Association between maternal and perinatal outcomes and histological changes in the placenta of patients with Covid-19: A cohort study.

Although studies evaluated placental involvement in Covid-19 patients, few have assessed its association with clinical repercussions. The study aimed to determine the association between the clinical status and maternal and perinatal outcomes of patients with Covid-19 at delivery and changes in placental histology. It is so far the largest cohort evaluating placentas of patients infected by the SARS-CoV-2. A secondary analysis was conducted of a database from which a cohort of 226 patients, who tested real-time polymerase chain reaction-positive for Covid-19 at delivery and whose placentas were collected and submitted to pathology, was selected for inclusion. One or more types of histological changes were detected in 44.7% of the 226 placentas evaluated. The most common abnormalities were maternal vascular malperfusion (38%), evidence of inflammation/infection (9.3%), fetal vascular malperfusion (0.8%), fibrinoid changes and intervillous thrombi (0.4%). Oxygen use (P = .01) and need for admission to an intensive care unit (ICU) (P = .04) were less common in patients with placental findings, and hospital stay was shorter in these patients (P = .04). There were more fetal deaths among patients with evidence of inflammation/infection (P = .02). Fetal death, albeit uncommon, is associated with findings of inflammation/infection. Oxygen use and need for admission to an ICU were less common among patients with placental findings, probably due to the pregnancy being interrupted early. None of the other findings was associated with maternal clinical status or with adverse perinatal outcome.

[Overview of long COVID in Brazil: a preliminary analysis of a survey to think about health policies]. / Panorama da COVID longa no Brasil: análise preliminar de um inquérito para pensar políticas de saúde.

Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.

Caracterizada por sintomas que permanecem ou aparecem pela primeira vez em até três meses após a infecção pelo SARS-CoV-2, a COVID longa pode se manifestar de diferentes formas, inclusive entre casos não hospitalizados ou assintomáticos. Nesse sentido, este artigo apresenta um panorama da COVID longa no Brasil, com ênfase no diagnóstico, nos sintomas e nos desafios para a nova gestão da saúde. Foram utilizados dados de um estudo realizado com objetivo de investigar a COVID longa em pessoas acometidas pela COVID-19, com dados originais de um inquérito com indivíduos brasileiros adultos (18 anos ou mais) que tiveram COVID-19, coletados entre 14 de março e 14 de abril de 2022, por meio de questionário divulgado em redes sociais. O questionário abordou características sociodemográficas, histórico de infecções por COVID-19, vacinação contra a doença, investigação da situação de saúde e da qualidade de vida antes e após a COVID-19, além da busca e acesso a tratamento. Dos 1.728 respondentes, 720 foram considerados elegíveis para a análise. Desses, 496 (69%) tiveram COVID longa. Os indivíduos com COVID longa reportaram manifestações clínicas como ansiedade (80%), perda de memória (78%), dor generalizada (77%), falta de atenção (75%), fadiga (73%), queda de cabelo (71%), alterações de sono (70%), alterações de humor (62%), indisposição (60%) e dor nas articulações (59%). A maioria procurou os serviços de saúde durante e após a fase aguda de COVID-19 (94% e 80%, respectivamente), o que representa a necessidade de estruturar o sistema de saúde para atender esses pacientes.

