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      24-hour Holter findings in infants with in-utero exposure to the Zika virus: a series of cases

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          ABSTRACT

          Severe neurological problems and other special manifestations such as high prevalence of structural cardiac changes has been described in infants vertically exposed to the Zika virus (ZIKV) and has been called congenital Zika virus syndrome (CZS). Previous studies have shown that the 24-hour Holter heart rate variability (HRV) analysis allows the prediction of worse outcomes in infants with neurological impairment and higher risk of sudden infant death syndrome (SIDS), hypertension, diabetes mellitus and other cardiovascular diseases. This study describes the 24-hour Holter findings of infants with confirmed vertical exposure to the ZIKV by positive polymerase chain reaction (PCR) assays in the mother's blood during pregnancy and/or in the urine or cerebrospinal fluid of the newborn. Data analysis was descriptive and included two subgroups according to the presence of fetal distress, positive PCR to ZIKV in the newborn, CZS and severe microcephaly. Heart rate, pauses, arrhythmias, ST segment and QT interval analyses and HRV evaluation through R-R, SDNN, pNN50 and rMMSD were described. The Mann-Whitney test was performed to assess differences between the two subgroups. The sample consisted of 15 infants with a mean age of 16 months, nine of whom were male. No arrhythmias or QT interval changes were observed. The comparison of HRV through the Mann-Whitney test showed a significant difference between patients with and without CZS, with and without severe microcephaly, with lower HRV in the groups with severe microcephaly and CZS. The study suggests that there is an increased risk of SIDS and cardiovascular diseases in this group of patients.

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          Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data

          Introduction This is the first of seven articles from a preterm birth and stillbirth report. Presented here is an overview of the burden, an assessment of the quality of current estimates, review of trends, and recommendations to improve data. Preterm birth Few countries have reliable national preterm birth prevalence data. Globally, an estimated 13 million babies are born before 37 completed weeks of gestation annually. Rates are generally highest in low- and middle-income countries, and increasing in some middle- and high-income countries, particularly the Americas. Preterm birth is the leading direct cause of neonatal death (27%); more than one million preterm newborns die annually. Preterm birth is also the dominant risk factor for neonatal mortality, particularly for deaths due to infections. Long-term impairment is an increasing issue. Stillbirth Stillbirths are currently not included in Millennium Development Goal tracking and remain invisible in global policies. For international comparisons, stillbirths include late fetal deaths weighing more than 1000g or occurring after 28 weeks gestation. Only about 2% of all stillbirths are counted through vital registration and global estimates are based on household surveys or modelling. Two global estimation exercises reached a similar estimate of around three million annually; 99% occur in low- and middle-income countries. One million stillbirths occur during birth. Global stillbirth cause-of-death estimates are impeded by multiple, complex classification systems. Recommendations to improve data (1) increase the capture and quality of pregnancy outcome data through household surveys, the main data source for countries with 75% of the global burden; (2) increase compliance with standard definitions of gestational age and stillbirth in routine data collection systems; (3) strengthen existing data collection mechanisms—especially vital registration and facility data—by instituting a standard death certificate for stillbirth and neonatal death linked to revised International Classification of Diseases coding; (4) validate a simple, standardized classification system for stillbirth cause-of-death; and (5) improve systems and tools to capture acute morbidity and long-term impairment outcomes following preterm birth. Conclusion Lack of adequate data hampers visibility, effective policies, and research. Immediate opportunities exist to improve data tracking and reduce the burden of preterm birth and stillbirth.
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            The Apgar Score.

            (2015)
            The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered as evidence of, or a consequence of, asphyxia; does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.
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              Basic notions of heart rate variability and its clinical applicability.

              Autonomic nervous system (ANS) plays an important role in the regulation of the physiological processes of the human organism during normal and pathological conditions. Among the techniques used in its evaluation, the heart rate variability (HRV) has arising as a simple and non-invasive measure of the autonomic impulses, representing one of the most promising quantitative markers of the autonomic balance. The HRV describes the oscillations in the interval between consecutive heart beats (RR interval), as well as the oscillations between consecutive instantaneous heart rates. It is a measure that can be used to assess the ANS modulation under physiological conditions, such as wakefulness and sleep conditions, different body positions, physical training and also pathological conditions. Changes in the HRV patterns provide a sensible and advanced indicator of health involvements. Higher HRV is a signal of good adaptation and characterizes a health person with efficient autonomic mechanisms, while lower HRV is frequently an indicator of abnormal and insufficient adaptation of the autonomic nervous system, provoking poor patient's physiological function. Because of its importance as a marker that reflects the ANS activity on the sinus node and as a clinical instrument to assess and identify health involvements, this study reviews conceptual aspects of the HRV, measurement devices, filtering methods, indexes used in the HRV analyses, limitations in the use and clinical applications of the HRV.
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                Author and article information

                Journal
                Rev Inst Med Trop Sao Paulo
                Rev. Inst. Med. Trop. Sao Paulo
                rimtsp
                Revista do Instituto de Medicina Tropical de São Paulo
                Instituto de Medicina Tropical
                0036-4665
                1678-9946
                13 July 2020
                2020
                : 62
                : e50
                Affiliations
                [1 ]Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Epidemiologia Clínica, Rio de Janeiro, Rio de Janeiro, Brazil
                [2 ]Fundação Oswaldo Cruz, Instituto Fernandes Figueira, Departamento de Pediatria, Rio de Janeiro, Rio de Janeiro, Brazil
                [3 ]Fundação Oswaldo Cruz, Instituto Fernandes Figueira, Departmento de Doenças Infecciosas, Rio de Janeiro, Rio de Janeiro, Brazil
                [4 ]Universidade Estácio de Sá, Rio de Janeiro, Rio de Janeiro, Brazil
                [5 ]Escola de Medicina Souza Marques, Rio de Janeiro, Rio de Janeiro, Brazil
                Author notes
                Correspondence to: Dulce Helena Gonçalves Orofino, Fundação Oswaldo Cruz, Instituto Fernandes Figueira, Departamento de Pediatria, Av. Rui Barbosa, 716, CEP 22250-020 , Rio de Janeiro, RJ, Brazil, Tel: +55 21 986292498 E-mail: dulceorofino@ 123456yahoo.com.br
                Author information
                http://orcid.org/0000-0002-0953-1831
                http://orcid.org/0000-0001-9947-2291
                http://orcid.org/0000-0002-6246-8915
                http://orcid.org/0000-0002-5152-2242
                http://orcid.org/0000-0001-7721-0485
                http://orcid.org/0000-0002-7658-8002
                http://orcid.org/0000-0001-5216-9447
                http://orcid.org/0000-0002-5311-3864
                http://orcid.org/0000-0003-4417-3950
                http://orcid.org/0000-0003-2118-7161
                http://orcid.org/0000-0003-3345-9064
                http://orcid.org/0000-0002-2034-0294
                http://orcid.org/0000-0001-9387-8645
                Article
                00606
                10.1590/S1678-9946202062050
                7359722
                32667392
                a5c4627e-cd6f-4729-9e2c-487e3d81beae

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 March 2020
                : 30 June 2020
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 21
                Categories
                Brief Communication

                zika virus,holter,arrhythmias,heart rate variability,congenital zika virus syndrome,congenital infection,vertical transmission

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