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Background: Mother-to-child HIV transmission (MTCT) has substantially declined since the scale-up of prevention programs around the world, including Rwanda. To achieve full elimination of MTCT, it is important to understand the risk factors associated with residual HIV transmission, defined as MTCT at the population-level that still occurs despite universal access to PMTCT.Methods: We performed a case control study of children born from mothers with HIV with known vital status at 18 months from birth, who were followed in three national cohorts between October and December 2013, 2014, and 2015 in Rwanda. Children with HIV were matched in a ratio of 1:2 with HIV-uninfected children and a conditional logistic regression model was used to investigate risk factors for MTCT.Results: In total, 84 children with HIV were identified and matched with 164 non-infected children. The median age of mothers from both groups was 29 years (interquartile range (IQR): 24-33). Of these mothers, 126 (51.4 %) initiated antiretroviral therapy (ART) before their pregnancy on record. In a multivariable regression analysis, initiation of ART in the third trimester (Adjusted Odds Ratio [aOR]: 9.25; 95 % Confidence Interval [95 % CI]: 2.12-40.38) and during labour or post-partum (aOR: 8.87; 95 % CI: 1.92-40.88), compared to initiation of ART before pregnancy, increased the risk of MTCT. Similarly, offspring of single mothers (aOR: 7.15; 95 % CI: 1.15-44.21), and absence of postpartum neonatal ART prophylaxis (aOR: 7.26; 95 % CI: 1.66-31.59) were factors significantly associated with MTCT.Conclusions: Late ART initiation for PMTCT and lack of postpartum infant prophylaxis are still the most important risk factors to explain MTCT in the era of universal access. Improved early attendance at antenatal care, early ART initiation, and enhancing the continuum of care especially for single mothers is crucial for MTCT elimination in Rwanda. [ABSTRACT FROM AUTHOR]

The article focuses on the diagnosis of congenital syphilis and syphilis among females of reproductive age in Chicago, Illinois from 2015 to 2022. Topics include the impact of enhanced efforts by the Chicago Department of Public Health to eliminate congenital syphilis, increase in cases during the COVID-19 pandemic, and shift in missed prevention opportunities, with a particular emphasis on inadequate maternal treatment and late identification of seroconversion during pregnancy.

Background In Japan, congenital syphilis (CS) notifications have increased recently. However, little is known about the CS cases or the clinical and sociodemographic characteristics of the patients' mothers.Methods: Twelve cases of CS were reported through national surveillance in the period March-December 2016, and the mothers of seven patients were included in this study. The patients' mothers and physicians completed a self-administered questionnaire, providing sociodemographic and clinical information of the patients and their mothers. In addition, we explored the awareness and knowledge of, attitudes towards and practices regarding CS occurrence through semistructured interviews with the mothers.Results: Of the seven CS patients, three were asymptomatic, with a range of non-specific clinical manifestations in the rest. The mothers tended to be of young age, unmarried and to have a history of commercial sex work, other sexually transmissible infections (STIs) and no or irregular prenatal care visits during pregnancy. Of the four mothers who had had regular prenatal care visits, two had tested negative for syphilis at the first trimester antenatal screening. Themes emerged that indicated challenges in preventing CS, including a lack of guidance or guidelines for physicians to consider testing for syphilis after the first trimester, lack of physicians' awareness or experience of syphilis or CS and a lack of awareness or knowledge in pregnant women regarding STIs.Conclusions: Key characteristics of recent CS patients and their mothers in Japan were revealed, identifying previously reported factors as well as new challenges. A holistic approach, designed to address challenges at the level of the healthcare system, healthcare provider and the pregnant woman and her partner will be important in preventing CS. [ABSTRACT FROM AUTHOR]

Once believed to be a rare disease in developed countries, recent data suggest that there is a surge in incidence of congenital syphilis in many developed countries. Diagnosis of congenital syphilis can be difficult because more than two-thirds of affected infants are asymptomatic at birth, and signs of symptomatic infants may be nonspecific or subtle. On top of this, some affected infants may have atypical presentations. Familiarity with the diverse presentations is essential to diagnosis. We report a 2-week-old male infant with congenital syphilis whose cutaneous manifestations included diffuse, erythematous keratoderma with desquamation and fissures on his hands and feet, multiple linear scaly fissures at the angles of his mouth, and onychauxis of the fingernails and toenails To our knowledge, diffuse, erythematous keratoderma of the hands and feet and thick nails have not been reported previously in congenital syphilis. [ABSTRACT FROM AUTHOR]