Caracterizado por síntomas que permanecen o aparecen por primera vez dentro de los tres meses posteriores a la infección por SARS-CoV-2, la COVID larga puede manifestarse de diferentes formas, incluso entre casos no hospitalizados o asintomáticos. En este sentido, este artículo presenta un panorama la COVID larga en Brasil, con énfasis en el diagnóstico, los síntomas y los desafíos para la nueva gestión de la salud. Se utilizaron datos de una encuesta realizada para investigar la COVID larga en personas afectadas por COVID-19. Se trata de datos originales de una encuesta con individuos brasileños adultos (18 años o más), que tuvieron COVID-19, con datos recolectados entre el 14 de marzo y el 14 de abril de 2022, por medio de un cuestionario divulgado en las redes sociales. El cuestionario abordó características sociodemográficas, historial de infecciones por COVID-19, vacunación contra la enfermedad, investigación de la situación de salud y de la calidad de vida antes y después de COVID-19, además de la búsqueda y acceso a tratamiento. De los 1.728 encuestados, 720 fueron considerados elegibles para el análisis. De ellos, 496 (69%) tenían COVID larga. Las personas con COVID larga informaron manifestaciones clínicas como ansiedad (80%), pérdida de memoria (78%), dolor generalizado (77%), falta de atención (75%), fatiga (73%), pérdida de cabello (71%), cambios en el sueño (70%), cambios de humor (62%), malestar (60%) y dolor en las articulaciones (59%). La mayoría recurrió a los servicios de salud durante y después de la fase aguda de COVID-19 (94% y 80%, respectivamente), lo que representa la necesidad de estructurar el sistema de salud para atender a estos pacientes.

Active pelvic movements on a Swiss ball reduced labour duration, pain, fatigue and anxiety in parturient women: a randomised trial.

QUESTION: How much do active pelvic movements on a Swiss ball during labour affect maternal and neonatal outcomes? METHOD: A randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Two-hundred parturient women. INTERVENTION: The experimental group performed pelvic anteversion and retroversion, lateral pelvic tilts and circular hip movements according to individual obstetric evaluation (foetal station and position, cervical dilatation and the presence of early pushing urge) on a Swiss ball. The control group received usual care. Both groups were permitted to walk and shower. OUTCOME MEASURES: The primary outcome was the duration of the first stage of labour. The secondary outcomes were the duration of the second stage of labour, pain intensity, delivery mode, medication use, local swelling, fatigue, anxiety, satisfaction and neonatal outcomes. RESULTS: The experimental intervention reduced the duration of labour by 179 minutes (95% CI 146 to 213) in stage one and 19 minutes (95% CI 13 to 25) in stage two. It decreased pain by approximately 2 points (95% CI 2 to 2) on a 0-to-10 scale at 30, 60 and 90 minutes. It reduced the risk of a caesarean section (ARR 0.14, 95% CI 0.03 to 0.25; NNT 7, 95% CI 4 to 32) and vulvar swelling (ARR 0.11, 95% CI 0.03 to 0.19; NNT 9, 95% CI 5 to 31). It reduced fatigue by 18 points (95% CI 16 to 21) on a 15-to-75-point scale and anxiety by 9 points (95% CI 8 to 11) on an 18-to-72-point scale. Other effects were negligible or unclear. CONCLUSION: Active pelvic movements on a Swiss ball during labour reduced the duration of labour, pain intensity, and maternal fatigue and anxiety; they also lowered the risk of caesarean section and vulvar swelling. Several effects exceeded the smallest worthwhile effect. REGISTRATION: NCT04124835.

Clinical, epidemiological and laboratory characteristics of cases of Covid-19-related maternal near miss and death at referral units in northeastern Brazil: a cohort study.

