Características de recién nacidos hijos de madre con IgM positiva para el Virus Herpes Simplex

Introducción: El herpes connatal es una entidad infrecuente asociada a elevada morbimortalidad. La probabilidad de transmisión al recién nacido va de 5% al 85%. El diagnóstico se dificulta por falta de clínica, serología no confiable y por la no disponibilidad de PCR en los servicios públicos de países en vías de desarrollo. La IgM en gestantes podría ser utilizada como un marcador de sospecha para evaluar al neonato. Objetivo: Caracterizar a los recién nacidos, hijos de gestantes con IgM positiva para HVS 1-2 y la frecuencia de encefalitis en los infantes. Materiales y métodos : Estudio observacional, descriptivo, prospectivo, realizado de mayo de 2020 a octubre de 2021. Se incluyeron recién nacidos (RN) de madres con IgM positiva para Herpes Virus Simplex (HVS) a partir de la segunda mitad del embarazo. En el RN se realizó serología IgG e IgM, y además, PCR- RT para HVS 1-2 en sangre y/o LCR, excluyéndose los nacidos en otras maternidades y/o sin datos de serología materna. Resultados: 36 pacientes. Edad materna 28 años (DS + 4), 5% con antecedentes de HVS, 61% cesárea. 36% prematuros, 13% RCIU. Síntomas agudos en el RN 22%. De ellos, 19% plaquetopenia, 44% alteración de GOT. 63% PCR HVS en sangre y 44% en LCR. Se encontró hemorragia, hidrocefalia, leucomalacia en 27%. No se encontró diferencias en la expresión clínica por tipo de parto. Conclusiones: Los RN hijos de gestantes con IgM positiva para VHS desde la segunda mitad del embarazo o periparto, presentaron infección por VHS determinada por PCR en sangre o LCR, independiente de la vía del parto. El diagnóstico serológico en embarazadas permite la pesquisa, diagnóstico y tratamiento temprano del RN.

Introduction: neonatal herpes is a rare entity associated with high morbidity and mortality. The probability of transmission to the newborn ranges from 5% to 85%. The diagnosis is difficult due to the lack of clinical signs, unreliable serology and the non-availability of PCR in public services in developing countries. IgM in pregnant women could be used as a suspected marker to evaluate the neonate. Objective: To characterize newborn children of pregnant women with positive IgM for HSV 1-2 and the prevalence of encephalitis in infants. Materials and methods: Observational, descriptive, prospective study, carried out from May 2020 to October 2021. Newborns (NB) of mothers with positive IgM for Herpes Virus Simplex (HSV) from the second half of pregnancy were included. In newborns, IgG and IgM were performed, and in addition, PCR-RT for HSV 1-2 in blood and/or CSF, excluding those born in other hospitales and/or without maternal serology data. Results: We included 36 patients. Maternal age was 28 years (DS + 4), 5% with a history of HSV. 61% were delivered via cesarean section, 36% were premature, 13% had IUGR. 22% of the newborns had acute symptoms. 19% had thrombocytopenia, 44% had GOT alteration. 63% were PCR positive for HSV in serum and 44% were CSF-positive. Hemorrhage, hydrocephalus and leukomalacia were found in 27%. No differences were found in clinical expression by type of delivery. Conclusions: Newborns born to pregnant women with positive IgM for HSV from the second half of pregnancy or peripartum, presented HSV infection as determined by PCR in blood or CSF, regardless of the route of delivery. Serological diagnosis in pregnant women allows early screening, diagnosis and treatment of the NB.

Identificación de genotipos de Chlamydia trachomatis en neonatos con distrés respiratorio / Identification of Chlamydia trachomatis genotypes in newborns with respiratory distress

Introducción: Cada año se notifican ciento treinta millones de infecciones por Chlamydia trachomatis en todo el mundo. Diecinueve serotipos de este patógeno pueden causar infecciones en mujeres embarazadas y recién nacidos. En México se desconoce la distribución de estos genotipos en recién nacidos con infecciones respiratorias. Material y métodos: Se analizaron mil sesenta y dos muestras de lavado bronquial de neonatos con síndrome de dificultad respiratoria para detección de infección por clamidia. El diagnóstico de clamidia se realizó mediante la detección de plásmidos con un ensayo PCR interno y los genotipos se identificaron mediante un ensayo PCR-RFLP del gen ompA. Resultados: El genotipado de 40 cepas identificó a 14 como I/Ia (35%), 13 como E (32,5%), 7 como D (17,5%), 5 como F (12,5%) y 1 como L2 (2,5%). El análisis de riesgo relativo mostró que el genotipo D se asoció con sepsis neonatal (RR=5,83; IC 95%: 1,51-25,985; p <0,02), mientras que el genotipo I/Ia mostró asociación significativa con madres que desarrollaron corioamnionitis (2,8; IC 95%: 1,4-5,5; p <0,05). Conclusiones: Si bien los genotipos I/Ia y E de Chlamydia trachomatis fueron la causa más frecuente de infección respiratoria en neonatos mexicanos, el 80% de los genotipos F produjeron este padecimiento. En cambio, el genotipo D se asoció con el desarrollo de sepsis neonatal y el genotipo I/Ia con corioamnionitis. (AU)

Introduction: One hundred thirty million Chlamydia trachomatis infections are reported worldwide each year. Nineteen serotypes of this pathogen can cause infection in pregnant women and neonates. The distribution of these genotypes in newborns with respiratory infections in Mexico is unknown. Material and methods: We tested 1062 bronchial lavage samples from neonates with respiratory distress syndrome for Chlamydia infection. The diagnosis of Chlamydia was made by plasmid detection with an in-house PCR assay, and genotypes were identified using a PCR-RFLP assay for the ompA gene. Results: The genotyping of 40 strains identified 14 as I/Ia (35%), 13 as E (32.5%), 7 as D (17.5%), 5 as F (12.5%), and 1 as L2 (2.5%). The relative risk analysis showed that genotype D was associated with neonatal sepsis (RR, 5.83; 95% confidence interval [CI], 1.51-25.985; P<.02), while the I/Ia genotype was significantly associated with chorioamnionitis in the mother (2.8; 95% CI, 1.4–5.5; P<.05). Conclusions: Although Chlamydia trachomatis genotypes I/Ia and E of were the strains involved most frequently in respiratory infections in Mexican neonates, 80% of patients with genotype F developed respiratory disease. In contrast, genotype D was associated with neonatal sepsis, and genotype I/Ia with chorioamnionitis. (AU)

Identification of Chlamydia trachomatis genotypes in newborns with respiratory distress.

