Jornal de pediatria最新文献_第10页

Combining procalcitonin, c-reactive protein, and white blood cell count in predicting infections in pediatric open cardiac surgery with cardiopulmonary bypass 结合降钙素原、c反应蛋白和白细胞计数预测小儿体外循环心脏直视手术感染。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.04.006

Tuan Manh Ha , Man Minh Tran , Tung Viet Le , Nguyen The Nguyen Phung

Objective

This study aimed to evaluate the validity of models using Procalcitonin (PCT) alone and PCT combined with other biomarkers to predict early infection after pediatric open-heart surgery with cardiopulmonary bypass (CPB).

Methods

A prospective observational study was conducted on children undergoing open-heart surgery with CPB, without preoperative infection. Procalcitonin, C-reactive protein (CRP), and white blood cell (WBC) count were measured preoperatively and on postoperative days 1 and 3. Postoperative infection was defined according to the Centers for Disease Control and Prevention 2008 criteria.

Results

Fifty eligible cases were included, comprising 46 % males with a median age of 7 months (4–17). The AUC (area under the curve) for PCT on postoperative day 3 was 0.67 (0.51–0.82) (p = 0.085). The AUCs for the models combining PCT + CRP and PCT + WBC were 0.71 (0.57–0.86) (p = 0.014) and 0.72 (0.55–0.86) (p = 0.014), respectively. The AUC for the model combining PCT + CRP + WBC was 0.81 (0.69–0.93) (p = 0.002). The combination of PCT > 4.15 ng/ml, CRP > 22.03 mg/l, and WBC > 15.3 × 10³/µl predicted infection with a hazard ratio 9.66 times (2.94–31.72) higher than PCT > 4.15 ng/ml alone (p < 0.05).

Conclusions

PCT measurement on the third postoperative day alone cannot predict infection in pediatric open-heart surgery with CPB. The combination of PCT with CRP and WBC may enhance early infection prediction, although further validation in larger, multicenter cohorts is warranted.

目的：本研究旨在评价单独使用降钙素原（PCT）和PCT联合其他生物标志物预测儿童体外循环直视手术（CPB）后早期感染的模型的有效性。方法：采用前瞻性观察研究方法，对行CPB患儿行心内直视手术，术前无感染。术前及术后第1、3天分别测定降钙素原、c反应蛋白（CRP）、白细胞（WBC）计数。术后感染的定义是根据疾病控制和预防中心2008年的标准。结果：纳入50例符合条件的病例，包括46 %男性，中位年龄为7个月（4-17）。术后第3天PCT的AUC（曲线下面积）为0.67 (0.51-0.82)（p = 0.085）。PCT + CRP和PCT + WBC联合模型的auc分别为0.71 (0.57-0.86)（p = 0.014）和0.72 (0.55-0.86)（p = 0.014）。PCT + CRP + WBC模型的AUC为0.81 (0.69 ~ 0.93)（p = 0.002）。PCT > 4.15 ng/ml、CRP > 22.03 mg/l、WBC > 15.3 × 103/µl联合检测预测感染的风险比单独检测PCT > 4.15 ng/ml高9.66倍（2.94 ~ 31.72）（p ）结论：单独检测PCT术后第3天不能预测小儿心内直视手术合并CPB的感染。PCT联合CRP和WBC可以增强早期感染预测，但需要在更大的多中心队列中进一步验证。

{"title":"Combining procalcitonin, c-reactive protein, and white blood cell count in predicting infections in pediatric open cardiac surgery with cardiopulmonary bypass","authors":"Tuan Manh Ha , Man Minh Tran , Tung Viet Le , Nguyen The Nguyen Phung","doi":"10.1016/j.jped.2025.04.006","DOIUrl":"10.1016/j.jped.2025.04.006","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the validity of models using Procalcitonin (PCT) alone and PCT combined with other biomarkers to predict early infection after pediatric open-heart surgery with cardiopulmonary bypass (CPB).</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted on children undergoing open-heart surgery with CPB, without preoperative infection. Procalcitonin, C-reactive protein (CRP), and white blood cell (WBC) count were measured preoperatively and on postoperative days 1 and 3. Postoperative infection was defined according to the Centers for Disease Control and Prevention 2008 criteria.</div></div><div><h3>Results</h3><div>Fifty eligible cases were included, comprising 46 % males with a median age of 7 months (4–17). The AUC (area under the curve) for PCT on postoperative day 3 was 0.67 (0.51–0.82) (<em>p</em> = 0.085). The AUCs for the models combining PCT + CRP and PCT + WBC were 0.71 (0.57–0.86) (<em>p</em> = 0.014) and 0.72 (0.55–0.86) (<em>p</em> = 0.014), respectively. The AUC for the model combining PCT + CRP + WBC was 0.81 (0.69–0.93) (<em>p</em> = 0.002). The combination of PCT > 4.15 ng/ml, CRP > 22.03 mg/l, and WBC > 15.3 × 10<sup>3</sup>/µl predicted infection with a hazard ratio 9.66 times (2.94–31.72) higher than PCT > 4.15 ng/ml alone (<em>p</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>PCT measurement on the third postoperative day alone cannot predict infection in pediatric open-heart surgery with CPB. The combination of PCT with CRP and WBC may enhance early infection prediction, although further validation in larger, multicenter cohorts is warranted.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 634-641"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078091","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

