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CRECIMIENTO FÍSICO EN PACIENTES CON ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA POST VIRAL.
del Pino M*, Bauer G**, González Pena H**, Grenoville M **, Lejarraga H*
*Crecimiento y Desarrollo, **Neumonologia. Hospital Garrahan. Buenos Aires. Argentina

La enfermedad pulmonar obstructiva crónica (EPOC) secundaria a una injuria viral aguda grave tiene una prevalencia relativamente alta en la Argentina con relación a otros países y genera un fuerte impacto en la salud de los niños que la padecen. En nuestro Hospital hay un programa interdisciplinario para la atención de esta población. Al igual que en otros grupos de pacientes con condiciones de salud crónicas y complejas, la evaluación del crecimiento aplicada en forma individual es un indicador del estado de salud general y una herramienta útil para monitorear el tratamiento; aplicada a la población es un buen indicador de la calidad del funcionamiento de un programa. Objetivo: evaluar el crecimiento de niños con EPOC post viral. Pacientes y Métodos:
Se realizo la evaluación longitudinal y prospectiva del crecimiento de 100 niños con EPOC post viral, con edades entre 0,05 y 2,83 años al inicio del seguimiento. Se realizaron mediciones antropometricas estandarizadas cada 3 meses el primer año y luego cada 6 meses por un periodo variable entre 1 y 4,70 años. Para buscar asociación de retardo de crecimiento con indicadores de severidad de la función pulmonar se uso la prueba de Chi2. Resultados: Cuatro tipos de curva fueron identificados según el crecimiento en estatura: tipo 1 (n=45 niños) mostró un crecimiento compensatorio en algún momento del seguimiento; tipo 2 (n=49) con crecimiento normal; tipo 3 (n=5) con retardo de crecimiento en el periodo agudo seguido de crecimiento normal y tipo 4 (n=1) retardo de crecimiento persistente luego del periodo agudo de la enfermedad. Se encontró asociación entre necesidad de oxigenoterapia y PCO2 > de 43 con los periodos de retardo de crecimiento (p=0,027 y p = 0,029). Conclusiones: El crecimiento en este grupo de niños con EPOC postviral es heterogéneo siendo en la mayoría de los casos satisfactorio. Si bien encontramos asociación de los periodos de retardo de crecimiento con insuficiencia respiratoria crónica, pensamos que la causa es multifactorial donde el estado nutricional y la ingesta calórica deben jugar un rol importante además de otros factores.

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PHYSICAL GROWTH IN CHRONIC LUNG DISEASE AFTER SEVERE ACUTE LOWER INFECTION
del Pino M*, Bauer G**, Gonzalez Pena H**, Grenoville M **, Lejarraga H*
* Growth and Development ** Neumonology. Hospital Garrahan. Buenos Aires. Argentina

Chronic Lung Disease (CLD) secondary to a severe acute viral infection has relatively higher prevalence in Argentina, and this situation has a strong impact in the health condition of the affected children. As in other groups of patients with chronic conditions, the evaluation of physical growth is an excellent indicator of general health, treatment follow-up. Moreover, when applied to these populations, the evaluation of physical growth is an excellent indicator of the quality of the program. Objective: to evaluate the growth of children with post-viral CLD. Patients and Methods: Longitudinal and prospective growth of 100 children with CLD between ages 0,05-2,83 years at the onset of the follow up was evaluated. Anthropometric measurements were carried out in an standardized way every 3 months during the first year and every 6 months later on, for a period varying between 1.00 to 4,70 years. Chi2 test was used to look for the association between growth retardation and indicators of pulmonary function severity. Results: according to growth in height, four types of curves were identified: Type 1(n=45 children) with catch up growth at some time during the follow up; type 2 (n=49) with complete normal growth; type 3 (n=5) with growth delay during the acute period followed by a normal growth rate; and type 4 (n=1) with persistent growth delay after the acute period of illness. We found a significant association between periods of growth retardation and the need of 24 hours/day O2 therapy and PCO2 levels of more than 43 (p=0,027 and p= 0,029 respectively)
Conclusions: We evaluated the physical growth of children with post-viral CLD in a multidisciplinary program. We found that most of the patients grew with an heterogeneous pattern. We found an association between periods of growth retardation and chronic respiratory insufficiency. However, we support the idea that the etiology of the periods of growth retardation is multifactorial including the combination of nutritional deficits, caloric intake, socioeconomic issues, etc.

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FACTORES DETERMINANTES DE LA SITUACIÓN NUTRICIONAL DE LA NIÑEZ PARAGUAYA. EIH 2000/01
Sanabria M, Robles M.
Cátedra de Pediatría. FCM. UNA. Dirección General de Encuestas, Estadísticas y Censos (DGEEC).

Introducción: La desnutrición infantil es un problema vigente en Paraguay y en riesgo de aumentar en años recientes.
Objetivo: Analizar los factores determinantes de la situación nutricional de la niñez paraguaya por departamentos, durante el período 2000/01.
Material y Métodos: estudio transversal, descriptivo, con componente analítico. Se utilizó la base de datos de la Encuesta Integrada de Hogares 2000/01 (EIH) de la DGEEC. Nivel de estimación: nacional y departamental (excepto Alto Paraguay y Boquerón). Muestra: 4543 niños y niñas < 5 años. Se realizó antropometría (curvas NCHS) y se determinaron variables asociadas por análisis de regresión múltiple y logística.
Resultados: La prevalencia de desnutrición global fue del 4,6 %, desnutrición aguda 0,8 % y desnutrición crónica 13,7%; obesidad 6,1%. Los departamentos con mayor desnutrición fueron Concepción, San Pedro, Caazapá, Itapúa, Amambay y Canindeyú. Los análisis de regresión logística para determinantes del estado nutricional infantil, por departamentos, fueron altamente significativos para: peso al nacer, escolaridad materna, duración de lactancia materna, acceso a agua segura y acceso a saneamiento (p<0,01). El peso al nacer fue una variable significativa protectora del riesgo de desnutrición tanto en peso como en talla en casi todos los departamentos (p<0,01). Los factores determinantes para el compromiso de talla fueron bajo peso al nacer, baja escolaridad materna, pobreza, no acceso a agua segura y saneamiento básico (p<0,01).
Conclusiones: Existen problemas de desnutrición así como de obesidad infantil. El adecuado peso al nacer fue una variable significativa para reducir el riesgo de desnutrición infantil. Algunos departamentos podrían reducir la prevalencia de desnutrición crónica con un mayor acceso a saneamiento básico.

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DETERMINANT FACTORS OF THE NUTRITIONAL STATUS OF PARAGUAYAN CHILDHOOD. INTEGRATED HOME SURVEY - EIH 2000/ 01.
Sanabria M, Robles M.
Cátedra de Pediatría. FCM. UNA. Dirección General de Encuestas, Estadísticas y Censos (DGEEC).

Introduction: Pediatric malnutrition is real problem in Paraguay and in risk of increasing in recent years.
Objective: Evaluate the determinant factors of the nutritional status of Paraguayan childhood by departments, during the years 2000 and 2001.
Material and Methods: Descriptive, transverse study with analytic component. The database of the Integrated Home Survey - EIH (Encuesta Integrada de Hogares) 2000 / 01 obtained by the General Directorship of Surveys, Statistics and Census - DGEEC was used.
Level of estimate: national and departmental (except Alto Paraguay and Boquerón).
Cohort: 4543 children (boys and girls) < 5 years of age. Anthropometric measurements was carried out (NCHS curves) and associate variables were determinate by multiple regression and logistics analysis.
Results: The prevalence of global malnutrition was of 4,6%, acute malnutrition 0.8% and chronic malnutrition 13,7%. The prevalence of obesity was 6,1%. The departments with greater malnutrition were Conception, San Pedro, Caazapá, Itapúa, Amambay and Canindeyú. Logistic regression analysis for determinant factors of the nutritional status by departments were highly significant for: birthweight, maternal level of education (scholarity), duration of nursing, access to drinkable water, and access to health services (p< 0,01).
Birthweight was a significant variable that protects from the risk of malnutrition, weight and length in almost all departments (p< 0,01). The determinants factors for length compromise were low birthweight, low maternal level of education, poverty, and no access to drinkable water and health services (p< 0,01).
Conclusions: There are problems of pediatric malnutrition and obesity. An adequate birthweight was a significant variable to reduce the risk of pediatric malnutrition. Some departments could reduce the prevalence of chronic malnutrition with a wider access to basic health services.

