Gas6 drives Zika virus-induced neurological complications in humans and congenital syndrome in immunocompetent mice.

Zika virus (ZIKV) has the ability to cross placental and brain barriers, causing congenital malformations in neonates and neurological disorders in adults. However, the pathogenic mechanisms of ZIKV-induced neurological complications in adults and congenital malformations are still not fully understood. Gas6 is a soluble TAM receptor ligand able to promote flavivirus internalization and downregulation of immune responses. Here we demonstrate that there is a correlation between ZIKV neurological complications with higher Gas6 levels and the downregulation of genes associated with anti-viral response, as type I IFN due to Socs1 upregulation. Also, Gas6 gamma-carboxylation is essential for ZIKV invasion and replication in monocytes, the main source of this protein, which was inhibited by warfarin. Conversely, Gas6 facilitates ZIKV replication in adult immunocompetent mice and enabled susceptibility to transplacental infection. Our data indicate that ZIKV promotes the upregulation of its ligand Gas6, which contributes to viral infectivity and drives the development of severe adverse outcomes during ZIKV infection.

Temporal trend in early sepsis in a very low birth weight infants' cohort: an opportunity for a rational antimicrobial use.

OBJECTIVE: This study aimed to evaluate annual trends of early neonatal sepsis and antimicrobial use in very low birth weight infants for 12 years, as well as to identify microbiological agents, antimicrobial sensitivity profiles, and association with early neonatal death. METHOD: This was a retrospective cohort study including 1254 very low birth weight infants admitted from 2006 to 2017. Four groups were evaluated: culture-confirmed sepsis; presumed neonatal sepsis; ruled out neonatal sepsis group; and infants not exposed to antibiotics. RESULTS: The medians of gestational age and birth weight were 29 weeks (27-31) and 1090g (850-1310), respectively. The rates of culture-confirmed sepsis, presumed neonatal sepsis, ruled out neonatal sepsis, and not exposed to antibiotics were 1.3, 9.0, 15.4, and 74.3%, respectively. From the initial group of newborns whose antimicrobial treatment was administered for sepsis' suspicion, it was possible to discontinue antibiotic in 44%. The culture-confirmed sepsis rates remained stable (p=0.906). Significant tendencies of decreasing presumed sepsis rates (p<0.001) and increased ruled out neonatal sepsis/not exposed to antibiotics rates (p<0.001) were observed. Streptococcus agalactiae and enteric Gram-negative rods were the predominant agents and most of them were sensitive to crystalline penicillin/ampicillin (88.2%) and to ampicillin and/or amikacin. Early death occurred in 10.8%, specifically in the culture-confirmed sepsis and presumed neonatal sepsis groups. CONCLUSION: The confirmed sepsis rate was low and remained stable. There was a significant downward trend in the presumed neonatal sepsis rate and a significant upward trend in the ruled out neonatal sepsis group. The rate of not exposed to antibiotics infants was high, also presenting a significant downward trend. The identified bacteria were those commonly found and showed usual antimicrobial susceptibility patterns. Death predominantly occurred in groups that received antibiotic treatment.

Temporal trend in early sepsis in a very low birth weight infants' cohort: an opportunity for a rational antimicrobial use

Abstract Objective This study aimed to evaluate annual trends of early neonatal sepsis and antimicrobial use in very low birth weight infants for 12 years, as well as to identify microbiological agents, antimicrobial sensitivity profiles, and association with early neonatal death. Method This was a retrospective cohort study including 1254 very low birth weight infants admitted from 2006 to 2017. Four groups were evaluated: culture-confirmed sepsis; presumed neonatal sepsis; ruled out neonatal sepsis group; and infants not exposed to antibiotics. Results The medians of gestational age and birth weight were 29 weeks (27-31) and 1090 g (850-1310), respectively. The rates of culture-confirmed sepsis, presumed neonatal sepsis, ruled out neonatal sepsis, and not exposed to antibiotics were 1.3, 9.0, 15.4, and 74.3%, respectively. From the initial group of newborns whose antimicrobial treatment was administered for sepsis' suspicion, it was possible to discontinue antibiotic in 44%. The culture-confirmed sepsis rates remained stable (p = 0.906). Significant tendencies of decreasing presumed sepsis rates (p < 0.001) and increased ruled out neonatal sepsis/not exposed to antibiotics rates (p < 0.001) were observed. Streptococcus agalactiae and enteric Gram-negative rods were the predominant agents and most of them were sensitive to crystalline penicillin/ampicillin (88.2%) and to ampicillin and/or amikacin. Early death occurred in 10.8%, specifically in the culture-confirmed sepsis and presumed neonatal sepsis groups. Conclusion The confirmed sepsis rate was low and remained stable. There was a significant downward trend in the presumed neonatal sepsis rate and a significant upward trend in the ruled out neonatal sepsis group. The rate of not exposed to antibiotics infants was high, also presenting a significant downward trend. The identified bacteria were those commonly found and showed usual antimicrobial susceptibility patterns. Death predominantly occurred in groups that received antibiotic treatment.

