Abstract This research aimed to estimate the direct costs and analyze the epidemiological aspects of ambulatory care-sensitive conditions (ACSC) in children under one year of age, São Paulo municipality, 2011-2022. Total and average costs were calculated according to ACSC diagnosis groups by components (early neonatal, late neonatal, and post-neonatal). The trend in ACSC rates was analyzed using Prais-Winsten generalized linear regression. 98,679 hospitalizations were identified. There was an annual increase of 10.2% in the ACSC rate of early neonates and in the other components the trend was stationary. The cost for the period was estimated at R$ 130.5 million in <1 year, a reduction of 8.6%. The highest absolute values were related to the most frequent causes, such as lung diseases with 43.7% of the cost in <1 year, 52.5% in late neonates, and 48.8% in post-neonates. In early neonates, 83.5% of the cost was attributed to prenatal-related diseases, especially congenital syphilis. It is concluded that it was possible to identify the costs and characteristics of hospitalizations, showing an increase in ACSC rates and the conditions that require greater attention from primary health care services to reduce hospitalizations and hospital costs in the public sector.

Resumo O objetivo desta pesquisa foi estimar os custos diretos e analisar os aspectos epidemiológicos das Internações por Condições Sensíveis à Atenção Primária (ICSAP) em menores de um ano, município de São Paulo, 2011-2022. Os custos total e médio foram calculados segundo grupos de diagnóstico de ICSAP por componentes (neonatal precoce, tardio e pós-neonatal). Analisou-se a tendência das taxas de ICSAP por meio da regressão linear generalizada de Prais-Winsten. Foram identificadas 98.679 internações. Houve aumento anual de 10,2% na taxa de ICSAP dos neonatos precoces e nos demais componentes a tendência foi estacionária. O custo do período foi estimado em R$ 130,5 milhões em <1 ano, com redução de 8,6%. Os maiores valores absolutos estiveram relacionados às causas mais frequentes, como às Doenças pulmonares com 43,7% do custo em <1 ano, 52,5% nos neonatos tardios e 48,8% nos pós-neonatos. Nos neonatos precoces, 83,5% do custo foi atribuído às Doenças relacionadas ao pré-natal, especialmente à sífilis congênita. Conclui-se que foi possível identificar os custos e características das internações, evidenciando aumento das taxas de ICSAP e as condições que requerem maior atenção dos serviços de saúde primária para reduzir internações e gastos hospitalares no setor público.

Resumen Este artículo tuvo como objetivo estimar los costos directos y analizar los aspectos epidemiológicos de las Hospitalizaciones por Condiciones Sensibles a la Atención Primaria (HCSAP) en niños menores de un año, en São Paulo, Brasil, de 2011 a 2022. Se calcularon los costos totales y promedios según grupos de diagnóstico de HCSAP por componentes (neonatal temprano, tardío y posneonatal). The trend in ACSC rates was analyzed using Prais-Winsten generalized linear regression. Se identificaron 98.679 hospitalizaciones. Hubo un aumento anual del 10,2% en la tasa de HCSAP de recién nacidos tempranos y en los demás componentes la tendencia fue estacionaria. El costo del período se estimó en R$ 130,5 millones en <1 año, una reducción del 8,6%. Los valores absolutos más altos estuvieron relacionados con las causas más frecuentes, como las enfermedades pulmonares con el 43,7% del coste en <1 año, el 52,5% en neonatos tardíos y el 48,8% en posneonatos. El 83,5% del costo se atribuyó a enfermedades relacionadas con la atención prenatal, especialmente la sífilis congénita en los recién nacidos prematuros. Se concluye que fue posible identificar los costos y características de las hospitalizaciones, mostrando un aumento en las tasas de HCSAP y las condiciones que requieren mayor atención por parte de los servicios primarios de salud para reducir las hospitalizaciones y los gastos hospitalarios en el sector público.

Resumo Objetivos: analisar a dinâmica espaço-temporal da prevalência de anomalias congênitas em municípios de Mato Grosso (MT), Centro-Oeste brasileiro, no período de 2008 a 2019. Métodos: estudo ecológico de casos residentes em MT, no período de 2008 a 2019. Utilizou-se a Variação Percentual Anual (VPA) dos coeficientes na análise de tendência, por meio de regressão de Prais-Winsten e identificação de clusters de alto risco. Resultados: a taxa de malformação congênita no estado foi de 6,52 por 1.000 nascidos vivos, apresentando tendência estacionária (VPA= -1,02; IC95%= -2,93-0,93). A maioria das anomalias congênitas apresentou tendência estacionária, exceto do aparelho cardiovascular (VPA=13,58; IC95%= 3,60-24,52). Neonatos com ≤7 pontos do índice de Apgar no primeiro e no quinto minutos de vida, apresentaram tendência crescente (VPA=2,30; IC95%= 0,05-4,60 e VPA=4,15; IC95%= 1,52-6,65, respectivamente). A distribuição espacial teve caráter heterogêneo com as maiores taxas médias de casos entre as macrorregiões de saúde Oeste, Centro-Norte e Sul, e a varredura espaço-temporal identificou três clusters de alto risco entre 2015 e 2019, com RR de até cinco vezes maior para anomalias. Conclusão: as anomalias congênitas em MT apresentaram uma dinâmica heterogênea com áreas de alto risco específicas. A tendência crescente entre fatores maternos e neonatais destaca a necessidade de estratégias regionais de prevenção e controle.

