Epidemiological profile of 39 cases of microcephaly caused by congenital infections diagnosed in the state of Rio Grande do Sul between 2015-2017

Introduction: Microcephaly is a clinical finding that can arise from congenital anomalies or emerge after childbirth. Maternal infections acquired during pregnancy can result in characteristic brain damage in the newborn (NB), which may be visible even in the fetal stage. To describe the epidemiological profile of newborns with reported microcephaly and diagnosed with congenital infections in the state of Rio Grande do Sul between 2015 and 2017. Methods: A cross-sectional study was carried out on data collected from the Public Health Event Registry as well as from medical records. The investigation included serologies for toxoplasmosis and rubella; polymerase chain reaction (PCR) for Zika virus (ZIKV) in the blood and cytomegalovirus in the urine; non-treponemal tests for syphilis; and brain imaging tests. Results: Of the 257 reported cases of microcephaly, 39 were diagnosed with congenital infections. Severe microcephaly was identified in 13 patients (33.3%) and 51.3% of the cases showed alterations in brain imaging tests. In relation to the diagnosis of congenital infections, three patients (7.7%) were diagnosed with ZIKV, nine (23.1%) with cytomegalovirus, nine (23.1%) with toxoplasmosis, and 18 (46.1%) with congenital syphilis. The three cases of ZIKV showed calcification in brain imaging tests, signs of arthrogryposis, excess occipital skin and irritability, characterizing the typical phenotype of ZIKV infection. Conclusions: Most cases of congenital infection had severe neurological lesions, particularly the cases of ZIKV, which can cause neurodevelopmental delays and sequelae in these infants throughout early childhood.

Thyroid abnormalities in term infants with fungal sepsis / Alterações tireoidianas no recém-nascido de termo com sepse fúngica

Summary Objective: To describe thyroid alterations in term newborns (TNB) with fungal sepsis during NICU hospitalization. Method: The study included six TNB that during the clinical and laboratory manifestations of sepsis with positive cultures for fungus showed changes in thyroid hormones, called low T3 syndrome and low T3-T4 syndrome. TNB that could present hormonal changes caused by disease as those born to mothers with thyroid disease, or who had perinatal asphyxia and major surgeries were excluded. Results: Of six TNB with fungal sepsis, five had positive culture for Candida albicans and one had positive culture for Candida tropicalis. Low T3 syndrome was observed in two TNB (50%), while T3-T4 syndrome was observed in other two (100%). The four children progressed to septic shock. Conclusion: Fungal sepsis is becoming more common among newborns admitted to NICU. Thyroid insufficiency could be a marker of disease severity with possible need for hormone supplementation.

Resumo Objetivo: descrever as alterações tireoidianas em recém-nascidos de termo (RNT) que apresentaram sepse fúngica durante internação na UTI neonatal. Método: foram incluídos seis RNT que, durante as manifestações clínicas e laboratoriais de sepse, com culturas positivas para fungo, apresentaram alterações dos hormônios tireoidianos, denominadas síndrome do T3 baixo e síndrome do T3 e T4 baixo. Foram excluídos RNT que apresentaram alteração hormonal por doença, como RNT filhos de mães com doença tireoidiana, asfixia perinatal e cirurgias de grande porte. Resultados: dos seis RNT com sepse fúngica, cinco apresentavam cultura positiva para Candida albicans e um para C. tropicalis. A síndrome do T3 baixo foi observada em duas crianças (50%) e a do T3 e T4 baixo em dois RN (100%). As quatro crianças evoluíram com choque séptico. Conclusão: a sepse fúngica é cada vez mais frequente nos recém-nascidos internados em UTI neonatal. A insuficiência tireoidiana pode vir a ser marcadora de gravidade da doença, e a suplementação hormonal pode ser necessária.

Antibiotic sensitivity pattern of causative organisms of neonatal septicemia in an urban hospital of Bangladesh.

