RESUMEN
BACKGROUND: Preeclampsia is implicated in 14% of maternal deaths worldwide, mostly due to complications such as intracranial hemorrhage and cerebral edema. Cerebral edema increases intracranial pressure, which can be predicted by ultrasonographic measurement of the optic nerve sheath diameter (ONSD). Greater diameters have been reported in women with preeclampsia and eclampsia; however, data are lacking on the possible association with maternal and neonatal adverse outcomes. This study aimed to determine whether there is an association between hypertensive disorders of pregnancy and the ONSD, and between this measurement and maternal and neonatal adverse outcomes. METHODS: This was a cohort study involving 183 women in the third trimester of pregnancy or within 24 h following childbirth, distributed as follows: control group (n = 30), gestational hypertension (n = 14), chronic hypertension (n = 12), preeclampsia without severe features (n = 12), preeclampsia with severe features (n = 62), superimposed preeclampsia (n = 23) and eclampsia (n = 30). The participants underwent ocular ultrasonography, and data on maternal and neonatal outcomes were collected from the medical records. To compare the groups, analysis of variance was used for the normally distributed numerical variables and the Kruskal-Wallis test was used for variables with non-normal distribution. Two-tailed p-values ≤ 0.05 were considered statistically significant. RESULTS: Overall comparison between the seven groups showed no statistically significant difference in the mean ONSD (p = 0.056). Nevertheless, diameters were significantly greater in the eclampsia group compared to the control group (p = 0.003). Greater diameters were associated with maternal admission to the intensive care unit (ICU) (p < 0.01) and maternal near miss (p = 0.01). There was no association between ONSD and admission to the neonatal ICU (p = 0.1), neonatal near miss (p = 0.34) or neonatal death (p = 0.26). CONCLUSIONS: No association was found between ONSD and the hypertensive disorders of pregnancy in the overall analysis; however, ONSD was greater in women with eclampsia compared to controls. Greater diameters were associated with maternal admission to the ICU and maternal near miss. These findings suggest a potential use for bedside ultrasound as an additional tool for stratifying risk in patients with hypertensive disorders of pregnancy.
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Hipertensión Inducida en el Embarazo , Nervio Óptico , Preeclampsia , Resultado del Embarazo , Humanos , Femenino , Embarazo , Adulto , Nervio Óptico/diagnóstico por imagen , Recién Nacido , Resultado del Embarazo/epidemiología , Estudios de Cohortes , Preeclampsia/epidemiología , Tercer Trimestre del Embarazo , Ultrasonografía , Eclampsia , Estudios de Casos y Controles , Adulto JovenRESUMEN
Objective: To evaluate the association between the dietary patterns (DPs) of pregnant women with GDM (gestational diabetes mellitus) and the birth weight (BW) of the infants. Methods: Cross-sectional study with 187 adult pregnant women with GDM attended at a maternity in Rio de Janeiro from 2011 to 2014. Dietary intake was assessed in the third trimester using a semiquantitative food frequency questionnaire (FFQ). The outcomes were BW and weight adequacy for gestational age (GA). Reduced Rank Regression (RRR) was used to explain the following response variables: density of carbohydrates, fibres, and saturated fatty acids. Statistical analyzes included multinomial logistic regression models. Results: The mean BW was 3261.9 (± 424.5) g. Three DPs were identified, with DP 3 (high consumption of refined carbohydrates, fast foods/snacks, whole milk, sugars/sweets, and soft drinks and low consumption of beans, vegetables, and low-fat milk and derivatives) being the main pattern, explaining 48.37% of the response variables. In the multinomial logistic regression analysis no statistically significant association was found between the tertiles of DPs and BW or the adequacy of weight for GA, even after adjustments of confounding covariates. Conclusion: No significant associations were found between maternal DPs in the third trimester of pregnancy and infant BW or adequacy of weight for GA.