Background: The recent scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has rapidly accelerated antiretroviral therapy (ART) uptake among pregnant and postpartum women in sub-Saharan Africa. The Mother and Infant Retention for Health (MIR4Health) study evaluates the impact of a combination intervention administered by trained lay health workers to decrease attrition among HIV-positive women initiating PMTCT services and their infants through 6 months postpartum.Methods: This was a qualitative study nested within the MIR4Health trial. MIR4Health was conducted at 10 health facilities in Nyanza, Kenya from September 2013 to September 2015. The trial intervention addressed behavioral, social, and structural barriers to PMTCT retention and included: appointment reminders via text and phone calls, follow-up and tracking for missed clinic visits, PMTCT health education at home visits and during clinic visits, and retention and adherence support and counseling. All interventions were administered by lay health workers. We describe results of a nested small qualitative inquiry which conducted two focus groups to assess the experiences and perceptions of lay health workers administering the interventions. Discussions were recorded and simultaneously transcribed and translated into English. Data were analyzed using framework analysis approach.Results: Study findings show lay health workers played a critical role supporting mothers in PMTCT services across a range of behavioral, social, and structural domains, including improved communication and contact, health education, peer support, and patient advocacy and assistance. Findings also identified barriers to the uptake and implementation of the interventions, such as concerns about privacy and stigma, and the limitations of the healthcare system including healthcare worker attitudes. Overall, study findings indicate that lay health workers found the interventions to be feasible, acceptable, and well received by clients.Conclusions: Lay health workers played a fundamental role in supporting mothers engaged in PMTCT services and provided valuable feedback on the implementation of PMTCT interventions. Future interventions must include strategies to ensure client privacy, decrease stigma within communities, and address the practical limitations of health systems. This study adds important insight to the growing body of research on lay health worker experiences in HIV and PMTCT care.Trial Registration: Clinicaltrials.gov NCT01962220 . [ABSTRACT FROM AUTHOR]

Background: Neonatal infection constitutes one of Senegal's most important public health problems, with a mortality rate of 41 deaths per 1,000 live births. Methods: Between January 2007 and March 2008, 242 neonates with suspected infection were recruited at three neonatal intensive care units in three major tertiary care centers in Dakar, the capital of Senegal. Neonatal infections were confirmed by positive bacterial blood or cerebrospinal fluid culture. The microbiological pattern of neonatal infections and the antibiotic susceptibility of the isolates were characterized. In addition, the genetic basis for antibiotic resistance and the genetic background of third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae were studied. Results: A bacteriological infection was confirmed in 36.4 % (88/242) of neonates: 22.7 % (30/132) during the early-onset and 52.7 % (58/110) during the late-onset periods (p > 0.20). Group B streptococci accounted for 6.8 % of the 88 collected bacterial isolates, while most of them were Enterobacteriaceae (n = 69, 78.4 %). Of these, 55/69 (79.7 %) were 3GC-R. The blaCTX-M-15 allele, the blaSHV and the blaTEM were highly prevalent (63.5, 65.4 and 53.8 %, respectively), usually associated with qnr genes (65.4 %). Clonally related strains of 3GC-R Klebsiella pneumoniae and 3GC-R Enterobacter cloacae, the two most commonly recovered 3GC-R Enterobacteriaceae (48/55), were detected at the three hospitals, underlining the role of cross-transmission in their spread. The overall case fatality rate was 18.6 %. Conclusions:Measures should be taken to prevent nosocomial infections and the selection of resistant bacteria. [ABSTRACT FROM AUTHOR]

Background: Success in prevention of mother-to-child transmission (PMTCT) raises the prospect of eliminating pediatric HIV infection. To achieve global elimination, however, strategies are needed to strengthen PMTCT interventions. This study aimed to determine PMTCT outcomes and identify challenges facing its successful implementation in a rural setting in Kenya.Methods: A retrospective cohort design was used. Routine demographic and clinical data for infants and mothers enrolling for PMTCT care at a rural hospital in Kenya were analysed. Cox and logistic regression were used to determine factors associated with retention and vertical transmission respectively.Results: Between 2006 and 2012, 1338 infants were enrolled and followed up for PMTCT care with earlier age of enrollment and improved retention observed over time. Mother to child transmission of HIV declined from 19.4 % in 2006 to 8.9 % in 2012 (non-parametric test for trend p = 0.024). From 2009 to 2012, enrolling for care after 6 months of age, adjusted Odds Ratio [aOR]: 23.3 [95 % confidence interval (CI): 8.3-65.4], presence of malnutrition ([aOR]: 2.3 [95 % CI: 1.1-5.2]) and lack of maternal use of highly active antiretroviral therapy (HAART) (aOR: 6.5 [95 % CI: 1.4-29.4]) was associated with increased risk of HIV infection. Infant's older age at enrollment, malnutrition and maternal HAART status, were also associated with drop out from care. Infants who were not actively followed up were more likely to drop out from care (adjusted Hazard Ratio: 6.6 [95 % CI: 2.9-14.6]).Discussion: We report a temporal increase in the proportion of infants enrolling for PMTCT care before 3 months of age, improved retention in PMTCT and a significant reduction in the proportion of infants enrolled who became HIV-infected, emphasizing the benefits of PMTCT.Conclusion: A simple set of risk factors at enrollment can identify mother-infant pairs most at risk of infection or drop out for targeted intervention. [ABSTRACT FROM AUTHOR]