INTRODUCTION: One hundred thirty million Chlamydia trachomatis infections are reported worldwide each year. Nineteen serotypes of this pathogen can cause infection in pregnant women and neonates. The distribution of these genotypes in newborns with respiratory infections in Mexico is unknown. MATERIAL AND METHODS: We tested 1062 bronchial lavage samples from neonates with respiratory distress syndrome for Chlamydia infection. The diagnosis of Chlamydia was made by plasmid detection with an in-house PCR assay, and genotypes were identified using a PCR-RFLP assay for the ompA gene. RESULTS: The genotyping of 40 strains identified 14 as I/Ia (35%), 13 as E (32.5%), 7 as D (17.5%), 5 as F (12.5%), and 1 as L2 (2.5%). The relative risk analysis showed that genotype D was associated with neonatal sepsis (RR, 5.83; 95% confidence interval [CI], 1.51-25.985; P < .02), while the I/Ia genotype was significantly associated with chorioamnionitis in the mother (2.8; 95% CI, 1.4-5.5; P < .05). CONCLUSIONS: Although C. trachomatis genotypes I/Ia and E of were the strains involved most frequently in respiratory infections in Mexican neonates, 80% of patients with genotype F developed respiratory disease. In contrast, genotype D was associated with neonatal sepsis, and genotype I/Ia with chorioamnionitis.

Infecciones por Chlamydia trachomatis en una unidad de cuidados intensivos neonatales / Chlamydia trachomatis infections in a neonatal intensive care unit

Las infecciones por Chlamydia trachomatis han aumentado su prevalencia, especialmente en jóvenes embarazadas. Esto adquiere relevancia en pediatría por el elevado riesgo de transmisión vertical al neonato y su potencial gravedad en el lactante. Estas infecciones requieren de un alto índice de sospecha, por cuadro clínico atípico y signos radiológicos inespecíficos. Los métodos diagnósticos convencionales presentan limitaciones para su detección. Las técnicas moleculares son las recomendadas por su elevada sensibilidad, especificidad y rapidez, lo cual permite una terapéutica adecuada y oportuna. En este estudio, desarrollado en una unidad de cuidados intensivos neonatales de un hospital de alta complejidad durante 12 años, se describieron las características de la población, su presentación clínica y evolución. La detección microbiológica se realizó por métodos moleculares. Se incluyeron 29 pacientes (p) con infección por C. trachomatis (3,9% del total de muestras enviadas),13 p con infección respiratoria y 16 p con compromiso ocular. La mediana de edad fue de 19 días al momento del diagnóstico y el 65% de las gestantes tenía <25 años. Veinticuatro p (83%) eran recién nacidos a término y 23 p (79%) previamente sanos. Nueve p (31%) presentaron fiebre al momento del ingreso y 12 (41%) eosinofilia. De los 13 p con enfermedad respiratoria, 9 (69%) consultaron por tos y 11 (85%) con hipoxemia, con requerimientos de oxígeno en 8 (61%), asistencia respiratoria mecánica en 3 (23%) y uno (16%) requirió ECMO. Los hallazgos radiológicos mostraron un patrón intersticial inespecífico. Nueve p (31%) presentaron coinfección y uno falleció asociado a influenza A (AU)

The prevalence of Chlamydia trachomatis infections has increased, especially among young pregnant women. This is of particular relevance in pediatrics due to the high risk of motherto-child transmission and the potential severity of the infection in infants. A high index of suspicion is required for these infections due to the atypical clinical features and non-specific radiological signs. The usefulness of conventional diagnostic methods is limited. Molecular techniques are recommended because of their high sensitivity, specificity, and speed, allowing for adequate and timely treatment. In this 12-year study conducted in a neonatal intensive care unit of a tertiary-care hospital, patient characteristics, clinical presentation, and outcome are described. Microbiological detection was performed using molecular methods. Twenty-nine patients with C. trachomatis infection (3.9% of the total samples submitted), of whom 13 had respiratory tract infection and 16 ocular involvement, were included. The median age at diagnosis was 19 days and 65% of the mothers were <25 years old. Twenty-four p (83%) were term newborns and 23 patients (79%) were previously healthy. On admission, 9 patients (31%) had fever and 12 (41%) had eosinophilia. Of the 13 patients with respiratory tract involvement, 9 (69%) consulted for cough and 11 (85%) had hypoxemia, requiring oxygen in 8 (61%), mechanical ventilation in 3 (23%), and ECMO in 1 (16%). Radiological findings showed a nonspecific interstitial pattern. Nine patients (31%) presented with coinfection, one of whom died due to an associated influenza A infection (AU)