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Peso al Nacer , Diabetes Gestacional , Humanos , Femenino , Estudios Transversales , Embarazo , Adulto , Brasil/epidemiología , Diabetes Gestacional/epidemiología , Recién Nacido , Dieta , Conducta Alimentaria , Adulto Joven , Patrones DietéticosRESUMEN
Coal mining activities release harmful air pollutants, which affect children's health, particularly the lung function. Brazil has a large coal reserve in the southern region, where a coal-fired power plant and two coal mines are located. The study aimed to evaluate the prevalence of altered respiratory function and associated factors in children living in this region. A cross-sectional study was conducted in seven cities. It collected socioeconomic and demographic, prenatal and postnatal care, neonatal outcomes, child health information as well as lung function and air quality. The study included 396 children who lived in a high socio-environmental vulnerability due to low education levels and family income, high percentage of unemployed and families with a high bedroom density. There was a high prevalence of preterm birth, low birth weight and long-term exposure to environmental conditions. The most common respiratory problem in the parents was rhinitis, while in the children was wheezing and pneumonia. The prevalence of respiratory function alteration in the region was 7.78%. Variables associated with altered respiratory function were passive smoking, low birth weight, history of wheezing. The concentration of pollutants was equivalent when comparing stations within the coal mining host town (Candiota) and surrounding towns.
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Factores Socioeconómicos , Humanos , Brasil/epidemiología , Estudios Transversales , Femenino , Masculino , Niño , Preescolar , Pruebas de Función Respiratoria , Prevalencia , Minas de Carbón , Recién Nacido , Lactante , Exposición a Riesgos Ambientales/efectos adversos , Contaminantes Atmosféricos/análisis , Contaminantes Atmosféricos/efectos adversos , Factores de Riesgo , Pulmón/fisiopatologíaRESUMEN
OBJECTIVES: The control chart is a classic statistical technique in epidemiology for identifying trends, patterns, or alerts. One meaningful use is monitoring and tracking Infant Mortality Rates, which is a priority both domestically and for the World Health Organization, as it reflects the effectiveness of public policies and the progress of nations. This study aims to evaluate the applicability and performance of this technique in Brazilian cities with different population sizes using infant mortality data. RESULTS: In this article, we evaluate the effectiveness of the statistical process control chart in the context of Brazilian cities. We present three categories of city groups, divided based on population size and classified according to the quality of the analyses when subjected to the control method: consistent, interpretable, and inconsistent. In cities with a large population, the data in these contexts show a lower noise level and reliable results. However, in intermediate and small-sized cities, the technique becomes limited in detecting deviations from expected behaviors, resulting in reduced reliability of the generated patterns and alerts.
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Ciudades , Mortalidad Infantil , Densidad de Población , Humanos , Brasil/epidemiología , Lactante , Mortalidad Infantil/tendencias , Ciudades/epidemiología , Ciudades/estadística & datos numéricos , Recién NacidoRESUMEN
OBJECTIVE: To analyze neonatal factors associated with early weaning. METHOD: This is a cross-sectional study conducted between March and September 2023 with 180 women six months to two years postpartum, from a municipality in Bahia, Brazil. For bivariate analysis, Pearson's chi-square tests were used, considering p < 0.05. The adjusted analysis included variables with p < 0.20, keeping those with p < 0.05, using stepwise multiple logistic regression, with a 95% confidence interval. RESULTS: The provision of pacifiers/bottles (OR: 18.96; 95% CI: 7.68-46.79; p < 0.001) and supplements in the maternity ward (OR: 4.44; 95% CI: 1.76-11.17; p: 0.002) were associated with greater likelihood of early weaning. CONCLUSION: Habits and beliefs, such as the use of bottles and pacifiers, and the introduction of infant formulas within the maternity ward with continued supplementation after hospital discharge were the neonatal factors associated with early weaning in this context.