Statistically, 90% of the pregnant women who are also infected with Toxoplasma gondii do not show any symptoms. During the parasitemia that is consecutive to the primary site of infection, the parasite disseminates to the placenta through blood, so the infection can be transmitted to the fetus through the placenta. Most of the times, the routine examination of the newborns, does not show the usual signs of congenital toxoplasmosis. The study aims to determine the frequency of cases of congenital toxoplasmosis, to assess the health of babies and children from mothers with acute infection, and also to illustrate the consequences of the infection with Toxoplasma gondii on the offspring and to correlate them with the gestational age. This prospective study was conducted on a total sample of 152 pregnant women who were hospitalized and investigated in "Elena Doamna" Iasi Clinic of Obstetrics and Gynaecology. In the period of time between 2001 and 2014 we identified a number of 108 children (69%) showing a damage of the central nervous system (CNS) and 44 children (28%) with generalized manifestation of the disease. The mortality rate recorded in these children was 12%, without any significant differences between those with CNS damage and those with generalized disease (p<0.05). About 85% of the survivors developed mental retardation, 75% convulsions, spasticity, paralysis and 50% impaired vision. More than 80% of these children have an IQ < 70, most of them showing convulsions and severely impaired vision. The cutaneous manifestations of congenital toxoplasmosis include: rash, petechiae, bruising or massive hemorrhage secondary to thrombocytopenia. Also present in other congenital infections, the consequences on the offspring will be all the more severe as the transmission of the parasite toxoplasma infection from the pregnant woman to the foetus occurs earlier in pregnancy. [ABSTRACT FROM AUTHOR]

Background Despite a high burden of staphylococcal skin disease in children and high incidence of Staphylococcus aureus bacteremia in adult Indigenous populations in northern Australia, there are few studies describing incidence or clinical information of invasive S aureus (ISA) infections in children. Methods We conducted a retrospective review for all cases of S aureus bacteremia and sterile site infections, for children under 15 years, in northern Australia over a 4-year period (2007–2010). Cases were categorized as neonatal (<28 days) and pediatric (≥28 days). Results Forty-four cases (9 neonatal, 35 pediatric) were identified. The annual incidence of ISA was 27.9 cases per 100 000 population. Among pediatric cases, the annual incidence was significantly higher in the Indigenous (46.6) compared with the non-Indigenous (4.4) population (IRR: 10.6 [95% confidence interval, 3.8–41.4]). Pediatric infections were predominantly community-associated (86%). Clinical infection sites included osteoarticular (66%), pleuropulmonary (29%), and endocarditis (9%), and multifocal disease was common (20%). Eighty-three percent of pediatric cases presented with sepsis; 34% resulted in intensive care admission. Neonatal cases were all born prematurely; 89% were late-onset infections. Overall, 27% of infections were due to methicillin-resistant S aureus (MRSA). Compared with methicillin-sensitive S aureus (MSSA), there was no difference in severity or presentation in pediatric MRSA cases, but a higher proportion of MRSA cases were readmitted. Conclusions The annual incidence of ISA infection in this study is among the highest described, largely due to a disproportionate burden in Indigenous children. Infections are frequently severe and infection with MRSA is common. Children presenting with suspected ISA in this region should be treated empirically for MRSA. [ABSTRACT FROM PUBLISHER]

Background: The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement interventions. Over a period of six months, five experienced maternal-child health managers and researchers iteratively adapted and tested this systems analysis tool for pMTCT services. They prioritized components of the pMTCT cascade for inclusion, disseminated multiple versions to 27 health managers and piloted it in five facilities. Process mapping techniques were used to chart PMTCT cascade steps in these five facilities, to document antenatal care attendance, HIV testing and counseling, provision of prophylactic anti-retrovirals, safe delivery, safe infant feeding, infant follow-up including HIV testing, and family planning, in order to obtain site-specific knowledge of service delivery. Results: Seven pMTCT cascade steps were included in the Excel-based final tool. Prevalence calculations were incorporated as sub-headings under relevant steps. Cells not requiring data inputs were locked, wording was simplified and stepwise drop-offs and maximization functions were included at key steps along the cascade. While the drop off function allows health workers to rapidly assess how many patients were lost at each step, the maximization function details the additional people served if only one step improves to 100% capacity while others stay constant. Conclusions: Our experience suggests that adaptation of a cascade analysis tool for facility-level pMTCT services is feasible and appropriate as a starting point for discussions of where to implement improvement strategies. The resulting tool facilitates the engagement of frontline health workers and managers who fill out, interpret, apply the tool, and then follow up with quality improvement activities. Research on adoption, interpretation, and sustainability of this pMTCT cascade analysis tool by frontline health managers is needed. [ABSTRACT FROM AUTHOR]

