New Technologies to Dating Pregnancy at Birth

The chapter provides a vision of new methods of pregnancy dating at birth to overcome the high costs of existing approaches or lack of access to the existing technologies. The authors have presented a literature review on recent scientific reports exploring novel technologies, such as those based on the newborn’s skin maturity assessment as machine learning models based on clinical data. The effortlessness of new approaches based on simplified clinical systems contrasting with molecular genetics and newborns screening analytes is discussed, even in scientific validation. Without the intention of an exhaustive or systematic review, we searched databases for reports concerning postnatal gestational age, prediction or estimate, novel approach, low and medium-income countries since 2015. Therefore, the authors did not compromise to offer a comprehensive picture of all postnatal gestational age methods. On the other hand, prematurity identification at birth remains a challenge in many birth settings, mainly in a scenario with scarce resources. Although postnatal pregnancy dating methods have strengths and disadvantages, this information is critical to recognize the risk of the newborn during the first hours of life, justifying technological investments

Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures

AbstractBackgroundHealthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce.ObjectiveTo identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures.MethodsThis case–control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences.ResultsDuring the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p=0.03) and use of non-invasive ventilation was a protective factor (p=0.048). Statistically significant difference was also observed for mechanical ventilation duration (p=0.004), duration of non-invasive ventilation (p=0.04), and parenteral nutrition duration (p=0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p=0.041).ConclusionsShortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection

Fatores de risco para infecção de ferida cirúrgica em puérperas submetidas a cesarianas em hospital universitário de referência.

Backgound and Objectives: Surgical wound infections (SWI) postoperative complications are common and present significant morbidity and mortality with increased time and cost of hospitalization, especially for women undergoing cesarean delivery. Therefore, the aim of this study was to evaluate risk factors for IFC in the reference in high-risk pregnancies from public Belo Horizonte. Methods: A cohort study performed in a referral Maternity - HC / UFMG, 2011-2012, with notification of SWI by active surveillance. All patients undergoing cesarean section were included and telephone contact was performed up to 30 days postpartum. The database was entered in the Statistical Package for Social Sciences. Results: We identified 708 women undergoing cesarean section and telephone contact was achieved with 487 of them during postpartum period. In 14 cases criteria for diagnosis of SWI was full filled (2.9% rate). When comparing groups of women with and without SWI, only the number of digital vaginal examination (≥ 2) was statistically significant for SWI cases. Conclusion: In the case of IFC, the average of digital vaginal examination was below reported in literature. It is emphasized that the procedure should be performed when absolutely necessary, respecting the rules of asepsis. KEYWORDS: Cesarean section. Surgical wound infection. Epidemiological surveillance. Diseases notification. Postpartum period.Justificativa e Objetivos: Infecções de ferida cirúrgica (IFC) constituem complicações pós-operatórias comuns e apresentam importante morbimortalidade, com aumento no tempo e custo de hospitalização, especialmente para mulheres submetidas a parto cesariana. Por isso, o objetivo do presente estudo foi avaliar fatores de risco para IFC em serviço de referência em gestação de alto risco da rede pública de Belo Horizonte. Métodos: Estudo transversal realizado na maternidade do Hospital das Clínicas em Minas Gerais, de 2011 a 2012, com notificação de IFC por vigilância ativa. Todas as pacientes submetidas à cesárea no serviço foram incluídas e contato telefônico foi realizado até 30 dias pós-parto. Resultados: Identificaram-se 708 mulheres submetidas a cesariana, sendo 487 (68,8%) puérperas contatadas por telefone. Em 14 (2,9%) puérperas os dados fornecidos preencheram os critérios para diagnóstico de IFC. Na comparação entre grupos de mulheres com e sem IFC, apenas o número de toques vaginais (≥ 2) foi estatisticamente significativo para os casos IFC. Conclusão: Nos casos de IFC, o número médio de toques realizados está abaixo do observado na literatura. Ressalta-se que o procedimento deve ser realizado quando absolutamente necessário, respeitando-se as normas de assepsia

Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system

The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1st, 2004, to December 1st, 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB

Índice de risco cirúrgico e infecção de ferida operatória em puérperas submetidas a cesarianas.

