O nascimento psicológico e as crises do desenvolvimento no pensamento de Margaret Mahler / Nacimiento psicológico y crisis del desarrollo en el pensamiento de Margaret Mahler / Psychological birth and developmental crises in Margaret Mahler's thought / La naissance psychologique et les crises de développement dans la pensée de Margaret Mahler

O presente artigo tem como objetivo apresentar a teoria do desenvolvimento precoce da pediatra e psicanalista húngara Margareth Mahler, dando um maior enfoque às crises inerentes ao desenvolvimento, ou seja, às manifestações naturalmente perturbadoras vividas pelo bebê e pelo toddler, ao longo dos trinta e seis primeiros meses de vida. Mahler argumenta que, quando estas fases de alteração do equilíbrio não são satisfatoriamente neutralizadas, podem surgir neuroses infantis precoces, reconhecidas como respostas exacerbadas e rígidas, defensivas e ambivalentes na relação com o objeto de amor. Com este estudo, pretendemos contribuir para a ampliação do conhecimento acerca da primeira infância, em particular, para a elucidação dos impactos psíquicos de desequilíbrios naturais do desenvolvimento psíquico precoce

Este artículo tiene como objetivo presentar la teoría del desarrollo temprano de la pediatra y psicoanalista húngara Margareth Mahler, prestando mayor atención a las crisis inherentes al desarrollo, es decir, a las manifestaciones naturalmente perturbadoras que experimentan el bebé y el niño pequeño, a lo largo de los treinta y seis.primeros meses de vida. Mahler sostiene que, cuando estas fases de alteración del equilibrio no se neutralizan satisfactoriamente, pueden surgir neurosis infantiles tempranas, reconocidas como respuestas exacerbadas y rígidas, defensivas y ambivalentes en la relación con el objeto de amor. Con este estudio pretendemos contribuir a ampliar el conocimiento sobre la primera infancia, en particular, a dilucidar los impactos psíquicos de los desequilibrios naturales en el desarrollo psíquico temprano

This article presents the theory about early human development proposed by the Hungarian pediatrician and psychoanalyst Margaret Mahler. It emphasizes the crises inherent in development, i.e., the naturally disturbing manifestations experienced by infants and toddlers during their first thirty-six months of life. Mahler argues that early infantile neuroses may arise when these phases of altered equilibrium are not satisfactorily neutralized. These neuroses appear as exacerbated, rigid, defensive, and ambivalent responses in the relationship with the love object. This study aims at contributing to a more comprehensive knowledge of early childhood and the impact of natural imbalances in early mental development

Le présent article vise à présenter la théorie du développement précoce de la pédiatre et psychanalyste hongroise Margareth Mahler, en mettant l'accent sur les crises inhérentes au développement, c'est-à-dire sur les manifestations naturellement perturbatrices vécues par le bébé et le jeune enfant tout au long des trente-six premiers mois de la vie. Mahler soutient que lorsque ces phases d'équilibre altéré ne sont pas neutralisées de manière satisfaisante, des névroses infantiles précoces peuvent apparaître, reconnues comme des réponses exacerbées et rigides, défensives et ambivalentes dans la relation avec l'objet d'amour. Nous avons l'intention, avec cette étude, de contribuer à l'élargissement des connaissances sur la petite enfance, en particulier, à l'élucidation des impacts psychiques des déséquilibres naturels du développement psychique précoce

Effect of early comprehensive interventions on physical growth and nervedevelopment among premature infants / 预防医学

Objective@#To examine the effect of early comprehensive interventions on the physical growth and nerve development among premature infants, so as to provide insights into the follow-up management of premature infants after discharge from hospital.@*Methods@#A total of 130 premature infants delivered in Shaoxing Municipal Maternal and Child Health Care Hospital from 2019 to 2021 were selected and divided into high- and low-risk groups according to gestational age and birth weight, while 306 full-term normal infants in the same hospital during the study period served as controls. All premature infants were given early comprehensive interventions until age of 12 months, including nutritional support and parental guidance of children's feeding and development, and all normal infants received periodical health checkup according to the basic public health service program. All infants received periodical measurements of height, weight and head circumference, and the 12-month intellectual and motor development ability was measured using the Bayley Scales of Infant Development revised in Chinese cities was used to assess. Infants' physical growth, mental development index (MDI) and motor development index (PDI) were compared among groups.@*Results@#There were 130 premature infants with gestational ages of 28 to 36 weeks and birth weight of 1 200 to 3 440 g, including 79 male infants, and there were 80 infants in the low-risk group and 50 infants in the high-risk group. The full-term infants had a gestational age of 37 to 42 weeks, and birth weights of 2 500 to 4 000 g, including 162 male infants. There were significant differences in height (Wald χ2=28.664, P<0.001) and head circumference growth (Wald χ2=19.312, P=0.013) among the three groups as revealed by the generalized estimating equation; however, no significant differences were seen in the 12-month weight (F=0.639, P=0.528), height (F=1.051, P=0.350) or head circumference (F=0.318, P=0.728) among the three groups. The percentages of abnormal MDI were 2.00%, 0 and 1.31% among the high-risk premature infants, low-risk premature infants and full-term infants at ages of 12 months (χ2=1.319, P=0.517), while the percentages of abnormal PDI were 20.00%, 7.50% and 5.56% among the three groups at ages of 12 months (χ2=12.818, P=0.002).@*Conclusions@#Following implementation of early comprehensive interventions, the premature infants have favorable physical growth and comparable MDI with full-term infants; however, a high percentage of abnormal PDI is seen in high-risk premature infants. An improvement in the motor development among high-risk premature infants is recommended to be emphasized during the management of premature infants.

