BACKGROUND: Transfontanellar brain ultrasound is an essential tool for monitoring the size of the ventricles in preterm neonates and has many advantages over other alternative diagnostic techniques, including its accessibility and non-use of ionizing radiation. When considering the normal ventricular size, it is essential to have reference measurements based on age-matched populations. The objective of this article is to present our reference measures, based on a sample of preterm infants that we have studied.
METHODS: A retrospective observational study was conducted. Measurements of the Levene index, frontal horn thickness, and Evans index were obtained in preterm neonates from 25 to 45 weeks, over a period of 5 years, between January 2016 and December 2020. After applying the exclusion criteria, a sample of 199 patients and 350 ultrasound scans were obtained. The independent samples t-test and the Mann-Whitney test were used for the comparison of samples.
RESULTS: The distribution of the right and left Levene indices was normal (Shapiro-Wilk test with p = 0.16 and 0.05, respectively), unlike the thickness distribution of the frontal horns (p < 0.05 on both sides). No significant differences were detected between the sexes (p = 0.08). A linear correlation was found between the biparietal diameter and the Levene index.
CONCLUSIONS: From the results obtained in our study, we present reference tables for ventricular size, with the 3rd, 25th, 50th, 75th, and 97th, being the first ones made in our country.

Gastroesophageal reflux (GER) is a frequent normal phenomenon in children of any age. It is more common in infants, in whom the majority of episodes are short-lived and cause no other symptoms or complications, differentiating it from gastroesophageal reflux disease (GERD). The diagnosis and management of GER and GERD continue to be a challenge for the physician. Therefore, the aim of the Asociación Mexicana de Gastroenterología was to adapt international documents to facilitate their adoption by primary care physicians, with the goal of standardizing quality of care and reducing the number of diagnostic tests performed and inappropriate medication use. The ADAPTE methodology was followed, and the recommendations were approved utilizing the Delphi strategy. The executive committee carried out the review of the guidelines, position papers, and international reviews that met the a priori quality criteria and possible applicability in a local context. The recommendations were taken from those sources and adapted, after which they were approved by the working group. The consensus consists of 25 statements and their supporting information on the diagnosis and treatment of GER and GERD in infants. The adapted document is the first systematic effort to provide an adequate consensus for use in Mexico, proposing a practical approach to and management of GER and GERD for healthcare providers.

BACKGROUND: The factors and patterns associated with antibiotic consumption in infants are unclear. Our aim was to assess the cumulative incidence of antibiotic consumption from birth to 16 months and identify factors associated with antibiotic consumption among infants aged 4-16 months.
METHODS: We conducted a cross-sectional study in 2016 in a sample of 18 882 women from Galicia, Spain, who had given birth to a live child between September 1, 2015 and August 31, 2016. We calculated the cumulative incidence of antibiotic consumption based on maternal reports regarding the infant\'s consumption from birth to 14 months obtained through interviews; we did not estimate consumption at ages 15 and 16 months due to the small sample size. To assess which factors were associated with antibiotic consumption, we carried out a nested case-control study matching cases and controls for birth month on a 1:1 ratio.
RESULTS: The cumulative incidence of antibiotic consumption among infants aged 0-14 months increased from 7.5% to 66.0%. The case-control study included data for 1852 cases and 1852 controls. Daycare attendance (OR: 3.8 [95% CI: 3.2-4.6]), having older siblings (OR: 1.8 [95% CI: 1.6-2.1]), health care visits to private clinics (OR: 1.6 [95% CI: 1.4-2.0]), and passive smoking (OR: 1.3 [95% CI: 1.1-1.6]) were associated with an increased probability of antibiotic consumption. Maternal age between 30-39 years or 40 years and over at the time of birth was associated with a decreased probability of antibiotic consumption (OR: 0.8 [95% CI, 0.7-1.0] and OR: 0.6 [95% CI: 0.5-0.8], respectively).
CONCLUSIONS: Some of the factors associated with antibiotic consumption in infants are modifiable and should be considered in the development of public health measures aimed at reducing antibiotic consumption.

The AEP Immunization Calendar for 2024, with its immunization recommendations for pregnant women, children and adolescents residing in Spain, marks the 25th edition since the first one was introduced in 1995, being annual since 2003, as a vaccination calendar, and since 2023 as immunization schedule due to the inclusion of a monoclonal antibody for the prevention of RSV disease. Novelties for this year include the following: The rest of the recommendations from the previous calendar remain unchanged.

BACKGROUND: In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making.
OBJECTIVE: To analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments (PEDs) and the adherence of each hospital to the recommendations of the PECARN rule.
METHODS: We conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020.
RESULTS: Of 21 981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%-40.0%), skull X-rays in 162 (44.3 %; range, 0%-100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%-24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%-100%); 37.1% (36/97) classified as intermediate-risk (range, 0%-100%) and 57.4% (132/230) classified as low-risk (range, 0%-100%).
CONCLUSIONS: We found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish PEDs, mainly due to an excessive use of skull X-rays.