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Chupetes , Destete , Humanos , Estudios Transversales , Brasil , Femenino , Lactante , Adulto , Chupetes/estadística & datos numéricos , Lactancia Materna/estadística & datos numéricos , Factores de Tiempo , Alimentación con Biberón/estadística & datos numéricos , Fórmulas Infantiles/estadística & datos numéricos , Adulto Joven , Masculino , Recién NacidoRESUMEN
INTRODUCTION: Although extensive research exists on the morbidity and mortality associated with tracheostomy in pediatrics, scarse work has been done to analyze the outcomes after hospital discharge of tracheostomized children. In our country there are no publications referring to the follow-up of this population. The general objective of this study was to describe and analyze the situation of tracheostomized children living at home in Argentina. MATERIALS AND METHODS: Descriptive, cross-sectional study through a survey with convenience sampling. Surveys sent between January and July 2023 were collected and analyzed. RESULTS: We obtained 193 surveys during the study period. One hundred eighteen children (61%) underwent tracheostomies before one year of age. The majority (n=183) have a Single Disability Certificate (94.8%). Regarding health coverage, 113 children have social insurance (58.5%), 42 have prepaid coverage (21.8%) and 38 depend on public insurance (19.7%). Almost all of the families (n=184) received some training to care for their children (95.3%). In their homes, 152 families (78.7%) had to resolve some adverse event related to the tracheostomy, and 128 families (66%) had to abandon some paid job. Although 118 children are not in school (61%), 170 (88%) receive rehabilitation therapy. DISCUSSION: Our research, the first of its kind, provides a crucial epidemiologic analysis of the situation of tracheostomized children living at home in Argentina. These findings are significant as they shed light on a previously unexplored area, emphasizing the need for further studies to confirm and expand these data.
Introducción: Si bien existe investigación sobre la morbimortalidad asociada a la traqueostomía en pediatría, pocos trabajos analizan los resultados luego del alta hospitalaria. En nuestro país no existen publicaciones referidas al seguimiento de esta población. El objetivo general de este trabajo fue describir y analizar la situación de niños traqueostomizados que viven en su hogar en Argentina. Materiales y métodos: Estudio descriptivo, transversal a través de una encuesta con muestreo por conveniencia. Se recolectaron y analizaron las encuestas remitidas entre enero y julio de 2023. Resultados: Se obtuvieron 193 encuestas durante el período de estudio. Fueron traqueostomizados antes del año de vida 118 niños (61%). La mayoría (n=183) posee Certificado Único de Discapacidad (94.8%). En relación a la cobertura de salud, 113 niños cuentan con Obra Social (58.5%), 42 con cobertura prepaga (21.8%) y 38 dependen del sector público (19.7%). Casi la totalidad de las familias (n=184) recibió capacitación para el cuidado de su hijo (95.3%). En sus hogares, 152 familias (78.7%) debieron resolver algún evento adverso relacionado con la traqueostomía y 128 familias (66%) abandonaron algún trabajo remunerado. Si bien 118 niños no se encuentran escolarizados (61%), 170 (88%) reciben terapia de rehabilitación. Discusión: Nuestra investigación, la primera de su tipo, proporciona un análisis epidemiológico crucial de la situación de los niños traqueostomizados que viven en sus hogares en Argentina. Hallazgos importantes, ya que arrojan luz sobre un área previamente inexplorada, enfatizando la necesidad de más estudios para confirmar y ampliar estos datos.
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Traqueostomía , Humanos , Argentina/epidemiología , Traqueostomía/estadística & datos numéricos , Estudios Transversales , Masculino , Femenino , Preescolar , Lactante , Niño , Adolescente , Encuestas y Cuestionarios , Niños con Discapacidad/estadística & datos numéricos , Recién NacidoRESUMEN
BACKGROUND: The percentage of the world's population with disabilities is estimated to be 16%, although its distribution and intensity varies within nations. We aim to disentangle the degree and types of disabilities, estimate the years spent with more severe disabilities, and analyze their distribution across states and between sexes in Mexico. METHODS: The Mexican Census of 2020 includes information on disabilities, which allows the study of its national distribution. We used life tables and the Sullivan method to calculate the number of years spent with disability (NYSD) and its percentage with respect to life expectancy for each state and each sex. RESULTS: In Mexico, the population with disabilities is estimated to be 16.5%. Of this total, 69% have milder disabilities, while the remaining 31% have more severe disabilities. At age eighteen, there is a higher NYSD from more severe disabilities for females with 5.67 years (95% CI 5.66 to 5.69) as opposed to males with 3.66 years (95% CI 3.65 to 3.67). Across states, a more homogeneous distribution with lower NYSD is observed for men (between 2.44 and 5.69 years) than for women (4.14 and 8.08 years). A north-south division can also be observed, with particularly notorious disadvantages among coastal states, which is more distinctive among women. CONCLUSIONS: This study shows that comparing the number of years spent with disability and the total life expectancy between subpopulations is essential for monitoring the well-being of aging populations, guiding policy decisions, and promoting a society that values and supports all individuals, regardless of their abilities.
