Variación del perímetro cefálico en prematuros menores de 34 semanas expuestos a corioamnionitis histológica / Variation of head circumference variation in preterm infants less than 34 weeks to histologic chorioamnionitis

RESUMEN Objetivo : Analizar las variaciones del perímetro cefálico (PC) en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH), y observados hasta los 2 años de edad corregida. Material y métodos : Estudio de cohorte secundaria de dos estudios prospectivos. Los datos correspondieron a mediciones del PC al nacimiento, a las 40 semanas y a los 2 años de edad corregida. La variación del PC se analizó en los prematuros con y sin exposición a CAH. La CAH se analizó de acuerdo con los subtipos subcorionitis/corionitis, corioamnionitis y corioamnionitis más funisitis. Resultados : De 91 prematuros incluidos, el 41,8 % (38/91) tuvo CAH. El promedio del PC al nacimiento fue de 27,7 cm (percentil 31,2) en los expuestos y de 28,3 cm (percentil 42,1) en los no expuestos (p = 0,039); a las 40 semanas y a los 2 años, los promedios fueron similares. El subtipo corioamnionitis estuvo asociado con un menor PC (p < 0,05). La menor edad gestacional al nacer (p < 0,005) se relacionó con una mayor velocidad de crecimiento craneal. La CAH y el retardo de crecimiento intrauterino (RCIU) fueron los factores determinantes del menor PC en las tres edades evaluadas, y la sepsis confirmada solo tuvo lugar a las 40 semanas. Conclusiones : Los prematuros menores de 34 semanas expuestos a la CAH tuvieron menor percentil de PC al nacimiento; se observó recuperación del percentil de PC a las 40 semanas; y, finalmente, el subtipo corioamnionitis se relacionó con un menor PC a los 2 años de edad corregida. El factor RCIU potencia esta asociación en las tres edades y la sepsis solo a las 40 semanas. Se recomienda realizar futuros estudios para confirmar estos hallazgos.

SUMMARY Objective : To analyze the variations of head circumference (HC) in preterm infants, born with less than 34 weeks of gestation, exposed to histologic chorioamnionitis (CAH), and observed until 2 years of corrected age. Materials and methods : This is a cohort study derived from two prospective studies. The analyzed data corresponded to HC measures obtained from the subjects at three points: birth, 40 weeks, and 2 years of corrected age. The subjects were classified in two groups: exposed and not exposed to CAH. Preterm infants with CAH were divided according to its subtype in chorioamnionitis, subchorionitis and chorioamnionitis plus funisitis. Results : Out of 91 preterm infants included in the study. 41.8% (38/91) presented CAH. At birth, the average measure of HC in exposed infants was 27.7 cm (31,2 percentile), while in not exposed infants it was 28.3 cm. (42,1 percentile). At 40 weeks and at 2 years, the average measures were similar. The CAH chorioamnionitis subtype was found to be associated with PC growth retardation (p<0,05). A lesser gestational age (p=0.005) was related with greater cranial growth speed. Conclusions : Newborns younger than 34 weeks exposed to CAH had lower HC percentile at birth. We observed a recovery of HC at 40 weeks. The chorioamnionitis subtype was related to lower HC at 2 years of corrected age. Intrauterine growth restriction (IUGR) enhanced this association at these three points, while sepsis did so only at 40 weeks. Further research is required to confirm these findings.

Frecuencia de agentes patógenos en meningitis neonatal en Lima, Perú, entre los años 2001 y 2021 / Frequency of pathogens in neonatal meningitis in Lima, Perú, between 2001 and 2021

RESUMEN Objetivo : Describir los agentes patógenos más frecuentes de la meningitis neonatal en el Perú. Material y métodos : Estudio descriptivo, comparativo y de corte transversal. Se realizó una búsqueda bibliográfica en las bases de datos de PubMed y SciELO con las palabras clave «meningitis¼, «neonatal¼ y «Perú¼, y en los repositorios virtuales de las facultades de Medicina del Perú con las palabras clave «meningitis¼ y «neonatal¼, entre los años 2001 y 2021. Asimismo, dos revisores independientes evaluaron los títulos y abstracts de los artículos para su inclusión. Resultados : Se encontraron 477 artículos, de los cuales cinco fueron incluidos. De estos últimos, dos fueron excluidos por falta de datos descriptivos de los gérmenes, quedando tres elegidos. Conclusiones : Los microorganismos más frecuentes fueron Listeria monocytogenes, Staphylococcus coagulasa-negativo y Escherichia coli, con predominio de bacterias grampositivas. La etiología viral fue poco frecuente y de presentación tardía. Solo se registró un caso por Candida albicans. No se encontraron registros de vigilancia epidemiológica de meningitis neonatal.

ABSTRACT Objective : To describe the most frequent pathogenic agents identified in neonatal meningitis in Peru. Material and methods : Descriptive, comparative, cross-sectional study based on data bases from PubMed and SciELO, using the key words "Neonatal", "Meningitis" and "Perú", and from virtual repositories of medical schools in Peru, with the key words "Neonatal" and "Meningitis", between 2001 and 2021. Two independent reviewers assessed the articles' titles and abstracts to be included. Results : 477 articles were found from which only 5 were included; 2 studies were excluded due to lack of descriptive identification of the microorganisms, so that only 3 studies were finally selected. Conclusions : The most frequently found microorganisms were Listeria monocytogenes, coagulada-negative Staphylococcus and Escherichia coli, predominantly grampositive bacterias. The viral etiology was uncommon, and all cases had a late onset. There was only 1 case due to Candida albicans. An epidemiologic monitoring of neonatal meningitis is not established in Peru.

Corioamnionitis histológica y neurodesarrollo en niños prematuros menores de 34 semanas, Lima-Perú

Para determinar los efectos de la corioamnionitis histológica en el neurodesarrollo de los prematuros menores de 34 semanas evaluados a los 2 años de edad corregida se realizó un estudio secundario de casos y controles. Fueron analizados los datos clínicos, hallazgos histológicos de la placenta e índices del desarrollo medidos por la Escala Bayley III de 38 niños expuestos y 53 niños no expuestos. Las infecciones genitourinarias de la madre y la sepsis precoz fueron más frecuentes en el grupo expuesto (p<0,005). Las dimensiones del desarrollo cognitivo, motor y lenguaje fueron normales en ambos grupos. Los expuestos al subtipo subcorionitis obtuvieron menor desempeño en las tres dimensiones. La corioamnionitis histológica no mostró influencia sobre el neurodesarrollo en prematuros menores de 34 semanas a los 2 años de edad. Se recomienda estudios longitudinales y multicéntricos para definir los efectos a largo plazo.

