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Showing 1 - 200 of 3042 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 19, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, 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: 328, 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  
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: 205, 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: 22, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
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: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 124, 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)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 25, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
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)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
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: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
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: 39, 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: 45, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
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: 12)
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: 20, 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: 24)
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: 34, 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: 4)
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: 5, 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: 21, 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: 58)
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: 339, 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: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
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: 308, 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: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 422, 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: 50, 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: 10, 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: 5, 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: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, 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: 47, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 44, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, 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: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, 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: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 44, 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: 179, 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: 2)
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: 23, 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: 33, 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: 53, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 5)
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: 160, 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: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, 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: 153, 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   (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  [3042 journals]
  • 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
      Abstract: Publication date: Available online 16 June 2017
      Source:Anales de Pediatría (English Edition)
      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: 2017-06-19T22:49:21Z
      DOI: 10.1016/j.anpede.2016.06.009
  • 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: 2017-06-19T22:49:21Z
      DOI: 10.1016/j.anpede.2017.03.006
  • 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
  • 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
      Abstract: Publication date: Available online 13 June 2017
      Source:Anales de Pediatría (English Edition)
      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: 2017-06-14T20:32:58Z
      DOI: 10.1016/j.anpede.2016.07.004
  • 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
  • Spanish funded paediatric research: Contribution of Anales de
           Pediatría to its dissemination
    • Authors: María Francisca Abad-García; Aurora González-Teruel; Gonzalo Solís Sánchez
      Abstract: Publication date: Available online 13 May 2017
      Source:Anales de Pediatría (English Edition)
      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: 2017-05-15T14:59:16Z
      DOI: 10.1016/j.anpede.2016.04.009
  • 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
  • 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
      Abstract: Publication date: Available online 30 April 2017
      Source:Anales de Pediatría (English Edition)
      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: 2017-04-30T09:10:00Z
      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
      Abstract: Publication date: Available online 29 April 2017
      Source:Anales de Pediatría (English Edition)
      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: 2017-04-30T09:10:00Z
      DOI: 10.1016/j.anpede.2015.12.007
  • 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
  • Acute liver failure related to inherited metabolic diseases in young
    • Authors: Filipa Dias Costa; Rita Moinho; Sandra Ferreira; Paula Garcia; Luísa Diogo; Isabel Gonçalves; Carla Pinto
      Abstract: Publication date: Available online 4 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Filipa Dias Costa, Rita Moinho, Sandra Ferreira, Paula Garcia, Luísa Diogo, Isabel Gonçalves, Carla Pinto
      Introduction Pediatric acute liver failure (ALF) due to inherited metabolic diseases (IMD) is a rare life-threatening condition with a poor prognosis. Early intervention may be lifesaving. Objective To describe clinical presentation, investigation and outcomes of ALF related to IMD in young children. Material and methods Retrospective review of the medical records of children aged up to 24 months, admitted to a tertiary pediatric and neonatal Intensive Care Unit during a 27-year period, fulfilling the ALF criteria, with documented metabolic etiology. Results From 34 ALF cases, 18 were related to IMD: galactosemia (4), mitochondrial DNA depletion syndrome (MDS) (3), ornithine transcarbamilase deficiency (3), congenital defects of glycosylation (2), tyrosinemia type 1 (2), long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (1), hereditary fructose intolerance (1), classic methylmalonic aciduria (1) and citrulinemia type 1 (1). The median age was 1.3 months. At least one previous suggestive sign/symptom of IMD (vomiting, failure to thrive, hypotonia or developmental delay) was observed in 67% of the cases. The most common physical signs at admission included: hepatomegaly (72%), jaundice (67%) and encephalopathy (44%). The peak laboratorial findings were: mean international normalizad ratio 4.5, median lactate 5mmol/L, mean bilirubin 201μmol/L, median alanine aminotransferase (ALT) 137UI/L and median ammonia 177μmol/L. One patient was submitted to liver transplant in ALF context (MSD). The mortality rate was 44%. Discussion The identification of IMD as a frequent cause of ALF allowed specific therapeutic measures and adequate family counseling. Particular clinical features and moderated ALT and bilirubin levels can lead to its suspicion.

