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J Benito Fernández

Publications and source records attributed to J Benito Fernández.

At least 19 recordsLinked to original sources
PubMed2006

[Bronchodilators via metered-dose inhaler with spacer in the pediatric emergency department: what is the dosage?].

INTRODUCTION: Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage. OBJECTIVE: To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department. METHODS: This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child's weight (1 puff of salbutamol = 100 microg and 1 puff of terbutaline = 250 microg) and the other group received a number of puffs equivalent to one-third of the child's weight. RESULTS: Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (6 SD) age (58.34 +/- 34.72 vs 66.04 +/- 36.45 months), arterial oxygen saturation (95.49 +/- 1.93 vs 95.56 +/- 1.97) or pulmonary score (4.04 +/- 1.55 vs 3.97 +/- 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 +/- 1.60 vs 96.18 +/- 1.77], pulmonary score [1.87 +/- 1.33 vs 1.64 +/- 1.31]). The number of doses administered (2.17 +/- 0.91 vs 2.24 +/- 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups. CONCLUSIONS: The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children.

Adolescent↗
PubMed2005

[Infants aged 3-24 months with fever without source in the emergency room: characteristics, management and outcome].

OBJECTIVE: To determine the characteristics of infants aged 3-24 months admitted to a Hospital Pediatric Emergency Room with fever without source, the management of these infants and their subsequent outcome. PATIENTS AND METHOD: We performed a retrospective survey of 733 children aged 3-24 months with fever without source admitted to our Emergency Room between September 1, 2003 and December 31, 2003. Subsequently, the parents of all infants diagnosed with fever without source who were managed as outpatients were telephoned to ascertain their outcome and changes in the final diagnosis. RESULTS: Onset of fever occurred less than 6 hours before arrival at the hospital in 237 episodes (32.2%). The family reported a temperature of > or = 39 degrees C in 436 episodes. Diagnoses in the Emergency Room were the following: fever without source in 677 (92.3%), urinary tract infection in 53 (7.2%) and bacterial meningitis in three (0.4 %). Fifty-five infants with an altered dipstick were excluded and complete blood count (CBC) and blood culture were performed in 66 infants (9.7%). There was a significant negative association between the probability of a request for CBC and blood culture and higher age [6-11 months vs. 3-6 months OR 0.24 (95 % CI: 0.11-0.49); > or = 12 months vs. 3-6 months, OR 0.15 (0.07-0.3)] and a significant positive association with onset more than 12 hours previously [vs. less than 6 hours OR 2.3 (1.2-4.43)] and highest temperature registered at home > 40 degrees C [vs. less than 39 degrees C OR 4.22 (1.5-11.84)]. Follow-up was completed (by telephone or readmission to the Emergency Room) in 574 infants diagnosed with fever without source and managed as outpatients. The final diagnosis differed from that made in the Emergency Room in 158 infants (27.5%), and 70 received antibiotics (12.1%). CONCLUSIONS: A considerable percentage of infants aged 3-24 months with fever without source visits the Emergency Room with very short-term processes. Patient observation is very useful in the management of these infants, since the final diagnosis differed from that made in the emergency room in nearly 30% and 12% were treated with antibiotics.

Emergency Service, Hospital↗
PubMed2005

[Clinical and epidemiological study of community-acquired pneumonia in children aged less than 5 years old].

OBJECTIVE: To describe the clinical characteristics of community-acquired pneumonia and associated morbidity in children under 5 years old. PATIENTS AND METHOD: We performed a prospective epidemiological study in 12 primary care clinics and two pediatric emergency departments in Vizcaya, Spain. Demographic, clinical, radiological, laboratory and treatment data were recorded at diagnosis. Different pneumonia groups were established on the basis of radiological images (lobar pattern), total leucocyte count (> 15,000/ml) and C-reactive protein value (> 80 mg/l). These groups ranged from definitive pneumococcal pneumonia (pneumococcus isolated in usually sterile specimens) to pneumonia of probable non-pneumococcal etiology. All patients were followed-up for 7 to 15 days after diagnosis to ascertain outcome. RESULTS: Between February and April 2003, 412 children with pneumonia were enrolled. The mean age was 33.4 6 15.34 months and 21 % of the patients had received the pneumococcal conjugate vaccine. Overall 20 % had general malaise and 14.6 % required admission, with a mean length of hospital stay of 4.10 +/- 2.21 days. The mean length of treatment was 9.51 +/- 2.44 days and the mean number of visits to the primary care pediatrician was 2.02 6 1.10. Fifty-three patients (12.9 %) had definitive or highly probable pneumococcal pneumonia and these children had higher temperature (38.74 +/- 0.84 vs 38.38 +/- 0.94 degrees C), a higher percentage of general malaise (50.9 % vs 15.3 %) and a higher hospitalization rate (41.5 % vs 10.5 %). CONCLUSIONS: Community-acquired pneumonia in children under 5 years old provokes high morbidity. According to clinical, radiological and laboratory data, suspected pneumococcal pneumonia seems more severe than forms probably caused by other agents.

