RESUMEN
Background: In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016-2021 from 14 sentinel sites to describe the epidemiology of CRS. Method: We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model. Results: During 2016-21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6-16.2), cataract (OR = 7.8, 95% CI: 5.4-11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3-13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2-12.2) and glaucoma (OR = 3.1, 95% CI: 1.2-8.1). Nomogram, along with a web version, was developed. Conclusions: Rubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Cardiomiopatía Hipertrófica/etiología , Hipertensión/etiología , Feocromocitoma/complicaciones , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Neoplásicas del Embarazo/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/cirugía , Adulto , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/fisiopatología , Cesárea , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Neoplasias Primarias Múltiples/complicaciones , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/cirugía , Feocromocitoma/diagnóstico , Feocromocitoma/cirugía , Embarazo , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Complicaciones Neoplásicas del Embarazo/cirugíaRESUMEN
BACKGROUND: The management of hydrocephalus secondary to intraventricular haemorrhage in neonates can be controversial. Temporary diversion of cerebrospinal fluid (CSF) is often required due to the low birth weight and high risks of shunting in these patients. Ventriculosubgaleal (VSG) CSF diversion is an effective way of achieving this goal whilst minimising the risks of complications. It is a well-described technique but is rarely used in contemporary neurosurgical practice. METHODS: Nine neonates treated with VSG shunting for post-haemorrhagic hydrocephalus were assessed. Gestational age, birth weight, duration of treatment efficacy, requirement for permanent shunting and complications were recorded. RESULTS: In all 9 patients, the VSG shunt controlled the progression of hydrocephalus. A permanent shunt was avoided in 2 patients. One patient required revision of the subgaleal shunt to extend the interval to the insertion of a permanent shunt. None of the patients developed any CSF infection or leak. CONCLUSION: VSG CSF diversion offers a simple, effective and relatively safe means of treating hydrocephalus in the neonate, with a low risk of complications and the possibility of avoiding permanent shunting.
