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Introducción: Entre las modalidades de investigación científica en Medicina, los ensayos clínicos son los que tienen mayor importancia e impacto. Objetivo: Analizar los artículos científicos fase III y IV en temas pediátricos, publicados en Revistas con o sin índice de impacto, en el decenio 1994-2003. Métodos: A partir de la base electrónica de publicaciones científicas ISI de PubMed y de la revisión de las Revistas nacionales no indexadas, se analizaron los estudios clínicos Fase III o Fase IV que incluían a sujetos £ 18 años. Se consignó: autores, institución ejecutora, área pediátrica analizada. Resultados: Se encontraron 71 trabajos en revistas ISI y 11 trabajos en revistas nacionales no ISI (x = 8,2 trabajos/año). Del total, 40 artículos aparecen bajo el alero de la Universidad de Chile, 16 de la Universidad Católica, 4 de la Universidad de Santiago, 3 de la Universidad de Valparaíso, 2 de la Universidad de Concepción, 1 de la Universidad de La Frontera y 1 de la Universidad Austral. Además hubo 6 trabajos del Centro de Vacunas, 6 de Hospitales pediátricos, 2 de Clínicas privadas y 1 del Centro de Planificación Familiar. Las áreas temáticas principales fueron: Nutrición (n = 17), Endocrinología (n = 11), Broncopulmonar (n = 10), Vacunas (n = 8), Infectología (n = 6), Neonatología (n = 5) y Gastroenterología (n = 4). La mayoría de los trabajos fueron efectuados por grupos de investigación conocidos. Conclusiones: Los estudios clínicos fase III y IV son de baja frecuencia en Chile, con tendencia estacionaria en la última década. La mayoría de los trabajos han sido efectuados por las Universidades y por grupos de investigación consolidados. Las áreas temáticas más frecuentes fueron: Nutrición, Endocrinología, Vacunas y Broncopulmonar. Se requieren estrategias para mejorar el nivel de investigación científica pediátrica en Chile Introduction: The development of scientific research faces severe difficulties in Latin America, especially for those studies requiring more complex methodological designs. Objective: To analyze the clinical studies, performed in children or adolescents in Chile, published between 1994 and 2003. Methods: Review of all papers with clinical studies phase III or IV available at the PUBMED database or at the national non ISI Journals between 1994-2003, studying children or adolescents under 18 years in Chile. Results: 82 papers were published, 71 in ISI journals and 11 in non ISI journals; 82% of these were carried out at Universities; 40 at the University of Chile, 16 at the Catholic University, 4 at the University of Santiago, 3 at the University of Valparaíso, 2 at the University of Concepción, 1 at the University La Frontera, and 1 at the Austral University. Other papers were published by the Vaccination Center, 6 by Paedriatric Public Hospitals, 2 by private clinics and 1 by the Familiar Planification Center. The paedriatric specialities more frequently associated with these publications were nutrition 17, endocrinology 11, respiratory diseases 10, vaccines 8, infectious diseases 6, neonatalogy 5, and gastroenterology 4. Conclusions: We conclude that the rate of clinical studies performed in Chile is low, they are mainly performed by Universities and established academic teams. Strategies to improve the magnitude of research are required

