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Publisher: Elsevier   (Total: 3185 journals)

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Showing 1 - 200 of 3185 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 25, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 427, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 292, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 6, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 179, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 16, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 11, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 32, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 11)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 43, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 49, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 62, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 20, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 19, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 12, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 17)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 66)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 413, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 12, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 36, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 51, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 363, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 468, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 52, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 57, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 62, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 11)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 48)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 233, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 30, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 20, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 199, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 207, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Anales de Pediatría (English Edition)
Number of Followers: 0  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 2341-2879
Published by Elsevier Homepage  [3185 journals]
  • Insertion of a central venous reservoir using an exclusively ultrasound
           guided technique: Preliminary experience
    • Abstract: Publication date: Available online 7 July 2018Source: Anales de Pediatría (English Edition)Author(s): Ignacio Oulego-Erroz, Jose María Pradillos-Serna, Sara Fuentes-Carretero, Erick Ardela-Díaz
       
  • Haemophagocytic syndromes: the importance of early diagnosis and treatment
    • Abstract: Publication date: Available online 7 July 2018Source: Anales de Pediatría (English Edition)Author(s): Itziar Astigarraga, Luis I. Gonzalez-Granado, Luis M. Allende, Laia Alsina Haemophagocytic syndrome, or haemophagocytic lymphohistiocytosis (HLH), is a disorder with high mortality, typically recognised at paediatric age. Without proper treatment, HLH can be fatal. The risk of a rapid progression to multi-organ failure and central nervous system involvement leading to long-term sequelae are the most feared consequences of a diagnostic delay. Therefore, HLH is a medical emergency that paediatricians should be able to identify in a patient with fever and progressive worsening of general condition. The application of the HLH diagnostic criteria include clinical and analytical data (as well as a bone marrow aspirate) and the search for a trigger (infectious, oncological, rheumatological, or metabolic). These are decisive for the establishment of a targeted treatment, which aims at neutralising the trigger and reducing the hyper-inflammation. The most relevant data for general paediatricians are presented in this review, including the physiopathology, diagnosis, and treatment of this serious disease.ResumenEl síndrome hemofagocítico (SHF) o linfohistiocitosis hemofagocítica es una entidad con elevada mortalidad, típicamente reconocida en la edad pediátrica. Sin un correcto tratamiento, el SHF puede ser fatal: el riesgo de una rápida progresión a fallo multiorgánico y de afectación del sistema nervioso central con secuelas a largo plazo, son las consecuencias más graves de un retraso diagnóstico. Por lo tanto, el SHF es una urgencia médica que los pediatras deben saber identificar en un paciente con fiebre y afectación progresiva del estado general. La aplicación de los criterios diagnósticos de SHF, que consideran datos clínicos y analíticos (incluyendo un aspirado de médula ósea), y la búsqueda del factor desencadenante (infeccioso, oncológico, reumatológico, metabólico), son claves para poder instaurar un tratamiento dirigido, que neutralice el desencadenante y frene la hiperinflamación. En la presente revisión se exponen los datos más relevantes sobre la fisiopatología, diagnóstico y tratamiento de esta grave enfermedad para pediatras generales.
       
  • Statement by the Spanish Paediatric Association in relation to gender
           diversity in childhood and adolescence: Ethical and legal view from a
           multidisciplinary perspective
    • Abstract: Publication date: Available online 5 July 2018Source: Anales de Pediatría (English Edition)Author(s): Isolina Riaño Galán, Inés del Río Pastoriza, María Chueca Guindulain, Sabel Gabaldón Fraile, Federico de Montalvo Jääskeläinem An ethical and legal view of gender diversity in childhood and adolescence is presented from the perspective of the best interest of the child and the principle of protection against vulnerability. The identification of gender diversity in childhood and adolescence is a process that requires support, coordination and a multidisciplinary team that improves care and helps to obtain evidence that is lacking today. Secure, equitable and comprehensive access to care and health care should be guaranteed when required. It is necessary to promote a changing of social outlook, capable of overcoming the stereotypes that lead to discrimination and increase suffering. Respect for gender diversity in childhood and adolescence is a fundamental Human Right. The recognition of a positive value in diversity is an ethical imperative. All of this, without forgetting that we are talking about minors often in contexts of vulnerability, and currently very uncertain, so prudence is the main rule that should guide decision-making.ResumenSe realiza una mirada ética y jurídica de la diversidad de género en la infancia y la adolescencia desde la perspectiva del interés superior del menor y del principio de protección frente a la vulnerabilidad. La identificación de la diversidad de género en la infancia y la adolescencia es un proceso que además de acompañamiento exige coordinación y trabajo multidisciplinar que mejore la atención y ayude a obtener mayores evidencias que, a día de hoy, faltan. Se ha de garantizar el acceso seguro, equitativo e integral a cuidados y atención sanitaria en caso de que lo precisen. Es necesario promover un cambio de mirada social, capaz de superar los estereotipos que suponen discriminación y aumentan el sufrimiento. El respeto a la diversidad de género en la infancia y la adolescencia es un derecho humano fundamental. El reconocimiento de un valor positivo en la diversidad constituye un imperativo ético. Todo ello sin olvidar que hablamos de menores en contextos en muchas ocasiones de vulnerabilidad y actualmente de mucha incertidumbre, por lo que la prudencia es la regla principal que ha de guiar la toma de decisiones.
       
