Scielo RSS <![CDATA[Boletín médico del Hospital Infantil de México]]> http://www.scielo.org.mx/rss.php?pid=1665-114620100004&lang=es vol. 67 num. 4 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>Algunos factores determinantes de la investigación médica en un hospital de niños</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Deber profesional de obtener el asentimiento del niño para participar como sujeto de investigación</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400002&lng=es&nrm=iso&tlng=es Por largo tiempo se ha incluido a niños en investigaciones biomédicas. En un principio, sin considerar sus propios derechos como seres humanos y sujetos a la conciencia del investigador, aun cuando se tratase de ensayos experimentales. Con el paso del tiempo y desde la segunda mitad del siglo XX, se alzaron voces para promover un marco legal jurídico suficiente que brindara protección legal al menor de edad y limitara su inclusión en la investigación o, en su caso, brindarles la mayor protección con los mayores beneficios y los menores riesgos relacionados con ésta. En nuestro país, sabemos que los investigadores y comités de ética en los hospitales solicitan, en general, el consentimiento informado del paciente para aceptar participar en una investigación. Se desconoce cuántos solicitan el asentimiento del menor. El presente artículo pretende recalcar la necesidad de contemplar la figura del asentimiento en todo menor de edad mentalmente capaz de entender y, en su caso, aceptar participar en una investigación.<hr/>For a long time, many children have been included in biomedical investigations without first being mindful of their rights as human beings and depending only on the ethics of the investigator, although many were experimental studies. Over time and from the second half of the 20th century, many considerations have been made to promote legal protection for the child, attempting to conduct investigational studies with the maximum benefits and minimum risks to the minor. In Mexico, investigators and ethics committees of hospitals require informed consent to participate in a research study. However, we do not know how many investigators actually request assent for participation from minors. This article focuses on the need to ask mentally capable minors to assent to participate in an investigational study. <![CDATA[<b>Asociación entre prematuridad, bajo peso al nacer y lactancia materna exclusiva con rinitis alérgica, en niños de 2 a 7 años que acuden al <i>Hospital Nacional Cayetano Heredia</i>, Perú</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400003&lng=es&nrm=iso&tlng=es Introducción. La asociación entre factores perinatales para el desarrollo de rinitis alérgica es controversial. El objetivo de este trabajo es determinar la asociación entre prematuridad, bajo peso al nacer y lactancia materna exclusiva con rinitis alérgica, en pacientes pediátricos que acuden al Hospital Nacional Cayetano Heredia (HNCH). Métodos. Es un estudio tipo caso-control. Se realizó un cuestionario mediante entrevista directa a los padres para encontrar síntomas de rinitis alérgica, clasificando a los niños como casos y controles. El tamaño de la muestra fue de 366 niños, 122 casos y 244 controles (a= 5%; b= 20%). Se consignaron también los antecedentes de peso al nacer, edad de gestación y lactancia materna exclusiva con los padres; la información se corroboró con la historia clínica de los pacientes y la cartilla de control de crecimiento y desarrollo. Resultados. Ingresaron 369 niños de 2 a 7 años que acudieron a consulta externa de pediatría del Hospital Nacional Cayetano Heredia, entre agosto del 2006 y junio de 2007; de estos, 156 cumplieron con los criterios de caso y 213 cumplieron con los criterios de controles. Se encontró una razón de momios (RM) de 0.53 (IC 95%, 0.35, 0.80, P=0.0025) para la asociación entre rinitis alérgica y lactancia materna exclusiva. La razón de momios para rinitis alérgica y bajo peso al nacer fue de 0.55 (IC 95%, 0.27, 1.12, P=0.0658) y para rinitis alérgica y prematuridad fue de 1.20 (IC 95%, 0.67, 2.17, P=0.5414). Se realizó, además, el análisis estratificado para la relación entre rinitis alérgica y lactancia materna exclusiva con las variables de antecedente de atopia familiar y de exposición temprana a humo de tabaco, se utilizó como prueba estadística la prueba de Mantel-Haenszel. Se encontró una razón de momios Mantel-Haenszel de 0.52 (IC 95%, 0.33, 0.78, P=0.0025) para la asociación entre rinitis alérgica y lactancia materna exclusiva con el antecedente de atopia familiar; y una razón de momios Mantel-Haenszel de 0.56 (IC 95%, 0.36, 0.84, P=0.0064) para la asociación entre rinitis alérgica y lactancia materna exclusiva con el antecedente de exposición temprana a humo de tabaco. Conclusión. Nuestros resultados apoyan un efecto protector para rinitis alérgica en niños que reciben lactancia materna exclusiva; no se encontró asociación entre prematuridad y bajo peso al nacer con rinitis alérgica. Esta asociación protectora no se ve alterada por los antecedentes de atopia familiar ni de exposición temprana al humo del tabaco.