Fetal central nervous system anomalies according to RT-PCR and trimester of maternal infection with Zika virus: A prospective cohort study.

INTRODUCTION: In October 2015, an epidemic of Zika began in Colombia's geographic areas with a high population of mosquitoes of the genus Aedes. We aimed to describe the fetal brain ultrasound findings in pregnant women with active symptoms or a history of symptoms suggestive of Zika virus (ZIKV) infection. MATERIAL AND METHODS: Eligible pregnant women were tested with reverse transcriptase-polymerase chain reaction (RT-PCR) for ZIKV and followed prospectively using detailed anatomic ultrasound and transvaginal neurosonography to detect structural anomalies of the fetal central nervous system (CNS). RESULTS: A total of 115 symptomatic women with a positive ZIKV RT-PCR and 55 with a negative ZIKV RT-PCR were enrolled in the study; CNS compromise of the fetus occurred in 22% and 17%, respectively (p = 0.255). Callosal dysgenesis (14.5%) was the most frequent anomaly of the CNS, followed by microcephaly (13.6%) and neuronal migration disorders (8.3%). When symptomatic ZIKV RT-PCR-positive women were categorized by trimester of infection, CNS anomalies were present in 40% of first-trimester infections, compared with 21% and 7% in second- and third-trimester infections (p = 0.002). CNS anomalies were also more severe in first-trimester-infected fetuses than in second- and third-trimester-infected fetuses. The high prevalence of CNS anomalies in fetuses of symptomatic ZIKV RT-PCR negative women suggests a high rate of false-negative cases and an even higher prevalence of CNS anomalies than observed in this study. CONCLUSIONS: The prevalence of fetal CNS anomalies was higher than previously reported in the literature for both symptomatic RT-PCR-positive and -negative pregnant women. Corpus callosum anomalies, microcephaly, neuronal migration disorders, and brain parenchymal hyperechogenicities were the most frequent CNS anomalies detected. In addition, CNS anomalies were more frequent and severe in infected fetuses during the first trimester of pregnancy than during the second or third trimester.

Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women.

An epidemic of Zika virus (ZIKV) infection began in Colombia in October 2015. Previous studies have identified a cause-effect relationship between fetal exposure to the ZIKV and the development of microcephaly and other central nervous system (CNS) anomalies with variable degrees of neurodevelopmental delay. Less is known about the neurodevelopmental outcome of infants without CNS anomalies born to symptomatic ZIKV RT-PCR-positive women. We aimed to compare the neurodevelopmental outcome of these infants to a control group of infants without CNS anomalies born to asymptomatic ZIKV RT-PCR negative women who did not seroconvert during pregnancy. Participating infants were categorized according to ZIKV maternal exposure. Women with symptomatology suggestive of ZIKV infection and a positive RT-PCR for ZIKV were categorized as ZIKV-exposed. Maternal controls (ZIKV unexposed) from the same geographic area were subsequently captured during the tail end of the epidemic through a partner project, the ZIKAlliance, whose aim was to determine the prevalence of ZIKV in pregnant women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). The ZIKV-exposed women were found to be older, had less subsidized health care, had a higher percentage of women in middle-class socioeconomic strata, had higher technical and university education, were less likely to be living with a partner, and had higher rates of pregnancy comorbidity and premature births than ZIKV unexposed women. Compared to infants born to ZIKV unexposed women (unexposed), infants born to ZIKV exposed women (exposed) were of lower gestational age and required more speech and occupational therapy services. No differences between groups were observed in the proportion of cut-off scores <70 on the Bayley-III Scale at 12, 18, and 24 months for motor, language, and cognitive domains. When a cut-off of <85 was used, a higher percentage of motor and cognitive impairment was observed in unexposed infants at 12 and 24 months CA, respectively. Median and IQR score on the Bayley-III scale showed higher scores in favor of exposed infants for motor development at 12 and 18 months CA, language at 12 months, and cognitive domain at 12, 18, and 24 months. The adjusted median and IQR compound score of the difference between exposed and unexposed was higher in favor of exposed infants at 12 to 24 months CA for motor (3.8 [95% CI 1.0 to 6.7]) and cognitive domains (10.6 [95% CI 7.3 to 13.9]). We observed no differences in the language domain (1.9 [95% CI -1.2 to 5.0]). We conclude that infants with no evidence of microcephaly or other CNS anomalies born to ZIKV-exposed women had normal neurodevelopment up to 24 months of CA, supporting an all-or-nothing effect with maternal ZIKV exposure. Long-term follow-up to evaluate school performance is required. Clinical Trial Registration: www.clinicaltrials.gov, NCT02943304.

