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Nacer y crecer sin OH

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Alberto Cárceles-Alvarez
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Background: The Environmental Reproductive Nursing consultation involves a clinical consultation focused on detection, intervention and prevention of exposures to environmental hazards during the critical periods of fetus development (spermatogenesis and pregnancy) that pays special attention to legal and illegal drugs. Methods: The consultation is supplemented with an ultrasound at 12 weeks of gestation. The goals of the consultation are to detect and reduce environmental exposures that can negatively a ect the health of the fetus (or embryo) and to prevent recurrent diseases. In addition, to establish “environmental risk labels “ in those pregnancies where the exposures have been severe enough to trigger diseases related to those exposures and allow us to make diagnoses prenatally or in the rst months of life. The working tool is called the “hoja verde” and consists of a set of basic and concise questions that allow us to identify and manage/reduce environmental risk factors at critical periods of pregnancy (including spermatogenesis) and breastfeeding. We examine socioeconomic factors, reproductive history, ionizing radiation, drugs/herbalism/homeopathy, occupational exposures, smoking, illegal drugs, alcohol, pesticides and environmental perception of their community. Ethical approval was granted by La Hoja Verde’s ethics committee. Results: Of the first 1,500 couples with risk during early pregnancy (2009/2012), we found a rate of 34.9% of maternal smoking, 45.4% of paternal smoking, 59.4% of maternal alcohol consumption during early pregnancy, 85% of paternal alcohol consumption during spermatogenesis, and 10.1% of fetuses exposed to illegal drugs during early pregnancy. In the successive years, the data presented showed a signi cant decrease in women who drink some alcohol in early pregnancy, a signi cant decrease in the amount of alcohol that the couples consume and a decrease in the number of newborns with congenital heart disease associated with intrauterine exposure to ethanol. Conclusions: The Environmental Reproductive Nursing consultation is a clinical consultation/practice that allows us to identify, address and prevent environmental risk factors that would be otherwise go unnoticed. The training in this type of discipline/consultation is critical in order to increase the quality of pregnancy, health of the pregnant couple, as well as the health of the upcoming newborn.
Esther Tobarra Sánchez
added a research item
INTRODUCCIÓN Y OBJETIVOS: Nacer sin OH es un proyecto de prevención, detección y seguimiento de niños con trastornos neurocomportamentales asociados a la exposición prenatal y postnatal a alcohol y/o otras drogas ilegales. Incluye la realización del registro ELIJO MAS SANO (EMS) de niños en riesgo medioambiental por estas drogas. MATERIAL Y MÉTODOS: Estudio descriptivo de las historias clínicas ambientales de 23 pacientes de EMS. Incluye evaluación clínica, social y del neurodesarrollo. Criterios de inclusión en EMS (mínimo uno): 1: >20 gr/día alcohol y/o 3 atracones de ≥ 40 gr/día en etapa periconcepcional, gestacional o de lactancia. 2: exposición activa al menos una vez a la semana a cualquier droga ilegal. RESULTADOS Y DISCUSIÓN: Se analizaron 23 pacientes (10 varones) con un peso y SG medios al nacimiento de 3027.63 gramos (2619.5; 3435.8) y 37.64 (mín 30, máx 42) respectivamente. 4 presentaron una edad al nacimiento < 35 SG. 16 fueron incluidos por exposición prenatal a alcohol (>20g/d), 3 de ellos con exposición adicional a drogas ilegales, 5 por más de 3 atracones y 2 por >20g/d y >3 atracones. Al nacimiento, 2 presentaron un perímetro cefálico (PC) inferior al percentil 10 (p10), 4 un peso inferior al p10 y 1 talla inferior a p10 (no se incluyeron neonatos ≤ 35 SG). A los 2 años todos presentaron un crecimiento pondoestatural y del PC adecuado. Ninguno presentó alteraciones en los rasgos faciales característicos (hendidura palpebral, surco nasolabial, grosor del labio superior). 20 completaron la evaluación con un test de neurodesarrollo (test Battelle), donde se evaluaron las esferas personal social, adaptativa, motora, comunicación, adaptativa.15 han presentado retrasos en una esfera y 10 de ellos en 3 esferas. 2 de los niños estaban de forma más severa afectados. La mitad de los niñ@s incluidos en el registro de EMS, tienen retrasos en el neurodesarrollo antes de los 2 años de edad.
