Assessment of nutritional status in chronic obstructive airways disease patients in a tertiary care hospital at Himachal Pradesh, India: a cross sectional study

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortatlity worldwide. Malnourishment in COPD patients is very common and is a prognostic factor in its treatment. The present study has been conducted to assess nutritional status in COPD patients and its correlation with severity of disease. Methods: This institutional based analytical cross sectional study was conducted in the Department of Pulmonary Medicine at tertiary care hospital in Himachal Pradesh (India) from 1 Dec 2017 to 31st May 2018. A total of 52 COPD participants attending the pulmonary Medicine OPD and fulfilling the inclusion criteria were enrolled. Results: All participants reported being smoker since long with the mean years of smoking since 31 years and about 13.6 cigarettes being smoked per day. 22 (42%) of the participants were undernourished as per BMI criteria But when compared with MUAC criteria, a large number 38 (73%) came out to be undernourished. haemoglobin and cholesterol levels were less in patients with severe diseases than mild and moderate category (76.9%). Conclusions: The malnourishment and severity of the disease has direct correlation. More the severity of COPD, more is the malnourishment. Biochemical parameters, although not deranged significantly in any group, but more on the lower side in patients with severe COPD. There is a need for regular nutritional assessment of every COPD patient and recommendation of supplementary food for them.

Physical exercise improves body weight gain and liver function in malnourished rats without disturbing the redox balance / O exercício físico melhora o ganho de peso corporal e a função hepática em ratos desnutridos sem perturbar o balanço de redox

ABSTRACT Objective To study the relationship between exercise and malnourishment because recent evidence suggests that exercise can cause the beneficial adaptation of antioxidant systems, whereas malnourishment can cause harmful adaptation of these systems. Methods Thirty-two female Fischer rats were equally divided into Sedentary Control, Trained Control, Sedentary Malnourished and Trained Malnourished groups. The training protocol consisted of swimming for 30 minutes continuously for 5 days/week for 8 weeks. Results It was demonstrated that aspartate aminotransferase and alanine aminotransferase activities increased in malnourished rats, but physical training reversed these effects by lowering the raised levels. The glutathione level was diminished by malnourishment whereas physical training increased the levels of liver carbonyl protein and increased the levels of thiobarbituric acid reactive substances that were diminished by malnourishment. In addition, Trained Malnourished rats had a higher average body weight than Sedentary Malnourished ones (62.77g vs. 55.08g, respectively). Conclusion The data show that exercise was able to reverse or reduce damage caused by malnourishment, such as weight loss and liver dysfunction by a pathway independent of the participation of enzymes involved in antioxidant defense and that there is no interaction between exercise and malnutrition.

RESUMO Objetivo Estudar a relação entre exercício e desnutrição, pois evidências recentes sugerem que o exercício físico pode causar a adaptação benéfica de sistemas antioxidantes, enquanto a desnutrição pode causar adaptação prejudicial a esses sistemas. Métodos Trinta e duas ratas Fischer foram igualmente divididas nos grupos Controle Sedentário, Controle Treinado, Desnutrido Sedentário e Desnutrido Treinado. O protocolo de treinamento consistiu em nadar por 30 minutos continuamente por 5 dias/semana por 8 semanas. Resultados Demonstramos que as atividades de aspartato aminotransferase e alanina aminotransferase aumentaram em ratos desnutridos, mas o treinamento físico reverteu esses efeitos. O nível de glutationa foi diminuído pela desnutrição, enquanto o treinamento físico aumentou os níveis de proteína carbonilada do fígado e aumentou os níveis de substâncias reativas ao ácido tiobarbitúrico que foram diminuídas pela desnutrição. Além disso, os ratos desnutridos treinados tiveram um peso corporal médio maior que os desnutridos sedentários (62,77g vs 55,08g, respectivamente). Conclusão Os dados mostram que o exercício foi capaz de reverter ou reduzir os danos causados pela desnutrição, como perda de peso e a disfunção hepática por uma via independente da participação de enzimas envolvidas na defesa antioxidante e que não há interação entre exercício e desnutrição.