      PubDate: 2017-04-30T09:10:00Z
      DOI: 10.1016/j.anpede.2017.03.003
  • A real-world study focused on the effectiveness and safety of adalimumab
           as first-line anti-TNF treatment for paediatric Crohn's disease
    • Authors: Víctor Manuel Navas-López; Gemma Pujol-Muncunill; Enrique Llerena; María Navalón Rubio; David Gil-Ortega; Vicente Varea-Calderón; Carlos Sierra Salinas; Javier Martin-de-Carpi
      Abstract: Publication date: Available online 22 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Víctor Manuel Navas-López, Gemma Pujol-Muncunill, Enrique Llerena, María Navalón Rubio, David Gil-Ortega, Vicente Varea-Calderón, Carlos Sierra Salinas, Javier Martin-de-Carpi
      Background and objectives Adalimumab (ADA), a monoclonal humanised anti-TNF antibody, is usually prescribed as a second-line treatment in paediatric Crohn's disease (CD) patients who have become unresponsive or developed intolerance to infliximab (IFX). In the case series reported, more than 70% of patients had initially been treated with IFX. Data on short- and long-term efficacy of ADA in anti-TNF naïve patients is limited. The aim of this study is to describe our experience with ADA as a first-line anti-TNF in paediatric CD patients. Material and methods This is a multicentre retrospective study including anti-TNF naïve paediatric CD patients treated with ADA as first-line anti-TNF. Results Sixty-two patients (34 males), with a mean age of 13.0±2.4 years and a disease duration of 7.3 (IQR 2.7–21) months were included. Median wPCDAI was 35 (IQR 24.3–47.5). Fifty-eight out of 62 (93.5%) were on combo therapy at baseline. Clinical remission at week 12 was achieved in 50 out of 62 (80.6%) and in 57 out of 60 (95.0%) at week 52. Eight patients (13%) reported adverse events. Mean height, growth rate and BMI z-scores improved significantly between baseline and week 52, especially in patients with growth failure. Conclusions ADA treatment leads to lasting clinical remission in anti-TNF naïve paediatric patients with CD. ADA significantly improved growth rate in children with CD who had growth delay at baseline. Some patients remain in remission for prolonged time periods under monotherapy; however, some patients would require dose escalation.

      PubDate: 2017-04-23T06:43:29Z
      DOI: 10.1016/j.anpede.2017.03.001
  • 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
  • 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
      Abstract: Publication date: Available online 10 April 2017
      Source:Anales de Pediatría (English Edition)
      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: 2017-04-16T03:52:42Z
      DOI: 10.1016/j.anpede.2016.05.006
  • 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
  • Drug syrups: Errors in drug labels with possible consequences in patients
           with hereditary fructose intolerance
    • Authors: Elsa Izquierdo-García; Ismael Escobar Rodríguez; José Manuel Moreno-Villares; Irene Iglesias Peinado
      Abstract: Publication date: Available online 5 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Elsa Izquierdo-García, Ismael Escobar Rodríguez, José Manuel Moreno-Villares, Irene Iglesias Peinado

      PubDate: 2017-04-09T01:13:21Z
      DOI: 10.1016/j.anpede.2017.03.004
  • Familial EXOSC3-related pontocerebellar hypoplasia
    • Authors: Anna Paola Di Giovambattista; Itxaropena Jácome Querejeta; Purificación Ventura Faci; Gerardo Rodríguez Martínez; Feliciano Ramos Fuentes
      Abstract: Publication date: Available online 5 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Anna Paola Di Giovambattista, Itxaropena Jácome Querejeta, Purificación Ventura Faci, Gerardo Rodríguez Martínez, Feliciano Ramos Fuentes

      PubDate: 2017-04-09T01:13:21Z
      DOI: 10.1016/j.anpede.2016.09.004
  • Surgical closure of patent ductus arteriosus in premature neonates: Does
           the surgical technique affect the outcome'
    • Authors: Alejandro Avila-Alvarez; Marta Serantes Lourido; Rebeca Barriga Bujan; Carolina Blanco Rodriguez; Francisco Portela-Torron; Victor Bautista-Hernandez
      Abstract: Publication date: Available online 5 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Alejandro Avila-Alvarez, Marta Serantes Lourido, Rebeca Barriga Bujan, Carolina Blanco Rodriguez, Francisco Portela-Torron, Victor Bautista-Hernandez
      Introduction Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. Patients and methods A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. Results The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, p =.03). Conclusions The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term.

