Listeriosis neonatal un desafío diagnóstico: reporte de caso y revisión de la literatura / Neonatal listeriosis a diagnostic challenge: A case report and review of the literature

Introducción: La listeriosis es una patología de baja incidencia, con síntomas leves y autolimitados en la población en general, sin embargo, la transmisión materno-fetal, puede generar cuadros graves en neonatos, manifestados como sepsis, meningitis, endocarditis, encefalitis, meningoencefalitis. El diagnóstico oportuno por clínica y datos de laboratorio en coyuntura con la terapéutica adecuada favorecen la resolución de la enfermedad. Caso clínico: Neonato prematuro tardío de 34 semanas, 6 días de edad gestacional, nació por cesárea iterativa, al nacimiento no vigoroso con líquido amniótico meconial pesado, requirió reanimación básica y avanzada. Evolución: Por los antecedentes natales se realizó estudio de infección, con reporte positivo y desarrollo en hemocultivos de Listeria Monocytogenes, diagnóstico de sepsis, meningitis y conjuntivitis, recibió antibiótico terapia intrave-nosa, completó tratamiento y presentó evolución clínica favorable. Conclusiones: En el presente caso la listeriosis de transmisión materno-neonatal tuvo una presentación grave con aspiración de líquido meconial que requirió intubación y soporte ventilatorio, el paciente desarrolló meningitis y conjuntivitis. En la placenta se presentó corionitis.

Introduction: Listeriosis is a low-incidence pathology with mild and self-limiting symptoms in the general population; however, maternal-fetal transmission can generate severe conditions in neonates, manifested as sepsis, meningitis, endocarditis, encephalitis, meningoencephalitis. Timely diagnosis by clinical and laboratory data in conjunction with adequate therapy favors the resolution of the disease. Clinical case: Late preterm neonate of 34 weeks, six days of gestational age, was born by repetitive cesarean section at non-vigorous birth with heavy meconium amniotic fluid and required basic and advanced resuscitation. Evolution: Based on the birth history, an infection study was carried out, with a favorable report and development of Listeria Monocytogenes in blood cultures, diagnosis of sepsis, meningitis, and conjunctivitis, received intravenous antibiotic therapy, completed treatment, and presented favorable clinical evolution. Conclusions: In the present case, the listeriosis of maternal-neonatal transmission had a severe presentation with the aspiration of meconium fluid that required intubation and ventilatory support; the patient developed meningitis and conjunctivitis. Chorionitis occurs in the placenta.

Pesticides analysis in alternative biological matrices.

This review aims to bring together the works on pesticide analysis in alternative biological matrices, such as hair, breast milk, meconium, and placenta. Much is known about the harmful effects of the use and indirect consumption of pesticides; however, the assessment of long-term contamination is still unclear. In this sense, the use of hair as an alternative biological matrix has some advantages, such as segmentation, which makes it possible to assess the presence of xenobiotics to which individuals have been exposed over the years, and possibly relate this exposure to symptoms or diseases that may affect them. Complementarily, the other matrices discussed are able to provide information about the exposure of mothers and newborn children, who may have been indistinctly exposed to pesticides while in the womb. Through the analysis of studies already performed, it can be observed that organochlorine pesticides (OCPs) are the most likely to be found within the biological matrices discussed here, due to the lipophilic characteristics of these compounds. For the other classes, biotransformation products are more easily detected.

Meconium microbiota predicts clinical early-onset neonatal sepsis in preterm neonates.

BACKGROUND: Early-onset neonatal sepsis (EONS) remains one of the leading causes of morbidity and mortality related to premature birth, and its diagnosis remains difficult. Our goal was to evaluate the intestinal microbiota of the first meconium of preterm newborns and ascertain whether it is associated with clinical EONS. METHODS: In a controlled, prospective cohort study, samples of the first meconium of premature infants with a gestational age (GA) ≤32 weeks was obtained at Hospital de Clínicas de Porto Alegre and DNA was isolated from the samples. 16S rDNA based microbiota composition of preterm infants with a clinical diagnosis of EONS was compared to that of a control group. RESULTS: 40 (48%) premature infants with clinical diagnosis of EONS and 44 (52%) without EONS were included in the analysis. The most abundant phylum detected in both groups, Proteobacteria, was more prevalent in the sepsis group (p = .034). 14% of variance among bacterial communities (p = .001) correlated with EONS. The genera most strongly associated with EONS were Paenibacillus, Caulobacter, Dialister, Akkermansia, Phenylobacterium, Propionibacterium, Ruminococcus, Bradyrhizobium, and Alloprevotella. A single genus, Flavobacterium, was most strongly associated with the control group. CONCLUSION: These findings suggest that the first-meconium microbiota is different in preterm neonates with and without clinical EONS.

