Scielo RSS <![CDATA[Revista chilena de pediatría]]> http://www.scielo.cl/rss.php?pid=0370-410620020005&lang=es vol. 73 num. 5 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Comienzos de la pediatría en el antiguo Hospital San Juan de Dios de Santiago: El doctor Francisco Javier Tocornal]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500001&lng=es&nrm=iso&tlng=es <![CDATA[Nefropatía Diabética]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500002&lng=es&nrm=iso&tlng=es La nefropatía diabética afecta a cerca del 40% de los diabéticos adultos, con evidencias de que esta complicación se genera desde los primeros años del diagnóstico, pudiendo detectarse precozmente. En este artículo se revisan los mecanismos involucrados en la génesis de la enfermedad, las etapas de esta, los elementos del diagnóstico precoz y las medidas preventivas y terapéuticas que retrasarían su aparición o bien disminuirían la velocidad de progresión hacia la insuficiencia renal terminal<hr/>Diabetic nephropathy affects approximately 40% of adults diabetics. There are evidences that this complication commences in the first few years after diagnosis and could be detected early. This article reviews the mechanisms involved in this nephropathy, its clinical stages and development, and methods of early detection. It also focuse on the measures and therapeutic interventions that can delay its appearence or at least its progression to end stage renal failure <![CDATA[Uso de ventilación de alta frecuencia oscilatoria en pacientes pediátricos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500003&lng=es&nrm=iso&tlng=es Introducción: El enfoque ventilatorio actualmente sugerido en pacientes con Síndrome de Distress Respiratorio Agudo (SDRA) es lograr el reclutamiento y mantención del volumen pulmonar óptimo. La ventilación de alta frecuencia oscilatoria (VAFO) es una modalidad que emplea pequeños volúmenes corrientes con rápidas frecuencias respiratorias, reduciendo las presiones pico y el riesgo de volutrauma. Objetivo: Describir los resultados en nuestra Unidad de Cuidados Intensivos con la VAFO como terapia de la Falla Respiratoria Hipoxémica Aguda. Diseño: Un estudio clínico prospectivo no controlado de series de casos. Pacientes y métodos: Se incluyeron pacientes menores de 16 años de edad, con diagnóstico de Falla Respiratoria Hipoxémica Aguda (PaO2/FiO2 < 200) frente a fracaso de Ventilación Mecánica Convencional (VMC), es decir, con índice de oxigenación (IO) > 16. Resultados: Se presentan un total de 31 episodios de empleo de VAFO en 29 pacientes cuyo diagnóstico fue SDRA en 90%, con edad de 5 meses (1 día a 104 meses) y peso de 6 kilogramos (2,8 a 60 kg). La duración de la VMC previo a la VAFO fue de 33 horas (0-740). El IO al momento de iniciarse la VAFO fue de 27. La presión media vía aérea (PMVA) fue fijada en promedio 10 cmH2O sobre el valor en VMC. La duración promedio de la VAFO fue de 85 horas por paciente. Tanto en los pacientes vivos como fallecidos se observó un descenso del índice de oxigenación (IO) durante las primeras 48 horas, sin una diferencia estadística entre ambos grupos. El efecto adverso más frecuente fue la hipotensión transitoria (13 episodios). Diez pacientes fallecieron, 7 por causa pulmonar, dando una letalidad por este motivo de un 24% (7/29). Conclusión: La VAFO es una terapia eficaz en dar soporte ventilatorio ante el fracaso de las modalidades ventilatorias convencionales<hr/>Background: The goal of ventilatory management in patients with acute respiratory distress syndrome (ARDS) is alveolar recruitment and maintenance of lung volume. High frequency oscillatory ventilation (HFOV) produces very small tidal volumes with rapid respiratory rates, reducing peak inspiratory pressure and the risk of volutrauma. Aim: To present our experience of HFOV in a paedriatric ICU. Patients and Methods: Patients less than 16 years with acute respiratory failure (PaO2/FiO2 < 200 and oxygenation index (OI) > 16) refractory to conventional mechanical ventilation were included. A prospective observational study shows the clinical features, ventilatory settings and the response of oxygenation. Results: 29 patients had 31 HFO ventilations, 90% with ARDS. Patients had a median age of 5 months (range 1-104 months) and a weight of 6 kg (3.2-60 kg). Prior conventional ventilation had a median duration of 33 hrs (0-740). OI at the beginning of HFOV was 27. Mean airway pressure was initially set at 10 cm H2O above the conventional ventilation value. Mean duration on HFOV was 85 hrs. All patients presented a decrease in the OI during the first 48 hrs; no statistical difference between survivors and non-survivors was found. The most frequent side effect was transient hypotension. Ten patients died, a pulmonary cause in 7 with a specific lethality of 24% (7/29). Conclusions: If certain conditions are met, HFOV appears to be an effective mode of ventilation in paedriatric respiratory failure refractory to conventional ventilation <![CDATA[Estudio de concordancia clínica en educandos de pre y postítulo en Pediatría: Puntaje de Tal]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500004&lng=es&nrm=iso&tlng=es Los programas de formación médica deberían alcanzar criterios y destrezas en los educandos, que condujeran a evaluaciones concordantes ante una misma situación clínica. Hipótesis: Un sistema de puntaje (Tal) para calificar estado clínico en patología respiratoria, que agrupa diferentes signos, genera mayor concordancia entre observadores que cada elemento integrante (diferencia de 0,20 o mayor en el índice kappa). Material y método: Muestra: parejas de internos (n = 70) y médicos alumnos del Programa de Especialización en Pediatría (APE) (n = 30), evaluaron a 345 niños con patología respiratoria aguda (167 y 178 cada grupo respectivamente), según puntaje de Tal modificado. Se evaluó el sistema de puntaje, consignando además edad del paciente, género, estado nutricional y diagnósticos de ingreso. Estudio estadístico: Comparación de proporciones por ji² y de índices kappa. Resultados: El puntaje de Tal, por internos, mostró kappa de 0,515 y los signos individuales, de 0,080 a 0,379. En APE, 0,230 y 0,163 a 0,277, respectivamente. Una agrupación con menos categorías no mostró ventajas. Ambos grupos de examinadores sólo difirieron en el puntaje total, más concordante entre internos que médicos. Al comparar kappa para cada signo con el resultado del puntaje de Tal, se detectó cambio significativo sólo en internos y