Clinical characteristics and evolution of 71 neonates born to mothers with COVID-19 at a tertiary center in Brazil

Introduction: Limited data are available on pregnant women with COVID-19 and their neonates. Objective: This study aimed to describe clinical characteristics and evolution from birth to discharge of a retrospective cohort of 71 neonates, with one set of twins, born to women with COVID-19 diagnosed at the end of pregnancy. The authors included all newborns admitted into a neonatal unit of a tertiary hospital in Brazil, between March 2020 and March 2021, whose unvaccinated mothers had COVID-19 symptoms and RT-PCR (Real-Time Polymerase Chain Reaction) for SARS-CoV-2 positive within fourteen days prior to delivery. Newborns to mothers with COVID-19 symptoms and negative tests for SARS-CoV-2 were excluded. Results: The main route of birth delivery was cesarean, corresponding to 60 pregnant women (84.5%). The foremost indications for cesarean were pregnant with critical disease (24.6%) and acute fetal distress (20.3%). The mean birth weight was 2452 g (865‒3870 g) and the mean gestational age was 345/7 weeks (25‒40 weeks). There were 45 premature newborns (63.3%), of which 21 newborns (29.5%) were less than 32 weeks of gestational age. RT-PCR for SARS-CoV-2 on oropharyngeal swabs was positive in 2 newborns (2.8%) and negative in the other 69 newborns (97.2%). Most newborns (51.4%) needed respiratory support. Therapeutic interventions during hospitalization were inotropic drugs (9.9%), antibiotics (22.8%), parenteral nutrition (26.8%), and phototherapy (46.5%). Conclusion: Maternal COVID-19 diagnosticated close to delivery has an impact on the first days of neonatal life

MRSA outbreak in a Neonatal Intensive Care Unit in a developed country: importance of rapid detection of reservoirs and implementation of intervention measures

We described a MRSA bloodstream infection outbreak that was rapidly identified and controlled in a Neonatal Intensive Care Unit after implementation of a bundle of measures, including PCR-screening and HCW decolonization. We found 35% of healthcare workers(HCW) colonized with S. aureus by PCR, one of them that presented skin lesion positive for MSSA (same clone and spa type than two patients). Our findings raise the hypothesis that the outbreak could be related to HCW colonization

Cuidados paliativos em medicina fetal

Fetal malformations affect approximately 3% of pregnancies, and the possibility of this diagnosis is one of the main concerns of parents and family members. When a malformation that implies potential mortality for the child is diagnosed, the pregnancy’s follow-up needs to be planned, including diverse aspects such as thorough evaluation of the prognosis, organization of post-partum care, and follow-up with the family in a broad and integrated manner. Recently, palliative care concepts have been introduced into perinatology for this purpose. This article discusses the application of the palliative care model to the care of pregnant women and family members of fetuses with malformations.Malformações fetais acometem cerca de 3% das gestações, e a possibilidade desse diagnóstico é uma das principais preocupações vivenciadas pelos pais e familiares. Quando é diagnosticado uma malformação que implique em possível mortalidade da criança, é necessário o planejamento do seguimento da gestação, o que abrange diversos aspectos que incluem avaliação minuciosa do prognóstico, organização do cuidado após o parto, e seguimento da família de forma abrangente e integrada. Recentemente os conceitos de cuidados paliativos foram introduzidos na perinatologia com essa finalidade, e o presente artigo tem como objetivo discutir o modelo de cuidado paliativo aplicado no atendimento a gestantes e familiares de fetos com malformação

Vertical transmission of SARS-CoV2 during pregnancy: A high-risk cohort.

OBJECTIVE: Identify the potential for and risk factors of SARS-CoV-2 vertical transmission. METHODS: Symptomatic pregnant women with COVID-19 diagnosis in whom PCR for SARS-CoV-2 was performed at delivery using maternal serum and at least one of the biological samples: cord blood (CB), amniotic fluid (AF), colostrum and/or oropharyngeal swab (OPS) of the neonate. The association of parameters with maternal, AF and/or CB positivity and the influence of SARS-CoV-2 positivity in AF and/or CB on neonatal outcomes were investigated. RESULTS: Overall 73.4% (80/109) were admitted in hospital due to COVID-19, 22.9% needed intensive care and there were four maternal deaths. Positive RT-PCR for SARS-CoV-2 was observed in 14.7% of maternal blood, 13.9% of AF, 6.7% of CB, 2.1% of colostrum and 3.7% of OPS samples. The interval between COVID-19 symptoms and delivery was inversely associated with SARS-CoV-2 positivity in the maternal blood (p = 0.002) and in the AF and/or CB (p = 0.049). Maternal viremia was associated with positivity for SARS-CoV-2 in AF and/or CB (p = 0.001). SARS-CoV-2 positivity in the compartments was not associated with neonatal outcomes. CONCLUSION: Vertical transmission is possible in pregnant women with COVID-19 and a shorter interval between maternal symptoms and delivery is an influencing factor

