Ophthalmologic Findings in a Premature Infant leading to a Zika Diagnosis during the COVID-19 Pandemic: A Case Report.

We report on the first case of congenital Zika syndrome to be identified during the COVID-19 pandemic in Puerto Rico. The Zika virus (ZIKV) infection was first seen in Puerto Rico in December 2015. It is a flavivirus with vertical transmission, spreading from infected mothers to their fetuses and having a broad spectrum of clinical manifestations, of which microcephaly is the most worrisome. In Puerto Rico, routine ZIKV screening during pregnancy was implemented in October 2016. However, this practice has become less frequent over time. Nevertheless, the transmission of ZIKV continues, so it is important to ensure routine ZIKV screening in endemic regions, such as Puerto Rico.

Cumulative risk factors and mental health of mothers of infants admitted to the neonatal intensive care unit.

Purpose: The present study examined predictive linkages between multiple risk factors and their contribution to the development of anxiety and depression in Puerto Rican mothers of infants admitted to the Neonatal Intensive Care Unit (NICU).Method: The scales used were: the Hamilton Anxiety Rating Scale, the Edinburgh Postpartum Depression Scale, the Hollingshead, and a Demographic Questionnaire was constructed to obtain information about mother and infant characteristics.Results: Both the cumulative psychosocial risk factor (B = 0.267, p = .011) and the cumulative neonatal risk factor (B = -0.220, p = .039) were significant predictors of mothers' anxiety.Discussion: It could be beneficial to create psychosocial interventions in the NICU to address parents' needs and promote emotional resilience. Also, training staff to provide an adequate explanation to mothers, regarding the infants' recovery process is of particular importance.

First Autopsy of a Newborn with Congenital Zika Syndrome in Puerto Rico.

We report on the first autopsy performed on a neonate with congenital Zika syndrome in Puerto Rico. A term male was born to a mother with confirmed Zika virus infection; he had a prenatal diagnosis of microcephaly and multiple cerebral calcifications, among other anomalies, and a normal male karyotype (determined by amniocentesis). He required neonatal resuscitation at birth and died at 2 days ofage. At autopsy, his head circumference was only 1.5 standard deviations below the mean, not fulfilling the criteria for microcephaly. He presented scissor legs, clenched and hyperflexed hands, and multiple contractures (arthrogryposis). The central nervous system findings were consistent with Zika encephalopathy: ventriculomegaly, lissencephaly, and severe encephalic degeneration with numerous dystrophic calcifications, among other findings. These anomalies were most likely secondary to congenital ZV infection. Although prenatally diagnosed with microcephaly, he did not fulfill the criteria after birth, which fact indicates the need for reassessment of the definition of microcephaly as it applies to patients exposed prenatally to the ZV.

Neonatal Sacrococcygeal Neuroblastoma Mimicking a Teratoma.

We reported the first case of a congenital intrapelvic presacral neuroblastoma in Puerto Rico managed in the early neonatal period. The preoperative diagnosis was a sacrococcygeal teratoma Altman stage IV classification. This case confirms the importance of a comprehensive physical examination and observation of low-risk newborn infants with a history of adequate prenatal care and an unremarkable fetal ultrasonogram during pregnancy.

First case of dizygotic twins with lamellar ichthyosis in Puerto Rico.

Lamellar Ichthyosis is a rare condition requiring thickened collodion-like skin for clinical diagnosis. These infants have abnormal epidermal barrier, which leads to serious complications. It may present with extensive skin lesions and should be considered a diagnostic possibility in sick neonates. Recent studies have identified a condition characterized by deficiency of the interleukin-1 receptor antagonist (DIRA) resembling Ichthyosis. We report dizygotic twins that presented lamellar ichthyosis. Twin #1 had a neonatal period complicated with sepsis, fungemia and urinary tract infection. Twin #2 had sepsis, urinary tract infection and conjunctivitis. We tested the parents and one patient for DIRA. Tests were negative. To our knowledge, this is the first case of dizygotic twins that presented with lamellar ichthyosis in Puerto Rico. Physicians should include DIRA in the differential diagnosis of skin lesions in newborns.