Jornal de Pediatria (Vers?o em Português)最新文献

Objective

Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation.

Method

Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009–2011), patients who failed medical treatment underwent surgical closure; in second period (2012–2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival‐without‐morbidity were compared.

Results

This study included 188 patients (27 ± 2 weeks, 973 ± 272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 versus 56% P2, p < 0.001) and surgical closure (34.5% P1 versus 16.1% P2, p < 0.001) were observed. No differences were found in chronic lung disease (28.8% versus 13.9%, p = 0.056), severe retinopathy of prematurity (7.5% versus 11.8%, p = 0.403), necrotizing enterocolitis (15.5% versus 6.9%, p = 0.071), severe intraventricular hemorrhage (25.4% versus 18.4%, p = 0.264), mortality (17.5% versus 15.2%, p = 0.690) or survival‐without‐morbidity adjusted OR = 1.10 (95% CI: 0.55–2.22); p = 0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (n = 82) showed significant differences: lower incidence of chronic lung disease (50% versus 19.6%, p = 0.019) and more survival‐without‐morbidity (20% versus 45.6%, p = 0.028) were found.

Conclusion

A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival‐without‐morbidity. However, two‐thirds of preterm infants under 26 weeks are still treated.

Objectives

To present the currently available evidence on transmission, clinical, diagnostic methods, treatment, and prevention methods of major arboviruses that occur in childhood.

Source of data

Non‐systematic review carried out in MEDLINE (PubMed), LILACS (VHL), Scopus, Web of Science, Cochrane, CAPES Portal, and Google Scholar databases for the past five years using the search terms arboviruses, dengue, chikungunya, Zika, Mayaro, and West Nile fever, as well as child, newborn, and adolescent.

Synthesis of data

The main characteristic of arboviruses is the fact that part of their replication cycle occurs inside insect vectors, thus being classically transmitted to humans through the bite of mosquitoes (hematophagous arthropods), although non‐vector transmission of these viruses is also possible in specific situations. These diseases remain a major public health challenge, due to the lack of specific antiviral treatment, the co‐circulation of different arboviruses in endemic/epidemic regions, the lack of effective and safe immunizations for the vast majority of these viruses, and the great difficulty in vector control, especially in large urban centers.

Conclusions

Children are especially vulnerable to this group of diseases due to characteristics that facilitate the development of the most severe forms. More detailed knowledge of this group of diseases allows the pediatrician to diagnose them earlier, implement the correct treatment, monitor warning signs for the most severe forms, and establish effective preventive measures.

Objectives

To review the diagnostic criteria for encephalitis and encephalopathy of presumed infectious etiology, as well as the diagnostic workup for viral encephalitis and its treatment approaches. The authors also intended to summarize relevant information on specific viruses frequently found in Brazil.

Source of data

Literature search on Pubmed/MEDLINE using the following keywords: “viral”, “encephalitis”, “child”, or “adolescents”, filtering for articles on humans and in English.

Summary of data

Viral encephalitis is the most common cause of encephalitis and is responsible for high rates of morbidity, permanent neurologic sequelae, and according to the virus, may have high mortality rates. The most common etiologies are herpesviruses 1 and 2 (HSV‐1 and HSV‐2), non‐polio enterovirus, and arboviruses (in Brazil, dengue, Zika, and chikungunya). Other relevant etiologies are seasonal influenza, cytomegalovirus (CMV), Epstein‐Barr virus (EBV), human herpesvirus 6 (HHV‐6), and the re‐emergent measles.

Conclusion

Clinical data, laboratory results, and neuroimaging findings support the diagnosis of encephalitis and the specific viral etiology. To increase the likelihood of etiologic confirmation, it is important to know the best approach to collecting samples and to choose the best identification technique for each virus. The differential diagnosis of viral encephalitis includes other infections and immune‐mediated inflammatory central nervous system disorders.

Objective

To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy.

Sources of Data: A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review.

Synthesis of Data

Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines.

Conclusions

Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost‐effective preventative measure in future.

Objective

To analyze the association between age at menarche and variables of body composition in girls from the Northern region of Brazil, the Brazilian Legal Amazon.

Method

The sample was composed of 926 school girls, aged between 8 and 18 years, divided into two groups, those who had (G1; n = 727; 72.5%) and had not undergone menarche (G2; n = 199; 21.5%), from public and private schools, using the stratified random proportional sampling technique. Weight, fat weight, muscle weight, and body mass index were measured using bioimpedance analysis. Body height was measured using a stadiometer. Age at menarche was obtained using the conventional method. For the evaluation of sexual maturation, self‐assessment was performed according to criteria described by Tanner.

