Fiebre sin Foco en menores de 3 años.

Fever, one of the most common chief complaints of children seeking medical
attention, prompted over 5 million emergency department (ED) visits in
2002 . Most of these children have identifiable causes of their fevers, but many
will have fever without an apparent source (FWS) after conclusion of the history
and physical examination. Despite the frequency of fever as a chief complaint,
there is considerable controversy in the management of the young child who
has FWS . The challenge in the evaluation of the febrile young child lies
in balancing the minimization of risk to the patient with the costs of testing
and treatment.

Fever Without Source in Children 0 to 36 Months of Age : Paul Ishimine; Pediatr Clin N Am 53 (2006) 167 – 194

Intoxicaciones en Pediatría: Manejo General

Aproximadamente el 7% de las consultas pediátricas de urgencia son consecuencia de intoxicaciones. Sólo en el gran Santiago se producen anualmente unas 700 000 consultas de urgencia en pediatría, de las que 49 000 corresponden a intoxicaciones.

Intoxicaciones en pediatría: Manejo General Enrique Paris M: Rev. chil. pediatr. v.70 n.4 Santiago jul. 1999

Reflujo Gastro Esofágico: Guía Clínica de la NASPGHAM

Gastroesophageal reflux (GER), defined as passage of
gastric contents into the esophagus, and GER disease
(GERD), defined as symptoms or complications of GER,
are common pediatric problems encountered by both pri-
mary and specialty medical providers.

Pediatric Gastroesophageal Reflux: Clinical Practice Guideline : NASPGHAM J Pediatr Gastroenterol Nutr, Vol. 32, Suppl. 2, 2001

Cardiopatías congénitas mas frecuentes

Se hace una revisión de las cardiopatías congénitas (CC) más frecuentes diagnosticadas en el niño. Según varios autores, la incidencia de las CC está entre el 5-12‰ RN vivos. Se han seleccionado 7 cardiopatías que, según estos mismos estudios, son las más frecuentes en la infancia y adolescencia, y se describen las características clínicas y formas de presentación, los métodos diagnósticos de que disponemos en la actualidad, así como el tratamiento médico, cateterismo terapéutico o tratamiento quirúrgico.
En la evolución de estas CC cabe resaltar el cierre espontáneo de muchos defectos detectados en el período neonatal, como las comunicaciones interventriculares musculares y las comunicaciones interauriculares pequeñas, la buena evolución que presentan las estenosis pulmonares valvulares ligeras y, también, la progresión que experimentan las estenosis aórticas valvulares ligeras y moderadas.

Cardiopatias Congénitas mas frecuentes Dra. Perich Durán Pediatr Integral 2008;XII(8):807-818

Enuresis: Manejo basado en la evidencia BMJ

Bedwetting is a common symptom with many causes. Nocturnal enuresis is the most frequent cause; it is recognised by the absence of other urinary symptoms or signs of disease. Most children presenting with nocturnal enuresis have never been reliably dry, but in a minority enuresis has started after they had become dry, possibly triggered by stressful life events. If daytime wetting is present the child is most likely to have the urge syndrome, with or without urge incontinence as well, or dysfunctional voiding—functional  bladder disturbances that result in incontinence. Rarely, incontinence may be due to structural abnormalities of the urinary tract,  such as posterior urethral valves, or abnormalities of the nervous system, such as spinal dysraphism.

Evidence based paediatrics: Evidence based management of nocturnal enuresis Jonathan H C Evans BMJ 2001;323;1167-1169

Enfermedad Renal Crónica en Niños

Prior to 2002, the term chronic renal insufficiency was used to characterize patients who had progressive decline in renal function, defined as a glomerular filtration rate (GFR) of less than 75 mL/min per 1.73 m2 body surface area. Chronic kidney disease (CKD) is the new term defined by the National Kidney Foundation Kidney Disease and Outcome Quality Initiative (KDOQI) Group to classify any patient who has kidney damage lasting for at least 3 months with or without a decreased GFR or any patient who has a GFR of less than 60 mL/min per 1.73 m2 lasting for 3 months with or without kidney damage.

Chronic Kidney Disease in Children Dilys A. Whyte and Richard N. Fine Pediatr. Rev. 2008;29;335-341

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Deformidades del Pie

Las malformaciones se producen durante el período embrionario del desarrollo y las deformidades durante el período fetal. Ante la presencia de una deformidad del pie hay que descartar, siempre, una displasia del desarrollo de la cadera. Ante la presencia de un pie cavo sería preciso descartar enfermedad neurológica. El pie plano laxo infantil no precisa tratamiento de ortesis (plantillas) ni calzado ortopédico. El pie zambo y el pie plano convexo o astrágalo vertical congénito requieren un diagnostico precoz un tratamiento inmediato en el servicio de ortopedia pediátrica especializado.

Deformidades del Pie José Muñoz An Pediatr Contin. 2006;4(4):251-8

Hepatitis B en niños

One third of the world’s population has been infected by the hepatitis B virus (HBV), causing an enormous worldwide burden of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Although the virus can infect people of any age, those who are infected perinatally or as children are at greatest risk for developing the potentially fatal complications of the infection. Approval of the hepatitis B vaccine in 1982 has been the most important development in the clinical approach to this virus, changing the major goal from treatment to prevention. In this article, we review the nature of the virus, its epidemiology, serologic markers of disease, clinical manifestations of infection, the prevention of transmission, and current treatments.

Hepatitis B in Children Adam R. Davis and Philip Rosenthal Pediatr. Rev. 2008;29;111-120

Hepatitis por Virus A

Hepatitis A virus (HAV) infection occurs worldwide, affecting 1.4 million people annually and accounting for 20% to 40% of viral hepatitis cases in the United States. In young children, HAV infection often is asymptomatic or characterized by mild, nonspecific man ifestations; in adults, acute infection usually results in a clinical presentation lasting from 2 weeks to several months.

Hepatitis A Samer S. El-Kamary and Tina L. Cheng Pediatr. Rev. 2005;26;75-76

Fiebre Tifoidea

TYPHOID fever is a systemic infection with the bacterium Salmonella enterica serotype typhi. This highly adapted, human specific pathogenhas evolved remarkable mechanisms for persistence in its host that help to ensure its survival and transmission. Typhoid fever was an important cause of illness and death in the overcrowded and unsanitary urban conditions of the United States and Europe in the 19th century.The provision of clean water and good sew age systems led to a dramatic decrease in the incidence of typhoid in these regions. Today most of the burden of the disease occurs in the developing world, where sanitary conditions remain poor.

Typhoid Fever C. M. PARRY, M.B., T. T. HIEN, M.D.,G DOU.GAN, PH.D., N. J. WHITE, M.D., D.SC., J. J. FARRAR, M.B., D.PHIL. N Engl J Med, Vol. 347, No. 22 · November 28, 2002