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Personas con Discapacidad , Esperanza de Vida , Humanos , México , Masculino , Femenino , Personas con Discapacidad/estadística & datos numéricos , Persona de Mediana Edad , Adulto , Anciano , Adolescente , Adulto Joven , Preescolar , Niño , Lactante , Anciano de 80 o más Años , Recién NacidoRESUMEN
Orotracheal intubation and mechanical ventilation (MV) have become routine practices in intensive care units. Unplanned extubation (UE) is one of the most important complications, particularly in premature infants and critically ill newborns. The objective of this study was to determine the prevalence of UE in a tertiary care neonatal intensive care unit (NICU). In this analytical cross-sectional retrospective study, all data, including perinatal data, indications for ventilatory support, days of MV at the time of UE, work shift, month of the event, reintubation, and postextubation complications, were obtained from the manual review of clinical charts. In total, 151 neonates, who received invasive MV, were included in this study. The prevalence of UE was 2.0/100 days of ventilation. The most affected were premature infants, with a gestational age of ≤ 32 weeks (54.7%) and a birth weight of ≤ 1500 g. The main cause for UE was deficient fixation of the endotracheal tube (ETT) (27.7%). Most UE events occurred during night shifts (48.1%). Reintubation was required in 83.3% of newborns. Immediate complications developed in 96.3% of the UE events, including desaturation (57.7%) and bradycardia (36.5%). The prevalence of UE was high, particularly in premature infants, with a high rate of reintubation and immediate complications. Standardized protocols for ETT care must be implemented to reduce these events.
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Extubación Traqueal , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Intubación Intratraqueal , Respiración Artificial , Humanos , Recién Nacido , Estudios Transversales , Estudios Retrospectivos , Extubación Traqueal/efectos adversos , Extubación Traqueal/estadística & datos numéricos , Prevalencia , Femenino , Intubación Intratraqueal/estadística & datos numéricos , Masculino , Respiración Artificial/estadística & datos numéricos , Edad Gestacional , Centros de Atención Terciaria , Atención Terciaria de SaludRESUMEN
Although phthalate exposure has been linked with multiple adverse pregnancy outcomes, their underlying biological mechanisms are not fully understood. We examined associations between biomarkers of phthalate exposures and metabolic alterations using untargeted metabolomics in 99 pregnant women and 86 newborns [mean (SD) gestational age = 39.5 (1.5) weeks] in the PROTECT cohort. Maternal urinary phthalate metabolites were quantified using isotope dilution high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS), while metabolic profiles in maternal and cord blood plasma were characterized via reversed-phase LC-MS. Multivariable linear regression was used in metabolome-wide association studies (MWAS) to identify individual metabolic features associated with elevated phthalate levels, while clustering and correlation network analyses were used to discern the interconnectedness of biologically relevant features. In the MWAS adjusted for maternal age and prepregnancy BMI, we observed significant associations between specific phthalates, namely, di(2-ethylhexyl) phthalate (DEHP) and mono(3-carboxypropyl) phthalate (MCPP), and 34 maternal plasma metabolic features. These associations predominantly included upregulation of fatty acids, amino acids, purines, or their derivatives and downregulation of ceramides and sphingomyelins. In contrast, fewer significant associations were observed with metabolic features in cord blood. Correlation network analysis highlighted the overlap of features associated with phthalates and those identified as differentiating markers for preterm birth in a previous study. Overall, our findings underscore the complex impact of phthalate exposures on maternal and fetal metabolism, highlighting metabolomics as a tool for understanding associated biological processes. Future research should focus on expanding the sample size, exploring the effects of phthalate mixtures, and validating identified metabolic features in larger, more diverse populations.
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Metabolómica , Ácidos Ftálicos , Humanos , Femenino , Ácidos Ftálicos/orina , Embarazo , Adulto , Puerto Rico , Exposición Materna , Recién Nacido , Sangre Fetal/química , Sangre Fetal/metabolismo , Biomarcadores/sangre , Metaboloma , Exposición a Riesgos AmbientalesRESUMEN
Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia's health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors' knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.
