Jornal de pediatria最新文献

Objective: To determine whether the use of an electrocardiogram monitor in newborns receiving positive pressure ventilation (PPV) at birth affects the frequency of tracheal intubation in the delivery room.

Methods: Retrospective cohort of liveborn infants without congenital anomalies, with gestational age (GA) ≥ 23 weeks and birth weight ≥ 400 g who received PPV at birth, from 2014 to 2022. Newborns were stratified by GA (< 34 or ≥ 34 weeks) and by use or non-use of an electrocardiogram monitor during resuscitation. Logistic regression was used to assess the association between electrocardiogram monitoring and outcomes of interest for each GA group.

Results: Among 5622 live births, 516 met the inclusion criteria; 224 (43 %) were monitored, and 292 (57 %) were not. The frequency of tracheal intubation was similar between monitored and non-monitored groups: ≥ 34 weeks - 13 % vs. 14 %; < 34 weeks - 43 % vs. 43 %. Electrocardiogram monitoring increased the odds of initiating PPV with a face mask ≥ 60 seconds after birth by 2.45-fold (95 % CI: 1.08-5.54) for GA ≥ 34 weeks and by 2.72-fold (95 % CI: 1.13-6.59) for GA < 34 weeks, after adjustment for umbilical cord clamping time, year of birth, and birth weight.

Conclusion: Electrocardiogram monitor use did not reduce the frequency of tracheal intubation and was associated with delayed initiation of PPV with a face mask.

Objective: There is increasing awareness of the benefits of early nutritional intervention in children with acute pancreatitis (AP). This study aims to compare oral feeding with NG feeding in mild to moderately severe AP patients.

Methods: A single-center, prospective, randomized controlled trial was conducted from September 2021 to August 2024. The participants were randomly assigned to the oral feeding group or the NG feeding group. The primary outcomes were the duration of AP-related pain, tolerance rate, and changes in weight.

Results: A total of 56 pediatric patients were enrolled, of whom 48 patients (24 in each group) were included in the final analysis. There were no significant differences in baseline characteristics or etiological analysis results between the two groups. The median duration of abdominal pain after admission was 3 days in both groups (p = 0.104); no difference was found in the tolerance rate between the 2 cohorts (p = 0.489). There were no significant differences in weight change between the two groups at discharge or at 1 week or 5 weeks after discharge (p = 0.658, 0.502, and 0.927, respectively), and both groups presented slight increases in weight at 5 weeks post-discharge. Four patients in the NG group developed complications, while no complications were observed in the ORAL group (p = 0.109).

Conclusions: Oral feeding is effective for nutritional therapy in children with mild to moderately severe AP, reducing the number of invasive procedures, without significant adverse effects.

Objective: The number of children with type 1 diabetes (CwD) is rising globally, increasing demand for school-based support. The primary objective was to assess parents' perceptions of the current state of diabetes care in schools for CwD. The secondary objective was to gather feedback on a comprehensive educational program offered to participants.

Methods: Families of CwD attending an outpatient clinic completed a survey about diabetes care offered by schools. A comprehensive diabetes educational program was developed, comprising a mobile application, website, and printed diabetes management plan. The program was presented to the families to facilitate communication with school staff.

Results: A total of 107 families participated (mean age of students 10.7 ± 3.9 years; mean age at diagnosis 5.4 ± 3.3 years). Most were from the São Paulo metropolitan area (94.3%; 27 cities) and attended public schools (89.7%). Mean HbA1c was 8.8% ± 2.1 (n = 75). Family members often provided in-school insulin support (25.2% overall; 55% of children < 6 years; p < 0.05). Nearly half of caregivers (45.8%) reduced working hours due to diabetes care (55.2% for children < 6 years; p < 0.05). Most families (73.8%) reported schools had little or no knowledge of diabetes, and 31.8% were dissatisfied with the care received. The possibility of having diabetes material specifically directed to schools was valued by the families and patients.

Conclusion: Families of CwD in the São Paulo metropolitan area face challenges in school settings. Providing educational materials in different formats is necessary, but strategies are needed to involve school staff in the management actively.

Objective: To evaluate the effects of hydrotherapy and hammock positioning, applied individually or in combination, on pain reduction in preterm neonates.

Methods: This randomized clinical trial included 45 preterm neonates under 37 weeks of gestation and weighing less than 2,500g, admitted to the neonatal intensive care unit or intermediate care unit at Santa Casa Hospital in Sobral, Brazil. Palliative interventions were performed during routine invasive and painful procedures, specifically heel lances and handling of the orogastric tube during feeding. Neonates were randomized into three groups: hydrotherapy, hammock positioning, or a combined intervention, with 15 participants per group. Interventions were applied once daily for 15 consecutive days. Pain was assessed using the Neonatal Facial Coding System before and after each session, totaling 1,350 evaluations. Continuous variables were analyzed using Student's t-test, and categorical variables were analyzed using Fisher's exact test. The study was registered in the Brazilian Registry of Clinical Trials.

