[Association of illicit drug use in pregnant women and congenital syphilis in a public hospital in Mexico]. / Asociación del consumo de drogas ilícitas en mujeres embarazadas y sífilis congénita en un Hospital Público de México.

We conducted a nested case-control study within a cohort with the aim of studying the association between illicit drug use and congenital syphilis (CS). Cases were diagnosed based on treponemal and non-treponemal tests conducted both in the mother and the newborn (NB). Multivariate analysis with logistic regression was performed. A total of 6171 births with a mean gestational age of 37.8 weeks were recorded and 62 CS events were diagnosed (incidence 10.5 events/1000 NB). Associated maternal factors were illicit drug use (OR 14.08, 95% CI 1.19-166.6), <5 prenatal visits (OR 2.9, 95% CI 1.12-7.53), more than two sexual partners (OR 3.76, 95% CI 1.62-8.71) and professional education level (OR 0.06, 95% CI 0.005-0.85). Among the mothers of the cases presented, the prevalence of illicit drug use was 22.6% and the most frequent drugs were methamphetamines and cannabis.

Congenital infection by cytomegalovirus in newborns with very low birth weight.

Not available.

Birth weight percentiles in Western-Mexico.

Not available.

Associated congenital anomalies in infants with isolated gastroschisis: A single-institutional experience.

The aim of our study was to determine the frequency and type of associated congenital anomalies in patients with isolated gastroschisis born at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, México), and to explore its possible association with the included outcome variables. One hundred-eight cases with isolated gastroschisis were reviewed from 2009 to 2014. The occurrence of intestinal and extraintestinal associated anomalies (either secondary or primary) was prospectively assessed. The type of gastroschisis, length of hospital stay (LOS), and in-hospital mortality were outcome variables for statistical analysis. Of infants with gastroschisis, 52 (48.1%) had one or more associated anomalies (AA), with increased odds in males (OR = 2.3, 95%CI: 1.1-5.0). AA classified, as secondary and primary were present in 34.3 and 5.6% of patients, respectively. Of secondary AA, 25.9% were intestinal anomalies, and 17.6% were extraintestinal. Primary AA were congenital heart disease (n = 3), meningomyelocele, and hydrocephaly and amniotic band sequence in one instance, respectively. Multivariate logistic regression showed that secondary AA (both intestinal and extraintestinal) were associated with complex gastroschisis, prolonged LOS, and in-hospital death, whereas primary AA were not related to a worse outcome. Our results highlight the pathogenic importance of properly investigating and categorizing the presence of others secondary or primary AA when diagnosis of gastroschisis is made.

Factors associated with tuberculosis disease in children from a hospital in Western Mexico.

BACKGROUND: This study aimed to describe the clinical and demographic characteristics of children with confirmed tuberculosis disease and identify associated factors. METHODS: We conducted a retrospective and observational study at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Inpatient and outpatient children under 18 years of age who were reported to the National Epidemiological Surveillance System (SINAVE, for its Spanish acronym) for suspected tuberculosis and who had molecular or microbiological tests for mycobacteria were included in the study. Multivariate analysis with logistic regression was used to analyze associated factors. RESULTS: One hundred and nine patients under 18 years of age with suspected tuberculosis were included in the study. About 50.5% (55/109) were male, and the median age was 11 years. Tuberculosis was confirmed in 55% (n = 60): 15% (9/60) had a pulmonary infection, and the rest (51/60) had an extrapulmonary infection. The diagnostic tests used were histopathological study (n = 26), expectoration or gastric aspirate stains (n = 17), polymerase chain reaction (n = 12), and cultures (n = 5). Positive purified protein derivative (PPD) or interferon-gamma release assay (IGRA) tests were found in 33.9%. Malnutrition (odds ratio [OR] 15.9, 95% confidence interval [CI]: 2.3-109), and consumption of unpasteurized products (OR 7.45, 95% CI: 1.02-54.3) were associated with tuberculosis disease in children. CONCLUSIONS: Malnutrition and consumption of unpasteurized dairy products are associated with tuberculosis.

