Browsing by Author "Maturana, Andrés"
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Item Association of Cow's Milk Protein Allergy Prevalence With Socioeconomic Status in a Cohort of Chilean Infants(2020-09) Arancibia, María; Yalda, Lucero; Miquel, Isabel; Marchant, Pamela; Rodríguez, Lorena; Alliende, Francisco; Ríos, Gloria; Maturana, AndrésObjectives: The aim of the study was to compare the cow's milk protein allergy (CMPA) prevalence in 2 cohorts of children from different socioeconomic strata. Methods: Prospective birth cohort that included patients from 2 hospitals providing care for a low- and high-income population, respectively. Healthy newborns >= 34 gestational weeks were recruited and followed up to 12 months by a monthly telephone survey. If >= 2 predefined symptoms/signs suggestive of CMPA were detected, the patient was evaluated by a pediatric gastroenterologist. Diagnosis was confirmed by exclusion diet followed by open oral food challenge. Results: Overall the prevalence of CMPA was 5.2%, with a 6 times higher prevalence in the high income cohort (9.2%) compared with the low-income group (1.5%; relative risk 6.2; 95% confidence interval 1.8-20.7;P = 0.0005). All the cases were non-immunoglobulin E-mediated with predominantly gastrointestinal symptoms. High-income cohort did have higher frequency of Csection, mother's previous chronic disease, mother's history of atopy/food allergy, older age, and higher educational level of parents. Parent smoking and presence of pets at home were more frequent in the low-income cohort. Multiple logistic regression showed that the high-income cohort did have older age and higher educational level of both parents. Conclusion: In these cohorts the prevalence of CMPA was higher than reported previously in other developing countries and significantly higher in the high-income group. Our findings were associated with sociodemographic characteristics of the parents.Item Comparison between Ages & Stages Questionnaire and Bayley Scales, to predict cognitive delay in school age(2020-02) Schonhaut, Luisa; Pérez, Marcela; Armijo, Iván; Maturana, AndrésObjective To compare the predictive value of the Spanish Ages & Stages Questionnaire third edition adapted for Chilean population (ASQ-Cl) and the Bayley Scale of Infant and Toddler Development 3rd edition (Bayley-III) for cognitive delay at school age, and to identify the domain predictors. Methodology Data were collected from 306 term and preterm children of medium-high socio-economic level enrolled in a prospective cohort study. Developmental outcomes at 8, 18 and 30 months were assessed via the ASQ-Cl and Bayley-III; at 6–8 years cognitive development was assessed using the Wechsler Intelligence Scale for Children (WISC-III). The area under the curve (AUC), sensitivity, specificity and predictive values were calculated, and logistic regression analysis was used. Results Of 227 children studied, 6.6% had cognitive delay. ASQ-Cl and Bayley-III generate equivalent AUC [0.77 and 0.80]. Sensitivity 67% and 53%; specificity of 72% and 88%, positive predictive value of 14% and 24%, negative predictive values of 97% and 96% respectively. Greater predictive validity was obtained at 30 months assessment. Deficit in the communication and gross motor skills and problem-solving domains of the ASQ-Cl and all the Bayley-III domains were significantly associated with cognitive delay. Conclusions ASQ-Cl can be used to identify children at risk for cognitive delay at 6–8 years of age, being comparable with the Bayley-III. Some domains of ASQ-Cl and all domains of Bayley-III were significant predictors for cognitive delay. These results support the use of ASQ-Cl as a screening tool for developmental delay.Item Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile:Protocol for a Randomized Controlled Trial(2020) Bustamante, Jorge; Pérez Retamal, Marcela; Morgues Nudman, Monica Isabel; Maturana, Andrés; Salinas González, Ricardo; Cox, Horacio; González Mas, José Miguel; Muñoz, Lucia; López, Lilian; Simó, Sandra; Palau Subiela, Pascual; Guedeney, Antoine; Mendiburo-Seguel, AndrésBackground: Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age. Objective: The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms. Methods: This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale–revised. Results: Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021. Conclusions: This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up. Trial Registration: ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547. International Registered Report Identifier (IRRID): DERR1-10.2196/17943Item Medicina Basada en Evidencia: ¿podemos confiar en los resultados de los estudios clínicos aleatorizados bien diseñados?