ResumenIntroducciónEl síndrome de trisomía 18 (T18) ocurre por la presencia de un cromosoma 18 extra completo en la mayoría de los casos. La prevalencia en recién nacidos oscila entre uno en 6.000 a uno en 8.000. Los afectados tienen una elevada mortalidad, solo el 4% supera el primer año de vida. Son pocos los casos reportados que superan los 5 años.ObjetivoEl objetivo de este artículo es reportar un caso de T18 de larga sobrevida con características en la cavidad oral no descritas en la literatura, y aportar información a médicos y pediatras sobre la etiología, el fenotipo, la sobrevida y el consejo genético.Reporte de casoPaciente de sexo femenino de 7 años con 2 cariotipos realizados en cultivo de linfocitos que mostraron 47,XX+18 en todas las metafases. Con talla y peso bajos, facies dismórficas, retardo severo del desarrollo psicomotor y cognitivo, imposibilidad para alimentarse, ausencia del lenguaje verbal, sordera neurosensorial, marcha atáxica, hipoplasia cerebelosa; genitales con labios mayores y menores hipoplásicos. En la cavidad oral paladar en forma de cúpula, macroglosia, no se observaron incisivos centrales superiores y primeros molares superiores e inferiores. En las radiografías se encuentran hallazgos de formación de las piezas dentales ausentes en la boca, concluyéndose erupción tardía.ConclusionesEn los casos de T18 la mortalidad in útero y neonatal es alta, las características clínicas in útero y en recién nacidos han sido bien descritas. Dado que son pocos los casos que superan los 5 años el fenotipo aún está por establecerse. En la paciente aquí reportada se encontraron hallazgos en la cavidad oral no descritos en la literatura.AbstractIntroductionThe trisomy 18 syndrome occurs due to the presence of an extra chromosome 18 in most cases. The prevalence in infants is estimated at 1:6000 to 1:8000. Those affected have a high mortality rate, only 4% may survive their first year of life. There are few reported cases exceeding five years of age.ObjectiveThe aim of this paper is to report a case of trisomy 18 of long survival with oral cavity features not described in the literature, and to provide information to physicians and paediatricians about aetiology, phenotype, survival and genetic counselling.Case reportA 7 year-old female patient with 2 karyotypes performed by lymphocyte culture showing 47XX+18 in all metaphases. She presented with growth deficiency, dysmorphic facies, severe psychomotor retardation and cognitive disability, inability to feed, lack of verbal language, sensorineural hearing loss, ataxia, cerebellar hypoplasia, and genitals with hypoplastic labia majora and minora. In the oral cavity: dome shaped palate, macroglossia, absence of upper central incisors and first upper and lower molars in mouth. X-ray findings showed formation of missing teeth, with late eruption being concluded.ConclusionsIn cases of trisomy 18 syndrome there is an increased risk of neonatal and infant mortality. The clinical characteristics in utero and in neonates have been well described. Since few cases exceeding five years of age have been reported, the phenotype is yet to be established. In the case being reported we describe oral cavity findings not documented in the literature.

ResumenEl síndrome nefrótico idiopático es la glomerulopatía más frecuente en la infancia, afecta a 1-3/100 mil niños menores de 16 años y se presenta con más frecuencia entre los 2 y 10 años. Su causa es desconocida, y la histología corresponde a enfermedad por cambios mínimos en más del 90% de los casos, o a glomeruloesclerosis focal y segmentaria.Un 80 a 90% responde a esteroides (síndrome nefrótico corticosensible), con buen pronóstico a largo plazo y preservación de la función renal en el tiempo. De los pacientes con síndrome nefrótico corticosensible, el 70% presenta una o más recaídas en su evolución, y de estos, la mitad se comporta como recaedor frecuente o corticodependiente, grupo que concentra el riesgo de toxicidad por esteroides. Los pacientes con síndrome nefrótico corticorresistente tienen mal pronóstico, evolucionando el 50% a insuficiencia renal crónica terminal. El objetivo de la terapia del síndrome nefrótico idiopático es inducir y mantener la remisión de la enfermedad, disminuyendo los riesgos secundarios a la proteinuria, pero minimizando los efectos adversos de los tratamientos, especialmente por el uso prolongado de corticoides. Este documento es producto de un esfuerzo colaborativo de la Rama de Nefrología de la Sociedad Chilena de Pediatría con el objetivo de ayudar a los pediatras y nefrólogos infantiles en el tratamiento del síndrome nefrótico idiopático en pediatría. En esta primera parte, se presentan las recomendaciones de manejo del síndrome nefrótico corticosensible.AbstractIdiopathic nephrotic syndrome is the most common glomerular disease in childhood, affecting 1 to 3 per 100,000 children under the age of 16. It most commonly occurs in ages between 2 and 10. Its cause is unknown and its histology corresponds to minimal change disease in 90% of cases, or focal segmental glomerulosclerosis.80 to 90% of cases respond to steroids (steroid-sensitive nephrotic syndrome) with good prognosis and long-term preservation of renal function over time. 70% of patients with SSNS have one or more relapses in their evolution, and of these, 50% behave as frequent relapsing or steroid-dependent, a group that concentrate the risk of steroid toxicity. Patients with steroid-resistant nephrotic syndrome have a poor prognosis and 50% of them evolve to end-stage renal disease. The goal of therapy is to induce and maintain remission of the disease, reducing the risk secondary to proteinuria while minimizing the adverse effects of treatments, especially with prolonged use of corticosteroids. This paper is the result of the collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with aims at helping pediatricians and pediatric nephrologists to treat pediatric SNI. In this first part, recommendations of steroid-sensitive nephrotic syndrome are discussed.

