Publicación de la Sociedad Argentina de Pediatría
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Método de aplicación del B.C.G. en la Argentina
IA en publicación científica: la tecnología avanza, la integridad debe permanecer
Hiperplasia adrenal primaria nodular pigmentada
Características clínicas y de laboratorio de la infección por dengue en pacientes pediátricos durante el brote 2023-2024 en Buenos Aires, Argentina.
El dengue presenta un espectro clínico amplio en pediatría y existe información limitada sobre su curso en población infantil. Durante 2023-2024 se produjo la mayor epidemia de dengue en Argentina. Objetivo: caracterizar manifestaciones clínicas y alteraciones de laboratorio frecuentes en pacientes pediátricos con dengue confirmado. Métodos: estudio descriptivo, retrospectivo y observacional en menores de 17 años atendidos del 1-7-23 al 30-6-24 en un Hospital Universitario de gestión privada con dengue confirmado por RT-PCR o IgM. Se analizaron variables clínicas, bioquímicas y hematológicas, comparando subgrupos por edad (<13 vs. ≥13 años). Resultados: Se incluyeron 383 pacientes. El 86,4 % presentó dengue sin signos de alarma, el 13,3 % con signos de alarma y un caso fue dengue grave. Los síntomas más frecuentes fueron fiebre, cefalea y mialgias. Las alteraciones laboratoriales más comunes fueron leucopenia, plaquetopenia y elevación de transaminasas. Los pacientes ≥13 años presentaron mayor frecuencia de signos de alarma y alteraciones hematológicas. La mayoría se manejó ambulatoriamente; solo 1,6 % requirió internación. No se registraron fallecimientos. Conclusiones: La leucopenia temprana y la plaquetopenia fueron los hallazgos más frecuentes. Los adolescentes presentaron mayor proporción de dengue con signos de alarma. La consulta precoz y el seguimiento clínico y de laboratorio permitieron un abordaje adecuado y sin complicaciones graves.
En respuesta: Pérdida de peso y lactancia materna. Una asociación riesgosa
Parental Online Health-Seeking: How Cyberchondria and Health Literacy Shape Pediatric Health Decisions
Background: This study aims to determine parents' cyberchondria and health literacy levels and examine how these levels affect parents' behaviors regarding their own and their children's health. Method: This descriptive cross-sectional study was conducted between January 1, 2023, and June 30, 2023. Survey forms were used, and the surveys were filled out face to face. Results: 619 parents participated in the study. The parents' Cyberchondria Severity Scale (CSS) score was 71.51±22.46 (medium-high), and the Turkish Health Literacy Scale (THLS-32) score was 21.37±6.60 (insufficient). 92.2% of the parents stated that they diagnosed themselves and 91.1% of their children via the Internet, 14.2% of them stopped taking their medication, and 12% of their children stopped taking their medication due to information they read on the Internet. Conclusion: Parental internet use for health purposes is very high. Inadequate health literacy and high levels of cyberchondria increase the risk of making wrong health decisions. Health professionals should prioritize efforts to increase parents' health literacy and reduce the severity of cyberchondria.
Enfoque pediátrico de la enfermedad de Chagas-Mazza
Constancia de salud de niños, niñas y adolescentes, como requisito para realizar actividad física en Argentina. Posicionamiento de la Sociedad Argentina de Pediatría 2025
In light of the risk posed by sedentary lifestyles, the importance of school physical education as a health tool and the hierarchy of teachers and graduates who teach this subject is emphasized. The rights of children and adolescents to access health care, medical attention, recreation, and sports must be respected. A health certificate should be required as part of the annual documentation that students must submit, but this should not be a limitation to participate in physical education classes. Only children and adolescents who present a medical certificate indicating otherwise may be excluded from participation in these classes, either temporarily or permanently. Given the low incidence of serious events at these ages during physical exercise, the risk posed by a sedentary lifestyle is much greater.
From the beginning to 2023; did the COVID-19 pandemic affect the anxiety of parents and preschool children equally over the time?