Preschool period neurodevelopmental follow-up in children underwent antergrade cerebral perfusion / 中华胸心血管外科杂志

Objective:To investigate the preschool period neurodevelopmental status and analyze the perioperative data which associated with delayed neurodevelopment in patients underwent antergrade cerebral perfusion(ACP).Methods:To access the preschool period neurodevelopmental status in patients underwent ACP using Griffiths mental development scale-Chinese(GDS-C). Patients were classified as normal development group(ND) and low development group(LD) depending on the outcomes of assessment. Perioperative data including age, weight, CPB time, aortic cross-clamp time, mean arterial pressure, ACP time and flow were analyzed retrospectively.Results:62 children who met the inclusion criteria, of which 19 were accessed by GDS-C scale. Fourteen cases were lagged in general quotient(GQ) compared with normal children. The outcomes of assessment in six subscales of GDS-C scale indicated that 13 cases were delayed in language(C) and practical reasoning(F). Eight cases were delayed in locomotor(A) and personal-social(B). Eleven cases were delayed in eye-hand coordination(D). Ten cases were delayed in performance(E). The children in LD group had significant longer CPB time and aortic cross-clamp time than those in ND group. There were no differences between two groups in other perioperative data.Conclusion:The incidence of preschool period neurodevelopmental delay after ACP in infants is relatively high. In detailed analysis, their language and practical reasoning ability are lagged significantly. In addition, the longer time of CPB and aortic cross-clamp are associated with the neurodevelopmental delay.

O estudo concreto da atenção e seu desenvolvimento em contexto escolar / The concrete study of attention and development in schools

Diante da necessidade da superação de propostas organicistas e medicalizantes para a compreensão de supostos transtornos neurobiológicos relacionados a queixas de desatenção e hiperatividade/impulsividade, lançou-se mão neste artigo de referenciais do materialismo histórico-dialético e psicologia histórico-cultural, objetivando sistematizar a organização metodológica desenvolvida na tese de doutorado de Ferracioli (2018), no sentido de um estudo empírico no campo da psicologia concreta. Através de experimento formativo com coleta de dados em campo junto a alunos/as e professoras do segundo ano do Ensino Fundamental de uma escola municipal, identificou-se os determinantes pedagógicos responsáveis por melhor promover o desenvolvimento da atenção voluntária em contexto escolar. No entanto, o foco deste artigo está direcionado para os procedimentos elaborados para esta investigação, apresentados em três momentos fundamentais: empírico, abstrato e concreto. Os resultados indicaram que a atenção voluntária é consequência do ensino, observando-se significativa ampliação das capacidades atencionais e escolares dos sujeitos participantes, o que permitiu ao pesquisador constatar, no cerne dessas mudanças, a centralidade do processo de internalização de signos/conteúdos na atividade de estudo, assim como indicar formas de organização do ensino mais apropriadas ao desenvolvimento da atenção voluntária. Por fim, a partir dos resultados, fez-se uma crítica à cientificidade de concepções organicistas e medicalizantes em educação.

Faced with the need to overcome organicist and medicalizing proposals for the understanding of supposed neurobiological disorders related to complaints of inattention and hyperactivity/impulsiveness, this article uses references from historical-dialectic materialism and historical-cultural psychology, aiming to systematize the methodological organization developed in Ferracioli's (2018) doctoral thesis, in the sense of an empirical study in the field of concrete psychology. Through a formative experiment with data collection in the field with students and teachers of the second year of elementary school in a municipal school, we identified the pedagogical determinants responsible for better promoting the development of voluntary attention in a school context. However, the focus of this article directed to the procedures developed for this investigation, presented in three fundamental moments: empirical, abstract and concrete. The results indicated voluntary attention is a consequence of teaching. We observed a significant increase in the attentional and school capacities of the participating subjects, which allowed the researcher to verify, at the core of these changes, the centrality of the process of internalization of signs/contents in the study activity. In addition, we could indicate ways of organizing teaching more appropriate to the development of voluntary attention. Finally, based on the results, we performed a critique on the scientificity of organicist and medicalizing conceptions in education.

Transtorno do espectro autista e a suplementação por ácido fólico antes e durante a gestação / Autism spectrum disorder and folic acid supplementation before and during pregnancy

RESUMO Objetivo Elucidar se a suplementação com ácido fólico pouco antes da concepção e/ou durante a gestação pode estar realmente atrelado ao desenvolvimento do transtorno do espectro autista (TEA). Metódos Foi realizada uma revisão de literatura em base de dados, nos idiomas português e inglês, durante o período de novembro de 2017 até abril de 2018, com ênfase nas publicações mais recentes. Resultados Do total de 174 artigos, 87 compuseram este trabalho. Pesquisas apontam que o aumento dos casos de TEA se deve ao fato de que mais fatores genéticos estejam implicados na etiopatogênese neural. No entanto, a grande maioria dos artigos ressalta com maior precisão que há mais efeitos benéficos do uso de ácido fólico antes da concepção e durante a gestação na prevenção do TEA, assim como de outras anormalidades relacionadas aos defeitos do tubo neural. Conclusão Quando se analisa o risco-benefício da suplementação com ácido fólico nas doses recomendadas, 0,4 a 0,8 mg/dia, conclui-se que os benefícios sobrepujam os possíveis riscos de desenvolver o TEA.

ABSTRACT Objective Elucidating whether supplementation with folic acid shortly before conception and/or during pregnancy may actually be linked to the development of Autistic Spectrum Disorder (ASD). Methods A literature review was conducted in the Portuguese and English languages during the period from November 2017 to April 2018, with emphasis on the most recent publications. Results Of the total of 174 articles, 87 compose this work. Research indicates that the increase in ASD cases should take into account the fact that more genetic factors are implicated in neural pathogenesis. However, a large majority of articles point out that there are more beneficial effects of using folic acid before application and during pregnancy in the prevention of ASD, as well as other abnormalities related to neural tube defects. Conclusion When analyzing the risk-benefit of folic acid supplementation at the recommended doses, 0.4 to 0.8 mg/day, it is concluded that the benefits outweigh the possible risks of developing ASD.