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Gastos en Salud , Colombia , Humanos , Gastos en Salud/estadística & datos numéricos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Adolescente , Preescolar , Adulto Joven , Lactante , Niño , Recién NacidoRESUMEN
INTRODUCTION: The COVID-19 pandemic has had significant impacts on society, particularly on children and adolescents, who have faced serious social, educational, and health consequences due to the loss of their primary caregivers. MATERIALS AND METHODS: Female fertility rates were analyzed, and estimates of male fertility were made to calculate the number of children under 18 years old by age group. Demographic and mortality information from COVID-19 infection was used to calculate the resulting orphanhood in Argentina during the period 2020-2021, considering the loss of one or both parents or the main caregiver grandparent. RESULTS: A total of 25161 Argentine children and adolescents lost one of their primary caregivers due to COVID-19 during the pandemic. Of these, 22729 were orphaned by mother or father during the analyzed period. The majority of cases (79.5%) were related to the father's death. Specific age groups with higher incidence of orphanhood were identified. The loss of caregiver grandparents was also significant, affecting 2432 children and adolescents. DISCUSSION: The findings underscore the need for specific policies and programs to address the comprehensive needs of children and adolescents affected by orphanhood during the pandemic. Potential long-term impacts on the physical, mental, educational, and socioeconomic health of these children and adolescents are highlighted.
Introducción: La pandemia de COVID-19 ha ejercido impactos significativos en la sociedad, particularmente en niños, niñas y adolescentes (NNA), quienes han enfrentado consecuencias sociales, educativas y de salud graves debido a la pérdida de sus cuidadores principales. Materiales y métodos: Se analizaron las tasas de fertilidad femenina y se realizaron estimaciones sobre la fertilidad masculina a fin de calcular los hijos menores de 18 años por grupo de edad. Se utilizó información demográfica y de mortalidad por infección por COVID-19 para calcular la orfandad resultante en Argentina durante el período 2020-2021, considerando la pérdida de uno o ambos progenitores o del cuidador principal abuelo/a. Resultados: Un total de 25161 NNA argentinos perdieron a uno de sus cuidadores principales por el COVID-19 durante la pandemia. De ellos, 22729 NNA quedaron huérfanos de madre o padre durante el periodo analizado. La mayoría de los casos (79.5%) estuvo relacionada con la muerte del padre. Se identificaron grupos de edad específicos con mayor incidencia de orfandad. La pérdida de abuelos cuidadores también fue significativa, afectando a 2432 NNA. Discusión: Los hallazgos subrayan la necesidad de políticas y programas específicos para abordar las necesidades integrales de los NNA afectados por la orfandad durante la pandemia. Se destacan los posibles impactos a largo plazo en la salud física, mental, educativa y socioeconómica de estos niños y adolescentes.
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COVID-19 , Niños Huérfanos , Humanos , Argentina/epidemiología , COVID-19/epidemiología , Adolescente , Niño , Femenino , Masculino , Niños Huérfanos/estadística & datos numéricos , Preescolar , Lactante , Cuidadores/estadística & datos numéricos , Pandemias , Recién Nacido , Tasa de Natalidad/tendencias , SARS-CoV-2RESUMEN
BACKGROUND: Continued breastfeeding reduces infant mortality and provides nutritional, immunological, and developmental benefits for the child. OBJECTIVES: A prospective cohort study conducted in 2015 followed 608 children who were breastfed between 6 and 24 months. The study assessed the risk of breastfeeding interruption at 12, 18, and 24 months, as well as the factors associated with this outcome, in a cohort of newborns in Rio Branco, using the life table method. METHODS: The factors associated with breastfeeding cessation and their 95% confidence intervals (CI95%) were analyzed using both crude and adjusted Cox proportional hazards regression in a hierarchical model. The risks of breastfeeding cessation at 12, 18, and 24 months were 19%, 65%, and 71%, respectively. RESULTS: Factors positively associated with the risk of breastfeeding cessation include the use of a pacifier before 6 weeks of age (HR = 1.62; CI: 95% 1.24-2.11) and the use of a bottle during the first year of life (HR = 1.41; CI: 95% 1.11-1.78). Maternal return to work after the birth of the baby (HR = 0.78; CI: 95% 0.62-0.97) was found to be negatively associated with the risk of breastfeeding interruption. CONCLUSIONS: Early pacifier use before 6 weeks and the introduction of a bottle in the first year affect continued breastfeeding. Maternal employment was associated with reduced risk of breastfeeding cessation, contrary to most studies.
