Clinical and Epidemiologic Characteristics of a Cohort of HIV-Infected Mother-Infant Pairs During 21 Years.

BACKGROUND: HIV infection continues to be a worldwide public health problem. After the introduction of effective preventive measures, perinatal transmission dramatically decreased. Our aim was to assess the sociodemographic changes in pregnant women living with HIV infection and trends in perinatal transmission rates over time. SETTING: The Madrid cohort of HIV-infected mother-infant pairs is a multicenter, prospective, observational, and cohort study that collects information on HIV-infected pregnant women and their children. METHODS: Information on clinical-epidemiological characteristics of HIV-infected pregnant women until delivery and their children from 9 public hospitals was included. Data were collected from a standardized questionnaire from medical records. The results were classified in 3 periods: period 1 (P1) 2000-2006, period 2 (P2) 2007-2013, and period 3 (P3) 2014-2020. RESULTS: A total of 1521 women living with HIV and 1548 newborns were included. In P1, most mothers (75.8%) were Spanish, whereas in P2 and P3 there was a predominance of foreign origin [62.8% and 70.5% respectively ( P < 0.01)]. The percentage of women with antiretroviral treatment before pregnancy increased significantly in P3 ( P < 0.01). The proportion of Caesarean sections decreased over time ( P < 0.01): 66.2% (n = 472) in P1, 54.9% (n = 245) in P2, and 46.7% (n = 141) in P3. The percentage of preterm and low birth weight newborns showed a statistically significant decrease. Even though there were no statistically significant differences ( P = 0.154), a decrease in cases of perinatal infection was observed (1.6% in P1, 1.3% in P2 and 0.3% in P3). CONCLUSIONS: The epidemiologic characteristics of pregnant women with HIV infection have changed over time in our setting, with an increase of non-Caucasian, heterosexual, and perinatally infected mothers. Although there are still perinatal infections, especially in vulnerable populations such as immigrant women, transmission rate has markedly decreased in recent years and is still of major concern. Prevention measures should be reinforced in the most socially disadvantaged groups.

Safety and Experience With Combined Antiretroviral Prophylaxis in Newborn at High-risk of Perinatal HIV Infection, in a Cohort of Mother Living With HIV-infant Pairs.

BACKGROUND: Perinatal transmission of HIV has dramatically decreased in high-income countries in the last few years with current rates below 1%, but it still occurs in high-risk situations, mainly pregnant women with late diagnosis of infection, poor antiretroviral adherence and a high viral load (VL). In these high-risk situations, many providers recommend combined neonatal prophylaxis (CNP). Our aim was to evaluate the safety and toxicity of CNP in infants deemed at high-risk of HIV infection among mother-infant pairs in the Madrid Cohort. MATERIALS AND METHODS: Prospective, multicenter, observational cohort study between years 2000 and 2019. The subgroup of newborns on CNP and their mothers were retrospectively selected (cohort A) and compared with those who received monotherapy with zidovudine (cohort B). Infants with monotherapy were classified according to treatment regimes in long (6 weeks) and short (4 weeks) course. RESULTS: We identified 227 newborns (33.3% preterm and 7 sets of twins) with CNP. A maternal diagnosis of HIV-1 infection was established during the current pregnancy in 72 cases (36.4%) and intrapartum or postpartum in 31 cases (15.7%). Most infants received triple combination antiretroviral therapy (65.6%; n = 149). The perinatal transmission rate in cohort A was 3.5% (95% confidence interval: 1.13%-5.92%). Infants from cohort A developed anemia (26.1% vs. 19.4%, P = 0.14) and neutropenia more frequently at 50-120 days (21.4% vs. 10.9%, P < 0.01), without significant differences in grade 3 and 4 anemia or neutropenia between the two cohorts. There were no differences in increased alanine aminotransferase. Neutropenia was more common in the long zidovudine regimes. CONCLUSIONS: Our findings provide further evidence of the safety of CNP in infants with high-risk of HIV-1 perinatal transmission.

