El recién nacido expuesto a cocaína antenatal: una propuesta de intervención médica y psicosocial integrada / The newborn exposed to antenatal cocaine: a proposal for integrated medical and psychosocial intervention

Introducción: El consumo de cocaína durante la gestación gatilla isquemia, muerte y licuefacción celular en el cerebro fetal, consolidando en la infancia grados variables de retraso mental. El presente estudio busca identificar mediante test de drogas en orina los recién nacidos (RN) expuestos a cocaína en el embarazo y describir el procedimiento clínico y social a seguir. Metodología: Estudio de cohorte prospectivo enero 2016 y enero 2018 en RN con exposición antenatal a cocaína, Unidad de Neonatología del Hospital Clínico San Borja Arriarán. Resultados: Se estudió a 64 RN con test en orina positivo a cocaína. El 42% fue pequeño para la edad gestacional, 33% tenía microcefalia. Se encontraron malformaciones en sistema nervioso y vías urinarias, trastornos del ritmo cardíaco e hipoacusia. Solo 32,8% de las madres controló su embarazo y 52% rechazó la rehabilitación. Servicio Social interpuso medidas de protección a los RN e instó a las madres a programas de rehabilitación. El 12,5% de los RN no tenía familia de apoyo y debió ser derivado a instituciones gubernamentales. Conclusiones: Las consecuencias de la exposición a cocaína antenatal en el RN son devastadoras. Este trabajo permite orientar la pesquisa, estudio y pasos legales a seguir con los RN afectados y sus madres.

Introduction: The consumption of cocaine during pregnancy triggers events such as ischemia, death and cell liquefaction in the fetal brain, consolidating varying degrees of intellectual disability. This study proposed to identify by urine drug test the newborns (NB) with antenatal exposure to and describe the clinical and social procedure to follow with them and their mothers until neonatal discharge. Methodology: Prospective cohort study, conducted in RN who met criteria for risk of antenatal exposure to cocaine, Neonatology Unit of the San Borja Arriaran Clinical Hospital between January 2016 -2018. Results: Antenatal exposure to cocaine was confirmed on 64 NB. Forty-two percent of them were small for gestational age and 33% had microcephaly. Malformations were found in the nervous system urinary tract, as well as disorders in the rhythm of the heart and loss of hearing. Only 32% of mothers controlled her pregnancy, none of them was derived to the secondary. Social Services implemented all the NB protective measures in place and urged mothers to participate in rehabilitation programs. Fifty-two percent rejected rehabilitation and 12.5% of the NB have not family support and had to be referred to government institutions. Conclusions: The consequences of exposure to antenatal cocaine in the NB are devastating. This work allows orienting the research with the NB and showing the legal steps should be taken with the RN and their mothers.

Efeitos da exposição pré-natal e pós-natal ao etanol no córtex cerebral de ratos: um estudo do neurópilo / Effects of prenatal and postnatal ethanol exposure in the cerebral cortex of rats: a study of neuropil

INTRODUÇÃO: Exposição pré-natal ao etanol é freqüentemente associada a microcefalia e atraso na migração celular. O mecanismo pelo qual o etanol induz seus efeitos no desenvolvimento do sistema nervoso não é muito bem entendido. OBJETIVOS: Avaliar o efeito da exposição crônica ao etanol sobre o córtex visual de ratos durante seu desenvolvimento. MATERIAL E MÉTODO: Ratos Wistar provenientes do acasalamento de 30 fêmeas, divididos nos grupos etanol (n = 10) - 3 g/kg/dia - e controle (n = 10), foram utilizados nesse experimento. Os ratos foram perfundidos e o encéfalo, dividido em três partes: anterior, médio e posterior. Os cortes obtidos do fragmento posterior foram expostos à rotina histológica e submetidos a diferentes técnicas de coloração. Na análise estatística foi utilizado o teste t para comparar os pesos encefálicos e corporais. Considerou-se como nível de rejeição de hipótese nula um valor de p < 0,05. RESULTADO: Houve redução de peso cerebral em diferentes períodos analisados, além de ectopia e heterotopia neuronal. Não se observou deposição de fibras. DISCUSSÃO/CONCLUSÃO: O etanol atua de maneira negativa no desenvolvimento dos ratos, incluindo alterações na migração neuronal e microcefalia. Essas alterações podem ajudar a explicar as disfunções relatadas na síndrome do alcoolismo fetal (SAF).

