Revista chilena de pediatría

Federico Puga y el Latrodectus formidabilis

Adelanto de la pubertad en Chile y el mundo

La menarquia se ha adelantado progresivamente desde mediados del siglo XIX, hecho conocido como tendencia secular de la menarquia, fenómeno que parece ser una característica evolutiva del ser humano en relación al mejoramiento de las condiciones de vida. Sin embargo, durante los últimos treinta años la edad de la menarquia se ha mantenido estable. A diferencia de la menarquia, la telarquia está ocurriendo a una edad más precoz que hace algunas décadas y es frecuente encontrar casos de telarquia aislada en niñas menores de 8 años. En el varón, en cambio, no hay evidencias de que su desarrollo esté ocurriendo más tempranamente. En el presente artículo, se discute la etiología del adelanto puberal y los factores que se deben tomar en cuenta en las pacientes para decidir un eventual estudio y tratamiento

The menarche age has fallen since last century to 1960s or 1970s, related to the improvement in children health. This phenomenon has been known as the secular trend of menarche. However, during the last 30 years, menarche age has remain stable in Chile and European countries. In contrast, thelarche age has fallen during the last 3 decades, becoming frequent that girls younger than 8 years-old have isolate breast development in Chile and worldwide. In boys, there is no convincing evidence of an earlier sexual development. We discuss the etiology of early pubertal development and factors that should be considered to decide an eventual treatment

Análisis comparativo de la canasta básica de alimentos, pirámide alimentaria y recomendaciones nutricionales para preescolares y escolares chilenos: A comparative analysis

La canasta básica de alimentos (CBA) se elaboró para evaluar pobreza a nivel nacional, ajustada para cubrir los requerimientos de energía (E) y proteínas de la población. Las guías alimentarias y la pirámide alimentaria (PA) son instrumentos educativos, representando el ideal de consumo. No se conoce la relación entre ambos instrumentos. Objetivo: Analizar el consumo de nutrientes de preescolares (PE) y escolares (ES) de una familia chilena urbana representativa, de acuerdo a la CBA urbana y compararla con las recomendaciones internacionales y con la PA chilena. Métodos: Se analizó la información base de la CBA (MIDEPLAN) y de la PA chilena; se asumió una familia con 2 hijos (4 y 10 años), una estimación de consumo proporcional de la canasta según recomendaciones de E y una frecuencia de consumo semanal para los grupos de alimentos por esta familia tipo. Resultados: El consumo de E fue 125% para el PE y 91% para el ES de los estándares FAO/OMS 2002; el consumo de proteínas de alto valor biológico fue bajo comparado con la recomendación: PE: 76% y ES: 42%. El porcentaje de E de la canasta como grasas, estuvo de acuerdo a lo recomendado: 21%, con 7% de grasa saturada. La adecuación del consumo de Ca fue 31% para el PE y 29% para el ES; en Zn alcanzó al 76% para PE y 73% para ES. Conclusiones: La CBA chilena presenta deficiencias en aportes de proteínas de alto valor biológico, Ca y Zn; la PA chilena está excedida en proteínas y deficiente en Zn, ambas comparadas con las recomendaciones internacionales; se justifica reanalizar ambos instrumentos

The basic food basket (BFB) has been developed to evaluate poverty and patterns of food consumption in many countries, including Chile. Different alternatives, like food pyramid (FP), have been proposed as guidelines for nutritional education. The relationship between both tools is unknown. Objective: To analyze the nutrient intake of children belonging to low-income Chilean families according to the BFB, in order to compare it with nutritional recommendations and Chilean FP. Methods: Information included in the CBA (MIDEPLAN) and Chilean BFB was analyzed. A family with 2 children (4 and 10 years-old) was studied in their feeding based on the BFB. We assume a proportional rate of intake according to normal energy (E) requirements by age and gender. The standard for nutrients consumption were those of FAO-WHO 2002 for energy and protein and WHO 1996 for zinc. Results: The E consumption with the BFB was 125% for preschool (PS) and 91% for school children (SC) of recommendations. High quality protein consumption was 76% in PS and 42% in SC children. Energy provided by fats was similar in terms of recommendations (21% with 7% saturated fats). The intake of calcium was 31% for PS and 29% for SC; zinc intake was 76% for PS and 73% for SC, all compared to WHO 1996 recommendations. Conclusions: BFB does not provide adequate amounts of protein, calcium and zinc. Chilean FP for children exceeds in proteins and contains few zinc. The analysis of both tools is recommended