Objective: We aimed to determine the perceived anxiety levels of children aged 3-6 and their parents, children's behavioral patterns and the frequency of expressions/words used during the day that may be associated with anxiety at four different time points in four years since the beginning from the pandemic to the present. Method: This descriptive-cross-sectional study was conducted between May 17, 2020 and October 30, 2023. An online questionnaire form was used at four different time points. Results: 3732 parents with children aged 3-6 participated in the study. Children's anxiety-related behaviors and expressions were more frequent during the first and second time points. Anxiety-related behaviors were more common in children during the long-term bans. Conclusion: Perceived anxiety levels of the children aged 3-6 years at different time points during COVID 19 pandemic reflected the epidemic trends of the disease and parental anxiety levels. Understanding how the effects are distributed is important for the future
Perdida de peso y lactancia materna. Una asociación riesgosa
Breastfeeding is a fundamental pillar during the first six months of life and should be initiated within the first minutes after birth. Early implementation requires timely evaluation to ensure proper technique and to prevent common complications such as dehydration, among others. One of the proposed methods for assessing the success of breastfeeding is monitoring neonatal weight loss during the first days of life. However, this parameter must be interpreted within a comprehensive clinical context, considering both individual and environmental factors, to provide the best possible support for the mother-infant dyad. In this regard, formula supplementation may appear to be a quick solution to address an isolated numerical concern, but it does not always represent the best approach to ensure the success and long-term continuity of breastfeeding.
Más Allá del Estigma: Estrategias Efectivas en el Tratamiento de la Obesidad Infantil y Adolescente
The increase in cases of overweight and obesity is a public health issue affecting various populations. Among them, children and adolescents are a group with a growing incidence. The article "Subjective Experiences Related to the Body, Perception of Interventions, and Empathy of the Healthcare Team in Adolescents with Excess Weight" highlights aspects that require further analysis and for which we propose new alternatives. The original article analyzes subjective experiences through semi-structured interviews and gathers information on social factors, self-perception, and reasons for treatment abandonment. Based on this, we conducted research, analysis, and a comparison of the proposed solutions to this issue and suggested other alternatives that we consider more effective and better supported, with a greater positive impact on patients. For instance, we propose a comparative analysis using strategies such as Cognitive Behavioral Therapy and the 5As framework from the Canadian Obesity Network to reduce dropout rates and improve treatment adherence. Both the original article and our analysis conclude that the social environment and self-perception influence the development of overweight and obesity. Although Intuitive Eating was suggested as a supportive tool, it is not suitable for patients with eating disorders. However, strategies like Cognitive Behavioral Therapy and the 5As approach have stronger support and are more effective in this process, helping to improve patients’ emotional well-being and significantly contributing to weight loss.
Consenso sobre gastrostomías en pediatría: un enfoque multidisciplinario
Gastrostomy (GTT) is a procedure that surgically or endoscopically connects the stomach to the outside of the abdomen, providing a long-term enteral feeding route. It is an essential nutritional alternative for children and adolescents (CHI) with oral feeding difficulties, as it significantly improves their physical, psychological, and social quality of life, as well as that of their caregivers. This consensus has several key objectives: to identify children and adolescents who are candidates for this intervention, to describe the different types of procedures, to unify diagnostic criteria, to promote rational use of resources, to detail associated complications, to improve the quality of life of patients and their families, and to foster interdisciplinary collaboration. To achieve this, a comprehensive review of the scientific literature was conducted, selecting the best available evidence to develop practical recommendations specific to pediatricians and adaptable to the local context.
pediatría, gastrostomía, alimentación enteral, gastrostomía endoscópica percutánea (PEG), gastrostomía endoscópica
Congenital Syphilis in Argentina: temporal trends and association with income inequality in the period 2006-2021
Introduction: Congenital syphilis (CS) remains a persistent public health issue, and in recent years, Argentina has experienced an increase in its incidence. The distribution of CS is influenced by various social factors. This study aims to describe the temporal trends in CS rates and evaluate their association with income inequality in Argentina from 2006 to 2021. Methods: An ecological study was developed, with the 24 Argentine jurisdictions (23 provinces and CABA) as the units of analysis. CS rates were estimated for each jurisdiction for each study year, and their temporal distribution was analyzed at the national level and by region. An exploratory analysis of the distribution of CS rates and the Gini coefficient was performed at both the national and regional levels. Mixed linear models were then used to estimate the association between the Gini coefficient and CS rates. Results: The CS rate has shown an upward trend across all regions, with Cuyo and the Northwest being the most affected. As the Gini coefficient increases, the CS rate also rises in the provinces, with the northeast region exhibiting the highest increase. Conclusions: It is recommendable to strengthen programs focused on the prevention of CS through comprehensive interventions that ensure accessible services, particularly in regions with greater social inequality.
