Ethical Issues during Zika Epidemic in Puerto Rico and the Americas.

The Zika virus epidemic and the possible devastating teratogenic effects of the virus represent a challenge. Health authorities have the responsibility to create programs that provide adequate preventive, medical and psychological services to the affected population. The estimated risk of microcephaly in infants of mothers infected with Zika virus is 1 to 13% when the infection occurs in the first trimester of pregnancy. There is insufficient data to estimate the risk of microcephaly when infection occurs in the second or third trimester. Pregnant women and those in reproductive age are advised to avoid traveling to places where there is local transmission of the Zika virus. Human rights advocates have requested, comprehensive sexual and reproductive health services that include expanded access to contraceptive methods including emergency contraception and safe abortion services. These strategies created a debate between the abortion rights and the right of the disabled. The discussion rests on the assumption that there are lives that are not worth living. Most people focus on the most severely affected patients, but few consider that the spectrum of disabilities associated with congenital Zika infection is broad. The rights of children with disabilities and their dignity as individuals should be respected.

Comparative study of the effectiveness of thyroxine and steroids on reduction of neonatal morbidity: outcome at 20 months follow-up.

This study analyzes health, growth and neurodevelopmental outcome of infants who received prenatal corticosteroids with or without thyroxine for fetal lung maturation. During a 12 month period infants from a prospective double blind study who received either steroids or steroids combined with thyroxine for pulmonary maturation and who had reached 18 months of age were recalled for evaluation of health status, growth parameters and neurodevelopmental outcome using the Bayley Scales 2nd edition (BSID-II). Mental developmental index (MDI), psychomotor developmental index (PDI), language developmental age (LDA), cognitive developmental age (CDA), and behavioral rating scales (BRS) were compared for the two treatment groups. The Hollingshead Socioeconomic Status Index was determined for each infant. Of a total of 134 patients enrolled during the study period, 66 patients return for follow up. Data from 60 patients was included in the final analysis. Of these, 32 had received the combination regimen and 28 had solely received only steroids. Demographics and neonatal morbidity were similar in both groups. No statistical differences in growth parameters, hospital admissions, respiratory problems, surgical procedures or frequency of infections were found. Neurodevelopmental parameters (MDI, PDI) were similar in both treatment groups, although, below normal in both groups. Language delay was more common in infants who received prenatal corticosteroids. There were no difference in the incidence of neurologic abnormalities. The addition of thyroxine to steroids did not affect growth or neuro-developmental outcome of the infants at 18 to 22 postnatal age.

Determinants of mortality in patients with the syndrome of persistent pulmonary hypertension of the newborn

El síndrome de hipertensión pulmonar persistente del recién nacido (HPPR) es una de las principales causas de muerte en recién nacidos. Los factores que determinaron mayor riesgo de mortalidad en infantes recién nacidos con HPPR fueron investigados en 38 pacientes administrados a la Unidad de Intensivo Neonatal del Hospital Universitario Pediátrico durante un período de 15 meses. Se compraron factores del historial perinatal, parametros de la admisión, curso clínico, complicaciones surgidas durante la enfermedad y respuesta a tratamiento entre los que sobrevivieron y los que murieron. La diferiencia más significativa entre ambos grupos fue la mayor incidencia de complicaciones, especialmente de escapes de aire del pulmón ("air leaks") en los pacientes que murieron. Esta complicación no se encontró relacionada con los parametros (tratamiento usando en todos los pacientes) fue un determinante del resultado final. El uso de hiperventilación esta asociado a una incidencia alta de neumotorax y de disturbios en el sistema nervioso central. Existen otras modalidades de tratamiento que se estan ensayando en pacientes con pobre prognostico. Tanto el uso de ventilación de altra frecuencia como el uso de oxigenación extracorporea estan asociadas a complicaciones serias. Se hace necesario poder identificar temprano en la enfermedad cuales son los pacientes con altas probabilidades de morir para poder escoger juiciosamente el tratamiento que se ha de instaurar

Management of the neonate with persistent pulmonary hypertension

El síndrome de hipertensión pulmonar persistente del recien nacido (PPHN) es el resultado de la falta de transición normal de la circulación fetal a la extrauterina. El manejo de infantes con hipertensión pulmonar del recien nacido debe llevarse acabo en una unidad de cuidado intensivo neonatal. El objetivo del tratamiento de infantes von PPHN es el de disminuir los cortocircuitos de sangre de derecha a izquierda. El tratamiento cae en tres categorías; a saber, la ventilación mecánica, los agentes farmacológicos, y la terapia de sostén. El manejo de cada infante es individual y depende de la etioloía y la severidad de la enfermedad. A pesar del uso de nuevas modalidades terapéuticas en el manejo de infantes con PPHN, la mortalidad es de 40-60% en los casos más severos. Los infantes que sobreviven tienen un buen pronóstico en cuanto a crecimiento, desarrollo neurológico y cognoscitivo