[The psychoneurological status of newborn infants with congenital heart disease before surgical intervention]. / Estado psiconeurológico de los recién nacidos afectados de cardiopatía congénita antes de su intervención.

AIMS: This study was conducted to evaluate, from a psychological and neurological point of view, the situation of newborn infants (NI) suffering from congenital heart disease before they are treated surgically. At the same time, we aimed to compare this group of patients with another group of children who were considered to be healthy. PATIENTS AND METHODS: Patients psychological development was evaluated using developmental landmarks from the Observational Scale of Development (OSD), which provides a percentage of elements acquired in different areas. Behaviour was evaluated by the observational recording of particular patterns of behaviour. The neurological study was based on a detailed neonatal examination, performed by people from the Child Neurology Section at our hospital, and which took into account the different behaviours displayed by the NI: reactive, grasping, communicative and affective. RESULTS: Findings show significant differences both in the psychological and neurological variables studied. They show how, generally speaking, healthy infants score higher in the areas of development that were evaluated than children suffering from heart disease. Likewise, lower average scores were observed in heart disease patients who require an early intervention, as compared with those who will be submitted to surgery later on. From the neurological point of view, a number of significant differences were found in their muscular activity. CONCLUSIONS: This analysis, a groundbreaker in the study of infants suffering from heart disease before their surgical intervention, shows how newborn infants who have been submitted to surgery in the neonatal period present a significant degree of hypotonia, a certain frailness and retardation in their motor development.

Estado psiconeurológico de los recién nacidos afectados de cardiopatía congénita antes de su intervención / The psychoneurological status of newborn infants with congenital heart disease before surgical intervention

Objetivo. Este estudio se llevó a cabo para evaluar, desde un punto de vista psicológico y neurológico, la situación de los recién nacidos que padecen una cardiopatía congénita, antes de tratarse quirúrgicamente, y, a su vez, comparar este grupo de pacientes con otro grupo de niños considerados sanos. Pacientes y métodos. El desarrollo psicológico se evaluó mediante hitos evolutivos procedentes de la escala observacional del desarrollo, la cual proporciona un porcentaje de elementos adquiridos en diversas áreas. El comportamiento se evalúa mediante el registro observacional de determinados patrones de conducta. El estudio neurológico se basó en un detallado examen neurológico neonatal, realizado por personas adscritas a la Sección de Neurología Infantil de nuestro hospital, en el que se tuvieron en cuenta las distintas conductas del recién nacido: reactiva, prensora, comunicativa y afectiva. Resultados. Los resultados muestran diferencias significativas, tanto en las variables psicológicas estudiadas como en las neurológicas. Muestran que, en general, los niños sanos obtienen puntuaciones más altas en las áreas de desarrollo evaluadas que los niños afectados de cardiopatías. Asimismo, se observan menores puntuaciones medias en los cardiópatas que deben intervenirse precozmente, que en los que se intervendrán con posterioridad. Desde el punto de vista neurológico, se encontraron unas diferencias significativas en la actividad muscular. Conclusiones. El presente análisis, pionero en el estudio de los niños cardiópatas antes de su intervención, demuestra que los neonatos que se han intervenido en el período neonatal ya presentaban, de forma significativa, hipotonía, cierta fragilidad y retraso en el desarrollo motor (AU)

Aims. This study was conducted to evaluate, from a psychological and neurological point of view, the situation of newborn infants (NI) suffering from congenital heart disease before they are treated surgically. At the same time, we aimed to compare this group of patients with another group of children who were considered to be healthy. Patients and methods. Patients’ psychological development was evaluated using developmental landmarks from the Observational Scale of Development (OSD), which provides a percentage of elements acquired in different areas. Behaviour was evaluated by the observational recording of particular patterns of behaviour. The neurological study was based on a detailed neonatal examination, performed by people from the Child Neurology Section at our hospital, and which took into account the different behaviours displayed by the NI: reactive, grasping, communicative and affective. Results. Findings show significant differences both in the psychological and neurological variables studied. They show how, generally speaking, healthy infants score higher in the areas of development that were evaluated than children suffering from heart disease. Likewise, lower average scores were observed in heart disease patients who require an early intervention, as compared with those who will be submitted to surgery later on. From the neurological point of view, a number of significant differences were found in their muscular activity. Conclusions. This analysis, a groundbreaker in the study of infants suffering from heart disease before their surgical intervention, shows how newborn infants who have been submitted to surgery in the neonatal period present a significant degree of hypotonia, a certain frailness and retardation in their motor development (AU)

[Recurrent ingestion of foreign bodies. Unusual presentation of Munchausen by Proxy syndrome]. / Ingestión reiterada de cuerpos extraños. Forma inusual de presentación del síndrome de Munchausen por poderes.

A case with unusual presentation of Munchausen syndrome by proxy is reported. It was shown through reiterated ingestion of foreign bodies (two earrings, probably a button but not confirmed, a 5 cm. screw and two sewing needles) perpetrated by a 22-year-old mother with a psychiatric record of behavior disorders and family dysfunctions on a 10-month-old infant with a history of prematurity, repeated visits to emergency rooms, and nonjustified multiple hospital admissions. The difficulties in the diagnosis and the need for an early detection are brought up, making considerations in regard to indicators, diagnostic criteria, and management procedure.

[Children at risk. Our experience]. / Niños de riesgo. Nuestra experiencia.

Seventy children in a situation of risk, evaluated and treated in the Social Work Unit of the Children's Hospital "Virgen del Rocío" over a period of 22 months, were analyzed. Of these children, 89% corresponded to low-middle, low or very low social classes. The most common problems included those of the family (77.1%) with history of maltreatment and unwanted pregnancies being the most prevalent problems. In second place was the personal pathology of the parents (74.2%), with mental disorders and alcoholism being the main causes, followed by drug addiction and delinquency. Social factors (57.1%), which included predominantly unemployment and illiteracy, were the next most common finding. The final factor was the personal pathology of the child (10%). The consequences of the risk situation are described, emphasizing the psychic and treatment carried out. Final comments are made underlining the importance of awareness and professional training, multiprofessional teams, means of detecting and intervention into the problems, manpower and material as well as how to carry out studies in this area.