Resúmenes XL Reunión Anual, Pinamar Argentina- 2002(pág. 1 de 9)
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ESTUDIO LONGITUDINAL DEL CRECIMIENTO Y CONTROL METABÓLICO EN PACIENTES CON DIABETES TIPO 1 Y CELIAQUÍA.
Araujo M, Ozuna B, Krochik G, Mazza C.
Servicio de Nutrición. Hospital J.P. Garrahan. Buenos Aires. Argentina.

La diabetes tipo 1 se asocia a otras enfermedades autoinmunes como la celiaquía.. La misma puede presentarse como formas oligo o asintomáticas siendo de utilidad el screening por Ac AGA y EMA. No existen suficientes datos acerca de la evolución clínica y del crecimiento de estos pacientes una vez instaurado el tratamiento con la dieta libre de gluten.
Objetivo Evaluar el crecimiento y el control metabólico de un grupo de pacientes DBT1 con celiaquía. M Y M Se realizó un estudio retrospectivo de los pacientes Dbt1 con celiaquía que cumplieron seguimiento en el hospital 1 año antes (excepto cuando el diagnóstico fue simultáneo) y por lo menos 1 año después del diagnóstico de celiaquía y se aparearon por sexo, edad, y duración de la diabetes al comienzo de la enf. celiaca con pacientes diabéticos sin celiaquía. Se analizaron score Z del índice de masa corporal (ZIMC), el score z de la talla (Z Talla), la Hb glicosilada(HbA1C) y los requerimientos de insulina. Los datos estadísticos fueron evaluados con Statistix 7. Para las variables continuas se realizó test student y para las categóricas chi cuadrado. Se realizó test t para dos muestras.
Resultados Se estudiaron 11 pacientes (9 mujeres y 2 varones) DBT1 con diagnóstico de enf ermedad celíaca y sus controles La edad al debut de la diabetes de los pacientes con celiaquía fue 5.4 años (rango 2.5-11.2) No hubo diferencias significativas en el ZIMC a lo largo de la evolución de los pacientes, en cambio fue menor el Z Talla comparado con los controles en el momento del diagnóstico de la celiaquía (-1.07 vs. 0.7 P=0.05) La HbA1c de los pacientes DBT 1 con celiaquía aumentó con respecto a los controles a los 2 años de evolución (9.06% vs 9.59% P<0.02) y la dosis de insulina fue significativamente menor en el momento del diagnóstico en los pacientes con celiaquía (1.2 vs 0.94 U/k/dia P0.0002). No hubo diferencias significativas en otros parámetros de laboratorio.
Conclusiones La enfermedad celíaca en los pacientes diabéticos produjo un deterioro en el crecimiento valorado sólo a través de la talla que se revirtió con la implementación de la dieta libre de gluten.

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LONGITUDINAL STUDY OF GLYCEMIC CONTROL AND GROWTH IN CHILDREN UIT TYPE 1 DIABETES AND CELIAC DISEASE.
Araujo M, Ozuna B, Krochik G, Mazza C.
Servicio de Nutrición. Hospital J.P. Garrahan. Buenos Aires. Argentina.

Type 1 diabetes is associated with another autoimmune diseases like celiac disease. The prevalence of the association in our series was 4.4%. A significant proportion of these patients is clinically asymptomatic or have atypical manifestations, so, the screening for AGA and EMA antibodies is important. Information about longitudinal evolution in these patients is scare.
Objective to evaluate the longitudinal growth characteristics and glycemic control in type 1 diabetes children ith celiac disease.
M Y M we studied retrospectively data on growth and glycemic control. The period of study was one year before and one to three years after the diagnosis of celiac disease. Were included as control diabetes patients ithout celiac disease l, matched for age, sex and duration of diabetes. The variables analyzed were Z score of BMI (ZBMI), Z score of height (Z Height), HbA1C and insulin requirements.
Results We studied 11 patients with diabetes and celiac disease (9 females and 2 males) and 11 controls ithout celiac disease. The age of the diabetes onset was 5,4 years in the celiac group and 6,2 in the control group (p: ns). There were no significal diferences in ZBMI in the evolution of the patients, Z Height was lower in the celiac group at the age of diagnosis compared with control (-1.07 vs. 0.7 P=0.05). Whereas HbA1c raised ithin case subjects compared with control at 2 years of evolution (9.06% vs. 9.59% P<0.02) The insulin requirement as significantly lower at diagnosis of celiac disease in case subjects (1.2 vs. 0.94 U/k/dia P0.0002). We didn't found another differences in others variables.
Conclusions In children with type 1 diabetes the celiac disease resulted in deterioration of growth in height, with recovery after implementation of a gluten free diet.

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ACTITUDES Y CONDUCTA ALIMENTARIA DE NIÑOS DE 10 A 19.9 AÑOS CON SOBREPESO U OBESIDAD.
Kovalskys I, Bay L, Herscovci C, Berner E, Bergesio A, Orellana L.
Sociedad Argentina de Pediatría.

Conocer las actitudes y conducta alimentaria de los niños con sobrepeso u obesidad, contribuye a desarrollar programas preventivos..Objetivo:Analizar los datos obtenidos de un cuestionario para detectar trastornos de conducta alimentaria, en niños y adolescentes con Indice de masa corporal (IMC) >del percentilo (Pc) 90 (Rolland Cachera) comparados con el resto de la población estudiada. Material y Métodos: Entre 1998 y 2001 se encuestaron 1971 casos (1231 mujeres y 740 varones) de 10 a 19.9 años. El instrumento utilizado es el (EDEQ-4) que cosiste en 34 preguntas agrupadas en 5 subescalas. Se evalúan las respuestas del EDEQ-4 y datos demográficos de todos los casos. Se comparan los datos obtenidos en los niños con IMC > PC 90 ( casos) vs con IMC<90 ( controles) Resultados: 521 n (26,43% de la población) tiene IMC > 90 percentilo. Los puntajes del EDE Q se obtienen de las subescalas. Ellos son: 1-Restricción alimentaria: casos(C):0.97±1.0 vs controles (c) 0.51± 0,82(p:0,0000) 2- Preocupación por la alimentación: C 0,90±1,02 vs c 0,49±0,72 (p:0,0000) 3-Preocupación por el cuerpo: C: 1.75±1.45 vs c: 0,97 ± 1.07(p:0,0000) 4-Preocupación por el peso 1,69±1.43 vs 0,87 ± 1.08(p:0,0000) 5-bulimia: 0,51±0.58 vs 0,3±0.46( p:0.0000)Las preguntas del EDE Q que resultaron relevantes sonlas que evalúan: a) Intento de restricción: el 22,26% de los casos vs el 10% de los controles (p0.0000); b)Seguimiento de regla alimentaria: C: 20,7% vs c:11,46% (p0.0000), c) Temor a aumentar de peso C: 34,35% y c: 17,54% (p0.0000) d) compulsión alimentaria: C:10,9% y c:8,62% (diferencia no significativa) (NS) e)Sentimiento de gordura: C: 46,5% y c:16,62% (p0.0000) f) Sensación de ingesta exagerada C: 12% y c: 1,5% g) Pérdida de control C: 1,3% vs c:0,5% (NS) g) Purga: ninguno de los dos grupos refirió vómitos, diuréticos o laxantes h) Influencia del peso en la autovaloración: 23% de los (C) vs el 13% de los (c)(p0.000) i) Influencia del cuerpo en la autovaloración: diferencias NS entre grupos(24% vs. 21,5%) j)Act. Física: el 2% de los SO u O y el 1,8% de los controles hace ejercicios físicos para bajar de peso más de 3 veces por semana y el 80% del grupo de estudio no hace actividad física.Conclusión: En el grupo de niños y adolescentes con sobrepeso y obesidad la autovaloración está influida por el peso corporal. A pesar del mayor miedo a aumentar de peso, hacen poca actividad física para modificarlo y sólo el 22% restringe su ingesta.


