Jornal de pediatria最新文献_第10页

Dietary and nutritional interventions in the treatment of childhood neuropsychiatric disorders: evidence and myths 饮食和营养干预治疗儿童神经精神疾病：证据和神话。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-30 DOI: 10.1016/j.jped.2025.101465

Regina Torres Duarte Kostenko , Nathalia Ferreira Antunes de Almeida , Juliana Fernandez Santana e Meneses

Objective

To analyze the current scientific literature on the main dietary and nutritional interventions proposed for children and adolescents with neuropsychiatric disorders and describe their efficacy and safety, differentiating evidence-based practices from common myths.

Data source

The search was conducted using PubMed, SciELO, Cochrane, and Web of Science databases (2019–2025). The specific terms used in the search were formulated to encompass dietary interventions in children and adolescents with neuropsychiatric disorders and their outcomes.

Data synthesis

Gluten-free and casein-free (GFCF) diets did not reduce ASD symptoms and should be reserved for confirmed allergy or intolerance. Probiotics have shown inconsistent results for core ASD/ADHD symptoms, although they may alleviate gastrointestinal complaints in subgroups. Omega-3 s have shown modest and heterogeneous effects; In ADHD, high-dose EPA may improve attention when baseline levels are low, without consistent benefit in other domains. N-acetylcysteine reduced irritability in some trials, with no consistent effect on core symptoms. Folinic acid showed benefits in subgroups defined by biomarkers (folate receptor autoantibodies) and in ASD with language impairment, but this needs to be confirmed in larger studies. For vitamin D, high rates of insufficiency and possible modest gains in sub-outcomes were observed, with methodological heterogeneity.

Conclusions

This literature review showed that there is no scientific support for generalized dietary interventions, such as restrictive diets or nutritional supplementation, in the treatment of childhood neuropsychiatric disorders. Current evidence suggests the need for individualization and continuous monitoring. Specific interventions are justified only in the case of documented nutritional deficiencies.

目的：分析目前关于儿童和青少年神经精神障碍的主要饮食和营养干预措施的科学文献，描述其有效性和安全性，区分循证实践和常见神话。数据来源：检索使用PubMed、SciELO、Cochrane和Web of Science数据库（2019-2025）。在搜索中使用的具体术语是制定的，以涵盖患有神经精神疾病的儿童和青少年的饮食干预及其结果。数据综合：无麸质和无酪蛋白（GFCF）饮食不能减轻ASD症状，应保留给确认过敏或不耐受的患者。益生菌对核心ASD/ADHD症状的治疗结果不一致，尽管它们可能减轻亚组的胃肠道症状。Omega-3 显示出适度和异质性的影响；在ADHD中，当基线水平较低时，大剂量EPA可能会改善注意力，但在其他领域没有一致的益处。n -乙酰半胱氨酸在一些试验中减少了易怒，但对核心症状没有一致的影响。叶酸在生物标志物（叶酸受体自身抗体）定义的亚组和伴有语言障碍的ASD中显示出益处，但这需要在更大规模的研究中得到证实。对于维生素D，观察到较高的不足率和可能适度的亚结局，方法上存在异质性。结论：本文献综述显示，在儿童神经精神疾病的治疗中，没有科学支持广泛的饮食干预，如限制性饮食或营养补充。目前的证据表明需要个体化和持续监测。具体的干预措施只有在有记录的营养缺乏的情况下才有理由。

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引用次数: 0

Myths and facts in the treatment of neurodevelopmental disorders – other therapies 治疗神经发育障碍的神话和事实-其他疗法。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-29 DOI: 10.1016/j.jped.2025.101452

Chaves Livio Francisco S. , Pessoa Fabio Borges , Marques Pedro Henrique Resende

Objective

To critically examine the effectiveness of complementary and alternative therapies (CATs) in the treatment of neurodevelopmental disorders, distinguishing myths from evidence-based practices and supporting informed therapeutic decision-making for healthcare professionals, educators, and families.

Data sources

Evidence was collected from PubMed, Scopus, and Web of Science up to August 2025. Systematic reviews, meta-analyses, and international consensus statements addressing attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), specific learning disorders, communication and language disorders, intellectual disability, and developmental coordination disorder were included.

