An update on vaccination in preterm infants

Abstract Objective: The objective of this article is to review the most current literature on vaccines, focusing on their safety, immunogenicity, and efficacy in preterm newborns, aiming to improve vaccine coverage in this population. Data source: Most recent scientific publications addressing the immunization of preterm newborns. Data synthesis: Despite its immunological immaturity, vaccination is well tolerated by preterm infants, and protective immune responses are observed, but some studies have shown that preterm infants undergo unjustified delays in their vaccination schedule. Conclusions: Despite being widely recommended, the routine immunization of preterm infants is often delayed, putting this vulnerable population at risk for several diseases, many of which are preventable by immunization. Every effort should be made to develop universal guidelines that define the immunization of preterm infants.

An update on vaccination in preterm infants.

OBJECTIVE: The objective of this article is to review the most current literature on vaccines, focusing on their safety, immunogenicity, and efficacy in preterm newborns, aiming to improve vaccine coverage in this population. DATA SOURCE: Most recent scientific publications addressing the immunization of preterm newborns. DATA SYNTHESIS: Despite its immunological immaturity, vaccination is well tolerated by preterm infants, and protective immune responses are observed, but some studies have shown that preterm infants undergo unjustified delays in their vaccination schedule. CONCLUSIONS: Despite being widely recommended, the routine immunization of preterm infants is often delayed, putting this vulnerable population at risk for several diseases, many of which are preventable by immunization. Every effort should be made to develop universal guidelines that define the immunization of preterm infants.

[Infant breastfeeding prevalence in the city of São Paulo, Brazil, 2008]. / Avaliação da situação do aleitamento materno em menores de um ano de idade no Município de São Paulo, Brasil, em 2008.

This cross-sectional epidemiological study based on AMAMUNIC aimed to evaluate infant breastfeeding (BF) prevalence and duration in São Paulo, Brazil. Sample size was based on a cluster calculation, selecting 35 primary care units and 35 infants (< 1 year of age) per unit. A total of 1,424 interviews with mothers were performed (56 items on feeding in the previous 24 hours) in August 2008, subsequently analyzed according to residential areas: Central West, East, North, Southeast, and South. Prevalence of exclusive breastfeeding (EBF) was 52% up to three months and 39% up to six months, as follows: 44% (Central West), 57% (East), 62% (North), 43% (Southeast), and 48% (South) up to three months and 36% (Central West), 46% (East), 39% (North), 36% (Southeast), and 33% (South) up to six months. Prevalence of EBF according to infant age was 58% in the first month, 50% in the second and third, and 13% in the sixth. In conclusion, EBF prevalence up to six months is still heterogeneous in the city, suggesting the need for programs to encourage BF that are differentiated according to region.

Longitudinal study of Cystatin C in healthy term newborns.

OBJECTIVE: The purpose of this study was to determine the levels of Cystatin C in healthy term newborns in the first month of life. INTRODUCTION: Cystatin C may be a suitable marker for determining the glomerular filtration rate because it is not affected by maternal renal function. METHODS: Cohort study. Inclusion: term newborns with appropriate weight; mother without renal failure or drugs that could affect fetal glomerular filtration rate. Exclusion: malformations; hypertension or any condition that could affect glomerular filtration rate. Cystatin C (mg/L)and creatinine (rng/dl) were determined in the mother (Mo) and in the newborn at birth (Day-0), 3rd (Day-3), 7th(Day-7) and 28t>h(Day-28) days. STATISTICS: one way ANOVA and Pearson's correlation tests. Sample size of 20 subjects for a = 5% and a power test = 80% (p<0.05). RESULTS: Data from 21 newborns were obtained (mean + standard deviation): MoCystatin C=1.00 ± 0.20; Day-0 Cystatin C 1.70 ± 0.26; Day-3 Cystatin C = 1.51 ± 0.20; Day-7 Cystatin C = 1.54 ± 0.10; Day-28 Cystatin C = 1.51 ± 0.10. MoCystatin C was smaller than Day-0 Cystatin C (p < 0.001), while MoCreatinine was not different from Day-0 Creatinine. Cystatin C only decreased from Day-0 to Day-3 (p = 0.004) but newborns Creatinine decreased along the time. Correlations were obtained between MoCystatin C and MoCreatinine (p = 0.012), as well as Day-3 (p = 0.047) and Day-28 (p = 0.022) Cystatin C and Creatinine values. CONCLUSION: Neonatal Cystatin C values were not affected by MoCystatin C and became stable from the 3rd day of life.

