Seguimiento de la actividad clínica y del daño orgánico acumulado en una cohorte de pacientes con lupus eritematoso sistémico de la península de Yucatán, México (1995-2016) / Follow-up of clinical activity and accumulated organic damage in a cohort of patients with Systemic Lupus Erythematosus from the Yucatán peninsula, México (1995-2016)

Introducción: El lupus eritematoso sistémico (LES) es una enfermedad autoinmune con severidad variable, frecuente en individuos hispanos y afroamericanos. Objetivo: Conocer la actividad clínica y el daño acumulado, así como la prevalencia e incidencia, en una cohorte dinámica de pacientes con LES de la península de Yucatán (1995 a 2016). Pacientes y métodos: Se analizaron 200 pacientes con LES, beneficiarios del servicio médico del Hospital Regional ISSSTE de Mérida, Yucatán, durante 22 años. Se evaluó la actividad de la enfermedad y el daño acumulado mediante la escala MEX-SLEDAI y SLICC-ACR-DI, respectivamente, y su correlación con variables clínicas y demográficas. Resultados: Se analizaron 185 pacientes mujeres y 15 hombres. Los índices promedio de actividad y daño acumulado durante el seguimiento fueron de 4,63 y 1,10, respectivamente. El índice de actividad se observó significativamente menor en las mujeres respecto de los hombres (4,36 vs. 7,43), y el daño acumulado no presentó diferencia por sexo. Las manifestaciones asociadas con mayor actividad fueron las mucocutáneas y articulares, y los órganos con mayor daño acumulado el musculoesquelético, el neurológico y el gonadal. Se encontró relación de los índices con el tiempo de evolución, las remisiones/reactivaciones y la actividad persistente. La mortalidad se relacionó con actividad persistente por complicaciones vasculares sistémicas e insuficiencia renal y hepática. La incidencia y prevalencia anual del LES calculada fue de 2,86% y 48,43% en la península de Yucatán. Conclusiones: Los pacientes presentaron actividad persistente, con reactivaciones leves a moderadas y daño acumulado más agresivo en hombres. La actividad clínica disminuye e incrementa el daño acumulado a mayor tiempo de evolución, con menor afección renal y mayor sobrevida, lo que sugiere un curso más benigno en la población de la península de Yucatán.(AU)

IntroductionSystemic lupus erythematosus (SLE) is an autoimmune with variable severity, common in Hispanic and African-American individuals.Objective: To know the clinical activity and the accumulated damage, as well as the prevalence and incidence, in a dynamic cohort of patients with SLE from the Yucatan Peninsula (1995-2016). Patients and methods: A cohort of 200 patients with SLE, medical service beneficiaries of the ISSSTE Regional Hospital of Mérida, Yucatán, was analyzed for 22 years. Disease activity and accumulated damage were evaluated using the MEX-SLEDAI scale and the SLICC-ACR-DI, respectively, and its correlation with clinical and demographic variables. Results: 185 female and 15 male patients were analyzed. Average accumulated damage and activity indices during follow-up were 4.63 and 1.10, respectively. The activity index was significantly lower in females compared to males (4.36 vs 7.43), and the accumulated damage did not present a difference by sex. The manifestations associated with greater activity were the mucocutaneous and articular ones, and the organs with the greatest accumulated damage were the musculoskeletal, neurological and gonadal. A relationship between the indices was found with the evolution time, remissions / reactivations, and persistent activity. Mortality was related to persistent activity due to systemic vascular complications and kidney and liver failure. The annual incidence and prevalence of SLE calculated was 2.86% and 48.43% in Yucatán Peninsula. Conclusions: The patients presented persistent activity, with mild to moderate reactivations, and accumulated damage more aggressive in men. The clinical activity decreases and increases the accumulated damage at a longer evolution time, with less kidney disease and greater survival, which suggests a more benign course in the population of the Yucatan Peninsula.(AU)

Follow-up of clinical activity and accumulated organic damage in a cohort of patients with systemic lupus erythematosus from the Yucatán Peninsula, Mexico (1995-2016).

