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Baena-Palomino C, Castellano-Martínez A, Rodríguez-González M. The relevance of electrocardiogram filtering in the differential diagnosis of Brugada syndrome: An illustrative case report. Cardiol Young 2024; 34:221-223. [PMID: 38037807 DOI: 10.1017/s1047951123003992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
We present a clinical case of a teenager in whom a Brugada syndrome electrical pattern was found which was finally diagnosed as a Brugada phenocopy due to a wrong setup of the high-pass filter on the electrocardiogram.
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Acuñas-Soto S, Castellano-Martínez A, Alonso-Ojembarrena A, Roldán-Cano V, Rodríguez-González M. Incidencia y factores asociados a daño renal agudo en cirugía no cardíaca neonatal. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
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Rodríguez-González M, Castellano-Martínez A, Estalella-Mendoza A, Rodríguez-Campoy P, Estepa-Pedregosa L, Calero-Ruiz MM, Sáez-Benito Godino A, Flores-González JC. Correlation between urinary and serum NT-proBNP in acute bronchiolitis: A pilot study. Pediatr Pulmonol 2023; 58:492-499. [PMID: 36314349 DOI: 10.1002/ppul.26215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/25/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIMS We aimed to analyze the correlation of urinary with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and its association with severity in acute bronchiolitis. MATERIAL AND METHODS A pilot observational study was conducted between October 1, 2021 and March 31, 2022 including acute bronchiolitis cases who attended our institution. Serum and urinary NT-proBNP concentrations were determined using the Alere i NT-proBNP assay in time-matched urine and blood samples. The Mann-Whitney U test, Spearman's correlations, and simple linear regression were utilized to analyze the association of urine NT-proBNP levels with serum NT-proBNP and with variables indicative of severe bronchiolitis. RESULTS Seventeen infants (median age 68 [IQR: 36-91] days) with 36 time-matched samples were included. The urine NT-proBNP was positively and strongly correlated with the serum NT-proBNP concentrations (Spearman's ρ = 0.81 & R2 coefficient = 0.751; p < 0.001), and increased with higher C-reactive protein, (p = 0.004), procalcitonin (p = 0.001), and pCO2 (p = 0.029) levels. The initial urinary NT-proBNP concentrations were higher in those infants that required ventilatory support compared with those without this outcome (1.85 [IQR: 1.16-2.44] vs. 0.63 [IQR: 0.45-0.84] pg/mg); p < 0.001); and resulted positively and strongly correlated with the duration of the ventilatory support (Spearman's ρ = 0.76; p < 0.001) and the length of stay hospitalization (Spearman's ρ = 0.84; p < 0.001). CONCLUSION The urinary NT-proBNP concentrations could be a reliable surrogate for serum NT-proBNP levels and resulted elevated in cases of acute bronchiolitis with complicated evolution, suggesting a potential as a noninvasive tool to assess severity in this setting.
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Affiliation(s)
- Moises Rodríguez-González
- Pediatric Cardiology Division, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - Ana Castellano-Martínez
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Nephrology Division, Puerta del Mar University Hospital, Cádiz, Spain
| | - Ana Estalella-Mendoza
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Patricia Rodríguez-Campoy
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Lorena Estepa-Pedregosa
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - María Mercedes Calero-Ruiz
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Clinical Laboratory Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Ana Sáez-Benito Godino
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Clinical Laboratory Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Jose Carlos Flores-González
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
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Rodríguez-González M, Estepa-Pedregosa L, Estalella-Mendoza A, Rodríguez-Campoy P, Romero-Castillo E, Castellano-Martínez A, Flores-González JC. Routine laboratory test to assess the need of respiratory support in acute bronchiolitis. Pediatr Pulmonol 2022; 57:1339-1347. [PMID: 35224889 DOI: 10.1002/ppul.25870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 11/23/2021] [Accepted: 02/22/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Accurate and readily available biomarkers to predict the clinical course of bronchiolitis would enable enhanced decision-making in this setting. We explored the relationship of several biochemical parameters available at the pediatric emergency care setting with the need of advanced respiratory support (ARS): continuous positive airway pressure (CPAP), biphasic positive airway pressure (BiPAP), or invasive mechanical ventilation (MV) in bronchiolitis. METHODS Single-center, prospective, observational, including infants aged less than 12 months diagnosed with acute bronchiolitis at the Pediatric Emergency Department. Determination of plasmatic values of several laboratory tests was performed at the time of hospital admission. Multivariate logistic analysis identified independent predictors for need of ARS. RESULTS From October 1, 2018 to May 1, 2020, we recruited 149 infants (58% males; median age of 1 [0.5-2.5] month). Thirty-seven (25%) cases required ARS. After adjusting by age, bacterial superinfection, and comorbidities in the multivariate analysis, only higher levels of glycemia (p = 0.001), C-reactive protein (CRP) (p = 0.028), CRP/albumin ratio (p = 0.032), and NT-proBNP (p = 0.001) remained independently associated with ARS. These biomarkers reached moderate prediction accuracy with area under the curve of receiver operator curve curves ranging from 0.701 to 0.830 (p = 0.001). All they presented relatively high specificity (0.75-0.84) and negative predictive values (0.77-0.89) with low sensitivity and positive predictive values. They also correlated significantly with length of stay hospitalization (p = 0.001). CONCLUSION Increased plasmatic levels of CRP, CRP/albumin ratio, glycemia, and NT-proBNP at hospital admission are associated with the need for ARS in infants with acute bronchiolitis.
