ABSTRACT USHUAIA (pág. 6 de 6)
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CHRONIC INFANTILE NEUROLOGICAL CUTANEOUS ARTICULAR SINDROME - CINCA
Roberto Marini, Andre S.L. Pinheiro,  Adil M. Samara. Reumatologia Pediátrica, Departamento de Pediatria / CIPED – Universidade Estadual de Campinas (Unicamp) / SP – Brazil

JAA, branca, feminino, 11 anos de idade. Desde o nascimento apresenta exantema máculo papular de intensidade variável, associado a febre recorrente diária com surtos de linfonodomegalia hepato e esplenomegalia. Apresenta desproporção crânio facial e a fontanela bregmática ainda está aberta. Aos 12 meses iniciou artrite aditiva em joelhos, punhos, dedos, tornozelos, cotovelos e ombros, levando a contratura de joelhos e cotovelos. Andou com dificuldade aos 30 meses  passando longos períodos restrita ao leito. Hipoacusia foi detectada aos 10 anos. Aos 8 anos, manifestado como quadro de obnubilação, foi diagnosticado um surto de hipertensão intracraniana. Não apresenta déficit intelectual. O líquor sempre apresentou hipercelularidade com predomínio de neutrófilos, sem alterações bioquímicas e culturas negativas. Os parâmetros laboratoriais sempre demonstraram atividade inflamatória (VHS e PCR elevados); leucocitose, anemia e trombocitose estavam freqüentemente presentes; negativo para autoanticorpos; hipergamaglobulinemia com aumento de IgG e IgE eram constantes.
Não houve alterações no metabolismo dos aminoácidos, carbohidratos e cálcio. Todos os testes sorológicos foram negativos para doenças infecciosas. As manifestações desta doença multissistêmica como o início extremamente precoce, a erupção cutânea, a artrite e meningite crônicas, associadas às alterações laboratoriais e às radiológicas, ossificação anormal das epífises, são as mesmas daquelas definidas por Prieur(1987) como síndrome de CINCA. Os tratamentos com corticosteróides, antiinflamatórios não hormonais, imunossupressores, imunoglobulina humana, utilizados em diferentes regimes e associações foram todos inefetivos. Os diagnósticos anteriores desta paciente foram mastocitose, artrite séptica e artrite reumatóide juvenil.

CHRONIC INFANTILE NEUROLOGICAL CUTANEOUS ARTICULAR SYNDROME - CINCA
Roberto Marini, Andre S.L. Pinheiro,  Adil M. Samara. Pediatric Rheumatology Unit - Department of Pediatrics/CIPED - State University of Campinas (Unicamp)/SP - Brazil

JAA, white female, 11 years old. Since birth she has presented a generalized maculopapular erythema that waxed and waned, associated with recurrent daily fever and bouts of limphonodes, liver and spleen enlargement. A craniofacial disproportion and a large anterior fontanel were noted, being the fontanel still palpable nowadays. At 12 months she started an additive arthritis involving knees, wrists, fingers, ankles, elbows and shoulders, leading to contractures of the knees and elbows. She hardly walked at 30 months, spending long periods bedridden. Deafness was detected when she was 10 years old. Intracranial hypertension clinically manifested as obnublation was first detected when she was 8 years old, without any mental retardation. The cerebrospinal fluid was always pleiocytotic with predominance of neutrophils, with no biochemical abnormality and negative cultures. Laboratory data always showed nonspecific inflammatory activity (elevated ESR and CRP); leukocytosis, anemia and thrombocytosis were often present; autoantibodies were negative; hypergamaglobulinemia with increase of IgG and IgE was constant. There were no alterations of amino acid, carbohydrates and calcium metabolism. All serologic tests for infectious diseases were negative. The features of this multisystemic disease such as very early onset, chronic skin eruption, chronic arthritis and chronic meningitis, together with other clinical and laboratorial features and also with the abnormal epiphyseal ossification as seen on X-ray, were the same as those defined by Prieur (1987) as the CINCA syndrome. The therapeutical trials with corticosteroids, NSAID, immunosuppressive agents and human immunoglobulin, used in different association regimens were, all ineffective. The patient was previously diagnosed as having mastocytosis, septic arthritis and juvenile rheumatoid arthritis.

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RECUPERACION DEL RETARDO DE CRECIMIENTO PRENATAL ASIMETRICO EN RATAS POR TRATAMIENTO CON HORMONA DE CRECIMIENTO

Guimarey, L ⁽¹⁾; Oyhenart, E ^(2,3); Quintero, F ⁽²⁾; Fucini, M ⁽²⁾.

⁽¹⁾ Hospital. "SSM Ludovica",  Endocrinología y Crecimiento - CIC-PBA; ⁽²⁾ CIGEBA. Facultad de Ciencias Veterinarias-UNLP; ⁽³⁾ CONICET. La Plata. Argentina.

La alteración en el intercambio materno-fetal, dependiendo del período en que actúe, produce diferentes patrones de retardo prenatal del crecimiento (RPC).
El objetivo del presente trabajo es estudiar: (1) si la obstrucción de las arterias uterinas provoca RPC y en caso afirmativo, (2) la posible recuperación del crecimiento posnatal por tratamiento con hormona de crecimiento (GH). Material y método: Se constituyeron 4 grupos experimentales: 1-control (C); 2-sham operados (S); 3- RPC inducido (RPCI) y 4-tratados con GH.(RPCI+GH). Las arterias uterinas de las madres de los grupos RPCI fueron parcialmente ligadas a los 14 días de gestación. El grupo RPCI+GH recibió diariamente GH (9UI/kg/día) (21- 60 días). El grupo S actuó como control para descartar efectos del diluyente hormonal y/o procedimiento quirúrgico. Madres y crías consumieron dieta stock ad libitum. Las crías fueron radiografiadas y pesadas (P) cada 21 días desde el nacimiento hasta los 84 días. Se midió: longitud, ancho y altura del neuro y esplacnocraneo y longitud de la columna (LC). Se calcularon los índices neural (IN) y facial (IF) y valores de puntaje Z. Se realizó análisis de varianza para mediciones repetidas.
Resultados Machos y hembras con RPCI presentaron los siguientes valores Z al nacimiento: P (-8.1; -12.5), LC (-2.7; -2.4), IN (-1.3; -1.8) e IF (-0.7; -1.1) y a los 84 días de edad los RPCI: P (-1.8; -0.6), LC (-1.8; -0.8), IN (-2.5; -1.0) e IF (-0.5; 0.1). y los RPCI+GH: P (-1.3; -0.1), LC (-1.9; -0.2), IN (-0.6; -0.3) e IF (-1.2; -0.6), respectivamente. Los pruebas post hoc indicaron diferencias significativas entre RPCI y RPCI+GH, en P, IN e IF.
Conclusión: El RPC en ratas, provocado en el 3er. tercio de la gestación es asimétrico, afectando más al peso y la columna que al cráneo. El tratamiento con GH acentúa la recuperación ponderal y del neurocráneo en ambos sexos y de la longitud de la columna sólo en las hembras.

RECOVERY OF ASYMMETRIC PRENATAL GROWTH RETARDATION IN RATS WITH       GROWTH HORMONE TREATMENT

Guimarey, L ⁽¹⁾; Oyhenart, E ^(2,3); Quintero, F ⁽²⁾; Fucini, M ⁽²⁾.