Cateterización de la vena subclavia en pacientes pediátricos menores de 10 kg de peso

El acceso venoso central es requerido frecuentemente en las Unidades de Cuidados Intensivos Pediátricos, ya sea con fines de monitorización o terapéuticos. En nuestro medio, el acceso venoso subclavio está aún poco extendido en los pacientes pediátricos críticamente enfermos. Objetivo: Demostrar que la cateterización venosa central de la vena subclavia (VSC) en menores de 10 kg de peso es una alternativa exitosa y segura de efectuar por médicos staff de UCI. Diseño: Estudio prospectivo observacional, período 2003 a 2005 (34 meses). Pacientes: Todos los pacientes ingresados menores de 10 kilos de peso en quienes se instaló vía infraclavicular un acceso subclavio por técnica de Seldinger. Medición: Se registraron las características demográficas y antropométricas de los pacientes y sus condiciones clínicas relevantes. Se tabularon las variables técnicas del procedimiento (lugar de acceso, número de intentos) y las complicaciones asociadas. Se realizó análisis de subgrupos según peso (menor o igual a 5 kg o mayores a 5 kg). Resultados: Se efectuaron 73 canulaciones en 51 pacientes, 59% masculino, rango de edad de 8 días y 18 meses y de peso entre 2,3 y 9,6 kg (mediana 5 kg), 78% en ventilación mecánica, 62% se ubicaron en vena subclavia derecha. Para el grupo total se canuló exitosamente la VSC en 70/73 (96%, 64% al primer intento) y fue de 97% y 95% para los menores y mayores de 5 kg respectivamente. Ocurrieron 9 (12%) complicaciones, correspondiendo a 4 (5%) mayores (neumotórax). No hubo diferencia en los dos grupos analizados para éxito de canulación y complicaciones. Conclusiones: La instalación percutánea de la VSC es segura de emplear en niños bajo 10 kg de peso, presentando un bajo riesgo de complicación. Debe ser considerada como una alternativa más de abordaje para el niño críticamente enfermo.

Central venous access are often required in Pediatric Intensive Care Units for hemodynamic monitorization and treatment. The subclavian vein catheterization is unfrequently used in critically ill children. Objective: To demonstrate that subclavian vein catheterization performed by pediatric staff is a safe and successful access in children with body weight less than 10 kg. Method: Prospective and observational study that lasts 34 months and includes children with body weight less than 10 kg. A subclavian central venous access was attempted by infraclavicular approach with Seldinger technique. The demographic and anthropometric characteristics of the patients and their relevant clinical conditions were registered. The technical variables of the procedure (insertion side, number of attempts) and related complications were listed. Group analysis was made according to weight (< 5 kg or > 5 kg). Results: 73 catheter insertions were performed in 51 patients; 59% male with age between 8 days and 18 months, weight between 2,3-9,6 kg (median 5 kg). 62% were placed in the right side. 78% cases required mechanical ventilation. 70 out of 73 attempts (96%) were successful (64% first attempt), 97% belonging to the group with weight < 5 kg and 95% to the ones with body weight > 5 kg. 9 (12%) complications occurred. There were no differences between both groups in terms of success and procedure related complications. Conclusions: Percutaneous subclavian vein catheterization is safe in children with body weight less than 10 kg and it presents low risk of complications. This procedure must be considered as an alternative in critically ill children

