Jornal de pediatria最新文献

Infrared thermography in the assessment of brown and white adipose tissue in children with different nutritional states 红外热成像在评估不同营养状态儿童棕色和白色脂肪组织中的作用。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-01-10 DOI: 10.1016/j.jped.2025.101498

Gisele Bailich , Paulo Roberto Santos Lopes , Danubia da Cunha de Sá-Caputo , Alessandro Sartório , Gabriela Peixe , Mario Bernardo Filho , André Everton de Freitas , Anelise Sonza

Objective

To evaluate brown adipose tissue (BAT) and white adipose tissue using Infrared Thermography (IRT) in children with different nutritional statuses and correlate findings with anthropometric variables.

Methods

This cross-sectional observational study assessed body composition via bioelectrical impedance (BIA), skin temperature (supraclavicular and abdominal) through IRT, and anthropometric variables such as neck (NC), waist (WC), and hip (HC) circumferences. Calculations included waist-to-hip ratio (WHR) and conicity index (CI). Statistical analyses were performed in SPSS 20.0, with normality checked by the Shapiro-Wilk and homogeneity by Levene tests. Groups (eutrophic, overweight, obese) were compared using Pearson's Chi-square for categorical variables, Kruskal-Wallis, and ANOVA tests for quantitative data. Correlations were analyzed using Spearman's method. The significance level was set at p ≤ 0.05.

Results

Of 160 participants, 116 children were analyzed (eutrophic: N = 58; overweight: N = 26; obese: N = 32). Significant differences were noted between the eutrophic and obese groups. Supraclavicular temperature negatively correlated with BIA variables (total body water, fat-free mass, body fat percentage).

Conclusions

IRT demonstrated inverse correlations between BAT temperature and BMI, NC, WC, and HC, underscoring its potential in obesity risk analysis. IRT also offers quantitative assessments of BAT activity and may estimate body fat percentages, suggesting its relevance for monitoring adipose tissue function and metabolic effects of physical exercise.

目的：利用红外热像仪（IRT）评价不同营养状况儿童的棕色脂肪组织（BAT）和白色脂肪组织，并与人体测量变量进行相关性分析。方法：本横断面观察性研究通过生物电阻抗（BIA）、IRT皮肤温度（锁骨上和腹部）和人体测量变量（如颈部（NC）、腰部（WC）和臀部（HC）周长）评估身体组成。计算包括腰臀比（WHR）和锥度指数（CI）。采用SPSS 20.0进行统计学分析，采用Shapiro-Wilk检验正态性，采用Levene检验齐性。各组（富营养化、超重、肥胖）的分类变量采用Pearson's卡方，定量数据采用Kruskal-Wallis检验，方差分析（ANOVA）检验。使用Spearman方法分析相关性。显著性水平设为p≤0.05。结果：在160名参与者中，分析了116名儿童（富营养化：N = 58；超重：N = 26；肥胖：N = 32）。富营养化组和肥胖组之间存在显著差异。锁骨上温度与BIA变量（全身水分、无脂质量、体脂率）呈负相关。结论：IRT显示BAT温度与BMI、NC、WC和HC呈负相关，强调了其在肥胖风险分析中的潜力。IRT还提供了BAT活性的定量评估，并可能估计体脂百分比，这表明它与监测脂肪组织功能和体育锻炼的代谢影响有关。

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引用次数: 0

Determinants and spatial distribution of early newborn care in Somalia: evidence from the 2020 Somalia health and demographic survey 索马里早期新生儿护理的决定因素和空间分布：来自2020年索马里卫生和人口调查的证据。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-01-06 DOI: 10.1016/j.jped.2025.101496

Abdirahman Omer Ali , Awo Mohamed Kahie , Nura Mohamed Omer , Muhyadin Yusuf Dahir , Abdisalam Mahdi Hassan , Hodo Abdi Abdillahi , Md. Moyazzem Hossain

Objective

Early newborn care (ENC) is important for reducing neonatal mortality; however, the rate of receiving adequate newborn care is low in Somalia. Therefore, this study aimed to identify the individual, household, and community-level determinants and map the spatial patterns of ENC in Somalia to take the required actions and policies.