Infecciones neonatales tardías / Late neonatal infections

Introducción: La infección neonatal constituye una de las enfermedades más comunes debido a la susceptibilidad de estos pacientes. Esta infección puede llegar a la sepsis neonatal e incrementar la mortalidad. Objetivo: Determinar las características clínicas y epidemiológicas de la infección neonatal tardía. Métodos: Estudio descriptivo retrospectivo y transversal de registros de neonatos ingresados en el servicio de neonatología del Hospital William Soler Ledea entre los años 2017-2019 con diagnóstico de infección. Se excluyeron aquellos registros de neonatos infectados intervenidos quirúrgicamente. Las variables estudiadas fueron: epidemiológicas, factores de riesgo, clínicas y paraclínicas. Se emplearon técnicas de estadísticas descriptivas como porcentajes, razón, media o promedio. Resultados: La muestra estuvo conformada por 1078 registros de pacientes para una tasa de infección de 59,4 × 100 ingresos. Los factores de riesgo prenatales y connatales obtuvieron razón de prevalencia < 1. Los factores de riesgo posnatales con mayor prevalencia fueron el sexo masculino (57,6 por ciento) y el cateterismo venoso central (53,6 por ciento). De 83 a 88 por ciento de los neonatos infectados presentaron alteraciones del perfil hematopoyético. Las infecciones respiratorias, de piel y de partes blandas se presentaron en 36 por ciento de los neonatos y fueron las bacterias grampositivas los principales microorganismos aislados. Hubo 11 pacientes fallecidos para una tasa de mortalidad del 22,9 por ciento. Conclusiones: La morbilidad por infección tardía es notable, predominan los factores de riesgo posnatales y el sexo masculino; la prematuridad y el bajo peso tuvieron la mayor representación en los fallecidos(AU)

Introduction: Neonatal infection is one of the most common diseases due to the sensitivity of these patients. This infection can lead to neonatal sepsis and increase mortality. Objective: Determine the clinical and epidemiological characteristics of late neonatal infection. Methods: Retrospective and cross-sectional descriptive study of records on neonates admitted to the neonatology service of William Soler Ledea Hospital in the period 2017-2019 with a diagnosis of infection. Records of infected infants undergoing surgery were excluded. The variables studied were: epidemiological, risk factors, clinical and paraclinical. Descriptive statistical techniques such as percentages, ratio, mean or average were used. Results: The sample consisted of 1078 patient´s records, with an infection rate of 59.4 × 100 admissions. Prenatal and conatal risk factors obtained prevalence ratio < 1. The postnatal risk factors with the highest prevalence were male sex (57.6 percent) and central venous catheterization (53.6 percent). From 83 to 88 percent of infected neonates had alterations in the hematopoietic profile. Respiratory, skin and soft tissue infections occurred in 36 percent of the neonates and gram-positive bacteria were the main isolated microorganisms. There were 11 patients who died representing a mortality rate of 22.9 percent. Conclusions: Morbidity due to late infection is remarkable, postnatal risk factors predominate and male sex; prematurity and low weight had the highest representation in the deceased ones(AU)

Factores de riesgo materno y neonatal en la infección probada de inicio precoz en pretérminos / Maternal and neonatal risk factors for early-onset infection proven in the preterm term / Fatores de risco maternos e neonatais em infecção de início precoce comprovado em pré-períodos

RESUMEN Introducción: la infección neonatal es un síndrome clínico que constituye una causa importante de morbilidad y mortalidad neonatal. Objetivo: determinar la relación existente entre algunos factores maternos y neonatales y la ocurrencia de las infecciones de inicio precoz probada en el servicio de neonatología del Hospital General Docente Universitario Carlos M. de Céspedes en el periodo de enero del 2014 a diciembre de 2019. Métodos: se realizó una investigación analítica de casos y controles cuya muestra estaba constituida por 450 neonatos diagnosticados con infección precoz probada y 900 controles con una relación de 1 caso por 2 controles. Resultados: en relación a las variables maternas la edad de la madre, con O.R 1.74, un IC. 95% (1.28- 2.34) con p. 0,003, la edad gestacional menor de 31 semanas un O.R:2.14. y una p:0.006, la infección vaginal un OR:5.19, y p:0.000, la infección urinaria OR: 4.99, y p:0.000; el parto distócico como factor de riesgo un OR:0.98, una p:0.923, el resto de las variables maternas como tiempo de roturas de membranas mayor de 18 horas, el líquido amniótico anormal (fétido y/o purulento), el tiempo total de parto prolongado y el politacto p<0.05; la corioamnionitis clínica e histológica con p<0.05; el peso del neonato menor de 1000 gramos y de 1000-1499 gramos con p:0.004 y 0.02 respectivamente, el sexo masculino con OR:1.82 y p:0.000 y el puntaje de Apgar menor de 7 al primer y quinto minuto de vida p<0.05 Conclusiones: las variables maternas excepto parto distócico fueron significativas, y las variables neonatales estudiadas resultaron significativas.

SUMMARY Introduction: Neonatal infection is a clinical syndrome that constitutes an important cause of neonatal morbidity and mortality. Objective: to determine the relationship between some maternal and neonatal factors and the occurrence of early-onset infections tested in the neonatology service of the General University Teaching Hospital Carlos M. de Céspedes in the period from January 2014 to December 2019. Methods: an analytical investigation of cases and controls was carried out whose sample consisted of 450 neonates diagnosed with proven early infection and 900 controls with a ratio of 1 case to 2 controls. Results: in relation to maternal variables, the age of the mother, with O.R 1.74, an IC. 95% (1.28-2.34) with p:0.003, the gestational age less than 31 weeks an O.R: 2.14, and a p: 0.006, vaginal infection an OR: 5.19, and p: 0.000, urinary infection OR: 4.99, and p: 0.000; dystocic delivery as a risk factor an OR: 0.98 y p: 0.923, the rest of the maternal variables such as membrane rupture time greater than 18 hours, abnormal amniotic fluid (fetid and / or purulent), the total time of prolonged labor and the politact p <0.05; clinical and histological chorioamnionitis with p <0.05; the weight of the neonate less than 1000 grams and 1000-1499 grams with p: 0.004 and 0.02 respectively, the male sex with OR: 1.82 and p: 0.000 and the Apgar score less than 7 at the first and fifth minute of life p <0.05. Conclusions: the maternal variables except dystocic delivery were significant, and the neonatal variables studied were significant.

