RESUMO
BACKGROUND: In early 2023, when Omicron was the variant of concern, we showed that vaccinating pregnant women decreased the risk for severe COVID-19-related complications and maternal morbidity and mortality. OBJECTIVE: This study aimed to analyze the impact of COVID-19 during pregnancy on newborns and the effects of maternal COVID-19 vaccination on neonatal outcomes when Omicron was the variant of concern. STUDY DESIGN: INTERCOVID-2022 was a large, prospective, observational study, conducted in 40 hospitals across 18 countries, from November 27, 2021 (the day after the World Health Organization declared Omicron the variant of concern) to June 30, 2022, to assess the effect of COVID-19 in pregnancy on maternal and neonatal outcomes and to assess vaccine effectiveness. Women diagnosed with laboratory-confirmed COVID-19 during pregnancy were compared with 2 nondiagnosed, unmatched women recruited concomitantly and consecutively during pregnancy or at delivery. Mother-newborn dyads were followed until hospital discharge. The primary outcomes were a neonatal positive test for COVID-19, severe neonatal morbidity index, severe perinatal morbidity and mortality index, preterm birth, neonatal death, referral to neonatal intensive care unit, and diseases during the neonatal period. Vaccine effectiveness was estimated with adjustment for maternal risk profile. RESULTS: We enrolled 4707 neonates born to 1577 (33.5%) mothers diagnosed with COVID-19 and 3130 (66.5%) nondiagnosed mothers. Among the diagnosed mothers, 642 (40.7%) were not vaccinated, 147 (9.3%) were partially vaccinated, 551 (34.9%) were completely vaccinated, and 237 (15.0%) also had a booster vaccine. Neonates of booster-vaccinated mothers had less than half (relative risk, 0.46; 95% confidence interval, 0.23-0.91) the risk of being diagnosed with COVID-19 when compared with those of unvaccinated mothers; they also had the lowest rates of preterm birth, medically indicated preterm birth, respiratory distress syndrome, and number of days in the neonatal intensive care unit. Newborns of unvaccinated mothers had double the risk for neonatal death (relative risk, 2.06; 95% confidence interval, 1.06-4.00) when compared with those of nondiagnosed mothers. Vaccination was not associated with any congenital malformations. Although all vaccines provided protection against neonatal test positivity, newborns of booster-vaccinated mothers had the highest vaccine effectiveness (64%; 95% confidence interval, 10%-86%). Vaccine effectiveness was not as high for messenger RNA vaccines only. Vaccine effectiveness against moderate or severe neonatal outcomes was much lower, namely 13% in the booster-vaccinated group (all vaccines) and 25% and 28% in the completely and booster-vaccinated groups, respectively (messenger RNA vaccines only). Vaccines were fairly effective in protecting neonates when given to pregnant women ≤100 days (14 weeks) before birth; thereafter, the risk increased and was much higher after 200 days (29 weeks). Finally, none of the neonatal practices studied, including skin-to-skin contact and direct breastfeeding, increased the risk for infecting newborns. CONCLUSION: When Omicron was the variant of concern, newborns of unvaccinated mothers had an increased risk for neonatal death. Neonates of vaccinated mothers had a decreased risk for preterm birth and adverse neonatal outcomes. Because the protective effect of COVID-19 vaccination decreases with time, to ensure that newborns are maximally protected against COVID-19, mothers should receive a vaccine or booster dose no more than 14 weeks before the expected date of delivery.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Complicações Infecciosas na Gravidez , SARS-CoV-2 , Humanos , Feminino , Gravidez , COVID-19/prevenção & controle , COVID-19/epidemiologia , Recém-Nascido , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Estudos Prospectivos , SARS-CoV-2/imunologia , Vacinação , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Eficácia de VacinasRESUMO
Introducción. En los últimos años, creció la evidencia sobre la efectividad de la inclusión de los padres o las parejas en las intervenciones que promueven la lactancia para mejorar las tasas de iniciación, duración y exclusividad. Objetivos. Identificar perspectivas y valoraciones sobre la lactancia en las parejas de las personas que amamantan, y generar información que permita la creación de intervenciones apropiadas que favorezcan la incorporación de los padres en los espacios de cuidado y en el sostén de la lactancia. Materiales y métodos. Estudio cualitativo, con diseño de teoría fundamentada. Se realizaron 4 grupos de enfoque con padres. Los datos fueron procesados definiendo unidades de análisis por flujo libre, codificadas en dos planos, una codificación abierta, en categorías que emergieron y la agrupación de las categorías en cinco temas principales. Resultados. Participaron 16 padres. Se identificaron 5 temas principales: conocimiento de los padres sobre la lactancia, sentimientos frente a la lactancia, participación de la pareja en la lactancia, construcción de la idea de paternidad, lactancia en la sociedad. La lactancia recibió una valoración positiva. Si bien se consensuó una responsabilidad familiar compartida en su sostén, no se identificaron acciones suficientes de coparticipación. Los participantes manifestaron el deseo de ejercer una paternidad más comprometida, sin embargo, relataron que los entornos laborales no acompañan estas transformaciones. Conclusión. Se evidenciaron valoraciones positivas hacia la lactancia, conocimientos adecuados y preocupación por las dificultades. Se asumió una responsabilidad compartida en su sostén, pero faltaron en los relatos la mención de acciones concretas de coparticipación.
