Revista Chilena de Pediatria-Chile最新文献

{"title":"El niño con estridor persistente","authors":"Andrés Alvo","doi":"10.32641/rchped.v91i6.2115","DOIUrl":"https://doi.org/10.32641/rchped.v91i6.2115","url":null,"abstract":"El estridor es un ruido respiratorio anormal generado por obstrucción o colapso de la vía aérea laringotraqueal, de manera aguda o de evolución crónica. Existen distintas causas tanto congénitas como adquiridas capaces de producir dificultad respiratoria, que puede llegar a ser grave y con potencial riesgo vital. El diagnóstico clínico del paciente con estridor persistente debe ser complementado con un estudio endoscópico de la vía aérea y en ocasiones con imágenes, para intentar determinar el o los sitios comprometidos y posibles malformaciones asociadas. La indicación de tratamiento debe ser individualizada, considerando el estado general del paciente, las etiologías responsables, el impacto sobre la respiración y la deglución, el pronóstico y la capacidad técnica del equipo tratante, entre otras. Las alternativas pueden incluir observación, medidas no farmacológicas, medicamentos locales o sistémicos, procedimientos endoscópicos, cirugías abiertas, o bien la instalación de una traqueostomía de manera temporal o como manejo definitivo. El objetivo de esta revisión es entregar un adecuado conocimiento de la fisiopatología y la etiopatogenia del estridor pediátrico persistente, fundamental para el correcto manejo de estos pacientes complejos, que debiera realizarse idealmente en un contexto multidisciplinario.","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47442781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnóstico y manejo de Himen Imperforado en una lactante menor","authors":"G. Sanhueza, S Carolina Pastene, D Francisco Saitua, T Isabel Fuentealba, F. Romero, O. Muñoz","doi":"10.32641/rchped.v91i4.1313","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.1313","url":null,"abstract":"Imperforated hymen is the most frequent congenital malformation of the female genital tract. Most cases are not investigated in childhood, due to an insufficient genital examination. Its diagnosis and resolution must be early and definitive to avoid subsequent complications. Objective: A clinical case of an infant with imperforated himen is presented. To update on genital examination technique necessary to detect this pathology in the newborn and infants, and the proper treatment. Clinical Case : 3-months-old infant that consulted due to an increase in bulging volume in the introitus area. In the physical examination, the Valsalva’s maneuver was performed allowed the expulsion of a homogeneous pearly mass with a smooth surface, between the labia majora, suggesting imperforate hymen. The study was complemented with gynecological ultrasound, which demonstrated the presence of hydrocolpos, ruling out other anomalies. A hymenotomy was performed, which allowed for the evacuation of abundant serous material, with no bad smell, and then the hymenectomy was completed by resection of the hymenal membrane. In follow-up monitoring 4 months after the intervention, a widely permeable hymen was found. Conclusion: Neonatal care teams require training on the correct technique of external genital examination of the newborn and infant. Hymenectomy is the technique that allows definitely resolving the condition, avoiding complications.","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":"91 1","pages":"579-583"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49191473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percepción del equipo de salud sobre los beneficios del calostro como factor protector de enterocolitis necrotizante en recién nacidos prematuros","authors":"Juan Pablo Rojas Beytía, José Cariaga Irarrázabal, Francisca Castro Guerrero, Paula Domingo Carrasco, Keila Fernández Pérez, Ivette Pavez Ortiz, Nicole Ghislaine Iturrieta Guaita, Anamaría Silva Dreyer","doi":"10.32641/rchped.v91i4.1522","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.1522","url":null,"abstract":"La incidencia de enterocolitis necrotizante (ECN), en Chile es de 0,3 a 2,4 por mil recién nacidos vivos, siendo principalmente afectados los neonatos prematuros, y de 8 a 12 por ciento en prematuros menores a 1.500 gramos.Objetivo: Describir la percepción de profesionales de salud sobre el uso de calostro en recién nacidos prematuros, como factor protector de enterocolitis necrotizante.Sujetos y Método: Estudio cualitativo, mediante entrevista semiestructurada a 18 profesionales de la salud en tres hospitales públicos de la región de Valparaíso. La pauta de entrevista incluyó 3 temas: Conocimientos, percepción del suministro temprano de calostro y opinión acerca de la extensión de la medida, y 6 subtemas, 2 para cada tema respectivamente: Autopercepción del nivel de conocimiento y fuentes de información; Experiencia: aspectos positivos/eventos adversos y opinión del calostro como factor protector de enterocolitis; aspectos facilitadores u obstaculizadores y opinión acerca de la medida como política nacional. Procesamiento de datos mediante análisis de contenido cualitativo, temático.Resultados: El uso de calostro en prematuros se da de modo protocolizado en dos de las tres unidades de alta complejidad neonatal de la región de Valparaíso. Los participantes opinan positivamente acerca de los resultados preventivos de esta medida. Aun cuando en un tercer establecimiento no se aplique, hay una percepción favorable acerca