<hr/>Background. The association among perinatal factors for the development of allergic rhinitis is controversial. The aim of this study was to determine the association among prematurity, low birth weight, and exclusive breastfeeding with allergic rhinitis in pediatric patients from the Hospital Nacional Cayetano Heredia (HNCH). Methods. We carried out a case-control study with a sample size of 366 children (122 cases and 244 controls) (a = 5%; b = 20%). A questionnaire was completed through direct interview with the parents to assess allergic rhinitis symptoms in order to classify the children as cases or controls. Previous medical history such as birth weight, gestational age and exclusive breastfeeding were entered and verified with the clinical chart of the patients as well as with the growth and development chart. Results. There were 369 children included in the study aged 2 to 7 years. They were seen as outpatients at the Pediatric Service at HNCH between August 2006 and June 2007. Of these children, 156 met the criteria for cases and 213 were identified as controls. An odds ratio (OR) of 0.53 was found (95% CI 0.35-0.80, p = 0.0025) for the association between allergic rhinitis and exclusive breastfeeding. Also, an OR of 0.55 (95% CI 0.27-1.12, p = 0.0658) was found for allergic rhinitis and low birth weight and an odds ratio of 1.20 (95% CI 0.67-2.17, p = 0.5414) was found for allergic rhinitis and prematurity. A stratified analysis was executed to evaluate the relationship between allergic rhinitis and exclusive breastfeeding with a family history of atopy and early environmental tobacco smoke exposure. Mantel-Haenszel statistical test was used for this purpose: OR of 0.52 was found (95% CI, 0.33-0.78, p = 0.0025) for the association between allergic rhinitis and exclusive breastfeeding with family history of atopy. Mantel-Haenszel odds ratio of 0.56 (95% CI 0.36-0.84, p = 0.0064) was found for the association between allergic rhinitis and exclusive breastfeeding with early environmental tobacco smoke exposure. Conclusions. Our results support a protective effect for allergic rhinitis in children who receive exclusive breastfeeding. We did not find any association between prematurity and low birth weight with the subsequent development of allergic rhinitis. The previously described protective effect is seemingly not altered by family history of atopy or early exposure to environmental tobacco smoke. <![CDATA[<b>Setting priorities for pediatric research: an exercise for the research agenda of the <i>Hospital Infantil de Mexico Federico Gomez</i></b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400004&lng=es&nrm=iso&tlng=es Background. There is a clear understanding of the need to establish the principles that should underlie health research to meet the goals of health care systems. The aim of this study was to conduct an exercise of priority setting for health research and to analyze the congruence between the perceived priorities and the primary causes of hospital care at Hospital Infantil de Mexico Federico Gomez (HIMFG). Methods. A cross-sectional survey was conducted with investigators affiliated with the HIMFG through a semi-structured and self-applied questionnaire. A technique of priority setting developed by the World Health Organization was used for the exercise. Concurrently, the analysis included the ongoing research projects at HIMFG and their relative position according to the list of the main causes of mortality, hospital discharges, ambulatory consultations, number of published scientific papers and funding. Results. Of 104 invited researchers, 55 responded to the questionnaire; 43.7% belonged to the National System of Investigators (SNI). Most research studies were within the biomedical area followed by clinical trials. The top research priorities were infectious and parasitic diseases. The main causes of hospital care were chronic conditions such as cancer and congenital malformations. We observed moderate congruence between health research priorities and the epidemiology of the hospital. Conclusion. It is possible to carry out institutional priority settings for health research. The priorities set by the investigators were partially in accordance with the actual provision of care; however, further activities to gain the commitment of researchers to participate