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Introduction: Paediatric Emergency Departments (PED) should have written disaster plans, to ensure a rapid and efficient response., Objectives: 1) to determine if Spanish PED have written disaster plans, 2) to describe the characteristics of these plans, and 3) if paediatric victims were included in them., Material and Methods: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. The structured survey included questions about external emergency plans (EEP) and internal emergency plans (IEP)., Results: Twenty-five out of 44 surveys were replied. Eighteen PED had an EEP, most of them had been written 10 years ago and were reviewed every 3 years or more. In 11/18 PED, the EEP was well-known by health care providers. Drills were never performed in 13/18 PED. Twenty-one PED had an IEP, most of them had been written 8 years ago and were reviewed every 3 years or more. In 13/21 PED, IEP was well-known by health care providers but drills were never performed in 12/21 PED. IEP included evacuation plans (22), fire emergency plans (19), bomb threat plan (13) and flood plans (9). Nine PED have paediatric-specific disaster plans and in 7 PED, disaster plans included adult and paediatric victims. Children were not included In 1 EEP and in 5 IEP., Conclusions: Most of PED have written disaster plans, but these plans are old, unknown by health care providers and almost half of them do not include paediatric victims. It is necessary to improve disaster planning in Spanish PED., (Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Background: Ionizing radiation due to diagnostic tests and treatment can contribute to the later development of cancer. The patients with cerebrospinal fluid shunts (CFS) are exposed to greater risk., Objective: To estimate the cumulative radiation dose from radiological studies in children with CFS and to determine the potential factors associated with a high level of radiation., Methods: Descriptive observational study. All children treated for hydrocephalus with a CFS between 2005 and 2006 were included. We registered the number of radiological examinations performed on these patients due to neurosurgical control or evaluation for possible shunt malfunction. The cumulative radiation dose from radiological studies was estimated for each patient., Results: Thirty-six patients were included. The median patient age was 6.1 months (range: 20 days - 15.3 years). One hundred thirty-six CT scans were performed and 19 shunt series were done. The median patient radiation was 6.9 mSv (range: 0 to 28.6 mSv); 85% of examinations were performed for neurosurgical control. The median absorbed radiation dose was higher in patients who were evaluated for some possible shunt malfunction than in patients without a suspected shunt malfunction (9 mSv vs 5 mSv, p=0.02)., Conclusion: The radiation exposure from radiological examinations performed on children with CFS was considerable. The use of non-ionizing techniques would help in the neurosurgical control of patients with CSF. The development of clinical-diagnostic scales could enable patients with increased risk of shunt malfunction to be selected before a radiological test was carried out., (Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Introduction: In recent years, the prevalence of Acute Alcohol Intoxication (AAI) in adolescents has increased. One of its impacts had been the increase in consultations in the Emergency Services (ES). The objective of this study is to assess the psychosocial profile of adolescents who consult for AAI and study their personal, family and social functioning., Methods: 104 families of adolescents who attended for AAI in ES and 104 controls, matched by age and sex, were interviewed by telephone to obtain sociodemographic, clinical, academic and family functioning data., Results: 72% of the adolescents who were attended for AAI were under 16 years old. Academic data showed that 37.7% had repeated a school year, 20% had truancy and 19.6% abandoned their basic studies. 9,8% were in psychiatric treatment. Only 11.4% of patients were referred to specialist service. There were no significant differences between in any of the clinical variables between the study and control group., Conclusions: This study provides new information on the characteristics of this population and provides guidance on the need to develop protocols for working in the ES that includes not only biochemical/ toxicological parameters but also includes the assessment of psychosocial parameters., (Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Background: Household product ingestion is the second cause of visiting an Emergency Department for poisoning in children. Among these products, caustics are of great interest because of their potential