Repercussões do choro dos bebês durante o processo de adaptação à creche / Repercussions of infants´s crying during the process of adaptation to day care / Repercusiones del llanto de bebés durante el proceso de adaptación a guardería

O presente estudo buscou compreender a percepção das mães e dos pais sobre o choro dos bebês no contexto de adaptação à creche. Participaram do estudo dez mães e dois pais e a idade dos bebês variou de dois meses e meio a quinze meses. A partir de análise de conteúdo qualitativa, os resultados apontaram uma preocupação quanto ao choro, considerando-o, às vezes, como uma dificuldade no processo de adaptação. A discussão salientou a naturalidade dessa reação manifestada pela criança durante esse momento, ressaltando-se a importância de se compreender o choro como uma forma de comunicação. É preciso observar outros aspectos ao refletir sobre como esse momento está sendo sentido pelo bebê, visto que a ausência do choro não garante o bem-estar. Dessa forma, compreende-se que o processo de adaptação contempla a tríade: criança, família e escola. Além disso, o choro pode estar relacionado aos diversos sentimentos vivenciados pelos envolvidos e a partir das relações estabelecidas entre eles. (AU)

The present study aimed to understand the perception of mothers and fathers about the crying of infants in the context of adaptation to early childhood education. Ten mothers and two fathers participated in the study, and the age of the infants ranged from two months and a half to fifteen months. Based on qualitative content analysis, the results indicated a concern about crying, sometimes considering it a difficulty in the adaptation process. The discussion emphasized the naturalness of this reaction manifested by the child during this moment, emphasizing the importance of understanding crying as a form of communication. In addition, it is necessary to observe other aspects when reflecting on how this moment is being felt by the infant, since the absence of crying does not guarantee well-being. In this way, it is understood that the process of adaptation contemplates the triad: child, family and school. In addition, crying may be related to the various feelings experienced by those involved and from the relationships established between them. (AU)

El presente estudio buscó comprender la percepción de las madres y de los padres sobre el llanto de los bebés en el contexto de adaptación a la guardería. Participaron del estudio diez madres y dos padres y la edad de los bebés varía de dos meses y medio a quince meses. A partir de análisis de contenido cualitativo, los resultados apuntaron una preocupación en cuanto al llanto, considerándolo, a veces, como una dificultad en el proceso de adaptación. La discusión subrayó la naturalidad de esa reacción manifestada por el niño durante ese momento, resaltando la importancia de comprender el llanto como una forma de comunicación. Además, hay que observar otros aspectos al reflexionar sobre cómo ese momento está siendo sentido por el bebé, ya que la ausencia del llanto no garantiza el bienestar. De esta forma, se comprende que el proceso de adaptación contempla la tríada: niño, familia y escuela. Además, el llanto puede estar relacionado a los diversos sentimientos vivenciados por los involucrados ya partir de las relaciones establecidas entre ellos. (AU)

Involuntary Emotional Expression Disorder in a Patient With Toluene Leukoencephalopathy / Trastorno de expresión emocional involuntaria en un paciente con leucoencefalopatía por tolueno

ABSTRACT Objective: Inhalant users may develop toluene leukoencephalopathy, a devastating neuropsychiatric disorder. We present a case of toluene-induced damage to the corticospinal and the corticonuclear tracts, which presented with involuntary emotional expression dis-order. Methods: Case study of a 20-year-old man with a 3-year history of frequent solvent abuse was admitted to the Neuropsychiatry Unit of the National Institute of Neurology and Neurosurgery because "he could not speak or walk" but would keep "laughing and crying without reason". Results: Neuropsychiatric examination revealed pathological laughter and crying, facial and speech apraxia, a bilateral pyramidal syndrome, and lack of control of urinary sphincter. Magnetic resonance imaging revealed a highly selective bilateral damage to the pyramidal system and the somatosensory pathway. SPECT imaging showed left fronto-parietal hypoperfusion. Conclusions: This document provides support for the understanding of involuntary emotional expression disorders as a differential diagnosis in the clinical practice of psychiatrists, as well as the functional anatomy of these conditions.