Clinical and nutritional profile of children and adolescents with autism spectrum disorder in Brazil: a nationwide online survey 巴西患有自闭症谱系障碍的儿童和青少年的临床和营养状况：一项全国性的在线调查。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2024.12.008

Gabriele Gonçalves de Souza Corrêa, Fernanda Valente Mendes Soares, Zilton Farias Meira de Vasconcelos, Ana Carolina Carioca Costa, Adriana Duarte Rocha

Objective

To characterize the clinical and nutritional profile of children and adolescents with ASD in Brazil and their eating problems.

Method

This is a cross-sectional study using a national online survey, with a sample of 613 children and adolescents with ASD aged between 2 and 17 years. Data analysis consisted of descriptive analysis, followed by Pearson's chi-square test with a statistical significance of 0.05 and a 95% confidence interval.

Results

Food allergy was reported by 33.8% of the participants, the most frequent being cow's milk (70.2%), among those who reported gastrointestinal problems, constipation was the most frequent (54.1%). The presence of pica was reported by 25% and food selectivity was present in 77.2%, with greater refusal of fruit, vegetables and pasty textures. Most of the participants do not have follow-ups with a nutritionist and 44.5% are on some special diet, excluding gluten/wheat (75.4%) and without casein/animal milk (76.1%). More than half of the participants did not eat fruit (50.6%), vegetables (68.1%), or leafy greens (83.6%) frequently. A positive correlation was found between food selectivity and gastrointestinal symptoms (p-value < 0.050); food allergy and gastrointestinal symptoms (p-value < 0.001) and pica and gastrointestinal symptoms (p-value < 0.001).

Conclusions

The results of this study show changes in food consumption and increased risk of nutritional deficiencies for children and adolescents with ASD in Brazil.

目的：了解巴西儿童和青少年ASD的临床和营养状况及其饮食问题。方法：这是一项横断面研究，采用全国在线调查，样本为613名2至17岁的ASD儿童和青少年。资料分析采用描述性分析，Pearson卡方检验，统计学意义为0.05，置信区间为95%。结果：33.8%的参与者报告了食物过敏，最常见的是牛奶（70.2%），在报告胃肠道问题的人中，便秘最常见（54.1%）。据报道，有25%的人患有异食癖，77.2%的人有食物选择性，其中对水果、蔬菜和面糊质地的拒绝较多。大多数参与者没有与营养学家进行随访，44.5%的人有一些特殊的饮食，不包括麸质/小麦（75.4%）和不含酪蛋白/动物奶（76.1%）。超过一半的参与者不经常吃水果（50.6%）、蔬菜（68.1%）或绿叶蔬菜（83.6%）。食物选择性与胃肠道症状呈正相关（p值< 0.050）；食物过敏和胃肠道症状（p值< 0.001）以及异食癖和胃肠道症状（p值< 0.001）。结论：这项研究的结果表明，巴西患有自闭症的儿童和青少年的食物消费发生了变化，营养缺乏的风险增加了。

