Eight children presenting with the Sandifer syndrome (with neck contorsion, radiologic studies of the cervical spine and normal neurologic exploration) have been studied in relation to gastro-esophageal reflux (GER). In the eight cases barium swallow, 24 h pH-metering, manometry, endoscopy and biopsy were made, presenting pathological GER. The barium swallow was pathologic in 62% of them. The pH-metering in 37%. The lower esophageal sphincter pressures were decreased in 37%, with esophageal motility alteration in 75%. Signs of macro and/or microscopic esophagitis were found in 62%. Three patients received surgical treatment and the rest medical treatment, with improvement of the neck contorsion in all cases. We have attempted to evaluate which one of the functional explorations for the GER diagnosis is better in this kind of patients, and we have demonstrated that the most frequently found alteration is the esophageal dysmotility.

OBJECTIVES: To assess the effectiveness and safety of delayed antibiotic prescription (DAP) compared to immediate antibiotic prescription (IAP) and no antibiotic prescription (NAP) in children with uncomplicated respiratory infections. METHODS: Randomized clinical trial comparing 3 antibiotic prescription strategies. The participants were children with acute uncomplicated respiratory infections attended to in 39 primary care centers. Children were randomly assigned into prescription arms as follows: (1) DAP, (2) IAP, or (3) NAP. Primary outcomes were symptom duration and severity. Secondary outcomes were antibiotic use, parental satisfaction, parental beliefs, additional primary care visits, and complications at 30 days. RESULTS: In total, 436 children were included in the analysis. The mean (SD) duration of severe symptoms was 10.1 (6.3) for IAP, 10.9 (8.5) for NAP, and 12.4 (8.4) for DAP (P = .539), although the differences were not statistically significant. The median (interquartile range) of the greatest severity for any symptom was similar for the 3 arms (median [interquartile range] score of 3 [2–4]; P = .619). Antibiotic use was significantly higher for IAP (n = 142 [96%]) compared to DAP (n = 37 [25.3%]) and NAP (n = 17 [12.0%]) (P < .001). Complications, additional visits to primary care, and satisfaction were similar for all strategies. Gastrointestinal adverse effects were higher for IAP. CONCLUSIONS: There was no statistically significant difference in symptom duration or severity in children with uncomplicated respiratory infections who received DAP compared to NAP or IAP strategies; however, DAP reduced antibiotic use and gastrointestinal adverse effects.

Episodes of apnea during the first year of life have been classified with the term "Apparent Life-Threatening Events" (ALTE). Gastroesophageal reflux (GER) has been accepted to be one of the factors which can favor ALTE. The aim of this work is to study the continuous 24 h gastroesophageal pH-metering (fundamentally the Reflux Index [RI] and the Area Under Curve [AUC] parameters in three different periods of time: total pH-metering, pH-metering excluding the first two post-prandial hours, and pH-metering during sleep time, for 24 infants, 14 with ALTE and 10 without it). Between these two groups (with and without ALTE) there were no significant differences in the total pH-metering concerning the RI (2 +/- 1.2 vs 5.6 +/- 7.5 p > 0.05) and concerning the AUC (24.9 +/- 14.4 vs 67.4 +/- 84 p > 0.05), but in the analysis of the sleep period, the RI (p < 0.05) and the AUC (p < 0.01) both showed significant differences in the group of infants without ALTE. These results confirm that pH-metering study during sleep is the procedure of choice for recognizing infants with ALTE.

No abstract

ResumenObjetivo: evaluar la influencia de la asistencia a la guardería sobre la morbilidad y el consumo de recursos sanitarios en los niños menores de 2 años. Material y métodos: diseño: estudio longitudinal prospectivo. Centros participantes: centros de Atención Primaria, coordinados por el Grupo de Investigación de la Asociación Española de Pediatría de Atención de Primaria (AEPap). Sujetos: niños menores de 2 años que acuden a las consultas de pediatría de los centros de salud participantes. Muestra: niños nacidos entre el 1 de abril y el 30 de octubre de 2009 que cumplan los criterios de inclusión. Variables: la variable independiente será asistencia o no a la guardería. Como variables dependientes se analizarán el número y el tipo de infecciones, los tratamientos recibidos y la asistencia a centros sanitarios. Se recogerán variables de caracterización familiares y personales que pudieran actuar como factores de confusión. Recogida de datos: entrevistas realizadas en la primera visita y a los 6, 12, 18 y 24 meses de edad. Análisis estadístico: para analizar las diferencias entre el número de infecciones dependiendo de la edad del niño al entrar en la guardería se realizará un test de Anova. Para comparar el consumo de antibióticos y de broncodilatadores, así como la utilización de recursos sanitarios entre los niños que acuden a la guardería y aquellos que no lo hacen se aplicará el test de la T de Student o el test U de Mann-Whitney. Se realizará un análisis multivariante de regresión lineal paso a paso para identificar factores personales y familiares que pueden considerarse como variables predictoras del número de infecciones, controlando los posibles factores de confusión e interacciones. g Fundación IMABIS. Málaga. España. Rev Pediatr Aten Primaria. 2009;11:695-708 Guadalupe del Castillo Aguas, gdelcas@teleline.es Los autores declaran no presentar conflictos de intereses en relación con este manuscrito y el proyecto de investigación.Del Castillo Aguas G, y cols. Influencia de la asistencia a las guarderías sobre la morbilidad y el consumo de recursos sanitarios en niños menores de 2 años 696 Revista Pediatría de Atención Primaria Volumen XI. Número 44. Octubre/diciembre 2009 Abstract Objective: to evaluate the influence of child day-care centres on morbidity and consumption of health resources in children younger than 2 years. Methods: design: prospective longitudinal study. Participating institutions: Primary Health Care centers, coordinated by "Grupo de Investigación de la Asociación Española de Pediatría de Atención Primaria" (AEPap) (Research Group of the Spanish Primary Care Pediatrics Association). Subjects: children aged 0 to 2 years attending pediatric appointments of the participating health centres. Sample: all children born between April 1st and October 30th, 2009, that meet the inclusion criteria. Variables: independent variable will be Child day-care center or not. As dependent variables it will be analyzed the number and type of infection, treatments received and assistance to Health Ca...