RESUMEN Objetivo: Los usuarios de inhalantes pueden contraer leucoencefalopatía por tolueno, un trastorno neuropsiquiátrico devastador. Se presenta un caso de daño inducido por tolueno en el tracto corticoespinal y corticonuclear, que se manifestó con un trastorno involuntario de la expresión emocional. Métodos: Un varón de 20 años con antecedente de 3 años de abuso de solventes ingresó en la Unidad de Neuropsiquiatría del Instituto Nacional de Neurología y Neurocirugía porque «no podía hablar ni caminar¼ y presentaba episodios súbitos de risa y llanto sin razón aparente. Resultados: La valoración neuropsiquiátrica reveló risa y llanto patológicos, apraxia facial y fonatoria, síndrome piramidal bilateral y ausencia de control del esfínter urinario. La resonancia magnética cerebral mostró un daño bilateral muy selectivo del sistema piramidal y la vía somatosensorial. La imagen de tomografía computarizada por emisión monofotónica mostró hipoperfusión frontoparietal izquierda. Conclusiones: Este documento proporciona apoyo para la comprensión de los trastornos de la expresión emocional involuntaria como diagnóstico diferencial en la práctica clínica de los psiquiatras, así como de la anatomía funcional de estas condiciones.

Cómo clasificar llanto del recién nacido mediante una red neuronal supervisada / How to classify newborn cry through a supervised neural network

El llanto es una vía de comunicación del recién nacido con el medio circundante. Investigaciones acerca del llanto infantil han correlacionado características acústicas de éste con patologías, demostrándose que el llanto puede reflejar la integridad neurofisiológica del niño y dar una medida de su interacción con el ambiente y su desarrollo cognitivo y social. Esta contribución muestra cómo clasificar el llanto de neonatos con hipoxia y de un grupo de control, en normal o patológico, a través de una red neuronal artificial supervisada. Para implementar la red neuronal se aprovechan las posibilidades de la plataforma MATLAB®. El diseño y estructuración de la red considera algoritmo de aprendizaje o entrenamiento, iteraciones, pruebas e intervalos de clasificación, obteniéndose arquitectura y topología, y funcionalidades de la red neuronal que en la generalización proporciona la mejor clasificación. En el trabajo se aplica el método de selección de casos, el método acústico para extraer parámetros cuantitativos de la señal de llanto en tiempo, intensidad y frecuencia, así como métodos vinculados con el diseño, implementación y validación, con pruebas diagnósticas, de la red neuronal artificial obtenida para cumplir el objetivo del trabajo que es la generación de clases (clasificación del llanto). Con precisión del resultado de clasificación del 90 por ciento se está en condición de concebir una solución informática (agregando interfaz para interactuar con base de datos) para ayudar complementariamente al diagnóstico médico no invasivo usando el llanto del neonato provocado ante dolor(AU)

Cry from newborn (0-28 days) is a way of communication for the interaction with surrounding world. Infant cry researches provide information that correlate among cries acoustic features with pathologies. It has been demonstrated that the infant cry is able to reflect child neurophysiology integrity and give meaning from newborn interaction with environment, also cognitive and social development from child. This contribution shows how to classify the cry of neonates with hypoxia and of a control group, into normal or pathological, through a supervised artificial neural network. Network implementation makes use of MATLAB® platform possibilities. Design and structuring of network take into consideration aspects as training algorithm, iterations, tests and classification intervals. All these referred aspects give as result an architectural, topology and functionalities from neural network able to classify cry in generalization stage offering good outcome. Different methods are applied in this paper as selection of cases, acoustic methods in order to obtain quantitative parameters from cry signals (in time, intensity and frequency domain). Methods related with design, implementation and validation (diagnostic test) of an artificial neural network able to carry out the goal of this paper (classification of cry) are used. With accuracy results in cry classification about 90 percent, authors get ready conditions for an informatic solution (with addition of interface for data base interaction) for help as a non-invasive complement to medical diagnosis using cry from neonate induced by pain(AU)

Breve historia de las lágrimas y el llanto

Las lágrimas y el llanto son fenómenos biológicos enmarcados en diferentes contextos sociales, culturales y de conocimiento a lo largo de los años. Este artículo es una revisión sobre la construcción de las concepciones alrededor de las lágrimas y el llanto. Se exploran las formulaciones en el tema desde las civilizaciones más antiguas, pasando por la discusión alrededor del origen de las lágrimas (corazón vs. cerebro), así como los hallazgos con la introducción de la disección anatómica y la experimentación fisiológica. Finalmente, se exponen las posturas evolucionistas y psicológicas del llanto para estudiar su funcionalidad en la supervivencia y su papel en las relaciones sociales. El objetivo de este es presentar, en forma sucinta, los aspectos históricos de las lágrimas y el llanto.

SUMMARY Tears and crying are biological phenomena framed in different social and cultural contexts throughout the years. This article is a review of the construction of different conceptions around tears and crying. We explore proposals on the subject from the oldest civilizations, going through the discussion around the origin of tears (heart vs. brain), and the findings with the introduction of anatomical dissection and physiological experimentation. Finally, the evolutionary and psychological positions of crying are exposed, to study its functionality in survival and its role in social relations. The aim of this article is to present, succinctly, what have been the tears and crying through the history.

