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Despite high vaccination coverage, a recent increase in pertussis incidence rates has been observed. The objective of the study was to describe epidemiological trends in pertussis between 2012 and 2024 in the Community of Madrid (central Spain). Population-based observational study of pertussis cases reported to the regional epidemiological surveillance system. The cumulative incidence (CI) per 100 000 person-years was estimated for 2012-2015, 2016-2019, 2020-2022 and 2023-2024, as well as the proportion of hospitalizations and timely vaccination. The cumulative incidence for the age groups 1-4 years, 5-9 years, and 10-14 years were, respectively, 24.4, 16.5, and 15.9 cases per 100,000 person-years in 2012-2015 and 40.1, 62.1, and 58.0 cases per 100,000 person-years in 2023-2024. The cumulative incidence in infants aged less than one year was 243.6 cases per 100,000 person-years in 2012-2015 and 160.1 cases per 100,000 person-years in 2023-2024. The proportions of timely vaccination were 49.4, 89.2, 85.3, 79.1, and 67.2% in the&#x202f;<1, 1-4, 5-9, 10-14, and 15-19 years groups, respectively. The median interval between the last vaccination dose and the onset of symptoms was 3.4 years. In the group of infants aged less than 4 months, 52.2% of mothers had been vaccinated during pregnancy. Five deaths occurred among those infants aged less than 3 months whose mothers had not been vaccinated. Despite the increase in pertussis in older children and adolescents during the 2023-2024 epidemic wave, a remarkable decrease was observed in infants aged less than 6 months. It is necessary to consolidate the vaccination program during pregnancy, ensure timely vaccination and evaluate the age at which the booster is given in adolescence.

The Urgent Epileptic Seizures Care Process (UESP), also known as the Seizure Code, is a care process implemented in the Community of Madrid with the objective of standardizing and optimizing the urgent management of epileptic seizures (ESs) in pediatric and adult patients. The aim of this care process, which is based on the recommendations of the national consensus guideline in Spain and international guidelines, is to standardize the diagnosis, treatment, and follow-up of severe ESs across all levels of care. It was developed through a multidisciplinary collaborative effort involving professionals in emergency medicine, intensive care, neurophysiology, pediatric neurology, and primary care, and was structured into twelve sub-processes reviewed and endorsed by Spanish scientific societies. The Seizures Code establishes operational criteria for activation and defines specific algorithms for management in different clinical settings. It includes intervention times, therapeutic sequences with early and systematic use of benzodiazepines and early combination therapy with antiseizure medications, as well as strategies for coordination between care levels. It also promotes early use of electroencephalography (EEG), ongoing training for health care professionals and families, and a standardized registry of care activity. The Seizure Code is the first comprehensive model for urgent management of severe ESs implemented in a Spanish autonomous community. Its design promotes an early, homogeneous, and evidence-based response, with particular impact on the pediatric population. It enhances interhospital coordination and therapeutic adherence and is a dynamic tool that supports continuous evaluation and improvement of care quality in pediatric neurology.

The aim of the study was to assess psychiatric manifestations, including externalizing and internalizing symptoms, as well as anxiety and depression symptoms, in children diagnosed with overactive bladder (OAB) and underactive bladder (UAB). The study included 53 children with a diagnosis of OAB, 23 children with a diagnosis of UAB, and 30 controls. Participating children completed the Revised Child Anxiety and Depression Scale-Child Version (RCADS-C), while their parents completed the Strengths and Difficulties Questionnaire (SDQ). There were no statistically significant differences among the three groups in terms of age, sex, socioeconomic status, or years of education (P&#x202f;>&#x202f;.05). The SDQ subscale comparisons revealed that children with OAB scored significantly higher in conduct problems, hyperactivity, and externalizing problems compared to both children with UAB and controls (P&#x202f;=&#x202f;.024, P&#x202f;=&#x202f;.013, and P&#x202f;=&#x202f;.034, respectively). No significant differences were found among groups in emotional symptoms, peer relationship problems, prosocial behavior, or internalizing problems (P&#x202f;>&#x202f;.05). Similarly, RCADS anxiety and depression scores did not differ significantly between groups (P&#x202f;>&#x202f;.05). Our findings suggest that externalizing psychiatric symptoms are more prevalent in children diagnosed with OAB than children with UAB or healthy controls. These behavioral issues may be associated with delayed cortical maturation. Longitudinal studies using neuroimaging techniques are needed to further explore this association. Routine screening for psychiatric symptoms in children with bladder dysfunction may improve treatment outcomes and support a more comprehensive care approach.

