¿Afecta la infección asintomática, leve y moderada por Covid-19 en el primer y segundo trimestre los resultados del embarazo?

Objetivo : Determinar los efectos de la infección Covid-19 asintomática, leve y moderada en el primer y segundo trimestres en los resultados del embarazo. Métodos : El estudio se realizó en las gestantes que acudieron al Departamento de Perinatología de la Universidad de Ciencias de la Salud de Izmir entre octubre de 2021 y julio de 2022. Se registraron las mujeres embarazadas que presentaban infección asintomática, leve y moderada por Covid-19 en el 1º y 2º trimestre y se siguió el desarrollo de la gestación. Resultados : Un total de 437 pacientes participaron en el estudio. El número de pacientes asintomáticos, leves y moderados de Covid-19 fue de 142, 157 y 138, respectivamente. Cada grupo se analizó como subgrupo del 1º y 2º trimestre según el momento de la infección por Covid-19. La edad media de las pacientes con Covid-19 moderado era superior a la de las pacientes con Covid-19 leve/asintomático (p=0,021). Se observó que el índice de masa corporal era mayor en las pacientes con Covid-19 moderado que en las pacientes con infección leve/asintomática (p=0,048). El parto pretérmino (entre las semanas 34 y 37) fue significativamente mayor en los casos con infección moderada por Covid-19 (p=0,041). Este aumento ocurrió principalmente en pacientes con infección por Covid-19 en el 2º trimestre. No hubo modificaciones significativas en las tasas de cesárea, trastornos hipertensivos del embarazo, pérdida fetal, retraso del crecimiento intrauterino, colestasis del embarazo y diabetes gestacional. Conclusiones : Los efectos de la infección por Covid-19 al inicio del embarazo (1º y 2º trimestres) siguen siendo objeto de investigación. La infección moderada por Covid-19, especialmente en el 2º trimestre, puede provocar un aumento de la tasa de partos prematuros.

Objectives: To evaluate the effects of asymptomatic, mild and moderate Covid-19 infection in the 1st and 2nd trimesters on pregnancy outcomes. Material and methods: The study was performed among patients who applied to the Perinatology Department of Izmir University of Health Sciences, between October 2021 and July 2022. Pregnant women who had asymptomatic, mild and moderate Covid-19 infection in the 1st and 2nd trimesters were registered and their pregnancy processes were followed. Results: A total of 437 patients participated in the study. The numbers of asymptomatic, mild and moderate Covid-19 patients were 142, 157 and 138, respectively. Each group was analyzed as 1st and 2nd trimester subgroups according to the time of Covid-19 infection. The mean age of patients with moderate Covid-19 was higher than with mild/asymptomatic Covid-19 (p=0.021). Body mass index was found to be higher in patients with moderate Covid-19 compared to patients with mild/asymptomatic infection (p=0.048). Preterm labor (between 34th and 37th weeks) was significantly higher with moderate Covid-19 infection (p=0.041). This significant increase was mainly due to the preterm birth rate in patients with previous Covid-19 infection in the 2nd trimester. There was no significant change in the rates of cesarean section, hypertensive disorders of pregnancy, fetal loss, intrauterine growth restriction, cholestasis of pregnancy and gestational diabetes. Conclusions: The effects of Covid-19 infection in early pregnancy (1st and 2nd trimester) are still the subject of research. Moderate Covid-19 infection, especially in the 2nd trimester, may lead to an increase in the rate of preterm birth.

Early exposure to agricultural pesticides and the occurrence of autism spectrum disorder: a systematic review / Exposição precoce a agrotóxicos de uso agrícola e ocorrência do transtorno do espectro autista: uma revisão sistemática

Abstract Objective: The aim of this study was to evaluate the influence of early exposure to agricultural pesticides and their relationship with autism spectrum disorder. Data source: This systematic review was registered at PROSPERO as CRD42020204842. The subject was systematically analyzed on PubMed, Scopus, and Web of Science databases until April 2021. Only studies with humans with early exposure to agricultural pesticides and diagnosis of autism were included. Exclusion criteria were studies on pesticides for domestic or veterinary use and late exposure. There were no language and time restriction. The quality analysis of the studies used the Newcastle-Ottawa Scale. Data synthesis: Six case-control studies were included; three of them measured the route of exposure by maternal biomarkers and the others by the residence address. The studies had scores between moderate and high in the quality assessment tool. It was found high rates of association between early exposure to agricultural pesticides and autism and detection limit above the quantification for a sample of polychlorinated biphenyls, hexachlorobenzene, and dichlorodiphenyldichloroethylene. Conclusions: There is evidence concerning the exposure to agricultural pesticides in early life and the development of the autism spectrum disorder; however, more studies are required to better understand their possible association.

RESUMO Objetivo: Compreender a influência da exposição precoce a agrotóxicos de uso agrícola e sua relação com o transtorno do espectro autista. Fontes de dados: Esta revisão sistemática foi registrada no banco de dados PROSPERO sob número CRD42020204842. Por meio das bases de dados PubMed, Scopus e Web of Science, o assunto foi analisado sistematicamente até abril de 2021. Foram incluídos somente estudos com humanos, sendo critérios de inclusão a exposição precoce a agrotóxicos de uso agrícola e o diagnóstico de autismo e critérios de exclusão agrotóxicos de uso doméstico ou veterinário e exposição tardia. Todos os estudos foram analisados sem restrição de linguagem e tempo. A qualidade dos estudos foi avaliada pela NewCastle Ottawa Scale. Síntese dos dados: No total, seis estudos caso-controle foram incluídos. Três deles mensuraram a exposição pelos biomarcadores maternos e os demais (50%) pelo endereço de moradia. Os trabalhos apresentaram qualidade entre moderada e alta. Encontrou-se alta taxa de associação entre a exposição precoce à agrotóxicos e o autismo e detecção acima do limite de quantificação para amostras de bifenilas policloradas, hexaclorobenzeno e diclorodifenildicloroetileno. Conclusões: Existem evidências sobre a exposição a agrotóxicos de uso agrícola precocemente e o desenvolvimento do transtorno do espectro autista, porém mais pesquisas são necessárias para melhor compreensão da associação.