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VALIDADE DE EQUAÇÕES PARA A ESTIMATIVA DA GORDURA CORPORAL RELATIVA EM MODELOS ADOLESCENTES.
Costa R, Rodrigues A, Fisberg M.
Centro de Atendimento e Apoio ao Adolescente - Depto de Pediatria - UNIFESP - São Paulo - Brasil.

Introdução: Normalmente utiliza-se a equação de Slaughter et al. (1988) para a avaliação da composição corporal de crianças e adolescentes, porém em grupos específicos como o de modelos, que apresentam características físicas bastante particulares, há a necessidade de se testar a validade dessa equação, bem como de outras que possam ser utilizadas. Objetivo: O objetivo deste estudo foi testar a validade de duas equações antropométricas de estimativa da densidade corporal: Lewis et al. (1978) e Slaughter et al. (1988), em um grupo de modelos profissionais adolescentes do sexo feminino. Métodos: Foram avaliadas 11 modelos (17,09 + 1,92 anos de idade), utilizando-se a pesagem hidrostática (PH) como técnica padrão. As densidades obtidas pelas equações foram convertidas em porcentagem de gordura (%G), utilizando-se a fórmula de Siri (1961). As medidas de dobras cutâneas foram obtidas por meio de um adipômetro da marca Sanny®, seguindo-se a padronização descrita por Costa (2001). O critério de determinação da validade adotado foi o proposto por Lohman (1992): correlação linear de Pearson ( r ) > 0.80, Erro Padrão de Estimativa (EPE) < 3,5 % de gordura corporal, e diferença não significante no teste t de Student para amostras dependentes. Resultados:

Conclusão: A análise dos resultados demonstra que somente a equação proposta por Lewis et al. (1978) para avaliar atletas jovens do sexo feminino, atendeu a todos os critérios de validade no grupo estudado, permitindo-nos concluir que para modelos profissionais adolescentes, com características semelhantes, esta pode ser uma boa opção para a avaliação da composição corporal.

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VALIDITY OF EQUATIONS TO ESTIMATE BODY FAT IN TEENAGERS TOP MODELS
Costa R, Rodrigues A, Fisberg M.
Centro de Atendimento e Apoio ao Adolescente - Depto de Pediatria - UNIFESP - São Paulo - Brasil.

Introduction: It´s usually used Slaughter´s equation for body composition assessment in children and adolescents, however in specific groups as the one of top models, that presents particular physical characteristics, it is necessary the cross-validation of this equation, as well as of others that can be used. Objective: The purpose of this study was to test the validity of two anthropometric equations for body density estimation: Lewis et al. (1978) and Slaughter et al. (1988), in a professional top models teenagers group. Methods: They were going evaluated 11 top models (17,09 + 1,92 years old), using hydrostatic weighing (HW) as "gold standard". The densities obtained by the equations were converted in body fat percentage (BF), using the formula proposed by Siri (1961). The skinfold thickness was obtained by Sanny® skinfold caliper, following the standardizations proposed by Costa (2001). The criteria adopted to determinate the validity of the equations was the proposed by Lohman (1992): Pearson´s correlations coefficient ( r ) > 0.80, Standard Error of Estimate (SEE) < 3,5 % of body fat, and non- significant difference in paired t test.
Results:

Conclusion: The analysis of the results demonstrates that only the equations proposed by Lewis et al. (1978) to evaluate female young athletes, attended to all of the validity criteria in the studied group, so we conclude that for top models teenagers, with similar characteristics, this can be a good option to assess body composition.

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CAMBIOS EN LOS NIVELES DE MINERALES Y PROTEINAS EN LECHE HUMANA SEGÚN LA FRECUENCIA DE AMAMANTAMIENTO
Ronayne de Ferrer PA1,,Greco C1, Baroni A1, Macías de Costa M2, Rodríguez de Pece S2. 1Facultad de Farmacia y Bioquímica, UBA Buenos Aires, Argentina. 2Universidad Nacional de Santiago del Estero. (Proyecto UBACYT B062)

Existe escasa información sobre los cambios en la composición de la leche humana durante el destete gradual, el que comienza alrededor de los 6 meses, al incorporar los alimentos complementarios. La involución de la glándula mamaria durante esta etapa afectaría a los distintos nutrientes en diferente magnitud.
El objetivo de este trabajo fue determinar los niveles de calcio (Ca), fósforo (P) y zinc (Zn) y la relación Proteínas del suero(PS)/Caseína(CAS) en leche humana madura en función de la frecuencia de mamadas.
Se analizaron 127 muestras de leche materna (meses 5, 6 y 7 post-parto), en el Hospital Distrital de Forres, Santiago del Estero, previo consentimiento. Los minerales se determinaron por espectrometría de absorción atómica (previa digestión). Se utilizó electroforesis en gel de poliacrilamida para PS/CAS. El análisis estadístico se realizó por el test t de Student.
Resultados: ( X+ESM)

Se observó un aumento significativo para la relación PS/CAS con menor número de mamadas. Por el contrario, no hubo diferencias en los minerales analizados. Los resultados obtenidos indican que la disminución en la frecuencia de mamadas, que llevaría a una involución de la glándula mamaria, afecta la proporción entre las proteínas lácteas pero no modifica los niveles de los minerales estudiados. (Agradecemos a las Autoridades del Hospital Distrital de Forres por su apoyo).

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CHANGES IN MINERAL AND PROTEIN LEVELS IN HUMAN MILK ACCORDING TO BREAST-FEEDING FREQUENCY
Ronayne de Ferrer PA1,,Greco C1, Baroni A1, Macías de Costa M2, Rodríguez de Pece S2. 1Facultad de Farmacia y Bioquímica, Buenos Aires, Argentina ; 2Universidad Nacional de Santiago del Estero. (Project UBACYT B062)

There is little information about changes in human milk composition during gradual weaning, which starts around the 6th month postpartum, with the incorporation of complementary foods. The involution of the mammary gland during this period would affect different nutrients in diverse magnitude.
The objective of the present study was to determine calcium (Ca), phosphorus (P) and zinc (Zn) levels and Whey Protein(WP)/Casein(CAS) ratio in human mature milk as a function of breast-feeding frequency.
One hundred and twenty seven milk samples were analyzed (months 5, 6 and 7 postpartum), in the Forres District Hospital, Santiago del Estero, previous consent. Minerals were determined by atomic absorption spectrometry (previous digestion). WP/CAS ratio was evaluated by polyacrylamide gel electroforesis. Statistical analysis was performed using the Student t test.
Results:( X+SEM)

A significant increase in WP/CAS ratio was observed with a smaller number of feedings. However, there were no differences in mineral concentrations. These results indicate that the decrease in breast-feeding frequency, which would lead to an involution in the mammary gland, affects milk proteins proportion but does not modify the levels of the studied minerals. (We are grateful to the authorities of the Forres District Hospital for their support).