Updated pooled estimates of vertical hepatitis C (HCV) infection risk to children of HCV RNA–positive mothers ranges between 5.8% and 10.8%, depending on maternal HIV coinfection. Additional risk factors need to be captured and reported by future studies.Background. We conducted a systematic review of estimates of hepatitis C virus (HCV) vertical transmission risk to update current estimates published more than a decade ago.Methods. PubMed and Embase were searched and 109 articles were included. Pooled estimates of risk were generated for children born to HCV antibody–positive and viremic women, aged ≥18 months, separately by maternal human immunodeficiency virus (HIV) coinfection.Results. Meta-analysis of the risk of vertical HCV infection to children of HCV antibody–positive and RNA-positive women was 5.8% (95% confidence interval [CI], 4.2%–7.8%) for children of HIV-negative women and 10.8% (95% CI, 7.6%–15.2%) for children of HIV-positive women. The adjusted meta-regression model explained 51% of the between-study variation in the 25 included risk estimates. Maternal HIV coinfection was the most important determinant of vertical transmission risk (adjusted odds ratio, 2.56 [95% CI, 1.50–4.43]). Additional methodological (follow-up rate and definition of infection in children) and risk factors independently predicted HCV infection and need to be captured and reported by future studies of vertical transmission. Studies assessing the contribution of nonvertical exposures in early childhood to HCV prevalence among children at risk of vertical transmission are needed.Conclusions. More than 1 in every 20 children delivered by HCV chronically infected women are infected, highlighting that vertical transmission likely constitutes the primary transmission route among children. These updated estimates are a basis for decision making in prioritization of research into risk-reducing measures, and inform case management in clinical settings, especially for HIV-positive women in reproductive age. [ABSTRACT FROM AUTHOR]

Objective: To ascertain and compare microbial growth pattern in blood culture of septic neonates who were either totally breast or formula fed. Study Design: Cross sectional study. Place and Duration of Study: The Children's Hospital Lahore, Pakistan from Feb 2012 to Dec 2012. Methodology: All clinically septic neonates, who were either exclusively breast fed or formula fed, were enrolled in the study. They were divided into two groups and studied for the type of organisms grown on blood culture. Group-A were breast fed and group-B were formula fed. Neonates who were blood culture negative or had growth of multiple organisms or had incomplete data or who died / left against medical advice before completing the required data or babies receiving milk feeding from multiple sources or no feeding at all were excluded. BACTEC technique was used for obtaining bacterial growth. SPSS version 19 was used for statistical analysis. Results: A total of 380 clinically septic neonates were enrolled. Each group consisted of 190 subjects. Incidence of culture positive sepsis in breast fed and in formula fed was 6.7% and 15.7% respectively (p-value = 0.0001). Overall, gram-negative organisms constituted the majority (61.1%). Thirty severn percent cultures grew coagulase negative Staphylococcus (CoNS) followed by Klebsiella spp (23.4%). In group A, gram-negative and gram-positive organisms were equally distributed whilst in group-B, gram-negative organisms were three times more frequent than gram-positive organisms. Predominant pattern of organisms was also different in the two groups. In group-A, CoNS was predominant while in group-B, Klebsiella spp. was most frequent. Conclusion: Culture positive sepsis is more than two times greater in formula fed babies and is caused predominantly by gram-negative organisms whilst in breast fed babies, CoNS is the commonest organism. [ABSTRACT FROM AUTHOR]

Background: Polymicrobial bloodstream infections (PBSIs) have been associated with complex underlying medical conditions and a high incidence of specific microorganisms in several settings, but the relevant data are scarce in neonates. Methods: Positive blood cultures from January 2004 to December 2011 in the neonatal intensive care unit (NICU) of Chang Gung Memorial Hospital (CGMH) were reviewed. Each neonate with PBSI (case episode) was matched to two episodes of monomicrobial BSI (control episode) by birth weight, gestational age and gender. Records were reviewed to compare their underlying medical conditions, organisms isolated, adequacy of therapy, clinical characteristics and outcomes. Results: Forty-five episodes of PBSI (4.4% of all neonatal BSIs) were identified in 43 neonates. Gram-negative organisms constituted 59.8% of all PBSI pathogens, and 33 (73.3%) of PBSIs were caused by at least one Gram-negative organism. PBSIs were significantly more likely to be the recurrent episode and have endotracheal tube in place. No significant difference was found between PBSIs and controls in terms of demographics and most chronic conditions. PBSIs were significantly associated with a higher severity of illness, a longer duration of septic symptoms, and a higher rate of modification of antimicrobial regimens than monomicrobial BSIs. However, the sepsis-attributable mortality rates were comparable between these two groups. Conclusions: In the NICU, PBSIs were more often caused by Gram-negative bacilli, and often occurred in neonates without any chronic conditions. The clinical significance of PBSIs included a more severe illness, longer duration of septic symptoms and a higher rate of modification of antimicrobial regimens. [ABSTRACT FROM AUTHOR]