      PubDate: 2017-04-09T01:13:21Z
      DOI: 10.1016/j.anpede.2015.12.005
  • The little and large of pediatric obesity prevention
    • Authors: Manuel Moya
      Abstract: Publication date: Available online 4 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Manuel Moya

      PubDate: 2017-04-09T01:13:21Z
      DOI: 10.1016/j.anpede.2017.03.002
  • Criteria for hospital discharge of the healthy term newborn after delivery
    • Authors: Segundo Rite Gracia; Alejandro Pérez Muñuzuri; Ester Sanz López; José Luis Leante Castellanos; Isabel Benavente Fernández; César W. Ruiz Campillo; M. Dolores Sánchez Redondo; Manuel Sánchez Luna
      Abstract: Publication date: Available online 3 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Segundo Rite Gracia, Alejandro Pérez Muñuzuri, Ester Sanz López, José Luis Leante Castellanos, Isabel Benavente Fernández, César W. Ruiz Campillo, M. Dolores Sánchez Redondo, Manuel Sánchez Luna
      Criteria for newborn hospital discharge have to include physiological stability and family competence to provide newborn care at home. In this document, the Committee of Standards of the Spanish Society of Neonatology reviews the minimum criteria to be met before hospital discharge of a term newborn infant. We include a review of hospital discharge criteria for the late preterm infants, as these infants are often not hospitalised and remain with their mother after birth. A shortened hospital stay (less than 48h after delivery) for healthy term newborns can be considered, but it is not appropriate for every mother and newborn. Newborn infants discharged before 48h of age, should be examined within 3–4 days of life.

      PubDate: 2017-04-09T01:13:21Z
      DOI: 10.1016/j.anpede.2016.08.006
  • Kawasaki disease is more prevalent in rural areas of Catalonia (Spain)
    • Authors: Judith Sánchez-Manubens; Jordi Antón; Rosa Bou; Estibaliz Iglesias; Joan Calzada-Hernandez; Xavier Rodó; Josep-Antón Morguí
      Abstract: Publication date: Available online 3 April 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Judith Sánchez-Manubens, Jordi Antón, Rosa Bou, Estibaliz Iglesias, Joan Calzada-Hernandez, Xavier Rodó, Josep-Antón Morguí
      Introduction Kawasaki disease (KD) is an acute self-limited systemic vasculitis relatively common in childhood. The etiology of KD is still unknown, although clinical, laboratory and epidemiological features suggest an infectious origin or trigger. Differences on incidence between countries have been related to specific genetic factors, ethnicity, country of birth and some other sociocultural and environmental factors. We present a population-based study on incidence of KD in Catalonia (Spain), focusing on differences between patients in rural and non-rural areas of the region. Methods Observational population-based study including all Pediatric Units in Catalan hospitals, between 2004 and 2014. A 12-month (March 2013–March 2014) prospective collection of new cases of KD was carried out to determine the incidence of KD. The rest of the data was retrieved retrospectively. Results Data from 399 patients over the 10-year study period was analyzed. Among the total KD patients, 353 (88.5%) lived in non-rural areas and 46 (11.5%) in rural areas. It was found that there is a significant difference (p <0.001) between the percentage of rural population observed in patients with KD (11.5%), and the expected 5% of the Catalan population. Conclusion This is the first population-based study showing significant differences on KD incidence rates between rural and non-rural areas.

