a b s t r a c t a r t i c l e i n f oBackground: Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. Methods: We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV). The study population was low birth weight (LBW) newborns b 2500 g, very low birth weight (VLBW) newborns b 1500 g and extremely low birth weight (ELBW) newborns b1000 g. Results: There were 53% female patients, mean gestational age was 31 weeks, mean weight 1352 g and the CVC was placed at a mean of 12 days of extrauterine life. Birth weight distribution was 39% LBW; 33% VLBW and 28% ELBW. A mean of two (1-8) attempts were necessary with a procedure duration of 16.8 (10-40) minutes. Success of RIJV catheterization was 94%. One attempt was necessary in 50% and up to 5 attempts in 95.7%. Success by weight was VLBW, 97.2%; ELBW, 92.9%; LBW, 91.7%. A venous hematoma occurred in 5% of cases. Conclusions: Ultrasound-guided RIJV cannulation with real-time visualization to gain access to the central venous circulation in low birth weight newborns is effective and safe.

Mexico took swift action and has strictly followed mitigation measures to prevent the spread of coronavirus disease, COVID-19. In this study we compared influenza activity indicators in our country after the implementation of public health measures for COVID-19. We compared indicators of influenza activity in 2020 before and after public health measures were taken to reduce COVID-19 with the corresponding indicators from three preceding years and the immediate one, and the potential decrease in seasonal influenza cases/deaths. Nationwide surveillance data revealed a drastic decline in influenza diagnosis in outpatient clinics and public hospitals, influenza positivity rates of clinical specimens, and confirmed severe cases during the following 10 weeks of 2020 as lockdown activities and control measures were established compared with the same period of 2019. Our results suggest that the measures taken for COVID-19 were effective in reducing the spread of other viral respiratory diseases as influenza in our country.

Traumatic asphyxia is a rare condition in children that usually occurs after severe compression to the chest or abdomen. We report 3 cases in patients 18, 20, and 36 months of age who presented signs and symptoms of traumatic asphyxia after car accidents. Two clinical features were consistent in all 3 patients: multiple petechiae on the face and bulbar conjunctival hemorrhage; 2 patients had facial cyanosis, and 1 had facial edema.In children, the number of clinical manifestations that should be evident to diagnose traumatic asphyxia has not been ascertained. However, in any history of trauma with compression of the chest or abdomen and signs of increased intravenous craniocervical pressure, traumatic asphyxia should be suspected.

Objective: To determine the dimensions and depth of the right internal jugular vein (RIJV) in low birth weight newborns by ultrasound and assess the differences in weight and determine the relationship of the vein with the carotid artery. Method: We performed a vascular assessment of the RIJV in 100 low birth weight newborns. The subjects were divided into three groups, low birth weight (LBW) newborns, 52500 g; very low birth weight (VLBW) newborns, 51500 g; and extremely low birth weight (ELBW) newborns 51000 g. Results: Of the newborns, 39% had LBW, 33% had VLBW, and 28% had ELBW. The medians were gestational age 31 weeks, weight 1300 g, anteroposterior diameter of the RIJV 2.2 mm, and the distance from the skin-RIJV 3.6 mm. In LBW newborns, the median anteroposterior diameter of RIJV was 2.7 mm; in LBW newborns 2.2; in ELBW newborns 1.9 (p50.001); the median distance from skin to RIJV for LBW newborns was 4.1 mm; for VLBW newborns, 3.6 and for ELBW newborns 2.9 (p50.01); differences that were statistically significant. Conclusions: In low birth weight newborns, the diameter and depth of the RIJV is directly proportional to the weight of the subjects studied.

In the development of the foetal immune system, cytokines play an important role in its function. Therefore, we sought to determine whether the mode of delivery affects the expression of leptin, IL-6 and TNF-α in umbilical cord blood in healthy term newborns. We collected 125 samples of umbilical cord blood to analyse leptin, IL-6 y TNF-α levels with multiplex immunoassay (MIA). The samples were classified according to mode of delivery: vaginal delivery (VD) and caesarean section (CS). Leptin and IL-6 had higher concentrations in umbilical cord blood in VD than in CS: 42.55 ng/ml (11.92-104.28) versus 35.20 ng/ml (3.26-9326.76), p  =  0.039; 9.32 pg/ml (1.13-2020.31) versus 3.81 pg/ml (0.52-834.69) p < 0.001, respectively. Also, a weak correlation between TNF-α and IL-6 was found (r = 0.238, p = 0.007). The most important finding in our study was the differential concentrations of leptin and IL-6 according to mode of delivery.

Background: The primary caregiver is an important person in the life of patients with JIA. Their reactions depend on social, emotional and economic factors that affect the therapeutic alliance. Some generic instruments have been used to evaluate burden, anxiety, or quality of life of caregivers. This study aims to develop a specific instrument to measure the psychosocial and economic impacts on primary caregivers of patients with JIA. Methodology: This is a mixed methods research, that includes qualitative and quantitative data, and was carried out in two phases. First phase: a pragmatic qualitative study (questionnaire construction) was conducted in two parts, a non-systematic literature review followed by interviews with primary caregivers. Second phase: a crosssectional study (questionnaire validation) to complete validation and estimate Cronbach's alphas based on tetrachoric correlation coefficients, correlation matrix and Cohen's kappa coefficient test. Results: There were 38 articles found related to the experience of caregivers. 15 primary caregivers were interviewed (female 93%, median age 45 years). Thematic analysis identified 9 important topics from the perspective of participants (economic impact, coping, family roles, impact of diagnosis, mental health, couple/mate relationships, impact at work, religion, and knowledge of the disease). These topics were combined to create the interview questionnaire (56 items). Later, it was modified to 62 items that were divided into five dimensions: impact of the disease (psychosocial, economic, family, and relationships), knowledge of the disease, alternative medicine, future, and religion. The interview questionnaire was applied to 32 primary caregivers (female 93%, median age 37 years), results identify depression on 29 (90%), 18 (56%) feel sadness at diagnosis, 20 (63%) mentioned that JIA has influenced in their financial situation, 23 (72%) feel anxiety about the future, and 11 (37%) considered that their family relationships have changed. Statistical analysis identified inconsistencies during convergent and divergent validity of the construct. Consequently, 11 items were eliminated, 3 relocated, 6 modified, and 39 compacted obtaining the "Impact of Pediatric Rheumatic Diseases on Caregivers Multi-assessment Questionnaire" (CAREGIVERS questionnaire). This final version resulted on an eight-dimension (28 items) instrument. Conclusions: The CAREGIVERS questionnaire captures perspectives of both the participants and clinicians. It will be helpful to measure the impact of the disease and thus, to improve the quality of care of children with JIA and their families.

Congenital abdominal wall defects that are located outside of the anterior wall are extremely rare and difficult to classify because there are no well accepted guidelines. There are two regions outside of the anterior wall: the flank or lateral wall; and the lumbar region. We report the case of a patient with an oval 3 cm-diameter hernia defect located above the anterior axillary line, which affects all layers of the muscular wall. An anorectal malformation consisting of a recto-vestibular fistula was also identified, and chest X-ray showed dextrocardia. The suggested treatment is repair of the defect before 1 year of age. Given that the anomalies described may accompany lateral abdominal wall hernia, it is important to diagnose and treat the associated defects.

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