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Lactancia Materna , Chupetes , Humanos , Lactancia Materna/estadística & datos numéricos , Brasil/epidemiología , Femenino , Lactante , Estudios Prospectivos , Chupetes/estadística & datos numéricos , Masculino , Recién Nacido , Adulto , Factores de Riesgo , Cohorte de Nacimiento , Alimentación con Biberón/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Preescolar , Adulto Joven , Estudios de CohortesRESUMEN
Invasive infections caused by non-albicans Candida are increasing worldwide. However, there is still a lack of information on invasive candidiasis (IC) in the pediatric setting, including susceptibility profiles and clonal studies. We investigated the clinical, epidemiologic, and laboratory characteristics of IC, possible changes in antifungal susceptibility profiles over time, and the occurrence of clonality in our tertiary children's hospital. We analyzed 123 non-duplicate Candida isolates from sterile sites of pediatric patients in a tertiary hospital in southern Brazil, between 2016 and 2021. Data on demographics, comorbidities, and clinical outcomes were collected. Candida species distribution, antifungal susceptibility profiles, biofilm production, and molecular epidemiology of isolates were assessed using reference methods. The range of IC incidence was 0.88-1.55 cases/1000 hospitalized patients/year, and the IC-related mortality rate was 20.3%. Of the total IC cases, 42.3% were in patients aged < 13 months. Mechanical ventilation, parenteral nutrition, and intensive care unit (ICU) admission were common in this group. In addition, ICU admission was identified as a risk factor for IC-related mortality. The main site of Candida spp. isolation was blood, and non-albicans Candida species were predominant (70.8%). No significant clonal spread was observed among isolates of the three most commonly isolated species, and 99.1% of all isolates were biofilm producers. Non-albicans Candida species were predominant in this study. Notably, clonal expansion and emergence of antifungal drug resistance were not observed in our pediatric setting.
The epidemiology of invasive candidiasis has changed over time and there is still a lack of information in the pediatric setting. Non-albicans Candida species predominated in this study, clonal expansion and emergence of antifungal drug resistance were not observed in our pediatric setting.
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Antifúngicos , Candida , Candidiasis Invasiva , Pruebas de Sensibilidad Microbiana , Centros de Atención Terciaria , Humanos , Centros de Atención Terciaria/estadística & datos numéricos , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Candidiasis Invasiva/microbiología , Candidiasis Invasiva/mortalidad , Candidiasis Invasiva/epidemiología , Lactante , Masculino , Femenino , Brasil/epidemiología , Preescolar , Candida/efectos de los fármacos , Candida/aislamiento & purificación , Candida/clasificación , Niño , Hospitales Pediátricos/estadística & datos numéricos , Biopelículas/crecimiento & desarrollo , Biopelículas/efectos de los fármacos , Incidencia , Farmacorresistencia Fúngica , Adolescente , Recién Nacido , Factores de Riesgo , Estudios RetrospectivosRESUMEN
One of the measures for monitoring microbial resistance is the calculation of the defined daily dose of antimicrobial agents. For this calculation, the weight of an adult of 70 kg is used as a standard, so that application in neonatology is not possible. The aim of this study is to describe the use profile and calculate the defined daily dose (DDD) of antimicrobials in a neonatal intensive care unit (NICU) of a public hospital in the interior of Bahia, Brazil. From March 2020 to December 2021, the medical records of 712 newborns admitted to a NICU between September 2018 and June 2020 were analyzed. A total of 410 newborns diagnosed with neonatal sepsis were included. The most used antimicrobials per patient were gentamicin (408/410; 99.5%), ampicillin (407; 99.3%), amikacin (29; 7.1%) and oxacillin (21; 5.1%), with a mean (SD) treatment duration of 9.8 (3.9) days. The most commonly used combination of antimicrobials was ampicillin with gentamicin, which was used in 406 patients (99.0%). The values for neonatal DDDs were on average 26 times lower than those for adult DDDs. The neonatal DDDs were similar to those observed in other studies. Ampicilin and cefepime were the antimicrobials for which the greatest differences were observed in neonatal DDDs compared with adult DDDs, which differed mainly between maintenance doses, reflecting the lack of international standards in neonatology. Standardization of DDDs as a surveillance measure has the potential to clarify the pattern of antimicrobial use in neonatal patients worldwide and, in particular, to prevent indiscriminate use and bacterial resistance.