toxicity and risk of sequelae., Objectives: To describe the epidemiological and clinical features of patients admitted to our hospital due to possible caustic ingestion. To analyse the risk factors associated with oesophageal or gastric injury. To review the latest treatment recommendations., Materials and Methods: Retrospective review of all patients admitted with suspicion of caustic ingestion between January 2005 and April 2010. Epidemiological, clinical and therapeutic aspects were recorded., Results: A total of 78 patients were admitted, 45 (57.7%) were male, with a median age of 2.2 years (range: 1-17.3 years). In 13 cases the product was kept in a container different than the original. In 36 children, the family had induced vomiting or had given a liquid to dilute the product. Fifty two patients were symptomatic, and 46 of them had some sign on physical examination. Thirty nine oesophagoscopies were performed, and 7 oesophageal or gastric lesions were observed. When patients with normal and abnormal endoscopic findings were compared, the factors associated with an increased risk of mucosal injury were vomiting (P=0.01), and two or more symptoms at admission (P=0.03). No complication was described in patients without endoscopy., Conclusions: Family education about preventive and initial measures after caustic ingestion must be improved in an attempt to prevent wrong actions which can be harmful. Some patients might benefit from clinical observation without aggressive therapeutic measures., (Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Background: Bacterial isolation using conventional microbiologic techniques rarely surpasses 25% in children with clinical and laboratory findings indicative of an invasive bacterial infection. The aim of this study was to determine the role of real-time polymerase chain reaction (RT-PCR) from whole blood samples compared with automated blood cultures (BC) in detection of relevant microorganisms causing bacteremia in episodes of high-risk febrile neutropenia (HRFN) in children with cancer., Methods: Children presenting with HRFN at 6 hospitals in Santiago, Chile, were invited to participate. Blood samples were obtained at admission for BC, and at admission and 24 hours for RT-PCR targeting DNA of Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa causing bacteremia in children with HRFN., Results: A total of 177 HRFN episodes were evaluated from May 2009 to August 2010, of which 29 (16.3%) had positive BC, 9 (5%) positive for 1 of the 3 selected bacterial species: 5 for E. coli, 3 for S. aureus, and 1 for P. aeruginosa. RT-PCR detected 39 bacteria in 36 episodes (20%): 14 E. coli, 20 S. aureus, and 5 P. aeruginosa. The sensitivity, specificity, and positive and negative predictive values of RT-PCR compared with BC were 56%, 80%, 13%, and 97%. The final clinical diagnosis was compatible with an invasive bacterial infection in 30/36 (83%) RT-PCR-positive episodes., Conclusions: In our series, RT-PCR significantly improved detection of the most relevant bacteria associated with HRFN episodes. Large number of patients and close clinical monitoring, in addition to improved RT-PCR techniques will be required to fully recommend RT-PCR-based diagnosis for the routine workup of children with cancer, fever, and neutropenia.

Introduction: Child malnutrition carries a high morbimortality worldwide. Therapeutic feeding centers are essential in the treatment of malnourished children., Objective: To evaluate the effectiveness of the therapeutic intervention in under-5 undernourished children in a Therapeutic Feeding Center., Methods: A retrospective descriptive research was made through the revision of the clinical histories of children under 5 years that entered the Nutritional Recovery Center for Children in Matagalpa, Nicaragua, from January 2006 to July 2010., Results: Median age at admission was 17.2 months (p25:10.7-p75:27.2) and median stay in the center was 92 days (p25:61.5-p75:134.5). Prevalence of patients with severe acute malnutrition was 45%, moderate acute malnutrition 24% and risk for malnutrition 31%. At discharge 86% of patients were properly nourished. Median weight gain percentage after the first month in the center was 15% (p25:12.6-p75:17.4). Median weight gain was 3.7 g/kg/day (p25:2.6-p75:5.4), being higher in children under 6 months (4.6 g/kg/day; p25:4.3-p75:7.5). Cured rate in the center was 87.5%, being the death rate 0% and the abandonment rate 9%., Discussion: The center evaluated works adequately, and fulfills the internationally recommended quality indicators. However, recommended average stay of 1-2 months and average weight gain of 8 g/kg/day are far of being fulfilled. Therefore, the Nutritional Recovery Center performs an effective intervention, but it's not efficient enough.

