Socioeconomic inequalities in low birth weight risk before and during the COVID-19 pandemic in Argentina: A cross-sectional study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have exacerbated existing socioeconomic inequalities in health. In Argentina, public hospitals serve the poorest uninsured segment of the population, while private hospitals serve patients with health insurance. This study aimed to assess whether socioeconomic inequalities in low birth weight (LBW) risk changed during the first wave of the COVID-19 pandemic. METHODS: This multicenter cross-sectional study included 15929 infants. A difference-in-difference (DID) analysis of socioeconomic inequalities between public and private hospitals in LBW risk in a pandemic cohort (March 20 to July 19, 2020) was compared with a prepandemic cohort (March 20 to July 19, 2019) by using medical records obtained from ten hospitals. Infants were categorized by weight as LBW < 2500 g, very low birth weight (VLBW) < 1500 g and extremely low birth weight (ELBW) < 1000 g. Log binomial regression was performed to estimate risk differences with an interaction term representing the DID estimator. Covariate-adjusted models included potential perinatal confounders. FINDINGS: Of the 8437 infants in the prepandemic cohort, 4887 (57•9%) were born in public hospitals. The pandemic cohort comprised 7492 infants, 4402 (58•7%) of whom were born in public hospitals. The DID estimators indicated no differences between public versus private hospitals for LBW risk (-1•8% [95% CI -3•6, 0•0]) and for ELBW risk (-0•1% [95% CI -0•6, 0•3]). Significant differences were found between public versus private hospitals in the DID estimators (-1•2% [95% CI, -2•1, -0•3]) for VLBW risk. The results were comparable in covariate-adjusted models. INTERPRETATION: In this study, we found evidence of decreased disparities between public and private hospitals in VLBW risk. Our findings suggest that measures that prioritize social spending to protect the most vulnerable pregnant women during the pandemic contributed to better birth outcomes. FUNDING: No funding was secured for this study.

Respiratory and emotional reactivity to ethanol odor in human neonates is dependent upon maternal drinking patterns during pregnancy.

BACKGROUND: Beyond the well-known deleterious effects of ethanol defining Fetal Alcohol Spectrum Disorders (FASD), the notion of fetal alcohol programming has gained scientific support. This phenomenon implies early neural plasticity relative to learning mechanisms comprising ethanol´s sensory cues and physiological effects of the drug; among others, its reinforcing properties and its depressant effects upon respiration. In this study, as a function of differential ethanol exposure during gestation, we analyzed neonatal physiological and behavioral responsiveness recruited by the odor of the drug. METHODS: A factorial design defined by maternal ethanol intake during pregnancy (Low, n = 38; Moderate, n = 18 or High, n = 19) and olfactory stimulation (ethanol odor and/or or a novel scent) served as the basis of the study. Neonatal respiratory and cardiac frequencies, oxygen saturation levels and appetitive or aversive facial expressions, served as dependent variables. RESULTS: Newborns of High drinkers exhibited significant physiological and behavioral signs indicative of alcohol odor recognition; specifically, respiratory depressions and exacerbated appetitive facial reactions coupled with diminished aversive expressions. Respiratory depressions were not accompanied by heart rate accelerations (cardiorespiratory dysautonomia). According to ROC curve analyses respiratory and behavioral reactivity were predictive of high maternal intake patterns. CONCLUSIONS: These results validate the notion of human fetal alcohol programming that is detected immediately after birth. The reported early functional signs indicative of relatively high alcohol gestational exposure should broaden our capability of diagnosing FASD and lead to appropriate primary or secondary clinical interventions (Registry of Health Research N.3201- RePIS, Córdoba, Argentina).

Hernia diafragmática posterolateral de presentación tardía / Late presentation of postero lateral diaphragmatic hernia

La hernia diafragmática congénita se presenta frecuentemente en el período neonatal; sin embargo,hasta un 5 por ciento puede hacerlo después de este período, lo que representa un desafío diagnóstico para los pediatras.Presentamos un niño de 11 meses con hallazgos radiográficos compatibles con masa ocupante enhemitórax izquierdo, sin antecedentes respiratorios específicos para hernia diafragmática congénita.Se realizó tomografía axial computada de tórax,que confirmó el diagnóstico de hernia diafragmática congénita. Se efectuó corrección quirúrgica exitosa de su defecto anatómico, con evolución favorable.(AU)

Hernia diafragmática posterolateral de presentación tardía / Late presentation of postero lateral diaphragmatic hernia

La hernia diafragmática congénita se presenta frecuentemente en el período neonatal; sin embargo,hasta un 5 por ciento puede hacerlo después de este período, lo que representa un desafío diagnóstico para los pediatras.Presentamos un niño de 11 meses con hallazgos radiográficos compatibles con masa ocupante enhemitórax izquierdo, sin antecedentes respiratorios específicos para hernia diafragmática congénita.Se realizó tomografía axial computada de tórax,que confirmó el diagnóstico de hernia diafragmática congénita. Se efectuó corrección quirúrgica exitosa de su defecto anatómico, con evolución favorable.

[Nine cases of HELLP syndrome (hemolysis, elevated liver enzymes and low platelets]. / Nueve casos del síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia).