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune with variable severity, common in Hispanic and African-American individuals. OBJECTIVE: To know the clinical activity and the accumulated damage, as well as the prevalence and incidence, in a dynamic cohort of patients with SLE from the Yucatan Peninsula (1995-2016). PATIENTS AND METHODS: A cohort of 200 patients with SLE, medical service beneficiaries of the ISSSTE Regional Hospital of Mérida, Yucatán, was analysed for 22 years. Disease activity and accumulated damage were evaluated using the MEX-SLEDAI scale and the SLICC-ACR-DI, respectively, and its correlation with clinical and demographic variables. RESULTS: 185 female and 15 male patients were analysed. Average accumulated damage and activity indices during follow-up were 4.63 and 1.10, respectively. The activity index was significantly lower in females compared to males (4.36 vs 7.43), and the accumulated damage did not present a difference by sex. The manifestations associated with greater activity were the mucocutaneous and articular ones, and the organs with the greatest accumulated damage were the musculoskeletal, neurological and gonadal. A relationship between the indices was found with the evolution time, remissions/reactivations, and persistent activity. Mortality was related to persistent activity due to systemic vascular complications and kidney and liver failure. The annual incidence and prevalence of SLE calculated was 2.86% and 48.43% in Yucatán Peninsula. CONCLUSIONS: The patients presented persistent activity, with mild to moderate reactivations, and accumulated damage more aggressive in men. The clinical activity decreases and increases the accumulated damage at a longer evolution time, with less kidney disease and greater survival, which suggests a more benign course in the population of the Yucatan Peninsula.

Oral Motor Treatment Efficacy: Feeding and Swallowing Skills in Children with Cerebral Palsy.

This study is aimed at identifying the relationship between oral motor treatment and the improvement of abilities for feeding and swallowing in boys and girls with CP residing in the state of Yucatán. The sample consisted of 30 patients with a diagnosis of CP and the presence of ADT, with gross motor function levels from II to V, between 3 and 14 years old, of which 50% received oral motor treatment. The predominant diagnosis was spastic CP and tetraplegia. An interview was carried out with the tutor, the application of the gross motor skills scale, and an assessment of feeding skills. The feeding and swallowing skills that improved significantly with the oral motor treatment were mandibular mobility, tongue activity, abnormal reflexes, control of breathing, and general oral motor skills (p ≤ 0.05). Within the sample that did not receive oral motor treatment, 46% presented low or very low weight and 40% referred recurrent respiratory diseases. In the end, it was concluded that feeding skills improve significantly with oral motor treatment, regardless of the severity of gross motor involvement. Likewise, oral motor treatment was associated with a lower presence of respiratory diseases and nutritional compromise.

Abnormalities of the rib growth plate and the periphysis of previously healthy infants and toddlers dying suddenly and unexpectedly.

AIMS: Histological examination of the rib is of critical value in perinatal pathology and points to the health of the child preceding death. The rib is considered ideal because it is the most rapidly growing long bone in infants and demonstrates growth arrest at onset of the insult. We aimed to identify: (1) changes in the perichondrial ring (PR) in the rib of infants and children up to 16 months of age dying suddenly at our institution and (2) any association with presence of histological changes of vitamin D deficiency (VDD)/metabolic bone disease (MBD) in the growth plate. METHODS: Retrospective review of the PR histology and comparison with the presence or absence of histological features of VDD in the growth plate of 167 cases. The cases were anonymised and divided in six age/gender categories. RESULTS: Periphyseal abnormalities were only seen in 38% of the cases; of whom 33% had established and 67% had mild changes. Only 14.5% of cases with established histological appearance of VDD at the growth plate had significant PR abnormality; of whom majority (83%) were ≤3 months of age and none ≥9 months old, reflecting a temporal relation with birth and beyond the perinatal period. CONCLUSION: The histological changes in the PR are significantly associated with histological changes of VDD/MBD at the rib growth plate with an OR of 3.04.

