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Introducción: casi un 20% de los grandes prematuros abandona el seguimiento en los hospitales y tienen peor evolución que los que continúan el programa. Obtener datos sobre la implicación de los pediatras de Atención Primaria (PAP) en el seguimiento del prematuro de menos de 32 semanas o con peso < 1500 g es necesario para plantear estrategias de mejora. Material y métodos: estudio observacional, transversal, descriptivo, en el ámbito de las 17 comunidades autónomas españolas, a través PAPenRED (304 PAP). Se recogieron datos mediante encuestas cumplimentadas online acerca del número de grandes prematuros por pediatra, el tipo de seguimiento y las dificultades en su atención. Se describen las distribuciones de frecuencias, en porcentajes, de las variables cualitativas. Resultados: se incluyeron 870 grandes prematuros con una media por pediatra de 3,8. El 68,84% de los PAP no tienen programa común de seguimiento para el hospital y Atención Primaria (AP), y al 99% les gustaría tenerlo. El 84,27% manifiesta que estos niños tienen problemas más complejos y las patologías que presentan con mayor frecuencia en comparación con los nacidos a término son: la ansiedad familiar, la patología respiratoria y los problemas relacionados con el crecimiento, la alimentación, el desarrollo motor y los cognitivos y del comportamiento. Conclusiones: los PAP creen necesarios los programas conjuntos hospital-AP para el seguimiento de los grandes prematuros (AU)

Introduction: almost 20% of premature babies abandons the follow-up in hospitals and they have worse outcomes than those who continue the program. Obtaining data on the involvement of Primary Care pediatricians (PAPs) in monitoring premature babies born at less than 32 weeks or weighing less than 1500 g is necessary to propose strategies for improvement. Methods: it is an observational, transversal, descriptive study, in the area of ​​the 17 Spanish autonomous communities, through PAPenRED network (304 PAPs). Data were collected by questionnaires filled out online about the number of premature babies by pediatrician, the type of monitoring and the difficulties found in their attention. Frequency distributions, percentages, qualitative variables are described. Results: 870 very premature infants were included with an average of 3.8 per pediatrician. 68.84% of PAPs do not share a common monitoring program between hospitals and Primary Care centers, despite the fact that 99% of the pediatricians would like to have it. 84.27% say that these children have more complex problems. The diseases that occur more frequently compared to those born at term are family anxiety, respiratory disease and problems in relation to growth, feeding, motor development and cognitive and behavioral issues. Conclusions: PAPs believe necessary commmon programs between hospitals and Primary Care centers for monitoring the very premature babies (AU)

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Meningococcal sepsis with cardiovascular manifestations is one of the leading causes of pediatric intensive care admission (14.85%) in our area. We carried out a two phase study over period of 10 years from 1979 to 1988, involving a retrospective analysis of clinical and analytical manifestations in order to determine a prognostic score of the severity of meningococcal infections in our area. A total of 86 cases were studies over a two year period. After establishing the prognostic score, we applied a previously assayed therapeutic protocol, based on the number of criteria of severity, in 170 children selected as having the same criteria. The factors of seriousness considered were: Appearance of the first symptoms less than 12 h. previously, appearance of petechia less than 6 h. previously, hyperthermia, shock at admission, absence of meningitis, fulminating course of purpura and convulsions, leukopenia less than or equal to 5,000 mm3, prothrombin activity less than or equal to 45%, platelets less than or equal to 75,000 mm3, fibrinogen less than or equal to 250 mgrs% and FPD greater than 40 micrograms/ml (p less than or equal to 0.01 (CHI SQUARE]. In the first phase of study, overall mortality was associated with the presence of three criteria, and was highest when more than seven criteria were present. The results indicate that mortality from meningococcal sepsis is linked to fulminating deterioration of hemodynamics and DIC.(ABSTRACT TRUNCATED AT 250 WORDS)

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The most frequent cause of toxic shock in our area is meningococcal sepsis. It is currently assumed that endotoxin produce by this bacteria, a lipopolysaccharide with toxic properties, is able to trigger shock and DIC by stimulating both arachidonic acid pathways, among other actions. Previous studies in our laboratory demonstrated significant differences (p +/- 0.001) in the amounts of endotoxins released in vitro by strains from patients and healthy carriers and statistically related criteria of severity with mortality in 256 patients in our center over the last 10 years. In the present study we attempted to establish whether plasma levels of endotoxin were correlated with the severity of the disease. We studied 32 patients with meningococcal sepsis, dividing the subjects into two groups: those in whom six or more criteria of severity were present, and those in whom less than six criteria were found. Blood levels of endotoxin were determined upon admission and after the administration of antibiotics (penicillin and chloramphenicol) using the limulus test with a chromogenic substrate (Coatest, Endotoxin, Kabivitrum, Sweden). Levels of endotoxins were significantly higher in patients with more than six criteria of severity both upon admission (0.6 +/- 0.03) ng/ml) and 4 h. afterward (0.74 +/- 0.006 ng/ml) in comparison to children in whom the clinical picture was less serious (0.27 +/- 0.18 ng/ml and 0.27 +/- 0.18 ng/ml and 0.27 +/- 0.16 ng/ml7 t = 5.8 y t = 5.6 respectively. Endotoxin levels were highest in patients presenting shock, disseminated intravascular coagulation in the hypocoagulability phase and more than 8 criteria.(ABSTRACT TRUNCATED AT 250 WORDS)

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Secretory component of IgA is the major class of immunoglobulin in secretions and mucous membranes. Many causes have been involved in etiopathogenesis of respiratory tract disease in children, one of them the possible deficit of secretory component of IgA. Authors have studied 191 children with respiratory tract disease secondary to infections and/or allergy and a control group of 35 healthy children. In all of them the secretory IgA non stimulated sputum was measured. In the group with respiratory disease serum IgA, IgG, IgM and IgE were also measured. Levels of secretory IgA were greater in group with respiratory disease than in control; also serum level of IgA was above normal for their ages. Level of secretory IgA was greater in children with "wheezing respiratory disease". These findings do not agree with theory of existence of an IgA secretory deficit as a cause or respiratory tract disease in children.

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