Neuropsiquiatría del síndrome de Susac: a propósito de un caso / Neuropsychiatry of Susac Syndrome: a Case Report

RESUMEN El síndrome de Susac es una entidad clínica poco frecuente, posiblemente mediada por un proceso autoinmune; la tríada clásica se compone de retinopatía, disminución en la agudeza auditiva y síntomas neuropsiquiátricos (encefalopatía). Hay pocos casos descritos con sintomatología neuropsiquiátrica como la sintomatología principal. Presentamos un caso de síndrome de Susac, que corresponde a una mujer de 34 arios, con predominio de sintomatologia neuropsiquiátrica, caracterizada por un síndrome de Klüver-Bucy parcial, un síndrome apático, risa y llanto patológico y alteraciones cognitivas de predominio atencional; dichos síntomas mejoraron cualitativamente con el uso de terapia inmunológica. Este caso revela la importancia de las manifestaciones neuropsiquiátricas como presentación clínica en pacientes con entidades neurológicas.

ABSTRACT Susac syndrome is a rare clinical condition, possibly mediated by an autoimmune process; the classic triad is composed of retinopathy, decreased hearing acuity and neuropsychiatric symptoms (encephalopathy). There are few cases reported with neuropsychiatric symptoms as the main manifestation. We present a case of Susac syndrome in a 34-year-old female with a predominance of neuropsychiatric symptoms, characterised by partial Klüver-Bucy syndrome, apathy syndrome, pathological laughter and crying, and cognitive dysfunction predominantly affecting attention, which showed a qualitative improvement with the use of immunological therapy. This case report highlights the importance of neuropsychiatric manifestations as clinical presentation in patients with neurological conditions.

Intervenção de enfermagem-primeiro banho do recém-nascido: estudo randomizado sobre o comportamento neonatal / Intervención de enfermería-primer baño del recién nacido: estudio aleatorizado sobre el comportamiento neonatal / Nursing intervention-first bath of the NB: a randomized study on neonatal behavior

Resumo Objetivo Avaliar os efeitos da intervenção Enfermagem-primeiro banho sobre o choro e o sono do recém-nascido. Métodos Ensaio clínico randomizado controlado realizado no alojamento conjunto do Hospital Universitário do Espírito Santo (Brasil). A amostra constituiu-se de 33 neonatos a termo. O grupo experimental composto por 18 recém-nascidos recebeu a técnica intervenção de enfermagem-primeiro banho. As variáveis dependentes foram a presença de choro e o tempo de sono após o banho do RN a Intervenção-Primeiro Banho foi definida como variável independente. As variáveis de controle relacionadas ao recém-nascido foram: idade gestacional; peso ao nascimento; peso antes do banho; perda ponderal; dor neonatal; saturação; sinais vitais; temperatura do ambiente; temperatura da água; tempo do banho; e tempo do cuidado corporal por formulário específico após 24 horas de nascimento. Utilizou-se a Escala de Avaliação do Estado de Sono e Vigília, adaptada de Brazelton, a escala de NIPS para avaliação da dor neonatal. Resultados Os recém-nascidos do grupo intervenção do estudo dormiram cerca de 180 minutos, não apresentaram choro durante o experimento, e a avaliação da escala de dor neonatal foi menor. Conclusão A intervenção de enfermagem-primeiro banho pode apresentar melhora no estado comportamental dos recém-nascidos.

Resumen Objetivo Evaluar los efectos de la intervención enfermería-primer baño sobre el llanto y el sueño del recién nacido. Métodos Ensayo clínico aleatorizado controlado, realizado en la internación conjunta del Hospital Universitario de Espírito Santo (Brasil). La muestra consistió en 33 neonatos a término. El grupo experimental compuesto por 18 recién nacidos recibió la técnica intervención de enfermería-primer baño. Las variables dependientes fueron la presencia de llanto y tiempo de sueño después del baño del RN, la intervención-primer baño fue definida como variable independiente. Las variables de control relacionadas con el recién nacido fueron: edad gestacional, peso al nacer, peso antes del baño, pérdida ponderal, dolor neonatal, saturación, signos vitales, temperatura del ambiente, temperatura del agua, tiempo del baño y tiempo del cuidado corporal por formulario específico luego de 24 horas del nacimiento. Se utilizó la Escala de evaluación del estado del sueño y vigilia, adaptada de Brazelton, la escala de NIPS para evaluar el dolor neonatal. Resultados Los recién nacidos del grupo experimental del estudio durmieron cerca de 180 minutos, no presentaron llanto durante el experimento y la evaluación de la escala de dolor neonatal fue menor. Conclusión La intervención de enfermería-primer baño puede presentar mejoras en el estado de comportamiento de los recién nacidos. Número REBEC: U1111-1239-4388