Efecto de la velocidad de crecimiento intrahospitalaria en la somatometría a los 2 años en niños con peso de nacimiento menor de 1500 gramos / Effect of intrahospital growth rate on somatometric measurements at 2 years old in children with a birth weight of less than 1500 grams

Objetivo. Determinar la asociación de la velocidad de crecimiento (VC) intrahospitalaria y la fortificación de leche humana con la somatometría y el riesgo de muerte tras el alta o discapacidad grave a los 2 años de edad corregida (EC). Población y método. Análisis retrospectivo de la VC y evolución posterior. Se incluyeron los recién nacidos del período 1990-2015, con peso al nacer < 1500 g. Se excluyeron neonatos con patología que afectaba al crecimiento. Se estudió una cohorte global y dos subcohortes: los nacidos en 1990-2001 (sin fortificación) y los nacidos en 2002-2015 (fortificada). La VC se calculó según la fórmula de Fenton y se consideró adecuada si resultó > 12 g/kg/día. Resultados. Se reclutaron 1194 pacientes. La VC adecuada se asoció a mayor mediana de peso a los 2 años de EC en la cohorte global (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0,02. La cohorte 2002-2015 alcanzó mayor talla media (86,42 ± 4,03 cm versus 85,56 ± 4,01, p = 0,02) y mayor porcentaje de prematuros que alcanzaron un crecimiento compensatorio (catch-up) a los 2 años de EC en la cohorte global con VC adecuada (62,50 % versus 34,69 %, p < 0,02). No se encontraron diferencias en el riesgo de muerte tras el alta o discapacidad grave a los 2 años de EC con VC adecuada (OR: 0,79; IC95 %: 0,47-1,12) ni al considerarse el análisis por subcohortes. Conclusiones. Una VC adecuada se asoció con mejor crecimiento, pero no con menor riesgo de muerte tras el alta o discapacidad grave. La cohorte fortificada alcanzó mayor talla media a los 2 años de EC.

Objective. To determine the association between intrahospital growth rate (GR) and breast milk fortification and somatometry, and risk for death after discharge or severe disability at 2 years of corrected age (CA). Population and method. Retrospective analysis of GR and subsequent course. Infants born in the 1990-2015 period with a birth weight < 1500 g were included. Infants with diseases affecting growth were excluded. An overall cohort and 2 sub-cohorts were studied: infants born in the 1990-2001 period (without fortification) and 2002-2015 period (with fortification). The GR was estimated and deemed adequate if > 12 g/kg/day. Results. A total of 1194 patients were recruited. An adequate GR was associated with a higher median weight at 2 years of CA in the overall cohort (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0.02). The 2002-2015 cohort reached a higher mean height (86.42 ± 4.03 cm versus 85.56 ± 4.01, p = 0.02). More preterm infants caught-up growth at 2 years of CA in the overall cohort with an adequate GR (62.50 % versus 34.69 %, p < 0.02). No differences were observed in the risk for death after discharge or severe disability at 2 years of CA with an adequate GR (OR: 0.79; 95 % confidence interval: 0.47-1.12). Conclusions. An adequate GR was associated with improved growth, but not with a lower risk for death after discharge or severe disability. The cohort with fortified breast milk reached a higher mean height at 2 years of CA

Effect of intrahospital growth rate on somatometric measurements at 2 years old in children with a birth weight of less than 1500 grams. / Efecto de la velocidad de crecimiento intrahospitalaria en la somatometría a los 2 años en niños con peso de nacimiento menor de 1500 gramos.