Meconium microbiome and its relation to neonatal growth and head circumference catch-up in preterm infants.

The purpose was identify an association between meconium microbiome, extra-uterine growth restriction, and head circumference catch-up. MATERIALS AND METHODS: Prospective study with preterm infants born <33 weeks gestational age (GA), admitted at Neonatal Unit and attending the Follow-Up Preterm Program of a tertiary hospital. Excluded out born infants; presence of congenital malformations or genetic syndromes; congenital infections; HIV-positive mothers; and newborns whose parents or legal guardians did not authorize participation. Approved by the institution's ethics committee. Conducted 16S rRNA sequencing using PGM Ion Torrent meconium samples for microbiota analysis. RESULTS: Included 63 newborns, GA 30±2.3 weeks, mean weight 1375.80±462.6 grams, 68.3% adequate weight for GA at birth. Polynucleobacter (p = 0.0163), Gp1 (p = 0.018), and Prevotella (p = 0.038) appeared in greater abundance in meconium of preterm infants with adequate birth weight for GA. Thirty (47.6%) children reached head circumference catch-up before 6 months CA and 33 (52.4%) after 6 months CA. Salmonella (p<0.001), Flavobacterium (p = 0.026), and Burkholderia (p = 0.026) were found to be more abundant in meconium in the group of newborns who achieved catch-up prior to 6th month CA. CONCLUSION: Meconium microbiome abundance was related to adequacy of weight for GA. Meconium microbiome differs between children who achieve head circumference catch-up by the 6th month of corrected age or after this period.

Rio Birth Cohort Study on Environmental Exposure and Childhood Development - PIPA Project.

Background/Objective: As a developing country, Brazil presents a wide range of environmental risks that can constitute hazards to child health. The country also presents different socio-economic-cultural conditions that could be responsible for determining different vulnerability and susceptibility levels for the population, which can potentiate the effects of the environmental pollutants. The Rio Birth Cohort Study (PIPA project) is a prospective maternal-infant health study, hosted in the city of Rio de Janeiro (Southeastern Brazil), designed to investigate separate and combined effects of environmental chemical pollutants, as well as the interactions between these exposures and sociocultural environment and epigenetic patterns. This paper presents the learned lessons and strategies to address the shortcomings detected from this pilot study. Methods: The study population will be all children born at the Federal University of Rio de Janeiro Maternity Hospital from July 1st, 2020 to June 30th, 2021. The estimated population is of 2,500 children. The study will collect social, demographic, and health information from pregnant women and their children up to four years of age. Biological samples from both mothers and newborns will be collected to assess metal, pesticide and plasticizer exposure. All newborns will have their landmarks of physical, neurological, psychological, and cognitive development recorded at specific ages. Findings: A pilot study was carried out between September 2017 and August 2018, totaling 142 enrolled pregnant women, leading to 135 (95%) births and the collection of umbilical cord (126-93%,) and mother (139-98%) blood samples, as well as both mother (142-100%) and newborn (54-40%) urine samples and newborn meconium samples (117-86.7%). Conclusions: The study proposes a comprehensive assessment of pre- and postnatal exposure to environmental chemicals at multiple time points in a population living in a highly urbanized developing country. As far as we know, this is the only birth cohort in Brazil specifically designed for this purpose.

Influence from the type of birth on the content of lactic acid bacteria in neonate meconium. / Influencia del tipo de nacimiento sobre el contenido de bacterias acidolácticas en meconio de neonatos.

The study's objective was to determine the influence of vaginal birth compared to cesarean birth on the content of lactic acid bacteria with probiotic characteristics from newborns. Vaginal and cesarean sec tion meconium samples of lactic acid were evaluated, which were duly enriched, seeded and incubated. The resulting colonies were identified to be subjected to bile salt tolerance, acid pH, and fermentation. A greater development of meconium colonies was obtained in those born vaginally compared to those born by caesarean section (p <0.001). A total of 48 strains were isolated, the majority being tolerant to bile salts and acid pH; likewise, the fermentation of lactose in milk was positive. This study supports previous findings that support vaginal birth favors the greatest development of lactic acid bacteria with probiotic characteristics, compared to cesarean birth, and highlights the presence of bacteria of the genus Lactobacillus.