Incidence of metabolic bone disease in neonates under 32 gestational weeks at the Hospital Universitario de Santander in Colombia / Incidencia de enfermedad metabólica ósea en neonatos con menos de 32 semanas de gestación en el Hospital Universitario de Santander en Colombia

Introduction. Metabolic bone disease of premature infants is a rare complication characterized by a lower mineral content in bone tissue. Objective. To establish the incidence of metabolic bone disease in premature infants and to determine associated risk factors. Materials and methods. We conducted a descriptive prospective cohort study for one year in all newborns under 32 gestational weeks, or 1,500 g, at the Hospital Universitario de Santander to determine the incidence of metabolic bone disease. We collected demographic data and prenatal histories of the selected patients, and later, we measured serum alkaline phosphatase and serum phosphorus at the third week of birth, having as reference values for diagnosis less than 5.6 mg/dl for the first one and more than 500 UI/L for the second one. We applied statistical tools for data analysis, such as average proportions, dispersion, distribution and association measures, and binomial regression. Results. From a total of 58 patients, 7 had a diagnosis of metabolic bone disease, with an incidence of 12%. The weight was reported as an independent variable for the development of the disease, being significant in children under 1,160 g, as well as prolonged parenteral nutrition for more than 24 days. When performing the multivariate analysis, low weight and short time of parenteral nutrition appeared as risk factors; in the same way, maternal age below 22 years is associated with a higher relative risk, even more than a newborn weight inferior to 1,160 g. Conclusion. Establishing an early intervention in patients with metabolic bone disease enhancing risk factors, such as low weight and prolonged parenteral nutrition, is critical to prevent severe complications.

Introducción. La enfermedad metabólica ósea de neonatos prematuros es una complicación poco común que se caracteriza por una disminución del contenido mineral en el hueso. Objetivo. Establecer la incidencia de la enfermedad metabólica ósea en neonatos prematuros y los factores de riesgo asociados. Materiales y métodos. Durante un año, se realizó un estudio prospectivo de cohorte, descriptivo, con todos los neonatos nacidos con menos de 32 semanas de gestación o un peso menor de 1.500 g en el Hospital Universitario de Santander. Se recolectaron datos demográficos y antecedentes prenatales de los pacientes seleccionados. A la tercera semana de nacimiento, se midieron la fosfatasa alcalina y el fósforo sérico, tomando como valores de referencia diagnóstica aquellos inferiores a 5,6 mg/dl para el primero y aquellos mayores de 500 UI/L para la segunda. Para el análisis de la información, se emplearon herramientas estadísticas, como proporciones de promedios, medidas de dispersión, distribución y asociación, y regresión binomial. Resultados. De un total de 58 pacientes, 7 tuvieron diagnóstico de enfermedad metabólica ósea, con una incidencia del 12 %. De las variables estudiadas, el peso se reportó como una variable independiente para el desarrollo de la enfermedad, significativa en aquellos neonatos con peso menor de 1.160 g, al igual que la nutrición parenteral prolongada por más de 24 días. Al hacer el análisis multivariado, La edad materna menor de 22 años representó un riesgo relativo mayor, en comparación con un peso inferior a 1.160 g. Conclusión. Se estableció la importancia de una intervención temprana en pacientes con factores de riesgo para enfermedad metabólica ósea, como bajo peso (menor de 1.160 g) y nutrición parenteral prolongada (mayor de 24 días), con el fin de prevenir complicaciones graves.

