RESUMO
OBJECTIVE: To assess the peak systolic velocity in the middle cerebral artery (PSV-MCA) in the prediction of fetal anemia in case of severe red-cell alloimmunization. METHODS: A prospective study, from January 2003 to April 2006, of 47 consecutive pregnancies with severe alloimmunization. Fetal surveillance was based on titration and dosage of antibodies, ultrasound scans, and doppler for PSV-MCA measurement up to twice a week. A fetal blood sampling and in utero transfusion was performed in case of increase in PSV-MCA above 1.5 multiples of the median (MoM), and/or signs of hydrops on ultrasound. Severe fetal anemia was defined by fetal hemoglobin below 0.55MoM for gestational age. Analyses performed included the correlation between PSV-MCA and fetal hemoglobin, the value of PSV-MCA in the prediction of severe fetal anemia, and the determination of adequate threshold for intervention based on ROC curve analysis. RESULTS: Four hundred and eighty-five PSV-MCA were performed in 47 high-risk pregnancies, of which 125 were coupled with hemoglobin measurement by fetal blood sampling. There is a significant negative correlation between PSV-MCA and fetal hemoglobin (R2=0.6545 ; p<0.0001). Based on all prospective data, the negative predictive value of PSV-MCA was 97.8 %, sensitivity was 86.7 %, with a false positive rate of 12.2%. Area under the ROC curve was 0.85 (IC 95 %, 0.742-0.927 ; p<0.0001), suggesting an excellent value of this test. When switching the threshold for intervention from 1.5 to 1.6MoM, the positive predictive value increased, without decrease in sensitivity or negative predictive value. CONCLUSION: This study confirms the correlation between PSV-MCA and fetal hemoglobin. It allows a decrease of invasive procedures in the follow-up of pregnancies with severe red-cell alloimmunization.
Assuntos
Anemia/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Transfusão de Sangue Intrauterina/métodos , Doenças Fetais/diagnóstico por imagem , Hemoglobina Fetal/análise , Artéria Cerebral Média/diagnóstico por imagem , Isoimunização Rh/complicações , Anemia/sangue , Anemia/diagnóstico , Feminino , Doenças Fetais/sangue , Doenças Fetais/diagnóstico , Humanos , Artéria Cerebral Média/fisiologia , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Curva ROC , Fluxo Sanguíneo Regional , Isoimunização Rh/diagnóstico por imagem , Isoimunização Rh/terapia , Fatores de Risco , Ultrassonografia Pré-NatalRESUMO
Vertical transmission of the HCV infection is asymptomatic, occurring in 0-25% of infants born to viremic mothers in Europe. Nowadays, the only preventive measure in to advise against breastfeeding. Favourable conditions for a seroprophylaxis trial in neonates at risk are the low viral charge and the absence of former replication or integration. Several impediments to a randomized-controlled trial should be considered: Epidemiological: paucity of recruitment; low risk of transmission; possible antenatal transmission in cases of high maternal viremia; risk for intrafamilial transmission. Methodological: complex randomization of the study groups (genotyping, quantitative PCR, activity of mothers' diseases, modes/durations of delivery and feeding). Ethical: a direct individual benefit is not clearly established; should viremic mothers be allowed to breast feed their babies in the absence of prophylaxis? the risk of the emergence of mutants or quasi-species of the transmitted hepatitis C virus in neonates; the origin and selection of seropositive plasma donors.
Assuntos
Hepatite C/transmissão , Imunoglobulinas/análise , Recém-Nascido/imunologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Aleitamento Materno , Hepatite C/epidemiologia , Hepatite C/imunologia , Anticorpos Anti-Hepatite C/análise , Humanos , Prevalência , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: The necessity of saving blood products has established the practice of exchange transfusion (ET) with reconstituted blood in newborns. The aim of this retrospective study was to evaluate the indications and the practice of this technique at the Perinatal Hemobiology Centre (Paris, France). METHODS: The records of intervention allowed us to review the etiologic categories for neonates having undergone exchange transfusion with reconstituted blood, the dosages used (bilirubin, hemoglobin), and the other main parameters of ET. RESULTS: Sixty ETs were performed in 48 newborns between the 1st July 1996 and the 1st July 1998. Twenty-seven with Rh hemolytic disease had 39 ETs (19 for hyperbilirubinemia, 12 for anemia, and eight for both), whereas ten out of 12 repeated ETs were indicated for hyperbilirubinemia (six of these cases were in newborns weighing > or = 2500 g and after a volume exchange < or = 1 blood mass [range 0.72-1.0] at the last ET). Twenty-one cases showed other diseases: six of them had anemia, nine had hyperbilirubinemia, and seven showed disseminated coagulopathy. The tolerance of ET was poor in 24% infants in this group. CONCLUSIONS: The volume of 1.3 blood mass for ET is sufficient for the majority of cases with hyperbilirubinemia, allowing transfusional savings in comparison with the previous recommendation of two blood volumes. Exact labeling of the content of units of packed red cells and plasma is essential to fulfill the volume and hematocrit requirements in every case.
