Trastorno del espectro alcohólico fetal: Un trastorno del neurodesarrollo infradiagnosticado y de pronóstico incierto / Fetal alcohol spectrum disorder. An underdiagnosed neuro-development disorder of uncertain prognosis

La exposición prenatal al alcohol es causa de alteraciones somáticas, cognitivas y conductuales que se agrupan bajo el término de trastorno del espectro alcohólico fetal (TEAF). La evolución a largo plazo de los sujetos afectados a menudo es desfavorable, especialmente a nivel académico y adaptativo social. En el perfil neuropsicológico es característica la disfunción ejecutiva a menudo asociada a trastornos de la conducta que evolucionan en muchos casos hacia la delincuencia a partir de la adolescencia y en la edad adulta. Se han descrito también déficits de las habilidades sociales y la empatía. La exposición prenatal al alcohol constituye la causa más frecuente de trastorno del neurodesarrollo adquirido y prevenible.

Prenatal exposure to alcohol is the cause of cognitive and behavioural disorders grouped under the term fetal alcohol spectrum disorders (FASD). The long-term evolution of subjects with FASD is often unfavourable, especially in social and academic fields. Executive dysfunction is a hallmark deficit for children with FASD with increased rates of externalizing behaviours, such as aggressiveness and frequently delinquency in adolescence and adulthood. Deficits in social skills, empathy and communication ability are frequent observed among FASD. Prenatal exposure to alcohol is the most frequent cause of acquired and preventable neurodevelopmental disorder.

Triagem neurológica de recém-nascidos pré-termo com hemorragias peri e intraventriculares: estudo transversal observacional / Neurological screening of preterm infants with peri- and intra-ventricular hemorrhage: observation transversal study

INTRODUÇÃO: Recém-nascidos pré-termo (RNPT) com menos de 27 semanas de idade gestacional apresentam vulnerabilidade para o desenvolvimento de hemorragias peri e intraventriculares (HPIV), o que pode afetar a mielinização e organização do córtex cerebral, acarretando possíveis prejuízos ao desenvolvimento. OBJETIVO: Avaliar o comportamento neurológico de RNPT acometido por HPIV com e sem sepse segundo a versão resumida do Método Dubowitz, delimitar a presença de itens desviantes da avaliação e comparar com as respostas obtidas pelo grupo controle (sem HPIV). MÉTODOS: Estudo transversal realizado no Hospital Municipal Universitário de São Bernardo do Campo (SP). Os RNPT foram divididos em três grupos, sendo dois estudos (HPIV e HPIV + sepse) e um controle. Os participantes foram avaliados com idade correspondente ao termo. A versão resumida do método, utilizada como triagem para recém-nascidos de risco neurológico é constituída por 12 itens. As análises foram realizadas segundo pontuações desviantes nestes itens e comparadas com as pontuações esperadas para a normalidade. Os dados obtidos foram comparados na pontuação resumida e na pontuação da versão íntegra. RESULTADOS: A frequência de RNPT com pontuações atípicas foram: 40% no grupo HPIV + sepse, 10% no grupo HPIV e 15% no controle. CONCLUSÃO: A HPIV de forma isolada não parece ser um fator significante para presença de itens desviantes no Método Dubowitz resumido. A presença de HPIV em graus mais severos esteve associada à presença de sepse. Os RNPT com HPIV associada à sepse obtiveram pior desempenho neurológico.