⁽¹⁾ Hospital. "SSM Ludovica", Endocrinología y Crecimiento - CIC-PBA; ⁽²⁾ CIGEBA. Facultad de Ciencias Veterinarias.-UNLP; ⁽³⁾ CONICET. La Plata. Argentina. 

The alteration in  maternal-fetal exchange produces different patterns of prenatal growth retardation (PGR) depending on the period in wich it acts.
The aim of the present study is to analyze: (1) the effect caused by the obstruction of  uterine vessels in fetal growth and (2) the recovery of  postnatal growth with growth hormone (GH) treatment.
Material and method: Pups were distributed in 4 groups: 1-control (C); 2-sham operated (S); 3- induced PGR -(IPGR) and 4-treated with GH (IPGR+GH). The uterine vessels of the mothers of the IPGR and IPGR+GH were partially bent on the 14^th day of gestation. The IPGR+GH received, daily, GH (9UI/kg/day) (21 - 60 days). The S group  acted as control to eliminate any effect of the surgical technique and/or the injection vehicle. Mothers and offsprings were fed with stock diet ad libitum. Pups were radiographied and weighted (W) every 21 days from  birth until the 84^th day. Neuro and esplachnocranial length, wideth and height, and vertebral column length (CL) were measured. Neural (NI) and facial (FI) indices, and Z scores were calculated. Variance analysis for repeated measures were done.
Results Male and females with IPGR showed at birth the following Z values: W (-8.1; -12.5), CL (-2.7; -2.4), NI (-1.3; -1.8) and FI (-0.7; -1.1), and at the 84^th day of age the IPGR: W (-1.8; -0.6), CL (-1.8; -0.8), NI (-2.5; -1.0) and FI (-0.5; 0.1) and the IPGR+GH: W (-1.3; -0.1), CL (-1.9; -0.2), NI (-0.6; -0.3) and FI (-1.2; -0.6), respectively. Post hoc tests indicated significant differences between IPGR and IPGR+GH, in W, NI and FI. Conclusion: The IPGR in the 3^rd third of rats gestation presents an asymmetric pattern: weight and vertebral column were more affected than skull. GH treatment increased weight and neurocranial recovery in both sexes bat vertebral column length only in females.

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USO RACINAL DE SANGUE E COMPONENTES EM UNIDADE NEONATAL DE CUIDADOS INTENSIVOS

ALBIERO, André L.; VAZ, Flávio A. C.; CHAMONE, Dalton A.F. and POZZI, Diana H. B. Faculdade de Medicina da Universidade de São Paulo, Brasil

Introdução Como as estratégias para restringir o uso de sangue e componentes em adultos em estado crítico parecem ser tão eficazes quanto as liberais e preocupações acerca da disponibilidade e segurança do sangue encorajam abordagens conservadoras para transfusões, determinamos se a estratégia transfusional restritiva produz resultados em recém-nascidos criticamente doentes equivalentes àqueles observados em adultos comprando as taxas de mortalidade por todas as causas até 200 dias de seguimento.
Métodos Comparamos 46 recém-nascidos em que a estratégia liberal foi praticada (Grupo L) (média do nível sérico de hemoglobina pré-transfusional de 10,56 g/dl) e 106 recém-nascidos em que uma estratégia transfusional mais restritiva foi praticada (Grupo R) (média do nível sérico de hemoglobina pré-transfusional de 9,66 g/dl), um programa de exposição limitada a doadores e o uso de componentes leuco-reduzidos foram aplicados.
Resultados A mortalidade geral em 200 dias foi um tanto diferente entre os dois grupos [Grupo L: 35 % vs. 22 % (Grupo R), P=0,07]. Entretanto, as taxas foram significativamente inferiores com a estratégia restritiva entre os recém-nascidos mais criticamente doentes – aqueles que necessitaram de mais de 5 unidades de hemocomponentes, 16 recém-nascidos do Grupo L e 20 do Grupo R: 75 % vs. 45 %, respectivamente, P<0,02. A mediana de unidades de hemocomponentes utilizadas pelos grupos L e R foram bastante diferentes (3,0 vs. 1,0; P=0,006). A mediana de unidades utilizadas por recém-nascidos pertencentes aos subgrupos de recém-nascidos mais graves (que receberam mais de 5 unidades) foi de 10 para o Grupo L e 7,5 para o Grupo R, (P=0,03).
Conclusões Medidas para limitar o uso de sangue alogênico, através de estratégias restritivas e limitar a exposição a múltiplos doadores em recém-nascidos criticamente doentes pode contribuir para melhorar sua sobrevida.

RATIONAL USE OF BLOOD AND COMPONENTS IN NEONATAL INTENSIVE UNIT CARE

ALBIERO, Andre L.; VAZ, Flavio A. C.; CHAMONE, Dalton A.F. and POZZI, Diana H. B. Faculty of Medicine of University of Sao Paulo, Brasil

Purpose As restrictive strategies of red-cell transfusion seems as effective as liberal ones in critically ill adult patients and concerns about the supply and safety of blood encourage conservative approaches to transfusions, we determine whether restrictive transfusion strategy produce equivalent results in critically ill infants to those observed in adults comparing the rates of deaths from all causes at 200 days.
Methods We compared 46 infants in which liberal (L group) strategy of red-cell transfusion was practiced (mean pre-transfusional hemoglobin concentration at 10.56 g/dl) and 106 infants in which a more restrictive (R group) strategy (mean pre-transfusional hemoglobin concentration at 9.66 g/dl), a limited donor exposure transfusion program and the use of some white cell-reduced components were applied. Summary Overall 200-day mortality was little different in the two groups [L group: 35 percent vs. 22 percent (R group), P=0.07]. However, the rates were significantly lower with the restrictive transfusion strategy among infants who were more critically ill – those who need more than 5 units of blood components, 16 infants on L group and 20 on R group: 75 percent vs. 45 percent, respectivelly, P<0.02. The median of used units by these latter subgroups were 10 and 7.5, respectivelly (P=0.03). The overall median of used units was also quite different (3.0 vs. 1.0, P=0.006).
Conclusions Measures to limit the use of allogeneic blood transfusion, through restrictive threshold strategies and limiting donor exposure on critically ill infants may improve their survival rates.

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PATOLOGÍAS ASOCIADAS A LA MUERTE FETAL

Fuksman R, Mazzitelli N, Grandi C. Hospital Materno Infantil “Ramón Sardá”, Buenos Aires, Argentina.