Background: The information of the sensitivity pattern of the causative organisms is very important for effective control of septicemia in neonates. OBJECTIVE: To determine the proportion and profile of pathogenic bacteria in the blood cultures of the neonates with clinically suspected septicemia and their susceptibility pattern to antimicrobial agents for developing a unified antibiotic treatment protocol. Materials and Methods: A cross-sectional retrospective study was conducted over a period of 3 year and 4 months (39 months). The study included 1000 patients admitted in the selected hospital in Bangladesh. Blood samples for culture were taken aseptically before starting antibiotic therapy. Microorganisms were isolated and identified by standard microbiological processes which include colony morphology, Gram stain, and biochemical profiles. Antimicrobial sensitivity patterns were performed by Kirby-Bauer's disc diffusion method against imipenem, ciprofloxacin, ceftazidime, chloramphenicol, netilmicin, gentamicin, ceftriaxone, aztreonam, cefotaxime, cephalexin, and ampicillin. Results: Among the patients, 633 (63.3%) were males and 367 (36.7%) were females. Blood cultures were found positive in 194 (19.4%) neonates. The organisms isolated were Pseudomonas spp. (31.4%), Klebsiella pneumoniae (23.2%), Staphylococcus aureus (12.4%), Escherichia coli (7.2%), Acinatobactor (5.7%), Gram-negative Bacilli (4.1%), Flavobacterium spp. (3.6%), Serratia spp. (5.7%), Citrobacter fruendi (3.1%), Streptococcus species (2.6%), and Enterobacter spp. (1.0%). A majority of the bacterial isolates in neonatal sepsis were found sensitive to imipenem (91.8%) and ciprofloxacin (57.2%) and resistant to commonly used antibiotics, eg. ampicillin (96.4%) and cephalexin (89.2%). Conclusion : The problem can be mitigated by careful selection and prudent use of available antibiotics.

Evaluation of the bedside glucose monitoring system in neonatal units.

OBJECTIVE: To evaluate the performance of a commercial reader compared with a laboratory method in neonates with a variety of diseases and conditions. PATIENTS AND METHOD: A total of 175 patients were included in the present study. Venous whole blood samples were analyzed with a commercial reader by trained nurse. Through the same sampling site, specimens were collected, spun and plasma were sent to the laboratory for measurement of plasma glucose. RESULTS: The regression analysis between the results of a commercial reader and laboratory glucose were significantly correlated (r = 0.97; p < 0.001) with the result as follows: A commercial reader = Laboratory glucose - 0.17 (n = 175). A positive slope of 0.04 was found between hematocrit and difference between a commercial reader and laboratory plasma glucose. However, this correlation was of little clinical significance. CONCLUSIONS: A commercial reader showed a good correlation with the standard laboratory method for the measurement of plasma glucose in neonates with a variety of diseases and conditions.

Triagem neonatal: investigação de hemoglobinoparias em recém-nascidos da cidade do Salvador - Bahia / Neonatal screening: hemoglobinopathies investigation in newborns from Salvador - Bahia

As hemoglobinopatias apresentam freqüência mundial elevada. No Brasil, tem sido registradas freqüências elevadas para a HbS, estimando-se 0,1 a 0,3% de recém-nascidos (RN) com anemia falciforme (SS). A talassemia a apresenta freqüência de 20 - 23% entre algumas populações estudadas. Um total de 600 amostras de sangue de cordão umbilical foi investigada. Os RN foram provenientes da Maternidade Pública Tsylla Balbino (SESAB) e as amostras coletadas no período de fevereiro a junho de 2000. A análise de hemoglobinas foi realizada por eletroforese em fitas de acetato de celulose pH 8,9 e em ágar - citrato pH 6,0; os dados hematológicos foram obtidos através de contador de células eletrônico (Coulter Count T - 890). O DNA foi isolado dos leucócitos e utilizado para a investigação das talassemias α2 3.7Kb e α2 4,ZKb por PCR (Reação em Cadeia da Polimerase). Os dados referentes aos RN foram obtidos através de entrevista às mães, consulta aos prontuários médicos e observação do RN. A análise estatística foi realizada através do software EPI-INFO versão 6.04. Foram encontrados 538 (90,9%) RN com perfil de hemoglobinas normal (AF); 33 (5,6%) heterozigotos para a HbS (ASF), 19 (3,2%) heterozigotos para a HbC (ACF) e 02 (0,3%) homozigotos para a HbC (CF). O peso, gênero e idade gestacional não demonstraram associação com a presença de hemoglobinas anormais. Vinte e seis RN com perfil ASF foram distribuídos de acordo com a classificação racial: 11 (42,30%) foram mulatos, 08 (30,77%) pretos e 07 (26,90%) brancos. A análise hematológica entre os RN com padrão de AF e ASF não demonstrou diferenças estatisticamente significativas. A análise hematológica entre os RN AF e ACF apresentou diferenças significativas para os valores de Ht (p=0,008), Hm (p=0,017) e CHCM (p=0,0045). Os padrões SF e SCF não foram encontrados na análise da presente amostra. A talassemia α2 3,7 Kb foi detectada em 134 (22,71%) dos RN, entre os quais 120 (20,34%) foram heterozigotos e...