Methods

This study considered a weighted sample of 15,024 mother-newborn pairs extracted from a countrywide cross-sectional survey, the 2020 Somali Health and Demographic Survey (SHDS). Multilevel logistic regression was employed to identify factors associated with receiving adequate ENC within two days of birth. Global Moran’s I and Getis-Ord Gi* statistics were used for spatial analysis.

Results

The prevalence of adequate ENC was critically low (5.23%). Findings revealed that delivery in a health facility (vs. home: Adjusted Odds Ratio (AOR) = 0.22, 95% CI: 0.18-0.26), higher household wealth (richest vs. poorest: AOR = 2.02, 95% CI: 1.59-2.57), and higher birth order were influential predictors of receiving ENC. However, having multiple or a higher number of living children was associated with significantly lower odds of receiving ENC. Spatial analysis identified a statistically significant hot spot of higher ENC coverage in the northwestern regions and cold spots of extremely low coverage in the south.

Conclusion

In Somalia, early neonatal care is shockingly insufficient, and significant social and regional disparities. To achieve Sustainable Development Goal 3, interventions must be implemented based on identified cold spots, prioritizing the strengthening of access to skilled care at birth, and addressing the economic vulnerabilities of families.

目的：新生儿早期护理对降低新生儿死亡率具有重要意义；然而，索马里获得适当新生儿护理的比率很低。因此，本研究旨在确定索马里ENC的个人、家庭和社区层面的决定因素，并绘制ENC的空间格局，以采取必要的行动和政策。方法：本研究考虑了从2020年索马里健康和人口调查（SHDS）全国横断面调查中提取的15,024对母亲-新生儿加权样本。采用多水平逻辑回归来确定与出生2天内接受足够ENC相关的因素。采用Global Moran’s I和Getis-Ord Gi*统计进行空间分析。结果：适足ENC的患病率极低（5.23%）。调查结果显示，在卫生机构分娩（相对于在家：调整优势比（AOR） = 0.22,95% CI: 0.18-0.26），较高的家庭财富(最富有vs最贫穷：AOR = 2.02,95% CI：出生顺序高是ENC接受的影响因素，而多胞胎或多胞胎儿童接受ENC的几率显著降低。空间分析发现，西北地区ENC覆盖率较高的热点地区和南方极低覆盖率的冷区具有统计学意义。结论：在索马里，早期新生儿护理严重不足，而且存在显著的社会和地区差异。为实现可持续发展目标3，必须根据已确定的冷点实施干预措施，优先加强在出生时获得熟练护理的机会，并解决家庭的经济脆弱性。

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引用次数: 0

Dietary protein intake and asthma in US children and adolescents: a cross-sectional analysis of NHANES data 膳食蛋白质摄入与美国儿童和青少年哮喘：NHANES数据的横断面分析

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-01-06 DOI: 10.1016/j.jped.2025.101495

Lingyu Li, Peipei Tian, Yanmei Teng, Rui Wang, Mingxiao Zhang, Qiuyu Ma

Objective

Evidence regarding total dietary protein intake remains inconsistent and limited for the US pediatric population. This study utilizes nationally representative data to examine the association between total dietary protein intake and asthma prevalence, thereby addressing this research gap.

Method

A cross-sectional study that involved 4825 people used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020. The relationship between total protein intake and asthma was investigated using multiple linear regression models. The linear relationship between the two was tested using a restricted cubic spline. Stratified analysis further confirms the stability of the findings.

Results

All eligible participants (N = 4,825; mean age 10.6 ± 2.9 years; 49.7% male) were analyzed. The fully-adjusted model revealed a positive association between total protein consumption and asthma after controlling for confounders. Compared to the lowest intake quartile Q1 (≤ 3.966 mg/day), adjusted odds ratios for asthma in Q2 (3.967-6.364 mg/day) and Q3 (≥ 6.365 mg/day) were 0.097 (95%CI:0.97-1.44, p = 0.097) and 0.036 (95%CI:1.01-1.55, p = 0.036), respectively. A dose-response relationship (p = 0.037) emerged between total protein consumption and asthma risk.

Conclusion

Total dietary protein intake demonstrated a positive association with asthma among US children and adolescents. These findings are statistically significant.