Wernicke’s encephalopathy: a case report

Wernicke’s encephalopathy (WE) is an acute neuropsychiatric condition that occurs due to reversiblebiochemical lesions caused by depletion of intracellular Thiamine (Vitamin B1). WE is characterized bythe triad of ophthalmoplegia, ataxia, and confusion. However only 10 % of patients present with all threefeatures and other symptoms may also be present. It is commonly regarded as a condition occurring due tomalnourishment due to alcohol use but a variety of other diseases can also lead to it. It is present in thegeneral population with a prevalence of around 2%. We present herewith a case of a 72 years old lady thatpresented with WE

Participação do nicho endosteal na regulação da hemopoese de camundongos submetidos à desnutrição proteica / Endosteal niche participation in the hematopoiesis of mice submitted to protein malnourishment

O nicho endosteal da medula óssea abriga as células-tronco hemopoéticas (CTH) em quiescência/autorrenovação. As CTH podem ser classificadas em dois grupos: células que reconstituem a hemopoese em longo prazo (LT-CTH) e curto prazo (CT-CTH). Investigamos, neste trabalho, os efeitos da desnutrição proteica (DP) no tecido ósseo e a participação do nicho endosteal na sinalização osteoblasto-CTH. Para tanto, utilizamos camundongos submetidos à DP induzida pelo consumo de ração hipoproteica. Os animais desnutridos apresentaram pancitopenia e diminuição nas concentrações de proteínas séricas e albumina. Quantificamos as CTH por citometria de fluxo e verificamos que os desnutridos apresentaram menor porcentagem de LT-CTH, CT-CTH e de progenitores multipotentes (PMP). Avaliamos a expressão das proteínas CD44, CXCR4, Tie-2 e Notch-1 nas LT-CTH. Observamos diminuição da expressão da proteína CD44 nos desnutridos. Isolamos as células LT-CTH por cell sorting e avaliamos a expressão gênica de CD44, CXCR4 e NOTCH-1. Verificamos que os desnutridos apresentaram menor expressão de CD44. Em relação ao ciclo celular, verificamos maior quantidade de LT-CTH nas fases G0/G1. Caracterizamos as alterações do tecido ósseo femoral, in vivo. Observamos diminuição da densidade mineral óssea e da densidade medular nos desnutridos. A desnutrição acarretou diminuição da área média das seções transversais, do perímetro do periósteo e do endósteo na cortical do fêmur dos animais. E na região trabecular, verificou-se diminuição da razão entre volume ósseo e volume da amostra e do número de trabéculas, aumento da distância entre as trabéculas e prevalência de trabéculas ósseas em formato cilíndrico. Avaliamos a expressão de colágeno, osteonectina (ON) e osteocalcina (OC) por imuno-histoquímica, e de osteopontina (OPN) por imunofluorescência no fêmur e verificamos diminuição da marcação para OPN, colágeno tipo I, OC e ON nos desnutridos. Evidenciamos, pela técnica do Picrosírius, desorganização na distribuição das fibras colágenas e presença de fibras tipo III nos fêmures dos desnutridos, além de maior número de osteoclastos evidenciados pela reação da fosfatase ácida tartarato resistente. Os osteoblastos da região femoral foram isolados por depleção imunomagnética, imunofenotipados por citometria de fluxo e cultivados em meio de indução osteogênica. Observamos menor positividade para fosfatase alcalina e vermelho de alizarina nas culturas dos osteoblastos dos desnutridos. Avaliamos, por Western Blotting, a expressão de colágeno tipo I, OPN, osterix, Runx2, RANKL e osteoprotegerina (OPG), e, por PCR em tempo real, a expressão de COL1A2, SP7, CXCL12, ANGPT1, SPP1, JAG2 e CDH2 nos osteoblastos isolados. Verificamos que a desnutrição acarretou diminuição da expressão proteica de osterix e OPG e menor expressão gênica de ANGPT1. Avaliamos a proliferação das células LSK (Lin-Sca1+c-Kit+) utilizando ensaio de CFSE (carboxifluoresceína succinimidil ester). Foi realizada cocultura de células LSK e osteoblastos (MC3T3-E1) na presença e ausência de anti-CD44. Após uma semana, verificamos menor proliferação das LSK dos desnutridos. O bloqueio de CD44 das LSK do grupo controle diminuiu a proliferação destas em três gerações. Entretanto, nos desnutridos, esse bloqueio não afetou a proliferação. Concluímos que a DP promoveu alterações no tecido ósseo e nas CTH. Entretanto, não podemos afirmar que as alterações observadas no sistema hemopoético foram decorrentes de alterações exclusivas do nicho endosteal