  • Evaluation of dysphagia. Results after one year of incorporating
           videofluoroscopy into its study
    • Abstract: Publication date: Available online 5 July 2018Source: Anales de Pediatría (English Edition)Author(s): Ruth García Romero, Ignacio Ros Arnal, María José Romea Montañés, José Antonio López Calahorra, Cristina Gutiérrez Alonso, Beatriz Izquierdo Hernández, Carlos Martín de Vicente IntroductionDysphagia is very common in children with neurological disabilities. These patients usually suffer from respiratory and nutritional problems. The videofluoroscopic swallowing study (VFSS) is the most recommended test to evaluate dysphagia, as it shows the real situation during swallowing.ObjectivesTo analyse the results obtained in our centre after one year of the implementation of VFSS, the clinical improvement after confirmation, and the prescription of an individualised treatment for the patients affected.Material and methodsVFSS performed in the previous were collected. The following variables were analysed: age, pathology, degree of neurological damage, oral and pharyngeal and/or oesophageal dysphagia and its severity, aspirations, prescribed treatment, and nutritional and respiratory improvement after diagnosis. A statistical analysis was performed using SPSS v21.ResultsA total of 61 VFSS were performed. Dysphagia was detected in more than 70%, being moderate-severe in 58%. Aspirations and/or penetrations were recorded in 59%, of which 50% were silent. Adapted diet was prescribed to 56%, and gastrostomy was performed on 13 (21%) patients. A statistical association was found between neurological disease and severity of dysphagia. The degree of motor impairment is related to the presence of aspirations. After VFSS evaluation and treatment adjustment, nutritional improvement was found in Z-score of weight (+0.3SD) and BMI (+0.4SD). There was respiratory improvement in 71% of patients with dysphagia being controlled in the Chest Diseases Department.ConclusionsAfter implementation of VFSS, a high percentage of patients were diagnosed and benefited from a correct diagnosis and treatment. VFSS is a fundamental diagnostic test that should be included in paediatric centres as a diagnostic method for children with suspected dysphagia.ResumenIntroducciónLa disfagia es muy frecuente en niños con discapacidad neurológica. Estos pacientes suelen presentar problemas respiratorios y nutricionales. El estudio de la deglución por videofluoroscopia (VFC) suele ser el más recomendado, ya que revela la situación real durante la deglución.ObjetivosEstudiar los resultados obtenidos en la evaluación diagnóstica tras un año desde la implantación de la VFC en nuestro centro, y analizar la mejoría clínica tras la confirmación por VFC y la prescripción de un tratamiento individualizado en los niños con disfagia orofaríngea.Material y métodosSe recogen las VFC realizadas en el último año. Se analizan las siguientes variables: edad, enfermedad, grado de afectación neurológica, tipo de disfagia (oral, faríngea y/o esofágica), gravedad, aspiraciones y/o penetraciones, tratamiento prescrito y mejora nutricional y/o respiratoria tras el diagnóstico. Se realiza análisis estadístico mediante SPSS v21.ResultadosSe realizaron 61 VFC. Se detectó disfagia en más del 70%, siendo moderadas-graves en el 58%. Se visualizaron aspiraciones y/o penetraciones en el 59%, siendo silentes el 50%. Se prescribió dieta adaptada al 56% y gastrostomía en 13 pacientes (21%). Se encontró asociación estadística entre enfermedad neurológica y la gravedad de la disfagia, existiendo relación según el grado de afectación motora y la presencia de aspiraciones. Tras la evaluación por VFC y la adecuación del tratamiento se encontró una mejoría nutricional en Z-score de peso (+0,3 DE) e IMC (+0,4 DE) y una mejoría respiratoria en un 71% de los pacientes disfágicos controlados en Neumología.ConclusionesTras la implantación de la VFC se ha diagnosticado a un alto porcentaje de pacientes, que se han beneficiado de un diagnóstico y un tratamiento correctos. La VFC es una prueba diagnóstica fundamental que debería ser incluida en los centros pediátricos, como método diagnóstico de los niños con sospecha disfagia.
       
  • Air pollution and children's health
    • Abstract: Publication date: Available online 3 July 2018Source: Anales de Pediatría (English Edition)Author(s): Juan Antonio Ortega-García, Manuel Sánchez-Solís, Josep Ferrís-Tortajada
       
  • The situation as regards diabetes mellitus type 1 in Andalusia. Care data,
           use of advanced therapies and human resources
    • Abstract: Publication date: Available online 3 July 2018Source: Anales de Pediatría (English Edition)Author(s): Juan Pedro López-Siguero, Olga Pérez-González, Ana Lucía Gómez-Gila, Isabel Leiva-Gea IntroductionThe representation of Spain in European epidemiological studies on diabetes is limited, with only one centre in the Hvidoere study and another in the SWEET study. No Spanish studies have been published that combine epidemiological data and care resources. The aim of this study was to determine the epidemiological data, care resources and use of new technologies in all Andalusian hospitals that care for children with diabetes mellitus type 1 (DM1) under 14 years.Material and methodsAn electronic questionnaire of 18 questions was sent to all paediatric endocrinologists who treated children with diabetes in Andalusian hospitals.ResultsThere was a mean of 3.12 (SD: 2.58) paediatric endocrinologist for every 100 patients, with a mean diabetes nurse educator ratio of 2.50 (SD: 3.94) per 100 patients and centre. Only 1 of the 29 centres had a psychologist, 9/29 had a day hospital and 11/29 had a 24-h telephone line. The mean of days of consultations exclusively for patients with DM1 was 1.56 days (SD: 1.21) per week. Continuous insulin infusion was used to treat 5% of patients, with a significant increase in centres with more than 150 patients.ConclusionsThis study offers, for the first time, current data on the epidemiological situation related to healthcare data, comparing them with the recommendations of European standards, highlighting a low ratio of endocrinologists and educators in diabetes, absence of psychologists and low technology penetrance.ResumenIntroducciónLa representación de nuestro país en los estudios epidemiológicos europeos en diabetes es exigua, tan solo un centro en el estudio Hvidoere y otro en el SWEET. No existen estudios publicados en España que combinen datos epidemiológicos y recursos asistenciales. El objetivo de este estudio es conocer los datos epidemiológicos, los recursos asistenciales y el uso de nuevas tecnologías en los hospitales andaluces que atienden a niños con diabetes mellitus tipo 1 (DM1) menores de 14 años.Material y métodosUn cuestionario electrónico de 18 preguntas fue enviado a los endocrinólogos pediátricos que atendían a niños con DM1 en todos los hospitales andaluces.ResultadosLa media de la ratio de endocrinólogo pediátrico por 100 pacientes fue 3,12 (DE: 2,58). La media de la ratio de enfermero educador en diabetes por 100 pacientes y centro fue de 2,50 (DE: 3,94). Solo uno de los 29 centros disponía de psicólogo, 9/29 disponían de hospital de día y 11/29 disponían de atención telefónica durante 24 h. La media de días de consulta a la semana destinados exclusivamente a pacientes con DM1 fue de 1,56 días (DE: 1,21). Un 5% de los pacientes fueron tratados con infusor continuo de insulina, con un aumento significativo en los centros que tenían más de 150 pacientes.ConclusionesEste estudio ofrece por primera vez datos actuales de la situación epidemiológica en Andalucía en relación con los datos asistenciales; comparándolos con las recomendaciones de estándares europeos, destaca una baja ratio de endocrinólogos y educadores en diabetes, ausencia de psicólogo y baja penetrancia de tecnología.
       