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ATTITUDES AND EATING HABITS IN AGE GROUP BETWEEN 10 AND 19.9 WHO ARE OBERWEIGHT OR OBESE.
Kovalskys I, Bay L, Herscovci C, Berner E, Bergesio A, Orellana L. Sociedad Argentina de Pediatría.

Knowledge of the attitudes and eating habits of this age group contributes to the development of prevention and therapeutic programs. Objective: Analyze the data obtained from a questionnaire designed to detect eating disorders in children and adolescents with a Body Mass Index (BMI) > percentile (PC) 90 (Rolland Cachera) compared to the rest of the sample studied. Method: Between 1998 2001, a total of 1971 cases were evaluated (1231 females y 740 males) ages 10 to 19.9. The instrument used was the Eating Disorder Examination Questionnaire (EDEQ-4), consisting of 34 questions grouped in 5 subscales. Responses and demographic data were assessed for all the sample.The subscale scores of the cases were compared with those of the control group. Results: A 26.43% of the sample (N=521) had a BMI > 90 PC. The scores of the subscales were: 1-Restraint cases(C):0.97±1.0 vs controls(c ) 0.51± 0,82(p:0,0000),2- Eating concern : C: 0,90±1,02 vs c: 0,49±0,72 (p:0,0000) 3-Shape concern: C: 1.75±1.45 vs c: 0,97 ± 1.07(p:0,0000) 4-Weight concern 1,69±1.43 vs 0,87 ± 1.08(p:0,0000) 5-Bulimia: 0,51±0.58 vs 0,3±0.46. The responses to the EDE-Q-4 questions that appeared to be relevant are: a) Attempted to restrain intake. C: 22. 26% vs c:10% (p0.0000); b) attempted to follow dietary rules: C:20.7 % vs c: 11.46% (p0.0000); c) Fear of gaining weight: C: 34.35% vs c: 17.54% (p0.0000); d) Binge eating is present in 10.9% and 8.62% respectively (non-significant difference); e) Feeling fat : 46.5% of the cases and a 16.62% of the control cases (p0.0000); f) Overeating: C:12% compared to c:1.5% g) A 1.3% experience loss of control over eating as compared 0,5% of controls (NS).g) Neither of both groups reported purging behavior (vomiting, laxative or diuretic abuse); h) Weight had an important influence on the person's self-evaluation in a 23% of the cases as compared to a 13% of the controls (p0.000); i) Body shape did not influence self-evaluation and this did not reach statistical difference between both groups (24% vs. 21.5%); j) A 2% of the overweight or obese and an 1.8% of the controls practice physical exercise more than 3 times a week in order to lose weight, and a 80% of the total sample does not exercise. Conclusion: In the group of overweight and obese children and adolescents, self-evaluation is influenced by body weight. Although they have greater fear of weight gain, they do not exercise in order to change it and only a 22% restrain their food intake.

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ALTERAÇÕES DE LINGUAGEM EM CRIANÇAS NASCIDAS PRÉ-TERMO COM HEMORRAGIA VENTRICULAR
Pedromônico MRM, Rufino AC, Shinzato A, Vilanova LCP, Kopelman BI. Universidade Federal de São Paulo-Escola Paulista de Medicina

A prematuridade se constitui num fator de risco para o desenvolvimento típico da criança. A hemorragia intra e periventricular (HIPV) acomete tipicamente prematuros de baixos peso e idade gestacional. Atrasos de linguagem apresentam associação com futuro status de habilidades acadêmicas. Objetivo: investigar o efeito da HIPV no desenvolvimento de linguagem de crianças nascidas pré-termo, entre 12 e 24 meses.Métodos: 54 crianças nascidas com idade gestacionais < 37 sem. e peso < 2000g foram selecionadas entre as inseridas no Prog. de Desenvolvimento de Prematuros (Dep. Pediatria, UNIFESP-EPM). As crianças foram divididas em dois grupos de acordo com o diagnóstico por imagem: GE 30 (55.55%) crianças com HIPV e GC 24 (44.44%) crianças sem HIPV, homogeneizadas pela idade cronológica, escolaridade das mães número de filhos e renda familiar. Foram avaliadas por meio de lista de comportamentos relacionados à emissão e recepção de linguagem e seus desempenhos foram classificados, segundo a percentagem de acertos previstos para a idade cronológica, em normal e alterado (< 90% acertos). Os dados foram analisados usando teste t e ANOVA. Para a análise da associação entre variáveis categóricas foi utilizado o teste da Razão de Verossimilhança. A Regressão Logística foi utilizada no estudo da relação entre HIPV, sexo e alterações de linguagem. Peso ao nascer (p=0.104), asfixia (p=0.055), displasia broncopulmonar (p=0.687) e ventilação mecânica (p=0.509) não estiveram relacionados à presença de HIPV. Quanto menor a idade gestacional maior a severidade da HIPV(p=0.035). 26 (86%) crianças acometidas por HIPV apresentaram alteração de linguagem quando da comparação com prematuras sem HIPV (p=0.000). A razão de chance de uma criança acometida por HIPV ao nascimento apresentar alteração de linguagem foi oito vezes maior que as crianças sem HIPV, sendo tal tendência três vezes maior no sexo masculino.A HIPV em crianças nascidas prematuras se constitui num fator de risco para o desenvolvimento da linguagem, especialmente para o sexo masculino. Programas de acompanhamento de crianças nascidas prematuras devem seguir o desenvolvimento global delas por longo prazo, visto que atrasos de linguagem estão associados a importantes níveis de funcionamento individual. Além disto, faz parte do procedimento do psicodiagnóstico avaliar em diferentes idades e vários aspectos do desenvolvimento, buscando verificar os efeitos das condições de nascimento em diferentes idades e áreas do funcionamento mental.

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LANGUAGE DISORDERS IN TODDLERS BORN PRETERM WITH VENTRICULAR HEMORRHAGE
Pedromonico MRM, Rufino AC, Shinzato A, Vilanova LCP, Kopelman BI. Universidade Federal de São Paulo-Escola Paulista de Medicina

Introduction: Prematurity is a risk factor to neurodevelopment outcome. Ventricular hemorrhage (VH) affects especially preterm infants with low birth weigh and low gestational age. Language delay is closely associated to future academic disability. Objective: Our study had the purpose of investigating the effect of the VH on the language development in children born prematurely. Methods: Fifty-four toddlers whose gestation was under 37 weeks and who had weighed less than 2000g at birth were assessed when they were 12 or 24 months. All of them were admitted to a follow-up Program at the Pediatric Department at Universidade Federal de São Paulo - Escola Paulista de Medicina. The children were divided in two groups: 30 (55.55%) had had VH at birth and 24 (44.44%) had not. We used a behavior list concerning expressive and receptive language to assess their language development. The performance was classified as typical or not according to the percentage of correct response at a given chronological age. To analyze the results we used t test and ANOVA to study the relation between numeric and categorical variables. Likelihood ratio tests were used to analyze the association between categorical variables. Finally, Logistic Regression model was built to explore the relation between VH, sex and language delay. Results: Low birth weight (p=0.104), asphyxia (p=0.055), bronchopulmonary dysplasia (p=0.687) and mechanic ventilating therapy (p=0.509) were not associated with VH occurrence. However, the lower the gestational age the more severe the VH (p=0.035). Twenty-six (86%) children with VH at birth showed language delay and this classification was statically significant when we compared them to their pairs without VH (p=0.000). The odds ration that a child with VH show language delay is eight times greater than his pair without VH, and three times greater in boys. Conclusions: VH preterm infants, especially boys, are at a high risk of language development delay. The follow-up program must pay attention to these children, because the language development is linked to the most important levels of functioning of a human being. Moreover, psychological diagnoses in risk conditions must assess children at different ages to verify how these conditions affect the different phases of the development.

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EVALUACIÓN DE LA TECNICA DE USO DE DIFERENTES DISPOSITIVOS DE POLVO SECO EN RESIDENTES DE PEDIATRÍA DEL HOSPITAL ITALIANO
Eymann A, Talamoni H, Llapur C. Departamento de Pediatría del Hospital Italiano, Buenos Aires.

