Estudo epidemiológico da sífilis congênita: a realidade de um hospital universitário terciário
Carregando...
Data
2017-02-14
Autores
Silveira, Sarah de Lima Alloufa da [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
INTRODUÇÃO: A incidência da sífilis congênita (SC) mais que dobrou na última década, sendo um importante problema de saúde pública e agravo de morbimortalidade perinatal. OBJETIVOS: Determinar a incidência de sífilis congênita e comparar dois períodos: 2011-2012 versus 2013-2014; Caracterizar o perfil dos recém-nascidos (RN) e suas mães; Determinar as principais formas de apresentação; Avaliar o seguimento dos expostos e estabelecer um fluxograma para o acompanhamento ambulatorial. METODOLOGIA: Estudo epidemiológico, retrospectivo, longitudinal, realizado no período de janeiro de 2011 a dezembro de 2014. Selecionados todos os casos notificados de mães com VDRL positivo e seus RN. Os dados foram coletados dos registros de notificação da Vigilância Epidemiológica e dos registros da Unidade Neonatal. Amostra de conveniência. Variáveis maternas: idade, pré-natal, uso de drogas, sorologia para sífilis, tratamento adequado, tratamento do parceiro e tipo de parto. Variáveis neonatais: peso ao nascer, idade gestacional, apgar, manifestações clínicas, sorologia para sífilis e exames complementares. Variáveis pós neonatais: líquor, avaliação auditiva, oftalmológica e sorologia aos 18 meses. Estatística descritiva com cálculo de proporções, testes não paramétricos com significancia se p<0.05. RESULTADOS: A incidência de SC foi de 21/1000 nascidos vivos (NV) aumentando entre os periodos de 18,5/1000 NV para 23,5 /1000 NV. A idade média materna foi de 24 anos (30% adolescentes), a maioria realizou pré-natal (87%). O tratamento adequado ocorreu em apenas 15% dos casos. Os parceiros foram tratados em 35% dos casos. 86% dos RN apresentaram VDRL positivo, 70% foram assintomáticos. As manifestações mais frequentes foram: neurossífilis (30%), prematuridade (25%), baixo peso ao nascer (24%), pequeno para idade gestacional (13%), anemia (10%), plaquetopenia (7%) e hepatoesplenomegalia (3%). A maioria dos pacientes não realizou seguimento e houve baixa adesão na avaliação oftalmológica e auditiva. CONCLUSÃO: A incidência de SC foi alta e aumentou entre os períodos. Embora tenha ocorrido ampla cobertura pré-natal, esta não foi eficaz, uma vez que a maioria das mães não trataram sífilis adequadamente, principalmente pela falta de tratamento do parceiro. A maioria dos RN foi assintomática, e a adesão ao seguimento dessas crianças foi baixa. SC continua sendo um grave problema de saúde pública.
INTRODUCTION: The incidence of congenital syphilis (CS) has more than doubled in the last decade, being an important public health problem and aggravating perinatal morbidity and mortality. OBJECTIVES: To determine the incidence of congenital syphilis and compare two periods: 2011-2012 versus 2013-2014; Characterize the profile of newborns and their mothers; Determine the main forms of presentation; Evaluate the follow-up of those exposed and establish an outpatient follow-up flowchart. METHODS: Epidemiological, retrospective, longitudinal study, carried out from January 2011 to December 2014. All reported cases of mothers with positive VDRL and their newborns were selected. Data were collected from Epidemiological Surveillance records and Neonatal Unit records. Convenience sample. Maternal variables: age, prenatal, drug use, serology for syphilis, adequate treatment, partner treatment and type of delivery. Neonatal variables: birth weight, gestational age, apgar, clinical manifestations, serology for syphilis and complementary tests. Post neonatal variables: cerebrospinal fluid, auditory and ophthalmologic evaluation and serology at 18 months. Descriptive statistics with proportions calculation, non-parametric tests with significance if p <0.05. RESULTS: Incidence of CS was 21/1000 live births (LB) increasing between the periods from 18.5/1000 LB to 23.5/1000 LB. The mean maternal age was 24 years (30% adolescents), the majority performed prenatal care (87%). Adequate treatment occurred in only 15% of cases. The partners were treated in 35% of cases. 86% of the newborns presented positive VDRL, 70% were asymptomatic. The most frequent manifestations were: Neurosyphilis (30%), prematurity (25%), low birth weight (24%), small for gestational age (13%), anemia (10%), thrombocytopenia (7%) and hepatosplenomegaly (3%). Most of the patients did not follow up and there was a low adhesion in ophthalmologic and auditory evaluation. CONCLUSION: The incidence of CS was high and increased between the periods. Although there was extensive prenatal coverage, this was not effective, since most mothers did not treat syphilis adequately, mainly due to inadequate treatment of the partner. Most of the newborns were asymptomatic, and adherence to post-neonatal follow-up of these children was low. CS continues to be a serious health problem.
INTRODUCTION: The incidence of congenital syphilis (CS) has more than doubled in the last decade, being an important public health problem and aggravating perinatal morbidity and mortality. OBJECTIVES: To determine the incidence of congenital syphilis and compare two periods: 2011-2012 versus 2013-2014; Characterize the profile of newborns and their mothers; Determine the main forms of presentation; Evaluate the follow-up of those exposed and establish an outpatient follow-up flowchart. METHODS: Epidemiological, retrospective, longitudinal study, carried out from January 2011 to December 2014. All reported cases of mothers with positive VDRL and their newborns were selected. Data were collected from Epidemiological Surveillance records and Neonatal Unit records. Convenience sample. Maternal variables: age, prenatal, drug use, serology for syphilis, adequate treatment, partner treatment and type of delivery. Neonatal variables: birth weight, gestational age, apgar, clinical manifestations, serology for syphilis and complementary tests. Post neonatal variables: cerebrospinal fluid, auditory and ophthalmologic evaluation and serology at 18 months. Descriptive statistics with proportions calculation, non-parametric tests with significance if p <0.05. RESULTS: Incidence of CS was 21/1000 live births (LB) increasing between the periods from 18.5/1000 LB to 23.5/1000 LB. The mean maternal age was 24 years (30% adolescents), the majority performed prenatal care (87%). Adequate treatment occurred in only 15% of cases. The partners were treated in 35% of cases. 86% of the newborns presented positive VDRL, 70% were asymptomatic. The most frequent manifestations were: Neurosyphilis (30%), prematurity (25%), low birth weight (24%), small for gestational age (13%), anemia (10%), thrombocytopenia (7%) and hepatosplenomegaly (3%). Most of the patients did not follow up and there was a low adhesion in ophthalmologic and auditory evaluation. CONCLUSION: The incidence of CS was high and increased between the periods. Although there was extensive prenatal coverage, this was not effective, since most mothers did not treat syphilis adequately, mainly due to inadequate treatment of the partner. Most of the newborns were asymptomatic, and adherence to post-neonatal follow-up of these children was low. CS continues to be a serious health problem.
Descrição
Palavras-chave
Recém-nascido, Sífilis congênita, Neurossífilis, VDRL, Newborns, Congenital syphilis, Neurosyphilis