目的：关于美国儿科人群总膳食蛋白质摄入量的证据仍然不一致且有限。本研究利用具有全国代表性的数据来检验总膳食蛋白质摄入量与哮喘患病率之间的关系，从而解决了这一研究空白。方法：采用2011年至2020年国家健康与营养检查调查（NHANES）的数据，对4825人进行横断面研究。采用多元线性回归模型研究总蛋白摄入量与哮喘的关系。用限制三次样条检验了两者之间的线性关系。分层分析进一步证实了研究结果的稳定性。结果：所有符合条件的参与者（N = 4,825人，平均年龄10.6±2.9岁，男性49.7%）均被纳入分析。完全调整的模型显示，在控制混杂因素后，总蛋白质摄入量与哮喘呈正相关。与最低摄入四分位数Q1（≤3.966 mg/天）相比，Q2（3.967-6.364 mg/天）和Q3（≥6.365 mg/天）哮喘的调整优势比分别为0.097 （95%CI:0.97-1.44, p = 0.097）和0.036 （95%CI:1.01-1.55, p = 0.036）。总蛋白质摄入量与哮喘风险之间存在剂量-反应关系（p = 0.037）。结论：在美国儿童和青少年中，总膳食蛋白质摄入量与哮喘呈正相关。这些发现具有统计学意义。

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引用次数: 0

Applicability of anthropometric indicators to assess physical fitness: proposal of percentiles for schoolchildren living at high altitude in Peru 人体测量指标评估体质的适用性：秘鲁高海拔地区学童百分位数的建议。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-01-01 DOI: 10.1016/j.jped.2025.101497

Jose Fuentes-Lopez , Ruben Vidal-Espinoza , Danilo Rodrigues Pereira da Silva , Dony Mamani-Velásquez , Eliseny Vargas-Ramos , Estanislao Pacompia-Cari , Wilbert Cossio-Bolaños , Marco Cossio-Bolaños , Rossana Gomez-Campos

Objective

a) To verify the applicability of anthropometric indicators to evaluate physical fitness in school children and b) Propose physical fitness reference values for Peruvian children living at high altitudes in Peru.

Methods

A cross-sectional study was carried out in children aged 6 to 12 years living at high altitude in Peru. A total of 1372 primary school children (785 males and 587 females) were evaluated. Weight, height and four physical tests [Hand grip strength (right and left HGS)], Horizontal jump (HJ), Round trip (5 × 10 repetitions), and the 6-minute walk test (6MWT)] were evaluated. Body Surface Area (BSA), Body Mass Index (BMI), and Triponderal Index (TPI) were calculated.

Results

The BSA presented a better comparative structure in relation to BMI and TPI with all physical tests. In males, HGS was related between r = 0.64 and 0.66; HJ (r = 0.26), agility (r = -0.31) and 6MWT (r = 0.30). In females, HGS was related between r = 0.63 and 0.64; HJ (r = 0.36), agility (r = -0.36), and 6MWT (r = 0.21). The predictive power in the four physical tests ranged from R² = 9% to 43% in males, and from 5% to 41% in females. Percentiles by age and sex were proposed for BSA, HGS (right and left), HJ, agility, and 6MWT.

Conclusion

BSA is the best predictor of physical fitness in schoolchildren from high altitude areas in Peru, surpassing BMI and TPI. In addition, reference values were proposed to evaluate physical fitness in these children.

目的：a)验证人体测量指标评价学龄儿童体质的适用性；b)提出秘鲁高海拔地区秘鲁儿童体质参考值。方法：对秘鲁高海拔地区6 ~ 12岁儿童进行横断面研究。共对1372名小学生（男785名，女587名）进行了评价。评估体重、身高和四项体能测试[握力（右手和左手HGS）]、水平跳跃（HJ）、往返（5 × 10次重复）和6分钟步行测试（6MWT）]。计算体表面积（BSA）、体重指数（BMI）和三体指数（TPI）。结果：在所有体格检查中，BSA与BMI和TPI具有较好的比较结构。男性HGS相关r = 0.64 ~ 0.66；HJ (r = 0.26)、灵活性(r = -0.31)和6 mwt (r = 0.30)。女性HGS相关r = 0.63 ~ 0.64；HJ (r = 0.36),敏捷(r = -0.36),和6 mwt (r = 0.21)。四项体格检查的预测能力R2 = 男性为9% ~ 43%，女性为5% ~ 41%。BSA、HGS（左、右）、HJ、敏捷性和6MWT按年龄和性别划分百分位数。结论：BSA是秘鲁高海拔地区学童体质的最佳预测指标，优于BMI和TPI。此外，还提出了评价这些儿童身体素质的参考值。