Introduction: Becoming a first-time father is an important change in the life of men and families. Studies on the subject show that these kinds of changes have the power to put life into perspective. Being an involved father has a deep meaning for the child and the family. Objective: To explore the experience of becoming a first-time father during the child first year of the life. Subjects and Methods: A qualitative systematic review was conducted in 2014 in three stages, based on the Joanna Briggs Institute Method for Qualitative Systematic Reviews (QSR). The stages used in this QSR were: establishing the question, determining the type of studies to be included, defining the evaluation criteria, and synthesizing the data. Papers that assessed clinical prognoses were considered such as first-time parenting experience and child care during the first year of life. Only primary qualitative studies including ethnography, phenomenology, narrative analysis, and action research were con sidered. Results: Three meta-syntheses were obtained from the analysis: 1) fatherhood adjustment process, 2) paternal role development, and 3) being an active father. The path towards adoption and the fulfillment of the paternal role is mediated by different processes that are consolidated during the child first year of life. Conclusions: The results support the idea that fathers want to be active parti cipants in the care of their children, that public policies should consider both parents equal in terms of their parenting responsibilities, and that the protection of the family and the family environment is a priority as a health promotion intervention. Resumen: Introducción: Ser padre por primera vez es un cambio importante en la vida del hombre y la familia. Los estudios en torno al tema demuestran que este tipo de cambios tienen la capacidad de poner la vida en perspectiva. Ser un padre participativo tiene un significado profundo para el niño/a y la familia. Objetivo: Explorar la experiencia de ser padre por primera vez durante el primer año de la vida del hijo/a. Sujetos y Método: Se realizó una revisión sistemática cualitativa en 2014 en 3 etapas, basado en el Joanna Briggs Institute Method para Revisiones Sistemáticas Cualitativas (QSR). Las etapas usadas en este QSR fueron: establecimiento de la pregunta, determinar el tipo de estudios a in cluir, definir los criterios de evaluación, y realizar la síntesis de los datos. Se consideraron manuscritos que evaluaran los pronósticos clínicos: experiencia de ser padre por primera vez y cuidados del niños durante el primer año de vida. Solo estudios cualitativos primarios incluyendo estudios de etnografía, fenomenología, análisis de narrativa e investigación de acciones fueron considerados. Resultados: Se obtuvieron tres meta-síntesis del análisis: 1) proceso de ajuste a la paternidad; 2) desarrollo del rol paterno y 3) ser un padre activo. El camino hacia la adopción y el cumplimiento del rol paterno está mediado por diversos procesos que durante el primer año de vida del niño/a se consolidan. Conclu siones: Los resultados apoyan la propuesta de que los padres desean ser protagonistas del cuidado de sus hijos/as, que las políticas públicas deben considerar a ambos padres como iguales en términos de sus responsabilidades de crianza, y que la protección de la familia y el entorno familiar es una priori dad como intervención de promoción de salud.

Chronic Abdominal Pain (CAP) in children is a common cause to seek medical care. This paper summarizes current physiological and biochemical concepts that help in understanding the symptomatology. A review of the main etiological causes connected to CAP is offered, as well as a systematic process to evaluate and diagnose each. Recommendations for management and referral are provided.

Newborn screening for congenital hypothyroidism in the province of Buenos Aires.Ten years experience in 1.377.455 evaluated children Introduction. Neonatal screening program for congenital hypothyroidism in the province of Buenos Airesbegan in 1995. Its aim was the early detection and treatment of infants with this disease. The objective ofthis paper was to analyse its performance during the 2000-2004 year period and compare it to the previous1995-1999 year period. Population: Every newborn in the province of Buenos Aires to whom the screeningtest for congenital hypothyroidism was performed in the reference centre, since April 1995 to December2004. Results: 1.377.455 newborns were evaluated with coverage of 56.8% in the province of Buenos Aires.568 newborns with congenital hypothyroidism were confirmed. The incidence of the disease was 1:2,425and the screening positive predictive value was 88.1%. During the second period, the total coverage andthe coverage of newborns from hospitals dependent of province's ministry (98%) were similar to those fromthe previous period. Median age of sample collection and at start of treatment were 6 and 19 days forprivate hospitals, 3 and 16 days for municipal hospitals, and 2 and 17 days for hospitals dependent ofprovince' ministry, respectively.