Summary of findings

Interest in interventions such as neurofeedback, transcranial direct current stimulation, music therapy, equine-assisted therapy, virtual reality, and gamification has grown substantially. However, most of these approaches lack methodological standardization and robust evidence to justify their use as primary treatments. Some demonstrate modest benefits as adjunctive strategies, especially when integrated into structured programs and supervised by multidisciplinary teams. Conversely, therapies including acupuncture, ozone therapy, and hyperbaric oxygen therapy present insufficient scientific support and should not be considered substitutes for validated methods.

Conclusion

Complementary and alternative therapies remain a topic of significant debate in the management of neurodevelopmental disorders. While certain approaches may offer limited adjunctive benefits, their clinical use should be carefully evaluated within evidence-based frameworks. The development of rigorous evaluations, standardized protocols, and the safe integration of innovative technologies is essential to optimize therapeutic outcomes without compromising access to scientifically validated interventions.

目的：严格检查补充和替代疗法（cat）治疗神经发育障碍的有效性，从循证实践中区分神话，并为医疗保健专业人员、教育工作者和家庭提供知情的治疗决策支持。数据来源：证据收集自PubMed、Scopus和Web of Science，截止到2025年8月。包括针对注意缺陷/多动障碍（ADHD）、自闭症谱系障碍（ASD）、特定学习障碍、沟通和语言障碍、智力残疾和发育协调障碍的系统综述、荟萃分析和国际共识声明。研究结果总结：对神经反馈、经颅直流电刺激、音乐治疗、马辅助治疗、虚拟现实和游戏化等干预措施的兴趣大幅增长。然而，这些方法大多缺乏方法学的标准化和强有力的证据来证明它们作为主要治疗的合理性。一些辅助策略显示出适度的好处，特别是当整合到结构化项目中并由多学科团队监督时。相反，包括针灸、臭氧治疗和高压氧治疗在内的治疗方法缺乏科学依据，不应被视为有效方法的替代品。结论：在神经发育障碍的治疗中，补充和替代疗法仍然是一个有重大争议的话题。虽然某些方法可能提供有限的辅助益处，但应在循证框架内仔细评估其临床应用。制定严格的评估、标准化的方案和创新技术的安全整合对于优化治疗结果而不影响获得科学验证的干预措施至关重要。

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引用次数: 0

Transdiagnostic irritability in youth: a clinical review 青少年易激惹症的临床回顾。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-28 DOI: 10.1016/j.jped.2025.101457

Luiza Magalhaes de Oliveira, Guilherme V. Polanczyk, Luisa Shiguemi Sugaya

Objective

Irritability is one of the most frequent concerns in pediatric mental health and a predictor of long-term psychopathology and burden. This article aims to provide a comprehensive review of non-episodic irritability along with evidence-based clinical recommendations for pediatric care professionals.

Sources

A narrative review was conducted based on the literature from the last 10 years and additional key studies. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses were considered.

Summary of the findings

Non-episodic irritability is a transdiagnostic construct associated with several mental disorders. Research on etiological pathways suggests that irritability may involve distinct mechanisms, moderate heritability, and genetic associations with attention-deficit/hyperactivity disorder (ADHD), and depression. Clinical manifestations vary across different developmental stages, and distinguishing pathological from normative irritability may be challenging. Although there is no gold-standard measure, validated instruments are available. Despite recent advances, evidence-based treatment remains limited. Evidence supports psychosocial interventions that integrate parent- and child-focused components, as well as the use of stimulants for patients with comorbid ADHD. Antipsychotics are effective in reducing irritability in children with autism spectrum disorder. However, its use requires caution in non-autistic youth with irritability without a diagnosable disorder or with oppositional defiant disorder due to inconclusive efficacy and potential adverse effects.

Conclusions

Although publications on non-episodic irritability have increased, the evidence remains relatively nascent. Further research is needed to advance the knowledge on underlying mechanisms, enhance clinical recognition, identify effective interventions, and support the development of new treatments, ensuring that irritability is adequately addressed in clinical practice.