Objetivo: Evaluar la técnica (habilidad), en el uso de diferentes dispositivos de polvo seco para el manejo del asma, en residentes de pediatría de un hospital de alta complejidad.
Material y métodos: Dos observadores entrenados evaluaron en forma práctica a 21 residentes de pediatría en el manejo de diferentes dispositivos de polvo seco (turbuhaler y diskus). Se utilizaron planillas con los pasos a seguir, considerándose ciertos items como fundamentales para definir como correcta a la prueba. Estos pasos fueron confeccionados en base a guías del fabricante y bibliografía publicada. Luego de la primera evaluación recibieron una clase teórico - práctica de adiestramiento en el manejo adecuado de los diferente dispositivos y fueron re-evaluados luego de 7 días. Previamente respondieron un cuestionario de opción múltiple para determinar los conocimientos teóricos sobre indicación y manejo de los dispositivos.
Resultados: En la técnica del uso del turbuhaler se evaluaron un total de 9 pasos, de los cuales 4 se consideraron fundamentales. En el pre test la mediana de tareas realizadas fue 4,5. Ninguno de los 21 residentes realizó todas las tareas necesarias, y 19 de los 21 (94,7%) cometieron algún error grave. En el post test la mediana de tareas realizadas fue 9. Quince de los 21 residentes (71,4%) realizaron todas las tareas necesarias y 1 (4,8%) cometió algún error grave. Las diferencias entre pre y post test fueron estadísticamente significativas (p=0.0001) tanto para la prueba completa como para los pasos fundamentales (p<0.0001). En la técnica del uso del diskus se evaluaron un total de 8 pasos. En el pre test la mediana de tareas realizadas fue 5. Ninguno de los 21 residentes realizó todas las tareas necesaria y 15 de los 21 (71,4%) cometieron algún error grave. En el post test la mediana de tareas realizadas fue 8. Catorce de los 21 residentes (66,7%) realizaron todas las tareas necesarias y 1 de los 21 (4,8%) cometió algún error grave. Las diferencias sobre pre y post test fueron estadísticamente significativas (p=0.0001) tanto para la prueba completa como para los pasos fundamentales (p=0.0002).
Conclusión: Estos resultados apoyan la hipótesis que la metodología de enseñanza empleada produjo un impacto positivo en los participantes.

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ASSESSMENT OF THE TECHNIQUE OF THE USE OF DIFFERENT DRY POWDER DEVICES FOR ASTHMATIC PACIENTS IN RESIDENTS OF THE PEDIATRIC DEPARTEMENT OF THE HOSPITAL ITALIANO DE BUENOS AIRES.
Eymann A, Talamoni H, Llapur C. Departamento de Pediatría del Hospital Italiano Buenos Aires.

Objective: To assess the ability of pediatric residents in a tertiary hospital to use different dry powder devices to handle asthma.
Material and methods: Two trained observers made a practical assessment of the use of different dry powder devices (turbuhaler and diskus) in 21 pediatric residents. Forms with the procedure were used, taking certain steps as essential to define the test as a right one. This procedure was based on maker's guides and published bibliography. After the first evaluation the residents attended a theoretical and practical class to be trained in the appropriate handling of these devices. Seven days later they were re-assessed. Previously they had answered a multiple-choice questionnaire in order to determine their theoretical knowledge about prescription and handling of the devices.
Results: In the use of turbuhaler 9 steps were evaluated, 4 of which were considered essential. In the pre-test the median of the completed tasks was 4,5. None of the 21 residents completed all of the necessary tasks, and 19 (94,7%) made some kind of serious mistake. In the post-test the median of the completed tasks was 9. Fifteen of the 21 residents (71,4%) completed all the necessary tasks, and only made a serious mistake. The differences between pre- and post-test were statistically significant (p=0,0001) for the test as well as for the essential steps of the procedure (p<0,0001).
In the use diskus a total of 8 steps were assessed. In the pre-test the median of completed tasks was 5. None of the 21 residents completed all of the necessary tasks, and 15 (71,4%) made some kind of serious mistake. In the post-test the median of completed tasks was 8. Fourteen residents (66,7%) completed all the necessary tasks, and only 1 (4,8%) made a serious mistake. The differences between pre- and post-test were statistically significant (p=0,0001) for the complete test as well as for the essential steps of the procedure (p=0,0002).
Conclusion: These results support the hypothesis about the teaching methodology which produced a positive impact on the participants.

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NACER EN ALTURA: INFLUENCIAS DE CONDICIONES SOCIOECONÓMICAS, NUTRICIONALES Y ALTITUD EN EL CRECIMIENTO FETAL.
Duran P. Programa Materno Infantil. Ministerio de Salud. Buenos Aires, Argentina.

La hipoxia crónica en la altura constituye un factor asociado a restricción del crecimiento, aun cuando existe adaptación genética, observado en estudios en población en altura (Tibet, Andes, Europa y Norteamérica). Sin embargo la deprivación socioeconómica y nutricional se observa frecuentemente, variables que guardan relación con el crecimiento fetal.
Objetivo: analizar medidas antropométricas al nacer según altitud, y estimar el efecto del estado nutricional materno, condiciones socioeconómicas y altura en las mismas.
Población y métodos: Se utilizó la información registrada en el Sistema Informático Perinatal (CLAP-OPS) entre 1996-1998 por los equipos de la provincia de Jujuy, y remitida al nivel nacional. Se consideró IMC pregestacional, ganancia de peso materno, educación materna, peso al nacer (PN), talla al nacer (TN) y perímetro cefálico (PC). Los registros se agruparon en tres categorías según altitud en que se encuentra la institución donde se asistió el parto: 84.1% (R1), 5,8% (R2) y 10,1% (R3), correspondiendo esta última a la zona de mayor altitud (Puna). Se controló el efecto de embarazos múltiples y morbilidad materna.
Resultados: Sobre 25.811 registros, se seleccionaron 24.651 con información completa. El PN fue 3259+538 g en R1; 3162+420 en R2 y 3080+483 en R3, con una diferencia de 179 gramos entre R1 y R3, (f 110,7; p <0,001) y 209 g entre los nacimientos en R1 y R3 (F 199; p < 0,001) en partos a termino. En este último subgrupo, la diferencia de TN fue de 0,3 cm (F=274,9, p<0,001), y en PC de 0,6 cm (F102,7; p <0,001) entre R1 y R3. El análisis multivariado, mediante regresión lineal brindó el siguiente modelo final PN= -1557,4 -183,2 * nacimiento en Puna + 28,9 * Nº de NV + 13,3 * BMI pregestacional + 8,7 * ganancia de peso + 113,3 * EG al parto + E.
Conclusión: La altitud influye significativamente sobre el peso al nacer. Sin embargo los factores nutricionales y sociales analizados guardan igualmente relación con dicha variable tanto en forma directa como sinérgica.

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TO BORN AT HIGH ALTITUDE: ALTITUDE, NUTRITIONAL AND SOCIOECONOMIC INFLUENCES ON FETAL GROWTH.
Duran P. Programa Materno Infantil. Ministerio de Salud. Buenos Aires, Argentina.