El objetivo del estudio fue determinar la influencia del nacimiento por vía vaginal en comparación con el nacimiento por cesárea sobre el contenido de bacterias acidolácticas con características probióticas de los recién nacidos. Se evaluaron muestras de meconio de recién nacidos por vía vaginal y por cesárea que fueron debidamente enriquecidas, sembradas e incubadas. Las colonias resultantes fueron identificadas para ser sometidas a tolerancia de sales biliares, pH ácido y fermentación. Se obtuvo un mayor desa rrollo de colonias en meconio de nacidos por vía vaginal en comparación con los nacidos por cesárea (p<0,001). Se aislaron 48 cepas en total, siendo en su gran mayoría tolerantes a sales biliares y pH ácido; asimismo, la fermentación de lactosa en leche fue positiva. Este estudio respalda hallazgos previos que sustentan que el nacimiento por vía vaginal favorece al mayor, desarrollo de bacterias acidolácticas con características probióticas, en comparación con el nacimiento por cesárea, y destaca la presencia de bac terias del género Lactobacillus.

Management of distal intestinal obstruction syndrome by enteroscopy in a post-lung transplant patient.

This is a case of a male patient who had a post-lung transplant complication given to distal intestinal obstruction by meconium. He was managed with laxative irrigation though enteroscope directly in the ileum with immediate resolution, without complications, avoiding surgical management. No similar cases have been reported.

Influencia del tipo de nacimiento sobre el contenido de bacterias acidolácticas en meconio de neonatos* / Influence from the type of birth on the content of lactic acid bacteria in neonate meconium

RESUMEN El objetivo del estudio fue determinar la influencia del nacimiento por vía vaginal en comparación con el nacimiento por cesárea sobre el contenido de bacterias acidolácticas con características probióticas de los recién nacidos. Se evaluaron muestras de meconio de recién nacidos por vía vaginal y por cesárea que fueron debidamente enriquecidas, sembradas e incubadas. Las colonias resultantes fueron identificadas para ser sometidas a tolerancia de sales biliares, pH ácido y fermentación. Se obtuvo un mayor desa rrollo de colonias en meconio de nacidos por vía vaginal en comparación con los nacidos por cesárea (p<0,001). Se aislaron 48 cepas en total, siendo en su gran mayoría tolerantes a sales biliares y pH ácido; asimismo, la fermentación de lactosa en leche fue positiva. Este estudio respalda hallazgos previos que sustentan que el nacimiento por vía vaginal favorece al mayor, desarrollo de bacterias acidolácticas con características probióticas, en comparación con el nacimiento por cesárea, y destaca la presencia de bac terias del género Lactobacillus.

ABSTRACT The study's objective was to determine the influence of vaginal birth compared to cesarean birth on the content of lactic acid bacteria with probiotic characteristics from newborns. Vaginal and cesarean sec tion meconium samples of lactic acid were evaluated, which were duly enriched, seeded and incubated. The resulting colonies were identified to be subjected to bile salt tolerance, acid pH, and fermentation. A greater development of meconium colonies was obtained in those born vaginally compared to those born by caesarean section (p <0.001). A total of 48 strains were isolated, the majority being tolerant to bile salts and acid pH; likewise, the fermentation of lactose in milk was positive. This study supports previous findings that support vaginal birth favors the greatest development of lactic acid bacteria with probiotic characteristics, compared to cesarean birth, and highlights the presence of bacteria of the genus Lactobacillus.

Adequacy of prenatal assistance in birth houses and causes associated with hospital transfers. / Adequação da assistência pré-natal em casa de parto e causas associadas com as transferências hospitalares.

