Scielo RSS <![CDATA[Boletín médico del Hospital Infantil de México]]> http://www.scielo.org.mx/rss.php?pid=1665-114620140002&lang=en vol. 71 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>Towards improving the quality of care in newborns</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Epidemiology of accidental injuries in children</b>: <b>Review of international and national statistics</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200002&lng=en&nrm=iso&tlng=en Las lesiones accidentales continúan siendo un importante problema de salud pública en todo el mundo. La población pediátrica está predispuesta a accidentes, y en este grupo las consecuencias son generalmente más graves. Las estadísticas internacionales y nacionales muestran que la pobreza y el nivel socio-económico bajo juegan un papel importante en la morbimortalidad por accidentes. Es evidente la heterogeneidad en las tasas de lesiones por edad, sexo y área geográfica. Se requieren más estudios científicos que analicen la epidemiología de las lesiones en la población pediátrica. Los resultados podrían ser de ayuda en el planteamiento de nuevas políticas de prevención de accidentes.<hr/>Accidental injuries remain to be an important public health problem worldwide. The pediatric population is predisposed to accidents and consequences are usually more severe. International and national statistics show that poverty and low socioeconomic level play an important role in morbidity and mortality due to accidents. Disparities in injury rates according to age, sex and geographical location are evident. Epidemiology of injury in the pediatric population needs more scientific study; these results may help to establish new policies on prevention and approach of accidents. <![CDATA[<b>Evaluation of the quality of care of neonates with necrotizing enterocolitis affiliated with Seguro Popular in Mexico</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200003&lng=en&nrm=iso&tlng=en Background: In Mexico there is an important gap of information regarding the quality of care for neonates with necrotizing enterocolitis (NEC). This study aimed at evaluating the quality of care for neonates with NEC affiliated with the program Medical Insurance Century XXI (MIC-XXI), which is a branch of Seguro Popular. Methods: From December 2011 to March 2012, a cross-sectional study took place in 61 hospitals of the Ministry of Health located in 22 Mexican states. A set of 16 quality indicators based on a literature review served for the evaluation. Results: We reviewed 262 medical records of neonates with NEC. More than half were male and born by caesarean section; 55.8% were premature, 55.3% had low birth weight and 12.2% died. Regarding the quality of care, 72.5% were breastfed before being diagnosed with NEC. Most cases had abdominal radiography (90%), 75.0% had diagnosis of NEC according to Bell's criteria, but only 30% had reported symptoms that met the criteria for the recorded stage. Suspension of enteral feeding and administration of antibiotics reached 95.8% and 93.9%, respectively. Twenty six neonates underwent surgery, of which 34% had reported radiographic findings. Conclusion: A wide margin exists to improve the quality of care of neonates with NEC in Mexican Hospitals. <![CDATA[<b>Neutrophilia induced by histamine challenge in guinea pig</b>: <b>The role of IL-5, IL-10 and IL-17A, but not CXCL8</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200004&lng=en&nrm=iso&tlng=en Background: Histamine is widely used as a pharmacological tool for the evaluation of airway responsiveness. Nevertheless, undesirable and contradictory effects have been described after histamine provocation tests. In previous evaluations of airway responsiveness in a guinea pig asthma model, the control groups consistently showed high neutrophil counts in bronchoalveolar lavage fluid (BALF) immediately after the histamine challenge. The changes in cytokine and chemokine levels in guinea pig lung associated with histamine induced-neutrophilia are described in this paper. Methods: Immediately and 24 h after histamine challenge, airway wall and BALF eosinophil and neutrophil counts as well as lung cytokines (IL-5, IL-10, IL-17A, TNFα and TGFβ) and chemokines (CCL11 and CXCL8) levels were evaluated. Results: Histamine inhalation generated an all-or-none bronchial response, and the dose inducing airway obstruction was similar in all guinea pigs. Immediate increases in neutrophil counts in airway wall and BALF and in IL-5, IL-10 and IL-17A levels in