SUMMARY The objective of this study was to determine the effects of histologically diagnosed chorioamnionitis on neurodevelopment of premature babies born with less than 34-week gestational age who were assessed at two-year corrected age. A secondary case-control study was carried out. Clinical data, placental histological findings, and development indexes assessed using the Bayley III scale were analyzed in 38 exposed children and 53 non-exposed children. Genitourinary infections in mothers and early sepsis were more frequent in the exposed group (p<0.005). Cognitive development, motor development and language were normal in both groups. Those children exposed to the chorionitis subtype had lower scores in the aforementioned variables. Histologically diagnosed chorioamnionitis did not show any influence on neurodevelopment in premature babies born with less than 34-week gestational age when they were assessed at two years. Longitudinal and multicenter studies are advised in order to define the long-term effects.

Características clínicas del estado epiléptico en niños de un hospital de tercer nivel de Lima / Clinical characteristics of status epilepticus in children in a third level hospital of Lima

RESUMEN El estado epiléptico (EE) en niños exhibe altos niveles de morbi-mortalidad y ha sido poco estudiado en el Perú. Objetivo: Describir la frecuencia y características clínicas de niños con estado epiléptico, atendidos en el Hospital Cayetano Heredia de Lima. Material y métodos: Estudio retrospectivo y observacional, tipo serie de casos de niños menores de 14 años con diagnóstico de estado epiléptico, atendidos entre enero y diciembre de 2021. Resultados: Se registró EE en un 28,8% de todos los niños atendidos por crisis epilépticas durante el año 2021. Se incluyeron 23 niños que presentaron 46 EE, varones (73,9%), con una mediana de la edad de 2 años, diagnóstico subyacente de epilepsia o malformación cerebral (21,7%), atendidos en emergencia pediátrica (91%). El tipo semiológico predominante fue el EE motor generalizado (52,2%), con etiología sintomática remota (87%) y EEG registrado en un 63% de los casos, predominantemente de tipo normal (75,9%). La mediana de duración fue de 22 minutos, de resolución total, 7 minutos y resolución parcial, 2 minutos. Se empleó midazolam (78%) como primera línea de tratamiento y fenitoína (85%), como segunda línea. Conclusiones: El EE en niños fue una emergencia prevalente durante el año 2021. La mayoría fueron varones, cuya etiología predominante fue sintomática remota y el tipo semiológico más común fue el motor generalizado. Los niños fueron atendidos de acuerdo con las guías internacionales de manejo. Se insiste en la necesidad de un sistemático afronte de vigilancia epidemiológica.

SUMMARY Status Epilepticus (SE) in children exhibits high levels of morbidity and mortality and has been poorly studied in Perú. Objective: To describe the frequency and clinical characteristics of children with Status Epilepticus treated at Cayetano Heredia Hospital in Lima. Material and Methods: Retrospective and observational study, case series type, in children under 14 years of age, with Status Epilepticus treated between January and December of 2021. Results: SE was recorded in 28.8% of children with epileptic seizures seen during 2021. Twenty-three children presenting 46 SEs were included. The median age was 2 years, the majority (73,9%) being males, with diagnosis of epilepsy or brain malformation (21.7%) and treated in the pediatric emergency (91%). The predominant semiological pattern was of generalized motor type (52.2%), with remote symptomatic etiology (73.9%), and EEG recorded in a 63% of all cases, mainly reported as normal (75,9%). The median duration was 22 minutes of total resolution, 7 minutes, and of partial resolution, 2 minutes. Midazolam was used as the first line of treatment (78%), and phenytoin as the second line (85%). Conclusions: SE was a frequent condition observed in children throughout the year 2021. Most affected children were male, the predominant etiology was remote symptomatic, and the most common semiological type was the generalized motor. The children were treated according to international management guidelines. Asystematic epidemiological surveillance approach is highly encouraged.

Síndrome de MELAS como causa de estado epiléptico en niños: Reporte del caso de dos hermanos en Perú / MELAS syndrome as a cause of status epilepticus in children: Report on two brothers' case in Peru

RESUMEN El Síndrome de MELAS, es una enfermedad mitocondrial asociada a crisis epilépticas. Se presenta el caso de dos hermanos portadores de MELAS, confirmado genéticamente, con historia de estados epilépticos recurrentes, acompañados de déficit neurológico, fallas de crecimiento, hiperlactacidemia y lesiones que simulan infartos cerebrales. Se destaca la presentación neurológica con estado epiléptico que permita tenerla presente en el correspondiente diagnóstico diferencial en salas de emergencia y hospitales pediátricos.

SUMMARY MELAS Syndrome is a mitochondrial disease associated with epileptic seizures. The case of two siblings with genetically confirmed MELAS is presented, with a history of recurrent status epilepticus accompanied by neurological deficits, failure to thrive, hyperlacticaemia, and brain lesions resembling strokes. The neurological presentation with epileptic status is highlighted to be considered in the corresponding differential diagnosis in emergency rooms and pediatric hospitals.

Guía de práctica clínica para el diagnóstico y tratamiento de la distrofia muscular de Duchenne. Sociedad Peruana de Neurología. Versión Corta / Clinical Practice Guidelines for diagnosis and treatment of Duchenne muscular dystrophy. Peruvian Neurology Society. Short Version

RESUMEN Objetivo : Elaborar una guía de práctica clínica peruana para el diagnóstico y tratamiento de la Distrofia Muscular de Duchenne y Becker (DMD). Materiales y métodos : Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas en neurología, neuropediatría, genética y metodología. El GEG formuló ocho preguntas para desarrollar las recomendaciones de la Guía de Práctica Clínica (GPC). Se realizó una búsqueda sistemática en Medline, Scopus y CCRT durante el periodo enero-abril 2021 para responder a las preguntas PICO. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados : Las preguntas PICO, se orientaron para explorar el tamizaje, diagnóstico y tratamiento de la DMD. Se formularon 15 recomendaciones (10 fuertes, 5 condicionales) y 11 puntos de buena práctica clínica Conclusión : Se presenta la guía para el diagnóstico y tratamiento de la DMD, elaborada bajo una metodología basada en las evidencias actuales.

ABSTRACT Objective : to provide evidence-based clinical recommendations for the diagnosis and treatment of Duchenne Muscular Dystrophy. Methods : a guideline development group (GEG) was formed that included specialized physicians in the fields of neurology, neuropediatrics, genetics, and methodology. The GEG asked eight clinical questions to be answered by recommendations in this clinical practice guidelines (CPG). We conducted a systematic search and - when deemed relevant - primary studies in Medline, Scopus, and the Cochrane Controlled Register of Trials during 2021 were reviewed. Evidence was selected to answer each of the clinical questions posed. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice, and a diagnosis and treatment flowchart. Results : this CPG addressed eight clinical questions, divided into three topics: screening, diagnosis, and treatment. Based on these questions, fifteen recommendations were formulated (10 strong, 5 conditional) and 11 points for good clinical practice. Conclusion : this paper summarizes the methodology and evidence- based conclusions of the CPG for the diagnosis and treatment of Duchenne muscular dystrophy.