Epidermolysis Bullosa constitutes a rare and heterogeneous group of diseases presenting with bullous changes in skin and mucous membranes of congenital origin. Maxillofacial involvement considers feeding, hygiene and dental treatment difficulties. The pediatrician, as the head of a multidisciplinary team that treats these affected children, must be aware of the importance of forwarding the patient to a dentist in order to start preventive measures and opportune treatment. This paper pretends to deeply review the general knowledge of oral manifestations of the EB, showing that early dental consultation is a priority.

Los patrones de alimentación adquiridos durante los primeros años son importantes en el crecimiento y desarrollo y pueden afectar las preferencias alimentarias en etapas posteriores. Los problemas nutricionales en Chile han cambiado en los últimos años, la prevalencia de obesidad infantil ha aumentado. Por otro lado, con la información científica disponible los organismos internacionales han propuesto modificaciones a los requerimientos de energía y de otros nutrientes para las distintas edades. Este artículo actualiza y propone nuevas recomendaciones de alimentación para población chilena durante los primeros dos años de vida Feeding patterns during infancy are important for growth and development and may also affect preferences and eating behavior later in childhood. The nutritional challenges have changed in Chile over the last few years, with an evident increase in childhood obesity along with a decrease in protein-energy malnutrition. Using scientific evidence international expert committees have proprosed modifications of energy requirements. This paper reviews and proposes new recommendations in children under 2 year alimentation

El objetivo de esta publicación es presentar los resultados del protocolo nacional 1993-1999 para tumores testiculares de células germinales. En el período 1993-1999 se reunieron 29 casos de tumores testiculares de células germinales no seminomas. La edad de presentación fue de 2 meses a 15 años, con una mediana para la edad de 1 año y 7 meses. En la histología de los tumores predominó el tipo saco vitelino (62%), los teratomas mixtos (17,3%), los teratomas inmaduros (13,8%) y los teratomas maduros (6,9%). El estudio de etapificación demostró que 69% estaban en etapa I, 24,1% en etapa II y 6,9% en etapa III. En todos se realizó orquidectomia inguinal alta. Los niños en etapa I se mantuvieron en observación, seguimiento y no recibieron quimioterapia. Durante el período de observación se presentaron 8 recaídas, 7 en etapa I y uno en etapa II, con un intervalo de 2 a 17 meses desde el diagnóstico; todos fueron locales o regionales al retroperitoneo, la histología saco vitelino incluyó a los 8 casos. En 6 recaídas se usó quimioterapia de 4 ciclos PVB y en 1 caso 4 ciclos PVB y 4 ciclos PEI. Se realizaron 3 cirugías y 2 fueron extirpación completa. En etapa II los 7 casos recibieron 4 ciclos PVB y sólo 1 cirugía con extirpación completa. Los 2 casos en etapa III, uno tenía metástasis pulmonares mínimas y recibió 4 ciclos PVB, el segundo tenía compromiso pulmonar y mediastínico y recibió 4 ciclos PEI seguidos de cirugía de mediastino con extirpación completa. La sobrevida total del grupo alcanzó a 96% con una mediana de seguimiento de 40 meses y la sobrevida libre de eventos fue de 68%. Conclusiones: a) La sobrevida total es satisfactoria en standard internacional, b) la sobrevida libre de eventos expresa un exceso de recaídas en etapa I, c) la conducta de observación y seguimiento es satisfactoria y evitó la quimioterapia en 12 pacientes etapa I, y d) la quimioterapia usada en este protocolo es efectiva y con toxicidad controlada The objective of this paper is to analize the results of the Germ Cell Testicular Tumour National Programme (PINDA) from 1993 to 1999. 29 cases of non-seminoma germ cell testicular tumours were enrolled in the programme. The age at diagnosis ranged from 2 months to 15 years, mean 19 months. Histological analysis showed a predominance of yolk-sack tumours (62%), mixed teratomas (17.3%), immature teratomas (13.85) and mature teratomas (6.9%). The staging was as follows; stage I 69%, stage II 24.1%, stage III 6.9%. All patients underwent unilateral orchidectomy with high ligation of the spermatic cord. Stage 1 patients did not receive chemotherapy, but remained under observation. 8 patients relapsed, 7 belonged to stage 1 and 1 to stage 2, the time to relapse being between 2 and 17 months, all were loco-regional. Rescue chemotherapy with 4 cycles of PVB was used in 6, and in the other case 4, cycles of PVB and PEI. Surgery was indicated in 3 cases, 2 achieving total tumour resection. All stage 2 cases received 4 cycles of PVB, in 1 case with the addition of surgery. There were 2 stage 3 cases, 1 ranked as low risk (minimal lung metastasis) and received PVB, the other as high risk (lung and mediastinal involvement) and received 4 PEI and mediastinal surgery. The overall survival rate was 96% with a 40- month follow-up, with free survival event of 68%. Conclusions: The survival rate is in keeping with international rates, the free survival event was affected by stage 1 relapses, observation alone in stage 1 patients saved 12 patients from un-necessary chemotherapy, the chemotherapeutic regimen gave excellent results combined with low toxicity