Prevalencia de defectos de la pared abdominal al nacer: Estudio ECLAMC

Introducción: Onfalocele y gastrosquisis son los defectos de la pared abdominal (DPA) más frecuentes. Ambos necesitan un diagnóstico precoz y tratamiento quirúrgico oportuno para sobrevivir. Objetivos: Determinar la prevalencia al nacimiento de los DPA en la maternidad del Hospital Clínico de la Universidad de Chile (HCUCH) y compararla con la del total de maternidades chilenas (MCh) y los resultados del Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC). Resultados: La prevalencia global de onfalocele fue de 3,4/ 10 000 nacimientos y 3,8/10 000 para gastrosquisis. La prevalencia de onfalocele fue 9/10.000 en HCUCH y 2,77/10 000 en MCh (p = 0,006) y la de gastrosquisis fue 1,9/10 000 en HCUCH y 1,1/10 000 en MCh (p = 0,036). El promedio de edad materna fue 24,2 años para gastrosquisis y 33,6 para onfalocele (p < 0,004). La sobrevida de gastrosquisis fue 100% versus 31,7% en onfalocele (p < 0,0425). Todos los RN con onfalocele, salvo uno, presentaban asociación con otras MC graves. El peso de nacimiento y edad gestacional fueron significativamente menores en onfalocele. Conclusión: La prevalencia de DPA fue significativamente mayor en el HCUCH que en el resto de las maternidades chilenas. Gastrosquisis se presentó en hijos de mujeres más jóvenes y onfalocele en las de mayor edad

Omphalocele and gastroschisis constitute the most frequent abdominal wall defects (AWD), requiring early diagnosis and surgical treatment. Objectives: To identify AWD prevalence at the Maternity of University of Chile Clinical Hospital (UChCH), in order to compare it with other Chilean Maternities (ChM) and ECLAMC results. Results: The prevalence of AWD was 10,9/10 000 births in UChCH versus 3,8 in ChM (omphalocele 9/10 000 versus 2,8 with p = 0.006 and gastroschisis 1,9/10 000 versus 1,1 with p = 0,036). Maternal age average was 24,2 years for gastroschisis and 33,6 years for omphalocele (p < 0,004). The survival rate for gastroschisis was 100% against 31,7% for omphalocele (p < 0,0425). Most newborns with omphalocele present small gestational age, low birth weight and other congenital malformations. Conclusions: AWD prevalence was significantly greater in UChCH than in other ChM and ECLAMC. Gastroschisis appeared in children with younger mothers than omphalocele

Infecciones invasoras por Streptococcus b hemolítico Grupo A

Desde los años ochenta ha habido un resurgimiento de infecciones severas por Streptococcus b hemolítico Grupo A (SBHGA). Objetivo: Evaluar en nuestro medio el comportamiento clínico y los factores predisponentes en infecciones invasoras por SBHGA. Material y Métodos: Se analizaron antecedentes clínicos de 37 fichas de niños con cultivo positivo al SBHGA hospitalizados en el Servicio de Pediatría y Cirugía Infantil del Hospital Dr. Félix Bulnes Cerda entre marzo de 1995 y enero de 2005. Resultados: 81% fueron pacientes eutróficos sin patología asociada. Destacan como factores condicionantes: quemadura (30%), varicela (19%) y traumatismo (16%). La sintomatología más frecuente fue fiebre (84%) y signos inflamatorios locales (40%). Los cuadros clínicos fueron: infección de tejido blando (32%), bacteremia sin focalización (30%), osteoartritis (10,8%), pleuroneumonía (10,8%), shock tóxico (8,1%) y fasceitis necrotizante (5,4%). Tres pacientes fallecieron. Conclusión: Las infecciones invasoras por SBHGA afectan mayoritariamente a niños sanos cuyo principal factor predisponente es una puerta cutánea, y puede ser fatal

Since 1980 there has been a resurgence of severe infections by Group A Streptococcus (GAS). Objective: To evaluate in our hospital the clinical behaviour and predisposing factors for GAS infections. Methods: Clinical information from 37 charts of children with GAS positive cultures hospitalized in Félix Bulnes Cerda Hospital were analyzed between March 1995 and January 2005. Results: 81% healthy children with predisposing factors: burns (30%), varicella (19%) and trauma (16%). The main symptoms were fever (84%) and local inflammatory signs (40%). The clinical manifestations include soft tissue infections (32%), bacteremia (30%), osteoarthritis (10,8%), empyema (10,8%), toxic shock (8,1%) and necrotizing fasciitis (5,4%). Three patients died. Conclusion: Invasive GAS mainly affects healthy children with skin port of entry and may cause death