Objective: Covid-19 poses a major risk during pregnancy and postpartum, resulting in an increase in maternal mortality worldwide, including in Brazil; however, little research has been conducted into cases of a near miss. This study aimed to describe the frequency of COVID-19-related near miss and deaths during pregnancy or in the postpartum in referral centers in northeastern Brazil, as well as the clinical, epidemiological, and laboratory characteristics of the women who experienced a severe maternal outcome.Methods: A retrospective and prospective cohort study was performed between April 2020 and June 2021 with hospitalized pregnant and postpartum women with a diagnosis of COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR). Data from five tertiary hospitals in northeastern Brazil were evaluated. Descriptive statistical analysis was performed using Epi Info, version 7.2.5.0.Results: A total of 463 patients were included. Of these, 64 (14% of the sample) had a severe maternal outcome, with 42 cases of near miss (9%) and 22 maternal deaths (5%). Patients who had a severe maternal outcome were predominantly young (median age 30 years) and 65.6% were black or brown-skinned. The women had between 6 and 16 years of schooling; 45.3% had a stable partner; 81.3% were pregnant at the time of admission to the study; and 76.6% required a Cesarean section. The great majority (82.8%) had severe acute respiratory syndrome (SARS). Other complications included hypertensive syndromes (40.6%), pneumonia (37.5%), urinary tract infections (29.7%), acute renal failure (25.0%) and postpartum hemorrhage (21.9%). Sepsis developed in 18.8% of cases, neurological dysfunction in 15.6%, and hepatic dysfunction and septic shock in 14.1% of cases each. The relative frequency of admission to an intensive care unit was 87.5%, while 67.2% of the patients required assisted mechanical ventilation, and 54.7% required noninvasive ventilation. Antibiotics were prescribed in 93.8% of cases and corticosteroids in 71.9%, while blood transfusion was required in 25.0% of cases and renal replacement therapy in 15.6%. Therapeutic anticoagulants were administered to 12.5% of the patients. Of the patients who had a severe maternal outcome, the frequency of respiratory dysfunction was 93.8%, with 50.0% developing neurological dysfunction and 37.5% cardiovascular dysfunction. Hematological dysfunction was found in 29.7%, renal dysfunction in 18.8%, and uterine dysfunction in 14.1%. Hepatic dysfunction occurred in 7.8% of the sample. The near-miss ratio for Covid-19 was 1.6/1000 live births and the maternal mortality ratio for Covid-19 was 84.8/100,000 live births, with a mortality index of 34.4% in the sample.Conclusion: This study revealed a low Covid-19-related maternal near miss (MNM) ratio of 1.6/1000 live births and a high Covid-19-related maternal mortality ratio (MMR) of 84.81/100,000 live births. The mortality index was also high. Most of the patients were admitted while pregnant, were young, married and black or brown-skinned, and none had completed university education. The majority had SARS and required admission to an intensive care unit and mechanical ventilation. Most were submitted to a Cesarean section.

Factors associated with severe maternal outcome in patients admitted to an intensive care unit in northeastern Brazil with postpartum hemorrhage: a retrospective cohort study.

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide, particularly in low- and middle-income countries; however, the majority of these deaths could be avoided with adequate obstetric care. Analyzing severe maternal outcomes (SMO) has been a major approach for evaluating the quality of the obstetric care provided, since the morbid events that lead to maternal death generally occur in sequence. The objective of this study was to analyze the clinical profile, management, maternal outcomes and factors associated with SMO in women who developed PPH and were admitted to an obstetric intensive care unit (ICU) in northeastern Brazil. METHODS: This retrospective cohort study included a non-probabilistic, consecutive sample of postpartum women with a diagnosis of PPH who were admitted to the obstetric ICU of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between January 2012 and March 2020. Sociodemographic, biological and obstetric characteristics and data regarding childbirth, the management of PPH and outcomes were collected and analyzed. The frequency of maternal near miss (MNM) and death was calculated. Multiple logistic regression analysis was performed to determine the adjusted odd ratios (AOR) and their 95% confidence intervals (95% CI) for a SMO. RESULTS: Overall, 136 cases of SMO were identified (37.9%), with 125 cases of MNM (34.9%) and 11 cases of maternal death (3.0%). The factors that remained associated with an SMO following multivariate analysis were gestational age ≤ 34 weeks (AOR = 2.01; 95% CI: 1.12-3.64; p < 0.02), multiparity (AOR = 2.20; 95% CI: 1.10-4.68; p = 0.02) and not having delivered in the institute (AOR = 2.22; 955 CI: 1.02-4.81; p = 0.04). CONCLUSION: Women admitted to the obstetric ICU with a diagnosis of PPH who had had two or more previous deliveries, gestational age ≤ 34 weeks and who had delivered elsewhere were more likely to have a SMO.