INTRODUCTION: Preterm infants with less than 27 weeks of gestacional age present vulnerability for development of periand intraventricular hemorrhage (PIVH). This can affect the myelinization and organization of cerebral cortex, leading to possible developmental impairment. OBJECTIVE: To evaluate the neurological behavior of preterm infants affected by PIVH with and without sepsis according to the Dubowitz Method summary, to delimit the presence of deviant items of the evaluation and to compare with the results of the control group (without PIVH). METHODS: This is a cross-sectional study. The preterm infants were divided in three groups, two study groups (PIVH and PIVH + sepsis), and one control group. The summary version of the Dubowitz Method was used as a neurological screening for the risk in preterm infants. The analysis was performed according to scores with deviation in these items and compared to the expected normal score. Data obtained were compared using the summary score and the full version of the test. RESULTS: The frequency of abnormal scores was: 40% in the group with PIVH + sepsis, 10% in the group only with PIVH, 15% in the control group. CONCLUSION: The PIVH does not seem to be a significant factor for the presence of items with deviation in the summary version of Dubowitz Method. The presence of PIVH in more severe stages was associated with the presence of sepsis. The preterm infants with PIVH with sepsis obtained worse neurological performance in the test.

Validation of vulnerability markers of dysfunctions in the socioemotional development of infants / Validação de marcadores de vulnerabilidade de lactentes para disfunções em seu desenvolvimento socioemocional / Validación de los marcadores de vulnerabilidad de los lactantes para las disfunciones en su desarrollo socioemocional

ABSTRACT Objectives: to validate the vulnerability markers of dysfunctions in the socioemotional development of infants. Methods: study with a sequential exploratory mixed-method design. The vulnerability markers elaborated in the qualitative phase were analyzed by experts in the quantitative phase using the Delphi technique with a minimum consensus of 70%. Seventeen judges answered the questionnaire in the first round of analysis and 11 answered in the second round. Results: in the first round, two markers did not reach minimum consensus: the presence of instability in family relationships (66%) and delinquency and/or drug abuse by parents/caregivers (65%). In the second round, all markers were validated, with more than 90% agreement in most of the attributes, and reached the minimum consensus of 73%. Conclusion: the eight vulnerability markers reached the minimum consensus for validation, and a relevant instrument for infant care can be developed after assessing the reliability and clinically validating these markers.

RESUMO Objetivos: validar marcadores de vulnerabilidade à disfunções no desenvolvimento socioemocional de lactentes. Métodos: pesquisa de método exploratório sequencial misto. Os marcadores de vulnerabilidade elaborados na fase qualitativa foram analisados por especialistas na fase quantitativa utilizando a técnica Delphi com consenso mínimo de 70%. Dezessete juízes responderam o questionário na primeira rodada de análise e 11 responderam na segunda rodada. Resultados: na primeira rodada, dois marcadores não alcançaram o consenso mínimo: presença de instabilidade nas relações familiares (66%) e situação de delinquência e/ou abuso dos pais/cuidadores (65%). Na segunda rodada, todos os marcadores foram validados, com mais de 90% de concordância na maioria dos atributos, e alcançaram o consenso mínimo de 73%. Conclusão: os oito marcadores de vulnerabilidade alcançaram consenso mínimo para a sua validação e foram habilitados à verificação de confiabilidade e validação clínica para compor um instrumento relevante ao cuidado do lactente.

RESUMEN Objetivos: validar los marcadores de vulnerabilidad de los lactantes para las disfunciones en el desarrollo socioemocional. Método: investigación de método exploratorio secuencial mixto. Los marcadores de vulnerabilidad, elaborados en la fase cualitativa, fueron sometidos a los especialistas en la fase cuantitativa del estudio, por medio de la Técnica Delphi, con el consenso mínimo del 70%. En la primera ronda de análisis, 17 jueces respondieron a la investigación y en la segunda ronda, 11 respondieron a la misma investigación. Resultados: en la primera ronda, dos marcadores no alcanzaron el consenso mínimo: Presencia de inestabilidad en las relaciones familiares (66%) y Situación de delincuencia y/o abuso de los padres/cuidadores (65%). En la segunda ronda, todos los marcadores fueron validados, con más del 90% de concordancia en la mayoría de los atributos, habiendo alcanzado el valor mínimo del 73%. Conclusión: los ocho marcadores de vulnerabilidad alcanzaron consenso mínimo para su validación, estando habilitados a la verificación de confiabilidad y validación clínica, para componer un instrumento relevante al cuidado del lactante.