OBJECTIVE: To analyze the adequacy of prenatal care in a Birth Center and the causes associated with maternal and newborn transfers to the hospital. METHODS: Cross-sectional study of the care provided at the only Birth Center in Rio de Janeiro, from 2009 to 2014. Statistical analyzes were based on the χ2 test and Prevalence Ratio (PR). RESULTS: Suitable prenatal care was predominant (42.8%) and there was no association (p = 0.55) with the transfers. Maternal transfer is caused by the ruptured amniotic sac (PR = 2.09, 95% CI 1.62-2.70) and altered fetal heart rates (PR = 3.06, 95% CI, 2.13-4.39). Newborn transfers are associated with the presence of meconium in the amniotic fluid (PR = 2.40, 95% CI 1.30-4.43); Apgar below 7 (PR = 5.33, 95% CI 2.65-10.73); and ventilatory assistance at birth (PR = 9.41, 95% CI 5.52-16.04). CONCLUSION: Complications during intrapartum care are the causes associated with transfers.

Diagnóstico prenatal y enfrentamiento postnatal de peritonitis meconial, a propósito de un caso / Prenatal diagnosis and postnatal confrontation of meconial peritonitis: a clinical case

INTRODUCCIÓN La peritonitis meconial (PM) es una peritonitis localizada o generalizada, aséptica, química o de cuerpo extraño; producto del paso de meconio a la cavidad peritoneal y esta correlacionada con la perforación prenatal del tracto digestivo. Se presenta en 1 de cada 30.000 recién nacidos (RN). El diagnostico ecográfico prenatal mejora los resultados perinatales, el hallazgo más frecuente es la ascitis. La PM requiere un tratamiento multidisciplinario urgente, la mayoría es de resolución quirúrgica. OBJETIVO Dar a conocer una patología infrecuente, que requiere un alto grado de sospecha diagnostica para otorgar un manejo perinatal específico y oportuno. Caso clínico Primigesta de 29 años sin antecedentes mórbidos, cursando embarazo controlado de 36+5 semanas. En control ecográfico se evidencia ascitis fetal. Se hospitaliza en alto riesgo obstétrico, descartando patología metabólica e infecciosa. A las 37 semanas por cesárea de urgencia, se obtiene RN con distensión abdominal y hepatomegalia. En laparotomía exploradora se evidencia asas intestinales indemnes. En re intervención se encuentra hernia de íleon distal perforada, se confecciona ostomia, evoluciona favorablemente y es dado de alta. DISCUSIÓN Es fundamental considerar la PM dentro de los diagnósticos diferenciales de ascitis fetal. Un diagnóstico oportuno mejora los resultados perinatales y permite prevenir posibles complicaciones.

INTRODUCTION Meconial peritonitis (PM) is localized or generalized peritonitis, aseptic, chemical or strange body; a product of meconium steps to the peritoneal cavity and is correlated with prenatal perforation of the digestive tract. It occurs in 1 in 30,000 newborns. Prenatal ultrasound diagnosis improves perinatal outcomes, the most frequent finding is ascites. PM requires urgent multidisciplinary treatment, most of cases need surgical resolution. OBJECTIVE To present an infrequent pathology, which requires a high degree of diagnostic suspicion to grant a specific and timely perinatal management. Clinical case Pregnant 29 years old woman without morbid history, 36 weeks of controlled pregnancy. Ultrasound control shown fetal ascites. He is hospitalized at high obstetric risk, ruling out metabolic and infectious pathology. At 37 weeks by emergency caesarean section, is obtained a baby boy with abdominal distension and hepatomegaly. In exploratory laparotomy there are undamaged intestinal handles. In re intervention it is noted herniated perforated distal ileum, ostomy is made. Patient evolves favourably and is discharged. DISCUSSION It is essential consider PM within the differential diagnoses of fetal ascites. An opportune diagnosis improves the perinatal results and could avoids possible complications.

Umbilical Cord Tissue and Meconium May Not Be Equivalent for Confirming in Utero Substance Exposure.

In a retrospective study of 501 neonates with potential in utero substance exposure, the drug detection performance of a commercially available umbilical cord tissue toxicology test was evaluated against a commercially available gold standard meconium toxicology test. Drugs detected in paired meconium and umbilical cord tissue samples were often discordant.