Abstract Objectives: to analyze the spatiotemporal dynamics of the prevalence of congenital anomalies in in cities of Mato Grosso (MT), in the Mid-West of Brazil, from 2008 to 2019. Methods: an ecological study of cases in MT during the period from 2008 to 2019. The Annual Percent Change (APC) of the coefficients was used in the tendency analysis, through Prais-Winsten regression and the identification of high risk clusters. Results: the congenital malformation rate in the State was 6.52 per 1,000 live births, demonstrating a stationary tendency (APC-1.02; 95%CI= -2.93-0.93). Most congenital anomalies showed a stationary tendency, except for those of the cardiovascular system (APC=13.58; 95%CI= 3.60-24.52). Newborns with an Apgar score of ≤ 7 at the first and fifth minutes of life showed an increased tendency (APC=2.30; 95%CI=0.05-4.60 and APC=4.15; 95%CI= 1.52-6.65, respectively). The spatial distribution was heterogeneous, with the highest average rates of cases in the West, Central North, and South health macro-regions. The spatiotemporal scan identified three high risk clusters between 2015 and 2019, with a relative risk (RR) up to five times higher for anomalies. Conclusion: congenital anomalies in MT exhibited a heterogeneous dynamic with specific high risk areas, and their increasing tendency among maternal and neonatal factors highlights the need for regional prevention and control strategies.

RESUMO Objetivo: Descrever dois casos graves de toxoplasmose congênita em crianças nascidas de mães cronicamente infectadas que não receberam orientação sobre a prevenção da toxoplasmose gestacional durante o pré-natal. Descrição do caso: As mães tinham sorologia prévia para toxoplasmose, realizada durante o pré-natal, com IgM não reagente (<10 UI/mL) e IgG reagente (>10 UI/mL) e foram consideradas “imunes” à infecção. Ambos os neonatos nasceram com sequelas da infecção congênita, incluindo alterações neurológicas e oculares. Comentários: O combate à toxoplasmose gestacional em gestantes suscetíveis é um desafio em vários países, especialmente na América do Sul. É necessário diagnosticar e monitorar a toxoplasmose gestacional crônica, pois ela pode ser decorrente de reativação ou reinfecção. Ambas as formas podem causar sequelas e danos irreparáveis aos recém-nascidos. Além disso, é essencial orientar todas as gestantes sobre como evitar o contato com Toxoplasma gondii, independentemente da sorologia.

ABSTRACT Objective: To describe two severe cases of congenital toxoplasmosis in infants born to chronically infected mothers who did not receive education or information on the prevention of gestational toxoplasmosis during prenatal care. Case description: The mothers had a previous serological diagnosis of toxoplasmosis conducted during prenatal care, with non-reactive (<10 IU/mL) IgM and reactive IgG (>10 IU/mL), and were considered “immune” to the infection. Both infants were born with sequelae of the congenital infection, including neurological and ocular alterations. Comments: Managing gestational toxoplasmosis in susceptible pregnant women is a considerable challenge in several countries, especially in South America. It is necessary to diagnose and monitor chronic gestational toxoplasmosis, as it may result from reactivation or reinfection. Both forms can cause sequelae and irreparable damage to newborns. In addition, it is essential to guide all pregnant women on how to avoid contact with Toxoplasma gondii, regardless of their serological status.

RESUMO: A placenta, apesar de ser um órgão temporário, é imprescindível para o desenvolvimento e sobrevivência do concepto. Durante a gestação, desempenha funções essenciais, como nutrição, proteção, circulação, excreção e secreção. Estudos em humanos já detalham medidas placentárias associando-as a desfechos perinatais e a doenças na vida adulta. No entanto, em cadelas, esses estudos ainda são limitados. Portanto, este trabalho tem como objetivo revisar e unificar os principais estudos já publicados sobre a avaliação da placenta de cadelas. Embora diversas formas de avaliação placentária tenham sido descritas, mais estudos sobre este tema, sejam eles macroscópicos ou microscópicos, são necessários para otimizar e priorizar a pesquisa clínica imediata e a longo prazo sobre a condição da placenta e a sua influência sobre os neonatos caninos. RESUMO temporário concepto gestação essenciais nutrição proteção circulação secreção associandoas associando as adulta entanto cadelas limitados Portanto descritas tema microscópicos caninos

ABSTRACT: The placenta, despite being a temporary organ, is essential for the development and survival of the conceptus. During pregnancy, it performs essential functions, such as nutrition, protection, circulation, excretion, and secretion. Studies in humans already detail placental measurements, associating them with perinatal outcomes and diseases in adult life. However, in dogs, these studies are still limited. Therefore, this research aimed to review and unify the main studies already published on the evaluation of the placenta in bitches. Although, several forms of placental assessment have been described, more studies on this topic, whether macroscopic or microscopic, are needed to optimize and prioritize immediate and long-term clinical research into the condition of the placenta and its influence on canine neonates. ABSTRACT organ conceptus pregnancy functions nutrition protection circulation excretion secretion measurements life However dogs limited Therefore bitches Although described topic microscopic longterm long term neonates

