Indicadores clínicos precoces de los trastornos generalizados del desarrollo / Early clinical indicators of pervasive development disorders

Introducción: Los trastornos generalizados del desarrollo (TGD) son procesos caracterizados por presentar déficits en múltiples áreas de la conducta. El resultado son alteraciones en la interacción social, la comunicación verbal y no verbal, y la presencia de intereses restrictivos y repetitivos. La importancia de su diagnóstico precoz radica en la posibilidad de la intervención temprana y su efecto en el pronóstico del paciente. Como el diagnóstico de TGD se ha incrementado en los últimos años, se plantea la detección de situaciones clínicas de fácil identificación en el primer año de vida que permitan mejorar el diagnóstico y facilitar la intervención temprana. Pacientes e intervenciones: Se estudia a 37 pacientes con TGD y 69 controles sanos de forma ambispectiva, a los que se les practica somatometría básica, exploraciones neurológicas y recogida de datos de variables del cuestionario modificado para la detección de riesgo de autismo(MCHAT). Resultados: La proporción de varones (OR: 3,87; IC del 95%, 1,23-12,96), el retraso en los primeros bisílabos (TGD = 20,1±23 meses vs control = 10,8±10,3 meses; p < 0,01), la ausencia de contacto visual (OR: 0,05; IC del 95%, 0,01-0,29), la falta de respuesta a la llamada de atención (OR: 0,12; IC del 95%, 0,02-0,67) y el aumento de «berrinches» (OR: 6,37; IC del 95%,2,39-17,34) fueron significativamente superiores en el grupo con TGD. Conclusiones: Las diferencias que hemos detectado entre ambos grupos no pueden constituir un sistema diagnóstico de certeza en este periodo; sin embargo, creemos que deben ser considerados signos de alarma en el contexto de retrasos madurativos de lactantes y preescolares, a la vez que sugieren la existencia de un fenotipo precoz de TGD(AU)

Introduction: Pervasive development disorders (PDD) conditions characterised by deficits in many areas of behaviour, such as delay in social interactions, abnormalities in verbal and non-verbal communication, and the presence of the restrictive and repetitive interests. The relevance of early diagnosis is based on the fact that early intervention could have a beneficial effect on the long term outcome. Due to the increase of the PDD diagnosis in the recent years, we aimed to study easily detectable clinical traits during the first year of life, leading to an improvement in the diagnosis. Patients and interventions: A prospective and retrospective study was conducted on 37 PDD patients and 69 healthy controls. Somatometric and neurological examinations were performed and a questionnaire with several variables from the Modified Checklist for Autism in Toddlers (M-CHAT) completed by the parents. Results: The male to female ratio (OR: 3.87; 95% CI: 1.23-12.96), delay in the first disyllabic words (PDD = 20.1±23 months vs Control = 10.8±10.3 months; P < 0.01), absence of visual contact (OR: 0.05; 95% CI: 0.01-0.29), the lack of response to attention call (OR: 0.12; 95%CI: 0.02-0.67), and the increase in tantrums (OR: 6.37; 95% CI: 2.39-17.34), were significantly higher in the PDD group. Conclusions: The differences detected between groups can not been considered as a diagnostic tool of certainty in this time period, however, we believe that they should be considered in the context of maturational delay, as alarm signs in infants and toddlers, as well as suggesting the existence of an early pervasive development phenotype(AU)

[Early clinical indicators of pervasive development disorders]. / Indicadores clínicos precoces de los trastornos generalizados del desarrollo.

INTRODUCTION: Pervasive development disorders (PDD) conditions characterised by deficits in many areas of behaviour, such as delay in social interactions, abnormalities in verbal and non-verbal communication, and the presence of the restrictive and repetitive interests. The relevance of early diagnosis is based on the fact that early intervention could have a beneficial effect on the long term outcome. Due to the increase of the PDD diagnosis in the recent years, we aimed to study easily detectable clinical traits during the first year of life, leading to an improvement in the diagnosis. PATIENTS AND INTERVENTIONS: A prospective and retrospective study was conducted on 37 PDD patients and 69 healthy controls. Somatometric and neurological examinations were performed and a questionnaire with several variables from the Modified Checklist for Autism in Toddlers (M-CHAT) completed by the parents. RESULTS: The male to female ratio (OR: 3.87; 95% CI: 1.23-12.96), delay in the first disyllabic words (PDD=20.1±23 months vs Control=10.8±10.3 months; P<.01), absence of visual contact (OR: 0.05; 95% CI: 0.01-0.29), the lack of response to attention call (OR: 0.12; 95% CI: 0.02-0.67), and the increase in tantrums (OR: 6.37; 95% CI: 2.39-17.34), were significantly higher in the PDD group. CONCLUSIONS: The differences detected between groups can not been considered as a diagnostic tool of certainty in this time period, however, we believe that they should be considered in the context of maturational delay, as alarm signs in infants and toddlers, as well as suggesting the existence of an early pervasive development phenotype.

[Intensive care in a pediatrics service. Epidemiologic study]. / Atención intensiva en un servicio de pediatría. Estudio epidemiológico.

During the past 10 years, there has been an increase in the number of pediatric services with intensive care units (ICUs). An epidemiological study based in the experience of two years in a ICU is presented. During the study period, 213 patients, accounting for the 6% of total admitted in the pediatric ward (2,898) and 1.8% of newborn (2,091), were admitted in the ICU. The average length of stay was 3.74 days. Regarding the degree of severity two groups of patients were considered: The first group were 104 (48.8%) and they were admitted for close nursing care and observation, while 109 (51%) were to receive an active treatment respiratory problems were the more frequent accounting for the 41% of patients. The total mortality rate was 5.6% and this rate raised until 20% if only newborn patients are considered. The results of this study can be helping in order to planing the organization in this units facing with many problems sometimes difficult to resolve.