de su potencial beneficio y su bajo costo de implementación. Se señala, no obstante, que ésta requiere de mayor evidencia y de un protocolo de aplicación. Otras limitantes serían la insuficiente dotación y formación del personal, y la necesidad de adquirir equipamiento e insumos.Conclusiones: Profesionales que han aplicado un protocolo de administración de calostro en neonatos prematuros en la Región de Valparaíso, reportan buenos resultados de salud, y promueven la motivación del equipo hacia esta praxis. Sin embargo, se considera relevante la difusión y discusión de protocolos nacionales e internacionales, así como el desarrollo de investigación local. Dadas las experiencias en curso en Chile, y el debate internacional, se considera oportuno que el tema sea abordado y discutido en la comunidad sanitaria nacional.","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44269036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desenlace de los pacientes pediátricos con falla medular tratados en un centro de alta complejidad","authors":"Diego Medina Valencia, Mayra Estacio, Ana Clarete, S. Timaran, Eliana Manzi, Estefanía Beltrán Gomez, A. Franco","doi":"10.32641/rchped.v91i4.1579","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.1579","url":null,"abstract":"Bone marrow failure (BMF) syndromes are rare disorders with an annual incidence of 2-4 cases per million. Treatment options include immunosuppressive therapy (IST) and hematopoietic stem cell transplantation (HSCT). Objective: To analyze the outcomes of pediatric patients diagnosed with BMF treated in a tertiary care center. Patients and Method: Retrospective study of pediatric patients diagnosed with BMF who consulted at Fundacion Valle de Lili, Cali. Descriptive statistical analysis was performed according to Acquired BMF (ABMF) and Inherited BMF (IBMF). The outcomes include treatment, complications, overall survival (OS) in transplant patients, calculated using the KaplanMeier method. Results: We included 24 patients with BMF, average age 6.5 ± 4 years, and 50% were women. 58% presented IBMF, 9 with Fanconi anemia (FA), 2 dyskeratosis congenita, 2 congenital amegakaryocytic thrombocytopenia, and 1 presented Diamond-Blackfan anemia. 12 patients treated with HSCT had a 5-year OS of 83%. ABMF represented 42%. 6 patients received IST-HSCT, 3 received IST, and 1 received HSCT. The OS of the IST-HSCT group was 86%. Six patients died, four of them related to infection. Conclusions: In this series, there was a higher number of cases with IBMF. The OS of patients treated with HSCT is similar to that reported in recent studies. The most frequent cause of death was of infectious origin which has also been previously reported. The treatment established in the patients showed favorable results in a Latin American tertiary care center.","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":"91 1","pages":"545-552"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69965503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nistagmo secundario a albinismo con compromiso ocular en paciente femenina","authors":"L. Schonhaut B, Joanna Britzmann L., Mario Zanolli S., Jovanka Pavlov N., Trinidad Hasbun Z., Gabriela Repetto L.","doi":"10.32641/rchped.v91i4.1240","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.1240","url":null,"abstract":"El nistagmo infantil es infrecuente y representa un desafío diagnóstico para el pediatra. El albinismo es una de sus principales causas, siendo difícil de sospechar en ausencia de compromiso cutáneo evidente, especialmente en pacientes femeninas, debido a que tipo de herencia del albinismo ocular.Objetivo: Describir un caso de nistagmo secundario a albinismo con compromiso ocular aislado en paciente femenina, para discutir el enfoque diagnóstico pediátrico.Caso Clínico: Paciente femenino de 3 semanas de vida, sin antecedentes mórbidos, derivada a neuropediatra y oftalmólogo por movimientos oculares paroxísticos desde las 2 semanas, con estudio con electroencefalograma e imágenes cerebrales normales. A los 3 meses se confirmó translucencia iridiana, nistagmo y astigmatismo hipermetrópico. La valuación dermatológica descartó compromiso cutáneo. Evolucionó con inclinación cefálica hacia abajo y retraso del desarrollo de la coordinación, fue manejada con lentes de corrección y kinesioterapia. A los 3 años, destacaba mejoría de la agudeza visual, disminución del nistagmo y neurodesarrollo normal. La evaluación oftalmológica de ambos padres fue normal y no había antecedentes de nistagmo o albinismo en la familia. Por decisión de los padres no se realizó estudio genético.Conclusión: El diagnóstico de nistagmo secundario a compromiso ocular del albinismo, aún en ausencia de afección cutánea, es clínico; el estudio genético permite confirmar la etiología, sin ser un examen imprescindible, a menos que se considere la planificación familiar. La pesquisa oportuna e intervención multidisciplinaria determinan un mejor pronóstico.","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46220281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compromiso neurológico en infección por COVID-19 en pacientes pediátricos","authors":"S. Quiroz, O. C. Amarales","doi":"10.32641/rchped.v91i4.2526","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.2526","url":null,"abstract":"La enfermedad por coronavirus ha extendido su compromiso más allá del sistema respiratorio con reportes crecientes de compromiso en diferentes sistemas, uno de