COVID-19: transmisión vertical, enfermedad y cuidados en recién nacidos / COVID-19: vertical transmission, disease and care in newborns

Existe la posibilidad que el SARS-CoV-2 se transmita tanto verticalmente en el útero, como durante y después del parto. La mayoría de bebés infectados presentan sintomatología leve o son asintomáticos. Las manifestaciones clínicas más frecuentes son la taquipnea y la disnea. En los exámenes de laboratorio, los hallazgos más frecuentes son la leucopenia y la linfopenia. Las lesiones pulmonares se muestran más claramente mediante la tomografía axial computarizada que mediante los rayos X. Las imágenes más comunes en ambas pruebas son las opacidades en vidrio esmerilado. No hay tratamiento antiviral y/o inmunomodulador aprobado para COVID-19 en recién nacidos. Aún no hay disponibilidad de guías específicas para el manejo respiratorio de neumonía por COVID-19 en recién nacidos. Los partos de madres positivas a COVID-19 deben efectuarse en una sala dedicada exclusivamente para ello. La vía de evacuación de elección es el parto vaginal. La evidencia actual no es suficiente para concluir que existe transmisión vertical de SARS-CoV-2 a través de la lactancia materna. Se deben tener precauciones para evitar el contagio posnatal a los recién nacidos y al personal de salud

There is a possibility that SARS-CoV-2 is vertically transmitted in the uterus, as well as during and after delivery. Most infected babies present mild symptoms or are asymptomatic. The most frequent clinical manifestations are tachypnea and dyspnea. In laboratory tests, the most common findings are leukopenia and lymphopenia. Pulmonary lesions are more clearly shown by computed tomography than by X-ray. The most common images in both tests are ground glass opacities. There is no approved antiviral and / or immunomodulatory treatment for COVID-19 in newborns. Specific guidelines for the respiratory management of COVID-19 pneumonia, in newborns, are not yet available. Deliveries of COVID-19 positive mothers must be carried out in rooms dedicated exclusively to these patients. The evacuation route of choice is vaginal delivery. Current evidence is not sufficient to confirm SARS-CoV-2 vertical transmission through breastfeeding. Precautions must be taken to avoid postnatal transmission to newborns and health personnel

CCHD Screening Implementation Efforts in Latin American Countries by the Ibero American Society of Neonatology (SIBEN).

Congenital heart disease (CHD) is among the four most common causes of infant mortality in Latin America. Pulse oximetry screening (POS) is useful for early diagnosis and improved outcomes of critical CHD. Here, we describe POS implementation efforts in Latin American countries guided and/or coordinated by the Ibero American Society of Neonatology (SIBEN), as well as the unique challenges that are faced for universal implementation. SIBEN collaborates to improve the neonatal quality of care and outcomes. A few years ago, a Clinical Consensus on POS was finalized. Since then, we have participated in 12 Latin American countries to educate neonatal nurses and neonatologists on POS and to help with its implementation. The findings reveal that despite wide disparities in care that exist between and within countries, and the difficulties and challenges in implementing POS, significant progress has been made. We conclude that universal POS is not easy to implement in Latin America but, when executed, has not only been of significant value for babies with CHD, but also for many with other hypoxemic conditions. The successful and universal implementation of POS in the future is essential for reducing the mortality associated with CHD and other hypoxemic conditions and will ultimately lead to the survival of many more Latin American babies. POS saves newborns' lives in Latin America.

Congenital and perinatal complications of chikungunya fever: a Latin American experience.

BACKGROUND: During the years 2014 and 2015, the Region of the Americas underwent a devastating epidemic of chikungunya virus (CHIKV) of the Asian genotype, resulting in millions of affected individuals. However, epidemiological and clinical information on this experience is scarce. Prior knowledge of congenital and neonatal illness caused by CHIKV is limited and almost exclusively based on data obtained from a single outbreak of the East/Central/South African (ECSA) genotype. The effect of chikungunya fever (CHIKF) on pregnancy outcomes and its consequences for infants born to infected mothers at the peak of the epidemic wave in Latin America are reviewed herein. Epidemiological and clinical data on maternal and neonatal infections were collected prospectively and analyzed. METHODS: One hundred sixty-nine symptomatic newborns with CHIKF seen at four large regional maternity hospitals in three different Central and South American countries were evaluated prospectively. The outcomes of pregnancies in symptomatic infected mothers at two of these clinical centers were also analyzed. RESULTS: The observed vertical transmission rate ranged between 27.7% and 48.29%. The incidence of congenital disease was unrelated to the use of cesarean section or natural delivery. The case fatality rate (CFR) at the only center that reported deaths was 5.3%. The most common clinical manifestations included fever, irritability, rash, hyperalgesia syndrome, diffuse limb edema, meningoencephalitis, and bullous dermatitis. Severe complications included meningoencephalitis, myocarditis, seizures, and acute respiratory failure. Leukocytosis with neutrophilia and normal or increased platelets was a common finding, and in those with signs of meningeal involvement, moderate lymphocytic pleocytosis with normal glucose and protein levels was typical. CONCLUSIONS: This study presents the largest number of symptomatic neonates with CHIKF analyzed so far in any region and is the first involving infection with the Asian genotype of CHIKV. Although the clinical manifestations found were similar to those reported previously, the percentage of neurological complications was lower. The CFR was comparatively high. Chikungunya represented a substantial risk for neonates born to symptomatic parturients during the chikungunya outbreak in the Americas Region, with important clinical and public health implications.