Boletín médico del Hospital Infantil de México最新文献

Background: Malnutrition is a risk factor for childhood development disorders. Although undernutrition is recognized as a public health problem, the impact of overweight/obesity on childhood development remains unknown. The objective is to determine the effects of undernutrition, overweight, and obesity on development in children aged between 1 and 59 months in rural/urban areas of Mexico.

Methods: The Childhood Development Evaluation (EDI, for its acronym in Spanish) test was administered to children 1-59 months of age who visited primary care units in Guanajuato State, Mexico, between 2013 and 2015. The World Health Organization classification (weight/height ratio) was used for nutritional status. Logistic regression adjusted by sex, age, rural/urban, and level of marginalization, used to calculate odds ratios (OR) to stablish the association between nutritional status and developmental outcomes.

Results: 34,972 participants were included. 50.3% were male, 39.5% had a very low level of marginalization, 58.6% lived in urban areas, and 55.0% were beneficiaries of a conditional cash transfer program. Age distribution: 31.9% between 1 and 12 months old; 17.5% between 13 and 24 months old; 16.3% between 25 and 36 months old; and 34.3% between 37 and 59 months old. Overall 85.8% of participants had normal nutritional status, whereas 9.1% were identified as malnourished, and 5.0% were classified as overweight or obese. 79.1% had typical development. The OR for atypical development was 1.820 (95% confidence interval [95% CI], 1.671-1.981) for mild undernutrition; 2.796 (95% CI: 2.195-3.562) for moderate undernutrition; 14.903 (95% CI: 8.149-27.257) for severe undernutrition; and 1.160 (95% CI: 1.030-1.307) for overweight/obesity.

Conclusion: Undernutrition and overweight/obesity are factors that increase the risk of developmental problems in children < 5 years of age.

Background: In Ibero-Latin America, the use of probiotics in pediatrics has increased in recent decades; however, clinical practice shows significant variability across countries and specialties. This situation prompted the development of a regional consensus based on the best available evidence and expert experience.

Objective: To develop an Ibero-Latin American clinical practice guideline on the use of probiotics in pediatric gastroenterology, hepatology, and nutrition.

Methods: A multidisciplinary panel of specialists from 12 countries, including gastroenterologists, hepatologists, nutritionists, and pediatricians, was convened. A systematic literature review was conducted in PubMed, Scopus, and Cochrane Library through December 2023. Evidence was assessed using the GRADE methodology, and key clinical questions were formulated. Recommendations were discussed and refined through a three-round Delphi process until consensus was reached.

Results: Specific recommendations were developed for the use of probiotics in acute diarrhea, antibiotic-associated diarrhea, gastrointestinal infections, functional gastrointestinal disorders, and inflammatory diseases. Strains and doses with proven efficacy, such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, were identified, and clinical scenarios where probiotic use is not justified were defined. The final consensus incorporated considerations of safety, applicability, and regional context.

Conclusions: This guideline represents the first Ibero-Latin American collaborative effort to unify criteria for the use of probiotics in pediatrics, providing a practical and evidence-based framework to improve clinical care across the region.

Early childhood caries (ECC) is the presence of one or more decayed, missing, or filled teeth in children up to 71 months of age. Among the recommendations proposed by the World Health Organization to counteract this condition is the application of silver diamine fluoride (SDF). The aim of this research was to analyze the available information on the cost-effectiveness of SDF as a public health intervention in the prevention and control of ECC. This scoping review included articles published in English between 2008 and 2023 about the cost-effectiveness of SDF for pre-schoolers. Scientific journal databases (PubMed, Free Medical Journal, Science Direct, Springer Link, and Google Scholar) were searched using the following keywords: ECCs, effectiveness, cost, SDF, economic evaluation, caries, pre-school, infant, and minimal invasive treatment. The information extracted included author, year, objective, population, design, perspective of the analysis, options to be compared, time horizon, discount rate, costs, and effectiveness. We identified a total of 526 articles. Of these, 514 were excluded due to lack of relevance to the study objective, and 5 were duplicates. The final sample comprised 7 articles. The reported costs of SDF treatments from the perspective of healthcare practitioners ranged from $0.7 to $1,456, with an incremental cost-effectiveness ratio ranging from -$7.73 to -$518.50. SDF is a cost-effective treatment for public health interventions to prevent and control ECC in pre-schoolers.