RESUMO Introdução: A infecção neonatal é uma síndrome clínica que é uma das principais causas de morbidade e mortalidade neonatal. Objetivo: determinar a relação entre alguns fatores maternos e neonatais e a ocorrência de infecções de início precoce testadas no serviço de neonatologia do Hospital Geral Universitário Carlos M. de Céspedes no período de janeiro de 2014 a dezembro de 2019. Métodos: Foi realizada uma investigação analítica de casos e controles cuja amostra consistia em 450 recém-nascidos diagnosticados com infecção precoce comprovada e 900 controles com razão de 1 caso a 2 controles. Resultados: em relação às variáveis maternas a idade da mãe, com O.R. 1,74, ic. 95% (1,28- 2,34) com p.0,003, idade gestacional inferior a 31 semanas por O.R:2,14. e p:0.006, infecção vaginal a OR:5.19, e p:0.000, a infecção do trato urinário OR: 4,99, e p:0.000; parto distópico como fator de risco or:0.98, p:0.923, o resto das variáveis maternas como tempo de ruptura da membrana maior que 18 horas, fluido amniótico anormal (fétido e/ou purulento), tempo total de entrega prolongada e politácto p<0,05; cooamnionite clínica e histológica com p<0,05; peso neonato inferior a 1000 gramas e 1000-1499 gramas com p:0.004 e 0,02, respectivamente, o sexo masculino com OR:1.82 e p:0.000 e o Escore de Apgar inferior a 7 ao primeiro e quinto minuto de vida p<0,05. Conclusões: variáveis maternas exceto parto distópico foram significativas, e as variáveis neonatais estudadas foram significativas.

Congenital cutaneous candidiasis associated with maternal peripartum candidemia.

BACKGROUND: Cutaneous congenital candidiasis (CCC) is a rare condition consisting of invasive fungal infection of the epidermis and dermis that mostly affects preterm infants. Maternal vaginal candidiasis is present in half of the cases, although the occurrence of invasive candidiasis during pregnancy or peripartum period is exceptional. CASE REPORT: We present the case of a full-term infant that was born by vacuum-assisted vaginal delivery to an apparently healthy 33 year-old woman with no history of intravenous drug use or vaginal candidiasis during pregnancy. The newborn showed a diffuse maculopapular rash with respiratory distress and bilateral interstitial lung infiltrates, requiring nasal continuous positive airway pressure support. Blood cultures obtained from the mother due to intrapartum fever yielded Candida albicans. Cultures of vaginal discharge and neonate skin also yielded C. albicans with the same in vitro susceptibly pattern. No alternative source for candidemia was identified. The clinical course after starting a systemic antifungal therapy was favorable in both the mother and the neonate, with clearance of candidemia and resolution of the skin lesions. CONCLUSIONS: CCC must be considered in full-term newborns with maculopapular rash at birth or during the first days of life. The absence of alternative sources for bloodstream infection in the present case suggests a potential etiopathogenic relationship between CCC and maternal candidemia. It is reasonable to rule out postpartum candidemia when CCC is suspected.

[The Spanish Society of Paediatric Infectious Diseases guidelines on the prevention, diagnosis and treatment of neonatal herpes simplex infections]. / Guía de la Sociedad Española de Infectología Pediátrica sobre prevención, diagnóstico y tratamiento de la infección neonatal por virus herpes simplex.

Neonatal herpes simplex virus infections are rare, but are associated with significant morbidity and mortality. Most newborns acquire herpes simplex virus infection in the peripartum period. For peripartum transmission to occur, women must be shedding the virus in their genital tracts symptomatically or asymptomatically around the time of delivery. There are evidence-based interventions in pregnancy to prevent the transmission to the newborn. Caesarean section should be performed in the presence of herpetic lesions, and antiviral prophylaxis in the last weeks of pregnancy is recommended to suppress genital tract herpes simplex virus at the time of delivery. The diagnosis and early treatment of neonatal herpes simplex virus infections require a high index of suspicion, especially in the absence of skin lesions. It is recommended to rule out herpes simplex virus infections in those newborns with mucocutaneous lesions, central nervous system involvement, or septic appearance. The prognosis of newborns with skin, eye, and/or mouth disease in the high-dose acyclovir era is very good. Antiviral treatment not only improves mortality rates in disseminated and central nervous system disease, but also improves the rates of long-term neurodevelopmental impairment in the cases of disseminated disease. Interestingly, a 6-month suppressive course of oral acyclovir following the acute infection has improved the neurodevelopmental prognosis in patients with CNS involvement.

[Clinical observation of newborns with infection risk: A safe practice]. / Observación clínica de recién nacidos con factores de riesgo infeccioso, una práctica segura.

INTRODUCTION: Early-onset neonatal sepsis refers to an infection which starts during the first 72hours of birth, and can lead to significant morbidity and mortality. Scientific evidence shows that infected infants present with symptoms during the first hours after delivery. There has been a significant decrease in this condition with the implementation of guidelines for its prevention. However, International guidelines still recommend the evaluation of these infants using painful tests. MATERIAL AND METHODS: A prospective cohort study was conducted on all asymptomatic infants born at>35 weeks gestation with one or more risk factors in a single tertiary care centre from 2011 to 2015. They were periodically observed in newborn nursery from admission until discharge looking for signs of infection. RESULTS: Out of the 9,424 babies born during this period, 1425 were included in the study. A total of 53 infants were admitted to the neonatal unit, half of them because of sepsis suspicion. Finally, just 7 were discharged with the diagnosis of sepsis. All these 7 presented with symptoms during their first 72hours of life. No sepsis was reported in asymptomatic infants. CONCLUSIONS: Truly infected infants present with symptoms during their first hours of life. This study supports the observation of infants at risk as a safe practice to detect early-onset sepsis.

