Recomendaciones para la prevención y manejo del recién nacido. Pandemia COVID-19 / Recommendations for the prevention and management of the newborn. COVID-19 pandemic

Resumen: La emergencia en el mundo del nuevo virus SARS-CoV-2 ha afectado a todos los grupos etarios obligando a los equipos salud a adoptar nuevos modelos de atención basados en la escasa evidencia disponible y ajustándolos en la medida que se genera nueva evidencia. Los efectos neonatales del virus SARS-CoV-2, las vías de transmisión, las medidas de prevención y tratamiento son todas áreas actualmente en estudio. En estas recomendaciones los autores sintetizan la información disponible en la literatura primaria y en las recomendaciones de diversas entidades internacionales ajustándolas a las particularidades locales. Las recomendaciones enfatizan las medidas de prevención de transmi sión de la enfermedad al recién nacido, al equipo de salud y a otros usuarios del sistema de salud en un contexto de facilitar la participación informada de los padres en la toma de decisiones. El artículo contiene recomendaciones para el uso correcto de los elementos de protección personal; para la aten ción del parto incluidas las medidas especiales para la reanimación; para permitir un contacto seguro entre la madre y el recién nacido; para promover la lactancia materna como forma preferida para la alimentación del recién nacido y entrega recomendaciones para su implementación segura en madres portadoras del virus. También se entregan recomendaciones para el manejo del recién nacido en las distintas circunstancias clínicas que éste puede enfrentar, tanto para su manejo en maternidad como en la unidad de neonatología y recomendaciones para el manejo y seguimiento post-alta. Los autores enfatizan la importancia de la evaluación y actualización periódica de estas recomendaciones según la disponibilidad de nueva evidencia y según la experiencia nacional.

Abstract: The emergence of the new SARS-CoV-2 virus has affected all age groups forcing health teams to adopt new models of care based on the limited evidence available and adjusting them as new evi dence is available. The neonatal effects of the SARS-CoV-2 virus, transmission routes, transmission prevention measures, and treatment are all areas currently under study. In these recommenda tions, the authors synthesize the information available in the primary literature and in the recom mendations of international entities adjusting them to local particularities. The recommendations emphasize measures to prevent transmission of the disease to the newborn, the health team, and other users of the health system in a context of facilitating informed parental participation in decision-making. The article contains recommendations for the correct use of personal protection equipment; for delivery care including special resuscitation measures; to allow safe contact bet ween mother and newborn; to promote breastfeeding as a preferred way to feed the newborn and provide recommendations for its safe implementation in mothers carrying the virus. Recommen dations are also given for the management of the newborn in the different clinical circumstances that it may face, both for its management in maternity and in the neonatology unit, and recom mendations for management and post-discharge follow-up. The authors emphasize the importan ce of the periodic updating of these recommendations according to the availability of new evidence and according to national experience.

Manejo de la neumonía del adulto adquirida en la comunidad: Resumen del consenso nacional / Summary of the Consensus for management of community acquired pneumonia in adults

This is an update of the Consensus for treatment of community acquired pneumonia in adults, prepared by the Chilean Society of Respiratory Diseases and the Chilean Society of Infectious Diseases. These norms were prepared by thirty specialists in respiratory diseases, internal medicine, infectious diseases, microbiology, intensive medicine and radiology. The purpose of the document is to norm the management of immunocompetent adults with community acquired pneumonia, by the public and private health systems of our country. The complete document will be published in June, in the respective journals of the Societies of Respiratory and Infectious Diseases. This is a summary to obtain a better diffusion of these norms among internists and general practitioners.

Terapia anti retroviral / Antiretroviral therapy

There are treatments to induce the long term suppression of viral replication and that delays the progression of HIV disease. To be effective, these treatments require the uninterrupted use of a combination of drugs (ideally three), patients must be highly compliant, must be instituted in early stages of the disease and drugs must be used for prolonged periods and given by specialists. These treatments are indicated in all symptomatic patients and in those with early immunologic deterioration or high viral load. Recent infection and acute primary retroviral infections should also be considered for treatment. The treatment sponsored and financed by the ministry of health for its beneficiaries is insufficient at this time, since it is received by a minority of eligible patients due to budgetary reasons, and only two drugs are given which is considered sub optimal by most experts. The committee considers that the responsibility for financing, providing and delivering these treatments in proper combination and dosages exceeds the duty of the Ministry of Health and should include all the involved parties. However, the state and its official institutions have a special responsibility to provide with adequate treatments to the poorer segments of our population. They also should promote, supervise and control the proper access of the rest of the population to efficient treatments. The committee also considers that the efforts to prevent new infections must not be neglected and that individuals under successful treatment should not consider themselves as non infectious

Declaración sobre el uso de terapia antiretroviral en pacientes infectados por virus de inmunodeficiencia humana / Statement about antiretroviral therapy use in HIV positive patients

