Prevalence of sleep disorders in children with Congenital Zika Syndrome.

Studies have reported that children with Congenital Zika Syndrome (CZS) experience changes in their sleep patterns, which can result in mood disturbances, behavioral issues and delays in growth and development. This systematic review synthesized the available evidence on the prevalence of sleep disorders in children with CZS. Eligible studies were those with an observational design that reported sleep disorders in children with CZS using validated questionnaires, polysomnography/electroencephalographic recording or parent/caregiver reports. Searches were conducted in PubMed, Web of Science, SCOPUS and Embase, as well as a gray literature search using Google Scholar. The Freeman-Tukey double-arcsine transformation with a random-effects model was used to estimate the pooled prevalence of sleep disorders with a 95% confidence interval (CI). Five studies were included and data from 340 Brazilian children with CZS were analyzed. The overall prevalence of sleep disorders was 27.4% (95% CI 16.7-39.4), without differences among studies using validated questionnaires (29.4%, 95% CI 21.4-37.8) or report from parents and caregivers (27.4%, 95% CI 11.5-47.0). Sleep disorders are prevalent in children with CZS, impacting their development and quality of life. It is critical to examine the quality of sleep in these children to develop appropriate interventions that can mitigate these issues.

The article discusses a systematic review of studies that have explored the prevalence of sleep disorders in children with Congenital Zika Syndrome (CZS), a condition caused by the Zika virus. The study found that children with CZS often experience changes in their sleep patterns, which can lead to mood disturbances, behavioral issues and delays in growth and development. The review included five studies with a total of 340 Brazilian children with CZS, and the overall prevalence of sleep disorders was found to be 27.4%. This indicates that sleep disorders are prevalent in children with CZS and can significantly impact their development and quality of life. The authors suggest that further research is needed to develop appropriate interventions to mitigate these issues.

Growth During Infancy After Extremely Preterm Birth: Associations with Later Neurodevelopmental and Health Outcomes.

OBJECTIVE: To evaluate associations between changes in weight, length, and weight/length ratio during infancy and outcomes later in life among individuals born extremely preterm. STUDY DESIGN: Among participants in the Extremely Low Gestational Age Newborn (ELGAN) study, we measured weight and length at discharge from the neonatal intensive care unit (NICU) and at age 2 years and evaluated neurocognitive, psychiatric, and health outcomes at age 10 years and 15 years. Using multivariable logistic regression, we estimated associations between gains in weight, length, and weight/length ratio z-scores between discharge and 2 years and outcomes at 10 and 15 years. High gain was defined as the top quintile of change; low gain, as the bottom quintile of change. RESULTS: High gains in weight and weight/length were associated with greater odds of obesity at 10 years, but not at 15 years. These associations were found only for females. High gain in length z-score was associated with lower odds of obesity at 15 years. The only association found between high gains in growth measures and more favorable neurocognitive or psychiatric outcomes was between high gain in weight/length and lower odds of cognitive impairment at age 10 years. CONCLUSIONS: During the 2 years after NICU discharge, females born extremely preterm with high gains in weight/length or weight have greater odds of obesity at 10 years, but not at 15 years. Infants with high growth gains in the 2 years after NICU discharge have neurocognitive and psychiatric outcomes in middle childhood and adolescence similar to those of infants with lower gains in weight and weight/length.

Quality of life, depressive symptoms, anxiety, and sexual function in mothers of neonates with congenital syphilis in the Northeast Brazil: A cohort study.

Background: Congenital syphilis is an important public health problem in low- and middle-income countries. Poor neonatal health outcomes associated with the disease may lead to maternal psychological distress and feelings of helplessness. This study aimed to evaluate the quality of life, anxiety levels, depressive symptoms, and sexual function in mothers of neonates with congenital syphilis in the Northeast of Brazil. Methods: This cohort study compared patient-centered outcomes between mothers of neonates with congenital syphilis and mothers of healthy neonates during the first three months of the postpartum period. The study was conducted in Sergipe state, Northeast Brazil, a region with one of the highest rates of congenital syphilis (14·1 cases per 1000 live births). Quality of life, depressive symptoms, anxiety levels, and sexual function were evaluated by using the World Health Organization Quality of Live - shortened version (WHOQoL-BREF) instrument, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Female Sexual Function Index, respectively. Unadjusted differences between groups were anayzed by using the Mann-Whitney test. Glass's delta with 95% confidence interval (CI) was used to measure the effect size. Findings: Sixty-three women were included in each group. During the in-hospital stay, mothers of neonates with congenital syphilis had lower scores for overall quality of life (p < 0·001; large effect size: -0·559 [95% CI -0·683 to -0·405]) and higher levels of anxiety (p < 0·001; large effect size: 0·558 [95% CI 0·403 to 0·681]) and depressive symptoms (p < 0·001; large effect size: 0·561 [95% CI 0·407 to 0·684]) than mothers of healthy neonates. Three months after childbirth, we found persistent depressive symptoms (p = 0·021; small effect size: 0·239 [95% CI 0·041 to 0·419]) and low overall sexual function (p = 0·041; small effect size: -0·211 [95% CI -0·394 to -0·012]) among mothers of neonates with congenital syphilis compared to the control group. Interpretation: Mothers of neonates with congenital syphilis present poorer quality of life, mental health, and sexual function compared to mothers of healthy neonates. Funding: Brazilian Federal Agency for Coordination of Improvement of Higher Education Personnel (CAPES).

