Incidence of Cerebral Palsy, Risk Factors, and Neuroimaging in Northeast Mexico.

BACKGROUND: Cerebral palsy (CP) comprises a group of lifelong motor and postural development disorders that can cause static motor encephalopathy. The etiology of CP is attributed to nonprogressive lesions of the central nervous system during fetal or infant brain development. A diagnosis of CP is based on a combination of clinical and neurological signs, typically identified between 12 and 24 months. A medical history, several available standardized tools, including the Neoneuro assessment, and the Hammersmith infant neurological examination (HINE) can be used to predict risk. Magnetic resonance imaging (MRI) can contribute to the diagnosis of CP. The incidence of CP is 2 to 3 per 1000 live births, and in Western industrialized nations, it is 2.0-2.5 per 1000 live births; to our knowledge, no epidemiological studies have reported the incidence of CP in Mexico. AIM: To assess the incidence of CP in children aged up to 18 months in northeast Mexico and analyze the risk factors and neuroimaging findings. METHODS: This was a multicenter, randomized, prospective, cohort, analytical study of newborn children in three community hospitals and an early intervention and CP center in Nuevo Leon, Mexico, from 2017 to 2021. This study included 3861 newborns randomly selected from a population of 75,951 mothers in the immediate puerperium. According to the Neoneuro tool, high-risk children (n = 432) had abnormal neurological results at birth; they were followed and assessed with the Spanish version of the HINE test by a pediatric neurologist and underwent neuroimaging studies. Neonates with normal results were randomly selected to be in the low-risk group (n= 864). These neonates were followed and assessed with the HINE by a neonatologist. RESULTS: The incidence of CP was 4.4 of 1000 up to 18 months old, which was higher than that reported in developed countries. Perinatal risk factors were predominantly recognized in the etiology of CP, such as brain hemorrhage, and prematurity, in addition to congenital anomalies. The most frequent neuroimaging findings were ventricular dilation/cortical atrophy and intraventricular/subependymal hemorrhage and periventricular leukomalacia on MRI. CONCLUSIONS: This study is the first on the incidence/prevalence of CP in Mexico, and there are no formal studies in this field in other Latin American countries either. The incidence of CP in northeast Mexico is higher than that reported in developed countries. The follow-up of high-risk young children must be reinforced in the Mexican population, as children with disabilities have high and sequential health-care needs and may usually be lost to follow-up. Neuroimaging of PVL was the more frequent finding by MRI in this population.

Características del embarazo y nacimiento en el Noreste de México y correlación con la evaluación neurológica del recién nacido / Pregnancy and delivery characteristics in northeastern Mexico and their correlation with neonatal neurological evaluation

Resumen OBJETIVO: Determinar las características del embarazo y nacimiento en hospitales públicos del estado de Nuevo León y analizar los resultados de la valoración neurológica de los recién nacidos. MATERIALES Y MÉTODOS: Estudio de serie de casos, ambispectivo, multicéntrico, aleatorizado y transversal efectuado del 2017 al 2020 en tres hospitales públicos de Nuevo León, México. La muestra se reclutó de madres en puerperio seleccionadas en forma aleatoria y recién nacidos con la valoración Neo Neuro and Up de Sheridan Perreira. RESULTADOS: De 75,951 madres en puerperio inmediato, asignadas al azar, se estudiaron 4241. El 87.2% eran residentes de Nuevo León y 12.7% de otros estados del Noreste de México. El 39.9% tuvieron control prenatal en los hospitales de nacimiento de sus hijos. El 51.0% nacieron por parto eutócico y 27.4% por cesárea programada. El 9.6% de los recién nacidos fueron pretérmino. Las características pre y perinatales más frecuentes fueron: infección urinaria y prematurez. El 12.02% de los recién nacidos tuvieron evaluación neurológica neonatal anormal. Los factores de riesgo para evaluación neurológica anormal al nacimiento fueron: peso al nacer menor de 2500 g, bajo peso para la edad gestacional, cesárea urgente y perímetro cefálico menor de 30 cm. CONCLUSIONES: Las características de las embarazadas del Noreste de México han sido poco estudiadas, casi la tercera parte ellas son adolescentes con un nivel importante de pobreza. Existe una relación significativa entre algunas características del parto relacionadas con una evaluación neurológica anormal del recién nacido.

