménez; Óscar Zurriaga
      Abstract: Publication date: Available online 12 August 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Clara Cavero-Carbonell, Silvia Gimeno-Martos, Lucía Páramo-Rodríguez, María José Rabanaque-Hernández, Carmen Martos-Jiménez, Óscar Zurriaga
      Background Despite the potential risks of drug use during pregnancy, consumption has increased in recent decades. Objective To identify the risk of congenital anomalies (CA) associated with the use of drugs in primary care in pregnant women resident in the Valencia Region. Methods A case-control study, considering a case as a less than one year old live birth in 2009–2010, diagnosed with a CA and resident in the Valencia Region, obtained from the CA population-based registry. Controls were selected from the Metabolic Disease Registry, and the drugs prescribed and dispensed from the Integral Management of Pharmaceutical Services. Crude odds ratio (OR) was calculated with its 95% confidence intervals and adjusted OR was calculated using logistic regression. Results A total of 1.913 cases and 3.826 controls were identified. The most frequently used drug groups were those acting on the musculoskeletal, nervous and respiratory systems, on the blood and blood forming organs, and anti-infection drugs. The most common drugs used were ibuprofen, dexketoprofen, paracetamol, amoxicillin, ferrous sulphate, and a combination of folic acid. A significantly increased risk of CA was identified for drugs acting on the musculoskeletal system (adjusted OR 1.14 [95% confidence interval 1.02–1.28]). A significantly decreased risk was observed for drugs acting on the blood and blood forming organs (adjusted OR 0.87 [95% confidence interval 0.78–0.98]). Conclusions Associations between drugs and CA in pregnant women resident in the Valencia Region have been identified for drugs that act as risk factors of CA, and for drugs that act as protective factors of CA.

      PubDate: 2017-08-20T19:45:40Z
      DOI: 10.1016/j.anpede.2016.08.011
  • Early kidney damage in patients born with unilateral renal agenesis
    • Authors: Ana Castellano-Martinez; Moises Rodriguez-Gonzalez; Virginia Roldan-Cano
      Abstract: Publication date: Available online 12 August 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Ana Castellano-Martinez, Moises Rodriguez-Gonzalez, Virginia Roldan-Cano

      PubDate: 2017-08-20T19:45:40Z
      DOI: 10.1016/j.anpede.2016.10.014
  • Views of the Spanish Paediatric Association Bioethics Committee on the
           refusal of essential and non-essential treatment in minors
    • Authors: Marta Sánchez Jacob; María Tasso Cereceda; Carmen Martínez González; Federico de Montalvo Jááskeläinem; Isolina Riaño Galán
      Abstract: Publication date: Available online 6 August 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Marta Sánchez Jacob, María Tasso Cereceda, Carmen Martínez González, Federico de Montalvo Jááskeläinem, Isolina Riaño Galán
      The conflicts that arise when minors or their legal representatives refuse to receive medical treatment considered necessary by the paediatrician pose a serious ethical dilemma and also have a considerable emotional impact. In order to adequately tackle this rejection of medical treatment, there is to identify and attempt to understand the arguments of the people involved, to consider the context in each individual case and be conversant with the procedure to follow in life-threatening scenarios, taking into account bioethical considerations and the legal framework.

      PubDate: 2017-08-10T19:12:42Z
      DOI: 10.1016/j.anpede.2016.11.006
  • Genetic predisposition to childhood cancer
    • Authors: Pilar Carrasco Salas; Pablo Lapunzina; Antonio Pérez-Martínez
      Abstract: Publication date: Available online 2 August 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Pilar Carrasco Salas, Pablo Lapunzina, Antonio Pérez-Martínez