Mortalidad infantil reciente en Chile: Éxitos y desafíos

Para que continúe la reducción de la mortalidad infantil en Chile se requiere conocerla en detalle para formular las políticas y acciones pertinentes. Objetivo: Evaluar la dinámica del proceso de la mortalidad infantil y de los factores de riesgo en la actualidad. Material y Método: Se han calculado los riesgos de mortalidad infantil en las regiones, provincias y comunas chilenas, como igualmente las tendencias en el tiempo y los factores determinantes asociados utilizando los datos básicos existentes en el INE, Ministerio de Salud, OPS y OMS. Resultados: Las causas actuales de mayor importancia son las afecciones perinatales y las malformaciones congénitas registrándose bajas cifras de desnutrición, diarreas y enfermedades trasmisibles y una ubicación intermedia de las muertes de origen respiratorio. Como factores asociados de mayor importancia aparecen factores sociales como la desocupación del jefe de familia junto a la desnutrición materna, el bajo peso de nacimiento, la atención profesional del parto y la disponibilidad de recursos técnicos en el S.N.S.S. Conclusiones: Una disminución de la mortalidad infantil a valores de 5 por mil nacidos vivos podría obtenerse reduciendo la mortalidad neonatal en un tercio y la infantil tardía a la mitad, lo que disminuiría el número actual de 1 935 fallecidos a 1 219. Como condiciones deseables para obtener esta reducción aparecen la alta escolaridad materna, una edad media de las madres (20 a 35 años) y un peso de los recién nacidos superior a 2 500 gramos. El objetivo del trabajo ha sido explorar la dinámica del proceso de la mortalidad y los factores determinantes de importancia en la actualidad

In order to continue with Chilean infant mortality rate decrease, it is necessary to acquire acute knowlegde that will allow the formulation of adequate actions. Objetive: Study the mortality dinamic process and important associated factors. Method: Evaluation of risk factors in Chilean regions and determinant factors using information from I.N.E, OPS, OMS and health goverment department. Results: The most important causes of infant death are congenital malformations and perinatal diseases. In second place, respiratory diseases and finally, malnutrition, diarrhea and infectious diseases. The most important risk factors are parents unemployment, maternal malnutrition, low birth weight and birth assistance, and S.N.S.S technical resources. Conclusions: A decrease in mortality rate to 5/1000 newborns could be achieved if neonatal mortality falls to 1/3 and infant mortality to 1/2, so that the actual deaths fall from 1935 to 1219. Appropiate conditions include maternal scolarity, mothers age between 20 - 35 years and birth weight over 2500 g

Cierre efectivo por vía broncoscópica de fístula broncopleural de alto flujo en paciente con síndrome de distress respiratorio agudo grave

Introducción: La fístula broncopleural (FBP) secundaria a cirugía o infección es un reto terapéutico. Su tratamiento puede ser expectante o quirúrgico, describiéndose cada vez más el cierre endoscópico. Objetivo: Descripción de caso clínico de un paciente en quién se logró el cierre de una FBP vía endoscópica mientras evolucionaba con un síndrome de distress respiratorio agudo (SDRA) grave. Caso clínico: Paciente de 14 años de edad con antecedente de lobectomía inferior izquierda por bronquiectasias crónicas, quien desarrolló una FBP central secundaria al drenaje transtorácico de un absceso lingular. Presentó un shock séptico asociado a un SDRA. En su evolución la FBP de alto flujo impidió una ventilación mecánica adecuada, siendo esta cerrada por vía broncoscópica con tetraciclina y Gelfoam®, lo que permitió una disminución significativa de su débito, con cierre definitivo a las tres semanas del procedimiento. Conclusión: La FBP secundaria a un absceso pulmonar, puede ser tratada eficientemente con selle fibrobroncoscópico durante el curso de un fallo respiratorio grave en un paciente críticamente enfermo, evitando alternativas quirúrgicas de mayor riesgo

