Jornal de pediatria最新文献

Objective: Meconium aspiration syndrome is a common cause of severe respiratory failure in term and post-term neonates. The timing for administering surfactant remains non-standardized. This study aimed to evaluate the predictive value of the lung ultrasound score for the need for surfactant therapy in infants with Meconium aspiration syndrome.

Method: This prospective multicenter study enrolled 218 neonates with meconium aspiration syndrome. Lung ultrasound was performed within 30 min of admission using a six-zone scoring system (0-18). Surfactant was given based on oxygenation criteria (FiO₂ > 0.5 or OI > 8), with clinicians blinded to ultrasound findings. Predictive performance of the lung ultrasound score for surfactant need was assessed by ROC analysis and compared with traditional indices. Multivariable regression and decision curve analysis were performed.

Results: Lung ultrasound score demonstrated near-perfect diagnostic accuracy for predicting surfactant need: at the optimal cutoff of 6 points, AUC was 0.999 (95% CI, 0.997-1), with 100% sensitivity. Performance was superior to pH (AUC 0.906) and chest radiograph grade (AUC 0.539), and consistent across subgroups by respiratory support, gestational age, and presence of persistent pulmonary hypertension. Multivariable analysis identified lung ultrasound as an independent predictor of surfactant use. Decision curve analysis confirmed greater net clinical benefit for lung ultrasound-based strategies over a wide range of threshold probabilities.

Conclusion: A lung ultrasound score of ≥ 6 exhibited near-perfect predictive capacity for guiding surfactant administration decisions (AUC 0.999). This technique provides rapid, non-invasive pulmonary morphological information, facilitating the identification of neonates meeting the criteria for surfactant therapy.

Objective: This study aimed to investigate the risk factors for acute neurological complications (ANCs) in neonates with bacterial meningitis (NBM).

Methods: This retrospective study analyzed 68 neonates (aged 0-28 days) with bacterial meningitis admitted to a tertiary pediatric medical center (Children's Hospital, Zhejiang University School of Medicine, China) between November 1, 2020, and June 30, 2025. ANCs were defined as a spectrum of conditions resulting from NBM, including subdural effusion/empyema, ventriculitis, hydrocephalus, brain abscess, and encephalomalacia. The cohort comprised 48 neonates without ANCs and 20 who developed ANCs.

Results: Compared with neonates without complications, those who developed ANCs were significantly older at symptom onset and demonstrated higher rates of seizures, elevated C-reactive protein (CRP) levels, increased cerebrospinal fluid (CSF) culture positivity, higher rates of Group B Streptococcus (GBS) infection, and more frequent dexamethasone administration. Multivariate logistic regression analysis identified seizures (OR = 10.951, 95% CI: 1.981-60.532, p = 0.006) and GBS infection (OR = 4.803, 95% CI: 1.072-21.523, p = 0.040) as independent risk factors for ANCs. Dexamethasone use (OR = 0.946, 95% CI: 0.185-4.834, p = 0.947) was not significant after adjustment. A predictive model incorporating both factors demonstrated good discriminatory capacity (AUC = 0.814, 95% CI: 0.686-0.942, p < 0.001).

Conclusion: Seizures and GBS infection are independent risk factors for ANCs in NBM. Dexamethasone administration did not reduce the incidence of ANCs in this cohort.

Objective: To conduct a narrative review of strategies and actions that can contribute to the prevention of functional constipation in children and adolescents.

Source: This narrative review used articles indexed predominantly in the PubMed database and compiled by the author over the past 30 years.

Summary of the findings: No specific prospective population-based studies have evaluated the effectiveness of preventive measures against constipation. However, some measures can contribute to the prevention of functional constipation, such as training healthcare professionals and educating the general population about the importance of breastfeeding, providing proper toilet training guidance, and encouraging actions to avoid postponing bowel movements. Nutrition is important at all life stages. When breastfeeding is prematurely discontinued, infant formulas are more effective than cow's milk. Dietary fiber and water intake are frequently below recommended levels. Therefore, after introducing complementary feeding throughout life, the adoption of healthy eating habits, including adequate dietary fiber and fluid intake, should be recommended.