Current knowledge of environmental exposure in children during the sensitive developmental periods / O estado atual do conhecimento sobre a exposição ambiental no organismo infantil durante os períodos sensíveis de desenvolvimento

Abstract: Objective: This study aims to identify the scientific evidence on the risks and effects of exposure to environmental contaminants in children during sensitive developmental periods. Data source: The search was performed in the Bireme database, using the terms: children's health, environmental exposure, health vulnerability, toxicity pathways and developmental disabilities in the LILACS, MEDLINE and SciELO systems. Data synthesis: Children differ from adults in their unique physiological and behavioral characteristics and the potential exposure to risks caused by several threats in the environment. Exposure to toxic agents is analyzed through toxicokinetic processes in the several systems and organs during the sensitive phases of child development. The caused effects are reflected in the increased prevalence of congenital malformations, diarrhea, asthma, cancer, endocrine and neurological disorders, among others, with negative impacts throughout adult life. Conclusion: To identify the causes and understand the mechanisms involved in the genesis of these diseases is a challenge for science, as there is still a lack of knowledge on children's susceptibility to many environmental contaminants. Prevention policies and more research on child environmental health, improving the recording and surveillance of environmental risks to children's health, should be an ongoing priority in the public health field.

Resumo: Objetivo: O presente estudo busca identificar as evidências científicas sobre os riscos e efeitos da exposição de contaminantes ambientais no organismo infantil durante os períodos sensíveis de seu desenvolvimento. Fonte de dados: As pesquisas foram feitas pelo banco de dados da Bireme, com os termos children's health, environmental exposure, health vulnerability, toxicity pathways e developmental disabilities nos sistemas Lilacs, Medline e SciELO. Síntese de dados: A criança difere do adulto por suas características singulares de ordem fisiológica, comportamental e do potencial de exposição a riscos frente às ameaças do ambiente. A exposição a agentes tóxicos é analisada por meio dos processos toxicocinéticos nos sistemas e órgãos durante as janelas sensíveis do desenvolvimento infantil. Os efeitos causados transparecem no aumento da prevalência de malformações congênitas, diarreia, asma, cânceres, distúrbios endócrinos e neurológicos, entre outros, com impactos negativos ao longo da vida adulta. Conclusão: Identificar as causas e compreender os mecanismos envolvidos na gênese desses agravos é um desafio que se impõe à ciência, visto que ainda há uma lacuna de conhecimento sobre a suscetibilidade infantil para muitos contaminantes ambientais. Políticas de prevenção e mais pesquisas em saúde ambiental infantil, que impulsionem o registro e a vigilância epidemiológica dos riscos ambientais à saúde da criança, devem ser uma prioridade contínua no campo da saúde pública.

Evaluation of child development: beyond the neuromotor aspect / Avaliação do desenvolvimento infantil: além do neuromotor

Abstract Objective: To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health. Sources: A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child. Summary of the findings: With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a ‘school readiness’ checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential. Conclusions: The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.

Resumo Objetivo: Revisar a epidemiologia e atualizar os conhecimentos científicos sobre os problemas do desenvolvimento e do comportamento na infância e das recomendações do papel do pediatra na identificação e conduta frente aos transtornos da saúde mental infantil. Fontes de dados: Pesquisamos a literatura relevante nas bases de dados PubMed e Scopus e em publicações do National Scientific Council on the Developing Child. Síntese dos dados: Com o declínio na incidência de doenças transmissíveis em crianças, problemas do desenvolvimento, comportamento e regulação emocional fazem cada vez mais parte do trabalho do pediatra, mas muitos ainda não estão treinados e se sentem desconfortáveis com essa extensão do seu papel. Os instrumentos de triagem do desenvolvimento e comportamento foram revisados e uma lista de verificação da “prontidão escolar” foi apresentada, juntamente com orientações sobre como o pediatra pode incorporar a vigilância da saúde mental em sua de rotina de atendimento, consciente da necessidade da aquisição das habilidades sociais, emocionais e cognitivas para que a criança possa desenvolver toda sua potencialidade. Conclusões: O papel do pediatra no futuro irá abranger tanto a saúde física quanto a mental e reconhecer que o desenvolvimento social, a resiliência e o amadurecimento emocional são tão importantes quanto o crescimento físico e as habilidades neuromotoras no curso da vida de uma criança.

