Resumen Con la implementación de estrategias de cuidado perinatal, la tasa de transmisión vertical del virus de inmunodeficiencia humana (VIH) ha disminuido considerablemente en el mundo. A pesar de no mostrar cargas virales, los infantes expuestos al VIH no infectados (ENI) cursan en sus primeros meses de vida con mayores tasas de morbimortalidad. Esto se relaciona con enfermedades infecciosas por microorganismos oportunistas y menor respuesta a las vacunas en comparación con infantes sin exposición al virus, lo que sugiere alteraciones en su sistema inmunitario. En esta revisión abordamos diferentes evidencias de alteraciones en las respuestas inmunitarias innatas y adaptativas de infantes ENI que pudieran explicar esta disfuncionalidad inmunitaria. Adicionalmente, este conocimiento ayuda a entender cómo se desarrolla el sistema inmunitario desde los primeros momentos de gestación que servirán para encontrar alternativas de manejo y terapias para el bienestar de los infantes con esta condición.

Abstract With the implementation of perinatal care strategies, the rate of vertical transmission of human immunodeficiency virus (HIV) has decreased considerably worldwide. Despite the absence of viral loads, infants exposed to HIV not infected during gestation have higher morbidity and mortality rates. This is found to be related to infectious diseases by opportunistic microorganisms and lower response to vaccines in their first months of life compared to non-HIV exposed infants, suggesting alterations in their immune system. In this review we address different evidence of alterations in the innate and adaptive immune responses of HIV exposed infants that could explain their immune dysfunctionality. Additionally, this knowledge helps to understand how the immune system develops from the early stages of gestation and will serve to find management alternatives and therapies for the welfare of the infants with this condition.

Resumen Introducción. La infección por SARS-CoV-2 en el periodo perinatal puede asociarse a un mayor riesgo de morbimortalidad tanto en la madre como en el neonato. Objetivo. Describir las características clínicas y los hallazgos de laboratorio e imagenológicos en gestantes con COVID-19 y sus recién nacidos. Materiales y métodos. Se realizó una búsqueda en PubMed, Scopus, Web of Science y Cochrane de revisiones sistemáticas, publicadas entre el 1 de febrero de 2020 y el 30 de mayo de 2021, que describieran características clínicas y hallazgos de exámenes de laboratorio y de imagen (tórax) en gestantes con COVID-19 y sus recién nacidos; no hubo restricciones de idioma. Se reanalizaron los datos mediante metaanálisis bayesianos utilizando métodos de Monte Carlo basados en Cadenas de Markov. El protocolo del estudio está registrado en PROSPERO bajo el código CRD42020178329. Resultados. Se recuperaron 6 revisiones sistemáticas (para un total de 617 estudios primarios). Se realizó una síntesis narrativa de las proporciones de los signos, síntomas y hallazgos imagenológicos y de laboratorio tanto de las madres, como de los neonatos. Las Odds ratio (OR) entre las embarazadas con y sin COVID-19 fueron: compromiso del bienestar fetal: 1.9 (IC95%:1.09-3.63), mortinato: 1.73 (IC95%:1.01-2.94), nacimiento prematuro: 1.77 (IC95%:1.25-2.61) y admisión de la madre a unidad de cuidados intensivos (UCI): 6.75 (IC95%: 1-31.19). Con relación a la sintomatología: la OR para la mialgia entre las embarazadas y las no embarazadas con COVID-19 fue 0.67 (IC95%:0.51-0.93). Conclusiones. Los síntomas más comunes en las embarazadas con COVID-19 son tos, fiebre, disnea y mialgias; además, existe un mayor riesgo de ingreso a UCI. En lo que respecta a los exámenes complementarios, las alteraciones más frecuentes son la linfopenia y las lesiones evidenciadas en los estudios de imagen del tórax. La presencia de COVID-19 en las gestantes se asocia con nacimiento prematuro. Al parecer, la infección por SARS-CoV-2 en neonatos no es grave y el riesgo de transmisión vertical es bajo, pues no se encontraron datos sobre malformaciones congénitas atribuibles al virus.

Abstract Introduction: SARS-CoV-2 infection in the perinatal period may be associated with an increased risk of morbidity and mortality in both the mother and the neonate. Objective: To describe the clinical characteristics and laboratory and imaging findings in pregnant women with COVID-19 and their newborns. Materials and methods: A search was conducted in PubMed, Scopus, Web of Science, and Cochrane databases for systematic reviews published between February 1, 2020, and May 30, 2021, describing clinical characteristics and laboratory and imaging (chest) findings in pregnant women with COVID-19 and their newborns; there were no language restrictions. Data were reanalyzed by means of Bayesian meta-analysis using Markov Chain Monte Carlo (MCMC) methods. The study protocol is registered in PROSPERO under code CRD42020178329. Results: Six systematic reviews were retrieved (for a total of 617 primary studies). A narrative synthesis of the percentage of signs, symptoms, and imaging and laboratory findings found in both mothers and neonates was performed. Odds ratios (OR) between pregnant women with and without COVID-19 were: fetal well-being involvement: 1.9 (95%CI: 1.09-3.63); stillbirth: 1.73 (95%CI: 1.01-2.94); preterm birth: 1.77 (95%CI: 1.25-2.61); and maternal admission to the intensive care unit (ICU): 6.75 (95%CI: 1-31.19). Regarding symptomatology, an OR of 0.67 (95%CI: 0.51-0.93) was obtained for myalgia between pregnant women and non-pregnant women with COVID -19. Conclusions: Cough, fever, dyspnea, and myalgia are the most common symptoms in pregnant women with COVID-19; in addition, there is a higher risk of admission to the ICU among them. Regarding complementary testing, the most frequent alterations are lymphopenia and the evidence of lesions in chest imaging studies. The presence of COVID-19 in pregnant women is associated with preterm birth. It seems that SARS-CoV-2 infection in neonates is not severe and that the risk of vertical transmission is low, considering that no data on congenital malformations attributable to the virus were found.