目的：易怒是儿童心理健康中最常见的问题之一，也是长期精神病理和负担的预测因子。本文旨在为儿科护理专业人员提供非发作性易怒的综合综述以及循证临床建议。资料来源：根据近10年的文献和其他重要研究进行了叙述性回顾。我们考虑了观察性研究、随机对照试验、系统评价和荟萃分析。研究结果总结：非发作性易怒是一种与多种精神障碍相关的跨诊断结构。对病因途径的研究表明，易怒可能涉及不同的机制，适度的遗传性，以及与注意缺陷多动障碍（ADHD）和抑郁症的遗传关联。不同发育阶段的临床表现各不相同，区分病理性和规范性易怒可能具有挑战性。虽然没有金标准的测量方法，但是可以使用经过验证的仪器。尽管最近取得了进展，但循证治疗仍然有限。证据支持将以父母和儿童为重点的成分结合起来的社会心理干预措施，以及对患有共病性多动症的患者使用兴奋剂。抗精神病药物在减少自闭症谱系障碍儿童的易怒方面是有效的。然而，由于不确定的疗效和潜在的不良反应，在没有诊断障碍的非自闭症青少年中使用它需要谨慎。结论：尽管关于非发作性易怒的出版物有所增加，但证据仍然相对较少。需要进一步的研究来推进对潜在机制的了解，增强临床认识，确定有效的干预措施，并支持新治疗方法的发展，确保在临床实践中充分解决烦躁不安问题。

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引用次数: 0

Transition to adolescence in neurodevelopmental disorders: challenges and clinical perspectives 神经发育障碍的青春期过渡：挑战和临床观点。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-24 DOI: 10.1016/j.jped.2025.101463

Eduardo Jorge Custódio da Silva , Evelyn Eisenstein

Objective

This review article describes the main clinical, emotional, educational, and social aspects involved in the transition to adolescence for individuals with these conditions. It also addresses implications for healthcare, the continuity of educational support, and the importance of individualized transition strategies, highlighting the need for a multidisciplinary approach centered on the individual and on continuity of care.

Data sources

Review of the latest literature on neurodevelopmental disorders in adolescents.

Data summary

Adolescence represents a vital period of biopsychosocial transformation, particularly challenging for individuals with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability.

Conclusions

Integrated, person-centered, continuous, and collaborative health care is essential to promote the well-being and inclusion of these adolescents.

目的：这篇综述文章描述了主要的临床，情感，教育和社会方面涉及到这些条件的个体过渡到青春期。它还讨论了对医疗保健的影响、教育支持的连续性以及个性化过渡战略的重要性，强调了以个人和护理连续性为中心的多学科方法的必要性。资料来源：关于青少年神经发育障碍的最新文献综述。数据摘要：青春期是生物心理社会转变的关键时期，对于神经发育障碍（ndd）患者，如自闭症谱系障碍（ASD）、注意力缺陷/多动障碍（ADHD）和智力残疾患者来说，这一时期尤其具有挑战性。结论：综合的、以人为本的、持续的、协作的卫生保健对促进这些青少年的福祉和包容性至关重要。

引用次数: 0

Pediatric Stevens–Johnson syndrome and toxic epidermal necrolysis: age-stratified insights from the FAERS database 儿童史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症：来自FAERS数据库的年龄分层见解。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-23 DOI: 10.1016/j.jped.2025.101455

Dilara Bayram-Ozgur , Onur Colak , Onur Gultekin , Narin Akici , Zehra Esra Onal , Ahmet Akici

Objective

Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but severe cutaneous adverse drug reactions, particularly concerning in pediatric populations due to their unique etiologies, clinical outcomes, and long-term complications. This study aims to examine pediatric cases of SJS/TEN reported in the U.S. FDA’s FAERS database, focusing on age-stratified patterns and drug associations.

Method

A retrospective cross-sectional analysis was conducted using FAERS reports submitted until the end of 2024. Pediatric cases (0–17 years) with a diagnosis of SJS or TEN and a single suspected drug were included. Reports were analyzed by age group (0–11 and 12–17 years), gender, and drug classification using ATC codes. Statistical analyses assessed associations between demographic groups and implicated medications.

Results

Out of 2673 pediatric reports, 67.4 % involved SJS and 32.6 % TEN. The majority (62.3 %) were in the 0–11 age group. Nervous system agents—especially antiepileptics—were predominantly associated with older children, while systemic antiinfectives such as amoxicillin, azithromycin, and cefaclor were more frequent in younger children. Lamotrigine showed both age groups and female predominance. Conversely, paracetamol and ibuprofen were significantly associated with the TEN phenotypes in younger males.