A teoria de Margaret Mahler sobre o desenvolvimento psíquico precoce normal / Margaret Mahler’s theory of early normal mental development / La teoría de Margaret Mahler sobre el desarrollo psíquico temprano normal

Este artigo tem como objetivo abordar a teoria sobre o desenvolvimento psíquico precoce de Margaret Mahler e contribuir para a compreensão de seu lugar de destaque nos mais importantes autores psicanalíticos que investigaram o desenvolvimento infantil. Mais especificamente, ele busca fornecer uma visão sistemática do processo do desenvolvimento psíquico precoce normal em crianças de 0 a 3 anos, segundo Mahler. Em um primeiro momento, apresentamos o lugar da autora no cenário da psicanálise infantil e descrevemos a metodologia de pesquisa empregada por Mahler e colaboradores em seus estudos clínicos e empíricos do desenvolvimento infantil. Em seguida, apresentamos os três níveis propostos pela autora em sua teoria do desenvolvimento psíquico, a saber, "desenvolvimento normal", "crises inerentes ao desenvolvimento" e "psicose infantil". Por fim, descrevemos, fase por fase, como se dá o primeiro desses níveis (desenvolvimento psíquico normal) na primeira infância.

This paper aims to approach Margaret Mahler’s theory of early normal mental development and contribute to the understanding of her prominent place among the most important psychoanalytic authors who studied child development. More specifically, it intends to provide a systematic view of Mahler’s account of the process of early normal mental development in children from birth to three years old. Initially, we outline the author’s place in the field of child psychoanalysis and describe the research methodology employed by her and her collaborators in their empirical and clinical studies in child development. Next, we present the three levels proposed by Mahler in her theory of mental development, namely, "normal development", "crises inherent in the development" and "infantile psychosis". Finally, we describe stage by stage how the first of these levels ("normal mental development") takes place in early childhood.

Este artículo tiene por objeto abordar la teoría sobre el desarrollo mental temprano de Margaret Mahler y contribuir a la comprensión de su lugar destacado entre los más importantes autores psicoanalíticos que investigaron el desarrollo del niño. Más precisamente, se trata de ofrecer una visión sistemática del proceso de desarrollo psíquico temprano normal en los niños de 0 a 3 años según Mahler. En un primer momento, se presenta el lugar de la autora en el contexto del psicoanálisis infantil y se describe la metodología de investigación utilizada por Mahler y sus colaboradores en sus estudios clínicos y empíricos del desarrollo del niño. A continuación, se presentan los tres niveles propuestos por la autora en su teoría del desarrollo psíquico, es decir, "desarrollo normal", "crisis inherentes al desarrollo" y "psicosis infantil". Finalmente, se describe, fase por fase, como tiene lugar el primero de estos niveles (el "desarrollo psíquico normal") en la primera infancia.

Crianza, nutrición y desarrollo infantil en niños de Sonora y del Estado de México / Rearing, nutrition and child development in children from Sonora and State of Mexico

Resumen Este estudio tuvo por objetivo examinar las prácticas de crianza (PRC) y su asociación con el desarrollo infantil, psicomotriz y mental, en niños con distinta condición nutricia provenientes de dos entidades federativas de México: Sonora (ES) y Estado de México (EM). Participaron 24 díadas cuidador-hijo, 12 del ES y 12 del EM. La edad de los niños (8 mujeres y 16 varones) fue de los 6 a los 19 meses (M = 10.2, DE = 3.1), quienes fueron evaluados mediante las Escalas de Desarrollo de Bayley. Los cuidadores aportaron datos sociodemográficos y de historia de salud del niño, además de responder el Cuestionario de Práctica Responsiva y Estimulación (CuPRE). Los resultados mostraron relación entre el estado de nutrición (EN) y el orden de nacimiento, así como la edad y escolaridad de los padres; entre el desarrollo infantil y las PRC, así como de éstas con la edad y el orden de nacimiento del niño. De las PRC evaluadas, solo la duración de la lactancia se asoció con el EN. De acuerdo con la procedencia de los participantes, fueron identificadas diferencias en las PRC y en las variables asociadas a éstas. Los resultados sugieren relaciones interesantes que, sin embargo, deberán ser corroboradas a partir del planteamiento de modelos a probar en futuros estudios.

Abstract The objective of this study was to examine the child-rearing practices (CRP) and its association with infant psychomotor and mental development in children with different nutritional status from two states in Mexico: Sonora (S) and State of Mexico (SM). A total of 24 pairs caregiver-child, 12 from S and 12 from SM (8 girls and 16 boys) with an age range of 6 to 19 months (M = 10.2, SD = 3.1) were evaluated using the Bayley Development Scales. Caregivers offer sociodemographic data and child's health history, in addition they answered the Questionnaire of Responsible Practice and Stimulation. The results showed a relationship between the state of nutrition (SN) and birth order, as well as the age and schooling of parents; between child development and CRPs, as well as the child's age and birth order. Of the CRPs assessed, only the breastfeeding duration was associated with SN. According to the origin of the participants, differences were identified in the CRP and in the variables associated to them. The results su ggest interesting relationships that should be confirmed on the approach of models tested in future studies.

Pesquisa em psicanálise com bebês e crianças pequenas: o que Margaret Mahler nos deixou como modelo / Psychoanalytical research with infants and young children: what Margaret Mahler left us as model / La investigación psicoanalítica con bebés y niños pequeños: lo que Margaret Mahler nos dejó como modelo

Margaret Mahler elaborou uma rica teoria sobre o desenvolvimento infantil a partir das hipóteses psicanalíticas, psiquiátricas e pediátricas disponíveis em sua época, assim como de suas próprias pesquisas. Pode-se dizer que uma de suas principais contribuições foi a elaboração de uma estratégia de investigação que permitiu integrar os dados oriundos da clínica com resultados de outros métodos empíricos, enriquecendo, assim, o método psicanalítico tradicional. O presente artigo tem como objetivo apresentar as pesquisas psicanalíticas desenvolvidas por Mahler e seus colaboradores, focando, principalmente, na descrição de seus métodos de pesquisa. Sugerimos que esses métodos fornecem um modelo relevante de pesquisa em psicanálise infantil, o qual merece maior atenção nesse campo.

Margaret Mahler formulated a rich theory on child development based on the psychoanalytic, psychiatric and pediatric hypotheses available in her time, and on her own research as well. It can be said that one of her main contributions was the development of strategies of research making it possible to integrate clinical data with the results of other empirical methods, thus making the traditional psychoanalytic method more productive. This paper aims at presenting the psychoanalytic research conducted by Mahler and her collaborators, emphasizing, first of all, her research methods. It is argued that these methods provide a relevant model for research in child psychoanalysis that deserves more attention in the field.

