Children with microcephaly due to vertical exposure to Zika virus are an interesting population for investigation. Highlighted among their unique aspects are those related to nutrition due to its impact on child growth and development. Knowledge about the nutrition of microcephalic infants can help mothers and caregivers provide better care. Thus, this study aimed to describe the nutritional status and feeding practices of infants with microcephaly due to Zika virus exposure at birth and 12–23 months of age. This is a descriptive study developed from a cohort of patients attending a public institution of reference. A total of 65 infants attended outpatient nutrition clinics. The food practices were described using the 24-h food recall and food consumption indicators. Anthropometric measurements and consultations were made using the Child Health Handbook to obtain information on the nutritional status (weight, height and head circumference) at the time of consultation and birth. There was a significant decrease in z-scores for weight, height and head circumference (HC) from birth to the time of the consultation. However, most infants did not show weight-for-height deficits. Additionally, HC was correlated with the anthropometric indices weight-for-age, height-for-age, body mass index-for-age and weight-for-height. Infants exhibited a worsening of their nutritional status between birth and the time of their consultation, notably when we evaluated the indices of height and head circumference for age. The main inadequacies regarding dietary practices were low food diversity, use of ultra-processed products and low lipid intake.

Background: Identify early predictors of poor neurodevelopment in infants with antenatal Zika virus (ZIKV) exposure. Methods: Analysis of a prospective cohort of infants with antenatal ZIKV exposure confirmed by maternal or infant RT-PCR or IgM during the epidemic in Rio de Janeiro, Brazil. Clinical findings before 3 months of age were associated with Bayley-III Scales of Infant and Toddler Development conducted after 6 months of age. Results: ZIKV exposure was confirmed in 219 cases; 162 infants were normocephalic, 53 were microcephalic, 4 had no head circumference recorded because of perinatal death/LTFU. Seven of the 112 normocephalic infants developed secondary microcephaly between 3 weeks and 8 months of age. Among the normocephalic at birth cohort, the mean HCZ among normal, at risk, and developmentally delayed children was significantly different (ANOVA, P = 0.02). In particular, the mean HCZ of the developmentally delayed group was significantly lower than that of the normal group (Tukey’s test, P = 0.014). HCZ was more strongly associated with lower expressive language scores (P = 0.04) than receptive language scores (P = 0.06). The rate of auditory abnormalities differed among the normal, at risk, and developmentally delayed groups (Chi-squared test, P = 0.016), which was driven by the significant difference between the normal and at risk groups (post hoc test, P = 0.011, risk ratio 3.94). Auditory abnormalities were associated with both expressive and receptive language delays (P = 0.02 and P = 0.02, respectively). Conclusions: Clear predictors of neurodevelopment in normocephalic ZIKV-exposed children have not been previously identified. Our findings demonstrate that smaller HCZ and auditory abnormalities in these infants correlate with poor neurodevelopment as toddlers. Language delay is the most prominent developmental concern among these children, who will require frequent auditory and speech evaluations throughout childhood.

Estimativas apontam que há mais de 7 mil doenças raras já identificadas, que representam de 6 a 10% de todas as doenças no mundo. No Brasil, considera-se doença rara aquela que afeta até 65 pessoas em cada 100 mil indivíduos. Quantificar os custos para as famílias de pacientes com essas condições e o seu comprometimento sobre a renda fornece informações capazes de apoiar as políticas públicas destinadas a esses pacientes. O objetivo deste estudo foi estimar o custo e a perda de renda sob a perspectiva das famílias de crianças e adolescentes com fibrose cística, mucopolissacaridoses e osteogênese imperfeita. Foi realizado com 99 famílias de pacientes atendidos em um hospital de referência nacional em doenças raras no Rio de Janeiro, mediante relato do cuidador principal. A análise descritiva dos dados mostrou que o custo mediano direto não médico para as famílias foi de R$ 2.156,56 para fibrose cística, R$ 1.060,00 para mucopolissacaridoses e R$ 1.908,00 para osteogênese imperfeita. A perda de renda superou 100% para as três condições analisadas. Um total de 54% das famílias não recebem benefícios assistenciais. A estimativa de coping costs indicou que 69% das famílias acessaram empréstimos e 22,5% venderam bens para lidar com os custos do curso do tratamento. Foram verificados gastos catastróficos para as famílias das três doenças analisadas. Os resultados trazem à tona um tema que descortina custos pouco estimados, não somente no campo das doenças raras. São resultados que indicam uma carga importante sobre a renda das famílias. É importante incorporar estudos de tal natureza na discussão do financiamento, da incorporação de novas tecnologias e da oferta de serviços de saúde.

