RESUMEN
BACKGROUND: Brazil is a large country with an elevated incidence of Chlamydiatrachomatis (CT) and Neisseriagonorrhoeae (NG) during pregnancy and variable access to health care. The objective of the study was to identify ophthalmia neonatorum prophylaxis practices in the country. METHODS: A prospective multidisciplinary survey was conducted using a closed social media group. Fifteen questions were developed after literature review. Specific content included categorization of respondents and practices such as type of medication, age at administration, occurrence of clinical and/or chemical conjunctivitis and microbiology identification. Questions were multiple choice, but some allowed written response. RESULTS: A total of 1.015 professionals responded, representing 24 states (92%) and 181 cities; mainly neonatologists (64%) and general pediatricians (21%). 96% of respondents reported performing prophylaxis at their institutions, mostly at birth or <1âh of life (99%), and regardless the mode of delivery (73%). Frequently used medications are: 1% silver nitrate (64%), 2.5% povidone iodine (18%) or 10% silver vitelinate (12%), with some regional variations. Occurrence of chemical conjunctivitis was stated by 58% of the respondents and microbiology identification was unusual. CONCLUSIONS: Ophthalmia neonatorum prophylaxis Brazil is almost universal and mainly performed by the use of anti-septic medications, with some regional variability. However, identification and treatment of CT and NG in both parents and newborns is not accomplished.
Asunto(s)
Actitud del Personal de Salud , Oftalmía Neonatal/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Brasil , Humanos , Oftalmía Neonatal/tratamiento farmacológico , Povidona Yodada/uso terapéutico , Prevalencia , Estudios Prospectivos , Nitrato de Plata/uso terapéuticoRESUMEN
Although oxidative stress and inflammation are important mechanisms in the pathophysiology of preeclampsia and preterm diseases, their contribution to the respiratory prognosis of premature infants of hypertensive mothers is not known. Our objective was to determine the levels of oxidative stress and inflammation markers in the airways of premature infants born to hypertensive and normotensive mothers, in the first 72 h of life, and to investigate whether they are predictors of bronchopulmonary dysplasia (BPD)/death. This was a prospective study with premature infants less than 34 weeks' gestation on respiratory support who were stratified into 2 groups: 32 premature infants of hypertensive mothers and 41 of normotensive women, with a mean gestational age of 29 weeks. Exclusion criteria were as follows: diabetes mellitus, chorioamnionitis, malformation, congenital infection, and death within 24 h after birth. The outcome of interest was BPD/death. Malondialdehyde (MDA), nitric oxide (NO), and interleukin 8 (IL-8) were measured in airway aspirates from the first and third days of life and did not differ between the groups. Univariate and multivariate statistical analyses were performed. The concentrations of MDA, NO, and IL-8 were not predictors of BPD/death. Premature infants who developed BPD/death had higher levels of IL-8 in the first days of life. The gestational age, mechanical ventilation, and a small size for gestational age were risk factors for BPD/death. In conclusion, the biomarkers evaluated were not increased in premature infants of hypertensive mothers and were not predictors of BPD/death.
Asunto(s)
Biomarcadores/análisis , Displasia Broncopulmonar/etiología , Hipertensión Inducida en el Embarazo/metabolismo , Inflamación/metabolismo , Estrés Oxidativo/fisiología , Displasia Broncopulmonar/metabolismo , Displasia Broncopulmonar/fisiopatología , Femenino , Humanos , Hipertensión Inducida en el Embarazo/fisiopatología , Recién Nacido , Recien Nacido Prematuro , Inflamación/fisiopatología , Interleucina-8/análisis , Estudios Longitudinales , Malondialdehído/análisis , Óxido Nítrico/análisis , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
Although oxidative stress and inflammation are important mechanisms in the pathophysiology of preeclampsia and preterm diseases, their contribution to the respiratory prognosis of premature infants of hypertensive mothers is not known. Our objective was to determine the levels of oxidative stress and inflammation markers in the airways of premature infants born to hypertensive and normotensive mothers, in the first 72 h of life, and to investigate whether they are predictors of bronchopulmonary dysplasia (BPD)/death. This was a prospective study with premature infants less than 34 weeks’ gestation on respiratory support who were stratified into 2 groups: 32 premature infants of hypertensive mothers and 41 of normotensive women, with a mean gestational age of 29 weeks. Exclusion criteria were as follows: diabetes mellitus, chorioamnionitis, malformation, congenital infection, and death within 24 h after birth. The outcome of interest was BPD/death. Malondialdehyde (MDA), nitric oxide (NO), and interleukin 8 (IL-8) were measured in airway aspirates from the first and third days of life and did not differ between the groups. Univariate and multivariate statistical analyses were performed. The concentrations of MDA, NO, and IL-8 were not predictors of BPD/death. Premature infants who developed BPD/death had higher levels of IL-8 in the first days of life. The gestational age, mechanical ventilation, and a small size for gestational age were risk factors for BPD/death. In conclusion, the biomarkers evaluated were not increased in premature infants of hypertensive mothers and were not predictors of BPD/death.