Exposição aos agrotóxicos em cidade de intensa atividade do agronegócio e desfechos gestacionais adversos / Exposure to pesticides in a city with intense agribusinessactivity and adverse gestational outcomes / Exposición a plaguicidas en una ciudad con intensa actividad agroindustria y resultados gestacionales adversos

Objetivo: analisar a prevalência e os efeitos da exposição aos agrotóxicos sobre a ocorrência de desfechos gestacionais adversos. Método: estudo transversal de base populacional, constituído de 275 mulheres selecionadas a partir das áreas de cobertura das Estratégia da Saúde da Família, com idade igual ou maior que 18 anos. A coleta de dados ocorreu por meio da aplicação de um questionário estruturado, construído a partir da junção e adaptação de dois instrumentos validados, sendo um de condições de saúde autorreferida e um questionário de identificação do perfil de exposição familiar aos agrotóxicos. A análise de dados se deu por meio de análise bivariada, estratificada e regressão multivariada de Poisson. Resultados: houve uma incidência de aborto e natimortos de 20,73% na amostra, cujas variáveis associadas a estes desfechos de gravidez foram, contato atual com agrotóxicos, intoxicação prévia pelos agroquímicos e cor não branca, sendo observado a interação entre as mulheres que lavam roupas utilizadas na manipulação de agrotóxicos. Conclusão: há evidências de que a exposição materna a agrotóxicosse encontrapossivelmente associada a maior ocorrência de óbito fetal (aborto e natimorto).

Objective: to analyzethe prevalence and effects of exposure to pesticides on the occurrence of adverse pregnancy outcomes. Method: population-based cross-sectional study, consisting of 275 women selected from the areas covered by the Family Health Strategy, aged 18 years or older. Data collection took place through the application of a structured questionnaire, constructed from the combination and adaptation of two validated instruments, one of which is self-reported health conditions and a questionnaire to identify the profile of family exposure to pesticides. Data analysis was performed using bivariate and stratified analysis and multivariate Poisson regression. Results: there was an incidence of miscarriage and stillbirths of 20.73% in the sample, whose variables associated with these pregnancy outcomes were current contact with pesticides, previous intoxication by agrochemicals and non-white color, observing the interaction between women who wash clothes used in handling pesticides. Conclusion: there is evidence that maternal exposure to pesticides is possibly associated with a higher occurrence of fetal death (abortion and stillbirth).

Objetivo: analizar la prevalencia y los efectos de la exposición a plaguicidas en la ocurrencia de resultados adversos del embarazo. Método: estudio transversal de base poblacional, compuesto por 275 mujeres seleccionadas de las áreas de cobertura de la Estrategia Salud de la Familia, con edad igual o superior a 18 años. La recolección de datos se realizó mediante la aplicación de un cuestionario estructurado, construido a partir de la combinación y adaptación de dos instrumentos validados, uno de los cuales es el autoinforme de condiciones de salud y un cuestionario para identificar el perfil de exposición familiar a plaguicidas. El análisis de datos se realizó mediante análisis bivariado y estratificado y regresión de Poisson multivariada. Resultados: hubo una incidencia de abortos y mortinatos de 20,73% en la muestra, cuyas variables asociadas a estos desenlaces de embarazos fueron contacto actual con plaguicidas, intoxicaciones previas por agroquímicos y color no blanco, observándose la interacción entre mujeres que lavan ropa usada en manejo de pesticidas. Conclusión: existe evidencia de que la exposición materna a pesticidas posiblemente esté asociada con una mayor ocurrencia de muerte fetal (aborto y muerte fetal).

Tuberculosis congénita - el desafío parte con la madre / Congenital tuberculosis - the challenge starts with the mother

La tuberculosis es la enfermedad infecciosa por un solo agente que provoca más muertes en el mundo. A la fecha, no hay un registro de casos de embarazadas con tuberculosis en el mundo ni en Chile, y menos de los casos de tuberculosis congénita. El diagnóstico en ambas situaciones suele ser tardío y con malos resultados clínicos. Se presenta una revisión de la literatura con relación a tuberculosis perinatal y dos casos clínicos de los binomios madre e hijo afectados.

Tuberculosis is the single agent infectious disease that causes the most deaths in the world. To date, there is no record of pregnant women with tuberculosis in the world or in Chile, even less of congenital tuberculosis. Diagnosis in both situations is usually late and with poor clinical results. A literature review is presented in relation to perinatal tuberculosis and two clinical cases of affected mother and child binomials.

Study of muscle fibers of the extensor digitorium longus and soleus muscles of C57BL/6 females exposed to glyphosate during pregnancy and lactation / Estudo das fibras musculares dos músculos extensor longo dos dedos e sóleo de fêmeas C57BL/6 expostas ao glifosato durante a prenhez e a lactação

ABSTRACT Objective To evaluate the morphology and morphometry of the muscles extensor digitorium longus and soleus of C57BL/6 females, who were exposed to glyphosate during pregnancy and lactation. Methods Twelve female mice from the C57BL/6 lineage were used. After detection of pregnancy, they were divided into a Control Group, which received only water, and a Glyphosate Group, which received water with 0.5% glyphosate during pregnancy and lactation. Both groups received ad libitum standard diet. After weaning, the females were euthanized and weighed; naso-anal length was measured, and fats were collected and weighed. The muscles extensor digitorium longus and soleus were collected, and their length and weight were measured. Then, the muscles were fixed in Methacarn to perform the histological study of muscle fibers. Results Glyphosate Group presented lower weight gain during pregnancy and also lower final body weight and naso-anal length; however, the other body parameters evaluated did not present a significant difference in relation to the Control Group. Significant differences were also not observed in the analysis of muscle fibers and connective tissue. Conclusion Exposure to 0.5% glyphosate during pregnancy and lactation resulted in lower weight gain during pregnancy, final weight, and naso-anal length. Despite not directly altering the morphology of muscle tissue, these results may indicate enough exposure to interfere with animal metabolism.

RESUMO Objetivo Avaliar a morfologia e a morfometria dos músculos extensor longo dos dedos e sóleo de fêmeas C57BL/6 expostas ao glifosato durante a prenhez e lactação. Métodos Foram utilizados 12 camundongos fêmeas da linhagem C57BL/6. Após detecção da prenhez, foram separadas em Grupo Controle, que recebeu somente água, e Grupo Glifosato, que recebeu água com 0,5% de glifosato durante a prenhez e lactação. Ambos os grupos receberam dieta padrão ad libitum. Após o desmame, as fêmeas foram eutanasiadas e pesadas; o comprimento nasoanal foi mensurado, e as gorduras foram coletadas e pesadas. Os músculos extensor longo dos dedos e sóleo foram coletados, e seu comprimento e peso foram mensurados. Em seguida, os músculos foram fixados em Methacarn para a realização do estudo histológico das fibras musculares. Resultados O Grupo Glifosato apresentou menor ganho de peso durante a prenhez e também menor peso corporal final e comprimento nasoanal, entretanto os demais parâmetros corporais avaliados não apresentaram diferença significativa em relação ao Grupo Controle. Na análise das fibras musculares e do tecido conjuntivo, também não foram observadas diferenças significativas. Conclusão A exposição a 0,5% de glifosato durante a prenhez e lactação resultou em menor ganho de peso na gestação, peso final e comprimento nasoanal, o que pode indicar que, apesar de não alterar a morfologia do tecido muscular diretamente, a exposição foi suficiente para interferir no metabolismo dos animais.

