ABSTRACT
Abstract Introduction Febrile neutropenia (FN) is a serious complication of cancer chemotherapy. The present study aimed to identify risk factors for documented infection in pediatric patients with FN and cancer. Methods This prospective cohort study included patients under 18 years from 2016 to 2018. Infection was defined according to the Centers for Disease Control and Prevention criteria. Results A total of 172 febrile neutropenic episodes were evaluated. From univariate analysis, the risk factors were: female gender; monocyte count < 100 cell/mm³, platelets < 50,000, C-reactive protein (CRP) > 90 mg/dl and hemoglobin < 7mg/dl at the onset of an episode; two or more episodes of FN, and; fever onset; positive blood culture at the fever onset. Independent risk factors according to the multivariate analysis were: CRP at the onset of a febrile episode > 90mg/dl, fever onset and first blood culture with a positive result. The lowest probability of infection was related to first episode and to platelets > 50,000 at the onset of fever. Conclusion A CRP > 90 at the onset of a febrile episode, platelets < 50,000, second episode or more, first fever episode during hospitalization and positive first blood culture were found to be associated with a higher risk of infection and they could be useful for the establishment of risk scores for infection in neutropenic children.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Sepsis , Febrile Neutropenia , Risk Factors , Bacteremia , Drug Therapy , NeoplasmsABSTRACT
Abstract Objectives: to investigate the information received by pregnant women considering assistance care and educational factors on syphilis and its association with the diagnostic of congenital syphilis in a referral maternity. Methods: a case-control study conducted in a referral maternity in Minas Gerais, Brazil, from 2017 to 2018. A case group included newborns' mothers with presumptive congenital syphilis and A control group was considered healthy newborns ' mothers. Clinical, obstetrics variables and information about maternal educational approach on syphilis during prenatal care were obtained through interviews and medical records. Descriptive and comparative analyses were performed. Chi-square or Fisher's exact test and odds ratio were calculated followed by multivariate logistic regression. Results: sixty mothers were included in the case group and 120 mothers in the control group. Mothers in the case group presented lower schooling level and they were 24 times more likely to have information about the risks of congenital syphilis and five times more likely to had received previous treatment for syphilis and mothers in the control group were 10 times more likely to receive information about Sexually Transmitted Infections during prenatal care. Conclusion: adequate health assistance identifying previous history of syphilis and health education improving its information about Sexually Transmitted Infections can help prevent congenital syphilis, which indicates the necessity of a better approach by the professionals during prenatal care.
Resumo Objetivos: investigar as informações recebidas pela gestante considerando fatores assis-tenciais e educacionais sobre sífilis e a suas associações com o diagnóstico de sífilis congênita em uma maternidade de referência. Métodos: estudo caso-controle realizado em maternidade de referência em Minas Gerais, Brasil, de 2017 a 2018. Grupo caso incluiu mães de recém-nascidos com sífilis congênita presuntiva e o grupo Controle foi considerado mães de recém-nascidos saudáveis. Variáveis clínicas, obstétricas e informações sobre a abordagem educacional materna sobre a sífilis durante a assistência no pré-natal foram obtidas por meio de entrevista e prontuário. Análises descritivas e comparativas foram realizadas. Calculou-se o teste do qui-quadrado ou exato de Fisher e a razão de chances, seguido de regressão logística multivariada. Resultados: sessenta mães foram incluídas no grupo caso e 120 mães foram incluídas no grupo controle. As mães do grupo caso apresentavam menor escolaridade e tiveram 24 vezes mais chances de ter informações sobre os riscos da sífilis congênita e cinco vezes mais chances de ter recebido tratamento anterior para sífilis e as mães do grupo controle tiveram 10 vezes mais chances de receber informações sobre as Infecções Sexualmente Transmissíveis durante a assistência no pré-natal. Conclusão: a assistência a saúde adequada identificando história previa de sífilis da gestante e educação em saúde com melhores informações sobre Infecções Sexualmente Transmissíveis podem ajudar na prevenção de sífilis congênita, o que indica necessidade de melhor abordagem pelos profissionais durante a assistência pré-natal.