RESUMEN
Identificar variáveis com potencial de intervenção que estejam associadas ao volume de leite esgotado das mães de recém-nascidos prematuros. Trata-se de um estudo de coorte, descritivo e exploratório. A coleta de dados ocorreu em um hospital materno-infantil do Sul do Brasil no período de julho de 2021 a janeiro de 2022, por meio de entrevistas a 20 mães de recém-nascidos prematuros. Verificou-se que, em relação ao número de vezes ao dia que foi realizado o esgotamento hospitalar e domiciliar, a mediana foi de 4 vezes. A maioria das mães utilizou dois métodos de esgotamento das mamas (manual e com bomba de sucção). O estudo identificou que o volume de leite esgotado foi abaixo do esperado pelo Ministério da Saúde. Destaca-se a falta de procura do banco de leite para o esgotamento, problemas relacionados à mama, como exemplo o método utilizado para esgotamento.
To identify variables with intervention potential that are associated with the volume of depleted milk from mothers of premature newborns. This is a cohort, descriptive, and exploratory study. Data collection occurred in a maternal-infant hospital in southern Brazil from July 2021 to January 2022, through interviews with 20 mothers of premature newborns. It was verified that, in relation to the number of times per day that hospital and home milk expression was performed, the median was 4 times. Most mothers used two methods of breast milk expression (manual and with suction pump). The study found that the volume of expressed milk was lower than expected by the Ministry of Health. We highlight the lack of demand of the milk bank for expression, problems related to the breast, as an example of the method used for expression.
Identificar variables con potencial de intervención que se asocian al volumen de leche agotada de madres de recién nacidos prematuros. Se trata de un estudio de cohortes, descriptivo y exploratorio. La recolección de datos ocurrió en un hospital materno-infantil en el sur de Brasil de julio de 2021 a enero de 2022, a través de entrevistas con 20 madres de recién nacidos prematuros. Se verificó que, en relación al número de veces por día que se realizaba el agotamiento hospitalario y domiciliario, la media fue de 4 veces. La mayoría de las madres utilizaron dos métodos de depleción mamaria (manual y con succión apretada). El estudio identificó que el volumen de leche empobrecida fue menor de que lo esperado por el Ministerio de Salud. Destacamos la falta de demanda del banco de leche por agotamiento, problemas relacionados con la mama, como ejemplo del método utilizado para el agotamiento.
RESUMEN
Objectives: The study was intended to verify the association between the gestational age of newborns classified as term and the success of breastfeeding in babies born by elective cesarean section. Also, to analyze how the variability of gestational age within the term influences breastfeeding. Materials and Methods: Retrospective study of a cohort, which included full-term newborns and their mothers, whose deliveries occurred by elective cesarean section. Among the inclusion criteria are delivery due to elective cesarean section and minimum gestational age of 37 weeks. The database consisted of medical birth information and interviews with mothers. Results: This study included 954 full-term newborns born by elective cesarean section. Exclusive breastfeeding at 3 months and being breastfed at 6 months showed a statistically significant association in the correlation with the variability of gestational age. There was a statistically significant association between exclusive breastfeeding at 3 months and breastfeeding at 6 months in the correlation between early term and full term. The trend test showed a significant progressive in the breastfeeding curve versus gestational age. Conclusion: Full-term newborns show better results of exclusive breastfeeding at 3 months and continued breastfeeding at 6 months, compared with those born at early term. Gestational age, even in term, has an influence on the success of breastfeeding in newborns undergoing elective cesarean delivery.
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Lactancia Materna , Cesárea , Recién Nacido , Embarazo , Humanos , Femenino , Lactante , Lactancia Materna/métodos , Edad Gestacional , Madres , Estudios RetrospectivosRESUMEN
BACKGROUND: The effects of antenatal corticosteroids (ANSs) on twins are not well established. OBJECTIVE: To determine the impact of ANS use according to the number of fetuses. METHODS: Retrospective cohort study of newborns between 23 and 33 weeks of gestational age, birth weight from 400 to 1499 g, without malformations, delivered at 20 public university hospitals from 2010 to 2014.Exposed group: Received ANS (any time, any dose) and no exposed group: no received ANS. Analysis of birth conditions and clinical outcomes. Association of variables, relative risks, and 95% confidence intervals estimated from the adjustment of log-binomial regression models. RESULTS: About 7165 premature infants were analyzed: 5167 singleton, 937 twins, and 104 triplets. Characteristics of gestations with one, two, or three fetuses not receiving ANS were similar. Reduced hemodynamic instability in single and twins gestations in the first 72 h were observed (Adj R2 Twins = 0.78; 95% CI = 0.69-0.86) (Adj R2 Singles = 0.79; 95% CI = 0.62-0.99). Reduced peri-intraventricular hemorrhage (Adj R2 Twins = 0.54; 95% CI = 0.36-0.78) (Adj R2 singles = 0.54; 95% CI = 0.36-0.78); and early sepsis reduction on single and triplex gestations (Adj R2 triplex = 0.51; 95% CI = 0.27-0.94) (Adj single R2 = 0.51; 95% CI = 0.27-0.94) were observed. CONCLUSIONS: This study demonstrates ANS produces an important protective factor for severe intraventricular hemorrhage and hemodynamic instability in single and multiple pregnancies. ANS had a protective effect on death and birth conditions improvement just in single gestations. Regarding respiratory aspects was not observed the protective effect in the single or multiple gestations.