Introduction. The evidence about the effectiveness of fathers' or partners' involvement in breastfeeding interventions to promote initiation, duration, and exclusiveness rates has increased in recent years. Objectives. To identify the perspectives and assessments of breastfeeding among partners of breastfeeding women and develop information to create adequate interventions that favor the inclusion of fathers in care spaces and in the support of breastfeeding. Materials and methods. Qualitative study with a grounded theory design. Four focus groups were held with fathers. Data were processed defining free flow analysis units, coded in 2 levels, an open code, with emerging categories, and such categories grouped into 5 main topics. Results. A total of 16 fathers participated. Five main topics were identified: fathers' knowledge about breastfeeding, feelings towards breastfeeding, partner's involvement in breastfeeding, development of the concept of fatherhood, breastfeeding in society. Breastfeeding was positively assessed. Although breastfeeding support was considered a shared family responsibility, there were not enough co-participation actions identified. Participants expressed their desire to play a more involved fatherhood role; however, they stated that these transformations are not supported at workplaces. Conclusion. The evidence showed a positive assessment of breastfeeding, adequate knowledge, and concern about difficulties. Breastfeeding support was considered a shared responsibility, but not enough specific co-participation actions were mentioned.
Assuntos
Humanos , Masculino , Feminino , Adulto , Aleitamento Materno , Pai , Gravidez , Pesquisa Qualitativa , Ingestão de Alimentos , EmoçõesRESUMO
INTRODUCTION: Introduction. The evidence about the effectiveness of fathers' or partners' involvement in breastfeeding interventions to promote initiation, duration, and exclusiveness rates has increased in recent years. OBJECTIVES: To identify the perspectives and assessments of breastfeeding among partners of breastfeeding women and develop information to create adequate interventions that favor the inclusion of fathers in care spaces and in the support of breastfeeding. MATERIAL AND METHODS: Qualitative study with a grounded theory design. Four focus groups were held with fathers. Data were processed defining free flow analysis units, coded in 2 levels, an open code, with emerging categories, and such categories grouped into 5 main topics. RESULTS: A total of 16 fathers participated. Five main topics were identified: fathers' knowledge about breastfeeding, feelings towards breastfeeding, partner's involvement in breastfeeding, development of the concept of fatherhood, breastfeeding in society. Breastfeeding was positively assessed. Although breastfeeding support was considered a shared family responsibility, there were not enough co-participation actions identified. Participants expressed their desire to play a more involved fatherhood role; however, they stated that these transformations are not supported at workplaces. CONCLUSIONS: The evidence showed a positive assessment of breastfeeding, adequate knowledge, and concern about difficulties. Breastfeeding support was considered a shared responsibility, but not enough specific coparticipation actions were mentioned.
