Unequal burden of Zika-associated microcephaly among populations with public and private healthcare in Salvador, Brazil.

OBJECTIVES: To describe the differences in clinical presentation and relative disease burden of congenital Zika syndrome (CZS)-associated microcephaly at 2 large hospitals in Salvador, Brazil that serve patients of different socioeconomic status (SES). METHODS: Clinical and serologic data were collected prospectively from pregnant women and their infants, who delivered at 2 study centers during the 2015-2016 Zika virus (ZIKV) epidemic in Salvador, Brazil. RESULTS: Pregnant women from Salvador, Brazil delivering in a low SES hospital had 3 times higher ZIKV exposure rate than women at a high SES hospital. However, different SES hospitals had similar prevalence of infants with CZS-associated microcephaly (10% vs 6%, p = 0.16) after controlling for ZIKV exposure in their mothers. CONCLUSIONS: Our study supports the positive association between low SES, high maternal ZIKV exposure, and high rates of CZS-associated microcephaly.

The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study.

BACKGROUND: The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). METHODS: This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil's federal law recommendations. RESULTS: The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment's health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. CONCLUSIONS: In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.

Risk of Zika microcephaly correlates with features of maternal antibodies.

Zika virus (ZIKV) infection during pregnancy causes congenital abnormalities, including microcephaly. However, rates vary widely, and the contributing risk factors remain unclear. We examined the serum antibody response to ZIKV and other flaviviruses in Brazilian women giving birth during the 2015-2016 outbreak. Infected pregnancies with intermediate or higher ZIKV antibody enhancement titers were at increased risk to give birth to microcephalic infants compared with those with lower titers (P < 0.0001). Similarly, analysis of ZIKV-infected pregnant macaques revealed that fetal brain damage was more frequent in mothers with higher enhancement titers. Thus, features of the maternal antibodies are associated with and may contribute to the genesis of ZIKV-associated microcephaly.

Síndrome da angústia respiratória aguda em um recém-nascido com varicela perinatal congênita / Acute respiratory distress syndrome in a newborn with congenital chickenpox

Um recém-nascido com varicela perinatal congênita, complicada por pneumonia e pulmpo de choque, foi admitido em nosso hospital com 14 dias de vida em insuficiência respiratória grave. O recém-nascido näo recebeu imunoglobulina específica para o vírus varicela-zoster. A mäe apresentou exantema característico de varicela três dias antes do parto. Com nove dias de vida o recém-nascido iniciou a sintomatologia com vesículas, evoluindo com aumento progressivo das lesöes de pele, febre, dificuldade para sugar e respirar e cianose progressiva. O raio X de tórax inicialmente revelava infiltrado pulmonar reticular difuso, progredindo rapidamente para imagem de reduçäo acentuada da transparência pulmonar, bilateralmente, com broncogramas aéreos difusos, compatível com pulmpo de choque. Foi iniciada ventilaçäo assistida convencional, associada a quimioterapia antiviral com aciclovir. Concomitante ao quadro pulmonar apresentou hepatite, meningoencefalite e CIVD. Permaneceu em ventilaçäo pulmonar mecânica por nove dias. Recebeu alta hospitalar após 21 dias de internaçäo, com idade de um mês e cinco dias de vida, sem doenta pulmonar crônica, sem dependência de oxigênio. Atualmente com dois anos de idade, sem seqnela pulmonar e/ou neurológica.

Malformaçäo pulmonar como causa de insuficiência respiratória / Pulmonary malformation as cause of respiratory insufficiency

Säo relatados dois casos de insuficiência respiratória grave associada a malformaçäo pulmonar em lactentes atendidos na UTI do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. Em ambas as crianças, face à má resposta ao tratamento inicialmente instituído, houve necessidade de aprofundamento da investigaçäo diagnóstica com a realizaçäo de exames subsidiários mais invasivos (broncoscopia e broncografia). O diagnóstico final foi de provável hipoplasia pulmonar. Chama-se a atençäo para a importância da inclusäo de tal diagnóstico na pesquisa etiológica de insuficiência respiratória em lactentes

Uso do ecocardiograma bidimensional para localizaçäo da ponta de cateteres intravenoso / Utilization of two-dimensional echocardiography for localization of intravenous catheters

Mostra-se a utilizaçäo do ecocardiograma bidimensional para determinar a posiçäo da ponta dos cateteres intravenosos centrais. Faz-se uma comparaçäo com o exame radiológico. Apontam-se as vantagens do exame, sua eficácia, limitaçöes e aplicabilidade clínica