RESUMO Objetivo: Verificar a utilização e identificar as vantagens dos métodos moleculares para diagnóstico de infecções congênitas no líquido cefalorraquidiano de neonatos. Fontes de dados: A revisão foi registrada na base PROSPERO (International Prospective Register of Systematic Reviews) sob CRD42021274210. A busca bibliográfica foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde/ Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BVS/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, e EBSCOhost. A busca foi feita no período de agosto a outubro de 2021 e atualizada em dezembro de 2022, respeitando as orientações do Preferred Reporting Items for Systematic Reviews e Meta-Analyises (PRISMA). A sequência da seleção dos estudos foi: 1) Remoção de duplicatas; 2) Exame de títulos e resumos; 3) Recuperação dos textos completos potencialmente relevantes; e 4) Avaliação do texto completo conforme critérios de elegibilidade por dois autores independentes. O critério de inclusão considerou ensaios clínicos randomizados e não randomizados, estudos longitudinais, transversais, revisados por pares, estudos em humanos, publicados em inglês, espanhol, italiano e português, com recém-nascidos de até 28 dias que sofreram neuroinfecções congênitas pelos agentes toxoplasmose, rubéola, citomegalovírus, herpes simples (TORCH), e outros como Treponema pallidum, Zika, parvovírus B-19, varicela zoster, Epstein-Barr, e SARS-CoV-2, diagnosticadas por reação em cadeia de polimerase (PCR). Dois avaliadores extraíram as seguintes informações: autor, ano de publicação, nacionalidade, sujeitos, tipo de estudo, métodos, resultados e conclusão. Síntese dos dados: O patógeno mais estudado foi Herpes Simples. Muitos artigos relataram somente sintomas iniciais inespecíficos, motivando a coleta de líquido cefalorraquidiano e realização da PCR para investigação etiológica. Conclusões: Os métodos moleculares são eficazes para detectar o genoma do patógeno no líquido cefalorraquidiano, o que pode impactar na evolução clínica e no prognóstico neurológico. Objetivo neonatos International CRD42021274210 CRD PubMed LatinoAmericano Latino Americano BVS/BIREME, BVSBIREME BVS/BIREME , BVS BIREME (BVS/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyises Meta Analyises PRISMA. PRISMA . (PRISMA) 1 duplicatas 2 resumos 3 relevantes 4 independentes longitudinais transversais pares humanos inglês espanhol português recémnascidos recém nascidos toxoplasmose rubéola citomegalovírus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV 2, SARS-CoV-2 PCR. (PCR) informações autor publicação nacionalidade sujeitos estudo conclusão Simples inespecíficos etiológica Conclusões neurológico CRD4202127421 (BVS/BIREME (EMBASE 20 (PRISMA (TORCH B1 B-1 SARS-CoV- (PCR CRD420212742 B- SARS-CoV CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Objective: To verify the use and identify advantages of molecular methods for congenital infections diagnosis in cerebrospinal fluid of neonates. Data source: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under CRD42021274210. The literature search was performed in databases: PubMed, Virtual Health Library/ Latin American and Caribbean Center on Health Sciences Information (VHL/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, and EBSCOhost. The search was carried out from August to October 2021 and updated in December 2022, respecting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The selection sequence was: 1) Duplicate title removal; 2) Examination of titles and abstracts; 3) Full-text retrieval of potentially relevant reports; and 4) Evaluation of the full text according to eligibility criteria by two independent authors. Inclusion criteria considered randomized and non-randomized control trials, longitudinal, cross-sectional, and peer-reviewed studies in humans, published in English, Spanish, Italian, and Portuguese, with newborns up to 28 days old who had congenital neuroinfections by toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH), and others such as Treponema pallidum, Zika, parvovirus B-19, varicella zoster, Epstein-Barr, and SARS-CoV2, diagnosed by polymerase chain reaction (PCR). Two evaluators extracted the following information: author, year of publication, nationality, subjects, study type, methods, results, and conclusion. Data synthesis: The most studied pathogen was herpes simplex. Several articles reported only nonspecific initial symptoms, motivating the collection of cerebrospinal fluid and performing PCR for etiological investigation. Conclusions: Molecular methods are effective to detect pathogen genomes in cerebrospinal fluid, which can impact clinical evolution and neurological prognosis. Objective neonates source PROSPERO, PROSPERO , (PROSPERO) CRD42021274210 CRD databases PubMed Library VHL/BIREME, VHLBIREME VHL/BIREME VHL BIREME (VHL/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyses Meta Analyses PRISMA (PRISMA guidelines 1 removal 2 abstracts 3 Fulltext Full reports 4 authors nonrandomized non trials longitudinal crosssectional, crosssectional cross sectional, sectional cross-sectional peerreviewed peer reviewed humans English Spanish Italian Portuguese toxoplasmosis rubella cytomegalovirus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV2, CoV2 CoV SARS-CoV2 PCR. . (PCR) information author publication nationality subjects type results conclusion synthesis symptoms investigation Conclusions prognosis (PROSPERO CRD4202127421 (VHL/BIREME (EMBASE 20 (TORCH B1 B-1 SARS-CoV (PCR CRD420212742 B- CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

Resumo O objetivo desta pesquisa foi estimar os custos diretos e analisar os aspectos epidemiológicos das Internações por Condições Sensíveis à Atenção Primária (ICSAP) em menores de um ano, município de São Paulo, 2011-2022. Os custos total e médio foram calculados segundo grupos de diagnóstico de ICSAP por componentes (neonatal precoce, tardio e pós-neonatal). Analisou-se a tendência das taxas de ICSAP por meio da regressão linear generalizada de Prais-Winsten. Foram identificadas 98.679 internações. Houve aumento anual de 10,2% na taxa de ICSAP dos neonatos precoces e nos demais componentes a tendência foi estacionária. O custo do período foi estimado em R$ 130,5 milhões em <1 ano, com redução de 8,6%. Os maiores valores absolutos estiveram relacionados às causas mais frequentes, como às Doenças pulmonares com 43,7% do custo em <1 ano, 52,5% nos neonatos tardios e 48,8% nos pós-neonatos. Nos neonatos precoces, 83,5% do custo foi atribuído às Doenças relacionadas ao pré-natal, especialmente à sífilis congênita. Conclui-se que foi possível identificar os custos e características das internações, evidenciando aumento das taxas de ICSAP e as condições que requerem maior atenção dos serviços de saúde primária para reduzir internações e gastos hospitalares no setor público.