Morbilidad neonatal extrema y sus desenlaces en un hospital de alta complejidad en el 2013 / Extreme neonatal morbidity and its outcomes in a high complexity hospital in 2013 / Morbidade neonatal extrema e seus resultados em um hospital de alta complexidade em 2013

Introducción. La Morbilidad neonatal extrema se refiere a cualquier evento ocurrido en los primeros veintiocho días de vida con riesgo vital inminente. Es multifactorial, son relevantes los retrasos en la atención. En 2010 se describió por primera vez como indicador de salud pública en Brasil. Metodología. Estudio transversal en un hospital de alta complejidad en el año 2013. Se revisaron las características sociodemográficas y asistenciales, los eventos de morbilidad y sus desenlaces, el indicador mismo, la mortalidad neonatal y los retrasos en la atención (tipos I - IV). Resultados. Ingresaron 1,190 neonatos, se presentaron 120 casos y se analizaron los primeros 60 por saturación de datos. La tasa de morbilidad neonatal extrema fue de 59 por cada 1,000 nacidos vivos y la de mortalidad de 13.9, similares a las brasileñas y superiores a las nacionales (33 por cada 1,000). Los eventos más importantes con respecto a mortalidad fueron peso menor de 1,500 gramos, ventilación mecánica, Apgar menor de 7 a los 5 minutos y malformaciones congénitas. Los retrasos en las madres fueron predominantemente de tipo I (45.4%) por pobre control prenatal. El retraso neonatal más frecuente fue el tipo IV (40%), por mala adherencia a protocolos institucionales. Discusión. El indicador local fue mayor que el nacional por la complejidad institucional y los retrasos en la atención, los cuales causaron saturación estadística. Se puede mejorar con mayor adherencia a estrategias existentes como el control prenatal y protocolos institucionales. Conclusión. La Morbilidad neonatal extrema visibiliza las falencias en atención materno­neonatal. Cómo citar. Delgado-Beltrán AM., Beltrán-Avendaño MA., Pérez-Vera LA. Morbilidad neonatal extrema y sus desenlaces en un hospital de alta complejidad en el 2013. MedUNAB. 2021;24(1): 61-71. Doi: https://doi.org/10.29375/01237047.3960

Introduction. Extreme neonatal morbidity refers to any event that occurs in the first twenty-eight days of life with imminent vital risk. It is multifactorial and delays in treatment are relevant. It was described for the first time as a public health indicator in Brazil in 2010. Methodology. This was a cross-sectional study in a high complexity hospital in 2013. Sociodemographic and assistance characteristics, morbidity events and their outcomes, the indicator itself, neonatal mortality, and delays in treatment (types I - IV) were reviewed. Results. 1,190 neonates were entered, 120 cases occurred and the first 60 were analyzed due to data saturation. The extreme neonatal morbidity rate was 59 for every 1,000 children born alive and the mortality rate was 13.9. This was similar to the figures in Brazil and greater than national statistics (33 for every 1,000). The most significant events with respect to mortality were weight lower than 1,500 grams, mechanical ventilation, an Apgar score lower than 7 at 5 minutes and congenital anomalies. Delays from mothers were predominantly type I (45.4%) due to poor prenatal control. The most frequent neonatal delay was type IV (40%) due to bad adherence to institutional protocols. Discussion. The local indicator was greater than the national indicator due to the institutional complexity and delays in treatment, which cause statistical saturation. This can be improved with better adherence to existing strategies, such as prenatal control and institutional protocols. Conclusion. Extreme neonatal morbidity shows the flaws in maternal - neonatal healthcare. Cómo citar. Delgado-Beltrán AM., Beltrán-Avendaño MA., Pérez-Vera LA. Morbilidad neonatal extrema y sus desenlaces en un hospital de alta complejidad en el 2013. MedUNAB. 2021;24(1): 61-71. Doi: https://doi.org/10.29375/01237047.3960