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CHILD BEHAVIOR CHECKLIST(CBCL): INSTRUMENTO DE TRIAGEM PARA PROBLEMAS DE COMPORTAMENTO EM CRIANÇAS E ADOLESCENTES
Marteleto MRF, Guedes DZ, Pedromônico MRM.
Universidade Federal de São Paulo

A assistência integral ao desenvolvimento da criança e do adolescente deve permear as ações e práticas do profissional de saúde. A presença de determinados comportamentos na criança em desenvolvimento sugere a necessidade de investigação psicológica. Buscar instrumentos que possam identificar crianças com dificuldades adaptativas e indicá-las para tratamento é uma determinação legal, política e ética. Objetivo: Verificar a utilidade do CBCL como instrumento para triagem de crianças com problemas de comportamento. Métodos: Três grupos de crianças. G1:35(29,66%) crianças diagnosticadas com Transtorno Autista(DSM-IV,1994) e expostas a escolarização na AMA( idade média=7a 6m). G2:31(26,27%) crianças com Transtorno de Linguagem (DSM-IV,1994) expostas a terapia fonoaudiológica no Ambulatório de Distúrbios da Comunicação Humana da UNIFESP(idade média=7a6m).G3:52( 44,06%) crianças escolares sem problemas de linguagem ou de comportamento selecionadas pela professoras e coordenadoras pedagógicas de duas escolas próximas à UNIFESP(idade média=7a 7m).A escolaridade das mães variou da primeira série de ensino fundamental ao ensino superior completo da seguinte maneira: G1:9anos(ensino médio incompleto).G2:6anos(ensino fundamental incompleto).G3: 9anos(ensino médio incompleto). O CBCL (Achenbach,1991) traduzido e adaptado por Bordin (1995),foi aplicado nas 118 mães das crianças em estudo, na forma de entrevista individual para evitar a interferência da escolarização materna.Tal questionário consta de 113 comportamentos atípicos que a mãe deve avaliar como ausente, às vezes presente e frequentemente presente, assinalando 0 ou 1 ou 2 respectivamente. A somatória dos pontos obtidos é convertida em escore T, cuja nota de corte em 60 separa os grupos clínicos e não clínicos. Para análise estatística empregou-se a análise de variância. Resultados: Os G1 e G2 tiveram T escores médios significativamente maiores que o G3 (p=0,001). Os escores médios de G2 foram maiores para a categoria agressivos e externalizadores (p=0,03). O G1 obteve escore significantemente maior (p=0,0001) na categoria problemas de pensamento e significativamente menor (p=0,01) na categoria ansiedade que G2 e G3. O G3 teve T escore médio significativamente menor nas categorias: isolamento, problemas sociais e problemas de atenção (p=0,0001). O CBCL diferenciou os grupos de crianças com patologias do grupo de escolares típicos,indicando ser uma ferramenta útil para triagem de crianças com perfil clínico e não clínico.

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CHILD BEHAVIOR CHECKLIST (CBCL): INSTRUMENT FOR SCREENING BEHAVIOR PROBLEMS IN CHILDREN AND ADOLESCENTS
Marteleto MRF, Guedes DZ, Pedromônico MRM.
Universidade Federal de São Paulo

Introduction: The total assistance to children and adolescent development should follow the action and practice of health professionals. The presence of determined behaviors in children under development suggests the need of psychological investigation. Looking for instruments that could screen children with difficulties and indicate them for the treatment is a legal, political and ethical issue. Objective: Verify the CBCL usage as an instrument for screening children with behavior problems. Method: Three groups of children. G1:35 (29,66%) children with autistic disorder diagnostic (DSM-IV, 1994) and in a special school - AMA (average age = 7 years and 6 months). G2: 31 (26,27%) children with language disorders (DSM-IV, 1994) under speech therapy on the ADCH-UNIFESP (average age = 7 years and 6 months). G3: 52 (44,06%) school children without language or behavior disorders selected by teachers and pedagogical coordinators from two schools closed to UNIFESP (average age = 7 years and 7 months). The mothers academic knowledge varied from the first grade up to the completed university degree: G1: 9 years (uncompleted high school), G2: 6 years (uncompleted secondary school), G3: 9 years (uncompleted high school). CBCL (Achenbach, 1991) was translated and adapted by Bordin et al (1995), and it was used on 118 children's mothers in study, on individual interview basis to avoid the maternal academic/schooling interference. This inquiry is made of 113 non-typical behaviors, which the mother should evaluate as present (score 2), sometimes present (score 1) or never present (score 0). The total score is done through the addition of these points. The value of 60 divide the groups in clinical and non-clinical children. For the statistical analysis it was used the ANOVA. Results: G1 and G2 had meaningful medium scores higher than G3 (p= 0,001). The medium scores in G2 were higher on the category "aggressive behavior" and "externalizing"(p= 0,03). On G1 the category "thought problems" had a meaningful medium score higher than G2 e G3 (p= 0,0001) and the "anxious behavior" had a meaningful low medium score than G2 and G3 (p= 0,01). The G3 had Tmedium score lower on the following categories: "withdraw", "social problems" and "attention problems" (p= 0,0001). Conclusion: CBCL was able to differentiate the group of clinical children from the non-clinical typical school children. New researches should be done using CBCL to emphasize the importance of this instrument.

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LA DEFICIENCIA DE HIERRO EN LA INFANCIA AFECTA LA VELOCIDAD DE TRANSMISION Y LA EFICIENCIA SINAPTICA DE LA VIA AUDITIVA.
Algarín C1, Nuñez JC1, Lozoff B2, Peirano P1
(1)Laboratorio de Sueño y Neurobiología Funcional, INTA, Universidad de Chile, Santiago Chile, y (2) Center for Human Growth and Development, Universidad de Michigan, Ann Arbor, USA

INTRODUCCION: La anemia por deficiencia de hierro (ADH) en la infancia altera el desarrollo neurofuncional. En este contexto, hemos demostrado que la transmisión de los estímulos sensoriales auditivos ocurre más lentamente. Efectos de larga duración han sido observados por medio de potenciales evocados auditivos de tronco cerebral (PEA), al evaluar los parámetros habitualmente utilizados en la práctica clínica, como latencia de las ondas e intervalos interondas.
OBJECTIVO: Determinar si los efectos de la ADH en la infancia sobre la transmisión de estímulos a través de la vía auditiva, también se observan al evaluar parámetros como duración y área bajo la curva (ABC) de los PEA.
METODOS: A los 6 meses de edad evaluamos cincuenta y cuatro lactantes nacidos de término y sanos, con parámetros antropométricos adecuados para la edad gestacional, de los cuales 29 presentaron ADH y 25 sin ADH, constituyeron el grupo control. Los PEA fueron realizados durante el sueño quieto, en condiciones habituales de su ciclo sueño/vigilia. Determinamos duración (ms) y ABC (uV/ms) de las ondas I, III y V a 85 decibeles (dB).
RESULTADOS: La duración de las ondas fue similar en ambos grupos. Por el contrario, el ABC de las ondas III y V fue menor en niños ADH respecto a los controles (5.37+1.9 vs 6.3+1.5, p <.002; y 8.4+2.0 vs 9.7+2.0, p <.04, respectivamente).
CONCLUSIONES: Los efectos de la ADH en la infancia sobre el funcionamiento del sistema auditivo, también se observa al evaluar el ABC en los PEA. Estos resultados indican que el hierro jugaría un rol relevante en los mecanismos involucrados en la sincronización neural que modula la ganancia en los relevos sinápticos de la vía auditiva. Estos antecedentes, sugieren que la ADH no solo afecta la velocidad de transmisión sensorial, sino también la eficiencia sináptica al interior del tronco cerebral. [Financiamiento: Proyectos NIH (R01 HD33487) y CONICYT (Fondecyt 1000657)]

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IRON DEFICIENCY ANEMIA IN INFANCY AFFECTS SPEED AND SYNAPTIC EFFICIENCY OF THE AUDITORY PATHWAY.
Algarín C1, Nuñez JC1, Lozoff B2, Peirano P1
(1)Sleep and Functional Neurobiology Lab, INTA, University of Chile, Santiago Chile, and (2) Center for Human Growth and Development, University of Michigan, Ann Arbor, USA