      PubDate: 2017-08-10T19:12:42Z
      DOI: 10.1016/j.anpede.2017.01.003
  • Acute gastroenteritis and enteric viruses: Impact on the detection of
    • Authors: Oihana Martínez Azcona; Lorena Vázquez Gómez; Paula Buyo Sánchez; Raquel Díaz Soto; Luz María Moldes Suárez
      Abstract: Publication date: Available online 31 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Oihana Martínez Azcona, Lorena Vázquez Gómez, Paula Buyo Sánchez, Raquel Díaz Soto, Luz María Moldes Suárez
      Introduction Norovirus is the second cause of acute viral gastroenteritis in infants after rotavirus. However, its prevalence is underestimated because a specific diagnosis is not usually performed. The comparative study of microbiological diagnostics, performed before and after the implementation date of a test for detecting a particular microorganism, allows the estimation of the percentage of cases not properly diagnosed earlier (for non-implementation of the test) and those that would be left to diagnose if the test is removed. In this paper we study the epidemiology of acute gastroenteritis virus before and after the implantation of the Norovirus GI+GII CerTest. Material and methods An observational retrospective cohort study was conducted on patients under 15 years old with acute gastroenteritis, from January 2013 to April 2015. The sample was divided into two groups. In the first group, the search was limited to adenovirus and rotavirus, and in the second one, the determination of norovirus became part of the systematic diagnosis. The study included 604 patients, 313 in the first group and 291 in the second one. Results Demographic characteristics were similar in both groups. In the first group, 58/313 (18.5%) enteric viruses were identified and in the second group, 97/291 (33.3%). In the second group, 31 positive cases for norovirus were identified, but only 12 (4.1%) of them were positive exclusively for this virus. No significant differences were found in clinical features of intestinal viruses. Conclusions An actual increase of 4.1% was observed in the cases with an identified aetiological agent after implementing the Norovirus GI+GII CerTest diagnostic technique. The most common cause of acute gastroenteritis is rotavirus, closely followed by norovirus.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.08.009
  • Acute bacterial gastroenteritis: 729 cases recruited by a Primary Care
           national network
    • Authors: César García Vera; María García Ventura; Guadalupe del Castillo Aguas; Begoña Domínguez Aurrecoechea; María Jesús Esparza Olcina; Ana Martínez Rubio; José María Mengual Gil
      Abstract: Publication date: Available online 31 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): César García Vera, María García Ventura, Guadalupe del Castillo Aguas, Begoña Domínguez Aurrecoechea, María Jesús Esparza Olcina, Ana Martínez Rubio, José María Mengual Gil
      Objective To determine the main clinical and epidemiological features of bacterial gastroenteritis in our environment. Patients and methods An observational study of a Spanish population in 17 Autonomous Communities. Questionnaires of children with a stool positive culture to bacteria were collected over a one year period. A bivariate analysis was performed on the variables involved, as well as two multivariate models (for antibiotic treatment variables, and comparison Campylobacter/Salmonella). Results A total of 729 bacterial gastroenteritis episodes were recorded in the 17 Spanish autonomous regions, of which 41.2% were girls and 58.8% boys. The median age was 3.41 years old (interquartile range 1.55–6.72). The bacteria isolated were 59.9% Campylobacter, 31.8% non-Typhi Salmonella, 2.7% Aeromonas, 2.4% Yersinia, and 1.5% had more than one strain. Most infections (70%) were direct contacts, and food poisoning was less probable (25.9%). Salmonella is significantly less frequent than Campylobacter in children under the age of 3 years (adjusted OR 0.61; 95% CI: 0.43–0.86; P =.005), and Campylobacter is more frequent in rural areas (adjusted OR 1.48; 95% CI: 1.07–2.07; P =.012). Antibiotic was prescribed in 33.2% of cases. There was a greater significant difference if stools contained blood or mucus (adjusted OR 1.53; 95% CI: 1.04–2.27; P =.031), if the symptoms lasted more than 7days (adjusted OR 2.81; 95% CI: 2.01–3.93; P <.000), or if the child was admitted to hospital (adjusted OR 1.95; 95% CI: 1.08–3.52; P =.027). Conclusions The aetiology of bacterial diarrhoea in paediatrics is typical of that of a developed country. The transmission mechanism is mainly direct, and more cases than appropriate are treated with antibiotics.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.04.011
  • Early clinical trials in paediatric oncology in Spain: A nationwide
    • Authors: Francisco Bautista; Soledad Gallego; Adela Cañete; Jaume Mora; Cristina Díaz de Heredia; Ofelia Cruz; José María Fernández; Susana Rives; Pablo Berlanga; Raquel Hladun; Antonio Juan Ribelles; Luis Madero; Manuel Ramírez; Rafael Fernández Delgado; Antonio Pérez-Martínez; Cristina Mata; Anna Llort; Javier Martín Broto; María Elena Cela; Gema Ramírez; Constantino Sábado; Tomás Acha; Itziar Astigarraga; Ana Sastre; Ascensión Muñoz; Mercedes Guibelalde; Lucas Moreno
      Abstract: Publication date: Available online 31 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Francisco Bautista, Soledad Gallego, Adela Cañete, Jaume Mora, Cristina Díaz de Heredia, Ofelia Cruz, José María Fernández, Susana Rives, Pablo Berlanga, Raquel Hladun, Antonio Juan Ribelles, Luis Madero, Manuel Ramírez, Rafael Fernández Delgado, Antonio Pérez-Martínez, Cristina Mata, Anna Llort, Javier Martín Broto, María Elena Cela, Gema Ramírez, Constantino Sábado, Tomás Acha, Itziar Astigarraga, Ana Sastre, Ascensión Muñoz, Mercedes Guibelalde, Lucas Moreno
      Introduction Cancer is the leading cause of death between the first year of life and adolescence, and some types of diseases are still a major challenge in terms of cure. There is, therefore, a major need for new drugs. Recent findings in cancer biology open the door to the development of targeted therapies against individual molecular changes, as well as immunotherapy. Promising results in adult anti-cancer drug development have not yet been translated into paediatric clinical practice. A report is presented on the activity in early paediatric oncology trials (phase I–II) in Spain. Material and methods All members of the Spanish Society of Paediatric Haematology Oncology (SEHOP) were contacted in order to identify early clinical trials in paediatric cancer opened between 2005 and 2015. Results A total of 30 trials had been opened in this period: 21 (70%) in solid tumours, and 9 (30%) in malignant haemopathies. A total of 212 patients have been enrolled. The majority was industry sponsored (53%). Since 2010, four centres have joined the international consortium of Innovative Therapies for Children with Cancer (ITCC), which has as its aim to develop novel therapies for paediatric tumours. A significant number of new studies have opened since 2010, improving the treatment opportunities for our children. Results of recently closed trials show the contribution of Spanish investigators, the introduction of molecularly targeted agents, and their benefits. Conclusions The activity in clinical trials has increased in the years analysed. The SEHOP is committed to develop and participate in collaborative academic trials, in order to help in the advancement and optimisation of existing therapies in paediatric cancer.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.07.007
  • Experience with junctional atrioventricular reciprocating tachycardia
    • Authors: Lidia Cardiel Valiente; Ariadna Ayerza Casas; Marta López Ramón; Lorenzo Jiménez Montañes; Georgia Sarquella-Brugada
      Abstract: Publication date: Available online 25 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Lidia Cardiel Valiente, Ariadna Ayerza Casas, Marta López Ramón, Lorenzo Jiménez Montañes, Georgia Sarquella-Brugada

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.12.003
  • Clinical observation: A safe alternative to radiology in infants with mild
           traumatic brain injury
    • Authors: David Muñoz-Santanach; Victoria Trenchs Sainz de la Maza; Sara Maya Gallego; Adriana Cuaresma González; Carles Luaces Cubells
      Abstract: Publication date: Available online 24 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): David Muñoz-Santanach, Victoria Trenchs Sainz de la Maza, Sara Maya Gallego, Adriana Cuaresma González, Carles Luaces Cubells
      Objective The protocol for the management of mild cranioencephalic trauma in the emergency department was changed in July 2013. The principal innovation was the replacement of systematic skull X-ray in infants with clinical observation. The aims of this study were to determine whether there was (1) a reduction in the ability to detect traumatic brain injury (TBI) in the initial visit to Emergency, and (2) a change in the number of requests for imaging tests and hospital admissions. Methodology This was a retrospective, descriptive, observational study. Two periods were established for the study: Period 1 (1/11/2011–30/10/2012), prior to the implementing of the new protocol, and Period 2 (1/11/2013–30/10/2014), following its implementation. The study included visits to the emergency department by children ≤2 years old for mild cranioencephalic trauma (Glasgow Scale modified for infants ≥14) of ≤24h onset. Results A total of 1,543 cases were included, of which 807 were from Period 1 and 736 from Period 2. No significant differences were observed as regards sex, age, mechanism, or risk of TBI. More cranial fractures were detected in Period 1 than in Period 2 (4.3% vs 0.5%; P <.001), without significant changes in the detection of TBI (0.4% vs 0.3%; P =1). However, there were more cranial X-rays (49.7% vs 2.7%; P <.001) and more ultrasounds (2.1% vs 0.4%; P <.001) carried out, and also fewer hospital admissions (8.3% vs 3.1%; P <.001). There were no significant differences in the number of computerised tomography scans carried out (2% vs 3%; P =.203). Conclusions The use of clinical observation as an alternative to cranial radiography leads to a reduction in the number of imaging tests and hospital admissions of infants with mild cranioencephalic trauma, without any reduction in the reliability of detecting TBI. This option helps to lower the exposure to radiation by the patient, and is also a more rational use of hospital resources.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2016.09.010
  • Short-term relevance of lower respiratory viral coinfection in inpatients
           under 2 years of age
    • Authors: Joana Gil; Sofia Almeida; Carolina Constant; Sara Pinto; Rosário Barreto; José Melo Cristino; Maria do Céu Machado; Teresa Bandeira
      Abstract: Publication date: Available online 16 June 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Joana Gil, Sofia Almeida, Carolina Constant, Sara Pinto, Rosário Barreto, José Melo Cristino, Maria do Céu Machado, Teresa Bandeira
      Introduction Advances in molecular diagnosis have made it possible to detect previously unknown viral agents as causative agents of lower respiratory tract infections (LRTI). The frequency and relevance of viral coinfections is still debatable. Objective Compare clinical presentation and severity between single virus infection and viral coinfection in children admitted for LRTI. Methods A 3-year period observational study (2012–2015) included children younger than two years admitted for LRTI. Viral identification was performed using PCR technique for 16 viruses. Clinical data and use of health resources was gathered during hospital stay using a standard collection form and we compared single virus infection and viral coinfections. Results The study included 524 samples (451 patients); 448 (85.5%) had at least one virus identified. Viral coinfections were found in 159 (35.5%). RSV and HRV were the most commonly identified virus; bronchiolitis and pneumonia the most frequent diagnosis. Patients with viral coinfections were older, attended day-care centers, had previous recurrent wheezing more frequently and were more symptomatic at admission. These patients did not have more complementary exams performed but were prescribed medications more often. Viral coinfection group did not show longer length of hospital stay and oxygen need, more need for ICU nor ventilatory support. Discussion Our study showed a significant proportion of viral coinfections in young infants admitted with LRTI and confirmed previous data showing that prescription was more frequent in inpatients with viral coinfections, without an association with worst clinical outcome.