The bone marrow endosteal niche hosts hematopoietic stem cells (HSC) in quiescence/self-renewal. HSC can be classified into two groups: cells capable of renewing indefinitely (LT-HSC) or repopulating in the short term (ST-HSC). In this work, we investigated the effects of protein malnutrition (PM) on bone tissue and the involvement of the endosteal niche in osteoblast-CTH signaling. Therefore, we used mice subjected to PM induced by the consumption of hypoproteic feed. Malnourished animals presented pancytopenia and decreased concentration of serum protein and albumin. We quantified the HSC by flow cytometry and found that the malnourished ones had lower percentage of LT-HSC, ST-HSC and multipotent progenitors (MPP). We assessed the expression of the CD44, CXCR4, Tie-2 and Notch-1 proteins in LT-HSC. We observed decreased expression of CD44 protein with the malnourished ones. We isolated the LT-HSC cells by means of cell sorting and assessed the gene expression of CD44, CXCR4 and NOTCH-1. We found that malnutrition had lower expression of CD44. Regarding the cell cycle, we see greater amount of LT-HSC in the G0 and G1 phases. We characterized the changes of the femoral bone tissue in vivo. We observed a decrease in the bone mineral density and medullar density in malnourished animals. As for malnourished animals, the femoral cortical region showed a significant decrease in tissue area, periosteal and endosteal perimeter. The femoral trabecular region of malnourished animals showed decreased bone volume/tissue volume ratio, decreased trabecular number, increased trabecular separation and prevalence of rod-like trabeculae. We investigated the expression of collagen, osteonectin (ON) and osteocalcin (OC) by means of immunohistochemistry and the expression of osteopontin (OPN) by immunofluorescence and we found that malnourished animals showed decreased labeling for OPN, type I collagen, OC and ON in the cortical region of the femur. Picrosirius staining was used to analyze disorganization of collagen fibers and presence of type III fibers in the femurs of the malnourished. Cortical and trabecular regions of malnourished animals presented a higher number of osteoclasts as shown by tartrate-resistant acid phosphatase reaction. Moreover, osteoblasts were isolated from the femoral region by immunomagnetic depletion and immunophenotyped by flow cytometry and cultured in osteogenic induction medium. Results proved less positive for alkaline phosphatase and alizarin red in the cultures of osteoblasts of malnourished animals. We assessed, by means of Western blotting, type I collagen expression, OPN, osterix, Runx2, RANKL and osteoprotegerin (OPG) and, by real time PCR, the expression of COL1A2, SP7, CXCL12, ANGPT1, SPP1, JAG2 and CDH2 with the isolated osteoblasts. We found that malnutrition led to osterix and OPG decreased protein expression and lower ANGPT1 gene expression. We evaluated LSK cell (Lin-Sca1+c-Kit+) proliferation by CFSE (carboxyfluorescein succinimidyl ester). LSK cells and osteoblasts (MC3T3-E1) cocultures were performed in the presence and absence of anti-CD44. After a week, we found lower proliferation of LSK in the malnourished. The LSK CD44 blocking in the control group decreased the proliferation of these three generations. However, as for the malnourished, such blockage did not affect proliferation. We concluded that the PM has promoted changes in bone tissue and the CTH. However, we can't claim that the alterations observed in hematopoietic system were due to endosteal niche-only changes