Introducción. En los últimos años, creció la evidencia sobre la efectividad de la inclusión de los padres o las parejas en las intervenciones que promueven la lactancia para mejorar las tasas de iniciación, duración y exclusividad. Objetivos. Identificar perspectivas y valoraciones sobre la lactancia en las parejas de las personas que amamantan, y generar información que permita la creación de intervenciones apropiadas que favorezcan la incorporación de los padres en los espacios de cuidado y en el sostén de la lactancia. Materiales y métodos. Estudio cualitativo, con diseño de teoría fundamentada. Se realizaron 4 grupos de enfoque con padres. Los datos fueron procesados definiendo unidades de análisis por flujo libre, codificadas en dos planos, una codificación abierta, en categorías que emergieron y la agrupación de las categorías en cinco temas principales. Resultados. Participaron 16 padres. Se identificaron 5 temas principales: conocimiento de los padres sobre la lactancia, sentimientos frente a la lactancia, participación de la pareja en la lactancia, construcción de la idea de paternidad, lactancia en la sociedad. La lactancia recibió una valoración positiva. Si bien se consensuó una responsabilidad familiar compartida en su sostén, no se identificaron acciones suficientes de coparticipación. Los participantes manifestaron el deseo de ejercer una paternidad más comprometida, sin embargo, relataron que los entornos laborales no acompañan estas transformaciones. Conclusión. Se evidenciaron valoraciones positivas hacia la lactancia, conocimientos adecuados y preocupación por las dificultades. Se asumió una responsabilidad compartida en su sostén, pero faltaron en los relatos la mención de acciones concretas de coparticipación.
Assuntos
Aleitamento Materno , Pai , Ingestão de Alimentos , Emoções , Feminino , Humanos , Masculino , Gravidez , Pesquisa QualitativaRESUMO
Nutrition in early stages of life is one of the most influential environmental factors for the good development of organs and systems and the wellbeing of the child. Epigenetic mechanisms can explain how prenatal and postnatal nutrition affects genes expression with the subsequent risk of immune and metabolic diseases. The objective of this paper is to update the knowledge of the role the nutritional status and dietary practices of pregnant women and the child's feeding patterns over the first year of life have in the risk of future diseases.
Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente , Estado Nutricional , Fenômenos Fisiológicos da Nutrição Pré-Natal , Feminino , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Gravidez , Fatores de TempoRESUMO
The composition of human milk is the main base for the development of infant formulas concerning its macronutrients and micronutrients contents and bioactive compounds. Technological advances in the composition of human milk have identified a great number of bioactive compounds such as prebiotics which are responsible for immunological protection and the prevention of different pathologies. In order to achieve similar benefits, they are part of the contents of infant formulas.
Assuntos
Alimentos Infantis , Leite Humano , Prebióticos , Humanos , Alimentos Infantis/análise , Recém-Nascido , Leite Humano/química , Prebióticos/análiseRESUMO
La composición de la leche materna es la base principal para el desarrollo de fórmulas infantiles en cuanto a su contenido de macronutrientes, micronutrientes y compuestos bioactivos. Los avances tecnológicos en el conocimiento de la composición de la leche materna han permitido identificar un gran número de componentes bioactivos, como los prebióticos, responsables de la protección inmunológica y de la prevención de diferentes patologías, lo cual ha llevado a su incorporación en las fórmulas infantiles para lograr beneficios similares.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Proteção da Criança , Imunidade , Intestinos , Leite Humano , OligossacarídeosRESUMO
La composición de la leche materna es la base principal para el desarrollo de fórmulas infantiles en cuanto a su contenido de macronutrientes, micronutrientes y compuestos bioactivos. Los avances tecnológicos en el conocimiento de la composición de la leche materna han permitido identificar un gran número de componentes bioactivos, como los prebióticos, responsables de la protección inmunológica y de la prevención de diferentes patologías, lo cual ha llevado a su incorporación en las fórmulas infantiles para lograr beneficios similares.(AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Leite Humano , Oligossacarídeos , Imunidade , Intestinos , Saúde da CriançaRESUMO
BACKGROUND/PURPOSE: Perinatal testicular torsion (PTT) is defined as testicular torsion occurring prenatally or within the first 30 days of life. The aim of this study was to evaluate the data obtained from patients with PTT and propose principles of management based on clinical, surgical, and histologic findings. METHODS: A retrospective analysis of 27 boys seen between 1990 and 2005 with surgically documented PTT was conducted. Patients were divided into 2 groups: A, prenatal testicular torsion; B, postnatal testicular torsion. The presence of acute scrotal inflammatory signs defined the urgency to operate. RESULTS: There were 4 clinical pictures in group A: A1, patients with a nubbin testis (n = 3); A2, patients with a small and hard testis (n = 12); A3, patients with a normal-sized and hard testis (n = 8); and A4, patients with an acute scrotum (n = 2). Group B (n = 2) presented no sign after birth and later developed an acute scrotum. Surgical exploration and histologic examination showed clear signs of a long-standing testicular torsion in groups A1, A2, and A3 or a recent-onset testicular torsion in groups A4 and B. Only one testis could be salvaged (group B). CONCLUSIONS: Clinical signs correlated very well with surgical and histologic findings and can define the need and the urgency to operate. Although testicular salvage rate is very low, the affected side always should be explored to confirm the diagnosis and to fix or remove the affected testicle. The contralateral scrotum also should be explored because of the risk of asynchronous contralateral testicular torsion.