      PubDate: 2017-04-09T01:13:21Z
      DOI: 10.1016/j.anpede.2017.02.001
  • Use of levetiracetam in neonatal seizures
    • Authors: Jose Maria Lloreda-García; Jose Ramón Fernández-Fructuoso; Elisabeth Gómez-Santos; Ana García-González; Jose Luis Leante-Castellanos
      Abstract: Publication date: Available online 24 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Jose Maria Lloreda-García, Jose Ramón Fernández-Fructuoso, Elisabeth Gómez-Santos, Ana García-González, Jose Luis Leante-Castellanos

      PubDate: 2017-03-26T21:05:50Z
      DOI: 10.1016/j.anpede.2016.08.005
  • Hypovitaminosis D and associated factors in 4-year old children in
           northern Spain
    • Authors: Ana Cristina Rodríguez-Dehli; Isolina Riaño-Galán; Ana Fernández-Somoano; Eva María Navarrete-Muñoz; Mercedes Espada; Jesús Vioque; Adonina Tardón
      Abstract: Publication date: Available online 15 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Ana Cristina Rodríguez-Dehli, Isolina Riaño-Galán, Ana Fernández-Somoano, Eva María Navarrete-Muñoz, Mercedes Espada, Jesús Vioque, Adonina Tardón
      Introduction Vitamin D is an essential prohormone in calcium and phosphorus homeostasis. Recent studies show a high frequency of insufficiency/deficiency of vitamin D in the general population worldwide. Our objective was to estimate the prevalence of circulating vitamin D [25(OH)D3] deficiency and insufficiency in children and examine the associated factors. Material and methods A total of 283 children, participants in the cohort INMA-Asturias, were studied. The 25(OH)D3 concentrations were quantified by high performance liquid chromatography. The prevalence of deficiency [25(OH)D3<20ng/mL] and insufficiency [20–29.9ng/mL] of vitamin D was estimated. Distribution of 25(OH)D3 for month of extraction of specimen, ingestion, and other factors were analysed. Results The mean 25(OH)D3 was 20.1ng/mL (range 2.7–49.8), with 8.8% ≥30ng/mL, 38.5% from 20 to 20.9ng/mL, and 52.7%<20ng/mL. Seasonal variation was found, with lower values in winter. There was no relationship between plasma levels and intake of vitamin D (median 2.7μg/day, range 0.81–12.62), time outdoors (mean 3h, range: 0:21–6:55), or BMI or gender, but there was one found with the mother's levels during gestation. Conclusions There is a high prevalence of vitamin D deficiency/insufficiency in children at 4 years. Solar exposure might not be enough in our region. Healthy children should be encouraged to follow adequate outdoor activities with associated sun exposure. Due to the deficit of intake in childhood, recommendations are needed about a varied diet with vitamin D-containing foods in this age group, especially during the winter, and assessing the need of vitamin D supplementation in children at risk.

      PubDate: 2017-03-15T20:13:17Z
      DOI: 10.1016/j.anpede.2016.02.006
  • Childhood obesity: Prevention or treatment'
    • Authors: Juan
      Abstract: Publication date: Available online 14 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Juan J. Díaz Martín

      PubDate: 2017-03-15T20:13:17Z
  • Invasive meningococcal disease in Navarra in the era of a meningococcal C
    • Authors: Desirée Morales; Laura Moreno; Mercedes Herranz; Enrique Bernaola; Iván Martínez-Baz; Jesús Castilla
      Abstract: Publication date: Available online 9 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Desirée Morales, Laura Moreno, Mercedes Herranz, Enrique Bernaola, Iván Martínez-Baz, Jesús Castilla
      Introduction Systematic childhood vaccination against meningococcus C has had a considerable impact on meningococcal invasive disease (MID). The aim of this study is to perform an analysis on the epidemiology, the clinical features, and the factors associated with a worse prognosis of MID, in the era of a meningococcal C vaccine. Material and methods The study included confirmed cases of MID in children less than 15 years of age in Navarra, Spain, between 2008 and 2014. The risk of death or permanent sequelae was evaluated according to the presence of clinical features and analytical parameters at diagnosis. Results The average annual incidence was 7.9 cases per 100000 children, with the highest attack rate in children <1 year. Of 53 cases analysed, 87% were due to meningococcus B. Fever (100%), rash (91%), and elevation of procalcitonin (94%) were the most frequent findings at diagnosis. Some sign of shock was observed in 70% upon arrival at the hospital. The case-fatality rate was 3.8% and 10% survived with permanent sequelae. Glasgow coma scale <15 (odds ratio [OR]=9.2), seizure (OR=8.3), sepsis without meningitis (OR=9.1), thrombocytopenia (OR=30.5), and disseminated intravascular coagulation (OR=10.9) showed a greater association with a worse prognosis. Conclusion The MID continues to be a significant cause of morbidity and mortality in children. Therefore, new advances are needed in the prevention, early diagnosis, and detection of the factors associated with poor prognosis.