Objetivos : Evaluar las posibilidades diagnósticas de diversos estudios postmorten y conocer las      patologías asociadas a la  muerte fetal
Se analizaron los resultados de  los estudios postmortem realizados a 114 fetos muertos de más de 400 g de PN nacidos en la Maternidad Sardá de Buenos Aires entre el 1/1/98  y el 31/12/99 (2 años). A 50 fetos se les realizó autopsia completa y examen de placenta (A),a 37  examen externo, antropometría y estudio anatomopatológico de placenta ( B ),  a 18   se les examinó sólo la placenta ( C ), a 3  se les realizó sólo la autopsia  ( AB ) y  a 5 se les realizó  examen externo y antropometría (D) . Se categorizaron los resultados según su satisfactoriedad en: a) satisfactorios por Patología sola ( S x AP), por patología más historia clínica ( S x AP + Hcl ) y por historia clínica sola  (S x Hcl); b) poco satisfactorios  (PS) y c) sin diagnóstico ( SD ).
Resultados : La mediana del PN fue de 1400 g (770-2550) y la media de la EG 30.3 +  9.3  sem. (19-40); 53% pesó <1500 g  y 57% <32 semanas de EG. El 75.4% (n = 86) de los estudios tuvo resultados S x AP, 10,5% (n = 12)  S x AP + Hcl,  2.6% (n = 3) S x Hcl,  7,8% (n = 9) fue PS y el 3,5% (n = 4 ) fue SD. En los 101 fetos con resultados satisfactorios  las patologías más frecuentemente asociadas a muerte fetal  fueron: Asfixia 62.3 % (n = 63), Anomalías del desarrollo 25,7% (n = 26), Infecciones intrauterinas 3,9% (n = 4), Hidrops Rh 3,9% (n = 4), Inmadurez 4,9%  (n 5 ) y otros 6% (n = 6). El 57% (n = 36) de los fetos asfixiados tenían lesiones placentarias no inflamatorias, el 22% (n = 14) accidentes de cordón, el 6,3% (n = 4) infección ovular severa, el 3,1 % (n = 2) lesiones de placenta y cordón no inflamatorias y en el 6.1% (n =7) no se pudo  determinar  la causa de la asfixia. Las anomalías del desarrollo más frecuentes halladas fueron: aneuploidías (n = 10) por feno o  cariotipo, anomalías de cierre de tubo neural (n = 3 ) y anomalías urinarias (n = 3) . Más de la mitad de las asfixias, todas las IIU y un grupo de Otros estaban macerados, mientras que todos los fetos muertos por inmadurez  no lo estaban.
Conclusiones :  El examen AP sumado a la Hcl  permitió demostrar  que las etiologías más frecuentemente asociadas a la mortalidad fetal en este estudio fueron  la asfixia, anomalías del desarrollo, inmadurez, infecciones intrauterinas e hidrops inmunológico.

PATHOLOGIES ASSOCIATED TO FETAL DEATH

Fuksman R, Mazzitelli N, Grandi C.Sardá Maternity Hospital, Buenos Aires, Argentina

Objectives : to evaluate the possibilities of different types of postmortem studies, to investigate the pathologies associates to fetal death and to evaluate the relationship between fetal pathologies and the presence of maceration.
Materials and methods: The results of the postmortem study of 114 fetal deaths born at Sardá maternity between 1^st. January 1998 and 31^st December 1999, weighing 400 g or more, were included. A complete autopsy and the study of the placenta in 50 fetuses (A), anthropometry, external examination and the study of the placenta in 37 (B), a study of only the placenta in 18 (C), only yhe autopsy in 3 (AB), and anthpometry and external examination in 5 (D) were perfomed. Studies were classified in Satisfactory (by pathology only [S x P], by pathology and clinical record [S x P + CR], only by clinical record [S x CR], barely satisfactory (BS), and without diagnosis (WD).
Results: Median birth weight were 1400 g (770-2550) and mean gestacional age 30.3_+ 9.3 (19-40): 53 % were VLBW and 57% below 32 weeks gestacional age. Pathologies associated with fetal death were: Asphyxia 62,3% (n=63), Congenital Anomalies 25,7% (n=26), Immaturity 4,9% (n=5), intrauterine infections 3,9% (n=4) and Inmunological hidrops 3,9% (n=4). Fifty per cent of asphyxiated fetus had non inflammatory placental lesions, 22% had cord accidents, 3,1% had both of them, and in 6,1% the etiology of asphyxia was not addressed. The most common congenital malformations were aneuploidies 38% (n=10), urinary defects 11,5% (n=3) and neutral tube defects 11,5% (n=3). In 86 patients with satisfactory results (studies A, B, and AB) 65 macerated fetuses, 19 non macerated, and not reported en 2 were found. All immature fetuses and less than half of asphyxiated were not macerated the other asphyxiated fetuses and all those with intrauterine infections were macerated.
Conclusions: the main pathology associated with fetal death was Asphyxia, being placental lesions its cornerstone finding. Asphyxia, intrauetrine infections and congenital malformations were most frequently related with macerated fetus.

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ESTRATEGIA DE PROTECCION PULMONAR CON ASISTENCIA MECANICA CONVENCIONAL VS VENTILACION DE ALTA FRECUENCIA: UNA ALTERNATIVA TERAPEUTICA

Vassallo,JC ; Cernadas,C ; Mazzucchelli,MT ; Landry,L ; Althabe,MJ ; de Sarasqueta,P ; Sasbon,J ; Magliola,R. , Hospital de Pediatría Garrahan, Buenos Aires, Argentina

Introducción: Los factores más importantes asociados a injuria pulmonar durante la ventilación mecánica  (VM) son la toxicicidad por el oxígeno y el barotrauma. Debido a que el Distress respiratorio del adulo (ARDS) no es una enfermedad homogénea, el valor de “ mejor Peep” es difícil  de alcancanzar. Existen datos publicados que sugieren que el fallo en la VM podría deberse a la imposibilidad de determinar el mejor Peep.El objetivo de este estudio fue comparar la VM convencional con la estrategia de protección pulmonar (EPP) vs Ventilación de Alta Frecuencia (VAF) en terminos de oxigenación y parámetros hemodinámicos.
Metodos: Cerdos recien nacidos fueron anestesiados intubados y ventilados para mantener PaO2>100mmHg,PaCO235-45 y pH7.25-7.45. Se les colocaron catéteres en arterias carótida y pulmonar y en la vena yugular. Se indujo el distress por  medio de lavados con solución salina normal hasta alcanzar valores de PaO2/FiO2 menor de 100mmHg. El Peep fue titulado en pasos de 0 to 15mmHg y se eligió el mejor valor de acuerdo a los mejores valores de complience dinámica del sistema respiratorio.PIM< 40 mmH2O,  hipercapnia permisiva y volumen tidal  >5 < 7 ml/Kg completaron la EPP Los animales fueron randomizados para un período de 2 horas en VMConvencional con EPP o VAF.
Métodos estadísticos. Los valores se presentan como media y DS. El análisis estadístico se realizó con Kruskal-Wallis para variables apareadas.Las comparaciones de los grupos se realizaron con MANOVA( dos colas ) ; cuando fueron significativas se utilizó un test Tuckey (HSD) post hoc test..Se aceptó como significativo un valor de p  < 0.05.
Resultados : Se estudiaron 12 animales. No hubo diferencias estadísticamente significativas en PaO2, Indice de Oxigenación (IO) o presión arterial en ambos grupos en cada fase del estudio. ( basal, distress,titulación de Peep y tratamiento ).Se encontraron diferencias significativas en cada grupo entr la fase basal y la de distress ( IO 1.6 +/- 0.5 vs 25.3 +/- 11.3 P < 0.05 )y entre distress y titulación de Peep ( OI 25.3 +/- 11vs 6.1 +/- 2.1 P 0.05 ).
Conclusiones: en un modelo animal de ARDS,VMC con EPP fue similar a la VAF en los parámetros respiratorios y hemodinámicos

LUNG PROTECTIVE STRATEGY USING CONVENTIONAL MECHANICAL VENTILATION VS HIGH FREQUENCY VENTILALATION. AN ALTERNATIVE THERAPEUTIC WINDOW.
Vassallo,JC ; Cernadas,C ; Mazzucchelli,MT ; Landry,L ; Althabe,MJ ; de Sarasqueta,P ; Sasbon,J ; Magliola,R.