Assuntos
Torção do Cordão Espermático/cirurgia , Humanos , Recém-Nascido , Masculino , Torção do Cordão Espermático/congênito , Torção do Cordão Espermático/diagnósticoRESUMO
Con el objetivo de valorar los efectos del tratamiento como rescate de un surfactante natural modificado producido en la República Argentina,entre el 1-8-1990 y el 31-7-1991,40 recíen nacidos prematuros(RNPret)con diagnóstico de EMH severa y en asistencia respiratoria mecánica(ARM)recibieron por instilación endotraqueal una dosis de 90 mg/Kg en las primeras 24 horas de vida,repitiéndose hasta 3 dosis adicionales dentro de las 48 horas según requerimientos de ARM y oxígeno.De 17 RNPret con pn menor a 1.00 g fallecieron 10(59 por ciento)de causas asociadas a la EMH y otros 5 de causas no relacionadas.De los 23 RNPret con PN superior a 1.000 g la sobrevida fue del 100 por ciento.Siete pacientes(17,5 por ciento) presentaron una o más formas de escape de aire extraalveolar(4 neumotórax y 4 enfisemas intersticiales pulmonares)Tres RNPret,todos con PN inferior a 1.200 g,desarrollaron displasia broncopulmonar.Si bien fue un estudio no controlado,comprobamos que la administración de este surfactante tuvo efectos inmediatos beneficiosos que hacen suponer se debieron al tratamiento instaurado.No se observaron efectos perjudiciales atribuibles al tratamiento
Assuntos
Recém-Nascido , Doença da Membrana Hialina/terapia , Recém-Nascido Prematuro , Surfactantes Pulmonares/administração & dosagem , PediatriaRESUMO
Con el objetivo de valorar los efectos del tratamiento como rescate de un surfactante natural modificado producido en la República Argentina,entre el 1-8-1990 y el 31-7-1991,40 recíen nacidos prematuros(RNPret)con diagnóstico de EMH severa y en asistencia respiratoria mecánica(ARM)recibieron por instilación endotraqueal una dosis de 90 mg/Kg en las primeras 24 horas de vida,repitiéndose hasta 3 dosis adicionales dentro de las 48 horas según requerimientos de ARM y oxígeno.De 17 RNPret con pn menor a 1.00 g fallecieron 10(59 por ciento)de causas asociadas a la EMH y otros 5 de causas no relacionadas.De los 23 RNPret con PN superior a 1.000 g la sobrevida fue del 100 por ciento.Siete pacientes(17,5 por ciento) presentaron una o más formas de escape de aire extraalveolar(4 neumotórax y 4 enfisemas intersticiales pulmonares)Tres RNPret,todos con PN inferior a 1.200 g,desarrollaron displasia broncopulmonar.Si bien fue un estudio no controlado,comprobamos que la administración de este surfactante tuvo efectos inmediatos beneficiosos que hacen suponer se debieron al tratamiento instaurado.No se observaron efectos perjudiciales atribuibles al tratamiento