The objective of this paper is to review the history, epidemiology, aetiology, clinical presentation and management of SARS. SARS is a transmissible acute infectious disease produced by a corona virus totally new to humans (SARS-CoV). The disease appeared in China and from there disseminated in a few weeks to several areas of the world, causing thousands of cases and hundreds of deaths, with a total mortality of almost 10%. For this reason the WHO ordered the immediate notification of cases and the implementation of measures to contain or prevent the global, local and intra-hospital transmission. Initially the disease was epidemiological and clinical; appearence within 10 days of an epidemiological risk factor, close contact with a person with suspected or possible SARS, travel to an area affected, and clinically a flu-like disease with fever followed by a respiratory phase that can be complicated by severe respiratory failure. In this phase it is noteworthy the absence of pulmonary signs and florid radiographic changes. Leucopenia, lymphopenia, thrombocitopenia, elevation of LDH, creatine-kinase and alanine aminotransferase as well as diturbances in coagulation can be seen. The diagnosis of SARS-CoV is confirmed by RT-PCR and antibody detection. It´s management is empirical and consists in the use of anti-virals, oseltamivir, ribavirin and steroids, with varying results. Commentary: SARS is a severe disease that has given the worlds population several lessons and losses.

Congenital hypothyroidism incidence in 14 sanitary regions of Paraguay Congenital hypothyroidism is one of the most common treatable causes of mental retardation, occurring in approximately 1 in 3,000 newborns. We investigated the incidence of congenital hypothyroidism in Paraguay, where iodine defi ciency disorders are considered endemic. Between October 1999 and February 2007, a total of 53,360 blood samples from 76 sampling stations in 14 of the country’s 18 health regions were taken by heel prick and collected on fi lter paper. Screening was initially carried out as part of a pilot project and later as part of the program for prevention of cystic fi brosis and mental retardation. Thyroid-stimulating hormone was measured by the ELISA method, and a value of >20 UI/ml was considered the cutoff point for recall. Results were obtained in 96% (n: 52,526) of samples. Positive results were found in 0.08% (40/52,526) and congenital hypothyroidism was con fi rmed in 35 cases, an incidence of 1 in 1,501 births, with a female to male ratio of 6:1. This incidence of congenital hypothyroidism is the highest yet reported in Latin America, a fact that emphasi-zes the importance of implementing this type of program in the fi ght to eliminate iodine defi ciency disorders.(

The objective of this paper was to establish the predictive incidence of familial and personality factors in the consumption of drugs and alcohol in adolescents. A representative sample of 467 adolescents from the Metropolitan Region of Santiago, Chile, were interviewed using the Chilean version of the Minessota Health Survey (ECRA-2), FACES III (family cohesion and adpatability) and DOI-JA (dimensions of personality). Using logistic regression analysis 4 areas were identified with a predictive capacity for adolescent drug and alcohol consumption. These were family cohesion, age, presocial and antisocial behaviour.