Esther Tobarra Sánchez
added 2 research items
Background: Born without OH is a comprehensive program of prevention, reduction of harm and management of neurobehavioral disorders associated with prenatal exposure to alcohol and other drugs through the pediatric environmental health from the beginning of pregnancy until the end of adolescence. Our objective is to prevent and reduce damage from exposure to alcohol and other drugs during critical periods of development (periconceptional until the end of adolescence). Methods: Beginning in 2009, at the University Clinical Hospital Virgen de la Arrixaca (Murcia, Spain), the GREEN SHEET was implemented in hospital and primary care. It is a set of basic and concise questions for women in the 1st trimester of pregnancy to detect the environmental risk factors related to alcohol and other drugs in early pregnancy. Those with high-risk criteria of prenatal exposure to alcohol and other drugs pass to a follow-up program called ELIJO MAS SANO (CHOOSE HEALTHIER): early and comprehensive intervention for the management and monitoring of pregnant women and / or children at risk of fetal alcohol spectrum disorders (FASD). Results: In the follow-up of 200 children in the program ELIJO MÁS SANO, there was a significant decrease (p <0.05) in women who drank some alcohol in early pregnancy and the amount of alcohol drunk by the couple. There was a decrease in the number of newborns with congenital heart disease associated with intrauterine exposure to ethanol controlled by the number of births and abortions. There were 6 children diagnosed with fetal alcohol syndrome (FAS) (in 1500 pregnant couples), estimating a prevalence of 4 cases of FAS per 1,000 newborns in the region of Murcia. Conclusions: The Born without OH programme has been implemented with good preliminary results: reducing the consumption of alcohol during pregnancy, decreased congenital heart diseases related to intrauterine exposure to alcohol and registration of syndromes and alcohol-related birth defects.
Introduction: This integrated study examines the prevention and detection/follow-up of children at risk of neurobehavioral disorders associated with prenatal and/or postnatal exposure to alcohol and illegal drugs. We utilized the Elijo Mas Sano (Choose Healthier) registry of children at environmental risk from drugs and alcohol. Methods: For this descriptive study of environmental clinical history, we observed the first 39 patients of Elijo Mas Sano. We included clinical, social and neurodevelopmental evaluations. The Elijo Mas Sano criteria of inclusion was a) >20 g/day of alcohol and/or 3 incidents of binge drinking of ≥40 g/day during periconceptional, gestational, or lactation stages and/or b) fetal exposure to any illegal drug at least once a week. Ethical approval was granted by the Clinical Research Ethics Committee of the University Hospital Virgen de la Arrixaca. Results: The study group was comprised 39 subjects, 19 girls and 20 boys. The gestation period was an average of 38.26 weeks (min. 30; max. 41). There were 5 premature newborns (<36 gestation week). The average birth weight (≥36 gestation week) was 3,055 g (min. 2,433.9; max. 3,676.1). The average consumption of alcohol at early pregnancy in mothers was 33.55 g (con dence interval 95% 23.7-43.2). In the study group, 33% reported 3 or more incidents of binge drinking. Fetal exposure to illegal drugs occurred in 18% of the study group. Four patients had neonatal anthropometry (≥36 gestation week) with an average head circumference of <p10, a birth weight of <p10: 9, and 3 patients had a height of <p10. There were 6 patients with major congenital malformations. Two patients had chromosomal comorbidities. We evaluated 37 of the 39 patients’ facial features: palpebral fissure (<-2 standard deviation): 2, philtrum (4-5): 2, upper lip (4-5): 4. The Battelle test neurodevelopmental evaluation was given to 30 of the 39 subjects to examine personal and social, adaptive, motor, and communication domains. Twenty-eight showed delays on one domain and 21 in 3 or more. A negative correlation existed between g/day of ethanol and months of cognitive delay (-0.37, p<0.05). In the study, 35% had an average cognitive delay of -8.5 months (confidence interval 95% -0.5;-16.5). For some of the study group participants, growth curves and head circumference showed normalization by 2 years. Conclusions: Half of the children from the Elijo Mas Sano registry had neurodevelopmental delays before the age of 2. The program of prevention and harm reduction of intrauterine exposure to alcohol and other drugs has been implemented with good preliminary results: decreased alcohol consumption during pregnancy and syndromes and alcohol-related birth defects. The next step is to follow-up to children who are at risk of fetal alcohol spectrum disorders through adolescence.