Effects of maternal exposure to arsenic on social behavior and related gene expression in F2 male mice

BACKGROUND@#Arsenic is a developmental neurotoxicant. It means that its neurotoxic effect could occur in offspring by maternal arsenic exposure. Our previous study showed that developmental arsenic exposure impaired social behavior and serotonergic system in C3H adult male mice. These effects might affect the next generation with no direct exposure to arsenic. This study aimed to detect the social behavior and related gene expression changes in F2 male mice born to gestationally arsenite-exposed F1 mice.@*METHODS@#Pregnant C3H/HeN mice (F0) were given free access to tap water (control mice) or tap water containing 85 ppm sodium arsenite from days 8 to 18 of gestation. Arsenite was not given to F1 or F2 mice. The F2 mice were generated by mating among control F1 males and females, and arsenite-F1 males and females at the age of 10 weeks. At 41 weeks and 74 weeks of age respectively, F2 males were used for the assessment of social behavior by a three-chamber social behavior apparatus. Histological features of the prefrontal cortex were studied by ordinary light microscope. Social behavior-related gene expressions were determined in the prefrontal cortex by real time RT-PCR method.@*RESULTS@#The arsenite-F2 male mice showed significantly poor sociability and social novelty preference in both 41-week-old group and 74-week-old group. There was no significant histological difference between the control mice and the arsenite-F2 mice. Regarding gene expression, serotonin receptor 5B (5-HT 5B) mRNA expression was significantly decreased (p < 0.05) in the arsenite-F2 male mice compared to the control F2 male mice in both groups. Brain-derived neurotrophic factor (BDNF) and dopamine receptor D1a (Drd1a) gene expressions were significantly decreased (p < 0.05) only in the arsenite-F2 male mice of the 74-week-old group. Heme oxygenase-1 (HO-1) gene expression was significantly increased (p < 0.001) in the arsenite-F2 male mice of both groups, but plasma 8-hydroxy-2'-deoxyguanosine (8-OHdG) and cyclooxygenase-2 (COX-2) gene expression were not significantly different. Interleukin-1β (IL-1β) mRNA expression was significantly increased only in 41-week-old arsenite-F2 mice.@*CONCLUSIONS@#These findings suggest that maternal arsenic exposure affects social behavior in F2 male mice via serotonergic system in the prefrontal cortex. In this study, COX-2 were not increased although oxidative stress marker (HO-1) was increased significantly in arsnite-F2 male mice.

Impact of environmental microplastics on maternal and fetal health / 中华围产医学杂志

Microplastics refer to plastic fibers, particles, or films with a particle size less than 5 mm, and microplastics pollution has become one of the major global environmental problems. Microplastics can be exposed to the human body through ingestion, inhalation and skin contact, affecting maternal and fetal health through mechanisms such as cytotoxicity and signal transduction, energy homeostasis and metabolic disorders, immune dysfunction, and as carriers of microorganisms or toxic chemicals. The purpose of this paper is to review the physical and chemical properties of microplastics, human exposure pathways, maternal-fetal effects, and its mechanisms.

Prevalencia de factores de riesgo ambientales prenatales en niños con trastorno del espectro autista controlados en un hospital de niños / Prevalence of prenatal environmental risk factors in children with autism spectrum disorder monitored in a children's hospital

INTRODUCCIÓN: El Trastorno del Espectro Autista (TEA) afecta al 1% de los niños y se ha demostrado que una de sus principales causas se debe a factores ambientales prenatales que afectan al feto durante el periodo gestacional. El objetivo fue estimar la prevalencia de factores de riesgo (FR) prenatales en niños con TEA menores de 8 años que se controlan en un Hospital de niños. MÉTODOS: Se realizó un estudio transversal descriptivo. Se aplicó una encuesta a los padres o tutores de los niños durante la espera a su control. Se realizó un análisis descriptivo de los datos. RESULTADOS: Participaron 76 madres de niños con TEA. Entre los niños predominó el sexo masculino, mediana de edad de 5,4 años, la mayoría puede hablar sin dificultad (78%) y un 28% tenía diagnóstico de alguna enfermedad crónica. La prevalencia de FR prenatales encontrados en este estudio es similar a las reportadas en otros estudios especialmente la edad de los padres, los años de educación materna, los abortos previos y el diagnóstico de enfermedades en el embarazo. Sin embargo, la prevalencia de factores como el embarazo de alto riesgo, el consumo materno de fármacos durante el embarazo, el parto prematuro y el consumo de tabaco y drogas durante el embarazo, fueron muy superiores en este estudio comparado con otros estudios, y podrían estar relacionadas con el diagnóstico de TEA en la infancia. CONCLUSIÓN: A partir de estos hallazgos, se establece una base para realizar estudios comparativos en el futuro.

INTRODUCTION: Autistic Spectrum Disorder (ASD) affects 1% of children and it has been shown that one of its main causes is due to prenatal factors that affect the fetus during the gestational period. The objective was to estimate the prevalence of prenatal risk factors (RF) in children with ASD under 8 years of age who are monitored in a Children's Hospital. METHODS: A descriptive cross-sectional study was carried out. A survey was applied to the parents or guardians of the children during the wait for their control. A descriptive analysis of the data was carried out. RESULTS: 76 mothers of children with ASD participated. The male sex predominated, the average age was 5.4 years, the majority could speak without difficulty (78%) and 28% had a diagnosis of a chronic disease. The prevalence of prenatal RF found in this study is similar to that reported in other studies, especially the age of the parents, the years of maternal education, previous abortions and the diagnosis of diseases in pregnancy. However, the prevalence of factors such as high-risk pregnancy, maternal consumption of medicines during pregnancy, preterm delivery and tobacco and drug use during pregnancy were much higher in this study compared to other studies, and could be related to the diagnosis of ASD in childhood. CONCLUSION: Based on these findings, a basis for comparative studies in the future is established.