Introduction: Most important factors associated to lung injury in mechanical ventilation ( MV) are oxygen toxicity and barotrauma. Since ARDS is not an homogenous disease,best PEEp value is difficult to achieve. Publishied data shows that failure of MV tratment could be produced by the lack of optimal Peep. The objective of this study was to compare conventional MV with lung protective strategy LPS)  vs high frequency ventilation (HFV)  in terms of oxygenation and hemodinamic parameters.
Methods: Newborn piglets were anesthesied,intubated and ventilated to keep PaO2>100mmHg,PaCO235-45 and pH7.25-7.45. Animals were placed carotid,pulmonary artery and jugular vein catheters. ARDS was induced with lung lavage of normal saline until they reached a PaO2/FiO2 ratio below 100mmHg. Peep was titrated stepwise from 0 to 15mmHG and best value was chosen according to best measurment of dynamic complience of the respiratory system. Peack inspiratory pressure < 40 mmH2O,  permissive hipercapnia and tidal volume >5 <7ml/Kg complete LPS. Animals were randomised allocated to 2hrs period of CMV-LPS or HFV.
Statistical methods: Values are given as means and DS.Statistical analysis were performed with MANOVA(TWO_tailed); if this was significant,a Tuckey (HSD) post hoc test was used A p value < 0.05 was accepted as significant.
Results:  12 animals were studied. There were no differences in PaO2, oxygenation index   (OI)  or arterial pressure in both groups in each phase of the study ( basal, distress, peep tritation and treatment ). Significative differences were found in each group among basal and distress phase ( OI 1.6 +/- 0.5 vs 25.3 +/- 11.3 P < 0.05 ) and among distress and titration of peep ( OI 25.3 +/- 11vs 6.1 +/- 2.1 P 0.05 )
Conclusions: In animal model of ARDS, CMV with LPS was similar to HFV in respiratory and hemodinamic parameters

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HERNIA DIAFRAGMATICA CONGENITA:RESPUESTA AL TRATAMIENTO CON OXIDO NITRICO.
Couceiro,C; M.T,Mazzucchelli; Figueroa,A; Domínguez,E; deSarasqueta P. , Hospital de Pediatría Garrahan, Buenos Aires, Argentina

Introducción:La hernia diafragmática congénita(HDC)sigue siendo una entidad de difícil manejo médico y alta mortalidad a pesar de los avances en terapia intensiva neonatal.Se estudió la respuesta al tratamiento con oxido nítrico inhalado(iNO) en neonatos con HDC y fallo respiratorio hipoxemico y su relación con la evolución final.Metodos: Se revisaron los datos de los neonatos con HDC entre Septiembre 1997 y Junio 2000.en dos grupos.GrupoA:iNO GrupoB:noiNO.Se compararon datos clínicos y evolutivos por medio de chi cuadrado y test de Student.Se analizó la espuesta al iNo en GrupoA.
Resultados: Ingresaron 40RNconHDC.GrupoA:n:24 GrupoB n:16 .

                                                          GrupoA                  GrupoB                         Valor de p

Peso al nacer                                  2949 +/- 506            3338 +/- 722                          0.052

Edad Gestacional                               38 +/- 2.3              38 +/- 1.8                         p > 0.05

Ventilación AltaFrecuencia                      21                         2                                p < 0.01

PaO2 al ingreso( mmHg )              126.7 +/- 105.3                   187.2 +/- 138.1            p < 0.05

IO al ingreso                                     27.2 +/- 25.5              10.9 +/- 14.2                     p 0.02

IO Prequirurgico                                28.9 +/- 20.9           4.55 +/- 2.8                        p< 0.01

HP severa por ECO                                   24                           0                              p <0.01

Fallecidos                                          21                                5                              p < 0.01

GrupoA. Respondieron al iNo un 50%. El 71% recibió iNo en el prequirúrgicoSe operaron el 45.8%. Todos presentaron HP severa por Eco. Mortalidad 87.5%
Conclusiones :En  HDC y fallo respiratorio  hipoxémico el tratamiento con iNO no modifica la evolución con alta mortalidad.

CONGENITAL DIAPHRAGMATIC HERNIA: RESPONSE TO INHALED NITRIC OXIDE TRATMENT
Couceiro,C; M.T,Mazzucchelli; Figueroa,A; Domínguez,E; deSarasqueta P.

Introduction:Congenital diaphragmatic hernia (CDH) continues to be a desease of difficult clinical managment and high mortality rate in spite of Neonatal Intensive Care advances.We studied the response to treatment with inhaled nitric oxide (iNO) in neonates with CDH and hipoxemic respiratory failure and the relationship with the final evolution.
Methods: The charts of all neonates with cdh admited between September 1997 and June 2000 were reviwed and separeted into two groups. GroupA.iNO and GroupB:no iNO.We compared the clinical  features and final outcome with Chi square test and t Test Student.In Group A the response to iNo were evaluated.
Results: 40 neonates with CDH were admited.24 in groupA and 16 in GroupB 

          GroupA                                 Group B                                      p value

Birth weight                         2949 +/- 506                      3338 +/- 722                          0.052

Gestational Age                     38 +/- 2.3                            38 +/- 1.8                         p > 0.05

High frequency ventilation                       21                                        2                   p < 0.01

PaO2 when admitted( mmHg )      126.7 +/- 105.3                    187.2 +/- 138.1               p < 0.05

IO when admitted                             27.2 +/- 25.5                10.9 +/- 14.2                    p 0.02

IO Presurgery                                    28.9 +/- 20.9            4.55 +/- 2.8                       p< 0.01

Severe PH by Eco                                     24                              0                            p <0.01

Death                                                     21                             5                            p < 0.01

In GroupA 50% responded.71%required iNO previous to the surgery.45.8% were operated.All had severe PH by Eco.The mortality rate  was87.5%
.Conclusions: In neonates with CDH and hipoxic respiratory failure iNO treatment doesn´t seem to modify the high  mortality rates.

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DESARROLLO NEUROMADURATIVO A LOS 6 MESES DE EDAD CORREGIDA (EC)EN LACTANTES DE FAMILIAS DE BAJOS RECURSOS:  APUNTANDO A LOS MÀS VULNERABLES. 