Congenital Heart Disease and Impacts on Child Development

Abstract Objective: To evaluate the child development and evaluate a possible association with the commitment by biopsychosocial factors of children with and without congenital heart disease. Methods: Observational study of case-control with three groups: Group 1 - children with congenital heart disease without surgical correction; Group 2 - children with congenital heart disease who underwent surgery; and Group 3 - healthy children. Children were assessed by socio-demographic and clinical questionnaire and the Denver II Screening Test. Results: One hundred and twenty eight children were evaluated, 29 in Group 1, 43 in Group 2 and 56 in Group 3. Of the total, 51.56% are girls and ages ranged from two months to six years (median 24.5 months). Regarding the Denver II, the children with heart disease had more "suspicious" and "suspect/abnormal" ratings and in the group of healthy children 53.6% were considered with "normal" development (P≤0.0001). The biopsychosocial variables that were related to a possible developmental delay were gender (P=0.042), child's age (P=0.001) and income per capita (P=0.019). Conclusion: The results suggest that children with congenital heart disease are likely to have a developmental delay with significant difference between children who have undergone surgery and those awaiting surgery under clinical follow-up.

Motor, linguistic, personal and social aspects of children with Down syndrome

AbstractA global developmental delay is expected from Down syndrome, affecting motor, cognitive, linguistic and personal-social skills. However, not always these delays are proportional; different conditions occur due to several intrinsic and extrinsic variables that must be controlled to form groups of greater homogeneity.Objective To enhance personal-social, fine motor-adaptive, gross motor and linguistic skills among children with Down syndrome and compare them with typically developing children, matched for gender, socioeconomic status and mental age, while controlling some variables that interfere with the global development.Methods The ethical aspects were fulfilled (Case No. 040/2009). The following inclusion criteria were considered: participants without a history of prematurity, very low birth weight, congenital hypothyroidism, significant hearing and vision problems, and signs of Autism Spectrum Disorder. After the inclusion criteria were considered, 40 children participated in the study, of which 20 had Down syndrome (experimental group - EG), these being of both genders and with chronological ages ranging from 38 to 63 months, and the other 20 being typically developing children (control group - CG), matching the EG in terms of gender, socioeconomic status and mental age, with this age ranging from 13 to 50 months. The evaluation consisted in applying the Denver Developmental Screening Test II, a test that assesses areas such as personal-social, fine motor-adaptive, linguistic and gross motor development. The results were subjected to statistical analysis using Student’s t-test.Results A statistically significant difference was verified between the groups for the language and fine motor-adaptive areas.Conclusion Children with Down syndrome showed lower performance in language and fine motor skills when compared with typically developing children. There was no statistically significant difference in gross motor and personal-social areas. It is worth mentioning the importance of controlling the variables to deal with more homogeneous groups.

Factors associated with bruxism in children with developmental disabilities

The aim of the present study was to investigate factors associated with bruxism in children aged from 1 to 13 years with developmental disabilities. A total of 389 dental records were examined. The bruxism analyzed was determined based on parental reports. The following variables were also analyzed: gender, age, International Code of Diseases (ICD), mouth breathing, history of gastroesophageal reflux, use of psychotropic drugs, gingival status, reports of xerostomia, hyperkinesis, pacifier use, thumb sucking and involuntary movements. For the purposes of analysis, the individuals were categorized as being with and without bruxism. Variables with a p-value < 0.25 in the bivariate analysis were incorporated into the logistic regression models. Females had a 0.44-fold (95%CI: 0.25 to 0.78) greater chance of exhibiting bruxism than males. Individuals with gastroesophageal reflux had a 2.28-fold (95%CI: 1.03 to 5.02) greater chance of exhibiting bruxism. Individuals with reported involuntary movements had a 2.24-fold (95%CI: 1.19 to 4.24) greater chance of exhibiting bruxism than those without such movements. Exhibiting involuntary movements, the male gender and gastroesophageal reflux are factors associated with bruxism in children with developmental disabilities.