the lung homogenate were observed after histamine challenge. Significant correlations were found between neutrophil counts from airway wall and IL-5, IL-10 and IL-17A levels in the lung homogenate. Conclusions: Histamine inhalation induced rapid neutrophil LBA and airway wall infiltration that was not associated with CXCL8 expression but with a Th2 and Th17 cytokines that probably are involved in the recruitment and activation of neutrophils. <![CDATA[<b>Relationship between body mass index and lipid profile in obese Mexican children and adolescents</b>: <b>A retrospective analysis</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200005&lng=en&nrm=iso&tlng=en Introducción: En México existen pocos datos referentes a la prevalencia de dislipidemia o de un perfil lipídico anormal en niños con obesidad, y su relación con el índice de masa corporal (IMC). El objetivo del estudio fue explorar esta asociación y los perfiles lipídicos más frecuentes en niños y adolescentes con obesidad. Métodos: Se realizaron mediciones antropométricas y bioquímicas en 289 niños entre 6 y 17 años de edad, y se estableció el grado de correlación de las variables lipídicas y el puntaje Z del IMC. Los pacientes se clasificaron de acuerdo con los perfiles lipídicos anormales; además, se determinó el más frecuente, y la diferencia en su frecuencia de acuerdo con el puntaje Z. Resultados: El puntaje Z del IMC demostró una correlación positiva con los niveles de colesterol total (CT) y colesterol de baja densidad (C-LDL) (r = 0.214, p <0.001 y r = 0.228, p <0.001, respectivamente). El perfil lipídico más frecuente fue el de colesterol de alta densidad bajo más hipertrigliceridemia (n= 128, 44.29%). Solamente el 16.26% de los niños fueron normolipémicos. Conclusiones: En niños con obesidad existe una correlación positiva entre el IMC y los niveles de CT y C-LDL. En estos niños, los perfiles lipídicos proaterogénicos comienzan en edades tempranas.<hr/>Background: In Mexico, data related to the prevalence of dyslipidemia or an abnormal lipid profile in obese children and its relation to body mass index (BMI) are scarce. The objective of this study is to explore this association and the most common lipid profiles in obese children and adolescents. Methods: Anthropometric and biochemical measurements were done on 289 children between the ages of 6 and 17 years, and the degree of correlation between lipid variables and BMI Z-score was established. Patients were classified according to abnormal lipid profiles. The most frequent profile was determined and the difference of their frequency according to Z-scores quartile. Results: Z-score showed a positive correlation with total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels (r = 0.214, p <0.001 and 0.228, p <0.001, respectively). The most frequent lipid profile was low high-density lipoprotein cholesterol plus hypertriglyceridemia (n = 128, 44.29%). Conclusions: In obese children there is a positive correlation between BMI and TC and LDL-C levels. In these children, proatherogenic lipid profiles begin early in life. <![CDATA[<b>Childhood anemia in Mexico</b>: <b>A public health problem at all socioeconomic levels</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200006&lng=en&nrm=iso&tlng=en Background: In Mexico, prevalence of anemia in children <5 years of age (preschool) is high at all socioeconomic levels. We undertook this study to analyze the socioeconomic determinants of the prevalence of anemia in preschool children and to explore the reasons why the prevalence is high, even in wealthier households. Methods: We used the National Survey of Health and Nutrition (ENSANUT) 2012 and calculated logistic regression models, considering as explanatory variables socioeconomic characteristics of children and mothers, among others. Models were estimated for all preschoolers and for each tercil of socioeconomic status. Results: The national prevalence of anemia in preschool children is 23.3%; in the lowest tertile it is 26.4%, whereas in the highest tertile it is 20.2%. Variables related to increased risk of anemia in the highest tertile are male children (OR: 1.24), those <2 years of age (OR: 2.31), stunting (OR: 2.01), and mother as the head of the household (OR: 2.06). Conclusions: Although anemia prevalence is higher at poorer socioeconomic levels, it remains high at all socioeconomic levels. Therefore, a general strategy is required to reduce the rate of childhood anemia rather than only the targeted efforts followed so far. Further research is