Occupation and maternal mortality in Brazil / Ocupação e mortalidade materna

ABSTRACT OBJECTIVE To estimate maternal mortality ratio according to occupation in Brazil. METHODS This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002. RESULTS A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found."Housewife" prevailed in SIM (35.5%) and SINASC (39.1%). CONCLUSIONS Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.

RESUMO OBJETIVO Estimar a razão de mortalidade materna segundo a ocupação no Brasil. MÉTODOS Trata-se de estudo de mortalidade realizado com dados nacionais do Sistema de Informação sobre Mortalidade (SIM) e do Sistema de Informação sobre Nascidos Vivos (Sinasc) no ano de 2015. Foram estimadas as razões de mortalidade materna de acordo com a ocupação registrada em declarações de óbito, utilizando a Classificação Brasileira de Ocupações, versão 2002. RESULTADOS Foram encontrados 1.738 registros de óbitos maternos, correspondendo a uma razão de mortalidade materna de 57,6/100.000 nascidos vivos. Esse índice variou entre as categorias ocupacionais, sendo maior entre as trabalhadoras dos serviços e da agropecuária, particularmente para as empregadas domésticas (123,2/100.000 nascidos vivos), seguidas pelas trabalhadoras agropecuárias em geral (88,3/100.000 nascidos vivos). Também apresentaram elevada razão de mortalidade materna as manicures e técnicas de enfermagem. A ocupação materna não foi informada em 17,0% dos casos do SIM e em 13,2% do Sinasc. Foram encontrados registros inconsistentes, como "dona de casa", o mais frequente no SIM (35,5%) e no Sinasc (39,1%). CONCLUSÕES A razão de mortalidade materna difere de acordo com a ocupação, sugerindo uma contribuição do trabalho, o que requer pesquisas adicionais para identificar os fatores de risco ocupacionais. Fatores socioeconômicos estão intimamente relacionados à ocupação, e sua combinação com exposições no trabalho e acesso a serviços de saúde precisa ser abordada.

Itinerário da criança com microcefalia na rede de atenção à saúde / Itinerario de los ninõs con microcefalia en la red de atencion de salud / Itinerary of children with microcephaly in the health care network

RESUMO Objetivos investigar o itinerário terapêutico de crianças com microcefalia associada ao Zika na rede de atenção à saúde; e descrever a vivência das mães em relação ao itinerário percorrido para o tratamento de seus filhos. Método Estudo norteado pela História Oral Temática, realizado em instituição pública filantrópica do município de João Pessoa-Paraíba. Foram entrevistadas dez mães de crianças com microcefalia entre abril e agosto de 2017. O material empírico foi submetido à análise de conteúdo temática. Resultados Os profissionais de saúde têm dificuldade para definir o diagnóstico de crianças com microcefalia, e se encontram despreparados para informá-lo aos pais, comprometendo o itinerário terapêutico dessas crianças. As experiências das mães em busca de tratamento para seus filhos são marcadas por estresse, medo, decepção e pela frágil rede de apoio familiar, resultando em sobrecarga materna. Conclusão e implicações para a prática A reestruturação dos fluxos e contrafluxos da Rede de Atenção à Saúde às crianças com microcefalia e seus familiares torna-se imprescindível, assim como, o fortalecimento da rede de apoio às mães.

RESUMEN Objetivos Investigar el itinerario terapéutico de los niños con microcefalia asociada al Zika en la red de atención de salud; y describir la experiencia de las madres en relación con el itinerario tomado para tratar a sus hijos. Método Estudio guiado por la Historia Oral Temática, realizado en una institución pública filantrópica en la ciudad de João Pessoa-Paraíba. Se entrevistó a diez madres de niños con microcefalia entre abril y agosto de 2017. El material empírico se sometió a análisis de contenido temático. Resultados Los profesionales de la salud tienen dificultades para definir el diagnóstico de niños con microcefalia y no están preparados para informar a los padres, lo que compromete el itinerario terapéutico de estos niños. Las experiencias de las madres que buscan tratamiento para sus hijos están marcadas por el estrés, el miedo, la decepción y la fragilidad de la red de apoyo familiar, lo que resulta en una sobrecarga materna. Conclusión e implicaciones para la práctica La reestructuración de los flujos y contraflujos de la Red de Atención de Salud para niños con microcefalia y sus familias se vuelve indispensable, así como el fortalecimiento de la red de apoyo para las madres.

ABSTRACT Objectives To investigate the therapeutic itinerary of children with Zika-associated microcephaly in the health care network; and describe the experience of mothers concerning the itinerary taken to treat their children. Method This study was guided by Thematic Oral History, conducted in a philanthropic public institution in João Pessoa, PB, Brazil. Ten mothers of children with microcephaly were interviewed from April to August 2017. The empirical material was subjected to thematic content analysis. Results Health professionals have difficulty diagnosing children with microcephaly, and they are not prepared to inform parents, compromising the therapeutic itinerary of these children. The experiences of mothers seeking treatment for their children are marked by stress, fear, disappointment caused by fragile family support network. This results in maternal overload. Conclusion and implications for the practice The restructuring of the flows and counterflows of the Health Care Network for children with microcephaly and their families becomes essential, as well as the strengthening of the support network for mothers.

Exposición a cocaína en niños menores de 5 años: serie de casos / Cases of exposure to cocaine in children under 5 years of age / Casos de exposição à cocaína em crianças menores de 5 anos

Resumen: Los hijos de madres consumidoras de cocaína están expuestos en la etapa prenatal y durante la lactancia. Asimismo, están en riesgo de ingesta no intencional o contacto mucoso de restos de la sustancia a su alcance y de inhalación pasiva del humo de cocaínas fumables en ambientes cerrados. Objetivo: describir el perfil epidemiológico de la exposición a cocaína en los niños menores a 5 años en nuestro país analizando circunstancias de exposición, manifestaciones clínicas y complicaciones agudas. Material y método: estudio observacional, descriptivo, retrospectivo de las consultas reportadas a un centro de toxicología en el período 2010-2016 de niños de hasta 5 años de edad con screening positivo para cocaína en orina. Resultados: se incluyeron 18 casos, se analizaron 17 por insuficiencia de datos. Todos fueron menores de 2 años. Predominaron manifestaciones neurológicas (12/17): convulsiones (7/12). Otras manifestaciones incluyeron: taquicardia (2/17), hipertensión (3/17), elevación de creatinfosfokinasa total (4/17) y rabdomiólisis (2/17). Catorce pacientes se encontraban en lactancia pero solo siete madres presentaron screening positivo. El screening de cocaína fue el criterio de selección por su baja tasa de falsos positivos. Esta serie coincide con la literatura en edad de riesgo para exposición a cocaína, planteándose la lactancia como principal vía de ingreso. Sin embargo, los resultados muestran que otras vías de ingreso son posibles. Las convulsiones fueron la forma de presentación más frecuente. Conclusiones: los casos reportados evidencian la necesidad de mantener un alto índice de sospecha ante síntomas neurológicos o cardiovasculares, evidencian el valor de los tests de screening y expanden las circunstancias de riesgo.