Healthcare-associated infections among neonates in Brazil.

OBJECTIVE: To describe the epidemiology of healthcare-associated infections (HAIs) among neonates. DESIGN: Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAI. SETTING: Seven neonatal units located in three Brazilian cities. PATIENTS: All admitted neonates were included and observed until discharge. RESULTS: Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI. Central venous catheter (CVC)-associated BSIs per 1,000 CVC-days ranged from 17.3 (BW, 1,501 to 2,500 g; device utilization [DU], 0.11) to 34.9 (BW, < or = 1,000 g; DU, 34.92). Ventilator-associated pneumonia per 1,000 ventilator-days ranged from 7.0 (BW, < or = 1,000 g; DU, 0.34) to 9.2 (BW, 1,001 to 1,500 g; DU, 0.14). CONCLUSIONS: The high proportion of HAIs of maternal origin highlights perinatal care issues in Brazil and the need to improve the diagnosis of neonatal HAIs. The very low BW group and device-associated infections should be priorities for prevention strategies in this population.

Prevention of Healthcare-associated Infections in Neonatology

[From the Introduction]: Advances in neonatology in recent decades have enabled the survival of preterm and extremely low birthweight newborns, as well as newborns with some malformations. However, with this improvement in initial survival, other problems have emerged, including an increase in healthcare-associated infections (HAIs), which has become one of the factors limiting survival of these children.

Prevenção de infecções relacionadas à assistência à saúde em neonatologia

[Introdução]. O progresso da Neonatologia nas últimas décadas tem permitido a sobrevida de recém-nascidos (RN) prematuros de extremo baixo peso e RN portadores de algumas malformações. No entanto, com essa melhora da sobrevida inicial, outros problemas começaram a surgir, entre eles o aumento das infecções relacionadas à assistência à saúde (IRAS), que passaram a ser um dos fatores limitantes da sobrevida dessas crianças... A Organização Pan-Americana da Saúde considera todas as infecções ocorridas no período neonatal como IRAS, exceto as de transmissão transplacentária. As IRAS são classificadas como precoces quando se manifestam nas primeiras 48 horas de vida, e como tardias quando se manifestam depois de 48 horas de vida. Muitos países da região das Américas possuem suas próprias definições de IRAS que devem ser seguidas pelos hospitais desses países. O estabelecimento de um critério nacional de IRAS a ser utilizado em todos os serviços de atendimento neonatal de um país é fundamental para a uniformização da coleta de dados epidemiológicos referentes à infecção permitindo o monitoramento dessas infecções e o estabelecimento de estratégias de prevenção e controle. Neste documento abordaremos especialmente os aspectos relacionados à prevenção de IRAS no ambiente hospitalar a partir do nascimento, alojamento conjunto e unidade de internação neonatal.

Prevenção de infecções relacionadas à assistência à saúde em neonatologia

[Introdução]. O progresso da Neonatologia nas últimas décadas tem permitido a sobrevida de recém-nascidos (RN) prematuros de extremo baixo peso e RN portadores de algumas malformações. No entanto, com essa melhora da sobrevida inicial, outros problemas começaram a surgir, entre eles o aumento das infecções relacionadas à assistência à saúde (IRAS), que passaram a ser um dos fatores limitantes da sobrevida dessas crianças... A Organização Pan-Americana da Saúde considera todas as infecções ocorridas no período neonatal como IRAS, exceto as de transmissão transplacentária. As IRAS são classificadas como precoces quando se manifestam nas primeiras 48 horas de vida, e como tardias quando se manifestam depois de 48 horas de vida. Muitos países da região das Américas possuem suas próprias definições de IRAS que devem ser seguidas pelos hospitais desses países. O estabelecimento de um critério nacional de IRAS a ser utilizado em todos os serviços de atendimento neonatal de um país é fundamental para a uniformização da coleta de dados epidemiológicos referentes à infecção permitindo o monitoramento dessas infecções e o estabelecimento de estratégias de prevenção e controle. Neste documento abordaremos especialmente os aspectos relacionados à prevenção de IRAS no ambiente hospitalar a partir do nascimento, alojamento conjunto e unidade de internação neonatal.