needed. <![CDATA[<b>Lymphatic malformation of the lesser omentum</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200007&lng=en&nrm=iso&tlng=en Introducción: Las malformaciones linfáticas se originan a partir de malformaciones de los vasos linfáticos durante el periodo embrionario, lo que condiciona sus características histopatológicas, el calibre de los vasos que lo componen, así como el sitio donde se localizan. Caso clínico: Se presenta el caso de un paciente masculino de un año 2 meses de edad, quien se diagnostica con una malformación linfática localizada en el omento menor. Esta localización es una de las menos frecuentes en este grupo de malformaciones. Conclusiones: Se expuso el abordaje diagnóstico y la resolución quirúrgica de una malformación linfática del omento menor, con resección completa del mismo, sin recidivas ni complicaciones.<hr/>Introduction: Lymphatic malformations are caused by malformations of the lymphatic vessels during embryonic life, conditioning their histopathological characteristics, the caliber of the vessels that compose it, and the site where they are located. Case report: We report the case of a male patient of 1 year and 2 months old who was diagnosed with a lymphatic malformation located in the lesser omentum, this localization being one of the least frequent of this group of malformations. Conclusion: We describe the diagnostic approach and surgical resolution of a lesser omentum lymphatic malformation with its complete removal and without complications or recurrence. <![CDATA[<b>Acute lymphoblastic leukemia in maintenance phase with central nervous system relapse and extensive hemosiderosis</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200008&lng=en&nrm=iso&tlng=en Introducción: Las malformaciones linfáticas se originan a partir de malformaciones de los vasos linfáticos durante el periodo embrionario, lo que condiciona sus características histopatológicas, el calibre de los vasos que lo componen, así como el sitio donde se localizan. Caso clínico: Se presenta el caso de un paciente masculino de un año 2 meses de edad, quien se diagnostica con una malformación linfática localizada en el omento menor. Esta localización es una de las menos frecuentes en este grupo de malformaciones. Conclusiones: Se expuso el abordaje diagnóstico y la resolución quirúrgica de una malformación linfática del omento menor, con resección completa del mismo, sin recidivas ni complicaciones.<hr/>Introduction: Lymphatic malformations are caused by malformations of the lymphatic vessels during embryonic life, conditioning their histopathological characteristics, the caliber of the vessels that compose it, and the site where they are located. Case report: We report the case of a male patient of 1 year and 2 months old who was diagnosed with a lymphatic malformation located in the lesser omentum, this localization being one of the least frequent of this group of malformations. Conclusion: We describe the diagnostic approach and surgical resolution of a lesser omentum lymphatic malformation with its complete removal and without complications or recurrence. <![CDATA[<b>Impact of the Social Determinants of Health in children</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200009&lng=en&nrm=iso&tlng=en El impacto de los Determinantes Sociales de la Salud (DSS) en los niños requiere ser analizado. Al evaluar los DSS en países desarrollados se observan amplias diferencias que deben ser analizadas. México, comparado con los países de la Organización por la Co-operación y el Desarrollo Económico (OCDE), muestra bajas calificaciones en la mayoría de los indicadores de bienestar infantil. Si bien nuestra posición internacional ha mejorado, aún revela importantes deficiencias. Destaca el impacto que los DSS tienen tanto en los ámbitos rurales como en los urbanos, en los que existen áreas de oportunidad para mejorar las condiciones de los niños. En el contexto Latinoamericano y del Caribe también existen algunos países con mejor desempeño que el nuestro. En México existen importantes diferencias en varios indicadores de bienestar infantil entre las entidades federativas, como la proporción de comunidades rurales y urbanas, la situación de la población infantil con discapacidad, la composición de las familias, el ejercicio del derecho a la identidad, las condiciones propias de la salud, la educación, la pobreza, la vivienda, el trabajo infantil y la regulación y protección del Estado sobre estos derechos. Por lo anterior, México requiere reforzar todas aquellas acciones que permitan, en el menor tiempo posible, lograr resultados más cercanos a los estándares del resto de los países de la OCDE. Para ello es indispensable una firme, estrecha y simultánea colaboración entre los sectores públicos, que incidan en las deficiencias en educación, vivienda, seguridad y condiciones sanitarias de las localidades, entre otras.