Tromboprofilaxia na cirurgia de varizes dos membros inferiores no Brasil / Thromboprophylaxis in lower limb varicose vein surgery in Brazil

Resumo Contexto Apesar de todo o investimento na profilaxia primária do tromboembolismo venoso (TEV) em pacientes cirúrgicos nos últimos anos, ainda não existem diretrizes específicas para aqueles que serão submetidos a procedimentos para tratamento de varizes de membros inferiores. Objetivos Avaliar o perfil de conduta de profilaxia do TEV pelos cirurgiões vasculares brasileiros para procedimentos de tratamento de varizes de membros inferiores. Métodos Pesquisa de levantamento por envio de questionário eletrônico a cirurgiões vasculares brasileiros. Os respondentes foram divididos entre os que realizam tratamento de veias safenas por cirurgia convencional e os que realizam termoablação para fim de comparação entre os grupos. Resultados Entre os 765 respondentes, o tratamento de escolha das veias safenas foi a cirurgia convencional para 405 (53%), espuma ecoguiada para 44 (6%) e termoablação (endolaser ou radiofrequência) para 199 (26%). Os cirurgiões que realizam termoablação prescrevem mais farmacoprofilaxia após o procedimento que aqueles que preferem cirurgia convencional (67/199, 34% vs. 112/405, 28%; p = 0,002). O grupo termoablação estratifica o paciente quanto ao risco de TEV com mais frequência que o grupo cirurgia convencional (102/199, 51% vs. 179/405, 44%; p =0,004). Ambos os grupos usam mais frequentemente enoxaparina como medicação para profilaxia, porém o grupo termoablação usa mais anticoagulantes orais diretos proporcionalmente que o grupo cirurgia convencional (26% vs. 10%, p < 0,001). Conclusões Cirurgiões vasculares brasileiros que fizeram o tratamento de veias safenas por termoablação prescrevem farmacoprofilaxia com maior frequência e por um período mais prolongado do que os que realizaram o tratamento por cirurgia convencional.

Abstract Background Despite all the investment in primary venous thromboembolism (VTE) prophylaxis for surgical patients in recent years, there are still no specific guidelines for those who undergo procedures to treat lower limb varicose veins. Objectives To evaluate the profile of VTE prophylaxis practices among Brazilian vascular surgeons conducting lower limb varicose vein procedures. Methods Survey design, sending an electronic questionnaire to Brazilian vascular surgeons. Respondents were divided between those who perform saphenous vein treatment with conventional surgery and those who perform thermoablation for the purpose of comparison between groups. Results Of 765 respondents, 405 (53%) treat saphenous veins with conventional surgery for, 44 (6%) with foam, and 199 (26%) with thermoablation (endolaser or radiofrequency). Surgeons who perform thermoablation prescribed more pharmacoprophylaxis after varicose vein surgery than those who perform conventional surgery (67/199, 34% vs. 112/405, 28%; p = 0.002). The thermoablation group stratifies patients for thromboembolism risk more frequently than the conventional surgery group (102/199, 51% vs. 179/405, 44%; p = 0.004). Both groups use enoxaparin as the most frequent drug for prophylaxis, but the thermoablation group uses proportionally more direct oral anticoagulants than the conventional surgery group (26% vs. 10%, p<0.001). Conclusions Brazilian vascular surgeons who perform saphenous vein treatment by thermoablation prescribe pharmacoprophylaxis more frequently and for a longer period than those who use conventional surgery.

Qualidade de vida e índices de rigidez arterial em pacientes com isquemia crônica ameaçadora ao membro / Quality of life and arterial stiffness indices in patients with chronic limb-threatening ischemia

Introdução: Os fatores associados ao comprometimento da qualidade de vida em pacientes com isquemia crônica ameaçadora ao membro não estão bem estabelecidos. Objetivo: Verificar se existe associação entre a qualidade de vida e os índices de rigidez arterial, velocidade de onda de pulso (VOP) e o índice de aumentação normalizado para a frequência cardíaca de 75 bpm (AIx@75). Métodos: Trata-se de um estudo transversal, observacional, com a participação de 17 pacientes (65,65 ±11,79 anos) com isquemia crônica ameaçadora ao membro definida pela classificação de Rutherford 4, 5 e 6, e com o índice tornozelo-braço (ITB) < 0,80. A avaliação dos parâmetros vasculares e os índices de rigidez arterial foram realizadas com o aparelho Mobil-O-Graph ® que gera a onda de pulso aórtica a partir da oscilometria da artéria braquial. A qualidade de vida foi avaliada pelo questionário Vascular quality of life questionaire (VascuQoL-6), versão curta, desenvolvido especificamente para avaliar pacientes com comprometimento circulatório, arterial ou venoso. Resultados: Os valores do ITB e do escore de qualidade de vida foram 0,48 ± 0,14 e 15,88 ± 1,03; respectivamente. Dos 17 pacientes, 12 apresentavam hipertensão arterial sistólica e dezesseis apresentaram a VOP maior que 10 m/s. Não foram observadas correlações entre o escore de qualidade de vida com o AIx@75 (p=0,54 e r=0,16), a VOP (p=0,332 e r=0,248) e o ITB (p=0,707 e r=0,098). Conclusão: O presente estudo demonstrou que pacientes com isquemia crônica ameaçadora ao membro apresentam comprometimento importante da qualidade de vida sem associação com os índices de rigidez arterial e ITB.

Introduction: The factors associated with impaired quality of life in patients with chronic limb-threatening ischemia are not well established. Objective: Check whether there is an association between quality of life and arterial stiffness indexes, pulse wave velocity (PWV) and the augmentation index corrected to 75 beats per minute heart rate (AIx@75). Methods: This is a cross-sectional, observational study, with the participation of 17 patients (65.65 ± 11.79 years) with chronic limb-threatening ischemia defined by the Rutherford classification 4, 5 and 6, and with the ankle-arm index (ABI) < 0.80. The evaluation of vascular parameters and arterial stiffness indeces was performed with the MobilO-Graph ® device that generates the aortic pulse wave from the brachial artery oscillometry. Quality of life was assessed using the questionnaire Vascular quality of life questionaire (VascuQoL-6), short version, developed specifically to evaluate patients with circulatory, arterial or venous involvement. Results: The values of the ITB and the quality of life score were 0.48 ± 0.14 and 15.88 ± 1.03; respectively. Of the 17 patients, 12 had systolic arterial hypertension and sixteen had PWV greater than 10 m / s. No correlations were observed between the quality of life score with AIx @ 75 (p = 0.54 and r = 0.16), PWV (p = 0.332 and r = 0.248) and ABI (p = 0.707 and r = 0.098). Conclusion: The present study demonstrated that patients with chronic limb-threatening ischemia present significant impairment of quality of life without association with arterial stiffness and ABI.