RESUMEN Introducción. La vacunación contra el virus de la hepatitis B (VHB) en recién nacidos es crucial para la prevención de la transmisión perinatal. Objetivo. Determinar factores individuales e institucionales asociados a la vacunación contra el VHB en las 12 y 24 primeras horas de vida. Métodos. Se diseñó un estudio transversal y multicéntrico. Los datos sobre la vacunación fueron recogidos de los padres y de la revisión de reportes. Los datos de los variables individuales de los recién nacidos y madres fueron recogidos de las historias clínicas. Los datos institucionales fueron recogidos de registros de atención inmediata y directamente del personal de inmunizaciones. Resultados. Se incluyó 777 recién nacidos en 10 establecimientos. En el análisis multinivel resultó favorable a la vacunación en las primeras 12 horas, el mayor tiempo de atención en los servicios de inmunizaciones (RP: 1,0; IC95%: 0,99 - 1,01). Para la vacunación dentro de las 24 horas de vida fue favorable la mayor cantidad de personal de enfermería en los servicios de vacunación (RP: 1,02; IC95%: 1,01 - 1,03) y desfavorable la mayor cantidad de partos al día de los establecimientos (RP: 0,99; IC95%: 0,99 - 0,997). No se identificó factores individuales. Conclusión. Factores institucionales, como el tiempo de atención, la cantidad de personal de enfermería y la cantidad de partos, estuvieron asociados con la vacunación contra el VHB en recién nacidos. Se requiere estrategias de mejora como la introducción de la vacunación en la atención inmediata del neonato para la prevención de la transmisión perinatal del VHB.

ABSTRACT Introduction. Vaccination against hepatitis B Virus (HBV) in newborns is crucial for the prevention of perinatal transmission. Objective. To determine the individual and institutional factors associated with vaccine for HBV in newborns in the first 12 hours and 24 hours of life. Methods. A cross-sectional, multicenter-design study was conducted in high level public and private hospitals in Lima Metropolitana and Callao. Information on vaccination was obtained through consultations with parents and review of health service reports. Individual variables of the newborns and their mothers were obtained from the medical records of the newborns. Institutional data were collected from immediate care records and from health personnel responsible for the immunization program. Results. The study was conducted in 10 health facilities, including 777 newborns. In the multilevel analysis, the longest care time in the vaccination service was favorable for vaccination within 12 hours of life (PR: 1,0; 95% CI: 0,9995-1,01); while for vaccination within 24 hours of life was favorable the greater number of nursing personnel (RP: 1,02; IC95%: 1,01-1,03) and unfavorable the greater number of deliveries per day in the institution (RP:0,99; IC95%: 0,99-0,997). No individual factors related to vaccination were identified. Conclusions. Institutional factors, such as length of care, number of nursing staff, and number of deliveries, were associated with newborn HBV vaccination. Improvement strategies are required, such as the introduction of vaccination in the immediate care of the newborn for the prevention of perinatal transmission of HBV.

SUMMARY OBJECTIVE: The objective of this study was to evaluate the correlation between clinical and serological findings of pregnant women and newborns with patterns of histopathologic changes of the placenta diagnosed with coronavirus disease 2019. METHODS: A prospective descriptive study was conducted with pregnant women who were positive for SARS-CoV-2 by reverse transcription polymerase chain reaction or serology (IgG and IgM). Clinical analyses were performed using ELISA to detect anti-SARS-CoV-2 IgG and IgA antibodies using the S1 spike protein domain with the Euroimmun kit. Histopathologic analyses of placentas were performed by two expert pathologists. RESULTS: Maternal SARS-CoV-2 infection was associated with increased neonatal hospital length of stay (p=0.03), increased preterm birth (p=0.04), and Apgar score<7 at 1st min (p=0.00) and 5th min (p=0.02). Pregnant women with positive IgG and/or IgA at delivery had a higher incidence of placental histopathologic changes in addition to a greater likelihood of having an IgG-positive fetus (p<0.0001). Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion changes (p=0.00). CONCLUSION: Maternal SARS-CoV-2 infection was associated with adverse perinatal outcomes. Pregnant women with positive IgG at delivery had a higher incidence of placental histopathologic changes. Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion.

BACKGROUND: Limited data exist on the differential risk of HIV acquisition between infants born preterm versus those born at term to women living with HIV (WLHIV). With a reported increase in preterm delivery among pregnant WLHIV, understanding the risk of vertical transmission of HIV in preterm infants can inform strategies to optimise the timing of diagnostic testing, antiretroviral prophylaxis, and infant feeding. OBJECTIVES: To describe the prevalence and timing of HIV acquisition, in utero versus perinatal, among infants with perinatal HIV exposure born prior to 37 weeks completed gestation age compared to those born at term in the Botswana-based Mpepu study and explore predictors of infant HIV acquisition. METHOD: Using data extracted from the Mpepu study, we describe the prevalence, timing and risk factors for HIV acquisition in infants born preterm versus those born at term. Fisher exact testing was used to test for differences in prevalence and timing of HIV and a multivariable logistic regression model was used to assess risk factors for infant HIV acquisition. RESULTS: 2866 infants born to WLHIV were included in this secondary analysis. 532 (19%) were born preterm. There was no observed difference in the prevalence of HIV acquisition among infants born preterm versus at term overall (0.8% vs 0.6%, P = 0.54), at birth (0.2% vs 0.3%, P = 1.00) or between 14 and 34 days post-delivery (0.6% vs 0.3%, P = 0.41). The absence of maternal antiretroviral use during pregnancy significantly predicted infant HIV acquisition, with the risk of HIV acquisition reduced by 96% among infants whose mothers were taking antiretroviral treatment (ART) during pregnancy (adjusted odds ratio: 0.003, confidence interval: 0.01-0.02, P < 0.001. CONCLUSION: There was no observed increase of in utero and peripartum HIV acquisition among infants born preterm following foetal exposure to HIV compared to those born at term.

