Cardiac Troponin T and Illness Severity in the Very-Low-Birth-Weight Infant

Introduction. Respiratory distress are very common in Very-low-birth-weight (VLBW) infants and Myocardial injury may play a role in the disease outcome. Cardiac troponin T (cTnT) is the most useful marker of injury in adult population, but has not been extensively studied in this population. Aim. To study the role of cTnT in VLBW infants and its association with clinical outcomes. Methods. All VLBW infants admitted to our NICU were included in the study. Echocardiography and blood samples for cTnT determination were collected at 24 and 48 hours of life, and values >0.1 ng/mL were considered CTnT-positive values. Results. A total of 116 neonates had their blood samples collected. The median cTnT concentration within 24 hours was 0.191 (0.1–0.79) ng/mL and within 48 hours was 0.293 (0.1–1.0) ng/mL. A logistic regression analysis showed that PDA, low GA, and use of dopamine were independently associated with positive cTnT and abnormal Dopplerfluxometry and diuretics use had protective effects and was independently associated with troponin values. Conclusion. We observed a high prevalence of positivecTnT values in VLBW infants associated with illness severity. Our findings suggest that cTnT may be a useful and early marker of myocardial injury in VLBW infants

Stigmas of congenital Zika syndrome: family perspectives.

This article uses a socio-anthropological framework to explore the stigmas around interactions with children born with congenital Zika syndrome caused by the Zika virus epidemic in two Brazilian municipalities. Semi-structured interviews were conducted with parents and other relatives. We reflected on the search for meaning when having a baby with unexpected body marks, the moral suffering, the societal ableism, the burden of care, and the need for support networks. We concluded that public policies, especially social policies (health, education, and social assistance), are essential for compensatory mechanisms, recognition, and social inclusion of these children and their families

Baixa estatura em crianças nascidas com muito baixo peso entre as idades de 4 a 8 anos

Introdução: O crescimento em recém-nascidos de muito baixo peso ao nascer tem sido associado com anormalidades futuras no desenvolvimento neurológico e doenças cardiovasculares e metabólicas na vida adulta. Objetivo: Avaliar o crescimento de crianças com idades entre 4 e 8 anos acompanhados em ambulatório de seguimento e que tinham muito baixo peso ao nascer. Métodos: Foram avaliadas 87 crianças nascidas com muito baixo peso (33 pequenas e 54 adequadas para a idade gestacional). Foi calculado o índice de massa corporal, assim como os escores-Z de peso para idade e gênero; a idade óssea foi determinada através da radiografia do punho esquerdo. O ponto de corte usado para calcular a prevalência de baixa estatura para idade e gênero foi – 2 desvios padrão da média na curva de referência do National Center for Health Statistics. Resultados: A prevalência de baixa estatura foi 4,6% (N 4/87, 95% IC 3,6–5,4). Índice de massa corporal baixo foi encontrado em 23% das crianças (20/87). Idade óssea um ano menor em relação à idade cronológica foi encontrada em 43,7 % das crianças (38/87). Conclusão: Este estudo mostrou que algumas crianças nascidas prematuras e de muito baixo peso podem manter baixa estatura e baixo índice de massa corporal até a idade pré-escolar e escolar, indicando que o acompanhamento após a alta da unidade deve ser mantido durante a infância.Palavras-chaves: Crescimento. Prematuro. Muito Baixo Peso.Abstract Introduction: Growth in newborns of very low birth weight has been associated with future abnormalities in the neurological development as well as in cardiovascular and metabolic diseases in the adulthood. Objective: To evaluate the growth of children with four to eight years of age that were born with very low birth weight. Methods: 87 children with very low birth weight were studied (33 small babies and 54 with appropriate size for their gestational age). The body mass index was calculated as well as the Z-scores for weight to age and gender. Bone age was determined through the X-ray of the left wrist. The cutoff point used for calculating the prevalence of short stature to age and sex was a standard deviation of two below the mean from the National Center of Health Statistics growth reference chart. Results: The prevalence of short stature was 4.6% (N 4/87, 95% CI 3.6–5.4). Low body mass index was found in 23% of the children (20/87). 43.7 % of the children (38/87) had a bone age one year below the chronological age. Conclusion: This study showed that some children who are born prematurely may have short stature and low body mass index until preschool and school ages. This shows that the follow up of these children after leaving hospital should be done during childhood.Keywords: Growth. Premature. Very Low Birth Weigh

Neurodevelopment of children exposed intra-uterus by Zika virus: A case series.