Traumatismo encéfalo-craneano por caída libre en neonatos

Objetivo : Describir las características clínicas del traumatismo encéfalo craneano en neonatos. Materiales y métodos : Se realizó una serie de casos de neonatos con traumatismo encéfalo craneano, todos con diagnóstico clínico y tomográfico atendidos por el Servicio de Neuropediatría y Neonatología del Hospital Cayetano Heredia del 2014 al 2019. Resultados : Se incluyeron 12 neonatos, 67% (8/12) fueron varones, 33% (4/12) menores de cuatro días de edad y 25% (3/12) hijos de madres añosas. La caída libre fue el mecanismo de lesión en todos los casos y tres de ellos se cayeron de coches de paseo para bebés. El lugar más frecuente de la caída fue el hospital, tres neonatos se encontraban en alojamiento conjunto, dos en la sala de espera de la consulta externa y uno en hospitalización. El 83% (10/12) de los casos cayó de ≥ 0.5 m de altura y 33% (4/12) cayó de ≥ 1m. El 58% (7/12) fue sintomático a la caída, cuatro casos con letargia y uno con irritabilidad. Además, se reportaron vómitos y dificultad respiratoria. Cuatro presentaron hematoma epidural y tres de ellos fractura craneal, dos de gravedad por hipertensión endocraneana descompensada que requirieron evacuación quirúrgica de emergencia. Conclusión : El traumatismo encéfalo craneano en neonatos es un problema potencialmente grave. El hematoma epidural fue la lesión intracraneal más frecuente. La letargia e irritabilidad fueron los síntomas más frecuentes en los neonatos que cayeron de ≥ 0.5m de altura.

Objective : To describe clinical characteristics of head trauma in neonates. Material and methods : This is a case series of neonate patients with head trauma. All of them had a clinical diagnosis and computed tomography scans performed. They were taken care of in both Neuropediatrics and Neonatology services in Cayetano Heredia National Hospital in Lima, Peru from 2014 to 2019. Results : Twelve neonates were included, 67% (8/12) were male, 33% (4/12) were less than four days old, and 25% (3/12) were born to mature mothers. Free fall was the mechanism of lesion for all cases, and three of them fell down from baby trolleys. Places where these accidents occurred were at the hospital. Three neonates were in joint housing, two were in the waiting room of the outpatient clinic, and one fall occurred in the hospitalization ward. Eighty- three per cent (10/12) of all cases fell from ≥0.5- m height, and 33% (4/12) fell from 1- m height. Fifty-eight per cent (7/12) developed symptoms after the fall, four had lethargy and one had irritability. Also, vomits and respiratory distress were reported. Four neonates developed epidural hematoma and three had cranial fracture, two of these latter cases were severe because of decompensated cranial hypertension that required emergency surgical decompression. Conclusion : Head trauma in neonates is a potentially severe condition. Epidural hematoma was the most frequent intracranial lesion. Lethargy and irritability were most frequent symptoms in neonates who fell from ≥0.5- m height.

Validación y puntos de corte de la versión en español del Cuestionario de Edades y Etapas: Social-emocional, 2da edición (ASQ:SE-2), en un entorno ambulatorio urbano de Lima-Perú / Validation and cut-off values of the Spanish version of Ages & Stages Questionnaires: Social-Emotional 2nd edition (ASQ:SE-2) in an urban outpatient setting at Lima-Perú

RESUMEN Objetivos: Determinar la confiabilidad, validez y puntos de corte de la versión en español del Cuestionario de Edades y Etapas, 2da edición (del inglés Ages & Stages Questionnaires: Social-Emotional, 2nd Edition (ASQ: SE-2). Material y Métodos: Mediante muestreo por conveniencia se aplicaron formas del cuestionario ASQ: SE-2 a padres de niños entre 15 y 48 meses de edad. La confiabilidad se determinó por medio de la consistencia interna del coeficiente alfa ordinal (α) y la validez de contenido mediante la correlación ítem-test (r). Los puntos de corte para establecer zonas de riesgo se determinaron empleando el percentil 65 y la curva ROC. Resultados: De un total de 236 cuestionarios aplicados, el coeficiente alfa ordinal se ubicó entre aceptable y bueno (α = 0.73-0.87) para los 5 cuestionarios de intervalos de edad entre 18 y 48 meses. El índice de correlación de prueba de ítems mostró un buen poder discriminatorio para la mayoría de los ítems (r> 0.30), con la excepción de un ítem para los meses 30, 36 y 48. Nuevos puntos de corte para los intervalos de edad entre 15 y 48 meses fueron determinados. Conclusiones: La versión en español de ASQ: SE-2 aplicada a padres de niños de 15 a 48 meses de edad en un entorno ambulatorio y en un área urbana de Lima-Perú, demostró ser una herramienta confiable y válida para la vigilancia y detección de etapas del desarrollo emocional.

SUMMARY Objectives: A study was carried out to determine the reliability, validity and cut-off points of the Spanish version of Ages & Stages Questionnaires: Social-Emotional, 2nd Edition (ASQ:SE-2). Material and Methods: Questionnaire forms of ASQ:SE-2 between 15 to 48 months were applied to parents of children chosen by convenience sampling. Reliability was determined by the internal consistency through Ordinal alpha coefficient (α), and validity of content through Item-test correlation (r). The cut-off points to establish risk zones were determined using the 65th percentile and ROC curve. Results: Two hundred thirty-six questionnaires were applied. The Ordinal alpha coefficient reached a between acceptable to good level (α = 0.73-0.87) for all 5 age-intervals questionnaires between 18 to 48 months. The Item-test correlation index pointed a good discriminatory power for most items (r > 0.30), with the exception of one item for the months 30, 36 and 48. New cut-off points for the intervals-age between 15 - 48 months were determined. Conclusions: The Spanish version of ASQ: SE-2, applied to parents of children from 15 to 48 months of age in an outpatient setting from an urban area of Lima-Peru proved to be a reliable and valid tool for surveillance and screening of steps of social-emotional development.