Could a Neonatal Care Bundle Be a Promising Strategy for the Prevention of Intraventricular Hemorrhage in Preterm Infants? A Retrospective Observational Cohort Study
Objectives: The aim of this study was to evaluate the effect of the Neonatal Care Bundle (NCB), which consists of care implemented in preterm infants in the first 72 hours, on the incidence of GM-IVH (Germinal matrix-intraventricular hemorrhage) by providing more stable cerebral venous blood flow. Methods: An observational-cohort study of preterm infants with a gestational age <30 weeks or with birthweight <1500 gr who were admitted to the Neonatal Intensive Care Unit was conducted. The infants were divided into two groups. Group 1 included infants that received standard neonatal care, and Group 2 included infants that received the NCB care. The NCB protocol includes keeping the head of the infant in the midline position, elevating the head of the incubator to 30°, and avoiding a head lowering position, sudden raising of the legs, or sudden position changes for the first 72 hours. Results: In total, 186 preterm infants were enrolled. The frequency of any grade of GM-IVH and severe IVH were statistically significantly lower in NCB group (p<0.05). In the subgroup analyses of the patients according to birth weight, the rate of GM-IVH was seen to decrease from 41% to 24% in preterm infants <1000 gr after NCB. Conclusion: This study is one of the few in the literature to show that rates of GM-IVH decrease with increased awareness, standardisation, and changes to neonatal care in the first 72 hours — the period during which preterm infants in the NICU are at the greatest risk of developing GM-IVH.
HAce 75 años - Meningitis tuberculosa tratada con estreptomicina. Resultados al cabo de 33 meses de observación.
Establecimiento de estándares en ECOEs de graduación para estudiantes de medicina: comparación entre los métodos de grupos límites y Hofstee
Introduction: Setting the cut-off point in objective structured clinical examinations (OSCEs) is a controversial aspect of assessment. In resource-limited settings, the Hofstee method requires additional tasks from other teachers outside the examination time. In contrast, the borderline group method is applied during the assessment, allowing for a more efficient use of time and resources. Objective: To compare the reliability of the borderline group and Hofstee methods applied in a graduation OSCE at an Argentine public university, providing local evidence to an internationally relevant debate. Population and methods: Cross-sectional study of 56 students in a 12-station OSCE. Two standardsetting methods were applied: borderline group (using observers during the exam) and Hofstee (electronic consultation with expert judges). Cut-off points, failure rates, and reliability (phi coefficient λ) were compared using generalizability theory.
Other sections (Medical education, Health and social pediatrics, Epidemiology)
Professional Competence; Clinical Competence; Educational Measurement; Students, Medical; Education, Medical, Undergraduate.
Sindrome de Cushing cíclico y alteraciones endocrinas en 2 niños con complejo de Carney
El Complejo de Carney (CC) se caracteriza por mixomas, lesiones cutáneas pigmentadas e hiperactividad endocrina, con predisposición a tumores. Se destaca la hiperplasia adrenocortical micronodular pigmentada primaria (PPNAD por sus siglas en inglés) que se manifiesta con cuadros subclínicos, progresivos o cíclicos de síndrome de Cushing (SC) por hipercortisolismo endógeno independiente de ACTH, caracterizada por un aumento paradójico del cortisol libre urinario (CLU) tras una prueba de inhibición con corticoides. Se describen 2 pacientes con diagnóstico clínico y molecular de CC que presentaron PPNAD con patrón bioquímico característico y tratamiento con suprarrenalectomía bilateral en ambos casos. Se debe sospechar PPNAD en pacientes con SC Cushing cíclico y considerar su asociación con CC. Ante fuerte sospecha clínica se debe realizar prueba de supresión para evidenciar la respuesta paradójica característica y realizar un diagnóstico precoz que permita evitar las repercusiones a largo plazo del hipercortisolismo.