The burden of disease and costs of respiratory syncytial virus (RSV) infections in children under 5 years in pediatric primary care are not well known. Observational, prospective, and analytical study of children with suspected RSV respiratory infection confirmed by molecular testing. Thirty-seven pediatricians in eight autonomous communities recruited patients aged 0-59 months with suspected RSV infection from November 2021 to January 2024. The data were collected on the day of recruitment and at 14 and 30 days. We evaluated direct and indirect health care costs. Of the 517 recruited children, 206 (39.8%) tested positive for RSV (64.5% for type A; 35.4% for type B; and 2.36% for both A and B). There were significant differences in the proportion of children with dyspnea in the RSV-positive group compared to the RSV-negative group (50.0% vs 31.8%; P < .001). In the RSV-positive group, a higher proportion of infants aged less than 12 months, compared to other age groups, visited the emergency department (39.6% versus 22.5%; P = .010) and required hospital admission (25.0% versus 9.5%; P = .004). Inhaled bronchodilators were administered to 58.4%, inhaled corticosteroids to 9.7%, oral corticosteroids to 11.9%, and antibiotics to 18.3%. In the subset of school-aged children, 69.2% missed at least one day of school (median, 8 days; IQR, 5-14). The total cost per episode was ;458, with significant differences between infants (;507) and children aged 1&#x202f;year or older (;419) (mean difference, ;88; 95% CI, 76-99; P < .001). The only differences between autonomous communities were in the use of bronchodilators and the frequency of emergency department visits. Infection by RSV in early childhood places a significant clinical, economic and health care resource burden in out-of-hospital settings, which supports the implementation of effective preventive measures.

Transient tachypnea of the newborn (TTN) is the main reason of admission to the neonatal intensive care unit (NICU). The aim of the study was to analyze the association of umbilical cord (UC) lactate with TTN. Retrospective observational study in a level III NICU including infants born alive at or after 34 weeks. We fitted a multivariate logistic regression model for TTN diagnosis, adjusted for confounders, and assessed its diagnostic performance by means of the area under the curve (AUC) and the sensitivity, specificity, and predictive values at the best cut-off point. A total of 2120 neonates (50.7% male) with a median age of 39.5 weeks (IQR, 38.6-40.5) were included between August 2022 and December 2023, of whom 101 (4.8%) were preterm. In the total sample, 120 infants (5.7%) developed TTN. We found that UC lactate was independently associated with TTN (adjusted OR, 1.365; 95% CI, 1.246-1.495), with an AUC of 0.61 (95% CI, 0.56-0.67). The best cut-off point was 5.9&#x202f;mmol/L, with a sensitivity of 34.5% (95% CI, 26.0-43.0), a specificity of 84.9% (95% CI, 83.3-86.5), a negative predictive value of 95.6% (95% CI, 94.7-96.5), and a positive predictive value of 12.0% (95% CI, 8.6-15.4). Umbilical cord blood lactate was independently associated with TTN in near-term and term neonates Although its diagnostic performance makes its use in isolation inapropriate for decision-making, it can be considered as an additional biomarker in the global evaluation of newborn infants in the delivery room.

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Despite current guideline recommendations, the empiric recommendation to place jaundiced infants "in the sun, by the window" is commonly issued to parents to prevent or treat jaundice. Spectral irradiance (350-1150&#x202f;nm) was measured with a spectroradiometer on sunny and cloudy days. Seven residential glazing configurations commonly used in dwellings were then interposed between the sun and the sensor. For each glass type, we obtained measurements without glass and with glass (5 and 30&#x202f;cm from the sensor) and calculated the relative spectral transmission. We analyzed the irradiance in the blue band (&#x2248; 460-490&#x202f;nm) and compared it with neonatal phototherapy thresholds (30-65&#x202f;&#xb5;W/cm&#xb2;/nm). Direct solar irradiance reached a maximum of 2.8&#x202f;W/m&#xb2;/nm at 582&#x202f;nm and mean values around 2.3&#x202f;W/m&#xb2;/nm in the 460-490&#x202f;nm band on clear days, which were several times higher than intensive phototherapy thresholds. Even on cloudy days, blue irradiance remained clearly above these thresholds. Visible light transmission through glazing elements was high. Transmission did not exhibit relevant attenuation below 400&#x202f;nm and increased again in the near-infrared region (>750&#x202f;nm). Typical residential glazing elements transmit very high levels of solar irradiance, with a broad spectrum that includes UVA and infrared radiation, and blue irradiance several times higher than used in phototherapy, but without spectral selectivity or dose control. Exposing healthy newborns to sunlight through home windows cannot be considered an appropriate or safe intervention to prevent jaundice in developed countries.