Adaptación, validación y puntos de corte del Cuestionario de edades y etapas-3ra edición (ASQ-3) en español, en una zona urbana de Lima-Perú / Adaptation, validation and cut-off values of the Ages & Stages questionnaire 3th edition (ASQ-3) Spanish version in a Lima, Perú urban setting

RESUMEN Objetivo : Adaptar y determinar la confiabilidad, validez y puntos de corte de la versión en español del Cuestionario de edades y etapas tercera edición (ASQ-3), un instrumento de vigilancia y tamizaje del desarrollo psicomotor, en una población urbana de la zona norte de Lima, Perú. Material y Métodos : Mediante muestreo por conveniencia, se aplicaron formas del cuestionario ASQ-3 a padres de niños entre 1 a 66 meses de edad, en un entorno de consulta ambulatoria. Resultados : Se aplicó un total de 5,830 cuestionarios correspondientes a 3,570 niños, 2,667 (45,7 %) de los cuales contaban entre 14 y 36 meses de edad. La consistencia interna general y por cada área del desarrollo, evaluadas mediante el Índice alfa ordinal, oscilaron entre 0,70 - 0,94. El Índice de validez de contenido por el criterio de jueces, medido con el método Lawshe, la V de Aiken o ambos, fue válido para la mayoría de los cuestionarios. La correlación biserial ítem-test fue > 0,30 en la mayoría de los ítems (p< 0,010). El Índice error medio cuadrático de aproximación (RMSEA) del análisis factorial fue < 0.10, puntualizando un nivel adecuado para las cinco áreas de evaluación del ASQ-3. Los puntos de corte fueron determinados por intervalos de edad y área. Conclusiones : La versión en español del ASQ-3 adaptada a la población del estudio demostró ser un instrumento confiable y válido para la vigilancia y tamizaje del desarrollo psicomotor de niños menores de 5 años de edad en un entorno urbano de consulta ambulatoria en Lima, Perú.

SUMMARY Objective : A cultural-linguistic adaptation of the Age and Stages Questionnaire third edition (ASQ-3)-Spanish version was performed in order to determine its reliability, validity and cut-off points in an urban population and pediatric outpatient setting of Lima, Perú. Material and Methods : Questionnaire forms were applied to parents of children between 1 to 66 months old of age, chosen through a convenience sampling method. Results : A total of 5,830 questionnaires were applied to parents of 3,507 children, 2 667 (45.7%) of whom had between 14 and 36 months of age. The general internal consistency and that of five specific areas, measured by means of the Ordinary alpha index oscillated between 0.70-0.94. Content validity by judges' criteria, using the index by Lawshe method, the Aiken V coefficient, or both, was valid for most of the questionnaires. The biserial item-test correlations were > 0.30 for most items (p <0.010). The construct validity according to the factorial analysis, determined that the five factors or areas of the ASQ-3 were adequate. Cut-off points were determined by age and area intervals of the ASQ- Conclusions : The Spanish version of the ASQ-3 proved to be a reliable and valid tool to survey and screen the psychomotor development of children under 5 years of age in an urban outpatient area setting of Lima, Perú.

Hemorragia intraventricular en prematuros menores de 28 semanas en un hospital general de Lima, 2013 - 2017 / Intraventricular hemorrhage in premature infants under 28 weeks in general hospital of Lima, 2013 - 2017

RESUMEN: Objetivo : Determinar la incidencia y características clínicas de la hemorragia intraventricular (HIV) en los prematuros menores de 28 semanas, nacidos en un hospital general. Material y Métodos : Estudio observacional, descriptivo, longitudinal, de cohorte retrospectiva, que incluyó a los prematuros menores de 28 semanas gestacionales (PT28), que sobrevivieron al primer día de vida, examinados con ecografía cerebral y atendidos en la unidad neonatal del Hospital Cayetano Heredia del 2013 al 2017. Se excluyeron los neonatos con malformaciones cerebrales, y aquellos con datos perinatales incompletos. Resultados : Se identificaron 84 PT28, de los cuales se incluyeron 72, doce fueron excluidos por malformaciones y falta de datos. La relación varón/ mujer fue 1.6. La frecuencia de HIV fue de 58.3% (42/72). En la forma temprana se encontraron 52.4% (22/42) y en la tardía 47.6% (20/42). Los grados severos se presentaron en el 64% (27/42). La hidrocefalia posthemorrágica ocurrió en 26% (11/42) y el infarto hemorrágico venoso en 21.4% (9/42). Fallecieron 51 pacientes, con una tasa de letalidad del 76.1% (32/42). Conclusiones : La HIV fue muy frecuente, severa y letal en los PT28, la mitad de los casos ocurrieron en los primeros tres días y el resto durante las dos primeras semanas de vida. Los factores asociados fueron el menor peso de nacimiento, el trabajo de parto y el neumotórax.

ABSTRACT: Objective : To determine the incidence and clinical characteristics of intraventricular hemorrhage (IVH) in premature infants younger than 28 weeks, born in a general hospital. Material and Methods : Observational, descriptive, longitudinal, retrospective cohort study, which included premature infants less than 28 weeks gestational (PT28), who survived the first day of life, examined with brain ultrasound and cared for in the neonatal unit of Hospital Cayetano Heredia del 2013 to 2017. Neonates with brain malformations and those with incomplete perinatal data were excluded. Results : 84 PT28 were identified, of which 72 were included, twelve were excluded due to malformations and lack of data. The male / female ratio was 1.6. The frequency of HIV was 58.3% (42/72). 52.4% (22/42) were found in the early form and 47.6% (20/42) in the late form. Severe grades were present in 64% (27/42). Posthemorrhagic hydrocephalus occurred in 26% (11/42) and venous hemorrhagic infarction in 21.4% (9/42). 51 patients died, with a fatality rate of 76.1% (32/42). Conclusions : HIV was very frequent, severe and lethal in the TST28, half of the cases occurred in the first three days and the rest during the first two weeks of life. Associated factors were lower birth weight, labor, and pneumothorax.

Tratamento de oclusão arterial em membro superior causada por costela cervical / Treatment of upper limb arterial occlusion caused by a cervical rib

Resumo A síndrome da costela cervical ocorre quando o triângulo intercostoescalênico é ocupado por uma costela cervical, deslocando o plexo braquial e a artéria subclávia anteriormente, o que pode gerar dor e espasmo muscular. O objetivo deste estudo é discutir sobre o diagnóstico da síndrome da costela cervical e as possibilidades de tratamento. Este desafio terapêutico descreve a condução clínica e cirúrgica de uma paciente de 37 anos com obstrução arterial em membro superior causada por costela cervical.

Abstract The cervical rib syndrome occurs when the interscalene triangle is occupied by a cervical rib, displacing the brachial plexus and the subclavian artery forward, which can cause pain and muscle spasms. The objective of this study is to discuss diagnosis of the cervical rib syndrome and treatment possibilities. This therapeutic challenge describes clinical and surgical management of a 37-year-old female patient with upper limb arterial occlusion caused by a cervical rib.

