Quality of clinical and neurologic monitoring in a cohort of extremely premature infants, 2002-2012

Objetivo Explorar el curso clínico de una cohorte de recién-nacidos <1000gr o <29 semanas de edad gestacional al nacer, luego del alta del Programa Madre Canguro (PMC). Método Encuesta telefónica a padres de una cohorte retrospectiva de 569 prematuros manejados en tres PMC entre 2002 y 2012. Resultados Se contactó 65,4 % de la cohorte a una mediana de edad de 4 años. 34 pacientes (6 %) fallecieron, 65 % en los primeros 6 meses de vida. Se rehospitalizaron 63 %. 32 % presentaban antecedente de hemorragia intraventricular, 30 % tenían enfermedad Pulmonar Crónica, 5,2 % parálisis cerebral o retardo mental y 2,7 % convulsiones. 72 % se controlaron por Pediatra, 65 % necesitaron terapia física y 39 % terapia del lenguaje. 7 % repitieron años escolares y 9 % de los mayores de 4 años no había iniciado escritura. 4 % de los que ya escribían, presentaba dificultades. 81 % de los mayores de 6 años presentaba dificultad para vestirse, 55 % no practicaba ningún deporte. Discusión Los prematuros extremamente inmaduros o de bajo peso tienen una tasa elevada de secuelas respiratorias y neurológicas que impactan su calidad de vida y la de su familia. Es importante continuar con un seguimiento estricto después de 12 meses para detectar y manejar a tiempo las alteraciones del desarrollo neuro-psicomotor.Q4500-513Recién nacidosObjective To explore the clinical course of a cohort of newborns <1000 gr or <29 weeks of gestational age at birth after discharge from the Kangaroo Mother Care Program (KMC). Method Telephone surveys with parents of a cohort of 569 premature babies treated in 3 KMC programs between 2002 and 2012. Results The study contacted 65.4 % of the cohort, averaging 4 years old. 34 patients (6 %) passed away, 65 % during the first 6 months of life. 63 % were re- hospitalized, 32 % presented antecedents of intraventricular hemorrhage, 30 % had chronic lung disease, 5.2 % had cerebral palsy or mental retardation, and 2.7 % had convulsions. 72 % were monitored by a pediatrician, 65 % needed physical therapy, and 39 % needed speech therapy. 7 % repeated years in school and 9% of those over 4 years old had not begun to write. 4 % of those who could write had difficulties. 81 % of those over 6 years old had difficulties dressing themselves; 55 % did not practice sports Discussion Extremely premature or low birth weight premature babies have a higher level of respiratory and neurological consequences that affect their quality of life and that of their family. It is important to strictly monitor their health after 12 months in order to promptly detect and manage neuro-psychomotor and sensorial development disorders

Calidad del seguimiento clínico y neurológico en una cohorte de recién nacidos muy prematuros, 2002-2012

Objetivo Explorar el curso clínico de una cohorte de recién-nacidos 1000gr o 29 semanas de edad gestacional al nacer, luego del alta del Programa Madre Canguro (PMC).Método Encuesta telefónica a padres de una cohorte retrospectiva de 569 prematuros manejados en tres PMC entre 2002 y 2012.Resultados Se contactó 65,4 % de la cohorte a una mediana de edad de 4 años. 34 pacientes (6 %) fallecieron, 65 % en los primeros 6 meses de vida. Se rehospitalizaron 63 %. 32 % presentaban antecedente de hemorragia intraventricular, 30 % tenían enfermedad Pulmonar Crónica, 5,2 % parálisis cerebral o retardo mental y 2,7 % convulsiones. 72 % se controlaron por Pediatra, 65 % necesitaron terapia física y 39 % terapia del lenguaje. 7 % repitieron años escolares y 9 % de los mayores de 4 años no había iniciado escritura. 4 % de los que ya escribían, presentaba dificultades. 81 % de los mayores de 6 años presentaba dificultad para vestirse, 55 % no practicaba ningún deporte.Discusión Los prematuros extremamente inmaduros o de bajo peso tienen una tasa elevada de secuelas respiratorias y neurológicas que impactan su calidad de vida y la de su familia. Es importante continuar con un seguimiento estricto después de 12 meses para detectar y manejar a tiempo las alteraciones del desarrollo neuro-psicomotor