María I. Scaramutti, Patricia Fernández, Isabel R. Kurlat y Equipo de Seguimiento. Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires

Objetivo: Establecer el desarrollo neuromadurativo a los 6 meses de EC en niños egresados de la UCIN de familias con bajos recursos socioeconómicos seguidos en el Consultorio de Alto Riesgo para determinar quienes requerirán mayor intervención y mayores recursos económicos y sociales.
Fundamento:El desarrollo neuromadurativo en pacientes egresados de UCIN está determinado por múltiples variables, incluyendo información genética, curso neonatal y nivel socioeconómico de la familia.  Niños con cursos neonatales similares pueden tener diferentes resultados a la edad escolar, determinados por el ambiente en el cual se desarrollan. Planear ayuda para estas familias requiere el conocimiento de la magnitud del problema y del tipo de intervención requerida. Este conocimiento permitirá el uso más eficiente de los limitados  fondos  que disponibles.
Material y métodos: Análisis retrospectivo. Período: 01/01/95-06/01/99. Los niños se  evaluaron con la escala chilena neuromadurativa de Rodríguez  Arancibia y con el Test de Amiel Tyson. Población: 200 pacientes : 15% RNT/PAEG; 5% RNT/BPEG; 50% RNPT/PAEG ;30% RNPT/BPEG; 64% presentaron  dificultad respiratoria; 4,2% DBP; 61% sepsis y 40% requirieron ARM. Más del 80% de las familias de los niños  ingresados en consultorio de seguimiento no tenían  cobertura médica de Obra Social, 66% tenían necesidades básicas insatisfechas. Solamente el 60% de las madres completaron la escolaridad primaria y 19% eran adolescentes.
Resultados:  Resultados de 146 pacientes (73%)  .

Conclusiones: Estos datos muestran que la población  que necesitará mayor  intervención es menos del 25%. Todos los esfuerzos deberían estar dirigidos a esos pacientes que necesitarán apoyo comunitario y médico para un mejor desarrollo. Con esta ayuda a los más vulnerables puede mejorar el pronóstico de estos niños y será más eficiente el uso de limitados recursos.

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¿FORMULAS DILUIDAS O LECHE ENTERA EN EL COMIENZO DE LA ALIMENTACIÓN DEL RECIÉN NACIDO DE MUY BAJO PESO (RNMBP) ?

Fabiana A.Postolow, Silvina Pinchetti, María del Carmen Ianella, Carolina Placentino, Adriana  B. Azcárate, Isabel Kurlat. Hospital de Clínicas “José de San Martín”.  Universidad de Buenos Aires., Argentina

Objetivo : Establecer si el uso de leches diluidas presenta ventajas sobre la leche entera para prematuros  en la alimentación inicial del RN MBP.
Fundamento: Cuándo alimentar y qué leche usar para el RNMBP es un punto controvertido en el cuidado intensivo neonatal. Cuando no hay leche humana disponible, algunos neonatólogos utilizan fórmulas maternizadas (LM 20 cal /oz). Otros prefieren usar esta misma fórmula pero diluida al ½ o al  ⅓. Otros prefieren el uso de fórmulas para prematuros (FP: 24 o 27 cal /oz) enteras o diluidas. Se presume que el uso de LM o FP diluida mejora la tolerancia pero lleva a un aumento más lento de peso y a una internación más prolongada. Además el uso de estas fórmulas diluidas interferiría con el patrón normal de motilidad intestinal.
Diseño y métodos: Estudio prospectivo, randomizado y ciego. Se incluyeron en el estudio a todos los  RNMBP (< 1500 g) sin patología gastrointestinal al nacer. Fueron divididos al azar en grupos A o B.  La composicion  de la leche A o B era conocida sólo por el servicio de nutrición. El protocolo de alimentación (volumen inicial e incrementos) fue similar para ambos grupos. Los pacientes se retiraron del protocolo cuando el volumen diario llegó a los 100 ml/kg.  Las variables primarias de evolución fueron intolerancia alimentaria (residuo con o sin distensión abdominal) y ECN. Las variables secundarias fueron tiempo para recuperar peso de nacimiento, aumento diario de peso. Los tests Kruskal Wallis H, exacto de Fisher y Mantel- Haenszel se usaron según correspondiera.
Resultados: 41 pacientes se randomizaron (21 a leche A y 20 a leche B) . No hubo diferencias significativas entre los grupos en peso de nacimiento, incidencia de retardo de crecimiento, ductus, hialina, requerimiento de asistencia respiratoria o edad al inicio de la alimentación. Tres niños en el grupo A y 4 en el B presentaron algun tipo de  intolerancia. Ningun paciente presentó ECN. El tiempo a recuperar el peso de nacimiento y el incremento diario de peso fue mayor en el grupo A.
Conclusiones: estos datos muestran que no existiría ventaja en el uso de fórmula diluida  medida por intolerancia e incidencia de ECN, y una tendencia a una mejor evolución ponderal en los pacientes del grupo A.

FEEDING THE VERY LOW BIRTH WEIGHT (VLBW) INFANT :ARE THERE ADVANTAGES TO THE USE OF DILUTE FORMULA?

Fabiana A.Postolow, Silvina Pinchetti, María del Carmen Ianella, Carolina Placentino, Adriana  B. Azcárate, Isabel Kurlat. Hospital de Clínicas “José de San Martín”.  Universidad de Buenos Aires, Argentina

Objective : To establish if there are advantages to the use of dilute formula to initiate feedings in the VLBW infant. 
Background: When to feed and what to feed the VLBW infant is the subject of much controversy. When human milk is unavailable, some neonatologists choose to feed full strength regular (20 kcal/oz) formula (RF). Others prefer ½ strength or ⅔  strength RF. Still others prefer 24 or 27 kcal/oz preterm formula (PF) diluted of full strength. Using dilute RF or PF is thought to improve tolerance but will result in slower weight gain and perhaps a longer stay in the unit. Furthermore, dilute formulas may interfere with  the development of a normal intestinal motility pattern.
Design/method: Prospective randomized blinded study. Infants with BW < 1500 g and no gastrointestinal disease were randomized to either group A or B according to the type of milk (full strength PF or ⅔ RF) they would receive. Investigators were blinded to the type of milk assigned, known only to the department of nutrition.  Feeding protocol (initial volume and daily increments) was similar for both groups. Patients were withdrawn from the study when receiving 100 cc/kg/day. Primary outcome measures were feeding intolerance (residuals, with or without abdominal distention) and NEC. Secondary outcome measures were time to regain BW and median daily weight gain. Kruskal Wallis H, Fisher exact and Mantel- Haenszel tests were used as appropriate. 
Results: 41 patients were randomized (21 to group A and 20 to group B) . There were no differences between groups in BW, incidence of SGA, PDA, RDS, need for mechanical ventilation or age at the beginning of oral feeds. Three infants in the Group A and 4 in group B had some feeding intolerance. There were no cases of NEC in either group. Time to regain BW was shorter and weight gain was higher in group B. 
Conclusions: These data show no advantage to the use of dilute milk and a trend towards better outcome in group B.