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引用次数: 0

Caregiver adherence to outpatient follow-up of children infected with or exposed to syphilis during pregnancy 护理人员坚持门诊随访的儿童感染或暴露于梅毒在怀孕期间。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-26 DOI: 10.1016/j.jped.2025.101493

Márcia Galdino Sampaio , Cristina Barroso Hofer

Objective

To describe the caregiver adherence to the various interventions proposed by the Ministry of Health in the follow-up of children infected with or exposed to Treponema pallidum during pregnancy.

Method

This is a prospective cohort study that included 256 children treated for congenital syphilis during the neonatal period. The children were referred from maternity to a reference outpatient clinic in the state of Rio de Janeiro between 2016 and 2021. Adherence was used as the outcome variable. It was assessed in two components: clinical-laboratory adherence (basic adherence) and adherence to specialist consultations (final adherence). Factors associated with adherence were investigated using logistic regression.

Results

It was observed that 41 % of the children were followed for at least 18 months, and 68 % had two consecutive non-reactive VDRL tests. Basic adherence was 32 %, while final adherence (including specialist consultations and clinical-laboratory follow-up) was only 16 %. Additionally, 36 children presented permanent sequelae during follow-up. Factors such as higher maternal age (OR = 1.10; 95 % CI:1.03–1.20) and the presence of permanent sequelae in the children (OR = 4.87; 95 % CI: 2.29–10.35) were predictors of adherence. Loss to follow-up occurred in 68 % (173/256) of the cases.

Conclusion

This study highlights a very low level of caregiver adherence to the congenital syphilis management protocol recommended by the Brazilian Ministry of Health. The presence of sequelae in children and higher maternal age were associated with improved adherence.

目的：描述护理人员在妊娠期感染或暴露于梅毒螺旋体的儿童随访中对卫生部提出的各种干预措施的依从性。方法：这是一项前瞻性队列研究，包括256名在新生儿期接受先天性梅毒治疗的儿童。这些孩子在2016年至2021年期间从产科转到里约热内卢州的参考门诊诊所。依从性被用作结果变量。评估分为两个部分：临床-实验室依从性（基本依从性）和对专家咨询的依从性（最终依从性）。采用logistic回归方法调查与依从性相关的因素。结果：41 %的儿童随访至少18个月，68 %的儿童连续两次无反应VDRL试验。基本依从性为32% %，而最终依从性（包括专家咨询和临床实验室随访）仅为16% %。此外，36名儿童在随访期间出现永久性后遗症。诸如母亲年龄较高（OR = 1.10;95 % CI:1.03-1.20）和儿童是否存在永久性后遗症（OR = 4.87;95 % CI: 2.29-10.35）等因素是依从性的预测因素。68% %（173/256）的病例失去随访。结论：这项研究强调了非常低水平的照护者遵守先天性梅毒管理方案由巴西卫生部推荐。儿童后遗症的存在和母亲年龄的增加与依从性的提高有关。

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引用次数: 0

Diet quality in Brazilian adolescents with cystic fibrosis 巴西青少年囊性纤维化患者的饮食质量

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-23 DOI: 10.1016/j.jped.2025.101488

Chiara Pascon , Maria Angela Bellomo-Brandão , José Dirceu Ribeiro , Elizete Aparecida Lomazi

Objective

To describe the quality of the diet and its relationship with lung function and nutritional status in adolescents with cystic fibrosis (CF).

Methods

A questionnaire was applied to 47 adolescents (12–19 years old) followed at a university reference center. Lung function impairment was classified as mild (FEV1pp ≥ 60%), moderate (FEV1pp 41–59%), or severe (FEV1pp < 40%) using spirometry. Food consumption frequency was classified as rarely, 1-2 times/week, 3-4 times/week, or ≥ 5 times/week. Linear regression analysis was used to model the relationship between lung function, BMI/age Z-score, and food frequency. Principal component analysis (PCA) was performed to identify patterns of diet quality.