  • Validation study of an acute bronchiolitis severity scale to determine
           admission to a paediatric intensive care unit
    • Abstract: Publication date: Available online 3 July 2018Source: Anales de Pediatría (English Edition)Author(s): José Miguel Ramos-Fernández, Pedro Piñero-Domínguez, Pilar Abollo-López, David Moreno-Pérez, Ana María Cordón-Martínez, Guillermo Milano-Manso, Antonio Urda-Cardona IntroductionAt present, there are few validated scoring tests for assessing acute bronchiolitis (AB) severity, and limited information on their test power. The aim of the present study is to evaluate the validity of an acute bronchiolitis severity score (ABSS) to help in deciding PICU admission.Patients and methodProspective, descriptive, observational study of previously healthy infants under 1 year of age with AB, where the ABSS was used to compare severity as regards the need for PICU admission. The sample size was estimated as at least 175 patients. The research team was trained in the use of ABSS. All patients in the study were evaluated with ABSS daily, as well as in the case of clinical deterioration. The initial and maximum ABSS scores were contrasted to the need for PICU admission. A receiver operative curve was constructed, and the area under the curve was calculated, and the optimum point of sensitivity/specificity was estimated.ResultsThe study included a total of 190 patients (male/female: 58%/42%). PICU was required in 11 (6%). The mean ± SD ABSS-maximal score for patients who required and did not require PICU was 10.55 ± 1.12 and 6.35 ± 2.3, respectively (p 
       
  • Comparative genomic hybridisation as a first option in genetic diagnosis:
           1000 cases and a cost–benefit analysis
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): Neus Castells-Sarret, Anna M. Cueto-González, Mar Borregan, Fermina López-Grondona, Rosa Miró, Eduardo Tizzano, Alberto Plaja Background and objectiveConventional cytogenetics diagnoses 3–5% of patients with unexplained developmental delay/intellectual disability and/or multiple congenital anomalies. The Multiplex Ligation-dependent Probe Amplification increases diagnostic rates from between 2.4 and 5.8%. Currently the comparative genomic hybridisation array or aCGH is the highest performing diagnostic tool in patients with developmental delay/intellectual disability, congenital anomalies and autism spectrum disorders. Our aim is to evaluate the efficiency of the use of aCGH as first-line test in these and other indications (epilepsy, short stature).Patients and methodA total of 1000 patients referred due to one or more of the abovementioned disorders were analysed by aCGH.ResultsPathogenic genomic imbalances were detected in 14% of the cases, with a variable distribution of diagnosis according to the phenotypes: 18.9% of patients with developmental delay/intellectual disability; 13.7% of multiple congenital anomalies, 9.76% of psychiatric pathologies, 7.02% of patients with epilepsy, and 13.3% of patients with short stature. Within the multiple congenital anomalies, central nervous system abnormalities and congenital heart diseases accounted for 14.9% and 10.6% of diagnoses, respectively. Among the psychiatric disorders, patients with autism spectrum disorders accounted for 8.9% of the diagnoses.ConclusionsOur results demonstrate the effectiveness and efficiency of the use of aCGH as the first line test in genetic diagnosis of patients suspected of genomic imbalances, supporting its inclusion within the National Health System.ResumenFundamento y objetivoLa citogenética convencional detecta un 3-5% de los pacientes con retraso global del desarrollo/discapacidad intelectual y/o malformaciones congénitas. La amplificación de sondas múltiples dependientes de ligación permite incrementar la tasa diagnóstica entre 2,4-5,8%. Actualmente, los arrays de hibridación genómica comparada o aCGH son la herramienta diagnóstica con mayor rendimiento en estos pacientes, en malformaciones congénitas y trastornos del espectro autista. El objetivo del presente trabajo ha sido evaluar la eficiencia del uso del aCGH como técnica de primera línea diagnóstica en estas y otras indicaciones (epilepsia, talla baja).Pacientes y métodoSe ha estudiado a 1.000 pacientes afectados por las patologías mencionadas mediante la técnica de aCGH.ResultadosSe detectaron desequilibrios de efecto patogénico en un 14% de los pacientes (140/1.000). Según el fenotipo, se diagnosticaron un 18,9% de los pacientes afectados de retraso global del desarrollo/discapacidad intelectual; un 13,7% de las malformaciones congénitas; un 9,76% de las patologías psiquiátricas, un 7,02% de los casos con epilepsia y un 13,3% de los pacientes con talla baja. Dentro de las malformaciones congénitas destacan las del sistema nervioso central con un 14,9% y las cardiopatías congénitas con un 10,6% de diagnósticos. En las patologías psiquiátricas destacan los pacientes con trastornos del espectro autista, con un 8,9% de diagnósticos.ConclusionesNuestros resultados demuestran la efectividad y la eficiencia de la utilización del aCGH como test de primera línea en el diagnóstico genético de los pacientes con sospecha de desequilibrios genómicos. Todo ello avala su inclusión dentro del Sistema Nacional de Salud.
       
  • The human genome and medicine
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): Francesc Palau, Alfredo García-Alix
       
  • The Spanish Society of Paediatric Infectious Diseases guidelines on the
           
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): Fernando Baquero Artigao, Luis M. Prieto Tato, José Tomás Ramos Amador, Ana Alarcón Allen, María de la Calle, Marie Antoinette Frick, Ana Goncé Mellgren, María Isabel González Tomé, David Moreno Pérez, Antoni Noguera Julian Neonatal herpes simplex virus infections are rare, but are associated with significant morbidity and mortality. Most newborns acquire herpes simplex virus infection in the peripartum period. For peripartum transmission to occur, women must be shedding the virus in their genital tracts symptomatically or asymptomatically around the time of delivery. There are evidence-based interventions in pregnancy to prevent the transmission to the newborn. Caesarean section should be performed in the presence of herpetic lesions, and antiviral prophylaxis in the last weeks of pregnancy is recommended to suppress genital tract herpes simplex virus at the time of delivery. The diagnosis and early treatment of neonatal herpes simplex virus infections require a high index of suspicion, especially in the absence of skin lesions. It is recommended to rule out herpes simplex virus infections in those newborns with mucocutaneous lesions, central nervous system involvement, or septic appearance. The prognosis of newborns with skin, eye, and/or mouth disease in the high-dose acyclovir era is very good. Antiviral treatment not only improves mortality rates in disseminated and central nervous system disease, but also improves the rates of long-term neurodevelopmental impairment in the cases of disseminated disease. Interestingly, a 6-month suppressive course of oral acyclovir following the acute infection has improved the neurodevelopmental prognosis in patients with CNS involvement.ResumenLa infección herpética neonatal es una entidad muy poco frecuente pero que se asocia a una alta morbimortalidad. La mayor parte de los neonatos afectos adquieren la infección por virus herpes simplex en el periodo periparto. Para que ocurra esta transmisión es necesaria la excreción viral genital, con o sin síntomas, alrededor del momento del parto. Existen intervenciones basadas en la evidencia para prevenir la transmisión del virus herpes simplex al recién nacido. La realización de una cesárea en presencia de lesiones herpéticas, y la disminución de la excreción viral administrando en las últimas semanas del embarazo tratamiento antiviral a gestantes con herpes genital activo, son las mejores medidas preventivas de las que se dispone. El diagnóstico y tratamiento precoz del herpes neonatal requiere de un alto índice de sospecha, sobre todo en ausencia de lesiones cutáneas. Se recomienda descartar la infección por herpes neonatal en aquellos recién nacidos con lesiones cutaneomucosas, afectación del sistema nervioso central o cuadro séptico de origen no aclarado. El pronóstico de los neonatos con enfermedad cutánea en la era del aciclovir a dosis altas es excelente. El tratamiento antiviral disminuye la mortalidad de las formas diseminadas y con afectación exclusiva del sistema nervioso central, pero también mejora el pronóstico neurológico en los casos de enfermedad diseminada. De forma notable, la introducción del tratamiento supresor con aciclovir oral durante los meses siguientes a la infección aguda ha mejorado el pronóstico neurológico en los pacientes con afectación del sistema nervioso central.
       