Adequação da assistência pré-natal em casa de parto e causas associadas com as transferências hospitalares / Adecuación de la asistencia pre-natal em casa de parto y causas asociadas com las transferências hospitales / Adequacy of prenatal assistance in birth houses and causes associated with hospital transfers

Resumo OBJETIVO Analisar a adequação da assistência pré-natal em Casa de Parto e as causas associadas com as transferências maternas e dos recém-nascidos para o hospital. MÉTODOS Estudo transversal dos atendimentos da única Casa de Parto, de 2009 a 2014, no Rio de Janeiro. As análises estatísticas foram pelo Teste χ2 e Razão de Prevalência (RP). RESULTADO A assistência pré-natal adequada predominou (42,8%) e não houve associação (p=0,55) com as transferências. A transferência materna é causada pela bolsa amniótica rota (RP= 2,09; IC 95% 1,62-2,70) e batimentos cardíacos fetais alterados (RP= 3,06; IC 95% 2,13-4,39). As transferências do recém-nascido estão associadas com a presença de mecônio no líquido amniótico (RP= 2,40; IC 95% 1,30 - 4,43); Apgar abaixo de 7 (RP= 5,33; IC 95% 2,65-10,73) e assistência ventilatória ao nascer (RP= 9,41; IC 95% 5,52-16,04). CONCLUSÃO As intercorrências na assistência intraparto são as causas associadas com as transferências.

Resumen OBJETIVO Analizar la adecuación de la asistencia prenatal en Casa de Parto y las causas asociadas con las transferencias maternas y de los recién nacidos para al hospital. MÉTODOS Investigación transversal de los atendimientos de la única Casa de Parto, de 2009 a 2014, en Río de Janeiro. Los análisis estadísticos fueron por el Test χ2 y Razón de Prevalencia (RP). RESULTADO La asistencia prenatal adecuada predominó (42,8%) y no hubo asociación (p = 0,55) con las transferencias. La transferencia materna es causada por la bolsa amniótica ruta (RP = 2,09, IC 95% 1,62-2,70) y batimientos cardíacos fetales alterados (RP = 3,06, IC 95% 2,13-4,39). Las transferencias del recién nacido se asocian con la presencia de meconio en el líquido amniótico (RP = 2,40; IC 95% 1,30 - 4,43); Apgar abajo de 7 (RP= 5,33; IC 95% 2,65-10,73) y asistencia ventilatoria al nacer (RP=9,41; IC 95% 5,52-16,04). CONCLUSIONES Las intercurrencias en la asistencia intraparto son las causas asociadas con las transferencias.

Abstract OBJECTIVE To analyze the adequacy of prenatal care in a Birth Center and the causes associated with maternal and newborn transfers to the hospital. METHODS Cross-sectional study of the care provided at the only Birth Center in Rio de Janeiro, from 2009 to 2014. Statistical analyzes were based on the χ2 test and Prevalence Ratio (PR). RESULTS Suitable prenatal care was predominant (42.8%) and there was no association (p = 0.55) with the transfers. Maternal transfer is caused by the ruptured amniotic sac (PR = 2.09, 95% CI 1.62-2.70) and altered fetal heart rates (PR = 3.06, 95% CI, 2.13-4.39). Newborn transfers are associated with the presence of meconium in the amniotic fluid (PR = 2.40, 95% CI 1.30-4.43); Apgar below 7 (PR = 5.33, 95% CI 2.65-10.73); and ventilatory assistance at birth (PR = 9.41, 95% CI 5.52-16.04). CONCLUSION Complications during intrapartum care are the causes associated with transfers.

Association between non-invasive nursing care technologies during childbirth and neonatal vitality: a cross-sectional study / Asociación entre tecnologías no-invasivas de cuidado en el parto y la vitalidad neonatal: estudio transversal / Associação entre tecnologias não invasivas de cuidado no parto e vitalidade do recém-nascido: estudo transversal

Abstract Objective: to compare the use of non-invasive midwifery care technologies (TNICEO) with the use of traditional care model practices, having as parameters the presence of meconium in the amniotic fluid and its repercussion on the newborn's vitality. Method: a cross-sectional study with secondary data of 10,219 parturients who delivered by midwives between September 2004 and October 2016. Logistic regression was used to assess Apgar> 8 Odds Ratio in exposure to noninvasive midwifery care technologies when compared to traditional care. Results: there were higher percentages of light amniotic fluid and neonates with good vitality in parturients who used only TNICEO compared with those exposed only to traditional care. Conclusion: nurse midwives' provision of TNICEO and its use by women are efficient strategies to reduce unfavorable neonatal outcomes. Implications of practice: investments in the performance of these experts is important, as their know-how to make them not medicalized through TNICEO confirms a process of humanized, safe and quality care that meets official recommendations and contributes to the change in the care model.