Ferran Campillo i López
added a research item
INTRODUCCIÓN Y OBJETIVOS Nacer sin OH es un programa integral de prevención, disminución de daño y manejo de los trastornos neurocomportamentales asociados con la exposición prenatal a alcohol y otras drogas desde el inicio del embarazo hasta el final de la adolescencia. Entre sus objetivos específicos pretende crear un Registro Regional de niños afectados con trastornos del espectro alcohólico fetal (TEAF) y otras drogas, así como disminuir los efectos teratogénicos y en el neurodesarrollo. Acciones desarrolladas: 1. “Prevención, detección y minimización de daño”: uso de la “Hoja Verde”, cribado medioambiental en gestantes que permite detectar y cuantificar la exposición a drogas; desarrollo de una aplicación de Salud Móvil basado en la Hoja Verde, distribución de trípticos informativos para población y profesionales, campañas de concienciación (“Esta ronda la paga él” y “Bosques para la Salud”) e ingresos terapéuticos de las gestantes consumidoras de drogas. 2. “Elijo Más Sano: manejo” agenda de seguimiento por alto riesgo medioambiental (ARMA) por exposición prenatal a alcohol u otras drogas; 3. “Formación” a profesionales sanitarios y 4. Investigación.Se han evaluado los resultados de algunos de los objetivos del programa. MÉTODOS El programa se viene implantado gradualmente desde noviembre 2009 en un hospital de referencia regional, habiendo realizado más de 4000 cribados. Presentamos el resultado de las primeras 1500 (09-12). RESULTADOS Disminución sostenida y significativa (p<0,05) de las mujeres que beben algo de alcohol al inicio del embarazo y de la cantidad de alcohol que toman ambos cónyuges. Disminución en el número de recién nacido con cardiopatías congénitas relacionadas al alcohol prenatal. El 18% (270) pasó a ARMA. Diagnóstico de 6 niños con síndrome alcohólico fetal al nacimiento, y de 92 niños en muy alto riesgo con algún efecto en el neurodesarrollo. Entre los expuestos a más de 20gramos de alcohol al inicio del embarazo, el 25% tenía una malformación mayor (CIE-9) al nacimiento. Casi 1/3 tenía criterios de riesgo de TEAF (trastorno del espectro alcohólico fetal). CONCLUSIONES El nivel de exposición intrauterina detectado con la hoja verde a tabaco, alcohol y drogas ilegales es alarmantemente elevado. Acciones breves y mantenidas en el tiempo permiten mejorar los resultados de exposición y disminuir los efectos relacionados con la exposición prenatal a drogas.