INTRODUCTION: Iron deficiency anemia (IDA) in infancy slows the developmental progression of auditory pathway transmission. Long-lasting effects on auditory brainstem responses (ABRs) have been demonstrated by assessing parameters usually used in clinical practice such as waves latency and inter-peak waves intervals, but not in amplitude.
OBJECTIVE: To determine whether the effects of IDA in infancy on stimuli transmission through the auditory pathway are also apparent by measuring waves duration and area under the curve (AUC) in ABRs.
METHODS: Healthy 6-month-old Chilean infants with IDA (n= 29) or nonanemic (n= 25) were compared on ABRs while in quiet sleep, under their naturally occurring sleep-wake cycling. Duration (ms) and AUC (uV/ms) were assessed for waves I, III, and V at 85 dB.
RESULTS: Duration of different waves was similar between groups. In contrast, AUC of waves III and V were smaller in IDA infants relative to controls (5.4+1.9 vs 6.3+1.5, p <.002; and 8.4+2.0 vs 9.7+2.0, p <.04, respectively).
CONCLUSION: The effects of IDA in infancy on auditory system functioning are also apparent through AUC assessments in ABRs. These results indicate that iron would play a key role in mechanisms involved in neural synchronization that modulate the gain in synaptic relays of the auditory pathway. As a whole, IDA appears to affect not only the speed of sensory transmission, but also the synaptic efficiency within the brainstem.
[Funded by NIH (R01 HD33487) and CONICYT (Fondecyt 1000657) grants]

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ESTUDIO DE RESPUESTA INMUNE PARA CAMPYLOBACTER JEJUNI EN LACTANTES Y NIÑOS CHILENOS ASINTOMÁTICOS.
Reyes A., Troncoso M, Navarrete P, Faúndez G, Catalán R., Figueroa G.
Lab. de Microbiología, INTA, Universidad de Chile.

Introducción: Campylobacter jejuni (Cj) es uno de los enteropatógenos bacterianos de más alta prevalencia en Chile y el mundo. La infección por Cj provoca un cuadro de gastroenteritis agudo luego de la ingestión de alimentos o agua contaminada. En países industrializados, esta situación es más frecuente en jóvenes adultos, por el contrario en países subdesarrollados la primoinfección ocurre tempranamente y los niños presentan altas tasas de infección. La campylobacteriosis es una zoonosis y entre los principales reservorios se destacan las aves de corral y de vida libre (cerdos, vacas, ovejas, perros y roedores). El contacto con Cj evoca en el huésped una fuerte respuesta inmune. En los países pobres, los lactantes poseen títulos elevados de IgG contra Cj lo que sugiere que no es infrecuente que éstos desarrollen infecciones subclínicas. Estudios realizados en lactantes chilenos mostraron una tasa de aislamiento de 10% de Cj en cuadros diarreicos y de 3.2% en niños asintomáticos. Objetivos: Estudiar la respuesta inmune para Cj en lactantes y niños chilenos en los que no se ha evidenciado sintomatología clínica. Materiales y métodos: Se evaluó la respuesta inmune para Cj en un total de 410 sueros La población estudiada incluyo cuatro grupos. Grupo 1 (n: 192) lactantes menores de 18 meses; Grupo 2 (n: 36) niños entre 2 y 8 años; Grupo 3 (n: 83) niños entre 9 y 13 años y Grupo 4 (n: 169) adultos donadores de sangre (edad promedio 30 años). Los niveles de IgG se determinaron mediante una ELISA desarrollada y estandarizada con antígenos de superficie de una cepa aislada localmente. El reconocimiento de epítopes de Cj se evaluó por Inmunoblot. Resultados: Se detectó anticuerpos IgG para Cj en 55 de 192 lactantes (29%). Los niños mayores (grupo 2 y 3) presentaron una tasa de infección alta, de 39 y 34% respectivamente. Por el contrario, en los adultos se observó un menor frecuencia de infección (18%, 30/169). Conclusión: La alta tasa de seropositividad a Cj en los niños chilenos sugiere que en nuestra población la infección se produce a corta edad y las tasas se mantienen elevadas en pre-escolares y niños mayores.

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STUDY ON THE IMMUNE RESPONSE OF CAMPYLOBACTER JEJUNI IN ASYNTOMATIC IN CHILEANS INFANTS AND CHILDREN.
Reyes A, Troncoso M, Navarrete P, Faúndez G, Catalán R, Figueroa G.
Lab. de Microbiología, INTA, Universidad de Chile.

Introducción: Campylobacter jejuni Cj is an enteropathogen with a wide distribution in Chile and the world. Cj infection causes enteritis in humans after the ingestion of contaminated food or untreated water. Campylobacter infections in the developing world differs markedly from that in the developed areas. In industrialized countries, illness is more common in young adults while in poorer environments the highest incidence of infection is found in children. Campylobacteriosis is a zoonosis, being poultry and cattle the most frequent sources of human infection. Puppies, kittens, pigs, sheep, rodents, and wild birds may also serve as reservoirs. Cj Infection induces a strong IgG antibody response. Infants from less developed regions usually have high IgG levels againts Cj because the infection is acquired during the first years of life, but often remains sub clinical or minimally symptomatic. Studies in Chilean infants showed Cj isolation rates of 10% in children with diarrhoea and 3.2 % in non-symptomatic children. Objetives: To study the immune response to Cj in infants and children that did not present clinical symptoms. Materials and Methods: immune response against Cj was studied in sera from 410 individuals. The population studied included four groups. Group 1 (n: 192): infants less 18 months; Group 2 (n: 36): children between 2 and 8 yeas old; Group 3 (n: 83): children between 9 and 13 years old and Group 4 (n: 169): healthy adults blood donors (average 30 years old). The serum IgG levels against Cj was determined through an "in house" ELISA protocol previously standardized in our laboratory, using a surface antigen obtained from a local isolate as capturer. The reactivity of the sera against Cj epitopes was evaluated by Immunoblot. Results: IgG antybodies for Cj were detected in 55 of 192 infants (29%). Groups 2 and 3 showed a higher incidence of infection, 39 and 34% respectively. On the contrary, a lower rate of infection (18%, 30/169) was observed in adults. Conclusions: The high rate of seropositivity to Cj in children suggest that in our population the infection occurs early, and the infection frequency remains elevated in pre-school and older children.

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FACTORES DE RIESGO Y CARACTERÍSTICAS PERINATALES EN PREECLAMPSIA SEVERA: ESTUDIO CASO CONTROL
Barreto, DS.
Instituto Materno Perinatal. Lima Perú.

Introducción: La preeclampsia severa es aún uno de los mayores problemas obstétricos en países en vías de desarrollo.
Objetivos: Identificar los factores de riesgo asociados a la presentación de esta patología en el Instituto Materno Perinatal y determinar su impacto en las características perinatales.
Diseño: Retrospectivo, caso control.
Población: 173 casos de madres con preeclampsia severa que hayan dado a luz en la institución, excluyéndose otras causas de hipertensión, diabetes, embarazo gemelar, enfermedad renal. Dos controles por caso, de similar nivel socioeconómico y edad, seleccionadas al azar, durante el periodo 1999 - 2001.
Medidas de los resultados principales: Odds ratio estimado por análisis de regresión logística.
Resultados: Del conjunto de factores considerados resultaron significativos el control prenatal inadecuado y la primiparidad, con valores de OR ajustado de 1.561 (NC95% 1.068-2.28) y 1.598 (NC 95% 1.063 - 2.4) respectivamente. Además se encontró que la preeclampsia severa está asociada al tipo de parto, bajo peso y muy bajo peso al nacer, edad gestacional, peso/edad gestacional, depresión severa, mortalidad fetal y neonatal (p<0.05).
Conclusiones: El control prenatal inadecuado y la primiparidad incrementan significativamente el riesgo para la presentación de la preeclampsia severa . Los resultados confirman que la preeclampsia severa continúa siendo un problema importante de salud pública.