Efecto de una intervención educativa sobre el estilo de vida, el control glucémico y el conocimiento de la enfermedad, en personas con diabetes mellitus tipo 2, Bokobá, Yucatán / Effect of an educational intervention on type 2 diabetes mellitus patients concerning lifestyle, glycemic control, and knowledge about the disease, in Bokobá, Yucatán

Resumen Introducción En México, en 2017 el Instituto Nacional de Estadística y Geografía reportó a la diabetes mellitus tipo 2 [DT2] como la segunda causa de muerte. Para lograr controlar esta enfermedad, uno de los enfoques más útiles es el de ofrecer educación suficiente y actualizada a quienes viven con ella. Objetivo Determinar el efecto de una intervención educativa sobre el estilo de vida, el grado de conocimientos sobre DT2 y el nivel de la hemoglobina glucosilada [HbA1c], Material y métodos Cuasi-experimento. Se impartieron pláticas educativas durante cuatro meses a personas con DT2 del Seguro Popular del Centro de Salud de Bokobá, Yucatán. El estilo de vida se evaluó con el Instrumento para medir el estilo de vida en diabéticos [IMEVID], y el grado de conocimientos en DT2 con un cuestionario validado. Se usaron pruebas t de student pareadas y pruebas de Wilcoxon para hacer las comparaciones. Resultados Participaron 39 pacientes. Las medias pre y post intervención: para el IMEVID 63.15 y 77.41 puntos [p < 0.001], para el grado de conocimientos 25.73 y 79.70 puntos [p < 0.001] y para la HbA1c de 9.25% y 8.14% [p < 0.001], respectivamente. Conclusiones La intervención educativa mejoró significativamente el estilo de vida y el grado en conocimientos. También, logró disminuir el nivel de HbA1c.

Abstract Introduction In Mexico in 2017, the National Institute of Statistics and Geography reported type 2 diabetes mellitus [DT2] as the second cause of death. In order to control this disease, one of the most useful approaches is to provide sufficient and updated training to those who live with it. Objective To determine the effect of an educational intervention based on proper lifestyle, the degree of theoretical knowledge about DT2 and on the level of glycosylated hemoglobin [HbA1c]. Materials and methods Quasi-experimental design. Educational sessions were held for four months to DT2 patients with Seguro Popular in the Bokobá Health Center, Yucatán. The Instrument for the Measurement of Lifestyle in Diabetics [IMEVID] was applied, and the degree of knowledge about DT2 was assessed using a validated questionnaire. Paired student t tests and Wilcoxon tests were used for the comparisons. Results 39 patients were included. The pre and post intervention mean values were: for Life Style Scores 63.15 and 77.41 points [p < 0.001], for knowledge levels 25.73 and 79.70 points [p < 0.001], and for HbA1c 9.25% and 8.14% [p < 0.001], respectively. Conclusions The educational intervention, significantly improved the lifestyle and the degree of knowledge about DT2, and significantly reduced the HbA1c values.

Cost Effectiveness of Intracranial Pressure Monitoring in Pediatric Patients with Severe Traumatic Brain Injury: A Simulation Modeling Approach.

OBJECTIVES: To conduct an economic evaluation of intracranial pressure (ICP) monitoring on the basis of current evidence from pediatric patients with severe traumatic brain injury, through a statistical model. METHODS: The statistical model is a decision tree, whose branches take into account the severity of the lesion, the hospitalization costs, and the quality-adjusted life-year for the first 6 months post-trauma. The inputs consist of probability distributions calculated from a sample of 33 surviving children with severe traumatic brain injury, divided into two groups: with ICP monitoring (monitoring group) and without ICP monitoring (control group). The uncertainty of the parameters from the sample was quantified through a probabilistic sensitivity analysis using the Monte-Carlo simulation method. The model overcomes the drawbacks of small sample sizes, unequal groups, and the ethical difficulty in randomly assigning patients to a control group (without monitoring). RESULTS: The incremental cost in the monitoring group was Mex$3,934 (Mexican pesos), with an increase in quality-adjusted life-year of 0.05. The incremental cost-effectiveness ratio was Mex$81,062. The cost-effectiveness acceptability curve had a maximum at 54% of the cost effective iterations. The incremental net health benefit for a willingness to pay equal to 1 time the per capita gross domestic product for Mexico was 0.03, and the incremental net monetary benefit was Mex$5,358. CONCLUSIONS: The results of the model suggest that ICP monitoring is cost effective because there was a monetary gain in terms of the incremental net monetary benefit.