Summary: Children born of cocaine-using mothers are exposed to the substance during the prenatal and breastfeeding periods. They are also at risk of cocaine unintentional ingestion or mucosal contact when the substance remains within their reach or at risk of passive inhalation of smoke from cocaine smoked in confined environments. Objective: describe the cocaine exposure epidemiological profile in children under 5 years of age in our country, analyze circumstances of exposure, clinical manifestations and acute complications. Material and methods: observational, descriptive and retrospective study of the consultations reported to a Toxicological Center during 2010-2016 of children up to 5 years of age with positive urine cocaine screening. Results: we included 18 cases, but only 17 were analyzed, due to insufficient data. All children were under 2 years of age. Neurological manifestations were predominant (12/17): seizures (7/12). Other manifestations included tachycardia (2/17), hypertension (3/17), total creatinine phosphokinase increase (4/17) and rhabdomyolysis (2/17). Fourteen patients have been breastfed, but only seven mothers showed positive screening. Cocaine positive screening was the selection criteria because of its low false positive rate. This series matches the literature regarding the main age risk regarding cocaine exposure; breastfeeding was considered the main source of exposure. However, the results show that other sources are possible. Seizures were the most frequent form of presentation. Conclusions: reported cases show that we should be cautious regarding neurological or cardiovascular symptoms, support the implementation of screening tests and expand risk circumstances.

Resumo: Os filhos de mães que usam cocaína estão expostos durante a fase pré-natal e durante a lactação. Da mesma forma, correm o risco de ingestão não intencional ou contato mucoso de restos da substância ao seu alcance e de inalação passiva de fumaça de cocaína fumável em ambientes fechados. Objetivo: descrever o perfil epidemiológico da exposição à cocaína em crianças menores de cinco anos de idade em Uruguai, analisar as circunstâncias de exposição, as manifestações clínicas e as complicações agudas. Material e métodos: estudo observacional, descritivo retrospectivo das consultas reportadas a um Centro de Toxicologia no período 2010-2016, realizado a crianças de até 5 anos de idade com triagem positiva para cocaína na urina. Resultados: nós incluímos 18 casos e analisamos 17 devido a dados insuficientes. Todos tinham menos de 2 anos de idade. As principais manifestações neurológicas (12/17) foram: convulsões (7/12). Outras manifestações incluíram: taquicardia (2/17), hipertensão (3/17), elevação total da creatinofosfoquinase (4/17) e rabdomiólise (2/17). 14 pacientes eram lactantes, mas apenas 7 mães tiveram triagem positiva. O rastreamento de cocaína foi o critério de seleção devido à baixa taxa de falsos positivos. Esta série coincide com a literatura sobre a idade de risco para a exposição à cocaína, considerando a amamentação como a principal via de entrada da substância no organismo. No entanto, os resultados mostram que existem outras vias de entrada da substancia no organismo. A forma de apresentação mais frequente foram as convulsões. Conclusões: os casos relatados mostram que devemos ser cautelosos quanto aos sintomas neurológicos ou cardiovasculares, apoiar a implementação de testes de triagem e expandir as circunstâncias de risco.

Research status on maternal pesticide exposure and offspring's risk of congenital heart disease / 中华围产医学杂志

We are interpreting the effects of maternal pesticide exposure during pregnancy on the heart development of offspring. Based on literature review till October 2018, 43 studies were included and three types of pesticide exposure (pesticides, herbicides and fungicides) were focused on. Our result show that maternal pesticide exposure during pregnancy could lead to an increased risk of congenital cardiovascular abnormalities in offsprings. Moreover, it is found that different types of pesticide exposure are associated with different subtypes of congenital heart disease. Generally and relatively, the evidence is consistent and strong for the following relationships: the associations of insecticide exposure with atrial septal defect, pulmonary valve stenosis and ventricular septal defects; the associations of herbicide exposure with transposition of the great arteries and ventricular septal defects; and the associations of bactericide exposure with hypoplastric left heart syndrome and aortic coarctation.

Macrophage activation syndrome in a newborn of adult-onset Still's disease mother: a case report and literature review / 中国新生儿科杂志

Objective To study the clinical characteristics of neonatal macrophage activation syndrome (MAS) associated with maternal rheumatic diseases and improve the understanding of neonatal MAS.Method Clinical data of MAS in a newborn infant with adult-onset Still's disease (AOSD) mother was retrospectively studied.From the establishment day of databases (CNKI,VIP,Wanfang,Pubmed and Embase) to December 2017,literature were retrieved with key words including "newborn","macrophage activation syndrome" and "hemophagocytic lymphohistiocytosis (HLH) ".Clinical features of infant MAS/HLH with maternal rheumatic diseases were summarized.Result A 27-day-old boy with AOSD mother manifested with fever,watery stools,irritability,prominent enlargement of right parotid gland and right cervical lymphadenitis.The infant was diagnosed with MAS due to coagulopathy,multiple organ dysfunction,hypofibrinogenemia and increased levels of ferritin.Anti-SSA/Ro52kD and stool rotavims antigen were positive.The infant recovered with intravenous immunoglobulin and steroids therapy.Follow-up at 2-year-old were normal.A total of 3 other cases of neonatal MAS/HLH were retrieved.All patients had high fever,hepatosplenomegaly and multiple organ dysfunction,impaired digestive system (abdominal distention,diarrhea and ascites),disseminated intravascular coagulation (2 cases),mental disorders (1 case),complete atrioventricular block (1 case) and severe hypotension (1 case).Laboratory results showed thrombocytopenia,elevated level of hepatic enzyme and serum ferritin in all patients.Targeted panel-based next generation sequencing were all negative for pathogenic gene mutations.After treatments of steroids,intravenous immunoglobulin and chemotherapy,all patients improved and ultimately cured.Conclusion In view of the impacts of the maternal rheumatic diseases on fetus,newborns with early onset high fever and hepatosplenomegaly should be suspected of MAS.Early diagnosis and effective treatment are crucial for clinical improvement.