Copyright of Jornal de Pediatria is the property of Sociedade Brasileira de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In contrast to consistent epidemiologic evidence of the role of sexual transmission of human papillomavirus (HPV) in adults, various routes may be related to HPV infection in infants. We have assessed the extent of HPV infection during the perinatal period, and the relationship between mode of delivery and vertical transmission. Results: A total of 291 pregnant women over 36 weeks of gestation were enrolled with informed consent. Exfoliative cells were collected from maternal cervix and neonatal buccal mucosa. HPV infection and genotypes were determined with an HPV DNA chip, which can recognise 24 types. The HPV-positive neonates were re-evaluated 6 months after birth to identify the presence of persistent infection. HPV DNA was detected in 18.9 % (55/291) of pregnant women and 3.4 % (10/291) of neonates. Maternal infection was associated with abnormal cytology (p = 0.007) and primiparity (p = 0.015). The infected neonates were all born to HPV-positive mothers. The rate of vertical transmission was estimated at 18.2 % (10/55) which was positively correlated with maternal multiple HPV infection (p = 0.003) and vaginal delivery (p = 0.050), but not with labour duration and premature rupture of membranes. The rate of concordance of genotype was 100 % in mother-neonate pairs with vertical transmission. The neonatal HPV DNAs found at birth were all cleared at 6 months after delivery. Conclusions: Vertical transmission of HPV DNA from HPV infected mother to the neonate increased when the infant was delivered through an infected cervix. However, the absence of persistent infection in infants at 6 months after delivery may suggest temporary inoculation rather than true vertical infection. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses a study which measured the coverage of services aimed at preventing mother-to-child human immunodeficiency virus (HIV) transmission in four African countries. The cross-sectional surveillance study of mother-infant pairs used umbilical cord blood samples from selected facilities that provide delivery services in several countries, including Cameroon and South Africa. The authors found that only 51 percent of HIV-exposed infants received the minimal regimen of single-dose nevirapine.

Mother-to-child transmission remains the main cause of global pediatric HIV infections, especially in sub-Saharan Africa. Many interventions based on single-dose antiretroviral therapy have been implemented to reduce the mother-to-child transmission of HIV. In resource-limited settings, highly active antiretroviral therapy (HAART) has only been recommended for HIV-infected pregnant women requiring treatment for their own health. Here, we assessed the efficacy over 18 months of maternal HAART versus peripartum short-course antiretroviral therapy (SCART) regimens for the prevention of mother-to-child transmission (PMTCT) of HIV. We conducted a retrospective cohort study of patients from two medical centers in Ouagadougou, Burkina Faso. The PMTCT files and registers from 1 January 2003 to 31 December 2006 were obtained from routine data collected at these sites. The main assessment criterion was the rate of HIV-1 positivity in children born to HIV-positive mothers as measured with HIV-1 rapid tests at 18 months. A total of 586 pregnant HIV-1-infected women in PMTCT programs were selected. Among these women, 260 were undergoing HAART and 326 received single-dose nevirapine (91.3%) or single-dose zidovudine (8.7%) at delivery. HIV-1 serological tests were performed on 454 children at 18 months old. The rate of HIV-1 vertical transmission was 0% (0/195) in the HAART group and 4.6% (12/259) in the single-dose monotherapy group (P<0.01). Eight infants in the HAART cohort and 30 in the SCART cohort were breastfed; three in the SCART group were HIV-positive. A total of 62 children died, 19 in the HAART group and 43 in the single-dose monotherapy group. Our study confirms that HAART for mothers effectively reduces the risk of infant HIV infection while preserving the breastfeeding option for mothers. [ABSTRACT FROM AUTHOR]

In this article the author discusses the ways on how to care a child born to an HIV-positive mother. The author states that transmission of the infection can be prevented through highly active antiretroviral drug therapy (HAART) during pregnancy, elective cesarean delivery and eliminating breastfeeding. In addition, virological testing must be performed during birth and an antiretroviral therapy must be conducted as soon as the new born baby can feed.

Pathogenetic mechanisms in neonatal infections The author reviewed the pathogenetic mecanisms of ante- intra and postnatal infections of the newborn. They also discussed the results of the antenatal infections on embrion and foetus, and the clinical variants of intra- and postnatal infections. The attention is focussed on the relationship between pathogenetic mechanisms and the relevant clinical and paraclinical alteration for the diagnosis of the most frequent encountered infections of the newborn. [ABSTRACT FROM AUTHOR]

Infections are a frecvent and important cause of morbidity and mortality in the newborn period. Infections in the newborn infant may be required in utero (congenital), at the terme/or birth (perinatal), or after birth and during the neonatal period (postnatal). The transplacental route is the most common means by which microorganisms reaches the fetus in utero. Some viruses: Toxoplasma gondii, Treponema pallidum, and occasionally other bacteria are transmitted by this route. Infection acquired in utero may result in resorption of the embryo, absorbtion, stillbirth, congenital malformations, intrauterine growth retardation, premature birth, acute diseases in the immediate neonatal, prenatal, or on asymptomatic, but persistent infection that cause neurologic sequelae later in life. Further on the author presents: Viral infections: rubella virus, cytomegalovirus, - herpes virus hominis, hepatitis B, Coksackie, HIV, measles virus, mumps virus, Varicella-zoster virus; - bacterial infections; - rickettiene infections; - infections with mycoplasme and chlamydia; - mycotic infections; - protozoar infections (toxoplasma, malaria, leishmaniasis - Kala - Azar, trypanosomiasis); - parasitic infections (echinococosis, schistosomiasis, ankilostomiasis). [ABSTRACT FROM AUTHOR]