Assuntos
Anemia/terapia , Eritroblastose Fetal/terapia , Transfusão Total/métodos , Icterícia Neonatal/terapia , Coagulação Intravascular Disseminada/terapia , Humanos , Recém-Nascido , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A study to evaluate the safety and immunogenicity of a recombinant hepatitis B vaccine containing the S and pre-S2 antigens (GenHevac B Pasteur) was conducted in healthy newborn infants. All infants received 20 micrograms of vaccine within 24 hours after birth, at 1 and 2 months with a booster injection at month 12. The vaccine was administered alone in 19 infants born to low risk mothers, i.e. surface antigen (HBsAg)-negative and antibody to the core antigen (Anti-HBc)-positive mothers. The vaccine was administered in combination with 100 IU hepatitis B immune globulin (HBIg) at birth and one month in 18 infants born to high risk mothers, i.e. HBsAg positive mothers. In the group not receiving HBIg, the anti-HBs seroconversion rate at the 10 mlU/ml threshold was 50% one month after the first injection. In both groups, the anti-HBs seroconversion rates were 100% one month after the third injection and above 85% one month after the second injection. After booster injection, more than 90% of the infants had an anti-HBs titre above 1,000 mlU/ml that will probably provide them with adequate protection for several years. The kinetics of the anti-pre-S2 response was similar to those of the anti-HBs response and 100% infants in both groups had seroconverted one month after the second injection of the vaccine. The side effects were scarce, all mild and transient. Given the protective role of the anti-pre-S2 antibodies, the precocity of the response to pre-S2 antigen may therefore increase the effectiveness of hepatitis vaccination.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Precursores de Proteínas/imunologia , Vacinas contra Hepatite Viral/imunologia , Feminino , Vacinas contra Hepatite B , Humanos , Imunização Passiva , Imunização Secundária , Imunoglobulinas/administração & dosagem , Recém-Nascido , Gravidez , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/efeitos adversos , Vacinas Sintéticas/imunologia , Vacinas contra Hepatite Viral/administração & dosagem , Vacinas contra Hepatite Viral/efeitos adversosRESUMO
The diagnosis of the risk for vertical infection with the virus of hepatitis C rests on the finding of specific antibodies in the mother. It is rare to see clinical signs of infection in the newborn. More frequently asymptomatic transmission of the viral genome occurs. As it is important to watch newborn infants at risk it is recommended that pregnant women who have a risk factor should have serum screening.
Assuntos
Hepatite C/congênito , Hepatite C/transmissão , Complicações Infecciosas na Gravidez/diagnóstico , Feminino , Hepatite C/diagnóstico , Humanos , Recém-Nascido , Gravidez , Fatores de RiscoRESUMO
The HBs antigen (AgHBs) was detected in 152 out of 6605 (2.3 percent) pregnant women who attended four representative maternity clinics in the Paris region. In 98 percent of the cases this finding reflected chronic hepatitis B virus infection. Among women born outside France (47 percent of the women tested, 79 percent of the AgHBs positive women), the relative risk was 6 for Asiatics, 5.5 for Africans and 4 for French women born in overseas departments or territories. Whatever the women's geographical origin, studies of their medical history revealed no significant difference between AgHBs positivity and AgHBs negativity. Overcrowding and multiparity correlated globally with the presence of AgHBs, but this correlation was absent in French women born in France. In non-African and non-Asiatic women detection guided by medical and socio-familial criteria would not be efficacious. The authors recommend systematic detection of AgHBs in pregnant women and estimate at about 180,000 french francs the cost of prevention for each case evolving toward the vital complications of chronic hepatitis B virus infection, an outcome which in the long term may affect 600 individuals born each year and who had contracted the infection during the perinatal period.