      PubDate: 2017-08-01T10:30:50Z
      DOI: 10.1016/j.anpede.2017.03.006
  • Two siblings with acute lymphoblastic leukaemia: Chance or genetics'
    • Authors: Elena Carceller; David Ruano; Luis Madero López; Álvaro Lassaletta
      Abstract: Publication date: Available online 21 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Elena Carceller, David Ruano, Luis Madero López, Álvaro Lassaletta

      PubDate: 2017-07-24T08:28:08Z
      DOI: 10.1016/j.anpede.2017.03.007
  • Vitamin D deficiency and morbimortality in critically ill paediatric
    • Authors: Patricia García-Soler; Antonio Morales-Martínez; Vanessa Rosa-Camacho; Juan Antonio Lillo-Muñoz; Guillermo Milano-Manso
      Abstract: Publication date: Available online 14 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Patricia García-Soler, Antonio Morales-Martínez, Vanessa Rosa-Camacho, Juan Antonio Lillo-Muñoz, Guillermo Milano-Manso
      Objectives To determine the prevalence and risks factors of vitamin D deficiency, as well as its relationship with morbidity and mortality in a PICU. Materials and methods An observational prospective study in a tertiary children's University Hospital PICU conducted in two phases: I: Cohorts study, and II: prevalence study. The study included 340 critically ill children with ages comprising 6 months to 16 years old. Exclusion criteria: Chronic kidney disease, known parathyroid disorders, and vitamin D supplementation. Total 25-hydroxyvitamin D [25(OH)D] was measured in the first 48h of admission to a PICU. Parathormone, calcium, phosphate, blood gases, blood count, C-reactive protein, and procalcitonin were also analysed. A record was also made of demographic features, characteristics of the episode, and complications during the PICU stay. Results The overall prevalence rate of vitamin D deficiency was 43.8%, with a mean of 22.28 (95% CI 21.15–23.41)ng/mL. Patients with vitamin D deficiency were older (61 vs 47 months, P =0.039), had parents with a higher level of academic studies (36.5% vs 20%, P =0.016), were admitted more often in winter and spring, had a higher PRISM-III (6.8 vs 5.1, P =0.037), a longer PICU stay (3 vs 2 days, P =0.001), and higher morbidity (61.1% vs 30.4%, P <0.001) than the patients with sufficient levels of 25(OH)D. Patients who died had lower levels of 25(OH)D (14±8.81ng/mL vs 22.53±10.53ng/mL, P =0.012). Adjusted OR for morbidity was 5.44 (95% CI; 2.5–11.6). Conclusions Vitamin D deficiency is frequent in critically ill children, and it is related to both morbidity and mortality, although it remains unclear whether it is a causal relationship or it is simply a marker of severity in different clinical situations.

      PubDate: 2017-07-15T07:37:18Z
      DOI: 10.1016/j.anpede.2016.09.007
  • Neuropsychological performance in neurofibromatosis type 1
    • Authors: Lilia Hernández del Castillo; Antonio Martínez Bermejo; José Antonio Portellano Pérez; Pilar Tirado Requero; Alexandra Garriz Luis; Ramón Velázquez Fragua
      Abstract: Publication date: Available online 12 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Lilia Hernández del Castillo, Antonio Martínez Bermejo, José Antonio Portellano Pérez, Pilar Tirado Requero, Alexandra Garriz Luis, Ramón Velázquez Fragua
      Introduction Neurofibromatosis type 1 (NF1) is a genetic disorder with various clinical manifestations that affect the peripheral and central nervous system, as well as the skin, bones and endocrine and vascular system. There is still insufficient knowledge of neuropsychological effects of NF1 on children, and there is some controversy about the cognitive deficits that defines the cognitive profile of patients affected by this disorder. Aims In this study an analysis is made of the neuropsychological performance of a group of patients affected by NF1, compared with a control group of healthy children. Subjects and method A comparison was made between the neuropsychological performance of a group of 23 boys and girls with a mean age of 8.7 years (+/−1.39) and diagnosed with NF1, and a control group consisting of 21 healthy children, with mean age of 8.9 years (+/−1.41) and with similar socio-demographic characteristics. The Wechsler Intelligence Scale for Children (WISC) was applied to evaluate the subjects of both groups. Results The group of patients affected with NF1 showed a lower performance in every primary index of WISC IV: Verbal Comprehension Index, Fluid Reasoning Index, Working Memory Index, Processing Speed Index, and full scale IQ. Only in two subscales were no statistically significant differences observed: similarities and coding. Conclusion The results show subtle and generalised neuropsychological alterations in the sample of children affected with NF1, which affect most of cognitive domains that have been evaluated. Proper specific and early neuropsychological treatment should be provided in order to prevent the high risk for these children of presenting learning difficulties and school failure.

      PubDate: 2017-07-15T07:37:18Z
      DOI: 10.1016/j.anpede.2016.07.006
  • Recommendations for the diagnosis and treatment of classic forms of
           21-hydroxylase-deficient congenital adrenal hyperplasia
    • Authors: Amparo Rodríguez; Begoña Ezquieta; José Igancio Labarta; María Clemente; Rafael Espino; Amaia Rodriguez; Aranzazu Escribano
      Abstract: Publication date: Available online 11 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Amparo Rodríguez, Begoña Ezquieta, José Igancio Labarta, María Clemente, Rafael Espino, Amaia Rodriguez, Aranzazu Escribano
      Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is an autosomal recessive disorder caused by mutations in the CYP21A2 gene. Cortisol and aldosterone synthesis are impaired in the classic forms (adrenal insufficiency and salt-wasting crisis). Females affected are virilised at birth, and are at risk for genital ambiguity. In this article, we give recommendations for an early as possible diagnosis and an appropriate and individualised treatment. A patient and family genetic study is essential for the diagnosis of the patient, and allows genetic counselling, as well as a prenatal diagnosis and treatment for future pregnancy.