Margaret Mahler produjo una rica teoría del desarrollo infantil a partir de las hipótesis psicoanalíticas, psiquiátricas y pediátricas disponibles en su tiempo, así como a partir de sus propias investigaciones. Se puede decir que uno de sus principales aportes fue el desarrollo de una estrategia de investigación que permitió la integración de los resultados clínicos con los de otros métodos empíricos, enriqueciendo así el método psicoanalítico tradicional. Este artículo tiene como objetivo presentar la investigación psicoanalítica desarrollada por Mahler y sus colaboradores, centrándose principalmente en la descripción de sus métodos de investigación. Sugerimos que estos métodos proporcionen un modelo de investigación relevante en psicoanálisis infantil, que merece mayor atención en este campo.

Effect of Breastfeeding Duration on Cognitive Development in Infants: 3-Year Follow-up Study

We investigated the association between breastfeeding and cognitive development in infants during their first 3 years. The present study was a part of the Mothers' and Children's Environmental Health (MOCEH) study, which was a multi-center birth cohort project in Korea that began in 2006. A total of 697 infants were tested at age 12, 24, and 36 months using the Korean version of the Bayley Scales of Infant Development II (K-BSID-II). The use and duration of breastfeeding and formula feeding were measured. The relationship between breastfeeding and the mental development index (MDI) score was analyzed by multiple linear regression analysis. The results indicated a positive correlation between breastfeeding duration and MDI score. After adjusting for covariates, infants who were breastfed for ≥ 9 months had significantly better cognitive development than those who had not been breastfed. These results suggest that the longer duration of breastfeeding improves cognitive development in infants.

Follow-up study on neuropsychological behavior development of preterm and low birth weight infants / 中华行为医学与脑科学杂志

Objective To study the neuropsychological behavior development of preterm infants and low birth weight infants,and to provide a reference to the early prevention and intervention on developmental retardations.Methods A total of 101 preterm infants and/or low birth weight infants received the infant development test of 0 ～ 6 year-old children intelligence developmental scale for neurological development and autism behavior checklist(ABC).Results 25 boys and 5 girls suffered from different psychological mental disorders.The occurrences were as follows:10 cases with mental retardation,9 cases with the language development delay,9 cases with motor retardation,1 case with cerebral palsy and 1 case with autism spectrum disorder.The incidence of intelligence problems were that language retardation (18.9％),the fine motor (16.8％),the adapative ability (12.6％),social action (9.5 ％) and the motor delay (3.2％).There were significant differences in the scores of social communication(x2=8.88,P=0.003),adaptive ability(x2=7.41,P=0.007),the fine motor(x2 =6.22,P=0.01) and total developmental quotient(x2 =5.58,P=0.02) between city children'and rural area.The behavioral problems more consisted in self-care ability and language retardation.Conclusion Preterm infants and low birth weight infants are exposed to language,fine motor,adaptive and communication ability problems,especially the children living in country.It is necessary to improve the early education and intervention for the rural preterm infants and low birth weight infants.

Efficacy and mental development comparison of caffeine citrate and aminophylline for treating primary apnea in premature infants / 中国新生儿科杂志

Objective To study the mental development and efficacy of caffeine citrate and aminophylline in treating primary apnea in premature infants. Methods Preterm infants who were diagnosed as primary apnea, received caffeine citrate therapy and recovered in the neonatal ward of our Hospital from December 2013 to December 2014, and followed-up in the high-risk infants outpatient clinic of our Hospital after discharge were recruited in the caffeine group. Preterm infants of aminophylline group were recruited randomly by number method. They were diagnosed as primary apnea, received aminophylline therapy and recovered in our neonatal ward from December 2011 to December 2013, and followed-up regularly in the high-risk infants outpatient clinic of our Hospital after discharge. The treatment effect and mental development at 6 and 12 months of corrected age between the two groups were compared. Results Each group included 150 cases of premature infants. The time (h) of oxygen therapy, noninvasive mechanical ventilation, and invasive mechanical ventilation in the caffeine group were all significantly shorter than that in the aminophylline group [(119. 1 ± 100. 2) vs. (156. 5 ± 134. 1), (107. 4 ± 100. 2) vs. (156. 7 ± 139. 8), (146. 4 ± 122. 6) vs. (270. 9 ± 257. 2), P < 0. 05]. The incidence of patent ductus arteriosus and bronchopulmonary dysplasia in the caffeine group were significantly lower than that in the aminophylline group (24. 0% vs. 45. 3% , 9. 3% vs. 21. 3% , P <0. 05). The scores of gross motor, fine motor and social intercourse in caffeine group were significantly higher than aminophylline group at 6 months of corrected age ( P < 0. 05). The scores of gross motor, fine motor, language and adaptability of infants at 12 months of corrected age from caffeine group were significantly higher than that of infants from aminophylline group ( P < 0. 05). Conclusions Caffeine citrate treatment of primary apnea in preterm infants is more effective than aminophylline. Caffeine citrate treatment can improve mental development of premature infants.

The development of the kindergarten’s children in Bayanzurkh and Khan-Uul district / Шинэ санаа Шинэ нээлт

BACKGROUNDPhysical, mental and gross motor development occur intensively during the childhood. Therefore it is important to detect any developmental delays early in order to take proper intervention which is significant for mental ability and personal development of a child. In this study, we aimed to evaluate mental and gross motor development of the kindergarten’s children in Bayanzurkh and Khan-Uul district.METHODSWe selected 157 children, aged from 3 to 6 years, from Bayanzurh district’s kindergarten and 125 children from Khan-Uul district’s kindergarten randomly. Population basedcross sectional study design was used. Mental and gross motor development was measured by Denver-II test. Statistical analysis of the collected data was conducted using SPSS 17.0 software program.RESULTSLanguage development delay, fine motor-adaptive development delay, gross motor development delay and personal-social development delay were observed in 42%, 15%, 12%, 8% of the kindergarten children, respectively.CONCLUSIONSWe conclude that it is imperative to pay more attention to mental, language and gross motor developments of children in kindergarten.