[Infection rate and Streptococcus agalactiae serotypes in samples of infected neonates in the city of Campinas (São Paulo), Brazil]. / Taxa de infecção e sorotipos de Streptococcus agalactiae em amostras de recém-nascidos infectados na cidade de Campinas (SP), Brasil.

PURPOSE: To describe the epidemiological cases and microbiological profile of Streptococcus agalactiae serotypes isolated from infected newborns of a Women's Health Reference Centre of Campinas, São Paulo, Brazil. METHODS: Cross-sectional laboratory survey conducted from January 2007 to December 2011. The newborns' strains, isolated from blood and cerebrospinal fluid samples, were screened by hemolysis on blood ágar plates, Gram stain, catalase test, CAMP test, hippurate hydrolysis or by microbiological automation: Vitek 2 BioMerieux®. They were typed by PCR, successively using specific primers for species and nine serotypes of S. agalactiae. RESULTS: Seven blood samples, one cerebrospinal fluid sample and an ocular sample, were isolated from nine newborns with infections caused by S. agalactiae, including seven cases of early onset and two of late onset. Only one of these cases was positive for paired mother-child samples. Considering that 13,749 deliveries were performed during the study period, the incidence was 0.5 cases of GBS infections of early onset per 1 thousand live births (or 0.6 per 1 thousand, including two cases of late onset) with 1, 3, 2, zero and 3 cases (one early and two late onset cases), respectively, for the years from 2007 to 2011. It was possible to apply PCR to seven of nine samples, two each of serotypes Ia and V and three of serotype III, one from a newborn and the other two from a paired mother-child sample. CONCLUSIONS: Although the sample was limited, the serotypes found are the most prevalent in the literature, but different from the other few Brazilian studies available, except for type Ia.

Incidence and risk factors of accidental extubation in a neonatal intensive care unit.

OBJECTIVE: To determine the incidence and risk factors of accidental extubation (AE) in a tertiary neonatal intensive care unit. METHODS: A prospective cohort study was conducted to determine AE incidence density per 100 patient-days, during a 23-month period, in 222 newborns receiving assisted ventilation (AV). Logistic regression analysis was used to determine risk factors for AE. The presence of a cyclical pattern in extubation rates, according to the variables of interest, was investigated by Cosinor analysis. RESULTS: The mean AE rate was 5.34/100 patient-days ventilated. AE-associated predictive variables were: subsequent use of the oral and nasal routes during AV [relative risk (RR) = 4.73; 95% confidence interval (95%CI) 1.92-11.60], AV duration (per day, RR = 1.03; 95%CI 1.02-1.04), and number of patient-days ventilated (RR = 1.01; 95%CI 1.01-1.02). According to the adjusted multiple regression analysis, total AV time was the only independent predictor of AE in this sample (RR = 1.02; 95%CI 1.01-1.03). AV time of 10.5 days showed an accuracy of 0.79 (95%CI 0.71-0.87) for the occurrence of AE. Cosinor analysis showed significant periodicity in overall AE rate and in the number of patient-days ventilated. There was a significant correlation between the number of patient-days ventilated and AE frequency. CONCLUSION: Mean AE density was 5.34/100 patient-days ventilated. AV duration was the only independent predictor of AE. The best accuracy for AE occurrence was achieved at 10.5 days of AV duration.

[Group B streptococcus maternal and neonatal colonization in preterm rupture of membranes and preterm labor]. / Colonização materna e neonatal por estreptococo do grupo B em situações de ruptura pré-termo de membranas e no trabalho de parto prematuro.