Resumen Este artículo tuvo como objetivo estimar los costos directos y analizar los aspectos epidemiológicos de las Hospitalizaciones por Condiciones Sensibles a la Atención Primaria (HCSAP) en niños menores de un año, en São Paulo, Brasil, de 2011 a 2022. Se calcularon los costos totales y promedios según grupos de diagnóstico de HCSAP por componentes (neonatal temprano, tardío y posneonatal). The trend in ACSC rates was analyzed using Prais-Winsten generalized linear regression. Se identificaron 98.679 hospitalizaciones. Hubo un aumento anual del 10,2% en la tasa de HCSAP de recién nacidos tempranos y en los demás componentes la tendencia fue estacionaria. El costo del período se estimó en R$ 130,5 millones en <1 año, una reducción del 8,6%. Los valores absolutos más altos estuvieron relacionados con las causas más frecuentes, como las enfermedades pulmonares con el 43,7% del coste en <1 año, el 52,5% en neonatos tardíos y el 48,8% en posneonatos. El 83,5% del costo se atribuyó a enfermedades relacionadas con la atención prenatal, especialmente la sífilis congénita en los recién nacidos prematuros. Se concluye que fue posible identificar los costos y características de las hospitalizaciones, mostrando un aumento en las tasas de HCSAP y las condiciones que requieren mayor atención por parte de los servicios primarios de salud para reducir las hospitalizaciones y los gastos hospitalarios en el sector público.

Abstract This research aimed to estimate the direct costs and analyze the epidemiological aspects of ambulatory care-sensitive conditions (ACSC) in children under one year of age, São Paulo municipality, 2011-2022. Total and average costs were calculated according to ACSC diagnosis groups by components (early neonatal, late neonatal, and post-neonatal). The trend in ACSC rates was analyzed using Prais-Winsten generalized linear regression. 98,679 hospitalizations were identified. There was an annual increase of 10.2% in the ACSC rate of early neonates and in the other components the trend was stationary. The cost for the period was estimated at R$ 130.5 million in <1 year, a reduction of 8.6%. The highest absolute values were related to the most frequent causes, such as lung diseases with 43.7% of the cost in <1 year, 52.5% in late neonates, and 48.8% in post-neonates. In early neonates, 83.5% of the cost was attributed to prenatal-related diseases, especially congenital syphilis. It is concluded that it was possible to identify the costs and characteristics of hospitalizations, showing an increase in ACSC rates and the conditions that require greater attention from primary health care services to reduce hospitalizations and hospital costs in the public sector.

Resumen A pesar de los beneficios bien conocidos de la anestesia raquídea (AR), esta técnica sigue siendo subutilizada entre los anestesiólogos pediátricos. De acuerdo con los datos de la Red Regional de Anestesia Pediátrica, la AR representó menos del 5% de todas las técnicas neuroaxiales. Algunos de los factores a los que se atribuye dicha subutilización son: su duración limitada, la falta de familiaridad con la técnica en niños de menor edad, y la preferencia del anestesiólogo por la anestesia general. El uso seguro y exitoso de la AR en niños implica el claro conocimiento de las diferencias anatómicas y fisiológicas entre adultos y niños, en virtud de las diferencias en las estructuras óseas, el crecimiento de la médula espinal y la fisiología del líquido cefalorraquídeo. Los reportes sobre el uso exitoso de la AR en niños para diferentes cirugías ha aumentado. La presente revisión educativa resumen la información conocida sobre AR en niños, revisiones de la literatura de la última década y ofrece sugerencias para el desarrollo de la AR en población pediátrica. Se discuten consideraciones técnicas, el papel de la ecografía, orientación sobre la dosificación, los efectos fisiológicos, aspectos no explicados del mecanismo de acción y la combinación de anestesia raquídea/caudal.

Abstract Despite the well-known benefits of spinal anesthesia (SA), this technique remains underutilized among pediatric anesthesiologists. According to the data from the Pediatric Regional Anesthesia Network, SA accounted for less than 5% of all neuraxial techniques. Some of the factors for underutilization of SA include: Limited duration, unfamiliarity with the technique in younger children, and surgeon preference for general anesthesia. The safe and successful use of SA in children involves recognition of anatomical and physiological differences between adults and children owing to differences in bony structures, spinal cord growth and cerebrospinal fluid physiology. Reports on successful use of SA in children for various surgeries have increased. This educational review summarizes what is known about SA in children, reviews the literature from the last decade and provides suggestions for development of SA in children. Technical considerations, role of ultrasound, guidance on dosing, physiological effects, unexplained aspects of the mechanism of action and combined caudal/SA are discussed.