22
RISK FACTORS AND PERINATAL CHARACTERISTICS OF SEVERE PREECLAMPSIA: A CASE - CONTROL ANALYSIS
Barreto, DS.
Instituto Materno Perinatal. Lima Perú.

Background: Severe preeclampsia remains one of the major obstetrical problem in developing countries
Objectives: Identify the risk factors associated with this pathology at Materno Perinatal Institute and determinate it's impact of perinatal characteristics.
Design: Retrospective: case - control.
Population: 173 cases and 346 controls deliveries at our institution. We exclude other hypertensive causes, diabetes, twin pregnancy, renal disease. The controls not differed on socio economic status and age and were randomly selected over the period 1999 - 2001.
Main Outcome Measure: Odds ratio calculated by means of logistic regression analysis.
Results: We find that inadequate prenatal control and primiparity were significantly associated with this pathology. The risk of severe preeclampsia: adjusted odds ratio 1.561 (95%CI 1.068-2.028), and 1.598 (95%CI 1.063-2.4) respectively. Also there was an association between severe preeclampsia and type of delivery, low birth weight, very low birth weignt, gestacional age, weight/gestacional age, severe depresion, neonatal and fetal deaths (p<0.05).
Conclusions: Inadequate prenatal control and primiparity are associated with an significant higher risk of severe preeclampsia These results confirm severe preeclampsia continue to be a major public health problem.

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INDOMETACINA: DOSIS ADMINISTRADA VS DOSIS REAL.
Goldsmit G, Salas G, Segretin S, Travaglianti M, Guido P, Bramuglia G, Fariña D, Rodriguez S, Laffaire E.
Neonatología y Farmacia Hosp. Garrahan. Fac. Farmacia y Bioquimica UBA

Introducción: En Neonatologia el uso de Indometacina (INDO) está ampliamente difundido para el cierre del Ductus Arteríoso Persistente en prematuros y la dosis habitual es 0,1 a 0,2 mg/kg.En Argentina la única forma comercial de lNDO(IM 75®= 50mg/2m!) obliga a la reconstitución del preparado luego de dos diluciones para alcanzar la dosis neonataI.En la práctica clínica se ha sugerido que esta dilución puede ser riesgosa e imprecisa,e incluso algunos neonatólogos han optado por otra droga de igual eficacia, aunque menos estudiada. No existen en la actualidad estudios publicados que demuestren si la dilución de la lNDO modifica la dosificación teórica indicada Objetivo:Evaluar si la dosis de indometacina (1M 75®) administrada en una UClN es equivalente a la dosis teórica indicada Material y método: Se seleccionaron aleatoriamente 50 enfermeras, quienes desconocían el objetivo del estudio. A cada una de ellas se les solicitó que realicen la dilución estándar de la droga para una dosis estimada de 0.2 mg/kg en un neonato con peso teórico de 1000 g. Se analizaron dos series de 50 muestras correspondientes a las diluciones para la dosis teórica indicada: 0.5mg/ml y 0.2 mg/12ml. Cada muestra fue analizada por triplicado mediante cromatografia liquida de alta performance y se consignó como concentración real de INDO el promedio de las tres mediciones. Se compararon las concentraciones obtenidas con respecto a las teoricas (0.5mg/ml y 0.2 mg/12ml) mediante test t de Student. Resultados: la dilución intermedia y final mostró diferencias significativas con la esperada

El 64 % (32/50) de las muestras de la dilución final superó en más del 20 % la concentración indicada de 0.2mg/12ml; en ningún caso se observaron mediciones por debajo del 20 % de la concentración teorica.Conclusiones: Luego de las diluciones, las dosis real de Indometacina (IM75®) no es equivalente a la indicada En la mayoria de los casos las dosis administradas superan ampliamente a la dosis teórica. Sería necesario analizar si estas diferencias se asocian a concentraciones plasmáticas tóxicas y/o mayores eventos adversos en los prematuros tratados con INDO en nuestro país.

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INDOMETHACIN: DELIVERED DOSE VS ACTUAL DOSE
Goldsmit G, Salas G, Segretin S, Travaglianti M, Guido P, G Bramuglia, Fariña D, Laffaire E, Rodríguez S.
Neonatología, Farmacia Hospital J P Garrahan. Facultad de Farmacia y Bioquímica UBA.

Introduction: Indomethacin (INDO) is frequentely used for the pharmacological closing of ductus in premature babies, and the usual dose is 0,1 to 0,2 mg/kg. In Argentina Indomethacin is supplied as 2cc vials (IM 75 5O mg/ml) and have to be diluited twice to reach the neonatal dose .It has been suggested that this dilution could be risky,and many physicians have chosen another drugs with similar effectiveness, although less well studied.To our knowledge,at present, published studies demostrating that INDO dilution modifies the theoretical dose indicated doesn't exist. Objective: To assess if INDO (IM75) dose. administered in a NICU is equivalent to the theoretical indicated dose .Material and Methods: 50 nurses were selected by random sampling . They were blinding to the study objective.They have to prepare the standard solution of the drug for a hypothetical 1000grs newborn (0,2 mg/k) .They did two series of 50 samples corresponding to the following dilutions: 0.5 mg/k and 0.2 mg/12ml.Each sample was analyzed by triplicate by liquid chromatography of high performance.The average of the three values was recorded. We compared the concentration obtained with the theoretical one (0.5 mg/ml , 0.2 mg/12ml). Student's t test was used for analysis Results:there were significant differences between the actual and awaited dose, with regard to intermediate and final dilution

Sixty four percent (32/50) of the final dilution samples surpassed by more than 20% the indicated concentration (0,2mg/12ml). No sample had a value less than 20% the theoretical dose . Conclusions: after dilution, the actual dose of indomethacin (IM75) is not equivalent to the indicated one. In most cases, the administered doses surpassed widely the theoretical indicated. It would be necessary to analyze if these differences are associated with toxic plasmatic concentrations and/or higher frequency adverse effects in premature babies undergoing indomethacin treatment in Argentina.

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AGRUPAMIENTO DE VARIABLES DE RIESGO EN OBESIDAD INFANTIL.
Krochik G, Ozuna B, Mazza C.
Servicio de nutrición, Hospital J. P. Garrahan. Buenos Aires. Argentina

La obesidad se asocia a dislipidemia, hipertensión, resistencia a la insulina e intolerancia a la glucosa y diabetes 2, agrupadas en el denominado síndrome metabólico, su agregación se considera potente factor de riesgo de enfermedad cardiovascular del adulto. El objetivo del presente trabajo fue estimar la prevalencia del agrupamiento de los componentes clásicos del síndrome metabólico en una población de niños y adolescentes obesos. Mat y métodos: Fueron incluidos 182 niños (99 m, 83 v) de edad media 11,1± 2,8 años, que consultaron por obesidad sin manifestaciones clínicas de otra patología. El síndrome metabólico fue definido como la asociación de resistencia insulínica o alteración del metabolismo hidrocarbonado sumado a otras 2 manifestaciones (OMS 1998. La obesidad fue evaluada por el IMC > 85 Plo (Rolland Cachera). A todos los pacientes se les realizó un test de tolerancia a la glucosa oral con dosajes de glucosa e insulina por RIA, dosaje de triglicéridos y colesterol y determinación de tensión arterial. Se definieron diabetes o intolerancia a la glucosa según criterios de ADA. La resistencia a la insulina fue evaluada por medio del modelo homeostático considerándose resistencia a un valor mayor a 1 DS de la media normal. La hipertensión arterial se definió como sistólica o diastólica mayores al plo 95 de las tablas dela Task Force. El análisis estadístico se realizó con Statistix 7. Las diferencias entre variables continuas se analizaron con test de student y test de chi cuadrado para variables categóricas. Se consideró significativa una p igual o menor a 0.05. Resultados: El síndrome metabólico estuvo presente en el 46,1 % de la población obesa. La frecuencia de las diferentes manifestaciones fue: resistencia a la insulina 65,3%, hipertensión 58.2%, hipertrigliceridemia 21,9% e intolerancia a la glucosa 8.8%. Se encontró una diferencia significativa en la magnitud de la obesidad entre el grupo con síndrome metabólico y sin este: IMC 32,9+-5,9 vs. 29,9 +- 5,3 ( p< 0,0005).No se encontraron diferencias en otras variables. La resistencia a la insulina fue la manifestación mas frecuente asociada a obesidad. Conclusiones: el agrupamiento de variables de riesgo cardiovascular denominado síndrome metabólico, basado en la definición de la OMS estuvo presente en 1 de cada 2 niños. La implicancia práctica es la necesidad de identificación temprana en función de objetivos preventivos.

