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Objetivo: examinar las diferencias, en la clínica y en la analítica de sangre y orina, en los pacientes que acuden a urgencias de pediatría de un hospital de III nivel que permitan distinguir a aquellos que tienen infección del tracto urinario (ITU) de los que presentan otros procesos infecciosos o febriles. Con este fin, se hace un examen comparativo de los datos clínicos, sanguíneos, y análisis de orina entre dos grupos de pacientes, con y sin ITU, atendidos consecutivamente en urgencias. Pacientes y Métodos: durante un periodo de 6 meses, fueron evaluados prospectivamente 349 niños con edades comprendidas entre menos de 1 mes y los 14 años (media: 4,1 años), de entre los 14.400 atendidos en urgencias y que presentaban fiebre > 38,1° C y/o otros signos o síntomas relacionados con una ITU. En 247 pacientes, la ITU fue descartada. A los restantes 102 se les practicó un urocultivo y fueron divididos en dos grupos según el resultado del mismo, con y sin ITU; analizándose las diferencias entre los datos clínicos, exámenes de orina y análisis de sangre. Resultados: la sospecha de ITU en los 14.400 pacientes atendidos en urgencias, se planteó en 349 casos (2,4 por ciento), con una prevalencia de ITU en el conjunto de pacientes con sospecha de tener infección del 12,3 por ciento. La incidencia global de ITU en la población pediátrica que acudió a urgencias fue del 0,3 por ciento. Los 59 pacientes del grupo con urocultivo negativo, mostraron un porcentaje más alto de signos clínicos inespecíficos y examen microscópico de orina normal (p < 0,05), que los 43 pacientes del grupo con urocultivo positivo (ITU confirmada). El multistix de orina anormal, se obtuvo en mayor porcentaje (p < 0,05), en los pacientes con ITU. No se hallaron diferencias relevantes en otros parámetros clínicos y análisis de sangre entre ambos grupos. Fue necesario hospitalizar, basándose en la gravedad de los signos clínicos, en una proporción más elevada a los pacientes con ITU (27,9 por ciento vs 1,7 por ciento) y a los menores de 6 meses con ITU (66,6 por ciento). Conclusiones: el multistix y el examen microscópico anormal de orina en los pacientes con ITU, y los signos clínicos inespecíficos en los que no la tienen, poseen valor discriminativo en el diagnóstico diferencial. Se observa un gran solapamiento entre los signos clínicos y los análisis de sangre entre los pacientes que acuden a urgencias con infecciones varias y los que padecen una ITU. Estos parámetros, no son de utilidad significativa en el diagnóstico diferencial. Los multistix son útiles para el cribado en los casos sospechosos de ITU, si se conocen bien sus limitaciones. Es imprescindible obtener una muestra limpia de orina con cultivo positivo, para el diagnóstico de infección urinaria verdadera (AU)