Conclusions: Preventive measures for functional constipation have rarely been discussed in the literature. Training healthcare professionals and educating the general population are important for understanding the physiology of defecation from newborns to adulthood and avoiding unnecessary dietary changes or therapeutic measures. After introducing complementary feeding throughout life, the adoption of healthy eating habits, including adequate dietary fiber and fluid intake, should be recommended.

Objectives: The increasing prevalence of metabolic dysfunction associated with steatotic liver disease (MASLD) is consistent with the global obesity epidemic. The aim of the study was to investigate the presence of MASLD in a high-risk group of children and to compare cardiovascular risk factors between the groups with and without MASLD, in addition to investigating potential biomarkers.

Methods: This cross-sectional study was carried out at a public institution with thirty-eight patients (19 girls, 13.2 ± 2.7 y) with excess weight. Blood pressure (BP), abdominal fat, carotid intima-media thickness (CIMT), and blood biochemistry were evaluated. Steatosis was assessed by the controlled attenuation parameter (CAP) obtained via transient elastography, and the participants were grouped as ¨Non-Steatosis¨ (n = 24) and ¨Steatosis¨ (n = 14).

Results: The "Steatosis group" showed higher BP (Z SBP 1.56 vs. -0.25; Z DBP 1.38 vs. 0.07; p = 0.0001), BMI (z-BMI 3.48 vs. 2.39; p < 0.0001), right CIMT (0.07 vs. 0.06 cm; p = 0.013), basal insulin (41 vs. 14 mcUI/l; p < 0.0001), and HOMA-IR (8.2 vs. 3.1; p < 0.0001), and lower adiponectin (2.75 vs. 6.46 µg/ml; p = 0.004) compared to the "Non-Steatosis" group even after z-BMI adjustments. ROC curves indicated adiponectin (cutoff ≤ 4.5 μg/mL) and insulin (cutoff ≥ 22 mcIU/mL) as biomarkers of steatosis.

Conclusion: In pediatric age with excess weight, hepatic steatosis was associated with higher BP, severe obesity, and worse glycemic profile. Low adiponectin and high insulin levels appeared as possible biomarkers of MASLD. The study reinforces the need for children with obesity and a worse metabolic profile to be investigated for early diagnosis of MASLD.

Objective: To investigate lipid profile alterations and their associated sociodemographic, anthropometric, and lifestyle factors among adolescents living in São Paulo in 2008 and 2015.

Methods: The authors analyzed data from the ISA-Capital study, a population-based cross-sectional survey, including 448 adolescents (12-19 years). Socioeconomic, anthropometric, lifestyle, and biochemical data were collected. Cardiometabolic risk factors assessed included high blood pressure, obesity, increased waist circumference, dyslipidemia, and lipid profile alterations. Statistical analyses included Chi-square tests, t-tests/Wilcoxon tests, and logistic regression models (p < 0.05).

Results: Dyslipidemia was the most prevalent risk factor (67.6%; 95% CI 63.1-71.8), with low HDL-c affecting 52.4% (95% CI 47.7-57.0). High blood pressure and obesity were observed in 16.1% (95% CI 12.9-19.7) and 11.7% (95% CI 9.0-15.1) of adolescents, respectively. 7% had 3 or more risk factors. Compared to 2008, adolescents in 2015 were twice as likely to present high blood pressure (OR = 2.04; p = 0.011). Older adolescents had lower odds of obesity (OR = 0.83; p = 0.024) but were more likely to have increased waist circumference (OR = 1.22; p = 0.027) and high blood pressure (OR = 1.17; p = 0.017). Adolescents self-declared as non-white had lower odds of dyslipidemia (OR = 0.59; p = 0.018) and high triacylglycerol (OR = 0.58; p = 0.012). Higher household education was associated with lower risk of presenting dyslipidemia (OR = 0.54; p = 0.004). Physically active adolescents had lower odds of high LDL-c (OR = 0.48; p = 0.045).