para sibilancias y cianosis, en cuatro categorías (p < 0,05). Conclusión: La concordancia encontrada es escasa, tanto para un solo signo como para el conjunto y no mejora al reducir las categorías de evaluación. La propuesta de Tal genera mejor concordancia que los signos aislados sólo en internos y para cianosis o sibilancias. Es indispensable revisar los objetivos y métodos de los programas docentes, para alcanzar entre los educandos, un nivel de acuerdo mayor en la valoración clínica de los enfermos<hr/>Medical education programmes should result in the uniform development of clinical skills and criteria leading to a concordant assessment of clinical situations. Hypothesis: a scoring system (Tal) for assessing the clinical status for a group of signs on physical examination will produce a higher level of concordance between observers than each individual sign (a kappa index difference of > 0.20). Patients and Methods: sample size; according to previous data, with a standard error of the kappa index of 0.08, a difference within and between groups of 0.20, which was confirmed in a pilot study, estimated the sample size to be between 74 to 126 cases per group, with an alpha error of 5%. Observers were a random group of medical interns (n = 70) and medical doctors in the Paedriatric Specialty Programme (n = 30). The scoring system was assessed, considering the age of the patients, gender, nutritional status and diagnosis on admission. Statistics: Kappa indexes, chi² in comparison of proportions. Results: 345 infants and children admitted with lower respiratory tract infections were examined, 167 by interns and 178 by medical doctors, both groups being similar at the initial examination. The Tal score in interns resulted in a kappa index of 0.515 and for individual signs from 0.080 to 0.379 and in doctors 0.230 and 0.163 to 0.277 respectively. A significant difference was observed for the Tal score in interns with a higher kappa index. In comparing concordance for each sign against the total score, there was only a significant change in the intern group, and for cyanosis and wheezing in 4 categories (p < 0.05). Conclusions: The observed concordance was rather weak for isolated signs and also for the complete scoring system of Tal. This gave a better concordance for individual signs only in interns and for cyanosis and wheezing. Teaching goals and methods to develop clinical skills should be reviewed <![CDATA[Prevalencia de factores de riesgo de enfermedades crónicas no transmisibles en estudiantes de medicina de la Universidad de Valparaíso]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500005&lng=es&nrm=iso&tlng=es Introducción: La génesis de las enfermedades crónicas no transmisibles, se encuentran asociadas a factores de riesgo relacionados con estilos de vida nocivos para la salud. Resulta interesante observar como se comportan estos factores en estudiantes de medicina. Objetivos: Cuantificar la prevalencia de factores de riesgo de enfermedades crónicas no transmisibles en estudiantes de Medicina. Población y método: Se realizó un estudio de corte transversal en 242 alumnos que constituyen el universo de estudiantes de 1&deg; a 5&deg; año de la carrera de Medicina, de la Escuela de Medicina de la Universidad de Valparaíso. Los factores de riesgo cuantificados fueron: inactividad física, sobrepeso y obesidad, tabaquismo e hipertensión arterial. Resultados: Luego de analizar estadísticamente sus valores, se encontró que el factor de riesgo de mayor prevalencia con un 88% es la inactividad física, cifras similares para hombres y mujeres y no encontrándose diferencias entre los cursos en estudio. El sobrepeso y obesidad, presentó una prevalencia de un 31,8%, siendo ésta mayor para hombres que para mujeres, pero no se encontraron diferencias entre los cursos. En cuanto al tabaquismo, éste presenta una prevalencia de 23,6%, siendo mayor para mujeres que para hombres, pero al cuantificar la intensidad del hábito tabáquico, se observó que ésta era mayor en hombres. No se encontraron variaciones del hábito tabáquico entre los diferentes cursos. Por último, la presión arterial alta presentó una prevalencia de 4,6%, siendo mayor para hombres que para mujeres. Conclusiones: La prevalencia de los factores de riesgo estudiados es alta. Se recomienda efectuar intervenciones preventivas<hr/>Introduction: The origin of non-transmissible diseases is associated with risk factors related to harmful life styles. It is interesting to observe these factors in medical students. Objectives: To quantify the prevalence of risk factors of chronicnon-transmissible diseases in medical students. Patients and methods: A cross sectional study was carried out on 242 medical students, in yearly groups, 1st to 5th year attending the School of Medicine of the University of Valparaiso. Risk factors quantified were: physical inactivity, overweight and obesity, tabacco addiction and hypertension. Results: After statistical analysis, the risk factor with the highest prevalence (88%) was physical inactivity, with no sex or year difference. Over weight and obesity (31.8%) was higher in males but with no year difference. In relation to tabacco abuse (22.7%) it was higher in females, but smoking intensity was higher in males, with no differences between early groups. Finally, normal high arterial pressure (4.6%) was higher in males. Conclusion: The prevalence of risk factors is high and preventive strategies are recommended. <![CDATA[Enfermedad de Kikuchi-Fujimoto]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500006&lng=es&nrm=iso&tlng=es Se presenta el caso clínico de una paciente de 12 años con el diagnóstico de enfermedad de Kikuchi-Fujimoto que evolucionó con fiebre dos meses previos acompañado de adenopatías cervicales bilaterales, baja de peso de 5 kilos y compromiso del estado general. Sin respuesta a tratamiento antibiótico, se descartaron causas habituales de fiebre. La biopsia ganglionar mostró necrosis difusa, abundantes inmunoblastos, histiocitos, restos celulares necróticos y ausencia de neutrófilos. Evolucionó en forma favorable con caída de la fiebre a los 3 meses desde el inicio del cuadro y regresión de las adenopatías. Se destaca la importancia del diagnóstico diferencial de adenopatías cervicales persistentes acompañado de síndrome febril prolongado<hr/>A 12 year old girl with a diagnosis of Kikuchi-Fujimoto' disease is presented. The patient was referred with a history of 2 months of fever, bilateral cervical adenopathy, weight