Air pollution and low birth weight in an industrialized city in Southeastern Brazil, 2003-2006 / Poluição do ar e baixo peso ao nascer em uma cidade industrial no Sudeste do Brasil, 2003-2006

ABSTRACT: Introduction: Birth weight is an important indicator of several conditions that manifest earlier (as fetal and neonatal mortality and morbidity, inhibited growth and cognitive development) and later in life such as chronic diseases. Air pollution has been associated with adverse pregnancy outcomes. Objective: Retrospective cohort study investigated the association between low birth weight (LBW) and maternal exposure to air pollutants in Volta Redonda city, Rio de Janeiro, Brazil, from 2003 to 2006. Methods: Birth data was obtained from Brazilian Information System. Exposure information (O3, PM10, temperature and humidity) was provided by Governmental Air Quality Monitoring System. Linear and Logistic models, adjusted for sex, type of pregnancy, prenatal care, place of birth, maternal age, parity, education, congenital anomalies and weather variables were employed. Results: Low birth weight (LBW) represented 9.1% of all newborns (13,660). For an interquartile range increase in PM10 it was found OR2 ndTrimester = 1.06 (95%CI 1.02 - 1.10), OR3 rdTrimester = 1.06 (95%CI 1.02 - 1.10) and, in O3 it was found OR2 ndTrimester = 1.03 (95%CI 1.01 - 1.04), OR3 rdTrimester = 1.03 (95%CI 1.02 - 1.04). The dose-response relationship and a reduction in birth weight of 31.11 g (95%CI -56.64 - -5.58) was observed in the third trimester of pregnancy due to an interquartile increase of O3. Conclusion: This study suggests that exposures to PM10 and O3, even being below the Brazilian air quality standards, contribute to risks of low birth weight.

RESUMO: Introdução: O peso de nascimento é considerado como um indicador importante de várias condições que se manifestam mais cedo (como mortalidade fetal e neonatal e morbidade, inibição do crescimento e desenvolvimento cognitivo) e mais tarde na vida, tais como as doenças crônicas. A poluição atmosférica tem sido associada a efeitos adversos da gestação. Objetivo: Estudo de coorte histórica que associa o baixo peso ao nascer (BPN) e a exposição materna aos poluentes do ar em Volta Redonda, Rio de Janeiro, Brasil, entre 2003 e 2006. Metodologia: Dados sobre nascidos vivos foram obtidos no sistema de informação Brasileiro, e os de exposição (O3, PM10, temperatura e umidade) na rede pública de monitoramento do ar. Foram utilizados modelos lineares e logísticos, ajustados por sexo, tipo de gravidez, assistência pré-natal, local de nascimento, idade materna, paridade, educação, anomalias congênitas e variáveis meteorológicas. Resultados: A prevalência de BPN foi de 9,1% sobre 13.660 nascimentos. Para o aumento de um interquartil no nível de PM10 (OR2 ºtrimestre = 1,06; IC95% 1,02 - 1,10; OR3 ºtrimestre = 1,06; IC95% 1,02 - 1,10) e no nível de O3 (OR2 ºtrimestre = 1,03; IC95% 1,01 - 1,04; OR3 ºtrimestre = 1,03; IC95% 1,02 - 1,04). Observou-se uma relação dose-resposta e uma redução do peso ao nascer de 31,11 g (95%IC -56,64 - -5,58) no terceiro trimestre da gravidez devido ao aumento de um interquartil de O3. Conclusão: Este estudo sugere que exposições ao PM10 e O3, mesmo abaixo de padrões de qualidade do ar, contribuem para os riscos de BPN.

Applying temporally-adjusted land use regression models to estimate ambient air pollution exposure during pregnancy / 中华预防医学杂志

The impact of maternal air pollution exposure on offspring health has received much attention. Precise and feasible exposure estimation is particularly important for clarifying exposure-response relationships and reducing heterogeneity among studies. Temporally-adjusted land use regression (LUR) models are exposure assessment methods developed in recent years that have the advantage of having high spatial-temporal resolution. Studies on the health effects of outdoor air pollution exposure during pregnancy have been increasingly carried out using this model. In China, research applying LUR models was done mostly at the model construction stage, and findings from related epidemiological studies were rarely reported. In this paper, the sources of heterogeneity and research progress of meta-analysis research on the associations between air pollution and adverse pregnancy outcomes were analyzed. The methods of the characteristics of temporally-adjusted LUR models were introduced. The current epidemiological studies on adverse pregnancy outcomes that applied this model were systematically summarized. Recommendations for the development and application of LUR models in China are presented. This will encourage the implementation of more valid exposure predictions during pregnancy in large-scale epidemiological studies on the health effects of air pollution in China.

Infant morbidity and mortality attributable to prenatal smoking in Chile / Morbilidad y mortalidad del lactante atribuible al tabaquismo prenatal en Chile / Morbidade e mortalidade infantis atribuíveis ao tabagismo durante a gestação no Chile

ABSTRACT Objective To estimate annual infant morbidity and mortality attributable to prenatal smoking in Chile during 2008−2012. Methods Population-attributable fractions (PAFs) for several infant outcomes were calculated based on previous study estimates of prenatal smoking prevalence and odds ratios associated with exposure (prenatal smoking relative to non-prenatal smoking). Prenatal smoking-attributable infant morbidity and mortality cases were calculated by multiplying the average annual number of morbidity and mortality cases registered in Chile during 2008-2012 by the corresponding PAF. Results PAFs for 1) births ≤ 27 weeks; 2) births at 28-33 weeks; 3) births at 34-36 weeks; and 4) full-term low-birth-weight infants were 12.3%, 10.6%, 5.5%, and 27.4% respectively. PAFs for deaths caused by preterm-related causes and deaths caused by sudden infant death syndrome were 11.9% and 40.0% respectively. Annually, 2 054 cases of preterm-birth and full-term low-birth-weight (1 in 9 cases), 68 deaths caused by preterm-related causes (1 in 8 cases), and 26 deaths caused by sudden infant death syndrome (1 in 3 cases) were attributable to prenatal smoking. Conclusions In Chile, infant morbidity and mortality attributable to prenatal smoking are unacceptably high. Comprehensive individual and population-based interventions for tobacco control should be a public health priority in the country, particularly among female adolescents and young women who will be the mothers of future generations.