Resultados do tratamento do refluxo de veias safenas com endolaser 1. 470 nm e correlação com o grau de insuficiência venosa / Results of venous reflux treatment with 1, 470 nm endolaser and correlation with degree of venous insufficiency

Resumo Contexto Pacientes com doença venosa crônica avançada são mais propensos a exigir outros procedimentos para recidiva de veias varicosas. Ainda não está estabelecido se a gravidade da insuficiência venosa é um fator que influencia a taxa de oclusão de veias safenas tratadas por endolaser. Objetivos Analisar a taxa de oclusão dos segmentos venosos tratados com endolaser e correlacionar com o Venous Clinical Severity Score (VCSS) e a classificação Clínica-Etiológica-Anatômica-Patológica (CEAP) dos pacientes. Métodos Análise retrospectiva de coorte de pacientes operados com endolaser 1.470 nm entre novembro/2012 a março/2020. Foram realizadas estatística descritiva e curva de sobrevida de Kaplan-Meier com regressão de Cox para grupos de VCSS e CEAP. Resultados Foram analisados 170 pacientes e 180 segmentos venosos; a idade média foi de 44,3 ± 9,2, sendo a maioria do sexo feminino (71%). A densidade de energia média utilizada na veia safena magna foi 49,2 ± 8,3 J/cm. As principais complicações foram dor no trajeto da safena (12,2%) e parestesias após 6 meses (17,2%). Não houve diferença na taxa de oclusão venosa entre grupos com VCSS ≤ 7 e VCSS > 7 (p = 0,067). O grupo de pacientes com CEAP agrupada C4-C5-C6 teve taxa de oclusão menor em relação ao grupo C2-C3 [hazard ratio (HR) = 3,22; intervalo de confiança (IC) 1,85, 5,61; p = 0,001]. Conclusões As taxas de oclusão de segmentos venosos tratados com endolaser foram menores na presença de classificações CEAP avançadas. Nesses pacientes, provavelmente deve-se despender mais energia para o tratamento eficaz das safenas.

Abstract Background Patients with advanced chronic venous disease are more likely to need additional procedures for relapsed varicose veins. It has not yet been established whether severity of venous insufficiency is a factor that influences the occlusion rate of saphenous veins treated with endolasers. Objectives To analyze occlusion rate of venous segments treated with endolaser and correlate it with patients' Venous Clinical Severity Score (VCSS) and Clinical-Etiological-Anatomical-Pathological (CEAP) classification. Methods Retrospective analysis of a cohort of patients operated using a 1,470 nm endolaser from November 2012 to March 2020. Descriptive statistics were calculated and Kaplan-Meier survival curves were plotted with Cox regression for groups stratified by VCSS and CEAP. Results A total of 180 venous segments were analyzed in 170 patients. Mean age was 44.3 ± 9.2 and the majority of patients were female (71%). Mean energy density used in the great saphenous vein was 49.2 ± 8.3 J/cm. The most common complications were pain along the course of the saphenous vein (12.2%) and paresthesias at 6 months (17.2%). There was no difference in venous occlusion rate between groups with VCSS ≤ 7 and VCSS > 7 (p = 0.067). A group of patients classified as CEAP classes C4, C5, or C6 had a lower occlusion rate than a group at classes C2 or C3 (hazard ratio [HR] = 3.22; confidence interval [CI] 1.85, 5.61; p = 0.001]. Conclusions The occlusion rates of venous segments treated with endolaser were lower in patients with higher CEAP classes. It is probably necessary to use more energy in these patients to achieve effective treatment of saphenous veins.

Compartilhamento de risco na saúde suplementar brasileira / Risk sharing in Brazilian supplementary health

Objetivos: Este trabalho discute os recentes impactos do avanço tecnológico no mercado da saúde e a crescente importância do aumento de custos em toda a sua cadeia e investiga uma alternativa para aumentar o acesso a essas novas tecnologias por um maior número de pessoas na saúde suplementar. Nesse contexto, o objetivo geral proposto para este trabalho foi evidenciar as visões de gestores de saúde com papel de destaque no Brasil a respeito do uso de modelos de compartilhamento de risco (risk sharing) em diferentes geografias e em diferentes financiadores no sistema. Pretendeu-se aprofundar o tema com o cumprimento dos seguintes objetivos específicos, também sob a perspectiva dos participantes da pesquisa: verificar a utilização desses modelos de pagamento e, consequentemente, determinar as características e adaptações necessárias a eles; identificar os desafios para a consolidação do risk sharing na saúde suplementar; verificar o impacto do risk sharing nos custos com saúde das operadoras a partir da percepção dos entrevistados. Métodos: Trata-se de estudo qualitativo, com entrevistas em profundidade com os principais gestores e formadores de opinião em saúde de diferentes instituições no Brasil, totalizando 25 entrevistas. A análise de conteúdo foi escolhida como método de interpretação e construção das categorias para a análise. Resultados: Os resultados foram agrupados nas seguintes categorias: as sugestões e adaptações sugeridas para o melhor funcionamento na realidade brasileira; as críticas e desafios aos modelos propostos. Os resultados sugerem que o compartilhamento de risco pode ser uma alternativa capaz de promover uma nova forma de relacionamento entre os pagadores e a indústria fabricante, substituindo o tradicional modelo de remuneração, que limita a relação linear com todos os setores, buscando sempre o objetivo de atender o paciente com novas alternativas de acesso. Conclusões: Em meio à complexidade do sistema de saúde brasileiro, é importante que os players avaliem novas alternativas de remuneração e incorporação tecnológica. Os desafios são inúmeros, desde a efetivação do perfil dos pacientes elegíveis até a aplicabilidade do risk sharing que ocorre a partir do interesse de ambas as partes em trazer novas tecnologias ao sistema, sem impactos orçamentários significativos, desde que seja viável clínica e economicamente, gerando valor em saúde, na efetividade e nos resultados de desfecho em taxa de sobrevida real

Objectives: This paper discusses the recent impacts of technological advancement on the health market, the growing importance of increasing costs throughout its chain, and investigates an alternative to increasing the access of these new technologies to a greater number of people within supplementary health. In this context, the general objective proposed for this work was to highlight the views of health managers with a prominent role in Brazil regarding the use of risk-sharing models in different regions and in different payers in the system. It was intended to deepen the theme with the fulfillment of the following specific objectives, also from the perspective of the research participants: verify the use of these payment models and consequently determine the characteristics and necessary adaptations for them; identify the challenges for the consolidation of risk-sharing in Supplementary Health; to verify the impact of risk-sharing on health costs of operators based on interviewees' perceptions. Methods: This is a qualitative study with in-depth interviews with main health managers and opinion makers from different institutions in Brazil, totaling 25 interviews. Content analysis was chosen as a method of interpretation and construction of categories for analysis. Results: The results were grouped into the following categories: the suggestions and adaptations suggested for the best operation in the Brazilian reality; criticisms and challenges to the proposed models. The results suggest that risk-sharing may be an alternative capable of promoting a new form of relationship between payers and the manufacturing industry, replacing the traditional remuneration model, which limits the linear relationship with all sectors, always seeking the objective of assisting the patient with new access alternatives. Conclusions: Amid the complexity of the Brazilian health system, it is important for players to evaluate new alternatives for remuneration and technological incorporation. The challenges are innumerable from the realization of the profile of eligible patients and the applicability of risk-sharing that occurs from the interest of both parties in bringing new technologies to the system, without significant budgetary impacts, as long as it is clinically and economically viable, generating health value, effectiveness, and outcomes in survival rates in real world evidences

Riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica, Lima, Perú / Risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis Lima, Peru

RESUMEN Objetivos: Evaluar el riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH). Materiales y métodos: Se realizó un estudio de cohortes en el Hospital Cayetano Heredia, durante el 2015. Fueron incluidos prematuros menores de 34 semanas que tuvieran examen histopatológico de la placenta. Los tipos de CAH evaluados fueron subcorionitis, corionitis, corioamnionitis, con o sin funisitis. El daño cerebral se evaluó en tres periodos de edad, entre 0 y 7 días, entre 7 y 30 días y a las 40 semanas gestacionales corregidas. Se realizó un seguimiento neurológico y controles con ecografía cerebral. Resultados: Se estudiaron 85 prematuros, 47,1% eran mujeres y la media de la edad gestacional fue de 30,9 semanas. El 42% (36/85) nacieron expuestos a CAH. La ruptura prematura de membrana fue la principal generatriz de sepsis, y la sepsis se relacionó con daño neurológico. La CAH estuvo asociada con hemorragia intraventricular (HIV) durante la primera semana y con lesiones de la sustancia blanca entre los 7 y 30 días de edad (p = 0,035). El tipo corioamnionitis de CAH se asoció al daño neurológico durante la primera semana (RR = 2,11; IC 95%: 1,09-4,11) y entre los 7 y 30 días de vida (RR = 2,72; IC 95%: 1,07-6,88). Conclusiones: La corioamnionitis fue un factor de riesgo para desarrollar lesiones cerebrales en prematuros menores de 34 semanas, para HIV durante los primeros 7 días y lesiones de sustancia blanca entre los 7 y los 30 días de edad. A las 40 semanas de edad corregida, los prematuros extremos con CAH tuvieron lesiones cerebrales más extensas.

ABSTRACT Objectives: To assess the risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis (HCA). Materials and methods: A cohort study was conducted at the Hospital Cayetano Heredia, during 2015. Premature infants under 34 weeks of gestational age, who had histopathological examination of the placenta, were included. The types of HCA evaluated were sub-chorionitis, chorionitis, chorioamnionitis, with or without funisitis. Brain damage was evaluated in three age periods, between 0 and 7 days, between 7 and 30 days and at 40 weeks of corrected gestational age. A neurological follow-up and regular controls were performed with brain ultrasound. Results: A total of 85 premature infants were included, 47.1% were women and the mean gestational age was 30.9 weeks. From the total, 42% (36/85) were born exposed to HCA. Premature rupture of membranes was the main cause of sepsis, which was related to neurological damage. HCA was associated with intraventricular hemorrhage (IVH) during the first week and with white matter lesions between 7 and 30 days of age (p = 0.035). The chorioamnionitis type of HCA was associated with neurological damage during the first week (RR = 2.11, 95% CI: 1.09-4.11) and between 7 and 30 days of age (RR = 2.72, 95% CI: 1.07-6.88). Conclusions: Chorioamnionitis was a risk factor for developing brain injuries in premature infants under 34 weeks of gestational age. It was also a risk factor for HIV during the first 7 days and for white matter injuries between 7 and 30 days of age. At 40 weeks of corrected gestational age, extreme premature infants with HCA had more extensive brain damage.

Meningitis neonatal: estudio multicéntrico en Lima, Perú / Neonatal meningitis: a multicenter study in Lima, Peru

RESUMEN Objetivo: Determinar la incidencia y las características clínicas, bacteriológicas y del líquido cefalorraquídeo de la meningitis neonatal en hospitales de Lima. Materiales y métodos: Se realizó un estudio observacional, multicéntrico en seis hospitales de la ciudad de Lima, con una vigilancia epidemiológica durante un año. Resultados: La incidencia acumulada hospitalaria fue de 1,4 casos por mil nacidos vivos. Fueron incluidos 53 casos de meningitis neonatal, 34% (18/53) fueron tempranos y 66% (35/53) tardíos. Los factores maternos asociados fueron líquido amniótico meconial e infección de tracto urinario. El 58,8% (30/51) presentó controles prenatales insuficientes. El factor neonatal más asociado fue sepsis. Los principales síntomas fueron fiebre, irritabilidad, hipoactividad y dificultad respiratoria. En el líquido cefalorraquídeo (LCR) se destacó la pleocitosis, sin predominio de polimorfonucleares (PMN), hipoglucorraquia y proteinorraquia. Los patógenos aislados con mayor frecuencia fueron Escherichia coli y Listeria monocytogenes. Conclusiones: La incidencia hospitalaria de meningitis neonatal fue de 1,4 por mil nacidos vivos, siendo diez veces mayor en prematuros. La dificultad respiratoria fue el síntoma más frecuente en la forma temprana, mientras que la fiebre e irritabilidad en la forma tardía. El LCR mostró pleocitosis sin predominio de PMN. Los gérmenes más frecuentes fueron Escherichia coli y Listeria monocytogenes. La ventriculitis e hidrocefalia fueron las complicaciones neurológicas más comunes.

ABSTRACT Objective: To determine the incidence and the clinical, bacteriological and cerebrospinal fluid characteristics of neonatal meningitis in Lima hospitals. Materials and methods: An observational, multicenter study was conducted in six hospitals in the city of Lima during 1 year of epidemiological surveillance. Results: The cumulative hospital incidence was 1.4 cases per 1000 live births. A total of 53 cases of neonatal meningitis were included, 34% (18/53) were early and 66% (35/53) late. The associated maternal factors were meconium-stained amniotic fluid and urinary tract infection. Insufficient prenatal check-ups were found in 58.8% (30/51). The most associated neonatal factor was sepsis. The main symptoms were fever, irritability, hypoactivity and respiratory distress. Pleocytosis in cerebrospinal fluid (CSF) was significant, without predominance of polymorphonuclear lymphocytes (PMN), hypoglycorrhagia and proteinorrhagia. The most frequent pathogens isolated were Escherichia coli and Listeria monocytogenes. Conclusions: The hospital incidence of neonatal meningitis was 1.4 per 1000 live births, being ten times higher in preterm infants. Breathing difficulty was the most frequent symptom in the early stage, while fever and irritability in the late stage. CSF showed pleocytosis without predominance of PMN. The most frequent germs were Escherichia coli and Listeria monocytogenes. Ventriculitis and hydrocephalus were the most common neurological complications.