Introdução. A morbidade neonatal extrema refere-se a qualquer evento que ocorra nos primeiros vinte e oito dias de vida com risco de vida iminente. É multifatorial, e os atrasos no atendimento são relevantes. Em 2010 foi descrita pela primeira vez como um indicador de saúde pública no Brasil. Metodologia. Estudo transversal em um hospital de alta complexidade em 2013. Foram revisadas as características sociodemográficas e assistenciais, os eventos de morbidade e seus resultados, o próprio indicador, a mortalidade neonatal e os atrasos no atendimento (tipos I - IV). Resultados. Foram internados 1,190 recém-nascidos, foram identificados 120 casos e os primeiros 60 foram analisados devido à saturação dos dados. A taxa de morbidade neonatal extrema foi de 59 por 1,000 nascidos vivos e a taxa de mortalidade de 13,9, semelhante às taxas brasileiras e superior às taxas nacionais (33 por 1,000). Os eventos mais importantes em relação à mortalidade foram peso inferior a 1,500 gramas, ventilação mecânica, Apgar menor que 7 em 5 minutos e malformações congênitas. Os atrasos nas mães foram predominantemente do tipo I (45.4%) devido ao cuidado pré-natal precário. O atraso neonatal mais frequente foi do tipo IV (40%), devido à falta de aderência aos protocolos institucionais. Discussão. O indicador local foi superior ao nacional devido à complexidade institucional e aos atrasos no atendimento, o que causou saturação estatística. Pode ser melhorado com uma maior adesão às estratégias existentes, como atendimento pré-natal e protocolos institucionais. Conclusão. A morbidade neonatal extrema torna visíveis as deficiências no cuidado materno-neonatal. Cómo citar. Delgado-Beltrán AM., Beltrán-Avendaño MA., Pérez-Vera LA. Morbilidad neonatal extrema y sus desenlaces en un hospital de alta complejidad en el 2013. MedUNAB. 2021;24(1): 61-71. Doi: https://doi.org/10.29375/01237047.3960

Sífilis congénita en el Hospital Universitario de Santander, Bucaramanga (Colombia), 2006 - 2007 / Congenital syphilis in the Hospital Universitario de Santander, Bucaramanga (Colombia), 2006-2007

Antecedentes. La sífilis congénita (SC) aumenta en nuestro país a pesar de existir un programa diseñado para su control. Se requiere conocer las características de los afectados y sus padres, para implementar medidas de control. Objetivo. Caracterizar los casos de SC atendidos en el Hospital Universitario de Santander, Bucaramanga (Colombia), entre Junio/2006 y Septiembre/2007. Materiales y métodos. Estudio de corte transversal prospectivo. Se analizaron variables sociodemográficas y clínicas de los recién nacidos y sus padres. Resultados. Se presentaron 36 recién nacidos (RN) con SC. Nueve sintomáticos (25%), 6 con compromiso del sistema nervioso central (16.7%); 2 murieron (5.6%). En 12 casos (33.3%) las madres no hicieron control prenatal; 16 (44.4%) no aparecen inscritas al sistema de seguridad social en salud. Tres madres (8.3%) infectadas por VIH; 6 (16.7%) con más de 9 compañeros sexuales y 10 (27.8%) con un compañero sexual; 8 (22.2%) usó drogas ilícitas. El diagnóstico de sífilis fue hecho en el tercer trimestre del embarazo en 15 casos (41.7%) y 14 (38.9%) en postparto. El 47.2% de las madres no recibió tratamiento durante el embarazo (17 casos); 25 padres (69.5%) no lo recibieron. Conclusiones. Pese a que la SC es una enfermedad prevenible, en el Hospital Universitario de Santander se encontraron 36 casos entre junio de 2006 a septiembre 2007. Sobresalen factores inherentes a la madre, a su entorno y al acceso al servicio de salud que hacen que la SC aumente en nuestro medio. Para modificar la incidencia de la SC es mandatorio mejorar la calidad del control prenatal, garantizar el acceso y captación de las gestantes de manera oportuna, lograr adherencia a los protocolos de manejo por parte de las IPS para poder mejorar la calidad de vida de la infancia en Santander.