RESUMEN Objetivo Calcular las tasas anuales de morbilidad y mortalidad de lactantes atribuibles al tabaquismo prenatal en Chile entre los años 2008 y 2012. Métodos Se calcularon las fracciones atribuibles a la población (FAP) correspondientes a diferentes resultados de salud en lactantes tomando como base la prevalencia estimativa del tabaquismo prenatal y las razones de posibilidad asociadas a la exposición (tabaquismo prenatal frente a tabaquismo no prenatal) calculadas en estudios previos. Los casos de mortalidad y morbilidad de lactantes atribuibles al tabaquismo prenatal se calcularon multiplicando el promedio anual de casos de morbilidad y mortalidad registrados en Chile entre los años 2008 y 2012 por la FAP correspondiente. Resultados Las FAP para los lactantes nacidos 1) a las 27 semanas o menos de gestación; 2) de 28 a 33 semanas de gestación; 3) de 34 a 36 semanas de gestación; y 4) al término de la gestación, pero con peso bajo al nacer, fueron de 12,3%, 10,6%, 5,5% y 27,4%, respectivamente. Las FAP correspondientes a las muertes por causas relacionadas con el nacimiento prematuro y las muertes por síndrome de muerte súbita del lactante fueron de 11,9% y 40,0%, respectivamente. Al año, 2 054 casos de bebés prematuros y de bebés nacidos con peso bajo al término de la gestación (1 de 9 casos), 68 muertes por causas relacionadas con el período prenatal (1 de 8 casos) y 26 muertes causadas por el síndrome de muerte súbita del lactante (1 de 3 casos) fueron atribuibles al tabaquismo prenatal. Conclusiones En Chile, las tasas de morbilidad y mortalidad de lactantes atribuibles al tabaquismo prenatal son inadmisiblemente altas. En el país, las intervenciones integrales para el control del tabaco a nivel individual y poblacional deben ser una prioridad de salud pública, particularmente en las mujeres adolescentes y jóvenes que serán las madres de las generaciones futuras.

RESUMO Objetivo Estimar a morbidade e a mortalidade infantis anuais atribuíveis ao tabagismo durante a gestação no Chile em 2008-2012. Métodos As frações atribuíveis populacionais (PAFs) para vários desfechos infantis foram calculadas com base em estimativas de estudos anteriores da prevalência do tabagismo durante a gestação e razões de possibilidades associadas à exposição (tabagismo durante a gestação relativo ao tabagismo fora da gestação). Os casos de morbidade e mortalidade infantis atribuíveis ao tabagismo durante a gestação foram calculados multiplicando-se o número médio anual de casos de morbidade e mortalidade registrados no Chile em 2008-2012 pela PAF correspondente. Resultados As PAFs para 1) recém-nascidos ≤ 27 semanas, 2) recém-nascidos com 28-33 semanas, 3) recém-nascidos com 34-36 semanas e 4) recém-nascidos de termo com baixo peso foram 12,3%, 10,6%, 5,5% e 27,4%, respectivamente. As PAFs para mortes devidas a causas relacionadas à prematuridade e mortes devidas à síndrome de morte súbita do recém-nascido foram 11,9% e 40,0%, respectivamente. Anualmente, 2.054 casos de recém-nascidos prematuros e de termo com baixo peso (1 em 9 casos), 68 mortes devidas a causas relacionadas à assistência pré-natal (1 em 8 casos) e 26 mortes devidas à síndrome de morte súbita do recém-nascido (1 em 3 casos) foram atribuíveis ao tabagismo durante a gestação. Conclusões No Chile, a morbidade e a mortalidade infantis atribuíveis ao tabagismo durante a gestação são inadmissivelmente elevadas. Amplas intervenções individuais e populacionais para o controle do tabagismo devem ser uma prioridade de saúde pública no país, sobretudo em adolescentes e jovens que serão mães das futuras gerações.

Exposición a plaguicidas y prácticas de uso y protección en embarazadas de zona rurales en control de atención primaria en la región de Valparaíso, Chile / Exposure to pesticides and use and protection practices in pregnant women from rural areas in primary care control in the Valparaíso region, Chile

ANTECEDENTES: Los trabajadores agrícolas y habitantes rurales están expuestos a productos plaguicidas. Aun cuando las políticas sanitarias se preocupan de normarlos, diversos estudios demuestran exposición en trabajadores y residentes cercanos a las zonas productivas. Entre ellos se encuentran mujeres gestantes, consideradas población particularmente vulnerable frente a plaguicidas. OBJETIVO: Identificar el contacto con plaguicidas, así como conductas asociadas a su uso, en mujeres gestantes de dos comunas agrícolas de la V Región en control prenatal en Centros de Salud Familiar. MÉTODO: Estudio observacional transversal, realizado en una muestra de ochenta gestantes que ingresaron a control entre mayo 2013 y abril 2014. El instrumento de recolección de datos fue una encuesta, aplicada por el equipo de salud al ingreso. RESULTADOS: Las gestantes, en su gran mayoría, alguna vez han tenido contacto con plaguicidas, y cerca de la mitad lo tuvo en el mismo año en que se aplicó la encuesta. La exposición a plaguicidas se da tanto en los espacios productivos, como residenciales. Se observó que las medidas preventivas asociadas al contacto con agrotóxicos son insuficientes. A la vez, destaca la exposición a fumigaciones aéreas, frente a las cuales la posibilidad de prevención es aún menor. CONCLUSIÓN: En comunas rurales puede existir un contacto permanente de la población femenina gestante con plaguicidas, lo cual sucede sin las medidas de protección adecuadas, incrementando el riesgo de exposición a estas sustancias. Es pertinente entonces, desarrollar una labor educativa activa para mejorar las prácticas de uso de plaguicidas.

BACKGROUND: Agriculture workers and rural dwellers are exposed to pesticide products. Sanitation policies attempt to regulate their use, but studies demonstrate that a significant percentage of workers and residents who are close to the productive zones are exposed to these chemicals. Pregnant women are particularly vulnerable to pesticides. AIM: To identify the risk of exposure to pesticides and practices of pesticide handling in women under pregnancy control programs in Family Health Care Centers in two rural districts of the 5th Region. METHOD: Cross-sectional study, conducted during May 2013 and April 2014 on eighty women, who entered pregnancy control programs in either rural district. The health professionals of the Centers collected the data in a survey. RESULTS: Most of the pregnant women declared having been in contact with pesticides at some point. Almost half of them had this contact in the same year of their interview, that is previous or during their pregnancy. The exposure to pesticides takes place in productive locations as well as residential areas. The preventive measures associated to the contact with pesticides are not sufficient. Rural populations are also exposed to aerial fumigations, which further limits preventive measures. CONCLUSION: Pregnant women living in a rural district may be permanently exposed to pesticides. Exposure to agrochemicals is not associated to safe prevention practices which increase the risk of exposure. Educational programs may aid to enhance safe pesticide use.