SUMMARY OBJECTIVE: The aim of this study was to examine the impact of symptom-based screening on the prevalence and outcomes of neonatal coronavirus disease 2019 in pregnant women admitted for delivery. METHODS: A retrospective observational study was conducted from June to August 2020 at Gonzaga Mota of Messejana Hospital, Fortaleza, CE, Brazil. All pregnant women were screened for coronavirus disease 2019 based on symptoms. Reverse transcription-polymerase chain reaction or immunology assays for severe acute respiratory syndrome coronavirus 2 were performed when a patient reported a symptom. All newborns of symptomatic patients were submitted for Reverse transcription-polymerase chain reaction. Newborns were divided into groups according to the Reverse transcription-polymerase chain reaction results to identify the relationship between maternal symptoms and neonatal coronavirus disease 2019. RESULTS: A total of 55 (55/1,026, 5.4%) and 50 (50/1,026, 4.8%) pregnant women reported symptoms and had a positive confirmatory test, respectively. The most common symptom of coronavirus disease 2019 among the pregnant women with positive confirmatory test was cough (n=23, 46%). Seven newborns (7/50, 14%) of symptomatic mothers had positive Reverse transcription-polymerase chain reaction. Upon birth, no newborn had serious complications. CONCLUSION: Universal screening of pregnant women admitted for delivery can reduce the perinatal transmission of coronavirus disease 2019. Symptom-based screening can be an alternative for regions with a low prevalence of the disease where a better allocation of financial resources is necessary.

Resumen: Introducción: el SARS-CoV-2 produjo una pandemia afectando la salud de la población mundial desde el año 2019, lo que determinó cambios en las conductas sanitarias. Objetivos: describir resultados obstétricos-neonatales en madres COVID-19 positivas al momento del nacimiento en la asistencia pública y privada en el período desde marzo de 2020 a junio de 2021. Metodología: estudio observacional descriptivo, retrospectivo de las embarazadas COVID-19 positivas al momento del parto y sus neonatos en en el Centro Hospitalario Pereira Rossell y en Médica Uruguaya. Resultados: se obtuvo una muestra de 240 madres y 244 neonatos. El 0,42% (n=1) de las madres presentó sintomatología grave por COVID-19. El 46% (n=110) de los embarazos finalizaron por cesárea. El 3% (n=7) de las madres ingresaron a terapia intensiva, en su mayoría por complicaciones de la gestación. En cuanto a los recién nacidos, tuvieron contacto con su madre el primer día de vida el 86,5% (n=211), siendo la causa principal de ingreso a Terapia Intensiva no contar con cuidador. Se realizó PCR a todos sin identificar transmisión vertical. La internación fue mayor a tres días en 36,48% (n=89). Se registró una sola muerte neonatal por prematurez extrema. Fueron alimentados con pecho exclusivo el 19,67% (n=48) en la internación. Conclusiones: la pandemia afectó la asistencia inicial del binomio madre-hijo. No observamos ascenso en el número de cesáreas pero sí disminución en lactancia exclusiva, prolongación de la estadía hospitalaria y aumento del ingreso en áreas de cuidado intensivo sin detectar contagios en los neonatos.

Summary: Introduction: SARS-CoV-2 virus caused a pandemic that affected the health of the world´s population since 2019, what resulted in changes in health behaviors. Objectives: to describe obstetrical and neonatal results in mothers positive for COVID-19 at the time of birth in public and private institutions between March, 2020 and June, 2021. Method: observational, descriptive, retrospective study of pregnant women positive for COVID-19 at the time of delivery and their neonates at Pereira Rossell Hospital and Medica Uruguaya. Results: a sample of 240 mothers and 244 neonates was studied. 0.42% (n=1) of mothers evidenced severe symptoms for COVID-19. 46% (n=110) of pregnancies ended up in C-sections. 3% of mothers were admitted to ICU due to gestational complications in most cases. As to the newborns, 86.5% of them were in contact with their mother their first day of life, the first cause for their being admitted to ICU was absence of a caregiver. PCR tests were performed to all newborns and no vertical transmission was identified. Hospitalization was longer than three days in 36.48% of cases (n=89). Only one neonatal death was recorded as a consequence of extreme prematurity. Exclusively breastfed babies represented 19.67% (n=48) during hospitalization. Conclusions: the pandemic affected the initial assistance of the mother-child binomial. No increase was observed in the number of C-sections, although exclusive breastfeeding did decrease, hospitalization was longer and there was an increase in admission to the ICU although no neonate contagion was observed.