  • Recommendations for the creation and operation of maternal milk banks in
           Spain
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): Javier Calvo, Nadia Raquel García Lara, María Gormaz, Manuela Peña, María José Martínez Lorenzo, Pilar Ortiz Murillo, Josep Maria Brull Sabaté, Carmen María Samaniego, Antoni Gayà It is widely agreed that the best source of nutrition for the newborn is the milk of their own mothers. In those cases where it is not available, especially in very premature and/or very low birth weight infants, as well as other sick newborns, the preferred choice before formula is human milk provided by selected donors. This indication is supported by the highest international bodies dedicated to the health of the child population, including the World Health Organisation as well as the main national and international scientific societies in the field of Paediatrics.Milk banks are health institutions responsible for the collection, processing and distribution of donated human milk. Currently, there are 14 human milk banks operating in Spain, grouped in the Spanish Association of Human Milk Banks, created in September 2008.In order to homogenise the criteria and to unify the working methods of the different milk banks, the Spanish Association of Human Milk Banks has developed standards to harmonise the protocols, and to serve as a guide for the start-up of new milk banks in the Spanish territory. These standards, set out in the present article, range from the donor selection and the evaluation process to the collection, processing, storage, and distribution of donor human milk.ResumenLa mejor alimentación para un recién nacido es la leche de su propia madre. En aquellos casos en los que esta no está disponible, especialmente en los recién nacidos muy prematuros o de muy bajo peso al nacer, así como en otros recién nacidos enfermos, el alimento de elección es la leche materna de donantes seleccionadas, antes que la fórmula artificial. Esta indicación está respaldada por los máximos organismos internacionales dedicados a la salud de la población infantil, como la Organización Mundial de la Salud, así como las principales sociedades científicas nacionales e internacionales en el ámbito de la Pediatría.Los bancos de leche surgen como instituciones sanitarias responsables de la gestión de las donaciones, del procesamiento y de la distribución de leche materna donada. Actualmente existen 14 bancos de leche materna en España, agrupados en la Asociación Española de Bancos de Leche Humana, creada en septiembre de 2008.Con el fin de homogeneizar los criterios y unificar los métodos de trabajo, la Asociación Española de Bancos de Leche Humana ha elaborado unos estándares para armonizar los protocolos de los diferentes bancos y para que sirvan de guía para la puesta en marcha de nuevos bancos de leche en el territorio español. Dichos estándares, presentados en este artículo, abarcan desde el proceso de selección y evaluación de la donante hasta la recogida, el procesamiento, el almacenamiento y la distribución de leche materna de donante.
       
  • Phenotype variability in thirteen 16p11.2 deletion patients
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): Diana Rodà, Elisabeth Gabau, Neus Baena, Miriam Guitart
       
  • Pseudoachondroplasia: Descriptions of a de novo and familial case
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): Dídac Casas-Alba, Anna Fernández López, Esther Gean Molins, Patricia Suero Toledano, Antonio Martínez-Monseny
       
  • Clinical and genetic heterogeneity of congenital hyperinsulinism
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): Juncal Reguera Bernardino, Ignacio Oulego Erroz, Jorge Martínez Sáenz de Jubera, Rocío Quiroga González, Laura Regueras Santos
       
  • Spanish translation and validation of the EMPATHIC-30 questionnaire to
           measure parental satisfaction in intensive care units
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): Francisco Javier Pilar Orive, Jasone Basabe Lozano, Aurora López Zuñiga, Yolanda M. López Fernández, Julene Escudero Argaluza, Jos M. Latour IntroductionFew validated surveys measuring parental satisfaction in the Paediatric Intensive Care Unit (PICU) are available, and none of them in Spanish language. The aim of this study is to translate and validate the questionnaire EMpowerment of PArents in THe Intensive Care (EMPATHIC). This questionnaire measures parental perceptions of paediatric intensive care-related satisfaction items in the Spanish language.Material and methodsA prospective cohort study was carried out using questionnaires completed by relatives of children (range 0–17 years old) admitted into a tertiary PICU. Inclusion criteria were a length of stay more than 24 h, and a suitable understanding of Spanish language by parents or guardians. Exclusion criteria were re-admissions and deceased patients. The questionnaire was translated from English to Spanish language using a standardised procedure, after which it was used in a cross-sectional observational study in order to confirm its validity and consistency. Reliability was estimated using Cronbach's α, and content validity using Spearman's correlation analysis.ResultsA total of 150 questionnaires were collected. A Cronbach's α was obtained for domains greater than 0.7, showing a high internal consistency from the questionnaire. Validity was measured by correlating 5 domains with 4 general satisfaction items, documenting an adequate correlation (Rs: 0.41–0.66, p 
       