Indicadores imunológicos (IgM e proteína C-reativa) nas infecçöes neonatais / Immunological indicators (IgM and C-reactive protein) in neonatal infections

A sepse, no período neonatal, está associada com a presença de fatores de risco para infecçao e com o estado imunológico do recém-nascido. Objetivo. Verificar, em recém-nascidos com fatores de risco para infecçao, o papel da proteína C reativa (PCR) e da imunoglobulina M (IgM) como indicadores de infecçao. Casuística e Metodologia. Foram estudados 57 recém-nascidos que apresentavam, como fatores de risco para infecçao: ruptura prematura de membranas, associada ou nao a amniotite clínica ou a infecçao de trato urinário. Estes foram classificados em três grupos, de acordo com a idade gestacional <34 semanas, entre 34-36 6/7 semanas e (>37 semanas). O diagnóstico de infecçao foi baseado em critérios clínicos e laboratoriais, e foram incluídos entre os métodos de diagnóstico e dosagem de PCR e de IgM. Os exames laboratoriais foram colhidos ao nascimento e no quinto dia de vida. Resultados. Dos 57 recém-nascidos estudados, 18 (31,5 por cento) apresentaram sepse, sendo 13 (22,8 por cento) a forma precoce e cinco (8,7 por cento) a forma tardia. Houve associaçao estatisticamente significante entre idade gestacional, peso e presença de infecçao, constituindo o grupo com idade gestacional inferior a 34 semanas o mais acometido e o que apresentou também maior número de óbitos relacionados com o processo infeccioso. Nao se observou associaçao estatisticamente significante entre sexo e infecçao nos três grupos estudados. Em relaçao à IgM, houve diferença estatisticamente significante entre níveis séricos médios de IgM dos RNs infectados que se mostraram superiores aos dos nao-infectados nos três grupos de idade gestacional, tanto ao nascimento como no quinto dia, sendo esta diferença mais evidente no quinto dia. Constatou-se forte associaçao estatística entre níveis de PCR > 10mg/litro e presença de infecçao nos três grupos estudados. Conclusoes. Nesta casuística, a PCR foi o melhor indicador de infecçao, revelando-se esta prova confiável para seguimento clínico no quinto dia de vida, e naqueles casos que apresentaram infecçao tardia foi a primeira prova a se mostrar alterada.

Haematological screening in diagnosis of neonatal sepsis

Neonatal sepsis is a clinical syndrome haracterized by bacteremia and clinical symptoms caused micro-organisms or their toxic products Diagnosis is confirmed by growth of micro-organisms in body fluid cultures. When available, blood culture positivity is approximately 40% and takes as long as 48-72 hours. In order to determine the predictive value of simple to performs hematological tests for neonatal sepsis, a prospective randomized study was carried out in 100 neonates who had strong clinical suspicion of sepsis. Thirty normal neonates served as controls Role of TLC, DLC, Absolute Neutrophil Count ANC, I:T ratio, platelet counts and degenerative morphological changes was determined. Out of 100 clinically suspected cases, 40 neonates were proved to be septic by blood culture and 60 neonates were of probable sepsis [strong clinical suspicion despite negative culture]. An abnormal ANC was found to be the most sensitive [67%], single parameter for prediction of neonatal sepsis followed by elevated LT ratio and thrombocytopenia Derangement of either ANC or I:T ratio had sensitivity of 80% higher sensitivity was found in cases of late onset sepsis. Combination of abnormal ANC and elevated I:T ratio scents reasonable as a surrogate parameter for neonatal sepsis especially in the late onset type

C-reactive protein as a marker for guiding the duration of antibiotic therapy in suspected neonatal bacterial infection

The need to assign an effective and safe strategy to manage neonates with different forms of bacterial infections was an important objective among neonatologists at different centers. The classic approach is to provide the appropriate antibiotic regimen for cases with proved bacterial infection for a definite minimum duration and to discontinue the treatment after clinical and culture evidence of cure. This strategy, although reliable and effective, was found to pose a burden of longer duration of hospital stay and antibiotic therapy with undesired medical and economic consequences. This study was prospectively done to evaluate the use of C-reactive protein [CRP] as a reliable and safe guide to stop antibiotic therapy in those patients. It included 306 term neonates with suspected bacterial infection. C-reactive protein was highly sensitive in confirming bacterial infection in all the 72 cases [23.5%] who had positive cultures and was extremely specific in excluding bacterial infection in all the 234 [76.5%] neonates with negative cultures. Follow up of neonates with culture proved bacterial infection showed that, CRP value < 10 mg/dl could be used as a quite effective marker to terminate antibiotic therapy in neonates with various forms of bacterial infections, including the serious forms; septicemia and/or meningitis. The duration of antibiotic treatment in the group of neonates with CRP guided protocol was significantly less than the duration of treatment in the group guided by culture evidence of cure. At the same time, there was no significant difference in the rate of relapse among both groups. The results obtained in this study might provide a highly needed guide to limit the unnecessary use of antibiotics, in an economic, easy, safe and reliable manner, a situation that would be of great value in countries with rather limited economic resources

Biochemical abnormalities in neonatal seizures.