INTRODUCCIÓN: El objetivo de este estudio fue describir las características clínicas y demográficas de niños con enfermedad tuberculosa confirmada e identificar los factores asociados. MÉTODOS: Se realizó un estudio observacional retrolectivo en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron menores de 18 años hospitalizados y ambulatorios que se notificaron al Sistema Nacional de Vigilancia Epidemiológica (SINAVE) por sospecha de tuberculosis y que contaron con pruebas moleculares o microbiológicas para micobacterias. El estudio de los factores asociados se realizó mediante análisis multivariado con regresión logística. RESULTADOS: Se incluyeron en el estudio 109 menores de 18 años con sospecha de tuberculosis. El 50.5% (55/109) fueron de sexo masculino y la mediana de edad fue de 11 años. Se confirmó enfermedad tuberculosa en el 55% (n = 60) de los casos: el 15% (9/60) presentaron infección pulmonar y el resto extrapulmonar. Las pruebas diagnósticas utilizadas fueron el estudio histopatológico (n = 26), tinciones de expectoración o aspirado gástrico (n = 17), reacción en cadena de la polimerasa (n = 12) y cultivos (n= 5). 33.9% de los pacientes presentaron prueba de derivado proteico purificado (PPD) o ensayo de liberación de interferón gamma (IGRA) positiva. Se observó que la desnutrición (razón de momios (RM) 15.9, intervalo de confianza (IC) 95% 2.3 ­ 109) y el consumo de productos no pasteurizados (RM 7.45, IC 95% 1.02 ­ 54.3) se asociaron con enfermedad tuberculosa en niños. CONCLUSIONES: La desnutrición y el consumo de lácteos no pasteurizados se asocian con la enfermedad tuberculosa.

Assessment of alcohol consumption in mexican pregnant women by hair testing of ethyl glucuronide.

There are no studies that have utilized both biomarkers and self-reported data to evaluate maternal alcohol use during pregnancy in Mexico. Therefore, we aimed to describe the prevalence of alcohol consumption in a cohort of 300 Mexican pregnant women. We used a validated ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method to measure hair ethyl glucuronide (EtG) in hair segments that corresponded to the first and second half of pregnancy. We compared the hair EtG values to a self-reported questionnaire on maternal drinking habits and evaluated whether the gestational alcohol use was associated with psychotropic drug use. Based on the EtG measurements, 263 women (87.7%) were alcohol-abstinent during the entire pregnancy, while 37 (12.3%) had used alcohol at least once during the pregnancy. Of these, only two women were found to have problematic alcoholic behavior during the entire pregnancy. No significant differences in sociodemographic characteristics were observed between alcohol-abstinent women and women with drinking habits. The self-reporting data and hair EtG gave heterogeneous results: although 37 women had self-reported alcohol use during pregnancy, only 54.1% of these women tested positive for hair EtG. Of the women who tested positive for hair EtG, 54.1% tested positive for psychoactive substances. In our cohort, the use of drugs of abuse was independent of gestational drinking. This study provided the first objective evidence of prenatal ethanol consumption in a cohort of Mexican pregnant women.

Assessment of licit and illicit drugs consumption during pregnancy by Ultra-High Performance Liquid Chromatography-High Resolution Mass Spectrometry (UHPLC-HRMS) target screening in Mexican women hair.

Substance use in pregnancy is a global public health problem, both in developed and developing countries. Whereas information is available for major western countries, scarce data are present for the second ones. The objective assessment of pregnancy consumption of xenobiotic is provided by analysis of maternal hair, which can account for gestational consumption, given the possibility to analyze 9 cm hair corresponding to the pregnancy months. Here, we describe an ultra-high-performance liquid chromatography high-resolution mass spectrometry (UHPLC-HRMS) method used as screening analysis of classic drugs, new psychoactive substances and medications in hair from a cohort of pregnant Mexican women. The UHPLC-HRMS method included Accucore™ phenyl Hexyl (100 × 2.1 mm, 2.6 µm, Thermo, USA) column with a gradient mobile phase and a full-scan data-dependent MS2 (ddMS2) mode for substances identification (mass range 100-750 m/z). Results from the first 100 samples disclosed the presence of several undeclared and declared psychoactive substances and medications, being methamphetamine and paracetamol the most prevalent ones found in 20% and 43% cases, respectively. In addition, biomarkers of cannabis and tobacco use as well as those of antihistamines and antiemetic drugs were also prevalent. Albeit preliminary, these data confirm the feasibility of hair screening by UHPLC-HRMS to objectively assess xenobiotic consumption in pregnant women with consequent risk of fetal exposure to toxic substances.