A Multi-facetted Visual Analytics Tool for Exploratory Analysis of Human Brain and Function Datasets

Brain research typically requires large amounts of data from different sources, and often of different nature. The use of different software tools adapted to the nature of each data source can make research work cumbersome and time consuming. It follows that data is not often used to its fullest potential thus limiting exploratory analysis. This paper presents an ancillary software tool called BRAVIZ that integrates interactive visualization with real-time statistical analyses, facilitating access to multi-facetted neuroscience data and automating many cumbersome and error-prone tasks required to explore such data. Rather than relying on abstract numerical indicators, BRAVIZ emphasizes brain images as the main object of the analysis process of individuals or groups. BRAVIZ facilitates exploration of trends or relationships to gain an integrated view of the phenomena studied, thus motivating discovery of new hypotheses. A case study is presented that incorporates brain structure and function outcomes together with different types of clinical data

Curso clínico y pronóstico a un año de una cohorte de prematuros dados de alta con oxígeno domiciliario en bogotá, colombia

Objetivo Documentar el curso clínico y pronóstico de una cohorte de niños prematuros dados de alta con oxígeno domiciliario en Bogotá, Colombia. Método Cohorte prospectiva de 194 prematuros  de 34 o menos semanas de edad gestacional (EG) al nacer, egresados de 12 unidades neonatales con oxígeno suplementario, seguidos hasta la edad corregida de 12 meses para determinar supervivencia, crecimiento, desarrollo y morbilidad. Resultados 49 niños (25,3 %) tenían una oxigenodependencia leve y 145 (74,7 %) moderada-severa. Se presentaron 3 muertes (1,5 %), el estado vital a 40 semanas de EG  fue conocido en 169 pacientes (87,1 %) y en 103 (53 %) a 12 meses. La lactancia materna fue exitosa en 147 (75,8 %) niños a 40 semanas. La antropometría al año fue: peso 8 991 g, talla 73 cm y perimetro craneano 46,2 cm. A las 40 semanas y a 3 meses 74,1 % y 22,7 % de la cohorte aún utilizaba oxígeno el cual fue descontinuado en promedio a los109 días postnatales. El 56,8 % de los niños tuvo al menos un reingreso y 47 % por patologías respiratorias. Sólo se tamizó para retinopatía al 71 % y en ellos la incidencia de retinopatía de la prematurez (ROP) fue 38 % con 3 cirugías y 1 niño ciego. Un tamizado neuropsicomotor y sensorial se realizó solamente en 19 % encontrando algún tipo de alteración neuropsicomotriz en 30 %, refractiva en 40 % y auditiva en 5 %. Conclusión Más del 60 % de los niños oxígeno-dependientes fueron dados de alta sin plan de seguimiento estructurado. El problema de los niños oxigenodependientes  es complejo y nuestros datos  sugieren  un gran espacio para  mejorar el seguimiento

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm

Q1Q1Jóvenes adultosAim: The protective effects of Kangaroo mother care (KMC) on the neurodevelop-ment of preterm infants are well established, but we do not know whether the ben-efits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. Method: Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20-year-old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. Results: The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct rela-tionship between brain volumes and duration of KMC, after controlling for potential confounders. Conclusion: Our findings suggest that the neuroprotective effects of KMC for pre-term infants persisted beyond childhood and improved their lifetime functionality and quality of life.https://orcid.org/0000-0001-6697-5837https://orcid.org/0000-0002-1923-3934https://orcid.org/0000-0001-5464-2701Revista Internacional - IndexadaA1N

El Programa Madre Canguro de Yopal, Colombia: una oportunidad de seguimiento del niño prematuro

