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      Frecuencia de riesgo neurobiológico en recién nacidos Translated title: Neurobiological risk frequency on newborns

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          Abstract

          Introducción: Los niños de alto riesgo o vulnerabilidad neurobiológica son aquellos que por sus antecedentes pre, peri o postnatales tienen una mayor probabilidad de presentar alteraciones en su desarrollo psicomotor. La evidencia sugiere que estos niños deben ingresar a Programas de Atención Temprana. objetivo: Describir la frecuencia de niños de alto riesgo neurobiológico que nacieron en hospitales públicos del Servicio de Salud Vina del Mar Quillota, durante al ano 2008. Paciente y Método: Se utilizó un diseno descriptivo a partir del análisis de información existente en los libros de registros de los servicios de maternidad y neonatología, del universo de niños nacidos vivos en hospitales públicos de la red de este servicio. Resultados: Los niños de alto riesgo representaron un 21,01% del total de recién nacidos vivos. Los factores de riesgo biológico más frecuentes fueron la prematurez (11,4%), el retardo de crecimiento intrauterino (9,0%) y el bajo peso de nacimiento (7,8%). Conclusión: Este estudio epidemiológico, representa el punto de partida para explorar la necesidad existente de disponer de registros estadísticos de los distintos factores de riesgo biológico y contar con espacios formales para realizar atención temprana en el servicio de salud Vina del Mar Quillota con el propósito de prevenir y tratar alteraciones del desarrollo psicomotor en todos los niños con riesgo neurobiológico.

          Translated abstract

          Introduction: High-risk or neurobiological vulnerable children are those who are more likely to have alterations in their psychomotor development during their pre-, peri-, or post-natal periods. Evidence suggests that these children must have early medical care. objective: To describe the frequency of high-risk neuro-biological infants born during 2008 in Vina del Mar Quillota public health hospitals. Methods: A descriptive design was used based on the analysis of existing information in the maternity and neonatology record books regarding live births in public hospitals of this service network. Results: The high-risk children accounted for 21.01% of all live births. The most frequent biological risk factors were prematurity (11.4%), intrauterine growth retardation (9.0%) and low birth weight (7.8%). Conclusion: This epidemiological study represents the starting point for exploring the existing need to have statistical records of the various risk factors as well as have formal spaces for early treatment in the Quillota Vina del Mar health service to prevent and treat abnormal psychomotor development in all children with neurobiological risk.

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          Most cited references42

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          An overview of mortality and sequelae of preterm birth from infancy to adulthood.

          Survival rates have greatly improved in recent years for infants of borderline viability; however, these infants remain at risk of developing a wide array of complications, not only in the neonatal unit, but also in the long term. Morbidity is inversely related to gestational age; however, there is no gestational age, including term, that is wholly exempt. Neurodevelopmental disabilities and recurrent health problems take a toll in early childhood. Subsequently hidden disabilities such as school difficulties and behavioural problems become apparent and persist into adolescence. Reassuringly, however, most children born very preterm adjust remarkably well during their transition into adulthood. Because mortality rates have fallen, the focus for perinatal interventions is to develop strategies to reduce long-term morbidity, especially the prevention of brain injury and abnormal brain development. In addition, follow-up to middle age and beyond is warranted to identify the risks, especially for cardiovascular and metabolic disorders that are likely to be experienced by preterm survivors.
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              Neurobiology of periventricular leukomalacia in the premature infant.

              J Volpe (2001)
              Brain injury in the premature infant is a problem of enormous importance. Periventricular leukomalacia (PVL) is the major neuropathologic form of this brain injury and underlies most of the neurologic morbidity encountered in survivors of premature birth. Prevention of PVL now seems ultimately achievable because of recent neurobiologic insights into pathogenesis. The pathogenesis of this lesion relates to three major interacting factors. The first two of these, an incomplete state of development of the vascular supply to the cerebral white matter, and a maturation-dependent impairment in regulation of cerebral blood flow underlie a propensity for ischemic injury to cerebral white matter. The third major pathogenetic factor is the maturation-dependent vulnerability of the oligodendroglial (OL) precursor cell that represents the major cellular target in PVL. Recent neurobiologic studies show that these cells are exquisitely vulnerable to attack by free radicals, known to be generated in abundance with ischemia-reperfusion. This vulnerability of OLs is maturation-dependent, with the OL precursor cell highly vulnerable and the mature OL resistant, and appears to relate to a developmental window characterized by a combination of deficient antioxidant defenses and active acquisition of iron during OL differentiation. The result is generation of deadly reactive oxygen species and apoptotic OL death. Important contributory factors in pathogenesis interact with this central theme of vulnerability to free radical attack. Thus, the increased likelihood of PVL in the presence of intraventricular hemorrhage could relate to increases in local iron concentrations derived from the hemorrhage. The important contributory role of maternal/fetal infection or inflammation and cytokines in the pathogenesis of PVL could be related to effects on the cerebral vasculature and cerebral hemodynamics, to generation of reactive oxygen species, or to direct toxic effects on vulnerable OL precursors. A key role for elevations in extracellular glutamate, caused by ischemia-reperfusion, is suggested by demonstrations that glutamate causes toxicity to OL precursors by both nonreceptor- and receptor-mediated mechanisms. The former involves an exacerbation of the impairment in antioxidant defenses, and the latter, an alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid/kainate receptor-mediated cell death. Most importantly, these new insights into the pathogenesis of PVL suggest potential preventive interventions. These include avoidance of cerebral ischemia by detection of infants with impaired cerebrovascular autoregulation, e.g. through the use of in vivo near-infrared spectroscopy, the use of free radical scavengers to prevent toxicity by reactive oxygen species, the administration of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid/kainate receptor antagonists to prevent glutamate-mediated injury, or the use of maternal antibiotics or anticytokine agents to prevent toxicity from maternal/fetal infection or inflammation and cytokines.
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                Author and article information

                Journal
                rcp
                Revista chilena de pediatría
                Rev. chil. pediatr.
                Sociedad Chilena de Pediatría (Santiago, , Chile )
                0370-4106
                December 2012
                : 83
                : 6
                : 552-562
                Affiliations
                [01] Valparaiso orgnamePontificia Universidad Católica de Valparaiso orgdiv1Escuela de Kinesiología Chile lisseth.barra@ 123456ucv.cl
                [02] Santiago orgnameUniversidad de Chile orgdiv1Facultad de Medicina Chile
                Article
                S0370-41062012000600004 S0370-4106(12)08300604
                10.4067/S0370-41062012000600004
                962f5d90-9f33-45dc-9070-c57e3d8be2d5

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 10 August 2012
                : 03 March 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 11
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                SciELO Chile

                Categories
                ARTÍCULOS ORIGINALES

                Atención Temprana,Desarrollo Psicomotor,Neurobiological risk,psychomotor development,early medical care,Alto Riesgo Neurobiológico

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