Factors associated with severe acute respiratory syndrome in pregnant/postpartum women with COVID-19 receiving care at referral centers in northeastern Brazil: Secondary analysis of a cohort study.

Background: At the beginning of the COVID-19 pandemic, the greater risks associated with the new SARS-CoV-2 pathogen in pregnant women were as yet unclear. This study analyzed factors associated with severe acute respiratory syndrome (SARS) in pregnant/postpartum women with COVID-19. Methods: A prospective and retrospective cohort study was conducted in eight referral centers in northeastern Brazil between April 2020 and December 2021 involving pregnant/postpartum women with a positive COVID-19 RT-PCR test. A multivariate analysis was then conducted using a hierarchical logistic regression model to evaluate the association between the independent variables and the presence of SARS. Findings: Of 611 patients included, 522 were pregnant and 83 were postpartum, at the time of admission. Criteria for SARS were present in 215 patients (35·2%). Factors associated with SARS included overweight and/or obesity (adjusted odds ratio/AOR: 1·95; 95%CI: 1·21-3·12; p = 0·0054), parity ≥2 (AOR: 1·72; 95%CI: 1·21-2·45; p = 0·0025), gestational age <34 weeks (AOR: 3·54; 95%CI: 2·47-5·07; p < 0·0001) and duration of symptoms >7 days (AOR: 1·97; 95%CI: 1·35-2·89; p = 0·0004). SARS increased the likelihood of requiring oxygen therapy (RR = 8·80; 95%CI: 6·25-12·40; p = 0·0000), mechanical ventilation (RR = 8·15; 95%CI: 4·67-14·21; p = 0·0000), and admission to an ICU (RR = 6·54; 95%CI: 4·70-9·11; p = 0·0000), and of maternal near miss (RR = 10·82; 95%CI: 1·20-22·47; p = 0·0000) and maternal death (RR = 8·12; 95%CI: 3·11-21·09; p = 0·0000). Interpretation: In patients with COVID-19, parity ≥2, overweight/obesity, gestational age <34 weeks and duration of symptoms >7 days increased the risk of SARS. Cesarean sections, oxygen therapy, and mechanical ventilation were more common in patients with SARS.

Sleep in children from northeastern Brazil with congenital Zika syndrome: assessment using polysomnography.

STUDY OBJECTIVES: We performed this study to describe the characteristics of sleep in children with congenital Zika syndrome through polysomnographic assessment. METHODS: Polysomnography with neurological setup and capnography was performed. Respiratory events were scored according to American Academy of Sleep Medicine criteria. Children were classified based on neuroclinical examination as having corticospinal plus neuromuscular abnormalities or exclusively corticospinal abnormalities. Neuroradiological classification was based on imaging exams, with children classed as having supratentorial plus infratentorial abnormalities or exclusively supratentorial abnormalities. RESULTS: Of 65 children diagnosed with congenital Zika syndrome, sleep apnea was present in 23 children (35.4%), desaturation in 26 (40%), and snoring in 13 (20%). The most prevalent apnea type was central in 15 children (65.2%), followed by obstructive apnea in 5 (21.7%) and mixed type in 3 (13%). The average of the lowest saturation recorded was slightly below normal (89.1 ± 4.9%) and the mean partial pressure of end-tidal carbon dioxide value was normal. Periodic leg movements were present in 48 of 65 children. Lower ferritin levels were observed in 84.6% of children. Palatine and pharyngeal tonsils (adenoids) were small in most children and not associated with the presence of obstructive apnea. Ventriculomegaly and subcortical and nucleus calcification were the most frequent neuroimaging findings. Supratentorial and infratentorial anomalies were present in 26.7% (16 of 60) and exclusively supratentorial changes in 73.3% (44 of 60). In the neuroclinical classification, isolated corticospinal changes were more frequent and the mean peak in capnography was lower in this group. There was no difference regarding the presence of apnea for children in the neuroclinical and neuroradiological classification groups. CONCLUSIONS: Sleep disorders were frequent in children with congenital Zika syndrome, with central sleep apnea being the main finding. CITATION: Brandão Marquis V, de Oliveira Melo A, Pradella-Hallinan M, et al. Sleep in children from northeastern Brazil with congenital Zika syndrome: assessment using polysomnography. J Clin Sleep Med. 2023;19(10):1759-1767.