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COLONIZAÇÃO FÚNGICA DA CAVIDADE ORAL DE CRIANÇAS NASCIDAS DE MÃES SOROPOSITIVAS PARA HIV NO PRIMEIRO ANO DE VIDA

Hörnke, Lorena; Colombo, Arnaldo L; Succi, Regina CM.  Universidade Federal de Sao Paulo, Escola Paulista de Medicina, San Pablo, Brasil

A candidíase oral é a infecção oportunista mais freqüente na população com AIDS e contribui para o aumento da morbidade e custo no tratamento destes pacientes. A colonização oral por espécies de Candida está bem estudada na população de adultos com AIDS mas poucos estudos foram feitos com crianças. Sabendo-se que a maioria destas infecções são provenientes da flora colonizante endógena, estudamos a colonização por fungos na  cavidade oral de pares mães e filhos soropositivos para HIV e os comparamos com pares mães soropositivas para HIV e seus filhos sororevertidos para HIV e um grupo controle de mães e filhos soronegativos para HIV na mesma faixa etári
Fizeram parte de nosso estudo 92 pares mães soropositivas para HIV e seus filhos soronegativos para HIV, 14 pares mães/filhos soropositivos para HIV e 75 pares mães/filhos soronegativos para HIV. Foram isoladas 509 cepas de Candida spp. Nas mães houve predomínio das espécies de  C.
albicans ocorrendo em 83,2% das mães soropositivas para HIV e 89,2% nas mães soronegativas para HIV; já nas crianças houve predomínio das espécies de  C. não-albicans, ocorrendo em 72,5% das crianças infectadas por HIV, 67,2% nas crianças sororevertidas para HIV e 69,1% das crianças sonegativas para HIV.     
Entre as espécies não albicans nas mães houve predomínio de  C. tropicalis e C. glabrata e nos grupos de crianças houve predomínio das espécies de C.
parapsilosis e C. tropicalis. A colonização mista foi  mais freqüente na população de crianças, estando assim distribuido: crianças HIV positivas 21%, crianças sororevertidas para HIV 27%, crianças soronegativas para HIV 17,6%, mães soropositivas para HIV 10,6% e esteve ausente nas mães soronegativas para HIV. Em relação a susceptibilidade aos antifungicos testados observamos que as espécies não-albicans são menos susceptíveis aos antifungicos em relação a C. albicans. Não encontramos C. albicans resistentes aos antifungicos sendo todas as espécies de susceptibilidade reduzida pertencem ao grupo de C. não-albicans.

FUNGAL ORAL COLONIZATION IN CHILDREN BORN OF HIV-POSITIVE MOTHERS DURING THE FIRST YEAR OF LIFE.

Hörnke, Lorena; Colombo, Arnaldo L; Succi, Regina CM. Universidade Federal de Sao Paulo, Escola Paulista de Medicina, San Pablo, Brasil

Oral candidiasis is the most common opportunistic infection in AIDS patients and contributes to the increasing of morbidity and treatment costs of those patients. The  source of the majority of those infection is the endogenous colonizating flora. Adult Candida oral colonization is documented, but there is a lack of information about HIV-infected children colonization.
Having the aim of knowing the Candida oral colonization in the HIV-infected infants it was determined the fungal colonization of the oral mucosa in HIV-infected mothers and their children in comparison with HIV-seronegative mother-infant pairs.
Ninety two pairs of HIV-positive mothers and their HIV-seroreverted children, 14 pairs of HIV-positive mothers and their seropositive children as well as 75 control  pairs of HIV-negative mothers and their HIV-negative children had cultures of Candida of their oral mucosa taken for the isolation of Candida species.
Five hubdred nine Candida species were isolated. Candida albicans was the predominant species among the mothers and was recovered in 83.2% of the HIV-positive mothers and 89.2% of the HIV-negative ones. The C. non-albicans were more commom in children (72.5% among the HIV-infected, 67.2% in the seroreverters and 69.1% in the HIV-seronegative ones).
The non-albicans Candida species recovered from the mothers were mainly C. tropicalis and C. glabrata. In the pediatrics the non-albicans Candida species were predominatly C. parapsilosis and C. tropicalis. The  growth of two or more different organisms (mixed colonization) was more frequent in the pediatrics population and its distribution was: 21% in the HIV-positive children, 27% in the seroreverters, 17.6% in the HIV-negative children and 10.6% in the HIV-positive mothers. No HIV-negative mothers have mixed colonization.
Candida albicans species have higher antifungal susceptibility than non-albicans species. All the drug reduced-susceptive species were non-albicans. There was no drug-resistance amidst the Candida albicans species

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PROGRAMA DE AVALIAÇÃO DOS CURADOS: RESULTADOS PRELIMINARES NOS TRÊS PRIMEIROS ANOS DE ESTUDO

Barros, M.H.B.; Morais, V.L.L.; Leite, E.P.; Branco, C.A.; Barros Júnior, T.D.P.; Alves, J.S. Centro de Oncologia Pediátrica – Recife-PE / Brazil ( ceon@mailbr.com.br )

Aproximadamente 75% das crianças que tiveram diagnóstico de câncer estão sendo curadas de suas doenças graças às modernas técnicas terapêuticas antineoplásicas. Estima-se que para o ano de 2010 um em cada 200 adultos jovens seja sobrevivente de câncer infantil. Paralelo ao aumento da sobrevida, tem sido observado o aparecimento de números significativamente maiores de efeitos adversos tardios. O Programa de Avaliação dos Curados, criado em janeiro de 1997, tem a finalidade de detectar e estudar os efeitos tardios do tratamento do câncer infantil. Foram convocados todos os pacientes tratados no Centro de Oncologia Pediátrica do Hospital Universitário Oswaldo Cruz com pelo menos 5 anos livres de doença. Dos 333 pacientes convocados, foram avaliados 121. A sobrevida livre de doença variou de 60 a 218 meses estando o maior número de pacientes no intervalo entre 76 e 110 meses. Os tipos histológicos mais comuns foram o tumor de Wilms (20,83%/121), linfoma não Hodgkin (14,16%/121) e linfoma de Hodgkin (13,33%/121). Foram encontradas 145 alterações sendo 40 endócrinas, 26 cardíacas, 28 estéticas, 13 otorrinolaringológicas, 12 renais, 10 em SNC, 6 osteomusculares, 6 segundas neoplasias e 3 outras (esteatose, atrofia do nervo óptico e catarata). Com relação as alterações endócrinas, 75 (62%) dos 121 pacientes foram avaliados, tendo 25 (33,33%/75) algum tipo de alteração. Seqüelas estéticas foram encontradas em 28 (23,15%) dos 121 pacientes analisados. Alterações em SNC existiu em 10 (8,27%), osteomusculares e segunda neoplasia em 6 (5%) dos 121 pacientes avaliados. A cardiotoxicidade foi encontrada em 22 (27,16%) pacientes de um total de 81. A ototoxicidade esteve presente em 12 (20,6%) dos 58 pacientes avaliados. Nefrotoxicidade foi estudada em 53 pacientes sendo encontrada alterações em 11 (20,76%). Com relação ao déficit de crescimento (alteração endócrina), além da quimioterapia e radioterapia em SNC e neuroeixo, a desnutrição foi um grande contribuinte. As seqüelas decorrentes do tratamento antineoplásico são freqüentes e o Programa de Avaliação dos Curados mostrou ser eficiente na detecção precoce dessas alterações mesmo com a falta de recursos encontrada em nosso meio.