Abstract OBJECTIVE: To determine the characteristics of pregnancy and birth in public hospitals in northeastern Mexico. Analyze the results of the neurological evaluation of newborns MATERIALS AND METHODS: Case series, ambispective, multicenter, randomized, cross-sectional study conducted from 2017 to 2020 in three public hospitals in Nuevo León, Mexico. The sample was recruited from randomly selected puerperium mothers and newborns with Sheridan Perreira's Neo Neuro and Up assessment. RESULTS: Of 75,951 mothers in immediate puerperium, randomly assigned, 4,241 were studied. Eighty-seven percent were residents of Nuevo León and 12.7% were from other states in northeastern Mexico. Thirty-nine.9% had prenatal care in the hospitals where their children were born. Fifty-one percent were born by euthyroid delivery and 27.4% by programmed cesarean section. Of the newborns, 9.6% were preterm. The most frequent pre and perinatal characteristics were urinary tract infection and prematurity. Abnormal neonatal neurological evaluation was observed in 12.02% of the newborns. The risk factors for abnormal neurological evaluation at birth were birth weight less than 2500 g, low weight for gestational age, emergency cesarean section and head circumference less than 30 cm. CONCLUSSIONS: The characteristics of pregnant mothers in northeastern Mexico have been little studied, almost a third of these mothers are adolescents with a significant level of poverty. There is a significant relationship between some characteristics of delivery related to an abnormal neurological evaluation of the newborn.

[Cerebral palsy associated urological pathologies. Nurse´s role.] / Patologias urologicas asociadas a paralisis cerebral. El rol de la enfermera.

OBJECTIVES: The objectives of this study were: To analyze the causes of urological consultation of the child with CP, to analyze the role of nursing in the urological care of children with CP referred to Urology, and to know the relationship between the child's urinary tract infection and CP and its degree of independence. METHOD: Retrospective analytical observational study based on the review of the clinical records of patients diagnosed with cerebral palsy. Forty-seven patients selected by simple randomization in an age range of 2 to 16 years were included in the study in an outpatient clinic for CP patients located in a town in northern Mexico. RESULTS: The causes of urological consultation of the child with CP, referred by nursing were: urinary infection, phimosis, retractable testicle, cryptorchidism, hypogonadism, overactive bladder, and hypospadias. The relationship between the urinary infection of the child with CP and its degree of independence was established with the level of urinary sphincter control. CONCLUSIONS: The nursing staff is a key and decisive factor in the diagnosis, early reference for treatment and monitoring of the evolution of urinary disorders in children with CP. It is not indicated to start a toilet training program in children with CP, without having previously ruled out a urinary tract infection.

OBJETIVOS: Los objetivos de este estudio fueron: analizar las causas de consulta urológica del niño con Parálisis Cerebral (PC), analizar el rol de enfermería en el cuidado urológico de niños con PC referidos a Urología, y conocer la relación entre la infección urinaria del niño con PC y su grado de independencia. MATERIAL Y METODO: Estudio observacional analítico retrospectivo en base a la revisión del expediente clínico de pacientes con diagnóstico de parálisis cerebral. Se incluyeron en el estudio a 47 pacientes seleccionados mediante aleatorización simple en un rango de edad de 2 a 16 años en una clínica de atención ambulatoria para pacientes con PC, ubicada en una población del norte de México. RESULTADOS: Las causas de consulta urológica del niño con PC, referidos por enfermería fueron: infección urinaria, fimosis, testículo retráctil, criptorquidia, hipogonadismo, vejiga hiperactiva, e hipospadias. La relación entre la infección urinaria del niño con PC y su grado de independencia se estableció con el nivel de control de esfínter urinario. CONCLUSIONES: El personal de enfermería es factor clave y decisivo en el diagnóstico, referencia temprana para tratamiento y vigilancia de la evolución de los trastornos urinarios en niños con PC. No está indicado iniciar un programa de control de esfínteres en niños con PC, sin haber descartado antes una infección urinaria.