Results: The sample consisted of 53.3% male neonates, with a mean gestational age of 32.4±2.1 weeks. Hydrotherapy significantly reduced pain scores and pain prevalence. Hammock positioning also produced significant reductions in pain scores and prevalence. The combined intervention resulted in the greatest reduction in pain scores and pain prevalence. All within-group comparisons showed statistically significant improvements. No statistically significant differences were observed when the three intervention groups were compared directly.

Conclusion: Hydrotherapy and hammock positioning, applied individually or in combination, are effective, safe, and feasible strategies for reducing pain in preterm neonates and may complement standard neonatal care in NICUs.

Objective: To analyze the structure, processes, and outcomes of different models of community-based palliative care of children, adolescents, and their families reported in the literature.

Methods: The authors conducted a systematic review of original, full-text studies in MEDLINE and Embase (January 2014-May 2024), following PRISMA. Two reviewers screened/extracted data; a third resolved disagreements. Study quality and reporting were appraised with the Newcastle-Ottawa Scale and, as applicable, STROBE, COREQ, and CARE. Narrative synthesis was organized with Donabedian's framework.

Prospero: CRD42018747214.

Results: Twenty-six high-quality studies (5 qualitative, 18 quantitative, 3 mixed-methods) described community PPC across home-based services, outpatient programs, community health and social support centers. Common structures included multidisciplinary teams with 24/7 availability, assistive devices/equipment, telemedicine, and screening/assessment tools (e.g., PedsQL, PedsQL-FIM, PIP, PaPaS). Core processes were home visits, caregiver education, symptom monitoring (including digital tools), advance care planning, interprofessional teamwork, and coordination with schools and social services. Reported outcomes most frequently included reduced hospital admissions and emergency use, improved symptom control and health-related quality of life, higher caregiver satisfaction, and lower parenting stress; however, measures and follow-up were heterogeneous.

Conclusions: Community-based PPC can improve children's and families' quality of life when medical, psychosocial, and social resources are integrated beyond the hospital. To advance the field, validated outcome measures, sustainable financing, workforce training, and stronger policy frameworks are urgently needed.

Objective: This randomized controlled trial investigated the effectiveness of supervised lumbopelvic stabilization and urotherapy on factors associated with lower urinary tract symptoms in children with Duchenne Muscular Dystrophy and lower urinary tract dysfunction (LUTD).

Method: The study included 32 children aged 5-12 years, who were ambulatory and had a Dysfunctional Voiding and Incontinence Symptom Scale (DVISS) of 8.5 or higher. Lower urinary tract symptoms were assessed using the DVISS, a three-day bladder diary, and a nocturnal enuresis diary. Bowel symptoms were assessed with a seven-day bowel diary. Moreover, physical performance tests, the strength of pelvis-related muscle groups, and participation in activities of daily living were evaluated using validated measurement tools. Participants were randomized into two groups: the active control group (n:16, weight:25.81±9.53 kg, height:121.25±18.22 cm) received only urotherapy, while the treatment group (n:16, weight:25.88±9.67 kg, height: 122.69±16.63 cm) additionally performed lumbopelvic stabilization-based exercises for eight weeks under the supervision of a physiotherapist.

Results: Urotherapy significantly reduced LUTD severity (p < 0.001), enuresis frequency (p = 0.014), and the number of symptoms associated with LUTD (p = 0.001). However, adding lumbopelvic stabilization exercises conferred no superiority over urotherapy alone (p > 0.05). Supervised lumbopelvic stabilization improved functional mobility (p < 0.003), muscle strength (p < 0.05), and participation in activities of daily living (p < 0.049). However, neither urotherapy nor lumbopelvic stabilization training had a significant effect on Gower's time or daytime voiding frequency (p > 0.05).

Conclusion: Both interventions were effective in improving bladder and bowel outcomes in children with Duchenne Muscular Dystrophy and LUTD, with no superiority observed on lower urinary tract symptoms.

Objective: To evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), serum lactate, and Pediatric Trauma Score (PTS) for mortality in a large case series of critically ill pediatric trauma patients admitted to a specialized PICU in Brazil.

Methods: Retrospective case series conducted in the Pediatric Intensive Care Unit of a tertiary trauma hospital in Brazil. All trauma patients aged 1 month to 18 years admitted between March 2018 and March 2025 and hospitalized for >24 h were eligible (n = 1495). Demographic, clinical, and laboratory data were collected, including PIM2, initial lactate, and PTS. The primary outcome was all-cause PICU mortality.

Results: Death occurred in 1.5% of patients. ROC curve analysis was performed in 620 patients with complete data for the three markers. Areas under the curve (AUCs) were: PIM2, 0.93 (95% CI, 0.91-0.95); lactate, 0.86 (95% CI, 0.83-0.88); and PTS, 0.82 (95% CI, 0.79-0.85). In univariable logistic regression, all markers were independently associated with mortality. A 10-fold increase in PIM2 and lactate raised death odds by 36-fold and 226-fold, respectively, while each point increase in PTS reduced odds by 34.6%. In the multivariable model, PIM2 and lactate remained significant predictors. In the multivariable model, PIM2 and lactate remained significant predictors.

Conclusions: PIM2 and lactate remained independently associated with mortality after mutual adjustment in pediatric trauma patients admitted to a specialized PICU. PTS, while valuable for prehospital triage, added little once intensive care was initiated.