Regular follow-up on physical growth and mental development of small and appropriate for gestational age preterm infants / 临床儿科杂志

Objective To investigate the physical and mental development of small and appropriate for gestational age preterm infants in their early life. Methods This study recruited 220 preterm infants, who were discharged from our hospital and visited preterm following-up clinic at regular intervals from February 2009 to December 2012. All of those infants were divided into two groups based on whether their birth weight below 10th percentile for their gestational ages or not. Weights, lengths and head circumferences were measured up to seventh month age adjusted by gestational age. Meanwhile, mental tests were conducted by the professional staffs working on the children developmental assessment at their adjusted months of 5th, 6th or 7th. All of physical and mental scores were compared between the two groups. Results The SGA group was statistically less than the AGA group on the Z-score of weights from the ifrst to sixth month adjusted by gestational age (P0.05). The SGA group was statistically less than the AGA group on the Z-score of lengths from the ifrst to iffth month adjusted by gestational age (P0.05). The SGA group was statistically less than the AGA group on the Z-score of head circumferences from the ifrst to seventh month adjusted by gestational age (P<0.05). The SGA babies scored statistically less than the AGA babies with a mean development quotient score of 96.7 and 102.9, respectively (P<0.05). The scores of movement, cognitive, language in the SGA group were statistically less than those in the AGA group(P<0.05). Conclusions Preterm SGA could achieve satisfactory weight catch-up gain, with a decreasing difference from preterm AGA while they were getting older. But the length catch-up growth of preterm SGA seemed unsatisfactory with a big differece from preterm AGA. There was the worst catch-up on head circumference in those preterm SGA, backward in mental development, particularly in their movement, cognitive and language capacity.

El aporte de Peter Fonagy a la comprensión del trastorno de personalidad limítrofe / Peter Fonagy's contribution to the understanding of borderline personality disorder

En este trabajo, el autor, considera los aportes de Peter Fonagy y su conceptualización de la mentalización en la comprensión y tratamiento de los pacientes limítrofes. Fonagy psicoanalista de formación empírica ha desarrollado una teoría psicoanalítica en la cual integra la teoría del apego con conceptos winnicottianos y bionianos, aportando descripciones operacionalizables que han permitido el testeo empírico de estas ideas y una mejor comprensión del funcionamiento mental de pacientes con trastornos graves de la personalidad.El concepto de mentalización es central en la teoría de Fonagy. En este trabajo se lo define y se describe en forma sucinta la teoría del desarrollo mental que lleva a adquirir esta función. Este logro necesita de una relación de apego que permita al niño internalizar aspectos del cuidador necesarios para simbolizar, autoregularse y finalmente a mentalizar. El fallo frecuente de esta función, sobre todo cuando se activan relaciones de apego, es lo que caracteriza a los pacientes que llamamos limítrofes.Para concluir, se hace una breve comparación de similitudes y diferencias entre la teoría de Otto Kernberg y la de Peter Fonagy.

The author, in this paper, considers the work of Peter Fonagy and his development of the concept of mentalization in the understanding and treatment of borderline patients. Fonagy ,psychoanalyst with strong empirical background, has developed a psychoanalytic theory that integrates attachment theory with winnicottian and bionian concepts, giving them operational descriptions which has allowed empirical testing of these ideas and a better understanding of the mental functioning of patients with severe personality disorders. Mentalization is Fonagy’s theory main concept. This paper defines it and describes briefly the child’s mental development which culminates with the acquisition of this function. This achievement needs an attachment relationship which allows internalization of caregiver aspects, necessary to symbolize, self-regulate and finally mentalize.Frequent failure of this function, especially when attachment relationships are activated, is characteristic of patients called borderline.Finally, there is a brief comparison of similarities and differences between Kernberg’s and Fonagy’s theory.

Impact of diversified early comprehensive nursing intervention on physical and mental development in children with high risk of cerebral palsy / 中国实用护理杂志

Objective To explore the influence of early comprehensive nursing intervention on physical and mental development in children with high risk of cerebral palsy.Methods 150 children with high risk of cerebral palsy who were treated in neonatal intensive care unit(NICU) of Xinxiang central hospital were randomly divided into two groups.78 cases in the intervention group received early comprehensive nursing intervention,including functional training combined with medication and physical treatment method.At the same time,their parents received systematic training and participated in the intervention till the babies reached 2 years old.72 cases in the routine group were given conventional baby care.74 termfor-age neonates who were born in our department of maternity in the same period were selected as the control group,which received conventional baby care.The infants of the routine care group received only conventional baby care.The physical development of the weight,length and head circumference and intelligence of three groups were checked at the age of six months,one year and two years.Results M the age of six months,one and two years old,the physical development were higher significantly in the intervention group than those in the routine group,and had not evident difference with the control group.The mental development index (MDI) of the intervention group was lower than that of the control group at the 6 months,had no obvious difference with the control group at one year old,and was great higher than that of the control group.At the sixth month and one year phychomotor development index (PDI) of the intervention group had no difference with that of the control group,and at two years old were higher than that in the control group.The incidence of the phychomotor development retardment and the cerebral palsy in the intervention group was lower than that in the routine group.Conclusions Early nursing intervention is beneficial to the development of the physical and intelligent development of children with high risk of cerebral palsy.

O desenvolvimento psíquico precoce e o risco de psicose de uma perspectiva psicanalítica / Early mental development and the risk of psychosis from a psychoanalytic perspective

Este artigo tem como objetivo retomar e discutir algumas das hipóteses sobre o desenvolvimento psíquico precoce e o risco de psicose, elaboradas por certos autores de orientação psicanalítica, sobretudo, Margareth Mahler, Donald Winnicott, Renè Spitz e Arminda Aberastury. Em um primeiro momento, apresentamos e discutimos as fases do desenvolvimento do primeiro ano de vida consideradas como características do desenvolvimento psíquico infantil normal e, em seguida, nos voltamos para a questão das possíveis falhas nesse desenvolvimento que poderiam estar associadas à psicose segundo os autores acima mencionados.