      PubDate: 2017-07-15T07:37:18Z
      DOI: 10.1016/j.anpede.2016.12.002
  • Clinical impact of translocation t(7;15) (p22;q26) on several family
    • Authors: Victoria Caballero Pérez; Francisco Javier López-Pisón; María Dolores Miramar Gallart; Alejandro González Álvarez; María Concepción García Jiménez
      Abstract: Publication date: Available online 8 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Victoria Caballero Pérez, Francisco Javier López-Pisón, María Dolores Miramar Gallart, Alejandro González Álvarez, María Concepción García Jiménez

      PubDate: 2017-07-15T07:37:18Z
      DOI: 10.1016/j.anpede.2016.11.005
  • Respiratory viral infections in a cohort of children during the first year
           of life and their role in the development of wheezing
    • Authors: Cristina Calvo; Isabel Aguado; María Luz García-García; Esther Ruiz-Chercoles; Eloisa Díaz-Martinez; Rosa María Albañil; Olga Campelo; Antonio Olivas; Luisa Muñóz-Gonzalez; Francisco Pozo; Rosa Fernandez-Arroyo; Adelaida Fernandez-Rincón; Ana Calderon; Inmaculada Casas
      Abstract: Publication date: Available online 6 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Cristina Calvo, Isabel Aguado, María Luz García-García, Esther Ruiz-Chercoles, Eloisa Díaz-Martinez, Rosa María Albañil, Olga Campelo, Antonio Olivas, Luisa Muñóz-Gonzalez, Francisco Pozo, Rosa Fernandez-Arroyo, Adelaida Fernandez-Rincón, Ana Calderon, Inmaculada Casas
      Introduction It is known that infants with viral respiratory infections severe enough to require hospital admission have a high risk of developing recurrent wheezing. Few data have been published on unselected populations. The main aim of this study was to analyse symptomatic and asymptomatic respiratory viral infections during the first year of life in a cohort of infants, recruited at birth, and the development of recurrent wheezing. Patients and methods A total of 302 newborns were recruited. A nasopharyngeal aspirate was taken when the patients had a respiratory infection, as well as in the visits for vaccination at 2, 4, 6, and 12 months. RT-nested PCR assays were performed to detect 16 viruses. Results A total of 1293 samples were analysed (1005 healthy controls and 288 respiratory infections). Samples taken during routine check-ups were positive in 30.8% of cases, while those with respiratory infection were positive in 77.8%, P <.001 (OR: 3, 95% CI: 2.4–3.8). A total of 239 (79%) infants had at least 1 positive respiratory viral infection detected. The most frequent virus (71%) was rhinovirus (RV). Recurrent wheezing was found in 27 (11%) children during their first year of life (1.2 episodes, SD 2.9). Recurrent wheezing was present in 58.3% of patients admitted to hospital during their first viral infection, vs. 8.6% of infants when the first infection was mild or who had asymptomatic viral detection, P <.001 (OR: 2.18; 95% CI: 1.05–4.5). Conclusions In our series, severe respiratory infections leading to hospitalisation in the first months of life are risk factors for developing wheezing, but not in the case of mild RV infections.

      PubDate: 2017-07-15T07:37:18Z
      DOI: 10.1016/j.anpede.2016.08.008
  • Virus and wheezing in infants. Certainties or doubts'
    • Authors: Alfredo Cano Garcinuño
      Abstract: Publication date: Available online 5 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Alfredo Cano Garcinuño

      PubDate: 2017-07-06T05:19:11Z
      DOI: 10.1016/j.anpede.2017.02.005
  • Toxic shock syndrome in a paediatric intensive care unit over the last 15
    • Authors: Laura Butragueño Laiseca; Marina García Morín; Estíbaliz Barredo Valderrama; Andrés J. Alcaraz Romero
      Abstract: Publication date: Available online 5 July 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Laura Butragueño Laiseca, Marina García Morín, Estíbaliz Barredo Valderrama, Andrés J. Alcaraz Romero

      PubDate: 2017-07-06T05:19:11Z
      DOI: 10.1016/j.anpede.2016.10.013
  • Giant coronary aneurysms in infants with Kawasaki disease
    • Authors: Antonio Sánchez Andrés; Inmaculada Salvador Mercader; Julia Seller Moya; José Ignacio Carrasco Moreno
      Abstract: Publication date: Available online 28 June 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Antonio Sánchez Andrés, Inmaculada Salvador Mercader, Julia Seller Moya, José Ignacio Carrasco Moreno
      Introduction Kawasaki disease (KD) is an acute vasculitis of unknown origin and predominant in males. The long-term effects of the disease depend on whether there are coronary lesions, particularly aneurysms. The prognosis of patients with giant aneurysms is very poor due to their natural progression to coronary thrombosis or severe obstructive lesions. Objectives A series of 8 cases is presented where the epidemiology and diagnostic methods are described. The treatment of the acute and long-term cardiovascular sequelae is also reviewed. Methods A descriptive analysis was conducted on patients admitted to the Paediatric Cardiology Unit of La Fe University Hospital (Valencia) with KD and a coronary lesion. Results More than one artery was involved in all patients. Although early diagnosis was established in only two cases, none of the patients had severe impairment of ventricular function during the acute phase. Treatment included intravenous gammaglobulin and acetylsalicylic acid at anti-inflammatory doses during the acute phase. A combination of dual antiplatelet therapy and corticosteroids was given in cases of coronary thrombosis. The silent aneurysms continue to persist. Conclusions KD is the most common cause of acquired heart disease in children. The delay in diagnosis is associated with a greater likelihood of coronary lesions that could increase the risk of cardiovascular events in adulthood. Thus, this subgroup requires close clinical monitoring for a better control of cardiovascular risk factors over time.