{"title":"Clinical and nutritional profile of children and adolescents with autism spectrum disorder in Brazil: a nationwide online survey","authors":"Gabriele Gonçalves de Souza Corrêa, Fernanda Valente Mendes Soares, Zilton Farias Meira de Vasconcelos, Ana Carolina Carioca Costa, Adriana Duarte Rocha","doi":"10.1016/j.jped.2024.12.008","DOIUrl":"10.1016/j.jped.2024.12.008","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the clinical and nutritional profile of children and adolescents with ASD in Brazil and their eating problems.</div></div><div><h3>Method</h3><div>This is a cross-sectional study using a national online survey, with a sample of 613 children and adolescents with ASD aged between 2 and 17 years. Data analysis consisted of descriptive analysis, followed by Pearson's chi-square test with a statistical significance of 0.05 and a 95% confidence interval.</div></div><div><h3>Results</h3><div>Food allergy was reported by 33.8% of the participants, the most frequent being cow's milk (70.2%), among those who reported gastrointestinal problems, constipation was the most frequent (54.1%). The presence of pica was reported by 25% and food selectivity was present in 77.2%, with greater refusal of fruit, vegetables and pasty textures. Most of the participants do not have follow-ups with a nutritionist and 44.5% are on some special diet, excluding gluten/wheat (75.4%) and without casein/animal milk (76.1%). More than half of the participants did not eat fruit (50.6%), vegetables (68.1%), or leafy greens (83.6%) frequently. A positive correlation was found between food selectivity and gastrointestinal symptoms (p-value < 0.050); food allergy and gastrointestinal symptoms (p-value < 0.001) and pica and gastrointestinal symptoms (p-value < 0.001).</div></div><div><h3>Conclusions</h3><div>The results of this study show changes in food consumption and increased risk of nutritional deficiencies for children and adolescents with ASD in Brazil.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 529-535"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990775","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

Is the capacity to consent different from the capacity to refuse treatments and procedures in adolescence? 在青春期，同意的能力与拒绝治疗和程序的能力不同吗？

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.04.004

Guilherme Henrique Martins , Kalline Eler , Aline Albuquerque , Rui Nunes

Objective

The objective of this article is to broaden the discussion on the factors that constitute adolescent healthcare decisional capacity, ensuring that adolescents are recognized as capable of refusing treatments or procedures.

Sources

Materials from different sources were analyzed, including articles from reputable databases and documents from government agencies, forming a purposefully selected sample. The research was conducted in two phases: document selection and reflective analysis, followed by a report. The discussion was approached from a phenomenological perspective, with reflections grounded in human rights principles.

Summary of the findings

Healthcare decisional capacity must be sufficiently robust to allow adolescents to refuse treatments or procedures. It is essential to respect the right of capable adolescents to refuse treatments and procedures. Protecting the vulnerability of adolescent patients involves honoring their growing autonomy. Data from field research regarding the refusal of treatments and procedures in adolescence are scarce, which limits the scope of the proposed discussion.

Conclusions

It cannot be argued that adolescents should have different abilities to refuse a treatment or procedure compared to those required to give consent. The importance of these skills seems to vary between these situations. This difference is justified by the need to consider potential harm to health, even though it could be argued that damage to health should be part of the bioethical deliberation surrounding the decision, rather than a factor in the assessment of decisional capacity.

目的：本文的目的是扩大对构成青少年保健决策能力的因素的讨论，确保青少年被认为有能力拒绝治疗或程序。来源：分析了来自不同来源的材料，包括来自知名数据库的文章和政府机构的文件，形成了一个有目的地选择的样本。研究分两个阶段进行：文献选择和反思分析，然后是一份报告。讨论是从现象学的角度进行的，并根据人权原则进行了反思。调查结果总结：医疗保健决策能力必须足够强大，以允许青少年拒绝治疗或程序。必须尊重有能力的青少年拒绝治疗和程序的权利。保护青少年患者的脆弱性包括尊重他们日益增长的自主权。关于青少年拒绝治疗和手术的实地研究数据很少，这限制了所提议讨论的范围。结论：不能争辩说，青少年应该有不同的能力来拒绝治疗或程序，而不是那些需要给予同意的人。这些技能的重要性似乎在不同的情况下有所不同。有必要考虑到对健康的潜在危害，这说明存在这种差异是合理的，尽管可能有人认为，对健康的损害应该是围绕决策进行的生物伦理审议的一部分，而不是评估决策能力的一个因素。

{"title":"Is the capacity to consent different from the capacity to refuse treatments and procedures in adolescence?","authors":"Guilherme Henrique Martins , Kalline Eler , Aline Albuquerque , Rui Nunes","doi":"10.1016/j.jped.2025.04.004","DOIUrl":"10.1016/j.jped.2025.04.004","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this article is to broaden the discussion on the factors that constitute adolescent healthcare decisional capacity, ensuring that adolescents are recognized as capable of refusing treatments or procedures.</div></div><div><h3>Sources</h3><div>Materials from different sources were analyzed, including articles from reputable databases and documents from government agencies, forming a purposefully selected sample. The research was conducted in two phases: document selection and reflective analysis, followed by a report. The discussion was approached from a phenomenological perspective, with reflections grounded in human rights principles.</div></div><div><h3>Summary of the findings</h3><div>Healthcare decisional capacity must be sufficiently robust to allow adolescents to refuse treatments or procedures. It is essential to respect the right of capable adolescents to refuse treatments and procedures. Protecting the vulnerability of adolescent patients involves honoring their growing autonomy. Data from field research regarding the refusal of treatments and procedures in adolescence are scarce, which limits the scope of the proposed discussion.</div></div><div><h3>Conclusions</h3><div>It cannot be argued that adolescents should have different abilities to refuse a treatment or procedure compared to those required to give consent. The importance of these skills seems to vary between these situations. This difference is justified by the need to consider potential harm to health, even though it could be argued that damage to health should be part of the bioethical deliberation surrounding the decision, rather than a factor in the assessment of decisional capacity.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 501-510"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086304","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