Introduction: The current debate on induced abortion and the age when a young woman is considered mature to have this without parental consent, shows the need to know the real importance of adolescent pregnancy in the Emergency Department., Objectives: a) To determine the adolescent pregnancy rate variation in the Emergency Department during last 12 years; b) to determine the characteristics of the pregnant adolescent and the outcome of their pregnancies., Material and Methods: Retrospective study of pregnant adolescents diagnosed in the Emergency Department between July 1, 1997 and June 30, 2009. Pregnancy rates were calculated per 1000 annual female adolescent consultations. Two periods were considered: 1/from July 1, 1997 to June 30, 2003 and 2/from July 1, 2003 to June 30, 2009., Results: Eighty-three pregnancies were diagnosed in adolescents. Pregnancy rates varied from 0.5 to 2.0 per 1000 females; an increased trend in adolescent pregnancy rate was observed in the second period. Metrorrhagia, abdominal pain and vomiting were the most frequent complaints. There were 62 on-going pregnancies, 20 abortions and one ectopic pregnancy. Only 35 of the outcomes of the 62 on-going pregnancies were known: 19 ended in live birth, 11 in induced abortion and 4 in stillbirth., Conclusions: The adolescent pregnancy rate is low; nevertheless an increased trend is being observed in the last few years. Many adolescents diagnosed with pregnancy had nonspecific complaints, so it is important to ask about sexual habits in all adolescents. A high percentage of diagnosed pregnancies end in abortion., (Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Introduction: Adequate antibiotic prescribing in Paediatric Emergency Departments (PEDs) is a necessity due to the high number of patients consulting for infectious diseases. The aim of this study was to evaluate the antibiotic prescription quality in a PED., Material and Methods: Retrospective study of patients attending a PED and diagnosed with acute otitis media, pharyngotonsillitis or community-acquired pneumonia during 2008. A random sample of 100 cases for each disease was selected. The parameters employed for assessing the prescribing quality were: illness subject to being treated with antibiotics, adequate antibiotic, dosage, interval of administration and length of treatment. An error in any of these parameters was considered an inappropriate prescription. The appropriateness of the antibiotic prescriptions was assessed based on the recommendations described on our hospital protocols., Results: Antibiotics were prescribed to 219 patients (73%). Therapy was considered to be inappropriate in 67 children (22.3%). Unnecessary treatment was indicated in 15 cases (6.8%) and in 4 patients (2%) the antibiotic selected was incorrect. Antibiotic was not prescribed to one patient subject to being treated (1.2%). The treatment length was wrong in 22 cases (11.5%), inappropriately short in all of them, the interval of administration in 20 (10.1%) and dosage in 13 (6.5%)., Conclusions: The use of antibiotics was appropriate for the diseases analysed, particularly as regards to the indication and antibiotic selection. The length of the treatment was the aspect found to be most deficient. Some important measures should be undertaken in order to improve antibiotic prescription quality., (2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Objectives: To evaluate the appropriateness of ambulance use as transport to Emergency Medical Services and to determine if ambulance use is associated with preferential attention and to illness severity., Patients and Method: All patients attended in a Paediatric Emergency Department during 2008 were included. Two groups were defined: Group 1, patients arriving by ambulance and Group 2, patients arriving by any other means of transport. In order to evaluate the appropriateness of ambulance use, a random sample of 300 patients from the Group 1 was selected; the "Paediatric Ambulance Need Evaluation tool" was applied to final diagnosis. To assess the preferential attention, the rate of patients with triage evaluation, time to triage and time to medical attention were compared. Finally, to determine differences in the severity of illness, patients with triage level < or =3 and patients needing complementary examinations and/or hospital admission were analysed., Results: A total of 80537 patients were included, of which 2.5% arrived by ambulance. Estimation of the prevalence of inappropriate transport use