Loxoscelism is the toxic picture produced by the venom of spiders of genus Loxosceles, in Chile L. laeta. It may presents in two clinical forms, cutaneous loxoscelism (CL) and viserocutaneous loxoscelism (VCL). The objective of this paper is to present and analyze the clinico-epidemiological aspects of 56 paedriatric cases, 38CL and 18 VCL treated in the Metropolitan Region. The highest incidence of both forms was in spring-summer, and in bedrooms when the child was sleeping or dressing. The skin of the limbs and face were most frequently affected with a burning stinging sensation as the initial symptom. Local clinical manifestations were, pain, oedema and a livedoid plaque most of which evolved into a necrotic scar, in VCL, hematuria, hemoglobinuria, jaundice, fever and sensorial involvement, with a mortality of 22.2%. The occurence of VCL had no relationship with the size of the bite, size of the local lesion or season. If visceral involvement does not appear within the first 24 hours it is most probably that the diagnosis is CL, with a good prognosis. If a patient with VCL survives 48 hours the possibilities of recovery are high. Patients were parenterally treated with antihistamines or steroids in CL and steroids in VCL. Conclusion: In this serie there was a female predominance, without seasonal differences or differences in age. The majority of cases occurred at home, affecting prinicipally the extremieties. VCL was more frequent in girls, heamaturia and hemoglobinuria the most frequent manifestations. Early diagnosis and treatment are fundamental for the prognosis.

Las pruebas de función pulmonar contribuyen al diagnóstico de la patología respiratoria, determinando el tipo de disfunción fisiológica, como por ejemplo, la obstrucción, la restricción, la hiperreactividad bronquial y la variabilidad de la vía aérea. Las pruebas que más se utilizan en niños mayores de 5 años son la espirometría, la curva flujo-volumen, la provocación bronquial con ejercicio y con metacolina, y la flujometría. Este trabajo fue realizado con el objetivo de unificar criterios en la realización e interpretación de estas pruebas, por un grupo de 18 médicos representantes de los distintos centros donde se realizan pruebas de función pulmonar en el niño en Chile. Se describen, para cada una de ellas, sus indicaciones, contraindicaciones, técnica de realización e interpretación de los resultados LFTs contribute to the diagnosis of respiratory disease, determining the type of physiological defect, e.g. obstructive, restrictive, bronchial hyperreactivity and the variation in the airways. LFTs most used in children older than 5 years are spirometry, flow-volume curve, bronchial reaction to exercise and metacholine and peak flow. The objective of this paper was to unify the criteria for the practice and interpretation of these tests by a group of 18 specialists from different medical centers where LFTs are performed in children in Chile. We describe for each one the indications, contraindications, the procedure and interpretation of results

ResumenEl síndrome nefrótico idiopático es la glomerulopatía más frecuente en la infancia, afecta a 1-3/100 mil niños menores de 16 años y se presenta con más frecuencia entre los 2 y 10 años. Su causa es desconocida, y la mayoría de las veces responde a corticoides, con buen pronóstico a largo plazo. El síndrome nefrótico corticorresistente representa un 10-20% de los síndromes nefróticos idiopáticos en pediatría. Tiene mal pronóstico, y su manejo constituye un desafío terapéutico significativo. La mitad de los pacientes evoluciona a insuficiencia renal crónica terminal en un plazo de 5 años, estando expuestos además a las complicaciones secundarias a un síndrome nefrótico persistente y a efectos adversos de la terapia inmunosupresora. El objetivo fundamental del tratamiento es conseguir una remisión completa, pero una remisión parcial se asocia a una mejor sobrevida renal que la falta de respuesta. Este documento surgió de un esfuerzo colaborativo de la Rama de Nefrología de la Sociedad Chilena de Pediatría con el objetivo de ayudar a los pediatras y nefrólogos infantiles en el tratamiento del síndrome nefrótico idiopático en pediatría. En esta segunda parte, se discute el manejo del síndrome nefrótico corticorresistente, así como de las terapias no específicas.AbstractIdiopathic nephrotic syndrome is the most common glomerular disease in childhood, affecting 1 to 3 per 100,000 children under the age of 16. It most commonly occurs in ages between 2 and 10. Its cause is unknown, and its histology corresponds to minimal change disease in 90% of cases, or focal segmental glomerulosclerosis. Steroid-resistant nephrotic syndrome represents 10-20% of idiopathic nephrotic syndrome in pediatrics. It has a poor prognosis, and its management is a significant therapeutic challenge. Half of patients evolve to end-stage renal disease within 5 years, and are additionally exposed to complications secondary to persistent NS and to the adverse effects of immunosuppressive therapy. The primary goal of treatment is to achieve complete remission, but even a partial remission is associated with a better renal survival than the lack of response. This paper is the result of the collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with aims at helping pediatricians and pediatric nephrologists to treat pediatric idiopathic nephrotic syndrome. In this second part, handling of steroid-resistant nephrotic syndrome as well as nonspecific therapies are discussed.

