Alice D’Agostini Deutsch

Persistence of Zika Virus in Breast Milk after Infection in Late Stage of Pregnancy

We detected Zika virus in breast milk of a woman in Brazil infected with the virus during the 36th week of pregnancy. Virus was detected 33 days after onset of signs and symptoms and 9 days after delivery. No abnormalities were found during fetal assessment or after birth of the infant.

CPAP em selo d'água versus CPAP com fluxo variável em recém-nascidos com desconforto respiratório: um ensaio controlado randomizado

OBJECTIVE: To evaluate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) using devices with variable flow or bubble continuous positive airway pressure (CPAP) regarding CPAP failure, presence of air leaks, total CPAP and oxygen time, and length of intensive care unit and hospital stay in neonates with moderate respiratory distress (RD) and birth weight (BW) > 1,500 g. METHODS: Forty newborns requiring NCPAP were randomized into two study groups: variable flow group (VF) and continuous flow group (CF). The study was conducted between October 2008 and April 2010. Demographic data, CPAP failure, presence of air leaks, and total CPAP and oxygen time were recorded. Categorical outcomes were tested using the chi-square test or the Fishers exact test. Continuous variables were analyzed using the Mann-Whitney test. The level of significance was set at p 1,500 g and moderate RD, the use of continuous flow NCPAP showed the same benefits as the use of variable flow NCPAP.OBJECTIVE To evaluate the efficacy and safety of nasal continuous positive airway pressure (NCPAP) using devices with variable flow or bubble continuous positive airway pressure (CPAP) regarding CPAP failure, presence of air leaks, total CPAP and oxygen time, and length of intensive care unit and hospital stay in neonates with moderate respiratory distress (RD) and birth weight (BW) ≥ 1,500 g. METHODS Forty newborns requiring NCPAP were randomized into two study groups: variable flow group (VF) and continuous flow group (CF). The study was conducted between October 2008 and April 2010. Demographic data, CPAP failure, presence of air leaks, and total CPAP and oxygen time were recorded. Categorical outcomes were tested using the chi-square test or the Fishers exact test. Continuous variables were analyzed using the Mann-Whitney test. The level of significance was set at p < 0.05. RESULTS There were no differences between the groups with regard to demographic data, CPAP failure (21.1 and 20.0% for VF and CF, respectively; p = 1.000), air leak syndrome (10.5 and 5.0%, respectively; p = 0.605), total CPAP time (median: 22.0 h, interquartile range [IQR]: 8.00-31.00 h and median: 22.0 h, IQR: 6.00-32.00 h, respectively; p = 0.822), and total oxygen time (median: 24.00 h, IQR: 7.00-85.00 h and median: 21.00 h, IQR: 9.50-66.75 h, respectively; p = 0.779). CONCLUSION In newborns with BW ≥ 1,500 g and moderate RD, the use of continuous flow NCPAP showed the same benefits as the use of variable flow NCPAP.

Características clínicas e ecocardiográficas associadas à evolução do canal arterial em recém-nascidos com peso de nascimento inferior a 1.500g

ABSTRACT Objective: To identify clinical and echocardiographic parameters associated with the evolution of the ductus arteriosus in neonates with birth weight lower than 1,500g. Methods: Retrospective study of 119 neonates in which clinical parameters (Prenatal: maternal age, risk of infection and chorioamnionitis, use of corticosteroid, mode of delivery and gestational age. Perinatal: weight, Apgar score, gender and birth weight/gestational age classification; Postnatal: use of surfactant, sepsis, fluid intake, heart murmur, heart rate, precordial movement and pulses, use of diuretics, oxygenation index, desaturation/apnea, ventilatory support, food intolerance, chest radiography, renal function, hemodynamic instability, and metabolic changes) and echocardiographic parameters (ductus arteriosus diameter, ductus arteriosus/weight ratio, left atrium/ aorta ratio, left ventricular diastolic diameter, and transductal flow direction, pattern and velocity) were analyzed. The clinical and echocardiographic parameters analyzed were considered statistically significant when p<0.05. Results: In the 119 neonates, the incidence of patent ductus arteriosus was 61.3%; 56 received treatment (46 pharmacological and 10 surgical treatment), 11 had spontaneous closure, 4 died, and 2 were discharged with patent ductus arteriosus. A higher incidence of chorioamnionitis, use of surfactant, lower weight and gestational age, sepsis, heart murmur, ventilatory support and worse oxygenation indices were observed in the neonates receiving treatment. The group with spontaneous closure had a smaller ductus arteriosus diameter, lower ductus arteriosus/weight ratio, and higher transductal flow velocity. Conclusion: Based on clinical and echocardiographic parameters, the neonates with spontaneous closure of the ductus arteriosus could be differentiated from those who required treatment.