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Corticoesteroides , Nacimiento Prematuro , Corticoesteroides/uso terapéutico , Estudios de Cohortes , Femenino , Edad Gestacional , Hemorragia , Humanos , Lactante , Recién Nacido , Embarazo , Embarazo Múltiple , Embarazo Gemelar , Nacimiento Prematuro/prevención & control , Estudios RetrospectivosRESUMEN
Abstract Objective: To determine the prevalence of life support limitation (LSL) in patients who died after at least 24 h of a pediatric intensive care unit (PICU) stay, parent participation and to describe how this type of care is delivered. Methods: Retrospective cohort study in a tertiary PICU at a university hospital in Brazil. All patients aged 1 month to 18 years who died were eligible for inclusion. The exclusion criteria were those brain death and death within 24 h of admission. Results: 53 patients were included in the study. The prevalence of a LSL report was 45.3%. Out of 24 patients with a report of LSL on their medical records only 1 did not have a donot-resuscitate order. Half of the patients with a report of LSL had life support withdrawn. The length of their PICU stay, age, presence of parents at the time of death, and severity on admission, calculated by the Pediatric Index of Mortality 2, were higher in patients with a report of LSL. Compared with other historical cohorts, there was a clear increase in the prevalence of LSL and, most importantly, a change in how limitations are carried out, with a high prevalence of parental participation and an increase in withdrawal of life support. Conclusions: LSLs were associated with older and more severely ill patients, with a high prevalence of family participation in this process. The historical comparison showed an increase in LSL and in the withdrawal of life support.
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Humanos , Lactante , Niño , Cuidado Terminal , Cuidados para Prolongación de la Vida , Brasil/epidemiología , Unidades de Cuidado Intensivo Pediátrico , Estudios Retrospectivos , Muerte , Tiempo de InternaciónRESUMEN
OBJECTIVE: To evaluate the use of cerebrospinal fluid (CSF) ferritin levels in the diagnosis of purulent meningitis (PM). METHOD: We studied 81 children between 28 days and 12 years of age who presented with clinical suspicion of meningitis to the emergency department. CSF ferritin levels were measured and compared between diagnostic groups (PM, aseptic meningitis (AM) and no meningitis). RESULTS: The median age was 24 (IQR 8-69) months. There were 32 patients with AM (39%), 23 with PM (28%) and 26 with no meningitis (32%). Median CSF ferritin was 4.2 ng/mL (IQR 3.0-6.5), 52.9 ng/mL (IQR 30.7-103 ng/mL) and 2.4 ng/mL (IQR 2-4), respectively. CSF ferritin was higher in children with PM compared with AM (p<0.001) or no meningitis (p<0.001). There was no difference between AM and no meningitis. CONCLUSION: CSF ferritin may be a useful biomarker to discriminate PM in children with clinical symptoms of this disease.