Neonatal Cranial Ultrasound Findings among Infants Born Extremely Preterm: Associations with Neurodevelopmental Outcomes at 10 Years of Age.

OBJECTIVE: To examine the association between neonatal cranial ultrasound (CUS) abnormalities among infants born extremely preterm and neurodevelopmental outcomes at 10 years of age. STUDY DESIGN: In a multicenter birth cohort of infants born at <28 weeks of gestation, 889 of 1198 survivors were evaluated for neurologic, cognitive, and behavioral outcomes at 10 years of age. Sonographic markers of white matter damage (WMD) included echolucencies in the brain parenchyma and moderate to severe ventricular enlargement. Neonatal CUS findings were classified as intraventricular hemorrhage (IVH) without WMD, IVH with WMD, WMD without IVH, and neither IVH nor WMD. RESULTS: WMD without IVH was associated with an increased risk of cognitive impairment (OR 3.5, 95% CI 1.7, 7.4), cerebral palsy (OR 14.3, 95% CI 6.5, 31.5), and epilepsy (OR 6.9; 95% CI 2.9, 16.8). Similar associations were found for WMD accompanied by IVH. Isolated IVH was not significantly associated these outcomes. CONCLUSIONS: Among children born extremely preterm, CUS abnormalities, particularly those indicative of WMD, are predictive of neurodevelopmental impairments at 10 years of age. The strongest associations were found with cerebral palsy.

Resilience in Mothers of Children with Congenital Zika Syndrome.

BACKGROUND: Resilience is a dynamic process influenced by life circumstances. This study evaluated the association between resilience and anxiety, depressive symptoms, and quality of life (QoL) of mothers of children with congenital Zika syndrome (CZS). METHOD: This was a cross-sectional study including 31 mothers of children with CZS assisted in rehabilitation centers in Sergipe state, Northeast Brazil, an endemic area for Zika virus (ZIKV). RESULTS: Mothers' age ranged from 18 to 42 years and all of them had low income. There were high levels of anxiety (scores > 40) in 80.6% of mothers and 19.3% had moderate (scores 19-29) to severe (scores 30-63) depressive symptoms. We found a relationship between increased levels of anxiety and depressive symptoms and lower levels of personal competence (p = 0.007) and acceptance of self and life (p = 0.003), respectively. We also found a positive relationship between social QoL and personal competence (p = 0.003). CONCLUSION: This study showed that lower personal competence is significantly associated to psychological distress and poorer social QoL in mothers of children with CZS.

Oral and maxillofacial conditions, dietary aspects, and nutritional status of children with congenital Zika syndrome.

OBJECTIVE: The aim of this study was to investigate oral and maxillofacial outcomes in children with congenital Zika syndrome (CZS) and the presence of nonnutritive sucking habits, functional habits, and features related to breastfeeding and nutrition of these children. STUDY DESIGN: We conducted a cross-sectional study with 45 children with CZS and 50 healthy controls in Sergipe state, Brazil, from February 2018 to June 2018. Demographic and clinical data, including breastfeeding and feeding data, were obtained for each child. Additionally, oral and maxillofacial evaluation was performed. RESULTS: Low weight (prevalence rate [PR] 8.33; 95% confidence interval [CI] 2.02-34.45), nonexclusive breastfeeding up to 6 months (PR 1.56; 95% CI 1.18-2.08); mouth breathing (PR 3.46; 95% CI 1.83-6.52); difficulty in swallowing (PR 6.00; 95% CI 2.53-14.25); and excessive salivation (PR 4.81; 95% CI 2.18-10.62) were more frequent in children with CZS. Children with CZS were more likely to have abnormal insertion of the upper labial frenulum (PR 7.04; 95% CI 2.23-22.20); ogival palate (PR 3.70; 95% CI 1.63-8.40), dental enamel defects (PR 2.22; 95% CI 1.05-4.69); and delayed dental eruption (PR 8.89; 95% CI 1.16-68.32) compared with healthy children. CONCLUSIONS: Children with CZS had a higher frequency of problems related to breastfeeding, low weight, and oral and maxillofacial abnormalities compared with healthy children.