loss of 5 kg and malaise. There was no response to antibiotic therapy and laboratory studies excluded other aetiologies. A cervical lymph node biopsy showed diffuse necrosis, immunoblasts, histiocytes and absence of neutrophils. The patient’s evolution was favorable with disappearance of the fever by 3 months and regression of the adenopathy. We emphasize the importance of the differential diagnosis of persistent cervical adenopathies associated with prolonged fever <![CDATA[Infección por hongos en catéteres venosos centrales]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500007&lng=es&nrm=iso&tlng=es Objetivo: Presentar nuestra experiencia en el manejo de infecciones micóticas de catéteres venosos centrales (CVC) de larga duración en pacientes pediátricos con enfermedades hemato-oncológicas. Material y método: Estudio retrospectivo entre Enero de 1998 y Diciembre de 1999 en el Servicio de Pediatría del Hospital Clínico Regional Valdivia. Se registraron 19 pacientes con CVC. Resultados: Ocho casos presentaron infección del catéter, 5 por Cándida. De estos últimos, todos consultaron por síndrome febril. El tiempo de permanencia del CVC fue en promedio de 208 días (rango 92 y 451 días). La tasa de infección de torrente sanguíneo por hongos asociado a 1 000 días de uso de CVC Hickman es de 1,9‰. Todos se manejaron con antifúngicos y retiro del catéter. Conclusiones: Las cándidas constituyen la causa principal de infección de catéter en el presente estudio. El adecuado manejo de esta infección es el retiro precoz del catéter asociado a una terapia antifúngica oportuna<hr/>Objective: To present our experience in the management of fungal infections of central venous lines in paedriatric haematological-oncological patients. Methods: A retrospective study carried out between January 1998 and December 1999 at the Division of Pediatrics, Valdivia Hospital. Results: Of 19 children with a central venous line, 8 presented with a central line infection, of which 5 were caused by Candida. They presented with fever. The average length of catheter implantation was 208 days (range 92-451). The rate per 1 000 days for fungal infection using the Hickman line was 1.9‰. All were treated with line removal and antifungal therapy. Conclusions: Candida is the main cause of fungal line infections and the appropriate treatment is early line removal and antifungal therapy <![CDATA[Nefrectomía laparoscópica en niños]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500008&lng=es&nrm=iso&tlng=es La cirugía laparoscópica ha tenido un gran impacto en la cirugía urológica actual. Objetivo: Evaluar la experiencia en nefrectomía laparoscópica en niños en 2 Centros asistenciales privados de 2 ciudades del país. Pacientes y método: Se revisan los casos de niños sometidos a nefrectomía laparoscópica entre noviembre de 1992 y febrero del 2001. En todos se utilizó un abordaje transperitoneal, con 3 trócares de trabajo. Se evaluaron parámetros intra y postoperatorios. Resultados: Se efectuaron 18 nefrectomías laparoscópicas, 13 niñas y 5 varones, edad promedio de 7,9 años (8 meses a 15 años). Los procedimientos realizados fueron; 14 nefrectomías simples, 3 nefroureterectomías y una heminefrectomía. El tiempo quirúrgico promedio fue de 91,9 minutos (25-180 min). El tiempo de estadía hospitalaria tuvo un promedio de 52,4 horas (20 a 72 horas). El sangrado promedio fue de 87,7 ml (0 a 1 000 ml). Sólo un caso requirió conversión a cirugía abierta. En la serie no hubo complicaciones postoperatorias ni mortalidad. Conclusiones: Consideramos que la laparoscopía es la vía de abordaje de elección para la nefrectomía del niño. La nefrectomía laparoscópica tiene todas las ventajas que ofrece la cirugía mínimamente invasiva, el aspecto cosmético, el escaso dolor postoperatorio y la rápida reintegración a la vida normal, sumando el hecho que en el caso de los niños tiene especial significado una corta hospitalización, por las repercusiones psicológicas y sociales tanto para el niño como su familia<hr/>Introduction: Laparoscopic surgery has been of great benefit in children, especially laparoscopic nephrectomy. Objective: To report our experience in this technique in children. Material and methods: A review of all laparoscopic nephrectomies carried out in children between November 1992 and February 2001, a tranperitoneal procedure was used in all cases. Results: The procedure was carried out in 18 children, 13 girls and 5 boys with an average age of 7.9 years (range 8 months-15 years). Surgery was a total nephrectomy in 14, total nephroureterectomy in 3 and a heminephrectomy in 1. The average operative time was 91.9 minutes (range 25-180) and hospital stay 52.4 hours (range 20-72). The average intraoperative bleeding was 87.7ml (range 0-1 000). Only in 1 case open surgery was required due to incontrollable bleeding. There were no postoperative complications and no mortality. Conclusions: We conclude that laparoscopic nephrectomy should be considered as the first line surgical treatment in children requiring a nephrectomy for benign diseases. It has all the advantages of laproscopic surgery, comestical aspects, less postoperative pain and a faster revovery. All these factors have a large impact on the social and psychological aspects of a sick child and his family. <![CDATA[Caso clínico-radiológico para diagnóstico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500009&lng=es&nrm=iso&tlng=es La cirugía laparoscópica ha tenido un gran impacto en la cirugía urológica actual. Objetivo: Evaluar la experiencia en nefrectomía laparoscópica en niños en 2 Centros asistenciales privados de 2 ciudades del país. Pacientes y método: Se revisan los casos de niños sometidos a nefrectomía laparoscópica entre noviembre de 1992 y febrero del 2001. En todos se utilizó un abordaje transperitoneal, con 3 trócares de trabajo. Se evaluaron parámetros intra y postoperatorios. Resultados: Se efectuaron 18 nefrectomías laparoscópicas, 13 niñas y 5 varones, edad promedio de 7,9 años (8 meses a 15 años). Los procedimientos realizados fueron; 14 nefrectomías simples, 3 nefroureterectomías y una heminefrectomía. El tiempo quirúrgico promedio fue de 91,9 minutos (25-180 min). El tiempo de estadía hospitalaria tuvo un promedio de 52,4 horas (20 a 72 horas). El sangrado promedio fue de 87,7 ml (0 a 1 000 ml). Sólo un caso requirió conversión a cirugía abierta. En la serie no hubo complicaciones postoperatorias ni mortalidad. Conclusiones: Consideramos que la laparoscopía es