Chronic hypoxia in high altitude constitutes an associated factor to fetal growth restriction, even though exists genetic adaptation, as observed in studies on population living at high altitude (Tibet, Andes, Europe and North America). Socioeconomic and nutritional deprivation are frequently observed in those populations, which are also associated to fetal growth.
Objective: to analyze anthropometric measures at birth according to altitude, and to assess the effect of maternal nutrition status, socioeconomic conditions and altitude on those measures.
Population and methods: The study was based on the information registered in the Perinatal Information System (SIP - Clap-OPS) between 1996-1998 by the provincial team from Jujuy province, and sent to the national level. Variables included Pre pregnancy BMI, maternal weight gain, maternal education, birth weight (BW), lenght at birth (LB) and head circumference (HC). Cases were grouped in three categories according to altitude, based on the institution where the childbirth was attended: 84.1% R1, 5.8% R2 and 10.1% R3, corresponding the later to the area at higher altitude (Puna). Confoundign variables were controlled by exclusion and analytical tools.
Results: From 25,811 registries, 24,651 with complete information were selected. Mean birth weight was 3259+538 g in R1; 3162+420 in R2 and 3080+483 in R3, with a difference of 179 grams between R1 and R3, (F 110,7; p < 0.001) and 209 g between R1 and R3 (F 199; p < 0.001) in term deliveries. In this group, LB showed a difference of 0.3 cm (F=274,9, p<0,001), and 0,6 cm of difference on HC (F102,7; p < 0.001) between low and highlands (R1 and R3 respectively). Multivariate analysis, by linear regression analysis showed a final model to predict birth weight = -1557,4 183,2 * birth at high altitude + 28.9 * parity + 13.3 * 8.7 BMI + 8,7 * maternal weight gain + 113.3 * gestagional age at birth + S.
Conclusion: Altitude influences BW significantly. Nevertheless nutritional and social factors analyzed have direct and sinergic relation to birthweight.

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ABSORCIÓN DE HARINA DE TRIGO FORTIFICADA CON HIERRO REDUCIDO
Arredondo M, Salvat V, Pizarro F, Olivares M. Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile. Santiago, Chile.

Antecedentes. El hierro reducido es uno de los fortificantes más utilizados, debido a su bajo costo y baja reactividad. Su biodisponibilidad no ha sido medida confiablemente en humanos debido a dificultades técnicas. Objectivo. Evaluar la biodisponibilidad de harina de trigo fortificada con hierro reducido. Métodos. Se utilizó una digestión in vitro y el modelo de células Caco-2 para medir la biodisponibilidad de dos tipos de hierro reducido (tamaño de partícula 8 y >20 µm), empleando las concentraciones de hierro intracelular y de ferritina como indicadores del hierro incorporado al enterocito. Se preparó pan fortificado con los dos tipos de hierro reducido. Resultados. Los estudios de digestión in vitro mostraron una mayor solubilidad y dializabilidad del hierro reducido-8 µm comparado con el hierro reducido >20 µm Fe. Las células Caco-2 expuestas a digeridos de pan fortificado con hierro reducido-8 µm presentaron mayores concentraciones de hierro intracelular y ferritina que con el pan fortificado con hierro reducido >20 µm. Cuando se empleó como referencia pan fortificado con FeSO4:ácido ascórbico (proporción molar 1:2), las biodisponibilidades relativas del pan fortificado con hierro reducido-8 µm o hierro reducido >20 µm fueron 68,2% y 31,1 % respectivamente. Conclusión. El hierro reducido es un buen compuesto para utilizar en la fortificación de la harina de trigo

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ABSORPTION OF WHEAT FLOUR FORTIFIED WITH REDUCED IRON
 Arredondo M, Salvat V, Pizarro F, Olivares M. Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile. Santiago, Chile.

Background. Reduced iron is one of most commonly used iron fortificants, because of its low cost and lack of chemical reactivity. The bioavailability of this fortificant has not been reliably measured in humans because of technical difficulties. Objective. To assess iron bioavailability of wheat flour fortified with reduced iron. Methods. Homemade bread fortified with two reduced iron compounds was produced. We used an in vitro digestion and the Caco-2 cells model to measure the bioavailability of two types of reduced Fe (8 and >20 µm particle size), using ferritin formation by Caco-2 cells and intracellular Fe concentration as indicators of Fe incorporated to the enterocyte. Results. In vitro digestion experiments showed higher values of solubility and dializability of reduced-8 µm Fe compared to reduced >20 µm Fe. Intracellular iron and ferritin concentrations in Caco-2 cells exposed to digest from bread fortified with reduced-8 µm Fe was higher than bread fortified with reduced >20 µm Fe. When bread fortified with FeSO4:ascorbic acid (molar ratio 1:2) was used as a reference, the relative iron bioavailabilities of the bread fortified with reduced-8 µm Fe or >20 µm Fe were 68.2% and 31.1 % respectively. Conclusion. Reduced iron is a good compound to be used in wheat flour fortification

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EVENTOS ADVERSOS EN RECIEN NACIDOS DE MADRES ADOLESCENTES EN EL PERU.
Shimabuku R, Oliveros M, Ulloa L, Nakachi G, Tantaleán J. Instituto de Salud del Niño; INEI; UNMSM. Lima, Perú.

Objetivo: determinar a nivel nacional la fuerza de la asociación entre ser madre adolescente y la presencia de eventos adversos perinatales. Método: se usó la base de datos de la Encuesta Nacional de Demografía y Salud (ENDES 2000) que abarca una muestra representativa de la población en todo el territorio del Perú. Se compararon datos de los hijos de madres adolescentes (15 a 19 años, grupo de estudio) con los de las madres de 20 a 24 años (grupo control) en relación a variables perinatales, usando la prueba Z de diferencias de proporciones. Resultados: las características de peso al nacer y tasas de mortalidad de 456 RN de madres de 15 a 19 años y 2 010 RN de madres de 20 a 24 años fueron :

Variables
Edad de las madres
Valores
15 a 19
20-24
Z
P
Bajo peso al nacer
14,25
8,45
3,31
0,001*
Muy bajo peso al nacer
0,64
0,37
0,77
0,44
Mortalidad perinatal
28,5
10,4
3,08
0,002 *
Mortalidad neonatal temprana
19,81
11,35
2,03
0,043 *
Mortalidad neonatal
24,2
16,5
1,28
0,201
Mortalidad postneonatal
21,0
17,9
0,49
0,628
Mortalidad infantil
45,2
34,4
1,26
0,206

*P< 0.05
Conclusiones: las madres adolescentes tuvieron hijos con mayor proporción de bajo peso al nacer (< 2 500 g), y tasas mayores de mortalidad neonatal temprana y perinatal, al ser comparadas con el grupo de 20 a 24 años, con diferencias estadísticamente significativas. Las mayores tasas de mortalidad deben estar relacionadas al bajo peso al nacer.

7
ADVERSE OUTCOMES IN NEWBORN BABIES OF ADOLESCENT MOTHERS IN PERU.
Shimabuku R, Oliveros M, Ulloa L, Nakachi G, Tantaleán J. Instituto de Salud del Niño; INEI; UNMSM; Lima, Perú.

Objective: to determine the strength of association between being an adolescent mother and the presence of perinatal adverse outcomes in Peru. Method: we used the database of Demographic and Health Survey (ENDES 2000) which covers a significant sample of the population. We compared the data of children from adolescent mothers (15 a 19 years, study group) with those from mothers, age 20 to 24 years (control group), in relation to perinatal variables using the Z test for differences in proportions. Results: the characteristics of weight at birth and mortality rate of 456 newborn babies of mothers 15 to 24 years of age and 2 010 newborn babies of mothers were as follows:

Variable
Age of the Mother
Value
15 a 19
20-24
Z
P
Low birth weight
14,25
8,45
3,31
0,001*
Very low birth weight
0,64
0,37
0,77
0,44
Perinatal mortality
28,5
10,4
3,08
0,002 *
Early neonatal mortality
19,81
11,35
2,03
0,043 *
Neonatal mortality
24,2
16,5
1,28
0,201
Postneonatal mortality
21,0
17,9
0,49
0,628
Infant mortality
45,2
34,4
1,26
0,206

* P< 0.05
Conclusions: adolescent mothers had a greater proportion of low birth weight babies (< 2 500g), and greater perinatal and early neonatal mortality rates, when compared to the group 20 - 24 years of age, with significant statistical differences. The greater mortality rates were related to low birth weights.

8
TALLA, PESO, ÍNDICE DE MASA CORPORAL Y PERÍMETRO CEFÁLICO EN NIÑOS CON HIPOTIROIDISMO CONGÉNITO DIAGNOSTICADO POR PESQUISA NEONATAL.
Guimarey L1,,2 , Morin A1, Santucci Z1, Apezteguía M1,,2, Ansaldi M1 1Endocrinología, Hosp. Sor M Ludovica, 2Comisión de Investigaciones Científicas, Prov. Bs As -La Plata-Argentina.