Understanding the natural history of selective IgA deficiency 了解选择性IgA缺乏症的自然历史。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.03.002

Nayara Maria Furquim Nasser, Antonio Carlos Pastorino, Thais Costa Lima de Moura, Beni Morgenstern, Mayra de Barros Dorna, Ana Paula Beltran Moschione Castro

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.

目的：选择性IgA缺乏症（SIgAD）患者与感染、过敏性疾病、自身免疫性疾病和肿瘤相关的发病率升高。本研究旨在描述SIgAD患儿队列的临床表现、疾病进展和实验室结果。方法：研究纳入确诊SIgAD且临床病史至少5年的患者。数据包括疾病的临床表现、患者预后和实验室结果，包括IgA、IgG、IgM、IgE水平和全血细胞计数。结果：共纳入51例患者，男女比例为1.2:1，诊断时中位年龄为6岁。感染是SIgAD最常见的临床表现（98 %），肺炎最常见（94 %），其次是鼻窦炎（70 %）。此外，47例患者（92.1 %）出现过敏表现，包括鼻炎或哮喘。10例患者有自身免疫性疾病，主要是甲状腺炎（60% %），3例患者有肿瘤。疾病的发病顺序显示了一个自然的进展，从感染性疾病开始，其次是过敏和自身免疫性疾病。在25例患者中观察到免疫球蛋白水平（IgM或IgG）升高，高γ球蛋白血症与自身免疫性疾病或自身抗体的存在显著相关(p 结论：SIgAD是一种临床显著的疾病。了解其自然史加深了我们对疾病的认识，有助于早期发现和诊断可能出现在患者生命各个阶段的合并症。监测其他免疫球蛋白水平可能为预测自身免疫性疾病提供潜在的生物标志物；然而，需要更大规模的研究来验证这些生物标志物。

{"title":"Understanding the natural history of selective IgA deficiency","authors":"Nayara Maria Furquim Nasser, Antonio Carlos Pastorino, Thais Costa Lima de Moura, Beni Morgenstern, Mayra de Barros Dorna, Ana Paula Beltran Moschione Castro","doi":"10.1016/j.jped.2025.03.002","DOIUrl":"10.1016/j.jped.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 569-575"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764056","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

Immediate effect of food intake by the nursing mother on the macronutrient content of colostrum 哺乳母亲摄入食物对初乳中宏量营养素含量的直接影响。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.03.004

Regina C.F.A. Nascimento , Virgínia G.A. Hochman , Camila B.M. da Silva , Bernardo V. do Valle , Yasmin N.di V. do Amaral , Manuela Dolinsky , Alan A. Vieira

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 %.

目的：人乳具有一种动态成分，非常适合婴儿的需要。然而，影响母乳营养成分的因素仍不清楚。本研究旨在评估母体食物摄入（午餐）对初乳宏量营养素组成的直接影响。方法：这项前瞻性研究对健康产后妇女初乳中的常量营养素浓度进行了配对分析。在65名参与者的餐前（午餐）30 min和餐后（午餐）2 h，采用人工表达法采集初乳3毫升。这顿饭的营养成分对所有母亲来说都是相似的。使用人乳分析仪（Miris®）进行初乳分析。结果：午餐后2 h采集的初乳样品脂肪含量显著高于午餐前30 min采集的初乳样品（2.3 ± 1.1 vs.）。2.8 ± 1.4 g %,p = 0.002)。蛋白含量(1.9 ± 0.7 vs。1.9 ± 1.0)和碳水化合物(6.4 ± 0.8 vs.； 6.4±0.8 )内容。结论：母亲午餐后2小时，初乳脂肪浓度增加20% %。