Longitudinal study of Cystatin C in healthy term newborns

OBJECTIVE: The purpose of this study was to determine the levels of Cystatin C in healthy term newborns in the first month of life. INTRODUCTION: Cystatin C may be a suitable marker for determining the glomerular filtration rate because it is not affected by maternal renal function. METHODS: Cohort study. Inclusion: term newborns with appropriate weight; mother without renal failure or drugs that could affect fetal glomerular filtration rate. Exclusion: malformations; hypertension or any condition that could affect glomerular filtration rate. Cystatin C (mg/L)and creatinine (rng/dl) were determined in the mother (Mo) and in the newborn at birth (Day-0), 3rd (Day-3), 7th(Day-7) and 28t>h(Day-28) days. Statistics: one way ANOVA and Pearson's correlation tests. Sample size of 20 subjects for a = 5 percent and a power test = 80 percent (p<0.05). RESULTS: Data from 21 newborns were obtained (mean + standard deviation): MoCystatin C=1.00 ± 0.20; Day-0 Cystatin C 1.70 ± 0.26; Day-3 Cystatin C = 1.51±0.20; Day-7 Cystatin C = 1.54 ± 0.10; Day-28 Cystatin C= 1.51±0.10. MoCystatin C was smaller than Day-0 Cystatin C (p<0.001), while MoCreatinine was not different from Day-0 Creatinine. Cystatin C only decreased from Day-0 to Day-3 (p = 0.004) but newborns Creatinine decreased along the time. Correlations were obtained between MoCystatin C and MoCreatinine (p = 0.012), as well as Day-3 (p = 0.047) and Day-28 (p = 0.022) Cystatin C and Creatinine values. CONCLUSION: Neonatal Cystatin C values were not affected by MoCystatin C and became stable from the 3rd day of life.

O recém-nascido de muito baixo peso / The newborn very low birth weight

A Sociedade de Pediatria de São Paulo, através do seu Departamento de Neonatologia, tem imenso orgulho em colocar à disposição dos pediatras brasileiros e, especificamente, dos neonatologistas, esta obra, que aborda de forma completa e extensiva o recém-nascido de muito baixo peso. Seus capítulos cobrem praticamente todo o curso destas crianças, do nascimento à alta, passando pelo ambiente físico, o suporte nutricional, as intercorrências mais freqüentes, metabólicas ou infecciosas, e a evolução em curto e longo prazos.

O Recém-nascido de muito baixo peso / The newborn very low birth weight

A Sociedade de Pediatria de São Paulo, através do seu Departamento de Neonatologia, tem imenso orgulho em colocar à disposição dos pediatras brasileiros e, especificamente, dos neonatologistas, esta obra, que aborda de forma completa e extensiva o recém-nascido de muito baixo peso. Seus capítulos cobrem praticamente todo o curso destas crianças, do nascimento à alta, passando pelo ambiente físico, o suporte nutricional, as intercorrências mais freqüentes, metabólicas ou infecciosas, e a evolução em curto e longo prazos

Resposta imune à vacinação contra Hepatite B, iniciada no primeiro dia de vida, em recém-nascidos pré-termo / Immune response to vaccination against hepatitis B started in the first days of life in newborn preterm

A hepatite B, incluindo as complicações crônicas como a hepatite crônica persistente, a cirrose e o hepatocarcinoma, é uma das principais doenças infecciosas da humanidade que pode ser prevenida através da imunização. O desenvolvimento de vacinas seguras e eficazes contra o VHB tornou, teoricamente possível, a erradicação deste através da intensificação das campanhas de vacinação e a estratégia de vacinação universal dos recém-nascidos. Na literatura pode-se encontrar vários estudos sobre a resposta imune à vacinação em recém-nascidos a termo (RNT) com porcentagens de soroproteção acima de 95%, quando iniciada no primeiro dia de vida. Entretanto, ainda há controvérsias sobre a resposta imune à vacinação contra o vírus da hepatite B (VHB), em recém-nascidos pré-termo (RNPT), quando iniciada nos primeiros dias de vida. Na tentativa de esclarecer esta dúvida optou-se por realizar um estudo para investigar a resposta imune à vacina contra vírus da hepatite B em RNPT visando determinar a taxa de soroproteção, analisar a relação desta com a idade gestacional (IG) e o peso de nascimento (PN). A vacina recombinante ( 5 µg/dose, Recombivax ® - MSD) foi aplicada em 35 RNPT e 21 RNT, em três doses, com menos de 24 horas de vida, um e seis meses. Os RN que não responderam às três doses de vacina, receberam uma quarta dose, com 100,0% de resposta. Os AA sugerem que nos RN com ≤ 1500 g, que iniciarem a vacina no primeiro dia de vida, deve-se monitorar a resposta imune aos nove meses ou aplicar quatro doses da vacina