Objetivo: Estudiar el crecimiento de niños con hipotiroidismo congénito (HC) detectado por pesquisa neonatal. Material y Método: Setenta y nueve niños (V=21, M=58) con HC detectado por el Programa de Pesquisa Neonatal de la Prov de Bs AS, fueron seguidos longitudinalmente hasta la edad de 3 años. La edad mediana de diagnóstico y comienzo del tratamiento fue de 16 días (Mn=6, Mx=30). El tratamiento con levotiroxina se inició en todos los casos en el momento del diagnóstico. La dosis inicial promedio de levotiroxina fue de 12,8±2,1mg/kg/día. Siempre se mantuvo el nivel de TSH entre 0,5 y 5mUI/ml y el nivel de T4 en la mitad superior del rango de normalidad. La estatura, el peso, el índice de masa corporal (IMC) y el perímetro cefálico se evaluaron a las edades de 3, 6, 9, 12, 18, 24 y 36 meses (±10 días). Las variables de crecimiento se compararon con las curvas estándar mediante el test de Wilcoxon. Resultados: El promedio de estatura fue inferior al estándar solo en los varones a los 12 meses (p=0.02). A los 3 y 6 meses el peso fue significativamente mayor que el estándar (p<0.05) en ambos sexos. A partir de los 6 meses de edad el promedio de peso fue superior al estándar solo en las niñas de 24 meses (p=0.03). En las niñas el IMC fue mayor que el estándar en todas las edades con diferencias significativas durante los dos primeros años (p<0.01). En los niños el promedio de IMC también fue siempre superior al estándar, alcanzando significación estadística solo a los 3 (p<0.01) y a los 6 (p=0.02) meses. El promedio del perímetro cefálico fue mayor que el estándar solo al inicio del tratamiento y a los 3 meses en las niñas. Por último a los 3 años de edad todos los parámetros de crecimiento estudiados fueron normales. Conclusiones: (i) estos niños durante los primeros años de vida presentaron una moderada tendencia a la obesidad. (ii) sin embargo, a los tres años de edad el crecimiento de este grupo de niños con HC detectado y tratado precozmente es esencialmente normal.

8
HEIGHT, WEIGHT, BODY MASS INDEX AND HEAD CIRCUMFERENCE IN CHILDREN WITH CONGENITAL HYPOTHYROIDISM DETECTED BY NEONATAL SCREENING.
Guimarey L1,,2 , Morin A1, Santucci Z1, Apezteguía M1,,2, Ansaldi M1 1Endocrinología, Hosp. Sor M Ludovica, 2Comisión de Investigaciones Científicas, Prov. Bs. As. La Plata-Argentina.

Objective: To study the growth in children with congenital hypothyroidism (CH) detected by neonatal screening. Material and Method: Seventy nine children (M=21, F=58) with CH detected by the Neonatal Screening Program of Buenos Aires Province were followed-up longitudinally up to the age of 3. The median age at diagnosis and the start of treatment was 16 days (Mn=6, Mx=30). Levotiroxine treatment started at diagnosis in all cases. Mean initial levotiroxine dose was 12,8±2,1mg/kg/day. The goal was to keep a TSH level between 0,5 and 5mUI/ml, and a T4 level within the upper half of the normal range. Height, weight, body mass index (BMI) and head circumference were examined at diagnosis and at the age of 3, 6, 9, 12, 18, 24 and 36 months age (±10 days). Wilcoxon test was used to compare the growth data with the standards. Results: Mean height was below the mean reference standard only at 12 months in boys (p=0,02). Median weights for girls and boys were significantly greater than those for normal children at 3 and 6 months age(p<0,05). From 6 months of age onwards median weight was above the median reference standard only in girls at 24 months age (p=0,03). BMI for girls was greater than median reference standard at all ages with a significant difference during the first 24 months (p<0,01). In boys median BMI was slightly above the median reference standard reaching significant difference only at 3 and 6 months age (p<0,01 and p=0,02 respectively). Mean head circumference was greater than mean reference standard only in girls at the start of the treatment and at 3 months of age (p<0,01). Finally, by the age of 3 years height, weight, BMI and head circumference were normal. Conclusion: These results indicate that : (i) these children showed, in their first years of life, a moderate tendency to the obesity (ii) however by the age of 3 the growth is essentially normal in these early treated children with congenital hypothyroidism.

9
TENDÊNCIA SECULAR DE CRESCIMENTO EM ESCOLARES DE PAULÍNIA, SÃO PAULO- BRASIL (1979/80 - 1993/94).
Zambon Mp1, Marmo Db1, Morcillo Am1, Guimarey Lm2
1universidade Estadual De Campinas (Unicamp). Brasil 2 Comision De Investigaciones Cientificas, Provincia De Bsas (Cic). Argentina

A tendência secular de crescimento e desenvolvimento vem sendo estudada em vários países, e ainda permanece positiva nos países em desenvolvimento.
Objetivo: avaliar a tendência secular de altura, peso e da relação peso/altura em escolares de Paulínia, São Paulo, Brasil entre 1979/80 e 1993/94.
População e Métodos: calculou-se a variação por década do peso (P), da altura (A) e da relação P/A entre dois estudos realizados com 15 anos de intervalo em escolas públicas de Paulínia. No primeiro estudo em 79/80 (e1) avaliaram-se 812 crianças de 6,5 a 12,5 anos de idade (49,2%M e 50,8%F) e no segundo (e2), realizado em 93/94, 1.903 crianças (51,5%M e 48,5%F) da mesma idade.
Resultados: as médias de altura e peso do e2 foram sempre superiores às do e1. Os incrementos para a altura variaram: no sexo masculino de 1,13cm aos 11 anos a 5,0cm aos 12 anos e no feminino 1,2cm aos 8 anos a 4,33cm aos 6,5 anos. Para o peso a variação foi de 0,53kg aos 11 anos a 4,13kg aos 12 anos nos meninos e 0,87kg aos 11,5 anos a 3,0kg aos 11 anos nas meninas. Para a relação P/A as médias dos dois estudos foram muito semelhantes em ambos os sexos.
Conclusões: o aumento da estatura e do peso neste período pode ser explicado pelo desenvolvimento sócio-econômico de Paulina neste período. A tendência secular positiva encontrada foi semelhante à observada em países desenvolvidos após a II guerra mundial e de outros trabalhos brasileiros realizados em classes econômicas mais altas. O aumento do peso e da estatura ocorreram de forma harmônica não alterando a relação P/A

9
GROWTH SECULAR TRENDS AMONG SCHOOLCHILDREN FROM PAULÍNIA CITY, SÃO PAULO - BRAZIL (1979/80 - 1993/94).
Zambon Mp1, Marmo Db1, Morcillo Am1, Guimarey Lm2
1universidade Estadual De Campinas (Unicamp). Brazil. 2 Comision De Investigaciones Cientificas, Provincia De Bsas (Cic). Argentina

Growth and development secular trends have been studied in many countries and it is still positive in development ones.
Background: the purpose of this study was to evaluate the secular trends in height, weight and weight/height in schoolchildren from Paulínia, São Paulo, Brazil between 1979/80 and 1993/94.
Material and methods: anthropometric measurements (height, weight and weight/height) of 1,903 children (6,5-12,5y); 51.5%M:48,5%F in 1993/94 (study2), from Paulínia public schools were compared with 812 children (49,8%M:50,2F) from a previous study carried out in the same city 15 years before (1979/80 study1). Decade increments were calculated.
Results: height and weight mean values were always higher in study2, with positive increments. Height increment ranged from 1,13(11y) to 5,0(12y)cm in boys and from 1,2(8y) to 4,33(6,5y)cm in girls. Weight increment ranged from 0,53(11y) to 4,13(12y)kg in males and from 0,87(11,5y) to 3,0(11y)kg in females. Weight/height mean were very similar in both sex.
Conclusions: increment in height and weight are a development indicator in economical and health level. Positive secular trend were also observed in developed countries after II world war and in Brazil's middle-class children. Children gained proportionally height and weight, and didn't change weight/height.