Objective: To determine the association between intrahospital growth rate (GR) and breast milk fortification and somatometry, and risk for death after discharge or severe disability at 2 years of corrected age (CA). Population and method: Retrospective analysis of GR and subsequent course. Infants born in the 1990-2015 period with a birth weight < 1500 g were included. Infants with diseases affecting growth were excluded. An overall cohort and 2 sub-cohorts were studied: infants born in the 1990-2001 period (without fortification) and 2002-2015 period (with fortification). The GR was estimated and deemed adequate if > 12 g/kg/day. Results: A total of 1194 patients were recruited. An adequate GR was associated with a higher median weight at 2 years of CA in the overall cohort (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0.02). The 2002-2015 cohort reached a higher mean height (86.42 ± 4.03 cm versus 85.56 ± 4.01, p = 0.02). More preterm infants caught-up growth at 2 years of CA in the overall cohort with an adequate GR (62.50 % versus 34.69 %, p < 0.02). No differences were observed in the risk for death after discharge or severe disability at 2 years of CA with an adequate GR (OR: 0.79; 95 % confidence interval: 0.47-1.12). Conclusions: An adequate GR was associated with improved growth, but not with a lower risk for death after discharge or severe disability. The cohort with fortified breast milk reached a higher mean height at 2 years of CA.

Objetivo. Determinar la asociación de la velocidad de crecimiento (VC) intrahospitalaria y la fortificación de leche humana con la somatometría y el riesgo de muerte tras el alta o discapacidad grave a los 2 años de edad corregida (EC). Población y método. Análisis retrospectivo de la VC y evolución posterior. Se incluyeron los recién nacidos del período 1990-2015, con peso al nacer < 1500 g. Se excluyeron neonatos con patología que afectaba al crecimiento. Se estudió una cohorte global y dos subcohortes: los nacidos en 1990-2001 (sin fortificación) y los nacidos en 2002-2015 (fortificada). La VC se calculó según la fórmula de Fenton y se consideró adecuada si resultó > 12 g/kg/día. Resultados. Se reclutaron 1194 pacientes. La VC adecuada se asoció a mayor mediana de peso a los 2 años de EC en la cohorte global (11 400 g [10 300-12 500] versus 11 000 g [10 000-12 140], p = 0,02. La cohorte 2002-2015 alcanzó mayor talla media (86,42 ± 4,03 cm versus 85,56 ± 4,01, p = 0,02) y mayor porcentaje de prematuros que alcanzaron un crecimiento compensatorio (catch-up) a los 2 años de EC en la cohorte global con VC adecuada (62,50 % versus 34,69 %, p < 0,02). No se encontraron diferencias en el riesgo de muerte tras el alta o discapacidad grave a los 2 años de EC con VC adecuada (OR: 0,79; IC95 %: 0,47-1,12) ni al considerarse el análisis por subcohortes. Conclusiones. Una VC adecuada se asoció con mejor crecimiento, pero no con menor riesgo de muerte tras el alta o discapacidad grave. La cohorte fortificada alcanzó mayor talla media a los 2 años de EC.

Procalcitonina en sangre de cordón en la valoración del riesgo de sepsis neonatal precoz / Cord blood procalcitonin in the assessment of early-onset neonatal sepsis

Introducción: El diagnóstico precoz es esencial para disminuir la morbimortalidad en la sepsis neonatal precoz (SNP). La procalcitonina (PCT) en sangre de cordón permitiría identificar al nacimiento a los pacientes infectados. Objetivo: Estudiar la utilidad y seguridad de un protocolo de valoración de recién nacidos con riesgo de SNP, basado en los valores de procalcitonina en sangre de cordón. Pacientes y métodos: Se incluyeron los nacidos en nuestro hospital de octubre de 2013 a enero de 2015, con factores de riesgo infeccioso. Se procedió según un algoritmo basado en los valores de procalcitonina (<0,6 ng/ml frente a ≥0,6 ng/ml). Posteriormente se clasificaron como infección comprobada, probable o no infección. Resultados y conclusiones: De 2.519 nacidos en el periodo de estudio 136 cumplieron criterios de inclusión. De 120 casos con PCT <0,6 ng/ml ninguno desarrolló SNP (valor predictivo negativo 100%). Por el contrario, de 16 casos con PCT ≥0,6 ng/ml, diez presentaron infección comprobada o probable (valor predictivo positivo 62,5%). La sensibilidad de la PCT frente a infección fue 100% y la especificidad 95,2% (área bajo la curva operador receptor 0,969). La incidencia de infección en el grupo de estudio fue de 7,4%; en RN de madre con corioamnionitis 26,1%. Recibieron antibioterapia 21 recién nacidos (15,4%). El protocolo clínico estudiado ha demostrado ser efectivo y seguro para diferenciar entre pacientes con mayor riesgo de SNP, en los que la aproximación diagnóstica y terapéutica fue más intervencionista, frente a aquellos con menor probabilidad de sepsis, que se beneficiaron de un manejo más conservador (AU)