Variaçäo secular do peso de recem-nascidos do hospital das clinicas de Sao Paulo em quatro periodos nos ultimos 50 anos / Secular variation of newborns' birth weight in the Sao Paulo clinic's hospital in 4 periods during the past 50 years

Optou-se por avaliar a variacao de peso medio de nascimento dos RNs admitidos no Bercario Anexo a Maternidade do Hospital das Clinicas - FMUSP (BAM-HC-FMUSP), num periodo de 50 anos, aceitando que esse dado possa fornecer informacoes do crescimento intra-uterino e, indiretamente, refletir a qualidade da assistencia perinatal e das condicoes de saude da gestante. METODOS: realizou-se um estudo retrospectivo, avaliando-se os RNs admitidos no...

Alteracoes placentarias nas infeccoes hematogenicas de etiologia viral / Placental alterations in hematogenic infections of viral etiology

Os autores apresentam uma revisao das alteracoes placentarias encontradas nas infeccoes por via hematogenica de etiologia viral, especialmente as causadas pelo virus da rubeola, citomegalovirus, hepatites e parvovirus. As alteracoes placentarias, tanto macroscopicas como microscopicas, sao muito semelhantes e independem da etiologia viral. O exame da placenta para determinar a etiologia da infeccao necessita utilizar metodos de isolamento do virus atraves da cultura ou inoculacao , metodos imuno-histoquimicos ou tecnicas de biologia molecular

Acidemia propionica no periodo neonatal / Propionic acidemia in the neonatal period

A acidemia propionica e uma desordem do metabolismo de acidos organicos caracterizada por um amplo espectro de variacao clinica e laboratorial. Muitas vezes ja se manifesta no periodo neonatal, quando a mortalidade e elevada e as sequelas neurologicas sao graves nos sobreviventes. O caso apresentado refere-se a um recem-nascido do sexo masculino, saudavel ate 49 horas de vida, quando iniciou quadro de recusa alimentar, gemencia e hipotermia. Evoluiu com piora clinica progressiva atingindo estado de neurotoxicidade importante. Desenvolveu acidose metabolica grave e a deteccao de elevados niveis de acido 3-hidroxi-propionico, 2-metil-3-hidroxibutirico e metil-citrico na urina, confirmou o diagnostico de acidemia propionica

Uso de captopril durante a gestaçäo e suas repercussöes sobre o feto e o recém-nascido: relato de caso / Neonatal and fetal effects of captopril use in pregnancy: case report

Os inibidores da enzima conversora da angiotensina tem sido largamente utilizados para o controle da hipertensao, mas o uso destes durante a gestacao pode provocar obito fetal, retardo de crescimento intra-uterino, sequencia de oligamnio, hipotensao e insuficiencia renal aguda no periodo neonatal e persistencia de canal arterial. O objetivo e chamar a atencao para os possiveis efeitos neonatais do uso desta droga durante a gestacao. Os autores descrevem um caso de uso de captopril durante a gestacao, cujo RN apresentou insuficiencia renal aguda logo apos o nascimento e persistencia de canal arterial necessitando de tratamento clinico...

Efeitos do uso materno de warfarin no feto: relato de caso / Fetal warfarin syndrome: case report

Os autores descrevem uma criança que apresenta sinais clinicos compativeis com embriopatia por warfarin. Os principais achados säo facies peculiar com hipoplasia nasal, membros encurtados e presença de calcificaçöes peri-epifisárias no estudo radiológico. A patogenese da embriopatia e recomendaçöes terapeuticas para as mulheres que necessitam fazer uso de anticoagulante oral durante a gestaçäo, säo discutidas