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Líquido Cefalorraquídeo/metabolismo , Ferritinas/líquido cefalorraquídeo , Meningitis Aséptica/líquido cefalorraquídeo , Meningitis Bacterianas/líquido cefalorraquídeo , Biomarcadores/análisis , Brasil/epidemiología , Estudios de Casos y Controles , Líquido Cefalorraquídeo/microbiología , Niño , Preescolar , Estudios Transversales , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Aséptica/diagnóstico , Meningitis Aséptica/microbiología , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/microbiologíaRESUMEN
BACKGROUND: Retinochoroiditis is the most frequent manifestation of congenital toxoplasmosis. We aimed to describe the ocular outcome and factors that may influence the visual prognosis of these patients. METHODS: Cohort of patients with confirmed congenital toxoplasmosis seen between 1996 and 2017 in Porto Alegre, southern Brazil. RESULTS: Seventy-seven patients were included, of which 65 (85.5%) were identified by routine screening. Median age at the end of the follow-up was 10 years (minimum 2, maximum 25). Retinochoroiditis was present in 55 patients (71.4%). New retinochoroidal lesions developed after the first year of life in 77.8% of the patients who began treatment after the fourth month of life, compared with 35.2% among those treated before 4 months of life (relative risk = 0.45, 95% confidence intervals: 0.27-0.75, P = 0.02) and 33.3% among those treated before 2 months of life (relative risk = 0.42, 95% confidence intervals: 0.25-0.72, P = 0.01). There was a peak incidence of new retinochoroidal lesions between 4 and 5 years and another peak between 9 and 14 years, the latter only among girls. Thirty-four patients with retinochoroiditis were followed up for 10 years or more, and the school performance was appropriate in 28 (82.4%). CONCLUSIONS: The high incidence of new retinochoroidal lesions during the follow-up period indicates the importance of long-term follow-up of patients with congenital toxoplasmosis. Initiating treatment within the first 4 months of life, especially within the first 2 months, was a protective factor against the later development of retinochoroiditis. Despite the usual favorable prognosis, the high morbidity of congenital toxoplasmosis in Brazil was confirmed.
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Coriorretinitis , Toxoplasmosis Congénita , Adolescente , Adulto , Anticuerpos Antiprotozoarios/sangre , Brasil , Niño , Preescolar , Coriorretinitis/diagnóstico , Coriorretinitis/epidemiología , Coriorretinitis/parasitología , Coriorretinitis/fisiopatología , Femenino , Humanos , Incidencia , Masculino , Pronóstico , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Toxoplasmosis Congénita/complicaciones , Toxoplasmosis Congénita/diagnóstico , Toxoplasmosis Congénita/epidemiología , Toxoplasmosis Congénita/fisiopatología , Agudeza Visual , Adulto JovenRESUMEN
OBJECTIVE: To determine the prevalence of life support limitation (LSL) in patients who died after at least 24h of a pediatric intensive care unit (PICU) stay, parent participation and to describe how this type of care is delivered. METHODS: Retrospective cohort study in a tertiary PICU at a university hospital in Brazil. All patients aged 1 month to 18 years who died were eligible for inclusion. The exclusion criteria were those brain death and death within 24h of admission. RESULTS: 53 patients were included in the study. The prevalence of a LSL report was 45.3%. Out of 24 patients with a report of LSL on their medical records only 1 did not have a do-not-resuscitate order. Half of the patients with a report of LSL had life support withdrawn. The length of their PICU stay, age, presence of parents at the time of death, and severity on admission, calculated by the Pediatric Index of Mortality 2, were higher in patients with a report of LSL. Compared with other historical cohorts, there was a clear increase in the prevalence of LSL and, most importantly, a change in how limitations are carried out, with a high prevalence of parental participation and an increase in withdrawal of life support. CONCLUSIONS: LSLs were associated with older and more severely ill patients, with a high prevalence of family participation in this process. The historical comparison showed an increase in LSL and in the withdrawal of life support.
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Cuidados para Prolongación de la Vida , Cuidado Terminal , Brasil/epidemiología , Niño , Muerte , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Tiempo de Internación , Estudios RetrospectivosRESUMEN
Abstract Objective: The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome. Method: This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours. Results: The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8 -22) stable microbubbles/mm2; control group = 100 (48 -230) microbubbles/mm2 (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85 -0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm2, the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively. Conclusion: The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.