and to include other interested parties are necessary to strengthen this exercise. <![CDATA[<b>Condiciones asociadas a la mortalidad neonatal específica en < 1000 g, en el <i>Hospital de Gineco-Obstetricia N° 23</i>, periodo 2005-2006</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400005&lng=es&nrm=iso&tlng=es Introducción. La mortalidad en pacientes <1000 g de peso ha disminuido de 90% a 55%, desde 1970 al 2000, pero se han incrementado las secuelas y la estancia intrahospitalaria. Métodos. Para conocer las causas de mortalidad en neonatos de <1000 g, se revisaron certificados y registros hospitalarios y para cuantificar se usaron tasas, medidas de dispersión y proporciones. Resultados. En el periodo de agosto-2005 a julio-2006 nacieron 18, 952 pacientes; 152 (0.8%) eran de <1000 g de peso. De estos pacientes fallecieron 98 (64.4%), 54 masculinos y 44 femeninos (1.2:1). El peso promedio fue de 760 g y la edad gestacional promedio fue de 26 semanas (22 a 35). El Apgar al minuto fue de 4-5 en promedio y 6-7 a los 5 minutos. Las causas de defunción fueron inmadurez en 28/98 casos (28%), hemorragia intracraneana (HIC) 22/98 (22%), sepsis 17/98 (17%), hemorragia pulmonar 9/98 (9%) y falla orgánica múltiple 3/98 (3%). Conclusiones. Se observó 64% de mortalidad en pacientes de <1000 g de peso. Las causas de muerte fueron: inmadurez, HIC y sepsis; la mitad de las muertes ocurrieron en las primeras 48 horas de vida.<hr/>Background. Mortality in neonates <1 000 g has decreased since the 1970s until now from 90% to 55%, but neurological sequelae and hospital stay have increased. We undertook this study in order to determine the prevalence and etiology of mortality in neonates <1 000 g in an Ob-Gyn Unit of the IMSS. Methods. Causes of death in neonates weighing <1 000 g were obtained from hospital registries using dispersion, rates and proportions. Results. During a 1-year period, 18 952 neonates were born; 152 (0.8%) weighed <1 000 g and 98(64%) did not survive. There were 54 (55.1%) males and 44 (44.9%) females (1.2:1). The mean weight was 760 g, and mean gestational age was 26 weeks (range: 22-35 weeks). The principal causes of deaths were immaturity in 28/98 cases (28%), intracranial hemorrhage (ICH) in 22/98 (22%), sepsis in 17/98 (17%), pulmonary hemorrhage in 9/98 (9%) and multiple organ failure in 3/98 (3%). Conclusion. Mortality in neonates with very low birth weight (VLBW, <1 000 g) was 64%. Immaturity, ICH and sepsis were the main causes of death. Half of these deaths occurred during the first 48 h of life. <![CDATA[<b>Tendencias del consumo y precio promedio ponderado sobre los costos de los medicamentos anti-infecciosos en un hospital pediátrico</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400006&lng=es&nrm=iso&tlng=es Introducción. Se evalúa la tendencia de consumo, precio promedio ponderado (PPP) y costo total, así como la influencia del consumo y PPP sobre los costos totales, en los subgrupos de medicamentos (dosis diaria definida/100 días-cama) antibacterianos, antimicóticos, antimicobacterianos y antivirales de 2005 a 2007. Métodos. De la base de datos de la farmacia del hospital, se calcularon, para cada medicamento, su consumo, PPP y costo total de los cuatro subgrupos terapéuticos. El análisis estadístico fue regresión lineal múltiple y coeficiente de correlación de Spearman. Resultados. El subgrupo con mayor consumo y costo fue el de antibacterianos, y el de mayor precio ponderado el de los antivirales. Se identificó que el consumo y los precios ponderados influyeron significativamente en los costos totales. El cambio por cada unidad de consumo y de precio ponderado produjo un incremento de $190,893.8 USD (IC95% 118,196.1-263,591.6) y de $3,050.4 USD (IC95% 1,912.5-4,188.3), respectivamente. Conclusiones. El aumento porcentual progresivo del costo de los antiinfecciosos en comparación con el total de grupos terapéuticos del hospital fue consecuencia del consumo y de los PPP. El análisis estadístico empleado y el uso de las variaciones porcentuales permitieron identificar, por subgrupos terapéuticos, el efecto que los consumos y los PPP tienen sobre los costos totales. El análisis individual de los medicamentos de alto costo también permitió interpretar algunos comportamientos; por lo que se recomienda efectuar este tipo de evaluaciones para identificar las diversas variables que influyen en los costos.