Evoluation Program of Cured Children: Preliminary Results

Barros, M.H.B.; Morais, V.L.L.; Leite, E.P.; Branco, C.A.; Barros Júnior, T.D.P.; Alves, J.S. Centro de Oncologia Pediátrica – Recife-PE / Brazil ( ceon@mailbr.com.br )

It is considered, nowadays, that almost two children are cured thanks to the progress in diagnostic and treatment multimodalities, especially antineoplastic drugs during the last few years. It is also estimated that in the year 2010, one out of two hundred young adults will be a survival of a malignancy acquired in the childhood. In addition to the increasing survival rate, it has been observed the appearance of numerous and significant late effects. The proposed program, created in January 1997, it is aimed to detect and study the late effects in children with cancer who were treated and cured. For that, all patients treated at the Centro de Oncologia Pediátrica do Hospital Universitário Oswaldo Cruz with at least five years of disease-free survival were summoned. Only 121 showed up and were evaluated out of 333 who were asked to come. The disease-free survival ranged from 60 to 218 months and most of them be between 76 and to 110 months. The commenest histological types were Wilms' Tumour (20,83% / 121), non Hodgkin Lymphoma (14,16% / 121 ), and Hodgkin Lymphoma (13,335 / 121). A total of 144 varied disturbancies were found such as endocrine (40), cardiac (26), aesthetics (28), otorhinolaryngological (13), renal (12), in central nervous system (10), osteomuscular (6), second neoplasias (6) and others (3 more: 1 hepatic steatosis, 1 optic  nerve atrophy, and 1 cataract). Late complications caused by antineoplastic treatment are very frequent and the Evaluation Program of Cured Children proved to be efficient in early detecting such sequelae.

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NUTRICIÓN DE ZINC Y HIERRO EN NIÑOS CHILENOS ALIMENTADOS CON UNA LECHE FORTIFICADA DEL PROGRAMA NACIONAL DE ALIMENTACIÓN COMPLEMENTARIA.
Torrejón CS, Castillo CD, Hertrampf E, Ruz M. INTA, Universidad de Chile

Introducción. El déficit de zinc y de hierro en lactantes chilenos está asociada a  factores de riesgo, tales como bajo peso de nacimiento y alimentación con bajo contenido de proteínas de origen animal.  Se ha incorporado desde 1999 al Programa Nacional de Alimentación Complementaria (PNAC), una leche fortificada con hierro (10 mg/L como sulfato ferroso), zinc (5 mg/L) y cobre (0,5 mg/L) (2 Kg  de leche en polvo mensuales hasta los 18 meses). Objetivos. Analizar el estado nutricional de zinc y hierro a los 18 meses en lactantes que consumieron  la leche fortificada.
Sujetos y métodos.  Se estudiaron 36 niños varones sanos, eutróficos,  de estratos socioeconómico medio-bajo y bajo. Se efectuó una encuesta nutricional y además en ayunas se obtuvo muestras para determinaciones de zinc plasmático y en pelo, hematocrito, hemoglobina (Hb) y ferritina sérica.
Resultados.  La ingesta de energía fue entre 77 y 171 kcal/Kg/d,  proteínas 2,7 a 6,8 g/Kg/d, zinc 2,6 a 11,5 mg/d (x: 0,98 mgZn/MJ;  67% de las recomendaciones OMS), hierro 3,3 a 25,7 mg/d (x:11,5mg/d), fibra dietaria de 2,8 a 21,7 g/d (x:10,7 g/d). El zinc plasmático fue en un 64% < 90 ug/dL; Zn en pelo 58% < 90 ug/dL, Hb < 11 g/dL en el 11%,  ferritina < 12 ug/dL en el 55%. El Zn en plasma se correlacionó sólo con Zn ingerido (r: 0.53; p=0,01).
Conclusiones. La Leche fortificada  tendría   un efecto favorable sobre la nutrición de hierro y  escaso impacto sobre la nutrición de zinc, lo cual hace necesario el reanálisis de su contenido de zinc.

ZINC AND IRON NUTRITION IN CHILDREN FED A FORTIFIED COW`S MILK OF THE CHILEAN COMPLERMENTARY FOOD PROGRAM

Torrejón CS, Castillo CD, Hertrampf E, Ruz M. INTA, Universidad de Chile.

Introduction. Nutritional zinc deficiency in Chilean infants is associated with risk factors such as: low birth weight and feeding after weaning with low animal protein diet. Recently a powdered cow milk fortified with iron (10 mg/L as ferrous sulfate), zinc (5 mg/L) and copper (0.5 mg/L) has been introduced to the Complementary Food Program in Chile, providing 2 kg/mo to each child until 18 mo of age. 
Objective.To analyze zinc and iron status after completing the provision of the fortified milk at 18 mo,
We assessed  36 healthy  male children, from low income groups for: dietary surveys, plasma zinc, hair zinc, serum ferritin, hematocrit and hemoglobin (Hb)
Dietary surveys showed energy intakes between 77 and 177 Kcal/Kg/d; protein 2,7-6.8 g/Kg/d; zinc 2.6-11.5 mg/d (x: 0.98 mgZn/MJ; 67% of WHO recommendations); iron 3.3-25.7 mg/d; dietary fiber 2.8-21.7 g/d. Plasma Zn < 90 ug/dL) appeared in 64% of the children; hair zinc< 90 ug/g  in  58% of the subjects. Hb< 11 g/dL was found in 11% and ferritin < 12 ug/dL in  55% of them. Plasma zinc was correlated with zinc intake (r: 0.53; p= 0.01).
Conclusions. The fortified powdered cow milk delivered by the Complementary Food Program in Chile would favorably affect iron status and produce a low impact on zinc nutrition; we suggest to reanalyze the levels of zinc fortification.

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GASTO ENERGÉTICO DURANTE O EXERCÍCIO EM CRIANÇAS OBESAS  PRÉ-PÚBERES

Fróes MSS, Leme RB, Yazbek P, Zarzana A, Cardoso AL, Battistela LR, Carrazza FR – Instituto da Criança – Grupo de Nutrição – Divisão de Reabilitação Vergueiro – HCFMUSP.

O estímulo à atividade física é fator primordial para o tratamento da obesidade infantil .Os parâmetros ergoespirométricos das crianças obesas durante o exercício precisam ser melhor conhecidos.
Objetivos: avaliar parâmetros ergoespirométricos de crianças obesas submetidas a um teste de esforço em esteira rolante. Comparar os achados com as variáveis antropométricas.
Casuística e Métodos: Foram avaliadas 71 crianças com idade média de 9,0+ 1,3 anos: 51 sobrepeso ou obesas (SO), 20Masculinas e 31 Femininas, com IMC maior ou igual ao p > 80 para sexo e idade e 20 não obesas (NO), 18M e 2F com IMC menor que o referido. Foi aplicado o teste de Bruce em esteira. O critério de interrupção foi: exaustão ou platô de VO2 após ser atingido o limiar anaeróbio. Consideramos a média do VO2 máximo e as kcal consumidas no tempo do teste ( seg ). Os parâmetros antropométricos avaliados foram : peso (P),  estatura (E), IMC e peso da massa magra e gorda ( PMM e PMG ).
Resultados: Médias e DP das variáveis antropométricas: P- 54,9 +12,5 (SO) e 29,66+5,14 (NO)*kg ; E - 1,4+0,1 (SO) e 1,3+0,1 (NO)*m ; IMC - 27,7+5,5 (SO) e 17+1,1 (NO)*; PMM: 31+5,8 (SO) e25+3,2 (NO)*kg; PMG: 23+7,7 (SO) e 6,3+5,6 (NO)*kg. As variáveis relacionadas com o gasto de energia estão na tabela 1:

Conclusões: – O grupo SO apresentou menor média de consumo de O2 medido pelo VO2 máximo, num menor tempo de esforço e com igual consumo calórico. Mesmo considerando o maior PMM nos obesos, o consumo de O2 se mantém inferior ( VO2/ PMM ), refletindo o alto custo do esforço com baixa performance. Estes valores deverão ser considerados na orientação para a atividade aos obesos, que necessitam um prolongado tempo de atividade para obter um GE eficaz no seu tratamento.