Preterm children have unfavorable motor, cognitive, and functional performance when compared to term children of preschool age / Crianças pré-termo apresentam desempenho motor, cognitivo e funcional desfavorável em relação a neonatos a termo em idade pré-escolar

OBJECTIVE: to compare the motor coordination, cognitive, and functional development of preterm and term children at the age of 4 years. METHODS: this was a cross-sectional study of 124 four-year-old children, distributed in two different groups, according to gestational age and birth weight, paired by gender, age, and socioeconomic level. All children were evaluated by the Movement Assessment Battery for Children - second edition (MABC-2), the Pediatric Evaluation of Disability Inventory (PEDI), and the Columbia Mental Maturity Scale (CMMS). RESULTS: preterm children had worse performance in all tests, and 29.1% of the preterm and 6.5% of term groups had scores on the MABC-2 indicative of motor coordination disorder (p = 0.002). In the CMMS (p = 0.034), the median of the standardized score for the preterm group was 99.0 (± 13.75) and 103.0 (± 12.25) for the term group; on the PEDI, preterm children showed more limited skill repertoire (p = 0.001) and required more assistance from the caregiver (p = 0.010) than term children. CONCLUSION: this study reinforced the evidence that preterm children from different socioeconomic backgrounds are more likely to have motor, cognitive, and functional development impairment, detectable before school age, than their term peers. .

OBJETIVO: comparar o desenvolvimento da coordenação motora, o desenvolvimento cognitivo e o desempenho funcional de crianças nascidas pré-termo e a termo, aos quatro anos de idade. MÉTODOS: estudo transversal com 124 crianças de quatro anos de idade, distribuídas em dois grupos distintos, de acordo com a idade gestacional e peso ao nascimento, pareadas com relação ao sexo, idade e nível socioeconômico. Todas as crianças foram avaliadas pelos testes Movement Assessment Battery for Children - Second Edition (MABC-2), Inventário de Avaliação Pediátrica de Incapacidade (PEDI) e Escala de Maturidade Mental Colúmbia (EMMC). RESULTADOS: as crianças pré-termo tiveram pior desempenho em todos os testes, sendo que 29,1% das crianças do grupo pré-termo e 6,5% do grupo a termo apresentaram pontuação no MABC-2 indicativa de sinais de transtorno da coordenação motora (p = 0,002). No Columbia (p = 0,034), a mediana do resultado padronizado para o grupo pré-termo foi de 99,0 (±13,75), e do grupo a termo foi 103,0 (±12,25); no PEDI, crianças pré-termo tiveram menor repertório de habilidades (p = 0,001) e necessitaram de maior assistência do cuidador (p = 0,010) do que as crianças a termo. CONCLUSÃO: este estudo reforça as evidências de que crianças pré-termo, de diferentes níveis socioeconômicos, são mais propensas a apresentarem alterações no desenvolvimento motor, cognitivo e funcional, detectáveis antes da idade escolar, que seus pares nascidos a termo. .

Evolución de los niños con retraso del desarrollo y conductas del espectro autista / [Follow up of patients with developmental delay and autistic spectrum disorders].