was 31 % (95 CI%: 26.2-35.8%). Their main diagnoses were: epileptic attack (23-24.7%), panic attack (12-12.9%) and fever (12-12.9%). It was observed that triage evaluation, time to triage and time to medical attention was shorter in Group 1. The proportion of children with triage level < or =3, needing complementary examinations and/or hospital admission was higher in-Group 1., Conclusion: A high number of patients arriving by ambulance could have used another means of transport. However, the greater severity of a significant number of patients justifies the preferential attention given. Triage use in all patients arriving by ambulance would help in the detection of high priority cases and to improve the Emergency Department performance., (2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Introduction and Aim: Cannabis is the most frequently consumed illicit substance in Spain. Adolescence is the period when most people come into contact with this drug. The aim of this study is to evaluate the characteristics of patients who have recently consumed cannabis and who are evaluated in the Paediatric Emergency Department in order to pinpoint their profile and do a follow-up., Material and Method: Study of the medical reports of patients who tested positive for cannabis in urine toxicological analysis over 2 years (2007-2008). Epidemiological characteristics (patient age, sex, psychiatric antecedents and if they were placed in institutional care) as well as the patient's reason for checking into hospital, the specialist who asked for the test, the test result, its positivity for other drugs of abuse and the patient's whereabouts once he or she had been released from hospital were evaluated., Results: Seventy-two of 533 patients tested positive for cannabis. Excluding one child with an accidental intoxication, their mean age was 16.2 years (SD 1.2 years; range 13.4-18 years-old); 43 (60.6%) were male. Thirteen (18.3%) teenagers were being looked after by the Administration and 24 (33.8%) had psychiatric antecedents. Thirty-five (48.6%) consultations took place from Friday to Sunday, with no particular increase in the number of patients in specific time-periods. The medical consultations were mainly related to alterations in the level of consciousness 29 (40.3%) and agitation 19 (26.4%). In 12 (16.7%) cases the patients had also been known to have drunk alcohol, and 4 (5.6%) of them had also taken cocaine. In 42 (58.3%) occasions, patients were discharged to home, 20 (27.8%) were admitted to the hospital and 10 (13.9%) were referred to the outpatients' department for a follow-up., Conclusions: There was a predominance of teenage males in the consumption of cannabis. In many cases, there was a related psycho-social element to the use of the substance and those who consumed cannabis appeared in many cases to have consumed other drugs of abuse. There are still many patients who, after having checked into the Paediatric Emergency Department, show no record of having received a proper follow-up. We highlight the need to improve this aspect., (Copyright 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Background and Objectives: To describe psychoactive substances (PS)-related visits of adolescents to the emergency department and to explore possible differential features in patients according to the kind of PS consumed., Patients and Methods: Observational and analytic study. PS-related visits of adolescents to the emergency department during 30 months were studied. Patients were divided in two groups: those with alcohol intoxication only (Group&#95;1) and those with other PS (Group&#95;2) and they were compared., Results: 333 consults were included, corresponding to 321 patients. Their mean age was 16,1 years (SD:1,1 years). Two hundred sixty-two(78,7%) were alcohol-related visits, and 110(33%) were related with another PS consumption. Of the 262 alcohol-related visits, 223 were only related with alcohol(Group&#95;1), while the other 110 visits made up Group&#95;2. Group&#95;2 was composed of more males, more adolescents placed in Institutional Care and more adolescents with psychiatric records than Group&#95;1. Likewise, distribution of Group&#95;2 visits was less predictable than distribution of Group&#95;1., Conclusions: PS consumption is a frequent major complaint in an Emergency Department. There are more poly-intoxications in males with psycho-social problems. In those cases, consumption seems to happen regardless of the time in the day or the day of the week.