Conclusions

The study reveals clear age- and drug-specific patterns in pediatric SJS/TEN. Findings emphasize the importance of age-stratified pharmacovigilance issues and cautious prescribing of high-risk drugs such as lamotrigine and antibiotics. Better awareness of potential biases, such as protopathic misattribution, is crucial for accurate signal detection in pediatric pharmacovigilance.

目的：Stevens-Johnson综合征（SJS）和中毒性表皮坏死松解症（TEN）是罕见但严重的皮肤药物不良反应，由于其独特的病因、临床结局和长期并发症，在儿科人群中尤其受到关注。本研究旨在检查美国FDA FAERS数据库中报告的SJS/TEN儿科病例，重点关注年龄分层模式和药物相关性。方法：采用截至2024年底的FAERS报告进行回顾性横断面分析。诊断为SJS或TEN且使用单一可疑药物的儿童病例（0-17岁）被纳入研究。报告按年龄组（0-11岁和12-17岁）、性别和使用ATC代码的药物分类进行分析。统计分析评估了人口群体与相关药物之间的关联。结果：在2673份儿科报告中，67.4% %涉及SJS， 32.6% %涉及TEN。大多数（62.3 %）是0-11岁年龄组。神经系统药物——尤其是抗癫痫药物——主要与年龄较大的儿童有关，而全身性抗感染药物，如阿莫西林、阿奇霉素和头孢克洛在年龄较小的儿童中更常见。拉莫三嗪在不同年龄组和女性中均有优势。相反，扑热息痛和布洛芬与年轻男性的TEN表型显著相关。结论：该研究揭示了儿童SJS/TEN明确的年龄和药物特异性模式。研究结果强调了按年龄分层的药物警戒问题和谨慎开高风险药物如拉莫三嗪和抗生素的重要性。更好地意识到潜在的偏差，如原发错误归因，对于儿科药物警戒中准确的信号检测至关重要。

{"title":"Pediatric Stevens–Johnson syndrome and toxic epidermal necrolysis: age-stratified insights from the FAERS database","authors":"Dilara Bayram-Ozgur , Onur Colak , Onur Gultekin , Narin Akici , Zehra Esra Onal , Ahmet Akici","doi":"10.1016/j.jped.2025.101455","DOIUrl":"10.1016/j.jped.2025.101455","url":null,"abstract":"<div><h3>Objective</h3><div>Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but severe cutaneous adverse drug reactions, particularly concerning in pediatric populations due to their unique etiologies, clinical outcomes, and long-term complications. This study aims to examine pediatric cases of SJS/TEN reported in the U.S. FDA’s FAERS database, focusing on age-stratified patterns and drug associations.</div></div><div><h3>Method</h3><div>A retrospective cross-sectional analysis was conducted using FAERS reports submitted until the end of 2024. Pediatric cases (0–17 years) with a diagnosis of SJS or TEN and a single suspected drug were included. Reports were analyzed by age group (0–11 and 12–17 years), gender, and drug classification using ATC codes. Statistical analyses assessed associations between demographic groups and implicated medications.</div></div><div><h3>Results</h3><div>Out of 2673 pediatric reports, 67.4 % involved SJS and 32.6 % TEN. The majority (62.3 %) were in the 0–11 age group. Nervous system agents—especially antiepileptics—were predominantly associated with older children, while systemic antiinfectives such as amoxicillin, azithromycin, and cefaclor were more frequent in younger children. Lamotrigine showed both age groups and female predominance. Conversely, paracetamol and ibuprofen were significantly associated with the TEN phenotypes in younger males.</div></div><div><h3>Conclusions</h3><div>The study reveals clear age- and drug-specific patterns in pediatric SJS/TEN. Findings emphasize the importance of age-stratified pharmacovigilance issues and cautious prescribing of high-risk drugs such as lamotrigine and antibiotics. Better awareness of potential biases, such as protopathic misattribution, is crucial for accurate signal detection in pediatric pharmacovigilance.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101455"},"PeriodicalIF":2.5,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnostic yield of array-CGH in children with suspected rare disease 阵列- cgh在疑似罕见病患儿中的诊断率。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-17 DOI: 10.1016/j.jped.2025.101450

M. Carla Criado-Muriel , Ramón Arroyo-Ruiz , Elena Marcos-Vadillo , María Justel-Rodriguez , Lydia Alcubilla-García , María Isidoro-García , Pablo Prieto-Matos

Objective

This study aims to analyze the diagnostic yield of aCGH in pediatric patients with suspected rare diseases, focusing on its diagnostic value and effectiveness depending on different clinical symptoms.