Bronchopleural fistula (BPF) secondary to surgery or infections implies a therapeutic challenge, either expectant or surgical treatment. Nowadays, the endoscopic closure procedure is performed more often. Objective: Case-report of a child presenting a successful endoscopic closure of a bronchopleural fistula during acute respiratory distress syndrome (ARDS). Case-report: A 14 year-old boy with previous left lower lobectomy due to chronic bronchiectasis, who developed a central BPF after transthoracic drainage of a lingular abscess, associated to mechanical ventilation failure, septic shock and ARDS. The BPF was sealed through bronchoscopy with Tetracycline and Gelfoam, with great decrease of BPF high flow until definitive closure 3 weeks after the procedure. Conclusion: BPF development after pulmonary abscess drainage could be effectively treated with bronchoscopic closure during ARDS in a critically ill child, avoiding higher surgical risks

Perforación intestinal espontánea durante el período neonatal

Introducción: La perforación intestinal espontánea (PIE) es una patología no habitual de baja frecuencia en el período neonatal. Objetivo: Describir la evolución clínica de dos recién nacidos (RN) con perforaciones intestinales espontáneas y discutir la presentación clínica, el diagnóstico imagenológico, el tratamiento médico quirúrgico y las posibles causas que pueden producir esta patología. Casos clínicos: RN de pretérmino, ambos de sexo masculino de 680 y 1 370 gramos de peso al nacer, que a las 36 horas de vida presentaron signos clínicos de distensión abdominal y compromiso del estado general. La sospecha diagnóstica se confirmó con radiografía de abdomen simple, efectuándose una laparotomía en la cual se encontró una perforación única del colon en el neonato de menor peso, y dos perforaciones del ileon terminal en el otro. En ambos neonatos se realizó resección intestinal y anastomosis término terminal. El RN de mayor peso y edad gestacional evolucionó satisfactoriamente y el otro falleció a los 4 días de vida por falla mutisistémica. Conclusión: La perforación gastrointestinal espontánea neonatal se presenta como una brusca y progresiva distensión abdominal, el diagnóstico se sospecha por clínica y por el neumoperitoneo en la radiología de abdomen, y se confirma en la laparotomía

Background: Spontaneous intestinal perforation (SIP) is a rare pathology in the neonatal period. Objective: To describe the clinical evolution of 2 newborns with spontaneous gastrointestinal perforations, in order to discuss clinical manifestations, diagnosis and medical-surgical treatment. Also, review possible events that may trigger this pathology. Case-reports: preterm newborns with SIP, both males with birth weight 680 and 1 370 g, showing clinical signs of abdominal distension before 36 hours of life. In both cases, the diagnostic suspicion arose from the abdominal radiography that revealed a pneumoperitoneum. Laparotomy was performed, where a single colon perforation was found in the smaller newborn and two ileum perforations in the other child. In both neonates, intestinal resection and end to end anastomosis was done. The newborn with major gestational age and birth weight evolved successfully, whereas the other one died at the 4° day of life due to systemic failure. Conclusion: Spontaneous gastrointestinal perforation in neonates presents with abdominal distension. Diagnosis is suspected from clinical signs, abdominal radiology and confirmed by laparotomy

Síndrome nefrótico y complicaciones tromboembólicas, 4 casos clínicos y revisión de la literatura

Los fenómenos tromboembólicos en pacientes con síndrome nefrótico constituyen una de las complicaciones más temidas debido al riesgo vital asociado. Objetivo: Describir los principales mecanismos fisiopatológicos responsables del desarrollo de este tipo de complicación a propósito de cuatro casos clínicos, en tres de los cuales se describen fenómenos tromboembólicos cerebrales y en uno trombosis extensa de extremidad inferior asociado a dificultad respiratoria. Las interacciones entre cuatro condiciones: actividad desbalanceada entre moléculas procoagulantes y anticoagulantes, trombocitosis, hiperagregación plaquetaria e hiperviscosidad sanguínea, promueven un estado de hipercoagulabilidad que conduce al desarrollo de complicaciones tromboembólicas, sin embargo, los mecanismos fisiopatólogicos subyacentes no han sido completamente aclarados. La presencia de otros factores tales como infecciones, complejos inmunes circulantes, hipovolemia, hipertensión, terapia esteroidal, punciones venosas e inmovilización pueden jugar un rol en la trombogénesis asociada al síndrome nefrótico. Conclusión: El síndrome Nefrótico representa una condición de alto riesgo de tromboembólismo, y requiere consideraciones terapéuticas tales como el uso criterioso de diuréticos, prevención de infecciones, mantenimiento de niveles adecuados de albúmina y el uso de fármacos antiplaquetarios y/o anticoagulantes