  • Prevalence of breastfeeding and factors associated with the start and
           duration of exclusive breastfeeding in the Community of Madrid among
           participants in the ELOIN
    • Abstract: Publication date: July 2018Source: Anales de Pediatría (English Edition), Volume 89, Issue 1Author(s): María D. Ramiro González, Honorato Ortiz Marrón, Celina Arana Cañedo-Argüelles, María Jesús Esparza Olcina, Olga Cortés Rico, María Terol Claramonte, María Ordobás Gavín IntroductionBreastfeeding has important benefits for population health. The aims of this study are: (i) to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (ii) analyse the reasons for not starting or abandoning of breastfeeding, and (iii) describe the factors associated with the initiation and duration of exclusive breastfeeding.Material and methodsCross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2627 children born in 2008–2009 from the Community of Madrid was studied. Logistic regression models were used.ResultsPrevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6 months 25.4%, and prevalence of breastfeeding at 2 years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35 years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop.ConclusionsBreastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008–2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring.ResumenIntroducciónLa lactancia materna tiene importantes beneficios para la salud poblacional. Los objetivos de este estudio son: a) conocer la prevalencia y duración de la lactancia materna y lactancia materna exclusiva; b) analizar las razones de no inicio y de abandono de la lactancia materna, y c) describir los factores asociados a la lactancia materna exclusiva y con su mantenimiento durante 6 meses.Material y métodosEstudio transversal a partir de datos basales de la cohorte ELOIN, obtenidos por cuestionario epidemiológico. Se estudió una muestra de 2.627 niños de 4 años nacidos en 2008-2009 de la Comunidad de Madrid. Se utilizaron modelos de regresión logística.ResultadosLa prevalencia de lactancia materna exclusiva y lactancia materna fue del 77,6 y del 88%, respectivamente; la lactancia materna exclusiva a los 6 meses fue del 25,4%, y la lactancia materna a los 2 años, del 7,7%. Las razones principales de finalización de la lactancia fueron la producción insuficiente de leche (36%) y la incorporación al trabajo (25,9%). Las variables asociadas con el inicio o mantenimiento de la lactancia materna exclusiva fueron: madre de más de 35 años, estatus económico medio-alto, extranjera con menos de 10 años de residencia en España y haber participado en taller de lactancia tras el parto.ConclusionesLa prevalencia de lactancia materna en la Comunidad de Madrid no alcanzó en 2008-2009 las recomendaciones internacionales. Es necesario intensificar estrategias de promoción, protección y apoyo a la lactancia materna, incluyendo su monitorización periódica.
       
  • A comparison of post-surgical plasma glucose levels in patients on fluids
           with different glucose concentrations
    • Abstract: Publication date: Available online 30 June 2018Source: Anales de Pediatría (English Edition)Author(s): Isabel Martínez Carapeto, José Domingo López Castilla, Reyes Fresneda Gutiérrez ObjectiveTo compare plasma glucose levels and incidence of hyperglycaemia in the post-operative period after general surgery using fluids with different glucose.MethodologyA randomised, open-label, non-blind, clinical trial was conducted on patients admitted to Paediatric Intensive Care Unit after elective surgery. The inclusion criteria were from 6 months to 14 years of age, with a weight greater than 6 kg, onset glucose level> 60 mg/dL, and a signed informed consent, with no oral intake and maintenance intravenous fluid therapy using fluids with 3.3% or 5% glucose. Plasma glucose levels were measured before surgery, on admission, and 8, 24, and 48 h, with the mean glucose levels and incidence of hyperglycaemia (glucose level> 150 mg/dL) in both groups being compared.ResultsA total of 60 patients received glucose/saline 1/3 (51 mEq/L sodium and 33 g/L glucose), and 70 glucose/saline 5/0.9% (154 mEq/L sodium and 50 g/L glucose). Mean glucose levels were higher in the group receiving glucose 5%, with no statistical difference. There was no significant difference in the incidence of hyperglycaemia; 8 h: 26% in the 3.3% group vs. 21.3% in the 5% group (P = .63); 24 h: 20% vs. 22.7% (P = .8); and 48 h: 19% vs. 23.1% (P = .78).ConclusionsThe use of fluids with 3.3% glucose in the post-operative period of general surgery maintains mean glucose levels in a similar range to that of patients receiving fluids with 5% glucose, with no difference in the incidence of hyperglycaemia.ResumenObjetivoComparar los niveles de glucemia e incidencia de hiperglucemia en el postoperatorio de cirugía general usando sueros con diferente concentración de glucosa.MetodologíaEnsayo clínico aleatorizado, abierto, no ciego, en pacientes no diabéticos, que ingresan en Cuidados Intensivos Pediátricos tras cirugía electiva, de 6 meses a 14 años, peso superior a 6 kg, glucemia >60 mg/dl y firma de consentimiento informado, manteniéndose a dieta con sueroterapia de mantenimiento intravenosa mediante suero con glucosa al 3,3 o 5%. Se determinan niveles de glucemia preoperatoria, al ingreso, y a las 8, 24 y 48 h, comparando los valores medios y la incidencia de hiperglucemia (glucemia> 150 mg/dl) en ambos grupos.ResultadosUn total de 60 pacientes recibieron suero glucosalino 1/3 (51 mEq/l de sodio y 33 g/l de glucosa) y 70 pacientes suero glucosalino 5/0,9% (154 mEq/l de sodio y 50 g/l de glucosa). La glucemia media fue mayor en el grupo al 5%, sin diferencia estadística. No hubo diferencia en la incidencia de hiperglucemia; 8 h: 26% del grupo 3,3% vs. 21,3% del grupo 5% (p = 0,63); 24 h: 20% vs. 22,7% (p = 0,8); 48 h: 19% vs. 23,1% (p = 0,78).ConclusionesEn el postoperatorio de cirugía general, el uso de soluciones glucosadas al 3,3% consigue niveles de glucemia similares a los detectados en pacientes que reciben suero con glucosa 5%, con una incidencia de hiperglucemia similar.
       