Prevalence of Licit and Illicit Drugs Use during Pregnancy in Mexican Women.

For the first time, the present study employed hair testing to investigate the prevalence of classical drugs of abuse and new psychoactive substances use during gestation in a cohort of 300 Mexican pregnant women. An interview was conducted to collect data on sociodemographic aspects of the patients, and a 9 cm-long hair strand was taken from the back of the head of each mother one month after delivery. A validated ultra-high-performance liquid chromatography−high-resolution mass spectrometry method was used for the screening of classic drugs, new psychoactive substances, and medications in maternal hair. Out of 300 examined hair samples from pregnant women, 127 (42.3%) resulted positive for psychoactive substances: 45 (35.4%) for cannabis only, 24 (18.9%) for methamphetamine only, 13 (10.2%) for cocaine only, 1 (0.3%) for heroin, 1 for N-N-dimethyltryptamine (0.3%), 1 for ketamine (0.8%), and 35 (16.3%) for more than one psychoactive substance. Furthermore, seven samples (2.3%) resulted positive for new psychoactive substances (NPS): two samples for synthetic cannabinoids, two for synthetic cathinones, and three for nor-fentanyl, and 3.3% of women hair resulted positive for anticonvulsant, antidepressant, and antipsychotic medications. Finally, 83 women hair samples (27.7%) tested positive for nicotine. Nonsteroidal anti-inflammatory drugs (NSAIDs) and other painkillers (60.0%), medications for the treatment of nausea and vomiting (12.3%), antihistamines (8.7%) and nasal/sinus decongestants (6.7%), cough suppressants (5.0%), and bronchodilator agents (5.0%) were also detected in pregnant women hair. The gestational use of psychoactive substances and exposure to tobacco smoke, assessed by hair testing, were associated with a significantly younger age and with a low education grade of the mothers (p < 0.005). This study provides a significant preliminary indication of the under-reported gestational consumption of licit and illicit psychoactive and pharmacologically active drugs in a Mexican environment, showing the value of toxicological and forensic analyses in the global effort to determine the health risks caused by classic drugs and new psychoactive substances during pregnancy.

Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico.

INTRODUCTION: Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS: Case-control study nested in a cohort and matched for birth weight. We estimated the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS: The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04, 95% CI 1.13-8.14), systemic antibiotics (OR 7.48, 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02, 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14, 95% CI 1.04-1.25) or with venous catheter central (OR 1.11, 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32, 95% CI 0.12-0.84). CONCLUSIONS: Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.

[Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico]. / Incidencia y factores asociados a candidiasis invasiva en una unidad de cuidados intensivos neonatales de México.

INTRODUCTION: Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS: Case-control study nested in a cohort and matched for birth weight. We estimate the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS: The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04; 95% CI 1.13-8.14), systemic antibiotics (OR 7.48; 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02; 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14; 95% CI 1.04-1.25) or with venous catheter central (OR 1.11; 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32; 95% CI 0.12-0.84). CONCLUSIONS: Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.

[Bloodstream infections with Candida glabrata in a neonatal intensive care unit that uses prophylaxis with fluconazole]. / Infección del torrente sanguíneo por Candida glabrata en una unidad de cuidados intensivos neonatales con prescripción de profilaxis con fluconazol.