The Committee based its postition paper on the following fact: existence of an effective way of inducing long term suppression of viral replication which in turn is associated with delayed progression of HIV disease. In order to reach this aim, the treatment requires to be: given in combination of drugs (ideally 3), highly compliant, not interrupted, iniciated early, prolonged and carried out by specialists. This treatment is indicated in all symptomatic patients and those with early immunologic deterioration and/or high viral load. Recent infection and acute primary retroviral infection should also be considered for treatment. General criteria for treatment of children (including newborn) are given. The treatment sponsored and financed by the Ministry of Health for beneficiaries of the public health system at this time in insufficient since only a minority of elegible patients receive it due to budgetary reasons and, because only 2 drugs are given, is considered by most experts as suboptimal. The Committee considers that the responsability for financing, providing and delivering of these treatments (in proper combination and dosages) exceeds the duty of the State and Ministry of Health and should include all the parties involved and that the society as a whole should respond generously and solidariously. However, the State and its official institutions have a special responsibility with the poorer segments of the populations in orden to provide them with medically proven treatments and besides that cannot resign the other responsability of promoting, supervising and controlling the mechanisms ensuring proper access to adecuate treatment of non public health system beneficiaries. The Committee also considers that the efforts to prevent new infections in the populations should not be abandoned but intensified and that people under treatment, however succesful, should not consider themselves as noninfectious

Posición sobre los estudios serológicos de la infección por virus de inmunodeficiencia humana / Statement about serologic screening for human immunodeficiency virus infection

At present there are adecuate tests for diagnosing VIH infection, both for screening (ELISA) and confirmation (western blot) purpose. Polimerase chain reaction (PCR) and P24 antigen tests can be used for viral detection in infants before the age of 18 months (including neonatal period), before antibody seroconversion and in serologically indetermined cases. The Chilean Infectious Disease Society Advisory Committee on AIDS (CC-SIDA) strongly recommends that the following principles be followed in ordering/performing HIV diagnostic tests: informed consent (although under unusual and restricted circumstances in which the well being of third parties is involved this requirement can be waived), confidentiality of the information. Professional councelling before and after test is performed. For public health purposes it should be performed in all blood, blood products and germinative tissue as well as organ and tissue donation. It should also be performed anonymously in various population to monitor the evolution of the epidemic. Pregnant women should be encouraged to have the test performed in order to minimize vertical transmission through antiretroviral therapy. In non health care settings it should not be performed. Specifically it should not be a requirement in applying for job or education, obtainig life or health insurances, visa or authorization for crossing frontiers

Recomendaciones para la inmunización activa de pacientes con compromiso inmunológico y/o con riesgos específicos / Recommendations for active inmunization in patients with altered immunocompetence and with specific risks

Although vaccines are powerful public health tools, are unwarrantedly denied or incompletely administered to patients with altered immunocompetence. The advisory Immunization Committee presents an updated revision, according to the local epidemiological reality, that may guide the care of these patients. Recommendations are centered in patients with congenital immunodeficiencied, HIV infected individuals, offspring of HIV infected mothers, and subjects with medical conditions that increase the susceptibility towards one or more infectious disease. In each case, the indications and contradictions of immunizations included in the Extended Immunization Program or special vaccines, recommended for special groups are analyzed. Special situations that must be considered in each risk group are also analyzed

Consideraciones sobre la vacunación contra la hepatitis A / Considerations about hepatitis A vaccination

Hepatitis A is endemic in Chile with rates of 100 cases per 100.000 inhabitants/years, figure that triplicates in school age children. Its social impact justifies educational and other public work measures to control it. Vaccines are an effective but expensive control resourse. The vaccine elaborated with the inactive HM 175 strain, recently licensed in Chile, is immunogenic, effective and well tolerated in adults and children over 3 years old. Its main indication is for voyagers to endemic areas and patients with chronic liver diseases. In Chile, its individual prescription requires the assessment of patient's individual risk and basal immunological status. Its massive application requires a better knowledge of hepatitis A geographical distribution, age of infection and cost benefit ratios

Consideraciones de la Sociedad Chilena de Infectología sobre la vacunación contra la hepatitis A / Considerations of the Chilean society of infectology about the vaccination against hepatitis A

La hepatitis A es una enfermedad endémica en Chile con tasas cercanas a 100 casos x 100000 habitantes/año, cifra que se triplica en escolares. Su impacto laboral y en ausentismo escolar justifican medidas educativas y obras públicas orientadas al control de ella y de otras infecciones de trasmisión fecal-oral. Las vacunas en desarrollo surgen como un recurso efectivo aunque costoso en el control de la enfermedad. La vacuna elaborada con cepa HM 175 inactivada, recientemente licenciada en Chile es inmunogénica, eficaz y bien tolerada en adultos y niños sobre 3 años de edad. Su principal indicación es en viajeros a áreas endémicas y en pacientes portadores de hepatopatías crónicas. En Chile la prescripción individual requiere evaluar el riesgo personal y el estado inmunitario basal; su aplicación masiva en campañas o programas de vacunación exige conocer mejor su distribución geográfica, edad de adquisición y estudios de costo vs beneficio