      PubDate: 2017-03-15T20:13:17Z
      DOI: 10.1016/j.anpede.2015.12.004
  • Clinical interventions in overweight and obesity: A systematic literature
           review 2009–2014
    • Authors: Luis Rajmil; Joan Bel; Rosa Clofent; Carmen Cabezas; Conxa Castell; Mireia Espallargues
      Abstract: Publication date: Available online 8 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Luis Rajmil, Joan Bel, Rosa Clofent, Carmen Cabezas, Conxa Castell, Mireia Espallargues
      Objective To update the literature review on the effectiveness of clinical interventions on childhood obesity, proposed in Clinical Practice Guidelines, excluding prevention and pharmacological and surgical treatments. Method A systematic review was carried out in electronic databases of the Cochrane Database of Systematic Reviews (The Cochrane Library), MEDLINE, and SCOPUS, replicating the search for the Clinical Practice Guidelines, from 2009 to 2014. The Clinical Practice Guidelines of National Institutes for Health and Care Excellence were taken as a reference. Systematic reviews were given priority, and the quality of the studies was assessed. Results Out of a total of 3.703 documents initially identified, 48 were finally included. Studies showed great heterogeneity in the type and duration of interventions, and in outcome measures. Adherence to treatment was, in general, low. Multi-component interventions including diet, physical activity, sedentary lifestyle, and behaviour changes, involving the family, and starting at early ages, were the most effective for reducing body mass index. There is no consensus on criteria for referral to specialised care. Conclusions It is recommended to implement multi-component programs conducted by professionals with previous training, involving the family, and addressing behavioural, individual and socio-demographic aspects. Lack of adherence is one of the reasons for failure of interventions. Diagnostic and referral criteria, the outcome measures, and the type and duration of interventions need to be improved and standardised.

      PubDate: 2017-03-09T14:46:32Z
      DOI: 10.1016/j.anpede.2016.03.013
  • Light and noise: Environmental factors in intensive care units
    • Authors: Alejandro Bosch; Anna Falcó; Marta Santaolalla; María Carmen Dominguez; Iolanda Jordan
      Abstract: Publication date: Available online 7 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Alejandro Bosch, Anna Falcó, Marta Santaolalla, María Carmen Dominguez, Iolanda Jordan

      PubDate: 2017-03-09T14:46:32Z
      DOI: 10.1016/j.anpede.2016.07.003
  • Neopterin levels and systemic inflammatory response syndrome in pediatric
           critically ill patients
    • Authors: Raquel Gil-Gómez; Javier Blasco-Alonso; Pilar Sánchez-Yáñez; Vanessa Rosa-Camacho; Guillermo Milano
      Abstract: Publication date: Available online 6 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Raquel Gil-Gómez, Javier Blasco-Alonso, Pilar Sánchez-Yáñez, Vanessa Rosa-Camacho, Guillermo Milano
      Introduction Neopterin and biopterin are subproducts of redox reactions, which act as cofactor of enzymes responsible for nitric oxide production. We hypothesized that plasma neopterin suffers different evolution during the first days of a critically ill child. Methods Single-center prospective observational study in patients 7 days to 14 years admitted to our PICU and that met SIRS criteria. Neopterin and biopterin levels as well as other acute phase reactants were collected at admission and at 24h. Results A total of 28 patients were included, 78.9% male, median age 5.04 years (interquartile range [IQR] 1.47–10.26), PRISM II 2.0% (IQR 1.1–5.0). Mechanical ventilation (MV) in 90% of patients, median duration of 6.0h (IQR 3.7–102.0); median PICU length of stay 5.0 days (IQR 2.7–18.7), maximum VIS through 0 (IQR 0–14). Baseline neopterin level 2.3±1.2nmol/l and at 24h 2.3±1.4nmol/l. Baseline biopterin is 1.3±0.5nmol/l and 1.4±0.4nmol/l at 24h. Neopterin levels significantly higher in patients with PICU length of stay >6 days (p = .02), patients who needed MV >24h (p = .023) and those who developed complications (p = .05). Neopterin correlates directly and statistically significant with the duration of MV (rho = .6, p = .011), PICU length of stay (rho = .75, p <.0001) and VIS (rho = .73, p = .001). Additionally, biopterin directly correlates with the PRISM (rho = .61, p = .008). Discussion There is a higher neopterin level when longer PICU stay, higher VIS score, longer MV and occurrence of complications, pointing at the involvement of an activation of the cellular immune system.

