Proceso de atención integrada para niños con necesidades especiales (PAINNE) / Process for integrated care for children with special needs (PAINNE)

Introducción y objetivos: la prevención de las deficiencias infantiles resulta más eficiente cuando coordinamos recursos, implicamos a los profesionales e incorporamos herramientas para la detección e intervención temprana en las deficiencias infantiles y en situaciones de riesgo biológico, psicológico y/o social. Material y métodos: presentamos los primeros resultados de la implantación del Proceso de atención integrada en niños con necesidades especiales (PAINNE), de la Organización Sanitaria Integrada Bilbao-Basurto (Bilbao, España), siguiendo el modelo de atención temprana del País Vasco, en una población de 20 655 menores de seis años. Aplicando metodología cualitativa, incorporamos nuevos datos básicos del paciente sobre desarrollo infantil en la historia clínica electrónica, junto con los indicadores del proceso, recogidos en la guía PAINNE 2013. Resultados: el 75% de los pediatras y el 56% de los profesionales de enfermería participaron previamente en actividades de formación en atención temprana. Las propuestas desde los equipos de Pediatría se validaron por el equipo técnico de valoración en atención temprana de la Diputación Foral de Bizkaia (EVAT), en el 93,27% de los casos. La edad media de derivación a salud mental infantil descendió en ocho meses, hasta los tres años, en casos de enfermedad mental grave, mejorando el diagnóstico precoz y el inicio de los programas de intervención. Conclusiones: los resultados obtenidos en el primer año indican que los equipos de Pediatría se consolidan como gestores válidos de 516 niños con necesidades especiales de salud en programas de atención temprana entre 0 y 6 años (AU)

Introduction and objectives: the prevention of childhood deficits is more efficient when resources are coordinated amongst the professionals responsible for the child's care and screening tools are utilized to detect and provide early intervention to address situations of biological, psychological, and/or social risk. Material and methods: we present the initial results of the implementation of the process for integrated care for children with special needs, PAINNE, in the integrated health organization Bilbao-Basurto, following the model of early intervention in the Basque Country, with a population of 20 655 children under the age of 6 years old. Applying the qualitative methodology, we have incorporated developmental screening tools in the electronic medical record, along with the other process indicators, as described in the guide PAINNE 2013. Results: 75% of the pediatricians and 56% of the nurses participated in continuing educational activities regarding early intervention. The referrals for early intervention were accepted in 93.27% of the cases by the Basque Early Intervention Team (EVAT). The median age for referral to mental health services for children with severe mental health problems decreased by 8 months to 3 years old, showing improvement in the early detection and implementation of services. Conclusions: the results obtained in the first year indicated that the Pediatric Primary Care teams have reliably identified and referred 516 children with special needs, ages 0-6 years, to early intervention programs (AU)

Efecto analgésico de la lactancia materna en la toma sanguínea del talón en el recién nacido / Analgesic effect of breastfeeding when taking blood by heel-prick in newborns

Objetivo: Comparar la eficacia analgésica de la lactancia materna en la toma sanguínea del talón en el recién nacido sano frente a otros procedimientos. Pacientes y métodos: Se estudió a 228 recién nacidos en nuestra maternidad en 2 fases consecutivas. En una primera fase participaron 150 recién nacidos distribuidos en 3 grupos: el primer grupo no recibió intervención analgésica específica y el segundo y el tercer grupo recibieron succión no nutritiva-placebo o succión no nutritiva-sacarosa al 24%, respectivamente. En la segunda fase participaron 78 recién nacidos, en los que la extracción se realizó durante la toma de lactancia materna. Los resultados en la escala de malestar se compararon con los obtenidos en el resto de los procedimientos analgésicos explorados. Resultados: El grupo que recibió analgesia con lactancia materna mostró una puntuación en la escala de malestar de 0,62 y un tiempo de llanto medio de 0,19s. El análisis comparativo de los resultados obtenidos durante el amamantamiento frente al resto de procedimientos mostró que la lactancia materna es la mejor opción analgésica, con un descenso en el malestar del 51% y de un 98% en el tiempo de llanto (p<0,001). Conclusiones: El amamantamiento durante la toma sanguínea del talón representa el método analgésico más efectivo. Un procedimiento de contención junto con succión no nutritiva es el método analgésico de elección en recién nacidos que no reciben lactancia materna (AU)