  • Haemophagocytic syndrome secondary to endocarditis due to Bartonella
           henselae
    • Abstract: Publication date: Available online 30 June 2018Source: Anales de Pediatría (English Edition)Author(s): Esmeralda Núñez Cuadros, Ana Cabrera del Moral, Jose Manuel Jiménez Hinojosa, Isabel Leiva Gea, Lourdes Conejo Muñoz
       
  • A first step to teaching basic life support in schools: Training the
           teachers
    • Abstract: Publication date: Available online 30 June 2018Source: Anales de Pediatría (English Edition)Author(s): María Pichel López, Santiago Martínez-Isasi, Roberto Barcala-Furelos, Felipe Fernández-Méndez, David Vázquez Santamariña, Luis Sánchez-Santos, Antonio Rodríguez-Nuñez, en nombre del Grupo de trabajo Proyecto ANXOS IntroductionTeachers may have an essential role in basic life support (BLS) training in schoolchildren. However, few data are available about their BLS learning abilities.AimTo quantitatively assess the quality of BLS when performed by school teachers after a brief and simple training program.Materials and methodsA quasi-experimental study with no control group and involving primary and secondary education teachers from four privately managed and public funded schools was conducted in three stages: (1) a knowledge test, (2) BLS training, and (3) performance test. Training included a 40-min lecture and 80-min hands-on session with the help of feedback on the quality of the chest compressions.ResultsA total of 81 teachers were included, of which 60.5% were women. After training, the percentage of subjects able to perform the BLS sequence rose from 1.2 to 46% (p 
       
  • Ventilation during cardiopulmonary resuscitation in the infant. Mouth to
           mouth and nose, or bag-valve-mask' A quasi-experimental study
    • Abstract: Publication date: Available online 23 June 2018Source: Anales de Pediatría (English Edition)Author(s): Myriam Santos-Folgar, Martín Otero-Agra, Felipe Fernández-Méndez, María Teresa Hermo-Gonzalo, Roberto Barcala-Furelos, Antonio Rodríguez-Núñez IntroductionIt has been observed that health professionals have difficulty performing quality cardiopulmonary resuscitation (CPR). The aim of this study was to compare the quality of ventilations performed by Nursing students on an infant model using different methods (mouth-to-mouth-and-nose or bag-valve-mask).Material and methodsA quasi-experimental cross-sectional study was performed that included 46 second-year Nursing students. Two quantitative 4-min tests of paediatric CPR were performed: (a) mouth-to-mouth-and-nose ventilations, and (b) ventilations with bag-valve-mask. A Resusci Baby QCPR Wireless SkillReporter® mannequin from Laerdal was used. The proportion of ventilations with adequate, excessive, and insufficient volume was recorded and analysed, as well as the overall quality of the CPR (ventilations and chest compressions).ResultsThe students were able to give a higher number of ventilations with adequate volume using the mouth-to-mouth-and-nose method (55 ± 22%) than with the bag-valve-mask (28 ± 16%, p 
       
  • Pregnancy in adolescents in the last 11 years. Reasons for consulting and
           risk factors
    • Abstract: Publication date: Available online 20 June 2018Source: Anales de Pediatría (English Edition)Author(s): Laura María Palomino Pérez, Esther Pérez Suárez, Marta Cabrero Hernández, Ana de la Cruz Benito, Gustavo Cañedo
       
  • Severe diarrhoea due to autoimmune enteropathy: Treatment and outcomes
    • Abstract: Publication date: June 2018Source: Anales de Pediatría (English Edition), Volume 88, Issue 6Author(s): Carmen Lázaro de Lucas, Laura Tesouro Rodríguez, Lorena Nélida Magallares García, Eva Martínez-Ojinaga Nodal, Esther Ramos Boluda
       
  • Spanish collaborative study: Description of usual clinical practice in
           infant obesity
    • Abstract: Publication date: June 2018Source: Anales de Pediatría (English Edition), Volume 88, Issue 6Author(s): Alfonso Lechuga Sancho, Enrique Palomo Atance, María José Rivero Martin, Mercedes Gil-Campos, Rosaura Leis Trabazo, María Pilar Bahíllo Curieses, Gloria Bueno Lozano, on behalf of the Working Group on Obesity of the Spanish Society of Endocrinology IntroductionChildhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines.Material and methodsAn observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of “Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity” issued by the Spanish Ministry of Health.ResultsA total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used.ConclusionsThere are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition.ResumenIntroducciónLa obesidad infantil es un problema de salud de alta prevalencia. Aunque existen guías clínicas para su manejo, la variabilidad en su abordaje clínico es un hecho. El objetivo de este estudio es describir la práctica clínica habitual en unidades de Endocrinología Pediátrica y evaluar su adecuación a la guía recomendada.Material y métodosSe realizó un estudio observacional, transversal y descriptivo mediante encuesta a endocrinólogos infantiles de la Sociedad Española de Endocrinología Pediátrica. Las preguntas fueron formuladas en base a las recomendaciones de la «Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantojuvenil» del Ministerio de Sanidad español.ResultadosSe obtuvieron 125 encuestas de todas la Comunidades Autónomas. Se observó variabilidad en el número de pacientes atendidos al mes y en la frecuencia de las visitas. El 70% de los encuestados no dispone de un nutricionista ni de psicólogo o psiquiatra al que derivar los pacientes. En el tratamiento, las medidas dietéticas son las más empleadas; un 69% nunca ha prescrito fármacos para perder peso. De los que prescriben, el 52,6% no utilizan el consentimiento informado como paso previo a su empleo.ConclusionesPocos centros cumplen las recomendaciones de la Guía de Práctica Clínica sobre la Prevención y el Tratamiento de la Obesidad Infantil en un plan de calidad establecido. La práctica clínica difiere mucho entre los endocrinólogos pediátricos encuestados, sin existir protocolos unificados de actuación, y con escasa disponibilidad de recursos para el tratamiento integral que precisa esta enfermedad.
       
  • Influence of demographic changes on the number of visits to hospital
           emergency departments: 13 years’ experience
    • Abstract: Publication date: June 2018Source: Anales de Pediatría (English Edition), Volume 88, Issue 6Author(s): José Lorenzo Guerra Diez, Luis Gaite Pindado, Cristina Álvarez Álvarez, María Teresa Leonardo Cabello, Lino Álvarez Granda, María Jesús Cabero Pérez ObjectiveThe aim of the present study is to describe the trend in volume and age-specific rates in visits to the paediatric emergency department of a university teaching hospital in Cantabria (Spain) from January 2001 to December 2013, and evaluate the influence of population growth on emergency department use.Material and methodsA retrospective study was conducted to analyze all emergency department visits over a 13 year period. Simple and polynomial linear regressions were used to assess the relationship between population size and emergency department attendance rates across 2 age groups (0–2 and 3–14 years).ResultsFrom 2001 to 2013, attendance in the emergency department increased by 14.1%, whereas the paediatric population rose by 26.3%. Rates of presentation per head of population were greatest among those aged
       
  • A new year of AEP. What has happened with innovation, research and the
           merger, and with independence, leadership and the next generation'
    • Abstract: Publication date: June 2018Source: Anales de Pediatría (English Edition), Volume 88, Issue 6Author(s): María José Mellado
       