10
IMPACTO NUTRICIONAL DE LANCHES ESCOLARES SAUDÁVEIS EM ESCOLA PRIVADA DE SÃO PAULO-BRASIL
Amodio MFP, Fisberg M**-
*Colégio Dante Alighieri ;** Universidade Federal de São Paulo/ Universidade São Marcos.

Introdução : Entre as inúmeras ações propostas para a prevenção da obesidade e do excesso de peso em escolares, está a mudança do ambiente, especialmente intervindo na venda de alimentos em cantinas escolares. A proibição de venda de alimentos não saudáveis ou aumento de taxas, incentivos fiscais para alimentos adequados são algumas propostas. Objetivos: Avaliar o impacto nutricional de uma política de ações educativas em escolares , com a análise da implantação de cardápios saudáveis ( kits -lanches ) , em um ano de intervenção, em alunos de uma grande escola privada de São Paulo. Metodologia: há quatro anos, foi iniciado um programa de educação nutricional maciço , com aulas , palestras e implantação de um projeto de kits com lanches supervisionados, com alimentos saudáveis, para escolares de 4 a 14 anos, em que os pais voluntariamente inscreviam seus filhos para recebimento diário de pacotes com sanduíches, frutas, sucos, derivados lácteos. Comparou-se o perfil antropométrico dos 497 usuários ao princípio do ano 2001 e após um ano de intervenção (2002) , com o perfil de 543 não usuários. Estado nutricional foi avaliado por medidas de peso e estatura, com análise do Índice de Massa Corporal( IMC)/idade e sexo (CDC2000), sendo considerados desnutridos os abaixo do Percentil (P) 5, risco de sobrepeso P85-95 e sobrepeso > P95. Resultados: entre os usuários do kit lanche, 3,8% apresentavam desnutrição, 33,5% excesso de peso, sendo 19,7% risco de sobrepeso e 13,7% sobrepeso. Os não usuários apresentavam 1,71%de desnutrição, 30,7% de excesso de peso( 18,7% risco e 12% sobrepeso). Não houve diferenças entre os grupos entre si, e após um ano de intervenção (x2 e t pareado). A variação para melhora nutricional foi de 12 a 13%, independente do grupo. A maior prevalência de excesso de peso registrada ocorreu em usuários de 7 a 10 anos, com 39,5%das crianças, contra 28% dos não usuários. Não houve diferenças nos resultados de acordo com a faixa etária. Todos os grupos etários reduziram os índices de excesso de peso, em torno de 14 %, independentemente da intervenção do kit lanche. Conclusão: A ação educativa global foi eficiente para toda a instituição, com maior consumo de frutas, lanches com menor teor de gordura e maior consumo de derivados lácteos e sucos. Apesar dos altíssimos índices de excesso de peso na escola, houve diminuição sensível destes valores após um ano de intervenção

10
NUTRITIONAL IMPACT OF HEALTHY SNACKS IN A PRIVATE SCHOOL IN SAO PAULO-BRASIL
Amodio MFP, Fisberg M**-
*Dante Alighieri College ;** e Federal University of São Paulo and São Marcos/ University.

Introduction : among many actions designed to prevent obesity, environment change is the most important in school children, specially acting in school cafeterias. Prohibition of selling and taxes increases for unhealthy foods , or benefits for the selling of healthy foods are some of the proposals. Objectives: To evaluate the nutritional impact of a program designed to educate children and parents, with the analysis of the implementation of healthy foods choice by means of the distribution of snacks kits in one year intervention, for the students of a private high school in Sao Paulo, Brazil. Methodology: In 1998, a huge project, supported by school board and parents , was launched, with classes, and nutritional education, with a voluntary approach, where parents chose that their children 4-14 years old, would receive or not daily packages with fruits, natural sandwiches, juices, dairy products, supervised by a nutritionist. Anthropometric profiles of 497 users of the healthy snack (U) were compared in march 2001 and after one year ( 2002), with the profile of 543 non users (NU), the control group. Nutritional status was evaluated by means of weight and height, and BMI indices ( CDC2000), considering malnourished those with BMI below the 5th percentile (P), risk of overweight those with P85-95 and overweight those > P95th. Results: among U children, 3.8 were malnourished, 33.5% presented excess weight , being 19.7% risk of overweight and 13.7 % overweight. Non Users were 1.71%underweight, 30.7% excess weight ( 18.7% risk and 12% overweight ). No differences were found between groups and after one year of intevention (X2 and paired T test). A positive change of nutritional status was of 12 -13%, regardless of the group. Higher taxes of excess weight occurred among users 7 -10 years old children, 39,5% of U against 28% of NU. No differences were seen by age . All age groups improved their nutritional status with a mean of 14 % variation independently of healthy snack use. Conclusion: Global educational intervention was useful with higher consume of fruts, fatless snacks, and higher intake of dairy products and juices instead of soft drinks. Despite high levels of excess weight among the students ( 50% higher than national standards ), a sensible decrease of overweight and obesity occurred in one year intervention. Studies are being designed for more long term intervention.

11
CAPTACIÓN, ACUMULACIÓN, Y LIBERACIÓN DE BUDESONIDE EN UN MODELO "IN VITRO" DE EPITELIO BRONQUIAL (CALU-3) CULTIVADO EN MONOCAPA.
Cassara ML, Figueroa JM, Roemele PE, Florea BI, Junginger HE, Borchard G.
Fundación P.Cassara (Argentina); y Universidad de Leyden (Holanda).

Introducción: los glucocorticoides tópicos inhalados (GCTI) son el tratamiento de elección para el asma. El aumento del tiempo de permanencia de los GCTI en el tejido bronquial permitiría prolongar el intervalo entre dosis, mejorando la adhesión al tratamiento. La retención de los GCTI en el epitelio ha sido asociada a su unión inespecífica con membranas celulares y subcelulares (relacionada a su vez con la lipoafinidad de las drogas). Estudios recientes han evaluado la eficacia clínica de GCTI usando una misma dosis total en una o dos dosis diarias. Se ha descripto que el budesonide (Bude) en una sola dosis diaria es igualmente efectivo que una dosis total equivalente administrada en dos dosis en el tratamiento del asma leve y moderado. Esto no ocurre con otros GCTI que han mostrado diferencias de eficacia entre ambos regímenes de uso, pese a ser más lipofílicos que Bude. Experiencias in vivo e in vitro han mostrado que el Bude se acumula dentro del tejido bronquial mediante la formación de esteres inactivos. Objetivos: evaluar la captación, acumulación, y eventual liberación de Bude en una línea de células bronquiales humanas "in vitro" (células Calu-3 en monocapas). Material y Métodos: se cultivaron monocapas de células Calu-3. Cada monocapa se dispuso entre dos compartimientos de muestreo, uno apical y otro basolateral. Se aplicó una solución de Bude en la cámara apical durante 2 horas. Para evaluar la liberación del Bude que contuvieran las células se lavaron ambas cámaras con una solución libre de Bude y se evaluó la reaparición de Bude en las cámaras durante 12 horas. Para evaluar la acumulación intracelular se lisaron las células y se identificaron Bude y sus esteres por Espectrometría de Maza. Resultados: Bude es captado por las células y retenido en las mismas como compuestos derivados. Luego es luego liberado en su forma activa libre por reversibilidad de la esterificación. Esta liberación continúa por lo menos durante las 12 horas siguientes. Estas observaciones en monocapas de células Calu-3 complementan los resultados previos sobre la eficacia del Budesonide en una única inhalación diaria.