BACKGROUND: Prenatal exposure to ethanol is frequently associated with microencephaly and delayed cell migration. The mechanism by which ethanol affects the development of the nervous system is still not fully understood. OBJECTIVE: To evaluate the effect of chronic exposure to ethanol on the visual cortex of rats during their development. MATERIAL AND METHOD: Wistar rats, born from the mating of 30 females, were divided into two groups: those exposed to ethanol (n = 10) - 3 g/kg/day - and a control group (n = 10). The rats were perfused and brain was divided into three parts: anterior, middle and posterior. Slices taken from the posterior fragment were subjected to histological analysis routine and different staining techniques. A statistical analysis was carried out using t test to compare brain and body weight. A value < 0,05 was considered a rejection of null hypothesis. RESULTS: There was a reduction of brain weight in different analyzed periods. There were no fiber deposits. Ectopia and neuronal heterotopia were observed. DISCUSSION/CONCLUSION: Ethanol has a negative effect on the development of rats, including alterations in neuronal migration and microencephaly. These alterations may help to explain some of the dysfunctions reported in patients with fetal alcohol syndrome (FAS).

Neuroembryotoxic effect of 5- Fluorouracil in rat: injecting in late phase of gestation.

Macro and microscopic findings in developing brain of rat fetuses were observed after intraperitoneal injection with a single dose (30mg/kg) of 5-Fluorouracil (5-FU) in late phase of gestation. 5-FU induced more than 60.0% lethality with significant reduction (p<0.001) in weight and various dimensions of the developing brain. Macroscopic findings of the developing brain revealed microcephaly, regression or absence of the olfactory lobe and obliteration of the various fissures on the dorsal surface. Microscopic examination of the olfactory lobe of treated brain showed the obliteration of the olfactory ventricle, distortion of the cellular arrangement of various layers of the olfactory cortex with clumping of degenerated neurons and glial cells. Cerebral cortex of the treated brain revealed the distortion of normal cytoarchitecture of the various cortical layers. The neurons of the treated brain revealed the degeneration, deeply stained eccentric nucleus with loss of mitotic figures and pyknotic changes. Subcortical zone of the treated cerebrum showed the degenerative changes in the fibrous structure along with paucity of the glial cells. The hippocampus of the treated brain revealed the loss of normal cytoarchitecture and shrinkage of all the layers. Neuroembyopathic effect of 5-FU is severe, when given in late phase of pregnancy, so it is advisable that the drug should be avoid during the late period of pregnancy.

Efectos deletéreos de la inhalación de solventes volátiles durante el período crítico del desarrollo: oncogenia cerebral y conductual / Adverse effects of flying solvent inhalation during critic period of the development: behavioral and cerebral oncogenic

La inhalación de solventes orgánicos volátiles (en especial el contenido en pegamentos) es una práctica frecuentemente observada en niños pertenecientes a estratos socioeconómicos y culturales deprivados. Evidencias clínicas hans demostrado que los adictos a estas sustancias psicotrópicas, sufren marcados trastornos conductuales, potenciados por grados variables de alcoholismo, desnutrición, etc. Tales influencias adversas, resultan difíciles de aislar clínicamente. El objetivo del presente estudio fue evaluar experimentalmente los probables efectos negatios que produce la inhalación crónica de solventes volátiles, realizada durante el período crítico del desarrollo, sobre la oncogenia cerebral y conductual. 64 ratas albinas de la cepa Sprague-Dawley fueron expuestas a inhalación de tolueno y hexano (contenidos en pegamentos) entre los días postnatales 2 y 21. La dosis fue determinada (previa estandarización realizada en estudio piloto) por el tiempo de inhalación, el tamaño de la superficie de emanación y frecuencia de exposiciones diarias. Se estudió la oncogenia de conductas neuromotoras básicas conjuntamente con mediciones encefálicas macroscópicas (peso cerebral y cerebeloso, diámetros cerebrales). Los resultados obtenidos indican que los sujetos expuestos al solvente presentan grados variables de retraso, tanto a nivel conductual (natación, geotaxia negativa, trepa en cuerda, reacción de apoyo, coordinación-equilibrio, evitación de precipicio y exploratividad en campo abierto) como cerebral (peso y diámetros cerebrales)