Abstract Objective To assess the effects of nursing intervention-first bath on NB crying and sleep. Methods Randomized controlled clinical trial conducted at the joint accommodation of the University Hospital of the state of Espírito Santo (Brazil). Sample consisted of 33 full-term infants. The experimental group of 18 NBs received the nursing intervention-first bath technique. The dependent variables were the presence of crying and sleep time after the NB's bath. First bath intervention was defined as an independent variable. The control variables related to the NB were: gestational age; birth weight; weight before bath; weight loss; neonatal pain; saturation; vital signs; room temperature; water temperature; bath time; and time of body care by form after 24 hours of birth. We used the Brazelton Sleep and Wake Status Assessment Scale, the NIPS scale for assessing neonatal pain. Results The NBs in the study intervention group slept for about 180 minutes, did not cry during the experiment, and the neonatal pain scale assessment was lower. Conclusion Nursing intervention-first bath may improve NBs' behavioral state. REBEC number: U1111-1239-4388

Principales aspectos neurofisiológicos, clínicos, y genéticos, en una recién nacida con Síndrome de Cayler / Clinical, genetic, and neurophysiological main features in a newborn girl with Cayler Syndrome

En los neonatos, la hipoplasia o agenesia congénita del músculo depresor del ángulo de la boca (depresor anguli oris), es la causa de la asimetría facial durante el llanto. Los pacientes con esta anomalía, presentan caída de la comisura labial del lado intacto a diferencia de la parálisis facial de origen traumático o congénito, y su diagnóstico se obtiene fácilmente, mediante el examen físico. Esta anomalía está asociada con otras de origen congénito, sobre todo los defectos cardíacos, por lo que se nombra síndrome cardiofacial de Cayler. Se presenta una niña, recién nacida de 56 horas, atendida en el servicio de Neonatología del Hospital Pediátrico "Octavio de la Concepción de la Pedraja" de Holguín, Cuba. La paciente egresa con diagnóstico de síndrome de Cayler, al presentar asimetría facial durante el llanto, y tetralogía de Fallot. Se realizan estudios neurofisiológicos como: electroneurografía del nervio facial y electromiograma de los músculos depresores del labio.

Asymmetrical Crying Facies Syndrome, is caused by congenital hypolapsia or anguli oris agenesis. Patients usually present drop of the intact corner of their mouths while crying. Though it is easily diagnosed, it must be differentiated from traumatic or congenital facial palsies. This condition has been associated with several other anomalies, especially with heart issues. That´s why it is called Cayler Cardiofacial Syndrome. We have reported a case of a 56 hours newborn girl. She shows facial asymmetry as a valuable sign for suspecting other congenital anomalies. Clinical evaluation, including facial nerve electroneurography and electromyography, were performed.

Assessment of a Brief Intervention with Parents to Prevent Shaken Baby Syndrome / Avaliação de Intervenção Breve com Pais para Prevenção da Síndrome do Bebê Sacudido / Evaluación de Intervención Breve con Padres para Prevención del Síndrome del Bebé Sacudido

Abstract Shaken Baby Syndrome (SBS) is a form of physical abuse, which may result in serious consequences for child development. Despite its severity, SBS can be prevented through parent training. This study aimed to evaluate the effectiveness of a brief intervention to increase knowledge on SBS with 252 parents. Participants were randomly assigned into two conditions: Experimental Group (EG) and a waiting Control Group (CG). The intervention consisted of exhibition of an educational video and reading a pamphlet on SBS. To measure parental knowledge, the Attitudes towards the Infant Crying Scale was used. An increase in participants' knowledge about consequences of shaking, caregiver's wellbeing, caregiver strategies to deal with crying, beliefs about infant care and about characteristics of infant crying were observed in the EG at posttest, indicating the effectiveness of the intervention.