Hiperplasia adrenocortical micronodular pigmentada primaria
Experiencia con Denosumab en el tratamiento de enfermedades óseas en pediatría en un hospital de tercer nivel
El quiste óseo aneurismático (QOA), el tumor de células gigantes (TCG) y la lesión central de células gigantes (LCCG) son neoplasias líticas con alta expresión de RANK-L. Denosumab demostró mejorar morbilidad postquirúrgica en formas resecables y detener progresión en irresecables; reportándose efectos adversos intra y post tratamiento. Se realizó un estudio prospectivo y descriptivo, incluyendo 6 pacientes (P) tratados con Denosumab, con edad mediana de inicio de 7,4 años y relación masculino/femenino de 5/1. 5/6 P presentaron respuesta favorable al tratamiento con Denosumab. Todos presentaron hipocalcemia e hipofosfatemia tempranas que se trataron con ajuste de los suplementos de carbonato de calcio y ergo/colecalciferol (6/6); adición de calcitriol (5/6) y sales de fósforo (3/6). 4/6 P presentaron hipercalcemia de rebote, severa sintomática (mediana 17 mg/dl) en los 3P que no recibieron bifosfonatos; y moderada asintomática (13,4 mg/dl) en P6 que recibió 1 dosis de bifosfonato preventivo. Se evidenciaron bandas metafisarias en 4/6 P, no se registraron fracturas y en la mayoría no se observó compromiso del crecimiento. La hipocalcemia y la hipofosfatemia fueron leves pero no pudieron prevenirse con suplementos. El calcitriol podría ser una estrategia prometedora en futuros pacientes. La hipercalcemia resultó el efecto adverso más grave y de manejo intensivo, pero podría ser prevenible con un esquema adecuado de bifosfonatos. Los factores de riesgo incluyen menor edad de inicio, mayor número de dosis y bandas metafisarias. Palabras clave: Denosumab, hipercalcemia, Quiste óseo aneurismático, Tumor de células gigantes, Lesión central de células gigantes
Multisystem Langerhans cell histiocytosis whit gastrointestinal involvement in an infant. Clinical case
La histiocitosis de células de Langerhans es una enfermedad rara, caracterizada por un acúmulo de células dendríticas mieloides, asociada a un componente inflamatorio significativo y compromiso sistémico variado. El compromiso gastrointestinal es poco frecuente, precedida en más del 80% de los casos, de lesiones cutáneas. Se reporta el caso de una niña de 5 meses de edad cuya expresión clínica fue lesiones cutáneas y proctorragia. El abordaje transdisciplinario permitió llegar al diagnóstico para instaurar un tratamiento oportuno.
A Novel Homozygous NR1H4 Mutation In Idiopathic Elevated Transaminases
Here we describe a patient with homozygous loss of NR1H4 function presented with idiopathic mildly elevated transaminases, and he is not consistent with limited number of previous reports of Progressive Familial Intrahepatic Cholestasis (PFIC 5). Case Summary: A 7-year-old boy was admitted to our outpatient clinic because of permanent elevation in transaminases since he was 12 months old. PFIC5 has been reported as a rapidly progressive disease that requires liver transplantation over time. But, our patient’s laboratory tests showed normal gamma-glutamyl transferase (GGT), international normalized ratio (INR), albumin, alpha-fetoprotein (AFP) levels and liver biopsy showed mild fibrosis. And, the patient has been followed for the last two years with only mild transaminase elevation. Conclusion: Infants with cryptogenic liver disease should be evaluated for NR1H4 mutation associated PFIC5. This mutation may be a novel genetic metabolic etiology of idiopathic mildly elevated transaminases.
Voriconazole-associated peripheral polyneuropathy
Descripción clínica y electromiográfica de 2 pacientes pediátricos en tratamiento con voriconazol y presentaron neuropatía periférica durante el mismo. Se efectuó un análisis descriptivo de las historias clínicas de los pacientes, revisión bibliográfica de artículos sobre neurotoxicidad asociada a Voriconazol publicados en Pubmed y Cochrane. . Resultados: Caso clínico 1: Niño de 5 años, con Leucemia mieloblástica aguda. Inicia tratamiento para infección por Aspergillus con Voriconazol, desarrollando dolor en miembros inferiores y debilidad a predominio distal. Caso clínico 2: Niña de 10 años con inmunodeficiencia primaria y antecedente de trasplante celular de precursores hematopoyéticos con cuadro de impotencia funcional y dolor en miembros inferiores, realizando tratamiento con voriconazol. Ambos casos con electromiograma con polineuropatía sensitivo-motora axonal primaria revirtieron la clínica luego de la suspensión del tratamiento. Conclusión: Dada la rápida resolución ante la suspensión del voriconazol consideramos de importancia esta neurotoxicidad periférica en niños expuestos.
Lactancia, mastitis y probióticos, respuesta a carta al editor
Procesos aplicados a la elaboración de fórmulas infantiles y alimentos para propósitos médicos específicos.
Breastfeeding is the gold standard in pediatric nutrition. When breastfeeding is not possible, desired or sufficient, there are infant formulas and foods for specific medical purposes, developed to meet special nutritional requirements. These products are manufactured through complex technological processes, under strict quality, hygiene, safety and international regulation standards. Unlike other mass consumption products (cookies, snacks), they are designed to contribute to children's nutrition. Their formulation includes adaptations in proteins, lipids, carbohydrates, vitamins and minerals, according to the infant's needs. They can be indicated in cases of prematurity, allergies, intolerances, digestive and metabolic pathologies or special conditions, and should always be indicated by Nutrition professionals. Their correct use guarantees the nutrients necessary for adequate growth and development and/or those necessary for dietary-nutritional therapy.