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Antibacterianos , Unidades de Cuidado Intensivo Neonatal , Neonatología , Humanos , Recién Nacido , Neonatología/métodos , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Femenino , Masculino , Brasil , Gentamicinas/administración & dosificación , Gentamicinas/uso terapéutico , Sepsis Neonatal/tratamiento farmacológico , Sepsis Neonatal/microbiología , Ampicilina/administración & dosificación , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Amicacina/administración & dosificación , Amicacina/uso terapéutico , Estudios RetrospectivosRESUMEN
BACKGROUND: Understanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants. METHODS: Data were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant's first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction. RESULTS: Three distinct patterns were identified and named according to their main characteristics: Pattern 1 - "Low Infant Formula and Timely CF Introduction"; Pattern 2 - "High Infant Formula and Early CF Introduction"; and Pattern 3 - "High Infant Formula and Later Ultra-processed Food Introduction". Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10-1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53-0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13-2.01) or > 34 years (PR = 1.42; 95% CI = 1.04-1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01-1.80). CONCLUSIONS: We identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants.
Asunto(s)
Lactancia Materna , Fenómenos Fisiológicos Nutricionales del Lactante , Humanos , Lactante , Brasil , Femenino , Lactancia Materna/estadística & datos numéricos , Masculino , Fórmulas Infantiles , Alimentos Infantiles/estadística & datos numéricos , Conducta Alimentaria , Adulto , Recién Nacido , Factores de Edad , Estudios de CohortesRESUMEN
Objective: To compare the effectiveness and safety of non-mRNA versus mRNA COVID-19 vaccines on pregnant women and their newborns in a systematic review with meta-analysis. Data sources: We searched PubMed, Embase, and Cochrane Central in May 2023. Study selection: The search strategy yielded 4451 results, 16 studies were fully reviewed. We selected case-control studies analysing non-mRNA versus mRNA vaccines. Data collection and analysis: we assessed the risk of bias using the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Standardised mean differences were pooled using random-effect models. Data synthesis: We identified 8 prospective and retrospective studies with a total of 32,153 patients. Non-mRNA vaccines were associated with a higher incidence of fever (OR 2.67; 95% CI 2.08-3.43; p<0.001), and a lower incidence of fetal or neonatal death (OR 0.16; 95% CI 0.08-0.33; p<0.001). In subgroup analyses, the Jansen vaccine (Ad26.COV2.S) was found to have a higher rate of premature labor/delivery (OR 4.48; 95% CI 1.45-13.83; p=0.009) and missed/spontaneous abortion (OR 1.90; 95% CI 1.09-3.30; p=0.02), as compared with the Pfizer (BNT162b2) vaccine. Conclusion: non-mRNA vaccines are associated with a lower incidence of fetal or neonatal death among pregnant women who receive a Covid19 vaccine, although at an increased rate of pyrexia compared with mRNA vaccines. Other studies are required for better assessment. PROSPERO: CRD42023421814.
Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Complicaciones Infecciosas del Embarazo , Vacunas de ARNm , Femenino , Humanos , Recién Nacido , Embarazo , COVID-19/prevención & control , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/efectos adversos , Vacunas de ARNm/administración & dosificación , Vacunas de ARNm/efectos adversos , Complicaciones Infecciosas del Embarazo/prevención & control , Resultado del Embarazo , SARS-CoV-2/inmunologíaRESUMEN
The main causes of difficult fetal extraction during cesarean section are deeply impacted fetal head and floating presentation of the fetus. Studies of management techniques for difficult fetal extraction during cesarean section and the maternal and neonatal results lack scientific evidence, as these predominantly come from case reports, small case series and expert opinions. The deeply impacted fetal head is usually associated with prolongation of the expulsion period and/or unsuccessful attempts at operative vaginal delivery. The main maternal complications associated with the management of the deeply impacted fetal head are lacerations in the lower uterine segment, hematomas in the uterine ligaments and injuries to the uterine vessels, cervix and/or urinary tract. The main neonatal complications associated with the management of a deeply impacted fetal head are intracranial hemorrhage, fractures of the skull and/or cervical spine, nerve injuries, perinatal asphyxia and even death. Among the maneuvers for delivery of the deeply impacted fetal head, the abdominovaginal delivery (push method) seems to be the most associated with maternal and neonatal complications. In the non-insinuated and floating fetal head, the internal podalic version followed by pelvic extraction differs from the reverse breech extraction (pull method). When the fetal head is high in the pelvis, the fetus is internally ejected before the extraction of its body segments, similar to the internal version performed in the vaginal delivery of the second twin with floating presentation of the fetus.
Asunto(s)
Cesárea , Femenino , Humanos , Recién Nacido , Embarazo , Feto/cirugía , CabezaRESUMEN
Spinal muscular atrophy (SMA) is a genetic neuromuscular progressive disorder that is currently treatable. The sooner the disease-modifying therapies are started, the better the prognosis. Newborn screening for SMA, which is already performed in many countries, has been scheduled to begin in the near future. The development of a well-organized program is paramount to achieve favorable outcomes for the child who is born with the disease and for the costs involved in health care. We herein present a review paper hoping to point out that SMA neonatal screening is urgent and will not increase the cost of its care.
A atrofia muscular espinhal (AME) é uma doença genética neuromuscular progressiva tratável atualmente. Quanto antes o tratamento com as terapias modificadoras da doença for iniciado, melhor será o prognóstico. A triagem neonatal para a AME, já implementada em vários países, está programada para iniciar no Brasil em um futuro próximo. O desenvolvimento de um programa bem organizado é fundamental para que se alcance um resultado favorável para as crianças que nascem com a doença e para os custos envolvidos nos cuidados de saúde. Apresentamos um artigo de revisão na esperança de enfatizar que a triagem neonatal para a AME é urgente e não aumentará os custos relacionados aos cuidados.
Asunto(s)
Atrofia Muscular Espinal , Tamizaje Neonatal , Humanos , Tamizaje Neonatal/métodos , Recién Nacido , Atrofia Muscular Espinal/diagnóstico , Atrofia Muscular Espinal/genéticaRESUMEN
INTRODUCTION: Developmental dysplasia of the hip (DDH) includes a spectrum of clinical and imaging findings at birth or early infancy. The circumstances in which this condition is detected and managed may be heterogeneous in Brazil owing to its large territory and regional socio-economic differences. Mapping DDH perspectives in a country is fundamental for designing guidelines and strategies for public policy. This scoping review aims to map the available literature related to screening, diagnosis, treatment and outcomes of DDH in the Brazilian population to provide an overview of this condition and to describe regional variations in presentation and management across the country. METHODS AND ANALYSIS: This study will follow the methods outlined in the Joanna Briggs Institute Reviewers manual for conducting a scoping review. Relevant publications will be first searched in PubMed/MEDLINE, Scientific Electronic Library Online, Web of Science, Scopus, "Biblioteca virtual em saúde" and "Biblioteca Digital Brasileira de Teses e Dissertações" using search terms developed from a brief preliminary search of those databases. There were no language or date range limitations for study inclusion. Databases will be searched from their inception until February 2024. Titles and abstracts will be analysed by two or more independent reviewers to assess them against the inclusion criteria for the review. The search results and study inclusion process will be reported in full in the final version of the scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flowchart. The resulting data will be recorded and organised to present the key information contained in all examined articles. ETHICS AND DISSEMINATION: This review will include existing available studies and does not require a specific ethical review or approval. The final study will be submitted for presentation at conferences that focus on Brazilian healthcare and publication in peer-reviewed journals. This scoping review protocol was registered in the Open Science Framework. DOI registration (https://doi.org/10.17605/OSF.IO/V3AYH).