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Affiliation(s)
- Moisés Rodríguez-González
- Pediatric Cardiology Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - Lorena Estepa-Pedregosa
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Ana Estalella-Mendoza
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Patricia Rodríguez-Campoy
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Ana Castellano-Martínez
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Pediatric Nephrology Division, Puerta del Mar University Hospital, Cádiz, Spain
| | - Jose C Flores-González
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
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Castellano-Martínez A, Roldan-Cano V, Rodríguez-González M. Factors associated with the development of renal sequelae in a series of cases with Shiga toxin hemolytic-uremic syndrome. Med Clin (Barc) 2021; 157:449-450. [PMID: 33272684 DOI: 10.1016/j.medcli.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Ana Castellano-Martínez
- Sección de Nefrología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España; Instituto de Investigación Biomédica e Innovación de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, España.
| | - Virginia Roldan-Cano
- Sección de Nefrología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España; Instituto de Investigación Biomédica e Innovación de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, España
| | - Moisés Rodríguez-González
- Instituto de Investigación Biomédica e Innovación de Cádiz (INiBICA), Unidad de Investigación, Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, España; Sección de Cardiología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
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Castellano-Martínez A, Rodríguez-González M. Bilateral acute focal nephritis by Enterococcus faecalis associated to Kawasaki disease in a pediatric patient. Rev Esp Quimioter 2021; 34:261-263. [PMID: 33709677 PMCID: PMC8179934 DOI: 10.37201/req/138.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- A Castellano-Martínez
- Ana Castellano-Martínez, Servicio de Pediatría y áreas específicas, Hospital Universitario Puerta del Mar, Avenida Ana de Viya 21, 11009, Cádiz, Spain.
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Rodríguez-González M, Estepa-Pedregosa L, Estalella-Mendoza A, Castellano-Martínez A, Rodríguez-Campoy P, Carlos Flores-González J. Early elevated NT-proBNP but not troponin I is associated with severe bronchiolitis in infants. Clin Chim Acta 2021; 518:173-179. [PMID: 33831420 DOI: 10.1016/j.cca.2021.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND We aimed to explore and to compare the association between the NT-proBNP and high-sensitivity troponin I (hs-cTnI) at early stages of acute bronchiolitis with echocardiographic alterations, clinical severity and outcomes. METHODS A single centre, prospective observational study including previously healthy infants aged 1-12 months with bronchiolitis admitted to a tertiary hospital from April 2019 to March 2020. All patients underwent clinical, laboratory and echocardiographic evaluation at the same time point within 12 h of hospital admission. NT-proBNP > 1121 pg/ml and hs-cTnI > 26 ng/L were considered elevated. The primary outcome measure was the association of raised cardiac biomarkers with the need for PICU admission. RESULTS We enrolled 40 infants with median levels of NT-proBNP of 1176 (520-3030) pg/ml and hs-cTnI of 11.5 (5-21) ng/L at the time of hospital admission. Raised levels of NT-proBNP and hs-cTnI in 50% and 20% of cases, respectively. Of them, 15 (37%) required PICU admission during the hospitalization. Increased NT-proBNP was associated with PICU admission (adjusted OR 9.5 (CI95% 1.4-64); p = 0.020), prolonged hospitalization (β = 2.7; p = 0.012) and duration of oxygen administration (β = 2.7; p = 0.004) in the multivariate analysis. There were no differences in hs-cTnI levels regarding PICU admission (p = 0.866). Increased hs-cTnI levels were only associated with oxygen administration duration (Spearman rho = 0.38; p = 0.017), but this association disappeared in the multivariate analysis. Only NT-proBNP was associated with echocardiographic parameters of myocardial dysfunction (p < 0.001), and pulmonary hypertension (p < 0.001) CONCLUSION: Early elevated NT-proBNP but not hs-cTnI could be used as a biomarker for myocardial strain and disease severity in bronchiolitis.