Resumo A Síndrome do Bebê Sacudido (SBS) é uma forma de maus-tratos físicos que pode acarretar consequências gravíssimas para o desenvolvimento infantil, podendo ser prevenida pela educação parental. Este estudo teve por objetivo avaliar a eficácia de uma intervenção breve para o aumento de conhecimento sobre a SBS em 252 pais. Os participantes foram divididos aleatoriamente em dois grupos: Experimental e Controle de Espera. A intervenção consistiu na exibição de vídeo educativo e leitura de panfleto sobre a SBS. Para avaliação do conhecimento foi utilizada a Escala de Atitudes Frente ao Choro do Bebê. Após a intervenção foi observado no grupo experimental o aumento do conhecimento sobre as consequências de se sacudir o bebê, estratégias para o bem-estar do cuidador, estratégias para lidar com o choro relacionadas ao cuidador, crenças sobre o cuidado do bebê e características do choro do bebê nos primeiros meses de vida, indicando a efetividade da intervenção.

Resumen El Síndrome del Bebé Sacudido (SBS) es una forma de abuso físico que puede resultar en consecuencias muy graves para el desarrollo infantil y puede ser prevenido mediante la educación de los padres. Este estudio evaluó la eficacia de una intervención breve para aumentar el conocimiento sobre el SBS con 252 padres. Los participantes fueron divididos aleatoriamente en dos grupos: Grupo experimental y Grupo de control de espera. La intervención consistió en la proyección de un vídeo educativo y de la lectura de un folleto sobre el SBS. Para evaluar el conocimiento se utilizó la Escala de Actitudes Frente al Llanto del Bebé. Después de la intervención, se observó que el grupo experimental obtuvo mayor conocimiento sobre las consecuencias de sacudir a los bebes, estrategias para el bienestar del cuidador, estrategias del cuidador para lidiar con el llanto del bebé, las creencias sobre el cuidado del bebé y las características del llanto del bebé en los primeros meses de vida, indicando la efectividad de la intervención.

Software para la conectividad de la consuta provincial del neurodesarrollo infantil y la discapacidad en Santiago de Cuba / Software for connectivity of the medical consultation for infant neuro-development and handicap in Santiago de Cuba

El presente trabajo aborda los primeros pasos hacia la conexión informática de las entidades que conforman la Consulta Provincial del Neurodesarrollo Infantil y la Discapacidad (CPNDI) en Santiago de Cuba. Se propone un sistema basado en tecnología Web para su uso en infraestructuras de comunicación limitadas como ocurre en zonas rurales, desarrollado en colaboración con la Universidad de Ciencias Aplicadas de Dus-seldorf y la Univ. Benemérita de Puebla, México. El sistema se basa en el acoplamiento de un sistema de gestión de pacientes con acceso a equipos médicos ambulatorios con un sistema de asistencia especializada orientado al tratamiento de pacientes vía un navegador de internet. La combinación efectiva de aplicaciones web remotas y locales facilita una integración efectiva del equipamiento médico ambulatorio requerido en el sitio remoto donde se encuentra el paciente con el sistema de asistencia especializada donde se encuentran los doctores y especialistas todo a través de tecnología web(AU)

In this paper are discussed, the first steps for a telemedicine network which connects the units and places within the Medical Consultation for Infant Neurodevelopment and Handicap (CPNDI) in Santiago de Cuba. A web-based system for use to connect sites within the CPNDI structure and to access rural areas with limited communication infrastructures is finally proposed. The system consists of a patient management system and a medical device system that are available to the doctor and the patient-side assistant during treatment via an Internet browser. The combination of local and remote web applications enables a seamless integration of the medical devices required at the patient's location into the doctor's remote station based on browser technology(AU)

Llanto excesivo en los primeros meses de vida: Revisión / Excessive crying in infants in the first months of life: Review

El comportamiento caracterizado por llanto e irritabilidad, una de las presentaciones clínicas más frecuentes en los primeros meses de vida, surge de una compleja interacción de factores culturales, psicosociales, ambientales y biológicos. El 5% de los casos presenta alguna afección orgánica. Un enfoque holístico de tipo biopsicosocial del problema parece ser el más conveniente. El presente manuscrito examina la evidencia reciente con el propósito de actualizar el manejo clínico de esta afección e intentar redefinirla.

Cry-fuss problems are among the most common clinical presentations in the first few months of life. Cry-fuss behaviour emerges out of a complex interplay of cultural, psychosocial, environmental and biologic factors, with organic disturbance implicated in only 5% of cases. A holistic biopsychosocial approach can be most effective. This article reviews recent evidence to update clinical management, and will attempt to reconceptualize infant colic definition.