Resumo: Introdução: o SARS-CoV-2 produziu uma pandemia afetando a saúde da população mundial desde 2019, o que determinou mudanças nos comportamentos de saúde. Objetivos: descrever os desfechos obstétrico-neonatais em mães positivas para COVID-19 no momento do parto na rede pública e privada no período de março de 2020 - junho de 2021. Metodologia: estudo observacional descritivo retrospectivo de gestantes positivas para COVID-19 no momento do parto e seus recém-nascidos no Hospital Pereira Rossell e Médica Uruguaya. Resultados: obteve-se uma amostra de 240 mães e 244 recém-nascidos. 0,42% (n=1) das mães apresentaram sintomas graves de COVID-19. 46% (n=110) das gestações terminaram por cesariana. 3% (n=7) das mães foi internada em terapia intensiva devido a complicações na gravidez. Em relação aos recém-nascidos, 86,5% (n=211) tiveram contato com a mãe no primeiro dia de vida, sendo a principal causa de internação em terapia intensiva a falta de cuidador. O teste PCR foi realizado em todos sem detecção de transmissão vertical. Em 36,48% (n=89) a internação foi superior a três dias. Foi registrado um único óbito neonatal por prematuridade extrema. 19,67% (n=48) foram amamentados exclusivamente durante a internação. Conclusões: a pandemia afetou o atendimento inicial do binômio mãe-filho. Não se registrou um aumento do número de cesáreas, porém observou-se diminuição do aleitamento materno exclusivo, prolongamento da internação e aumento das internações em unidades de terapia intensiva sem detecção de contágio em recém-nascidos.

Abstract: Chagas Disease is a pathology caused by the parasite Trypanosoma cruzi. It is considered a public health issue, especially its congenital transmission, not only in endemic countries but also in non endemic ones, being the main form of transmission in Chile. Objectives: To describe a congenital Chagas Disease case and to report about the usefulness of prenatal screening for Chagas Disease. Cli nical Case: A 29-week preterm newborn of a multiparous mother with Chagas Disease detected in the perinatal screening of current pregnancy. Due to history of Trypanosoma cruzi, PCR was performed on the 4th day of life resulting undetectable. At the 6th and the 8th week of life, a macular erythema tous rash and fever and respiratory distress were observed, respectively, both self-limited. At the 8th week of life, as a routine prematurity follow-up, a fundus examination was performed which showed bilateral retinal granulation, therefore, a TORCH study was performed with a negative result. Also, in this same week, a second Trypanosoma cruzi PCR was performed, with a positive result. Lab tests reported visualization of trypomastigotes, confirming the Congenital Chagas Disease diagnosis. The patient was treated with Nifurtimox, presenting an adverse reaction at 35 days of treatment with neu tropenia, vomiting, and poor weight gain. The treating drug was replaced by Benznidazole, achieving 60 days of treatment. At 22 months of chronologic age, the patient has remained asymptomatic. Con clusions: It is necessary to increase efforts in prevention, early detection, and study of direct relatives. This report is an example of the usefulness of Chagas disease prenatal screening for the detection and early treatment of new cases.

Resumen: La enfermedad de Chagas (EC) es una patología parasitaria producida por el Tripanosoma cruzi. Constituye, sobre todo su transmisión congénita, un problema de salud pública tanto para territorios endémicos como no endémicos, siendo la principal forma de contagio en Chile. Objetivos: Descri bir un caso de EC congénita y dar a conocer la utilidad del tamizaje prenatal. Caso Clínico: Recién nacida de pretérmino de 29 semanas, hija de madre multípara con antecedente de EC detectado en tamizaje prenatal de embarazo actual. Por el antecedente se realizó PCR de Tripanosoma cruzi a los 4 días de vida que resultó indetectable. A las 6 y 8 semanas de vida, respectivamente, presentó rash máculo eritematoso y cuadro febril asociado a dificultad respiratoria, ambos autolimitados. En fondo de ojo de seguimiento por prematuridad a las 8 semanas de vida, se observaron granulaciones retinales bilaterales por lo que se realizó estudio de TORCH resultando negativo. Simultáneamente a las 8 semanas, por el antecedente materno de EC, se realizó una segunda PCR de Tripanosoma cruzi que resultó positiva. Se informó visualización de tripomastigotes confirmándose el diagnóstico de EC congénita. Se trató con Nifurtimox presentando reacción adversa a los 35 días con neutropenia, regurgitaciones y peso estacionario, por lo que se sustituyó el medicamento por Benznidazol, con lo que completó 60 días de tratamiento. A 22 meses de seguimiento, se mantiene asintomática. Con clusiones: Es necesario aumentar los esfuerzos en la prevención, detección precoz de nuevos casos y estudio de familiares directos, siendo este reporte un ejemplo de la utilidad del tamizaje prenatal para la pesquisa y tratamiento precoz de nuevos casos de EC.