PURPOSE: To identify the prevalence and risk factors of maternal colonization by group B streptococcus (GBS) in pregnant women with premature labor (PL) and/or premature membrane rupture (PMR). METHODS: Two anal and two vaginal swabs were collected from 203 pregnant women with diagnosis of PL or PMR assisted at the practice along one year. Pregnant women with imminent labor at admission were excluded. One swab of each source was placed in a transfer milieu and sent for culture in blood-agar plates; the two remaining swabs were incubated for 24 hours in Todd-Hewitt milieu for further sowing in blood-agar plates. Risk factors were analyzed by the chi-square test, Student's t-test (p-value set at 0.05 and 95% confidence interval) and logistic regression. The following variables were analyzed: age, race, parity and mother schooling; culture results by source and type of culture; admission diagnosis; gestational age at admission; asymptomatic bacteriuria; gestational age at delivery; type of delivery; neonatal GBS colonization rate and immediate neonatal condition. RESULTS: Prevalence of maternal GBS colonization was 27.6% (56 cases). The colonization rates according to gestational complications were 30% for PMR, 25.2% for PL and 17.8% for PL + PMR. Univariate analysis has shown that the variables Caucasian race, low level of schooling and bacteriuria were associated with higher colonization rates. Multivariate analysis showed that the presence of urinary infection was the only variable associated with maternal colonization. The GBS detection rate was significantly higher with the use of a selective milieu and collection from both anal and vaginal sources. The neonatal colonization rate was 3.1%. Two cases of early sepsis by GBS occurred in the sample, with prevalence of 10.8 cases per one thousand live births and 50% mortality rate. CONCLUSION: The studied sample showed high maternal colonization rates by Streptococcus agalactiae. To increase GBS detection rate, it is necessary to use a selective culture milieu and to combine anal-rectal and vaginal cultures. There was a high incidence of early neonatal sepsis.

Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis.

OBJECTIVE: To evaluate the diagnostic value for late neonatal sepsis of white blood cell count (WBC) and assays for C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha), in isolation and in conjunction. METHODS: This was a diagnostic test validation study. Chemiluminescence was used to assay CRP, IL-6 and TNF-alpha at the time of clinical suspicion and again after 24 and 48 hours, whereas the WBC was performed only once, at the time of suspicion. Patients were classified into three groups based on clinical progress and culture results: confirmed sepsis (CS), probable sepsis (PS), and not infected (NI). Statistical analysis was performed using the Wilcoxon and chi-square tests and Friedman analysis of variance; cutoffs were defined by plotting receiver operator characteristic curves. RESULTS: The total study sample comprised 82 children, 42 of whom were classed as CS, 16 as PS and 24 as NI. At all three test times, the medians for CRP and IL-6 were significantly more elevated in the CS and PS groups, while the medians for TNF-alpha were abnormal only in the CS group. The CRP test had elevated indices of diagnostic utility at all three test times, better accuracy than the WBC and similar accuracy to the first IL-6 and TNF-alpha assays. There was no statistical difference between the cytokines, nor between them and the WBC. Combining tests did not increase diagnostic power, with the exception of the combination of WBC with CRP2 and when the sequential CRP assays were combined. CONCLUSIONS: Both CRP and WBC were useful for the diagnosis of late neonatal sepsis and comparable with IL-6 and TNF-alpha. Accuracy increased when CRP and WBC were combined and when sequential CRP assay results were used.

Taxa de infecção e sorotipos de Streptococcus agalactiae em amostras de recém-nascidos infectados na cidade de Campinas (SP), Brasil / Infection rate and Streptococcus agalactiae serotypes in samples of infected neonates in the city of Campinas (São Paulo), Brazil