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Affiliation(s)
- Moisés Rodríguez-González
- Pediatric Cardiology Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
| | - Lorena Estepa-Pedregosa
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
| | - Ana Estalella-Mendoza
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
| | - Ana Castellano-Martínez
- Pediatric Nephrology Division, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain.
| | - Patricia Rodríguez-Campoy
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
| | - Jose Carlos Flores-González
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain
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Sanchez-Codez MI, Rodríguez-González M, Castellano-Martínez A, Zafra Rodríguez P. Ventricular arrhythmia as the first manifestation of congenital toxoplasmosis. Med Clin (Barc) 2020; 155:514-515. [PMID: 31492450 DOI: 10.1016/j.medcli.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/23/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022]
Affiliation(s)
- María Isabel Sanchez-Codez
- Unidad de Gestión Clínica de Pediatría, Sección de Infectología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - Moises Rodríguez-González
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación Hospital Universitario Puerta del Mar, Cádiz, España
| | - Ana Castellano-Martínez
- Unidad de Gestión Clínica de Pediatría, Sección de Nefrología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Unidad de Investigación Hospital Universitario Puerta del Mar, Cádiz, España
| | - Pamela Zafra Rodríguez
- Unidad de Gestión Clínica de Pediatría, Sección de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España
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Rodríguez-González M, Castellano-Martínez A. [Coronary vasospasm in a child allergic to latex: Kounis syndrome]. ARCH ARGENT PEDIATR 2020; 117:e514-e518. [PMID: 31560503 DOI: 10.5546/aap.2019.e514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 03/06/2019] [Indexed: 11/12/2022]
Abstract
Kounis syndrome consists of the simultaneous occurrence of anaphylaxis and acute coronary syndrome. It is a rare entity that may be underdiagnosed in paediatrics. The clinical presentation is variable, atypical and usually unexpected, and it carries possible serious complications such as ventricular arrhythmias, myocardial infarction and sudden death. Therefore, an early diagnosis and treatment for myocardial revascularization and the anaphylactic reaction are crucial. We report the case of an 11-year-old male who, after contact with latex, presented an anaphylactic reaction associated with coronary vasospasm, with rapid and complete recovery after administration of intramuscular adrenaline. The cardiological study ruled out coronary pathology as the cause of the event. The allergy study revealed a latex-fruit (kiwi and pineapple) cross-reactivity syndrome. The patient was diagnosed with type I Kounis syndrome triggered by latex, recommending the avoidance of possible triggers.
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Affiliation(s)
- Moisés Rodríguez-González
- Sección de Cardiología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - Ana Castellano-Martínez
- Servicio de Pediatría, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
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Rodríguez-González M, Castellano-Martínez A, Alonso-Ojembarrena A. Usefulness of age-adjusted N-terminal prohormone of brain natriuretic peptide level as a diagnostic marker for incomplete Kawasaki disease in children. Emergencias 2019; 31:111-114. [PMID: 30963739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The main objective was to assess the diagnostic usefulness of age-adjusted level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as a diagnostic marker in children suspected of having incomplete Kawasaki disease (IKD). The secondary aim was to compare the diagnostic yield of NT-proBNP level with the yield of other markers currently recommended by the American Heart Association (AHA). MATERIAL AND METHODS Descriptive cross-sectional study of a case series of patients under the age of 14 years admitted with clinical suspicion of IKD between 2013 and 2017. We analyzed NT-proBNP level adjusted for age. Demographic, clinical, echocardiographic, analytic, and microbiologic findings were gathered from computerized charts. Two independent evaluators made the diagnosis of IKD according to AHA criteria. RESULTS We included 70 cases, and 19 (27%) were diagnosed with IKD. Patients with IKD had higher NT-proBNP levels than patients with other febrile diseases, and the proportion of cases of elevated age-adjusted NT-proBNP level was also higher in the IKD group (84% vs 4%; P<.001). The diagnostic yield of age-adjusted NT-proBNP for IKD was good (area under the receiver operating characteristic curve, 0.90; 95% CI, 0.80-0.99) and significantly higher than the yields for C-reactive protein, erythrocyte sedimentation rate, albumin, and sterile pyuria (P<.001, all comparisons). CONCLUSION NT-proBNP level may prove to be a valid diagnostic marker for IKD, possibly offering a higher diagnostic yield than the analyses currently recommended for children suspected of having IKD.