Monitorización de la presión intracraneal en traumatismo craneoencefálico severo / Monitoring intracranial pressure in severe traumatic brain injury

Introducción: El traumatismo craneoencefálico severo (TCES) es una entidad grave. La monitorización de la presión intracraneal (PIC) permite dirigir el tratamiento, el cual es de limitado acceso en países en vías de desarrollo. Objetivo: Describir la experiencia clínica de pacientes pediátricos con TCES. Pacientes y método: Se incluyeron pacientes con TCES, edad entre 1 y 17 años, previo consentimiento informado de los padres y/o tutores. Se excluyeron pacientes con enfermedades crónicas o retraso psicomotor. Los pacientes ingresaron desde el Servicio de Urgencia, donde se les realizó scanner cerebral (TAC), clasificándose las lesiones por Escala de Marshall. Los pacientes fueron divididos en 2 grupos según criterio neuroquirúrgico: con monitorización (CM) y sin monitorización (SM) de presión intracraneana. La monitorización de la PIC se realizó a través de un catéter intraparenquimatoso 3PN Spiegelberg conectado a un monitor Spiegelberg HDM 26. Los pacientes fueron tratados de acuerdo a las guías pediátricas para TCES. Se consideró la supervivencia como los días transcurridos entre el ingreso hospitalario y el fallecimiento, o su evaluación por Escala de Glasgow para un seguimiento de 6 meses. Resultados: Cuarenta y dos pacientes (CM = 14 y SM= 28). Aquellos con monitorización tenían menor puntuación de la escala de coma de Glasgow y clasificación de Marshall con peor pronóstico. En ellos la supervivencia fue menor y el resultado moderado a bueno. No se registraron complicaciones con el uso del catéter de PIC. Conclusión: Pacientes con monitorización tuvieron mayor gravedad al ingreso y una mayor mortalidad; sin embargo, el resultado funcional de los sobrevivientes fue de moderado a bueno. Se requiere de la realización de ensayos clínicos aleatorizados para definir el impacto de la monitorización de la PIC en la supervivencia y calidad de vida en estos pacientes.

Introduction: Severe traumatic brain injury (TBI) is a serious condition. Intracranial pressure (ICP) monitoring can be used to direct treatment, which is of limited access in developing countries. Objective: To describe the clinical experience of pediatric patients with severe TBI. Patients and Method: A clinical experience in patients with severe TBI was conducted. Age was 1-17 years, exclusion criteria were chronic illness and psicomotor retardation. Informed consent was obtained in each case. Two groups were formed based on the criterion of neurosurgeons: with and without intracraneal pressure (ICP) monitoring. PIC monitoring was performed through a 3PN Spiegelberg catheter and a Spiegelberg HDM 26 monitor. Patients were treated according international pediatric guides. The characteristics of both groups are described at 6 months of follow-up. Results: Forty-two patients (CM=14 and SM=28). Those in the CM Group had lower Glasgow coma scale score and Marshall classification with poorer prognosis. Among them survival rate was lower, although the outcome was from moderate to good. No complications were reported with the use of the ICP catheter. Conclusion: Patients with ICP monitoring had greater severity at admission and an increased mortality; however, the outcome for the survivors was from moderate to good. It is necessary to conduct randomized clinical trials to define the impact of ICP monitoring on survival and quality of life in severe TBI patients.

[Monitoring intracranial pressure in severe traumatic brain injury]. / Monitorización de la presión intracraneal en traumatismo craneoencefálico severo.

INTRODUCTION: Severe traumatic brain injury (TBI) is a serious condition. Intracranial pressure (ICP) monitoring can be used to direct treatment, which is of limited access in developing countries. OBJECTIVE: To describe the clinical experience of pediatric patients with severe TBI. PATIENTS AND METHOD: A clinical experience in patients with severe TBI was conducted. Age was 1-17 years, exclusion criteria were chronic illness and psicomotor retardation. Informed consent was obtained in each case. Two groups were formed based on the criterion of neurosurgeons: with and without intracraneal pressure (ICP) monitoring. PIC monitoring was performed through a 3PN Spiegelberg catheter and a Spiegelberg HDM 26 monitor. Patients were treated according international pediatric guides. The characteristics of both groups are described at 6 months of follow-up. RESULTS: Forty-two patients (CM=14 and SM=28). Those in the CM Group had lower Glasgow coma scale score and Marshall classification with poorer prognosis. Among them survival rate was lower, although the outcome was from moderate to good. No complications were reported with the use of the ICP catheter. CONCLUSION: Patients with ICP monitoring had greater severity at admission and an increased mortality; however, the outcome for the survivors was from moderate to good. It is necessary to conduct randomized clinical trials to define the impact of ICP monitoring on survival and quality of life in severe TBI patients.