Objective: To determine the prevalence, the presentation, the evaluation and the evolution of abdominal pain of gynaecological cause in adolescents who came to a Paediatric Emergency Department., Methods: An observational and descriptive study was performed. All adolescent female aged 12 to 18 years who came to Emergency Service during 2008 with abdominal pain were included. The patients diagnosed with gynaecological disorders were studied., Results: Six hundred and ninety-nine adolescents with abdominal pain were evaluated and 54 (7,7%) of them were of gynaecological cause. Their mean age was 15,2 (SD 1,7) years. Fifty-one (94,4%) had had the menarche. Thirteen (59,3%) of the 32 adolescents, who were asked, said that they had had sex. The median evolution of pain was 2 days (p25-75: 6hours-4days). The most frequent associated symptoms were micturition syndrome (11; 20,4%) and vomiting (9; 16,7%). Thirty-one (57,4%) adolescents were evaluated by two or more specialists. Forty-two (77,7%) patients were subjected to complementary examinations; abdominal ultrasound (29; 53,7%) and urinary sediment (26; 48,1%) were the two most common. The main diagnoses were peri-ovular pain (16; 29,6%) and dysmenorrhoea (14; 25,9%). Six (9,3%) patients were admitted to the hospital and 4 (7,4%) needed surgery., Conclusions: Although the main causes of abdominal pain in adolescent females are physiological, an accurate anamnesis and physical examination is essential to rule out other more serious causes. A multidisciplinary evaluation is often necessary to make a correct diagnosis., (Copyright 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Introduction: Parental participation in medical decisions involving their children is essential and family presence during invasive procedures (IP) is fundamental., Objectives: 1) To determine the frequency of parental presence during different IP in Spanish Paediatrics Emergency Departments (PED). 2) To assess the reasons for restricting parental presence. 3) To evaluate the agreement of health care professionals with regards to parental presence., Materials and Methods: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED., Results: Thirty-two out of 43 questionnaires were replied. Family presence during IP is never allowed in 11 hospitals. In the rest, this varies depending on the type of IP: blood sampling (15 hospitals), wound suture (14), urethral catheterization (9), lumbar puncture (7), intubation (1) and cardiopulmonary resuscitation (1), with no significant differences between hospitals. The main arguments for restricting parental presence are parental anxiety (26/30) and a lower performance by health personnel (23/30). Occasional problems, such as nausea (22/28), have arisen due to family presence. The interviewed physicians in charge think that health care professionals' agreement rates for parental presence decrease significantly with the increasing invasiveness of the procedure. Two hospitals have a working group and one a specific protocol to address parental presence., Conclusions: Parental presence during IP is limited in Spanish PED, due to parental anxiety and is detrimental to the success of the procedure. Physicians and nurses disagree with family presence, especially during the most invasive procedures., (2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Introduction: Cerebrospinal fluid shunt valves are the preferred treatment in many cases of childhood hydrocephalus. Cerebrospinal fluid shunt valve dysfunctions usually present in an unspecific manner, which delays their diagnosis and, consequently, can increase the morbidity and mortality rates in these patients., Aim: To determine the signs and symptoms that are most suggestive of valve dysfunction in the childhood population., Patients and Methods: We conducted a retrospective study of the reports of patients who visited the emergency department of a tertiary care paediatric hospital with a clinical picture that suggested valve dysfunction. In each case the clinical manifestations were determined, and also whether there had been a diagnosis of valve dysfunction or not. A univariate analysis and later a logistic regression study were performed., Results: In all, 183 visits were included. Valve dysfunction was confirmed in 28.5% of them. The most frequent complication was obstruction of the proximal drainage catheter. The univariate analysis showed a significant relation between the presence of irritability, sleepiness, abdominal pain, paresis of the cranial nerves and increased perimeter of the skull, and the existence of valve dysfunction. The logistic regression analysis revealed that sleepiness, irritability and abdominal pain could predict valve dysfunction., Conclusions: Sleepiness and irritability are the clinical manifestations that best predict valve dysfunction, which means that they are almost undoubtedly candidates for an urgent neuroimaging study. In most cases the abdominal pain is related to abdominal pseudocysts. Headaches, vomiting and a high temperature are less predictive of valve dysfunction.

