Jornal de pediatria最新文献

Objective: Low maternal education is a risk factor for early childhood development (ECD), while exclusive breastfeeding (EBF) is a protective factor. This study examined the association between maternal education and ECD outcomes such as cognitive, language, and motor domains and whether EBF modifies this association in Brazil.

Methods: This cross-sectional study analyzed data from a non-probabilistic sample of 12-month-old infants born during the COVID-19. Moderation analyses using the Mann-Whitney test examined the effect of EBF at 6 months (effect modifier) on the relationship between Bayley-III cognitive, language, and motor scores as well as Bayley Global Score (BGS) (outcomes) and maternal education (independent variable). The effect size (r) from the sensitivity analysis of the effect modifier was estimated.

Results: A total of 269 full-term infants were evaluated. Higher maternal education was associated with better cognitive, language, and BGS (p < 0.00). EBF was associated with higher cognitive (p < 0.01), language (p < 0.02), and BGS (p < 0.00). EBF modified the effect of low maternal education (<10 years; and 10-12 years) on cognitive score and BGS. Among mothers with >10 years of education, a large effect size of EBF was observed on the BGS (r = 0.51), and a medium effect size was noted in the cognitive domain (r = 0.38).

Conclusion: Higher maternal education is associated with better scores on Bayley-III domains, and EBF can modify the effect of lower maternal education on ECD in Brazil. This is the first study to identify EBF as a mechanism to protect ECD in adverse conditions such as low maternal education.

Objective: Human milk has a dynamic composition that is ideal for the needs of infants. However, the factors that affect the nutritional content of human milk are still unclear. This study aimed to evaluate the immediate effect of maternal food intake (lunch) on the macronutrient composition of colostrum.

Methods: This prospective study performed a paired analysis of macronutrient concentrations in the colostrum of healthy postpartum women. Three milliliters of colostrum were collected from 65 participants 30 min before and 2 h after a meal (lunch) by manual expression. The nutritional content of the meal was similar for all mothers. Colostrum analysis was performed using a Human Milk Analyzer (Miris®).

Results: The fat content was significantly higher in colostrum samples collected 2 h after lunch than in those collected 30 mins before lunch (2.3 ± 1.1 vs. 2.8 ± 1.4 g %, p = 0.002). No significant differences were observed in the protein (1.9 ± 0.7 vs. 1.9 ± 1.0) and carbohydrate (6.4 ± 0.8 vs. 6.4 ± 0.8) content.

Conclusions: Two hours after the mother had lunch, the colostrum fat concentration increased by 20 %.

Objective: To evaluate the accuracy of neonatal 17-hydroxyprogesterone (N17OHP) levels adjusted for birth weight (BW) and time of the sample collection (TC) and propose optimized cutoff values to improve the effectiveness of newborn screening tests for congenital adrenal hyperplasia (CAHNBS) programs, utilizing a comprehensive dataset encompassing all newborn screening tests for 21-hydroxylase deficiency (21OHD) conducted over a decade in a Brazilian metropolitan region.

Methods: A cross-sectional study analyzed all CAHNBS tests from newborns aged 2 to 7 days in the Federal District, Brazil, from January 2012 to September 2022. The accuracy of cutoff values based on the 99.5th percentile (99.5P) for BW and TC was compared to the CAHNBS program of São Paulo and a threshold of ≥20 mg/dL. New cutoff values were proposed to enhance screening effectiveness.

Results: Among the 340,291 newborns screened, CAH-21OHD was confirmed in 11 cases. The N17OHP cutoff in this sample reduced false positives for neonates ≤ 2500 g but increased them for those > 2500 g The proposed cutoff values based on 99.5P from the sample for neonates ≤ 2500 g, combined with a fixed cutoff ≥ 20 mg/dL for those > 2500 g, showed superior specificity (99.83 %, 95 % CI: 99.81-99.84 %), LR+ (579.16, 95 % CI: 524.23-627.87), PPV (1.84, 95 %CI: 1.70-1.99), and accuracy (99.83 %, 95 %CI: 99.81-99.84 %) than prior criteria.