To breastfeed or not to breastfeed? Lack of evidence on the presence of SARS-CoV-2 in breastmilk of pregnant women with COVID-19.

A rapid systematic review was carried out to evaluate the current evidence related to the presence of SARS-CoV-2 in breast milk from pregnant women with COVID-19. Eight studies analyzing the presence of SARS-CoV-2 RNA in the breast milk of 24 pregnant women with COVID-19 during the third trimester of pregnancy were found. All patients had fever and/or symptoms of acute respiratory illness and chest computed tomography images indicative of COVID-19 pneumonia. Most pregnant women had cesarean delivery (91.7%) and two neonates had low birthweight (< 2 500 g). Biological samples collected immediately after birth from upper respiratory tract (throat or nasopharyngeal) of neonates and placental tissues showed negative results for the presence SARS-CoV-2 by RT-PCR test. No breast milk samples were positive for SARS-CoV-2 and, to date, there is no evidence on the presence of SARS-CoV-2 in breast milk of pregnant women with COVID-19. However, data are still limited and breastfeeding of women with COVID-19 remains a controversial issue. There are no restrictions on the use of milk from a human breast milk bank.

Se llevó a cabo una revisión sistemática rápida para evaluar la evidencia disponible sobre la presencia de SARS-CoV-2 en la leche materna de mujeres embarazadas afectadas con COVID-19. Se encontraron ocho estudios que analizaron la presencia de ARN de SARS-CoV-2 en la leche materna de 24 mujeres embarazadas con COVID-19 durante el tercer trimestre del embarazo. Todas las pacientes tenían fiebre o síntomas de enfermedad respiratoria aguda e imágenes de tomografía computarizada de tórax indicativas de neumonía por COVID-19. La mayoría de las mujeres embarazadas (91,7%) tuvieron un parto por cesárea y dos neonatos presentaron bajo peso al nacer (< 2 500 g). Las muestras biológicas recogidas inmediatamente después del parto de las vías respiratorias superiores (faringe o nasofaringe) de los neonatos y los tejidos placentarios mostraron resultados negativos para SARS-CoV-2 mediante RT-PCR. Ninguna muestra de leche materna fue positiva para SARS-CoV-2 y, hasta la fecha, no hay evidencia de la presencia de SARS-CoV-2 en la leche materna de las mujeres embarazadas con COVID-19. Sin embargo, los datos disponibles todavía son limitados y la lactancia materna en las mujeres con COVID-19 sigue siendo un tema controvertido. No hay restricciones para el uso de leche materna de banco.

Foi realizada uma revisão sistemática rápida para avaliar as evidências atuais relacionadas à presença da SARS-CoV-2 no leite materno de mulheres grávidas com COVID-19. Foram encontrados oito estudos analisando a presença de RNA do SARS-CoV-2 no leite materno de 24 gestantes com COVID-19 durante o terceiro trimestre de gravidez. Todas as pacientes apresentavam febre ou sintomas de doença respiratória aguda e imagens de tomografia computadorizada do tórax indicativas de pneumonia pela COVID-19. A maioria das gestantes teve parto cesáreo (91,7%) e dois recém-nascidos tiveram baixo peso ao nascer (< 2 500 g). As amostras biológicas coletadas imediatamente após o nascimento do trato respiratório superior (faringe ou nasofaringe) de neonatos e tecidos placentários apresentaram resultados negativos para a presença do SARS-CoV-2 pelo teste RT-PCR. Nenhuma amostra de leite materno foi positiva para o SARS-CoV-2 e, até à data, não há evidências da presença do SARS-CoV-2 no leite materno de mulheres grávidas com COVID-19. No entanto, os dados ainda são limitados e a amamentação de mulheres com COVID-19 continua a ser uma questão controversa. Não há restrições ao uso de leite de um banco de leite materno humano.

