Zika virus infection during pregnancy can lead to congenital Zika syndrome. Implementation of screening programs and interpretation of test results can be particularly challenging during ongoing local mosquitoborne transmission. We conducted a retrospective chart review of 2,327 pregnant women screened for Zika virus in Miami–Dade County, Florida, USA, during 2016. Of these, 86 had laboratory evidence of Zika virus infection; we describe 2 infants with probable congenital Zika syndrome. Delays in receipt of laboratory test results (median 42 days) occurred during the first month of local transmission. Odds of screening positive for Zika virus were higher for women without health insurance or who did not speak English. Our findings indicate the increase in screening for Zika virus can overwhelm hospital and public health systems, resulting in delayed receipt of results of screening and confirmatory tests and the potential to miss cases or delay diagnoses.

RESUMENObjetivo: Determinar los factores sociales y económicos que afectan el estado nutricional de los niños menores de cinco años. Metodología: Se llevó a cabo un estudio de corte transversal con una muestra de 600 menores que asistieron al Hospital Infantil Napoleón Franco Pareja (HINFP) a cuyas madres se les aplicó un instrumento estandarizado para capturar la información socioeconómica y el estado nutricional del niño y de la madre. Se estimaron dos modelos econométricos de Umbral Generalizado, tomando como variable dependientes talla para la edad y peso para la talla y como variables independientes: peso al nacer del menor, número de controles prenatales, nivel de ingresos del hogar, uso de servicios de alcantarillado y acueducto, índice de masa corporal (IMC) de la madre, entre otras. Resultados: De acuerdo al indicador de talla para la edad, el 48.05% de los niños sufren de desnutrición crónica. El indicador de peso para la talla reflejó que el 22.09% de los niños tuvieron un déficit en su masa corporal (desnutrición aguda) y un 13.53% se encontraba en sobrepeso u obesidad. El 76.02% de las madres con hijos con talla para la edad normal tienen educación media o superior. El 56% de los niños pertenecientes a hogares con ingresos inferiores al salario mínimo mensual legal vigente tuvieron problemas de desnutrición aguda. Respecto a los determinantes, mayores ingresos reducen la probabilidad de que un niño sufra desnutrición. El tiempo de lactancia materna, la ocupación y el estado nutricional de la madre resultaron ser factores protectores. El incremento de la edad gestacional al nacimiento, aumenta la probabilidad de tener una talla normal. Conclusiones: La presente investigación genera evidencia para revisar la política sanitaria de nutrición infantil. Elevar el nivel de ingresos y promover la lactancia materna mejorarían el estado nutricional de los niños.Palabras claves: Nutrición infantil, determinantes, indicadores de salud, peso para la estatura, salud pública.

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Objective: Postpartum preeclampsia, defined as de novo preeclampsia that develops at least 48 hours following delivery, can be particularly dangerous as many patients are already discharged at that point. The goal of our study was to identify risk factors uniquely associated with the development of late postpartum preeclampsia. Study Design: In a retrospective cohort study of deliveries between July 1, 2016 and June 30, 2018 at a safety-net hospital in Atlanta, Georgia, we used multinomial logistic regression models to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between demographic, medical, and obstetric factors and development of preeclampsia, categorized as a 3-level outcome: no preeclampsia, antepartum/intrapartum preeclampsia (diagnosed prior to or < 48 hours of delivery), and late postpartum preeclampsia (diagnosed ≥ 48 hours postpartum). Results: Among 3,681 deliveries, women were primarily ages 20-35 (76.4%), identified as non-Hispanic Black (68.5%), and covered by public health insurance (88.6%). Preeclampsia was diagnosed prior to delivery or within 48 hours postpartum in 12% (n=477) of the study population, and 1.5% (57) developed preeclampsia greater than 48 hours postpartum. In the adjusted models, maternal age ≥ 35, race/ethnicity, nulliparity, a diagnosis of pre-gestational or gestational diabetes, and chronic hypertension were associated with increased odds of antepartum preeclampsia only, while maternal obesity (OR 1.9, 95% CI 1.0-3.5) and gestational hypertension (OR 2.7, 95% CI 1.5-4.8) were uniquely associated with postpartum preeclampsia. Multifetal gestations and Cesarean delivery predicted both postpartum and antepartum/intrapartum preeclampsia, however the association was stronger for postpartum preeclampsia. Conclusion: Patients with obesity, gestational hypertension, multifetal gestations, or Cesarean delivery may benefit from additional follow-up in the early postpartum period to detect postpartum preeclampsia.

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