HELLP syndrome (Hemolysis, Elevated Liver Enzymes and Low Platelets) was described by Weinstein in 1982. It has a high maternal and perinatal morbi-mortality rate. We undertook this study to evaluate perinatal outcome in patients with HELLP syndrome. Patients with HELLP syndrome were identified in a retrospective study between March 1998 and March 2001 at the Hospital Privado de Córdoba. Maternal and neonatal variables were analyzed. Nine patients with HELLP syndrome were identified (incidence 2.3@1000). Mean maternal age was 24.5 (15-36) years. Five patients were nuliparous. The mean gestational age was 34.5 weeks (29-40). The main symptom was epigastric pain (77.7%). In seven women delivery was made by cesarean section. Three patients had postpartum HELLP syndrome. Three patients had difficult control hypertension; one had eclampsia and another one had disseminated intravascular coagulopathy with acute renal failure and died. Three women needed blood products transfusions. The average admission time was 4.4 days. There were six preterm infants (75%). Mean birth weight was 2030 g (736-3200). Four neonates had Apgar score < 7 at the first minute, all had > 7 at 5 minutes. Three neonates had alimentary disorders, one had hypoglucemia and another hyaline membrane disease, patent ductus arteriosus, sepsis and thrombocytopenia. The high maternal and perinatal morbi-mortality of HELLP syndrome requires management in a centre where intensive maternal and neonatal care are available.

Nueve casos del síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia). / [Nine cases of HELLP syndrome (hemolysis, elevated liver enzymes and low platelets]

HELLP syndrome (Hemolysis, Elevated Liver Enzymes and Low Platelets) was described by Weinstein in 1982. It has a high maternal and perinatal morbi-mortality rate. We undertook this study to evaluate perinatal outcome in patients with HELLP syndrome. Patients with HELLP syndrome were identified in a retrospective study between March 1998 and March 2001 at the Hospital Privado de Córdoba. Maternal and neonatal variables were analyzed. Nine patients with HELLP syndrome were identified (incidence 2.3@1000). Mean maternal age was 24.5 (15-36) years. Five patients were nuliparous. The mean gestational age was 34.5 weeks (29-40). The main symptom was epigastric pain (77.7

). In seven women delivery was made by cesarean section. Three patients had postpartum HELLP syndrome. Three patients had difficult control hypertension; one had eclampsia and another one had disseminated intravascular coagulopathy with acute renal failure and died. Three women needed blood products transfusions. The average admission time was 4.4 days. There were six preterm infants (75

). Mean birth weight was 2030 g (736-3200). Four neonates had Apgar score < 7 at the first minute, all had > 7 at 5 minutes. Three neonates had alimentary disorders, one had hypoglucemia and another hyaline membrane disease, patent ductus arteriosus, sepsis and thrombocytopenia. The high maternal and perinatal morbi-mortality of HELLP syndrome requires management in a centre where intensive maternal and neonatal care are available.

Nueve casos del sindrome hellp (hemolisis, enzimas hepaticas elevadas y plaquetopenia) / Nine cases of Hellp syndrome (hemolysis, elevated liver enzymes and low platelets)

El síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia) descripto por Weinstein en 1982, se asocia a alta morbi mortalidad materna y perinatal. Se evaluaron retrospectivamente Ias pacientes que presentaron síndrome HELLP entre marzo 1998 y marzo 2001 en el Hospital Privado de Córdoba. Se identificaron nueve pacientes con Síndrome HELLP (incidencia 2.3%o). La edad media de Ias pacientes fue 24.5 anos (15 36) con una edad gestacional media de 34.5 semanas (29 40). Cinco pacientes fueron nulíparas. El síntoma principal fue epigastralgia (77.7%). El parto fue por cesárea en siete pacientes y tres tuvieron síndrome HELLP post parto. Tres pacientes resentaron hipertensión de difícil manejo, una eclampsia y otra coagulación intravascular diseminada, insuficiencia renal aguda y muerte. Tres requirieron transfusión de derivados sanguíneos y el promedio de internación fue 4.4 días. Seis (75%) neonatos fueron pretérmino. El peso medio de nacimiento fue 2030 gramos (736 3200). Cuatro recién nacidos tuvieron un score de Apgar menor de 7 ai minuto y todos mayor de 7 a los cinco minutos. Tres neonatos presentaron trastomos alimentarios, uno hipoglucemia y otro enfermedad de membrana hialina, ductus arterioso permeable, sepsis y plaquetopenia. Debido a Ia morbi mortalidad materna yperinatal el síndrome HELLP requiere atención en un centro de alta complejidad mediante un equipo multidisciplýnario.(AU)

Nueve casos del sindrome hellp (hemolisis, enzimas hepaticas elevadas y plaquetopenia) / Nine cases of Hellp syndrome (hemolysis, elevated liver enzymes and low platelets)

El síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia) descripto por Weinstein en 1982, se asocia a alta morbi mortalidad materna y perinatal. Se evaluaron retrospectivamente Ias pacientes que presentaron síndrome HELLP entre marzo 1998 y marzo 2001 en el Hospital Privado de Córdoba. Se identificaron nueve pacientes con Síndrome HELLP (incidencia 2.3%o). La edad media de Ias pacientes fue 24.5 anos (15 36) con una edad gestacional media de 34.5 semanas (29 40). Cinco pacientes fueron nulíparas. El síntoma principal fue epigastralgia (77.7%). El parto fue por cesárea en siete pacientes y tres tuvieron síndrome HELLP post parto. Tres pacientes resentaron hipertensión de difícil manejo, una eclampsia y otra coagulación intravascular diseminada, insuficiencia renal aguda y muerte. Tres requirieron transfusión de derivados sanguíneos y el promedio de internación fue 4.4 días. Seis (75%) neonatos fueron pretérmino. El peso medio de nacimiento fue 2030 gramos (736 3200). Cuatro recién nacidos tuvieron un score de Apgar menor de 7 ai minuto y todos mayor de 7 a los cinco minutos. Tres neonatos presentaron trastomos alimentarios, uno hipoglucemia y otro enfermedad de membrana hialina, ductus arterioso permeable, sepsis y plaquetopenia. Debido a Ia morbi mortalidad materna yperinatal el síndrome HELLP requiere atención en un centro de alta complejidad mediante un equipo multidisciplìnario.