Thromboembolic phenomena in patients with nephrotic syndrome are one of the most feared complications due to its associated vital risk. Objective: To describe the major physiopathologic mechanisms responsible for the development of this type of complication, analyzing four clinical cases. Case-Reports: three of them presented with cerebral thromboembolic phenomena and one related to an extense inferior limb thrombosis associated to respiratory distress. The interactions between four conditions: unbalanced activity of procoagulant/anticoagulant molecules, thrombocytosis, platelet hyperaggregation and blood hyperviscosity promote an hypercoagulability state that leads to the development of thromboembolic complications, although the underlying physiopathologic mechanisms have not been completely clarified. The presence of other factors such as infections, circulating immune complexes, hypovolemia, arterial hypertension, steroid therapy, venipuncture and inmobilization may also play a role in the thrombogenesis associated to nephrotic syndrome. Conclusions: We conclude emphatising some therapeutic considerations such as judicious diuretics use, prevention of infections, adequate albumin levels and use of antiplatelet drugs and/or anticoagulants

Caso Clínico-Radiológico

Ácidos Grasos Omega-3 y Atopia

Evaluation of risk factors associated with increased blood pressure in children

Objetivos: Identificar fatores associados a níveis elevados de pressão arterial em crianças. Métodos: Estudo transversal da pressão arterial de 672 crianças entre 2 e 11 anos de idade em duas instituições de ensino de Belo Horizonte, entre setembro e dezembro de 2001. A pressão arterial foi mensurada seguindo os parámetros estabelecidos pelo relatório do Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. As seguintes variáveis foram estudadas: idade, sexo, cor da pele, índice de qualidade de vida urbana, estatura e índice de massa corporal. Para a comparação das médias, foi utilizada a análise de variãncia, e para a comparação de proporções, o teste quiquadrado. As variãveis associadas a níveis mais elevados de pressão arterial foram incluídas em análise de regressão linear múltipla. Resultados: Na análise univariada, níveis mais elevados de pressão arterial sistólica e diastólica estiveram associados com crianças de cor branca, crianças da região com alto índice de qualidade de vida urbana e com elevado índice de massa corporal. Na análise multivariada, apenas o índice de massa corporal, o índice de qualidade de vida urbana e a estatura mantiveram-se associados com níveis elevados de pressão sistólica. Em relação aos níveis mais elevados de pressão arterial diastólica, apenas as variáveis índice de qualidade de vida urbana e idade foram mantidas no modelo após o ajustamento. Conclusão: O sobrepeso e a obesidade estiveram associados com níveis mais elevados de pressão arterial sistólica. Outros fatores, não identificados, foram parcialmente associados a níveis mais elevados de pressão arterial de crianças do estabelecimento privado do ensino

To identify factors associated with increased arterial blood pressure in children. Methods: In this cross-sectional study, arterial blood pressure was measured in 672 children between 2 and 11 years of age from two schools in the city of Belo Horizonte, Brazil. After providing informed consent, all children had their blood pressure and anthropometric parameters measured. Blood pressure was measured based on the recommendations of the Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. The following variables were assessed: age, sex, race, urban life quality index, weight, height, and body mass index. Analysis of variance was used for comparison of means and the chi-square was used for comparison of proportions. Variables associated with increased blood pressure were included in a multiple regression model. Results: According to univariate analysis, increased systolic and diastolic blood pressure were associated with high urban life quality index, white race and high body mass index. On multivariate analysis, body mass index, urban life quality index and height remained associated with increased systolic blood pressure; urban life quality index and age were associated with increased diastolic blood pressure. Conclusion: In this study, excess weight and obesity were associated with increased systolic blood pressure. Other unidentified factors were partially associated with increased blood pressure in children from the school with elevated urban life quality index