Aspectos clínicos y epidemiológicos en pacientes con infección neonatal / Clinical epidemiological aspects in patients with neonatal infection

Se realizó un estudio descriptivo, prospectivo y transversal de 69 pacientes con infección neonatal nacidos en el Hospital Docente Materno Sur "Mariana Grajales Coello" de Santiago de Cuba, desde enero de 2012 hasta diciembre de 2013, con vistas a caracterizarles según aspectos clinicoepidemiológicos. Entre los resultados principales predominaron la infección de inicio precoz (72,5 %), los bajo peso pretérminos (82,6 %), las infecciones sistémicas (59,4), la infección vaginal como factor de riesgo materno más frecuente (47,8 %), la dificultad respiratoria (50,7 %), así como los gérmenes gramnegativos como los principales factores causales. Las infecciones de inicio precoz mostraron mayor mortalidad, aunque de manera global hubo una supervivencia elevada.

A descriptive, prospective and cross-sectional study of 69 patients with neonatal infection, born in "Mariana Grajales Coello" Teaching Southern Maternal Hospital in Santiago de Cuba, was carried out from January, 2012 to December, 2013, aimed at characterizing them according to clinical epidemiological aspects. Among the main results the early onset of infection (72.5%), preterm low weight (82.6%), systemic infections (59.4%), vaginal infection as the most frequent maternal risk factor (47.8%), respiratory failure (50.7%), as well as the gramnegative pathogens as the main causative factors prevailed. The early onset of infections showed higher mortality, although in a global way there was a high survival.

Aspectos clínicos y epidemiológicos en pacientes con infección neonatal / Clinical epidemiological aspects in patients with neonatal infection

Se realizó un estudio descriptivo, prospectivo y transversal de 69 pacientes con infección neonatal nacidos en el Hospital Docente Materno Sur Mariana Grajales Coello de Santiago de Cuba, desde enero de 2012 hasta diciembre de 2013, con vistas a caracterizarles según aspectos clinicoepidemiológicos. Entre los resultados principales predominaron la infección de inicio precoz (72,5 por ciento), los bajo peso pretérminos (82,6 por ciento), las infecciones sistémicas (59,4), la infección vaginal como factor de riesgo materno más frecuente (47,8 por ciento), la dificultad respiratoria (50,7 por ciento), así como los gérmenes gramnegativos como los principales factores causales. Las infecciones de inicio precoz mostraron mayor mortalidad, aunque de manera global hubo una supervivencia elevada(AU)

A descriptive, prospective and cross-sectional study of 69 patients with neonatal infection, born in Mariana Grajales Coello Teaching Southern Maternal Hospital in Santiago de Cuba, was carried out from January, 2012 to December, 2013, aimed at characterizing them according to clinical epidemiological aspects. Among the main results the early onset of infection (72.5 percent), preterm low weight (82.6 percent), systemic infections (59.4 percent), vaginal infection as the most frequent maternal risk factor (47.8 percent), respiratory failure (50.7 percent), as well as the gramnegative pathogens as the main causative factors prevailed. The early onset of infections showed higher mortality, although in a global way there was a high survival(AU)

Presentación de un caso con toxoplasmosis congénita / Case presentation: congenital Toxoplasmosis

La toxoplasmosis, enfermedad conocida como “Parasitosis del Siglo XX”, cobra importancia en los neonatos cuyas madres se infectaron por primera vez durante la gestación. El objetivo del trabajo es presentar el caso de un recién nacido de 40 semanas con toxoplasmosis congénita. El peso al nacer fue de 3 500 g, Apgar 2/3. Requirió intubación orotraqueal y resucitación cardiopulmonar inmediata. Hubo presencia de líquido amniótico meconial, tiempo de rotura de membranas de 14 h, antecedentes maternos de sepsis vaginal, y con un descenso detenido de la presentación lo que llevó a cesárea de urgencia. A las 4 h de vida desarrolla cuadro de coagulación intravascular diseminada, acompañado de hipotonía marcada, mirada fija sin respuesta pupilar ni esfuerzo respiratorio. A las 48 h aparece insuficiencia renal aguda con evolución rápida a fallo múltiple de órganos. Ultrasonido de cráneo con aumento de la ecogenicidad cerebral, borramiento de las circunvoluciones cerebrales y ventrículos laterales dilatados. Evolución tórpida, sin recuperación neurológica, alteraciones del medio interno y trastornos del equilibrio ácido-base e hidroelectrolítico, empeoramiento progresivo de la función cardiaca y respiratoria, fallece a los 21 días de vida.

Toxoplasmosis, known as the "Twentieth century parasites disease", becomes important in infants whose mothers were infected for the first time during pregnancy. The aim of this work is to present the case of a 40 weeks newborn with congenital toxoplasmosis. The birth weight was 3 500 g, Apgar 2/3. Immediate endotracheal intubation and cardiopulmonary resuscitation was required. There were meconium, 14-hour membrane rupture time, maternal history of vaginal sepsis, detained presentation prompting emergency caesarean section. At 4 hours of life, disseminated intravascular coagulation develops, accompanied by marked hypotonia, staring with no pupillary response or respiratory effort. At 48 hours, acute renal failure appears with rapid progression of multiple organ failure. Skull ultrasound showed increased brain echogenicity, effacement of the cerebral convolutions and dilated lateral ventricles. Torpid evolution, with no neurological recovery, internal disorders and disorders of acid-base and electrolyte balance, progressive deterioration of the cardiac and respiratory functions, dies at 21 days of life. Decease occurs at 21 days of life.