      PubDate: 2017-07-06T05:19:11Z
      DOI: 10.1016/j.anpede.2016.07.005
  • A family history of renal lithiasis in children diagnosed of urinary tract
           infection by Escherichia coli
    • Authors: Víctor García Nieto; Jorge Sotoca Fernández; Monica O’Hagan; Pedro Arango Sancho; Maria Isabel Luis Yanes
      Abstract: Publication date: Available online 27 June 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Víctor García Nieto, Jorge Sotoca Fernández, Monica O’Hagan, Pedro Arango Sancho, Maria Isabel Luis Yanes
      Introduction Urinary tract infections (UTI) caused by Escherichia coli (E. coli) are common in patients with idiopathic hypercalciuria. As both UTI and hypercalciuria (prelithiasis) have a genetic basis, we wanted to know whether the family history of urolithiasis is more common in children with UTIs caused by E. coli. Secondarily, we wondered if the renal scars are more common in children with prelithiasis. Material and methods Ambispective study with collected data from 104 patients (40 male, 64 female) followed after having been diagnosed of UTI by E. coli at least once. These patients were asked about the existence of urolithiasis in relatives. The calcium and citrate urinary elimination was quantified in 80 children. Results In the total sample, family history was positive for urolithiasis in a significantly higher frequency in those children (n =71; 68.3%) than in the control population in our area (29.7%; previously published data). Prelithiasis frequency in children with UTI was 47.5% (38/80). An association was observed between the diagnosis of prelithiasis both with family history of urolithiasis (p =0.030) and the diagnosis of vesicoureteral reflux (p =0.034). Children who developed renal scarring had an increased risk of prelithiasis (OR 5.3; p =0.033). Conclusions The frequency of family history of urolithiasis in children with UTI caused by E. coli is very high. Based on our results we hypothesize that the predisposition to lithiasis can involve a constitutively altered defense to E. coli and, therefore, a greater possibility for renal scars.

      PubDate: 2017-07-06T05:19:11Z
      DOI: 10.1016/j.anpede.2017.04.002
  • Fever without source in infants less than 3 months of age. What's new'
    • Authors: Cristina Calvo; María de Ceano-Vivas
      Abstract: Publication date: Available online 16 June 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Cristina Calvo, María de Ceano-Vivas

      PubDate: 2017-06-19T22:49:21Z
      DOI: 10.1016/j.anpede.2017.02.004
  • Elevated thyroid hormone levels following low molecular weight heparin
    • Authors: Iñigo de Noriega Echevarría; Alberto García-Salido; M. Teresa Muñoz-Calvo; Jesús Argente
      Abstract: Publication date: Available online 15 June 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Iñigo de Noriega Echevarría, Alberto García-Salido, M. Teresa Muñoz-Calvo, Jesús Argente

      PubDate: 2017-06-19T22:49:21Z
      DOI: 10.1016/j.anpede.2016.09.006
  • Hospital discharge criteria for very low birth weight newborns
    • Authors: Isabel Benavente-Fernández; María Dolores Sánchez Redondo; Jose Luis Leante Castellanos; Alejandro Pérez Muñuzuri; Segundo Rite Gracia; Cèsar W. Ruiz Campillo; Ester Sanz López; Manuel Sánchez Luna
      Abstract: Publication date: Available online 2 June 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Isabel Benavente-Fernández, María Dolores Sánchez Redondo, Jose Luis Leante Castellanos, Alejandro Pérez Muñuzuri, Segundo Rite Gracia, Cèsar W. Ruiz Campillo, Ester Sanz López, Manuel Sánchez Luna
      Hospital discharge criteria for the pre-term newborn are mainly based on physiological competences (thermoregulation, respiratory stability, and feeding skills), although family support and ability to care for the baby, as well as a well-planned discharge are also cornerstones to ensure a successful discharge. In this article, the Committee of Standards of the Spanish Society of Neonatology reviews the current hospital discharge criteria in order for it to be useful as a clinical guide in Spanish neonatal units.

      PubDate: 2017-06-04T18:33:33Z
      DOI: 10.1016/j.anpede.2016.11.004
  • Cultural adaptation to Spanish and assessment of an Adolescent Peer
           Relationships Tool for detecting school bullying: Preliminary study of the
           psychometric properties
    • Authors: J.J. Gascón-Cánovas; J.R. Russo De León; A. Cózar Fernandez; J.M. Heredia Calzado
      Abstract: Publication date: Available online 31 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): J.J. Gascón-Cánovas, J.R. Russo De León, A. Cózar Fernandez, J.M. Heredia Calzado
      Background and objectives School bullying is a growing problem. The current study is aimed at culturally adapting and assessing the psychometric properties of a brief scale to measure bullying. Material and methods A cross-cultural adaptation of the brief scale—Adolescent Peer Relations Instrument-Bullying (APRI)—was performed using the translation and back-translation technique. The Spanish version of APRI questionnaire was administered to a sample of 1428 schoolchildren aged 12–14years in the region of Mar Menor in Murcia (Spain). Exploratory factor analysis, with oblique rotation, was used to assess the validity of the internal structure, the Cronbach's alpha to analyse their consistency, and the Kruskal–Wallis test to check their ability to discriminate between subjects with varying degrees of bullying according to Kidscreen-52 scale of social acceptability. Results Two factors were identified in the adapted version of APRI (physical victimisation and verbal/social victimisation), similar to those in the original scale. The questionnaire has high internal consistency (Cronbach's alpha=0.94) and discrimination capacity (P <.01), with significant effect sizes between degrees of bullying. Conclusions The internal structure of the APRI Spanish version is similar to the original, and its scores confirm high reliability and construct validity. Further studies need to be performed with broader age ranges and confirmatory analysis techniques, to ratify the equivalence of the adapted version with the original version.

      PubDate: 2017-06-04T18:33:33Z
      DOI: 10.1016/j.anpede.2015.12.008
  • Multiple organ failure after spontaneous return of circulation in cardiac
           arrest in children
    • Authors: Tania Carbayo; Alba de la Mata; Marina Sánchez; Jesús López-Herce; Jimena del Castillo; Angel Carrillo
      Abstract: Publication date: Available online 27 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Tania Carbayo, Alba de la Mata, Marina Sánchez, Jesús López-Herce, Jimena del Castillo, Angel Carrillo
      Objective To assess the frequency of the multiple organ failure and the prognostic value of multiple organ failure scores in children who have recovered from an in-hospital cardiac arrest. Patients and methods A single centre, observational, and retrospective study was conducted on children between 1 month and 16 years old who suffered an in-hospital cardiac arrest and achieved return of spontaneous circulation (ROSC). In the first 24–48h and between the fifth and the seventh day after ROSC, a record was made of the scores on paediatric severity (PRISM and PIM II) and multiple organ failure scales (PELOD and P-MODS), along with the clinical and analytical data, and including monitoring and treatment, mortality and cause of death. Results Of the total of 41 children studied, 70.7% were male, and the median age was 38 months. The overall mortality during admission was 41.5%, with 14.6% dying in the first 48h, and 7.6% in the following 3–5 days. In the first 48h, clinical severity and multiple organ failure scores were higher in the patients that died than in survivors (PRISM 29 vs. 21) p =0.125, PIM II (26.8% vs. 9.2%) p =0.02, PELOD (21 vs. 12) p =0.005, and P-MODS (9 vs. 6) p =0.001. Between the fifth and seventh day, the scores on the four scales were also higher in patients who died, but only those of the PELOD (20.5 vs. 11) p =0.002 and P-MODS (6.5 vs. 3) p =0.003 reached statistical significance. Conclusions Mortality in children after return of spontaneous circulation after cardiac arrest is high. The multiple organ failure after return of spontaneous circulation after cardiac arrest in children is associated with increased mortality.