Objectives: to analyze the adherence to prophylactic measures implemented in pregnant women for reduction of vertical H/V transmission in this reference maternity in the city of Fortaleza, State of Ceará, Brazil. Methods: cross sectional study. with descriptive and analytical components. Included were all of the pregnant HIV infected women that attended the maternity during January 2000 to August 2004. Results: one hundred and ten pregnant HIV infected women were studied and 102 (92.7%) informed to have frequented prenatal service. Sixty three of them (57.3%) were informed about their serological status during prenatal, 39 (35.5%) knew they had Aids before becoming pregnant. It was identified a high percentage of interventions for reduction of HIV vertical transmission, not having statistically difference among women that knew of their serological status the ones that didn't. It is needed to be emphasized that in 86 (78.1%) cases the adherence to these interventions was considered completed. Conclusions: the high adherence to conducts for reducing vertical HIV transmission observed in this study reveals the viability of the application of those actions in Fortaleza, nonetheless the specific conditions in this reference hospital doesn't apply to all situations in other services in Fortaleza. [ABSTRACT FROM AUTHOR]

The article presents a study to determine the cost-effectiveness of on-site prenatal syphilis screening with newly available rapid point-of-care screening tests in sub-Saharan Africa. Health and economic outcomes linked with screening strategies that varied by the initial test, need for confirmation with Treponema pallidum hemagglutination assay, and number of visits required were analyzed in this study. It was found that there were 256 cases of congenital syphilis, 583 low birth weight infants and 170 stillbirths or neonatal deaths with no screening.

The article discusses the management and treatment of maternal and congenital syphilis of children in Great Britain. When the disease hit the country, the government encountered difficulty in addressing it because it still remains a national health issue despite the introduction of effective treatment and availability of diagnostic testing for the disease. Research shows that late congenital syphilis occurs in children over the age of 2 and often present in puberty. This disease is dangerous because it can affect many organ systems including bones, teeth and nervous system and 25 to 33% of infants with untreated congenital syphilis have a symptomatic neurosyphilis which can lead to eighth nerve deafness.

Abstract: Maternal syphilis adversely affects close to one million pregnancies worldwide every year with consequences that may include spontaneous abortion, stillbirth, neonatal death, premature birth, neurological impairment and bone deformities of the neonate. In Bolivia, the maternal syphilis rate has been estimated at 4.3% among women with live births and 26% among women with stillbirths. Partner notification is critical to the prevention of maternal re-infection and vertical transmission of syphilis. Patient-led partner notification, also known as patient referral, is the recommended starting point for partner notification programs in resource poor settings because it requires less infrastructure and provider involvement. Though patient referral requires a higher level of engagement on the part of individuals, few studies have examined, in depth, the process of patient-led notification. Further, we found no studies of this type conducted in Bolivia, a country where culturally acceptable and appropriate interventions are needed to control maternal syphilis. This study examined partner notification, for the first time, from the perspective of women accessing treatment for maternal syphilis in Bolivia. Semi-structured interviews were conducted with 18 women who had attempted or planned to attempt notifying their partner. The interview guide was designed to investigate the experience of patient-led partner notification for syphilis with particular emphasis on the strengths and capacities of the participants. Accordingly, we applied an existing theoretical model for individual empowerment in the analysis of the interviews with the participants. This emphasis on the positive, solution-finding capacities of the participants allowed us to investigate the ways in which participants took control over an aspect of concern to their health. More studies are needed which examine successful patient-led strategies for partner notification and their connections with long-term health outcomes. [Copyright &y& Elsevier]

The article reports on the study conducted to determine the incidence of possible neonatal herpes simplex virus (HSV) infections, HSV infection status of women with infected infants and use of measures that will reduce the risk of HSV transmission to the neonate in a large US managed-care population. The study made use of retrospective analysis of claims from the Integrated Health Care Information Services National Managed Care Benchmark. It was concluded that the results aided in the national surveillance of neonatal incidence of HSV, strengthen health policies, and develop prevention and treatment.

Abstract: Objective: The objective was to determine whether the interleukin-6 (IL-6) level in umbilical cord blood can be used for the prediction of histologic chorioamnionitis, funisitis, fetal membrane cultures and neonatal infection. Study design: A case–control study was conducted on 30 controls (control group) and on 40 women with term premature rupture of the membranes (PROM group). The interleukin-6 concentration of cord blood was measured. Fetal membranes and newborn blood were cultured. Placentas were examined for histologic chorioamnionitis and funisitis. Receiver operator curve analysis was used to obtain a cut-off value of interleukin-6 concentration for predicting histological and clinical infection. Results: The mean interleukin-6 level in cord blood was significantly higher in the PROM group (p =0.01). Histological chorioamnionitis and positive placental cultures were significantly higher in the PROM group (p =0.006 and 0.02, respectively). The PROM group had seven (17.5%) cases of funisitis and positive newborn blood cultures while neither was observed in the control group. A cord blood interleukin-6 level >29pg/ml was found to have 84% sensitivity and 72.5% specificity for predicting positive placental cultures and 74.1% sensitivity and 76.7% specificity for identifying cases of histologic chorioamnionitis. For predicting funisitis and positive newborn cord blood cultures a cord blood interleukin-6 level >39pg/ml has 100% sensitivity and 81% specificity. Conclusion: Cord blood interleukin-6 level can be a tool for the evaluation of the extent of maternal–fetal infection and guides proper planning of the treatment. [Copyright &y& Elsevier]