Resumo O objetivo deste artigo foi identificar a utilização de tecnologias e estimar o custo direto da atenção hospitalar de crianças e adolescentes com condições crônicas complexas em um hospital público federal especializado na assistência de alta complexidade a pacientes pediátricos. O trabalho foi realizado concomitantemente com um estudo de coorte durante o período de um ano e incluiu 146 pacientes com condições complexas crônicas e 37 pacientes não-crônicos. A análise identificou que a maioria dos pacientes com condições complexas crônicas internou em média duas vezes em um ano e que tinham doenças com o envolvimento de pelo menos dois sistemas orgânicos. O uso de drenos e cateteres e a gastrostomia foram as tecnologias de maior utilização. Na comparação com os pacientes não-crônicos, o custo direto mediano dos pacientes com condições complexas crônicas foi superior quando se comparou a utilização de tecnologias. O estudo indica um elevado custo da atenção hospitalar para esses pacientes. Documentar a utilização de tecnologias e o custo da atenção hospitalar permite subsidiar os gestores e contribuir para a tomada de decisões de planejamento, gestão e financiamento das políticas de saúde na área pediátrica.

Background At present, dengue control focuses on reducing the density of the primary vector for the disease, Aedes aegypti, which is the only vulnerable link in the chain of transmission. The use of new approaches for dengue entomological surveillance is extremely important, since present methods are inefficient. With this in mind, the present study seeks to analyze the spatio-temporal dynamics of A. aegypti infestation with oviposition traps, using efficient computational methods. These methods will allow for the implementation of the proposed model and methodology into surveillance and monitoring systems. Methods The study area includes a region in the municipality of Rio de Janeiro, characterized by high population density, precarious domicile construction, and a general lack of infrastructure around it. Two hundred and forty traps were distributed in eight different sentinel areas, in order to continually monitor immature Aedes aegypti and Aedes albopictus mosquitoes. Collections were done weekly between November 2010 and August 2012. The relationship between egg number and climate and environmental variables was considered and evaluated through Bayesian zero-inflated spatio-temporal models. Parametric inference was performed using the Integrated Nested Laplace Approximation (INLA) method. Results Infestation indexes indicated that ovipositing occurred during the entirety of the study period. The distance between each trap and the nearest boundary of the study area, minimum temperature and accumulated rainfall were all significantly related to the number of eggs present in the traps. Adjusting for the interaction between temperature and rainfall led to a more informative surveillance model, as such thresholds offer empirical information about the favorable climatic conditions for vector reproduction. Data were characterized by moderate time (0.29 – 0.43) and spatial (21.23 – 34.19 m) dependencies. The models also identified spatial patterns consistent with human population density in all sentinel areas. The results suggest the need for weekly surveillance in the study area, using traps allocated between 18 and 24 m, in order to understand the dengue vector dynamics. Conclusions Aedes aegypti, due to it short generation time and strong response to climate triggers, tend to show an eruptive dynamics that is difficult to predict and understand through just temporal or spatial models. The proposed methodology allowed for the rapid and efficient implementation of spatio-temporal models that considered zero-inflation and the interaction between climate variables and patterns in oviposition, in such a way that the final model parameters contribute to the identification of priority areas for entomological surveillance.