OBJETIVO: Descrever os casos e o perfil microbiológico dos sorotipos de Streptococcus agalactiae provenientes de recém-nascidos em um Centro de Referência da Saúde da Mulher na cidade de Campinas, São Paulo, Brasil. MÉTODOS: Estudo transversal clínico-laboratorial realizado de janeiro de 2007 a dezembro de 2011. As cepas suspeitas, isoladas em amostras de sangue e líquor, foram identificadas a partir da hemólise em ágar sangue, coloração de Gram, provas de catalase, teste de CAMP, hidrólise do hipurato ou por automação microbiológica Vitek 2 BioMerieux®. A seguir, estas cepas foram tipadas por PCR utilizando sucessivamente primers específicos para espécie e para nove sorotipos de S. agalactiae. RESULTADOS: Foram isoladas sete amostras de sangue, uma de líquor e uma de secreção ocular provenientes de nove recém-nascidos com infecções causadas pelo S. agalactiae, sendo sete casos de infecção de início precoce e duas de início tardio. Apenas um destes casos foi positivo para amostras pareadas mãe-filho. Para um total de 13.749 partos no período, os 7 casos correspondem a 0,5 caso de infecção precoce por Streptococcus do Grupo B a cada 1 mil nascidos vivos (ou 0,6 casos por 1 mil, incluindo os 2 de infecção tardia), tendo ocorrido 1, 3, 2, nenhum e 3 casos (um precoce e dois tardios), respectivamente, nos anos de 2007 a 2011. Foi possível realizar o PCR para sete amostras, sendo duas de cada um dos sorotipos Ia e V e o sorotipo III em três amostras, uma delas em um recém-nascido e outras duas em amostra pareada mãe-filho. CONCLUSÕES: Embora com casuística limitada, os sorotipos encontrados coincidem com os mais prevalentes na literatura mundial, mas diferem dos estudos brasileiros, exceto para o sorotipo Ia.

PURPOSE: To describe the epidemiological cases and microbiological profile of Streptococcus agalactiae serotypes isolated from infected newborns of a Women's Health Reference Centre of Campinas, São Paulo, Brazil. METHODS: Cross-sectional laboratory survey conducted from January 2007 to December 2011. The newborns' strains, isolated from blood and cerebrospinal fluid samples, were screened by hemolysis on blood ágar plates, Gram stain, catalase test, CAMP test, hippurate hydrolysis or by microbiological automation: Vitek 2 BioMerieux®. They were typed by PCR, successively using specific primers for species and nine serotypes of S. agalactiae. RESULTS: Seven blood samples, one cerebrospinal fluid sample and an ocular sample, were isolated from nine newborns with infections caused by S. agalactiae, including seven cases of early onset and two of late onset. Only one of these cases was positive for paired mother-child samples. Considering that 13,749 deliveries were performed during the study period, the incidence was 0.5 cases of GBS infections of early onset per 1 thousand live births (or 0.6 per 1 thousand, including two cases of late onset) with 1, 3, 2, zero and 3 cases (one early and two late onset cases), respectively, for the years from 2007 to 2011. It was possible to apply PCR to seven of nine samples, two each of serotypes Ia and V and three of serotype III, one from a newborn and the other two from a paired mother-child sample. CONCLUSIONS: Although the sample was limited, the serotypes found are the most prevalent in the literature, but different from the other few Brazilian studies available, except for type Ia.

Incidência e fatores de risco para a extubação acidental em uma unidade de terapia intensiva neonatal / Incidence and risk factors of accidental extubation in a neonatal intensive care unit

OBJETIVO: Determinar a incidência e fatores de risco para a extubação acidental (EA) em uma unidade de terapia intensiva neonatal de nível terciário. MÉTODOS: Estudo de coorte prospectivo para determinar a densidade de incidência de EA por 100 pacientes-dia, no período de 23 meses, em 222 recém-nascidos em assistência ventilatória (AV). Foram estudados os fatores de risco para a EA utilizando análise de regressão logística. A presença de padrão cíclico nas taxas de extubação, segundo variáveis de interesse, foi investigada pela análise de Cosinor. RESULTADOS: A média da taxa de EA foi de 5,34/100 pacientes-dia ventilados. As variáveis preditoras que se associaram à EA foram o uso subsequente da via oral e nasal durante a AV [risco relativo (RR) = 4,73; intervalo de confiança de 95 por cento (IC95 por cento) 1,92-11,60], a duração da AV (a cada dia RR = 1,03; IC95 por cento 1,02-1,04) e o número de pacientes-dia ventilados (RR = 1,01; IC95 por cento 1,01-1,02). Pela regressão múltipla ajustada, o tempo total de AV foi o único preditor independente para a EA nesta amostra (RR = 1,02; IC95 por cento 1,01-1,03). O tempo de AV de 10,5 dias apresentou acurácia de 0,79 (IC95 por cento 0,71-0,87) para a ocorrência de EA. A análise de Cosinor demonstrou periodicidade significativa na taxa geral de EA e no número de pacientes-dia ventilados. Houve correlação significativa entre o número de pacientes-dia e a frequência de EA. CONCLUSÃO: A densidade média de EA foi de 5,34/100 pacientes-dia. O único preditor independente para EA foi a duração da AV. A melhor acurácia para a ocorrência de EA foi obtida aos 10,5 dias de duração da AV.