RESUMEN Introducción: La pandemia COVID-19 se inicia en Perú en marzo de 2020. Al parecer la evolución a formas graves de la enfermedad en las embarazadas no es frecuente. Las complicaciones más frecuentes son la rotura prematura de membranas, parto prematuro y sufrimiento fetal. La transmisión vertical no ha sido demostrada. Los estudios nacionales son en su mayoría solo de la primera etapa de la pandemia. Objetivo: determinar las características epidemiológicas, obstétricas y perinatales en gestantes con SARS-CoV-2. Material y métodos: Se realizó un estudio descriptivo en el Hospital Nacional Dos de Mayo. Se admitieron 579 gestantes positivas al SARS-CoV-2 y 533 recién nacidos. Se procedió a la revisión de historias clínicas. Se realizó una estadística descriptiva. El estudio está registrado en PRISA con código EI00002469. Resultados: El SARS-CoV-2. fue detectado por anticuerpos serológicos en 91,0%, y en 8,0% por prueba antigénica. El 94,5% (547/579) de los casos, permanecieron asintomáticas. 19 casos (3,3%) se complican con neumonía COVID-19. En 65,5% no se presentaron complicaciones obstétricas; las más comunes fueron rotura prematura de membranas (9,7%), pre eclampsia (8,2%) e infección del tracto urinario (5,0%). Las características neonatales como edad gestacional, peso al nacer y Apgar, tuvieron en la mayoría resultados dentro de los límites normales. Conclusión: las gestantes con SARS-CoV-2 son asintomáticas en su mayoría, tienen baja frecuencia de complicaciones y los recién nacidos no presentan complicaciones mayores.

ABSTRACT Introduction: The COVID-19 pandemic starts in Peru in March 2020. It appears that progression to severe forms of the disease in pregnant women is infrequent. The most frequent complications are premature rupture of membranes, premature delivery and fetal distress. Vertical transmission has not been demonstrated. National studies are mostly only from the first stage of the pandemic. Objective: determine the epidemiological, obstetric and perinatal characteristics in pregnant women with SARS-CoV-2. Material and methods: A descriptive study was conducted at the Hospital Nacional Dos de Mayo. A total of 579 SARS-CoV-2 positive pregnant women and 533 newborns were admitted. Medical records were reviewed. Descriptive statistics were performed. The study is registered in PRISA with code EI00002469. Results: SARS-CoV-2 was detected by serological antibodies in 91.0% and in 8.0% by antigenic test. Of the cases, 94.5% (547/579) remained asymptomatic. Nineteen cases (3.3%) were complicated by COVID-19 pneumonia. There were no obstetric complications in 65.5%; the most common were premature rupture of membranes (9,7%), preeclampsia (8,2%) and urinary tract infection (5,0%). Neonatal characteristics such as gestational age, birth weight and Apgar were mostly within normal limits. Conclusion: that pregnant women with SARS-CoV-2 are mostly asymptomatic, have a low frequency of complications and the newborns do not present major complications.

Resumen Introducción: se busca cuantificar los retornos de la inversión asociados a una intervención en el sistema público de salud de un municipio de la Provincia de Buenos Aires, Argentina, consistente en el fortalecimiento de la estrategia denominada Eliminación de la Transmisión Maternoinfantil de la Infección por VIH, Sífilis, enfermedad de Chagas Congénita e Infección Perinatal por Hepatitis B (ETMI-PLUS). Metodología: el estudio (cuantitativo) se basa en la metodología de Retorno Social de la Inversión (RSI). Se establecieron definiciones ad-hoc para la medición de los retornos sobre la base de los datos disponibles provenientes de diversas fuentes: información primaria de la Secretaría de Salud del MAB; tasas de transmisión congénita de cada enfermedad notificados al Sistema Nacional de Vigilancia de Salud; presupuestos detallados de los recursos asignados al proyecto por parte de la Fundación Mundo Sano y costos de tratamientos e insumos de nomencladores oficiales. Resultados: por cada peso invertido para reforzar la ETMI-PLUS en el MAB, se obtuvo un retorno de casi 4 pesos, gracias a las mejoras en la eliminación vertical de las cuatro enfermedades y al descenso de las complicaciones cardiacas en las mujeres embarazadas diagnosticadas con chagas y tratadas oportunamente. Conclusiones: estos resultados sugieren la existencia de una relación retorno-inversión favorable, analizada bajo una perspectiva conservadora, ya que, se incluyen exclusivamente los ahorros para el sistema de salud y se excluyen otras dimensiones de los retornos vinculadas con las mejoras en los resultados alcanzados.

Abstract Introduction: we seek to quantify the returns on investment associated with an intervention in the public health system of a Municipality of the Province of Buenos Aires, Argentina. This intervention consists of strengthening the strategy for the Elimination of Mother-to-Child Transmission of HIV Infection, Syphilis, Congenital Chagas Disease and Perinatal Hepatitis B Infection, a strategy called ETMI-PLUS. Methodology: the study (quantitative) is based on the Social Return on Investment (RSI) methodology. Ad-hoc definitions are established for the measurement of returns based on the information available from various sources: primary information from the Ministry of Health of the MAB; rates of congenital transmission of each disease reported to the National Health Surveillance System; detailed budgets of the resources assigned to the project by Fundación Mundo Sano and costs of treatments and supplies from official nomenclators. Results: for each argentinean peso invested in strengthening the ETMI-PLUS in the MAB, a return of almost 4 pesos would have been obtained thanks to the improvements in the vertical elimination of the 4 diseases and the reduction of cardiac complications in pregnant women.Conclusions: these results suggest the existence of a return / investment relationship favorable to the intervention, analyzed under a conservative analysis since savings for the health system are exclusively included and other dimensions of returns associated with improvements in results are excluded.