Results

The highest cumulative distribution of menarche was found at age 11, and presented significant differences between G1 and G2 at ages 11 and 12 years in all variables of body composition, except body mass index Z‐score. Fat and muscle mass were associated with age at menarche.

Conclusion

The present results support the notion of menarche anticipation in girls from Brazilian Amazon and its association with body composition. Further studies are needed to investigate the influence of other possible factors that may interfere with the time of growth spurt, thus determining the timing of puberty in these girls in comparison to other regions of Brazil.

Objective

Using a wide and representative sample of adolescents from 37 countries, this study aimed to analyze how age changes adolescents’ healthy lifestyle.

Methods

The study included 148,839 adolescents who participated in the Health Behavior in School‐aged Children 2010 survey. A composite score of a healthy lifestyle was created using the combination of daily physical activity, daily fruit and vegetable consumption, <2 h daily on screen‐based behaviors, abstinence from alcohol, and abstinence from tobacco products. Healthy lifestyle measures were based on self‐report.

Results

4.7% of boys and 4.4% of girls aged 11 years, 3% of boys and 2% of girls aged 13 years, and 1.5% of boys and 0.8% of girls aged 15 scored perfectly on the healthy lifestyle score. As age increased, the prevalence of adolescents with a healthy lifestyle decreased. In 37 countries and regions, the prevalence of healthy behaviors decreased linearly between early adolescence and the age of 15 years.

Conclusions

In general, adolescents do not have a healthy lifestyle. Results from this study highlight that there is still much work to be done in promoting healthy lifestyles and to raise awareness among adolescents of the potential risk to their health status.

Objectives

To capture evidence of the efficacy and safety of pharmacological analgesia for uncomplicated acute sickle‐cell pain in pediatric patients compared to placebo.

Sources of data

Searches for key evidence were performed from March 1 to 31, 2018, for randomized controlled trials of pharmacological analgesia compared to placebo for uncomplicated acute sickle‐cell pain in a pediatric sample. The authors searched ten scientific databases including, among others, PubMed, MEDLINE, Embase, and Clinicaltrials.gov for this systematic review and meta‐analysis.

Summary of the findings

Four trials (n = 227) were selected by the inclusion criteria (intranasal fentanyl, intravenous magnesium, arginine, and inhaled nitric oxide). The quality of evidence ranged from low to moderate for each outcome. Meta‐analysis of changes in the ladder of pain score (p = 0.72), length‐of‐stay in hospital (p = 0.65), and amount of narcotics used during the study (p = 0.10) showed non‐statistically significant differences and a lack of amelioration provided by pharmaceutical analgesics in treatment group. The adverse events reported that more participants in the intervention arm underwent pain, with statistically significant differences at the drug delivery site in studies using intranasal fentanyl and intravenous magnesium (p = 0.03).

Conclusions

Pharmacological analgesia appears to be uncertain in improving the intensity and providing relief of acute pain crisis in pediatric patients with sickle‐cell anemia. With respect to clinical advantage, no decisive deduction about the clinical efficacy may be made regarding these medications in acute sickle‐cell pain management in the pediatric age group.

Objective

To provide cutting‐edge information for the management of community‐acquired pneumonia in children under 5 years, based on the latest evidence published in the literature.

Data source

A comprehensive search was conducted in PubMed, by using the expressions: “community‐acquired pneumonia” AND “child” AND “etiology” OR “diagnosis” OR “severity” OR “antibiotic”. All articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading.

Data synthesis

In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community‐acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤ 96%) and increased work of breathing are signs most associated with community‐acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X‐ray and serum procalcitonin < 0.25 ng/dL was 92% (77‐98%) and 93% (90‐99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation < 90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients.

Conclusions

Distinct aspects of childhood community‐acquired pneumonia have changed during the last three decades.

Objectives

To present current evidence on the etiology, risk factors, diagnosis, and management of early and late neonatal sepsis.

Source of data

Non‐systematic review of the Medline (PubMed), Scopus, Web of Science, Cochrane, and Google Scholar databases regarding the following terms: neonatal sepsis, early neonatal sepsis, late neonatal sepsis, empirical antibiotic therapy, sepsis calculator, vancomycin, newborn, preterm newborn.

Data synthesis

Neonatal sepsis is a frequent cause of neonatal morbidity and mortality. Its diagnosis is difficult. Continuous observation of the patient is critical to diagnostic suspicion. When neonatal sepsis is suspected, bacteriological tests should be collected. Vancomycin should not be routinely using in the empirical antibiotic regimen in late neonatal sepsis, and the main protective mechanisms against neonatal sepsis are handwashing and the use of breast milk.

Conclusions

Newborns constitute a group that is more vulnerable to sepsis. Knowledge of risk factors and etiological agents allows a better approach to the newborn with sepsis.