ABSTRACT
Resumen La deficiencia de hierro (DFe) es la patología nutrimental infantil de mayor prevalencia en el mundo y afecta la maduración cerebral y el consiguiente desarrollo cognitivo, lingüístico, motor y comportamental de quienes la padecen. El informe que se presenta tuvo como objetivo estudiar, en profundidad, literatura acerca del efecto de la DFe sobre el desarrollo neuropsicológico en lactantes. Para ello, se analizaron 51 estudios originales realizados en humanos, 49 de los cuales fueron obtenidos a través de Pubmed y 2, de Scielo. Cabe resaltar que, con el fin de discutir los hallazgos de estos artículos, se incluyeron investigaciones sobre el efecto de la DFe que utilizan modelo animal, así como estudios en humanos con desarrollo típico. Esta búsqueda se realizó a conveniencia. El reconocimiento de sus implicaciones facilitaría el trabajo terapéutico, así como la inclusión de programas de estimulación temprana junto con el manejo de la deficiencia nutrimental.
Abstract Iron is involved in various aspects related to brain function, including oxygen transport, neurotransmitters metabolism, DNA synthesis, ATP production, dendritic growth, axonal development and transport, myelin production, glial development, in plasticity markers such as the brain-derived growth factor, and in synaptic plasticity. Human development (biological, cognitive, social) is associated with a bidirectional and dynamic interaction between gene activity, neural activity and environment. An environmental variable is nutrition, and it is known that the central nervous system is extremely vulnerable to nutritional deficiencies during pregnancy and in the first two years of life, period in which an accelerated maturational dynamism occurs. Therefore, a disturbance of these by an iron deficiency would result in neuropsychological alterations, with varied expressions depending on the age at which it occurs and the severity and duration of the nutritional disease. Iron deficiency is defined as the depletion of iron reserves in the body by various factors (nutritional, physiological, pathological, etc.). Three stages of the illness have been established: iron depletion, iron deficiency without anemia and iron deficiency anemia. The first is associated with a decrease in iron reserves without reaching the deficiency; it may be due to a reduction in iron intake and or absorption, excessive loss or an increase in iron requirements. At this stage, there are no functional consequences in the organism. The second stage, is characterized by biochemical changes that reflect a pathologically reduced concentration of serum ferritin with a normal hemoglobin concentration. Finally, iron deficiency anemia is defined by the combination of low concentration of serum ferritin and hemoglobin. Given that iron deficiency is the most prevalent childhood nutritional disorder in the world (affecting 43 % of children aged 6-59 months) and that it impacts brain maturation and the consequent cognitive, linguistic, motor and behavioral development of those who suffer from it, in this paper, the literature on the effect of iron deficiency on neuropsychological development in infants is analyzed in depth. The review was performed considering the short, medium and long lasting effects of iron deficiency without anemia, iron deficiency anemia, chronic iron deficiency during the first two years of life and the presence of treatment. To contextualize, the analysis of the relationship between iron and brain functioning is included and the variables that modulate the expression of its effect are addressed. To carry out the search of literature regarding the effect of iron deficiency on neuropsychological development in infants, Pubmed and SciELO were consulted. No date or language restriction was established. Different combinations of terms were used: "iron deficiency infant", "iron deficiency fetal", "iron deficiency neonatal", "iron deficiency long lasting". The analyzed reports fulfilled the following inclusion criteria: a) primary sources, b) establish a value of hemoglobin and at least one of iron (i.e, serum ferritin, mean corpuscular volume, free erythrocyte, protoporphyrin, transferrin saturation) to define the children of each group, c) human sample, d) description of the measures used for the evaluation, e) studies examined after this stage, had to determine that the sample evaluated presented iron deficiency during the first two years of life. In this paper, 51 original articles conducted in humans were analyzed, of which 49 were obtained through Pubmed and 2 from SciELO. It should be noted that, in order to discuss the findings of these reports, literature was included on the effect of iron deficiency using animal models, as well as studies in humans with typical development. The search for these was done at convenience. The recognition of its implications would facilitate the therapeutic work, as well as the inclusion of early stimulation programs together with the management of nutritional deficiency.