la vía de abordaje de elección para la nefrectomía del niño. La nefrectomía laparoscópica tiene todas las ventajas que ofrece la cirugía mínimamente invasiva, el aspecto cosmético, el escaso dolor postoperatorio y la rápida reintegración a la vida normal, sumando el hecho que en el caso de los niños tiene especial significado una corta hospitalización, por las repercusiones psicológicas y sociales tanto para el niño como su familia<hr/>Introduction: Laparoscopic surgery has been of great benefit in children, especially laparoscopic nephrectomy. Objective: To report our experience in this technique in children. Material and methods: A review of all laparoscopic nephrectomies carried out in children between November 1992 and February 2001, a tranperitoneal procedure was used in all cases. Results: The procedure was carried out in 18 children, 13 girls and 5 boys with an average age of 7.9 years (range 8 months-15 years). Surgery was a total nephrectomy in 14, total nephroureterectomy in 3 and a heminephrectomy in 1. The average operative time was 91.9 minutes (range 25-180) and hospital stay 52.4 hours (range 20-72). The average intraoperative bleeding was 87.7ml (range 0-1 000). Only in 1 case open surgery was required due to incontrollable bleeding. There were no postoperative complications and no mortality. Conclusions: We conclude that laparoscopic nephrectomy should be considered as the first line surgical treatment in children requiring a nephrectomy for benign diseases. It has all the advantages of laproscopic surgery, comestical aspects, less postoperative pain and a faster revovery. All these factors have a large impact on the social and psychological aspects of a sick child and his family. <![CDATA[¿Cómo se maneja el paciente diabético quirúrgico?]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500010&lng=es&nrm=iso&tlng=es La cirugía laparoscópica ha tenido un gran impacto en la cirugía urológica actual. Objetivo: Evaluar la experiencia en nefrectomía laparoscópica en niños en 2 Centros asistenciales privados de 2 ciudades del país. Pacientes y método: Se revisan los casos de niños sometidos a nefrectomía laparoscópica entre noviembre de 1992 y febrero del 2001. En todos se utilizó un abordaje transperitoneal, con 3 trócares de trabajo. Se evaluaron parámetros intra y postoperatorios. Resultados: Se efectuaron 18 nefrectomías laparoscópicas, 13 niñas y 5 varones, edad promedio de 7,9 años (8 meses a 15 años). Los procedimientos realizados fueron; 14 nefrectomías simples, 3 nefroureterectomías y una heminefrectomía. El tiempo quirúrgico promedio fue de 91,9 minutos (25-180 min). El tiempo de estadía hospitalaria tuvo un promedio de 52,4 horas (20 a 72 horas). El sangrado promedio fue de 87,7 ml (0 a 1 000 ml). Sólo un caso requirió conversión a cirugía abierta. En la serie no hubo complicaciones postoperatorias ni mortalidad. Conclusiones: Consideramos que la laparoscopía es la vía de abordaje de elección para la nefrectomía del niño. La nefrectomía laparoscópica tiene todas las ventajas que ofrece la cirugía mínimamente invasiva, el aspecto cosmético, el escaso dolor postoperatorio y la rápida reintegración a la vida normal, sumando el hecho que en el caso de los niños tiene especial significado una corta hospitalización, por las repercusiones psicológicas y sociales tanto para el niño como su familia<hr/>Introduction: Laparoscopic surgery has been of great benefit in children, especially laparoscopic nephrectomy. Objective: To report our experience in this technique in children. Material and methods: A review of all laparoscopic nephrectomies carried out in children between November 1992 and February 2001, a tranperitoneal procedure was used in all cases. Results: The procedure was carried out in 18 children, 13 girls and 5 boys with an average age of 7.9 years (range 8 months-15 years). Surgery was a total nephrectomy in 14, total nephroureterectomy in 3 and a heminephrectomy in 1. The average operative time was 91.9 minutes (range 25-180) and hospital stay 52.4 hours (range 20-72). The average intraoperative bleeding was 87.7ml (range 0-1 000). Only in 1 case open surgery was required due to incontrollable bleeding. There were no postoperative complications and no mortality. Conclusions: We conclude that laparoscopic nephrectomy should be considered as the first line surgical treatment in children requiring a nephrectomy for benign diseases. It has all the advantages of laproscopic surgery, comestical aspects, less postoperative pain and a faster revovery. All these factors have a large impact on the social and psychological aspects of a sick child and his family. <![CDATA[Craneosinostosis: Visión del neurocirujano]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500011&lng=es&nrm=iso&tlng=es La cirugía laparoscópica ha tenido un gran impacto en la cirugía urológica actual. Objetivo: Evaluar la experiencia en nefrectomía laparoscópica en niños en 2 Centros asistenciales privados de 2 ciudades del país. Pacientes y método: Se revisan los casos de niños sometidos a nefrectomía laparoscópica entre noviembre de 1992 y febrero del 2001. En todos se utilizó un abordaje transperitoneal, con 3 trócares de trabajo. Se evaluaron parámetros intra y postoperatorios. Resultados: Se efectuaron 18 nefrectomías laparoscópicas, 13 niñas y 5 varones, edad promedio de 7,9 años (8 meses a 15 años). Los procedimientos realizados fueron; 14 nefrectomías simples, 3 nefroureterectomías y una heminefrectomía. El tiempo quirúrgico promedio fue de 91,9 minutos (25-180 min). El tiempo de estadía hospitalaria tuvo un promedio de 52,4 horas (20 a 72 horas). El sangrado promedio fue de 87,7 ml (0 a 1 000 ml). Sólo un caso requirió conversión a cirugía abierta. En la serie no hubo complicaciones postoperatorias ni mortalidad. Conclusiones: Consideramos que la laparoscopía es la vía de abordaje de elección para la nefrectomía del niño. La nefrectomía laparoscópica tiene todas las ventajas que ofrece la cirugía mínimamente invasiva, el aspecto cosmético, el escaso dolor postoperatorio y la rápida reintegración a la vida normal, sumando el hecho que en el caso de los niños tiene especial significado una corta hospitalización, por las repercusiones psicológicas y sociales tanto para el niño como su familia<hr/>Introduction: Laparoscopic surgery has been of great benefit in children, especially laparoscopic nephrectomy. Objective: To report our experience in this technique in children. Material and methods: A review of all