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19

Risk factors for fungemia in very low birth weight newborns

Introdução: A fungemia no período neonatal é uma complicação grave principalmente entre recém-nascidos de muito baixo peso (RN MBP). O maior conhecimento dos fatores de risco associados possibilita o desenvolvimento de estratégias para prevenir sua ocorrência. Objetivos: 1) descrever a incidência de sepse fúngica e identificar as espécies de fungo; 2) analisar os fatores de risco exploratóriamente nessa população. Métodos: Estudo prospectivo observacional de uma coorte de RN MBP admitidos em Unidade de Terapia Intensiva Neonatal de um hospital terciário no período de 25 meses, de 01 de junho de 2005 a 30 de junho de 2007. Foram excluídos aqueles com idade igual ou inferior a 72 horas de vida. Criou-se um banco de dados dividindo a amostra em cinco grupos, baseados na primeira hemocultura positiva: sem infecção; sepse com hemocultura negativa; sepse por bactéria gram-positiva; sepse por bactéria gram-negativa; sepse fúngica. Para análise estatística, foram utilizados: teste do qui-quadrado de Pearson, teste não paramétrico de Kruskal-Wallis e um modelo de regressão logística multinomial para as medidas quantitativas e as categorizadas. Resultados: Foram incluídos no estudo 187 recém-nascidos, dos quais 110 (58,8%) evoluiram com sepse neonatal tardia, sendo 13 casos de sepse fúngica (7%). A taxa de mortalidade foi 69,2%. As espécies de fungo identificadas foram C.albicans (50%), C. parapsilosis (41,7%) e C. não albicans (8,3%). Os fatores de risco encontrados na comparação, entre o grupo com fungemia e o restante da amostra foram: peso de nascimento (PN), idade gestacional (IG), exposição a cateter venoso central (CVC), nutrição parenteral prolongada (NPP), jejum (JJ), ventilação pulmonar mecânica (VPM), exposição a vancomicina, cefepime, meropenem e amicacina. A análise estatística mostrou que: a cada incremento de 10 gramas no PN, o risco de fungemia diminuiu em 3%; a cada dia de CVC, o risco aumentou em 8,1%; a cada dia de VPM, o risco aumentou em 11,1%. Após a categorização das variáveis, observou-se que: o PN 1000 g aumentou o risco para fungemia 23 vezes; a VPM 14 dias, aumentou 36 vezes o risco para fungemia; cada dia de CVC no RN com PN 1000 g aumentou o risco de infecção fúngica em 9,3%. Conclusões: A incidência de sepse fúngica em RNMBP foi de 7%; as espécies de fungo identificadas foram C.albicans, C.parapsilosis e C. não albicans, com mortalidade de 69,2%. O PN 1000 g e a duração da ventilação mecânica 14 dias aumentaram 23 e 36 vezes o risco de sepse fúngica, respectivamente. Cada dia de CVC no RN 1000 g aumentou o risco de infecção fúngica em 9,3%. A maior proporção de recém-nascidos que permaneceu em jejum por tempo igual ou superior a sete dias ocorreu no grupo com sepse fúngica (92,3%).Introduction: Fungemia is a severe complication on neonatal period among very low birth weight infants (VLBW). A better understanding of the risk factors involved could help improving prevention strategies of its occurrence. Objectives: 1) To describe the incidence of fungal sepsis and to recognize the fungal species involved 2) To analyse the risk factors among this population. Methods: Data were collected prospectively over a 25 months period from 1st june 2005 to 30 june 2007 to asses risk factors among VLBW infants admitted at the Neonatal Intensive Care Unit of a tertiary hospital. All newborns with 72 hours of life or less were excluded from the study. Patients were divided in five groups, based on the first positive blood culture: without sepsis; sepsis with negative blood culture; Gram-positive bacterial sepsis; Gram-negative bacterial sepsis and fungal sepsis. For statistical analyses the Pearson test, the Kruskal-Wallis test and a logistic regression model were used. Results: 187 newborns were included in the study: 110 (58,8%) had late-onset sepsis; 13 (7%) had fungal sepsis. Rate of mortality was 69,2%. The fungal species identified were: C.albicans (50%), C. parapsilosis (41,7%) and one non identified Candida (8,3%). The risk factors identified at the comparison between the fungal sepsis group and the group without fungal sepsis were: birth weight (BW), gestational age (GA), central venous catheter, parenteral nutrition, fasting, mechanical ventilation, exposure to vancomycine, cefepime, meropenem, and amikacine. Further statistical analyses have shown: for each increasing of 10 grams in BW, the risk of fungemia diminished 3%; each day of central venous catheter, increased this risk in 8,1%; each day of mechanical ventilation increased this risk in 11,1%. The analyses of the categorized variables have shown: BW 1000 g increased the risk of fungemia 23 times; mechanical ventilation 14 days increased the risk 36 times; each day of central venous catheter increased the risk of fungemia in 9,3%. Conclusions: The incidence of fungal sepsis in VLBW infant was 7%; the fungal species identified were C.albicans, C.parapsilosis and one non identified Candida. The mortality rate was 69,2%. BW 1000 g and mechanical ventilation during 14 days or more increased the risk of fungemia 23 and 36 times, respectively. Each day of central venous catheter increased the risk of fungemia in 9,3%. 92,3% of the newborns with fungal sepsis were submitted to fasting for seven days or more, the biggest proportion found