Efecto biológico de la recuperación nutricional en las concentraciones séricas de citocinas inflamatorias en el niño desnutrido grave / Biological effect of nutritional recovery on serum concentrations of inflammation cytokines in the malnourished child

El niño con desnutrición grave tiene una disfunción de la respuesta inmune que puede aumentar de manera significativa la morbilidad y la mortalidad por infecciones. El objetivo de la presente investigación fue evaluar el efecto de la recuperación nutricional en las concentraciones séricas de citocinas inflamatorias; tales como: interleucina 12 (IL-12), interleucina 17 (IL-17), interferón gamma (IFN-γ) y factor de necrosis tumoral alfa (TNF-α). En un estudio de tipo prospectivo y longitudinal, se seleccionó la población con base a criterios clínicos y antropométricos, constituida por 24 niños desnutridos graves en edades comprendidas entre 1 y 2 años, quienes formaban parte de un programa de recuperación nutricional. La concentración sérica de las citocinas investigadas se determinó antes y después del tratamiento nutricional, empleando la técnica de Inmunoanálisis Enzimático (ELISA) de doble anticuerpo. Para establecer comparaciones se utilizó la t de Student, y se consideró una p<0,05 como estadísticamente significante. Se observó una diferencia en las concentraciones de IL-12, IL-17, IFN-γ y TNF-α antes y después del tratamiento (p<0,05), lo cual parece indicar que la desnutrición per se provoca un estado inflamatorio y que 2 meses de apoyo nutricional intensivo, favorecen no solo la recuperación clínica del niño desnutrido grave, sino también la recuperación de su respuesta inmunitaria en cuanto a la producción de mediadores solubles como son las citocinas.

Children with severe malnutrition have a dysfunction of the immune response that can significantly increase morbidity and mortality from infections. The aim of this investigation was to evaluate the effect of nutritional recovery in serum measurements of inflammatory cytokines; such as interleukin 12 (IL-12), interleukin 17 (IL-17), interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). In a prospective and longitudinal study, 24 severe malnourished children aged between 1 and 2 years-old, who were part of a program of nutritional recovery, were selected based on clinical and anthropometric criteria. Serum measurements of cytokines were determined before and after dietary treatment, using the technique of sandwich Enzyme-Linked ImmunoSorbent Assay (ELISA). For comparisons, Student’s t test was used, considered p <0.05 as statistically significant. A difference was observed in the concentrations of IL-12, IL-17, IFN-γ and TNF-α before and after treatment (p <0.05), which suggests that malnutrition provokes an inflammatory state and two months of intensive nutritional support, not only promotes the clinical recovery of severe malnourished children, but also the recovery of the immune response with regard to the production of soluble mediators, such as cytokines.

Deficiencia de vitamina A en niños con fibrosis quística / Vitamin A deficiency in children with cystic fibrosis

INTRODUCCIÓN: la carencia subclínica de vitamina A es frecuente en niños y adolescentes con fibrosis quística, y tiene un origen multifactorial; contribuye al deterioro pulmonar y ensombrece el pronóstico de la enfermedad. OBJETIVO: caracterizar el estado de esta vitamina en niños y adolescentes fibroquísticos y su relación con el estado nutricional y algunas variables clínicas. MÉTODOS: se realizó un estudio descriptivo, transversal (año 2014), de los 11 pacientes menores de 18 años atendidos en consulta multidisciplinaria del Hospital Pediátrico Centro Habana, que recibían suplementos diarios de vitamina A, como parte de la recomendación dietética y que se encontraban estables de su enfermedad, sin síntomas carenciales. Se evaluó el nivel de retinol sérico por cromatografía de alta resolución y se consideraron valores normales, según la OMS, entre 30 y 79 µg/dL, marginales entre 20 y < 30 µg/dL y deficiencia subclínica entre 10 y < 20 µg/dL. El estado nutricional se evaluó según percentil de índice de masa corporal, correspondiente a la población cubana según edad decimal y sexo. Se clasificó, además, a los enfermos, según mutación reportada, presencia de insuficiencia pancreática y enfermedad pulmonar típica, de acuerdo con registros clínicos. RESULTADOS: en la muestra predominó la mutación del 508F (2 homocigotos y 6 heterocigotos) y la enfermedad típica con insuficiencia pancreática (10 de 11). En 7 niños (63,6 %) se detectaron niveles bajos de vitamina A (4 marginales y 3 deficientes), con predominio en niños con bajo peso (80 vs. 50 % en los eutróficos), prescolares (2 de 2) y adolescentes (3 de 5). CONCLUSIONES: es importante el monitoreo de esta vitamina en el seguimiento de los enfermos de fibrosis quística.