Assuntos
Hepatite B/prevenção & controle , Adulto , Feminino , França , Hepatite B/economia , Hepatite B/epidemiologia , Hepatite B/transmissão , Antígenos da Hepatite B/análise , Humanos , Recém-Nascido , Gravidez , Diagnóstico Pré-Natal , Prevalência , Fatores de RiscoAssuntos
Transfusão Feto-Materna/diagnóstico , Doença Crônica , Feminino , Humanos , Recém-Nascido , GravidezRESUMO
HBs Ag carrier rate among pregnant women is 1.5% in our hospital near Paris, six times higher than French national prevalence among women. 78% of them are of extra-metropolitan origin (especially from the African continent), 80% have a low socioeconomic status. Their newborns are at risk of "mother-to-infant" transmission of the virus HB. The risks, mechanisms and consequences of such a transmission are studied. For these reasons, it seems reasonable to perform routine prenatal testing for HBs Ag carriage. We have successively carried out two prophylactic methods. From June 1980 to October 1982, prevention with specific immunoglobulins (HBIG) was used: ten infants received at birth 0.5 ml, and 0.1 ml/kg at 1, 2, 4, 6 months of age. At 6 months, they all were safe of liver damage, HBs Ag and HBe Ag negative. Eleven infants received only the first HBIG injection. From October 1982 to September 1983, fifteen carrier women were identified at the time of delivery, and all accepted the sero-vaccination procedure for the newborn: HBIG (1 ml) and vaccine before 48 hours of life and at one month, vaccine alone at two months. The babies were controlled (9 at 4 months, 3 at 12 months) and all were safe of liver damage, HBs Ag and HBe Ag negative, with HBs antibody mean value of 240 m I.U./ml. We are grateful to the collaboration of the Departments for Mother and Infant Protection in our region--according to the usual chronology of the visits--for these satisfactory performance and results of the sero-vaccination.
Assuntos
Vírus da Hepatite B , Hepatite B/transmissão , Portador Sadio , Controle de Doenças Transmissíveis/métodos , Feminino , Hepatite B/prevenção & controle , Antígenos de Superfície da Hepatite B/análise , Vírus da Hepatite B/imunologia , Humanos , Imunização , Lactente , Recém-Nascido , Gravidez , Fatores SocioeconômicosRESUMO
The review of 15 cases of cardiac involvement demonstrate the cardiac tropism of the human parvovirus B19. Ten of these cases were collected from fetuses during second trimester of maternal-fetal infections. In situ hybridisation detects viral DNA sequences in the nucleus of infected myoblasts. Myocarditis is the most frequent histological damage. Cardiac failure, secondary to myocarditis, may occur in the absence of fetal anaemia. When the fetus is deeply anaemic, like usually in cases of hydrops, damages of the cardiac tissues might hamper the reactional increase of cardiac output; therefore, they might account for the poor prognosis of parvovirus B19 fetal hydrops in the second trimester of pregnancy, despite transfusional therapy attempts in the third trimester.
Assuntos
Eritema Infeccioso/complicações , Miocardite/etiologia , Parvovirus B19 Humano/isolamento & purificação , Complicações Infecciosas na Gravidez/virologia , Eritema Infeccioso/virologia , Feminino , Humanos , Recém-Nascido , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da GravidezRESUMO
HBsAg was detected in 152 pregnant women among 6,605 (2.3%) screened in the prenatal clinics of four hospitals representative of the Paris metropolitan area. In 98% of cases, HBsAg positivity indicated chronic HBV carrier status. Among patients born out of continental France (47% of screened women, 79% of positive women) relative risk of chronic infection was 6 in Asians, 5.5 in Africans, and 4 in French women born in non-continental France. No significant difference in medical history was seen between HBsAg-positive and HBsAg-negative patients, in any of the birthplace groups. In women born out of continental France, number of children and crowding of the home were correlated with HBsAg-positivity; these correlations were not found in French women born in continental France. In non-African, non-Asian women, screening on the basis of medical, social and familial criteria (simulated in this study) would not be effective. Routine screening for HBsAg in pregnancy is advocated. The cost of the prevention of each case of perinatally acquired chronic HBV infection by routine screening followed by prophylactic treatment of at risk neonates was estimated at 180,000 French Francs (35,000 dollars). This approach is the only means of preventing the long-term life-threatening complications of chronic HBV infection in the 600 neonates born each year in France to HBsAg-positive mothers.
Assuntos
Hepatite B/transmissão , Feminino , Hepatite B/economia , Hepatite B/epidemiologia , Hepatite B/etnologia , Humanos , Recém-Nascido , Troca Materno-Fetal/imunologia , Paris , Gravidez , Fatores de RiscoRESUMO
HBsAg was detected in 152 pregnant women among 6,605 (2.3%) screened in the prenatal clinics of four hospitals representative of the Paris metropolitan area. In 98% of cases, HBsAg positivity indicated chronic HBV carrier status. Among patients born out of continental France (47% of screened women, 79% of positive women) relative risk of chronic infection was 6 in Asians, 5.5 in Africans, and 4 in French women born in non-continental France. No significant difference in medical history was seen between HBsAg-positive and HBsAg-negative patients, in any of the birthplace groups. In women born out of continental France, number of children and crowding in the home were correlated with HBsAg-positivity; these correlations were not found in French women born in continental France. In non-African, non-Asian women, screening on the basis of medical, social and familial criteria (simulated in this study) would not be effective. Routine screening for HBsAg in pregnancy is advocated. The cost of the prevention of each case of perinatally acquired chronic HBV infection by routine screening followed by prophylactic treatment of a risk neonates was estimated at 180,000 French Francs (35,000 dollars). This approach is the only means of preventing the long-term life-threatening complications of chronic HBV infection in the 600 neonates born each year in France to HBsAg-positive mothers.