      PubDate: 2017-05-30T17:18:13Z
      DOI: 10.1016/j.anpede.2016.06.008
  • Rituximab therapy for refractory thrombocytopenia in patients with
           antiphospholipid antibodies
    • Authors: Felisa Vázquez Gómez; María Prieto Arce; Luis Ignacio González-Granado; Eugenia Enríquez Merayo; Jaime de Inocencio Arocena
      Abstract: Publication date: Available online 26 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Felisa Vázquez Gómez, María Prieto Arce, Luis Ignacio González-Granado, Eugenia Enríquez Merayo, Jaime de Inocencio Arocena

      PubDate: 2017-05-30T17:18:13Z
      DOI: 10.1016/j.anpede.2016.09.005
  • Current situation on fertility preservation in cancer patients in Spain:
           Level of knowledge, information, and professional involvement
    • Authors: Carmen Garrido-Colino; Alvaro Lassaletta; María Ángeles Vazquez; Aizpea Echevarria; Ignacio Gutierrez; Maitane Andión; Pablo Berlanga
      Abstract: Publication date: Available online 25 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Carmen Garrido-Colino, Alvaro Lassaletta, María Ángeles Vazquez, Aizpea Echevarria, Ignacio Gutierrez, Maitane Andión, Pablo Berlanga
      Introduction The estimated risks of infertility in childhood cancer due to radiation, chemotherapy and surgery are well known. The involvement of professionals and advances in the different methods of preservation are increasing. However, many patients do not receive information or perform any method of preservation. Material Questionnaires to paediatric onco-haematology institutions throughout Spain. The questionnaire consisted of 22 questions assessing their usual practices and knowledge about fertility preservation. Results Fifty members of the Spanish Society of Paediatric Haematology and Oncology, representing 24 of 43 centres, responded. These represented 82% of centres that treated higher numbers of patients. The effect of treatment on fertility was known by 78% of those who responded, with 76% admitting not knowing any guideline on fertility in children or adolescents. As for the ideal time and place to inform the patient and/or family, only 14% thought it should be done in the same cancer diagnosis interview. In clinical practice, 12% of those surveyed never referred patients to Human Reproduction Units, another 12% only did so if the patients showed interest, and 38% only refer patients in puberty. Just over one-third (34%) of those referrals were going to receive highly gonadotoxic treatment. Conclusions There are clear differences between pre-puberty and puberty patients. The frequency with which some method of fertility preservation is performed in patients is low. All respondents believe that the existence of national guidelines on the matter would be of interest.

      PubDate: 2017-05-30T17:18:13Z
      DOI: 10.1016/j.anpede.2016.04.010
  • Point-of-care ultrasound in Spanish paediatric intensive care units
    • Authors: Rafael González Cortés; Luis Renter Valdovinos; Ana Coca Pérez; José Luis Vázquez Martínez
      Abstract: Publication date: Available online 10 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Rafael González Cortés, Luis Renter Valdovinos, Ana Coca Pérez, José Luis Vázquez Martínez
      Introduction Point-of-care (bedside) ultrasound is being increasingly used by paediatricians who treat critically ill children. The aim of this study is to describe its availability, use, and specific training in Paediatric Intensive Care Units in Spain. Material and methods A descriptive, cross-sectional, multicentre study was performed using an online survey. Results Of a total of 51 PICUs identified in our country, 64.7% responded to the survey. Just over half (53.1%) have their own ultrasound machine, 25% share it, with other units with the usual location in the PICU, and 21.9% share it, but it is usually located outside the PICU. Ultrasound machine availability was not related to size, care complexity, or number PICU admissions. The ultrasound was used daily in 35% of the units, and was associated with the location of the machine in the PICU (P =.026), the existence of a transplant program (P =.009), availability of ECMO (P =.006), and number of admissions (P =.015). 45.5% of PICUs have less than 50% of the medical staff specifically trained in bedside ultrasound, and 18.2% have all their medical staff trained. The presence of more than 50% of medical staff trained was associated with a higher rate of daily use (P =.033), and with specific use to evaluate cardiac function (P =.033), intravascular volume estimation (P =.004), or the presence of intra-abdominal collections (P =.021). Conclusions Bedside ultrasound is frequently available in Spanish PICUs. Specific training is still variable, but it should serve to enhance its implementation.

      PubDate: 2017-05-15T14:59:16Z
      DOI: 10.1016/j.anpede.2016.06.007
  • Unilateral amaurosis as an initial symptom of juvenile idiopathic
    • Authors: Alba Rubio San Simón; Ana Ortueta Olartecoechea; Estefanía Barral Mena; Pilar Tejada Palacios; Jaime de Inocencio Arocena
      Abstract: Publication date: Available online 9 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Alba Rubio San Simón, Ana Ortueta Olartecoechea, Estefanía Barral Mena, Pilar Tejada Palacios, Jaime de Inocencio Arocena

      PubDate: 2017-05-10T12:58:39Z
      DOI: 10.1016/j.anpede.2016.10.012
  • Improved lung function in cystic fibrosis using mechanical
    • Authors: Laura Azahara Fuentes; Pilar Caro; Antonio Jose Garcia-Ruiz; Gregorio Muñoz Gómez; Elisa Martín-Montañez
      Abstract: Publication date: Available online 9 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Laura Azahara Fuentes, Pilar Caro, Antonio Jose Garcia-Ruiz, Gregorio Muñoz Gómez, Elisa Martín-Montañez

      PubDate: 2017-05-10T12:58:39Z
      DOI: 10.1016/j.anpede.2016.08.007
  • Solid paediatricians in liquid times: Reviving professionalism
    • Authors: Carmen Martínez González; María Tasso Cereceda; Marta Sánchez Jacob; Isolina Riaño Galán
      Abstract: Publication date: Available online 8 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Carmen Martínez González, María Tasso Cereceda, Marta Sánchez Jacob, Isolina Riaño Galán
      Professionalism is rarely taught formally. It is learned by osmosis through the hidden curriculum: a set of attitudes that each one of us transmits unconsciously to students, medical residents, and colleagues. All of us are a model or counter-model of professionalism through a series of values that have been the pillars of our profession since Hippocrates. Values that do not seem to be strong enough to pass our time. There are specific factors of the 21st century such as the financial crisis, the highly technical nature of medicine, bureaucratisation or trivialisation of the medical process that could explain, but not justify, the decline in the values of our profession: Empathy, integrity, solidarity, the altruism, or confidentiality. That is why, from the Bioethics Committee of the Spanish Paediatrics Association we establish the need to revive professionalism. Building and maintaining the values of our profession by training scientifically competent paediatricians, as well as being excellent from an ethical point of view, is part of our responsibility.