INTRODUCTION: subclinical Vitamin A deficiency is common in children and adolescents with cystic fibrosis of multifactoral origin; it influences the pulmonary deterioration and casts a shadow over the disease prognosis. OBJECTIVE: to characterize the state of this vitamin in children and adolescents with cystic fibrosis and its association with the nutritional status and with some clinical variables. METHODS: a cross-sectional and descriptive study was conducted in younger than 18 years-old children. They were seen at the multidisciplinary service of Centro Habana pediatric hospital, and received daily Vitamin A supplements as part of dietary recommendations; they were stable with no symptoms of shortage at the time of study. A high resolution chromatography evaluated the level of serum retinol, whose values, according to WHO standards, were considered normal when yielding 30-79 µg/dL, marginal from 20 to less than 30 µg/dL and subclinical deficiency ranging from 10 to lower than 20 µg/dL. The nutritional status was measured as body mass index percentiles of the Cuban population by decimal age and sex. Additionally, the patients were classified on the basis of reported mutation, pancreatic deficiency and typical pulmonary disease pursuant to the medical histories. RESULTS: in the sample, the 508F mutation (2 homozygotic and 6 heterozygotic) and typical disease with pancreatic disease (10) prevailed. Seven children (63.2 %) had low Vitamin A levels (4 marginal and 3 deficient), being low weighed children (80 vs. 50 % in the eutrophic ones), preschool children (2 out of 2) and adolescents (3 out of 5) predominant. CONCLUSIONS: it is important to monitor Vitamin A in the follow-up of patients with cystic fibrosis.

Infant Feeding Practices in Kaski District, Pokhara.

Introduction: Children in developing countries are prone to infectious diseases due to insufficient and inappropriate feeding practices. Socio-demographic and socio-economic factors directly and indirectly play a role in influencing infant feeding practices. This study was conducted to assess the sociodemographic and economic factors associated with initiation of breastfeeding, complimentary feeding, and the various prelacteal feeds practiced in Kaski, Pokhara. Materials and Methods: In this prospective study, interviews were conducted to 500 mothers at Manipal Teaching Hospital who brought their child for treatment. The interviews were conducted in a questionnaire format relating to their demographic and financial statuses. Results: A total of 500 mothers were questioned, out of which 86.6% gave their child breastmilk as its first food. 47% initiated breastfeeding within half an hour of child’s birth. 86% gave Jaulo as the first complementary food to their children. About 26% of the mothers gave complementary feeding to their children before the recommended time of 6 months. Conclusion: Initiation of breastfeeding after life and complementary feeding practices overall has improved from previous studies. There is still need of making awareness campaigns and such in order to further improve this trend.