Patologias urologicas asociadas a paralisis cerebral. El rol de la enfermera / Cerebral palsy associated urological pathologies. Nurse's role

Objetivos: Los objetivos de este estudio fueron: analizar las causas de consulta urológica del niño con Parálisis Cerebral (PC), analizar el rol de enfermería en el cuidado urológico de niños con PC referidos a Urología, y conocer la relación entre la infección urinaria del niño con PC y su grado de independencia. Material y método: Estudio observacional analítico retrospectivo en base a la revisión del expediente clínico de pacientes con diagnóstico de parálisis cerebral. Se incluyeron en el estudio a 47 pacientes seleccionados mediante aleatorización simple en un rango de edad de 2 a 16 años en una clínica de atención ambulatoria para pacientes con PC, ubicada en una población del norte de México. Resultados: Las causas de consulta urológica del niño con PC, referidos por enfermería fueron: infección urinaria, fimosis, testículo retráctil, criptorquidia, hipogonadismo, vejiga hiperactiva, e hipospadias. La relación entre la infección urinaria del niño con PC y su grado de independencia se estableció con el nivel de control de esfínter urinario. Conclusiones: El personal de enfermería es factor clave y decisivo en el diagnóstico, referencia temprana para tratamiento y vigilancia de la evolución de los trastornos urinarios en niños con PC. No está indicado iniciar un programa de control de esfínteres en niños con PC, sin haber descartado antes una infección urinaria

Objectives: The objectives of this study were: To analyze the causes of urological consultation of the child with CP, to analyze the role of nursing in the urological care of children with CP referred to Urology, and to know the relationship between the child’s urinary tract infection and CP and its degree of independence. Method: Retrospective analytical observational study based on the review of the clinical records of patients diagnosed with cerebral palsy. Forty-seven patients selected by simple randomization in an age range of 2 to 16 years were included in the study in an outpatient clinic for CP patients located in a town in northern Mexico. Results: The causes of urological consultation of the child with CP, referred by nursing were: urinary infection, phimosis, retractable testicle, cryptorchidism, hypogonadism, overactive bladder, and hypospadias. The relationship between the urinary infection of the child with CP and its degree of independence was established with the level of urinary sphincter control. Conclusions: The nursing staff is a key and decisive factor in the diagnosis, early reference for treatment and monitoring of the evolution of urinary disorders in children with CP. It is not indicated to start a toilet training program in children with CP, without having previously ruled out a urinary tract infection

Factores De Riesgo Asociados A Parálisis Cerebral En Una Poblacion De Niños Y Jovenes Mexicanos / Risk Factors Associated With Cerebral Palsy In A Population Of Mexican Children

RESUMEN OBJETIVOS: Establecer los factores de riesgo asociados a Parálisis Cerebral en una población de niños mexicanos y comparar los resultados con estudios de otros países. MATERIAL Y MÉTODOS: Estudio observacional analítico, retrospectivo, aleatorizado, por medio de la revisión del expediente y una encuesta, comparación de proporciones. PARTICIPANTES: 230 pacientes con Parálisis Cerebral de entre 0 a 29 años de edad y sus madres biológicas de una institución especializada de México. RESULTADOS: Se estudiaron 29 factores de riesgo, con un rango de 0-9 en cada paciente. Factores prenatales 244; Factores perinatales 378; Factores postnatales 319. Factores de riesgo más frecuentes: PRENATALES: infección urinaria 99 (43%), y sangrado transvaginal 61(27%); PERINATALES: hipoxia perinatal 131 (57%); y prematuridad 116 (50%); POSTNATALES: síndrome convulsivo en pacientes <2 años, 92 (42%) e ictericia 84 (37%). CONCLUSIONES: Los factores de riesgo asociados a Parálisis Cerebral más frecuentes fueron los perinatales, lo que difiere a lo reportado en otros estudios de países como España, EUA e Inglaterra; donde los prenatales son los más frecuentes. Suecia reporta porcentajes similares a México. Se sugiere realizar estudios prospectivos en este campo.