Measurement of nucleated red blood cells in the peripheral blood as a marker of hypoxia in sudden unexpected death in infancy.

AIMS: A recently proposed classification of sudden unexpected infant death incorporates consideration of possibly asphyxia. This depends on an adequate postmortem, scene investigation and history. A reliable marker of asphyxia has yet to be identified. Such a marker could assist in classifying these deaths. Our aim was to determine if the level of nucleated red blood cells (nRBCs) in the peripheral blood could help identify those possibly asphyxia-related deaths and if risk factors could influence this level in the peripheral blood. METHODS: Cases of sudden unexpected deaths in infancy and sudden infant death syndrome (SIDS) which occurred over a period of 6 years (2007-2013) and were autopsied at Sheffield Children's Hospital were reviewed and categorised according to a new classification proposed by Randall et al. The cases were then correlated with the blood level of nRBCs determined at the time of post mortem examination. The study was approved by the Clinical Governance Department, number SE331. RESULTS: 139 deaths were classified into Group A (true SIDS, 67 cases), Group B (possible asphyxia related, 24 cases), Group C (non-asphyxia-related, 6 cases), Group D (no crime scene investigation, 0 cases) and Group E (identifiable cause, 42 cases). The levels were significantly increased in ex-premature babies, in infants with an underlying condition (Group C) and in deaths related to illness or trauma (Group E). There was a trend towards higher levels of nRBCs in younger age groups and in babies born to smoking mothers. CONCLUSIONS: SIDS remains a difficult diagnosis to make despite the current medical technological advances where no marker of hypoxia has yet been identified.

Increased number of fetal nucleated red blood cells in the placentas of term or near-term stillborn and neonates correlates with the presence of diffuse intradural hemorrhage in the perinatal period.

Release of nucleated red blood cells (nRBCs) into the peripheral blood occurs in stillbirths/neonates with a probable hypoxic mode of death and antenatal stress. We correlated the number of nRBCs in the placenta with the occurrence of intradural (IDH) and subdural hemorrhage (SDH) and the potential link with fetal hypoxia. Two groups of 22 cases each of nonmacerated term or near-term (≥36 weeks of gestational age) stillborn or newborns dying in the 1st day of life were studied. One group had IDH (with or without SDH) and the other did not have IDH or SDH. In each case, the number of nRBCs was determined in 10 consecutive placental fields at ×40. Data were analyzed with Fisher exact test, receiver operating characteristic (ROC) curve analysis, and logistic regression. There was a significant association between the diffuse IDH and increased number of nRBCs (Fisher exact test P  =  0.0165). An ROC curve analysis showed that the cut-off number of nRBCs with the highest accuracy was 2.15 nRBCs/high-power field, with 79% sensitivity and 67% specificity. The presence of diffuse IDH was associated with SDH (Fisher exact test, P  =  0.002). The absence of hypoxic brain change was associated with the absence of diffuse IDH (odds ratio 0.308; P  =  0.039). We established a significant correlation between the release of nRBCs into the placental circulation and the occurrence of diffuse IDH and between diffuse IDH and the presence of SDH.

The impact of public expenditure on undernourishment distribution in Mexico.

The status of undernourishment in children under the age of five in Mexico is open to debate. Linked to poverty, underweight and stunting, the rates of undernourishment are reported to be diminishing, although poverty remains an incessant problem. This study was done to determine whether there is an association between public expenditure and underweight and stunting distribution in Mexico based on data from the 2006 health and population census and from macroeconomic, social, and demographic variables. We used principal component analysis to reduce the number of variables and analyze their behavior. Multiple regressions showed that underweight and stunting are significantly associated with the marginalization index, support from the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) supplies and breakfast program, the gross domestic product per capita, and expenditure from the Opportunities program. Further, public expenditure aimed to combat undernourishment is inadequately oriented to address the needs of the poor.

Nontraumatic intradural and subdural hemorrhage and hypoxic ischemic encephalopathy in fetuses, infants, and children up to three years of age: analysis of two audits of 636 cases from two referral centers in the United Kingdom.