Objective: To determine management practices of minor head trauma in children evaluated at Spanish Hospital Emergency Departments and to determine patient variables associated with intracranial injury., Methods: Multicenter and prospective study during 18 months in 9 hospitals in Spain. Patients up to the age of 18 years with minor head trauma (Glasgow Coma Scale score higher than or equal to 13 on admission), treated in Emergency Departments and with a maximum onset of 72h since the traumatism, were included in the study., Results: A total of 1070 patients were studied with a median age of 2.4 years (p25-75 0.9-6.4 years); 61.2% were male. The median time between head trauma and medical consultation was 1 hour (p25-75 0.6-2.5h). Skull X-rays were performed on 64.5% of the children and a head CT scan on 9%; 91.4% of X-ray and 84.4% of CT were normal. The prevalence of intracranial injury was 1.4% (95% CI: 0.8-2.3). Twenty-five point three percent of the patients were admitted; 4 (3.7%) required neurosurgical intervention during admission. None of the patients died. Multiple logistic regression analysis identified loss of consciousness (OR 4.2, 95% CI: 1.1-17; P=0.045), neurological deterioration (OR 8.8, 95% CI: 2.1-37.6; P=0.003) and cephalhaematoma (OR 14.6, 95% CI: 4.9-44; P <0.001) as independent predictors of intracranial injury., Conclusions: The combination of clinical parameters allows selection of patients with minor head trauma who need complementary explorations. In consequence, the routine use of skull X-ray in their initial evaluation is unnecessary.

Illegal drug use among adolescents has increased in recent years in Spain, as well as has the risk behaviours and problems typical of adolescence. The results of studies on drug use during this stage of life reveal the serious and wide-ranging consequences that can arise. Emergency services are often the first to receive and deal with these and its professionals must face situations that pose contradictions between two of the basic ethical principles, the principle of autonomy and the principle of beneficence; an ethical dilemma that is addressed in this work.

Introduction and Aim: Patients arriving in Paediatric Emergency Departments due to alcohol abuse is fairly common. The aim of this study is to determine the profile of the patients seen in the emergency room for acute ethanol intoxication., Material and Method: A descriptive study was performed on all patients seen in the emergency department with an acute ethanol intoxication over a 12-month period (2007). Patients with accidental poisoning or with related chronic illness were excluded., Results: A total of 104 patients were included (50% males). Their mean age was 16.2 years (standar desviation [SD] 1.2 years); 95.8% were older than 14 years. There was on patient who was seen twice for the same reason. The majority, 72.4%, were seen on holiday days; 82.9%, from 8:00 pm to 8:00 am. A total of 81.9% of the patients were brought in by ambulance. No cases of hypoglycaemia were detected and 7.5% of the patients had hypothermia. Ethanol levels and urine toxicology were measured in 66 cases. The mean blood ethanol was 186.1mg/dl (SD 56.2mg/dl); 21.2% were slightly intoxicated, 75.8% moderate and 3% severe. Cannabis was detected in seven cases and amphetamines in three. Three patients needed hospital admission., Conclusions: The profile of the patient who arrives to emergency department with acute ethanol intoxication is a teenager who is seen on holiday nights, after a consumption of high proof alcoholic drinks, presents a moderate intoxication, and does not require hospitalisation.

