OBJECTIVE: To describe the epidemiology of healthcare-associated infections (HAIs) among neonates.DESIGN: Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAL SETTING: Seven neonatal units located in three Brazilian cities.PATIENTS: All admitted neonates were included and observed until discharge.RESULTS: Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI.

BackgroundWe aim to investigate possible maternal- and pregnancy-related factors associated with the development of Congenital Zika Syndrome (CZS) in children of mothers with probable gestational infection.MethodsThis case-control study, we recruited mother-infant pairs between May 2015 and October 2017 in a pediatric infectious disease clinic in Rio de Janeiro. Inclusion criteria required either that the mother reported Zika infection symptoms during pregnancy or that the infant presented with clinical or imaging features of the CZS. Exclusion criteria included detection of an alternative cause for the patient’s presentation or negative polymerase chain reaction assays for Zika in all specimens tested within 12 days from the beginning of maternal symptoms. Infants with CZS (CDC definition) were selected as cases and infants without CZS, but with probable maternal Zika virus infection during pregnancy, were selected as controls. Maternal and pregnancy-related informations were collected and their relationship to the presence of congenital anomalies due to CZS was assessed by Fisher exact or Mann-Whitney test.ResultsOut of the 42 included neonates, 24 (57.1%) were diagnosed with CZS (cases). The mean maternal age at the birth was 21 years old. The early occurrence of maternal symptoms during pregnancy was the only variable associated with CZS (odds ratio = 0.87, 95% CI: 0.78–0.97).Case’s mothers presented symptoms until the 25th week of gestational age (GA), while control’s mothers presented until 36th weeks of GA. Income; illicit drug, alcohol, or tobacco use during pregnancy; other infections during pregnancy (including previous dengue infection) were not associated with CZS.ConclusionsOur study corroborates the hypothesis that Zika virus infection earlier in pregnancy is a risk factor to the occurrence of congenital anomalies in their fetuses.

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Background We aimed to evaluate the Neisseria meningitidis C conjugated vaccine (MCC) seroconversion and adverse events (AE) in HIV-infected and uninfected children and adolescents in Rio de Janeiro, Brazil. Methods HIV-infected or uninfected subjects, 2–18 years old, with CD4+ T-lymphocyte cell (CD4) percentage >15%, without active infection or antibiotic use, were enrolled. All patients were evaluated before and 1–2 months after immunization for seroconversion (defined as ≥4-fold titer increase in human serum bactericidal activity), and for AEs at 20 minutes, 3 and 7 days after immunization. Factors associated with seroconversion among HIV-infected group were studied. Results 204 subjects were enrolled: 154 HIV-infected and 50 HIV-uninfected. Median age was 12 years and 53% were female. Among the HIV-infected group, 82 (53%) had a history of at least one C clinical category Centers for Diseases Control and Prevention event, and 134 (87%) were using combination antiretroviral therapy (cART). The median nadir CD4 percentage was 13% (0%–47%). 76(37.3%) experienced mild AEs. Seroconversion occurred in 46/154 (30%) of the HIV-infected group, and in 38/50 (76%) of the uninfected group (p<0.01). Factors associated with seroconversion in the HIV-infected group were: Never had a C clinical category event (OR=2.1, 95%CI=1.0–4.4); undetectable viral load at immunization (OR=2.4, 95%CI=1.1–5.2), and higher CD4 nadir/100 cells (OR=1.1, 95%CI=1.0–1.2). Conclusion MCC vaccine should be administered to HIV-infected children and adolescents after maximum immunologic and virologic benefit has been achieved with cART. Our data suggest that a single dose of MCC vaccine is insufficient for HIV-infected individuals 2–18 years of age.

The aim of present study was to describe the frequency of lipodystrophy syndrome associated with HIV (LSHIV) and factors associated with dyslipidemia in Brazilian HIV infected children. HIV infected children on antiretroviral treatment were evaluated (nutritional assessment, physical examination, and laboratory tests) in this cross-sectional study. Univariate analysis was performed using Mann-Whitney test or Fisher's exact test followed by logistic regression analysis. Presence of dyslipidemia (fasting cholesterol >200mg/dl or triglycerides >130mg/dl) was the dependent variable. 90 children were enrolled. The mean age was 10.6 years (3-16 years), and 52 (58%) were female. LSHIV was detected in 46 children (51%). Factors independently associated with dyslipidemia were: low intake of vegetables/fruits (OR=3.47, 95%CI=1.04-11.55), current use of lopinavir/ritonavir (OR=2.91, 95%CI=1.11-7.67). In conclusion, LSHIV was frequently observed; inadequate dietary intake of sugars and fats, as well as current use of lopinavir/ritonavir was associated with dyslipidemia.