Esther Tobarra Sánchez
added 2 research items
Background: Prenatal exposure to alcohol causes a variety of clinical manifestations known as fetal alcohol spectrum disorder (FASD), with neurodevelopmental effects, among others. Alcoholism is common among mothers of children adopted from Spanish institutions, especially from Eastern Europe. Methods: A 17-year old boy, born in Ukraine and adopted by a Spanish family at the age of two was referred to the Genetics Unit because of psychomotor delay and facial dysmorphia. He is the product of an unknown controlled pregnancy, and had a sister with psychomotor retardation. The presence of dysmorphic features was detected in infancy by the Medical Genetics Unit, as well as psychomotor and pondostatural growth retardation. At the age of 7 he developed inattention and hyperactivity, as well as anxiety and depressive symptoms. The child was evaluated by the Neuropediatrics and Psychiatry Unit. Subsequently, the child was evaluated at school and by the Environmental Pediatric Service. Results: He presented with behavioral problems and poor school performance, limited IQ and verbal reasoning capacity below average, as well as significant curricular gaps in grammatics, mathematics and languages and difficulties in social relationships. He did not show an adequate level of autonomy, all in the context of FASD. The child was diagnosed with FASD. Conclusions: Patients with FASD may have a normal or decreased IQ, from minimum to profound mental retardation. Executive functions are the most frequently afected. In addition, they usually have poor performance in behavioral inhibition and self-control, verbal and nonverbal fluency, organization and planning. Other manifestations include difficulties in the area of mathematics and social communication because of language disorders. Problems in socialization are influenced by understimulation, common in adopted children. Behavioral problems, substance use, sexual behavior and psychotic disorders are also common. Early diagnosis and intervention and psychopedagogical treatment seem to achieve an improvement in the neurodevelopment of these patients.
INTRODUCCIÓN Y OBJETIVOS Los niños de hoy disponen de menos tiempo y menos espacios para jugar al aire libre que sus padres cuando eran niños. Los niños españoles de 4 a 12 años pasan 990 horas anuales de media frente al televisor, el ordenador o los juegos electrónicos. Se ha observado cómo el contacto con la naturaleza mejora el control de enfermedades crónicas, contribuye a prevenir la adicción a alcohol y otras drogas, mejora los resultados reproductivos y neonatales, mejora el rendimiento escolar y los tests cognitivos, incrementa la función pulmonar y los niveles de vitamina D y una reducción significativa de visitas al médico. Desarrollar programas de salud medioambiental que estimulen y ‘reconecten’ al niño con la madre naturaleza constituye por si mismo un reto sanitario para este siglo. Presentamos los resultados del proyecto pediátrico Bosques para la Salud (BpS). BpS pretende que cada niñ@ de la CC.AA. nazca y crezca vinculado a un árbol, incorporando un ‘bosque para la salud’ a cada uno de los hospitales con maternidad. Objetivo General: a) Fomentar el vínculo y el apego con la naturaleza de las parejas embarazadas y sus futuros hijos e hijas, desde el momento del embarazo y su nacimiento en las maternidades hasta el final de la adolescencia y; b) Estimular el autocuidado y contacto con la naturaleza como herramientas preventivas y terapéuticas para alcanzar cuotas de bienestar y salud de los ciudadanos, con especial foco de atención desde la infancia y adolescencia a la creación de ambientes más saludables para la prevención de drogas legales e ilegales. MÉTODOS En el momento de alta de maternidad se realiza una intervención que incluye paquete informativo (guía para recién nacidos ‘los primeros pasos en la naturaleza’, Diploma ‘Nacido para proteger el medio ambiente’, Tríptico prevención del acohol, tabaco, contacto con la naturaleza). Además, se le entrega un arbolito, que cuidará hasta la repoblación en la época de lluvias. Video de la 1ª repoblación: https://www.youtube.com/ watch?v=mZpevYbAKeU RESULTADOS Árboles entregados a familias/RN: 3637, a niños de agenda pediatría social 92; árboles plantados en el BpS o familias que acudieron a plantar al: 970. Toneladas CO2absorbidas: 4,694 Tn CO2/año. Video de la 1ª repoblación: https://www.youtube.com/watch?v= mZpevYbAKeU CONCLUSIONES En la primera infancia los pediatras deberíamos apoyar la tendencia innata de los niños/as a la empatía para acercarse a la madre naturaleza en cualquiera de sus formas. La sencillez del proyecto, en un periodo tan receptivo para las familias le hace viable y transferible.