ABSTRACT OBJECTIVES: To establish the risk factors associated with Cerebral Palsy in a population of Mexican children and compare the results with studies from other countries. METHODS: Analytical, retrospective, randomized, observational study, through review of the file and a survey, comparison of proportions. PARTICIPANTS: 230 patients with Cerebral Palsy between 0 and 29 years of age and their biological mothers from a specialized institution in Mexico. RESULTS: We studied 29 risk factors , range 0 to 9 in each patient. Prenatal 244 factors; Perinatal 378, Postnatal 319. Most frequent prenatal risk factors: urinary infection, 99 (43%), and transvaginal bleeding, 61 (27%). Perinatal: perinatal hypoxia, 131 (57%); and prematurity, 116, (50%). Postnatal: convulsive syndrome <2 Years old, 92 (42%); and jaundice, 84 (37%). CONCLUSIONS: The most common cerebral palsy associated risk factors were perinatal, which differs from that reported in countries such as Spain, USA and England, where the prenatal ones are. Sweden results are similar to Mexico. It is suggested to carry out prospective studies in this field.

Terapia oromotora y suplemento dietético, mejora en las habilidades de alimentación y en la nutrición de pacientes con parálisis cerebra / Oromotortherapy and dietary supplement, improve feeding skills and nutrition of patients with cerebral palsy

Fundamentos: La parálisis cerebral (PC)compromete los procesos de alimentación y el estado nutricional de los niños que la padecen. El objetivo de este estudio fue evaluar los resultados nutricionales y las habilidades de alimentación de niños con PC trasterapia oromotora y suplemento dietético. Métodos: Estudio de cohorte, longitudinal, prospectivo, cuasi experimental. Participaron 80 pacientes con PC, que se dividieron en 2 grupos (tratado en una institución y en su hogar) y tuvo una duración de 3 años 9 meses. Los participantes recibieron una evaluación nutricional al inicio y al término del estudio, todos recibieron dieta hipercalórica, terapia oromotora y suplemento dietético. Resultados: El mayor porcentaje de mejora se obtuvo en los casos clasificados con desnutrición moderada (GTI: 42,5% vs GTH: 30 %). En los pacientes GTH, la nutrición normal aumentó un 12,6 %.En los pacientes GTI, la desnutrición leve disminuyó un 15 %, la moderada 27,6 %; y la nutrición normal aumentó un 40%. Las habilidades de succión, masticación y deglución severas disminuyeron un 22,9%. Conclusiones: La terapia oromotora, dieta hipercalórica e hiperproteica y la suplementación dietética, son altamente eficaces para mejorar el estado nutricional de los niños con PC, siendo más efectiva cuando se aplica en una institución especializada

Background: Cerebral palsy (PC) compromises the feeding processes and the nutritional status of the children who suffer from it. The objective of this study was to evaluate the nutritional results and feeding abilities of children with CP after oral-motor therapy and dietary supplement. Methods: Longitudinal, prospective and quasi-experimental cohort study. 80 patients with PC, who were divided into 2 groups (treated in an institution and in their home), were included in this study thatlasted 3 years 9 months. Participants received a nutritional evaluation at the beginning and at the end of the study, all received a high calorie diet, oral-motor therapy and dietary supplement. Results: The highest percentage of improvement was obtained in the cases classified as moderate malnutrition (GTI: 42.5% vs. GTH: 30%). In GTH patients, normal nutrition increased by 12.6%. In GTI patients, mild malnutrition decreased 15%, moderate27.6%; and normal nutrition increased40%. Severe sucking, chewing and swallowing skills decreased22.9%. Conclusions: Oral motor therapy combined with a high calorie and high protein diet, and a dietary supplement, is highly effective in improving nutritional status of children with CP, and is most effective when applied in a specialized institution by professionals

Impacto de una intervención psicosocial en la carga del cuidador de niños con parálisis cerebral / Impact of a psychosocial intervention in caregiver burden of children with cerebral palsy

