MICROCEFALIA: ACHADOS CLÍNICOS NEONATAIS E CONDIÇÕES PERINATAIS INFECCIOSAS ASSOCIADAS

Abstract

Introduction – Microcephaly developed into a public health emergency of international importance at the end of 2015. Characterized by reduction of head circumference in two standard deviations below the mean and malformations of the central nervous system, it can be diagnosed even in the intrauterine phase. Given the political, social and economic diversity, among others that Brazil presents, it becomes challenging for the government to point out strategies that meet the real needs of the population that is affected microcephaly. Objectives – To evaluate the clinical aspects of neonates with microcephaly and associated infectious perinal conditions in a public maternity in the city of Salvador, Bahia, and to analyze social and economic aspects of families with a member who is diagnosed with microcephaly. Methods – It is a cross-sectional study, which used, in its first stage, data from medical records of 49 newborns that are diagnosed with microcephaly and were born in the reference maternity Professor José Maria de Magalhães Netto. In a second moment, interviews were conducted with 13 children that were involved in the previous stage. For descriptive and inferential statistical analysis of the data, was used statistical tools PHStat2 - Statistical Supplement of Prentice Hall, R software - Rstudio and SPSS. For the comparison among variables, the Exact test of Fisherwas applied, considering a level of 5% significance. Results - The results are presented in two articles. In the first article , the clinical and epidemiological profile of newborns that were diagnosed with microcephaly is outlined, and it was found, in the profile of parents: predominant age group from 21 to 30 years, which corresponds to 45% ( ± 31); from the state capital and the metropolitan region (67.35%); primiparous (59.18%); number of prenatal consultations between five and seven (46.94%); hypertensive vascular disease patients (34.69%); with diagnosis of microcephaly in the third trimester of pregnancy (95.92%). As for the associated pathologies, which were grouped with the terminology TORCHES + ZIKA, there was a predominance of serological zika virus (37%), with clinical confirmation in the third trimester (78.57%), and presence of other malformations in 40% of thesample. Regarding the neonatal clinical profile, there was a predominance of full-term newborns (86%), of natural delivery (79.59%); female (51.02%); appropriate for gestational age (61.22%); diagnosed with microcephaly associated with patent foramen ovale (20%), deformities of limbs and liver alterations (6%, each). Of the malformations diagnosed by transfontanelar ultrasonography, bilateral periventricular changes (20.65%), followed by calcifications (11.96%), ventriculomegaly (6.52%), among others, predotitude. There was statistical significance of 5% for mothers who presented exantheus (p 0.050), had alcohol intake (0.037) and presented negative RH factor (p 0.043). In according to article, which presents the sociodemographic profile of families with a member diagnosed with microcephaly, it was found that 100% of the mothers interviewed declared themselves black or brown, aged between 18 and 40 years ( ± 31 years and sd of 8 years) and 85% had complete high school. Household income per capita ranged from 1 to 2 minimum wages, 10 (77%). Regarding occupation, 69% were unemployed. As for the place of residence, 85% lived on the outskirts of Salvador and 77% had own property. On the impacts on the family structure, 100% incorporated new family routines, 85% gave up work to care for their children full-time after pregnancy and 76.92% considered that the financial resources were insufficient. The variable related to having missed any consultation, when associated with the level of education, showed that mothers who missed these consultations had no higher education and had income between 1 and 2 minimum wages. However, these and other variables were not significant, most likely due to the limitation represented by the reduced sample size. Conclusions – Prematurity does not appear to be associated with neonatal microcephaly; there is an increase in the occurrence of patent foramen ovale and positive serology for Zika virus during prenatal care in patients with microcephaly. Intrauterine diagnoses occurred late, which may indicate insufficient public health services. The proportion of children with other malformations is higher in mothers who presented exanthropic, ingested alcohol and had a negative RH factor. The sociodemographic profile of the families showed that the Zika virus epidemic strongly affected low-income families, consisting of blacks and browns, living in the periphery. A probable association was revealed between the parents' schooling and the treatment of children.