Symptoms of anxiety and depression in women with gestational trophoblastic disease compared to women who had a miscarriage: a cross-sectional study.

This study was conducted between March 2020 and February 2021 to analyze anxiety and depression symptoms in 64 women with gestational trophoblastic disease (GTD) and 99 women who had miscarried. The Hospital Anxiety and Depression Scale (HADS) was applied by telephone three months after pregnancy loss. Multivariate analysis was performed using hierarchical logistic regression to evaluate associations between variables. Probable anxiety (HADS-A ≥ 8) and depression (HADS-D ≥ 8) were found in 53.1% and 43.8% of the GTD group and 49.5% and 39.4% of the miscarriage group, with no difference between the groups. Severe symptoms of anxiety (HADS-A 15-21) and depression (HADS-D 15-21) were found, respectively, in 12.5% and 4.7% of the GTD group and in 9.1% and 4.0% of the miscarriage group, also with no difference between the groups. Lack of partner support proved a risk factor for anxiety and depression, while poor education increased the risk of depression symptoms 3.43-fold following pregnancy loss. In conclusion, three months after pregnancy loss the frequency of anxiety and depression symptoms was similarly high in both groups, with poor education and lack of partner support being significant risk factors for the subsequent development of psychiatric morbidity.

Analysis of the Measurement Properties of the Female Sexual Function Index 6-item Version (FSFI-6) in a Postpartum Brazilian Population.

OBJECTIVE: We evaluated internal consistency, test-retest reliability, and criterion validity of the Brazilian Portuguese version of the Female Sexual Function Index 6-item Version (FSFI-6) for postpartum women. METHODS: Therefore, questionnaires were applied to 100 sexually active women in the postpartum period. The Cronbach α coefficient was used to evaluate the internal consistency. Test-retest reliability was analyzed by Kappa for each item of the questionnaire and by the Wilcoxon parametric test, comparing the total scores of each evaluation. For the assessment of criterion validity, the FSFI was used as the gold standard and the receiver operating characteristic (ROC) curve was constructed. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 21.0 (IBM Corp., Armonk, NY, USA). It was found that the internal consistency of the FSFI-6 questionnaire was considerably high (0.839). RESULTS: The test-retest reliability results were satisfactory. It can also be stated that the FSFI-6 questionnaire presented excellent discriminant validity (area under the curve [AUC] = 0.926). Women may be considered as having sexual dysfunction if the overall FSFI-6 score is < 21, with 85.5% sensitivity, 82.2% specificity, positive likelihood ratio of 4.81 and negative likelihood ratio of 0.18. CONCLUSION: We conclude that the Brazilian Portuguese version of FSFI-6 is valid for use in postpartum women.

OBJETIVO: Avaliamos a consistência interna, a confiabilidade teste-reteste e a validade de critério do questionário FSFI-6 para a população brasileira no pós-parto. MéTODOS: Foram aplicados questionários em 100 mulheres sexualmente ativas no pós-parto. O coeficiente alfa de Cronbach foi utilizado para avaliar a consistência interna. A confiabilidade teste-reteste foi analisada pelo Kappa para cada item do questionário e pelo teste paramétrico de Wilcoxon, comparando-se os escores totais de cada avaliação. Para avaliar a validade de critério, o FSFI foi utilizado como padrão-ouro e a curva característica de operação de receptor (ROC, na sigla em inglês) foi construída. As análises estatísticas foram realizadas utilizando-se o software IBM SPSS Statistics for Windows, versão 21.0 (IBM Corp., Armonk, NY, USA). RESULTADOS: Os resultados da confiabilidade teste-reteste foram satisfatórios. O FSFI-6 apresentou uma excelente validade discriminante (área sob a curva [AUC, na sigla em inglês] = 0,926). Considera-se presente a disfunção sexual se o escore geral do FSFI-6 for < 21, com sensibilidade de 85,5%, especificidade de 82,2%, razão de verossimilhança positiva de 4,81 e razão de verossimilhança negativa de 0,18. CONCLUSãO: Concluímos que a versão em português do FSFI-6 se mostrou válida para uso em mulheres no pós-parto.