laparoscopic nephrectomies carried out in children between November 1992 and February 2001, a tranperitoneal procedure was used in all cases. Results: The procedure was carried out in 18 children, 13 girls and 5 boys with an average age of 7.9 years (range 8 months-15 years). Surgery was a total nephrectomy in 14, total nephroureterectomy in 3 and a heminephrectomy in 1. The average operative time was 91.9 minutes (range 25-180) and hospital stay 52.4 hours (range 20-72). The average intraoperative bleeding was 87.7ml (range 0-1 000). Only in 1 case open surgery was required due to incontrollable bleeding. There were no postoperative complications and no mortality. Conclusions: We conclude that laparoscopic nephrectomy should be considered as the first line surgical treatment in children requiring a nephrectomy for benign diseases. It has all the advantages of laproscopic surgery, comestical aspects, less postoperative pain and a faster revovery. All these factors have a large impact on the social and psychological aspects of a sick child and his family. <![CDATA[Enfermedad Inflamatoria Intestinal (EII)]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500012&lng=es&nrm=iso&tlng=es La cirugía laparoscópica ha tenido un gran impacto en la cirugía urológica actual. Objetivo: Evaluar la experiencia en nefrectomía laparoscópica en niños en 2 Centros asistenciales privados de 2 ciudades del país. Pacientes y método: Se revisan los casos de niños sometidos a nefrectomía laparoscópica entre noviembre de 1992 y febrero del 2001. En todos se utilizó un abordaje transperitoneal, con 3 trócares de trabajo. Se evaluaron parámetros intra y postoperatorios. Resultados: Se efectuaron 18 nefrectomías laparoscópicas, 13 niñas y 5 varones, edad promedio de 7,9 años (8 meses a 15 años). Los procedimientos realizados fueron; 14 nefrectomías simples, 3 nefroureterectomías y una heminefrectomía. El tiempo quirúrgico promedio fue de 91,9 minutos (25-180 min). El tiempo de estadía hospitalaria tuvo un promedio de 52,4 horas (20 a 72 horas). El sangrado promedio fue de 87,7 ml (0 a 1 000 ml). Sólo un caso requirió conversión a cirugía abierta. En la serie no hubo complicaciones postoperatorias ni mortalidad. Conclusiones: Consideramos que la laparoscopía es la vía de abordaje de elección para la nefrectomía del niño. La nefrectomía laparoscópica tiene todas las ventajas que ofrece la cirugía mínimamente invasiva, el aspecto cosmético, el escaso dolor postoperatorio y la rápida reintegración a la vida normal, sumando el hecho que en el caso de los niños tiene especial significado una corta hospitalización, por las repercusiones psicológicas y sociales tanto para el niño como su familia<hr/>Introduction: Laparoscopic surgery has been of great benefit in children, especially laparoscopic nephrectomy. Objective: To report our experience in this technique in children. Material and methods: A review of all laparoscopic nephrectomies carried out in children between November 1992 and February 2001, a tranperitoneal procedure was used in all cases. Results: The procedure was carried out in 18 children, 13 girls and 5 boys with an average age of 7.9 years (range 8 months-15 years). Surgery was a total nephrectomy in 14, total nephroureterectomy in 3 and a heminephrectomy in 1. The average operative time was 91.9 minutes (range 25-180) and hospital stay 52.4 hours (range 20-72). The average intraoperative bleeding was 87.7ml (range 0-1 000). Only in 1 case open surgery was required due to incontrollable bleeding. There were no postoperative complications and no mortality. Conclusions: We conclude that laparoscopic nephrectomy should be considered as the first line surgical treatment in children requiring a nephrectomy for benign diseases. It has all the advantages of laproscopic surgery, comestical aspects, less postoperative pain and a faster revovery. All these factors have a large impact on the social and psychological aspects of a sick child and his family. <![CDATA[Displasia broncopulmonar: Complicaciones y tratamiento durante los primeros años de vida]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500013&lng=es&nrm=iso&tlng=es La cirugía laparoscópica ha tenido un gran impacto en la cirugía urológica actual. Objetivo: Evaluar la experiencia en nefrectomía laparoscópica en niños en 2 Centros asistenciales privados de 2 ciudades del país. Pacientes y método: Se revisan los casos de niños sometidos a nefrectomía laparoscópica entre noviembre de 1992 y febrero del 2001. En todos se utilizó un abordaje transperitoneal, con 3 trócares de trabajo. Se evaluaron parámetros intra y postoperatorios. Resultados: Se efectuaron 18 nefrectomías laparoscópicas, 13 niñas y 5 varones, edad promedio de 7,9 años (8 meses a 15 años). Los procedimientos realizados fueron; 14 nefrectomías simples, 3 nefroureterectomías y una heminefrectomía. El tiempo quirúrgico promedio fue de 91,9 minutos (25-180 min). El tiempo de estadía hospitalaria tuvo un promedio de 52,4 horas (20 a 72 horas). El sangrado promedio fue de 87,7 ml (0 a 1 000 ml). Sólo un caso requirió conversión a cirugía abierta. En la serie no hubo complicaciones postoperatorias ni mortalidad. Conclusiones: Consideramos que la laparoscopía es la vía de abordaje de elección para la nefrectomía del niño. La nefrectomía laparoscópica tiene todas las ventajas que ofrece la cirugía mínimamente invasiva, el aspecto cosmético, el escaso dolor postoperatorio y la rápida reintegración a la vida normal, sumando el hecho que en el caso de los niños tiene especial significado una corta hospitalización, por las repercusiones psicológicas y sociales tanto para el niño como su familia<hr/>Introduction: Laparoscopic surgery has been of great benefit in children, especially laparoscopic nephrectomy. Objective: To report our experience in this technique in children. Material and methods: A review of all laparoscopic nephrectomies carried out in children between November 1992 and February 2001, a tranperitoneal procedure was used in all cases. Results: The procedure was carried out in 18 children, 13 girls and 5 boys with an average age of 7.9 years (range 8 months-15 years). Surgery was a total nephrectomy in 14, total nephroureterectomy in 3 and a heminephrectomy in 1. The average operative time was 91.9 minutes (range 25-180) and hospital stay 52.4 hours (range 20-72). The average intraoperative bleeding was 87.7ml (range 0-1 000). Only in 1 case open surgery was required due to incontrollable bleeding. There