The present paper is a Hve years study of the experience in the treatment of nasal lip palate cleft in the Lip and Palate Cleft Clinic from Plastic and Burns Uni t of the Service of Pediatric Surgery at Dr. Exequiel Gonzalez Cortes Children's Hospitalwith a technique that permits at the age of three month the inmediate correction of the nasal area through an external nasal incision joined to labial closure in the complete complicated unilateral cleft lip. All the patients are evaluated by means of a pre operator.' study and conclusions are taken out from the advantages and disadvantages of this technique.

Idiopatic HypereosinophiliaEosinophilia is a common finding in clinical practice. The presence of increased number of circulatingeosinophils will alert the clinician to the presence ot common diseases in which eosinophilia is a marker (v. gr,parasitic, atopic. hypersensitivity diseases).Persistent high percentage of eosinophils specially associated with leukocytosis in abscence of other associa-ted conditions will suggest the diagnosis of Idiopathic Hypereosinophilic Syndrome.This paper presents iive patients with the condition. Clinical findings as well as etiopathogenic considera-tions are discussed.

RESUMENSe presenta el primer programa de deteccionprecoz de hipotiroidismo congenito en nuestropa is, realizado desde 1983 en la Maternidad delHospital Militar de Santiago.De 3.084 recien nacidos tenemos 32 conniveles de TSH superiores al valor de corte y queingresaron a un programa de rellamado, lo querepresenta un 1% del total. El unico caso confir-mado corresponde al mayor valor de TSH (masde 200 n\ll x ml) y que en la reevaluacion nopresenta signos climcos de sospecha, pero cuyodiagnostico se confirma por niveles Iimites nor-males bajo de T4 y altos de TSH en el plasma. Elcintigrama confirma un tiroides ectopico(sublingual).Se enfatiza la importancia de disponer de unplan nacional de deteccion precoz de hipotiroi-dismo congenito para lo cual puede servir de basenuestra experiencia y resultados.REFERENCIAS 1. Fisher, D.: Deteccion de Hipotiroidismo en neona-tps. Clin. Pediatr. Am. 3: 423, 1978.2. Brasel, J., Boyd, D.: Influence of thyroid hormoneon fetal brain growth and development in: Fisher A.and Burrow G. (Ed.) Perinatal thyroid psysiologyand disease, New York, Raven Press, 1975,pp . 59-71.3. Klein, A., Meltzer, S., Kemmy, F.: Improvedprognosis in Congenital Hypothyroidism Treatedbefore age three months. J. Pediatr. 81: 912, 1972.4. New England Congenital Hypothyroidism Collabo-rative. Effects of Neonatal Screening for Hypo-thyroidism: Prevention of Mental Retardation bytreatment before clinical manifestation. Lancet 2:1095, 1981.5. Glorieux, J., Dussault, J,, Letarte, H. et al: Prelimi-nary results on the mental development ofhypothyroid infants detected by Quebec ScreeningProgram. J. Pediatr. 102: 19, 1983.6. Jacobsen, B., Brandt, N.: Congenital Hypothyroi-dism in Denmark. Arch. Dis. Child. 56: 134, 1981.7. Dussault, J., Coulombe, C., Laberge, C, et al:Preliminary report on a mass screening program forneonatal hypothyroidism. J. Pediatr. 86*670, 1975.S.'Dussault, J., Letarte, H., Guyda, H., et al: Thyroidfuntion in neonatal hypothyroidism. J. Pediatr. 89:541,1976.9. Dussault, J., Parlow, A., Letarte, J., et al: TSHmeasurements from blood spots on filter paper: Aconfirmatory screening test for neonatal hypothy-roidism. J. Pediatr. 89: 550, 1976.10. Klein, A., Foley, T., Larsen, R.: Neonatal thyroidfuntion in congenital hypothyroidism. J. Pediatr.89