Factores asociados al bajo peso al nacer en un hospital universitario del departamento de Nariño / Factors associated with low birth weight at a university hospital from the department of Nariño (Colombia)

Resumen Introducción: El Bajo Peso al Nacer (BPN) tiene múltiples causas y continúa siendo un problema que afecta diferentes regiones de Colombia. Objetivo: Determinar los factores asociados con BPN en el Hospital Universitario Departamental de Nariño. Materiales y métodos: Estudio de casos y controles que incluyó madres y recién nacidos, cuyo parto fue atendido entre noviembre de 2014 y junio de 2015. Resultados: El riesgo de BPN fue mayor en mujeres con edad entre 10-19 años (OR=7,79, IC95%=2,61-23,23), con antecedente de infección vaginal durante el embarazo (OR=4, IC95%=1,26-12,66), nivel educativo primaria incompleta (OR=10,93, IC95%=1,51-79,13) o primaria completa (OR=2,94, IC95%=1,06-8,13), afiliadas al régimen de salud subsidiado (OR=4,96, IC95%=1,71-14,41). El riesgo de tener un recién nacido con BPN se redujo un 10% (OR=0,90, IC95%=0,84-0,96) por cada incremento en una unidad de Índice de Masa Corporal y un 76% (OR=0,23, IC95%=0,16-0,34) por cada incremento en una semana de gestación. Conclusiones: La mayoría de factores de riesgo identificados pueden ser prevenidos o intervenidos precozmente desde un enfoque de salud pública.

Abstract Introduction: Low Birth Weight (LBW) has multiple causes and continues to be a problem that affects different regions of Colombia. Objective: To determine factors associated with LBW in the Departmental University Hospital of Nariño (Colombia). Materials and methods: A case-control study that included newborns and mothers whose delivery took place between November 2014 and June 2015. Results: Risk of LBW was higher in: women aged between 10-19 years (OR=7.79, 95%CI=2.61-23.23); with history of vaginal infection during pregnancy (OR=4, 95%CI=1.26-12.66); and those affiliated with the subsidized health regimen (OR=4.96, 95%CI=1.71-14.41). The risk of having a newborn with LBW was reduced by 10% (OR=0.90, 95%CI=0.84-0.96) for each one unit increase in Body Mass index, and by 76% (OR=0.23, 95%CI=0.16-0.34) for each increase in one week of gestation. Conclusions: Most of the identified risk factors can be prevented or intervened with through an early public health approach.

[Unusual Organophosphate Poisoning: Transplacental Route]. / Intoxicación inusual por organofosforados: Vía transplacentaria.

INTRODUCTION: Accidental or intentional intoxication by organophosphates, which are toxic substances that inhibit acetylcholinesterase, constitutes a serious public health problem worldwide, with a greater impact in developing countries. Chronic intoxication during pregnancy with alterations in neurodevelopment and fetal growth has been described. OBJECTIVE: To describe an unusual case of transplacentally acquired organophosphorus poisoning, highlighting the clinical presentation, the management with atropine, and the neurological outcome. CLINICAL CASE: 36-weeks premature newborn, whose mother presented acute intentional organophosphorus poisoning 17 hours before birth. The patient was born by emergency C-section, without respiratory distress, with bradycardia, hypotonia, miosis, and bron- chorrhea, as well as clinical signs and laboratory evidence of acute poisoning, with severe metabolic acidosis, and decreased cholinesterase activity. She required advanced resuscitation, management in the Neonatal Intensive Care Unit with invasive ventilation, inotropes, and repeated doses of atropine. She evolved with left hemiparesis and convulsive syndrome that was treated with phenobarbital. She was discharged at 34 days of life with her mother, under custody and supervision of social and family welfare. Treatment and follow-up were suspended until her first year of life when her custody was transferred to an aunt. In neurological control at 18 months, she presented persistence of hemiparesis and speech-language delay, without new seizures. CONCLUSIONS: Organophosphorus poisoning is very rare in the neonatal period and due to the absence of guidelines for the management of this type of patients its treatment is challenging and must be individualized, multidisciplinary, evaluating the risk and benefit of each intervention.