OBJECTIVE: To determine the incidence and risk factors of accidental extubation (AE) in a tertiary neonatal intensive care unit. METHODS: A prospective cohort study was conducted to determine AE incidence density per 100 patient-days, during a 23-month period, in 222 newborns receiving assisted ventilation (AV). Logistic regression analysis was used to determine risk factors for AE. The presence of a cyclical pattern in extubation rates, according to the variables of interest, was investigated by Cosinor analysis. RESULTS: The mean AE rate was 5.34/100 patient-days ventilated. AE-associated predictive variables were: subsequent use of the oral and nasal routes during AV [relative risk (RR) = 4.73; 95 percent confidence interval (95 percentCI) 1.92-11.60], AV duration (per day, RR = 1.03; 95 percentCI 1.02-1.04), and number of patient-days ventilated (RR = 1.01; 95 percentCI 1.01-1.02). According to the adjusted multiple regression analysis, total AV time was the only independent predictor of AE in this sample (RR = 1.02; 95 percentCI 1.01-1.03). AV time of 10.5 days showed an accuracy of 0.79 (95 percentCI 0.71-0.87) for the occurrence of AE. Cosinor analysis showed significant periodicity in overall AE rate and in the number of patient-days ventilated. There was a significant correlation between the number of patient-days ventilated and AE frequency. CONCLUSION: Mean AE density was 5.34/100 patient-days ventilated. AV duration was the only independent predictor of AE. The best accuracy for AE occurrence was achieved at 10.5 days of AV duration.

Colonização materna e neonatal por estreptococo do grupo B em situações de ruptura pré-termo de membranas e no trabalho de parto prematuro / Group B streptococcus maternal and neonatal colonization in preterm rupture of membranes and preterm labor

OBJETIVO: identificar a prevalência e os fatores de risco de colonização materna por estreptococo do grupo B (EGB) em gestantes com trabalho de parto prematuro (TPP) e/ou ruptura prematura pré-termo de membranas (RPM). MÉTODOS: foram colhidos dois swabs anais e dois swabs vaginais de 203 gestantes com diagnóstico de TPP ou RPM entre 22 e 36 semanas completas de gestação atendidas no serviço em um período de um ano. Foram excluídas as gestantes que deram entrada com parto iminente. Um swab de cada local foi colocado em meio de transporte, sendo posteriormente enviados para cultura em placas de ágar-sangue, os outros dois foram incubados por 24 horas em meio de Todd-Hewitt para posterior semeadura em placas de ágar-sangue. Foram analisados fatores de risco com o uso do teste do qui-quadrado, t de Student (p ajustado a 0,05 e intervalo de confiança 95 por cento) e de regressão logística. Foram analisadas as seguintes variáveis: idade, raça, paridade e escolaridade maternas; resultados das culturas por local de coleta e tipo de cultura; diagnóstico de admissão; idade gestacional de admissão; bacteriúria assintomática; idade gestacional no parto; tipo de parto; taxa de colonização neonatal por EGB e resultado neonatal imediato. RESULTADOS: a prevalência de colonização materna por EGB foi de 27,6 por cento (56 gestantes). As taxas de colonização segundo as complicações da gestação foram 30 por cento para RPM, 25,2 por cento para TPP e 17,8 por cento para TPP + RPM. As variáveis "raça branca", "baixo nível de escolaridade" e "bacteriúria" foram associadas a maiores taxas de colonização na análise univariada. A presença de infecção urinária foi a única variável significativamente associada à colonização materna na análise multivariada. A taxa de detecção do estreptococo do grupo B foi significativamente maior com o uso do meio seletivo e com a associação de coleta de culturas anais e vaginais. A taxa de colonização neonatal foi de 3,1 por cento. ...