Analysis of the Measurement Properties of the Female Sexual Function Index 6-item Version (FSFI-6) in a Postpartum Brazilian Population / Análise das propriedades de medição do female sexual function index 6-item version (FSFI-6) em uma população brasileira de pós-parto

Abstract Objective We evaluated internal consistency, test-retest reliability, and criterion validity of the Brazilian Portuguese version of the Female Sexual Function Index 6-item Version (FSFI-6) for postpartum women. Methods Therefore, questionnaires were applied to 100 sexually active women in the postpartum period. The Cronbach α coefficient was used to evaluate the internal consistency. Test-retest reliability was analyzed by Kappa for each item of the questionnaire and by the Wilcoxon parametric test, comparing the total scores of each evaluation. For the assessment of criterion validity, the FSFI was used as the gold standard and the receiver operating characteristic (ROC) curve was constructed. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 21.0 (IBM Corp., Armonk, NY, USA). It was found that the internal consistency of the FSFI-6 questionnaire was considerably high (0.839). Results The test-retest reliability results were satisfactory. It can also be stated that the FSFI-6 questionnaire presented excellent discriminant validity (area under the curve [AUC] = 0.926). Women may be considered as having sexual dysfunction if the overall FSFI-6 score is < 21, with 85.5% sensitivity, 82.2% specificity, positive likelihood ratio of 4.81 and negative likelihood ratio of 0.18. Conclusion We conclude that the Brazilian Portuguese version of FSFI-6 is valid for use in postpartum women.

Resumo Objetivo Avaliamos a consistência interna, a confiabilidade teste-reteste e a validade de critério do questionário FSFI-6 para a população brasileira no pós-parto. Métodos Foram aplicados questionários em 100 mulheres sexualmente ativas no pós-parto. O coeficiente alfa de Cronbach foi utilizado para avaliar a consistência interna. A confiabilidade teste-reteste foi analisada pelo Kappa para cada item do questionário e pelo teste paramétrico de Wilcoxon, comparando-se os escores totais de cada avaliação. Para avaliar a validade de critério, o FSFI foi utilizado como padrão-ouro e a curva característica de operação de receptor (ROC, na sigla em inglês) foi construída. As análises estatísticas foram realizadas utilizando-se o software IBM SPSS Statistics for Windows, versão 21.0 (IBM Corp., Armonk, NY, USA). Resultados Os resultados da confiabilidade teste-reteste foram satisfatórios. O FSFI-6 apresentou uma excelente validade discriminante (área sob a curva [AUC, na sigla em inglês] = 0,926). Considera-se presente a disfunção sexual se o escore geral do FSFI-6 for < 21, com sensibilidade de 85,5%, especificidade de 82,2%, razão de verossimilhança positiva de 4,81 e razão de verossimilhança negativa de 0,18. Conclusão Concluímos que a versão em português do FSFI-6 se mostrou válida para uso em mulheres no pós-parto.

Motor and cognitive response to intensive multidisciplinary therapy: the first reported case of congenital Zika virus syndrome.