End of life care for newborns with major congenital malformations in a tertiary neonatal referral center in Brazil

INTRODUÇÃO: As malformações congênitas maiores constituem uma das principais causas de óbito em UTIN. A indicação de intervenções terapêuticas e a suspensão daquelas já instituídas suscitam frequentemente dilemas éticos na assistência neonatal. Os cuidados oferecidos no final de vida destes neonatos são pouco descritos. MÉTODOS: Foram incluídos no estudo todos os recém-nascidos portadores de malformações congênitas maiores que faleceram durante a internação na UTI neonatal entre 01/01/2015 e 31/12/2017. Foram analisados: tratamento oferecido em até 48 horas antes do óbito, como suporte ventilatório, uso de drogas vasoativas, antibióticos, sedação e/ou analgesia, presença de acesso venoso central, realização de procedimentos invasivos, registro em prontuário de conversa com a família, decisão por limite de intervenção terapêutica e acompanhamento pelo grupo de cuidado paliativo perinatal antes do nascimento. RESULTADOS: 74 RN portadores de malformações congênitas faleceram na UTIN durante o período do estudo. 81,1% tinha um acesso venoso central,74,3% estava em suporte ventilatório, 56,8% recebia ATB e 43,2% usava alguma medicação para sedo-analgesia. Houve registro de conversa em prontuário em 76% dos casos e limite de intervenção terapêutica em 46%. 41,9% das famílias haviam sido acompanhadas pelo grupo de cuidado paliativo perinatal durante a gestação. Na comparação entre o grupo que decidiu por limite de intervenção terapêutica e o grupo que manteve cuidados plenos, observou-se que houve menor exposição a drogas vasoativas (p=0,003), antibióticos (p=0,003) e realizou-se menos procedimentos invasivos (p=0,046). Não houve mudança quanto ao suporte ventilatório oferecido (p=0,66) e não se realizou extubação paliativa em nenhum paciente. A análise comparativa do grupo com acompanhamento pelo grupo de cuidado paliativo perinatal e sem mostrou que o primeiro teve um tempo de internação um pouco mais curto (p=0,049), foi menos submetido a ventilação invasiva (p=0,0391) e recebeu menos antibióticos (p=0,018). CONCLUSÕES: Os cuidados de fim de vida analisados na UTIN caracterizaram-se pela presença de acesso venoso central (81,1%), uso de ventilação invasiva (74,3%), uso de drogas vasoativas (70,3%). O limite de intervenção terapêutica foi caracterizado pela manutenção do tratamento vigente no momento de identificação de situação de terminalidade com rejeição de novas intervenções terapêuticas que pudessem aumentar o sofrimento. O acompanhamento pelo grupo de cuidado paliativo perinatal permitiu que o tempo de internação dos pacientes fosse menor e que eles fossem menos expostos a ventilação invasiva e antibioticoterapia. A abordagem da família mostrou-se essencial para tomada de decisões difíceis em uma UTIN.INTRODUCTION: Major congenital malformations are an important cause of death in the NICU. The therapeutics interventions and the suspension of those already in place often raise ethical dilemmas in neonatal care. The care offered at the end of life of these newborns is poorly described. METHODS: All newborns with major congenital malformations who died during hospitalization in the neonatal ICU between 01/01/2015 and 31/12/2017 were included in the study. The treatment offered up to 48 hours before death, such as ventilatory support, use of vasoactive drugs, antibiotics, sedation and / or analgesia, presence of central venous access, performing invasive procedures, registration in the medical record of conversation with the family, decision to limit therapeutic intervention and follow-up by the perinatal palliative care group before birth were analyzed. RESULTS: 74 newborns with congenital malformations died in the NICU during the study period. 81.1% had central venous access, 74.3% were on ventilatory support, 56.8% received antibiotics and 43.2% used some sedative or analgesic drugs. Conversation was registred in medical records in 76% of cases and 46% of the families chose therapeutic intervention limits. 41.9% of families had been followed up by the perinatal palliative care group during pregnancy. When compared, the group that decided on the limit of therapeutic intervention and the group that maintained full care, it was observed that there was less exposure to vasoactive drugs (p = 0.003), antibiotics (p = 0.003) and less invasive procedures were performed ( p = 0.046). There was no change in the ventilatory support offered (p = 0.66) and palliative extubation was not performed in any patient. The comparative analysis of the group monitored by the perinatal palliative care group and without showed that the first had a slightly shorter hospital stay (p = 0.049), was less submitted to invasive ventilation (p = 0.0391) and received less antibiotics ( p = 0.018). CONCLUSIONS: End-of-life care analyzed at the NICU was characterized by the presence of central venous access (81.1%), use of invasive ventilation (74.3%), use of vasoactive drugs (70.3%). of therapeutic intervention was characterized by the maintenance of the current treatment at the moment of identification of a terminal situation with rejection of new therapeutic interventions that could increase suffering. Follow-up by the perinatal palliative care group allowed the patients\' hospital stay to be shorter and that they were less exposed to invasive ventilation and antibiotic therapy. The family\'s approach proved to be essential for making difficult decisions in an NICU