The evolution of autism symptoms during life were revised, from childhood to adulthood. Little information is available. After a search in PubMed, no more than 40 publications address this issue. The review was divided into two parts: a) how change the three main symptoms of autism change; b) how change the other autism-associated symptoms. The three main symptoms, called "Triad of Wing" (communication problems, social skills deficits, and a restricted repertoire of interests) do not change significantly during lifetime. The diagnosis of autism remains stable during lifetime, and 80

of children continue with this diagnosis in adulthood. Furthermore, it is difficult to establish first diagnostic of autism in adults. In relation to the associated symptoms, one of the earliest are sleep disturbances and one of the most prevalent is both bipolar and anxiety disorders. Sleep disturbances are age-limited and disappear easily. Bipolar disorders are usually more severe in children with autism when compared to children without autism. The mood transitions are faster in autistic children. Anxiety is usually more intense in cognitive preserved autistic patients and tends to increase with age. The two main prognostic factors for autism in adults are: a) total IQ above 70. b) functional language before 6 years of age.

Desarrollo psicomotor en niños de nivel socioeconómico medio-alto / Psychomotor development among children of upper-middle class in Chile

Objective: Describe the psychomotor development (PMD) in upper middle class children, utilizing Bayley's Scale of Intellectual Development (BSID), internationally standarized. Patients and Methods: A total of 119 children in groups of 8, 18 and 30 months were enrolled at the well-baby clinic in a Private Hospital in Santiago, Chile. BSID III was utilized in all cases. Children born preterm, or with neurological, genetic, or metabolic diseases were excluded. Results: BSID scores followed a normal distribution (100.3 +/- 10). Prevalence of déficit was found to be 30%) at 8 months, 7.7%> at 18 months, and 2.7%> at 30 months, without gender difference. Gross motor development and language predominated at 8 months. Ther threee subscales showed an upward trend, cognitive and motor scales most significantly. Gross motor scales, which had been deficient at 8 months became normal at 18 months. Conclusions: The high frequency of motor deficits found at 8 months of age was striking. While all scales improved, cognitive and motor scales were most significant. The effect of stimulation and upbringing patterns upon chil development is discussed, being important for future studies of causality.

Objetivo: Describir los puntajes de desarrollo psicomotor (DSM) en niños sanos de nivel socio económico medio alto mediante la Escala de Bayley de Desarrollo Infantil (BSID), estandarizada internacionalmente. Pacientes y Métodos: Estudio transversal descriptivo. Se enrolaron 119 niños 8, 18 y 30 meses, que acudieron a control sano en una Clínica privada de Santiago de Chile, para la aplicación de BSID III. Se excluyeron los nacidos de pre-término o con enfermedad neurológica, genética o metabólica conocida. Resultados: Los puntajes obtenidos en BSID siguieron una distribución normal (100,3 +/- 10). La prevalencia de déficit en el DSM fue 30% a los 8 meses, 7,7% a los 18 y 2,7% a los 30 meses, no hubo diferencia por sexo. A los 8 meses predominó el déficit motor grueso y posteriormente el lenguaje. Las tres subescalas mostraron una tendencia al alza, las áreas cognitiva y motriz siguieron una progresión significativa. La motricidad gruesa, que estaba en el rango inferior a los 8 meses, fue normal a los 18. Conclusiones: Destaca la alta frecuencia de déficit motor en la población evaluada, especialmente a la edad de 8 meses. Todas las subescalas mostraron una tendencia al alza, siendo ésta diferencia significativa en las áreas cognitiva y motora. Se discute el efecto de la estimulación y los patrones de crianza en el desempeño de los niños, siendo necesario planificar estudios prospectivos para conocer su relación de causalidad.

Development of High-Risk Newborns ? A Follow-up Study from Birth to One Year.

We followed 55 high risk newborns from birth till one year using Trivandrum Development Screening Chart (TDSC) and Denver Development Screening Test (DDST). We also assessed their muscle tone, vision and hearing. Babies were classified into mild, moderate, and severe risk groups using a scoring system. Babies with developmental delay were categorized as having mild, moderate, or severe delay. The risk score was significantly associated with the severity of developmental delay (Plt; 0.001). Abnormalities of tone were also associated with development delay (P< 0.001).