Background: Congenital syphilis is increasing in Colombia despite of the program specifically designed for its control. Understanding the characteristics of affected individuals and their parents are of the essence for the implementation of control measures. Objective: Characterize the cases of congenital syphilis at Hospital Universitario de Santander in Bucaramanga, Colombia from June 2006 to September 2007. Materials and Methods: Prospective transversal study. Social, demographic, and clinical variables in newborn babies and their parents were analyzed. Results: 36 cases of congenital syphilis were found. Nine newborn babies showed symptoms (25%); 6 of them had a compromise of the Central Nervous System (16.7%) and 2 of them died (5.6%). 12 mothers (33.3%) were not under a prenatal control program. 16 of these mothers (44.4%) were not registered in the Social Security System. 3 mothers (8.3%) were positive for HIV; 6 mothers (16.7%) had a history of more than 9 sexual partners and 10 (27.8%) reported to have only 1 sexual partner; 8 mothers (22.2%) were drug addicts. Syphilis diagnosis was conducted on third trimester of pregnancy in 15 cases (41.7%) while 14 cases were detected after birth. 47.2% of the mothers did not receive any treatment during pregnancy (17 cases). Conversely, 25 fathers (69.5%) did not receive treatment against this condition. Conclusions: Persistence of congenital syphilis cases at Hospital Universitario de Santander is the result of the high percentage of mothers (among those who gave birth to children with congenital syphilis) that are not registered at the Social Security System or are not under any prenatal control. Furthermore, the late treatment of gestational syphilis as well as the lack of treatment of affected couples contribute also to this persistence of presentation. Correction of these variables would improve the situation.

Hemorragia intraventricular en niños pretérmino, incidencia y factores de riesgo. Un estudio de corte transversal / Intraventricular hemorrhage in preterm newborns, incidence and risk factors. A cross-sectional study

La hemorragia intraventricular (IVH) es la más común de las hemorragias intracraneales neonatales. Ocurre principalmente en prematuros y se ha asociado en forma significativa a déficit neurológico. La patogénesis de la IVH es multifactorial. Nuestro objetivo fue determinar la frecuencia y severidad de los factores de riesgo asociados. Se realizó un estudio de corte transversal en el Hospital Ramón González Valencia en el que se incluyern todos los neonatos con pesos al nacer entre 500 y 1500 gramos y con edad gestacional entre 25 y 32 semanas. Se describieron caractedísticas sociodemográficas y clínicas tanto de las madres como de los neonatos. La ecografía tranfontanelar fue realizada, como método diagnóstico, entre los días cinco y siete de vida o antes de ser necesario. La población de estudio fue de 101 niños pretérmino. La frecuencia de IVH fue del 22 por ciento. En un 55 por ciento de los casos fue clasificada como severa (grado III y IV). Los factores de riesgo asociados fueron: bajo peso al nacer (OR 6.83), intubación orotraqueal (OR 8.45), uso de infusión de derivados sanguineos (OR 4.39), enfermedad de membrana hialina (OR 2.91), uso de bicarbonato (OR 3.43) y uso de dopamina (OR 3.21). El presente estudio plantea la necesidad de mejorar, hasta donde sea posible, el control prenatal y asegurar una atención óptima del recién nacido prematuro desde el momento de nacer