Objective: To compare the analgesic effectiveness of breastfeeding when taking blood by the heel-lance procedure in healthy newborns, as opposed to other procedures. Patients and methods: We studied 228 term infants from the Maternity Unit of our Hospital. The study was developed in two consecutive phases. In the first stage, 150 newborns were distributed into three randomised groups, the first group (50 newborns) did not receive any specific analgesic intervention; the second and third groups (50 newborns) received non-nutritive sucking-placebo or non-nutritive sucking-24% sucrose respectively. Patients and methods: In the second phase, 78 newborns participated, and the blood was taken during breast-feeding. The results on a discomfort scale were compared with those obtained in the rest of examined analgesic procedures. Results: The group that received analgesia with breast-feeding showed a score on the discomfort scale of 0Œ62 and an average time of crying of 0Œ19s. The comparative analysis of the results obtained during breastfeeding, as opposed to the rest of procedures, showed that breast-feeding is the best analgesic option, with a reduction in the discomfort of 51% and of 98% in the time of crying (P<0,001). Conclusions: Breast-feeding during the blood test by heel-prick procedure represents the most effective analgesic method. A containment procedure along with non-nutritive sucking is the analgesic method of choice in the newborn that does not receive maternal lactation (AU)

Analgesia en la toma sanguínea de talón en los recién nacidos / Analgesia when taking heel-lance blood in the newborn

Objetivo: Determinar el grado de malestar y de dolor causado por la toma sanguínea de talón y comparar diferentes tratamientos analgésicos. Pacientes y método: Se estudiaron 150 recién nacidos procedentes de la maternidad durante un período de 3 meses; se formaron tres grupos aleatorios, previo consentimiento informado. Un primer grupo estaba formado por 50 recién nacidos y no recibió ninguna intervención analgésica específica durante la extracción para el cribado endocrinometabólico, salvo nuestra técnica habitual de contención. Los grupos segundo y tercero (con 50 recién nacidos cada uno), recibieron succión no nutritiva-placebo y succión no nutritiva-sacarosa al 24 %, respectivamente. Resultados: En el grupo control, la puntuación media en la escala de malestar fue de 3,92, con dolor moderado, que provocó un tiempo de llanto de 51,72 s; el grupo que recibió succión no nutritiva-placebo obtuvo una puntuación de 2, 1, dolor leve, con 10,68 s de llanto, mientras que el grupo que recibió succión no nutritiva-sacarosa obtuvo 1,5 puntos, dolor leve, y un tiempo de llanto de 10,70 s. En la comparación de los resultados entre el grupo control y los grupos de succión no nutritiva se observaron diferencias significativas tanto en la puntuación de la escala de molestias como en el tiempo de llanto (p < 0,001). En el análisis comparativo entre los grupos de succión no nutritiva con placeboy sacarosa no se detectaron diferencias significativas. Conclusiones: La toma sanguínea de talón es un procedimiento doloroso de moderada intensidad susceptible de tratamiento analgésico. Un adecuado procedimiento de contención de enfermería, junto con el complemento de succión no nutritiva, disminuye de forma significativa el malestar y el llanto, por lo que no consideramos necesarios otros procedimientos analgésicos (AU)

Objective: To evaluate the pain in healthy newborns requiring blood test by a heel-prick procedure and compare different pain management methods. Patients and method: We studied 150 term infants, in three randomized groups, from the Maternity Unit of our Hospital for a period of three months. The first group of 50 newborns, received no specific analgesic intervention during blood tests, except our usual nursing intervention (“facilitated tucking”). The second and third group (50 newborns), received non-nutritive sucking-placebo and non-nutritivesucking-24% sucrose respectively. Results: In the control group, the average score on the scale of discomfort was 3.92, moderate pain, causing a crying time of 51.72 seconds; the group receiving a non-nutritive sucking-placebo scored 2.1, slight pain, 10.68 seconds crying, while the group receiving non-nutritive sucking-24% sucrose, expressed a level of discomfort of 1.5 points, slight, with an average crying time of 10.70 seconds. The comparative results between the control group and groups of non-nutritive sucking on placebo and 24 % sucrose, both showed significant differences in the scores of the scale of discomfort, as well as in the time crying (p < 0.001). The comparative analysis between groups of non-nutritive sucking sucrose and placebo showed no significant differences. Conclusions: The blood test by heel lance represents a painful procedure of moderate intensity capable of analgesic treatment. A proper nursing method, along with a complement of non-nutritive sucking during extraction, significantly decreases the discomfort and crying, it being unnecessary to consider other analgesics (AU)

[Analgesia when taking heel-lance blood in the newborn]. / Analgesia en la toma sanguínea de talón en los recién nacidos.