{"title":"Immediate effect of food intake by the nursing mother on the macronutrient content of colostrum","authors":"Regina C.F.A. Nascimento , Virgínia G.A. Hochman , Camila B.M. da Silva , Bernardo V. do Valle , Yasmin N.di V. do Amaral , Manuela Dolinsky , Alan A. Vieira","doi":"10.1016/j.jped.2025.03.004","DOIUrl":"10.1016/j.jped.2025.03.004","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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®).</div></div><div><h3>Results</h3><div>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 <em>g</em> %, <em>p</em> = 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.</div></div><div><h3>Conclusions</h3><div>Two hours after the mother had lunch, the colostrum fat concentration increased by 20 %.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 584-589"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780163","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

Mental health mediates the association between cardiorespiratory fitness and academic performance in European schoolchildren 心理健康在欧洲学龄儿童心肺健康和学习成绩之间起中介作用。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2024.10.013

Adrià Muntaner-Mas , Pedro L. Valenzuela , Tania Pinto-Escalona , Kirk I. Erickson , Óscar Martínez-de-Quel

Objective

The objective of this study was to assess the potential mediating role of mental health in the association between cardiorespiratory fitness (CRF) and academic performance in European schoolchildren.

Method

The study followed a cross-sectional design. 507 schoolchildren (51.5 % girls, 7.4 ± 0.4 years) from 20 schools in five European countries were included in the analyses. Academic performance was assessed using school grades, mental health was assessed through the Strengths and Difficulties Questionnaire (SDQ) for parents, and CRF was estimated through the multistage 20-m shuttle run test. Linear regression and mediation analyses were conducted to test these hypotheses.

Results

Mental health difficulties were associated with worse performance on academic indicators (β ranging from -0.121 to -0.324, p < 0.05). Further, mental health difficulties were associated with lower CRF (β ranging from -0.121 to -0.189, p < 0.05). Mediation analyses revealed that the association between CRF and academic performance indicators was partially mediated (from 8 % to 25 %) by mental health [except for conduct and peer problems (β ranging from -0.025 to -0.080, p > 0.05).

Conclusion

The present results highlight that mental health is a possible mediator in the association between CRF and academic performance. These findings might support the importance of improving CRF levels to reduce mental health difficulties with subsequent potential benefits on academic performance.

目的：调查的目的是评估心理健康在欧洲学童心肺健康（CRF）和学业成绩之间的关联中的潜在中介作用。方法：采用横断面设计。来自5个欧洲国家20所学校的507名学童（51.5 %女生，7.4 ± 0.4岁）被纳入分析。学业成绩采用学校成绩评估，心理健康采用家长优势与困难问卷（SDQ）评估，CRF采用多阶段20米穿梭测验评估。对这些假设进行了线性回归和中介分析。结果：心理健康困难与学业指标较差相关（β范围为-0.121 ~ -0.324,p  0.05）。结论：本研究结果表明，心理健康可能是CRF与学业成绩之间的中介关系。这些发现可能支持提高CRF水平对减少心理健康问题的重要性，以及随后对学习成绩的潜在益处。

{"title":"Mental health mediates the association between cardiorespiratory fitness and academic performance in European schoolchildren","authors":"Adrià Muntaner-Mas , Pedro L. Valenzuela , Tania Pinto-Escalona , Kirk I. Erickson , Óscar Martínez-de-Quel","doi":"10.1016/j.jped.2024.10.013","DOIUrl":"10.1016/j.jped.2024.10.013","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to assess the potential mediating role of mental health in the association between cardiorespiratory fitness (CRF) and academic performance in European schoolchildren.</div></div><div><h3>Method</h3><div>The study followed a cross-sectional design. 507 schoolchildren (51.5 % girls, 7.4 ± 0.4 years) from 20 schools in five European countries were included in the analyses. Academic performance was assessed using school grades, mental health was assessed through the Strengths and Difficulties Questionnaire (SDQ) for parents, and CRF was estimated through the multistage 20-m shuttle run test. Linear regression and mediation analyses were conducted to test these hypotheses.</div></div><div><h3>Results</h3><div>Mental health difficulties were associated with worse performance on academic indicators (β ranging from -0.121 to -0.324, <em>p</em> < 0.05). Further, mental health difficulties were associated with lower CRF (β ranging from -0.121 to -0.189, <em>p</em> < 0.05). Mediation analyses revealed that the association between CRF and academic performance indicators was partially mediated (from 8 % to 25 %) by mental health [except for conduct and peer problems (β ranging from -0.025 to -0.080, <em>p</em> > 0.05).</div></div><div><h3>Conclusion</h3><div>The present results highlight that mental health is a possible mediator in the association between CRF and academic performance. These findings might support the importance of improving CRF levels to reduce mental health difficulties with subsequent potential benefits on academic performance.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 616-624"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013672","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