BACKGROUND: Candida glabrata is an emerging pathogen with the ability to develop tolerance and resistance to azole antifungals, which creates uncertainty about the usefulness of antifungal prophylaxis in newborns. AIMS: The aim of this study was to describe the factors associated with C. glabrata infection in a NICU that uses prophylaxis with fluconazole. METHODS: A case-control study paired by gestational age was designed and conducted at the Civil Hospital of Guadalajara Dr. Juan I. Menchaca. Newborns with C. glabrata infection were studied and for each one a matched control was selected by gestational age. Odds ratios (OR) were estimated with 95% confidence intervals (95% CI) and McNemar test for contrast of hypothesis was applied. RESULTS: Twenty-one infected patients were identified, from whom 66.7% were male; the median gestational age was 31.5 weeks. Increased risk of infection with C. glabrata was observed when there was a prescription of more than one antimicrobial scheme (OR 21, 95% CI, 1.23 - 358.3; p=0.006) and also among patients with surgical comorbidities (OR 8, 95% CI 1.01 - 63.9; p=0.04). During the study period, exposure to fluconazole showed no difference in the risk of infection. CONCLUSIONS: Neonates with more than one antimicrobial regimen and those with surgical comorbidities had a higher risk of C. glabrata infection.

[Risk factors associated to neonatal cross-infection]. / Factores de riesgo asociados a sepsis neonatal nosocomial.

BACKGROUND: Late-onset sepsis (occurring after 3 days of age) either cross-infection (CI) or perinatal is the first cause of morbidity and mortality in neonatal intensive care units (NICU) around the world. Our objective was to determine the current incidence of CI risk factors in neonates admitted to the NICU of the Hospital Civil de Guadalajara during a 9-month period. METHODS: A case-control study with 114 newborns; 38 with CI and 76 controls. Odds ratio with 95 % confidence interval were calculated. RESULTS: Associated risk factors were total parenteral nutrition (OR = 16.54, CI = 6.30-43.39, p < 0.001); weight < 1000 g (OR = 7.33, CI = 2.15-25.01, p < 0.001); intravascular catheter (OR = 6.79, CI = 2.68-17.00, p < 0.001); gestational age < 30 weeks (OR = 4.54, CI = 1.61-12.81, p < 0.003); intratracheal intubation and mechanical ventilation with (OR = 6.98, CI = 2.94-16.5, p < 0.001). CONCLUSIONS: Total parenteral nutrition and weight < 1000 g showed the greatest association with cross-infection; in this study, male gender was not a risk factor.

[Prevalence of extended-spectrum beta-lactamases in enterobacteria of neonatal sepsis and associated factors]. / Prevalencia de ß-lactamasas de espectro extendido en enterobacterias causantes de sepsis neonatal y factores asociados.

BACKGROUND: Infections caused by extended-spectrum beta-lactamases enterobacteria (ESBL-EP) have implications for neonatal morbidity and mortality. AIM: To describe the prevalence of ESBL-EP in neonatal sepsis and associated factors. METHODS: A prospective cohort study was conducted from August 2016 to August 2017; newborn babies (NB) hospitalized in the Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" were included. The ESBL-EP were investigated by double-disk synergy test and its association with clinical and demographic characteristics of the NB. RESULTS: A total of 1,501 hospitalized NB were studied, with an average gestational age of 36.3 weeks. They were diagnosed 196 neonatal sepsis events, the most frequent etiologies were enterobacteria (45.5%). Resistance to ampicilin was found in 88.8% and to broad spectrum cephalosporins in more than 42% of the strains; 22.9% of them were ESBL phenotype. Apgar ≤ 7 at five minutes of life (OR 4.6; 95% CI 1.47-14.6) and gestational age < 37 weeks (OR 5.4; 95% CI 1.04-27.) increase the risk. CONCLUSION: In enterobacteria that cause neonatal sepsis, 22.9% were EP-ESBL; infection was more likely in patients with Apgar ≤ 7 at five minutes of age and in preterm infants.

[Neonatal morbidity and mortality associated with low adherence to prenatal corticosteroids]. / Morbimortalidad neonatal en un entorno de baja adherencia a corticosteroides prenatales.