<hr/>The impact of the Social Determinants of Health (SDH) needs to be analyzed. Upon evaluating SDH in developed countries, we observed broad differences. Mexico, compared with countries belonging to the Organization for Cooperation and Economic Development (OCED), shows low ratings in many of the indicators for childhood well-being. On the positive side, our international position has improved as well as revealing significant deficiencies. Emphasis is placed on the impact of SDH on both rural and urban localities where there are areas of opportunity to improve the conditions of children. In the context of Latin American and the Caribbean, some countries demonstrate better performance than Mexico. In Mexico, important differences exist according to various indicators of childhood well-being in both rural and urban areas where there are still major shortcomings: the childhood population with disabilities, the family composition, the right to autonomy, the actual health conditions, education, poverty, housing, child labor and the regulation and protection of rights provided by the government. Therefore, Mexico requires strengthening of all actions within the shortest time possible in order to achieve standards equal to other OECD countries. Essential to this is a strong, close and simultaneous collaboration among the public sectors to impact on deficiencies in education, housing, safety and health conditions of the various localities, among others. <![CDATA[<b>Importance of public health focused on childhood and adolescence in Mexico</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462014000200010&lng=en&nrm=iso&tlng=en Los niños y niñas tienen derecho a la salud y a disfrutar su niñez de la mejor forma posible. Esta revisión tiene como objetivos mostrar los principios de la salud pública aplicables a la práctica pediátrica, describir los cambios demográficos y epidemiológicos en la niñez mexicana y el papel de los principales determinantes de la salud y de las herramientas modernas de la salud pública para este grupo de edad. El análisis de la información demográfica y epidemiológica disponible muestra la reducción de la mortalidad neonatal, infantil y, en el menor de un año, la prevalencia creciente de enfermedades crónicas y la persistencia de padecimientos infecciosos y nutricionales. Se describe la influencia de los determinantes sociales de la salud y las herramientas de salud pública, que consisten en la medición de necesidades y del estado de salud, la capacitación del personal, el diseño e implementación de mediciones del desempeño y el desarrollo de investigación multidisciplinaria. Se concluye que es indispensable tratar de mantener un paralelismo entre la dinámica demográfica y epidemiológica de este grupo de edad, sus necesidades de salud y la oferta de servicios de salud pública, con lo cual se puede contribuir a mejorar el estado de salud en los niños y mejorar sus probabilidades de crecer, desarrollarse y aprender, para que puedan convertirse en adultos sanos y productivos.<hr/>Children have the right to health and to enjoy their childhood in the best possible way. This paper aims to show the principles of public health that are applicable to pediatric practice. It describes demographic and epidemiological changes happening in Mexican children, the influence of social determinants of health and the modern tools of public health for this age group. Analysis of demographic and epidemiological information shows the reduction of neonatal and infant mortality, the increasing prevalence of chronic disease and the persistence of infectious and nutritional diseases. The influence of social determinants of health are described, and the public health tools that consist of measuring needs and health status, staff training, design and implementation of performance measures and development of multidisciplinary research were addressed. We conclude that it is essential for public health services to keep pace with the demographic and epidemiological dynamics and health needs of this age group. Improvement of the health status of children increases their chances to grow, develop and learn in order to become healthy and productive adults.