Child, Preschool↗
PubMed2005

[Telephone triage performed by emergency room physicians].

OBJECTIVE: To determine the applicability and utility of a telephone triage performed by physicians in a pediatric emergency department (PED). PATIENTS AND METHOD: All the telephone consultations registered between 2003-10-1 and 2004-10-3 were reviewed. The variables analyzed were: telephone call record (n = 2,560), compliance with the advice given (randomized sample of patients who were not referred to the PED and all patients who were referred) and parent satisfaction (callers over a 1-month period were contacted). A protocol for answering queries was organized and residents received specific training. RESULTS: There were 59,088 episodes and 2,560 calls were registered (1 call/23 episodes). Forty-eight percent of the calls were received between 5 and 11 pm. All calls were answered by a physician (72% residents, 28% attending physicians). The most frequent reason for calling was to seek advice on symptoms. Eighty-two percent of the calls were resolved through telephone instructions to be carried out in the home. A total of 274 patients were advised to attend the PED, but 29% did not attend, usually because the child's symptoms improved. Twenty patients were admitted to the hospital (6 to wards, 14 to the observation unit). Of the patients not advised to attend, 21% attended the PED and 0.9% were admitted (compared with 7.2% in the referral group, p = 0.0001). More than 90% of the families questioned were satisfied with the advice given. Seventy-five percent would have attended the PED if telephone consultation had not been available. By giving telephone advice, we avoided 115 visits in 1 month. COMMENTS: If special training programs and answering systems are established after a training period, telephone consultation in a PED is a safe and useful method of performing patient triage. Satisfaction among families was high.

Child↗
PubMed2004

[Patient demand and management in a hospital pediatric emergency setting].

OBJECTIVE: To describe patient demand and management in a hospital pediatric emergency setting. PATIENTS AND METHOD: We analyzed the number of episodes registered in our pediatric emergency unit between 1995 and 2002 and performed a retrospective, random survey of 540 episodes in children aged less than 14 years admitted between 2001-10-1 and 2002-09-30. Epidemiological details, physical findings, complementary tests, the treatment administered, admissions, and unscheduled return visits were analyzed. RESULTS: Between 1995-1-01 and 2002-31-12, a total of 337,842 episodes were registered in our emergency unit, requiring 11,767 (3.48 %) admissions to a ward or the pediatric intensive care unit (PICU). The number of episodes/ year increased from 38,659 in 1995 to 51,933 in 2002 (Delta = 34.3 %). The mean age of the sample (n = 540) was 3.5 6 3.2 years (54.6 % were younger than 3 years) and 306 (56 %) were boys. Nearly one-third of the children presented with processes of recent onset (less than 6 hours). The most frequent chief complaints were fever in 160 children (29.6 %), respiratory distress in 78 (14.4 %) and vomiting-diarrhea in 65 (12 %). Complementary investigations were performed in 176 patients (32.6 %), mainly radiologic tests (115; 21.2 %). One hundred fifty-three (28.3 %) received treatment in our emergency unit, mainly antipyretics and bronchodilators. Sixty-five percent stayed less than 1 hour in the emergency unit. The most frequent diagnoses were fever without source in 66 patients (12.2 %), diarrhea/acute gastroenteritis in 40 (7.4 %), asthma in 35 (6.5 %), and croup in 27 (5 %). Sixteen children (3 %) were admitted to a ward and three (0.6 %) were admitted to the PICU. Home drug treatment was recommended in 359 patients (71.8 %). Unscheduled return visits were registered in 59 patients (10.9 %), and five were admitted. CONCLUSIONS: The number of patients attended in our pediatric emergency unit gradually increased between 1995 and 2002, mostly due to young children with fever or respiratory distress. In nearly half of the patients, a thorough anamnesis and physical examination were sufficient for evaluation. Because many of the processes were of recent onset, continuous observation, whether at home or in hospital, was useful to adequately monitor these children.

Adolescent↗
PubMed2003

[Diagnostic yield of abdominal ultrasonography in acute appendicitis].