The objective of this article is to resume and discuss some hypotheses about early mental development and the risk of psychosis made by some psychoanalytic authors concerned with these issues, especially Margaret Mahler, Donald Winnicott, Renè Spitz and Arminda Aberastury. First, we describe and discuss the stages of development during the first year of life which are regarded as typical of normal children's mental development. Next, we approach the question of possible failures in this development that could be associated with psychosis according to the authors mentioned above.

A linguagem do bebê: experiências precoces Observações psicanalíticas na Unidade de Cuidado Intensivo Neonatal / Baby language: early experiences Psychoanalytical observations in the Neonatal Intensive Care Unit / El lenguaje del bebé: experiencias tempranas Observaciones psicoanalíticas en la Unidad de Cuidado Intensivo Neonatal

A Observação de Bebês, considerada a partir de várias perspectivas, deu forte impulso à compreensão do recém-nascido, inclusive do bebê dentro do ventre de sua mãe, seus desenvolvimentos e possibilidades psíquicas. A título de proposta, sugiro que se considere o compromisso emocional de duas mentes para iniciar e garantir a sobrevivência física e emocional do bebê pré-, peri e pós-natal. O recém-nascido não possui palavras, ele tem a linguagem do corpo para expressar cada movimento emocional que ocorra em sua existência. A função alfa da mãe em compromisso intenso com o seu bebê realiza, através de íntima rêverie, a condução para o mundo humano por meio da transformação criativa dos elementos beta projetados pelo bebê, em sensações, experiências, e elementos alfa capazes de serem tolerados pelo tempo necessário para que se constituam num exercício de pensamento para o bebê. Mensagens evidentes, como as de Pablo, um bebê prematuro com apenas 20 minutos de vida, aproximam-nos da oportunidade de aceitar o desafio do compromisso emocional que requer o emprego da linguagem do bebê como ato comunicativo e diálogo afetivo. Penso que a função alfa é a função sábia da personalidade, que oferece ao bebê, dentro do útero de sua mãe e fora dele, o espaço emocional no qual possa construir seu universo comunicativo para o desabrochar de seu psiquismo.

Baby Observation, considered from various angles, gave a strong impulse to the understanding of the newborn, as well as the understanding of the unborn baby in its mothers womb, its developments and mental possibilities. I suggest considering the emotional commitment of two minds as a start and a guarantee of thephysical and emotional survival of the unborn, theperi-natal and thepost-natal baby. The newborn does not dispose of words; it employs body language in order to express each emotional move-ment which occurs in its life experience. The mothers alpha function, in intense engagement with her baby, accomplishes through an intimate reverie, the guidance towards the human world, by means of a creative transformation of the beta elements projected by the baby, into sensations, experiences, alpha elements capable of being tolerated long enough as to make them become a thinking exercise for the baby. Clear messages, such as those of Pablo, a twenty minute old premature baby, take us close to the opportunity of accepting the challenge of the emotional commitment which requires the use of the baby's language as a communicative act and an affective dialogue. I think that the alpha function is the wise function of the personality, which offers the baby in its mother's womb, and out of it, the emotional space in which it can build the communicative universe necessary for the blossoming of its mind.

La Observación de bebés, desde varias perspectivas, ha dado un fuerte impulso a la compren-sión del recién nacido, e incluso del bebé en el vientre de la madre, sus desarrollos y sus posibilidades psíquicas. Como propuesta, ofrezco la consideración del "compromiso emocional" de dos mentes para iniciar y afianzar la supervivencia física y emocional del bebé pre, peri y neonato. El recién nacido no tiene palabras, tiene el lenguaje del cuerpo para expresar cada movimiento emocional que suceda en su existir. La función alfa de la madre en compromiso intenso con su bebé, realiza, en íntima ensonación, la guía hacia el mundo humano, a través de la transformación creativa de elementos beta (i) proyectados por el bebé, en sensaciones, experiencias, elementos alfa (a) factibles de ser tolerados el tiempo necesario para que se constituyan en un ejercicio de pensamiento para el bebé. Mensajes evidentes como los de Pablo, un bebé prematuro con sólo 20 minutos de nacido, nos acercan a la oportunidad de aceptar el reto del compromiso emocional que requiere usar el lenguaje del bebé como acto comunicativo y de diálogo afectivo. Creo que la función a es la "función sabia de la personalidad", que ofrece al infante en el útero y fuera de él, el espacio emocional en el cual construir su universo comunicativo para el despliegue de su psiquismo.

Follow-up study of the development in children conceived with assisted reproductive technology / 临床儿科杂志

Objective To perform a follow-up study on psychomotor development in children conceived with assisted reproductive technology. Methods A control-matched study was done including 63 infants born after assisted conception (study group)and 65 natural conception infants(control group). The pregnant women agreed to participate in the study when they were at 28 weeks of gestation and were followed-up in a predefine schedule till delivery. The regular developmental assessment was done with the CDCC Scales of Infant Development for the children of two groups till they were 24 months old. Results The mean birth weight and length were lower in the study group than those of the control group. The incidences of preterm birth,low birth weight,and NICU admission were significantly higher in the study group than those of control group. However,these differences were not significant when only singletons were compared between two groups. No statistical differences were found in the mental development index(MDI)and psychomotor development index(PDI)between two groups. Conclusions Psychomotor development of children born after assisted conception is normal at 24 months of age. Since the incidences of preterm birth,low birth weight,and multifetation are significantly higher in children born after assisted conception,their general health and development should be followed up for a longer time.