Fanconi anemia is a genetic disorder characterized by high risk of hematological and oncological disease. The aim of this review was to summarize the evidence on the safety and efficacy of gene therapy in pediatric patients with Fanconi anemia. Systematic review (PROSPERO registration record CRD420251152704). We searched PubMed/MEDLINE, Scopus, Web of Science, ClinicalTrials.gov, ICTRP, and CENTRAL. The study outcomes included safety, engraftment and persistence, and hematologic outcomes. The risk of bias was assessed with the RoB 2 tool. The review included seven studies, all conducted in patients with FANCA variants, that evaluated autologous hematopoietic stem cell-based gene therapy from mobilization and collection to lentiviral transduction and reinfusion without conditioning. Safety profile: favorable, with no serious adverse events attributable to the vector/cells and no evidence of lentiviral replication, clonal dominance, or genotoxicity in follow-up periods of up to 7 years. Engraftment/persistence: detectable vector copy numbers and stable polyclonal patterns, more durable engraftment with higher cell doses. Hematological outcomes: stabilization/improvement of cytopenia; transfusion independence in some patients and deferral of bone marrow transplantation. The efficacy of gene therapy was greater in younger patients and in those without advanced bone marrow failure. The overall risk of bias was high. Gene therapy showed a favorable safety profile, with no serious adverse events or evidence of genotoxicity. Efficacy was greater in younger children, in those without advanced marrow failure, and with higher doses of corrected CD34+ cells. However, as the included studies were phase I/II trials, the results should be interpreted cautiously; nevertheless, gene therapy appears to be a promising and safe treatment option in the early stages of the disease.

The aim of the Child Health Program is to issue recommendations on preventive activities to be carried out in the Spanish pediatric and adolescent population, based on the best available evidence and morbidity trends and the resources of the health care system in Spain. Its overarching goal is to improve the overall health of children across all stages of development. Routine health checkup visits in healthy children improve the early detection of physical and psychosocial health risks and promote better health and well-being throughout childhood and adolescence. Their impact on reducing severe disease, morbidity, and mortality is limited and depends on care quality and individualization.

The incidence of pediatric venous thromboembolism (VTE) has increased due to increased health care complexity, improved diagnostic techniques, and greater clinical awareness. Most episodes are associated with iatrogenic risk factors, particularly the use of central venous catheters, and occur in vulnerable populations such as neonates or children with cancer, congenital heart disease, and/or short bowel syndrome. To review special clinical scenarios of pediatric VTE and propose a practical approach to support decision-making in complex clinical settings. Narrative review focused on clinical practice, addressing pathophysiological features, diagnosis, treatment, and follow-up, integrating recent guideline recommendations, observational case series, and clinical experience reports. In neonatology, developmental hemostasis, bleeding risk, and pharmacokinetics influence the indication, selection, and monitoring of anticoagulation therapy. The review discusses umbilical venous catheter-associated thrombosis, neonatal purpura fulminans, and renal and portal vein thrombosis, highlighting the criteria for anticoagulation and/or thrombolysis and the need for long-term follow-up to detect sequelae. In children with cancer, congenital heart disease, or short bowel syndrome, VTE is multifactorial and frequently catheter-related, requiring therapeutic adjustments (eg, thrombocytopenia, invasive procedures, preservation of vascular access). We summarize the current strategies for anticoagulation-including the emerging role of direct oral anticoagulants, with caution in selected subgroups-and thrombolysis. In special pediatric populations, VTE requires individualized and multidisciplinary management. Disease severity, residual risk, and the need to balance bleeding and thrombosis should guide decisions regarding treatment intensity/duration as well as prophylaxis, with emphasis on organ preservation, maintenance of venous capital, and prevention of long-term complications.