  • Anales+de+Pediatría+editors+annual+report&rft.title=Anales+de+Pediatría+(English+Edition)&rft.issn=2341-2879&rft.date=&rft.volume=">The Anales de Pediatría editors
           annual report
    • Abstract: Publication date: June 2018Source: Anales de Pediatría (English Edition), Volume 88, Issue 6Author(s): Corsino Rey, Laia Alsina, Montserrat Antón, Alfredo Cano, Gonzalo Solís
       
  • Hypophosphatasia: Clinical manifestations, diagnostic recommendations and
           therapeutic options
    • Abstract: Publication date: June 2018Source: Anales de Pediatría (English Edition), Volume 88, Issue 6Author(s): Gabriel Ángel Martos-Moreno, Joan Calzada, María L. Couce, Jesús Argente Hypophosphatasia is a very rare bone metabolism disorder caused by a deficiency in alkaline phosphatase activity, due to mutations in the ALPL gene. Its clinical hallmark is the impairment of skeletal and tooth mineralization, although extra-skeletal manifestations are frequent. Its phenotypic spectrum is widely variable from a subtype with exclusive odontological impairment (odontohypophosphatasia) to five subtypes with systemic involvement, classified according to the age at the onset of the first symptoms (four of them in the paediatric age range: perinatal lethal, perinatal benign, infant and childhood hypophosphatasia). Those subtypes of hypophosphatasia with an earliest onset usually involve a worse prognosis, due to the risk of developing potentially lethal complications, such as seizures or severe respiratory insufficiency, secondary to rib cage malformations. Due to the extremely low prevalence of the severe forms of hypophosphatasia, its clinical variability and overlapping phenotypic features with several more prevalent conditions, the diagnosis of hypophosphatasia in the clinical setting is challenging. However, its potential lethality and impact on the patient's quality of life, along with the recent availability of an enzyme replacement therapy, increases the relevance of the early and accurate identification of patients affected with hypophosphatasia. On the basis of published evidence and clinical experience, this article suggests an algorithm with practical recommendations for the differential diagnosis of childhood hypophosphatasia, as well as an updated review of current therapeutic options.ResumenLa hipofosfatasia es una enfermedad ultra-rara del metabolismo mineral óseo causada por un déficit de actividad de la fosfatasa alcalina, debido a la existencia de mutaciones en el gen ALPL. Clínicamente, se caracteriza por el desarrollo de hipomineralización esquelética y dental, junto con la frecuente aparición de manifestaciones extraesqueléticas. Su espectro fenotípico es muy variable y engloba una forma de afectación exclusivamente odontológica (odontohipofosfatasia) y 5 subtipos de afectación sistémica diferenciados según el momento de inicio de los síntomas (4 de los cuales se desarrollan en la edad pediátrica: formas perinatal letal, perinatal benigna, del lactante e infanto-juvenil). Las formas de inicio más precoz presentan, generalmente, peor pronóstico, debido a la posibilidad de desarrollar complicaciones potencialmente letales, como la dificultad respiratoria grave por malformaciones torácicas o la presencia de convulsiones. Debido a la baja prevalencia de las formas graves de la enfermedad, y a su variabilidad y solapamiento fenotípico con otras patologías más prevalentes, el diagnóstico de la hipofosfastasia en la práctica clínica constituye un reto. No obstante, su potencial gravedad e impacto sobre la calidad de vida de los pacientes, así como la reciente disponibilidad de un tratamiento de reemplazo enzimático específico, confieren particular relevancia a la correcta identificación de los pacientes afectos de hipofosfatasia. A partir de la evidencia publicada y la experiencia clínica, en el presente artículo se propone un algoritmo con recomendaciones prácticas para el diagnóstico diferencial de la hipofosfatasia en niños, así como una revisión actualizada de las opciones de tratamiento existentes.
       
  • Paracetamol: Useful treatment of choice for persistent arterial duct in
           very low weight premature newborns
    • Abstract: Publication date: June 2018Source: Anales de Pediatría (English Edition), Volume 88, Issue 6Author(s): Raquel Gálvez Criado, Silvia Rodríguez Blanco, Ignacio Oulego Erroz, Aquilina Jiménez González, Paula Alonso Quintela
       
  • Hematemesis as debut of eosinophilic gastroenteritis in infants
    • Abstract: Publication date: June 2018Source: Anales de Pediatría (English Edition), Volume 88, Issue 6Author(s): María Soriano-Ramos, Enrique Salcedo Lobato, Yolanda Rodríguez Gil, Enrique Medina Benítez, Pedro Urruzuno Tellería
       
  • Cow's milk protein intolerance imitating septic shock in a young infant
    • Abstract: Publication date: Available online 20 April 2018Source: Anales de Pediatría (English Edition)Author(s): Sylvia Jacob, Artur Bonito Vitor
       
  • Prevalence and prognostic value of non-thyroidal illness syndrome among
           critically ill children
    • Abstract: Publication date: Available online 14 April 2018Source: Anales de Pediatría (English Edition)Author(s): Sohair Sayed Abu El-Ella, Muhammad Said El-Mekkawy, Mohamed Abdelrahman El-Dihemey IntroductionAlterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, paediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children.Materials and methodsA prospective observational study conducted on 70 critically ill children admitted into paediatric intensive care unit (PICU). Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24 h of PICU admission. Primary outcome was 30-day mortality.ResultsNTIS occurred in 62.9% of patients but it took several forms. The commonest pattern was low FT3 with normal FT4 and TSH (25.7% of patients). Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P = .028). NTIS independently predicted mortality (OR = 3.91; 95% CI = 1.006–15.19; P = .0491). Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR = 16.9; 95% CI = 1.40–203.04; P = .026). TSH was negatively correlated with length of PICU stay (rs = —0.35, P = .011). FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1 ± 0.66 versus 2.76 ± 0.91 pg/mL, P = .011).ConclusionNTIS is common among critically ill children and appears to be associated with mortality and illness severity.ResumenIntroducciónSe ha sugerido que las alteraciones en las hormonas tiroideas ocurridas en pacientes con enfermedad crítica, fenómeno conocido como síndrome del enfermo eutiroideo (SEE), pueden tener valor pronóstico. No obstante, los datos en población pediátrica son escasos. El objetivo del estudio fue evaluar la prevalencia y el valor pronóstico del SEE en niños críticos.Materiales y métodosEstudio prospectivo observacional en 70 niños críticos ingresados en la unidad de cuidados intensivos pediátricos (UCIP). Se determinaron los niveles de triyodotironina libre (T3L), tiroxina libre (T4L) y tirotropina (TSH) en las primeras 24 horas de ingreso. La variable de resultado principal fue la mortalidad a los 30 días.ResultadosSe observó SEE en el 62,9% de los pacientes, aunque adoptó formas diversas. El patrón más frecuente fue un nivel bajo de T3L con niveles normales de T4L y TSH (25,7% de los pacientes). La combinación de valores bajos de T3L, T4L, y TSH ocurrió en el 7,1% de los pacientes. Hubo un hallazgo inusual de TSH elevada en 3 pacientes que podría estar asociado a la gravedad de la enfermedad. Los valores bajos de T4L se observaron con una frecuencia significativamente mayor en pacientes fallecidos en comparación con supervivientes (50% versus 19,2%, p = 0,028). El SEE predijo la mortalidad de manera independiente (OR = 3,91; IC 95% = 10,06–15,19; p = 0,0491). La combinación de niveles bajos de T3L, T4L, y TSH fue el mejor factor pronóstico independiente de mortalidad (OR = 16,9; IC 95% = 1,40–203,04; p = 0,026). Se observó una correlación negativa entre la TSH y la duración de la estancia en la UCIP (rs = —0,35; p = 0,011). El valor de T3L fue significativamente menor en pacientes tratados con perfusión de dopamina, comparados con pacientes que no la recibieron (2,1 ± 0,66 versus 2,76 ± 0,91 pg/ml, p = 0,011).ConclusiónEl SEE es común en niños críticos y parece estar asociado a la mortalidad y la gravedad de la enfermedad.
       