were no postoperative complications and no mortality. Conclusions: We conclude that laparoscopic nephrectomy should be considered as the first line surgical treatment in children requiring a nephrectomy for benign diseases. It has all the advantages of laproscopic surgery, comestical aspects, less postoperative pain and a faster revovery. All these factors have a large impact on the social and psychological aspects of a sick child and his family. <![CDATA[Cómo elegir una cámara digital]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500014&lng=es&nrm=iso&tlng=es La cirugía laparoscópica ha tenido un gran impacto en la cirugía urológica actual. Objetivo: Evaluar la experiencia en nefrectomía laparoscópica en niños en 2 Centros asistenciales privados de 2 ciudades del país. Pacientes y método: Se revisan los casos de niños sometidos a nefrectomía laparoscópica entre noviembre de 1992 y febrero del 2001. En todos se utilizó un abordaje transperitoneal, con 3 trócares de trabajo. Se evaluaron parámetros intra y postoperatorios. Resultados: Se efectuaron 18 nefrectomías laparoscópicas, 13 niñas y 5 varones, edad promedio de 7,9 años (8 meses a 15 años). Los procedimientos realizados fueron; 14 nefrectomías simples, 3 nefroureterectomías y una heminefrectomía. El tiempo quirúrgico promedio fue de 91,9 minutos (25-180 min). El tiempo de estadía hospitalaria tuvo un promedio de 52,4 horas (20 a 72 horas). El sangrado promedio fue de 87,7 ml (0 a 1 000 ml). Sólo un caso requirió conversión a cirugía abierta. En la serie no hubo complicaciones postoperatorias ni mortalidad. Conclusiones: Consideramos que la laparoscopía es la vía de abordaje de elección para la nefrectomía del niño. La nefrectomía laparoscópica tiene todas las ventajas que ofrece la cirugía mínimamente invasiva, el aspecto cosmético, el escaso dolor postoperatorio y la rápida reintegración a la vida normal, sumando el hecho que en el caso de los niños tiene especial significado una corta hospitalización, por las repercusiones psicológicas y sociales tanto para el niño como su familia<hr/>Introduction: Laparoscopic surgery has been of great benefit in children, especially laparoscopic nephrectomy. Objective: To report our experience in this technique in children. Material and methods: A review of all laparoscopic nephrectomies carried out in children between November 1992 and February 2001, a tranperitoneal procedure was used in all cases. Results: The procedure was carried out in 18 children, 13 girls and 5 boys with an average age of 7.9 years (range 8 months-15 years). Surgery was a total nephrectomy in 14, total nephroureterectomy in 3 and a heminephrectomy in 1. The average operative time was 91.9 minutes (range 25-180) and hospital stay 52.4 hours (range 20-72). The average intraoperative bleeding was 87.7ml (range 0-1 000). Only in 1 case open surgery was required due to incontrollable bleeding. There were no postoperative complications and no mortality. Conclusions: We conclude that laparoscopic nephrectomy should be considered as the first line surgical treatment in children requiring a nephrectomy for benign diseases. It has all the advantages of laproscopic surgery, comestical aspects, less postoperative pain and a faster revovery. All these factors have a large impact on the social and psychological aspects of a sick child and his family. <![CDATA[High frequency oscillation ventilation compared to conventional mechanical ventilation plus exogenous surfactant replacement in rabbits]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500015&lng=es&nrm=iso&tlng=es Objetivos: a) avaliar o efeito na oxigenação e ventilação de coelhos artificialmente depletados de surfactante quando submetidos à ventilação mecânica convencional associada à reposição parcial de surfactante exógeno; b) comparar a evolução deste grupo com outro grupo submetido à ventilação de alta freqüência por oscilação (HFO) sem reposição associada de surfactante. Métodos: Vinte coelhos brancos da raça New Zealand, peso de &plusmn; 3 kg, foram anestesiados e artificialmente induzidos à depleção de surfactante endógeno através de sucessivas lavagens pulmonares com alíquotas (25 ml/kg) de solução fisiológica, até atingir uma PaO2 menor que 100 mmHg, quando ventilados via traqueostomia no modo de pressão controlada objetivando um volume corrente de 10 ml/kg, com PEEP de 5cm H2O, FiO2 de 100%, freqüência respiratória de 30 mpm, e tempo inspiratório de 0,65 s. Posteriormente, os coelhos foram divididos em (a) grupo CMV+S, submetido à ventilação convencional associada com reposição parcial de surfactante exógeno; (b) grupo HFO submetido à ventilação de alta freqüência por oscilação. Gasometrias arteriais foram coletadas antes da lavagem pulmonar, após a lavagem pulmonar, 15, 60 e 120 minutos após iniciado o tratamento. Os grupos foram comparados utilizando-se o teste t de Student. Resultados: Em ambos grupos a PaO2 (pós lavagem pulmonar) era inferior a 50 mmHg (p = 0,154), subindo aos 15 minutos de tratamento para 254 mmHg (CMV+S) e 288 mmHg (HFO, p = 0,626). Aos 60 e 120 minutos, a PaO2 foi maior (p = 0,001) no grupo HFO (431 e 431 mmHg) quando comparado com o grupo CMV+S, que apresentou queda progressiva (148 e 126 mmHg). Aos 60 minutos a PaCO2 era significativamente menor no grupo do CMV+S (29 versus 41 mmHg). Conclusões: Em modelo animal com SARA a estratégia de ventilação protetora como a HFO, isoladamente, promove uma rápida e persistente melhora na oxigenação, inclusive, com níveis superiores aos obtidos pelos animais submetidos à ventilação mecânica convencional associada à reposição de surfactante<hr/>Objectives: (a) to evaluate the effect on oxygenation and ventilation of rabbits with induced surfactant depletion when they are submitted to a conventional mechanical ventilation, plus a small dose of exogenous surfactant; (b) to compare this group with another group submitted to a High Frequency Oscillation (HFO) without exogenous surfactant administration. Methods: Twenty New Zealand White rabbits weighing (&plusmn; 3 kg) were anaesthetized and artificially induced to a endogenous surfactant depletion by successively lung lavage with normal saline (aliquots of 25 ml/kg) until to reach a persistent PaO2 less than 100 mmHg when submitted to a mechanical ventilation in a pressure control mode with a target tidal volume of 10ml/kg, PEEP of 5cm H2O, FiO2 1.0, respiratory rate 30/min, and inspiratory time of 0.65 s. Then the rabbits were divided in (a) CMV+S group, submitted