Introduction and Aim: The acts of violence between adolescents are becoming increasingly more common, generating problems of a diverse nature. The knowledge of the circumstances that surround this violence is important to implement measures to decrease their incidence. The aim of this study was to describe the epidemiology of violent assault in teenagers from the perspective of an Emergency Department., Material and Method: Retrospective analysis of information recorded on adolescent victims of assault, who attended our Emergency Department over a 1 year period (2006), was performed., Results: Of the 105 patients included, the mean age of the assault victims was 15.9 (SD: 1.4) years. Of those, 73.3 % were male. They were seen at holidays (58.1 %) and predominantly between the hours of 8 pm and 4 am (55.2 %). Forty-nine (46.7 %) of the events were classified as fights, 44 (41.9 %) as assaults, 7 (6.7 %) as physical abuse and 5 (4.8 %) as sexual abuse. Overall, 20 (19 %) patients reported that there was a weapon at the scene: in 13.3 % a blunt object and in 5.7 % a knife/piercing object. Bruises or haematomas were present in 93.3 % of patients; lacerations in 19 % and fractures in 11.4 %. Sixty-two (59 %) patients needed an X-ray, 10 (9.5 %) a urineanalysis and 7 (6.7 %) a blood test. Seven (6.7 %) patients were hospitalised and 6 (5.7 %) were evaluated by Social Work., Conclusions: The knowledge of the epidemiology of this problem and awareness by the professionals involved in handling this, must promote the coordinated creation of protocols and actions that can decrease its impact among adolescents, and in turn, society.

Objective: To determinate the chief complaints in neonates presenting to a pediatric emergency service and their management., Material and Methods: We performed a retrospective study of patients younger than 28 days old who presented to the pediatric emergency department in 2003. Patients directly admitted to the neonatal unit and those attended by the surgery and orthopedic surgery departments were excluded. Information on sex, age, time and date, waiting time, visit duration, source of referral, presenting complaint, complementary examinations, final diagnosis, and hospital admission were analyzed., Results: There were 1,481 neonatal visits. The mean chronological age was 15.8 days and 57.3 % were boys. Visits were most frequent on Fridays, evening shifts, and in July and December. The most frequent chief complaints were crying/irritability (16.3 %), fever (13.6 %), vomiting (11 %), and influenza (10.8 %). The most frequent final diagnoses were feeding problems (12.6 %), infantile colic (12.4 %), and upper respiratory tract infections (12 %). No abnormalities were detected in 11.7 % of the patients and complementary examinations were not required in 45.9 %. The admission rate was 26 %, most commonly due to fever and bronchiolitis., Conclusions: Many visits were due to minor problems that did not require complementary examinations and could have been resolved in primary care. Because of the greater vulnerability of this age group, thorough investigation is required to rule out severe disease. This phenomenon was reflected by the large number of complementary examinations and admissions.

Introduction: Pediatric acute spinal cord injury is rare but is often associated with significant disability and prolonged stay in the intensive care unit (ICU)., Objectives: The main objective of this study was to determine the epidemiology, initial clinical abnormalities, diagnostic studies, treatment and outcome of acute spinal cord injuries in a tertiary level pediatric hospital. A second objective was to analyze whether early tracheostomy allows earlier discharge of these patients., Patients and Methods: A retrospective analysis of patients with acute spinal cord injuries admitted to our pediatric ICU since 1992 was performed., Results: We included 16 patients in the study, 12 of whom were boys (75 %). The patients were aged from birth to 19 years on admission to the ICU. The length of stay in the ICU was between 12 hours and 6 years. The cause of the lesion was birth trauma in four patients; one died and the remaining three live at home under mechanical ventilation. Traumatic injuries occurred in seven patients, two of whom died; a further two live in a long-term care facility and the remaining three live at home. Vascular spinal malformation occurred in two patients, and the three remaining injuries occurred during the acute postoperative period following spinal surgery. Of the 16 children, 56.2 % were tracheostomized and 83 % of the survivors live at home., Conclusions: Early tracheostomy, the availability of invasive ventilation for home use and parent education permit earlier discharge of these patients and allow more of them to live at home.