Pediatric arrhythmia encompass a diverse array of conditions, ranging from asymptomatic cases to severe life-threatening episodes. Effective management of these conditions, especially for non-specialist physicians, is crucial to improving patient outcomes and reducing the risk of sudden cardiac death (SCD). This integrative review aims to synthesize the present evidence on the strategies for diagnosing and treating pediatric arrhythmias, providing a practical, symptom-based guide for non-specialist physicians. Following Cooper's methodological framework, we conducted a comprehensive literature search using electronic databases (PubMed/MEDLINE and Cochrane Library) up to August 7, 2024. Inclusion criteria focused on studies published between 2019 and 2024, involving pediatric patients aged 2-18 years with several types of arrhythmias, excluding those with congenital heart disease or other systemic conditions. Quality appraisal was performed using the GRADE and CONSORT methodologies. From 176 initially selected studies, 69 met the inclusion criteria. The evidence was synthesized into a symptom-based conceptual framework, categorizing arrhythmias into asymptomatic, paroxysmal tachycardia, and those associated with low cardiac output or syncope. Common arrhythmias, such as sinus arrhythmia, sinus bradycardia, and wandering atrial pacemaker typically do not require treatment. In contrast, conditions, such as supraventricular tachycardia, ventricular tachycardia, and inherited arrhythmias (e.g., long QT syndrome, Brugada syndrome) necessitate specific diagnostic and therapeutic strategies. This review provides a practical guide for non-specialist physicians to diagnose and manage pediatric arrhythmias, aiming to improve patient outcomes and reduce SCD incidence in children. Future research should focus on pediatric-specific studies and the development of novel therapeutic interventions.

Background: Early childhood development (ECD) is a critical period for achieving milestones in cognitive, motor, and socioemotional development. Parental knowledge of ECD influences the manner in which children are stimulated, as evidenced in previous studies, particularly in developing countries. This study examined parents' understanding of ECD, their stimulation and caregiving practices, and the sources of information that they utilize in the Mexican context.

Methods: A descriptive cross-sectional field study was conducted using a questionnaire validated by a panel of experts and a pilot test. A total of 536 mothers and fathers from socioeconomic levels C-, D+, and D/E residing in three Mexican cities were surveyed using non-probability convenience sampling. The questionnaire inquired about respondents' knowledge, stimulation practices, and sources of information related to ECD.

Results: In all, 60% of the surveyed parents did not consider the first 3 years of life as a relevant learning stage. Although 44.3% of mothers and 37.6% of fathers identified early learning (at 0-3 months), few socioemotional activities were considered relevant. Only 33% were familiar with the term "early stimulation," and television was the most consulted medium (30%).

Conclusions: It is necessary to raise awareness among parents about the importance of play, as well as socioemotional and communicative activities in ECD. The quality of information disseminated through mass media should be improved and public policies to strengthen parental education should be promoted.

Background: Hypokalemic periodic paralysis (HPP) is a rare genetic neuromuscular disorder characterized by an autosomal dominant inheritance pattern and a variable clinical phenotype. It is associated with low potassium levels due to defects in muscle ion channels. HPP can be life-threatening, but it can be completely reversed if diagnosed and treated promptly and correctly. Pathogenic variants in a heterozygous in the CACNA1S or SCN4A genes lead to HPP.

Clinical case: We present a 16-year-old male with a clinical history of flaccid paralysis associated with hypokalemia following intense physical activity and subsequent COVID-19 infection. During this evaluation, his 12-year-old maternal half-brother exhibited similar symptoms related to intense physical exercise. The affected mother, maternal aunt, and maternal grandfather have variable clinical histories. Genetic testing identified a heterozygous pathogenic variation in the CACNA1S gene (c.2700G>T; p.Arg900Ser) in the patient, his mother, and maternal half-brother.

Conclusion: The availability of a positive family history facilitates diagnostic guidance and provides insight into the factors triggering crises. Education is the first step in contributing to prevention and management. Furthermore, understanding the etiological cause is crucial for offering available therapeutic options and providing family genetic counseling.

Background: Pulmonary mucoepidermoid carcinoma is a rare neoplasm in children. Nonspecific symptoms such as hemoptysis may delay diagnosis because they are confused with other respiratory diseases.

Clinical case: A 9-year-old male patient presented recurrent episodes of cough and hemoptysis. The patient had two similar episodes associated with wheezing in previous months and was treated as an asthma attack. Radiological studies and bronchoscopy reported a lung mass obstructing the left main bronchus, causing atelectasis and involvement of the left lung. Transthoracic biopsy was positive for a salivary gland tumor. Treatment was surgical (left pneumonectomy). Histopathological and immunohistochemical studies reported low-grade mucoepidermoid carcinoma. He did not receive chemotherapy. After two years of follow-up, the patient was asymptomatic, and we did not see any recurrence.

Conclusions: Pulmonary mucoepidermoid carcinoma is rare in children. Hemoptysis and signs of bronchial obstruction may mimic other respiratory diseases, causing a delay in diagnosis. Treatment is surgical, with a good prognosis during follow-up.

Lung ultrasound has become a valuable tool in neonatal intensive care practice, with exponential diffusion of evidence of its diagnostic and functional applications over the last decade. In this pictorial essay, we review animal models and clinical cases where diagnosis was confirmed with high-resolution pulmonary computed tomography/cardiac angiotomography, biopsies, or autopsies, pointing out the main ultrasound features of neonatal respiratory disorders.