RESUMO
BACKGROUND: Congenital anomalies are the fifth most common cause of neonatal mortality in Nicaragua, and neural tube defects (NTDs) are the most common of all cases of lethality associated with a birth defect. Prevalence and mortality estimates are needed to propose effective intervention strategies that prevent NTDs over time. METHODS: A cross-sectional study was carried out in northwestern Nicaragua from January 2006 to December 2018. All cases of NTDs (anencephaly, spina bifida, and encephalocele) were registered in hospital surveillance systems, and the medical histories of the mothers and newborns were reviewed. Prevalence was calculated by considering the number of live births and stillbirths older than 20 weeks of gestation with NTDs, divided by the total number of live births and stillbirths in each study year. Neonatal mortality rate (NMR) for NTD, and case fatality for spina bifida was calculated. RESULTS: Two hundred fifty cases of NTDs were identified from 178,498 deliveries (177,316 live births and 1,182 stillbirths). The prevalence of NTDs during this time period was 14.01 (95% CI: 12.27-15.74) per 10,000 births. The prevalence of spina bifida (n = 140), anencephaly (n = 97), and encephalocele (n = 13) was 7.84, (95% CI: 6.54-9.14), 5.43 (95% CI: 4.30-6.45), and 0.73 (95% CI: 0.33-1.12) per 10,000 births, respectively. Mothers with fetus or newborns affected with NTDs did not use folic acid prior to conception, and 11% experienced periods of hyperthermia during the first trimester of pregnancy. NMR for NTDs was 0.55 per 1.000 livebirths. Case fatality for all NTDs and for spina bifida were 55% and 18%, respectively. CONCLUSION: The prevalence and mortality of NTDs in the northwestern region of Nicaragua present peaks and troughs during the study period. Spina bifida was the most frequent type of NTD. We believe that these findings could be of use by health policy makers to strengthen the primary prevention of NTDs in the region through the monitoring of the food fortification policy and folic acid supplementation to women of childbearing age. Additional etiologic studies of NTDs should be considered to identify additional prevention measures.
Assuntos
Anencefalia , Defeitos do Tubo Neural , Disrafismo Espinal , Gravidez , Feminino , Recém-Nascido , Humanos , Anencefalia/epidemiologia , Anencefalia/prevenção & controle , Encefalocele/epidemiologia , Natimorto , Prevalência , Estudos Transversais , Nicarágua/epidemiologia , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , Disrafismo Espinal/epidemiologia , Disrafismo Espinal/prevenção & controle , Ácido FólicoRESUMO
El obejtivo de estudio es describir características clínicas y e pidemiológicas, de los niños y niñas con infeccion de vias urinarias, incluyendo patron de resistencia de los microorganismos aislados, en el Departamento de Pediatría del Hospital Escuela Dr. Oscar Danilo Rosales, Junio 2002- Enero 2004. Se realizo un estudio descriptivo de serie de casos, a cerca de la Epidemiologia de las infecciones de Vias Urinarias y Patron de resistencia antibiótica, en 130 niños que acudieron al Hospital Escuela Dr. Oscar DaniloRosales durante el periodo de Junio 2002 a enero 2004 Fueron incluidos los niños y niñas con datos clínicos sugestivos de infección de vías urinarias y losniños menores de dos años con fiebre sin foco infeccioso aparente Se tomo como criterio de exclusión el uso de antibióticos durante la última semana. El 20 pOrciento de los niños con datos clinicos de infeccion de vias urinarias mostro crecimiento bacteriano El grupo de edad mas afectado fueron los lactantes. En el grupo menor de un año, las infecciones de vias urinarias fueron mas frecuentes en el sexo masculino y en el resto de grupos etereos hubo un claro incremento en el sexo femenino a medida se incrementaba en edad, con una relacion H M1 6 La fiebre fue la manifestacion clinica predominante en todos los grupos de edad, presentando ademas manifestaciones uretrovesicales en los preescolares y escolares Las bacterias aisladas con mayor frecuencia fueron la seguida de E.coli seguida de Enterobacter sps y Kllsiellas las cuales mostraron alta resistencia a laampicilina y al TMP/SMZ, siendo sensibles a ceftriaxone, ciprofloxacina, gentamicina y nitrofurantoina