Resumen Objetivo: comparar el uso de tecnologías no invasivas de cuidado de enfermería obstétrica (TNICEO) con el uso de prácticas del modelo tradicional de cuidado, con la presencia de meconio en el líquido amniótico y su repercusión en la vitalidad del recién nacido. Método: estudio transversal, com datos secundários, de 10.219 parturientas, asistidas por enfermeras obstétricas entre septiembre de 2004 y octubre de 2016. Se utilizó la regresión logística para evaluar la probabilidad de Apgar> 8 en la exposición a TNICEO en comparación con la atención tradicional. Resultados: se observaron porcentajes más altos de líquido amniótico claro y recién nacido con buena vitalidad en las parturientas que solo usaron TNICEO en comparación con las expuestas solo a la atención tradicional. Conclusión: la oferta de TNICEO por las enfermeras obstétricas y su uso por las mujeres es una estrategia eficaz para reducir los resultados neonatales desfavorables. Implicaciones para la práctica: enfatizase la importancia de los investimentos en el desempeño de estos especialistas, ya que su experiencia, a través del TNICEO, constituye un proceso de atención humanizada, segura y de alta calidad, que cumple con las recomendaciones oficiales y contribuye para cambiar el modelo de atención.

Resumo Objetivo: comparar o uso de tecnologias não invasivas de cuidado de enfermagem obstétrica (TNICEO) com o emprego de práticas do modelo de assistência tradicional, tendo como parâmetros a presença de mecônio no líquido amniótico e sua repercussão sobre a vitalidade do recém-nascido. Método: estudo transversal, com dados secundários, de 10.219 parturientes que tiveram parto acompanhado por enfermeiras obstétricas entre setembro/2004 e outubro/2016. Utilizou-se a regressão logística para avaliar a chance de Apgar >8 na exposição às tecnologias não invasivas de cuidado de enfermagem obstétrica quando comparada à assistência tradicional. Resultados: constataram-se maiores percentuais de líquido amniótico claro e neonatos com boa vitalidade nas parturientes que utilizaram somente TNICEO, em comparação com aquelas expostas, apenas, à assistência tradicional. Conclusão: o oferecimento das TNICEO pelas enfermeiras obstétricas e o seu uso pelas mulheres se configuram como estratégias eficientes para reduzir desfechos neonatais desfavoráveis. Implicações para a prática: destaca-se a importância de investimentos na atuação dessas especialistas, pois seu saber fazer desmedicalizado, por meio das TNICEO, confirma um processo de cuidar humanizado, seguro e de qualidade, que atende às recomendações oficiais e contribui para a mudança do modelo assistencial.

Associations of birth mode with cord blood cytokines, white blood cells, and newborn intestinal bifidobacteria.

The associations of Cesarean delivery with offspring metabolic and immune-mediated diseases are believed to derive from lack of mother-to-newborn transmission of specific microbes at birth. Bifidobacterium spp., in particular, has been hypothesized to play a health-promoting role, yet little is known about how delivery mode modifies colonization of the newborn by this group of microbes. The aim of this research was to examine the presence of Bifidobacterium in meconium and in the transitional stool, and to assess cytokine levels and hematological parameters in the venous cord blood of infants born by elective, pre-labor Cesarean section vs. vaginal delivery in Southern Brazil. We recruited 89 mother-newborn pairs (23 vaginal delivery and 66 elective cesarean delivery), obtained demographic information from a structured questionnaire and clinical information from medical records. We obtained umbilical cord venous blood and meconium samples following delivery and the transitional stool (the first defecation after meconium) before discharge. We determined plasma levels of IL-1ß, IL-10, IL-6, GM-CSF, IL-5, IFN-γ, TNF-α, IL-2, IL-4 and IL-8 in the cord blood, and presence of stool Bifidobacterium by real time PCR. Compared to vaginally-delivered neonates, Cesarean-delivered neonates had a lower leukocyte count (p = 0.037), lower hemoglobin (p = 0.04), and lower levels of the cytokine GM-CSF (p = 0.009) in the cord blood. Moreover, Bifidobacterium was detected less often in the transitional stool of Cesarean-delivered neonates compared to vaginally-delivered neonates (p = 0.001). The results indicate that pre-labor Cesarean birth may be associated with microbial and hematological alterations in the neonate. The clinical significance of these findings remains to be determined in larger prospective birth cohort studies.