Resumo Objetivo: O teste das microbolhas estáveis no aspirado gástrico e no líquido amniótico foi usado no diagnóstico da síndrome do desconforto respiratório do recém-nascido. Contudo, nenhum estudo fez esse teste nos aspirados bucais de neonatos prematuros. O objetivo deste estudo foi avaliar o desempenho do teste das microbolhas estáveis em aspirados bucais de recém-nascidos prematuros para prever síndrome do desconforto respiratório. Método: Este estudo incluiu neonatos com idade gestacional < 34 semanas. Os fluidos orais foram obtidos imediatamente após o nascimento e os fluidos gástricos foram coletados nos primeiros 30 minutos de vida. As amostras foram congeladas e testadas em 72 horas. Resultados: A amostra foi composta de aspirados pareados de 64 recém-nascidos, divididos em dois grupos: grupo de síndrome do desconforto respiratório (n = 21) e grupo de controle (n = 43). A mediana (intervalo interquartil) da contagem das microbolhas estáveis nas amostras de fluido oral dos neonatos com síndrome do desconforto respiratório foi significativamente menor que a dos neonatos que não desenvolveram sintomas respiratórios: grupo de síndrome do desconforto respiratório = 12 (8-22) microbolhas estáveis/mm2; grupo de controle = 100 (48-230) microbolhas/mm2 (p < 0,001). A correlação entre a contagem das microbolhas nos aspirados gástricos e bucais foi 0,90 (intervalo de confiança de 95% = 0,85-0,95; p < 0,001). Considerando um ponto de corte de 25 microbolhas/mm2, a sensibilidade e a especificidade do teste das microbolhas estáveis foram 81,4% e 85,7%, respectivamente. Conclusão: O estudo sugere que o teste das microbolhas estáveis feito no aspirado bucal é uma opção confiável ao fluido gástrico para a predição da síndrome do desconforto respiratório do recém-nascido.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Síndrome de Dificultad Respiratoria del Recién Nacido/diagnóstico , Saliva/química , Surfactantes Pulmonares/análisis , Microburbujas , Pruebas Diagnósticas de Rutina/métodos , Enfermedades del Prematuro/diagnóstico , Recien Nacido Prematuro , Estudios de Casos y Controles , Edad Gestacional , Jugo Gástrico/química , Enfermedades del Recién Nacido/diagnósticoRESUMEN
OBJECTIVE: The stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome. METHOD: This study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours. RESULTS: The sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n=21) and control group (n=43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group=12 (8-22) stable microbubbles/mm2; control group=100 (48-230)microbubbles/mm2 (p<0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval=0.85-0.95; p<0.001). Considering a cut-off point of 25microbubbles/mm2, the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively. CONCLUSION: The study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.
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Pruebas Diagnósticas de Rutina/métodos , Enfermedades del Prematuro/diagnóstico , Microburbujas , Surfactantes Pulmonares/análisis , Síndrome de Dificultad Respiratoria del Recién Nacido/diagnóstico , Saliva/química , Estudios de Casos y Controles , Femenino , Jugo Gástrico/química , Edad Gestacional , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Recien Nacido Prematuro , MasculinoRESUMEN
OBJECTIVE: To estimate the workload and size the nursing team using the scales TISS-28 and NEMS in a pediatric intensive care unit. METHODS: An observational prospective study with a quantitative approach was conducted at the pediatric intensive care unit of a university hospital from Jan 1st, 2009 to Dec 31st, 2009. All children who remained hospitalized for more than 8 hours were included, with length of stay of 4 hours in case of death. Clinical data were collected and the Paediatric Index of Mortality 2 and the scores TISS-28 and NEMS were determined. The TISS-28 and NEMS were converted into working hours of the nursing team and sizing complied with the parameters of the Brazilian Federal Nursing Council. Pearson's correlation and the Bland-Altman model were used to verify the association and agreement between the instruments. RESULTS: A total of 459 children were included, totaling 3,409 observations. The average values for the TISS-28 and NEMS were 20.8±8 and 25.2±8.7 points, respectively. The nursing workload was 11 hours by TISS-28 and 13.3 hours by NEMS. The estimated number of professionals by TISS-28 and NEMS was 29.6 and 35.8 professionals, respectively. The TISS-28 and NEMS showed adequate correlation and agreement. CONCLUSION: Time spent in nursing activities and team sizing reflected by the NEMS were significantly greater when compared to the TISS-28.
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Unidades de Cuidado Intensivo Pediátrico/organización & administración , Personal de Enfermería en Hospital/organización & administración , Administración de Personal , Carga de Trabajo/normas , Adolescente , Brasil , Niño , Preescolar , Femenino , Hospitales Universitarios , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Estudios Longitudinales , Masculino , Evaluación en Enfermería , Personal de Enfermería en Hospital/normas , Personal de Enfermería en Hospital/estadística & datos numéricos , Estudios Prospectivos , Carga de Trabajo/estadística & datos numéricosRESUMEN
ABSTRACT Objective: To estimate the workload and size the nursing team using the scales TISS-28 and NEMS in a pediatric intensive care unit. Methods: An observational prospective study with a quantitative approach was conducted at the pediatric intensive care unit of a university hospital from Jan 1st, 2009 to Dec 31st, 2009. All children who remained hospitalized for more than 8 hours were included, with length of stay of 4 hours in case of death. Clinical data were collected and the Paediatric Index of Mortality 2 and the scores TISS-28 and NEMS were determined. The TISS-28 and NEMS were converted into working hours of the nursing team and sizing complied with the parameters of the Brazilian Federal Nursing Council. Pearson's correlation and the Bland-Altman model were used to verify the association and agreement between the instruments. Results: A total of 459 children were included, totaling 3,409 observations. The average values for the TISS-28 and NEMS were 20.8±8 and 25.2±8.7 points, respectively. The nursing workload was 11 hours by TISS-28 and 13.3 hours by NEMS. The estimated number of professionals by TISS-28 and NEMS was 29.6 and 35.8 professionals, respectively. The TISS-28 and NEMS showed adequate correlation and agreement. Conclusion: Time spent in nursing activities and team sizing reflected by the NEMS were significantly greater when compared to the TISS-28.
