RESUMO
Abstract: Introduction: Early identification of developmental delays or disabilities in children is a challenge and a global concern. In Mexico, the prevalence of childhood disability is 6%, and it is estimated that 25% of the unattended delays will have consequences on their potential. VANEDELA is a rapid screening test to detect and prevent developmental disorders in primary health care. Objective: To determine the external validity and test-retest reliability of the behavioral (DB) and reflex (DR) developmental formats of the VANEDELA screening test, compared with the diagnostic test of Gesell's Developmental Schedule Test. Method: Descriptive, transversal, and prospective study in 379 infants aged one to 24 months attending the Neurodevelopment Monitoring Laboratory / INP and the ISSSTE Tlalpan Family Medicine Clinic from 2011 to 2014. Measurements: A set of four aspects was evaluated including validity by external criteria: sensitivity, specificity, positive-negative predictive criteria, and test-retest reliability. Results: In the DB format, we found a 79% - 89% sensitivity (S) and a 83% - 95% specificity (Sp). In the DR format, a 18% - 35% sensitivity and a 81% - 96% specificity were found. Using both DB-DR formats, we found a 82% - 89% sensitivity and 72% to 91% specificity, and a test-retest reliability .62-1. Discussion and conclusion: The VANEDELA increased its validity parameters with respect to the previous assessment with adequate stability. The DB formats and the DB-DR combination of VANEDELA have an adequate validity based on external criteria, making them suitable for use in primary health care.
Resumen: Introducción: La identificación temprana de retrasos o discapacidades del desarrollo en los niños es un reto y una preocupación mundial. En México, la prevalencia de discapacidad infantil es del 6% y se estima que un 25% de los retrasos no atendidos tendrán consecuencias en su potencial alcanzado. El VANEDELA es una prueba de tamizaje rápido para detectar y prevenir alteraciones del desarrollo en el primer nivel de atención. Objetivo: Determinar la validez (criterio externo) y confiabilidad (test-retest) de los formatos de conductas (CD) y reacciones del desarrollo (RD) de la prueba de tamizaje VANEDELA, contrastado con la Prueba Diagnóstica de Desarrollo de Gesell. Método: Estudio descriptivo, transversal y prospectivo en 379 lactantes de uno a 24 meses que asistieron al Laboratorio de Seguimiento del Neurodesarrollo del INP y la Clínica de Medicina Familiar Tlalpan del ISSSTE de 2011 a 2012. Mediciones: Validez por criterio externo, sensibilidad y especificidad, validez predictiva positiva y negativa; confiabilidad test-retest (intervalo de siete días). Resultados: En el formato CD, se encontró sensibilidad (S) de 79% a 89% y especificidad (E) de 83% a 95%. Utilizando ambos formatos CD-RD, se encontraron una sensibilidad de 82% a 89% y una especificidad de 72% a 91%. Test-retest .62-1. Discusión y conclusión: El VANEDELA aumentó sus parámetros de validez con respecto a la valoración anterior, estabilidad adecuada. Los formatos CD y la combinación CD-RD del VANEDELA poseen una adecuada validez por criterio externo y estabilidad test-retest, para ser utilizada en el primer nivel de atención.
RESUMO
BACKGROUND: Ultrasonography of cortical and cingulum maturity patterns, were studied in newborns and infants with congenital hypothyroidism (CH). METHOD: Transversal study of 29 newborns and infants with CH, detected by neonatal screening and confirmed with thyroid function test, thyroid ultrasonography, and thyroid scintigraphy. During the first 2 months of life, transfontanelar brain ultrasonography was performed. Brain cortex maturity was assessed by normality referents provided by Slagle and Timor methods. RESULTS: Cortical immaturity signs were observed in 69% of infants (20 patients with Slage's method brain cortex development delay (Pearson's p=0.05). Logistic nominal analysis for normality prediction demonstrated a correlation between brain cortex development and age, bone age, treatment duration, and type of CH. The most sensitive detecting technique was sagittal sight by Slagle's method. CONCLUSIONS: Brain cortex delayed development is frequent in children with CH. Bone age, postnatal age at treatment start, and time since treatment start, correlates with neurological development, but not athyreosis or sublingual nodule.