<hr/>Background. We undertook this study to evaluate the tendency of the consumption (defined as daily doses/100 bed-days), the weighted average price (WAP) and the total cost of antibacterials, antimycotics, antimycobacterials and antiviral subgroups from 2005 to 2007, as well as the influence of the consumption and the WAP on the total costs. Methods. We used the database of the hospital pharmacy in order to calculate consumption, WAP and total cost of each drug for therapeutic subgroups. Multiple linear regression and Spearman correlation coefficient were used for statistical analyses. Results. The antibacterial subgroup showed the highest consumption and the total cost. The antiviral subgroup showed the highest WAP. Consumption and WAP had a significant influence on the total costs. The change by each unit of consumption and WAP produced an increase of 190,893.8 USD (95% CI 118,196.1-263,591.6) and 3,050.4 USD (95% CI 1,912.5-4,188.3), respectively. Conclusion. The progressive percentage increase of the total cost of anti-infective drugs in comparison with the total cost of hospital's therapeutic subgroups was due to the consumption and WAP. Statistical analysis and percentage of variations can identify the effect of consumption and WAP on total costs according to therapeutic subgroups. The analysis of high-cost drugs allows interpretation of some behaviors. Therefore, it is recommended to carry out these types of evaluations so as to identify the different variables that can influence costs. <![CDATA[<b>Bebé colodión</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400007&lng=es&nrm=iso&tlng=es Introducción. La ictiosis es una entidad clínica poco frecuente a nivel mundial (1:300,000 nacimientos). Sus formas clínicas en el neonato son bebé colodión y su manifestación más severa, feto arlequín o queratoma maligno. Clínicamente, la ictiosis se caracteriza principalmente por piel gruesa, dura y con hendiduras profundas. Las fisuras más prominentes se localizan sobre las áreas de flexión. Además, se observa ectropión en ambos ojos, deformidades en orejas y nariz; los labios se evierten provocando la apariencia de boca de pez. Caso clínico. Se reporta el caso de un bebé colodión, que por su vulnerabilidad tegumentaria se mantuvo bajo aislamiento estricto para evitar infecciones; sin embargo, hubo necesidad de aplicar antibiótico por secreción ocular purulenta causada por Staphylococcus aureus coagulasa negativa. El paciente evolucionó aceptablemente. Conclusiones. El bebé colodión ha disminuido su mortalidad gracias al cuidado multidisciplinario, por lo que su identificación y manejo deben ser oportunos.<hr/>Background. Ichtyosis is an infrequent clinical entity worldwide (1:300 000 births). When diagnosed in a newborn, we can identify two forms: collodion baby and its most severe form, harlequin fetus or maligna keratoma. In both cases, clinical manifestations are thick and hard skin with deep splits. The splits are more prominent in flexion areas. Moreover, we can observe ectropion in both eyes and deformities in the ears and nose, as well as inverted lips that resemble the mouth of a fish, among others signs. Case report. We report a case of a collodion baby who was kept in strict isolation to avoid any infection. However, due to purulent ocular secretions due to coagulase-negative Staphylococcus aureus, antibiotic treatment was indicated. The evolution of the patient was favorable. Conclusions. Mortality of the collodion baby has decreased as a result of multidisciplinary care and opportune diagnosis and management. <![CDATA[<b>Dengue hemorrágico en un lactante después de primoinfección</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400008&lng=es&nrm=iso&tlng=es Introducción. El dengue es una enfermedad infecciosa causada por un flavivirus y transmitida por un vector. Puede originar cuadros febriles inespecíficos, fiebre hemorrágica por dengue (FHD) o, incluso, síndrome de choque. El tratamiento se basa en el control hemodinámico y control del balance hídrico. Caso clínico. Paciente femenino de 4 meses, inicia con fiebre y desarrolla síntomas y signos, primero de FHD y posteriormente síndrome de choque. Se corroboró el diagnóstico serológico de primoinfección por dengue. No existió evidencia de infección previa en la madre. Con tratamiento de soporte mejora y posteriormente se egresa asintomática. Conclusiones. Según algunas teorías, la FHD en lactantes se asocia a anticuerpos no neutralizantes, transmitidos de manera pasiva por una madre previamente infectada, que ocasionan en el lactante una reacción severa ante una primoinfección. En este caso, otros factores independientes del huésped, como virulencia del virus infectante, pudieran ser los responsables.