RESUMO Objetivo: Estimar a carga de trabalho e dimensionar a equipe de enfermagem utilizando as escalas TISS-28 e NEMS em uma unidade de terapia intensiva pediátrica. Métodos: Estudo prospectivo observacional com abordagem quantitativa, realizado na unidade de terapia intensiva pediátrica de um hospital universitário, no período de 1o de janeiro de 2009 a 31 de dezembro de 2009. Foram incluídas todas as crianças que permaneceram internadas por mais de 8 horas, com duração de internação de 4 horas em caso de óbito. Foram coletados os dados clínicos, e determinados o Paediatric Index of Mortality 2 e as escalas TISS-28 e NEMS. O TISS-28 e o NEMS foram convertidos em horas de trabalho da equipe de enfermagem, e o dimensionamento seguiu os parâmetros do Conselho Federal de Enfermagem. A correlação de Pearson e o modelo de Bland-Altman foram utilizados para verificar a associação e a concordância entre os instrumentos. Resultados: Foram incluídas 459 crianças, totalizando 3.409 observações. As médias do TISS-28 e do NEMS foram 20,8±8 e 25,2±8,7 pontos, respectivamente. A carga de trabalho de enfermagem foi de 11 horas pelo TISS-28 e 13,3 horas pelo NEMS. A estimativa do número de profissionais pelo TISS-28 e NEMS foi de 29,6 e 35,8 profissionais, respectivamente. O TISS-28 e o NEMS apresentaram correlação e concordância adequadas. Conclusão: O tempo despendido nas atividades de enfermagem e o dimensionamento da equipe refletido pelo NEMS foram significativamente maiores quando comparados ao TISS-28.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Administración de Personal , Unidades de Cuidado Intensivo Pediátrico/organización & administración , Carga de Trabajo/normas , Personal de Enfermería en Hospital/organización & administración , Brasil , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Estudios Prospectivos , Estudios Longitudinales , Carga de Trabajo/estadística & datos numéricos , Hospitales Universitarios , Evaluación en Enfermería , Personal de Enfermería en Hospital/normas , Personal de Enfermería en Hospital/estadística & datos numéricosRESUMEN
Abstract Objective: This study aimed to critically review the literature available regarding the Zika virus outbreak in Brazil and its possible association with microcephaly cases. Sources: Experts from Instituto do Cérebro do Rio Grande do Sul performed a critical (nonsystematic) literature review regarding different aspects of the Zika virus outbreak in Brazil, such as transmission, epidemiology, diagnostic criteria, and its possible association with the increase of microcephaly reports. The PubMed search using the key word “Zika virus” in February 2016 yielded 151 articles. The manuscripts were reviewed, as well as all publications/guidelines from the Brazilian Ministry of Health, World Health Organization and Centers for Disease Control and Prevention (CDC – United States). Summary of findings: Epidemiological data suggest a temporal association between the increased number of microcephaly notifications in Brazil and outbreak of Zika virus, primarily in the Brazil's Northeast. It has been previously documented that many different viruses might cause congenital acquired microcephaly. Still there is no consensus on the best curve to measure cephalic circumference, specifically in preterm neonates. Conflicting opinions regarding the diagnosis of microcephaly (below 2 or 3 standard deviations) that should be used for the notifications were also found in the literature. Conclusion: The development of diagnostic techniques that confirm a cause–effect association and studies regarding the physiopathology of the central nervous system impairment should be prioritized. It is also necessary to strictly define the criteria for the diagnosis of microcephaly to identify cases that should undergo an etiological investigation.