Results

The mean BMI/age Z-score was -0.62. Approximately 60% of adolescents had FEV1 ≥ 60%, and 21% had severe impairment (FEV1 < 40%). Better BMI/age Z-score was observed in groups with higher consumption frequencies of vegetables and fruit (≥ 5/week), white meat (> 3-4/week), and oil (> 3-4/week). Linear regression models identified significant relationships: BMI/age Z-Score = -3.25+ 0.8182*meat_b+0.5082*vegetables_fruit (p < 0.001): Increased white meat, fruit, and vegetable consumption positively influenced the BMI/age Z-Score; lung function = 0.6927 + 0.3356*vegetables-0.2406*fruit_vegetables-0.4550*fast_food (p < 0.001): Lower consumption of fruit and vegetables and higher fast-food intake were associated with more severe lung function; and lung function = 0.39376 -0.32345 *ZSCORE (p < 0.0001): The BMI/age Z-Score positively influenced lung function. PCA confirmed the positive relationship between fruit, vegetables, and white meat consumption and BMI/age Z-score.

Conclusion

Higher consumption of fruit, vegetables, and meat has a positive influence on the BMI/age Z-score and lung function among adolescents with CF.

目的：探讨青少年囊性纤维化（CF）患者饮食质量及其与肺功能和营养状况的关系。方法：采用问卷调查法对某高校参考咨询中心的47名12 ~ 19岁青少年进行随访。肺活量测定法将肺功能损害分为轻度（FEV1pp≥60%）、中度（FEV1pp 41-59%）和重度（FEV1pp < 40%）。进食频率分为很少、1-2次/周、3-4次/周、≥5次/周。采用线性回归分析对肺功能、BMI/年龄Z-score和食物频率之间的关系进行建模。采用主成分分析（PCA）确定饲粮质量模式。结果：平均BMI/age Z-score为-0.62。大约60%的青少年FEV1≥60%，21%的青少年FEV1严重受损（FEV1 < 40%）。食用蔬菜和水果（≥5/周）、白肉（> 3-4/周）和油（> 3-4/周）频率较高的组BMI/age - z评分较高。线性回归模型发现了显著的关系：BMI/age Z-Score = -3.25+ 0.8182*meat_b+0.5082* veget_fruit (p < 0.001)：白肉、水果和蔬菜消费的增加正影响BMI/age Z-Score；肺功能 = 0.6927 + 0.3356*蔬菜-0.2406*水果蔬菜-0.4550*快餐（p < 0.001）：低水果蔬菜摄入量和高快餐摄入量与更严重的肺功能相关；肺功能 = 0.39376 -0.32345 *ZSCORE (p < 0.0001): BMI/age Z-Score对肺功能有正向影响。PCA证实了水果、蔬菜和白肉消费与BMI/age Z-score之间的正相关关系。结论：多吃水果、蔬菜和肉类对青少年CF患者的BMI/age Z-score和肺功能有积极影响。

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引用次数: 0

The pediatrician’s role in the follow-up of children/adolescents with mental and/or neurodevelopmental disorders 儿科医生在患有精神和/或神经发育障碍的儿童/青少年随访中的作用。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-19 DOI: 10.1016/j.jped.2025.101492

Magda Lahorgue Nunes

引用次数: 0

Early childhood blood pressure trajectories in very low birth weight offspring: is there a legacy of maternal hypertension? 极低出生体重后代的早期儿童血压轨迹：是否存在母体高血压的遗传？

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-18 DOI: 10.1016/j.jped.2025.101482

Daiane de Oliveira Pereira Vergani , José Mauro Madi , Lucas Girotto de Aguiar , Vitória Rovatti Canello , Thiago Crocoli Balbinot , Letícia Lorenzet , Luciano da Silva Selistre , Vandréa Carla de Souza

Objective

To investigate the association between maternal hypertensive disorders of pregnancy (HDP) and blood pressure (BP) in preterm children born with very low birth weight (VLBW, < 1500 g).

Methods

Longitudinal cohort study of VLBW preterm infants from birth to early childhood. Systolic and diastolic blood pressure (SBP and DBP), and their age-, height- and sex-adjusted percentiles (SBP%, DBP%), were assessed at multiple time points. Linear quantile mixed models estimated BP trajectories across the 25th, 50th, and 75th quantiles, stratified by maternal HDP exposure.