Conclusion: The elevated prevalence of cardiometabolic risk factors, particularly dyslipidemia, underscores the need for targeted preventive strategies among adolescents in São Paulo.

Objective: This study aims to evaluate the quality of life (QoL) and glycemic control of children and adolescents living with type 1 diabetes mellitus (T1D) before and after an intervention with a multidisciplinary educational program.

Method: In this prospective interventional study, 47 participants were divided into an intervention group (IG), which underwent a six-month in-person and online multiprofessional education program, and a control group (CG), which received standard in-person follow-up. After three months, all participants in this study had a continuous interstitial glucose monitor (CGM). QoL was assessed by the Pediatric QoL Questionnaire PedsQL 3.0 - Diabetes Mellitus Module. Scores were separated into tertiles.

Results: Both groups had homogeneous general characteristics and mean HbA1c above the recommended levels. The QoL level in the IG and its guardians at T180 showed no differences but girls showed lower QoL scores at T0. Participants in the CG with intermediate perceptions showed a reduction in their QoL in the category "barriers to treatment" in relation to IG. The IG showed a significant increase in adherence to the carbohydrate counting method (CHCM). QoL, according to the parents'/guardians' perception, was lower than that of their children.

Conclusions: The intervention failed to significantly affect glycemic control either in HbA1c or in time in the therapeutic range. The intervention and CGM failed to improve glycemic control and QoL in individuals living with T1D and suboptimal glycemic control. However, it significantly increased adherence to CHCM.

Objective: Persistent candidemia (PC) in children can lead to unfavorable outcomes. However, its risk factors and clinical impact remain poorly understood. This study aimed to identify risk factors associated with PC in pediatric patients.

Method: We conducted a retrospective analysis of 141 children (0-17 years) diagnosed with candidemia at a children's hospital in Brazil between 2016 and 2022. Clinical data were collected from medical records. Microorganisms were identified by MALDI-TOF MS, tested for biofilm production, and sensitivity profile. Molecular typing was performed on the three most prevalent species, and ERG11 mutation screening was carried out on fluconazole-resistant isolates.

Results: PC was identified in 34.8% (n = 49) patients. Independent risk factors included early non-removal of the central venous catheter, parenteral nutrition, and cancer. The overall 30-day mortality was 23.4%, and the candidemia-related mortality was 16.3%. C. parapsilosis was the prevalent species. All isolates except one produced biofilm. One isolate of C. tropicalis, which had the missense mutation Y257H in ERG11, was resistant to fluconazole. Isolates showed high genetic diversity.

Conclusions: PC was associated with host factors and clinical management rather than aspects of the etiological agent, highlighting the importance of early patient monitoring.

Objective: Penicillin remains the only safe and effective drug recommended for treating syphilis in pregnant women and congenital syphilis (CS). Nevertheless, alternative therapies are needed when penicillin is contraindicated, such as in allergic reactions, or unavailable due to supply limitations. This study aimed to compare the serological response to the Venereal Disease Research Laboratory (VDRL) test in infants reported with CS and treated with either ceftriaxone or penicillin.

Method: A non-competitive cohort study was conducted in three public maternity hospitals in Fortaleza, Ceará, Northeast Brazil. Data were extracted from notification forms in the Notifiable Diseases Information System (SINAN), medical records from maternity hospitals and outpatient clinics, and electronic records from primary care units. The serological response of infants treated with ceftriaxone and penicillin was assessed. An adequate response was defined as two consecutive negative VDRL tests performed at the intervals recommended by the Brazilian Ministry of Health. Survival curves were estimated using the Kaplan-Meier method.

Results: Among 383 infants reported with CS, 56 (14.6 %) underwent VDRL testing in accordance with Ministry of Health guidelines. Of these, 19 (33.9 %) received ceftriaxone and 37 (66.1 %) penicillin. No statistically significant difference in time to VDRL negativity was observed between the groups (log-rank p = 0.73). The median time to negativity was 3 months in both cohorts.

Conclusions: Serological response to VDRL was comparable between infants treated with ceftriaxone and those treated with penicillin. No cases of kernicterus or other CS-related complications occurred among ceftriaxone-treated infants.