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RISK VARIABLE CLUSTERING IN THE METABOLIC SYNDROME IN CHILDHOOD OBESITY.
Krochik G, Ozuna B y Mazza C.
Servicio de Nutrición. Hospital J. P. Garrahan. Buenos Aires Argentina

Conditions of obesity, dyslipidemia, hypertension, insulin resistance and type 2 diabetes or impaired glucose tolerance (IGT) especially in constellation, named metabolic syndrome, are potent risk factors of coronary disease in adults. Objective: To estimate in obese children and adolescents the prevalence of clustering of manifestation of metabolic syndrome using the definition proposed by the World Health Organization (WHO 1998). Materials and methods: 182 overweight children and adolescents (99females, 83males). Age11.1± 2.1 yr was included from among the children who consulted by obesity without other disease. The metabolic syndrome was defined in children with overweight or obesity and type 2 diabetes or impaired glucose tolerance or insulin- resistance normal glucose tolerance with at least one of the following risk factors: hypertension or dyslipidemia. Children with a BMI greater than the 85 th percentile for age and sex reported on the BMI tables of Rolland Cachera were defined as overweight. All of the children were given an oral glucose tolerance test and venous blood samples were obtained to measure plasma glucose and insulin levels. Triglycerides concentrations were assessed at fasting samples. Blood pressure was measured at rest Systolic or diastolic hypertension was defined as a value grater than 95 th Plo of the tables of Task Force. Insulin resistance was assessed at baseline by using the homeostasis model assessment and considered abnormal a value greater than more than the mean and one SD of normal control. Type 2 diabetes and impaired glucose tolerance was defined according to the ADA guidelines. Results: A total of 46.1% of the patients had metabolic syndrome. The associations of obesity and the individuals conditions founded was Insulin resistance: 65,3%, hypertension: 58,2 % hypertrigliceridemia 21,8% and with impaired glucose tolerance 8,8%. The patients with metabolic syndrome were significativly more obese than the group without the syndrome BMI 32,9+- 5,9 vs 29.9+-5.3 (p<0.0005). Conclusions: The clustering of cardiovascular risk factors called metabolic syndrome based on the WHO definition is seen in 46,1 % the obese children and adolescents. It confers an increased risk of cardiovascular morbidity and its identifications may thus be important in the risk assessment and treatment of childhood obesity.

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ESTUDO DA PREVALÊNCIA E DO PAPEL DA CARÊNCIA DE FERRO COMO FATOR DE RISCO PARA A DEFICIÊNCIA DE VITAMINA A EM PRÉ-ESCOLARES BRASILEIROS
Ferraz I, Daneluzzi J, Vannucchi H, Jordão A, Ricco R, Del Ciampo L, Martinelli C, Engelberg A, Bonilha L, Custódio V, Carvalho A.
Dto. de Puericultura e Pediatria. Fac. de Medicina de Ribeirão Preto (Universidade de São Paulo).

Introdução: Carências nutricionais na infância se apresentam como importantes problemas de saúde pública em países em desenvolvimento. Além disso, crianças com carência de um micronutriente apresentam maior risco de apresentar, simultaneamente, carências de outros micronutrientes. Objetivos: Identificar a prevalência de carência de ferro no sangue periférico na população estudada, além de verificar se tal deficiência se apresenta como um fator de risco para a deficiência de vitamina A (DVA). Metodologia: Em um ambulatório de Pediatria Geral em Ribeirão Preto (SP/Brasil) foram selecionadas 188 crianças com idades ³ 24 meses e < 72 meses sem diarréia e/ou febre no momento da coleta. A identificação de DVA foi realizada através do +S30DR. Para a pesquisa da carência foi obtida amostra de sangue periférico em jejum para dosagem dos seguintes índices hematimétricos: níveis de hemoglobina, ferro sérico e da capacidade latente de fixação de ferro (UIBC). Foram consideradas com carência de ferro crianças com hemoglobina <11,0g/dl e/ou ferro sérico <50mg% e/ou relação ferro sérico:capacidade de ligação de ferro total (TIBC) <16% e/ou ainda UIBC >346mg/dl. Foi realizada inspeção ocular à procura de xeroftalmia, além das medidas de peso e altura para análise antropométrica do estado nutricional. Resultados: 39,9% (55/138) das crianças com DVA e 33,3% (16/48) sem DVA apresentaram carência de ferro. No total, 38,2% (71/186) das crianças apresentaram carência de ferro e 74,5% (140/188), DVA. A carência de ferro não se apresentou como um fator de risco para a DVA (p=0,42: teste do c2). Análise separada de cada índice hematimétrico também não mostrou diferença significativa entre as crianças com e sem DVA. Apenas 3,7% (7/188) das crianças apresentavam desnutrição. Nenhuma criança apresentou xeroftalmia. Conclusões: Apesar da carência de ferro não se apresentar como um fator de risco para a DVA, ambas as carências apresentaram prevalências elevadas em uma população "saudável" e com baixo índice de desnutrição; tal situação é conhecida como "fome oculta". Tais achados estimulam mais estudos para identificar grupos de risco para tais carências para se planejar ações para combatê-las.

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STUDY ON THE PREVALENCE AND ROLE OF IRON PRIVATION AS A RISK FACTOR FOR VITAMIN-A DEFICIENCY IN BRAZILIAN SCHOOL CHILDREN
Ferraz I, Daneluzzi J, Vannucchi H, Jordão A, Ricco R, Del Ciampo L, Martinelli C, Engelberg A, Bonilha L, Custódio V, Carvalho A.
Department of Puericulture and Pediatrics. Ribeirão Preto Medical School (University of São Paulo).

Introduction: Childhood nutritional privation is an important health care problem in developing countries. In addition, children lacking a micronutrient present a higher risk of lacking other micronutrients at the same time. Objectives: Identifying the predominance of iron privation in peripherical blood of the population studied, as well as verifying if such privation is a risk factor for vitamin-A deficiency (DVA). Methodology: In preschool children at a General Pediatrics outpatient clinic in Ribeirão Preto (SP/Brasil), 188 children at ³ 24 months and < 72 months of age, with no diarrhea and/or fever at collection, were selected. DVA identification was carried out through +S30DR. As to the research on privation, a sample of peripherical blood from fasting children was obtained for dosage of the following hematimetric indexes: hemoglobin counts, seric iron, and unsaturated iron binding capacity (UIBC). Children presenting hemoglobin count <11,0g/dl and/or seric iron level <50mg% and/or seric iron:total iron binding capacity (TIBC) rate <16% and/or UIBC >346mg/dl were considered having iron deficiency. Ocular inspection for signs of xerophthalmia was performed on all children, in addition to weight and height measurements for anthropometric analysis of nutritional status. Results: 39,9% (55/138) children with DVA and 33,3% (16/48) without DVA have presented iron deficiency. 38,2% (71/186) children have presented iron deficiency and 74,5% (140/188), DVA. Iron deficiency has not been presented as a risk factor for DVA (p=0,42: c2 test). A separate analysis for each hematimetric index has also demonstrated no significant difference between children with or without DVA. Only 3,7% (7/188) children have presented malnutrition. No children have presented xerophthalmia. Conclusion: Although iron deficiency has not been presented as a risk factor for DVA, both deficiencies have been presented in high levels in "healthy" population with low malnutrition index; such situation is known as "hidden hunger". Such findings stimulate further studies for identifying risk populations as to such deficiencies in order to plan actions against them.