Introduction: Early diagnosis of early-onset neonatal sepsis (EONS) is essential to reduce morbidity and mortality. Procalcitonin (PCT) in cord blood could provide a diagnosis of infected patients from birth. Objective: To study the usefulness and safety of a procedure for the evaluation of newborns at risk of EONS, based on the determination of PCT in cord blood. Patients and methods: Neonates with infectious risk factors, born in our hospital from October 2013 to January 2015 were included. They were processed according to an algorithm based on the values of cord blood procalcitonin (< 0.6 ng/ml versus ≥0.6 ng/ml). They were later classified as proved infection, probable, or no infection. Results and conclusions: Of the 2,519 infants born in the study period, 136 met inclusion criteria. None of 120 cases with PCT<0.6 ng/ml in cord blood developed EONS (100% negative predictive value). On the other hand, of the 16 cases with PCT ≥0.6 ng/ml, 10 were proven or probably infected (62.5% positive predictive value). The sensitivity of the PCT against infection was 100%, with a specificity of 95.2% (area under the receiver operator curve 0.969). The incidence of infection in the study group was 7.4%, and 26.1% in cases with maternal chorioamnionitis. 21 newborn (15.4%) received antibiotic therapy. The studied protocol has shown to be effective and safe to differentiate between patients with increased risk of developing an EONS, in those where the diagnostic and therapeutic approach was more interventionist, versus those with less likelihood of sepsis, who would benefit from a more conservative management (AU)

[Cord blood procalcitonin in the assessment of early-onset neonatal sepsis]. / Procalcitonina en sangre de cordón en la valoración del riesgo de sepsis neonatal precoz.

INTRODUCTION: Early diagnosis of early-onset neonatal sepsis (EONS) is essential to reduce morbidity and mortality. Procalcitonin (PCT) in cord blood could provide a diagnosis of infected patients from birth. OBJECTIVE: To study the usefulness and safety of a procedure for the evaluation of newborns at risk of EONS, based on the determination of PCT in cord blood. PATIENTS AND METHODS: Neonates with infectious risk factors, born in our hospital from October 2013 to January 2015 were included. They were processed according to an algorithm based on the values of cord blood procalcitonin (< 0.6ng/ml versus ≥0.6ng/ml). They were later classified as proved infection, probable, or no infection. RESULTS AND CONCLUSIONS: Of the 2,519 infants born in the study period, 136 met inclusion criteria. None of 120 cases with PCT<0.6ng/ml in cord blood developed EONS (100% negative predictive value). On the other hand, of the 16 cases with PCT ≥0.6ng/ml, 10 were proven or probably infected (62.5% positive predictive value). The sensitivity of the PCT against infection was 100%, with a specificity of 95.2% (area under the receiver operator curve 0.969). The incidence of infection in the study group was 7.4%, and 26.1% in cases with maternal chorioamnionitis. 21 newborn (15.4%) received antibiotic therapy. The studied protocol has shown to be effective and safe to differentiate between patients with increased risk of developing an EONS, in those where the diagnostic and therapeutic approach was more interventionist, versus those with less likelihood of sepsis, who would benefit from a more conservative management.