Maternal Disononyl Phthalate Exposure Activates Allergic Airway Inflammation via Stimulating the Phosphoinositide 3-kinase/Akt Pathway in Rat Pups / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To evaluate the effect of diisononyl phthalate (DINP) exposure during gestation and lacta- tion on allergic response in pups and to explore the role of phosphoinositide 3-kinase/Akt pathway on it.</p><p><b>METHODS</b>Female Wistar rats were treated with DINP at different dosages (0, 5, 50, and 500 mg/kg of body weight per day). The pups were sensitized and challenged by ovalbumin (OVA). The airway response was assessed; the airway histological studies were performed by hematoxylin and eosin (HE) staining; and the relative cytokines in phosphoinositide 3-kinase (PI3K)/Akt pathway were measured by enzyme-linked immunosorbent assay (ELISA) and western blot analysis.</p><p><b>RESULTS</b>There was no significant difference in DINP's effect on airway hyperresponsiveness (AHR) between male pups and female pups. In the 50 mg/(kg·d) DINP-treated group, airway response to OVA significantly increased and pups showed dramatically enhanced pulmonary resistance (RI) compared with those from controls (P<0.05). Enhanced Akt phosphorylation and NF-κB translocation, and Th2 cytokines expression were observed in pups of 50 mg/(kg·d) DINP-treated group. However, in the 5 and 500 mg/(kg·d) DINP-treated pups, no significant effects were observed.</p><p><b>CONCLUSION</b>There was an adjuvant effect of DINP on allergic airway inflammation in pups. Maternal DINP exposure could promote OVA-induced allergic airway response in pups in part by upregulation of PI3K/Akt pathway.</p>

Polysomnographic evaluation of uninfected babies born to human immunodeficiency virus type 1 positive mothers / Evaluación polisomnográfica de bebés no infectados nacidos de madres VIH-1 positivas

Introduction: Type 1 human immunodeficiency virus (HIV-1) is a lymphotropic and neurotropic retrovirus. Thus, it causes immunological and neurological alterations particularly in children. In the neonatal period the maturational changes of the central nervous system occur rapidly, and their alteration can be reflected in processes such as the sleep-awake pattern. Objective: To evaluate sleep organization, EEG and respiratory pattern in newborns to HIV-1 positive mothers. Methods: 22 infants underwent polysomnography. Delta brushes number in REM and NREM sleep, duration of interburst interval and interhemispheric synchrony were used to calculate EEG maturation. Analysis of the sleep architecture was based on polysomnographic sleep percentage of REM, NREM and transitional sleep to total sleep time. Results: The difference between electroencephalographically calculated and clinically calculated conceptional age was less than two weeks. Percentages of REM and NREM sleep ranged from 39-64 and 30-58 with a median of 52.5 and 36.5 respectively. Concordance was lower in newborns who had high transitional sleep percentages, compared to that in newborns who did not have high such characteristic (p<0.05). Discussion: Despite intrauterine exposure to HIV-1 and to antiretroviral drugs we did not observe a significant effect on EEG maturation. The decreased concordance in newborns with high transitional sleep percentages would suggest an alteration in the maturation process, but this aspect itself is not sufficient to consider that intrauterine exposure to HIV-1 and antiretrovirals affect the entire sleep architecture. Future studies should clarify whether the decreased concordance between behavior and NREM sleep is replicable.

Introducción: el virus de la inmunodeficiencia humana tipo 1 (VIH-1) es un retrovirus linfotrópico y neurotrópico. Esta característica genera alteraciones inmunológicas y neurológicas particularmente en niños. Durante el período neonatal la maduración del sistema nervioso central ocurre rápidamente, y su alteración puede perturbar diferentes aspectos del desarrollo tales como el ciclo sueño-vigilia. Objetivo: evaluar la organización del sueño y el patrón electroencefalográfico y respiratorio en recién nacidos VIH-1 negativos hijos de madres VIH-1 positivas. Métodos: se les hizo polisomnografía a 22 infantes. Se calculó la maduración electroencefalográfica usando el número de ondas delta en sueño REM y NREM, la duración del intervalo interespigas y la sincronía interhemisferica. Se analizó la arquitectura del sueño con base en el porcentaje de sueño REM, NREM y sueño transicional con relación al tiempo total de sueño. Resultados: la diferencia entre la edad electroencefalográfica y la edad concepcional calculada fue menor de dos semanas. El rango del porcentaje de sueño REM y NREM fue 39-64 y 30-58 y la media fue de 52,5 y 36,5, respectivamente. La concordancia en los recién nacidos con alto porcentaje de sueño transicional fue menor comparada con la de los neonatos con menor porcentaje de sueño transicional (p<0,05). Discusión: a pesar de la exposición intrauterina al VIH- 1 y a los antirretrovirales, no se evidenciaron cambios significativos en la maduración electroencefalográfica. La disminución de la concordancia en neonatos con alto porcentaje de sueño transicional podría sugerir una alteración en el proceso de maduración, pero este aspecto en particular no es suficiente para considerar que la exposición intrauterina al VIH-1 y a los antirretrovirales afecta toda la arquitectura del sueño. Estudios posteriores deberían aclarar si la disminución entre la concordancia, el comportamiento y el porcentaje de sueño NREM es duplicable.

A Case of Neonate with Acute Renal Failure after Maternal Treatment with Angiotensin II Receptor Blocker / 대한주산의학회잡지

Hypertension is common medical problem encountered during pregnancy. However medication administered for maternal hypertension may cause fetal or neonatal complications. Angiotensin converting enzyme inhibitor or angiotensin II receptor blocker are rarely used during pregnancy, and there are few reports about the effect of them, because administration of these drugs during pregnancy may cause oligohydramnios, renal tubular dysplasia, hypocalvaria, pulmonary hypoplasia, intrauterine growth retardation, neonatal anuria and persistent ductus arteriosus. We report a case of neonatal acute renal failure by angiotensin II receptor blocker during pregnancy. In this case, the neonate with meconium aspiration was admitted to neonatal intensive care unit (NICU). During the NICU stay, neonatal anuria occurred, and there was a medical history that his mother took Candesartan Cilexeril (Atacand(R)), one of angiotensin II receptor blockers during pregnancy. The neonate showed intrinsic acute renal failure, so fluid was restricted and diuretics were administered to the neonate, and after 10 days, anuria improved.