      PubDate: 2017-05-10T12:58:39Z
      DOI: 10.1016/j.anpede.2016.10.011
  • Editors’ corner: Anales de Pediatría annual report
    • Authors: Empar Lurbe i Ferrer; Laia Alsina Manrique de Lara; Gonzalo Solís Sánchez
      Abstract: Publication date: Available online 8 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Empar Lurbe i Ferrer, Laia Alsina Manrique de Lara, Gonzalo Solís Sánchez

      PubDate: 2017-05-10T12:58:39Z
      DOI: 10.1016/j.anpede.2017.04.001
  • Usefulness of brain natriuretic propeptide in the diagnosis and management
           of patent ductus arteriosus
    • Authors: Alicia Montaner Ramón; Zenaida Galve Pradel; Cristina Fernández Espuelas; Lorenzo Jiménez Montañés; María Pilar Samper Villagrasa; Segundo Rite Gracia
      Abstract: Publication date: Available online 5 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Alicia Montaner Ramón, Zenaida Galve Pradel, Cristina Fernández Espuelas, Lorenzo Jiménez Montañés, María Pilar Samper Villagrasa, Segundo Rite Gracia
      Introduction Patent ductus arteriosus (PDA) is a prevalent condition in preterm infants, and may be related to increased morbidity and mortality in the most immature newborns. Recent studies have examined the usefulness of brain natriuretic propeptide (proBNP) in the diagnosis of this pathology. The aim of the study was to evaluate the diagnostic efficacy of proBNP as a marker of haemodynamic overload in PDA. Paients and methods A retrospective study was conducted on preterm infants less than 32 weeks of gestation and/or weight less than 1500g. Echocardiogram and determination of proBNP levels were performed on all patients. Comparison was made by subgroups according to the presence of PDA and their haemodynamic characteristics. Results Of the 60 patients enrolled, 71.7% had PDA, of which 86% had haemodynamically significant patent ductus arteriosus (HS-PDA). All of them, but one, received medical treatment with ibuprofen or acetaminophen. Surgical closure was required in 29.7% of HS-PDA. Higher values of proBNP were found in patients with HS-PDA (33,338±34,494.47pg/mL; p =.000) compared to patients with closed or non-haemodynamically significant ductus arteriosus. Higher values were also found in patients who required surgical closure of PDA (30,596.8±14,910.9; p =.004). A greater decrease inproBNP levels was found in the group of patients which duct closure after pharmacological treatment (68±24.69% vs −12.22±99.4%; p =.030). ProBNP cutoff-level for HS-PDA was calculated by ROC curve and it was 9321.5pg/mL (Specificity: 100%, Sensitivity: 94.6%). Conclusions ProBNP levels are related to the presence or absence of haemodynamically significant patent ductus arteriosus; and its variations with treatment response. High values are also related to the need for surgical closure of PDA.

      PubDate: 2017-05-06T11:16:31Z
      DOI: 10.1016/j.anpede.2016.01.014
  • Spanish Paediatric Association (2009–2017). Time for accountability
    • Abstract: Publication date: Available online 2 May 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Serafín Málaga

      PubDate: 2017-05-06T11:16:31Z
  • Level of training in autistic spectrum disorders among hospital
    • Authors: Elena Martínez-Cayuelas; Salvador Ibáñez-Micó; Lourdes Ceán-Cabrera; Rosario Domingo-Jiménez; Helena Alarcón-Martínez; Eduardo Martínez-Salcedo
      Abstract: Publication date: Available online 29 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Elena Martínez-Cayuelas, Salvador Ibáñez-Micó, Lourdes Ceán-Cabrera, Rosario Domingo-Jiménez, Helena Alarcón-Martínez, Eduardo Martínez-Salcedo
      Background Training in autistic spectrum disorders is crucial in order to achieve an early diagnosis. However, the number of papers describing this training is limited. This study describes the level of knowledge among paediatricians from tertiary care hospitals in different regions of Spain and detects areas that need improvement. Material and method A total of one hundred and fifty-seven (157) paediatricians working in tertiary healthcare hospitals located in three different regions in Spain consented to complete an online questionnaire divided in three sections (socio-demographic, knowledge about childhood autism, and opinion). Data were analysed using SPSS version 15. Results The total mean score of participating paediatricians in the questionnaire was 20.34 (±2.43 SD) out of a total possible score of 23. Approximately two-thirds (65%) of paediatricians scored more or equal to the mean score. The knowledge gap was found to be higher with symptoms of repetitive behaviour patterns, concept of autism, and comorbidity, with no statistical significance. There were no differences in paediatrician scores within different socio-demographic groups. Just under two-thirds (64%) of paediatricians subscribed to the opinion that their own knowledge about autism is limited, and there is a significant lack of knowledge about facilities in every region. Conclusions There is a sufficient level of knowledge about autism among paediatricians in tertiary healthcare, although a lack of awareness about the management of these patients, with poor coordination between the different specialists that are involved in their treatment. Efforts should focus on achieving a better coordination between these specialists, and update the knowledge gaps identified.

      PubDate: 2017-04-30T09:10:00Z
      DOI: 10.1016/j.anpede.2016.05.007
  • Risks associated with the uncontrolled use of donated breast milk
    • Authors: Nadia Raquel García Lara; Manuela Peña Caballero
      Abstract: Publication date: Available online 12 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Nadia Raquel García Lara, Manuela Peña Caballero

      PubDate: 2017-04-16T03:52:42Z
      DOI: 10.1016/j.anpedi.2017.02.002
  • Self-medication, self-prescription and medicating “by proxy”
           in paediatrics
    • Authors: Valenzuela Ortiz; Francisco Javier Ruiz-Cabello Uberos Ana Checa Ros Cristina
      Abstract: Publication date: Available online 12 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): María Valenzuela Ortiz, Francisco Javier Sánchez Ruiz-Cabello, José Uberos, Ana Fátima Checa Ros, Cristina Valenzuela Ortiz, María Carmen Augustín Morales, Antonio Muñoz Hoyos
      Introduction Self-prescribing or medicating ‘by proxy’ is not an autonomous, free and voluntary decision in the case of children. On the contrary, in this case it is based on the subjective interpretation of symptoms made by the mother or by a third person who is legally responsible for the minor. Analysing this situation is of great importance in order to know the determining factors, perceptions, and realities related to this problem. Methods Our proposal is to perform a prospective observational study for analysing maternal and familiar determinant factors related to self-prescribing and self-medicating ‘by proxy’ in paediatrics. A validated survey was developed to be applied to mothers of children aged 0–14 who are users of the Paediatric Emergency Department in a hospital. Results A total of 1.714 mothers were recruited in a random period of time. This sample included 345 mothers who exclusively self-medicated their children (case group), and 1.369 mothers (control group) who did not meet this requirement. The overall percentage of medicating ‘by proxy’ was 32.8%. There is a significant association between self-medicating and educational level of the mother, the number of children, and the birth order among siblings. Neither maternal age nor social-occupational level are related to this problem. Most frequently used drugs include antipyretics and ‘anticatharrals’, usually administered as a monotherapy. Conclusions Our results seem to indicate that the educational level and the parental experience acquired with previous children could generate the required confidence in parents to choose the medication by themselves. Almost 85% of these drugs come from the ‘home first-aid kit’.