11
UPTAKE, ACCUMULATION AND RELEASE OF BUDESONIDE IN AN "IN VITRO" MODEL OF HUMAN BRONCHIAL CELLS (CALU-3) CULTURED IN MONOLAYERS.
Cassara ML, Figueroa JM, Roemele PE, Florea BI, Junginger HE, Borchard G.
Fundación P.Cassara (Argentina); y Universidad de Leyden (Holanda).

Introduction: Inhaled glucocorticoids (IGCS) have become the first-line therapy of asthma. By increasing the retention time of the IGCS in the airway-lung tissue, it might be possible to prolong the time between doses, increasing the compliance on the therapy. The retention of the IGCS in the airway epithelium has been correlate to its non-specific binding to cellular and subcellular membranes (related to the lipophilicity of drugs). Recent studies have evaluated the clinical efficacy of IGCS using a same total dose given once or twice daily. They reported that Budesonide (Bude) given once daily is as effective as the same total dose given twice daily in the therapy of mild-moderate asthma. Contrary other IGCS which are more lipophilic showed differences in efficacy between both inhalation regimens. In vivo and in vitro experiments have demonstrated that Bude is accumulated within airway tissue due to the formation of inactive pharmacological esters.Objectives: To evaluate the uptake, accumulation, and eventual release of Bude in a human bronchial cell line "in vitro"(Calu-3 cell monolayers). Material and Methods: monolayers of Calu-3 cells were cultured. Each monolayer was placed between two sample compartments, an apical and a basolateral chamber. Bude solution was applied on the apical chamber for 2 hr. To evaluate the release of Bude accumulated within the cells, both chambers were washed with free-Budesonide solution. Appearance of the drug in the chambers was followed for 12 hours. In order to assess if Bude was accumulated in the cells, lysis of the monolayers was performed followed by Mass Spectrometry identificaton of Bude and its esters. Results: Bude was efficiently taken up by the cells and a substantial fraction remained within the cells, mainly as derivative compounds. Bude was then released only as its active form due to the reversibility of the esterification. The release of Budesonide continuous at least during the following 12 hours. This observations in Calu-3 cells monolayers complements the previous results on the efficacy of Budesonide by once daily inhalation.

12
COMPARAÇÃO ENTRE DUAS DIETAS A BASE DE LEITE HUMANO ACRESCIDO DE "FEPT" OU DE "FORTIFICADOR" NA NUTRIÇÃO E METABOLISMO ÓSSEO DE RNMBP.
Gonçalves AB, Gonçalves AL.
Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto.

INTRODUÇÃO: A adequada alimentação do RNMBP é fundamental para seu bom crescimento e desenvolvimento, inclusive sua mineralização óssea (m.o.). O leite humano (LH) não supre as necessidades nutricionais desses prematuros. Foram desenvolvidas fórmulas lácteas infantis especiais para prematuros (FEPT), e "fortificadores" para o leite humano, visando adequá-lo a essas crianças. OBJETIVOS: Comparar a eficácia e tolerabilidade de 2 dietas a base de leite humano adicionado com FEPT ou "fortificador" na promoção do crescimento pôndero-estatural, na mo e no tempo da hospitalização de RNMBP. CASUÍSTICA E MÉTODO: Foram constituídos, 2 grupos de crianças aleatoriamente, - Grupo A - 14 crianças com dieta de LH + FM85; Grupo B - 11 crianças com LH + FEPT, v/v, a partir do 15º dia de vida, até a alta (2000g ± 20g). Foram aferidos: peso, comprimento e perímetro cefálico ao nascer, no início e na alta; prega cutânea tricipital média (15 dias e alta) calculou-se os incrementos de peso do nascimento à alta e no período de observação. Foram dosados no sangue: cálcio, fósforo, magnésio, fosfatase alcalina (FA), creatinina e na urina cálcio, fósforo, magnésio e creatinina, calculou-se as taxas de reabsorção tubular de fósforo (%TPR). A m.o. foi avaliada através de técnicas radiológicas padronizadas. RESULTADOS: Os grupos terminaram com 11 crianças cada, sendo excluídas 3 do Grupo A. Os índices antropométricos, os níveis séricos de cálcio, fósforo, magnésio e FA não apresentaram diferenças estatisticamente significantes entre os grupos ao nascer e/ou no início da observação. Os incrementos de peso das crianças do Grupo B foram significativamente superiores aos do Grupo A e a FA do Grupo A foi maior que do Grupo B (p < 0,05) no final da observação. Não houve diferenças significativas entre os 2 grupos quanto às %TPR; à avaliação radiológica da m.o. e ao tempo de hospitalização. DISCUSSÃO: As dietas foram bem toleradas, com taxas médias de ganho ponderal acima de 20g/dia, com ligeira mas significante superioridade do Grupo B, sem repercussão no tempo de internação. A mo em ambos os grupos foi satisfatória, apesar dos níveis da FA terem sido significativamente mais elevados no Grupo A. CONCLUSÃO: A suplementação do LH mostrou-se satisfatória quanto ao ganho pôndero-estatural de recém-nascidos de muito baixo peso e sua m.o., com ligeira superioridade do Grupo B.

12
COMPARISON BETWEEN TWO DIETS WITH HUMAN MILK INPROMOTING GROWTH AND BONÉ MINERALIZATION OF VLBW.
Gonçalves AB, Gonçalves AL.
Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto

INTRODUCTION: Adequate nutrition of VLBW (BW £ 1500g) is crucial for the growth and development of these infants, for their organic and functional maturation and bone mineralization. Human milk (HM) do not achieve all the nutritional requirements of VLBW infants, exposing them to lower weight gain, longer hospital stay, hypoproteinemia, hyphosphatemia and osteopenia. Special infant formulas as well as HM "fortifiers" were developed to match their needs and must be checked. OBJECTIVES: The aim of this study is to compare the efficacy and tolerability of 2 diets based on HM added with "fortifier" (FM85R) or a special infant formula for preterm babies (PRENANR) on physical growth, bone mineralization and duration of hospitalization. POPULATION AND METHODS: Two groups of VLBW infants were formed - group A - 14 infants fed with HM + 5g% FM 85R and group B - 11 infants fed with HM + PRENANR (V/V), from the 15th day of life up to 2000g of weight. The following parameters were measured:- weight, lenght, head circumference; mean left triciptal skinfold thickness; calcium, phosphorus, magnesium and creatinine (serum and urine); alkaline phosphatase (serum) at the begining and end of the observation. The tubular phosphorus reabsorption rate (% TPR) was calculated and bone mineralization was assessed by X-Ray images of the left wrist through conventional lecture and optic densitometry of the plate. RESULTS: Eleven infants of each group completed the study. There were no statistical significant differences between the 2 groups at the begining of the study, even considering the exclusions. Weight, lenght and head circumference increases were good in both groups, but weight gain were signficant higher in the group B, although duration of hospitalization was not significant statistically. Serum calcium, phosphorus and magnesium levels did not differ between the groups, but alkaline phosphatase levels were significantly higher in group A at the end of the study . No significant differences were detected on bone mineralization and % TPR. DISCUSSION: The 2 diets were well tolerated by the infants and the weight gain was satisfactory in both group (> 20g/dia). Bone mineralization was good in both groups suggesting that the 2 diets were efficient to prevent osteopenia. CONCLUSION: Suplementation of HM with PRENANR V/V showed to be satisfatory in terms of weight gain and bone metabolism, slightly but not significantly better than HM + FM85R

13
EFECTO DE GINKGO-BILOBA EN LA ANGIOGENESIS RETINIANA DE RATAS SOMETIDAS A HIPEROXIA AL NACER
Sánchez C, Tejerina H, Torres-Pereyra J, Lemus D, Mañé M.
Centro Investigación Perinatal - Facultad de Medicina- Universidad de Chile