INTRODUCTION: Acute appendicitis (AA) is the first cause of surgical abdomen in childhood but diagnosis continues to be difficult in some cases. Abdominal ultrasonography has been shown to be useful when there is doubt about the diagnosis and can be quickly and easily performed at the patient's bedside. OBJECTIVE: To evaluate the efficacy of abdominal ultrasonography in the diagnosis of acute appendicitis in our hospital. PATIENTS AND METHODS: All patients who visited the emergency department for abdominal pain and who underwent abdominal ultrasonography to rule out AA between January 1, 1999 and December 31, 2000 were retrospectively studied. RESULTS: During the study period, 4217 children were evaluated in our service for abdominal pain. Ultrasonography was performed in 528 children. Of these, the procedure was performed to rule out AA in 308 patients. Of these 308 patients who met the study's inclusion criteria, the results of ultrasonography were compatible with AA in 102 and were normal in 196. Ultrasonographic diagnosis differed from the final diagnosis in 16 patients. In eight children with ultrasonographic findings suggestive of AA, laparotomy revealed normal appendices. In the remaining eight patients, ultrasonographic findings were normal and surgery revealed AA. Based on these findings, the diagnostic yield of abdominal ultrasonography was: sensitivity: 96.6 %; specificity: 95.9 %, positive predictive value: 86 %; negative predictive value: 95.9 %. CONCLUSIONS: The overall diagnostic yield of abdominal ultrasonography in AA our hospital is acceptable. Because ultrasonographic diagnosis is not always accurate, others diagnostic methods such as computed tomography should be used in doubtful cases.

Acute Disease↗
PubMed2003

[Chest pain in pediatric emergency departments: a usually benign process].

OBJECTIVES: To describe the characteristics and management of the children aged less than 14 years presenting to the pediatric emergency department with chest pain. PATIENTS AND METHOD: Retrospective review of all the patients who presented to the pediatric emergency department with chest pain from 15 January 2001 to 14 January 2002. Families received a follow-up telephone call inquiring about the patient's outcome. The Mann-Whitney U test was used for non-parametric data and the Chi-square test with Yates' correction and Fisher's exact test were used for categorical data. Statistical significance was set at p<0.05. RESULTS: In 2001, 161 children presented with chest pain, representing 0.34% of the total number of consultations. Less than half of these patients (48%) had associated symptoms. Physical examination revealed abnormalities in 63% of the patients (39.1%). The most common finding was pain on palpation of the chest wall. Additional diagnostic tests were performed in 129 patients (80%). These included 116 radiographs, 62 electrocardiograms and nine miscellaneous tests. Abnormalities were found in seven chest radiographs. Only one child was admitted to hospital with pneumonia. The most common discharge diagnoses were idiopathic and/or musculoskeletal chest pain in 139 patients, pain of respiratory origin in 14 patients, gastrointestinal disorders in one patient, cardiac problems in one patient and other morbid processes in nine patients. Children with associated symptoms were more likely to receive a diagnosis other than nonspecific chest pain (28% vs 3.2% in children without other symptoms; relative risk: 8.66). Outpatient treatment included analgesics in 105 patients (65.2%). Only two children (1.2%) returned for reevaluation and no important findings were detected. Telephone follow-up was carried out in 117 children (72.6%). The pain lasted for less than 24 hours in 52 patients (32.2%). Thirty percent of the patients missed at least one day of school because of chest pain. CONCLUSIONS: Chest pain is an infrequent chief complaint in our setting and, in the absence of associated symptoms, is not generally associated with serious disorders. The decision to use complementary diagnostic tests should be individualized to each patient.

Adolescent↗
PubMed2002

[Emergency department visits for poisoning: epidemiological changes in the last 10 years].

OBJECTIVE: To study the epidemiological changes observed in pediatric poisonings treated in our Emergency Department between 1988 and 1999. PATIENTS AND METHODS: Descriptive, observational study performed in three 12-month periods (1988, 1993 and 1999). The circumstances surrounding the visit, treatment in the Emergency Department and clinical evolution were registered. RESULTS: Consultations for possible poisoning decreased between 1988 and 1999 (279 vs. 161, p 0). This decrease was noted both in poisonings caused by household products (91 vs. 48, -47 %) and those caused by drugs (112 vs. 87, -22 %). Antipyretics caused one-third of drug poisonings and psychotropics caused approximately 11 %. The most commonly implicated agent is currently paracetamol. Caustic alkali were the most common household products causing poisoning although the number of such poisonings decreased (48 episodes in 1988 and 18 in 1999). Hydrocarbons were the second most frequent cause of household product poisoning (12-16/year). Most episodes occurred at home. The poison, mainly household products, was kept in a container other than the original in nearly 5 % of episodes in 1988 and in 13.7 % in 1999. The number of children receiving treatment in the Emergency Department decreased between 1988 and 1993 and remained stable between 1993 and 1999 (62 % in 1988 and approximately 35 % in 1993 and 1999; p 0.000003). The number of admissions also decreased from 17 children in 1989 (6.0 %) to six in 1999 (3.7 %, p 0.39). No deaths were recorded. CONCLUSIONS: In the last ten years, visits for possible episodes of pediatric poisoning have decreased, mainly those due to mild poisoning caused by household products. Paracetamol has replaced acetyl-salicylic acid as the most frequently implicated drug.