Resumo Objetivos: O objetivo deste estudo foi realizar uma revisão crítica da literatura sobre o surto de vírus Zika no Brasil e sua possível associação com casos de microcefalia. Fonte de dados: Especialistas em áreas afins do Instituto do Cérebro do Rio Grande do Sul realizaram uma revisão crítica (não sistemática) da literatura sobre o vírus Zika, suas formas de transmissão, a epidemia no Brasil, critérios diagnósticos e a possível associação com os casos crescentes de microcefalia. O uso da palavra chave “Zika virus” na base de dados do PubMed em fevereiro de 2016, retorna 151 publicações. Estes textos foram revisados assim como todas as publicações e recomendações do Ministério da Saúde, Organização Mundial da Saúde e Centro de Controle de Doenças (CDC – USA). Síntese dos dados: Os dados epidemiológicos sugerem uma relação temporal entre aumento da notificação de casos de microcefalia e o surto de vírus Zika, principalmente no Nordeste do Brasil. Agentes virais comprovadamente podem ser causadores de microcefalia congênita adquirida. Não existe um consenso sobre a melhor curva de perímetro cefálico a ser utilizada, principalmente nos prematuros. Assim como também existem divergências sobre a definição de microcefalia (abaixo de 2 ou 3 desvios padrões) a ser padronizada nas notificações. Conclusão: Deve-se priorizar o desenvolvimento de técnicas diagnósticas que confirmem uma relação causa–efeito e estudos sobre mecanismos da patogênese da infecção pelo Zika no sistema nervoso central. Também é necessário definir e universalizar os critérios diagnósticos para a identificação dos casos de microcefalia que devem ser submetidos à investigação etiológica.
Asunto(s)
Humanos , Animales , Femenino , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Infección por el Virus Zika/epidemiología , Microcefalia/epidemiología , Microcefalia/virología , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/virología , Brasil/epidemiología , Brotes de Enfermedades , Aedes , Virus Zika/aislamiento & purificación , Infección por el Virus Zika/diagnóstico , Insectos Vectores , Microcefalia/diagnósticoRESUMEN
OBJECTIVE: This study aimed to critically review the literature available regarding the Zika virus outbreak in Brazil and its possible association with microcephaly cases. SOURCES: Experts from Instituto do Cérebro do Rio Grande do Sul performed a critical (nonsystematic) literature review regarding different aspects of the Zika virus outbreak in Brazil, such as transmission, epidemiology, diagnostic criteria, and its possible association with the increase of microcephaly reports. The PubMed search using the key word "Zika virus" in February 2016 yielded 151 articles. The manuscripts were reviewed, as well as all publications/guidelines from the Brazilian Ministry of Health, World Health Organization and Centers for Disease Control and Prevention (CDC - United States). SUMMARY OF FINDINGS: Epidemiological data suggest a temporal association between the increased number of microcephaly notifications in Brazil and outbreak of Zika virus, primarily in the Brazil's Northeast. It has been previously documented that many different viruses might cause congenital acquired microcephaly. Still there is no consensus on the best curve to measure cephalic circumference, specifically in preterm neonates. Conflicting opinions regarding the diagnosis of microcephaly (below 2 or 3 standard deviations) that should be used for the notifications were also found in the literature. CONCLUSION: The development of diagnostic techniques that confirm a cause-effect association and studies regarding the physiopathology of the central nervous system impairment should be prioritized. It is also necessary to strictly define the criteria for the diagnosis of microcephaly to identify cases that should undergo an etiological investigation.
Asunto(s)
Microcefalia/epidemiología , Microcefalia/virología , Complicaciones Infecciosas del Embarazo/epidemiología , Infección por el Virus Zika/epidemiología , Aedes , Animales , Brasil/epidemiología , Brotes de Enfermedades , Femenino , Humanos , Recién Nacido , Insectos Vectores , Microcefalia/diagnóstico , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/virología , Virus Zika/aislamiento & purificación , Infección por el Virus Zika/diagnósticoRESUMEN
INTRODUCTION: Previous studies have suggested that full-term newborns delivered by elective cesarean section who develop transient tachypnea have low gastric microbubble counts. In the present study, microbubble concentrations in oral fluid samples were used to evaluate pulmonary maturity. OBJECTIVE: To evaluate lung maturity in full-term newborns delivered by elective caesarean section using the stable microbubble test in oral aspirates collected at birth. METHOD: The study involved newborns with gestational age >37 weeks delivered by elective cesarean section. Oral fluid samples were obtained in the delivery room immediately after birth, and gastric fluid was collected within the first hour of life. Samples were frozen and analyzed by two blinded researchers. RESULTS: The sample comprised 544 newborns. Twenty-two were diagnosed with transient tachypnea of the newborn by the assisting physician, and required admission to the Neonatal Intensive or Intermediate Care Unit. The median (interquartile range) of the number of microbubbles in the oral samples of these patients was 67.5 (45-150) microbubbles/mm(2) . The remaining 498 newborns without respiratory difficulties had a count of 350 (150-750) microbubbles/mm(2) -P < 0.001. Gastric fluid tests revealed a count of 150 (82.5-700) microbubbles/mm(2) for neonates with respiratory difficulties, and of 600 (216-1125) microbubbles/mm(2) -P < 0.05 for those without respiratory symptoms. CONCLUSION: The present results suggest that transient tachypnea of the newborn is associated with surfactant dysfunction. Pediatr Pulmonol. 2016;51:596-600. © 2015 Wiley Periodicals, Inc.