to a conventional mechanical ventilation plus exogenous surfactant replacement; (b) HFO group, submitted to a High Frequency Oscillation Ventilation. Arterial blood gases were measured at control period, post lung lavage, 15, 16 and 120 minutes after treatment started. The groups were compared using Student t test. Results: The post lung lavage PaO2 in both groups was lower than 50mmHg (p = 0.154), increasing after 15 min of treatment to 254 mmHg (CMV+S) and 288 mmHg (HFO, p = 0.626). The PaO2 at 60 and 120 minutes were higher (p = 0.001) in the HFO group (431 e 431 mmHg) when compared with the CMV+S group, which showed a progressive fall (148 e 126 mmHg). At 60 minutes of treatment, the PaCO2 was lower (p = 0.008) in the CMV+S group (29 versus 41 mmHg). Conclusions: In ARDS animal model a protect mechanical ventilation strategy as HFO by itself promotes a fast and persistent increase in the oxygenation, with superior levels than those observed in animals treated with conventional mechanical ventilation plus exogenous surfactant replacement <![CDATA[Risk factors for suspicion of developmental delays at 12 months of age]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500016&lng=es&nrm=iso&tlng=es Objetivo: Verificar a prevalência de suspeita de atraso no desenvolvimento neuropsicomotor aos 12 meses nas crianças nascidas em Pelotas, RS, em 1993, e seus possíveis determinantes. Métodos: Uma amostra de 20% (1 363 crianças) de uma coorte de crianças nascidas nos hospitais de Pelotas, RS, durante o ano de 1993, foi avaliada aos 12 meses quanto ao desenvolvimento neuro-psicomotor, através da aplicação do teste de Denver II. As crianças que tiveram dois ou mais itens de falha no teste foram consideradas suspeitas de apresentarem atraso no desenvolvimento. As variáveis independentes escolhidas pertenciam a diferentes níveis de determinação de atraso, conforme modelo teórico hierarquizado (socioeco-nômico, reprodutivo e ambiental, condições ao nascer, atenção à criança, nutrição e morbidade). A análise foi realizada utilizandose o X2 de Mantel-Haenszel e técnica multivariada através de regressão logística, com o objetivo de controlar possíveis fatores de confusão. Resultados: Das 1 363 crianças avaliadas aos 12 meses, 463 (34%) apresentaram teste de Denver II suspeito de atraso no desenvolvimento. Na análise multivariada, após controle de variáveis de confusão, verificou-se que as crianças que tinham maior risco de suspeita de atraso em seu desenvolvimento foram: as mais pobres (OR = 1,5), as que haviam nascido com mais baixo peso (OR = 4,0), as que apresentaram idade gestacional menor do que 37 semanas (OR = 1,6), as que tinham mais de três irmãos (OR = 1,9) e as que haviam recebido leite materno por menos de três meses (OR = 1,6) ou não haviam sido amamentadas (OR = 1,9). As crianças que apresen-taram um índice peso/idade aos seis meses menor ou igual a "2 desvios-padrão da referência tiveram um risco dez vezes maior de suspeita de atraso no desenvolvimento. Conclusões: Este estudo reforça a característica multifatorial do desenvolvimento e o conceito de efeito cumulativo de risco. Na população estudada, a parcela mais desfavorecida acumula os fato-res (sociais, econômicos e biológicos) que determinam uma maior chance de atraso no desenvolvimento das crianças<hr/>Objective: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. Methodology: A sample of 20% (1 363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, children"s care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. Results: At 12 months of age, 34% (463) of the total of 1 363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR = 1,5), very low birth weight (OR = 4,0), gestational age less than 37 weeks (OR = 1,6), more than three siblings (OR = 1,9), and duration of breastfeeding less than three months (OR = 1,6), or no breastfeeding (OR = 1,9). Children who presented weight/age at six months of age less or equal to "2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. Conclusions: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development <![CDATA[Mortalidad infantil en Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500017&lng=es&nrm=iso&tlng=es Objetivo: Verificar a prevalência de suspeita de atraso no desenvolvimento neuropsicomotor aos 12 meses nas crianças nascidas em Pelotas, RS, em 1993, e seus possíveis determinantes. Métodos: Uma amostra de 20% (1 363 crianças) de uma coorte de crianças nascidas nos hospitais de Pelotas, RS, durante o ano de 1993, foi avaliada aos 12 meses quanto ao desenvolvimento neuro-psicomotor, através da aplicação do teste de Denver II. As crianças que tiveram dois ou mais itens de falha no teste foram consideradas suspeitas de apresentarem atraso no desenvolvimento. As variáveis independentes escolhidas pertenciam a diferentes níveis de determinação de atraso, conforme modelo teórico hierarquizado (socioeco-nômico, reprodutivo e ambiental, condições ao nascer, atenção à criança, nutrição e morbidade). A análise foi realizada utilizandose o X2 de Mantel-Haenszel e técnica multivariada através de regressão logística, com o objetivo de controlar possíveis fatores de confusão. Resultados: Das 1 363 crianças avaliadas aos 12 meses, 463 (34%) apresentaram teste de Denver II suspeito de atraso no desenvolvimento. Na análise multivariada, após controle de variáveis de confusão, verificou-se que as crianças que tinham maior risco de suspeita de atraso em seu desenvolvimento foram: as mais pobres (OR = 1,5), as que haviam nascido com mais baixo peso (OR = 4,0), as que apresentaram idade gestacional menor do que 37 semanas (OR = 1,6), as que tinham mais de três irmãos (OR = 1,9) e as que haviam recebido leite materno por menos de três meses (OR = 1,6) ou não haviam sido amamentadas (OR = 1,9). As crianças que apresen-taram um índice peso/idade aos seis meses menor ou igual a "2 desvios-padrão da referência tiveram um risco dez vezes maior de suspeita de atraso no desenvolvimento. Conclusões: Este estudo reforça a característica multifatorial do desenvolvimento e o conceito de efeito cumulativo de risco. Na população estudada, a parcela mais desfavorecida acumula os fato-res (sociais, econômicos e biológicos) que determinam uma maior chance de atraso no desenvolvimento das crianças<hr/>Objective: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. Methodology: A sample of 20% (1 363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, children"s care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. Results: At 12 months of age, 34% (463) of the total of 1 363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR = 1,5), very low birth weight (OR = 4,0), gestational age less than 37 weeks (OR = 1,6), more than three siblings (OR = 1,9), and duration of breastfeeding less than three months (OR = 1,6), or no breastfeeding (OR = 1,9). Children who presented weight/age at six months of age less or equal to "2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. Conclusions: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development <![CDATA[<B>RESEÑA DE LIBRO </B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500018&lng=es&nrm=iso&tlng=es Objetivo: Verificar a prevalência de suspeita de atraso no desenvolvimento neuropsicomotor aos 12 meses nas crianças nascidas em Pelotas, RS, em 1993, e seus possíveis determinantes. Métodos: Uma amostra de 20% (1 363 crianças) de uma coorte de crianças nascidas nos hospitais de Pelotas, RS, durante o ano de 1993, foi avaliada aos 12 meses quanto ao desenvolvimento neuro-psicomotor, através da aplicação do teste de Denver II. As crianças que tiveram dois ou mais itens de falha no teste foram consideradas suspeitas de apresentarem atraso no desenvolvimento. As variáveis independentes escolhidas pertenciam a diferentes níveis de determinação de atraso, conforme modelo teórico hierarquizado (socioeco-nômico, reprodutivo e ambiental, condições ao nascer, atenção à criança, nutrição e morbidade). A análise foi realizada utilizandose o X2 de Mantel-Haenszel e técnica multivariada através de regressão logística, com o objetivo de controlar possíveis fatores de confusão. Resultados: Das 1 363 crianças avaliadas aos 12 meses, 463 (34%) apresentaram teste de Denver II suspeito de atraso no desenvolvimento. Na análise multivariada, após controle de variáveis de confusão, verificou-se que as crianças que tinham maior risco de suspeita de atraso em seu desenvolvimento foram: as mais pobres (OR = 1,5), as que haviam nascido com mais baixo peso (OR = 4,0), as que apresentaram idade gestacional menor do que 37 semanas (OR = 1,6), as que tinham mais de três irmãos (OR = 1,9) e as que haviam recebido leite materno por menos de três meses (OR = 1,6) ou não haviam sido amamentadas (OR = 1,9). As crianças que apresen-taram um índice peso/idade aos seis meses menor ou igual a "2 desvios-padrão da referência tiveram um risco dez vezes maior de suspeita de atraso no desenvolvimento. Conclusões: Este estudo reforça a característica multifatorial do desenvolvimento e o conceito de efeito cumulativo de risco. Na população estudada, a parcela mais desfavorecida acumula os fato-res (sociais, econômicos e biológicos) que determinam uma maior chance de atraso no desenvolvimento das crianças<hr/>Objective: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. Methodology: A sample of 20% (1 363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, children"s care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. Results: At 12 months of age, 34% (463) of the total of 1 363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR = 1,5), very low birth weight (OR = 4,0), gestational age less than 37 weeks (OR = 1,6), more than three siblings (OR = 1,9), and duration of breastfeeding less than three months (OR = 1,6), or no breastfeeding (OR = 1,9). Children who presented weight/age at six months of age less or equal to "2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. Conclusions: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development <![CDATA[<B>FE DE ERRATAS </B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0370-41062002000500019&lng=es&nrm=iso&tlng=es Objetivo: Verificar a prevalência de suspeita de atraso no desenvolvimento neuropsicomotor aos 12 meses nas crianças nascidas em Pelotas, RS, em 1993, e seus possíveis determinantes. Métodos: Uma amostra de 20% (1 363 crianças) de uma coorte de crianças nascidas nos hospitais de Pelotas, RS, durante o ano de 1993, foi avaliada aos 12 meses quanto ao desenvolvimento neuro-psicomotor, através da aplicação do teste de Denver II. As crianças que tiveram dois ou mais itens de falha no teste foram consideradas suspeitas de apresentarem atraso no desenvolvimento. As variáveis independentes escolhidas pertenciam a diferentes níveis de determinação de atraso, conforme modelo teórico hierarquizado (socioeco-nômico, reprodutivo e ambiental, condições ao nascer, atenção à criança, nutrição e morbidade). A análise foi realizada utilizandose o X2 de Mantel-Haenszel e técnica multivariada através de regressão logística, com o objetivo de controlar possíveis fatores de confusão. Resultados: Das 1 363 crianças avaliadas aos 12 meses, 463 (34%) apresentaram teste de Denver II suspeito de atraso no desenvolvimento. Na análise multivariada, após controle de variáveis de confusão, verificou-se que as crianças que tinham maior risco de suspeita de atraso em seu desenvolvimento foram: as mais pobres (OR = 1,5), as que haviam nascido com mais baixo peso (OR = 4,0), as que apresentaram idade gestacional menor do que 37 semanas (OR = 1,6), as que tinham mais de três irmãos (OR = 1,9) e as que haviam recebido leite materno por menos de três meses (OR = 1,6) ou não haviam sido amamentadas (OR = 1,9). As crianças que apresen-taram um índice peso/idade aos seis meses menor ou igual a "2 desvios-padrão da referência tiveram um risco dez vezes maior de suspeita de atraso no desenvolvimento. Conclusões: Este estudo reforça a característica multifatorial do desenvolvimento e o conceito de efeito cumulativo de risco. Na população estudada, a parcela mais desfavorecida acumula os fato-res (sociais, econômicos e biológicos) que determinam uma maior chance de atraso no desenvolvimento das crianças<hr/>Objective: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. Methodology: A sample of 20% (1 363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, children"s care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. Results: At 12 months of age, 34% (463) of the total of 1 363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR = 1,5), very low birth weight (OR = 4,0), gestational age less than 37 weeks (OR = 1,6), more than three siblings (OR = 1,9), and duration of breastfeeding less than three months (OR = 1,6), or no breastfeeding (OR = 1,9). Children who presented weight/age at six months of age less or equal to "2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. Conclusions: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development