Asunto(s)
Humanos , Femenino , Recién Nacido , Biomarcadores/análisis , Displasia Broncopulmonar/etiología , Hipertensión Inducida en el Embarazo/metabolismo , Inflamación/metabolismo , Estrés Oxidativo/fisiología , Displasia Broncopulmonar/metabolismo , Displasia Broncopulmonar/fisiopatología , Hipertensión Inducida en el Embarazo/fisiopatología , Recien Nacido Prematuro , Inflamación/fisiopatología , Interleucina-8/análisis , Estudios Longitudinales , Malondialdehído/análisis , Óxido Nítrico/análisis , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.
Asunto(s)
Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Presión de las Vías Aéreas Positiva Contínua , Salas de Parto , Recién Nacido de muy Bajo Peso/fisiología , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Extubación Traqueal , Brasil , Mortalidad Hospitalaria , Hipertensión/diagnóstico , Intubación Intratraqueal , Tiempo de Internación , Bienestar Materno , Diagnóstico Prenatal , Respiración ArtificialRESUMEN
This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Salas de Parto , Recién Nacido de muy Bajo Peso/fisiología , Surfactantes Pulmonares/uso terapéutico , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Extubación Traqueal , Brasil , Femenino , Mortalidad Hospitalaria , Humanos , Hipertensión/diagnóstico , Recién Nacido , Intubación Intratraqueal , Tiempo de Internación , Masculino , Bienestar Materno , Embarazo , Diagnóstico Prenatal , Respiración Artificial/estadística & datos numéricosRESUMEN
OBJECTIVE: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death. STUDY DESIGN: Prospective cohort of 484 infants with 23(0/7) to 26(6/7) weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life. RESULT: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions. CONCLUSION: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day.
Asunto(s)
Mortalidad Infantil/tendencias , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Neonatología/normas , Obstetricia/normas , Corticoesteroides/uso terapéutico , Análisis de Varianza , Brasil , Reanimación Cardiopulmonar/normas , Reanimación Cardiopulmonar/tendencias , Cesárea , Estudios de Cohortes , Intervalos de Confianza , Parto Obstétrico/métodos , Femenino , Viabilidad Fetal , Edad Gestacional , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Relaciones Interprofesionales , Cuidados para Prolongación de la Vida/métodos , Modelos Logísticos , Masculino , Neonatología/tendencias , Obstetricia/tendencias , Oportunidad Relativa , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/tendencias , Embarazo , Pronóstico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Recem-nascidos (RN) prematuros apresentam elevada morbidade respiratoria e necessiade de ventilacao mecanica, assim, a fisioterapia respiratoria e a parte integrante da assistencia neonatal. Objetivo: comparar os efeitos da fisioterapia respiratoria convencional (FRC) versus aumento do fluxo expiratorio (AFE), na saturacao de O2 (SPO2), frequencia cardiaca (FC) e na frequencia respiratoria (FR) em prematuros no periodo pos-extubacao. Metodo: ensaio clinico randomizado realizado na UTI Neonatal do Hospital das Ckinicas de Botucatu - UNESP, comparando duas tecnicas fisioterapeuticas, aplicadas em recem-nascidos prematuros, nas primeiras 48 horas pos-extubacao. Para a analise estatistica foram utilizadas o teste t Student, Mann-Whimey, Qui-quadrado e o teste exato de Fisher, com nivel de significancia em 5 por cento. Resultados: os dois grupos de estudo: Grupo FRC(n=20) e grupo AFE(n=20), nao diferiram quanto a idade gestacional (media de 28 semanas) e peso de nascimento (media de 1100 gramas). Em ambos os grupos a sindrome do desconforto respiratorio (SDR) foi o principal diagnostico. A mediana da idade no inicio da fisioterapia foi de sete dias no grupo AFE e 11 dias na FRC. Ambas as tecnicas produziram aumento significativo da SpO2 aos 10 e 30 minutos, sem alteracoes na FR. A FC aumentou significativamente apos a FRC e nao se alterou apos o AFE. Conclusao: os resultados sugerem que o AFE e menos estressante que a FRC e pode ser aplicado em prematuros no periodo pos-extubacao. Nestes recem-nascidos o AFE parece ser seguro e benefico a curto prazo