OBJECTIVE: To evaluate the pain in healthy newborns requiring blood test by a heel-prick procedure and compare different pain management methods. PATIENTS AND METHOD: We studied 150 term infants, in three randomised groups, from the Maternity Unit of our Hospital for a period of three months. The first group of 50 newborns, received no specific analgesic intervention during blood tests, except our usual nursing intervention ("facilitated tucking"). The second and third group (50 newborns), received non-nutritive sucking-placebo and non-nutritive sucking-24% sucrose respectively. RESULTS: In the control group, the average score on the scale of discomfort was 3.92, moderate pain, causing a crying time of 51.72 seconds; the group receiving a non-nutritive sucking-placeboscored 2.1, slight pain, 10.68 seconds crying, while the group receiving non-nutritive sucking-24 % sucrose, expressed a level of discomfort of 1.5 points, slight, with an average crying time of 10.70 seconds. The comparative results between the control group and groups of non-nutritive sucking on placebo and 24% sucrose, both showed significant differences in the scores of the scale of discomfort, as well as in the time crying (p < 0.001). The comparative analysis between groups of non-nutritive sucking sucrose and placebo showed no significant differences. CONCLUSIONS: The blood test by heel lance represents a painful procedure of moderate intensity capable of analgesic treatment. A proper nursing method, along with a complement of non-nutritive sucking during extraction, significantly decreases the discomfort and crying, it being unnecessary to consider other analgesics.

[The clinical and epidemiological aspects of the neonatal abstinence syndrome]. / Aspectos clínicos y epidemiológicos del síndrome de abstinencia neonatal.

Retrospectively, were tested maternal-neonatal factors of 47 newborn with neonatal abstinence syndrome comparing them with a control group of 100 newborn, during the period from 1985 to 1991. An average incidence of 6/1000 living newborn were affected by abstinence syndrome. The mothers were young (75%), smokers (74%), unemployed (80%), with a high rate of previous abortions (21%) and with a bad pregnancy control. Within our environment, abstinence syndrome increase has been detected among children of young gypsy mothers. Heroin (88%) was the most popular drug. Nevertheless a change has been noted in the last few years in the drug administration going from intravenous to the inhalational route. The duration of syndrome was less in the newborn whose mothers had inhaled heroin and in the premature newborn. It was proved that there was a high rate of HIV (40%), hepatitis B (23%), and syphilis markers (25%).

[Diagnostic value of auditory brainstem evoked potentials (ABP) in high risk premature and newborn infants]. / Valor diagnóstico de los potenciales evocados auditivos troncoencefálicos (ABR) en prematuros y neonatos de alto riesgo.

In this work we have studied 37 children, both preterm and term, belonging ti high risk group of contracting hearing loss, in order to confirm the predictability of ABR in the diagnostic of the congenital hearing losses during the prenatal period and so make possible their immediate and proper rehabilitation. With this purpose we have studied parameters such as threshold, latency of waves and intervals. We have discovered that in preterm children, owing to reasons such as answers of little amplitude, movements of the children and difficulty to determine the gestational age, the parameters of normality are only the existence or not of waves, discarding the value of the threshold and the latency of waves. We have had to wait for 40 weeks to obtain ABR similar to the ones in adults, in which the threshold, latency of waves and intervals are certain to predict hearing. In spite of it all we have to agree that ABR are the best hearing test at those ages. We must not forget that normal ABR could include lesions in the upper part of hearing pathway.

[Influence of acoustic stimulation in the maturation of the auditory pathway]. / Influencia de la estimulación acústica en la maduración de la vía auditiva.

The aim of this study is to analyze the relationship between age and the maturational changes occurring in the peripherical auditory system and the influence of the acoustic stimulation. With this purpose Auditory Brainstem Responses (ABR) were recorded at the 35 and 39 weeks gestational age, in 56 ears of 28 premature infants. The ABR were analyzed the changes in latency values of the I, V waves and I-V intervals. In order to know the influence of the acoustic stimulation on the development of auditory pathway, we made 2 groups with the 28 premature children, one of them control group and the other stimulated with maternal voice from 35 till 39 weeks. The stimulated group had one maturate auditory evoked responses at 39 weeks gestational age. Showing a latency decrease wave V and I-V interval, compared to control group.

[Clinical and electrophysiological effects of auditive stimulation in preterm neonates]. / Efectos clínicos y electrofisiológicos de la estimulación auditiva en recién nacidos pretérmino.

Clinical results in 40 preterm newborns stimulated with maternal voice have been studied in a Neonatal Unit. We compared these results with a control group. After a period of ten days we observed a significant increase (p less than 0.001) in: weight gain (34 g. vs 26 g. per day), an advancement of the hospital discharge time of 3.8 days, spontaneous motor activity, hand sucking and increased interest in the human face. Auditory Brain Stem Response at 35 and 39 weeks, with a total of 21 registered in the experimental group vs 25 registered in the control group, showed that V wave latency decreased significantly (p less than 0.05) in the stimulated group--0.88 m.sc. vs, -0.61 m.sc.--in the control group. These results confirm an enhancement of the auditory way conduction speed from 0.06 m.sc. to 0.53 m.sc. (p less than 0.05).