Methods

This observational study analyzed 600 aCGH tests performed in a pediatric unit (2018–2022) for patients with suspected rare diseases. DNA was extracted from peripheral blood; aCGH resolution was adjusted to clinical features. CNVs were classified per international guidelines. Forty sociodemographic, clinical, and genetic variables were analyzed using IBM SPSS v.26.

Results

Of the 600 patients analyzed, 543 were included in the final study. The median age was 4.7 years (IQR: 6.36 years), and 66.3% were male. Most referrals came from pediatric neurology (84.3%), and the most common clinical manifestations were altered phenotype (38.6%), autism spectrum disorder (ASD) (38.6%), dysmorphia (28.2%), global developmental delay (GDD) (27.1%), and intellectual disability (21.0%). Among 543 patients, 30.4% presented CNVs, with 12.4% identified as pathogenic and 18.1% as variants of uncertain significance. Diagnostic yield was 12.2%, with 66 conclusive results — 90.9% of which were pathogenic. CNVs were most frequently detected on chromosomes 15 and 16. The highest yield was observed in clinical features such as coordination problems (35.7%), learning disorders (28.6%), and microcephaly (22.6%).

Conclusion

The diagnostic yield of aCGH in this study was 12.2%. The test demonstrated higher diagnostic value in patients with multiple clinical manifestations, highlighting the importance of aCGH as a first-line diagnostic tool for rare diseases. This technique enables earlier diagnosis, improves clinical management, and provides better counseling for affected families.

目的：本研究旨在分析aCGH对小儿疑似罕见病患者的诊断率，重点分析其根据不同临床症状的诊断价值和有效性。方法：本观察性研究分析了在儿科（2018-2022）对疑似罕见病患者进行的600例aCGH检测。提取外周血DNA；根据临床特征调整aCGH分辨率。根据国际准则对CNVs进行分类。使用IBM SPSS v.26对40个社会人口学、临床和遗传变量进行分析。结果：在分析的600例患者中，543例纳入最终研究。中位年龄4.7岁（IQR: 6.36岁），66.3%为男性。大多数转诊来自儿科神经病学（84.3%），最常见的临床表现是表型改变（38.6%）、自闭症谱系障碍（38.6%）、畸形（28.2%）、整体发育迟缓（27.1%）和智力障碍（21.0%）。在543例患者中，30.4%出现CNVs，其中12.4%被确定为致病性变异，18.1%为意义不确定的变异。确诊率为12.2%，有66例结论性结果，其中90.9%为致病结果。在第15和16号染色体上最常检测到CNVs。在协调问题（35.7%）、学习障碍（28.6%）和小头畸形（22.6%）等临床特征中，发生率最高。结论：本研究aCGH的诊断率为12.2%。该检测对具有多种临床表现的患者具有较高的诊断价值，突出了aCGH作为罕见病一线诊断工具的重要性。这项技术可以早期诊断，改善临床管理，并为受影响的家庭提供更好的咨询。

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引用次数: 0

Quality improvement initiative to reduce late-onset sepsis in very low birth weight preterm infants: a multicenter study from the Brazilian network on neonatal research 质量改善倡议，以减少迟发性脓毒症在极低出生体重早产儿：一项多中心研究从巴西网络新生儿研究。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-15 DOI: 10.1016/j.jped.2025.101459

Ligia Maria Suppo de Souza Rugolo , Maria Regina Bentlin , Fernanda Pegoraro de Godoi Melo , Maria Eduarda Gurgel , Gabriella Miranda Martins , Suely Dornellas do Nascimento , Edna Maria de Albuquerque Diniz , Renata Yoshida , Jamil Pedro de Siqueira Caldas , Silvia Cwajg , Marcia Pereira Alves de Souza , Clarissa Gutierrez Carvalho , Daniela Marques de Lima Mota Ferreira

Objective

To evaluate the impact of a quality improvement project (QI) on reducing proven late-onset sepsis (LOS) in centers of the Brazilian Network Neonatal Research (BNNR).