The main goal of this manuscript was to investigate the neurodevelopment of children exposed by Zika virus in the intrauterine period who are asymptomatic at birth. Newborns with documented Zika virus exposure during the intrauterine period who were asymptomatic at birth were followed in the first two years of life for neurodevelopment using Bayley III test. Children were classified as having normal or delayed neurodevelopment for age based on most recent Bayley III evaluation results. Eighty-four infants were included in the study. The first Bayley III evaluation was performed at a mean chronological age of 9.7±3.1 month; 13 children (15%) had a delay in one of the three domains, distributed as follow: 10 (12%) in the language domain and 3 (3.5%) in the motor domain. The most recent Bayley III evaluation was performed at a mean age 15.3±3.1 months; 42 children (50%) had a delay in one of the three domains: 4 (5%) in cognition, 31 (37%) in language, and 20 (24%) in motor performance. There were no statistical differences in Gender, Gestational Age, Birth Weight and Head Circurference at birth between children with normal and delayed neurodevelopment for age. A very high proportion of children exposed ZIKV during pregnancy who were asymptomatic at birth demonstrated a delay in neurodevelopment, mainly in the language domain, the first two years of life

Adverse fetal and neonatal outcomes in pregnancies with confirmed Zika Virus infection in Rio de Janeiro, Brazil: A cohort study.

OBJECTIVE: To analyze adverse fetal and neonatal outcomes of Zika virus infection by the timing of infection during pregnancy. Method: Cohort study of 190 pregnancies with 193 offspring with a positive RT-PCR test for Zika virus (March/2016 to April/2017). RESULTS: Death or defects related to congenital Zika virus infection were identified in 37.3% of fetuses and newborns, and microcephaly in 21.4% of the newborns. The proportion of small for gestational age newborns was 21.9%. Maternal symptoms in the first trimester were significantly associated with the birth of newborns with microcephaly/cerebral atrophy, small for gestational age and with the deaths (one abortion, one stillbirth and the two neonatal deaths). Maternal infection during the second trimester was further associated with asymptomatic newborns at birth. The study showed that 58.5% of the offspring with microcephaly and / or cortical atrophy were small for gestational age, with an evident decrease in symptomatic offspring without microcephaly, 24.1%, and with only 9.1% in the asymptomatic group. CONCLUSION: This study showed that the earlier the symptoms appear during gestation, the more severe the endpoints. We found a higher percentage of small for gestational age newborns exposed to Zika virus early in gestation. We also found a group of apparently asymptomatic newborns with proven Zika infection, which highlights the importance of follow up studies in this population

Language delay was associated with a smaller head circumference at birth in asymptomatic infants prenatally exposed to the Zika virus

Aim Our aim was to analyse 12-month outcomes of children who were prenatally exposed to the Zika virus and asymptomatic at birth. Methods This was an observational, exploratory study of infants exposed to the Zika virus during gestation and born between March 2016 and April 2017 without congenital Zika syndrome. They were followed until the age of 22 months. The outcome measure was neurodevelopment at 12 months of life, which was evaluated with the Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III). The scores were adjusted for maternal education and prematurity. Results A total of 96 infants were included in the study and 35.4% scored below the normal range in at least one Bayley-III domain. The majority (91.2%) of the infants with delayed scores presented with language delay, which was not associated with the gestational age at exposure. Receptive language was more affected by exposure than expressive language (27.0% vs 19.8%). There was a direct, and significant, association between the head circumference Z-score at birth and language delay. Conclusion Language delay was associated with a smaller head circumference at birth in infants prenatally exposed to the Zika virus and born asymptomatic. This may indicate future learning difficulties

Protocol for evaluating the in vitro effect of violet light-emitting diodes (LEDs) 410 nm ± 10 nm on yeast cultures