Hemorragia intraventricular y leucomalacia periventricular en neonatos de bajo peso al nacer en tres hospitales de Lima, Perú / Intraventricular hemorrhage and periventricular leukomalacia in low birth-weight neonates in three hospitals in Lima, Peru

RESUMEN Con el objetivo de describir la frecuencia y severidad de la hemorragia intraventricular y leucomalacia periventricular en neonatos de bajo peso en tres hospitales de Lima, Perú se evaluaron 385 neonatos menores de 2000 g de peso al nacer durante mayo del 2012 a julio del 2014. Se obtuvo ultrasonidos cerebrales a las 40 semanas de gestación, 3-5 días de vida y 3-4 semanas de vida. Hemorragia intraventricular se presentó en 19,2% neonatos con menos de 1500 g y fue severa (grado III o con infarto hemorrágico periventricular) en 9,6% neonatos menores de 1500 g. La mortalidad en neonatos con hemorragia intraventricular fue de 47,1%, se encontró leucomalacia periventricular en 5,4% de los neonatos menores de 1500 g. Ambos diagnósticos fueron más frecuentes en neonatos con menor peso. La frecuencia de hemorragia intraventricular es similar a lo reportado en otros países; sin embargo, la severidad y mortalidad es mayor.

ABSTRACT To describe the frequency and severity of intraventricular hemorrhage and periventricular leukomalacia in low birth-weight neonates in three hospitals in Lima, Peru, 385 newborn babies weighing under 2,000 g at birth were evaluated between May 2012 and July 2014. Brain ultrasounds were obtained at 40 weeks' gestation, 3-5 days of life, and 3-4 weeks of life. Intraventricular hemorrhage occurred in 19.2% of neonates weighing under 1,500 g and was severe (grade III or with periventricular hemorrhagic infarction) in 9.6% of neonates under 1,500 g. Mortality in infants with intraventricular hemorrhage was 47.1%, while periventricular leukomalacia was found in 5.4% of neonates 1,500 g and under; both diagnoses were more frequent in lower-weight babies. The frequency of intraventricular hemorrhage is similar to that reported in other countries; however, severity and mortality are greater.

Incidencia de macrocefalia neonatal en el Hospital Cayetano Heredia, 2016 - 2017 / Incidence of neonatal macrocephaly at the Hospital Cayetano Heredia, 2016 - 2017

Objetivo: Determinar la incidencia de macrocefalia neonatal en un hospital de tercer nivel en Lima, Perú. Material y Métodos: Se definió macrocefalia en función al perímetro cefálico mayor que el percentil 97 para la edad y sexo. La información fue obtenida de los registros del Sistema Informático Perinatal del Hospital Cayetano Heredia durante el periodo 1º de enero, 2016 a 31 de diciembre, 2017. Se usó la Tabla Fenton para determinar los límites de normalidad. Resultados: Se registraron 210 casos de macrocefalia neonatal y una tasa general de 26 por mil nacidos vivos, inversamente proporcional a la edad gestacional. Conclusiones: la macrocefalia es más frecuente en prematuros, con un factor de riesgo cinco veces mayor en este grupo poblacional.

Objective: To determine the incidence of neonatal macrocephaly in a third level hospital from Lima, Perú. Methods: Macrocephaly was defined on the basis of a cephalic perimeter higher than the 97th percentile for age and sex. The report records of the Perinatal Computer System of Cayetano Heredia Hospital between January 1st., 2016 and December 31st, 2017 were used, as well as the Fenton growth chart to determine the limits of normality. Results: A total of 210 cases of neonatal macrocephaly was registered, a general rate of 26 per 1,000 live births. Neonatal macrocephaly incidence were inversely proportional to gestational age. Conclusions: Macrocephaly was higher in preterm neonates, with a risk factor five times higher in this population group.

Microcefalia en recién nacidos en establecimientos de salud de nivel II y III del Ministerio de Salud de Perú / Microcephaly in newborns in level II and III health facilities of the Ministry of Health of Peru

RESUMEN Objetivos. Determinar la proporción de microcefalia en recién nacidos en establecimientos de salud (EESS) de nivel II y III del Ministerio de Salud (MINSA) de Perú durante el periodo 2005-2013. Materiales y métodos. Se realizó un análisis secundario de las bases de datos del Sistema Informático Perinatal durante 2005-2013. La identificación de microcefalia se realizó aplicando los criterios de la Organización Mundial de la Salud (OMS), de Fenton, mixto (OMS-Fenton) y de proporcionalidad. Se estimaron las proporciones y tasas de microcefalia por 10 000 nacidos vivos (NV) por regiones y se comparó la concordancia, considerando al parámetro de OMS como referencia. Resultados. La proporción de microcefalia durante el 2005 a 2013 fue de 3,4%, la tasa promedio de microcefalia fue de 335 por 10 000 NV según el criterio de OMS. El parámetro mixto mostró una concordancia sustancial (Kappa de 0,635), mientras que el de proporcionalidad mostró una concordancia razonable (Kappa de 0,298). Conclusiones. La proporción de microcefalia en EESS de nivel II y III del MINSA fue mayor a lo reportado en otros países de la región antes de la aparición del Zika en las Américas. Las variaciones de las frecuencias observadas con las de otros países y entre las regiones peruanas, se podrían explicar por diferentes factores, como la técnica de medición del perímetro cefálico, captura de datos, factores constitucionales y determinantes sociales. Sugerimos estandarizar las mediciones y su registro, uniformizar los criterios de diagnóstico y establecer las estrategias sanitarias para fortalecer la vigilancia epidemiológica de las causas de la microcefalia.

ABSTRACT Objectives. To determine the ratio of microcephaly in newborns in level II and III health facilities of the Ministry of Health (MINSA) of Peru for the period 2005-2013. Materials and Methods. A secondary analysis of the databases of the Perinatal Information System was carried out during 2005-2013. Microcephaly was identified applying World Health Organization (WHO), Fenton, mixed (WHO-Fenton), and proportionality criteria. The ratios and indices of microcephaly were estimated per 10,000 live births (LB) by region and concordance was compared, using the WHO parameter as a reference. Results. The ratio of microcephaly during 2005 to 2013 was 3.4%, the average rate of microcephaly was 335 per 10,000 LBs according to the WHO criterion. The mixed parameter showed a substantial concordance (Kappa of 0.635), while the proportionality parameter showed a reasonable concordance (Kappa of 0.298). Conclusions. The ratio of microcephaly in MINSA Level II and III health facilities was higher than that reported in other countries in the region before the appearance of Zika in the Americas. The frequency variations observed with those of other countries and among Peruvian regions could be explained by different factors, such as the technique for measuring head circumference, data capture, constitutional factors, and social determinants. We suggest standardizing measurements and their recording, harmonizing diagnostic criteria, and establishing health strategies to strengthen the epidemiological surveillance of the causes of microcephaly.