Hipotireoidismo neonatal transitório causado pelo uso de amiodarona durante a gestação: relato de dois casos e revisão da literatura / Transient neonatal hypothyroidism due to amiodarone administration during pregnancy: two cases report and review of literature

INTRODUÇÃO: A amiodarona (AMD) é uma droga antiarrítmica que contém 37 por cento de iodo. A AMD pode alcançar o feto por via transplacentária e causar hipotireoidismo congênito (HC) ou transitório (HCT). Relatamos dois casos de HCT em virtude de exposição gestacional à AMD, detectados pelo programa de triagem neonatal para HC no Estado do Paraná, Brasil. CASO CLÍNICO 1 (C1): TSH neonatal 78,2 mU/L (normal < 15 mU/L). A AMD foi utilizada durante toda a gestação em virtude de arritmia materna. As dosagens séricas iniciais confirmaram o HC; e na primeira consulta [aos 14 dias de vida (dv)], foi iniciada levotiroxina (L-T4), 50 µg/dia. CASO CLÍNICO 2 (C2): TSH neonatal 134 mU/L. A AMD foi utilizada no último trimestre da gestação em virtude de arritmia materna. As dosagens séricas iniciais confirmaram o HC; aos 13 dv, foi iniciada L-T4 50 µg/dia. ACOMPANHAMENTO: TSH e T4 estavam normais aos 51 dv (C1) e aos 36 dv (C2) sendo então gradativamente reduzida a dose da medicação e suspensa aos 16 meses (C1) e aos dez meses (C2). As pacientes foram acompanhadas até 22 meses (C1) e 16 meses (C2) com testes de função tireoidiana normais. O crescimento e o desenvolvimento neuropsicomotor (DNPM), avaliados pelo teste CAT/CLAMS, eram normais. CONCLUSÃO: As avaliações da função tireoidiana e do DNPM são necessários quando a AMD é utilizada na gestação. O tratamento do HCT deve ser instituído tão logo o diagnóstico seja realizado.

INTRODUCTION: Amiodarone (AMD) is an antiarrhythmic agent which contains 37 percent of iodine. It can reach the fetus by transplacental passage and induce transient congenital hypothyroidism (TCH). We report two cases of TCH caused by gestational exposure to AMD, detected by the Newborn Screening Program for Congenital Hypothyroidism of the State of Paraná - Brazil. CLINICAL CASE 1 (C1): Neonatal TSH value was 78,2mU/L (normal < 15 mU/L). AMD had been given to the mother during pregnancy to treat maternal arrhythmia. The screening results were confirmed by serum thyroid function tests. Levothyroxin (L-T4) (50µg/day) was started on the first visit, on the 14th day of life (dl). CLINICAL CASE 2 (C2): Neonatal TSH value was 134,0 mU/L. AMD had been given to the mother in the third trimester of pregnancy to treat maternal arrhythmia. The screening results were confirmed by serum thyroid function tests: L-T4 (50µg/day) was started on the first visit, with 13 dl. FOLLOW-UP: TSH and T4 normalized on 51 dl (C1) and 36 dl (C2); L-T4 could be diminished gradually and stopped within 16 months (C1) and 10 months (C2). They were followed-up until 22 months (C1) and 16 months (C2) with normal thyroid function tests. Their growth and mental development, evaluated by the Cognitive Adaptive Test/Clinical Linguistic & Auditory Milestone Scale (CAT/CLAMS test), were normal. CONCLUSION: Evaluation of thyroid function and mental development should be performed if AMD is used during pregnancy. Treatment of TCH must be started as soon as the diagnosis is made.

Predicción del desarrollo mental a los 20 meses de edad por medio de la evaluación del desarrollo psicomotor a los seis meses de vida en niños sanos / Psychomotor development at six months predicts mental development at 20 months in healthy children

Introduction The study of the possible protector factors and the risk factors can favour or harm women during pregnancy, and so, the infant during the pre- and post-natal periods, has today become a necessary and a high priority objective of world health. In agreement with this proposal, carrying out follow-up programs to prevent, detect and treat consequences in infant development is one of the objectives of Early Care (EC). The follow-up is the way to verify whether the development of the child is occurring within the guidelines of normalcy, or if there is a suspicion that he may be suffering from delays. In order to do this in an appropriate way, one of the necessary conditions is to have access to the tables and instruments that include up-to-date parameters of the course of overall development in the normal population. If the detection and follow-up of risk populations is a key task in the context of early attention, so are the longitudinal studies that use the normal population as the focus of their study. Currently, in various countries in the European Union, important follow-up studies are being carried out of a multi-disciplinary nature (EARNEST Project, NUHEAL Project, and Spanish INMA Network), with the purpose of evaluating the development of the child in general and, specifically, his mental development. These studies take into account, among others, a series of parameters that contemplate the eating habits of the mother, exposure to environmental contaminants, styles of care and the physical, mental and social follow-up of the development of the children up to ages that include adolescence. One of the factors associated with mental development is psychomotricity. The psychomotor development refers to the acquisition of skills observed in the child in a continuous way throughout childhood, and it is associated, on the one hand, with the maturing of the Central Nervous System (proliferation of the dendrites, synaptogenesis and the myelinazation of the axons) from the first months of life up to the age of two. This maturation process has a pre-established order and a clear and predictable sequence: the progress is in a cephalocaudal sense and from proximal to distal. On the other hand, the psychomotor development is also associated with the learning done by the baby and the child in their interactions with themselves and their surroundings, with the affective links they establish based on the affect and stability of the care received and the perception of everything around them (people, images, sounds, movement…). These conditions are determinants in the emotional development, communicative functions, adaptive behaviours and attitude toward learning. It has been proposed that the psychomotor development precedes the mental development and forms the base on which it is established. And although it must be kept in mind that there are degrees of individual variation in normal psychomotor development, depending on the interaction between genetic and environmental factors, it can be said that full term babies who are born healthy follow a pattern of development or skills acquisition. This pattern is clear, and basic milestones have been defined that are easy to measure and that make it possible to know when a child is progressing satisfactorily. In these children, the rhythm of psychomotor development in the first two years of life is quite rapid. At six to seven months, they can sit and crawl; at eight to nine months, they stand up; and at 10 to 12 months, they walk with help. Through their movements and manipulations, they are exploring, imitating, learning and understanding. It is important to observe and rigorously follow the way the psychomotor development is occurring and being established in children because it may provide us with early indications of possible consequences in some parameters of their mental development. Another factor that is related to the mental development, in addition to the psychomotor development, is the somatic growth or development of the child. Numerous studies show how the weight, length and cephalic perimeter are predictors of disorders in development in the case of a risk, high-risk and/or clinical population with established problems and diverse associated pathologies. Therefore, these measures of growth constitute essential parameters to keep in mind for an early intervention in the deviations and disorders in development. In this study, it has been proposed the need to verify whether this relationship of prediction between somatic growth and psychomotor and mental development also occurs in populations of healthy children. The main objective of this study was to describe the evolution of the neurodevelopment in healthy children from the sixth to the 20th month of life. We now present the results of a part of the follow-up from the NUHEAL Project. Material and method The sample studied was composed of 66 (32 boys/34 girls) full-term, healthy infants, with a weight at birth appropriate for their gestational age, born at the San Cecilio Clinical University Hospital in Granada. All of their mothers were participants in the NUHEAL project, and they did not received docosahexaenoic acid and eicosapentaenoic acid supplements. To evaluate the neurodevelopment of the infants, the Bayley Scales of Infant Development (BSID) were used at six months (6.22±0.29) (n:66) and at 20 months (19.56±1.17) (n:56). The evaluation was performed by a psychologist who had been trained for this. The BSID evaluates three aspects of development: motor development, mental development and the behaviour of the child. It provides an index of mental development (MDI) and an index of psychomotor development (PDI). In addition, an evaluation of the somatic or anthropometric development was also performed by an expert paediatrician, taking into account the following variables: weight, height, cephalic and thoracic perimeter at birth, at six months of age and at 20 months. The local Ethical Committee of the University Clinical Hospital "San Cecilio" of Granada approved the study protocol. After a careful explanation of the study details, written informed consent was obtained from all participating women. Results The preliminary data obtained in this study showed that the psychomotor development of the children was greater than the mental development, at both six and 20 months of age, with the mean from the Psychomotor Development Index (PDI) being (107.95±11.70 vs 125.39±10.51) at six and 20 months, respectively, and the mean from the Mental Development Index (MDI) being (97.73±9.14 vs. 119.64±12.41) at six and 20 months of age. The results showed that the MDI at 20 months was greater in those children who had a greater PDI at six months, (F(1. 52)= 4.27; p<0.044). No statistically significant relationships were found between the anthropometric data at six months and the EBDI development indices (MDI and PDI) at 20 months of age.