Asunto(s)
Frecuencia Cardíaca , Recién Nacido , Recien Nacido Prematuro , Especialidad de Fisioterapia , Trastornos Respiratorios , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién NacidoRESUMEN
Coagulase-negative staphylococci (CNS), components of the normal flora of neonates, have emerged as important opportunistic pathogens of nosocomial infections that occur in neonatal intensive care units. Some authors have reported the ability of some CNS strains, particularly Staphylococcus epidermidis, to produce a toxin similar to S. aureus delta toxin. This toxin is an exoprotein that has a detergent action on the membranes of various cell types resulting in rapid cell lysis. The objectives of the present study were to standardize the Polymerase Chain Reaction (PCR) technique for the detection of the gene responsible for the production of delta toxin (hld gene) in staphylococcal species isolated from catheters and blood cultures obtained from neonates, and to compare the results to those obtained with the phenotypic synergistic hemolysis method. Detection of delta toxin by the phenotypic and genotypic method yielded similar results for the S. aureus isolates. However, in S. epidermidis, a higher positivity was observed for PCR (97.4 por cento) compared to the synergistic hemolysis method (86.8 por cento). Among CNS, S. epidermidis was the most frequent islate and was a delta toxin producer. Staphylococcus simulans and S. warneri tested positive by the phenotypic method, but their positivity was not confirmed by PCR for the hld gene detection. These results indicate that different genes might be responsible for the production of this toxin in different CNS species, requiring highly specific primers for their detection. PCR was found to be rapid and reliable method for the detection of the hld gene in S. aureus and S. epidermidis
Asunto(s)
Humanos , Reacción en Cadena de la Polimerasa , Infecciones Estafilocócicas , Staphylococcus aureus/aislamiento & purificación , Staphylococcus epidermidis/aislamiento & purificación , Antitoxinas , Coagulasa , Exotoxinas , Unidades de Cuidado Intensivo NeonatalRESUMEN
Coagulase-negative staphylococci (CNS), components of the normal flora of neonates, have emerged as important opportunistic pathogens of nosocomial infections that occur in neonatal intensive care units. Some authors have reported the ability of some CNS strains, particularly Staphylococcus epidermidis, to produce a toxin similar to S. aureus delta toxin. This toxin is an exoprotein that has a detergent action on the membranes of various cell types resulting in rapid cell lysis. The objectives of the present study were to standardize the Polymerase Chain Reaction (PCR) technique for the detection of the gene responsible for the production of delta toxin (hld gene) in staphylococcal species isolated from catheters and blood cultures obtained from neonates, and to compare the results to those obtained with the phenotypic synergistic hemolysis method. Detection of delta toxin by the phenotypic and genotypic method yielded similar results for the S. aureus isolates. However, in S. epidermidis, a higher positivity was observed for PCR (97.4%) compared to the synergistic hemolysis method (86.8%). Among CNS, S. epidermidis was the most frequent isolate and was a delta toxin producer. Staphylococcus simulans and S. warneri tested positive by the phenotypic method, but their positivity was not confirmed by PCR for the hld gene detection. These results indicate that different genes might be responsible for the production of this toxin in different CNS species, requiring highly specific primers for their detection. PCR was found to be a rapid and reliable method for the detection of the hld gene in S. aureus and S. epidermidis.