Electrical impedance tomography to evaluate air distribution prior to extubation in very-low-birth-weight infants: a feasibility study

OBJECTIVES: Nasal continuous positive airway pressure is used as a standard of care after extubation in very-low-birth-weight infants. A pressure of 5 cmH2O is usually applied regardless of individual differences in lung compliance. Current methods for evaluation of lung compliance and air distribution in the lungs are thus imprecise for preterm infants. This study used electrical impedance tomography to determine the feasibility of evaluating the positive end-expiratory pressure level associated with a more homogeneous air distribution within the lungs before extubation. METHODS: Ventilation homogeneity was defined by electrical impedance tomography as the ratio of ventilation between dependent and non-dependent lung areas. The best ventilation homogeneity was achieved when this ratio was equal to 1. Just before extubation, decremental expiratory pressure levels were applied (8, 7, 6 and 5 cmH20; 3 minutes each step), and the pressure that determined the best ventilation homogeneity was defined as the best positive end-expiratory pressure. RESULTS: The best positive end-expiratory pressure value was 6.3±1.1 cmH20, and the mean continuous positive airway pressure applied after extubation was 5.2±0.4 cmH20 (p = 0.002). The extubation failure rate was 21.4%. X-Ray and blood gases after extubation were also checked. CONCLUSION: This study demonstrates that electrical impedance tomography can be safely and successfully used in patients ready for extubation to suggest the best ventilation homogeneity, which is influenced by the level of expiratory pressure applied. In this feasibility study, the best lung compliance was found with pressure levels higher than the continuous positive airway pressure levels that are usually applied for routine extubation.

Twin pregnancy and congenital cytomegalovirus: Case report and review

Primary cytomegalovirus (CMV) infection during pregnancy is the leading infectious cause of congenital neurological disabilities. Diagnosis of maternal primary CMV infection and fetal compromise can be difficult, as well as the fact that most infected child are asymptomatic at birth, which makes binomial CMV and pregnancy challenging. The treatment of pregnant women with CMV hyperimmunoglobulin (CMV-HIG) has shown promising results. However, as far as we know, no randomized trials of immunoglobulin therapy of CMV-infected fetuses are ongoing. We describe CMV-HIG administration for twin pregnancy as maternal and fetal infection early in gestation. The epidemiology, clinical manifestations, prevention strategies and treatment of CMV infections are reviewed.

Influence of assessment site in measuring transcutaneous bilirubin

ABSTRACT Objective: To investigate the influence of the site of measurement of transcutaneous bilirubin (forehead or sternum) in reproducibility of results as compared to plasma bilirubin. Methods: A cohort study including 58 term newborns with no hemolytic disease. Transcutaneous measurements were performed on the forehead (halfway between the headline and the glabella, from the left toward the right side, making consecutive determinations, one-centimeter apart) and the sternum (five measurements, from the suprasternal notch to the xiphoid process with consecutive determinations, one-centimeter apart) using Bilicheck® (SpectRx Inc, Norcross, Georgia, USA). The correlation and agreement between both methods and plasma bilirubin were calculated. Results: There was a strong linear correlation between both determinations of serum bilirubin at the forehead and sternum (r=0.704; p<0.01 and r=0.653; p<0.01, respectively). There was correspondence of the mean values of transcutaneous bilirubin measured on the sternum (9.9±2.2mg/dL) compared to plasma levels (10.2±1.7mg/dL), but both differ from the values measured on the forehead (8.6±2.0mg/dL), p<0.05. Conclusion: In newborn term infants with no hemolytic disease, measuring of transcutaneous bilirubin on the sternum had higher accuracy as compared to serum bilirubin measurement on the forehead.

