Background Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management.Methods We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups.
Los errores innatos del metabolismo representan un problema emergente de salud pública que requiere estrategias puntuales y esfuerzos continuos. Actualmente, el tamiz neonatal es el único método para la detección temprana de este tipo de enfermedades porque permite identificar a los recién nacidos afectados antes de que se genere el daño irreversible que causan estas enfermedades. En los últimos seis años, el panel de detección en la Secretaría de Salud ha pasado de 1 a 6 enfermedades. El financiamiento del programa ha sido fundamental para el desarrollo del tamiz neonatal porque lo ha garantizado como proceso integral, incrementando gradualmente los recursos asignados a esta política pública. La contratación de servicios especializados e integrales ha permitido una mejora sustancial en los indicadores del tamiz neonatal, agilizó la entrega de resultados, garantizó el acceso a pruebas confirmatorias al 100% de casos sospechosos en menos tiempo, lo que en conjunto ha conseguido reducir el tiempo de inicio del tratamiento y, por tanto, la limitación del daño o prevención de la discapacidad.PALABRAS CLAVE: Tamiz metabólico; errores innatos del metabolismo
Summary Background Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes. Methods GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes. Findings We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1·84 [95% CI 1·05–3·22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2·44 [1·02–5·85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities). Interpretation While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection...
INTRODUCCIÓN: La detección temprana de la fibrosis quística mediante tamiz neonatal tiene una repercusión clínica positiva; su implementación es compleja y no existe un protocolo universal para llevarla a cabo. La cuantificación del tripsinógeno inmunorreactivo es el inicio de todos los algoritmos actuales de tamiz neonatal.OBJETIVO: Reportar los resultados preliminares de la aplicación de un algoritmo de tamiz neonatal para fibrosis quística en la Secretaría de Salud de México.MATERIAL Y MÉTODOS: Estudio retrospectivo de los resultados de la aplicación de un algoritmo de tamiz neonatal consistente en la cuantificación del tripsinógeno inmunorreactivo (IRT/IRT) seguida de la prueba del sudor para la detección de fibrosis quística en el marco del programa de tamiz metabólico neonatal de la Secretaría de Salud de México.RESULTADOS: Se obtuvieron 1,267,122 muestras aptas para el procesamiento bioquímico de sangre en papel filtro de 1,273,727 recién nacidos; 3,216 muestras resultaron con valores sanguíneos de tripsinógeno inmunorreactivo superiores al percentil 99.5. Solo en 54% de los casos se logró tomar la segunda muestra de tripsinógeno inmunorreactivo en el tiempo adecuado y se practicaron 1,787 pruebas de sudor. Se identificaron 202 casos altamente sugestivos de fibrosis quística (1:6,273 recién nacidos) que se enviaron para seguimiento médico. La gran cantidad de muestras extemporáneas favoreció el gran número de pruebas del sudor. Estos resultados permiten identificar las principales dificultades que enfrenta la implementación de este tamiz mediante el algoritmo IRT/IRT/ST.CONCLUSIÓN: La incorporación de este primer algoritmo de detección de fibrosis quística al programa de tamiz neonatal en México representa un logro, susceptible de perfección.PALABRAS CLAVE: Tamiz neonatal; fibrosis quística; CFTR; tripsinógeno inmunoreactivo; IRT.
En el Sistema de Salud se reconoce al programa de tamiz neonatal como un programa esencial de prevención en Salud Pública. Se entiende como el “esfuerzo organizado de la sociedad, principalmente a través de sus instituciones de carácter público, para mejorar, promover, proteger y restaurar la salud de las poblaciones por medio de actuaciones de alcance colectivo”.
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