Results

Among 277 infants, 121 (43.6 %) were exposed to HDP. Median gestational age was 30 weeks (IQR: 28 - 32), and median birth weight was 1180 g (IQR: 985, 1340), 128 (46.2 %) were male. Maternal HDP was not significantly associated with SBP or DBP at any quantile. BP increased modestly with age across all quantiles. SBP increased by 0.06, 1.55, and 2.58 mmHg; DBP by 1.77, 1.80, and 3.06 mmHg at the 25th, 50th, and 75th quantiles, respectively. Conversely, SBP% and DBP% declined with age, indicating a relative downward shift in BP percentiles over time. This decline was more pronounced for DBP%, especially in the lower quantiles.

Conclusion

In this cohort of VLBW preterm children, maternal HDP was associated with modest differences in blood pressure, though not statistically significant. These findings suggest that the cardiovascular effects of prenatal hypertensive exposure may be delayed, subtle, or modulated by postnatal factors. Long-term follow-up is essential to clarify these trajectories and guide early prevention efforts.

目的：探讨极低出生体重早产儿（VLBW < 1500 g）妊娠期产妇高血压疾病（HDP）与血压（BP）的关系。方法：对VLBW早产儿从出生到幼儿期进行纵向队列研究。在多个时间点评估收缩压和舒张压（SBP和DBP）及其年龄、身高和性别调整的百分位数（SBP%, DBP%）。线性分位数混合模型估计了25分位数、50分位数和75分位数的BP轨迹，并按母体HDP暴露分层。结果：277例婴儿中，121例（43.6 %）暴露于HDP。中位胎龄为30周（IQR: 28 - 32），中位出生体重为1180 g (IQR: 985, 1340)，男性128例（46.2% %）。在任何分位数上，母体HDP与收缩压或舒张压均无显著相关性。所有分位数的血压都随着年龄的增长而适度增加。收缩压升高0.06、1.55、2.58 mmHg；DBP分别在第25、50和75分位数处降低1.77、1.80和3.06 mmHg。相反，收缩压%和舒张压%随着年龄的增长而下降，表明随着时间的推移，血压百分位数相对下降。DBP%的下降更为明显，特别是在较低的分位数。结论：在这个VLBW早产儿队列中，母亲HDP与血压的适度差异相关，尽管没有统计学意义。这些发现表明，产前高血压暴露对心血管的影响可能是延迟的，微妙的，或由产后因素调节的。长期随访对于阐明这些轨迹和指导早期预防工作至关重要。

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引用次数: 0

U-shaped association between hemoglobin to red blood cell distribution width ratio and all-cause mortality among critically ill pediatric patients 危重儿科患者血红蛋白与红细胞分布宽度比与全因死亡率的u型关系

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-17 DOI: 10.1016/j.jped.2025.101491

Weichao He , Jie Liu , Rui Jiang , Xinyu Yang , Xujie Zhang , Ruoyu Cao , Zhenshui Hu , Xiaolan Zhang , Yan Gao

Objective

The lower hemoglobin to red blood cell distribution width ratio (HRR) is associated with an increased risk of mortality in adult patients, but its relationship with clinical progress in the Pediatric Intensive Care Unit (PICU) is unclear. The authors aimed to investigate the association between HRR and all-cause mortality among pediatric patients.

Methods

The authors conducted a retrospective cohort study by analyzing the PIC database from 2010 to 2018.HRR was calculated based on laboratory tests conducted within the first 24 hours of PICU admission. The primary outcome was 28-day in-hospital all-cause mortality. Multivariable logistic regression models, restricted cubic spline, and threshold effects analysis were applied to assess the relationship between HRR and mortality in this cohort.

Results

A total of 8015 patients with an average age of the participants was1.5 (0.4, 4.8) years, and 3547 (44.3%) individuals were female. The 28-day in-hospital all-cause mortality was 4.1% (330/8015). The relationship between HRR and mortality was U-shaped, which had a threshold of around 8.91. The effect size on the left and right sides of the inflection point, was 0.803 (95% CI 0.742-0.869, p < 0.001) and 1.421 (95% CI 1.159-1.743, p < 0.001), respectively. No significant interactions were observed between HRR and all-cause mortality, except in patients with high lactate (p for interaction > 0.05). The results of the sensitivity analysis remained stable.