(2014) Maturana, Andrés; Benaglio, CarlaLa Medicina Basada en Evidencia es una propuesta que asiste en la toma de decisiones clínicas integrando la información críticamente analizada con los valores y preferencias del paciente en el contexto clínico existente. Un concepto fundamental en este paradigma es la jerarquización de la información. El estudio clínico aleatorizado es reconocido como uno de los diseños metodológicos con menor probabilidad de sesgo y por ende de la más alta calidad metodológica. En este tipo de estudios se basan muchas de las recomendaciones de las guías clínicas, que son uno de los principales instrumentos que utiliza la medicina basada en evidencia para transferir la información a la práctica clínica. En esta revisión se exponen algunas de las limitaciones que pueden tener los resultados de estudios clínicos aleatorizados incluso cuando han sido bien diseñados y ejecutados. Se discute también el porqué resultados validos pueden no necesariamente ser extrapolables a la población general en este tipo de estudios. Si bien el estudio clínico aleatorizado sigue siendo uno de los mejores diseños metodológicos, se sugiere que el usuario de la información sea cuidadoso al interpretar sus resultados.Item Predictive Validity of Developmental Screening Questionnaires for Identifying Children With Later Cognitive or Educational Difficulties: A Systematic Review(2021) Schonhaut, Luisa; Maturana, Andrés; Cepeda, Olenkha; Serón, PamelaContext: Parent/caregiver completing developmental screening questionnaires (DSQs) for children before 5 years of age is currently recommended. The DSQs recommended by the American Academy of Pediatrics (AAP) are the Ages and Stages Questionnaires (ASQ), Parents' Evaluation of Developmental Status (PEDS), and the Survey of Well-being of Young Children (SWYC). Nevertheless, their predictive validity has not been well-established. Objective: To assess in the current literature, the value of AAP-recommended DSQs (ASQ, PEDS, SWYC) administered between 0 and 5 years of age, for predicting long-term cognitive achievement and/or school performance (CA/SP), after 1 year or more of evaluation and at/or after age 5 years, in the general population. Data Sources: Cochrane, MEDLINE PubMed, CINAHL, EMBASE, Web of Science, Scielo, and Scopus databases (until March 2021). Study Selection: Two authors selected the studies. Forward and backward citation follow-up was done; authors of DSQ were contacted to identify additional studies. Data Extraction: Cohorts were identified, and authors of selected studies were contacted to corroborate and complete extracted data. Results: Thirty-two publications, corresponding to 10 cohorts, were included. All cohorts used ASQ. Only cohort using PEDS was identified but did not meet the inclusion criteria. No cohorts conducted with SWYC were identified. Associations between ASQ and CA/SP were extracted for eight cohorts. The odds ratios were >3, and the area under the curve was 0.66–0.87. A trade-off between sensitivity and specificity was observed. Limitations: Heterogeneity in population characteristics and in DSQ adaptations. Conclusions: A positive association between ASQ and later CA/SP was found in different social, cultural, and economic settings. Additional studies are necessary to determine the impact factors in the predictive capacity of DSQs.Item Prevalencia de patología oftalmológica en prematuros menores de un año de edad(2012) López, Juan Pablo; Ossandón, Diego; Denk, Oliver; Stevenson, Ricardo; Agurto, Ricardo; Uauy, Andrés; Salinas, Ricardo; Pérez, Marcelo; Cox, Horacio; Maturana, Andrés; Elías, SoledadReportar hallazgos oftalmológicos en niños prematuros examinados antes del año de edad gestacional corregida (EGC). Pacientes y Método: Revisión retrospectiva de fichas clínicas de una serie de prematuros ([peso nacimiento (PN) ≤ 1 500 g y/o ≤ 32 sem edad gestacional (EG)] nacidos en CAS entre 2006-2009, examinados antes del año de EGC. Se consignó EG, PN, antecedente de retinopatía del prematuro (ROP), EGC al examen, refracción, anisometropía y estrabismo. Resultados: De 149 prematuros nacidos en el período, 100 tuvieron examen oftalmológico antes del año de edad (67,14%); el promedio de EG y PN fue 29,3 (rango 23- 36) semanas y 1217 (343-2190) g, respectivamente. El 29% presentó ROP, requiriendo tratamiento el 4%. La EGC promedio al examen oftalmológico fue 6,4 (3-11,5) meses. El equivalente esférico fue +1,34D (-1,75 a +5,75), presentando anisometropía >1D el 2,2%(95% IC, -0,82-5,26). El 3,3%(95% IC, -0,38-7,04) presentaba indicación de lentes según recomendaciones internacionales y el 4%(95% IC, 0,16-7,84) presentó estrabismo. Conclusiones: La baja prevalencia de factores de riesgo para ambliopía detectada en esta cohorte comparada con la reportada para prematuros con ROP severa podría explicarse por la baja prevalencia de ésta última en la presente serie.