OBJETIVO: Demostrar que la terapia de resolución de problemas es eficaz para disminuir la carga en los cuidadores de niños con parálisis cerebral. DISEÑO: Ensayo clínico aleatorizado. Emplazamiento: Consulta de atención primaria dentro de una asociación privada no lucrativa. Participantes: Ciento cuarenta cuidadores divididos en un grupo control (GC) y un grupo experimental (GE). Intervenciones: Se realizó en ambos grupos una intervención psicosocial con una frecuencia de una sesión por semana durante 3 semanas a completar 120 min. En el GE se realizó una forma acortada de terapia de resolución de problemas con enfoque en la carga del cuidador y en el GC se realizó una intervención educativa con enfoque en enfermedades respiratorias. Mediciones principales: La variable respuesta corresponde a la puntuación obtenida mediante el cuestionario Zarit. La variable independiente correspondió a la intervención psicosocial. RESULTADOS: En el GE, de acuerdo con la puntuación del cuestionario Zarit, se obtuvo un promedio preintervención de 45,0 puntos contra 45,3 puntos en el GC; tras la intervención se obtuvo un promedio Zarit de 29,8 puntos en el GE y de 44,3 puntos en el GC (p < 0,0001). Se catalogó a los grupos según su puntuación Zarit en carga: nula, leve, moderada y severa, encontrando diferencias del impacto de la intervención en los diversas categorías (prueba de Wilcoxon Z = -6,281, p < 0,00001). CONCLUSIONES: La terapia de resolución de problemas es efectiva para disminuir la carga en los cuidadores de niños con parálisis cerebral

OBJECTIVE: To demonstrate that problem-solving therapy is effective in reducing the burden on caregivers of children with cerebral palsy. DESIGN: Randomized clinical trial. Location: Check primary care within a private nonprofit association. Participants: 140 caregivers divided into control group (CG) and experimental group (EG).Interventions: We performed in both groups a psychosocial intervention with a frequency of one session per week for three weeks to complete 120 minutes. In the EG performed a shortened form of problem-solving therapy with a focus on caregiver burden and the CG performed an educational intervention focusing on respiratory diseases. Main measures: The response variable corresponds to the score obtained by Zarit questionnaire. The independent variable accounted for psychosocial intervention. RESULTS: In the EG according to Zarit questionnaire score was obtained by averaging 45.0 points pre intervention against 45.3 points in the CP after intervention Zarit was obtained by averaging 29.8 points in the EG and 44.3 points in the CG (P <0.0001). The catalog groups according to their score Zarit in charge: none, mild, moderate and severe impact differences were found in the different intervention categories (Wilcoxon test Z = 6.281, P < 0.00001). CONCLUSIONS: Problem solving therapy is effective in reducing the burden on caregivers of children with cerebral palsy

[Impact of a psychosocial intervention in caregiver burden of children with cerebral palsy]. / Impacto de una intervención psicosocial en la carga del cuidador de niños con parálisis cerebral.

OBJECTIVE: To demonstrate that problem-solving therapy is effective in reducing the burden on caregivers of children with cerebral palsy. DESIGN: Randomized clinical trial. LOCATION: Check primary care within a private nonprofit association. PARTICIPANTS: 140caregivers divided into control group (CG) and experimental group (EG). INTERVENTIONS: We performed in both groups a psychosocial intervention with a frequency of one session per week for three weeks to complete 120minutes. In the EG performed a shortened form of problem-solving therapy with a focus on caregiver burden and the CG performed an educational intervention focusing on respiratory diseases. MAIN MEASURES: The response variable corresponds to the score obtained by Zarit questionnaire. The independent variable accounted for psychosocial intervention. RESULTS: In the EG according to Zarit questionnaire score was obtained by averaging 45.0 points pre intervention against 45.3 points in the CP after intervention Zarit was obtained by averaging 29.8 points in the EG and 44.3 points in the CG (P<.0001). The catalog groups according to their score Zarit in charge: none, mild, moderate and severe impact differences were found in the different intervention categories (Wilcoxon test Z=6.281, P<.00001). CONCLUSIONS: Problem solving therapy is effective in reducing the burden on caregivers of children with cerebral palsy.