Enfermedad neumoccócica invasora en recién nacidos, antes y después de la vacunación universal con vacuna conjugada 7 y 13 valente en Uruguay / Pneumococcal invasive disease in newborns before and after 7-valent and 13-valent universal pneumococcal vaccination in Uruguay

Introduction: Streptococcus pneumoniae infections are not frequent in neonates, but presents high morbidity and mortality. In 2008, the 7-valent pneumococcal conjugate vaccine (PCV) was introduced in the childhood vaccination schedule and then replaced by 13-valent PCV in 2010. First dose is given at 2 months of age. Protection of neonates is expected with universal vaccination. Objective: To describe the clinical presentation, microbiology and outcome of neonates with pneumococcal invasive infections (PII) detected in two hospitals in Uruguay in 2001-2007 (pre-vaccination), 2008 (intervention) and 2009-2013 (post-vaccination). Methods: A descriptive, retrospective study was done at Pereira Rossell Hospital and Paysandú Hospital. All isolates of S. pneumoniae obtained from normally sterile fluids were included. Data were obtained from the clinical records and the microbiology laboratory. A statistical analysis with absolute frequencies, relative, rates and relative risk was performed. Results: 25 neonates were enrolled with diagnosis of: sepsis (n = 13), meningitis (n = 9), bacteremia (n = 1), pneumonia with empyema (n = 1) and pneumonia (n = 1). The incidence of PII in the prevaccination period was 19/25, with a rate of 0.30/1,000 births, compared to post-vaccination rate of 0.04/1,000. The relative risk was 5.9. 6/20 (30%) cases of death were reported (meningitis n = 3; sepsis n = 2; empyema n = 1). Most common serotypes were 5 and 1 (14/25) and 24/25 strains were susceptible to penicillin. Discussion: The symptoms were indistinguishable to infections caused by other pathogens. PII cases decreased and no deaths occurred in the post-vaccination period. No increase in non-vaccine serotypes was observed.

Introducción: Streptococcus pneumoniae infrecuentemente produce infecciones en recién nacidos (RN), presentando elevada morbi-mortalidad. En Uruguay, en 2008 se incorporó al calendario de inmunizaciones infantil la vacuna conjugada neumocóccica (VCN) 7 valente, (sustituída por VCN13 en 2010). La vacunación comienza a los dos meses de vida. Se espera que la vacunación universal tenga impacto en la protección de RN. Objetivo: Describir la presentación clínica, microbiología y evolución de RN con enfermedad neumocóccica invasora (ENI), identificados en dos hospitales de Uruguay, años 2001-2007 (pre-vacunación), 2008 (intervención) y 2009-2013 (post-vacunación). Material y Métodos: Estudio descriptivo, retrospectivo. Lugar: Hospital Pereira Rossell y Hospital Paysandú. Se incluyeron todos los aislados de S. pneumoniae a partir de líquidos normalmente estériles. Fuente de datos: laboratorios de bacteriología e historias clínicas. Análisis estadístico: frecuencias absolutas, relativas, tasas y riesgo relativo. Resultados: RN con ENI: 25, sepsis (n: 13), meningitis (n: 9), bacteriemia (n: 1), neumonía con empiema (n: 1), neumonía (n: 1). Incidencia de ENI en el período pre-vacunación 19/25, tasa 0,30/1.000 nacimientos; tasa post-vacunación: 0,04/1.000. Riesgo relativo 5,9. Fallecimientos: 6/20 (30%): meningitis (n: 3), sepsis (n: 2), empiema (n: 1). Los serotipos más frecuentes fueron: 5 y 1 (14/25). Susceptibles a penicilina: 24/25. Discusión: Los síntomas fueron indistinguibles de infecciones causadas por otros patógenos. Disminuyeron los casos de ENI y no ocurrieron fallecimientos en el período post-vacunación. No aumentaron los serotipos no vacunales.

[Streptococcus agalactiae late-onset neonatal infections in Barcelona (1996-2010)]. / La infección neonatal tardía por Streptococcus agalactiae en el área de Barcelona (1996-2010).

OBJETIVE: To study the characteristics and evolution of group B Streptococcus (GBS) late-onset diseases, over a period of 15years in 8hospitals the Barcelona area and analyze the possible impact of prophylactic measures for the prevention of early-onset neonatal infections. METHODS: Retrospective review of all patients diagnosed with late-onset neonatal disease due to GBS from 1996 to 2010. RESULTS: A total of 143 patients were diagnosed. Of these, 51 were born in others hospitals. The overalll incidence was 0.42 per 1000 live births, varying between 0.14‰ in the year 2000 and 0.80‰ in 2009. A slight but sustained tendency of increased risk was observed over the years, 6.9% in the overall disease (with no statistical significance). Sepsis/bacteremia was detected in 63.6% of the newborns, meningitis in 32.8%, and arthritis/osteomyelitis in 3.5%. In cases with known obstetrics dates, 53% of mothers had been colonized by GBS during pregnancy, 53.8% received intrapartum antibiotic prophylaxis, and 41.2% had some obstetric risk factors, particularly premature birth in 35.9%. There was a 2.8% mortality rate in the neonates, and predominant serotypes were III and Ia. CONCLUSIONS: The incidence of GBS late-onset disease has not decreased despite the control practices of early-onset disease, and possibility of this appearing must be taken into account.

Representações sociais de infecção neonatal elaboradas por enfermeiras / Social representations of the neonatal infection produced by nurses / Representaciones sociales de infección en el neonato desarrolladas por enfermeras

O estudo objetivou apreender as representações sociais da infecção neonatal elaboradas por enfermeiras e analisar a relação dessas representações com a assistência ao recém-nascido com infecção. Pesquisa descritiva e exploratória realizada com 25 enfermeiras de uma maternidade pública de Teresina-PI, no período de março a abril de 2010. Os dados foram produzidos por meio de entrevista semiestruturada, processados pelo software Alceste 4.8. Os resultados foram cinco classes: prevenção e controle das infecções neonatais; o cuidado de enfermagem; riscos e implicações das infecções neonatais; a infecção neonatal: um problema de saúde pública e permanência hospitalar. As enfermeiras manifestaram preocupação com a infecção neonatal, no entanto fragilidades de gestão dificultam a articulação entre as equipes. Reconhecem a importância do cuidado humanizado, ao tempo em que relatam os fatores de risco para o desenvolvimento da infecção e a mortalidade neonatal relacionada ao tempo de permanência hospitalar.