BACKGROUND: Candida spp and Malassezia spp cause superficial infections that may be resistant to conventional treatments. Violet light-emitting diodes (LEDs) therapy is a therapeutic alternative. PURPOSE: To describe the protocol for evaluating the antifungal effect of violet LEDs 410 nm ± 10 nm on Candida spp and Malassezia spp in vitro. PROTOCOL: LEDs 410 nm ± 10 nm are applied to a fungal suspension at fluences of 61.13 J/cm2, 91.70 J/cm2, and 183.39 J/cm2. The isolates are cultured for 48 to 72 hours. Colony forming units (CFUs) are quantified by visual counting and percent culture plate occupancy by digital analysis. Morphology is assessed by light microscopy and Gram staining, and yeast metabolism/function by transmission electron microscopy, assessment of reactive oxygen species, and DNA fragmentation. DATA ANALYSIS: the percentage of LEDs inhibition is calculated considering the growth of the negative control condition and the percentage of plate occupancy by yeasts by dividing the number of pixels classified as colonies by the total number of pixels on the plate. The morphological and functional aspects are described for the intervention and negative control. The ANOVA test is used to compare the mean percentages of growth inhibition and plate occupancy between the three fluences of LEDs 410 nm ± 10 nm and the negative control. ESTIMATED RESULTS: We intend to determine the antifungal effect of the different fluences of LEDs 410 nm ± 10 nm on Candida spp and Malassezia spp. The evaluation of other fungal species by this protocol should be investigated

Programa de conscientização da população sobre o destino adequado dos dejetos fecais de animais em vias e logradouros públicos e exames laboratoriais

A contaminação ambiental por meio dos dejetos fecais de animais domésticos, principalmente em cães, nas vias públicas e logradouros tem sido motivo de preocupação, pois o parasitismo intestinal nesses animais, além de causar danos à saúde destes animais, constitui um sério problema de saúde pública, já que diversas espécies de parasitos possuem potencial zoonótico. A transmissão de parasitas como Ancylostoma spp., Giardia spp., Trichuris spp., Dipylidium caninum, Toxocara canis e Cystoisospora spp., ocorre através do contato com as fezes dos animais, por via oral ou per cutânea. Sendo assim, o projeto busca a conscientização da população sobre a destinação correta dos dejetos fecais de seus animais, por meio de intensa sinalização por toda a unidade do Hospital Veterinário da FMVZ – Botucatu, para que seja realizada análise coproparasitológica das amostras obtidas e diagnóstico para possíveis parasitoses. A metodologia consiste na distribuição de coletores, pôsteres nos locais de maior fluxo de pessoas, associado a ações informativas, distribuição de folders e orientação aos proprietários dos animais que frequentam o Hospital Veterinário, pelos bolsistas participantes. A colheita dos dejetos ocorreu diariamente e o processamento das amostras, realizado semanalmente, utilizando as técnicas de Faust e Willis. Após as análises das amostras, outra etapa do projeto iniciou-se, que contemplou a comunicação dos proprietários dos cães parasitados, instruindo-os para que retornassem ao Hospital Veterinário a fim de que os animais recebessem o tratamento adequado. Observou-se que a diminuição dos dejetos fecais nas dependências do Hospital Veterinário foi significativa, principalmente pela grande proporção de amostras não identificadas pelos proprietários, impossibilitando incluí-las no projeto. A cada ano de realização do projeto observa-se o predomínio de determinado parasita nas amostras colhidas de cães. No ano de 2011 observou-se maior incidência do parasita Ancylostoma brasiliensis com 60,9% (14/60 amostras); em 2012, 93,7% (32/61 amostras) continham oocistos de Giardia spp. e até o presente momento do corrente ano de 2013, há predomínio de Giardia spp. 91,6% (11/12 amostras). Os resultados positivos para Giardia spp., parasita do trato gastrintestinal de cães com potencial zoonótico, demonstra a importância do projeto não apenas com o intuito de conscientizar a população quanto ao destino adequado dos dejetos fecais de seus animais de companhia, a importância de tal fato para a saúde publica e a instrução dos proprietários para que seja realizado o tratamento dos animais parasitados

Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model.

Understanding functioning and disabilities in children with Congenital Zika Syndrome (CZS) is essential for health planning. We describe disabilities present in children with CZS followed in a reference hospital in Rio de Janeiro, Brazil, based on the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). This was a cohort study of children >3 years of age with CZS. Disability was characterized through outcomes related to ICF components assessed via clinical and motor development evaluations. Among 50 children, with a median age of 40 months, 47 (94%) presented with severe impairment and 46 (92%) had microcephaly. Damage to the head and neck was found in most children, with abnormal central nervous system imaging universally present. Most children had cognitive impairment (92%), muscle tone problems (90%), and speech deficits (94%). We found movement limitations in all categories but more pervasively (80-94%), in postural transfers and displacements. The main environmental factors identified in the ICF model were the use of products or substances for personal consumption and access to health services. Children with CZS have extremely high rates of disability beyond aged 3 years, particularly regarding motor activity. ICF-based models can contribute to the assessment of health domains