As it does every year, the CAV-AEP publishes the update of its recommendations for the use of vaccines in children, adolescents and pregnant women residing in Spain. The 2 + 1 schedule is maintained in infants (at 2, 4 and 11 months), including preterm infants, with the hexavalent vaccine (DTaP-IPV-Hib-HB) and the pneumococcal 13-valent conjugate vaccine. A booster dose with DTaP-IPV is needed at 6 years for those who received the 2 + 1 series with hexavalent vaccine as infants, in addition to 1 dose of dTap in adolescence. Routine vaccination of pregnant women with a dose of dTap is recommended in each pregnancy, preferably between weeks 27 and 32 of gestation, although can be given from 20 weeks if there is risk of preterm delivery. All infants should receive the rotavirus vaccine (2-3 doses) and the 4CMenB vaccine (2 + 1 series). All children aged 6-59 months should be vaccinated against influenza each year. The MenACWY vaccine should be given routinely at 12 months of age and in adolescence between ages 12 and 18 years. The recommendations for the MMR vaccine (12 months and 3-4 years) and varicella vaccine (15 months and 3-4 years) also remain unchanged, using the MMRV vaccine for the second dose. Recommendations for the use of SARS-CoV-2 vaccines in the paediatric age group will be updated periodically on the CAV-AEP website. The HPV vaccine is indicated in all adolescents, regardless of sex, at age 12 years. Novelties include the recommendation of routine administration of nirsevimab to neonates and infants aged less than 6 months for passive immunization against RSV, and the recommendations regarding the hexavalent vaccine are consolidated in a single section.

Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.

BACKGROUND: The use of nonpharmacological measures to reduce pain during vaccination has been studied extensively in infants, but there are fewer studies on its effectiveness in older children and on the parental perception of pain in children.
METHODS: We conducted a multicentre, quasi-experimental interventional study with a control group.
METHODS: infants aged 2-11 months and children aged 4 years that attended routine vaccination appointments.
METHODS: Primary care. Intervention during vaccination: infants were breastfed and 4-year-old children blew a party horn.
METHODS: vaccination performed following routine practice.
METHODS: NIPS (Neonatal Infant Pain Scale) and duration of crying in infants, Wong-Baker FACES pain rating scale in older children and parents.
RESULTS: The study included 125 children (intervention: 60; control: 65). There was a significant decrease in perceived pain in the intervention groups: NIPS score in infants, 3.8 ± 1.1 compared to 5.2 ± 0.7 (P < .001); Wong-Baker FACES score at 4 years of 3.3 ± 1.7 compared to 4.2 ± 1.6 (P = .042). These same differences in support of the intervention were reflected in the parental assessments (3.4 ± 1.3 vs 4.5 ± 1.5; P < .001). The correlation between child and parent scores was strongly positive: 0.7 (95% CI, 0.59-0.78). However, the duration of crying was longer in the intervention group.
CONCLUSIONS: The use of distraction techniques reduces pain in children and the pain perceived by parents in their children, thus increasing their satisfaction with the procedure.

After reviewing the best available scientific information, CAV-AEP publishes their new recommendations to protect pregnant women, children and adolescents living in Spain through vaccination. The same recommendations as the previous year regarding hexavalent vaccines, pneumococcal conjugate vaccine of 13 serotypes, booster with tetanus, diphtheria, pertussis and inactivated poliomyelitis (Tdpa-IPV) at 6 years and with tetanus, diphtheria and pertussis (Tdpa) at 12-14 years and pregnant women from week 27 (from week 20 if there is a high risk of preterm delivery). Also with rotavirus, tetraantigenic meningococcal B (2+1), meningococcal quadrivalent (MenACWY), MMR, varicella and human papillomavirus (HPV) vaccines, for both genders. As novelties this year the CAV-AEP recommends: Influenza vaccination from 6 to 59 months of age whenever feasible and does not harm the vaccination program aimed at people at higher risk. According to official national recommendations, the CAV-AEP recommends the systematic use of COVID mRNA vaccines since 5 years old.