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BAJA BIODISPONIBILIDAD DEL HIERRO ELEMENTAL EN HARINA DE TRIGO: UN ESTUDIO CON ISÓTOPOS ESTABLES.
Walter T,* Pizarro F, * Boy E, ‡ Abrams S, †
Laboratorio de Micronutrientes, INTA U de Chile, Santiago, ‡The Micronutrient Initiative, Ottawa Canada, y †USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX

Antecedentes: Como una estrategia en el control de la deficiencia de hierro, la fortificación de la harina de trigo está establecida en muchos países, especialmente el Latinoamérica. En la mayoría de los casos se usa hierro elemental reducido de pequeña partícula debido al menor costo y bajo efecto de cambios organolépticos. Sin embargo, su biodisponibilidad es cuestionable.
Objetivo : Apuntamos a determinar la biodisponibilidad de hierro elemental reducido de pequeña partícula en pan blanco tipo francés.
Métodos: Utilizamos un isótopo estable de hierro reducido como fortificante en pan de trigo de alta extracción (72%). A 12 niños de 5 a 7 años de le administraron panes con 3 mg de H2-reducodo 58Fe con tamaño de partícula ˜ 15 mm. La dosis de referencia fue de ascorbato ferroso con 57Fe. A los 14 días se analizaron muestras de sangre para medir enriquecimiento isotópico con espectrometría de masa. Solubilidad del H2-reducido 58Fe y un hierro reducido comercial se evaluó en condiciones que simulan la digestión en el tracto gastrointestinal.
Resultados: Normalizando al 40% de la absorción de la dosis de referencia la biodisponibilidad el promedio geométrico de biodisponibilidad (± rango de 1 SD) del hierro reducido en pan fue de 6,5% (5.6-7.5). La solubilidad del hierro comercial fue de 1,5% mientras que la del 58Fe fue de 8,6%. Una estimación del hierro 58Fe absorbido de 100 g de pan (75 g harina) fue 0.15 mg. i.e. alrededor de 12% del requerimiento diario de Fe absorbido.
Conclusiones: Apoyado por los resultados de solubilidad, la biosisponibilidad del Fe comercial elemental (tamaño de partícula 45mm) es razonable que sea muy inferior a la del producto estable usado aquí y no contribuya mayormente al estado nutricional de hierro de la población.
Financiado por The Micronutrient Initiative, Ottawa, Canada

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LOW BIOAVAILABILITY OF ELEMENTAL IRON POWDER IN WHEAT BREAD: A STABLE ISOTOPE STUDY
Walter T,* Pizarro F, * Boy E, ‡ Abrams S, †
Laboratorio de Micronutrientes, INTA U de Chile, Santiago, ‡The Micronutrient Initiative, Ottawa Canada, y †USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX

Background: As a strategy to eradicate iron deficiency, iron fortification of wheat flour is extensively used worldwide. In most cases elemental iron powders are utilized as fortificants due to their lower cost and few, if any, sensory problems. However, their bioavailability is questionable.
Objective : Our aim was to measure the bioavailability of hydrogen reduced elemental iron in French-type white wheat bread .
Methods: We used a stable isotope of hydrogen reduced iron powder as a fortificant in wheat bread . Twelve children were fed bread rolls with 3 mg of H2-reduced 58Fe with a particle size ˜ 15 mm. The reference dose was 57Fe ascorbate . After 14 days, blood samples were analyzed for isotopic enrichment using mass spectrometry. Solubility of H2-reduced 58Fe and a commercial elemental iron was assessed in a condition simulating digestion in the gastrointestinal tract..
Results: When normalized to 40% absorption of the reference dose, the geometric mean bioavailability (± range of 1 SD) of reduced iron in wheat bread rolls was 6,5% (5.6-7.5). Commercial iron's solubility in bread was 1,5% whereas for H2-reduced 58Fe it was 8,6%. Estimated absorbed 58Fe from 100 g of bread ( 75 g flour) was 0.15 mg. i.e. about 12% of daily requirements for iron.
Conclusions: Supported by the solubility results, the bioavailability the commercial iron powder ( particle size 45mm) is likely to be even lower than that of the smaller particle size H2-reduced 58Fe . Therefore, elemental iron powders in wheat bread are unlikely to have a significant beneficial impact on population iron status.
Funded by The Micronutrient Initiative, Ottawa, Canada

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ESTADO NUTRICIONAL DE PACIENTES CON SÍNDROME DE INTESTINO CORTO EN EL PERIODO POST NUTRICION PARENTERAL
González H, Martinez M, Malpeli A, Varea A, Pattín J, Brocchi M, Tonini S, Viteri F.
IDIP Hospital de Niños de La Plata, Argentina. UCBerkeley USA.

Objetivo: Evaluar el estado nutricional antropométrico y el estado nutricional de hierro, Vitamina B12 y Folato en pacientes con Síndrome de Intestino Corto (SIC) luego de suspendida la Nutrición Parenteral (NP) por no menos de 2 años. Pacientes y Métodos: Se estudiaron 10 pacientes pediátricos con SIC. Se evaluaron parámetros antropométricos: peso, talla, perímetro braquial y espesor de los pliegues cutáneos subescapular, suprailíaco, bicipital y tricipital con caliper Lange. Se utilizó la clasificación del estado nutricional de Waterloo según porcentajes de adecuación de peso/talla (P/T) y talla/edad (T/E) usando tablas de referencia de NCHS. Se dosaron los valores de hemoglobina y su volumen y concentración, ferritina, transferrina, ferremia y la saturación porcentual de transferrina, ácido fólico y vitamina B12. Se realizo una encuesta alimentaria. Resultados: El rango de edad fue 3.3-12.9 años. La media del intestino remanente fue 46.3 cm (rango:20-70), yeyuno: 30.4 (10-60), ileon 17.9 cm(0-60). El tiempo promedio de dependencia de NP fue 378.5 días (rango:70 - 900). El P/T fue normal en 8 pacientes, en 2 se encontró un déficit grado I, y bajo porcentaje de masa grasa y magra en 1 de ellos. La T/E fue anormalmente baja en 5 pacientes: 3 de grado 1, y 2 de grado II. Los mismos ya tenían afectada la talla durante el período de NP. El % de masa adiposa fue bajo en 5 pacientes; 3 pacientes mostraron anemia, 2 de los cuales presentaron macrocitosis. Esta alteración del VCM se encontró también en 2 casos no anémicos. Se observaron niveles bajos de vitamina B12 (1 paciente) y folatos séricos (4 pacientes). La encuesta alimentaria mostró que el consumo promedio diario de vitamina B12 y ácido fólico era adecuado y el 50% de los pacientes no lograba la adecuación del consumo de hierro. La ingesta calórica fue 110% (rango: 67-238) y proteica 326% (r:122-684). Conclusión: La malabsorción leve y la malabsorción de micro nutrientes puede manifestarse sutil y tardíamente. La talla de 50% de los pacientes fue afectada desde el período en que recibieron NP y a pesar de que el % de adecuación de ingesta proteica fue muy superior al 100% en todos los pacientes, parecieran no tener capacidad de crecimiento compensatorio en el periodo post NP. Los pacientes con SIC deben recibir un riguroso control nutricional y un estrecho seguimiento clínico biológico a largo plazo luego de suspendida la NP.