Method

An interventional study conducted in 12 BNNR centers from 2021 to 2023. Included preterm infants (PT) born at 22–36 weeks' gestational age, weighing 400–1499 grams, without malformations, and admitted to the NICU for > 72 h. QI tools were used and four process indicators were defined: central catheter complication (≤ 20 %); antibiotic discontinuation ≤48 h in non-infected infants (≥ 80 %); breast milk expression within the first 48 h and enteral feeding within the first 24 h of life (≥ 80 %); full enteral feeding without parenteral nutrition by day 11 (≥ 70 %). The outcome was the proportional reduction of LOS according to each center’s baseline (2020). Indicators were analyzed descriptively across three periods.

Results

A total of 1993 PT < 1500 grams were included. Half of the centers achieved the target for umbilical catheter complications, and 92 % for percutaneous catheters. Antibiotics were discontinued within 48 h in 67 % of non-infected infants. Early breast milk expression and enteral feeding were achieved in 44 % and 75 % of cases, respectively. 58 % achieved full enteral nutrition without parenteral support by day 11. LOS incidence declined in 67 % of centers, and half met their targets, with an overall 18.5 % reduction.

Conclusions

The project reduced LOS in most centers, although some clinical practices still need improvement. It demonstrates a reproducible, low-cost strategy with the potential to guide other neonatal units facing high sepsis incidence.

目的：评估巴西新生儿研究网络（BNNR）中心的质量改进项目（QI）对减少已证实的晚发型脓毒症（LOS）的影响。方法：于2021 - 2023年在12个BNNR中心进行介入研究。纳入胎龄22-36周出生、体重400-1499克、无畸形、入住NICU时间为bb0 72 h的早产儿（PT）。采用QI工具，定义4个过程指标：中心导管并发症（≤20 %）；未感染婴儿停药≤48 h(≥80 %)；出生后48小时内母乳表达和24小时内肠内喂养（≥80 %）；第11天完全肠内喂养，不进行肠外营养（≥70 %）。结果是根据每个中心的基线（2020年）按比例降低LOS。对三个时期的指标进行了描述性分析。结果：共纳入PT < 1500 g者1993例。一半的中心达到了脐导管并发症的目标，92%的中心达到了经皮导管的目标 %。67% %未感染婴儿在48小时内停用抗生素。早期母乳表达率为44. %，肠内喂养率为75. %。58% %在第11天达到完全肠内营养，无需肠外支持。在67% %的中心，LOS发生率下降，其中一半达到了目标，总体降低18.5% %。结论：该项目降低了大多数中心的LOS，尽管一些临床实践仍需改进。它展示了一种可重复的、低成本的策略，有可能指导其他面临高脓毒症发病率的新生儿单位。

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引用次数: 0

Fluid tolerance assessed by lung ultrasound and effect of crystalloid expansion on extravascular lung water in critically ill children with cancer 危重癌症患儿肺超声评估液体耐受性及晶体扩张对血管外肺水的影响。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-14 DOI: 10.1016/j.jped.2025.101456

Bruno S. Camargo, Orlei R. de Araujo, Dafne Cardoso B. da Silva

Objectives

To investigate the effect of a bolus of saline on extravascular lung water (EVLW), and to analyze correlations of EVLW with outcome.

Methods

Prospective cohort. Patients received 10 mL/kg of saline (bolus). Central venous blood gas analysis and echocardiography measurements were performed before and after. Lung ultrasound was performed with 12 measurements, repeated after expansion. Statistics included paired t-test and logistic regression models. The magnitude of the effect was assessed using Cohen's test.

Results

88 measurements were made on 83 patients. There was a response to volume in 48 measurements (54.5 %). 28 patients (33.7 %) had signs of shock, and 60 were on mechanical ventilation (MV, 72.2 %). In 68 paired measurements, there was an increase in B-lines after expansion (77.2 %). The mean number of B-lines pre- was 1.42 (SD 1.12) per intercostal space, increasing to 1.71 (SD 1.17) post-expansion (p < 0.001, Cohen's d 0.97). The mean pre-expansion cardiac index was 3.43 L/min/m2 (SD 1.05), increasing to 3.87 (SD 1.21, p < 0.001, Cohen's d = 0.8). In a multivariate model, lactate and mean pre-expansion B-lines were independent predictors of death in ICU: pre-B-lines, Odds ratio 1.87, p = 0.012; pre-lactate OR 1.59, p = 0.012. The same was observed with post-volume B-lines, in a model which also included MV: post-volume B-lines, OR 1.87, p = 0.01; post-volume lactate, OR 1.51, p = 0.03; MV, OR 4.32, p = 0.041.