BACKGROUND: Early empirical data shows that school-aged children, adolescents and adults are experiencing elevated levels of anxiety and depression during the COVID-19 pandemic. Currently, there is very little research on mental health outcomes for young children.
OBJECTIVE: To describe the formation of a global collaboration entitled, \'COVID-19 Unmasked\'. The collaborating researchers aim to (1) describe and compare the COVID-19 related experiences within and across countries; (2) examine mental health outcomes for young children (1 to 5 years) and caregivers over a 12-month period during the COVID-19 pandemic; (3) explore the trajectories/time course of psychological outcomes of the children and parents over this period and (4) identify the risk and protective factors for different mental health trajectories. Data will be combined from all participating countries into one large open access cross-cultural dataset to facilitate further international collaborations and joint publications.
METHODS: COVID-19 Unmasked is an online prospective longitudinal cohort study. An international steering committee was formed with the aim of starting a global collaboration. Currently, partnerships have been formed with 9 countries (Australia, Cyprus, Greece, the Netherlands, Poland, Spain, Turkey, the UK, and the United States of America). Research partners have started to start data collection with caregivers of young children aged 1-5 years old at baseline, 3-months, 6-months, and 12-months. Caregivers are invited to complete an online survey about COVID-19 related exposure and experiences, child\'s wellbeing, their own mental health, and parenting.
METHODS: Primary study outcomes will be child mental health as assessed by scales from the Patient-Reported Outcomes Measurement Information System - Early Childhood (PROMIS-EC) and caregiver mental health as assessed by the Depression Anxiety Stress Scale (DASS-21). The trajectories/time course of mental health difficulties and the impact of risk and protective factors will be analysed using hierarchical linear models, accounting for nested effects (e.g. country) and repeated measures.
Antecedentes: Los primeros datos empíricos muestran que los niños en edad escolar, los adolescentes y los adultos están experimentando niveles elevados de ansiedad y depresión durante la pandemia de COVID-19. Actualmente, hay muy poca investigación sobre los resultados de salud mental de los niños pequeños. Objetivos: Describir la formación de una colaboración global titulada ‘COVID-19 Desenmascarado’. Los investigadores colaboradores tienen como objetivos (1) describir y comparar las experiencias relacionadas con COVID-19 dentro y entre países; (2) examinar los resultados de salud mental de los niños pequeños (de 1 a 5 años) y los cuidadores durante un período de 12 meses durante la pandemia de COVID-19; (3) explorar las trayectorias/temporalidad de los resultados psicológicos de los niños y los padres durante este período e (4) identificar los factores de riesgo y de protección para las diferentes trayectorias de salud mental. Los datos de todos los países participantes se combinarán en un gran conjunto de datos transculturales de acceso abierto para facilitar más colaboraciones internacionales y publicaciones conjuntas. Métodos: COVID-19 Desenmascarado es un estudio de cohorte longitudinal prospectivo en línea. Se formó un comité directivo internacional con el objetivo de iniciar una colaboración global. Actualmente, se han formado asociaciones con 9 países (Australia, Chipre, Grecia, Países Bajos, Polonia, España, Turquía, Reino Unido y Estados Unidos de América). Los socios de investigación han comenzado la recopilación de datos con los cuidadores de niños pequeños de 1 a 5 años al inicio, a los 3 meses, a los 6 meses y a los 12 meses. Se invita a los cuidadores a completar una encuesta en línea sobre la exposición y las experiencias relacionadas con COVID-19, el bienestar del niño, su propia salud mental y parentalidad. Análisis de datos: Los resultados primarios del estudio serán la salud mental infantil según la evaluación de las escalas del Sistema De Información De medición de Resultados Informados Por El Paciente – Primera Infancia (PROMIS-EC) y la salud mental del cuidador según la evaluación de la Escala de estrés, ansiedad y depresión (DASS-21). Las trayectorias/temporalidad de las dificultades de salud mental y el impacto de los factores de riesgo y de protección se analizarán utilizando modelos lineales jerárquicos, teniendo en cuenta los efectos anidados (por ejemplo, el país) y las medidas repetidas.
背景: 早期经验数据表明, 在 COVID-19 疫情期间, 学龄儿童, 青少年和成人的焦虑和抑郁水平升高。目前, 关于幼儿心理健康结果的研究很少。 目的: 描述名为‘COVID-19 Unmasked’的全球合作的形成。合作研究者旨在 (1) 描述和比较国家内部和国家之间的COVID-19 相关经验; (2) 考查 COVID-19 疫情期间 12 个月中幼儿 (1 至 5 岁) 和看护人的心理健康结果; (3) 探索这一时期儿童和父母心理结果的轨迹/时间进程, 以及 (4) 确定不同心理健康轨迹的风险和保护因素。来自所有参与国的数据将合并为一个大型开放访问跨文化数据集, 以促进进一步的国际合作和联合出版。 方法: COVID-19 Unmasked 是一项线上前瞻性纵向队列研究。成立了一个国际指导委员会, 旨在开展全球合作。目前, 已与9个国家 (澳大利亚, 塞浦路斯, 希腊, 荷兰, 波兰, 西班牙, 土耳其, 英国和美利坚合众国) 建立了伙伴关系。研究合作伙伴已开始在基线, 3 个月, 6 个月和 12 个月时与 1-5 岁幼儿看护人的数据收集。邀请看护人完成一项关于 COVID-19 相关暴露和经历, 儿童身心健康, 个人心理健康和教养方式的线上调查。 数据分析: 主要研究结果将是根据患者报告结果测量信息系统——童年期早期 (PROMIS-EC) 的量表评估的儿童心理健康和由抑郁焦虑应激量表 (DASS-21) 评估的看护人心理健康。将使用考虑嵌套效应 (例如国家) 和重复测量的分层线性模型分析心理健康困难的轨迹/时间进程以及风险和保护因素的影响。.