RESUMEN Introducción: La bacteriemia asociada a dispositivos intravasculares en neonatos con patología quirúrgica abdominal constituye una de las infecciones nosocomiales más frecuentes. Objetivo: Determinar la frecuencia de bacteriemias relacionadas a dispositivos vasculares en neonatos con patología quirúrgica gastrointestinal en un servicio de neonatología entre 2019- 2021. Materiales y métodos: Estudio observacional, retrospectivo. Muestra constituida por fichas clínicas de pacientes con patologías quirúrgicas seleccionadas (atresia esofágica, atresia intestinal, gastrosquisis, onfalocele, malformación anorrectal, enfermedad de Hirschsprung), expuestos a dispositivos intravasculares que presentaron bacteriemia. Se utilizó estadística descriptiva. Resultados: Se incluyeron 99 neonatos, 17 presentaron bacteriemias, (total 29 eventos de bacteriemias relacionada a catéteres). 53% de sexo masculino, media del peso al nacer: 2615 g (1500 a 3550 g); media de edad gestacional: 36,5 semanas. La atresia intestinal fue la malformación congénita más frecuente (35.2%). Entre los factores de riesgo asociados, el 47% de los pacientes requirieron 2 o más cirugías mayores; el tiempo medio de ARM varió de 2 a 104 días (media 23.8 días); 100% recibieron NPT, 52.9% por >28 días. Los dispositivos vasculares centralizados fueron utilizados por >28 días en el 52.9 % de los casos, (media 54,5 días). El tiempo de estancia hospitalaria fue >28 días en el 88.2% y la letalidad fue del 47%. El total de días de uso de catéter fue: 2350. Se identificaron 29 infecciones asociadas al uso de los catéteres, siendo la tasa de incidencia de 12,3 por 1000 días de exposición de catéter venoso central y 29% por paciente expuesto. Los agentes etiológicos más frecuentes fueron: Staphylococcus coagulasa negativo (62%), K. pneumoniae 17,2% y C. albicans 10,4%. Conclusión: La bacteriemia asociada a dispositivos vasculares en RN con patologías quirúrgicas gastrointestinales presentó elevada incidencia. Se deben implementar y supervisar medidas estratégicas de prevención que permitan mejorar el pronóstico y calidad de vida a estos pacientes.

ABSTRACT Introduction: Bacteremia associated with intravascular devices in neonates with abdominal surgical pathology is one of the most frequent nosocomial infections. Objective: To determine the frequency of bacteremia related to vascular devices in neonates with gastrointestinal surgical pathology in a neonatology service between 2019-2021. Materials and methods: Observational, retrospective study. Sample consisting of clinical records of patients with selected surgical pathologies (esophageal atresia, intestinal atresia, gastroschisis, omphalocele, anorectal malformation, Hirschsprung disease), exposed to intravascular devices who presented bacteremia. Descriptive statistics were used. Results: 99 neonates were included, 17 presented bacteremia, (total 29 events of catheter-related bacteremia). 53% male, mean birth weight: 2615 g (1500 to 3550 g); Mean gestational age: 36.5 weeks. Intestinal atresia was the most frequent congenital malformation (35.2%). Among the associated risk factors, 47% of patients required 2 or more major surgeries; the mean time of MRV varied from 2 to 104 days (mean 23.8 days); 100% received TPN, 52.9% for >28 days. Centralized vascular devices were used for >28 days in 52.9% of cases (mean 54.5 days). The length of hospital stay was >28 days in 88.2% and the fatality rate was 47%. The total number of days of catheter use was: 2350. Twenty-nine infections associated with the use of catheters were identified, with an incidence rate of 12.3 per 1000 days of central venous catheter exposure and 29% per exposed patient. The most frequent etiologic agents were: coagulase-negative Staphylococcus (62%), K. pneumoniae 17.2% and C. albicans 10.4%. Conclusion: Bacteremia associated with vascular devices in newborns with gastrointestinal surgical pathologies presented a high incidence. Strategic prevention measures should be implemented and monitored to improve the prognosis and quality of life of these patients.

Abstract Topiramate is a new-generation pharmacological agent, used to treat partial and tonic-clonic epileptic seizures in adults and children, alone or in combination with other drugs, and as a prophylaxis of the migraine. It also can be used in the treatment of some pathologies such as alcoholism, obesity and bipolar disorder. In the last years, several cases of congenital malformations and restrictions in the intrauterine growth in fetuses of mothers exposed to topiramate have been published. We expose a clinic case of an amyelia of superior members in a fetus of a mother treated with topiramate during the first trimester of the pregnancy, with no other possible causes related.

Resumen El topiramato es un agente farmacológico antiepiléptico de nueva generación, empleado para el tratamiento de crisis parciales y tónico-clónicas primarias en adultos y niños, en monoterapia o en combinación con otros fármacos, y como profilaxis de la migraña en adultos, así como para el alcoholismo, la obesidad y el trastorno bipolar, entre otros. En los últimos años se han publicado numerosos casos de malformaciones congénitas y retraso de crecimiento intrauterino en neonatos de madres expuestas a este fármaco durante la gestación. Se presenta el caso de un feto con agenesia de ambos miembros superiores en una madre expuesta a topiramato durante el primer trimestre, sin otros factores asociados ni otro posible agente causal detectado.

Abstract: There is evidence of the benefits that breastfeeding (BF) provides to full-term and premature newborns who are hospitalized. In the latter, maintaining BF during and after hospitalization is difficult. Objective: To determine the factors associated with BF cessation in preterm infants one month after discharge from a neonatology unit. Patients and Method: Historical cohort of 218 newborns from the Very Low Birth Weight Newborn Follow-up Program of the Hospital Base Valdivia, hospitalized between January 2016 and June 2022 and who maintained BF at discharge. Biodemographic and clinical data were collected from available records and their relationship with BF cessation was evaluated one month after discharge. Results: One month after discharge, 35.8% of the infants abandoned BF (N = 78). The bivariate analysis highlighted a significantly lower median gestational age and lower mean birth weight in those who abandoned BF. Neonates born to married mothers, with a shorter median hospital stay and without requiring invasive mechanical ventilation had a lower proportion of BF abandonment. In the adjusted analysis, the educational level of maternal higher education was significantly associated with a lower probability of abandoning BF (adjusted OR: 0.3; 95% CI 0.11 - 0.85). Conclusions: One month after discharge, over a third of the children stopped BF which was significantly associated with the mother’s educational level. Support and educational interventions during hospitalization must consider the mother’s educational background.