INTRODUCTION: Prenatal corticosteroids reduce neonatal mortality and morbidity; however, there are few studies in developing countries, and with inconsistent results. The purpose of this study was to quantify the frequency of the use of prenatal corticosteroids and to estimate its effect on the morbidity and mortality of premature newborns. METHODS: A retrospective cohort study was performed on premature newborns selected from a census conducted between January 2016 and August 2017. The use of corticosteroids was taken from the maternal records, and the dependent variables from the neonatal records. An analysis was made of the relationship using logistic regression, adjusted to gestational age and weight. RESULTS: The study included 1083 premature infants of which 53.3% were male. The mean gestational age was 33.4 weeks. Corticosteroids were received by 42%, with latency ≥24hours in 23.6% and ≥48hours in 13.8%. Respiratory distress syndrome was observed in 35% (379/1083), early neonatal sepsis in 4.4% (48/1083), late neonatal sepsis in 10.7% (116/1083), intraventricular haemorrhage in 15.1% (137/908), chronic lung disease in 51.4% (165/321), and death in 22.3% (242/1083). Prenatal corticosteroids decreased the risk of death in children under 34 weeks (OR 0.63, 95% CI 0.40-0.98). The decrease was greater if they presented with latency ≥48hours (OR 0.40, 95% CI 0.20-0.80). The rest of the dependent variables were not modified by the intervention. CONCLUSIONS: In preterm infants, 42% received antenatal corticosteroids. In those with less than 34 weeks, there was a decrease in the risk of death without changes in morbidity.

Factors associated with tuberculosis disease in children from a hospital in Western Mexico / Factores asociados con enfermedad tuberculosa en niños de un hospital del occidente de México

Abstract Background: This study aimed to describe the clinical and demographic characteristics of children with confirmed tuberculosis disease and identify associated factors. Methods: We conducted a retrospective and observational study at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Inpatient and outpatient children under 18 years of age who were reported to the National Epidemiological Surveillance System (SINAVE, for its Spanish acronym) for suspected tuberculosis and who had molecular or microbiological tests for mycobacteria were included in the study. Multivariate analysis with logistic regression was used to analyze associated factors. Results: One hundred and nine patients under 18 years of age with suspected tuberculosis were included in the study. About 50.5% (55/109) were male, and the median age was 11 years. Tuberculosis was confirmed in 55% (n = 60): 15% (9/60) had a pulmonary infection, and the rest (51/60) had an extrapulmonary infection. The diagnostic tests used were histopathological study (n = 26), expectoration or gastric aspirate stains (n = 17), polymerase chain reaction (n = 12), and cultures (n = 5). Positive purified protein derivative (PPD) or interferon-gamma release assay (IGRA) tests were found in 33.9%. Malnutrition (odds ratio [OR] 15.9, 95% confidence interval [CI]: 2.3-109), and consumption of unpasteurized products (OR 7.45, 95% CI: 1.02-54.3) were associated with tuberculosis disease in children. Conclusions: Malnutrition and consumption of unpasteurized dairy products are associated with tuberculosis.

Resumen Introducción: El objetivo de este estudio fue describir las características clínicas y demográficas de niños con enfermedad tuberculosa confirmada e identificar los factores asociados. Métodos: Se realizó un estudio observacional retrolectivo en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron menores de 18 años hospitalizados y ambulatorios que se notificaron al Sistema Nacional de Vigilancia Epidemiológica (SINAVE) por sospecha de tuberculosis y que contaron con pruebas moleculares o microbiológicas para micobacterias. El estudio de los factores asociados se realizó mediante análisis multivariado con regresión logística. Resultados: Se incluyeron en el estudio 109 menores de 18 años con sospecha de tuberculosis. El 50.5% (55/109) fueron de sexo masculino y la mediana de edad fue de 11 años. Se confirmó enfermedad tuberculosa en el 55% (n = 60) de los casos: el 15% (9/60) presentaron infección pulmonar y el resto extrapulmonar. Las pruebas diagnósticas utilizadas fueron el estudio histopatológico (n = 26), tinciones de expectoración o aspirado gástrico (n = 17), reacción en cadena de la polimerasa (n = 12) y cultivos (n= 5). 33.9% de los pacientes presentaron prueba de derivado proteico purificado (PPD) o ensayo de liberación de interferón gamma (IGRA) positiva. Se observó que la desnutrición (razón de momios (RM) 15.9, intervalo de confianza (IC) 95% 2.3 - 109) y el consumo de productos no pasteurizados (RM 7.45, IC 95% 1.02 - 54.3) se asociaron con enfermedad tuberculosa en niños. Conclusiones: La desnutrición y el consumo de lácteos no pasteurizados se asocian con la enfermedad tuberculosa.