Expert recommendations for the care of newborns of mothers with COVID-19

This article presents expert recommendations for assisting newborn children of mothers with suspected or diagnosed coronavirus disease 2019 (COVID-19). The consensus was developed by five experts with an average of 20 years of experience in neonatal intensive care working at a reference university hospital in Brazil for the care of pregnant women and newborns with suspected or confirmed COVID-19. Despite the lack of scientific evidence regarding the potential for viral transmission to their fetus in pregnant mothers diagnosed with or suspected of COVID-19, it is important to elaborate the lines of care by specialists from hospitals caring for suspected and confirmed COVID-19 cases to guide multidisciplinary teams and families diagnosed with the disease or involved in the care of pregnant women and newborns in this context. Multidisciplinary teams must be attentive to the signs and symptoms of COVID-19 so that decision-making is oriented and assertive for the management of the mother and newborn in both the hospital setting and at hospital discharge

An unfavorable intrauterine environment may determine renal functional capacity in adulthood: a meta-analysis

Since studies show that an unfavorable environment during intrauterine development predisposes individuals to several diseases in adulthood, our objective is to assess the relation between fetal growth restriction and chronic renal disease in adults. We searched four different electronic databases through November 2017: CENTRAL, EMBASE, LILACS and MEDLINE. We selected studies with longitudinal or transversal designs associating kidney function in adulthood with low birth weight. Two reviewers evaluated the inclusion criteria and the risk of bias and extracted data from the included papers. Thirteen studies were selected for the systematic review and meta-analysis. We observed increased risks of presenting end-stage renal disease (risk ratio 1.31, 95% confidence interval: 1.17, 1.47), a lower glomerular filtration rate (ml/min) (mean difference 7.14; 95% confidence interval: -12.12, -2.16), microalbuminuria (risk ratio 1.40; 95% confidence interval: 1.28, 1.52) and a small increase in the albumin/creatinine ratio (mean difference 0.46; 95% confidence interval: 0.03, 0.90) in the low birth weight patients, compared with control group. These findings suggest that low birth weight is associated with renal dysfunction in adults