Resumen: Existe evidencia de los beneficios que la lactancia materna (LM) provee tanto a recién nacidos de término como prematuros que están hospitalizados. En estos últimos, mantener la lactancia durante y luego de la hospitalización es difícil. Objetivo: Determinar los factores asociados al abandono de la LM en prematuros un mes post alta de un servicio de neonatología. Pacientes y Método: Cohorte histórica de 218 recién nacidos pertenecientes al Programa de Seguimiento del Recién Nacido de Muy Bajo Peso de Nacimiento del Hospital Base Valdivia, hospitalizados en el periodo enero 2016 - junio 2022 y que mantenían LM al alta. Desde registros disponibles se extrajeron datos biodemográficos y clínicos y se evaluó su relación con el abandono de la lactancia un mes post alta. Resultados: Un mes post alta 35,8% de los niños abandonó la LM (N = 78). En el análisis bivariado destacó una edad gestacional mediana y peso de nacimiento medio significativamente menor en quienes abandonaron la LM. Neonatos de madres casadas, con menor estancia hospitalaria mediana y sin requerimiento de ventilación mecánica invasiva presentaron menor proporción de abandono de LM. En el análisis ajustado, el nivel educativo de educación superior materna se asoció significativamente a menor probabilidad de abandono de la LM (OR ajustado: 0,3; IC95% 0,11 - 0,85). Conclusiones: Al mes post alta más de un tercio de los niños abandonó la lactancia y se asoció significativamente al nivel educativo materno. Intervenciones de acompañamiento y educación durante la hospitalización deben considerar el nivel educacional de las madres.

Abstract Background: The objective of early identification of pregnant women living with HIV is to reduce mother-to-child transmission (MTCT) of HIV. In Colombia, despite the strategies implemented, new cases of infected children still occur. Aim: To characterize newborns exposed to maternal HIV in three reference hospital centers in Cucuta, Colombia; a city with a high prevalence of migrant care. Methods: A retrospective observational study was conducted between 2017-2020 in 3 different medical centers. We included 29 pregnant women with confirmed diagnosis of HIV infection, 34.4% of Venezuelan nationality. Results: In 3/32 exposed neonates HIV were diagnosed with an annual MTCT rate (2017-2020) calculated in the study population of 0%, 14.2%, 8.3%, and 25%, respectively, figures higher than the Pan American Health Organization (PAHO) target (≤ 2%). Absence/deficiency in prenatal controls (55.3%), absence and/or failure of antiretroviral treatment during gestation and late maternal diagnosis (62%) were the main risk factors identified for HIV MTCT. Discussion: The exposed data evidence the public health impact of the increase in the number of pregnant women with HIV/AIDS in the region, taking into account the implications of pediatric HIV. It is imperative to reinforce prevention strategies, diagnosis and early maternal and neonatal treatment, with a special focus on migrant pregnant women.

Resumen Introducción: El objetivo de la identificación temprana de mujeres gestantes viviendo con VIH es la disminución de la transmisión materno infantil (TMI) del virus. En Colombia, pese a las estrategias implementadas, todavía ocurren casos nuevos de niños infectados. Objetivo: Caracterizar a los recién nacidos expuestos al VIH materno en tres centros hospitalarios de referencia en Cúcuta, Colombia; ciudad con alta prevalencia de atención al migrante. Pacientes y Métodos: Se realizó un estudio observacional retrospectivo, comprendido entre 2017-2020 en tres centros hospitalarios de la ciudad. Se incluyeron 29 mujeres gestantes con diagnóstico confirmado de infección por VIH, 34,4% de procedencia venezolana. Resultados: En 3/32 neonatos expuestos, se diagnosticó infección por VIH, con una tasa de TMI anual (2017-2020) calculada en la población estudio de 0%, 14,2%, 8,3% y 25%, respectivamente, cifras mayores a la meta de la Organización Panamericana de la Salud (OPS) (< 2%). La ausencia/deficiencia en los controles prenatales (55,3%), ausencia y/o falla en el tratamiento antirretroviral durante la gestación y el diagnóstico materno tardío (62%) fueron los principales factores de riesgo identificados para TMI del VIH. Discusión: Los datos expuestos evidencian el impacto en materia de salud pública respecto al aumento de casos de mujeres gestantes con infección por VIH/SIDA en la región, teniendo en cuenta las implicaciones de esta infección en pediatría. Es imperativo reforzar las estrategias de prevención, diagnóstico y tratamiento materno y neonatal temprano con enfoque especial en mujeres gestantes migrantes.

RESUMEN Introducción: La prematuridad es un problema de salud pública por su alta morbimortalidad. Las principales causas de mortalidad en prematuros son infecciones asociadas. En Perú, el porcentaje de nacimientos prematuros aumentó de 6.4 %, en 2020; a 7.5 %, en 2023, con un promedio de 30 000 prematuros anuales. En el Instituto Nacional Materno Perinatal (INMP), de todas las muertes neonatales para 2023, 70 % correspondieron a prematuros y 46.5 %, a los que tenían menos de 1500 g. Objetivo: Determinar el efecto protector de la calostroterapia en prematuros de muy bajo peso al nacer en el INMP. Métodos: Se realizó un estudio observacional, analítico, longitudinal, de tipo cohorte retrospectiva. Se trabajó con 462 prematuros de muy bajo peso al nacer, dividido en dos grupos a razón de 1:1 para expuestos y no expuestos a la calostroterapia. Para evaluar su efecto protector, se plantearon tres modelos de estudio: Modelo 1 que es enterocolitis necrotizante; modelo 2, ventilación mecánica y modelo 3, mortalidad. Se trabajó con un modelo de regresión de Poisson bivariado y multivariado para estimar el riesgo relativo crudo y ajustado con sus respectivos intervalos de confianza al 95 %. Resultados: En el análisis multivariado, se evidenció que la calostroterapia actúa como factor protector para enterocolitis necrotizante (1.73 % vs. 7.79 %, RRa: 0.298, IC95 %: 0.1-0.91) y mortalidad (12.98% vs. 42.86%, RRa 0.494, IC95%: 0.32-0.76), a diferencia del requerimiento de ventiloterapia que no mostró asociación significativa (62.77 % vs 75.32 %, RRa 0.92, IC95 % 0.72-1.2). Conclusiones: La calostroterapia es un factor protector para la enterocolitis necrotizante y mortalidad en neonatos prematuros con muy bajo peso al nacer.