RESUMEN
We analyzed the perinatal outcome of 1,086 pregnancies classified according to the response to the 3-hour 100-gram glucose tolerance test and the diurnal glycemic profile into the Rudge groups corresponding to control pregnant women, class A gestational diabetic women, class A/B to FRH pregnant women and women with daily hyperglycemia. Despite treatment, the diabetic pregnant women and those with daily hyperglycemia presented higher mean blood glucose levels compared to controls (76.6+/-10.2 mg/dl). The pregnancies complicated by diabetes and by daily hyperglycemia were characterized by a high incidence of prematurity, macrosomia, large for gestational age newborn infants, malformation and fetal and neonatal death, with consequent perinatal mortality. The perinatal mortality of women with daily hyperglycemia was 10 times higher than that of the controls and was similar to that of the diabetic patients. These adverse perinatal results emphasize the need for the diagnosis and control of intrauterine hyperglycemia both in diabetic pregnant women and in women with an altered diurnal glycemic profile.
Asunto(s)
Hiperglucemia/complicaciones , Resultado del Embarazo , Embarazo en Diabéticas/complicaciones , Adulto , Peso al Nacer , Anomalías Congénitas/etiología , Femenino , Muerte Fetal/etiología , Macrosomía Fetal/etiología , Intolerancia a la Glucosa , Humanos , Mortalidad Infantil , Recién Nacido , Trabajo de Parto Prematuro/etiología , EmbarazoRESUMEN
The case of a six-day-old neonate admitted in an emergency situation because of dyspnea and increasing cyanosis is reported. Despite abnormal opacification on the chest X-ray and left ventricular overload on the electrocardiogram and echocardiogram, features compatible with the disease, the diagnosis of massive pulmonary arteriovenous fistula affecting the whole left superior lobe, was made possible only after necroscopic examination.
Asunto(s)
Fístula Arteriovenosa/congénito , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalías , Fístula Arteriovenosa/patología , Humanos , Recién Nacido , MasculinoRESUMEN
Analisamos um conjunto de indicadores de saude infantil em 30 paises do mundo e caracterizamos 4 grupos de paises: G1 compreende 18 paises nos quais a condicao de saude infantil e satisfatoria, destacando-se neste grupo o predominio de paises desenvolvidos, os paises europeus e o Japao como os melhores. Os EUA situam-se isoladamente em G1 em decorrencia de seus baixos indices de vacinacao. G2 onde se encontra o Brasil e G3 sao intermediarios. E finalmente G4 que compreende Bolivia, Camaroes, Republica Centro Africana, Paquistao, India e Bamgladesh, paises com as piores condicoes economicas, de desenvolvimento e de saude infantil. Esses dados alertam para a necessidade de maior investimento na area de saude infantil nos paises em desenvolvimento a fim de se tentar atingir a meta "Saude para todos no ano 2000" .
Asunto(s)
Niño , Indicadores de Salud/análisis , Naciones Unidas , Bolivia , BrasilRESUMEN
Analisamos um conjunto de indicadores de saude a fim de avaliar as condicoes de saude da crianca em paises das Americas do Sul e do Norte. Caracterizamos 3 grupos de paises: G1 (Argentina, Uruguai, Chile, Canada e Estados Unidos) com melhores condicoes de saude; G2 (Brasil, Guiana, Mexico, Colombia e Venezuela) intermediarios e G3 (Equador, Peru, Paraguai e no extremo Bolivia) onde as condicoes de saude sao menos favoraveis. Os EUA embora pertencam ao primeiro grupo, situam-se isoladamente em decorrencia de seus baixos indices de vacinacao. Esses dados demonstram que a saude da crianca nao e um privilegio de paises desenvolvidos e deve ser encarada como prioridade social na maioria dos paises americanos .