Ascitis fetal como manifestación de peritonitis meconial; presentación de un caso y revisión de literature / Fetal ascites as a manifestation of meconium peritonitis; presentation of a case and literature review

RESUMEN Introducción: La peritonitis meconial (PM) corresponde a una inflamación del peritoneo por una reacción química estéril producida por la presencia de meconio, secundaria a una perforación intestinal in útero. Se expone un caso real de PM cuya relevancia está dada por la baja incidencia de esta enfermedad, siendo de aproximadamente 1 caso por cada 30.000 nacidos vivos. El presente trabajo tiene como objetivo dar a conocer la presentación clásica de la PM mediante una revisión actualizada de la literatura. Caso clínico: Paciente de 21 años, primigesta, cursando embarazo de 33 + 5 semanas, con antecedentes de hipotiroidismo gestacional, es derivada al servicio de urgencia maternal por hallazgo en ecografía realizada ese mismo día: Ascitis fetal, intestino hiperecogénico, sin alteraciones en eco-Doppler fetal, hospitalizándose a paciente para estudio. Los exámenes de laboratorio, incluidos VIH y VDRL, resultaron negativos y no esclarecían una etiología. Dado hallazgos ecográficos posteriores se logra orientar el diagnóstico hacia una PM, la cual se objetivó una vez interrumpido el embarazo a la semana 38+5. Discusión: La PM representa un desafío para el médico tanto en su diagnóstico como tratamiento, lo cual está dado en parte por su baja incidencia. El caso expone la presentación más clásica de la PM, en la cual se logró establecer la importancia del diagnóstico prenatal y como este influye en el pronóstico y manejo posterior. Existe acuerdo en adoptar una conducta expectante frente a la PM e incluso esperar el inicio del parto espontaneo, si no existen otras contraindicaciones.

ABSTRACT Introduction: Meconial peritonitis (MP) corresponds to an inflammation of the peritoneum due to a sterile chemical reaction produced by the presence of meconium, secondary to a intestinal perforation in utero. We present a real case of MP whose relevance is given by the low incidence of this disease, being approximately 1 case per 30,000 live births. The present work has as objective to present the classic presentation of the MP through an updated literature review. Clinical case: A 21-year-old woman, primigravous, with a pregnancy of 33 + 5 weeks, and a history of gestational hypothyroidism, is referred to the maternal emergency service due to the following finding on ultrasound performed that same day: Fetal ascites, hyperechogenic bowel, without alterations in fetal echo-Doppler. Patient is hospitalized for study. Laboratory tests, including HIV and VDRL, were negative and did not clarify an etiology. Given later sonographic findings, the diagnosis is oriented towards MP, which was observed once the pregnancy was interrupted at week 38 + 5. Discussion: MP represents a challenge for the physician both in diagnosis and treatment, which is partly due to its low incidence. The case presents the most classic presentation of the MP, in which it was possible to establish the importance of prenatal diagnosis and how it influences the prognosis and subsequent management. There is agreement to adopt an expectant behavior towards MP and even wait for the start of spontaneous birth, if there are no other contraindications.

Simultaneous accelerated solvent extraction and hydrolysis of 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid glucuronide in meconium samples for gas chromatography-mass spectrometry analysis.

Cannabis misuse during pregnancy is associated with severe impacts on the mother and baby health, such as newborn low birth weight, growth restriction, pre-term birth, neurobehavioral and developmental deficits. In most of the cases, drug abuse is omitted or denied by the mothers. Thus, toxicological analyzes using maternal-fetal matrices takes place as a suitable tool to assess drug use. Herein, meconium was the chosen matrix to evaluate cannabis exposure through identification and quantification of 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic (THCCOOH). Accelerated solvent extraction (ASE) was applied for sample preparation technique to simultaneously extract and hydrolyze conjugated THCCOOH from meconium, followed by a solid-phase extraction (SPE) procedure. The method was developed and validated for gas chromatography-mass spectrometry (GC-MS), reaching hydrolysis efficiency of 98%. Limits of detection (LOD) and quantification (LOQ) were, respectively, 5 and 10 ng/g. The range of linearity was LOQ to 500 ng/g. Inter and intra-batch coefficients of variation were <8.4% for all concentration levels. Accuracy was in 101.7-108.9% range. Recovery was on average 60.3%. Carryover effect was not observed. The procedure was applied in six meconium samples from babies whose mothers were drug users and showed satisfactory performance to confirm fetal cannabis exposure.