PURPOSE: To provide a detailed description of the development of the first case of congenital Zika syndrome (CZS) to be reported in the literature worldwide. CASE DESCRIPTION: This report describes the case of a child with CZS monitored from pregnancy until four years of age, with periodic evaluations of head circumference, weight, height, motor function according to the Gross Motor Function Measure (GMFM-88), and the occurrence of comorbidities. OUTCOMES: The child's birth weight and length were normal (z-score = 1.1 and -1.95, respectively), while head circumference was below the expected value (z-score = -3.15). At 48 months, head circumference reached 43 cm (z-score = -4.48). During daily home physiotherapy sessions, the child achieved developmental milestones, standing unsupported at 17 months, with a GMFM-88x score of 137. With specialist therapy, the child walked independently at 36 months and a total GMFM-66 score of 214 was achieved by 42 months. In the four years of follow-up, the child was hospitalized four times for different reasons. No convulsive seizures occurred. CONCLUSIONS: Despite severe neurological impairment, the child's weight and height are adequate for age, with motor and cognitive function improving over the first four years of life.

Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium.

Background: Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies. Methods: We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks. Findings: Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association. Interpretation: This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%.

The Impact of COVID-19 Pandemic and Social Distancing on Motor Function and Growth of Children with Congenital Zika Syndrome: A Prospective Cohort Study.

This article describes the impact of social distancing during the COVID-19 pandemic on the motor function and growth of children with congenital Zika syndrome (CZS). Children's motor function, weight, height and joint range of movement (ROM) were evaluated before the onset of the pandemic and soon after their return to face-to-face activities at a rehabilitation center. Fifty-two children (Mean 46.07 months, SD 3.76 months) were assessed. Results showed a reduction in proportion of children with adequate body mass index (p = .04), an increase in proportion with adequate height (p < 0.001), deterioration in gross motor function in children with severe motor impairment (p < .01), and a reduction in the maximum ROM for shoulder (p < .01) and wrist flexion (p = .046), elbow (p = .01), knee (p = .03) and ankle extension (p < .01), and an increase in hip flexion (p = .04). The social distancing period appears to have contributed to important losses in motor function and joint mobility of children with CZS; however, this period of time appeared to have less impact on their growth.

Effect of neurodevelopmental treatment in children with congenital Zika syndrome: A pilot study.

AIM: To evaluate the effects of neurodevelopmental treatment (NDT) in children with congenital Zika syndrome (CZS). METHODS: This prospective, interventional cohort study involved children with CZS undergoing follow-up at a specialist centre in northeastern Brazil. The duration of the proposed NDT protocol was 1 year, with 45-min sessions delivered one to five times weekly. Motor function, weight, height, head circumference and the incidence of comorbidities were evaluated in children before protocol initiation and then at 3, 6 and 12 months of treatment. RESULTS: Thirty children were evaluated (age mean 30.1 ± 3 months). Motor function improved from baseline to 6 months (P = 0.001). No difference in weight and head circumference z-score (P = 0.51 and P = 0.29, respectively), but an increase in height z-score (P < 0.001) was observed over the evaluation period. There was a reduction in the incidence of upper respiratory tract infections, pneumonia and urinary tract infections over the follow-up period. CONCLUSIONS: NDT proved to be a viable treatment approach that can improve motor function and reduce the incidence of comorbidities in children with CZS, while having no harmful effects on their growth.

Vocalization during the second stage of labor to prevent perineal trauma: A randomized controlled trial.

BACKGROUND AND PURPOSE: Most women suffer some degree of perineal trauma during vaginal delivery. Second stage management strategies, including vocalization, to protect the perineum have been investigated. OBJECTIVE: To compare the frequency and degree of perineal trauma at vaginal delivery, with and without use of the vocalization maneuver during the second stage of labor. MATERIALS AND METHODS: This is an open-label, randomized controlled trial. We conducted the study at the Center for Normal Deliveries of IMIP. We included low-risk women without prior cesarean deliveries. Women who met the inclusion criteria and signed the informed consent form were randomized to one of two groups: Group A (experimental) and Group B (control). A physical therapist encouraged women in Group A to maintain an open glottis during pushing and to emit sounds when exhaling (vocalization). Women in Group B underwent routine humanized vaginal deliveries. The outcomes of the study were perineal integrity and degree of perineal laceration. These were measured by the study team immediately after completion of the third stage of labor. RESULTS: Women in Group A tended to have less severe perineal tear (less second and third degree lacerations) and smaller lacerations than women in group B. The vocalization maneuver reduced the risk of a perineal tear greater than 2 cm by 68% (NNT 2.2). There was no difference in other outcomes. CONCLUSION: Encouraging women to follow a vocalization protocol coached by a physical therapist during the second stage of labor can be a helpful labor assistance technique, since this study showed that vocalization is associated with less extensive perineal tears. CLINICAL TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov (www. CLINICALTRIAL: gov) registration number: NCT03605615.