Neonatal mortality and associated factors in newborn infants admitted to a Neonatal Care Unit. / Mortalidad neonatal y factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales.

INTRODUCTION: The increasing survival rate of preterm infants has altered the epidemiology of neonatal diseases; however, neonatal mortality is still the main component of child mortality. The objective of this study was to evaluate neonatal mortality and associated factors in newborn infants admitted to a neonatal care unit. MATERIAL AND METHODS: Prospective cohort study conducted between January 2016 and January 2017 at Hospital Civil de Guadalajara "Dr. Juan I. Menchaca." The incidence of deaths and associated conditions was evaluated using a multivariate logistic regression analysis. RESULTS: A total of 9366 live births were registered; 15% (n: 1410) of these were admitted to the neonatal care unit. The mortality rate was 125.5 per 1000 hospitalized newborn infants (95% confidence interval [CI]: 109-144); the main reasons for admission were congenital malformations or genetic disorders (28.2%), infections (24.9%), and respiratory distress (20.9%). The conditions associated with death were gestational age < 37 weeks (OR: 2.41, 95% CI: 1.49-3.93), birth weight < 1500 grams (OR: 6.30, 95% CI: 4.15-9.55), moderate/severe respiratory distress at 10 minutes (OR: 1.89, 95% CI: 1.24-2.86), Apgar score < 7 at 5 minutes (OR: 9.40, 95% CI: 5.76-15.31), congenital malformations (OR: 5.52, 95% CI: 3.12-9.78), and less than 5 antenatal care visits (OR: 1.51, 95% CI: 1.09-2.08). CONCLUSIONS: Preterm birth, low birth weight, respiratory distress, Apgar score < 7, congenital malformations, and a history of < 5 antenatal care visits were associated with a higher risk for death.

INTRODUCCIÓN: La mayor supervivencia de pacientes prematuros ha modificado la epidemiología de las enfermedades del recién nacido, pero la mortalidad neonatal aún es el principal componente de la mortalidad infantil. El objetivo del estudio fue cuantificar la mortalidad neonatal y los factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales. MATERIAL Y MÉTODOS: Estudio de cohorte prospectivo realizado de enero de 2016 a enero de 2017 en el Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Se cuantificó la incidencia de muertes y las condiciones asociadas mediante un análisis multivariado con regresión logística. RESULTADOS: Se registraron 9366 nacidos vivos; fueron internados en la Unidad de Cuidados Neonatales el 15% (n: 1410). La mortalidad fue de 125,5 por 1000 recién nacidos internados (IC 95%: 109-144); las principales causas fueron malformaciones o enfermedades genéticas (28,2%), infecciones (24,9%) y síndrome de dificultad respiratoria (20,9%). Las condiciones asociadas a muerte fueron edad gestacional < 37 semanas (OR 2,41; IC 95%: 1,49-3,93), peso al nacer < 1500 gramos (OR 6,30; IC 95%: 4,159,55), dificultad respiratoria moderada/grave a los 10 minutos de vida (OR 1,89; IC 95%: 1,242,86), Apgar < 7 a los 5 minutos de vida (OR 9,40; IC 95%: 5,76-15,31), malformaciones congénitas (OR 5,52; IC 95%: 3,12-9,78) y menos de cinco consultas de control prenatal (OR 1,51; IC 95%: 1,09-2,08). CONCLUSIONES: El nacimiento prematuro, bajo peso al nacer, dificultad respiratoria, Apgar < 7, malformaciones congénitas y antecedente de < 5 consultas de control prenatal se asociaron con mayor riesgo de muerte.

Airway anomalies in the oculoauriculofrontonasal syndrome.

Oculoauriculofrontonasal syndrome was the subset of patients with oculo-auriculo-vertebral spectrum and frontonasal malformation. Radiographic evidence of tracheal duplication was documented in a male infant with oculoauriculofrontonasal syndrome. Although previously unreported in oculoauriculofrontonasal syndrome, airway anomalies in our case can be attributed to the oculo-auriculo-vertebral component of the oculoauriculofrontonasal syndrome.