In the context of a concerning increase in rates of syphilis and congenital syphilis in the United States, this Viewpoint discusses the importance of improving screening programs and diagnostics, and it argues for legislation, media coverage, and activism by patient advocacy groups and policy makers to remove the stigma of this resurgent sexually transmitted infection (STI). [ABSTRACT FROM AUTHOR]

OBJECTIVE:: The skin is a potential source for invasive infections in neonates from developing countries such as Bangladesh, where the level of environmental contamination is exceedingly high. A randomized controlled trial was conducted from 1998 to 2003 in the Special Care Nursery of a tertiary hospital in Bangladesh to test the effectiveness of topical emollient therapy in enhancing the skin barrier of preterm neonates less than 33 weeks of gestational age. In the initial months of the study, the infection and mortality rates were noted to be unacceptably high. Therefore, an infection control program was introduced early in the trial to reduce the rate of nosocomial infections. STUDY DESIGN:: After a comprehensive review of neonatal care practices and equipment to identify sources of nosocomial infections, a simple but comprehensive infection control program was introduced that emphasized education of staff and caregivers about measures to decrease risk of contamination, particularly hand-washing, proper disposal of infectious waste, and strict asepsis during procedures, as well as prudent use of antibiotics. RESULTS:: Infection control efforts resulted in declines in episodes of suspected sepsis (47%), cases of culture-proven (61%) sepsis, patients with a clinical diagnosis of sepsis (79%), and deaths with clinical (82%) or culture-proven sepsis (50%). CONCLUSION:: The infection control program was shown to be a simple, low-cost, low-technology intervention to reduce substantially the incidence of septicemia and mortality in the nursery.Journal of Perinatology (2005) 25, 331-335. doi:10.1038/sj.jp.7211283 Published online 17 February 2005 [ABSTRACT FROM AUTHOR]

Hospital-born babies in developing countries are at increased risk of neonatal infections because of poor intrapartum and postnatal infection-control practices. We reviewed data from developing countries on rates of neonatal infections among hospital-born babies, range of pathogens, antimicrobial resistance, and infection-control interventions. Reported rates of neonatal infections were 3-20 times higher than those reported for hospital-born babies in industrialised countries. Klebsiella pneumoniae, other gram-negative rods (Escherichia coli, Pseudomonas spp, Acinetobacter spp), and Staphylococcus aureus were the major pathogens among 11 471 bloodstream isolates reported. These infections can often present soon after birth. About 70% would not be covered by an empiric regimen of ampicillin and gentamicin, and many might be untreatable in resource-constrained environments. The associated morbidity, mortality, costs, and adverse effect on future health-seeking behaviour by communities pose barriers to improvement of neonatal outcomes in developing countries. Low-cost, "bundled" interventions using systems quality improvement approaches for improved infection control are possible, but should be supported by evidence in developing country settings. [ABSTRACT FROM AUTHOR]

Against a background of increasing numbers of uninfected children born to HIV-infected women in Europe, we describe the social environment and occurrence of infectious disease in 1,667 infants enrolled in the European Collaborative Study (ECS) and followed prospectively. In the ECS, the proportion of children born to black women from Sub-Saharan Africa who acquired their HIV infection heterosexually has increased since the mid-1980s, while the proportion of those born to white women with a history of illicit drug use has decreased, in both northern and southern Europe. The percentage of children who had been in alternative (non-parental) care decreased from 17% (82/469) in 1985-1989 to 5% (23/436) in 1999-2002. A total of 135 infants (with 1,475 child-years of follow-up) experienced at least one moderate/severe infective or febrile episode requiring medical attention in the first year of life; there was little correlation with recorded sociodemographic and child characteristics. The rate of hospitalization remained relatively stable over the study period at between 243-299 admissions per 1,000 child-years. Description of disease burden and social circumstances of uninfected children is needed, not only because of their increasing numbers but also because they are often used as controls in studies addressing vertically-acquired HIV infection. [ABSTRACT FROM AUTHOR]