The Third National Pediatrics Congress was held in Zaragoza in 1925. There were 208 registered delegates. Among those registered were fourteen French pediatricians and three Italian pediatricians. The president of the meeting was Dr Patricio Borobio D&#xed;az. This paper presents an overview of the content of the conference presentations, which were divided into four sections: Pedagogy, Pediatric and Orthopedic Surgery, Hygiene, Nutrition and Child Protection, and Pediatric Medicine. In the latter section, the most common topics were infectious diseases (whooping cough, diphtheria, meningitis/encephalitis). Several papers attested to the effectiveness of ultraviolet light as a treatment for rickets and spasmophilia. Gregorio Vidal Jordana deduced that the increase in phosphatemia levels served as an exact test to verify the effectiveness of ultraviolet treatment and was superior to X-rays. Several pediatric surgeons debated the treatment of pyloric stenosis in infants. There is no record of any female pediatricians attending the Congress. Four women who were not doctors presented papers on legal and family changes in favor of children, abandoned and delinquent children, and education issues. Within the Child Protection Section, there were debates on the subject of illegitimate children and wet nursing. The conference was a harmonious international gathering where current pediatric issues were discussed alongside other topics related to child protection. Participation was diverse, with contributions from doctors, lawyers, teachers and people in other professions.

To determine the prevalence of fecal carriage of antimicrobial resistance (AMR) genes in 40 pediatric inpatients managed in a rural hospital in Ethiopia (May-June 2024). We conducted a prospective study in 40 pediatric inpatients managed at Gambo Rural General Hospital, Oromia, Ethiopia (May-June 2024). Stool samples were collected to assess for intestinal carriage and screened using the Allplex&#x2122; Entero-DR multiplex PCR assay for genes associated with carbapenemase-producing Enterobacterales (CPE), extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, and vancomycin-resistant Enterococcus (VRE). We collected data on demographic and clinical characteristics and antibiotic exposure. The statistical analysis included the Mann-Whitney U and Fisher's exact tests. Fecal carriage of AMR genes was detected in 82.5% of patients. The most prevalent resistance mechanism was CTX-M (80.0%), followed by NDM (37.5%), vanA (32.5%), and VIM (10.0%). Testing did not detect KPC, OXA-48, IMP, or vanB genes. Malnutrition was present in 65% of the patients. There were no statistically significant differences in clinical outcomes (length of stay, severity) between patients with and without AMR genes (P > .05 in all comparisons; limited by the sample size of n&#x202f;=&#x202f;40). Severe chronic malnutrition was less frequent among carbapenemase carriers (12.5% vs 62.5%; P = .033). This exploratory finding should be interpreted with extreme caution due to multiple testing, low statistical power (n&#x202f;=&#x202f;40), and potential sources of bias including altered gut microbiota, reduced health care exposure among severely malnourished children, or chance. These observations only describe colonization patterns and cannot be used to infer causality. We found a high prevalence of fecal carriage of AMR genes in stool samples from pediatric inpatients in this hospital in rural Ethiopia, underscoring the need for enhanced surveillance, stewardship, and infection control measures in resource-limited settings.

The diagnosis and management of monomorphic post-transplant lymphoproliferative disorder (mPTLD) require a multidisciplinary approach. This study describes clinical characteristics, diagnostic approach, therapeutic strategy and outcome of mPTLD after solid-organ transplant (SOT) in Spain. National retrospective observational study in children and adolescents with mPTLD following SOT. All pediatric oncology centers performing SOT were contacted. Data from January 2000 to December 2023 were collected. Thirty-seven patients from 8 out of the 10 centers with a SOT program were included, 57% were male, the median age at transplant was 4.3 years (range, 0.3-16.9), and the median age at diagnosis was 10.9 years (range, 1.7-17.2). The most commonly transplanted organ was the liver (29.7%). Eighty-eight percent of patients had symptoms, most frequently gastrointestinal (37.5%), with both nodal and extranodal involvement in 51.4% patients. Seventy-six percent of patients had stage III-IV disease. The first imaging test was performed 2.5 days (range, 0-45) from clinical suspicion, and PET/CT was used in 59.5% patients: for diagnosis (90.9%), assessment of treatment response (59.1%) or follow-up (45.5%). Immunosuppression was reduced in 97.2%, rituximab in monotherapy and low-dose (immune)chemotherapy was given in 21.6% patients, respectively, and high-intensity chemotherapy in 54.1%. The median follow-up was 6.8 years (range, 0.0-16.7), 18.9% patients died, and 19.4% experienced graft loss. Event-free and overall survival at five years were 80.2% and 82.9%, respectively. The absence of consensus guidelines to follow conveys differences in the management of mPTLD in Spain. Descriptive analysis of this situation acknowledges the need to create consensus protocols on how to suspect, diagnose and treat this rare disease. These data will contribute to the development of national guidelines for the management of mPTLD.

