Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people.

BACKGROUND: Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS: We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS: One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS: This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT: This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.

Triple versus monoterapia antibiótica en apendicitis complicada: ensayo clínico abierto, Instituto Hondureño de Seguridad Social, Tegucigalpa / Triple versus antibiotic monotherapy in complicated appendicitis: open clinical trial, Honduran Social Security Institute, Tegucigalpa

Antecedentes: En Honduras no se dispone de evidencia publicada sobre diferencias en eicacia de esquemas terapéuticos basados en antibióticos para el manejo post-quirúrgico para apendicitis aguda complicada en niños. Objetivo: Determinar la eicacia y seguridad de triple versus monoterapia antibiótica en pacientes pediátricos con apendicitis aguda complicada, Hospital de Especialidades, Instituto Hondureño de Seguridad Social (IHSS), Tegucigalpa, 2011-2013. Métodos: Ensayo clínico abierto, dos esquemas terapéuticos: Triple Terapia (Ampicilina+Amikacina+Clindamicina, GrupoTT) y Ertapenem (GrupoE) durante 7 días. Se incluyeron pacientes con diagnóstico de apendicitis aguda complicada y sometidos a apendicectomía abierta. Los pacientes fueron evaluados en Consulta Externa, 7 días post-quirúrgicos. Se obtuvo aprobación por Comité de Etica en Investigación IHSS. Se utilizó prueba Chi-cuadrado, Riesgo Relativo, intervalo de conianza de 95% y valor de p<0.05 para determinar diferencias entre grupos. Resultados: Seincluyeron 58 pacientes en GrupoTT y 29 en Grupo E, edad media fue 7.3 años (IC95% 6.7-7.9) GrupoTT y 8 años (IC95% 7-9) GrupoE. La evolución promedio del cuadro clínico fue 31.6 horas GrupoTT y 43.8 horas GrupoE (p=0.034). No se encontró diferencias signiicativas respecto a efectos adversos de importancia clínica, complicaciones postoperatorias, estancia intrahospitalaria en días, o necesidad de readmisión por recurrencia/complicación posterior al alta. Discusión: La monoterapia con ertapenem presentó similar eicacia y seguridad que la triple terapia con Ampicilina+Amikacina+Clindamicina empleada actualmente en el tratamiento del paciente pediátrico con apendicitis complicada. El estudio está limitado por que los dos grupos de estudio fueron diferentes en la evolución de la enfermedad...(AU)