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OBJECTIVE: All cases of neonatal septicemia among neonates admitted to the neonatal unit in the pediatric department (CHUS) in Santiago de Compostela between 1992 and 1995 were studied. Our aims were: 1) To assess the incidence and microbial epidemiology. 2) To study the incidence of coagulase-negative staphylococci (CONS) sepsis stratified according to birth weight and gestational age. 3) To assess the incidence density of sepsis (IDS) and 4) To analyze the associated mortality. PATIENTS AND METHODS: One hundred eighteen episodes of sepsis in 103 neonates which fulfilled clinical and laboratory criteria with positive blood cultures were included in this study. Between the years of 1992 and 1995 there were 318 neonates suspect of having sepsis among the 2,083 who were admitted to the unit during this period and which came from our own maternity department, as well as other centers. RESULTS: In this period there were 10,457 live births in our maternity department. The annual incidence of sepsis was 6/1000 live births. Early onset sepsis was observed in 2.5/1000 live births (26 cases) and the occurrence of late onset increased to 3.5/1000 live births (36 cases). Neonatal sepsis was confirmed in 103 neonates (4.9%) corresponding to 118 episodes of sepsis. S. epidermidis was the most frequent agent isolated in blood cultures (38.1%). The highest incidence of sepsis caused by S. epidermidis was observed in neonates below 1500 g (12.1%) and less than 32 weeks gestational age (13.4%). The incidence was lower in those whose birth weights were more than 2500 g (1.9%) and > 37 weeks of gestational age (1.6%), p < 0.001. Overall mortality due to sepsis was 0.7% and increased to 5.0% among hospitalized newborns with birth weights below 1500 g. The average IDS stratified in three groups of birth weight and gestational age was 18 sepsis work-ups per 1000 patient-days of hospitalization, the lowest IDS 12.9/1000 was found in neonates whose birth weights were between 1501 g and 2500 g in comparison with neonates who weighted more than 2500 g (21.5/1000), p < 0.05, and very similar to the IDS found in the intermediate group of gestational age (13.1/1000). CONCLUSIONS: S. epidermidis and other CONS are the main agents causing sepsis in hospitalized neonates, although there is a decreasing trend of incidence (-71.1%) between the years 1992 and 1995 (5.0% vs 1.5%). Gram-negative organisms and S. agalactiae played a minor role as agents causing sepsis even though S. agalactiae is the most important agent in early onset sepsis. Overall mortality associated with sepsis (7/1000 live births) is in or under the average range of international statistics. Indexes of IDS are more valuable as epidemiological tools in assessing septicemia than the simple attack rate because they have taken into consideration the length of stay, number of hospitalized newborns, as well as the number of positive sepsis work-ups in the calculating process.

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OBJECTIVE: Rotavirus (RV) remains as the leading cause of acute diarrheal disease in early infancy; nevertheless, there are few epidemiological studies in our geographical area. In order to better understand the clinical epidemiology of RV, we have carried out a revision of acute diarrheal illnesses in the area of Santiago de Compostela (Spain) in children younger than 2 years of age who needed hospitalization during a 12 month period. PATIENTS AND METHODS: In 155 children with suspected gastroenteritis, 339 stool samples were collected and separated into two groups depending upon the presence or not of RV antigen. RESULTS: In the group of RV-positive stool patients, the occurrence of vomiting, fever, need of intravenous fluid rehydration (p = 0.01), respiratory symptoms (p < 0.01), the incidence during winter, as well as the development of disaccharidase depression (p < 0.001), were more frequent as compared with the group of children of similar age who did not present RV in faeces. There was no difference between the two groups regarding the presence of other potential enteropathogen agents (p > 0.05). The incidence of RV-positive faeces per 100 hospitalized infants/year was 10.5 and that of infants with RV diarrhea who needed hospitalization was 5.5%/ year. CONCLUSIONS: There was no mortality related with gastroenteritis, but RV-infection remains an important cause of morbidity and socioeconomic burden. Nosocomially acquired hospital infections add to morbidity and the cost of hospitalization.

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Genetic risk is a primary contributing factor to the predisposition of a newborn child to elevated blood pressure later in life. An index of this factor is needed to assess in the neonate the success or failure of preventive interventions instituted for the pregnant women. This index could be based on characteristics of blood pressure and heart rate variability measured during the first 2 days after birth. In the search for such an index, the systolic and diastolic blood pressures and heart rates of 127 newborn babies were automatically monitored at about 30-min intervals for 48 h with a Nippon Colin device, starting early after birth. Circadian parameters (obtained by the linear least-squares fit of a 24-h cosine curve to each individual series) and descriptive statistics for the three circulatory variables were used in a multiple regression analysis to compute a linear prediction function for the cardiovascular risk score. This score was obtained for each neonate on the basis of the presence or absence of overt cardiovascular disease, elevated blood pressure, or obesity across two generations, those of the newborn's parents and grandparents. Results from regression indicate that the best model includes the circadian amplitudes of systolic and diastolic blood pressure and the circadian ranges of systolic blood pressure and heart rate. The contributions from patroclinous versus matroclinous family history were then compared. Results show that linear prediction models include the same variables for both paternal and maternal cardiovascular risk score. These results provide a neonatal index of cardiovascular risk, to be used later for the evaluation of the effects on the newborn of intervention for the pregnant women.

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