Objetivo En Colombia, la incidencia de prematurez y bajo peso al nacer (BPN) es del 12,8%. El objetivo del estudio fue describir el seguimiento estandarizado hasta 12 meses de 1 138 prematuros y/o BPN, atendidos en el Programa Madre Canguro (PMC) de Yopal durante 2014 y 2015.Materiales y Métodos Estudio de cohorte prospectiva.Resultados Los pacientes eran del sistema subsidiado. El 58,2% vivía en la ciudad y 24,6% a más de dos horas de la ciudad. El 80,6% de los padres eran parejas estables y 78,9% tenía empleo. El 69% de las madres inició control prenatal desde el primer trimestre. Las patologías obstétricas más frecuentes fueron la infección urinaria y la pre-eclampsia. El 47% de los partos fueron intrahospitalarios, 55% por cesárea. La mayoría eran prematuros tardíos. El 13,3% pasaron por cuidados intensivos con 27% ventilados y 5,9% oxígeno-dependientes al egreso. A los seis meses, más del 50% tenía lactancia materna exclusiva. Se realizó tamizado de oftalmología en 54% (4,6% retinopatía), de optometría en 72% y de audiología en 70% (4,7% con déficit de audición). A los 12 meses 4,4% tenían examen neurológico anormal y 95% vacunas completas. La deserción fue de 35% y la mortalidad de 0,4%.Conclusiones Es importante implementar PMC en las ciudades intermedias de Colombia que manejan BPN y/o prematuros para asegurar un seguimiento de alto riesgo que detecte anomalías del desarrollo somático, sensorial o neuro-psicomotor y realizar intervenciones oportunas.Objective In Colombia, the incidence of prematurity and low birth weight (LBW) is 12.8%. To describe a standardized follow-up until 12 months of 1138 premature and/or LBW included in the Yopal KMCP (2014 -2015).Materials and Methods Prospective cohort.Results The patients are from the subsidized health care system (Colombia government), 58.2% live in the city and 24.6% at more than two hours from the city; 80.6% of parents are stable couples and 78.9% are employed; 69% of mothers started prenatal control from the first trimester. The most frequent obstetric pathologies were urinary tract infection and pre-eclampsia; 97% of deliveries were in the hospital; 55% by caesarean section. Majority of infants were late preterm; 13.3% passed through the Neonatal Intensive Care Unit (NICU) with 27% ventilated and 5.9% oxygen-dependent at discharge. At 6 months more than 50% had exclusive breastfeeding. Ophthalmology screening was performed in 54% (4.6% retinopathy), optometry in 72% and audiology in 70% (4.7% with hearing deficit). At 12 months 4.4% had abnormal neurological exam and 95% complete vaccines schedule. Lost to follow up was 35% and mortality 0.4%.Conclusion It is important to implement KMCP in intermediate and isolated cities to ensure a high-risk follow-up for all LBW and / or premature babies, to detect somatic, sensory or neuro-psychomotor development anomalies and to perform timely interventions

Education and training in the implementation of kangaroo mother care

Q338-4

Genotoxicity in human lymphocytes exposed to PM10 from three sites in the Valle de Aburrá (Antioquia)