ABSTRACT
RESUMEN La problemática del muy bajo peso al nacer (MBP) ha sido abordada desde hace varios años, sin embargo, las investigaciones están enfocadas desde diferentes perspectivas y contextos, no siempre se ha considerado su repercusión a corto y a largo plazo, así como la interacción de los diferentes factores que se relacionan con este riesgo biológico. Por ello en esta revisión bibliográfica se realiza una valoración de estudios ejecutados a nivel internacional y en Cuba dedicados al desarrollo neuropsicológico de niños con muy bajo peso al nacer. Se concluye que el muy bajo peso al nacer repercute en el desarrollo neuropsicológicos desde edades tempranas, hasta la adolescencia; por ello es necesario una visión integradora que tenga en cuenta el riesgo biológico, las particularidades individuales y el contexto social en que se desenvuelve el niño desde los primeros momentos, lo que posibilitará, perfeccionar la atención a corto y largo plazo al grupo de riesgo.
ABSTRACT The problems of very low birth weight (MBP) have been dealt with for many years, however, research on the matter is approached from different perspectives and contexts, not always have its short and long term repercussions being considered as well as the interaction of different factors related to this biological risk. Therefore, this bibliographical review makes an assessment of international and Cuban studies devoted to very low birth weight children's neuropsychological development. It was reached the conclusion that very low birth weight affects neuropsychological development from early ages to adolescence; for that reason, it is necessary to have an integrated approach of the problem that takes into account the biologicals risk, individual characteristics and the social context in which the child develops from the beginning, which will make the improvement of short and long term care to this risk group possible.
ABSTRACT
Una forma de entender la estructura de las Funciones Ejecutivas (FE), es su estudio en el desarrollo temprano y el uso de métodos estadísticos avanzados que permiten entender la interrelación de los distintos componentes. Los hallazgos en la etapa adulta, apoyan la idea multifactorial de componentes relacionados, pero separables; mientras que evidencias recientes, en la etapa preescolar sugieren que la estructura de las FE, puede ser descrita por un solo factor. La estructura de las FE fue examinada en 128 niños de 3 a 6 años de edad, usando un análisis factorial confirmatorio. Los preescolares completaron una batería de tareas de FE, que evaluaban procesos de inhibición y memoria de trabajo, con sensibilidad adecuada para la edad. En la edad preescolar la estructura del funcionamiento ejecutivo puede ser diferenciada en dos procesos relacionados pero independientes: memoria de trabajo e inhibición. Las relaciones entre los componentes parecen cambiar en el desarrollo. La unidad estructural de las FE en edades muy tempranas, cambia a través del desarrollo, siendo cada vez más multifacética, que se relaciona con la maduración e integración de diferentes circuitos frontosubcorticales.
One way to understand the structure of executive functions (EF) is their study in early development and use of advanced statistical methods that allow us to understand the interrelationship of various components. The findings in the adult age, support the idea multifactorial of related components, but separable, while recent evidence in the preschool years suggest that the structure of the FE, can be described by a single factor. The structure of the EF was examined in 128 children aged 3 to 6 years of age, using a confirmatory factor analysis. Preschoolers completed a battery of EF tasks, assessing processes of inhibition and working memory with age-appropriate sensitivity. In the preschool the structure of executive functioning can be differentiated into two related but independent processes: working memory and inhibition. The relationships between the components seem to change in development. The structural unit of the FE at very early ages, it changes through the development, becoming more multifaceted, which is associated with the maturation and integration of different frontal-subcortical circuits.
ABSTRACT
El presente artículo expresa una articulación teórica entre dos posturas clásicas que explican el desarrollo infantil,a partir de la relectura que se hace del modelo teórico de Jean Piaget, a la luz de los desarrollos planteados por la neuropsicología en la perspectiva del modelo de las unidades funcionales de Alexander Luria. En este sentido representa un ejercicio de reflexión que trasciende la sola descripción detallada de los estadios del desarrollo piagetianos entendidos desde la perspectiva cognitiva, hacia una comprensión más interaccionista de la relación que existe entre el cerebro y la cognición. [Montoya DM, González L. Bases neuropsicológicas del desarrollo cognoscitivo entre el nacimiento y los doce años. MedUNAB 2009; 12:157-174].
This paper shows a theoretical articulation between two basic postures that aim at explaining child development, from the reinterpretation of Jean Piaget's theoretical model. This is based upon the neuropsychology developments based upon Alexander Luria's functional units model. This is a reflection exercise that transcends the detailed description of the Piagetian development stages, as understood from the cognitive perspective, and aims at a more interactional understanding of the relationship between brain and cognition. [Montoya DM, González L. Neuropsychological basis of the cognitive development from newborn to twelve years old. MedUNAB 2009; 12:157-174].