Comparação entre distribuições de referência para a classificação do estado nutricional de crianças e adolescentes com síndrome de Down / Assessment of anthropometric indexes of children and adolescents with Down syndrome

OBJETIVO: Avaliar a concordância da categorização dos índices peso para idade (P/I) e estatura para idade (E/I) em indivíduos com síndrome de Down segundo diferentes curvas. MÉTODOS: Desenvolveu-se estudo transversal em crianças (2 a 9,9 anos de idade) e adolescentes (10 a 17,9 anos de idade) com síndrome de Down assistidos em instituições da região metropolitana do Rio de Janeiro. Os índices de P/I e E/I foram categorizados segundo os percentis de três curvas: duas para indivíduos com síndrome de Down e outra para indivíduos saudáveis. Os limites utilizados na categorização foram o percentil 5 (P5) e o percentil 95 (P95). Utilizou-se o Kappa ponderado na avaliação da concordância das classificações (significativo quando p < 0,05). RESULTADOS: Foram obtidas informações de 98 crianças e 40 adolescentes. Entre as crianças, o P/I < P5 variou de 1,0 a 18,4 por cento; a concordância para essa categorização foi considerada fraca (Kappa = 0,16; IC95 por cento -0,03-0,34; p < 0,01); para E/I, não foi observada concordância na classificação. Entre os adolescentes, a categorização do P/I < P5 variou de 2,5 a 5,0 por cento; a concordância para essa classificação foi fraca (Kappa = 0,16; IC95 por cento -0,15-0,48; p > 0,05); para E/I, a concordância foi boa (Kappa = 1,00; IC95 por cento 0,23-1,00; p < 0,01). CONCLUSÃO: A concordância entre as classificações dos índices P/I e E/I geradas por diferentes distribuições mostrou-se fraca. Os dados indicam que o desenvolvimento de curvas específicas para indivíduos com síndrome de Down seria útil para a identificação de distúrbios ponderais, como o excesso de peso, que é freqüentemente observado nesse grupo.

OBJECTIVE: To compare the agreement between classifications of children and adolescents with Down syndrome (DS) by weight for age (W/A) and height for age (H/A) indexes according to a selection of international reference curves. METHODS: A cross-sectional study was carried out of children (2 to 9.9 years old) and adolescents (10 to 17.9 years old) with DS from cities in the state of Rio de Janeiro, Brazil, in 2005. The W/A and H/A indexes were classified according to the percentiles of two curves developed for individuals with Down syndrome and one distribution developed for healthy subjects. The cut-off limits applied for categorization were: below the 5th percentile (< P5) and above the 95th percentile (> 95). The weighted Kappa index was estimated to assess agreement between the classifications (p < 0.05). RESULTS: Information was obtained on 98 children and 40 adolescents. From 1.0 to 18.4 percent of the children were < P5 for W/A and the agreement for this index was considered weak (Kappa = 0.16; 95 percentCI -0.03-0.34; p < 0.01) no agreement was observed between the H/A classifications. For adolescents, W/A < P5 varied from 2.5 to 5.0 percent; and once more there was no agreement for this classification (Kappa = 0.16; 95 percentCI -0.15-0.48; p > 0.05). There was good agreement for the H/A index (Kappa = 1.00; 95 percentCI 0.23-1.00; p < 0.01). CONCLUSION: There was weak agreement between classifications of anthropometric indexes according to three different distributions. The data indicate that the construction of specific curves for individuals with DS would facilitate the identification of overweight, which is often observed among these patients.

Early intervention in developmental delay.