RESUMEN: Objetivo Evaluar la calidad del aire en tres sitios del Valle de Aburrá (Antioquia) a través de la determinación de la genotoxicidad del PM10 en linfocitos humanos. Métodos A partir del valor de referencia de PM10 para Colombia (50 μg/m3/año) se eligieron tres sitios del Valle de Aburrá con diferente promedio de PM10, Barbosa con 25 μg/m3, Corantioquia con 44 μg/m3y Facultad de Minas con 91 μg/m3. Los filtros de PM10 expuestos por 24 horas, se analizaron en la épocas de lluvia, transición y seca entre Julio de 2011 y abril de 2012. Con el extracto orgánico obtenido en cada filtro se trataron linfocitos humanos para evaluar in vitro el daño en el ADN por medio del ensayo Cometa Alcalino. Resultados Todos los sitios indujeron genotóxicidad altamente significativa (p< 0.001) respecto al control negativo, presentando el mayor daño durante la época de transición. Se observaron diferencias significativas (p<0.05) en la genotoxicidad inducida por el PM10 entre los tres sitios evaluados. Conclusiones Aunque los valores de PM10 reportados para Barbosa y Corantioquia fueron inferiores al nivel máximo permisible, se encontró actividad genotóxica del PM10 proveniente tanto de ellos como de Facultad de Minas cuyo valor de PM10 es superior a la norma. Estos resultados indican que únicamente el monitoreo fisicoquímico del material particulado es insuficiente para evaluar el riesgo relativo sobre la población expuesta. En consecuencia, estos estudios deben ser complementados con biomarcadores de genotoxicidad como el ensayo cometa.ABSTRACT: Objective Assessing air quality by determining PM10 genotoxicity in human lymphocytes at three locations in the Valle de Aburrá (Antioquia department). Methods Three sites were chosen in the Valle de Aburrá (Barbosa, Corantioquia and the School of Mines) using Colombian reference (50 g/m3) and PM10 content values, having annual low (25 mg /m3), medium (44 ug/m3) and high PM10 average (91 ug/m3). PM10 filters were analyzed during three different seasons between 2011and 2012: rainy, transitional and dry. Human lymphocytes were treated with the organic extract obtained from each filter to evaluate DNA damage using an alkaline comet assay. Results Genotoxicity was found to be highly significant (p<0.001) in all cases, compared to the negative control. The highest damage (six times) was seen in material from the School of Mines and during the transitional period. Differences were found between material from Barbosa and Corantioquia regarding that from the School of Mines concerning the induction of damage. Conclusions Although the PM10 values reported for Barbosa and Corantioquia were below the maximum permitted level, genotoxic activity was found for PM10 from both sites as well as for the School of Mines. These results show that physical- chemical monitoring of particulate matter is not enough for assessing the exposed population’s relative risk. Such analysis should thus be accompanied by using genotoxicity biomarkers, such as the comet assay

Twenty-year follow-up of kangaroo mother care versus traditional care

Q1Q1e20162063BACKGROUND AND OBJECTIVES: Kangaroo mother care (KMC) is a multifaceted intervention for preterm and low birth weight infants and their parents. Short- and mid-term benefits of KMC on survival, neurodevelopment, breastfeeding, and the quality of mother–infant bonding were documented in a randomized controlled trial (RCT) conducted in Colombia from 1993 to 1996. The aim of the present study was to evaluate the persistence of these results in young adulthood. METHODS: From 2012 to 2014, a total of 494 (69%) of the 716 participants of the original RCT known to be alive were identified; 441 (62% of the participants in the original RCT) were re-enrolled, and results for the 264 participants weighing ≤1800 g at birth were analyzed. The KMC and control groups were compared for health status and neurologic, cognitive, and social functioning with the use of neuroimaging, neurophysiological, and behavioral tests. RESULTS: The effects of KMC at 1 year on IQ and home environment were still present 20 years later in the most fragile individuals, and KMC parents were more protective and nurturing, reflected by reduced school absenteeism and reduced hyperactivity, aggressiveness, externalization, and socio-deviant conduct of young adults. Neuroimaging showed larger volume of the left caudate nucleus in the KMC group. CONCLUSIONS: This study indicates that KMC had significant, long-lasting social and behavioral protective effects 20 years after the intervention. Coverage with this efficient and scientifically based health care intervention should be extended to the 18 million infants born each year who are candidates for the method

Strategies discussed at the XIIth international conference on Kangaroo mother care for implementation on a countrywide scale.

AIM: Building strategies for the country-level dissemination of Kangaroo mother care (KMC) to reduce the mortality rate in preterm and low birth weight babies and improve quality of life. KMC is an evidence-based healthcare method for these infants. However, KMC implementation at the global level remains low. METHODS: The international network in Kangaroo mother brought 172 KMC professionals from 33 countries together for a 2-day workshop held in conjunction with the XIIth International KMC Conference in Bogota, Colombia, in November 2018. Participants worked in clusters to formulate strategies for country-level dissemination and scale-up according to seven pre-established objectives. RESULTS: The minimum set of indicators for KMC scale-up proposed by the internationally diverse groups is presented. The strategies for KMC integration and implementation at the country level, as well as the approaches for convincing healthcare providers of the safety of KMC transportation, are also described. Finally, the main aspects concerning KMC follow-up and KMC for term infants are presented. CONCLUSION: In this collaborative meeting, participants from low-, middle- and high-income countries combined their knowledge and experience to identify the best strategies to implement KMC at a countrywide scale