Análise da densidade energética de preparações servidas em uma Unidade de Nutrição e Dietética / Analysis of the energy density of preparations served in a Nutrition and Dietetics Unit

Given the special energy and nutrient needs and the malnourishment commonly seen in hospitalized patients, the energy density of a soft diet, low potassium diet, low sodium diet and bedtime fruit shakes and porridges offered to patients of a Nutrition and Dietetics Unit of Brasília, DF, was assessed. Data were collected by direct observation and technical cards regarding the preparation of foods and dishes were done to calculate the energy density (ED) of the preparations according to the "Food and energy-containing beverages method." The ED values were classified according to the CDC, 2005. Roughly 16.7% of the soft diets had an ED of 0.7 to 1.5kcal/g (low ED), 58.3% had an ED below 0.6kcal/g (very low ED) and 25% had an ED between 1.5 and 4.0kcal/g (average ED). The analysis of low-sodium and low-potassium diets showed that 20% had a low ED, 30% had a very low ED and 50% had an average ED. All fruit shakes and porridges had a low ED. The results show that the patients who receive the analyzed preparations are at risk of ingesting an amount of energy that is below their needs. The need for standardization, menu planning and attention to individual dietary requirements is evident within the studied nutrition and Dietetic Unit.

En función de las necesidades especiales de energía, nutrientes y de la mal nutrición que a menudo constatamos en pacientes internados, fue analizada la densidad energética de las preparaciones de la dieta pastosa, de las preparaciones de la dieta hipocalémica e hiposódica, de la leche batida con frutas y papillas servidas a los pacientes de una Unidad de Nutrición y Dietética de Brasilia (DF). Los datos se recolectaron por medio de observación directa y se elaboraron fichas técnicas de 12 preparaciones de dieta pastosa, nueve de la hipocalémica e hiposódica, cinco de leche con frutas y cuatro papillas en 3 días de la semana, para el cálculo de la densidad energética (DE) de acuerdo con el "Food and energy-containing beverages method". Las DE se clasificaron de acuerdo con el CDC de 2005. Se observó que un 16,7% de las preparaciones de la dieta pastosa presentaron DE entre 0,7 y 1,5kcal/g (DE baja), un 58,3% DE menor que 0,6kcal/g (DE muybaja) y un 25% DE entre 1,5 y 4,0 /g (DE media). El análisis de la dieta hiposódica y hipocalémica mostró que 20% presentaban DE baja, 30% DE muy baja y 50% DE media. Todas las leches con frutas y papillas presentaron DE baja. Los resultados indican que los pacientes que reciben las preparaciones analizadas corren el riesgo de ingerir una cantidad de energía inferior a sus necesidades energéticas, evidenciando la necesidad de una estandarización, planificación de menús y atención a los métodos dietéticos individualizados en la Unidad de Nutrición y Dietética estudiada.

Diante das necessidades especiais de energia, nutrientes e à má nutrição frequentemente observada em pacientes hospitalizados, foi analisada a densidade energética de preparações da dieta pastosa, das preparações da dieta hipocálica e hipossódica, e das vitaminas e mingaus servidos para todas as dietas aos pacientes de uma unidade de Nutrição e Dietética de Brasília - DF. Foram coletados dados por meio de observação direta e elaboradas fichas técnicas de 12 preparações da dieta pastosa, nove da hipocálica e hipossódica e cinco vitaminas e quatro mingaus em 3 dias da semana, para o cálculo da densidade energética (DE) de acordo com o "Food and energy-containing beverages method". As DE foram classificadas de acordo com o CDC, 2005. Observou-se que 16,7% das preparações da dieta pastosa apresentaram DE entre 0,7 e 1,5kcal/g (DE baixa), 58,3% DE menor que 0,6kcal/g (DE muito baixa) e 25% DE entre 1,5 e 4,0/g (DE média). A análise da dieta hipossódica e hipocálica mostrou que 20% apresentaram DE baixa, 30% DE muito baixa e 50% DE média. Todas as vitaminas e mingaus apresentaram DE baixa. Os resultados indicam que os pacientes que recebem as preparações analisadas correm o risco de ingerir uma quantidade de energia inferior às suas necessidades energéticas, ficando evidente a necessidade de padronização, planejamento de cardápios e atenção aos esquemas dietéticos individualizados dentro da Unidade de Nutrição e Dietética estudada.