Backgound and Objectives: Considering the use of active surveillance assists in infection identification and the need for studies that use Surgical Risk Index (SRI) for assessment of Surgical Site Infection (SSI) in cesareans, this study aims to determine the incidence of SSI and analyze the applicability of SRI in the prediction of SSI in women in the postpartum period after being submitted to a cesarean section at a university hospital between April 2012 and March of 2013. Methods: Prospective cohort study. Information notifying SSI by active surveillance was collected daily from the medical records. After hospital discharge, the mothers were contacted through telephone calls to identify infection criteria within 30 days after the cesarean. Descriptive and comparative analyses were performed. The chi-square test was used to compare groups. Results: 737 cesareans were performed. Telephone contact was achieved with 507 (68.8%) women up to 30 days postpartum, with loss of follow-up of 230 cases (31.2%). The medical consultation in the post-partum period occurred with 188 (37.08%) women, with whom telephone contact was obtained, on average, 17.28 days (SD=8.39) after delivery. It was verified that 21 patients met the criteria for SSI, with a 4.14% rate. A total of 12 cases (57.1%) were classified as superficial SSI, 5 (23.8%) as deep and 4 (19.1%) as infection of organs and cavities. The SRI and its risk variables were not associated with SSI in patients submitted to cesarean sections. Conclusion: The SRI and the risk variables included in this index were not associated to SSI in patients submitted to cesarean sections. KEYWORDS: Cesarean Section; Surgical Wound Infection; Epidemiological Surveillance; Infection Control; Risk Index; Disease Notification.Justificativa e Objetivos: Tendo em vista que o emprego de vigilância ativa colabora na identificação de infecção e a necessidade de estudos que utilizem o Índice de Risco Cirúrgico (IRC) para avaliação de Infecção de Ferida Cirúrgica (IFC) em cesarianas este estudo objetiva determinar a incidência de IFC e analisar a aplicabilidade do IRC na predição das IFC em puérperas submetidas à cesariana em hospital universitário entre abril de 2012 e março de 2013. Métodos: Estudo de coorte prospectivo concorrente. Informações de notificação das IFC por vigilância ativa foram coletadas diariamente nos prontuários. Após alta hospitalar, as puérperas eram contatadas por ligações telefônicas para identificação de critérios de infecção até 30 dias após a cesariana. Análises descritivas e comparativas foram conduzidas. Para comparação dos grupos foi utilizado teste de Qui-quadrado. Resultados: Foram realizadas 737 cesarianas. Contato telefônico foi conseguido com 507 (68,8%) puérperas até 30 dias pós-parto, com perda de seguimento de 230 casos (31,2%). A consulta médica no puerpério ocorreu em 188 (37,08%) mulheres com quem foi obtido contato telefônico, em média, 17,28 dias (± 8,39) após o parto. Verificou-se que 21 casos preencheram critérios para IFC, taxa de 4,14%. Classificou-se 12 (57,1%) casos como infecção de ferida cirúrgica superficial, 5 (23,8%) como profunda e 4 (19,1%) de órgãos e cavidades. O IRC e suas variáveis de risco não foram associados à IFC em pacientes submetidas a cesarianas. Conclusão: O IRC e as variáveis de risco incluídas nesse índice não foram associados à IFC em pacientes submetidas a cesarianas. DESCRITORES: Cesárea; Infecção da Ferida Operatória; Vigilância epidemiológica; Controle de Infecções; Índice de Risco; Notificação de doenças

Fluconazole prophylaxis in preterm infants: a systematic review

Objective: This article aims to review the use of antifungal prophylaxis with intravenous fluconazole in premature newborns and the occurrence of Invasive Candidiasis. Methods: This is a systematic review with search at databases: PubMed, Capes Portal, Virtual Health Library (BVS – Biblioteca Virtual em Saúde)/Lilacs, Scopus and Cochrane. The keywords used were: “Antifungal”, “Candida” “Fluconazole prophylaxis” and “Preterm infants”. Results: Invasive Candidiasis was evaluated in all the twelve items. In eleven of them, there was a statistically significant difference between the groups receiving prophylactic fluconazole, with lower frequency of Invasive Candidiasis, compared to placebo or no prophylaxis group. Colonization by Candida species was also evaluated in five studies; four of them presented statistically lower proportion of colonization in patients with Fluconazole prophylaxis, compared to placebo or no drugs. In one study, there was a significant difference, favoring the use of fluconazole, and reduction of death. Conclusion: Studies indicate the effectiveness of prophylaxis with fluconazole, with reduction in the incidence of colonization and invasive fungal disease. The benefits of prophylaxis should be evaluated considering the incidence of candidiasis in the unit, the mortality associated with candidiasis, the safety and toxicity of short and long-term medication, and the potential for development of resistant pathogens. Keywords: Antifungal, Candida, Fluconazole prophylaxis, Preterm infant

Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus ଝ,ଝଝ

Abstract Objective: The aim of this study was to compare two different empiric treatments for lateonset neonatal sepsis, vancomycin and oxacillin, in a neonatal intensive care unit with a high prevalence of coagulase-negative Staphylococcus. Methods: A cross-sectional study was conducted in an neonatal intensive care unit from 2011 to 2014. Data from the medical records of at-risk newborns were collected daily. Infections were defined according to the National Health Surveillance Agency criteria. Data analysis was performed using an internal program. Results: There was a significant reduction in the number of Staphylococcus aureus infections (p = 0.008), without endocarditis, meningitis, or lower respiratory tract infection, as well as a reduction in the frequency of deaths related to S. aureus infection. There were no significant changes in the incidence of Gram-negative bacterial or fungal infections. An increase in coagulase-negative Staphylococcus infections was observed (p = 0.022). However, there was no ଝ Please cite this article as: Romanelli RM, Anchieta LM, Silva AC, de Jesus LA, Rosado V, Clemente WT. Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus. J Pediatr (Rio J). 2016;92:472---8