Incidencia y factores asociados a candidiasis invasiva en una unidad de cuidados intensivos neonatales de México / Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico

Introducción: Las infecciones neonatales por Candida spp. son eventos graves por su morbimortalidad, sin embargo, en países en vías de desarrollo la información epidemiológica es insuficiente. El objetivo de este estudio fue describir la incidencia y los factores asociados a la infección invasiva por Candida spp. en una unidad de cuidados intensivos neonatales de México.Métodos: Estudio de casos y controles anidado en una cohorte y apareado por el peso al nacer. Se estimó la incidencia de infección neonatal invasiva por Candida spp., y para el análisis bivariado de los factores estudiados se usó la prueba de McNemar para contraste de hipótesis y análisis multivariado con regresión logística.Resultados: La incidencia de la infección fue de 2,27 eventos/1.000 RN vivos. Las especies identificadas fueron C. albicans 35,3% (n: 30), C. parapsilosis 30,6% (n: 26), C. glabrata 31,8% (n: 27) y 2 eventos con C. lipolytica. Los factores asociados a mayor riesgo fueron la ventilación mecánica (OR: 3,04; IC 95%: 1,13-8,14), los antibióticos sistémicos (OR: 7,48; IC 95%: 1,30-42,9), el número de esquemas antimicrobianos (OR: 2,02; IC 95%: 1,01-4,03) y los días con nutrición parenteral total (OR: 1,14; IC 95%: 1,04-1,25) o con catéter venoso central (OR: 1,11; IC 95%: 1,02-1,20). La profilaxis con fluconazol disminuyó el riesgo (OR: 0,32; IC 95%: 0,12-0,84).Conclusiones: Las intervenciones invasivas (catéter central, ventilación mecánica y nutrición parenteral) y el uso de antimicrobianos incrementan el riesgo de infección neonatal por Candida spp., mientras que el fluconazol profiláctico es protector. (AU)

Introduction: Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico.Methods: Case-control study nested in a cohort and matched for birth weight. We estimate the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression.Results: The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04; 95% CI 1.13-8.14), systemic antibiotics (OR 7.48; 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02; 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14; 95% CI 1.04-1.25) or with venous catheter central (OR 1.11; 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32; 95% CI 0.12-0.84).Conclusions: Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective. (AU)

Oxygen Monitoring Reduces the Risk for Retinopathy of Prematurity in a Mexican Population.

BACKGROUND: Retinopathy of prematurity (ROP), a potentially blinding disease, affects preterm infants. High levels of oxygen saturation are a well-known risk factor for ROP. OBJECTIVES: To assess the frequency of ROP type 1 needing treatment after improved oxygen monitoring (2011) in a Mexican preterm population selected for WINROP analyses and to retrospectively revalidate WINROP, an online surveillance system identifying infants at risk of developing ROP type 1. METHODS: Preterm infants born with birth weight (BW) <1,750 g and/or at gestational age (GA) ≤34 weeks, screened for ROP in 2012-2014 at the Hospital Civil de Guadalajara, Mexico were included (n = 151). Eighty-five infants with GA <32 weeks qualified for WINROP analyses. GA, BW, maximal ROP stage, ROP treatment and weekly weights were recorded. The results in the present study were compared to those of a previous WINROP study in the same hospital (2005-2010; n = 352). RESULTS: In the present WINROP cohort, 11.8% of the infants born at GA <32 weeks received treatment compared to 51.0% of the infants in the previous WINROP cohort. One infant (3%) born at GA ≥32 weeks received treatment during the present study period compared to 35.6% during the previous period. WINROP displayed 80.0% sensitivity in infants born at GA <32 weeks in the present study compared to 84.7% in the previous study. CONCLUSIONS: Uncontrolled oxygen supplementation is the major risk factor for severe ROP in infants born at GA ≥32 weeks. After improved oxygen monitoring, the frequency of ROP treatment was dramatically reduced at the Hospital Civil de Guadalajara, Mexico.