Urological outcomes in children with congenital Zika syndrome: The experience of a cohort in Campina Grande, Brazil.

OBJECTIVE: To describe the urological outcomes in children with congenital Zika syndrome (CZS) and investigate the relationship between clinical and urological findings in this population. METHODS: This cross-sectional study involved children with CZS followed up by a referral centre for children with microcephaly in the state of Paraiba in northeast Brazil. The urological evaluation included clinical history, urine culture results, ultrasonography of the urinary tract, and urodynamic evaluation, following the protocol proposed by Costa Monteiro et al. (2017). Descriptive statistical analysis was performed in addition to association and correlation tests, considering clinical and urodynamic variables. RESULTS: Among the 88 children with CZS (35.5 ± 5.5 months), 97.7% had microcephaly, and 51% presented urinary tract infection (UTI) confirmed with clinical history and lab tests. The number of confirmed UTI episodes varied from one to 14 per child. The urodynamic evaluation confirmed the presence of an overactive bladder in 78 children and incomplete voiding in 50. Urodynamic findings were associated with the number of confirmed UTI episodes, child's sex, and actual weight, in addition to the use of anticonvulsant and myorelaxant drugs. CONCLUSIONS: UTIs were confirmed in most children. Other urological outcomes observed were overactive bladder and low bladder capacity, which were associated with the number of confirmed UTI episodes, use of anticonvulsants and myorelaxants, and the child's sex and weight. These are treatable conditions, and it is paramount that paediatricians, neonatologists, and infectious disease specialists are aware of them to make clinical decisions and help reduce the risk of renal damage and other morbidities.

Association of sFlt-1 and C-reactive protein with outcomes in severe preeclampsia: A cohort study.

ABSTRACT: To determine the association between soluble FMS-like tyrosine kinase-1 (sFlt-1) and high-sensitivity C-reactive protein (hs-CRP) with maternal and perinatal outcomes in patients with preeclampsia (PE) with severe features.A cohort study was conducted on 100 patients, 60 with PE with severe features, and 40 healthy women in the third trimester of pregnancy. Admission serum levels of sFlt-1 and hs-CRP and clinical and epidemiological parameters were evaluated to quantify the predictive ability of adverse maternal and perinatal outcomes using hierarchical multiple regression and receiver operating characteristic curves.Compared to controls, patients with PE and severe features had significantly higher levels of sFlt-1 but not hs-CRP. sFlt-1 and hs-CRP proved to be reasonable parameters for the prediction of composite adverse maternal outcomes. However, we found no correlation between these 2 biomarkers. PE integrated estimate of risk scores were correlated only with sFlt-1 levels. Regarding fetal outcomes, unlike hs-CRP, sFlt-1 was strongly associated with birth weight and Apgar score < 7 at 5 minutes. Following multivariate analysis, maternal age, previous hypertension, sFlt-1, and hs-CRP levels remained independently associated with composite adverse maternal outcomes.sFlt-1 levels were elevated in patients with PE and severe features. Both sFlt-1 and hs-CRP may predict composite adverse maternal outcomes but do not correlate with each other and differ in perinatal morbidity patterns. These data support the hypothesis that the varied outcomes in PE may result from different pathogenic pathways.