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NUTRITIONAL CONDITION OF PATIENTS WITH SHORT BOWEL SYNDROME IN POST PARENTERAL NUTRITION PERIOD
González H, Martinez M, Malpeli A, Varea A, Pattín J, Brocchi M, Tonini S, Viteri F
IDIP, Hospital de Niños de La Plata. Argentina. UCBerkeley USA.

AIM: To evaluate the anthropometric, iron, B12 Vitamin and folato nutritional condition in patients with short bowel syndrome (SBS) after suspending parenteral nutrition (PN) for no less than 2 years. PATIENTS AND METHODS: We studied 10 pediatric patients with SBS. The anthropometric parameters evaluated were weight, height, brachial perimeter, and width of subscapular, suprailiac, bicipital and tricipital cutaneous folds with Lange caliper. The Waterloo classification of nutritional condition was used according to weight/height (W/H) and height/age (H/A) fitting percentages with the NCHS reference tables. Hemoglobin values, volume and concentration were assessed, as well as those of ferritin, transferrin, ferremia and percent saturation of transferrin, folic acid and B12 vitamin. A nutritional survey was also performed. RESULTS: The age range of the patients was 3.3 - 12.9 yrs. The means of residual bowel was 46.3 cm (range:20-70), jejunum: 30.4 (10-60), ileum 17.9 cm (0-60). The average time of dependence of PN was 378.5 days (range:70 - 900). The W/H was normal in 8 patients, with a Score I deficit in 2 patients and a low percent of fatty and lean body mass in 1 patient. The H/A was abnormally low in 5 patients: 3 Score 1, and 2 Score II. Height was already affected during the PN period The percent of adipose mass was low in 5 patients. Three patients presented anemia, two of which also developed macrocytosis. Such alteration in MCV was also found in two cases where anemia was absent. The levels of B12 vitamin (1 patient) and serum folates (4 patients) were low. The nutritional survey showed that the average daily intake of B12 vitamin and folic acid was adequate, while 50% of patients could not adapt the intake of iron. The caloric and protein intake were 110 (range: 67-238) and 326 (r:122-684), respectively. CONCLUSION: Malabsorption of macro and micronutrients can manifest subtly and late. Height in 50% of patients was affected as of the period they were receiving PN. Despite the protein intake fitting percent was well above 100% in all patients, they would apparently not be able to develop a compensatory growth capacity in the post-PN period. Both nutritional control and long-term clinical-biological follow-up should be very strict in SBS patients once PN has been suspended.

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APORTE INICIAL DE AGUA Y GLUCOSA EN PREMATUROS CON PESO ENTRE 1000 Y 1750 g: GASTROCLISIS VERSUS VÍA INTRAVENOSA. ESTUDIO ALEATORIZADO, CONTROLADO Y MULTICENTRICO.
Cravedi V, Mariani G, Armadans M, Valverde R, Alda E, Ramirez P, Lattuca D, Rodriguez M, Lupo E, Fustiñana C, Barziza J, Ceriani Cernadas J M.
Hospitales: Italiano de Buenos Aires, Oñativia, de San Isidro,Privado del Sur y Clínica Quintana.

Fundamentos: los recién nacidos (RN) de peso bajo reciben inicialmente dextrosa por vía intravenosa (IV). El aporte contínuo de soluciones glucosadas mediante gastroclisis (GC), podría ser una alternativa con ventajas potenciales.
Objetivo: evaluar la eficacia y seguridad de la GC en RN entre 1000 y 1750g.
Diseño/Métodos: estudio controlado,aleatorizado y multicéntrico. El punto final primario fue la necesidad de requerir vía IV. Todos los neonatos entre 1000 y 1750 g al nacer se consideraron para inclusión. Se excluyeron: Apgar al 5to. Minuto< 6,malformación congénita mayor, O2 >0,6, presión media en la vía aérea >8, hipoglucemia y condición clínica severa en las primeras dos horas de vida. Los RN fueron aleatorizados a GC o IV. Ambos grupos recibieron D10% en igual cantidad. La intervención duró hasta alcanzar 100 ml/kg/día. Se suspendió la GC ante: 1)residuo >25% del ingreso en las tres hs.previas, 2)policitemia sintomática 3)deterioro clínico a juicio del neonatólogo,4) ECN.
Resultados: 62 RN se aleatorizaron a GC y 67 a IV. El 40% del grupo GC no requirió vía IV. En los restantes se indicó la vía IV. No hubo diferencias en policitemia, hipernatremia, hipoglucemia, sepsis,pérdida de peso máxima y ECN. La principal causa para suspender la gastroclisis fue deterioro clínico y residuo. La regresión logística mostró que sepsis probable o confirmada (OR:12,9;IC95%2,4-65) y preeclampsia (OR5,9;IC95%1,3-28,2) estuvieron independientemente asociadas con la discontinuación de la GC.
Conclusiones: la GC en RN entre 1000 y 1750g redujo en un 40% el uso de la vía IV, y no presentó complicaciones. La preeclampsia se asoció con fracaso de la GC. Es probable que una política menos estricta con el residuo podría disminuir aun más la vía IV.

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RANDOMIZED CONTROLLED CLINICAL TRIAL OF OROGASTRIC VS INTRAVENOUS FOR THE INITIAL FLUID ADMINISTRATION IN PRETERM INFANTS.
Cravedi V, Mariani G, Armadans M, Valverde R, Alda E, Ramirez P, Lattuca D, Rodriguez M, Lupo E, Fustiñana C, Barziza J, Ceriani Cernadas J M.
Hospitales Italiano (Bs. As.), Oñativia, de San Isidro, Quintana and Privado del Sur. Argentina.

Early intravenous (IV) fluids are usually given to preterm infants to assure an adequate water and glucose balance. The continuous infusion of fluids through an orogastric (OG) tube may be an alternative with potential advantages such as easier, less painful and lower costs. Objective. To assess the efficacy and safety of a continuous OG infusion of glucose solutions in the initial fluid management of preterm infants with BW between 1000 and 1749 g. Design/ Methods. Multicenter randomized controlled trial. Primary outcome measure was need for IV access. Infants weighing 1000-1749 g at birth were considered for inclusion. Exclusion criteria were 5 minute Apgar score < 6, major congenital malformations, RDS requiring FiO2 > 0.6 and MAO > 8 in the first 2 hours, early hypoglycemia and severe clinical condition. Infants were randomized within the first 2 hours after birth to an OG or an IV group. The fluid solution (D10w) and the amount prescribed were the same for both groups. The intervention lasted until 100ml/k/d of enteral feedings were reached. Discontinuation of the OG infusion was considered if any of the following conditions were present: 1) Gastric residuals > 25% of previous 3 hours intake; 2) Symptomatic polycythemia; 3) Clinical deterioration as judged by the neonatologist; 4) NEC. Results. 62 infants were randomized to the OG group and 67 to the IV group. Forty percent of the infants in the OG group did not required an OG line. In the remaining 60%, fluid administration was switched to an IV route. No differences were found in polycythemia, hypoglycemia, hypernatremia time to reach reach 100ml/k/d of enteral feeds, maximum weight loss, sepsis and NEC. The major reasons for discontinuation of OG fluids were clinical deterioration and high residuals. A logistic regression analysis showed that suspected or proven sepsis (OR 12.9, 95% CI 2.4 - 68.5) and preeclampsia (OR 5.9, 95% CI 1.3 - 28.2) were independently associated with discontinuation of OG infusion. Conclusions. Early orogastric infusion of a glucose solution in stable preterm infants with BW 1000 - 1749 g resulted in a reduction of 40% in the use of IV lines, and was not associated with increased complications. Preeclampsia was associated with failure of successful early orogastric infusion.