Background: Girls born small for gestational age (SGA), with a birth weight < 1.5 SDS, are at increased risk of early onset and rapid progression of puberty, with reduced final height. In contrast, idiopathic precocious pubarche (PP) does not seem have negative effects on the onset of puberty or final height., Objective: We evaluated the relationship between birthweight, the onset and progression of puberty and final height in girls with PP., Methods: We performed a retrospective study of girls at the onset of puberty with a history of PP (pubic hair before the age of 8 years)., Results: A total of 124 girls (37 SGA) were investigated; 61 had presented menarche and 44 had reached final height. The mean ( SD) age was 6.8 0.8 years at pubarche, 9.5 0.9 at the onset of puberty and 11.7 6 0.9 at menarche. No significant differences were found in the correlation between birth weight expressed in SDS and age at presentation of pubarche, bone age at presentation of pubarche, age at telarche or age at menarche. A positive correlation was found between birthweight and height at pubarche, telarche, and menarche and final height. These data suggest that pubertal progression is faster in SGA girls. All patients reached the familial target height but only those with an appropriate birthweight were taller than their mothers., Conclusions: PP does not seem to modify age of onset or progression of puberty or final height in girls with adequate birth weight. In contrast, in SGA girls, PP is associated with faster puberal development and shorter final height. Therefore, SGA girls with PP require periodic monitoring.

Background: Somatization symptoms are a clinical reality in our environment. However, many pediatricians have little information about this condition or experience of its management., Objective: To determine the clinical and differential characteristics of these patients. The early identification of these patients and initiation of therapy in the initial stages of the process would improve prognosis., Material and Method: A retrospective review was performed of the children admitted to the short-stay unit of a tertiary hospital because of somatic complaints and whose final diagnosis was that of a somatization disorder., Results: Sixty medical records were analyzed, of which 38 (63 %) corresponded to girls, with a mean age of 11 years at presentation. The most frequent reasons for consultation were related to the digestive and neurological systems. Thirty-four patients (57 %) had previously consulted for the same reason. In the sample analyzed, the most frequent personality trait was anxiety. The main triggers were familial and school factors. The most frequent diagnosis was pain disorder in 42 children (70 %). All patients received psychotherapy and 39 received complementary pharmacological treatment., Conclusions: The data analyzed in this study indicate that somatization symptoms most frequently occur in anxious, prepubescent girls, with migraine or non-specific abdominal pain of approximately one month's duration. Patients have usually made several previous visits and no organic causes are discovered on physical examination.

Introduction Termination of artificial life-support in critically-ill patients without chance of recovery or with severe damage is frequent in the intensive care unit (UCI). Patients and methodsWe studied the present situation concerning the withdrawal of life support in Spain using data collected over 10 years in referral hospitals with pediatric ICUs. Forty-nine patients were included, of which 43 had chronic diseases.ResultsThe most frequent causes of admission to the pediatric ICU in this type of patiens was respiratory failure followed by cardiovascular surgery. The family seemed to be a key element when taking a decision although in a few cases the medical team acted paternalistically. The most common ways of limiting life-support were withholding or withdrawing some treatments (mainly mechanical ventilation and vasoactive drugs) and implementing do-not-resuscitate orders. Sedation and suitable pain management were widely used in terminal care. After the decision to limit life-support was made, six patients were discharged from the pediatric ICU. ConclusionsAlthough each case should be treated individually, because of the wide variation found in the limitation of life-support, we suggest the need for common guidelines that could help the decision-making process.

Popular opinion assumes that environmental humidity relieves the clinical symptoms of respiratory tract diseases. Various types of home humidifiers are available on the market. Parents buy them in the belief that they will improve their children's well-being but are usually unaware of whether these devices provide a real benefit. Pediatricians should bear the main responsibility in the task of informing and guiding families in the use of home humidifiers but general lack of knowledge on the subject and the scarcity of published data make this task difficult. The aim of this review is to increase general knowledge of home humidifiers. We describe what they are, their main types, their basic functioning, advantages and disadvantages and the importance of suitable maintenance. We define what environmental humidity means, how it can change according to temperature and how it can influence human health. Finally, we suggest that optimal relative humidity is approximately 40-60 % and that it should be measured before using a home humidifier.