RESUMEN
OBJECTIVES: Describe cases of children with hepatosplenomegaly (HS) attended at the General Pediatric Teaching Ambulatory (AGER) of Instituto da Criança, São Paulo, identifying the main causes, evolution, necessity for hospitalization and/or referral to specialists. METHODOLOGY: Retrospective analysis of the records of children presenting HS on admission at AGER from September 1, 1993 to August 31, 1996. RESULTS: Of the 89 children included (age range, 1 to 148 months; 24 months), 64 (72%) were referred from other services for HS investigation. Most common presenting complaints were: fever--39 (44%); pallor--26 (29%); weight loss--21 (24%) and jaundice--14 (16%). Main alterations noticed on physical examination were: pallor--47 (53%) and short stature--17 (19%). Anemia was diagnosed in 70 children (79%); 35 children (39%) had infections; 7 (8%) metabolic disorders and 5 (6%) neoplastic disorders. The most frequent infections were of the urinary tract--9 (10%) and hepatitis A--6 (7%). Thirty six children (40%) were referred to specialists, 17 of which were already diagnosed. CONCLUSIONS: Most of the children with HS present deficiency anemia associated with infections which the general pediatrician is able to diagnose. Persistence of unexplained HS for more than 2 months, especially when there is substantial volume enlargement or alteration in the organs consistency, is an indication for referral to specialists.
Asunto(s)
Atención Ambulatoria , Hepatomegalia/etiología , Esplenomegalia/etiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Hepatomegalia/diagnóstico , Hospitales de Enseñanza , Humanos , Lactante , Masculino , Estudios Retrospectivos , Esplenomegalia/diagnósticoRESUMEN
OBJECTIVE: The objective of this study was to identify risk factors associated with malnutrition and morbidity in the population of children accompanied by the Child Health Care Program in Embu, São Paulo (Brazil), with the aim of giving a better direction to health activities. METHODS: The case-study was constituted by a cross-section of 1,024 children, corresponding to 25.0% (probabilistic sistematic sample) of the total of children under 12 months registered in six primary health care centers in the Municipality, during the period from July 1988 to July 1989. The risk factors were analyzed according to the presence or absence of hospitalization and weight evolution - favorable or unfavorable - until two years of age. For the statistical analysis the multivaried approach was used, through the tecnique of logistic regression. RESULTS: Of a total of 1,024 children, 428 (39.1%) were classified as high risk, 658 (60.1%) as low risk and 8 (0.8%) presented pathologies at their first appointment, being excluded from the analysis. Prematurity (adjusted RR = 3.35), serious illness in the newborn (adjusted RR = 4.12) and the death of a younger brother or sister of less than five years (adjusted RR = 2.70) constituted risk factors for hospitalization in the first two years of life. Weight at birth between 2,500 and 2,750 g (adjusted RR = 2.46), brother or sister with malnutrition (adjusted RR = 4.17) and maternal age of 18 years old or less (adjusted RR = 1.87) constituted risk factors for unfavourable weight evolution. CONCLUSIONS: These results, as well as the process of carrying out this study, supported the reformulation of the Child Health Care Program in Embu, permitting differentiated action for the highest risk group, thus garanteeing the essential for all.