Low serum zinc levels in an endemic area of visceral leishmaniasis in Bihar, India.

Background & objectives: India carries approximately 50 per cent of the global burden of visceral leishmaniasis and majority of patients from the poor, rural communities of Bihar State. Zinc is an essential trace element and its relevance for proper functioning of the entire immune system is already well documented. Though low serum zinc levels have been reported in many parasitic diseases, limited information is available regarding zinc status in human leishmaniasis. We investigated to define the relationship between zinc level in visceral leishmaniasis (VL) patients in endemic and non-endemic regions. Methods: Venous blood was collected from 88 patients, 16 parasitologically confirmed VL, 35 healthy controls from endemic area (Bihar) and 37 healthy urban controls from non-endemic area, Delhi. In all the three groups, levels of serum albumin, total protein (markers of nutritional status) and zinc were estimated by colorimetric methods. Results: Serum zinc levels were found to be significantly lower (P<0.001) in VL patients than non-endemic controls. The serum zinc levels in VL endemic controls were also significantly lower (P<0.001) than non-endemic controls, but these values were not statistically significantly different from VL patients. However, all samples from Bihar (VL patients and controls) had lower serum zinc levels than non-endemic controls from Delhi. Interpretation & conclusion: Low serum Zn levels, in healthy subjects from Bihar and more significantly in VL patients of this region, are possibly associated with vulnerability and endemicity of visceral leishmaniasis in the region. Further studies need to be done to assess the role of oral zinc supplementation in better management and prevention of VL, particularly in endemic areas.

Recién nacidos con bajo peso; causas, problemas y perspectivas a futuro

El bajo peso al nacimiento (BPN) es un problema de salud pública mundial, que impacta sobre la mortalidad neonatal e infantil. Entre los múltiples factores asociados al BPN se han señalado las características antropométricas, nutricionales, socioculturales y demográficas de la madre; los antecedentes obstétricos y condiciones patológicas que afectan la funcionalidad y suficiencia placentaria, así como las alteraciones propiamente fetales. Las repercusiones del BPN no se confinan sólo al período neonatal inmediato o al mediano plazo, ya que el retardo en el crecimiento y desarrollo puede continuar hasta la edad adulta, e incluso manifestarse sobre su descendencia. Junto con la prematuridad, el BPN es el factor predictivo, más fuertemente asociado a mortalidad. Los niños con BPN son un grupo heterogéneo que comprende tanto a aquellos de término con peso bajo para la edad gestacional, aquellos con retardo del crecimiento intrauterino, a los prematuros, como a los productos de embarazos múltiples. Cada uno de ellos tiene diferente etiología, evolución ulterior, secuelas, morbilidad y mortalidad. Dicha diversidad dificulta su estudio grupal. Este panorama nos muestra la dificultad para determinar la magnitud y tipo de secuelas neurológicas que podría presentar un paciente con BPN, ya que el proceso dependerá de las alteraciones prenatales, del momento en que se presente el daño y la causa que lo origina, el tipo de paciente, el nivel de atención que recibe antes, durante y después del parto y las posibilidades de rehabilitación, determinadas muchas veces por aspectos ajenos al ambiente médico.

Low birth weight (LBW) is a worldwide health problem that affects the newborn morbidity and mortality. Among the multiple issues mentioned associated with LBW are: anthropological, nutritional, sociocultural and demographic status of the mother; obstetrical data and pathology that influences the function and sufficiency of the placenta in addition to fetal abnormalities. Repercussions seen in LBW are not confined to the immediate neonatal period, since the delay in development and growth can persist up to adulthood and can be manifested into their offspring. Besides prematurity LBW is the strongest predictive factor associated with mortality. Newborns with LBW are an heterogeneous group that comprises neonates at term with low weight for gestational age, those with intrauterine growth retardation, prematures and those born from multiple pregnancies. Each 1 with a different etiology, medical attention received before, during and after birth and finally different possibility to receive rehabilitation, often related to socioeconomic issues outside from the medical realm.