Multicenter Study of the Pediatric Donation Process in Argentina
Introducción: Aumentar el acceso al trasplante de pacientes pediátricos en lista de espera representa un desafío prioritario. La respuesta a esta demanda se encuentra en el sistema de salud, tanto agentes como instituciones que cuentan con unidades de atención de pacientes menores de 18 años en estado crítico. Se analizaron los factores relacionados al proceso de donación de órganos y tejidos en pacientes pediátricos de la Argentina. Métodos: Estudio descriptivo observacional, retrospectivo realizado en 5 instituciones de la Argentina. Se obtuvieron datos de la historia clínica de pacientes entre 0 a 18 años con clínica de muerte encefálica en las unidades de cuidados intensivos, emergencias y unidades de terapia cardiovascular entre el 01/01/2018 y 31/12/2022. Resultados: Se caracterizaron los centros participantes, 3 fueron pediátricos y 2 polivalentes. Se incluyeron 124 pacientes, 55% de sexo femenino, 94 % argentinos, con una mediana de 6 años (RIC 1-12). Hubo una demora mediana en iniciar el diagnóstico de muerte bajo criterios neurológicos de 3 días (RIC 1-6), siendo la principal causa de muerte la anoxia por parada cardiorrespiratoria (28%). Del total de pacientes analizados 21 (17 %) fueron donantes de órganos y/o tejidos, con una afirmativa familiar a la donación del 44%. Conclusiones: La muerte bajo criterios neurológicos es un evento poco frecuente en las terapias intensivas pediátricas. Este trabajo ofrece blancos de acción para optimizar la evaluación, detección y tratamiento de los potenciales donantes, necesarias para reducir la muerte de niños en lista de espera.
Effectiveness evaluation of respiratory syncytial virus vaccine in children under 6 months old in Córdoba, Argentina
Introducción: La vacuna contra el virus sincicial respiratorio (VSR), recientemente aprobada, se aplica a embarazadas y confiere inmunidad a sus bebés, sin embargo la evaluación de su efectividad resulta limitada. Objetivo: Evaluar la efectividad de la vacuna contra el VSR en niños menores de 6 meses durante la campaña de vacunación en gestantes. Métodos: Estudio casos y controles, anidado en una cohorte de gestantes con indicación de vacunación contra VSR en Córdoba, Argentina. Se incluyeron 180 casos con laboratorio positivo para VSR y 1.069 controles que asistieron a control de rutina. Se realizaron modelos de regresión logística múltiple considerando como variable respuesta primaria la presencia de VSR, ajustados por edad materna, edad gestacional y peso al nacer, vacuna antigripal materna, nivel de instrucción materna y parto múltiple. Se calculó la efectividad vacunal, mediante la fórmula EV= (1-OR)*100. Resultados: La vacuna contra el VSR disminuye la chance de enfermar por VSR un 74,0% (OR=0,26; IC=0,17-0,39), la vacuna antigripal en un 70% (OR=0,30; IC=0,21-0,43), por cada semana cumplida de edad gestacional, la protección contra la enfermedad se incrementa en un 10% (OR=0,90; IC=0,81-0,99). Conclusión: la vacuna implementada es efectiva contra las formas graves de VSR en niños menores de 6 meses, quienes conforman la población más vulnerable y podría constituirse en un importante insumo para el descenso de la morbimortalidad por VSR.
Crisis de la lectura, crisis de la cultura: ¿Qué revela la prueba Aprender 2024?
Open Fetal Surgery for Spina Bifida in Argentina: Short- and Long-Term Outcomes at a University Hospital
Introduction: Myelomeningocele (MMC) is a severe congenital anomaly associated with high neonatal morbidity and long-term disability. Since 2015, the Austral University Hospital has performed fetal MMC repairs using a modified open surgical technique. Objective: To describe obstetric and perinatal outcomes, the need for Hydrocephalus treatment and ambulation following open fetal surgery for MMC at a single center Argentina. Methods: We conducted a retrospective observational study analyzing maternal, neonatal, and long-term follow-up data from 102 consecutive fetal MMC repairs performed between 2015 and 2023. Results: The mean gestational age at the time of surgery was 26.1 weeks. Maternal and neonatal complication rates were comparable or lower than those reported in the MOMS Trial. At 12 months of age, 23,8%. of infants require ventriculoperitoneal shunt placement for hydrocephalus. At 30 months, 84.8% of patients achieved ambulation with or without orthopedic assistance. Conclusion: Open fetal surgery for MMC, performed by an experienced multidisciplinary team using a modified technique, demonstrates favorable maternal and neonatal safety profiles. It reduces the need for neurosurgical interventions for hydrocephalus and substantially enhances the motor function and quality of life of patients. This procedure should be considered he treatment of choice. in appropriately selected prenatal cases