PURPOSE: to indentify the prevalence and risk factors of maternal colonization by group B streptococcus (GBS) in pregnant women with premature labor (PL) and/or premature membrane rupture (PMR). METHODS: two anal and two vaginal swabs were collected from 203 pregnant women with diagnosis of PL or PMR assisted at the practice along one year. Pregnant women with imminent labor at admission were excluded. One swab of each source was placed in a transfer milieu and sent for culture in blood-agar plates; the two remaining swabs were incubated for 24 hours in Todd-Hewitt milieu for further sowing in blood-agar plates. Risk factors were analyzed by the chi-square test, Student's t-test (p-value set at 0.05 and 95 percent confidence interval) and logistic regression. The following variables were analyzed: age, race, parity and mother schooling; culture results by source and type of culture; admission diagnosis; gestational age at admission; asymptomatic bacteriuria; gestational age at delivery; type of delivery; neonatal GBS colonization rate and immediate neonatal condition. RESULTS: prevalence of maternal GBS colonization was 27.6 percent (56 cases). The colonization rates according to gestational complications were 30 percent for PMR, 25.2 percent for PL and 17.8 percent for PL + PMR. Univariate analysis has shown that the variables Caucasian race, low level of schooling and bacteriuria were associated with higher colonization rates. Multivariate analysis showed that the presence of urinary infection was the only variable associated with maternal colonization. The GBS detection rate was significantly higher with the use of a selective milieu and collection from both anal and vaginal sources. The neonatal colonization rate was 3.1 percent. Two cases of early sepsis by GBS occurred in the sample, with prevalence of 10.8 cases per one thousand live births and 50 percent mortality rate. CONCLUSION: the studied sample showed high maternal colonization ...

Acurácia diagnóstica do leucograma, proteína C-reativa, interleucina-6 e fator de necrose tumoral-alfa na sepse neonatal tardia / Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis

OBJETIVO: Avaliar o valor do leucograma, proteína C-reativa (PCR), interleucina-6 (IL-6) e do fator de necrose tumoral-alfa (TNF-α), isoladamente e em conjunto, na detecção da sepse neonatal tardia. MÉTODOS: Estudo de validação diagnóstica. A PCR, IL-6 e TNF-α foram dosados por quimioluminescência à suspeita clínica, 24 e 48 horas depois, e o leucograma unicamente à suspeita. De acordo com evolução clínica e resultados de culturas, três grupos foram definidos: sepse comprovada (SC), sepse provável (SP) e não infectados (NI). Os testes estatísticos utilizados foram os de Wilcoxon, qui-quadrado e análise de variância de Friedman e os limites de corte foram obtidos pela construção da curva ROC. RESULTADOS: Estudaram-se 82 crianças, sendo 42 no grupo SC, 16 no SP e 24 NI. Nos três momentos, as medianas da PCR e da IL-6 mostraram-se significativamente mais elevadas nos grupos SC e SP, e as do TNF-α alteraram-se apenas no grupo SC. Os índices diagnósticos da PCR foram elevados nos três momentos e com acurácia superior a do leucograma e semelhante a da IL-6 e a do TNF-α em suas primeiras medidas. Entre as citocinas, não houve diferença estatística entre elas, nem em relação ao leucograma. A associação dos testes não aumentou a capacidade diagnóstica, exceto na combinação entre leucograma e PCR2 e na dosagem seriada de PCR. CONCLUSÕES: A PCR e o leucograma mostram-se úteis no diagnóstico de sepse neonatal tardia e comparáveis à IL-6 e ao TNF-α. A acurácia aumentou com a associação PCR-leucograma e a dosagem seriada da PCR.

OBJECTIVE: To evaluate the diagnostic value for late neonatal sepsis of white blood cell count (WBC) and assays for C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), in isolation and in conjunction. METHODS: This was a diagnostic test validation study. Chemiluminescence was used to assay CRP, IL-6 and TNF-α at the time of clinical suspicion and again after 24 and 48 hours, whereas the WBC was performed only once, at the time of suspicion. Patients were classified into three groups based on clinical progress and culture results: confirmed sepsis (CS), probable sepsis (PS), and not infected (NI). Statistical analysis was performed using the Wilcoxon and chi-square tests and Friedman analysis of variance; cutoffs were defined by plotting receiver operator characteristic curves. RESULTS: The total study sample comprised 82 children, 42 of whom were classed as CS, 16 as PS and 24 as NI. At all three test times, the medians for CRP and IL-6 were significantly more elevated in the CS and PS groups, while the medians for TNF-α were abnormal only in the CS group. The CRP test had elevated indices of diagnostic utility at all three test times, better accuracy than the WBC and similar accuracy to the first IL-6 and TNF-α assays. There was no statistical difference between the cytokines, nor between them and the WBC. Combining tests did not increase diagnostic power, with the exception of the combination of WBC with CRP2 and when the sequential CRP assays were combined. CONCLUSIONS: Both CRP and WBC were useful for the diagnosis of late neonatal sepsis and comparable with IL-6 and TNF-α. Accuracy increased when CRP and WBC were combined and when sequential CRP assay results were used.