We analyzed the presence or absence of intradural hemorrhage (IDH) and subdural hemorrhage (SDH) and the degree of hypoxic-ischemic encephalopathy (HIE) in the brain of all nonmacerated fetuses of >24 weeks, neonates, and children up to 3 years of age who died of natural causes over a defined period. We looked into the cause of death and the performance of cardiopulmonary resuscitation in our cohort. The IDH was classified as macroscopic or negative/microscopic only; the HIE was classified as absent, indeterminate, or definite. In fetuses, SDH with IDH was present in 22%; IDH alone was present in 31%, and there was no or minimal hemorrhage in 47% of cases. In infants and children SDH with IDH was present in 19%; IDH alone was present in the 32%, and there was no or minimal hemorrhage in 49% of cases. There was a statistically significant correlation between SDH and HIE, especially in infants and children (P < 0.001). When cases were grouped per age, a significant association between age and hemorrhage (P < 0.0001) was demonstrated, SDH being more common in infants ≤1 month corrected age. Intradural hemorrhage can be the source of thin-film SDH in fetuses, infants, and young children. The presence of SDH is associated with hypoxia. Intradural and subdural hemorrhages are more common in autopsies of infants under 1 month corrected age. Although more rare, they can also be found in children between 1 month and 3 years of age in the absence of trauma.

Release of erythroblasts to the peripheral blood suggests higher exposure to hypoxia in cases of SIDS with co-sleeping compared to SIDS non-co-sleeping.

Sudden unexpected death in infancy (SUDI) includes sudden infant death syndrome (SIDS). Co-sleeping is regarded as a major risk factor for SIDS. Under normal circumstances, nucleated red blood cells (nRBCs) are absent from the peripheral blood and their release can occur in cases with a probable hypoxic mode of death. The aim of our study was to assess the significance of the release of nRBCs in SIDS occurring during co-sleeping and the association with hemorrhages in the dura and the lungs. 35 cases were retrospectively assigned to one of the following categories: (I) 9 SUDI (of various causes) with no co-sleeping; (II) 16 SIDS while co-sleeping; (III) cause of death in hypoxic circumstances (3 hangings, 2 cardiac malformations, 1 meningitis 1 intoxication with diazepam); (IV) 3 SIDS in the cot. nRBCs were present in 5/9 cases of Category I (mean: 0.5%); 10/16 cases of Category II (mean: 1.87%); 7/7 cases of Category III (mean: 3.8%) and 0/3 cases of Category IV (mean: 0). ANOVA one-way test showed a significance of 0.003 amongst the 4 groups. The presence of diffuse intra-alveolar hemorrhage was associated with a higher release of nRBCs (mean: 3.1%) than focal hemorrhage (mean 0.6%). nRBCs were associated with focal hemorrhages in the falx and tentorium (mean: 2.3 vs. 0.9% when no hemorrhages were seen). The high mean of nRBCs seen in the co-sleeping SIDS cases suggests a higher exposure to hypoxia in the co-sleeping group which may have led to the release of nRBCs. More cases need to be analyzed to confirm this hypothesis.

Discriminant function of perinatal risk that predicts early neonatal morbidity: its validity and reliability.

BACKGROUND: This study aimed to identify significant perinatal risk factors associated with neonatal morbidity to construct a scoring system to aid in distinguishing between healthy and ill neonates. Validity and reliability of the scoring system were determined. METHODS: We conducted a screening test and used logistic regression to analyze data from a cohort of 387 neonates and to determine the relationship between risk factors and morbidity. Twenty nine factors of perinatal risk were studied. Logistic regression and discriminant analysis were performed to assess risk for morbidity. This system was developed and validated prospectively on 238 new neonates. RESULTS: Risk factors that demonstrated association with morbidity by logistic regression were chronic maternal illness, premature rupture of membranes (PROM), amniotic fluid, low Apgar score at 5 min, obstetric trauma, hypertension, neonatal resuscitation, breathing pattern at 6 h after delivery, birth weight, and gestational age. Discriminant function obtained from discriminant analysis had sensitivity of 68% and specificity of 93%, while positive and negative predictive values were 88 and 86%, respectively. Area below receiver operating characteristic (ROC) curve was 0.86 (standard error [SE]: 0.02). In the validity study, these values were maintained without significant differences. Kappa statistic between two physicians was calculated at 0.84 (p < 0.001). CONCLUSIONS: Evidence indicated that discriminant function is a useful tool to assess initial neonatal risk, allowing pediatricians to predict morbidity prior to discharge of neonates.