Changes in Occupational Roles and Common Mental Disorders in Mothers of Children With Congenital Zika Syndrome.

IMPORTANCE: The functional limitations and long-term dependence of children with congenital Zika syndrome (CZS) may lead to changes in maternal occupational roles, which can have a negative impact on mothers' well-being and mental health. OBJECTIVE: To investigate changes in occupational roles and their effects on the mental health of mothers who have a child with CZS. DESIGN: Cross-sectional study. SETTING: Rehabilitation centers of the Brazilian Unified Health System in Alagoas, Northeast Brazil. PARTICIPANTS: Forty mothers of children with CZS. OUTCOMES AND MEASURES: The Role Checklist and the Self-Reporting Questionnaire-20 were used to assess the mothers' involvement in occupational roles and common mental disorders (CMDs), respectively. The relationship between changes in occupational roles and CMDs was analyzed using a logistic regression model. RESULTS: Our study showed that loss of paid work (p = .026) is associated with poor mental health of mothers of children with CZS. CONCLUSIONS AND RELEVANCE: Strengthening public policies to reduce the economic impact of CZS on families, offering multidisciplinary counseling, and implementing psychoeducational strategies for promoting maternal psychological adjustment are needed. WHAT THIS ARTICLE ADDS: The time and money spent by mothers in daily care activities for children with CZS contribute to a reduction in family income and social well-being and have a negative impact on mothers' mental health.

Bad news: Families' experiences and feelings surrounding the diagnosis of Zika-related microcephaly.

The rapidly increasing number of cases of Zika virus and limited understanding of its congenital sequelae (e.g., microcephaly) led to stories of fear and uncertainty across social media and other mass communication networks. In this study, we used techniques generic to netnography, a form of ethnography, using Internet-based computer-mediated communications as a source of data to understand the experience and perceptions of families with infants diagnosed with Zika-related microcephaly. We screened 27 YouTube™ videos published online between October 2015 and July 2016, during which the Zika epidemic started, peaked, and declined. We identified three themes: (a) experiencing the news of a diagnosis of Zika-associated microcephaly; (b) experiencing feelings and expectations of the 'imperfect' child; and (c) seeking to understand microcephaly to care for the child. We found that families experienced distressing feelings of shock, sadness, hopelessness, and pain, while dealing with emerging and sometimes conflicting information being transmitted by news outlets, uncertainty about the child's health, and healthcare providers' lack of clarity to guide the family members. The 'unknown' factor of ZIKA was an additional stressful factor in the experience of the families.

Assessing Positive Child Health among Individuals Born Extremely Preterm.

OBJECTIVE: To assess the development of a Positive Child Health Index (PCHI) based on 11 adverse outcomes and evaluate the association of PCHI with quality of life (QoL) scores in a preterm cohort. STUDY DESIGN: A total of 889 children enrolled in the Extremely Low Gestational Age Newborn (ELGAN) study in 2002-2004 were followed up at 10 years of age. A parent/caregiver completed questionnaires for child QoL, asthma, visual or hearing impairment, gross motor function impairment, epilepsy, attention deficit/hyperactivity disorder, anxiety, and depression. The child was assessed for cognitive impairment, autism, and obesity. PCHI scores were computed and linear regression models were used to evaluate the relationship between QoL categories (psychosocial, physical, emotional, social, school, and total) and the PCHI (dichotomized and coded as a multilevel categorical predictor) and to assess sex differences. RESULTS: Among ELGAN children, higher PCHI scores were associated with higher reported QoL scores for all QoL categories. Children with no disorders and a PCHI of 100% had Pediatric Quality of Life Inventory total scores that were 11 points higher than children with 1 or more adverse outcomes (PCHI of <100%). Boys had lower QoL scores for the total, psychosocial, social, and school categories. CONCLUSIONS: Positive child health assessed using a quantitative PCHI was associated with QoL across the ELGAN cohort at school age. In the current study, the PCHI encompassed 11 outcomes assessed in ELGANs. Future research could include an enhanced panel of child health outcomes to support the use of PCHI as an indicator of positive child health.

Femicide trends in Brazil: relationship between public interest and mortality rates.

In this information epidemiology (infodemiology) study, we describe the online public interest about the issue of femicide in Brazil and analyze the relationship between search queries and femicide trends from 2004 to 2015. We showed that information-seeking behavior for femicide in the Brazilian states has been strongly influenced by female homicide rates. Educational and policy-related interventions are needed to improve the population's knowledge and attitude toward femicide.