  • Attitudes towards cow's milk protein allergy management by Spanish
           gastroenterologist
    • Abstract: Publication date: Available online 2 March 2018Source: Anales de Pediatría (English Edition)Author(s): Alicia Isabel Pascual Pérez, Alejandra Méndez Sánchez, Óscar Segarra Cantón, Beatriz Espin Jaime, Santiago Jiménez Treviño, Carlos Bousoño García, Juan José Díaz Martín IntroductionFood allergy is an increasing health problem in the developed world. Cow's milk protein is the main cause of food allergy in infants. Without an appropriate diagnostic workup, there is a high risk of both over- and underdiagnosis and therefore, over and undertreatment. The objective of our study was to analyze the variability in cow's milk protein allergy (CMPA) management by pediatric gastroenterologists in Spain.MethodsA 50 item questionnaire, including open and closed items in a Likert's scale from 0 to 5, was drafted and distributed through the Spanish Society for Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) e-mail list.ResultsSeventy-three questionnaires were received back out of 321. Only 3 of the items achieved concordance greater than 90%. Thirty-three percent considered oral challenge to be necessary for the diagnosis of CMPA under any circumstance. Twenty-five percent considered that symptom improvement after cow's milk removal was enough for the diagnosis. Oral challenge was performed at home by 83.5% in non-IgE mediated cases. Extensively hydrolyzed casein formulas were the treatment of choice for 69.9%. Soy formulas were the last option. Almost all respondents were aware of the existence of clinical guidelines on CMPA, being European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines the most followed (64.4%). Twenty-three percent considered that their knowledge about allergy was inadequate.ConclusionsAlthough CMPA is a prevalent condition that pediatric gastroenterologists have been treating for decades, we found a huge variability on its management. There is potential for improvement in this field among pediatric gastroenterologist in the future.ResumenIntroducciónLa alergia alimentaria es un problema creciente, siendo la proteína de leche de vaca la principal causa en niños. Sin un proceso diagnóstico adecuado, existe un elevado riesgo de sobrediagnóstico e infradiagnóstico y, por lo tanto, de sobretratamiento e infratratamiento. El objetivo de nuestro estudio fue analizar la variabilidad en el manejo de la alergia a proteína de leche de vaca (APLV) por los gastroenterólogos pediátricos españoles.MétodosSe envió un cuestionario de 50 preguntas a través de la lista de email de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátricas.ResultadosRecibimos 73 cuestionarios de los 321 enviados. Solo 3 de las respuestas lograron más del 90% de acuerdo. El 33% considera que la provocación oral es necesaria para el diagnóstico de APLV siempre. El 25% considera que la mejoría clínica tras la retirada de las proteínas de leche de vaca es suficiente para el diagnóstico. La provocación oral es realizada en domicilio por el 83,5% de los encuestados en APLV no IgE mediada. Los hidrolizados extensos de caseína son el tratamiento de elección (69,9%). Las fórmulas de soja, la última opción. Casi todos los encuestados conocían la existencia de guías de manejo de APLV, siendo las de la Sociedad Europea de Gastroenterología, Hepatología y Nutrición Pediátrica las más utilizadas (64,4%). El 23% considera que su conocimiento sobre alergia es inadecuado.ConclusionesAunque la APLV es una patología prevalente que los gastroenterólogos pediátricos llevan décadas tratando, hemos encontrado una gran variabilidad en su manejo. Existe posibilidad de mejora en este campo en el futuro.
       
  • Five cases of aplasia cutis congenita
    • Abstract: Publication date: Available online 16 February 2018Source: Anales de Pediatría (English Edition)Author(s): Sónia Almeida, Filipa Rodrigues, Sónia Coelho, Maria Adelaide Bicho
       
  • Pubertal growth of 1,453 healthy children according to age at pubertal
           growth spurt onset. The Barcelona longitudinal growth study
    • Abstract: Publication date: Available online 16 February 2018Source: Anales de Pediatría (English Edition)Author(s): Antonio Carrascosa, Diego Yeste, Antonio Moreno-Galdó, Miquel Gussinyé, Ángel Ferrández, María Clemente, Mónica Fernández-Cancio IntroductionPubertal growth pattern differs according to age at pubertal growth spurt onset which occurs over a five years period (girls: 8–13 years, boys: 10–15 years). The need for more than one pubertal reference pattern has been proposed. We aimed to obtain five 1-year-age-interval pubertal patterns.Subjects and methodsLongitudinal (6 years of age-adult height) growth study of 1,453 healthy children to evaluate height-for-age, growth velocity-for-age and weight-for-age values. According to age at pubertal growth spurt onset girls were considered: very-early matures (8–9 years, n = 119), early matures (9–10 years, n = 157), intermediate matures (10–11 years, n = 238), late matures (11–12 years, n = 127) and very-late matures (12–13 years, n = 102), and boys: very-early matures (10–11 years, n = 110), early matures (11–12 years, n = 139), intermediate matures (12–13 years, n = 225), late matures (13–14 years, n = 133) and very-late matures (14–15 years, n = 103). Age at menarche and growth up to adult height were recorded.ResultsIn both sexes, statistically-significant (p 
       
 
 
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