Elevated blood pressure (EBP) in childhood is associated with excess adiposity. The aim was to compare anthropometric and body composition indicators to identify EBP (&#x2265;90th percentile) in schoolchildren. Cross-sectional study in 497 rural Andalusian schoolchildren (6-15 years). Weight, height, circumferences (waist and neck) and skinfolds (bicipital, tricipital, subscapular, and suprailiac) were recorded to calculate body mass index, waist-to-height ratio, the sum of 4 skinfolds and body fat percentage. Blood pressure was measured by oscillometry (3 readings; mean of the last 2) and classified using Spanish age- and sex-specific references (&#x2265;90th percentile for systolic and/or diastolic blood pressure). Age- and sex-adjusted logistic models and sex-stratified analyses of discrimination and calibration were performed; optimal cut-offs were derived using the Youden index. The prevalence of EBP was 5.8% and increased with excess weight, particularly in girls. After multivariable adjustment, neck circumference (NC) was the indicator most consistently associated with EBP. Discriminative ability was moderate in boys and high in girls, with optimal cut-offs of 29.15&#x202f;cm and 30.65&#x202f;cm, respectively. NC is a simple, low-cost measure that may complement traditional indicators for EBP screening in school settings and primary care; the proposed cut-offs require external validation.

To establish reference values for waist circumference (WC) and waist-to-height ratio (WHR) for Paraguayan children and adolescents aged 7 to 18 years to improve early detection of abdominal obesity. We conducted a cross-sectional study using a nationally representative sample of Paraguayan schoolchildren. The analysis included a total of 12 611 students from public, private, and subsidized educational institutions. We determined reference values using smoothed percentiles for WC and WHR using the lambda-mu-sigma (LMS) method, stratified by age and sex. Of the total sample, 52% of participants were female, 81% resided in urban areas, and 68% were enrolled in the public education system. Regarding nutritional status, 36% had malnutrition due to excess BMI for age, and 25% had abdominal obesity. We generated reference values for WC and WHR by age and sex in the form of tables and reference curves. The WC showed a progressive increase with age in both sexes, with higher values in male participants. At age18 years, the 90th percentile for WC reached values close to the WHO metabolic risk thresholds for adults in both sexes. This study provides, for the first time, national reference values for CC and WHR for the Paraguayan pediatric population. The generated curves are valuable tools for screening abdominal obesity and can complement nutritional monitoring for the early detection of cardiometabolic risk at an early age.

The HOSPITAL score is a tool that assesses the risk of readmission, but it considers oncological disease as the sole chronic condition category linked to readmission risk. In pediatrics, there is no score that includes children with medical complexity (CMC). The objective of this study was to analyze the clinical characteristics of all non-oncological pediatric readmissions and to describe risk factors for readmission of CMC. We conducted a retrospective and analytical study of readmissions to the pediatric wards of a tertiary hospital (January 2021-June 2023). Readmission was defined as occurring within 30 days of discharge. We compared variables from the HOSPITAL score and the PEDCOM score in patients with chronic and acute conditions. The analysis included 241 readmissions; 41.5% were CMC readmissions. Readmitted CMCs were older, predominantly male (76%), and were readmitted more frequently due to worsening of their underlying disease and for the same reason as the first admission (26% vs 7.1%; P<.01) compared to acute patients. Both the HOSPITAL (5 [3-7] vs 2 [1-4]; P<.01) and PEDCOM (9 [5-14] vs 1 [0-2]; P<.01) scores were higher in the readmitted CMC group. Children with complex chronic disease that have higher PedCom scores are at increased risk of potentially preventable readmission. Hospital readmissions of CMC patients have different characteristics that must be taken into account for the implementation of preventive measures to avoid readmission.

Achondroplasia is the most common skeletal dysplasia associated with disproportionate short stature, with an estimated prevalence of 4.6 per 100 000 births. It is caused by a pathogenic variant in the gene encoding fibroblast growth factor receptor 3 (FGFR3), which disrupts endochondral ossification of the growing skeleton. To provide an updated overview of the therapeutic approach to achondroplasia, including currently approved treatments and those under investigation. The approval of vosoritide in 2021 has brought a major shift in the management of these patients. Updated follow-up guidelines have been published, along with initial outcomes in treated patients, with the aim of determining not only the impact on growth and final height but also on associated comorbidities, such as foramen magnum stenosis, and body proportions. We also review other emerging therapeutic strategies currently under development. The availability of targeted therapies has modified the traditional approach to the management of achondroplasia, which makes ongoing updates on approved and investigational treatments essential.

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