Congenital Zika virus infection has stimulated great international concern. A prospective case series of 87 infants with laboratory-confirmed congenital Zika syndrome (CZS) at the epicenter of the Brazilian Zika epidemic in Pernambuco state is presented. Mothers were interviewed for symptoms of possible Zika virus (ZIKV) infection during pregnancy, and fetal ultrasounds were obtained. Infant cerebrospinal fluid (CSF) samples were tested for ZIKV-specific antibodies, and sera were screened for other congenital infections. Neuroimaging and ophthalmologic evaluations were also performed. Sixty-six mothers (76%) reported symptoms of ZIKV infection during gestation. Fetal ultrasounds were available from 90% of the mothers, and all demonstrated brain structural abnormalities. All of the CSF samples tested positive for ZIKV immunoglobulin M. The majority of infants (89%) were term; the mean birth weight was 2577 ± 260 g, and the mean head circumference was 28.1 ± 1.8 cm. Severe microcephaly, defined as head circumference 3 SD below the mean for sex and gestational age, was found in 72 (82%) infants. All infants had an abnormal neurological exam, and 18 (20.7%) had arthrogryposis. The main abnormalities detected in computed tomography scans were calcifications (99%), followed by ventricular enlargement (94%), cortical hypogyration (81%), and less commonly, cerebellar hypoplasia (52%). Unilateral diaphragm paralysis was identified in 3 infants. Maternal young age, term infant, small for gestational age, and the presence of ophthalmologic abnormalities were significantly associated with a smaller head circumference Z score. Our findings, based on laboratory-confirmed ZIKV infection, add valuable evidence for the understanding of CZS.

Early NIPPV did not decrease the need for mechanical ventilation compared with NCPAP, overall, in the first 72 hours of life. However, further studies to assess the potential benefits of noninvasive ventilation are warranted, especially for the most vulnerable or preterm infants.

Among neonates, detection of ZIKV IgM in serum is confirmatory of congenital ZIKV infection, and detection of ZIKV IgM in CSF is confirmatory of neurologic infection. Therefore, we recommend testing for ZIKV IgM in neonates suspected of having congenital ZIKV infection and performance of PRNTs in equivocal cases.

ReSUmOEstudo observacional, prospectivo, para determinar a incidência de eventos adversos (EAs) em Unidade de Terapia Intensiva Neonatal (UTIN). Utilizou-se um "instrumento" específico, adaptado do modelo americano utilizado pela Rede Vermont-Oxford. Dos 218 recém-nascidos, 183 (84%) apresentaram EAs, correspondendo a 2,6 EA/paciente. Distúrbios da termorregulação (29%), distúrbios da glicemia (17,1%) e Infecção Relacionada à Assistência à Saúde (IRAS) de origem hospitalar (13,5%) foram os mais frequentes. Alguns EAs apresentaram associação com peso de nascimento (p < 0,05). O percentual de IRAS e a extubação não programada foi diretamente proporcional ao tempo de internamento. A incidência de EAs em UTIN é elevada entre os recém-nascidos de muito baixo peso. A qualidade da assistência torna-se primordial na elaboração das estratégias preventivas. descritores: Eventos adversos; Recém-nascido; UTI Neonatal; Assistência de enfermagem. aBStRaCt This was a prospective, observational study conducted in a neonatal intensive care unit to determine the incidence of adverse events. A specific trigger tool instrument was used, based on the one from Vermont-Oxford Network. A total of 218 neonates were followed and AEs were detected in 183 (84%) of them, with a rate of 2,6 AE/patient. Thermoregulation disorders (29%), disorders of glycemic control (17,1%) and nosocomial infections (13,5%) were the most frequent. Some AE were associated with birth weight (p<0.05). The accidental extubations and nosocomial infections were associated with hospital days. The incidence of AEs is high, especially among neonates with very low birth weight. Best practices regarding preventive strategies are necessary to improve quality of health care for these infants. Key words: Adverse events; Newborn; Neonatal Unit. ReSUmeNEstudio observacional, prospectivo para determinar la incidencia de eventos adversos (EAs) en la Unidad Neonatal de Cuidados Intensivos (UNCI). Fue utilizado un instrumento específico adaptado del modelo americano Vermont-Oxford. De los 218 recién nacidos, el 84% presentaron EA, lo que corresponde a 2,6 EA / paciente. Trastornos de la termorregulación (29%), trastornos de la glicemia (17,1%) e infección relacionada con el cuidado de la salud (IRCS) nosocomiales (13,5%) fueron los más frecuentes. Algunos presentaron asociación con el peso al nacer (p<0,05). El porcentaje de IRCS y la extubación no programada fue directamente proporcional a la duración de la estancia hospitalaria. La incidencia de EAs en la UNCI es alta entre los recién nacidos de muy bajo peso al nacer. La calidad de la asistencia es fundamental en el desarrollo de estrategias de prevención.

More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.