Neonatal bacterial sepsis is a clinical syndrome characterized by systemic signs of infection as well as bacteremia in the first month of life. Two different patterns of sepsis have been associated with systemic bacterial infection: Early and late onset sepsis. In both, the clinical presentation is usually multisystemic and fulminant, fatality is high and is between 15 and 50%. Objective: To know the incidence of early onset sepsis that occurred in the Neonatal Intensive Care Unit of the Hospital Universitario Dr. Jose Eleuterio González between January and December of 2001, and the most frequently found microorganisms. Materials and methods; This is a retrospective study in which the clinical files of patients admitted to the Neonatal Intensive Care Unit during 2001 with identified risk factors for sepsis were reviewed. Results: 16 patients were included nine (56.2%) had criteria for early onset sepsis and a positive blood culture, and seven (43.7%) with sepsis like syndrome. The most frequently found organisms were Staphylococcus aureus and negative coagulase staphylococcus with 22.2% each. The most frequently found clinical findings were tachypnea (87.5%) and hyperthermia (25%). Conclusions: The incidence of early onset sepsis in this Neonatal Intensive Care Unit is of 24 of 1,000 live newborn, which is similar to what the literature reports; however, the most common etiologic agents were S. aureus and negative coagulase staphylococcus, both with 22.2%; however, it is known that these bacteria are more commonly found in late onset sepsis. [ABSTRACT FROM AUTHOR]

The promotion of nearly universal breastfeeding has played an important role in improving child health by providing optimum nutrition and protection against common childhood infections, and by promoting child spacing. Unfortunately, it has become clear that breastfeeding is responsible also for much of the increasing burden of worldwide pediatric human immunodeficiency virus (HIV) infection, especially in the developing nations (12–14% additional risk of HIV infection transmitted by breastfeeding; 35% total proportion of all HIV-infected children in an area infected through breastfeeding). Several factors influence the transmission of HIV by breastfeeding, including whether a woman acquires her infection during breastfeeding (29% risk of transmission) or before pregnancy (7–10% risk of breastfeeding transmission),the degree of maternal plasma and breastmilk viral load, and the presence of mastitis. In areas of the world where adequate sanitary replacement feeding is not available, the decision to withhold breastfeeding so as to decrease HIV transmission may lead to increased rates of child morbidity and mortality from diarrheal and respiratory diseases, and malnutrition. This review summarizes current data on the pathophysiology of breastfeeding transmission of HIV infection, the risk factors for and incidence rates of transmission, and the feasibility of possible alternatives to exclusive breastfeeding in the setting of maternal HIV infection. Clearly, women must be fully informed about the risks of breastfeeding transmission of HIV, the risks of morbidity and mortality among nonbreastfed infants, and the expense and availability of procuring adequate replacement formula. If an uninterrupted access to a nutritionally adequate breastmilk substitute that can be safely prepared is ensured (as is possible in industrialized countries), HIV-infected women should be counseled not to breastfeed their infants. [ABSTRACT FROM AUTHOR]

The article analyzes birth history data from 37 national surveys in developing countries to assess the quality of neonatal mortality data and to estimate levels and trends in neonatal mortality, that mortality occurring at 4-14 days. Demographic and health surveys are a useful source of information on the levels and trends of neonatal mortality in developing countries. Such surveys provide data on mortality occurring at 4-14 days of life, which is a sensitive indicator of neonatal tetanus mortality. For account, tetanus has been estimated to be responsible for 750,000 neonatal deaths annually and is considered one of the leading causes of neonatal mortality. From the analysis of the survey data, it is shown that mortality at 4-14 days has declined considerably during the last decade in most developing countries, concomitant with development and expansion of programs to reduce neonatal tetanus. These declines show that reductions in neonatal tetanus mortality probably have been an important contributor to the decline of neonatal and infant mortality during the 1980s.

The article discusses the National Institute for Health and Clinical Excellence (NICE) guideline on the management of early-onset neonatal infection and on the prevention and treatment of early-onset infection in neonates. Topics discussed include the key issues that the guideline addresses, the basis of the NICE guideline, and what medical practitioners need to know. A list of red flag risk factors or clinical indicators of early-onset neonatal infection is presented.

The article presents a summary of the analysis conducted by the U.S. Centers for Disease Control and Prevention (CDC) on recent trends in congenital syphilis (CS) rates in the U.S. The national surveillance data from the 2003-2008 period for CS cases reported to state and local health departments was used by the CDC in the analysis. The analysis discovered that CS rate among infants less than 1 year old increased by 23%, from 8.2 cases per 100,000 live births in 2005 to 10.1 during 2008. It also noted that most of the CS cases occurred in infants born to black mothers.

The article presents a clinical case report involving a 20-year-old primigravida in her 39th week of gestation, who was admitted to the maternity ward in labor. The patient had delivered a female neonate by an emergency Caesarian section after developing a fever and had released foul smelling liquor during the first stage of labor. Her baby was floppy and pale, and needed bag and mask ventilation with oxygen due to a poor respiratory effort. Clinical evaluations were taken and revealed that the neonate's blood contains oral commensal in cats and dogs, which imply that the infant is suffering from neonatal zoonosis. Clinicians noted that the mother has been taken care of a puppy for a couple of days prior to the delivery and was licked by the dog several times on the hands.

To determine whether GB virus C (GBV-C) infection is associated with protection against vertical transmission of human immunodeficiency virus (HIV), we tested 186 HIV positive pregnant women for GBV-C. Neither active nor prior GBV-C infection was associated with a lower rate of HIV acquisition among infants. Thus, GBV-C does not appear to protect against perinatal HIV acquisition. [ABSTRACT FROM AUTHOR]