Asunto(s)
Líquidos Corporales/química , Cesárea , Pulmón/metabolismo , Pulmón/fisiología , Microburbujas , Boca/química , Surfactantes Pulmonares/análisis , Nacimiento a Término , Taquipnea Transitoria del Recién Nacido/fisiopatología , Femenino , Jugo Gástrico/química , Humanos , Recién Nacido , Pulmón/fisiopatología , Masculino , Embarazo , Surfactantes Pulmonares/metabolismo , Taquipnea Transitoria del Recién Nacido/metabolismoRESUMEN
OBJECTIVE: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers. METHODS: Prospective cohort of 2646 inborn infants with gestational age 23-33 weeks and birth weight 400-1499 g, without malformations, born at 20 centers in 2012-2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with ≥1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3-4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP). RESULTS: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3-4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55-0.88), C-section (0.72; 0.58-0.90), gestational age <30 (4.00; 3.16-5.07), being male (1.44; 1.19-1.75), small for gestational age (2.19; 1.72-2.78), 5th-min Apgar <7 (3.89; 2.88-5.26), temperature at NICU admission <36.0 °C (1.42; 1.15-1.76), respiratory distress syndrome (3.87; 2.99-5.01), proven late sepsis (1.33; 1.05-1.69), necrotizing enterocolitis (3.10; 2.09-4.60) and patent ductus arteriosus (1.69; 1.37-2.09). CONCLUSIONS: More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.
Asunto(s)
Centros Médicos Académicos/estadística & datos numéricos , Mortalidad Infantil , Recién Nacido de muy Bajo Peso , Brasil , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios ProspectivosRESUMEN
This study included data on syphilis-positive pregnant women seen for delivery or miscarriage, between 1997 and 2004, in Sao Lucas Hospital, Porto Alegre, RS. Their subsequent obstetric outcomes were studied, until December 2011, to see if the disease recurred. From 450 pregnant women with positive syphilis serology, seen from 1997 to 2004, 166 had at least one more obstetric attendance until December 2011, with 266 new obstetric outcomes. Congenital syphilis (CS) was demonstrated in 81.9% of the initial pregnancies and in 68.4% of the subsequent ones. The main causes of CS in subsequent pregnancies were a negative VDRL that turned positive at delivery, and undocumented treatment. VDRL titers were higher than 1:4 in 50.4% of the initial and 13.3% of the subsequent pregnancies (p < 0.01). Perinatal mortality rate was 119/1000 in initial and 41/1000 in subsequent pregnancies (p < 0.01). CS recurrence was frequent in subsequent pregnancies of women who tested positive for syphilis in a preceding pregnancy. No or inadequate prenatal care was the main risk factor for CS, both in initial and in subsequent pregnancies. These data suggest that non-infected neonates could have been defined as CS cases because of insufficient information about the mother's history.
Asunto(s)
Complicaciones Infecciosas del Embarazo , Sífilis Congénita/epidemiología , Sífilis , Aborto Espontáneo , Brasil/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Embarazo , Atención Prenatal , Factores de Riesgo , Serodiagnóstico de la Sífilis/efectos adversos , Sífilis Congénita/etiologíaRESUMEN
ResumoEste estudo incluiu gestantes positivas para sífilis atendidas por parto ou aborto, entre 1997 e 2004, no Hospital São Lucas, Porto Alegre, RS. Foram levantados desfechos obstétricos subsequentes das mesmas, até dezembro 2011, para investigar a recorrência da doença. De 450 gestantes com sorologia positiva, atendidas de 1997 a 2004, 166 tiveram pelo menos mais um atendimento obstétrico até dezembro de 2011, sendo incluídos 266 novos desfechos obstétricos. A sífilis congênita (SC) foi evidenciada em 81,9% das gestações iniciais e em 68,4% das subsequentes. As principais causas da SC nas gestações subsequentes foram positivação do VDRL no parto e tratamento não documentado. Os títulos de VDRL foram superiores a 1:4, em 50,4% nas gestações iniciais, e em 13,3% nas subsequentes (p < 0,001). A taxa de natimortalidade foi de 119/1000, nas gestações iniciais, e de 41/1000, nas subsequentes (p < 0,01). A recorrência da SC foi frequente em gestações sucessivas da mesma paciente. A ausência ou inadequação de pré-natal foi o principal fator de risco para SC, tanto nas gestações iniciais quanto nas subsequentes. Os dados obtidos sugerem que, nas gestações subsequentes, mais neonatos não infectados podem ter sido definidos como casos de SC, pela insuficiência de informação sobre os antecedentes pré-natais da gestante.