Child, Preschool↗
PubMed2002

[The influence of human milk and various artificial formulae commercially available in Spain on the fatty acid status of infants in the first two months of life].

OBJECTIVE: To evaluate changes in the fatty acid composition of red blood cell phospholipids in breast-fed infants compared with those in infants fed with different formulas (conventional, omega -6-enriched formula, omega -6- and omega -3-enriched formula and nucleotide-enriched formula). METHODS: Thirty-seven healthy term infants were randomly assigned to one of five different feeding groups. Weight, length, head circumference, and arm circumference were assessed at 7 and 60 days of age. The fatty acid composition of the infants' red blood cell phosphatidylcholine (PC) and phosphatidylethanolamine (PE) were analyzed at these ages. RESULTS: The anthropometric variables studied showed no changes among the different groups. At 60 days old, arachidonic acid concentration (20:4 omega -6) was lower in non-omega -6 enriched formula-fed groups compared with that in the breast-milk fed group (4.03, 3.68 and 5.15 vs 7.20 g/100 g of fatty acids). Docosahexaenoic acid concentration (22:6omega -3) in both PC and PE clearly decreased in the non-omega -3 formula-fed groups compared with that in the breast-milk fed group (PC: 0.72 vs 2.82 g/100 g of fatty acids and PE: 5.15 vs 7.73 g/100 g of fatty acids). CONCLUSIONS: This study demonstrates differences in the fatty acid composition of red blood cell phospholipids between breast-milk fed infants and those fed with any of the artificial formulas available on the Spanish market. These data provide evidence of the influence of diet on certain essential fatty acids in the body.

Anthropometry↗
PubMed2000

[Use of a hospital pediatric emergency department during the night].

OBJECTIVE: To determine the characteristics of children younger than 14 years visiting our pediatric emergency department between 0:00 and 8:00 hours. PATIENTS AND METHODS: Retrospective review of 300 children visiting our emergency department at night. RESULTS: Between March 1 and 22 1999 we recorded 300 episodes from 0:00-8:00 hours (1.7 patients/hour) and 2350 episodes from 8:00-24:00 hours (6. 6 patients/hour). Of the 300 episodes registered at night, 132 children (44%) came between 0:00 and 2:00. The most common complaints were: respiratory symptoms in 116 patients (38.6%), fever in 61 (20.3%) and digestive symptoms in 61 (20.3%). We carried out at least one complementary test in 111 patients (37.0%). Five children (1.7%) were admitted to the hospital (80 between 8:00 and 24:00, 3.4%, p = 0.15) and 25 (8.3%) were admitted for a few hours to the observation ward (123 of the 2350 who came between 8:00 and 24:00, 5.2%, p = 0.06). Final diagnoses were: ear nose and throat infection in 91 (30.3%), fever without source in 38 (12.6%), asthma in 29 (9.6%), acute gastroenteritis in 27 (9%), croup in 22 (7.3%), vomiting in 14 (4.6%), abdominal pain in 13 (4.3%), febrile convulsion in 6 (2%), pneumonia in 5 (1.6%), bronchiolitis in 5 (1. 6%), bacteremia in 1 (0.3%), and other diagnoses in 46 (16.3%). CONCLUSIONS: The number of visits to our emergency department diminished at night, particularly between 0:00 and 2:00. The night-time admission rate was less than the daytime rate, although this difference was not statistically significant. Admission for a few hours to the observation ward was more common at night. The percentage of patients with respiratory illnesses was higher during the night.

Child↗
PubMed2000

[Intellectual development in the second year of life in healthy breast-fed children compared with formula-fed children].