Prevención de infecciones asociadas a la atención neonatológica

La Organización Panamericana de la Salud considera todas las infecciones que se producen en el período neonatal como infecciones asociadas a la atención de salud (IAAS), excepto aquellas de transmisión transplacentaria. Las IAAS se clasifican como tempranas cuando se manifiestan en las primeras 48 horas de vida, y como tardías cuando se manifiestan después de 48 horas de vida. Muchos países de la Región de las Américas poseen sus propias definiciones de IAAS que Deben seguir sus hospitales. Es fundamental definir un criterio nacional sobre las IAAS que han de aplicar todos los servicios de atención neonatal de un país a fin de uniformizar la recopilación de datos epidemiológicos relativos a la infección, lo que permitirá el monitoreo de esas infecciones y el establecimiento de estrategias de prevención y control. En este documento abordaremos especialmente los aspectos relacionados con la prevención de las IAAS en el ambiente hospitalario a partir del nacimiento, tanto en alojamiento conjunto como en la unidad de hospitalización neonatal.

Prevención de infecciones asociadas a la atención neonatológica

La Organización Panamericana de la Salud considera todas las infecciones que se producen en el período neonatal como infecciones asociadas a la atención de salud (IAAS), excepto aquellas de transmisión transplacentaria. Las IAAS se clasifican como tempranas cuando se manifiestan en las primeras 48 horas de vida, y como tardías cuando se manifiestan después de 48 horas de vida. Muchos países de la Región de las Américas poseen sus propias definiciones de IAAS que Deben seguir sus hospitales. Es fundamental definir un criterio nacional sobre las IAAS que han de aplicar todos los servicios de atención neonatal de un país a fin de uniformizar la recopilación de datos epidemiológicos relativos a la infección, lo que permitirá el monitoreo de esas infecciones y el establecimiento de estrategias de prevención y control. En este documento abordaremos especialmente los aspectos relacionados con la prevención de las IAAS en el ambiente hospitalario a partir del nacimiento, tanto en alojamiento conjunto como en la unidad de hospitalización neonatal.

Método para seleção e aquisição de soluções degermantes sem anti-séptico e dispensadores para lavagem de mãos / Method for selecting and acquiring antiseptic-free soap and hand-washing dispensers

Objetivo: descrever método para seleção e aquisição de soluções degermantes sem anti-sépticos e dispensadores para lavagem das mãos. Foi realizado teste cego dos produtos de setembro a novembro de 2003, num período de dez dias consectivos. Foram selecionadas para o teste as unidades de internação de ginecologia, alojamento conjunto e patologia obstétrica e cada uma testou apenas uma marca do conjunto de solução degermante e dispensador. Os resultados foram anotados no Formulário de Teste de Produto. De acordo com o desempenho do produto, os usuários concluíram os testes com parecer favorável ou desfavorável utilizado como critério de classificação do produto. Participaram da licitação três fornecedores que tinham o registro do produto na área de cosméticos. Os formulários de teste de produto enviados às unidades selecionadas foram desenvolvidos e encontravam-se devidamente preenchidos. Das marcas testadas duas foram aprovadas e uma reprovada pela equipe de saúde. Todos os dispensadores foram alvo de insatisfação por parte dos usuários. Não houve, porém, relatos sobre quebra ou outros defeitos. Embora não tenha ocorrido aprovação do dispensador, o processo de aquisição seguiu o critério de aprovação da solução degermante sem anti-séptico de menor preço entre as duas marcas classificadas. Não houve contestação por parte dos fornecedores sobre a realização do teste e da utilização de seus resultados nos critérios para aquisição dos produtos. Os produtos adquiridos por meio desse método mantiveram seus resultados satisfatórios após aquisição e utilização em todas as unidades assistenciais do hospital.