Resumen Introducción: El SARS-CoV-2 es un Betacoronavirus, así como el SARS-CoV y el MERS-CoV, ambos asociados a abortos espontáneos, parto prematuro, morbi-mortalidad materna y alto número de ingresos a UCI en las gestantes. Además, al ser un virus nuevo, se conoce poco sobre los efectos en la gestación. Esta revisión tiene como objetivo analizar la evidencia disponible sobre el SARS-CoV-2 en la gestación. Materiales y métodos: Se realizó una búsqueda de la literatura en PubMed, ProQuest, Scopus, BVS y SciElo. Se realizó la crítica de la evidencia y la extracción de la información con dos instrumentos propuestos por el Instituto Joanna Briggs. Lo anterior bajo las directrices de PRISMA-ScR. Resultados: Se incluyeron 85 artículos que evidenciaron que la mayoría de gestantes con SARS-CoV-2 desarrollaron enfermedad leve a moderada, pero presentaron mayor riesgo de muerte y complicaciones comparado con las pacientes no embarazadas. Se documentó bajo riesgo de transmisión vertical y los resultados perinatales se asociaron a la severidad del cuadro clínico materno. La efectividad del tratamiento no fue concluyente. Discusión: Se discute la presentación clínica de la infección en las gestantes, la transmisión vertical, el tratamiento, la gravedad de la enfermedad y los desenlaces neonatales. Conclusiones: La COVID-19 en la gestación es una complicación que genera mayor morbimortalidad, por lo que es de vital importancia el desarrollo de más investigaciones que amplíen la comprensión de su comportamiento, las implicaciones fisiológicas, emocionales y el posible tratamiento. Esta revisión hace un análisis riguroso de la calidad de los estudios y aporta información valiosa de la evidencia.

Abstract Introduction: SARS-CoV-2 is a betacoronavirus as well as SARS-CoV and MERS-CoV, both associated with spontaneous miscarriage, preterm birth, maternal morbidity and mortality and a higher number of ICU admissions for pregnant women. Being a new virus, its effects on pregnancy are little known. This review aims to analyze the available evidence on SARS-CoV-2 in pregnancy. Materials and Methods: A literature review was conducted in PubMed, ProQuest, Scopus, BVS and SciElo. Evidence criticism and information extraction were conducted using two instruments from the Joanna Briggs Institute, following the PRISMA-ScR guidelines. Results: 85 articles were included evidencing that most pregnant women with SARS-COV-2 suffered mild to moderate disease and were at a higher risk of death and complications compared to non-pregnant patients. Low risk of vertical transmission was documented and adverse perinatal outcomes were associated with severe maternal clinical manifestations. The effectiveness of treatment was inconclusive. Discussion: Clinical presentation of infection in pregnant women, vertical transmission, treatment, disease severity and neonatal outcomes were discussed. Conclusions: COVID-19 during pregnancy is a complication that generates greater morbidity and mortality, for which it is vital to develop further research on the understanding of the behavior, physiological and emotional implications and possible treatment. This review makes a rigorous analysis of the quality of studies and provides valuable information from evidence.

Resumo Introdujo: O SARS-CoV-2 é um betacoronavírus, assim como o SARS-CoV e o MERS-CoV, ambos associados ao aborto espontaneo, parto prematuro, morbidade e mortalidade materna e alto número de internares na UTI em mulheres grávidas. Além disso, sendo um novo virus, pouco se sabe sobre seus efeitos na gravidez. Esta revisao tem como objetivo analisar as evidencias disponíveis sobre o SARS-CoV-2 na gravidez. Materiais e métodos: Foi realizada uma pesquisa bibliográfica na PubMed, ProQuest, Scopus, BVS e SciElo. A analise crítica das provas e a extragáo de dados foram realizadas utilizando dois instrumentos propostos pelo Instituto Joanna Briggs sob as diretrizes do PRISMA-ScR. Resultados: 85 artigos foram incluidos, mostrando que a maioria das mulheres grávidas com SRA-CoV-2 desenvolveu doenga leve a moderada, mas tinha um risco maior de morte e complicares em comparagáo com pacientes náo grávidas. Baixo risco de transmissáo vertical foi documentado e os resultados perinatais foram associados a gravidade do quadro clínico materno. A eficácia do tratamento foi inconclusiva. Discussao: Apresentagáo clínica da infecgáo em mulheres grávidas, transmissáo vertical, tratamento, gravidade da doenga e resultados neonatais sáo discutidos. Condusdes: A COVID-19 na gravidez é uma complicagáo que gera maior morbidade e mortalidade, portanto, mais pesquisas para expandir a compreensáo de seu comportamento, implicares fisiológicas e emocionais, e o tratamento potencial sáo de vital importancia. Esta revisáo fornece uma análise rigorosa da qualidade dos estudos e informares valiosas a partir das evidencias.

Resumen Introducción: La infección por SARS-CoV-2 (coronavirus tipo 2 del síndrome respiratorio agudo grave) es habitualmente leve en niños, aunque llega a evolucionar de forma grave en algunos casos. Inicialmente surgieron dudas por la transmisión perinatal vertical en madres infectadas, por lo que las primeras recomendaciones fueron muy restrictivas, ya que sugerían la separación madre-hijo. El objetivo de este estudio fue describir el comportamiento clínico de los recién nacidos de madres con infección por SARS-CoV-2 y de los niños ingresados al hospital por COVID-19 (enfermedad por coronavirus 2) Métodos: Se llevó a cabo un estudio descriptivo retrospectivo de pacientes pediátricos hospitalizados entre el 1 de mayo de 2020 y el 30 de abril de 2021 Resultados: Se incluyeron 19 pacientes: el 47.4% eran neonatos hijos de madres infectadas con SARS-CoV-2 (1.63% de los partos) y el 52.6%, pacientes pediátricos de entre 2 meses y 12 años de edad con COVID-19 (3.43% de los ingresos pediátricos). Todos los pacientes presentaron sintomatología leve y permanecieron aislados en la habitación con un familiar. No se constató la transmisión vertical, aunque se detectó una tasa de positividad en el padre del 88.89% Conclusiones: Los ingresos pediátricos por COVID-19 no supusieron sobrecarga asistencial. Ningún paciente desarrolló complicaciones ni precisó tratamiento específico. La incidencia de partos COVID-19 fue baja y no se constató la transmisión vertical. El ingreso con un acompañante facilitó los cuidados pediátricos, lo que resultó favorable para el paciente y para el personal del servicio.