ABSTRACT Background: Prematurity is a public health problem due to its high morbidity and mortality. The main causes of mortality in premature infants are associated infections. In Peru, the percentage of premature births increased from 6.4% in 2020 to 7.5% in 2023, with an average of 30,000 premature babies annually. At the Instituto Nacional Materno Perinatal (INMP), of all neonatal deaths by 2023, 70% corresponded to premature babies and 46.5% to those less than 1500 g. Objective : To determine the protective effect of colostrum therapy in very low birth weight premature infants at the INMP. Methods : An observational, analytical, longitudinal retrospective, cohort study was carried out. We worked with 462 premature babies with very low birth weight, divided into two groups at a ratio of 1:1 for those exposed and not exposed to colostrum therapy. To evaluate its protective effect, three study models were proposed: Model 1, which is necrotizing enterocolitis; model 2, mechanical ventilation and model 3, mortality. A bivariate and multivariate Poisson regression model was used to estimate the crude and adjusted relative risk with their respective 95% confidence intervals. Results: The multivariate analysis showed that colostrum therapy acts as a protective factor for necrotizing enterocolitis (1.73 % vs 7.79 %, RRa: 0.298, 95 %CI: 0.1-0.91) and mortality (12.98% vs 42.86 %, RRa 0.494, 95 %CI: 0.32-0.76); in contrast, the requirement for ventilation therapy did not show a significant association (62.77 % vs 75.32%, RRa 0.92, 95%CI: 0.72-1.2). Conclusions: Colostrum therapy is a protective factor for necrotizing enterocolitis and mortality in premature neonates of very low birth weight.

Abstract: Parenteral nutrition is a high-risk therapy due to some of its components and the exceptional inclusion of drugs. It can contain more than 50 nutrients, with different characteristics of osmolarity, ionic charge, and pH, which can affect its physicochemical stability. In addition, environmental conditions such as light, temperature, and oxygen must be considered. Their prescription and administration represent a challenge for the healthcare team, especially in the pediatric and neonatal setting, due to factors such as the state of metabolic immaturity and greater susceptibility to oxidative damage. This group also requires smaller volumes with higher concentrations of nutrients, which complicates its preparation and risks of incompatibility/interactions. The objective of this article is to review current concepts of parenteral nutrition according to the criteria of the Scale for the Assessment of Narrative Review Articles (SANRA), to make recommendations on physicochemical stability according to clinical relevance. It describes how environmental conditions and inputs can affect the stability of the mixture and provides recommendations and values to reduce the risks of instability, including amino acids, lipids, cations, anions, and different calcium and phosphate salts. Given the variability in the reproduction of the same mixture due to clinical conditions and inputs, this subject constitutes an open area for research due to the methodological diversity used in the reports. Finally, the recommendations from the pediatric/neonatal sphere are the strictest in the literature, so they are valid for adults.

Resumen: La nutrición parenteral es una terapia de alto riesgo debido a algunos de sus componentes, y a la inclusión excepcional de fármacos. Puede contener más de 50 nutrientes, con diferentes características de osmolaridad, carga iónica y pH, lo que puede afectar su estabilidad fisicoquímica. Además se deben considerar las condiciones ambientales como la luz, temperatura y el oxígeno. Su prescripción y administración representa un desafío para el equipo de salud, especialmente en el ámbito pediátrico y neonatal, debido a factores como el estado de inmadurez metabólica y la mayor susceptibilidad a daño oxidativo. Este grupo también requiere de menores volúmenes con mayor concentración de nutrientes, lo cual complejiza su elaboración y riesgos de incompatibilidad/interacciones. El objetivo de este estudio es realizar una revisión bajo los criterios de Scale for the Assessment of Narrative Review Articles (SANRA), para hacer recomendaciones de estabilidad fisicoquímica según relevancia clínica. Se describe como las condiciones ambientales e insumos pueden afectar la estabilidad de la mezcla, se entregan recomendaciones y valores para disminuir los riesgos de inestabilidad, que incluye aminoácidos, lípidos, cationes, aniones y diferentes sales de calcio y fósforo. Dada la variabilidad en la reproducción de la misma mezcla debido a las condiciones clínicas y los insumos, este campo constituye un área abierta a la investigación por la diversidad metodológica empleada en los reportes. Finalmente, las recomendaciones del ámbito pediátrico/neonatal son las más estrictas de la literatura, por lo que son válidas para adultos.