Introducción El estudio de los posibles factores tanto protectores como de riesgo que puedan favorecer o dañar a la mujer durante el embarazo y, por tanto, al niño en el período prenatal y postnatal, se ha convertido hoy en una necesidad y en un objetivo prioritario de salud mundial. Uno de los objetivos de la Atención Temprana es la realización de programas de seguimiento para prevenir, detectar y tratar secuelas en el desarrollo infantil. El seguimiento es el modo de comprobar si el desarrollo se está produciendo dentro de unas pautas de normalidad. Si la detección y el seguimiento de poblaciones de riesgo son unas tareas claves en la atención temprana, no lo son menos la realización de estudios longitudinales que toman a la población normal como objeto de estudio. Actualmente, en diversos países de la Comunidad Europea se están llevando a cabo importantes estudios aleatorizados con seguimiento longitudinal (proyectos NUHEAL, EARNEST, Red de Excelencia INMA) para evaluar el desarrollo global de los niños sanos y el desarrollo mental, en particular. Dentro de los factores asociados al desarrollo mental se encuentran el desarrollo psicomotor y el desarrollo somático. Numerosos estudios muestran que el peso, la talla y el perímetro cefálico son predictores de trastornos del desarrollo cuando se trata de una población de alto riesgo o con alguna patología. El objetivo principal de este estudio es describir la evolución del neurodesarrollo en niños sanos desde el sexto al vigésimo mes de vida. En este artículo se presentan parte de los resultados del Proyecto Europeo NUHEAL. Material y método Se estudiaron 66 bebés sanos (32 niños / 34 niñas), nacidos a término, con peso al nacimiento apropiado para la edad gestacional, que fueron reclutados en el Hospital Clínico Universitario "San Cecilio" en Granada y cuyas madres eran participantes del proyecto NUHEAL pero que no recibieron suplementación de ácido docosahexaenoico y ácido eicosapentanoico. Se les realizó evaluación del neurodesarrollo a los seis (n:66) y 20 (n:56) meses de edad utilizando las Escalas Bayley de Desarrollo Infantil (EBDI). Estas escalas proporcionan un índice de desarrollo mental (IDM) y un índice de desarrollo psicomotor (IDP). Igualmente se realizó evaluación del desarrollo somático, mediante el estudio antropométrico de las siguientes variables: Peso, talla, perímetro cefálico y torácico al nacimiento, a los seis y 20 meses de edad. El protocolo del presente estudio fue aprobado por el Comité Ético local del Hospital Clínico Universitario <> de Granada. Resultados Los datos mostraron que la población estudiada tenía mayor desarrollo psicomotor que mental tanto a los seis como a los 20 meses de edad, siendo la media del Indice de Desarrollo Psicomotor (IDP) (107.95±11.70 vs 125.39±10.51) a los seis y 20 meses respectivamente, y la media del Índice de Desarrollo Mental (IDM) (97.73±9.14 vs 119.64±12.41) para los seis y 20 meses de edad. Los resultados también muestran que el IDM a los 20 meses es mayor en aquellos niños que tenían un IDP mayor a los seis meses (F (1.52)= 4.27; p<0.044). No se encontraron relaciones estadísticamente significativas entre las variables somatométricas a los seis meses y el IDM e IDP a los 20 meses de edad. Discusión Los resultados de este estudio indican que los niños incluidos en este trabajo de investigación se encuentran dentro de la normalidad. Los niños mostraron un buen desarrollo mental y psicomotor en ambas edades, aunque el desarrollo psicomotor era superior al mental tanto a los 6 como a los 20 meses. El IDP a los seis meses resultó ser un buen predictor del IDM a los 20 meses. Estos resultados corroboran los datos publicados por diversos autores que afirman que el desarrollo psicomotor precede al desarrollo mental, siendo el desarrollo psicomotor un factor protector y una base esencial para el establecimiento de las funciones mentales superiores. Respecto a los datos obtenidos de que ninguna variable somatométrica a los seis meses resultó predictora del desarrollo psicomotor y mental posterior a los 20 meses, probablemente sea debido a que los niños incluidos en este estudio eran niños sanos; si bien esta relación sí parece cumplirse cuando se trata de niños con antecedentes patológicos o en poblaciones de niños de alto riesgo.