Conclusions

There is a U-shaped relationship between HRR and 28-day in-hospital all-cause mortality in critically ill pediatric. With a lower mortality risk at an HRR of 8.91.

目的：血红蛋白与红细胞分布宽度比（HRR）降低与成人患者死亡风险增加相关，但其与儿科重症监护病房（PICU）临床进展的关系尚不清楚。作者旨在调查儿科患者HRR与全因死亡率之间的关系。方法：对2010 - 2018年PIC数据库进行回顾性队列研究。HRR是根据PICU入院前24小时内进行的实验室检查计算的。主要终点是28天住院全因死亡率。应用多变量logistic回归模型、受限三次样条和阈值效应分析来评估该队列中HRR与死亡率之间的关系。结果：共有8015例患者，参与者的平均年龄为1.5（0.4,4.8）岁，女性3547例（44.3%）。住院28天全因死亡率为4.1%（330/8015）。HRR与死亡率呈u型关系，阈值约为8.91。拐点左右两侧的效应量分别为0.803 （95% CI 0.742 ~ 0.869, p < 0.001）和1.421 （95% CI 1.159 ~ 1.743, p < 0.001）。除了高乳酸血症患者外，HRR和全因死亡率之间没有观察到显著的相互作用（相互作用p < 0.05）。敏感性分析结果保持稳定。结论：小儿危重症患者HRR与住院28天全因死亡率呈u型关系。死亡风险较低，HRR为8.91。

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引用次数: 0

Children with autism spectrum disorder and alterations in eating behavior: could it be gastroesophageal reflux disease? 儿童自闭症谱系障碍和饮食行为改变：可能是胃食管反流病吗？

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-12-17 DOI: 10.1016/j.jped.2025.101487

Christine Audet de Almeida , Eduardo Sampaio Siqueira , Marcelo do Rego Maciel Souto Maior , Kátia Galeão Brandt

Objective

Describe the occurrence of warning signs of gastroesophageal reflux disease (GERD) and esophagitis in children with eating behavior (EB) alterations associated with autism spectrum disorder (ASD).

Method

Descriptive study of 115 children aged 3 to 12 years, followed at a tertiary hospital and previously diagnosed with ASD. The BRCA-TEA instrument was applied to identify children with EB alterations, and the 17-ATN-GISSI instrument was applied to identify those with warning signs of GERD. The selected children were invited for a medical consultation to identify those with suspected esophagitis and an indication for upper gastrointestinal (GI) endoscopy with biopsies.

Results

Sixty-nine children (60 %) were classified with alterations in the EB and, among these, 62 (89.8 %) presented warning signs of GERD. Eighteen children had suspected esophagitis and an indication for upper GI endoscopy. Among the 8 children who underwent the exam, 1 child had grade A erosive esophagitis, 1 child had grade B erosive esophagitis, and 1 child had eosinophilic esophagitis.

Conclusion

A high frequency of EB alterations was found in children with ASD. The high frequency of GERD warning signs may be related to EB alterations in this group. Cases of esophagitis highlight the possibility of an organic disease. In these cases, performing upper GI endoscopy with biopsies is essential for diagnosis.

目的：描述与自闭症谱系障碍（ASD）相关的饮食行为（EB）改变儿童胃食管反流病（GERD）和食管炎预警信号的发生情况。方法：对115名3 ~ 12岁儿童进行描述性研究，随访于三级医院，既往诊断为ASD。采用BREB-ASD仪识别EB改变的儿童，采用17-ATN-GISSI仪识别有GERD警告信号的儿童。被选中的儿童被邀请进行医学咨询，以确定那些疑似食管炎和上胃肠道（GI）内窥镜活检的指征。结果：69名儿童（60 %）被分类为EB改变，其中62名（89.8% %）出现GERD的警告信号。18名儿童疑似食管炎，有上消化道内窥镜检查的指征。接受检查的8例患儿中，1例为A级糜烂性食管炎，1例为B级糜烂性食管炎，1例为嗜酸性食管炎。结论：ASD患儿EB改变发生率高。该组胃食管反流警告信号的高频率可能与EB改变有关。食管炎的病例强调器质性疾病的可能性。在这些病例中，进行上消化道内镜活检对诊断至关重要。

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