AbstractThis study included data on syphilis-positive pregnant women seen for delivery or miscarriage, between 1997 and 2004, in Sao Lucas Hospital, Porto Alegre, RS. Their subsequent obstetric outcomes were studied, until December 2011, to see if the disease recurred. From 450 pregnant women with positive syphilis serology, seen from 1997 to 2004, 166 had at least one more obstetric attendance until December 2011, with 266 new obstetric outcomes. Congenital syphilis (CS) was demonstrated in 81.9% of the initial pregnancies and in 68.4% of the subsequent ones. The main causes of CS in subsequent pregnancies were a negative VDRL that turned positive at delivery, and undocumented treatment. VDRL titers were higher than 1:4 in 50.4% of the initial and 13.3% of the subsequent pregnancies (p < 0.01). Perinatal mortality rate was 119/1000 in initial and 41/1000 in subsequent pregnancies (p < 0.01). CS recurrence was frequent in subsequent pregnancies of women who tested positive for syphilis in a preceding pregnancy. No or inadequate prenatal care was the main risk factor for CS, both in initial and in subsequent pregnancies. These data suggest that non-infected neonates could have been defined as CS cases because of insufficient information about the mother's history.
Asunto(s)
Humanos , Femenino , Complicaciones Infecciosas del Embarazo , Sífilis Congénita/epidemiología , Sífilis , Atención Prenatal , Sífilis Congénita/etiología , Brasil/epidemiología , Embarazo , Serodiagnóstico de la Sífilis/efectos adversos , Aborto Espontáneo , Factores de Riesgo , Estudios de SeguimientoRESUMEN
OBJECTIVE: To evaluate the predictive value of the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria for disease course severity in patients with or without acute kidney injury admitted to a PICU. DESIGN: Retrospective cohort study. SETTING: A 12-bed PICU at a tertiary referral center in Southern Brazil. PATIENTS: All patients admitted to the study unit over a 1-year period. INTERVENTIONS: A database of all eligible patients was analyzed retrospectively. MEASUREMENTS AND MAIN RESULTS: Patients were classified by pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score at admission and worst pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score during PICU hospitalization. The outcomes of interest were length of PICU stay, duration of mechanical ventilation, duration of vasoactive drug therapy, and mortality. The Pediatric Index of Mortality 2 was used to assess overall disease severity at the time of PICU admission. Of 375 patients, 169 (45%) presented acute kidney injury at the time of admission and 37 developed acute kidney injury during PICU stay, for a total of 206 of 375 patients (55%) diagnosed with acute kidney injury during the study period. The median Pediatric Index of Mortality 2 score predicted a mortality rate of 9% among non-acute kidney injury patients versus a mortality rate of 16% among acute kidney injury patients (p = 0.006). The mortality of patients classified as pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease F was double that predicted by Pediatric Index of Mortality 2 (7 vs 3.2). Patients classified as having severe acute kidney injury (pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease I + F) exhibited higher mortality (14.1%; p = 0.001) and prolonged PICU length of stay (median, 7 d; p = 0.001) when compared with other patients. Acute kidney injury is a very frequent occurrence among patients admitted to PICUs. CONCLUSIONS: The degree of acute kidney injury severity, as assessed by the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria, is a good predictor of morbidity and mortality in this population. Pediatric Index of Mortality 2 tends to underestimate mortality in pediatric patients with severe acute kidney injury.
Asunto(s)
Lesión Renal Aguda/fisiopatología , Enfermedad Crítica , Estado de Salud , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Lesión Renal Aguda/mortalidad , Adolescente , Brasil , Niño , Preescolar , Femenino , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Fallo Renal Crónico , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
BACKGROUND: Late-onset sepsis (LOS) is an important cause of morbidity and mortality in very low birth weight (VLBW) infants. AIM: To determine the incidence, risk factors and etiology of LOS. METHODS: LOS was investigated in a multicenter prospective cohort of infants at eight public university neonatal intensive care units (NICUs). Inclusion criteria included inborn, 23-33 weeks of gestational age, 400-1499 g birth weight, who survived >3 days. RESULTS: Of 1507 infants, 357 (24%) had proven LOS and 345 (23%) had clinical LOS. Infants with LOS were more likely to die. The majority of infections (76%) were caused by Gram-positive organisms. Independent risk factors for proven LOS were use of central venous catheter and mechanical ventilation, age at the first feeding and number of days on parenteral nutrition and on mechanical ventilation. CONCLUSION: LOS incidence and mortality are high in Brazilian VLBW infants. Most risk factors are associated with routine practices at NICU.