Surgical management for periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome: a systematic review and meta-analysis 周期性发热、口疮性口炎、咽炎和宫颈腺炎（PFAPA）综合征的手术治疗：一项系统回顾和荟萃分析。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.03.006

Luís Fernando Ferreira Cavalcante , Giovanna Costa , Sophia Massafelli Battistuta , Pedro Faria Makabe , Isadora Silva Fanucci Bueno , Bruno Yuamoto , Felipe Endrigo Gonçalves Vilela , Marco Aurélio Palazzi Sáfadi

Objective

This systematic review and meta-analysis aimed to evaluate the efficacy of surgical management, specifically total and partial tonsillectomy, for Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) syndrome, focusing on symptom resolution and recurrence reduction.

Data sources

A systematic search of MEDLINE, Scopus, and Cochrane databases identified randomized controlled trials (RCTs) comparing surgical to non-surgical management in children with PFAPA. Data extraction and quality assessment adhered to Cochrane guidelines and PRISMA protocols. Risk ratios (RR) and confidence intervals (CI) were calculated using random-effects models.

Summary of findings

After the removal of duplicates, 31 studies were screened and 3 studies were included. Pooled analysis revealed a 72% reduction in persistent symptoms following surgical interventions compared to non-surgical management (RR: 0.28, 95% CI: 0.12–0.68, I² = 22%, p = 0.005).

Conclusion

The findings confirm that surgical management, including total and partial tonsillectomy, is an effective therapeutic option for PFAPA, with substantial benefits in symptom resolution and quality of life improvement. While surgery offers long-term benefits, its risks, and broader immunological implications require careful consideration. The study underscores the necessity for larger, multicenter trials to validate these findings across diverse populations and optimize treatment strategies.

目的：本系统综述和meta分析旨在评估手术治疗的疗效，特别是全部和部分扁桃体切除术，治疗周期性发热、口腔溃疡、咽炎和宫颈腺炎（PFAPA）综合征，重点关注症状缓解和复发减少。数据来源：对MEDLINE、Scopus和Cochrane数据库进行系统检索，确定了比较手术和非手术治疗PFAPA儿童的随机对照试验（rct）。数据提取和质量评估遵循Cochrane指南和PRISMA协议。采用随机效应模型计算风险比（RR）和置信区间（CI）。结果总结：剔除重复项后，筛选了31项研究，纳入了3项研究。合并分析显示，与非手术治疗相比，手术干预后持续症状减少72% （RR: 0.28, 95% CI: 0.12-0.68, I²= 22%,p = 0.005）。结论：研究结果证实，手术治疗，包括全部和部分扁桃体切除术，是PFAPA的有效治疗选择，在症状缓解和生活质量改善方面有实质性的好处。虽然手术提供了长期的好处，但它的风险和更广泛的免疫学影响需要仔细考虑。该研究强调有必要进行更大规模的多中心试验，以在不同人群中验证这些发现并优化治疗策略。

{"title":"Surgical management for periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome: a systematic review and meta-analysis","authors":"Luís Fernando Ferreira Cavalcante , Giovanna Costa , Sophia Massafelli Battistuta , Pedro Faria Makabe , Isadora Silva Fanucci Bueno , Bruno Yuamoto , Felipe Endrigo Gonçalves Vilela , Marco Aurélio Palazzi Sáfadi","doi":"10.1016/j.jped.2025.03.006","DOIUrl":"10.1016/j.jped.2025.03.006","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review and meta-analysis aimed to evaluate the efficacy of surgical management, specifically total and partial tonsillectomy, for Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) syndrome, focusing on symptom resolution and recurrence reduction.</div></div><div><h3>Data sources</h3><div>A systematic search of MEDLINE, Scopus, and Cochrane databases identified randomized controlled trials (RCTs) comparing surgical to non-surgical management in children with PFAPA. Data extraction and quality assessment adhered to Cochrane guidelines and PRISMA protocols. Risk ratios (RR) and confidence intervals (CI) were calculated using random-effects models.</div></div><div><h3>Summary of findings</h3><div>After the removal of duplicates, 31 studies were screened and 3 studies were included. Pooled analysis revealed a 72% reduction in persistent symptoms following surgical interventions compared to non-surgical management (RR: 0.28, 95% CI: 0.12–0.68, I² = 22%, p = 0.005).</div></div><div><h3>Conclusion</h3><div>The findings confirm that surgical management, including total and partial tonsillectomy, is an effective therapeutic option for PFAPA, with substantial benefits in symptom resolution and quality of life improvement. While surgery offers long-term benefits, its risks, and broader immunological implications require careful consideration. The study underscores the necessity for larger, multicenter trials to validate these findings across diverse populations and optimize treatment strategies.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 494-500"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019549","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