<hr/>Background. Dengue fever is an infectious disease caused by a flavivirus and transmitted by a vector. It causes dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). When one of these last two appears, treatment consists of intensive fluid balance control. Case report. A 4-month-old female infant presented fever. She was admitted and later showed signs and symptoms of DHF followed by DSS. Serological diagnosis was confirmed, and appropriate treatment offered. The mother does not have evidence of prior infection. Discussion. One theory proposes that DHF occurs in infants when passively transferred maternal antibodies from a previous infection cause an enhanced immune response when the infant is infected by a different type of dengue virus. This theory does not explain the occurrence of DHF in our report. Factors not dependent on the host, such as virological factors, may be responsible. <![CDATA[<b>Lactante con cuprotoxicosis idiopática</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400009&lng=es&nrm=iso&tlng=es Introducción. El dengue es una enfermedad infecciosa causada por un flavivirus y transmitida por un vector. Puede originar cuadros febriles inespecíficos, fiebre hemorrágica por dengue (FHD) o, incluso, síndrome de choque. El tratamiento se basa en el control hemodinámico y control del balance hídrico. Caso clínico. Paciente femenino de 4 meses, inicia con fiebre y desarrolla síntomas y signos, primero de FHD y posteriormente síndrome de choque. Se corroboró el diagnóstico serológico de primoinfección por dengue. No existió evidencia de infección previa en la madre. Con tratamiento de soporte mejora y posteriormente se egresa asintomática. Conclusiones. Según algunas teorías, la FHD en lactantes se asocia a anticuerpos no neutralizantes, transmitidos de manera pasiva por una madre previamente infectada, que ocasionan en el lactante una reacción severa ante una primoinfección. En este caso, otros factores independientes del huésped, como virulencia del virus infectante, pudieran ser los responsables.<hr/>Background. Dengue fever is an infectious disease caused by a flavivirus and transmitted by a vector. It causes dengue fever, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). When one of these last two appears, treatment consists of intensive fluid balance control. Case report. A 4-month-old female infant presented fever. She was admitted and later showed signs and symptoms of DHF followed by DSS. Serological diagnosis was confirmed, and appropriate treatment offered. The mother does not have evidence of prior infection. Discussion. One theory proposes that DHF occurs in infants when passively transferred maternal antibodies from a previous infection cause an enhanced immune response when the infant is infected by a different type of dengue virus. This theory does not explain the occurrence of DHF in our report. Factors not dependent on the host, such as virological factors, may be responsible. <![CDATA[<b>Nurses: the "front gate" to provide effective pediatric preventive care</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400010&lng=es&nrm=iso&tlng=es The objective of this paper is to analyze the importance of nurses as key providers of preventive services for Mexican children and adolescents. Nurses represent a long-standing tradition as public health providers and are very close to the individual, the family and the community. Their contribution to the preventive care of patients of these age groups is explicit and tangible. Health needs for this segment of the population and the current conditions of the Mexican health care system call for further actions. Preventive care should be accessible, high quality and comprehensive. To accomplish these goals it is necessary to invest in the public health workforce. Also, the need to increase its efficiency and effectiveness of preventive services should prompt the Mexican health care system to support the skill mix and promote the presence of nurse practitioners in primary care facilities. <![CDATA[<b>La mortalidad por accidentes durante la niñez y la adolescencia en México, 1990-2010</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1665-11462010000400011&lng=es&nrm=iso&tlng=es The objective of this paper is to analyze the importance of nurses as key providers of preventive services for Mexican children and adolescents. Nurses represent a long-standing tradition as public health providers and are very close to the individual, the family and the community. Their contribution to the preventive care of patients of these age groups is explicit and tangible. Health needs for this segment of the population and the current conditions of the Mexican health care system call for further actions. Preventive care should be accessible, high quality and comprehensive. To accomplish these goals it is necessary to invest in the public health workforce. Also, the need to increase its efficiency and effectiveness of preventive services should prompt the Mexican health care system to support the skill mix and promote the presence of nurse practitioners in primary care facilities.