Conclusions

Most patients showed signs of fluid intolerance, with increased EVLW. EVLW assessed by ultrasound is a predictor of mortality.

目的：探讨生理盐水对血管外肺水（EVLW）的影响，并分析EVLW与预后的相关性。方法：前瞻性队列研究。患者接受10 mL/kg生理盐水（丸）。前后分别进行中心静脉血气分析和超声心动图测量。肺超声12次，扩张后重复。统计包括配对t检验和逻辑回归模型。效果的大小是用科恩的测试来评估的。结果：83例患者共行88次测量。48次测量对体积有反应（54.5 %）。28例患者（33.7% %）出现休克症状，60例患者采用机械通气（MV, 72.2 %）。在68个成对测量中，扩张后b线增加（77.2% %）。每个肋间隙前平均b线数为1.42条（SD 1.12），扩张后增加到1.71条（SD 1.17）（p ）。结论：大多数患者表现出液体不耐受的迹象，EVLW增加。超声评估EVLW是死亡率的预测指标。

{"title":"Fluid tolerance assessed by lung ultrasound and effect of crystalloid expansion on extravascular lung water in critically ill children with cancer","authors":"Bruno S. Camargo, Orlei R. de Araujo, Dafne Cardoso B. da Silva","doi":"10.1016/j.jped.2025.101456","DOIUrl":"10.1016/j.jped.2025.101456","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the effect of a bolus of saline on extravascular lung water (EVLW), and to analyze correlations of EVLW with outcome.</div></div><div><h3>Methods</h3><div>Prospective cohort. Patients received 10 mL/kg of saline (bolus). Central venous blood gas analysis and echocardiography measurements were performed before and after. Lung ultrasound was performed with 12 measurements, repeated after expansion. Statistics included paired <em>t</em>-test and logistic regression models. The magnitude of the effect was assessed using Cohen's test.</div></div><div><h3>Results</h3><div>88 measurements were made on 83 patients. There was a response to volume in 48 measurements (54.5 %). 28 patients (33.7 %) had signs of shock, and 60 were on mechanical ventilation (MV, 72.2 %). In 68 paired measurements, there was an increase in B-lines after expansion (77.2 %). The mean number of B-lines pre- was 1.42 (SD 1.12) per intercostal space, increasing to 1.71 (SD 1.17) post-expansion (<em>p</em> < 0.001, Cohen's d 0.97). The mean pre-expansion cardiac index was 3.43 L/min/m2 (SD 1.05), increasing to 3.87 (SD 1.21, <em>p</em> < 0.001, Cohen's <em>d</em> = 0.8). In a multivariate model, lactate and mean pre-expansion B-lines were independent predictors of death in ICU: pre-B-lines, Odds ratio 1.87, <em>p</em> = 0.012; pre-lactate OR 1.59, <em>p</em> = 0.012. The same was observed with post-volume B-lines, in a model which also included MV: post-volume B-lines, OR 1.87, <em>p</em> = 0.01; post-volume lactate, OR 1.51, <em>p</em> = 0.03; MV, OR 4.32, <em>p</em> = 0.041.</div></div><div><h3>Conclusions</h3><div>Most patients showed signs of fluid intolerance, with increased EVLW. EVLW assessed by ultrasound is a predictor of mortality.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101456"},"PeriodicalIF":2.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Behavioral approach to autism spectrum disorder: quality versus quantity in interventions 自闭症谱系障碍的行为方法：干预的质量与数量。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-07 DOI: 10.1016/j.jped.2025.101451

Jaime Lin , Júlio César Claudino dos Santos , Cinara Ludvig Gonçalves

Objective

To discuss the importance of balancing quality versus quantity in behavioral interventions for individuals with Autism Spectrum Disorder (ASD), highlighting evidence-based approaches and the role of therapist training.

Data sources

Narrative review of the literature examining evidence-based behavioral approaches for ASD, the tension between intervention intensity and quality, factors influencing individualized treatment planning, and the importance of professional qualification.

Summary of findings

Evidence indicates that more hours of therapy do not necessarily result in better outcomes, with studies showing no consistent dose–response relationship. Individual learning rates, comorbid conditions, and quality of implementation significantly influence results. High-quality, individualized planning, consistent execution, family engagement, and well-trained professionals are essential. Lack of regulation and standardized training, particularly in contexts without professional certification systems, poses challenges to delivering effective, evidence-based care.