Abstract: Hemodynamically significant patent ductus arteriosus (hs-PDA) in very low birth weight (VLBW) infants continues to be an issue of research regarding the timing of treatment and which would be the most appropriate drug. Objective: To assess the outcome of prolonged treatment with paracetamol in the closure of hemodynamically significant patent ductus arteriosus in preterm newborns. Patients and Method: Retrospective study in VLBW infants with echocardiographic and clinical diagnosis of hs-PDA who received treatment with intravenous paracetamol at 15 mg/kg every 6 hours for 6 days. At the end of treatment, control echocardiography was performed. To evaluate possible side effects, biochemical tests were performed before and after treatment. Results: 62 VLBW infants with average weight and gestational age ± SD of 1,094 ± 257 g and 27,9 ± 2,1 weeks, respectively, were evaluated. At the beginning of the treatment, the mean ± SD ductal size was 2,2 ± 0,5mm. The ductal closure rate with the first cycle of treatment was 69.4% (43/62) and with the second cycle, it increased to 87,1% (54/62). Surgical closure was required in 9,7% of the neonates (6/62). An increase in the incidence of retinopathy of prematurity and acute kidney injury was observed in preterm infants whose hs-PDA did not close with the first cycle of paracetamol. Biochemical tests after the treatment showed a significant decrease in creatinine and an increase in platelet count (p < 0,05). Conclusion: In VLBW infants with hs-PDA, prolonged treatment with intravenous paracetamol does not increase the ductal closure rate compared with the usual 3-day treatment.

Resumen: El Ductus arterioso persistente hemodinámicamente significativo (DAP-hs) en recién nacidos de muy bajo peso al nacer (RNMBPN) continúa siendo motivo de investigación respecto al momento de tratar y cuál sería el fármaco más adecuado. Objetivo: Evaluar el resultado del tratamiento prolongado con paracetamol en el cierre del ductus arterioso persistente hemodinámicamente significativo en recién nacidos prematuros. Pacientes y Método: Estudio retrospectivo, en RNMBPN con diagnóstico ecocardiográfico y clínico de DAP-hs que recibieron tratamiento con paracetamol endovenoso a 15mg/kg cada 6 horas durante 6 días. Al término del tratamiento se realizó ecocardiografia de control. Para la evaluación de posibles efectos secundarios se realizaron exámenes bioquímicos previo y posterior al tratamiento. Resultados: Se evaluaron 62 RNMBPN con peso y edad gestacional promedio ± DE 1.094 ± 257 g y 27,9 ± 2,1 semanas respectivamente. Al inicio del tratamiento, el tamaño ductal promedio ± DE fue de 2,2 ± 0,5 mm. La tasa de cierre ductal con el primer curso de tratamiento fue de 69,4% (43/62), y con el segundo curso aumentó a 87,1% (54/62). Requirieron cierre quirúrgico 9,7% de los neonatos (6/62). En los prematuros cuyo DAP-hs no cerró con el primer ciclo de paracetamol se observó un aumento en la incidencia de retinopatia del prematuro e injuria renal aguda. Los exámenes bioquímicos al término del tratamiento mostraron descenso significativo de la creatinina y ascenso del recuento plaquetario (p < 0,05). Conclusión: En RNMBPN con DAP-hs el tratamiento prolongado con paracetamol endovenoso no incrementa la tasa de cierre ductal respecto al tratamiento habitual de 3 días.

Resumen Introducción: El baclofeno es un agonista de los receptores GABA en el sistema nervioso central (SNC), cuyo efecto es la disminución de la espasticidad. La dosis utilizada en la terapia por bomba intratecal de baclofeno es de hasta 100 veces menor que por vía oral. Existen reportes de síndrome de abstinencia en neonatos expuestos a baclofeno en el útero. Presentación del caso: Se presenta el caso de una paciente de 31 años con antecedente de espasticidad secundaria a hipoxia neonatal en manejo con bomba intratecal de baclofeno desde el año 2012, quien en el 2023 cursó con embarazo. La paciente presentó cesárea a las 37+2 semanas de gestación, bajo anestesia general y sin complicaciones con desenlaces materno-fetales favorables. Discusión: Es necesario evaluar la seguridad del uso de tecnologías como bombas intratecales en el embarazo, ya que en este caso y con el uso de baclofeno se encontraron múltiples interrogantes dada la ausencia de estudios aleatorizados, así como su posible efecto teratogénico en el feto y el posible síndrome de abstinencia sobre el neonato. El presente caso clínico reporta el uso de esta tecnología con desenlace materno-fetales favorables y lo compara con los casos hallados en la literatura, encontrando además posibles efectos secundarios relacionados. Conclusiones: La información hasta la fecha parece demostrar que el uso de baclofeno vía intratecal durante el embarazo es completamente seguro, dadas sus bajas concentraciones en plasma.

Abstract Introduction: Baclofen is an agonist of GABA receptors in the central nervous system (CNS) whose effect is to reduce spasticity. The dose used in intrathecal baclofen pump therapy is up to 100 times lower than oral. There are reports of withdrawal syndrome in neonates exposed to baclofen in utero. Case presentation: The case of a 31-year-old patient with a history of spasticity secondary to neonatal hypoxia being managed with an intrathecal baclofen pump since 2012 is presented, who in 2023 had a pregnancy, cesarean section at 37+2 weeks of gestation under general anesthesia with no complications with favorable maternal-fetal outcomes. Discussion: It is necessary to evaluate the safety of the use of technologies such as intrathecal pumps in pregnancy, in this case with the use of baclofen with which we found multiple questions given the absence of randomized studies such as its possible teratogenic effect on the fetus and the possible syndrome of abstinence on the neonate, the present clinical case reports the use of this technology with favorable maternal-fetal outcomes and compares it with the cases reported in the literature, also finding possible related side effects. Conclusions: The information to date seems to demonstrate that the use of baclofen intrathecally during pregnancy is completely safe given its low plasma concentrations.