      PubDate: 2017-03-09T14:46:32Z
      DOI: 10.1016/j.anpede.2017.02.002
  • Management of gastroesophageal reflux in children. Single centre
           experience in conventional and laparoscopic Nissen fundoplication in the
           last 15 years
    • Authors: Josué Eduardo Betancourth-Alvarenga; José Ignacio Garrido Pérez; Aurora Lucía Castillo Fernández; Francisco Javier Murcia Pascual; Miguel Ángel Cárdenas Elias; Álvaro Escassi Gil; Rosa María Paredes-Esteban
      Abstract: Publication date: Available online 3 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Josué Eduardo Betancourth-Alvarenga, José Ignacio Garrido Pérez, Aurora Lucía Castillo Fernández, Francisco Javier Murcia Pascual, Miguel Ángel Cárdenas Elias, Álvaro Escassi Gil, Rosa María Paredes-Esteban
      Introduction Nissen fundoplication (NF) is the most used and effective technique for the treatment of gastroesophageal reflux in children. The laparoscopic approach (LNF) is safe, with low morbidity and high success rate, although some cases require a conventional approach (CNF). The aim of the study is to compare the results between LNF and CNF in our centre. Material and methods A retrospective review was performed on patients <14 years after NF between 2000 and 2015. A comparison was made of the complications, hospital stay, and follow-up for both approaches. Results Of the total 75 NF performed, 49 (65.3%) were LNF, 23 (30.7%) CNF, and 3 (4.0%) reconversions. Concomitant laparoscopic gastrostomy was performed in 10.7%, and open gastrostomy in 5.3% of cases. Prior to NF, 10.7% had a gastrostomy. The mean age was 4 years and 68.7% were male. Of the diagnoses, 36% had encephalopathy, 14.7% hiatal hernia, 5.4% oesophageal atresia, and 5.4% an acute life-threatening event. No differences were found in operation time. More than two-thirds (36%) had complications, which were more frequent in the CNF (OR=3.30, 95% CI: 1.1–9.6). The hospital-stay decreased by 9 days in the LNF (95% CI: 5.5–13.5). Mean follow-up was 26 months (95% CI: 20.9–31.6). Mortality during follow-up was of 5.3% (5 respiratory failure, 1 sudden cardiac death, and 2 due to complications of the encephalopathy), 4.2% required re-fundoplication, 15.8% had symptomatic improvement, and 64.0% had absence of symptoms. Conclusions The LNF is an effective technique for the treatment of gastroesophageal reflux, with lower morbidity and shorter hospital stay than CNF. It is recommended as the first surgical option.

      PubDate: 2017-03-09T14:46:32Z
      DOI: 10.1016/j.anpede.2015.12.003
  • The latest in paediatric resuscitation recommendations
    • Authors: Jesús López-Herce; Antonio Rodríguez; Angel Carrillo; Nieves de Lucas; Custodio Calvo; Eva Civantos; Eva Suárez; Sara Pons; Ignacio Manrique
      Abstract: Publication date: Available online 1 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Jesús López-Herce, Antonio Rodríguez, Angel Carrillo, Nieves de Lucas, Custodio Calvo, Eva Civantos, Eva Suárez, Sara Pons, Ignacio Manrique
      Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support.