"When I Want to Cry I Can't": Inability to Cry Following SSRI Treatment / «Cuando quiero llorar, no lloro¼: incapacidad para llorar tras el tratamiento con inhibidores selectivos de la recaptación de serotonina

Abstract Introduction: We describe seven cases of patients with an inability to cry after treatment with selective serotonin re-uptake inhibitor (SSRI) medication, even during sad or distressing situations that would have normally initiated a crying episode, in the light of the role of the serotonergic system in emotional expression. Method: Case series drawn from patients attended in a secondary care psychiatry service. Results: While excessive crying without emotional distress has been previously reported in the literature, and is associated with reduced serotonin function, these reports suggest cases of the reverse dissociation, where emotional distress and an urge to cry was present, but crying was impaired. Discussion: Although the case series presented here is new, these cases are consistent with the neuroscience of crying and their relationship with serotonergic function, and provide preliminary evidence for a double dissociation between subjective emotional experience and the behavioural expression of crying. This helps to further illuminate the neuroscience of emotional expression and suggests the possibility that the phenomenon is an under-recognised adverse effect of SSRI treatment.

Resumen Introducción: Se describen los casos de 7 pacientes con incapacidad para llorar tras tratamiento con un inhibidor de la recaptación de serotonina (ISRS), situación que se presenta aun en situaciones estresantes o tristes, que normalmente les habrían iniciado una respuesta de llanto. Los casos se examinan a la luz de lo que se conoce acerca del papel del sistema serotoninérgico en la expresión emocional. Método: Serie de casos de pacientes que acuden a un servicio de atención secundaria en psiquiatría. Resultados: Mientras el llanto excesivo sin estrés emocional ya se había descrito en la literatura asociado con una función serotoninérgica reducida, los presentes reportes apuntan casos de la disociación inversa, en los que el estrés emocional y la urgencia de llorar se encontraban presentes, pero con incapacidad para el llanto. Discusión:Aunque la serie de casos aquí presentada es nueva, concuerdan con la neurociencia del llanto y su relación con la función serotoninérgica, y proveen evidencia preliminar para una disociación doble entre la experiencia emocional subjetiva y la expresión conductual del llanto. Esto ayuda a elucidar la neurociencia de la expresión emocional y apunta la posibilidad de que el fenómeno sea un efecto adverso poco detectado del tratamiento con ISRS.

O contato pele a pele ao nascimento e o choro de recém-nascidos durante vacinação contra Hepatite B / The skin to skin contact at birth and newborn crying during vaccination against Hepatitis B / El contacto piel con piel en el nacimiento y llanto del recién nacido durante la vacunación contra la Hepatitis B

OBJETIVO: Testar a efetividade do contato pele a pele entre mãe e filho após o nascimento na redução do comportamento de estresse/dor manifestado pelo choro do recém-nascido (RN), decorrente do procedimento de vacinação contra a Hepatite B. MÉTODOS: Estudo comparativo quase-experimental abrangendo 40 RN a termo, divididos em dois grupos, com ou sem contato pele a pele com suas mães após o nascimento, e que foram comparados quanto ao tempo de choro durante a vacinação contra Hepatite B. RESULTADOS: Variações no tempo de choro foram observadas nos dois grupos durante as fases desse procedimento. CONCLUSÃO: O efeito do contato na diminuição do tempo de choro dos RN, não foi demonstrado estatisticamente. Clinicamente, a Síndrome do Chamado pelo Estresse foi observada, bem como a efetividade do período de contato, na modulação do comportamento de choro dos neonatos, enquanto estes estiveram sob o momento terapêutico.

OBJECTIVE: To test the effectiveness of skin to skin contact, between mother and child after birth, in reducing stress and pain behavior manifested by the cries of the newborn (NB), from the procedure of vaccination against Hepatitis B. METHODS: This is a quasi-experimental comparative study covering 40 full-term newborns, divided into two groups, with or without skin contact with their mothers after birth, and were compared in terms of time crying during vaccination against Hepatitis B. RESULTS: We observed, in both groups, changes in crying time during the phases of the process. CONCLUSION: The effect of contact in reducing crying time of neonates was not demonstrated statistically. Clinically, during the treatment time was observed Calling Syndrome caused by stress, as well as the effectiveness of the contact period in modulating the behavior of crying in newborns.

OBJETIVO: Comprobar la efectividad, del contacto piel con piel entre madre e hijo después del nacimiento, en la reducción del comportamiento de estrés y dolor manifestado por el llanto del recién nacido (RN), proveniente del procedimiento de vacunación contra la Hepatitis B. MÉTODOS: Se trata de un estudio comparativo casi-experimental abarcando 40 RN a término, divididos en dos grupos, con o sin contacto piel con piel con sus madres después del nacimiento, y que fueron comparados en lo que se refiere al tiempo de llanto durante la vacunación contra la Hepatitis B.. RESULTADOS: Se observó en los dos grupos, variaciones en el tiempo de llanto durante las fases de ese procedimiento. CONCLUSIÓN: El efecto del contacto en la disminución del tiempo de llanto de los RN, no fue demostrado estadísticamente. Clínicamente, durante el momento terapéutico, fue observado el Síndrome del Llamado causado por el estrés; así como la efectividad del período de contacto en la modulación del comportamiento del llanto en los recién nacidos.