The objective of this study was to understand the social representations of the neonatal infection produced by nurses and analyze the relationship of these representations with the assistance to newborns with infection. Exploratory described research with 25 nurses from a public maternity hospital of Teresina-PI, the period from march to april de 2010. Data were produced by semi-structured interview was processed in ALCESTE 4.8 software. The results were presented in five classes: the road to prevention of neonatal infections; the nursing care to newborns with infection; risks to the development of infections and their implications; neonatal infection as a health problem; the prolonged hospitalization. The nurses showed concern with of neonatal infection, however weaknesses impeding performace management body of the team. Recognize the importance of humane care, the time that report the risk for development factors linked to infection and damage caused by it, which constitute a cause of neonatal mortality related to hospital stay.

El objetivo del estudio fue aprender las representaciones sociales de infección en el neonato desarrolladas por enfermeras y analizar la relación de estas representaciones con la asistencia a los recién nacidos con infección. Investigación descriptiva y exploratoria realizada con 25 enfermeras de una maternidad pública de Teresina-PI-Brasil, en el período de marzo a abril de 2010. Los datos fueron producidas por entrevista semiestructurada, procesados en el software ALCESTE 4,8. Los resultados fueron cinco clases: prevención y control de las infecciones neonatales; el cuidado de enfermería; riesgos e Implicaciones de las infecciones neonatales; la infección neonatal: un problema de salud pública y estancia hospitalaria. Las enfermeras manifestaron preocupación ante la infección en el neonato, sin embargo, debilidades de gestión dificultan el desempeño articulado del equipo. Reconocen la importancia del cuidado humanizado, al tiempo en que relatan acerca de los factores de riesgo asociados con el desarrollo de la infección, y la mortalidad neonatal, relacionada con la duración de estancia hospitalaria.

Infección neonatal precoz: vigilancia y control / Early neonatal infection: surveillance and control

Se presentan los resultados de un estudio descriptivo transversal en el Hospital Ginecobstétrico Docente Guanabacoa, en el período de 2002 a 2006. Con el objetivo de caracterizar a los recién nacidos con sepsis neonatal precoz. El universo de estudio quedó constituido por 133 recién nacidos con diagnóstico de sepsis de inicio precoz. La recopilación de datos se realizó de las historias clínicas de los recién nacidos y sus madres a través de una planilla de recolección. Las variables estudiadas fueron: antecedentes maternos, antecedentes neonatales, signos inespecíficos de sepsis, germen aislado y terapéutica antibiótica. En el análisis de la información se utilizó la estadística descriptiva a través del empleo de medidas de resumen para variables cualitativas (distribución de frecuencias, comparación de proporciones (Ji-cuadrado) y la Dócima de Comparación múltiple de Duncan), para un valor p<0,001 y un índice de confianza de 99,9 por ciento en las variables de interés. Los resultados fueron resumidos en tablas. Los factores de riesgo maternos más frecuentes fueron sepsis vaginal (53,4 por ciento), rotura prematura de las membranas con más de 18 horas (52,6 por ciento). El factor de riesgo neonatal más frecuente fue la prematuridad (61,1 por ciento). Los signos clínicos inespecíficos fueron distrés respiratorio (68,4 por ciento) y cianosis (24,8 por ciento), apareciendo en las primeras 24 horas. En la mayoría de los cultivos realizados, no se obtuvo crecimiento bacteriano (66,9 por ciento) y en los positivos el germen más frecuente fue el Estreptococo ß hemolítico (21,8 por ciento). La combinación antimicrobiana más utilizada fue Trifamox y Gentamicina (53,4 por ciento) (AU)

It is presented the results of a descriptive, transversal study in Guanabacoa Gynecologic and Obstetric Teaching Hospital in the period from 2002-2006, with the objective of characterizing newborns with early neonatal sepsis. The study universe was composed of 133 newborns diagnosed with early-onset sepsis. Data were collected from the medical records of newborns and their mothers through a collection form. The variables studied were: maternal history, neonatal history, nonspecific signs of sepsis, isolated germ and antibiotic therapy. Descriptive statistics was used in the data analysis through the use of summary measures for qualitative variables (frequency distribution, comparison of proportions (chi-square) and Duncan's multiple range test), for a p<0,001 value and a confidence index of 99,9 per cent in the variables of interest. The results were summarized in tables. Vaginal sepses were the most frequent maternal risk factors (53,4 per cent), premature rupture of membranes with more than 18 hours (52,6 per cent). Prematurity was the most common neonatal risk factor (61,1 per cent). Cyanosis (24,8 per cent) and respiratory distress (68,4 per cent) were the nonspecific clinical signs, which appeared in the first 24 hours. In most of cultures, no bacterial growth was obtained (66,9 per cent) and among the positive ones the most common pathogen was Beta-Hemolytic Streptococcus (21,8 per cent). The most utilized antimicrobial combination was Trifamox and Gentamicin (53,4 per cent)

Impacto maternoperinatal de la corioamnionitis / Maternal and perinatal impact of chorioamnionitis

Se realizó un estudio de casos y controles de 96 gestantes (48 en cada grupo) que parieron en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba, desde enero de 2008 hasta diciembre de 2009, con vistas a determinar la repercusión de la corioamnionitis en los indicadores de salud del binomio madre-perinato. En la investigación fueron incluidas todas las embarazadas con 28 semanas de gestación y más. Para validar los resultados se utilizaron la prueba no paramétrica de Ji al cuadrado, el método porcentual y las proporciones. Se halló que esta afección repercutió en la ocurrencia de partos pretérmino, en los altos índices de cesárea, así como también en las infecciones neonatales precoces y puerperales. Se concluyó que la corioamnionitis incidió negativamente sobre los mencionados indicadores.

A case-control study of 96 pregnant women (48 in each group) who gave birth in «Tamara Bunke Bider¼ Teaching Gynecological and Obstetrical Hospital from Santiago de Cuba was carried out from January, 2008 to December, 2009, with the objective of determining the repercussion of chorioamnionitis in the health indicators of the binomial mother-neonate. All the pregnant women with 28 weeks of gestation and more were included in the investigation. To validate the results the non parametric test for X2, the percentage method and the proportions were used. It was found that this disorder influenced on the occurrence of preterm births, in the high rates of cesarean sections, as well as on the neonates and puerperal early sepsis. It was concluded that chorioamnionitis influenced negatively on the mentioned indicators.