Abstract Background: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is usually mild in children, although it can become severe in some cases. Initially, doubts arose due to vertical perinatal transmission in infected mothers. Therefore, the first recommendations were very restrictive, suggesting mother-newborn separation. This study aimed to describe the clinical behavior of newborns born to mothers with SARS-CoV-2 infection and of children admitted to hospital due to COVID-19 (coronavirus-2 disease). Methods: We conducted a retrospective descriptive study of pediatric patients hospitalized between May 1, 2020, and April 30, 2021 Results: We included 19 patients: 47.4% were neonates born to mothers infected with SARS-CoV-2 (1.63% of deliveries), and 52.6% were pediatric patients aged 2 months to 12 years with confirmed COVID-19 infection (3.43% of all pediatric admissions). All patients presented mild symptomatology and remained isolated with a family member in the room. Vertical transmission was not found, although a positivity rate of 88.89% was detected in fathers Conclusions: Pediatric admissions for COVID-19 did not represent an overload of care. No patient developed complications or required specific treatment. The incidence of COVID-19 deliveries was low, and vertical perinatal transmission was not observed. Admission with a companion facilitated pediatric care, which was favorable for the patient and the healthcare staff.

ABSTRACT Introduction Hepatitis C virus (HCV) can be vertically transmitted from mother to fetus. We evaluated knowledge about HCV vertical transmission in female blood donors who became pregnant following detection of HCV in their donated blood. Methods This was a retrospective descriptive study of females seen at a single blood bank in Sao Paulo, Brazil who were diagnosed with HCV infection in their donated blood. HCV-infected donors who subsequently became pregnant were invited to participate through letters or phone calls. Individuals who agreed to participate were interviewed by questionnaire to evaluate their knowledge on HCV vertical transmission. Results Among 282 HCV-positive female blood donors, 69 reported becoming pregnant after their HCV diagnosis in donated blood. While 24 of these women were successful treated for their infection prior to becoming pregnant, 45 (65.2%) were at risk for vertical HCV transmission either because they had never been treated for HCV, were pregnant before treatment or became pregnant after unsuccessful treatment. Of the 59 women who responded to the question of whether they were informed about the risk of HCV vertical transmission, 58 (98.3%) reported never receiving this information either after obtaining their blood donation results or during their pregnancy. Conclusion The lack of knowledge of HCV-infected women on the possibility for mother-to-child transmission of this virus highlights the critical need to improve communication about pregnancy-related risks between health professionals and HCV-infected women of childbearing age.

Resumen El objetivo del artículo es analizar los imaginarios que se (re) producen en los cursos de preparto de distintas instituciones de la ciudad de La Plata (provincia de Buenos Aires, Argentina), para el periodo comprendido entre el 2013 y el 2019. Siguiendo el esquema de una sociología de la atención médica de embarazos y partos que se basa en la (re) construcción de dos modelos analíticos de atención obstétrica (intervencionista y respetado), se analiza si dichos imaginarios que los cursos producen, abonan a uno u otro modelo o construyen zonas grises. El material empírico se compone de diarios de campo de observaciones con distintos grados de participación en treinta encuentros de seis cursos de preparto distintos; y de registros de entrevistas a mujeres-madres, varones-padres y profesionales de la salud obstétrica. Se analizan los discursos de estos cursos para conocer de qué modos promueven -si lo hacen- el acceso a derechos sexuales y reproductivos y a una atención respetuosa del proceso perinatal o, en otro extremo, si funcionan como dispositivo de transmisión e internalización de normas institucionales y biomédicas. Los cursos de preparto emergen como espacios de encuentro, de intercambio de saberes y experiencias y de (re) producción de imaginarios alrededor de lo normal y lo patológico, lo deseable y lo indeseable, para el tránsito del periodo perinatal, desde la gestación hasta la crianza y el maternaje. Se trata de espacios asistenciales-pedagógicos que adquieren rasgos peculiares según los grupos e instituciones coordinadoras. El desarrollo descriptivo y analítico realizado permitió concluir que en estos espacios se advierten zonas grises, tensiones, expectativas, metodologías y discursos diversos, pero que sigue primando una brecha entre lo que se dice en los cursos y lo que pasa en sala de partos, por la ausencia de líneas de trabajo generales que promuevan la atención obstétrica respetuosa de derechos humanos de las mujeres. Descriptores: autonomización, embarazo, medicina, socialización.