Función social de las lágrimas: una indagación empírica sobre los tipos de llanto emocional / Social function of tears: an empirical inquiry about the types of emotional tearing

El intercambio emocional humano implica expresión/reconocimiento de emociones. La cara es el lugar privilegiado para expresar o leer la emoción. Algunas emociones se asocian con llanto emocional, diferenciable del basal y del reflejo. Murube, Murube y Murube (1999) clasificaron el llanto emocional en de demanda y de ofrecimiento de ayuda. Se evaluó la validez de dicha tipología empleando rostros humanos de ambos sexos que lloraban por dolor propio y ajeno. Un grupo de jueces clasificó el llanto expresado en esos rostros. Se calcularon tasas de acierto de discriminación de llanto y se realizaron pruebas chi-cuadro por sexo. Los resultados no apoyan la idea de una habilidad para distinguir dos tipos de llanto y son explicados desde un punto de vista cultural.

Human emotional interchange implicates expression/recognition of emotions. The human face is a conspicuous place to express/read emotion. Certain emotions associate with emotional tearing, differentiable from basal and reflex tearing. Murube, Murube and Murube (1999) classified emotional tearing in requesting- and offering -help. The validity of that typology was evaluated using faces of people of both sexes crying because of their own suffering and because of other’s suffering. A group of judges classified the crying shown by those faces. Discrimination hit rates andqui-square tests were estimated by sex. Results do not support a human ability to distinguish two types of crying andare interpreted from a cultural point of view.