Growth of exclusively breastfed infants in the first 6 months of life

Objetivo: Avaliar a evolução do crescimento de crianças alimentadas exclusivamente com leite materno durante os primeiros 6 meses de vida. Métodos: Estudo longitudinal de 184 crianças que receberam atenÇão primária em instituiÇão pública (Programa de Incentivo ao Aleitamento Materno Exclusivo) de Belém (PA), entre fevereiro de 2000 e janeiro de 2001. Finalizaram o estudo 102 lactentes nascidos a termo, com peso igual ou superior a 2 500 g, sem intercorrências no período neonatal e alimentados exclusivamente com leite materno sob livre demanda desde o nascimento. Acompanhados mensalmente, foram avaliados os registros de peso e comprimento ao nascer, no primeiro, quarto e sexto meses de vida. Avaliou-se o crescimento através das médias de peso e estatura para cada idade, comparando-se os resultados com o percentil 50° dos gráficos de crescimento do National Center for Health Statistics (NCHS) e com outros estudos anteriores com crianças brasileiras em aleitamento materno exclusivo. Resultados: As crianças tiveram crescimento adequado, dobrando de peso antes do quarto més de vida, com desaceleração do ganho põndero-estatural após o quarto mês, porém chegando aos 6 meses com médias de peso superiores aos padrões utilizados para comparação. Conclusões: Os resultados mostraram que crianças em aleitamento materno exclusivo chegaram aos 6 meses com peso médio superior ao percentil 50° do NCHS, confirmando as vantagens nutricionais do leite materno, principalmente quando as mães recebem orientação o sobre a técnica adequada para amamentar

To evaluate the growth of exclusively breastfed infants from birth to 6 months of life. Methods: This was a longitudinal study of 184 children who received primary care at a public institution (Exclusive Breastfeeding Stimulation Program, PROAME) in BelÈm, state of Par•, Brazil, between February 2000 and January 2001. A total of 102 children completed the study. All were born at full term with a birth weight greater than or equal to 2,500 g. No events were recorded during the neonatal period and the infants were exclusively breastfed, on demand, since their birth. The infants were followed up monthly, and the weight and length measured at birth and at the end of the first, fourth and sixth months of life were compared to the 50th percentile line of the NCHS growth charts and to other previous studies of Brazilian children who were exclusively breastfed. Results: Growth was adequate for all the children, who doubled their weight before the fourth month of life. Despite a slow-down in weight and height gain after the fourth month, the weight averages at 6 months were greater than the standards used for comparison. Conclusions: The average weight of these exclusively breastfed children was above the 50th percentile of the NCHS curve at 6 months, thus confirming the nutritional advantages of breast milk, especially when the mothers receive guidance regarding the appropriate techniques for breastfeeding

Antenatal corticosteroid use and clinical evolution of preterm newborn infants

Objetivo: Descrever a freçüencia de utilização de corticosteróide antenatal e a evolução clínica dos recém-nascidos pré-termo. Métodos: Estudo observacional prospectivo tipo coorte de todos os neonatos com idade gestacional entre 23 e 34 semanas nascidos na Rede Brasileira de Pesquisas Neonatais entre agosto e dezembro de 2001. Os prontuários médicos foram revistos, as mães entrevistadas e os pré-termos acompanhados. A análise dos dados foi realizada com o teste do qui-quadrado, t de Student, Mann-Whitney, ANOVA e regressão logística múltipla, com nível de significãncia de 5%. Resultados: Avaliaram-se 463 gestantes e seus 514 recémnascidos. As gestantes tratadas tiveram mais gestações prévias, consultas de pré-natal, hipertensão arterial e maior uso de tocolíticos. Suas crianças apresentaram melhores escores de Apgar no 1º e 5º minutos, menor necessidade de intervenção na sala de parto e menor SNAPPE II. Nasceram com maior peso e idade gestacional, receberam menos surfatante exúgeno, ventilação mecánica e oxigenoterapia. Após regressão logística, o uso pré-natal de corticosteróides manteve de forma independente o efeito protetor para as condições de nascimento e para a diminuição do tempo de ventilação mecãnica e esteve associado com aumento na ocorrencia de sepse neonatal. Conclusão: O uso do corticosteróide antenatal foi associado a melhor atendimento pré-natal. As crianças nasceram em melhores condições e tiveram melhor evolução, porèm com maior risco de infecção

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection