Escala predictora de fallo de medro en lactantes / Predictive scale of failure to thrive in breastfed babies

INTRODUCCIÓN: el fallo de medro es identificado en niños con crecimiento significativamente menor que sus semejantes. OBJETIVOS: identificar la incidencia y características del fallo de medro en la población estudiada, y desarrollar una escala predictora de esta entidad en lactantes. MÉTODOS: se efectuó un estudio de cohorte prospectivo, en el Policlínico "Manuel González Díaz", del municipio Bahía Honda, en el período 2009-2013, en 3 etapas: en la primera, se efectuó la captación de los niños que formaron parte del estudio, se identificó la incidencia, y se obtuvo la descripción de las características relevantes de la entidad en 1 490 lactantes nacidos durante la etapa investigada; la segunda, posibilitó el diagnóstico de los factores de riesgo; y en la tercera, se elaboró y validó una escala predictora. RESULTADOS: la incidencia del fallo de medro fue del 19,4 %. Al aplicar la escala a la muestra A se obtuvo una sensibilidad del 72,1 % y una especificidad del 90,2 %; en la muestra B, la sensibilidad fue 76,34 y la especificidad 92,75. CONCLUSIONES: el fallo de medro es una entidad frecuente, con mayor incidencia en el segundo y tercer trimestre, en su mayoría es de causa orgánica, y resulta la afectación del peso, la variante antropométrica más frecuente. Se identificaron 13 factores de riesgo asociados a esta entidad. Se obtuvo una escala que permite predecir el riesgo de desarrollar fallo de medro en lactantes, con una sensibilidad aceptable y elevada especificidad.

INTRODUCTION: the failure to thrive is identified in children whose growth is significantly lower than their fellows. OBJECTIVES: to identify the incidence and the characteristics of the failure to thrive in the studied population and to develop a predictive scale of this illness in nursing babies. METHODS: a prospective cohort study was conducted in "Manuel Gonzalez Diaz" polyclinics in Bahia Honda municipality in three phases in the 2009 to 2013 period. In the first phase, the screening of children who participated in the study and of the incidence of disease together with the description of the relevant characteristics in 1 490 breastfed babies born in the studied phase; in the second one, the diagnosis of risk factors was possible and in the third phase, a predictive scale was designed and validated. RESULTS: the incidence of the failure to thrive was 19.4 %. When applying the scale to the sample A, the sensitivity was 72.1 % and the specificity reached 90.2 % whereas in the sample B, the sensitivity was 76.34 and the specificity 92.75 %. CONCLUSIONS: the failure to thrive is a common entity, with higher incidence in the second and third trimesters; it is mostly of organic cause and the most frequent anthropometric variant is the impaired weight. Thirteen risk factors associated to this illness were detected. The final scale allows predicting the risk of developing failure to thrive in breastfed babies with acceptable sensitivity and high specificity.

Algunos factores familiares asociados a fallo de medro en lactantes / Some Family Factors Associated To Growth Failure in Infants

Introducción: el fallo de medro es un problema comúnmente identificado en consultas ambulatorias, asociado con frecuencia a problemas médicos y psicosociales. Objetivo: identificar algunos factores familiares de riesgo de fallo de medro en lactantes. Métodos: estudio observacional de cohortes, prospectivo, en el Policlínico "Manuel González Díaz", del municipio Bahía Honda, provincia Artemisa, en el período de enero de 2009 a mayo de 2011. El universo estuvo constituido por 815 lactantes que cumplieron los criterios de inclusión del estudio. Se realizó un muestreo aleatorio estratificado, dividiéndose a la población en dos estratos, en dependencia de la presencia o no de fallo de medro, conformándose un grupo de casos constituido por 158 lactantes con fallo de medro y un grupo de control formado por 316 lactantes sin fallo de medro. El trabajo se desarrolló en dos etapas. En la primera, se efectuó la captación de los niños que formaron parte del estudio y se identificó la incidencia de la entidad en lactantes nacidos durante la etapa investigada. La segunda, posibilitó el diagnóstico de los factores de riesgo. Resultados: la incidencia de fallo de medro en lactantes fue del 19,4 por ciento. Ser hijo de madre no acompañada [OR 1,9; IC 95 por ciento (1,24-2,91)] y vivir en el seno de una familia disfuncional [OR 4,5; IC 95 por ciento (2,94-6,95)] constituyeron factores asociados a dicha entidad. Conclusiones: el fallo de medro es un problema identificado frecuentemente por médicos de familia. Ser hijo de madre no acompañada y vivir en el seno de una familia disfuncional constituyeron factores de riesgo asociados a esta condición(AU)

Introduction: the failure to thrive is a common problem identified in ambulatory medicine, frequently associate with medical and psychosocial disorder. Objectives: to identify some risk families factors of failure to thrive in breastfed babies. Methods: a prospective cohort study was conducted in "Manuel Gonzalez Diaz" polyclinics in Bahia Honda municipality in two phases in the 2009 to 2011 period. In the first phase, the screening of children who participated in the study and of the incidence of disease together with the description of the relevant characteristics in 815 breastfed babies born in the studied phase; in the second one, the diagnosis of risk family factors was possible. Results: the incidence of the failure to thrive in breastfed babies was 19.4 percent. To be child of unmarried woman [OR 1,9 IC 95 percent (1,24-2,91)] and to live under dysfunctional family [OR 4,5 IC 95 percent (2,94-6,95)] were factors associates to failure to thrive. Conclusions: the failure to thrive is a common entity, identify for family doctors. To be child of unmarried woman and to live under dysfunctional family were factors associates to failure to thrive in breastfed babies(AU)

La reactogenicidad y los aspectos inmune específicos de la vacuna pentavalente combinada: DTPw-HepB-Hib en el lactante menor de un año en el Hospital Distrital de Lambaré, Paraguay en 2007-2008 / The reactogenicity and specific immune aspects of the combined pentavalent vaccine: DTPw-HepB-Hib in breastfed babies under one year of age that attended the District Hospital of Lambaré, Paraguay in 2007 and 2008

La vacunación rutinaria de difteria, pertussis y tétanos a células enteras (DPTw) está presente desde 1940 y con elevadas coberturas en muchos países del mundo. La Organización Mundial de la Salud ha aprobado el uso universal de la vacuna anti-hepatitis B (HB) y combinaciones con DPT, en los últimos años ha sido incorporada la vacuna anti-Haemophilus influenzae tipo b (Hib) en programas de vacunación del niño. Es aplicada en Paraguay desde el 2002 a través del Programa Ampliado de Inmunizaciones del Ministerio de Salud Pública y Bienestar Social. Determinamos la reactoinmunogenicidad secundaria a la vacunación primaria pentavalente combinada en infantes concurrentes al Hospital Distrital de Lambaré­Paraguay en los años 2007-2008. Estudio longitudinal, observacional prospectivo de los efectos secundarios y los aspectos inmune- específicos de la vacuna Berna DTPw-HepB-Hib (QUINVAXEMTM) en lactantes menores de un año, a los 2 meses de edad, datos basales y post vacunales (1 mes luego de 3ª dosis). Efectos locales: 30(75%); rubor 17 (42.5%); tumefacción (menos 20 mm); 13 (32.5%); calor local 11 (27.5%). Efectos generales: fiebre: 37 (92.5%) llanto fuerte y persistente: 32(80%); irritabilidad: 23 (57.5%); hiporreactividad 16 (40%), anorexia 8 (20%); Inmunogenicidad: antes de la 1ª dosis; antitetánica IgG (+) 38/40 (95%), anti-difteria (+) IgG 29/40 (72.5%); anti-HBsAg 0/40 (0%) negativos. Respuesta post-vacuna penta comb. (7m. edad): antitetánica IgG 14/14 (100%) (+); anti-difteria IgG 12/14 (83%) (+); anti-HBsAg 14/14 (100%) positivos. Se evidencia la reactogenicidad de grado variable y decreciente. Niveles de anticuerpos de los componentes DT, satisfactorios y la Hep B excelentes

The combined cellular pentavalent vaccine is one the greatest achievements of human kind in the 20th century and is still successful in the 21st century. It is made up of five components and protects against the following diseases: diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b. The vaccine provides specific active immunization against infections caused by Corynebacterium diphtheriae, Clostridium tetani, Bordetella pertussis, Haemophilus influenzae type B and the Hepatitis B virus in children from six weeks of age. In Paraguay, it has been used since 2002 through the Widened Program of Immunization (PAI in Spanish) of the Ministry of Public Health. The objective of this work was to determine the secondary reactoinmunogenicity to the primary combined pentavalent vaccination in children attending the District Hospital of Lambaré, Paraguay in 2007 and 2008. This is a longitudinal, prospective observational study to evaluate the secondary effects and immune-specific aspects of the Berna DTPw-HepB-Hib combined pentavalent vaccine (QUINVAXEMTM) applied to breastfed babies under one year old, of both sexes, all races, origins and nutrition statuses in the Hospital of Lambaré. The vaccination was free, according to PAI's guidelines and by consecutive sampling previous written consent of the parents, at 2 months of age. Data were collected at baseline an post-vaccination after one month and a third dose. In a total population of 40 breastfed babies, good nutrition was found in 36 (90%). Local effects were seen in 30 (75%) distributed as follows: blush in 17 (42.5%), tumefaction (less than 20 mm) in 13 (32.5%) and local heat in 11 (27.5%). General effects were distributed as follows: fever in 37 (92.5%), loud and persistent cry in 32 (80%), irritability in 23 (57.5%), hyporeactivity in 16 (40%), anorexia in 8 (20%), hypotonicity and allergy, 2 each (5%), convulsions and paralysis in none. The effects are an average after the three doses with a decreasing trend at the end. The immunogenicity basal data before the 1st dose were as follows: antitetanic IgG (+) 38/40 (95%), antidiphtheria IgG (+) 29/40 (72.5%) and anti HBs Ag (-) 0/40 (0%). Post - vaccination responses (at 7 months old) were as follows: antitetanic IgG (+) 14/14 (100%), antidiphtheria IgG (+) 12/14 (83%) and anti HBs Ag (+) 14/14 (100%). These results show a reactogenicity of variable and decreasing degree. The antibodies levels of the DT components were satisfactory and those of Hep B excellent

La reactogenicidad y los aspectos inmune específicos de la vacuna pentavalente combinada: DTPw-HepB-Hib en el lactante menor de un año en el Hospital Distrital de Lambaré, Paraguay en 2007-2008 / The reactogenicity and specific immune aspects of the combined pentavalent vaccine: DTPw-HepB-Hib in breastfed babies under one year of age that attended the District Hospital of Lambaré, Paraguay in 2007-2008

La vacunación rutinaria de difteria, pertussis y tétanos a células enteras (DPTw) está presente desde 1940 y con elevadas coberturas en muchos países del mundo. La Organización Mundial de la Salud ha aprobado el uso universal de la vacuna anti-hepatitis B (HB) y combinaciones con DPT, en los últimos años ha sido incorporada la vacuna anti-Haemophilus influenzae tipo b (Hib) en programas de vacunación del niño. Es aplicada en Paraguay desde el 2002 a través del Programa Ampliado de Inmunizaciones del Ministeriode Salud Pública y Bienestar Social. Determinamos la reactoinmunogenicidad secundaria a la vacunación primaria pentavalente combinada en infantes concurrentes al Hospital Distrital de Lambaré–Paraguay en los años 2007-2008. Estudio longitudinal,observacional prospectivo de los efectos secundarios y los aspectos inmune- específicos de la vacuna Berna DTPw-HepB-Hib (QUINVAXEMTM) en lactantes menores de un año, a los 2 meses de edad, datos basales y post vacunales (1 mes luego de 3ª dosis). Efectoslocales: 30(75%); rubor 17 (42.5%); tumefacción (menos 20 mm); 13 (32.5%); calor local 11 (27.5%). Efectos generales: fiebre: 37 (92.5%) llanto fuerte y persistente: 32(80%); irritabilidad: 23 (57.5%); hiporreactividad 16 (40%), anorexia 8 (20%); Inmunogenicidad: antes de la 1ª dosis; antitetánica IgG (+) 38/40 (95%), anti-difteria (+) IgG 29/40 (72.5%); anti-HBsAg 0/40 (0%) negativos. Respuesta post-vacuna pentacomb. (7m. edad): antitetánica IgG 14/14 (100%) (+); anti-difteria IgG 12/14 (83%) (+); anti-HBsAg 14/14 (100%) positivos. Se evidencia la reactogenicidad de grado variable y decreciente. Niveles de anticuerpos de los componentes DT, satisfactorios y laHep B excelentes.

The combined cellular pentavalent vaccine is one the greatest achievements of human kind in the 20th century and is still successful in the 21st century. It is made up of fivecomponents and protects against the following diseases: diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b. The vaccine provides specific active immunization against infections caused by Corynebacterium diphtheriae, Clostridium tetani, Bordetella pertussis, Haemophilus influenzae type B and the Hepatitis B virus in children from six weeks of age. In Paraguay, it has been used since 2002 through the Widened Program of Immunization (PAI in Spanish) of the Ministry of Public Health. Theobjective of this work was to determine the secondary reactoinmunogenicity to the primary combined pentavalent vaccination in children attending the District Hospital of Lambaré, Paraguay in 2007 and 2008. This is a longitudinal, prospective observational study to evaluate the secondary effects and immune-specific aspects of the Berna DTPw- HepB-Hib combined pentavalent vaccine (QUINVAXEMTM) applied to breastfed babies under one year old, of both sexes, all races, origins and nutrition statuses in the Hospitalof Lambaré. The vaccination was free, according to PAI's guidelines and by consecutive sampling previous written consent of the parents, at 2 months of age. Data were collected at baseline an post-vaccination after one month and a third dose. In a total population of 40 breastfed babies, good nutrition was found in 36 (90%). Local effectswere seen in 30 (75%) distributed as follows: blush in 17 (42.5%), tumefaction (less than 20 mm) in 13 (32.5%) and local heat in 11 (27.5%). General effects were distributed as follows: fever in 37 (92.5%), loud and persistent cry in 32 (80%),irritability in 23 (57.5%), hyporeactivity in 16 (40%), anorexia in 8 (20%), hypotonicity and allergy, 2 each (5%), convulsions and paralysis in none. The effects are an average after the three...