ENERGY EXPENDITURE AFTER AN ERGOESPIROMETRIC TEST IN PREPUBERTAL CHILDREN

Fróes MS, Leme RB, Yazbeck P, Zarzana A, Cardoso AL, Battistela LR, Carrazza FR – Instituto da Criança – Grupo de Nutrição – Divisão de Reabilitação Vergueiro – HCFMUSP.

Physical activities in obese children are important for treatment proposals. Ergoespirometric values during exercises aren’t fully understand.
 Objectives: Asses the energy expenditure ( EE ) values in obese children by indirect calori metry with a standard open-circuit method on a  treadmill.  
Methods : 71 children aged 9,0+1,3 years were divided in two groups: a)  OW group- overweight and obese  children ( 20 boys and 31 girls ; above the  80^th BMI [ Weight (kg) /Height (m²)] percentile (Rosner et al.,1998 ) and b) NO- non-obese ( 18 boys and 2 girls below cited BMI ). Bruce treadmill test protocol was applied. The maximal effort accessed in time was that of exhaustion signs or after the anaerobic threshold stabilizing VO2 consumption.  The antrophometric measures obtained were: Weight ( W ), Height ( H ), Body mass index ( BMI ), Body fat mass ( BFM ) and FFM (fat-free mass ). Mean maximum VO2 consumption and Kcal consumption during the test were considered. The values were corrected to the  endurance time ( sec ) and  FFM.
Results: I. Mean and SD anthropometric data were: W- 54,9 +12,5 (OW) and 29,66+5,14 (NO)* kg; H- 1,4+0,1 (OW) and 1,3+0,1  (NO)*m; BMI- 27,7+5,5 (OW) and 17+1,1 (NO)*; FFM: 31+5,8 (OW) and 25+3,2 (NO)*kg; BFM: 23+7,7 (OW) and 6,3+5,6 (NO)*kg. II. Mean and SD for the ergoespiormetric data, are shown at table 1:

Conclusions: At the same time of exercise, the energy expenditure was significantly greater in SO than in NO group. Expressed per kilogram of FFM the VO2 consumption was lower in SO group despite the greater FFM. These values are in agreement with the limited performance and high energy cost in the SO group. A prolonged exercise time is necessary for children obesity treatment, to reach the net EE.

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CAMBIOS FISIOLÓGICOS POST SURFACTANTE  EN  MODELO ANIMAL DE ASPIRADO MECONIAL

Viale, Miriam; Ripani, Gabriela; Figurelli, Silvina; Paz, Susana; Tavosnanska, Jorge.

Objetivo: Evaluar los efectos de la administración de surfactante exógeno sobre la oxigenación, la función pulmonar y los cambios histopatológicos en un modelo animal con aspiración meconial.Introducción: Según los conocimientos actuales la presencia de meconio en las vías aéreas modifica los efectos del surfactante endógeno. En neonatos con SAM una mejoría en la oxigenación y en la mecánica pulmonar ha sido demostrada luego de la administración de surfactante. Sin embargo la administración de dosis repetidas fue necesaria en la mayoría de los casos y en algunos pacientes el fallo respiratorio se agravó luego de la terapia con surfactante exógeno. En este trabajo evaluamos un tipo diferente de surfactante usado en nuestro país en un modelo animal con SAM.
Diseño/Método: Se realizó un estudio experimental, controlado, prospectivo y longitudinal. Los conejos fueron instrumentados, traqueostomizados y ventilados, y luego de un período de estabilización de 30’ todos  recibieron 3 ml/kg de una solución de meconio humano al 20% dentro del tubo endotraqueal. Pasados los 60’ un grupo recibió surfactante exógeno y el otro grupo no recibió tratamiento. En ambos grupos se tomaron muestras de gases sanguíneos, test de función pulmonar y parámetros hemodinámicos cada 30’.
Resultados: Se analizaron los datos de 11 conejos con un peso entre 2400 y 3680 gr.(X±DS=2930 ± 440gr.); 6 pertenecían al grupo tratado y 5 al grupo control. No hubo diferencias significativas entre los pesos de ambos grupos. El resto de las mediciones de ambos grupos se realizaron con un test no paramétrico dado que las variables no presentan distribución normal. No se observaron diferencias significativas en ninguna de las mediciones respiratorias ni hemodinámicas basales. La medición a las 2 horas post surfactante mostró una tendencia significativa a menor requerimiento de presión inspiratoria máxima en el grupo tratado (p= 0.032) no así con la compliance dinámica.
Conclusiones: No se demostró el beneficio del uso de surfactante en este modelo de aspiración meconial.Sería necesario seguir desarrollando la línea de investigación con tiempos de experiencia más prolongados o mayor número de dosis y de animales.

PHYSIOLOGICAL CHANGES AFTER SURFACTANT IN AN ANIMAL MODEL OF MECONIUM ASPIRATION

Viale, Miriam; Ripani, Gabriela; Figurelli, Silvina; Paz, Susana; Tavosnanka, Jorge.

Objetive: To evaluate the exogenous surfactant’s effects on the oxigenation, the lung’s function and the histopathological findings in an experimental model of meconium aspiration.
Background: According to the current knowledge the meconium’s presence in the airways modifies the endogenous surfactant’s effects.An improvement on the oxigenation and on the mechanical properties of the lung has been shown after giving surfactant in newborns with MAS.However in most of the cases were necessary several doses and in some patients the respiratory failure has got worse after the surfactant therapy.Adifferent kind of surfactant used in our country was evaluated in this study.
Design/Methods: An experimental, checked, prospective and longitudinal study was done.The rabbits were instrumentated, tracheostomized, ventilated and after a stability period of 30’ all of them were instillated with 3cc/kg of a preparation of human meconium of 20% by trachea.After 60’ one group received surfactant teatment and the other didn’t  recive it.In both blood gas samples, lung’s function and hemodinamycs parameters were determined each 30’.
Results:11 rabbits were analized with weights of 2400 and 3680 gr. (X ± DS= 2930 ± 440 gr.); 6 belonged to the treated group and 5 to the control group.There weren’t significative differences between the weights.The other variables were analized with a non parametric test because its distribution weren’t normal.There weren’t significative differences in the respiratory and hemodinamyc basal measures.After 2 hours of surfactant there was a significative tendency to a low requeriment of maxime inspiratory pressure in the treated group ( p=0, 032) but no witth the dinamyc compliance.
Conclusions: We couldn’t show the surfactant’s benefit in this model.It would be necessary going on investigation with longer periods or more doses and animals.