Ochrobactrum anthropi bacteremia in a preterm infant with cystic fibrosis

Ochrobactrum anthropi infection in newborn patients is rare, and the treatment is challenging because of its widespread and unpredictable resistance to antimicrobial agents and discrepancies between in vitro susceptibility and in vivo efficacy. We report the clinical and microbiological characteristics of Ochrobactrum anthropi bacteremia in a preterm patient.

Acompanhamento de crianças prematuras com alto risco para alterações do crescimento e desenvolvimento: uma abordagem multiprofissional

Objetivo: Descrever a atividade do ambulatorio multiprofissional formado por neonatologista e fisiatra, fisioterapeuta, terapeuta ocupacional, fonoaudiologas e psicologa que realizaram avaliacoes aos 3, 6, 9, 12, 18 e 24 meses de idade corrigida. Metodos: Foram realizadas avaliacoes multiprofissionais pela equipe, incluindo avaliacao pela escala de desenvolvimento Bayley III. A amostra foi constituida por 20 criancas nascidas em hospital de nivel terciario em Sao Paulo, Brasil, com peso inferior a 1250 g ou idade gestacional abaixo de 32 semanas no periodo de Abril de 2006 a Abril de 2007. Resultados: A idade gestacional media ao nascimento foi de 28.8 semanas, peso medio 1055 g, tempo de internacao medio de 46,3 dias, e idade materna media de 35 anos. Observou-se que 15% das criancas apresentaram alteracoes sensorio-motoras, 20% alteracoes no desenvolvimento auditivo e 10% alteracoes motoras. Pela aplicacao da Bayley III, observou-se 10% dos casos com alteracao na area de comunicacao e 10% com alteracao na area motora. Os pais foram orientados a estimularem a crianca ou foi sugerida intervencao especifica. Observou-se que entre 6 e 18 meses de idade corrigida houve maior ocorrencia de atrasos do desenvolvimento, que se adequou aos 24 meses. Conclusoes: A maioria das criancas avaliadas alcancou crescimento e desenvolvimento adequado aos 24 meses de idade corrigida. Recomendam-se estudos futuros com amostra ampliada, assim como a possibilidade de um acompanhamento dessa populacao ate o periodo de alfabetizacao.

Efeitos do banho logo após o nascimento sobre as adaptações térmica e cardiorrespiratória do recém-nascido a termo

Objective: To determine the effect of bathing right after birth on newborn’s transition to extra-uterine life, mainly regarding thermoregulation and cardiorespiratory adaptation. Methods: A retrospective comparative study enrolled infants admitted between January and March 2006 in a private tertiary care maternity hospital in the city of Sao Paulo, Brazil. Inclusion criteria were: Apgar score ≥ 8 (5 th minute), birth weight ≥2500g; gestational age ≥37 weeks, no congenital anomalies. Newborns were divided in two study groups: ‘bath’ (bath right after birth) and ‘control’ (bath after the 3 rd hour of life). Outcome variables were evaluated at neonatal unit arrival: body temperature, heart and respiratory rate, oxygen saturation, mean arterial pressure. The time interval from birth to admission in the neonatal unit, the rate of breastfeeding in delivery room and mode of delivery were also analyzed. Results: 194 newborns were included: 98 in the bath and 96 in the control group. Both groups had similar temperature at admission in the neonatal unit (36.6±0.4 and 36.6±0.3°C; p=0.68); heart rate (143±13 and 146±14 bpm; p=0.26) respiratory rate (51±6 and 51±9 mov/min; p=0.90) mean blood pressure (44±6 and 47±9 mmHg; p=0.13) and oxygen saturation (98±2 and98±3%; p=0.99) were also similar. The breastfeeding rate (91% and 57%; p<0.001) as

Persistence of ventilatory defect after resolution of pulmonary interstitial emphysema in a preterm baby

Abstract Pulmonary interstitial emphysema is a common complication of mechanical ventilation in preterm babies. We report a case of severe unilateral pulmonary interstitial emphysema in a premature newborn, treated with high-frequency oscillatory ventilation, lateral decubitus positioning and selective intubation. After complete radiological resolution of the pulmonary emphysema in the left lung, the patient was studied by electrical impedance tomography and a marked reduction of ventilation was identified in the left lung despite radiological resolution of the cysts. This finding indicates that functional abnormalities may persist for longer periods after radiologic resolution of such lesions.