Conclusion: The proposed 17OHP cutoff strategy effectively reduced false positives, improving specificity, LR+, PPV, and accuracy Thus, it optimized CAHNBS programs while minimizing unnecessary costs and parental distress.

Objective: The objective of this review is to assess the use of support tools for children with asthma, based on web and mobile device technologies, and their impact on asthma control.

Method: This is a systematic review conducted in accordance with the PRISMA guidelines and the Joanna Briggs Institute (JBI) Manual. The research question defined by the PICO strategy was: ''What are the effects of web-based and mobile device support tools on asthma control in children?'' The search was conducted in the Medline (via PubMed), SciELO, and Embase databases between October and December 2023, with completion in July 2024.

Results: The systematic review analyzed 388 articles and selected 4 studies on technologies for managing asthma in children. The studies showed that mobile apps and electronic monitoring improve asthma control, treatment adherence, and caregivers' quality of life. The meta-analysis showed a mean increase in Asthma Control Test (ACT) scores of 2.73 (95 % CI: 1.95, 3.51) with P < 0.0001, indicating a significant improvement in asthma control scores, highlighting the effectiveness of these technologies.

Conclusions: This study demonstrates that digital tools, such as web technologies and mobile devices, can significantly improve the management of childhood asthma, as reflected by an increase in Asthma Control Test (ACT) scores. Despite limitations, the findings are promising. Future research is needed to strengthen the evidence and guide clinical practice in pediatric asthma management.

Objective: Patients with selective IgA deficiency (SIgAD) present elevated morbidity associated with infections, allergic conditions, autoimmune disorders, and neoplasms. This study aims to characterize clinical manifestations, disease progression, and laboratory findings in a cohort of pediatric patients with SIgAD.

Methods: The study included patients with confirmed SIgAD and a clinical history of at least 5 years. Data encompassed clinical manifestations of the disease, patient outcomes, and laboratory findings, including IgA, IgG, IgM, IgE levels and complete blood count.

Results: A total of 51 patients (1.2:1 female-to-male ratio) were included, with a median age at diagnosis of 6 years. Infections were the most common clinical manifestations of SIgAD (98 %), with pneumonia being the most frequent (94 %), followed by sinusitis (70 %). Additionally, 47 patients (92.1 %) exhibited allergic manifestations, including rhinitis or asthma. Autoimmune conditions were identified in 10 patients, predominantly thyroiditis (60 %), while neoplasms were observed in 3 patients. The sequence of disease onset revealed a natural progression, beginning with infectious diseases, followed significantly by allergic and autoimmune conditions. Elevated immunoglobulin levels (IgM or IgG) were observed in 25 patients, with hypergammaglobulinemia significantly associated with autoimmune conditions or the presence of autoantibodies (p < 0.05).

Conclusions: SIgAD is a clinically significant condition. Understanding its natural history deepens our knowledge of the disease and helps early detection and diagnosis of comorbidities that may arise at various stages of a patient's life. Monitoring other immunoglobulin levels may offer potential biomarkers for predicting autoimmune conditions; however, larger studies are needed to validate these biomarkers.

Objective: This study aimed to evaluate the intestinal microbiota development in the first week of life of preterm newborns (PTNB) treated at a public hospital in a municipality in the Brazilian Northeast.

Methods: This is an observational, longitudinal, and descriptive study with 23 PTNBs. Two stool samples were collected from each neonate (fasting/meconium and seventh day of life) for stool microbiota analysis by 16S rRNA gene sequencing. The authors analyzed alpha diversity (Chao1, Shannon, and Simpson indices) and principal coordinates of beta diversity.

Results: Forty-six stool samples from 23 PTNBs were analyzed at the taxonomic level. Microbiota's development was dynamic with low diversity. The authors observed a statistical association with the genera Enterobacterales, Streptococcus, Bacteroides, Clostridium_sensu_stricto_1, Enterococcus, and Bifidobacterium in the fasting samples when compared to the day-7 samples. The genus Staphylococcus also dominated at both times.

Conclusion: Dynamics were observed in the intestinal microbiota development, with an alpha diversity decrease in the stool samples collected at fasting/meconium and on the seventh day of life.