Comparison of electrical bioimpedance in newborns with electrodes positioned on the right and left sides of the body 新生儿身体左右两侧电极的电生物阻抗比较。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.03.007

Thatyana Ribeiro Medeiros, Camila Barros Melgaço da Silva, Flávia Nunes Benicio de Souza, Hannah Schmidel Kautsky, Luana Martins de Oliveira, Luana Martins de Toledo, Alan Araújo Vieira

Objective

Bioelectrical impedance analysis is a method used to assess body composition; a noninvasive test performed using an easy-to-handle portable device used in clinical practice. However, nonstandard methods in neonates hinder external validation and reliability. Currently, bioimpedance analysis is performed in newborns with electrodes positioned on the right side of the body; however, the use of medical devices, including vascular access, can prevent its use.

Methods

An uncontrolled before-after clinical trial comparing resistance and reactance measurements by bioelectrical impedance analysis on both sides was conducted. Measurements were performed immediately after the randomization of the initial measurement side. The sample size was calculated by considering a 10% deviation from the mean resistance and reactance values of previous studies with alpha and beta errors of 10% and 20%, respectively. Binary linear regression was used to quantify the correlation.

Results

A significant difference was observed between resistance (672.88 ± 136.30 vs. 649.22 ± 119.59) and reactance (46.34 ± 17.99 vs. 44.439 ± 19.42) values measured on the right and left sides, respectively. However, when measured on both sides of the body, resistance and reactance values showed a good correlation (0.98 for both models, p < 0.001). Positioning the electrodes on the left side significantly affected the resistance and reactance values measured by bioelectrical impedance analysis compared with those on the right side.

Conclusion

Electrodes positioned on opposite sides of the body generated different resistance and reactance values, implying the need to use the right side exclusively for standard positioning. This restriction can create difficulties for the routine use of this technique in newborns.

目的：生物电阻抗分析是一种评价人体成分的方法；在临床实践中使用易于操作的便携式设备进行的一种无创测试。然而，新生儿的非标准方法阻碍了外部验证和可靠性。目前，生物阻抗分析是在新生儿中进行的，电极位于身体的右侧；然而，医疗设备的使用，包括血管通道，可以阻止其使用。方法：采用非对照临床试验，比较双侧生物阻抗法测定的电阻和电抗。在初始测量侧随机化后立即进行测量。样本量的计算考虑了与以往研究的电阻和电抗平均值有10%的偏差，alpha和beta误差分别为10%和20%。采用二元线性回归对相关性进行量化。结果：左右两侧电阻值（672.88±136.30 vs. 649.22±119.59）和电抗（46.34±17.99 vs. 44.439±19.42）差异有统计学意义。然而，当在身体两侧测量时，电阻和电抗值显示出良好的相关性（两个模型均为0.98,p < 0.001）。与右侧电极相比，左侧电极对生物电阻抗分析测量的电阻和电抗值有显著影响。结论：放置在身体两侧的电极产生不同的电阻和电抗值，意味着需要仅使用右侧进行标准定位。这一限制可能给新生儿常规使用该技术带来困难。

{"title":"Comparison of electrical bioimpedance in newborns with electrodes positioned on the right and left sides of the body","authors":"Thatyana Ribeiro Medeiros, Camila Barros Melgaço da Silva, Flávia Nunes Benicio de Souza, Hannah Schmidel Kautsky, Luana Martins de Oliveira, Luana Martins de Toledo, Alan Araújo Vieira","doi":"10.1016/j.jped.2025.03.007","DOIUrl":"10.1016/j.jped.2025.03.007","url":null,"abstract":"<div><h3>Objective</h3><div>Bioelectrical impedance analysis is a method used to assess body composition; a noninvasive test performed using an easy-to-handle portable device used in clinical practice. However, nonstandard methods in neonates hinder external validation and reliability. Currently, bioimpedance analysis is performed in newborns with electrodes positioned on the right side of the body; however, the use of medical devices, including vascular access, can prevent its use.</div></div><div><h3>Methods</h3><div>An uncontrolled before-after clinical trial comparing resistance and reactance measurements by bioelectrical impedance analysis on both sides was conducted. Measurements were performed immediately after the randomization of the initial measurement side. The sample size was calculated by considering a 10% deviation from the mean resistance and reactance values of previous studies with alpha and beta errors of 10% and 20%, respectively. Binary linear regression was used to quantify the correlation.</div></div><div><h3>Results</h3><div>A significant difference was observed between resistance (672.88 ± 136.30 vs. 649.22 ± 119.59) and reactance (46.34 ± 17.99 vs. 44.439 ± 19.42) values measured on the right and left sides, respectively. However, when measured on both sides of the body, resistance and reactance values showed a good correlation (0.98 for both models, <em>p</em> < 0.001). Positioning the electrodes on the left side significantly affected the resistance and reactance values measured by bioelectrical impedance analysis compared with those on the right side.</div></div><div><h3>Conclusion</h3><div>Electrodes positioned on opposite sides of the body generated different resistance and reactance values, implying the need to use the right side exclusively for standard positioning. This restriction can create difficulties for the routine use of this technique in newborns.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 590-594"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019544","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