BACKGROUND: The role of breast milk with regard to W3 long-chain polyunsaturated fatty acids and infant intellectual development remains controversial. PATIENTS AND METHODS: Thirty-nine children born at term and from homogeneous sociocultural status were enrolled in a blind-prospective trial. Children were divided in two non-randomized groups: a breast-fed group and a standard formula-fed group. Red blood cell phospholipid fatty acids were analyzed at 7 and 60 days of life. Cognitive development was evaluated at the end of the second year of life through Bailey s test. RESULTS: Concentrations of phosphatidylethanolamine and phosphatidylcholine docosahexaenoic acid were significantly lower in the formula-fed group. No statistically significant differences between groups were found in cognitive function. Brain development index was significantly correlated with infant head circumference and educational status of the mother. CONCLUSIONS: Maternal nutrition provides higher red blood cell docosahexaenoic acid, but is not related to a higher developmental quotient at the age of 2 years. However, infant head circumference and maternal educational status were correlated with developmental cognition.

Breast Feeding↗
PubMed2000

[Children's unscheduled return visits to an emergency department].

OBJECTIVE: To study the patients who make unscheduled return vi-sits in less than week to a pediatric emergency department (ED). PATIENTS AND METHOD: Retrospective review of 495 episodes in 233 children who were attended at our ED in November 1999. RESULTS: In November 1999, we registered 3667 episodes at our ED (495 corresponding to 233 children who made repeat visits, 13.4%). The most common chief complaints among children who revisited were fever and respiratory symptoms. The most common diagnoses were fever with-out apparent source, ORL infections, asthma and acute gastro-enteritis. The diagnoses made at the initial and fi-nal visits were the same in 131 cases (56.2%), a complication was detected in 18 (7.7%) and 84 (36.1%) were given a different diagnosis. The percentage of patients who received a symptomatic diagnosis was lower in the final visit. The admission rate of children who revisited was higher than that of children who visited our ED once (6.4% vs. 3.0%, p = 0.009), caused by the group of patients who received a different diagnosis when they revisited our ED. CONCLUSIONS: Patients who revisit a pediatric ED within a week are more likely to be admitted to the hospital, especially if the diagnosis they receive varies.

Child↗
PubMed2000

[Efficacy of early administration of nebulized ipratropium bromide in children with asthmatic crisis].

AIM: To determine the efficacy of adding ipratropium bromide to nebulized salbutamol in the treatment of children with moderate-to-severe acute asthma attacks. METHODS: A total of 102 patients aged between 5 months and 16 years were included in a double-blind randomized trial. All patients were given nebulized salbutamol (0.2 mg/kg) and oral steroids (1 mg/kg). Patients in group A received two doses of nebulized ipratropium bromide (250 mg per dose) and patients in group B were given placebo. Oxygen saturation (SaO2) and a clinical score (heart rate, respiratory rate, dyspnea, retraction of the intercostal spaces, and wheezing) rated from 0 to 5 were measured before treatment and at 120 min. RESULTS: Patients in both groups showed similar SaO2 values and clinical scores at baseline (group A, 93.05% and 4.45; group B, 92.78% and 4.43) and at 120 min (group A, 94.33% and 2.45; group B, 94.03% and 2.74), but the percentage of patients admitted to the hospital was higher in group B than in group A (53% vs 35%, p = 0.07). In the subset of patients with the most severe attacks (baseline score 5), the clinical score after treatment and the percentage of admissions were significantly higher in group B (n = 22) than in group A (n = 23) (3.32 vs 2.69 and 73% vs 39%, p < 0.05). CONCLUSIONS: Coadministration of ipratropium bromide and repeat doses of nebulized salbutamol produced a small beneficial clinical effect compared with administration of nebulized salbutamol alone. This beneficial effect was related to a decrease in the hospitalization rate, particularly in patients with severe asthma attacks.

Administration, Inhalation↗
PubMed2000

[Outpatient management of children with viral meningitis].

OBJECTIVE: To describe our experience in the extrahospitalary management of children with suspected viral meningitis (YM). METHOD: Between April and July 1997. 156 children were diagnosed of YM in our hospital and 150 managed as outpatients, after being a few hours in our emergency department. All of them were suspected to have VM attending usual clinical and laboratory findings and were discharged with cautious instructions to demand a new assessment. We contacted telephonically with them one month and six months later. RESULTS: All the children with suspected viral meningitis and managed as outpatients had negative blood and CSF cultures and all of them did well. Telephonically, 104 children (69.3%) referred transient headache or back pain. and 20 of these (13.3% of all the 150) came again to our hospital, and 4 required rest for a few hours (4-12 hours) in our observation setting. Children with suspected VM didn't go to school during 5.9 x 6.1 days (1-30 days) and 71 (47.3%) were absent less than 3 days. CONCLUSION: Outpatient management of most of the children with suspected VM is possible. When a patient is sent home, detailed instructions must be given to the family.

Adolescent↗