OBJECTIVES: To establish the socio-demographic and clinical profile of children attending Early Intervention Program (EIP). METHODS: Retrospective analysis of case records of 100 consecutive children examined from July 2002 to June 2004. Data regarding socio-demographic variables, clinical profile, locomotor, speech and audiology functions were recorded. Data is described in terms of frequency and mean (with SD). RESULTS: Mean age of these children was 4.0 +/- 1.4 years. 70% were male and a similar percentage hailed from urban areas. 88% were mentally retarded with mean IQ of 50 +/- 24.3. Cerebral Palsy was seen in 50% of the children, learning disorder in 24%, Attention Deficit Hyperactivity Disorder (ADHD) in 12% and autism in 4%. 25% of children suffered from epilepsy and 66% were unable to communicate verbally. 21% of children had strong evidence of genetic disorders. An etiological diagnosis could not be made in 31% of children. CONCLUSIONS: Awareness of developmental delay as well as of possible interventions is low in India. Speech delay is the only delay which is considered important by parents. Active involvement and early referrals from pediatricians, obstetricians and other specialists is suggested.

Factores predisponentes de anemia en recién nacidos: Hospital Ernesto Segundo Pauline: abril-junio 2005 / Factors related to anemia in newborn: Hospital Ernesto Segundo Pauline: april-june 2005

La anemia es un cuadro clínico y de laboratorio, con incidencia mundial de 34 por ciento primordialmente en países en vías de desarrollo, siendo los niños los más afectados, se manifiesta de muchas formas acarreando problemas irreversibles; como objetivo se planteo determinar la incidencia de anemia en los Recién Nacidos, para lo cual previo consentimiento de las madres se realizó estudio hematológico en las primeras horas del nacimiento a 57 neonatos, evidenciándose que la ausencia de control prenatal, el embarazo en adolescentes y la primiparidad afectan las concentraciones de hemoglobina, lo que nos permite concluir la importancia de programas educativos en salud reproductiva responsable.

Manifestaçoes neurológicas em crianças e adolecentes infectados e expostos ao HIV-1 / Neurological findings in a group of children and adolescents exposed and infected by HIV-1

The CNS infection by HIV-1 in infancy could be present immediately after infection or became manifest later. Microcephalia, mental retardation, pyramidal signs, humor and behavioral disorders and antiretroviral therapy complications are common. This is an observational, sectional and descriptive study about findings on neurological examination of 173 patients in a group of children and adolescents infected and exposed to HIV-1 in perinatal period. Most of them had more than one neurological finding or different diagnosis. The more common findings were: encephalopathy, mental retardation, language delay, pyramidal signs, hyporeflexia. The neurological examination was abnormal in 67% of all patients even in seroreverters. We suggest that this group has a high risk to neurological disease and the development of co-morbidity is directly correlated to clinical deterioration by HIV-1 infection.

O envolvimento do sistema nervoso central SNC na infecção pelo HIV-1 em crianças pode estar evidente desde o início ou demorar muitos anos para se manifestar. Microcefalia, rebaixamento cognitivo, sinais piramidais, distúrbios do humor e do comportamento e complicações pelo uso da terapia antiretroviral são comuns. Este é um trabalho observacional, descritivo e seccional cuja finalidade é descrever as alterações do exame neurológico em um grupo de crianças e adolescentes expostos pelo HIV-1 durante o período perinatal. Foram avaliados 173 pacientes. Muitos pacientes tinham superposição de alterações de exame neurológico e/ou mais de um diagnóstico. As alterações mais comuns foram: retardo do desenvolvimento neuropsicomotor, atraso de linguagem, deficiência mental, síndrome piramidal, hiporreflexia. O exame neurológico foi alterado em 67% dos casos, mesmo naqueles pacientes soro-revertidos. Sugerimos que existe alto risco para doença neurológica nesse grupo de pacientes e que a progressão da infecção pelo HIV-1 acentua o aparecimento de co-morbidades e comprometimento de seu prognóstico.

Telarca precoz

Se estudian doce niñas con telarca precoz vistas en la Consulta de Ginecología Pedíatrica del Hospital San Juan de Dios de Cúcuta y en mi clientela particular. Se analizan los hallazgos. Se insiste en que no se deben tomar mamografías a niñas y en el seguimeinto a las pacientes por un período no inferior a dos años antes de formular un diagnóstico definitivo