      PubDate: 2017-04-16T03:52:42Z
  • Effects of growth hormone treatment on anthropometrics, metabolic risk,
           and body composition variables in small for gestational age patients
    • Authors: Esther Aurensanz Clemente; Pilar Samper Villagrasa; Ariadna Ayerza Casas; Pablo Ruiz Frontera; Olga Bueno Lozano; Luis Alberto Moreno Aznar; Gloria Bueno Lozano
      Abstract: Publication date: Available online 10 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Esther Aurensanz Clemente, Pilar Samper Villagrasa, Ariadna Ayerza Casas, Pablo Ruiz Frontera, Olga Bueno Lozano, Luis Alberto Moreno Aznar, Gloria Bueno Lozano
      Introduction and objectives Small for gestational age (SGA) children without catch-up growth can benefit from treatment with growth hormone (rhGH). However, they should be monitored very closely because they are at increased risk of metabolic syndrome. Material and method A group of 28 SGA children with a mean age of 8.79 years and undergoing treatment with rhGH were selected for evaluation. Over the course of 4 years, an annual evaluation was performed on the anthropometric variables (weight, height, body mass index [BMI], growth rate, blood pressure and waist perimeter), metabolic risk variables (glycaemia, glycosylated haemoglobin, cholesterol ratio, insulinaemia, insulin-like growth factor 1[IGF1], IGF binding protein-3 [IGFBP-3], IGF1/IGFBP3 ratio, and HOMA index), and body composition variables. Results Treatment with rhGH was associated with a significant increase in height (−2.76±.11 SD to −1.53±.17 SD, P =.000), weight (−1.50±.09 SD to −1.21±.13 SD; P =.016), and growth rate (−1.43±.35 SD to .41±.41 SD; P =.009), without a corresponding change in the BMI. Insulinaemia (9.33±1.93mU/ml to 16.55±1.72mU/ml; P =.044) and the HOMA index (3.63±.76 to 6.43±.67; P =.042) increased, approaching insulin resistance levels. No changes were observed in the lipid profile. Body composition changes were observed, with a significant increase in lean mass (73.19±1.26 to 78.74±1.31; P =.037), and a reduction of fat mass (26.81±1.26 to 21.26±1.31; P =.021). Conclusion Treatment with rhGH is effective for improving anthropometric variables in SGA patients who have not experienced a catch-up growth. It also produces changes in body composition, which may lead to a reduction in risk of metabolic syndrome. However, some insulin resistance was observed. It is important to follow up this patient group in order to find out whether these changes persist into adulthood.

      PubDate: 2017-04-16T03:52:42Z
      DOI: 10.1016/j.anpede.2016.05.005
  • Malnutrition in children admitted to hospital. Results of a national
    • Authors: José Manuel Moreno Villares; Vicente Varea Calderón; Carlos Bousoño García
      Abstract: Publication date: Available online 8 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): José Manuel Moreno Villares, Vicente Varea Calderón, Carlos Bousoño García
      Introduction Malnutrition on admission is closely related to a longer hospital stay and a higher morbidity. The prevalence of hospital malnutrition has been reported as almost as high as 50%, with 6% being the lowest. DHOSPE study investigates nutrition status in Spanish hospitals and its outcome during the hospital stay. Patients and methods A longitudinal, multicentre, descriptive, cross-sectional study, with a short follow-up period was conducted in 32 hospitals during 2011. A total of 991 patients were included, with ages from 0 to 17 years. Each patient was measured at admission (weight, length, weight for length -W/L-, length for age -L/A-), and at 7 and 14 days. The STAMP nutritional screening tool was completed on admission. Anthropometric measurements were reported as z-score, and nutrition status classified according to W/L and L/A for acute and chronic malnutrition, respectively. Results The prevalence of malnutrition was 7.1% for moderate, and 0.7% for severe acute malnutrition. For chronic malnutrition, 2.7% was moderate, and 1.4% severe. There were significant differences according to the underlying condition but not according to age. Results of STAMP show that around 75% of patients had a moderate to high risk of malnutrition. Nutritional status changed during admission for weight, as well as W/L and L/A. A worse nutritional status at admission and a higher STAMP score were positively correlated with the need for nutrition support. Conclusions The prevalence of undernutrition was slightly lower (<8%) than previously reported, probably in relation to the variety of hospitals in the survey. Nevertheless, nutritional risk when evaluated with STAMP showed a high risk of malnutrition.

      PubDate: 2017-04-09T01:13:21Z
      DOI: 10.1016/j.anpede.2015.12.006
  • Growth hormone treatment in small for gestational age children in Spain
    • Authors: José Manuel Rial Rodríguez; Antonio de Arriba Muñoz; Jordi Bosch Muñoz; Paloma Cabanas Rodríguez; Ramón Cañete Estrada; Ignacio Díez López; María Magdalena Hawkins Solís; María José Martínez-Aedo Ollero; Ana Cristina Rodríguez Dehli; Lourdes Ibáñez Toda
      Abstract: Publication date: Available online 8 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): José Manuel Rial Rodríguez, Antonio de Arriba Muñoz, Jordi Bosch Muñoz, Paloma Cabanas Rodríguez, Ramón Cañete Estrada, Ignacio Díez López, María Magdalena Hawkins Solís, María José Martínez-Aedo Ollero, Ana Cristina Rodríguez Dehli, Lourdes Ibáñez Toda
      Introduction Since its approval by the European Medicines Agency, a great number of patients born small for gestational date have received recombinant growth hormone treatment in Spain. The aim of this study is to analyse its outcome in the setting of ordinary clinical practice. Methods Information was gathered from the registers of the assessment boards that authorise all growth hormone treatments prescribed in public hospitals in six autonomic communities (regions). Results Valid data from 974 patients was obtained. All of them complied with criteria established by the European Medicines Agency. Patients in the sample were smaller in length than weight at birth, with their median target height being below 1 standard deviation (SD), and 23% of them had been delivered prematurely. Treatment was started at 7.2±2.8 years (mean±SD). The mean patient height at start was −3.1±0.8 SD. They gained 0.7±0.2 SD in the first year, and 1.2±0.8 SD after two years. Final height was attained by 8% of the sample, reaching −1.4±0.7 SD. Conclusions These results are similar to other Spanish and international published studies, and are representative of the current practice in Spain. Despite treatment being started at a late age, adequate growth is observed in the short term and in the final height. Up to a 24% of patients show a poor response in the first year.

      PubDate: 2017-04-09T01:13:21Z
      DOI: 10.1016/j.anpede.2016.04.008
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