Análisis del llanto en niños hipoacúsicos y normoyentes de 0 a 2 años de edad

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Abstract: Infant crying is a complex phenomenon that implies several functions: breathing, action of laryngeal and supralaryngeal muscles under the control of the neurovegetative systems of the brainstem, and the limbic system, and the association of cortical areas and the cerebellum. Although it is a communication system different to babbling and language, it is related with the future development of phonation. Cry analysis provides information about the neuro-physiologic and psychological states of newborns and the identification of perinatal abnormalities. It is necessary to discuss the subject extensively because there are new data on situations such as laringomalacia, congenital hypothyroidism, deafness and sleep apnea that seem to be associated to infantile crying behaviors. Infant cries can be analyzed as behavioral conditions (hunger, anger and pain cries) allows knowing of mother-child relationship or the effect under diverse cultural conditions, such as stress, emo-tional deprivation or illness. A spectrographic analysis of the cries may identify several characteristics: threshold, latency, duration of phonation, maximum and minimum of the fundamental frequency (F0), occurrence and maximum pitch of shift, gliding, melody, biphonation, bifurcation, noise concentration, quality of the voice, double harmonic break, glottal plosives, vibratos, melody types, F0 stability and inspiratory stridor. To date, it has not been possible to establish alteration patterns. The best studied variables are F0, its harmonics and the duration of each emission; it is accepted that F0 varies between 400 and 600 Hz, during 1.4 ± 0.6s. Under such approaches, diverse alterations and risk factors have been studied: congenital alterations, malnutrition, sudden death, maternal exposition to drugs, prematurely born babies or perinatal asphyxia and disturbances of the central nervous system. Authors have reported F0 equal or less than 300 Hz in cases of sudden death or with high frequencies, near the 1000 Hz in the Cri du chat syndrome, perinatal asphyxia and other cases who died suddenly. During the cry, there is an increase of intra-abdominal pressure, heart rate and blood pressure, reduction of oxygen saturation, increase of the intra cranial-pressure, beginning of stress reactions, depletion of the energy anf oxygen reserves, such as the found in the Valsalva's maneuver. Every event of prolonged cries implies alteration of the breathing control like a Hering-Breuer reflex. Considering that some authors have proposed early vocalizations are a good predictor of deafness, in a previous paper we reported the characteristics of the cry of 20 deaf neonates. However, we were not able to demonstrate differences when comparing them with normal hearing neonates and infants, using only parametric methods. Still, we decided to go further and investgate the quality of infant cries of deaf neonates and infants. Material and methods. Twenty zero-to two-year old cases were studied; they were deaf children of both sexes; all cases were included in a follow-up program on the Human Communication Department of the National Institute of Perinatology of Mexico and were compared with 20 normal hearing children. We re-corded Brain Stem Evoked Auditory Responses (BEAR) and cry recording using a digital Sony recorder during the physical exploration. We analyzed the frequency (Hz) and duration of the espiratory cries, the duration of inspiration between two cry emissions and the characteristics of the spectrogram. Quantitative analysis. The usual estimates of means and standard variation were obtained and they were compared with one way analysis of variance. We organized typologies of frequency by means of cluster techniques (Ward method). The distribution of the duration of the periods of crying and silence was explored with a contingency tables. Qualitative analysis. Two standardized observers visually analyzed all the cries to determine any variation of F0 and of harmonic frequencies. Whenever a variation of F0 was observed, we obtained maximum and minimum frequencies, as well as average duration of each cry emission. The procedure was validated by means of the graphic comparison with a Fouries analysis. Results. Mean duration of cries in the deaf group was 0.5845 ± 0.6150 s (range 0.08-5.2 s), while in the group of normal hearing cases was 0.5387 ± 0.2631 (range 0.06-1.75 s). From the deaf group, five cases had very prolonged duration of cries, without statistical significance. The mean duration of the inspiration was 0.3962 ± 0.2326, with a range of 0.06 to 1.75 in the deaf group and of 0.4083 ± 0.1854, with a range of 0.21 at 0.96, in the controls, without difference among groups. There was no correlation between the time of espiratory cry and that of the inspiration. Three cry topologies were organized: one of shorter duration (mean 0.30 s), with 111 spectrograms, an intermediate one (mean 0.73) with 85 spectrograms and one of prolonged duration (mean 4.5 s) with spectrograms of three cases. Three topologies of the inspiratory period were obtained: one of short periods (mean 0.33 s), with 171 spectrograms, one of intermediate duration (mean 0.80 s) with 18 spectrograms and one of prolonged duration (mean 1.60 s) with three cases. There were no statistical differences of tipologies between the deaf groups and normal hearing cases. On the qualitative analysis of cries, we came across several variations which are interpreted as abnormalities: vibratos, poor melodic control, loss of fundamental frequencies, harmonic limited production, plosives, gliding, bi phonation, and a loss of intensity at end of cry emissions. These changes were also observed on the control cases, but only in a very limited number. Discussion. Cry spectrogram analysis are non invasive indicators of the neonate's neurophysiologic organization. Although cry duration varies in healthy newborns, the accepted variation for a normal range is 1.1 to 2.8 s, with standard deviations around 0.6 s. Consistent differences have not been demonstrated between risk and control groups. However, abnormal cases such as Down syndrome or severe asphyxia have very short cries, whereas on the Cri du chat syndrome the duration of cries is prolonged. Extended cries imply cardiac and respiratory risks which have been associated with later outcomes as development retardation and sudden death. There are also some questions to solve, such as the regulation and control of cry, starting from breathing mechanisms or from a sensorial afferent, mediated by hearing. The deaf infants are constituted in a study model, considering that the auditory afference is suppressed and the control of the cry is restricted to the breathing environment. In the studied spectrograms, the duration of the cry was within reported normal limits by other authors, inasmuch in the normal hearing control cases as in the deaf, except the dissident cases, but without these reaching statistical significance. Further research of brainstem function is needed for the abnormal cases with prolonged cry periods, since such cries are interpreted as an alteration of the breathing reflexes of Hering-Breuer, which might have a pathological meaning in the sense of the sob's spasm or even more severe risk factors as sleep apnea and even sudden death. The qualitative analysis in the deaf individuals demonstrated a poor quality and unstable character of melodic control, with a smaller number of harmonics. The deaf cases lost the relationship between the fundamental frequencies and their harmonics, mainly because of the participation of supraglottic structures that modulate pitch and due to the poorness of melodic control, either for monotony or due to the impossibility of returning to a normal pattern, following variations such as vibrato, plosives or noise concentration. In the cases of prolonged cries, starting from the third second, the sound intensity tends to diminish and the harmonics are lost, perhaps due to a decrease of the subglottal pressure of phonation. This finding supports the auditory control of crying related to breathing mechanisms. Conclusions. In preliminary terms, by means of the melodic analysis of the spectrograms, differences are demonstrated be-tween the cries of the deaf and of the normal hearing cases. The increase of the complexity of the melody of the cry, or their poverty, are indicative of the neuromuscular function and they may support the evaluation of phonation before language development. The study of the spectrograms of deaf individuals does not constitute an element for the detection or for diagnosis since, to date, estimators of sensibility or of specificity have not been established, but they constitute a support for its integral evaluation, with the possibility of evaluating and of improving therapeutic rehabilitation.