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Affiliation(s)
- Moisés Rodríguez-González
- Sección de Cardiología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Ana Castellano-Martínez
- Sección de Nefrología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Almudena Alonso-Ojembarrena
- Sección de Neonatología, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
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Rodríguez-González M, Castellano-Martínez A, Pérez-Reviriego ÁA, Alonso-Ojembarrena A. Authors' reply. Emergencias 2019; 31:367-368. [PMID: 31625317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Moisés Rodríguez-González
- Unidad de Gestión Clínica de Pediatría, Departamento de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Ana Castellano-Martínez
- Unidad de Gestión Clínica de Pediatría, Departamento de Nefrología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Álvaro Antonio Pérez-Reviriego
- Unidad de Gestión Clínica de Pediatría, Departamento de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Almudena Alonso-Ojembarrena
- Unidad de Gestión Clínica de Pediatría, Departamento de Neonatología, Hospital Universitario Puerta del Mar, Cádiz, España
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Rodríguez-González M, Alonso-Ojembarrena A, Castellano-Martínez A, Estepa-Pedregosa L, Benavente-Fernández I, Lubián López SP. [Heart murmur in children less than 2 years-old: looking for a safe and effective referral strategy]. An Pediatr (Barc) 2018; 89:286-293. [PMID: 29803643 DOI: 10.1016/j.anpedi.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/30/2017] [Accepted: 01/09/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Current guidelines in Spain recommend performing transthoracic echocardiography (TTE) in all children under 2 years of age with a heart murmur. In 2014, the American Paediatric Association published the first appropriate use criteria (AUC) for outpatient paediatric transthoracic echocardiography (TTE) to promote its cost-efficient use. The aim of this article is to analyse the AUC and other clinical factors as predictors of congenital heart disease (CHD) in children less than 2 years of age with a heart murmur, and to develop a safe and efficient referral strategy. PATIENTS AND METHOD Case-control study conducted with children less than 2 years of age, referred from Paediatric Primary Care to Paediatric Cardiology during a 4-year study. A predictive model for CHD was determined using multivariate analysis. RESULTS A total of 688 patients were included, with 129 (19%) cases of CHD. An age less than 3 months (adjusted odds ratio [ORa] 3.8 [1.5-8.4], p=.030) and fulfilling AUC (ORa 16.3 [9.4-28.3], p<.001) were predictors of CHD. Concurrent infection (ORa 0.6 [0.2-0.8], p<.001) and a negative neonatal screening with pulse oximetry (ORa 0.1 [0.05-0.4], p=.001) decreased the risk of CHD. The referral strategy that included these criteria had a 98% sensitivity, 39% specificity, and positive and negative predictive values of 27% and 99%, respectively. It could not diagnose 2% of CHD (all mild), and showed a 32% TTE reduction rate compared to our current strategy. CONCLUSION To refer children less than 3 months old, fulfilling AUC, without a concurrent infection, or without negative neonatal pulse oximetry screening, is a safe and efficient strategy for the management of heart murmur in children under 2 years of age.
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Affiliation(s)
- Moisés Rodríguez-González
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - Almudena Alonso-Ojembarrena
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Ana Castellano-Martínez
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Lorena Estepa-Pedregosa
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Isabel Benavente-Fernández
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Simon P Lubián López
- Unidad de Gestión Clínica de Pediatría, Sección de Cardiología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
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Castellano-Martínez A, Rodriguez-Gonzalez M, Benavente-Fernandez I, Zuazo-Ojeda A. Hemangioma, aortic coarctation and intracranial dolichoectasia: PHACE syndrome. Pediatr Int 2017; 59:230-233. [PMID: 28211225 DOI: 10.1111/ped.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/27/2016] [Accepted: 09/14/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Amaya Zuazo-Ojeda
- Department of Radiology, Puerta del Mar University Hospital, Cadiz, Spain
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