Ensuring breastfeeding equity has promise to help equalize early childhood development 确保母乳喂养公平有望帮助实现儿童早期发展的平等。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.06.001

Cecília Tomori

引用次数: 0

Prevalence of excessive screen time in hospitalized pediatric patients 住院儿科患者屏幕时间过长的患病率。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.02.005

Guilherme Hoff Affeldt , Gleice Medeiros , Vanessa Vieira , Bruna Ziegler

Objective

This study aimed to understand the prevalence of screen time in hospitalized children and identify factors predicting excessive screen use during hospitalization.

Methods

This cross-sectional quantitative study was conducted with patients from the Pediatric Inpatient Unit of a Brazilian hospital, from March 2022 to April 2023. A total of 260 children were included. Family members completed questionnaires about screen time during hospitalization and at home, as well as providing information on physical activity and functionality. Socioeconomic and demographic details were obtained from electronic records.

Results

During hospitalization, children spent a median of 270 min per day on screens, significantly more than at home. Excessive screen time at home, better patient functionality, and lower caregiver education levels were significant predictors of excessive screen use during hospitalization.

Conclusion

Excessive use of screen devices among hospitalized children, with only a minority adhering to the World Health Organization’s screen time recommendations. Key predictors of excessive screen use included high screen time at home, lower caregiver education levels, and preserved child functionality.

目的：本研究旨在了解住院儿童屏幕时间的流行情况，并确定预测住院期间屏幕过度使用的因素。方法：从2022年3月至2023年4月，对巴西一家医院儿科住院病房的患者进行了横断面定量研究。总共包括260名儿童。家庭成员完成了关于住院期间和在家看屏幕时间的问卷调查，并提供了有关身体活动和功能的信息。从电子记录中获得社会经济和人口统计细节。结果：住院期间，儿童每天花在屏幕上的时间中位数为270分钟，明显多于在家时。在家过多的屏幕时间、更好的患者功能和较低的护理人员教育水平是住院期间过度屏幕使用的显著预测因素。结论：住院儿童过度使用屏幕设备，只有少数人遵守世界卫生组织的屏幕时间建议。过度使用屏幕的主要预测因素包括在家屏幕时间过长、照顾者教育水平较低和儿童功能完好。

{"title":"Prevalence of excessive screen time in hospitalized pediatric patients","authors":"Guilherme Hoff Affeldt , Gleice Medeiros , Vanessa Vieira , Bruna Ziegler","doi":"10.1016/j.jped.2025.02.005","DOIUrl":"10.1016/j.jped.2025.02.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to understand the prevalence of screen time in hospitalized children and identify factors predicting excessive screen use during hospitalization.</div></div><div><h3>Methods</h3><div>This cross-sectional quantitative study was conducted with patients from the Pediatric Inpatient Unit of a Brazilian hospital, from March 2022 to April 2023. A total of 260 children were included. Family members completed questionnaires about screen time during hospitalization and at home, as well as providing information on physical activity and functionality. Socioeconomic and demographic details were obtained from electronic records.</div></div><div><h3>Results</h3><div>During hospitalization, children spent a median of 270 min per day on screens, significantly more than at home. Excessive screen time at home, better patient functionality, and lower caregiver education levels were significant predictors of excessive screen use during hospitalization.</div></div><div><h3>Conclusion</h3><div>Excessive use of screen devices among hospitalized children, with only a minority adhering to the World Health Organization’s screen time recommendations. Key predictors of excessive screen use included high screen time at home, lower caregiver education levels, and preserved child functionality.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 544-550"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966591","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