ellos, el Sistema Nervioso. El potencial neuroinvasivo de este agente patógeno se explicaría por su neurotropismo dada la presencia de receptores de ACE2 a nivel de encéfalo y médula espinal, además del importante compromiso inflamatorio sistémico. El compromiso neurológico debido a la infección se ha dividido en Sistema Nervioso Central, destacando síntomas inespecíficos y leves como mareos y cefalea, así como cuadros graves con encefalitis y patología cerebrovascular, y Sistema Nervioso Periférico en donde la mayor relevancia guarda relación con la anosmia, ageusia y miositis. A nivel pediátrico el compromiso parece ser menor que en adultos, pero existe un reporte creciente en la literatura respecto a estos hallazgos. Es de gran importancia de contar con un adecuado registro y anamnesis que permita identificar precozmente el compromiso neurológico.","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48770841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respuesta a la prueba de caminata de seis minutos en niños con riesgo cardiovascular","authors":"Daniel Ciudad, Ester Arellano, P. Díaz, R. Donoso, Yocelin Rival, V. Rojas, N. Sánchez, Marcelo Cano-Capellacci","doi":"10.32641/rchped.v91i4.1634","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.1634","url":null,"abstract":"Introduction: Cardiovascular risk (CVR) is defined as the possibility of a subject suffering from cardiovascular disease within a certain period. Although the pathology appears in adult life, the physiopathological changes start to develop at an early age. Objective: To establish the relationship between cardiorespiratory capacity (CRC)and CVR in children with metabolic syndrome. Patients and Methods: We analyzed data corresponding to 42 children aged from 5 to 15 years who were seen at the Children’s Cardiology Unit of the Carlos Van Buren Hospital between 2015 and 2017. Each participant was categorized according to the Alustiza’s CVR score, which defines 3 levels of risk: low (0 to 6 points), medium (7 to 8 points) and high (9 or more points), which representing a greater probability of developing cardiovascular disease, and performed 6MWT. Results: The mean age of the children was 10.9 ± 2.7 years, body mass index (BMI) = 31.0 ± 4.6 kg/m2 (z-score 3.2 ± 0.7), percentage of theoretical distance walked = 75.2 ± 8.9, and percentage of heart rate reserve (HRR) = 31.0 ± 9.4. There was no statistical association between 6MWT and CVR. Conclusions: There is no relationship between the cardiorespiratory capacity and the CVR. The use of the 6MWT is questioned as an instrument to assess CVR in the population under study.","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":"91 1","pages":"561-567"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69965552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vacuna BCG, Inmunodeficiencias Primarias e Inmunodeficiencia Combinada Severa","authors":"Comité Asesor en Vacunas Y Estrategias de Vacunación","doi":"10.32641/rchped.v91i4.2140","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.2140","url":null,"abstract":"","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47317846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uso racional de antibióticos y tecnología FilmArray para identificación rápida de bacteriemias en unidad de cuidados intensivos pediátrica","authors":"Liliana Mazzillo Vega, Nancy Cabrera Bravo","doi":"10.32641/rchped.v91i4.1458","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.1458","url":null,"abstract":"Severe infections are the leading cause of admission to pediatric intensive care. The FilmArray BCID panel quickly identifies microorganisms that cause bacteremia. Objective: To evaluate if the rapid identification of the microorganisms that cause bacteremia, along with a Rational Use of Antibiotics (RUA) Program, allows optimizing the time of antibiotic therapy in a pediatric hospital. Patients and Method: Retrospective study which included 100 patients presenting their first episode of bacteremia, divided into 2 groups of 50 each. The first one was Intervention (FilmArray BCID and RUA program) and the second one was Historical Controls (conventional automated ID/AST). The variables evaluated were the time required for microbial identification, duration of appropriate therapy, and antibiotic de-escalation. Results: The groups were comparable in terms of demographic characteristics, focus of infection, and etiology of bacteremia. The average time of microorganisms’ identification of the control group was 70.5 hours (IC 95% 65.2-78.6) and 23.0 hours (IC 95% 12.4- 26.7) in the intervention one (p 0.05). Conclusion: The FilmArray panel along with the RUA Program allows the identification of the microorganisms causing bacteremia faster than conventional methods, which positions it as a tool that optimizes antibiotic therapy of critical patients.","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69965436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pearson Winsorizado: un coeficiente robusto para las correlaciones con muestras pequeñas","authors":"José Ventura-León","doi":"10.32641/rchped.v91i4.2300","DOIUrl":"https://doi.org/10.32641/rchped.v91i4.2300","url":null,"abstract":"","PeriodicalId":46023,"journal":{"name":"Revista Chilena de Pediatria-Chile","volume":"91 1","pages":"642-643"},"PeriodicalIF":0.0,"publicationDate":"2020-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69965580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}