Conclusion

Behavioral interventions for ASD must prioritize quality over quantity, ensuring evidence-based, individualized, and well-supervised treatment plans delivered by qualified professionals to achieve meaningful outcomes.

目的：探讨在自闭症谱系障碍（ASD）个体行为干预中平衡质与量的重要性，强调循证方法和治疗师培训的作用。数据来源：对ASD循证行为治疗方法、干预强度与质量之间的紧张关系、影响个体化治疗计划的因素以及专业资格的重要性的文献进行叙述性回顾。研究结果总结：有证据表明，治疗时间更长并不一定导致更好的结果，研究显示没有一致的剂量-反应关系。个体学习率、共病条件和实施质量显著影响结果。高质量、个性化的计划、一致的执行、家庭参与和训练有素的专业人员是必不可少的。缺乏监管和标准化培训，特别是在没有专业认证制度的情况下，对提供有效的循证护理构成挑战。结论：ASD的行为干预必须优先考虑质量而不是数量，确保由合格的专业人员提供循证、个性化和良好监督的治疗计划，以取得有意义的结果。

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引用次数: 0

Development and validation of entrustable professional activities in pediatric surgery for pediatricians 为儿科医生开发和验证可信赖的儿科外科专业活动。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-30 DOI: 10.1016/j.jped.2025.101444

Rodrigo Pinheiro de Abreu Miranda , Edna Regina Silva Pereira , Leopoldo Luiz dos Santos-Neto

Objective

To develop and validate entrustable professional activities (EPAs) for the training of pediatric residents on topics that interface with pediatric surgical areas in the Brazilian context.

Methods

The study was conducted in two phases. In the first phase, experts were oriented and contextualized, and they were responsible for developing the initial list of EPAs. In the second phase, the Delphi technique was applied in three rounds: the first for consensus, the second for selection according to relevance and agreement, and the third for validation and detailing of the EPAs.

Results

In the first phase of the study, 9 experts listed 88 EPAs, which were applied in the Delphi method. In the first round of Delphi, the consensus of these experts defined 31 EPAs, with CVI ≥ 0.80, and ICC of 0.893 (95 % CI 0.823–0.945). In the second round, 25 coordinators of Medical Residency Programs selected 17 EPAs by agreement and relevance (CVI ≥ 0.80, and ICC of 0.851–95 % CI 0.753 to 0.924). In the third round, 50 preceptors from all over Brazil validated 14 EPAs with CVI ≥ 0.965 and ICC 0.866 (95 % CI 0.804–0.915), which were organized and detailed into 7 final EPAs.

Conclusion

Seven pediatric surgery EPAs were developed, consensualized, selected, and validated by experts for the work of pediatricians in Brazil through the Delphi method. The great participation and interest of medical residency preceptors with a wide geographical coverage in Brazil were strong points of this study, and these EPAs can be applied, reviewed, and updated.

目的：开发和验证可信赖的专业活动（EPAs），培训儿科住院医师的主题，与巴西儿科外科领域的接口。方法：研究分两期进行。在第一阶段，以专家为导向，结合具体情况，他们负责制定初步的环境保护措施清单。在第二阶段，德尔菲技术被应用于三轮：第一轮达成共识，第二轮根据相关性和一致性进行选择，第三轮对epa进行验证和详细说明。结果：在第一阶段的研究中，9位专家列出了88个EPAs，采用德尔菲法。在第一轮德尔菲中，这些专家的共识定义了31个EPAs， CVI≥0.80，ICC为0.893（95 % CI 0.823-0.945）。在第二轮中，25名住院医师项目协调员根据一致性和相关性（CVI≥0.80，ICC为0.851-95 % CI 0.753至0.924）选择了17个EPAs。在第三轮中，来自巴西各地的50位预言家对14个CVI≥0.965、ICC 0.866（95 % CI 0.804-0.915）的EPAs进行了验证，并将其组织细化为7个最终EPAs。结论：通过德尔菲法，为巴西儿科医生的工作制定了7个儿科外科EPAs，经专家协商一致、选择和验证。巴西住院医师导师的高度参与和广泛的地理覆盖是本研究的优势，这些EPAs可以应用、审查和更新。

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引用次数: 0