INTRODUCCION :La retinopatía del prematuro ( ROP ) es una enfermedad que afecta el desarrollo normal de los vasos de la retina en los recién nacidos más inmaduros y se caracteriza por una proliferación vascular desorganizada. En la actualidad la ROP afecta aproximadamente al 60% de los niños que pesan menos de 1250 gramos al nacer. Las etapas más severas son menos frecuentes y conllevan el riesgo de desprendimiento de retina y ceguera, a pesar de los tratamientos disponibles. La inmadurez y la presencia de oxígeno son los factores más importantes en este proceso de neoangiogénesis. El gingko-biloba (G-B) y otras drogas actuarían bloqueando este proceso. El objetivo de este trabajo fue evaluar el efecto de la administración de una dosis de G-B en la proliferación vascular de la retina en ratas sometidas a hiperoxia durante los primeros días de vida. MATERIAL Y METODO: Se usaron tres grupos de ratas recién nacidas, un grupo control, un grupo sometido a hiperoxia entre los días 7-12 de vida y un grupo expuesto a hiperoxia más G-B. Se sacrificaron y se cuantificaron núcleos de vasos sanguíneos de la retina. Se obtuvo el promedio con su desviación estandard y se realizó un análisis de varianza usando el test de Kruskal-Wallis para evaluar las diferencias entre los distintos grupos con un p < 0.05. RESULTADOS: El grupo sometido a hiperoxia y el grupo G-B más hiperoxia mostró un aumento del número de núcleos en comparación con el grupo control. El grupo con G-B más hiperoxia no mostró diferencias con el otro grupo sometido a hiperoxia. DISCUSION: El G-B en este estudio no mostró efectos debido probablemente a la dosis usada y al momento en que fue realizada la administración. Utilizar otras dosis y medir factores de crecimiento vascular son los pasos a seguir en esta línea de investigación. El estudio de esta alternativa más bien preventiva sin efectos adversos importantes podrá ser la base para un estudio randomizado controlado.

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EFFECT OF GINKGO-BILOBA IN THE RETINAL ANGIOGENESIS OF RATS EXPOSED TO HYPEROXIA AT BIRTH
Sánchez C, Tejerina H, Torres-Pereyra J, Lemus D, Mañé M.
Centro Investigación Perinatal - Facultad de Medicina- Universidad de Chile

INTRODUCTION: The retinopaty of the prematurity (ROP) is a disease that affects the normal development of the vessels of the retina in the most immadure newborn babies and it is characterized by a vascular proliferation disorganized. At the present time the ROP approximately affects 60% of the babies who weigh less than 1250 grams . The most severe stages are less frequent and entail the risk of retinal detachment and blindness, in spite of the treatments available. The oxygen immaturity and presence are the most important factors in this process of neoangiogenesis. Gingko-biloba (G-B) and other drugs would act blocking this process. The objective of this work was to evaluate the effect of the administration of a dose of G-B in the vascular proliferation of the retina in rats exposed to hyperoxia during the first days of life. MATERIAL and METHODS: Three groups of rats newborn were used, a group control, a group exposed to hyperoxia between the days a 7-12 of life and group exposed to hyperoxia more the G-B. They were sacrificed and nuclei of blood vessels of the retina were quantified. The average with its standard deviation was obtained and a variance analysis was made using the test of Kruskal-Wallis to evaluate the differences between the different groups with p < 0.05. RESULTS: The number of 3,49 nuclei was ± 1,75 in the group control, 7,03 ± 4,00 in the group with hyperoxia and 6,93 ± 3,33 in the group with hyperoxia more G-B. Only were statistically significant the differences between the group control and both groups exposed to hyperoxia (p < 0,05). DISCUSSION: The G-B in this study probably did not show effects due to the used dose and the moment in which the administration was made. To use other doses and to measure vascular growth factors are the steps to follow in this line of investigation. The experimentation with G-B of preventive way, which does not have important adverse effects, could be the base for a randomized controlled trial .

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VALIDACIÓN DE UN SCORE CLÍNICO PARA DETECTAR ALTERACIONES DEL GASTO CARDÍACO EN RECIÉN NACIDOS VENTILADOS
Bellani P, Salgado G, de Sarasqueta P, Mazzucchelli M, Gamez A.
Area de Neonatología Hospital de Pediatría "Prof. J. P. Garrahan"

Introducción: La medición del gasto cardíaco (GC) es una variable clínica de gran importancia en la Unidad de Cuidados Intensivos Neonatales. Si bien se han empleado diferentes métodos clínicos para este fin no hay estudios que hayan validado estos resultados en relación a un método de referencia de medición instrumental del gasto cardíaco. El presente estudio prospectivo analizó la relación entre el GC estimado por métodos clínicos y por ecocardiografía Doppler.
Material y Métodos: Se estudiaron 26 pacientes, internados en la Unidad de Cuidados Intensivos Neonatales del Hospital de Pediatría"Prof. J.P.Garrahan" , de forma consecutiva quienes cumplian con los siguientes criterios de inclusión: pacientes en asistencia respiratoria mecánica y con 4 o más horas de internación . Se excluyeron los pacientes con diagnóstico de cardiopatía congénita estructural y aquellos que hubiesen requerido maniobras de reanimación en las 6 horas precedentes. Se categorizó el gasto cardíaco clínico en: normal y bajo, aplicando un score de variables que incluían el examen físico, el estado ácido base y datos de la tensión arterial y la diuresis en las 4 horas precedentes al examen. Las mediciones ecocardiográficas fueron realizadas 30 minutos después de la valoración clínica y se determinó como el promedio de 4 mediciones, en forma ciega con respecto al método clínico. Se calculó la sensibilidad (S), especificidad (E) , el valor predictivo positivo (VPP), negativo(VPN) y valor de p para el método clínico.
Resultados: El GC fue normal en 20 pacientes y bajo en 6 pacientes. La medición clínica del GC tuvo una S de 75%, E de 88%, VPP 75% , VPN 88% y p= 0.003. Hubo dos casos de GC normal por la clínica que correspondía a GC bajo por ecocardiografía. Dos pacientes presentaron GC bajo por clínica con GC normal por ecocardiografía, ambos con shunt ductal.
Conclusiones: La prevalencia de GC bajo en recién nacidos ventilados sin cardiopatía estructural en nuestra población fue baja.
La medición del GC en la UCIN por métodos clínicos es satisfactoria y sería util para complementar la evaluación del GC en recién nacidos ventilados sin cardiopatía congénita estructural.

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CLINICAL SCORE VALIDATION FOR DETECTING CARDIAC OUTPUT VARIATIONS IN VENTILATED NEWBORNS
Bellani P, Salgado G, de Sarasqueta P, Mazzucchelli M, Gamez A.
Neonatal Intensive Care Unit. Hospital de Pediatría "Prof. Dr. .J. P. Garrahan"

Introduction: Measuring cardiac output (CO) is an important clinical feature in the neonatal intensive care unit (NICU). Different clinical methods has been used meanwhile different clinical methods has been employed in order to evaluate CO clinically, there are not studies validating those results regarding any instrumental method of measuring CO. This prospective study analyzed the relationship between estimation of CO trough clinical methods and Doppler ultrasonography.
Material and Methods: 26 patients admitted in the NICU at Hospital de Pediatría"Prof. J.P.Garrahan" were studied consecutively. Inclusion criteria were patients receiving mechanical ventilation with admission longer than 4 hours. Patient with structural congenital heart disease and those who required reanimation maneuver during preceding 6 hours were excluded. Cardiac output was classified in: normal and low, using a score including physical examination, blood gas, arterial tension and urinary output during preceding 4 hours. Ultrasonography measuring was performed 30 minutes after clinical examination and was an average of 4 examinations, blinded to the clinical method. Sensibility (S), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and p value were estimated for the clinical method.
Results: The CO was normal in 20 patients and low in 6 patients. Clinical CO had a S=75%, SP= 88%, PPV=75%, NPV=88% and p= 0.003. Two patients had normal clinical CO and low CO in ultrasonography evaluation. Two patients had low clinical CO and normal CO in ultrasonographic evaluation both with ductal shunting.
Conclusions:
Low Cardiac output prevalence was low in our population.
CO measuring in the NICU trough clinical methods is satisfactory and would be useful complementing CO evaluation in ventilated newborns without structural congenital heart disease.

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