Abstract The objective of the article is to analyze the imaginaries that are (re) produced in the prepartum courses of different institutions in the city of La Plata (province of Buenos Aires, Argentina), for the period 2013-2019. Following the scheme of a sociology of medical care for pregnancies and childbirth that I developed in my doctoral thesis, based on the (re) construction of two analytical models of obstetric care (interventionist and respected), I will analyze whether said imaginary that the courses they produce, pay to one or another model or build gray. The empirical material consists of field diaries of Ig observations with different degrees of participation in 30 meetings of different preparotum courses; and records of interviews with women-mothers, men-fathers, and obstetric health professionals. The discourses of the courses are analyzed to find out in what ways they promote -if they do- access to sexual and reproductive rights and care that is respectful of the perinatal process or, at the other extreme, if they function as a device for the transmission and internalization of institutional and biomedical norms. Prepartum courses emerge as spaces for meeting, exchange of knowledge and experiences and (re) production of imaginaries around the normal and the pathological, the desirable and the undesirable, for the transit of the perinatal period, from pregnancy upbringing and mothering. These are care-pedagogical spaces that acquire peculiar features according to the coordinating groups and institutions. The descriptive and analytical development carried out allowed to conclude that in these spaces there are grays, tensions, expectations, methodologies, and diverse discourses, but that there is a gap between what is said in the courses and what happens in the delivery room, due to the absence of general lines of work that promote obstetric care respectful of women's human rights. Descriptors: autonomization, medicine, pregnancy, socialization.

Resumo O objetivo do artigo é analisar os imaginários que são (re) produzidos nos cursos pré-parto de diferentes instituições da cidade de La Plata (província de Buenos Aires, Argentina), no período entre 2013 e 2019. De acordo com o esquema de uma sociologia da assistência médica à gravidez e ao parto , baseado na (re) construção de dois modelos analíticos de assistência obstétrica (intervencionista e respeitada), analisa-se se esses imaginários, que os cursos produzem, contribuem para um ou outro modelo ou constroem áreas cinzentas. O material empírico consiste em diários de campo de observações com diferentes graus de participação em trinta encontros de seis diferentes cursos pré-parto, bem como registros de entrevistas com mulheres-mães, homens-pais e profissionais de saúde obstétrica. Os discursos dos cursos são analisados para saber de que forma promovem -se o fazem- o acesso aos direitos sexuais e reprodutivos e a cuidados que respeitem o processo perinatal ou, no outro extremo, se funcionam como dispositivo de transmissão e internalização das normas institucionais e biomédicas. Os cursos pré-parto surgem como espaços de encontro, troca de saberes e experiências e (re) produção de imaginários em torno do normal e do patológico, do desejável e do indesejável, para o trânsito do período perinatal, da gravidez para a maternidade. São espaços pedagógico--assistenciais que adquirem características peculiares conforme os grupos e instituições coordenadores. O desenvolvimento descritivo e analítico realizado permitiu concluir que nestes espaços existem zonas cinzentas tensões, expectativas, metodologias e discursos diversos, mas que existe um distanciamento entre o que se fala nos cursos e o que passa na sala de parto, devido à ausência de linhas gerais de trabalho que promovam a assistência obstétrica respeitosa dos direitos humanos da mulher. Descritores: autonomização, gravidez, medicina, socialização.

Abstract: Introduction: Vertical transmission of SARS-CoV-2 from the infected mother to the newborn is still uncertain and the definitive answer is under evaluation. The objective: of this review was to evaluate the evidence available in the literature regarding whether the pregnant woman infected by SARS-CoV-2 represents a potential risk of vertical transmission to the fetus and/or newborn. Material and Method: A scoping review was performed using Science Direct, PubMed, and Cochrane library to search for research papers. Inclusion criteria: published studies of pregnant mothers with COVID-19, with perinatal outcomes reported in the first 72 hours after birth. Results: 569 studies were found; 65 of them were repeated. Therefore, 504 were evaluated, of which 460 were excluded. Finally, 42 research papers that met the inclusion criteria were analyzed. 334 pregnant women with COVID-19 and 335 new borns were described; of which 20 presented SARS-CoV-2 infection confirmed by Polymerase chain reaction (PCR) from nasopharyngeal swab. Of these, 18 were identified in the first 48 hours after birth and 12 presented with symptoms. The most frequent route of delivery was cesarean section in 76.2%, and the gestational age range of the newborns was between 26 and 40 weeks. In 86.8% of the cases, mother-child pairs were isolated. Conclusion: Vertical transmission of COVID-19 is possible, although infrequent. Prospective studies are required to establish the possibility of in utero maternal- fetal transmission and its consequences.

Resumen: Introducción: La transmisión vertical del SARS-CoV-2 de la madre infectada al neonato es una interrogante y la res puesta definitiva está en evaluación. Objetivo: Evaluar la evidencia disponible en la literatura respecto si la embarazada infectada por SARS-CoV-2 significa un riesgo potencial de transmisión vertical para el feto y/o recién nacido. Material y Método: Se realizó una revisión sistemática exploratoria utilizán dose Science Direct, PubMed y Cochrane library para la búsqueda de los trabajos de investigación. Criterios de inclusión: estudios publicados de madres embarazadas con COVID-19 con resultados perinatales informados las primeras 72 horas postnatales. Resultados: Se encontraron 569 estudios; resultando duplicados 65; por lo cual se evaluaron 504, de los cuales se excluyeron 460. Se analiza ron finalmente 42 trabajos de investigación que cumplían criterios de inclusión. Se describen 334 pacientes embarazadas con COVID-19 y 335 recién nacidos, de los cuales 20 presentaron infección por SARS-CoV-2, confirmada por PCR en hisopado nasofaríngeo. De estos, 18 se pesquisaron en las primeras 48 horas postparto y 12 presentaron sintomatología. La vía de parto más frecuente fue la ce sárea en un 76,2%, y el rango de edad gestacional de los recién nacidos fue entre 26 y 40 semanas. En el 86,8% se realizó aislamiento del binomio madre-hijo. Conclusión: La transmisión vertical madre e hijo es posible, aunque infrecuente. Se requieren estudios prospectivos para poder determinar con certeza la posibilidad de la transmisión materno fetal in útero y sus consecuencias.