      PubDate: 2017-03-02T20:55:47Z
      DOI: 10.1016/j.anpede.2016.11.003
  • Emergency department consultations due to foreign body ingestion
    • Authors: Ana Lobeiras; Amaia Zugazabeitia; Nerea Uribarri; Santiago Mintegi
      Abstract: Publication date: Available online 1 March 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Ana Lobeiras, Amaia Zugazabeitia, Nerea Uribarri, Santiago Mintegi
      Introduction Foreign body (FB) ingestion is an uncommon reason for going to the Paediatric Emergency Department (PED). The aim of this study was to assess the clinical and epidemiological characteristics of foreign body ingestion and the management of these patients. Patients and methods Retrospective study, including children under 14 years old with suspected foreign body ingestion seen in the PED between 2010 and 2013. An analysis was made of the circumstances of the FB ingestion, its management in the PED, and patient outcomes. Results Of the 226.666 presentations recorded, 1.608 (0.7%) were for a FB, 970 corresponding to ingestion of mainly fish bones (367, 38.7%) and coins (181, 18.7%), except in children under 1 year (plastic objects). The median age was 4.7 years, with boys being more common in those older than 4 years (58.5%). A total of 557 patients (57.3%) reported some symptom, and complementary tests were performed in 414 (42.7%). Another specialist was called in 315 (32.4%) cases, mainly from Ear, Nose and Throat (fish bones) or Surgery (coins). The FB was removed in 305 (31.4%) cases, which were mostly fish bones or sunflower seeds. Seventy-one patients (7.3%) were admitted, especially ingestion of fish bones or coins. No patient died. Discussion Ingestion of fish bones or coins by young children is a relatively common presentation in the PED, and it is associated with frequent medical interventions. Although the overall prognosis is good, improving the health education of the population should be considered to reduce the frequency of these episodes.

      PubDate: 2017-03-02T20:55:47Z
      DOI: 10.1016/j.anpede.2015.11.014
  • High incidence of type 1 diabetes in the immigrant population of Osona and
           Baix Camp
    • Authors: Meritxell Torrabías-Rodas; Albert Feliu-Rovira; Ines Porcar-Cardona; Jacint Altimiras-Roset
      Abstract: Publication date: Available online 27 February 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Meritxell Torrabías-Rodas, Albert Feliu-Rovira, Ines Porcar-Cardona, Jacint Altimiras-Roset
      Introduction It has been postulated that migration could act as a modifying factor in the incidence of type 1 diabetes mellitus (T1DM), so the aim of this study is to determine if there are differences in the incidence of T1DM by origin. Material and methods Retrospective study of cases of T1DM onset in the population younger than 19 years old in Osona and Baix Camp between 2000 and 2012, using the medical histories of endocrinology units of the health centres and demographics from Catalonia Statistical Institute as sources. Results The child population in Osona and Baix Camp increased by 36.6%, with 18.9% in the local population, and 482% in the immigrant population, and most of this increase (90%) in the Maghreb immigrant group. A total of 118 diabetics onset were found, 66.9% in the local population, 32.2% Maghrebi population, and 0.9% in children from other countries, with a total incidence rate of 14.4 cases per 100,000 population/year (c/105p-y). The incidence is higher in the Maghrebi population compared to the local population, 37.1 vs 11.2 c/105p-y (P <.001), and in children under 5 years compared to the 5–18 years group, 18.9 vs 12.5 c/105p-y (P <.05), with no differences between sexes (P >.05). The relative risk is 3.1 for the Maghrebi population, and 1.5 for children under 5 years. Conclusions The total incidence of T1DM remains stable, but is higher in the Maghrebi than in the local population, and in children under 5 years compared to 5–18 years group. These results open a study field of which risk factors could be affecting this immigrant population in their destination countries.

      PubDate: 2017-03-02T20:55:47Z
      DOI: 10.1016/j.anpede.2015.10.027
  • In vitro activity of azithromycin in faecal isolates of Aeromonas
    • Authors: Jorge Jover-García; Virginia Pérez-Doñate; Javier Colomina-Rodríguez
      Abstract: Publication date: Available online 17 February 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Jorge Jover-García, Virginia Pérez-Doñate, Javier Colomina-Rodríguez

      PubDate: 2017-02-23T20:26:04Z
      DOI: 10.1016/j.anpede.2016.06.004
  • Enterovirus and neurological complications
    • Authors: Alfons Macaya; Ana Felipe-Rucián
      Abstract: Publication date: Available online 4 February 2017
      Source:Anales de Pediatría (English Edition)
      Author(s): Alfons Macaya, Ana Felipe-Rucián

      PubDate: 2017-02-04T23:49:12Z
      DOI: 10.1016/j.anpede.2017.01.001
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