Impacto maternoperinatal de la corioamnionitis / Maternal and perinatal impact of chorioamnionitis

Se realizó un estudio de casos y controles de 96 gestantes (48 en cada grupo) que parieron en el Hospital Ginecoobstétrico Docente Tamara Bunke Bider de Santiago de Cuba, desde enero de 2008 hasta diciembre de 2009, con vistas a determinar la repercusión de la corioamnionitis en los indicadores de salud del binomio madre-perinato. En la investigación fueron incluidas todas las embarazadas con 28 semanas de gestación y más. Para validar los resultados se utilizaron la prueba no paramétrica de Ji al cuadrado, el método porcentual y las proporciones. Se halló que esta afección repercutió en la ocurrencia de partos pretérmino, en los altos índices de cesárea, así como también en las infecciones neonatales precoces y puerperales. Se concluyó que la corioamnionitis incidió negativamente sobre los mencionados indicadores(AU)

A case-control study of 96 pregnant women (48 in each group) who gave birth in Tamara Bunke Bider Teaching Gynecological and Obstetrical Hospital from Santiago de Cuba was carried out from January, 2008 to December, 2009, with the objective of determining the repercussion of chorioamnionitis in the health indicators of the binomial mother-neonate. All the pregnant women with 28 weeks of gestation and more were included in the investigation. To validate the results the non parametric test for X2, the percentage method and the proportions were used. It was found that this disorder influenced on the occurrence of preterm births, in the high rates of cesarean sections, as well as on the neonates and puerperal early sepsis. It was concluded that chorioamnionitis influenced negatively on the mentioned indicators(AU)

Infección neonatal precoz: vigilancia y control / Early neonatal infection: surveillance and control

Se presentan los resultados de un estudio descriptivo transversal en el Hospital Ginecobstétrico Docente Guanabacoa, en el período de 2002 a 2006. Con el objetivo de caracterizar a los recién nacidos con sepsis neonatal precoz. El universo de estudio quedó constituido por 133 recién nacidos con diagnóstico de sepsis de inicio precoz. La recopilación de datos se realizó de las historias clínicas de los recién nacidos y sus madres a través de una planilla de recolección. Las variables estudiadas fueron: antecedentes maternos, antecedentes neonatales, signos inespecíficos de sepsis, germen aislado y terapéutica antibiótica. En el análisis de la información se utilizó la estadística descriptiva a través del empleo de medidas de resumen para variables cualitativas (distribución de frecuencias, comparación de proporciones (Ji-cuadrado) y la Dócima de Comparación múltiple de Duncan), para un valor p<0,001 y un índice de confianza de 99,9 por ciento en las variables de interés. Los resultados fueron resumidos en tablas. Los factores de riesgo maternos más frecuentes fueron sepsis vaginal (53,4 por ciento), rotura prematura de las membranas con más de 18 horas (52,6 por ciento). El factor de riesgo neonatal más frecuente fue la prematuridad (61,1 por ciento). Los signos clínicos inespecíficos fueron distrés respiratorio (68,4 por ciento) y cianosis (24,8 por ciento), apareciendo en las primeras 24 horas. En la mayoría de los cultivos realizados, no se obtuvo crecimiento bacteriano (66,9 por ciento) y en los positivos el germen más frecuente fue el Estreptococo ß hemolítico (21,8 por ciento). La combinación antimicrobiana más utilizada fue Trifamox y Gentamicina (53,4 por ciento)

It is presented the results of a descriptive, transversal study in Guanabacoa Gynecologic and Obstetric Teaching Hospital in the period from 2002-2006, with the objective of characterizing newborns with early neonatal sepsis. The study universe was composed of 133 newborns diagnosed with early-onset sepsis. Data were collected from the medical records of newborns and their mothers through a collection form. The variables studied were: maternal history, neonatal history, nonspecific signs of sepsis, isolated germ and antibiotic therapy. Descriptive statistics was used in the data analysis through the use of summary measures for qualitative variables (frequency distribution, comparison of proportions (chi-square) and Duncan's multiple range test), for a p<0,001 value and a confidence index of 99,9 per cent in the variables of interest. The results were summarized in tables. Vaginal sepses were the most frequent maternal risk factors (53,4 per cent), premature rupture of membranes with more than 18 hours (52,6 per cent). Prematurity was the most common neonatal risk factor (61,1 per cent). Cyanosis (24,8 per cent) and respiratory distress (68,4 per cent) were the nonspecific clinical signs, which appeared in the first 24 hours. In most of cultures, no bacterial growth was obtained (66,9 per cent) and among the positive ones the most common pathogen was Beta-Hemolytic Streptococcus (21,8 per cent). The most utilized antimicrobial combination was Trifamox and Gentamicin (53,4 per cent)

Sepsis neonatal tardía por Streptococcus pyogenes / Late neonatal sepsis caused by Streptococcus pyogenes

Actualmente, Streptococcus grupo A es una causa infrecuente de infección en el período neonatal. La descripción de casos de infección grave en el recién nacido es esporádica. Presentamos un recién nacido de 12 días de vida que acudió al servicio de urgencias por síndrome febril sin foco, que durante su ingreso desarrolló afectación neurológica y sistémica. Describimos la presentación clínica, la evolución y el tratamiento. El aislamiento de Streptococcus grupo A en el hemocultivo confrma la sepsis tardía por este germen con probable meningitis asociada.

Currently, the group A Streptococcus is a unusual cause of infection in the neonatal period. The description of cases of severe infection in the newborn is sporadic. We present a 12-days-old newborn attended at the emergency room for fever without focus, which developed neurological and systemic involvement during admission. Clinical presentation, evolution and treatment are described. Blood culture isolation of group A Streptococcus confrmed late sepsis by this bacteria, probably with associated meningitis.