Early diagnosis and appropriate treatment of biochemical abnormalities accompanying neonatal seizures is important for effective seizure control and to avoid further brain damage. The present study was carried out on 35 neonates to determine the frequency of various biochemical abnormalities in neonatal seizures. Diagnostic evaluation included estimation of levels of serum calcium, phosphorus, magnesium, sodium, potassium, zinc, and blood glucose. Two-thirds of the neonates with seizures had biochemical disturbances in their sera. A variety of abnormalities occurred in asphyxiated infants, including hyponatremia, hypoglycemia, hypocalcemia, and hypomagnesemia. Primary metabolic disorders accounted for one-forth of the cases of neonatal seizures, the most common being hypoglycemia, hypoglycemia/hypocalcemia, and hypocalcemia/hyperphosphatemia. Inappropriate intrauterine growth, inadequate feeding, and feeding with cow's milk were the main risk factors for primary metabolic seizures. Hyponatremia was a frequent finding in seizures resulting from brain damage like birth asphyxia, meningitis, and intracranial hemorrhage. No infant had hypernatremia, hyperkalemia, hypokalemia, or low serum zinc.

Fibronectin levels in Indian neonates in health & disease.

Cord blood samples were estimated for serum fibronectin (Fn) by immunoelectrophoresis (IE) and enzyme linked immuno sorbent assay (ELISA) in 250 newborn healthy and sick infants classified into 6 categories: i.e., term appropriate for date (TAFD), preterm appropriate for date (PTAFD), term small for date (TSFD), preterm small for date (PTSFD), birth asphyxia (BA) and septicemia (SEP). TAFD infants were assayed for plasma Fn in addition. Comparison of Fn levels in the different groups by the Wilcoxan rank sum test indicated no significant difference between term and preterm infants, between PTAFD and PTSFD, TAFD and TSFD and in infants with and without birth asphyxia. Babies with septicemia had a significantly (P < 0.01) lower Fn level (29.97 +/- 29.03 mg/l) than those with no septicemia (42.77 +/- 30.20 mg/l). TAFD infants had Fn levels (serum 41.44 +/- 31.08 mg/l, plasma 85.20 +/- 33.38 mg/l) that are less than half the levels reported in the Western literature for newborn term infants. A possible cause could be the associated medical problems in mothers as 41 per cent of mothers of TAFD infants had conditions such as pregnancy induced hypertension, gestational diabetes, rheumatic heart disease, infection etc.

Newborn depression and its relation to umbilical cord pH and blood gases

The study comprised 300 term nulliparous women with spontaneous onset of labour and with no medical or surgical disorders. Umbilical artery pH and blood gases were measured immediately after labour and evaluated in relation to 5 minute Apgar score to assess the importance of obtaining cord blood gas levels in all deliveries. Acidemic newborns [pH < 7.2] had highly significant increase in the C02 tension [P Col] and highly significant decrease in standard base concentration [SBE] and O2 saturation [SAT]. The incidence of depressed newborns [Apgar score < 7] was 16.3% among them the incidence of normal umbilical cord arterial pH was 83.7%, while of the vigorous newborns [Apgar score > 7], there was 2.3% incidence of cord arterial blood acidemia. There was highly significant increase in the frequency of newborns with abnormal pH and SAT values among the depressed newborns in comparison with vigorous newborns. Thus our study suggests that cord arterial pH value is extremely useful in railing out the diagnosis of birth asphyxia in 83.7% of the depressed newborns as well as providing objective documentation of normal acid base balance in 97.7% of the vigorous newborns. Also, cord arterial SAT values has significant correlation with pH and Apgar score, a finding suggesting further evaluation

Alteraciones hematologicas en ninos de madres toxemicas / Hematological disorders in children from toxemic mothers

La toxemia del embarazo se ha asociado con alteraciones hematologicas, neutropesia y trombocitopenia, sobre todo en el recien nacido, aunque hay controversias al respecto. Para dilucidar este hecho se estudiaron prospectivamente con seguimiento clinico y hematologico completo 81 recien nacidos, hijos de madres toxemicas, la mayoria con toxemia severa. Como controles se analizaron 21 recien nacidos sanos escogidos en forma secuencial. El etudio se hizo en el Hospital Universitario del Valle, Cali, Colombia, entre septiembre y noviembre de 1987. En los hijos de madres toxemicas hubo mayor anoxia perinatal; no se encontro leucopenia ni robocitopenia como lo informa la literatura; hubo mayor hematocrito y menor numero de nuetrofilos sin llegar a neutropesia; a mayor severidad de la toxemia se encontraron alteraciones en las plaquetas, es decir, trombocitopenia y trombocitosis, por igual, siendo este ultimo hallazgo un hecho no informado. Finalmente, las drogas que se usaron para el manejo de la toxemia, no influyeron en el recuento plaquetario