Assuntos
Portador Sadio/epidemiologia , Hepatite B/transmissão , Troca Materno-Fetal , Complicações Infecciosas na Gravidez/epidemiologia , África/etnologia , Ásia/etnologia , Portador Sadio/diagnóstico , Feminino , França , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Antígenos de Superfície da Hepatite B/análise , Humanos , Recém-Nascido , Programas de Rastreamento , Paris/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Prevalência , Fatores de RiscoRESUMO
A study to evaluate the safety and immunogenicity of a recombinant hepatitis B vaccine containing the S and pre-S2 antigens (GenHevac B Pasteur) was conducted in healthy newborn infants. All infants received 20 micrograms of vaccine within 24 h of birth and at 1 and 2 months with a booster injection at month 12. The vaccine was administered alone in 19 infants born to low risk mothers, i.e. surface antigen (HBsAg)-negative and antibody to the core antigen (Anti-HBc)-positive mothers. The vaccine was administered in combination with 100 IU hepatitis B immune globulin (HBIg) at birth and 1 month in 18 infants born to high risk mothers, i.e. HBsAg positive mothers. In the group not receiving HBIg, the anti-HBs seroconversion rate at the 10 mIU ml-1 threshold was 50% 1 month after the first injection. In both groups, the anti-HBs seroconversion rates were 100% 1 month after the third injection and greater than 85% 1 month after the second injection. After the booster injection greater than 90% of the infants had an anti-HBs titre greater than 1000 mIU ml-1 which will probably provide them with adequate protection for several years. The kinetics of the anti-pre-S2 response was similar to that of the anti-HBs response and 100% of infants in both groups had seroconverted 1 month after the second injection of the vaccine. The side effects were scarce, all mild and transient.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Anticorpos Anti-Hepatite B/biossíntese , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Imunoglobulinas/imunologia , Vacinas contra Hepatite Viral/imunologia , Antígenos de Diferenciação , Feminino , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/genética , Vacinas contra Hepatite B , Humanos , Imunização , Imunoglobulinas/administração & dosagem , Recém-Nascido , Masculino , Precursores de Proteínas/genética , Precursores de Proteínas/imunologia , Fatores de Risco , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/efeitos adversos , Vacinas Sintéticas/imunologia , Vacinas contra Hepatite Viral/administração & dosagem , Vacinas contra Hepatite Viral/efeitos adversosRESUMO
BACKGROUND: Because GB virus type C(GBV-C)/HGV (GBV-C/HGV) is blood-borne and sexually transmitted, persons at risk of infection with such viruses have a high prevalence of GBV-C/HGV markers. However, adults with no apparent risk factors, such as blood donors, frequently are positive for GBV-C/HGV markers. Mother-to-infant transmission could explain this high prevalence, but it has been studied only through small series of GBV-C/HGV-infected mothers co-infected with HCV or HIV. STUDY DESIGN AND METHODS: To determine the rate of mother-to-infant transmission of GBV-C/HGV RNA in women who are HCV- or HIV-negative, a prospective study was performed in a cohort of 288 mothers screened for viral RNA and in the infants born to GBV-C/HGV-infected mothers. RESULTS: Thirteen mothers (4.5%) were found positive for GBV-C/HGV RNA. Of the infants in whom at least one blood sample was collected between the third and the ninth months of life, 89 percent were positive for viral RNA. The majority of these newborns were negative for GBV-C/HGV RNA at birth and positive after the third month. The viral RNA titers of infants born to GBV-C/HGV-infected mothers appeared as elevated as those of their mothers. All the GBV-C/HGV-infected infants remained positive for viral RNA during the entire study period. No clinical events possibly linked to a primary GBV-C/HGV infection were reported in infants. Serum ALT level and blood count remained within normal values throughout the follow-up of all GBV-C/HGV-infected infants. CONCLUSION: The frequency of mother-to-infant GBV-C/HGV transmission is elevated and could explain the high prevalence of GBV-C/HGV markers (viral RNA and E2 antibody) in adults at low risk for blood-borne or sexually transmitted viruses, such as blood donors.