Jornal de pediatria最新文献_第2页

Unveiling autism spectrum disorder for the pediatrician 为儿科医生揭开自闭症谱系障碍的面纱。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2025-11-03 DOI: 10.1016/j.jped.2025.101458

Marcio Moacyr Vasconcelos , Luciana Gonçalves Azevedo Vasconcelos , Adriana Rocha Brito

Objectives

To review the state of the art in autism spectrum disorder (ASD), including its etiologic puzzle, clinical features, pathophysiologic mechanisms, differential diagnosis, and therapeutic management.

Data sources

A search for papers published over the past 10 years in the databases PubMed-MEDLINE, Cochrane Library, and SCIELO was performed using the following terms: “autism” and “clinical features”, “differential diagnosis”, “pathophysiology”, or “management”. The search yielded 3240, 590, 6904, and 5023 papers, respectively. A total of 120 most relevant papers were selected based on their title and abstract content.

Data synthesis

The current prevalence of ASD is 1 in every 31 eight-year-old children. A genetic defect is found in 10–20% of individuals with ASD. Environmental risk factors that increase the likelihood of ASD include advanced parental age and maternal health conditions. Epigenetic mechanisms may play a crucial role in the interplay between genetic and environmental factors in the pathogenesis of ASD. In addition to language delay, pediatricians should monitor and screen for several early signs of ASD. Differential diagnosis is complex because several neurodevelopmental conditions show clinical features that overlap with ASD. Medications may be used to treat comorbid conditions.

Conclusions

Management is based on a multidisciplinary team, and pediatricians are in a unique position to coordinate this team, given the trustworthy relationship they have with patients and their families.

目的：综述自闭症谱系障碍（ASD）的病因、临床特征、病理生理机制、鉴别诊断和治疗管理等方面的研究进展。数据来源：在PubMed-MEDLINE、Cochrane Library和SCIELO数据库中检索过去10年发表的论文，使用以下术语：“自闭症”和“临床特征”、“鉴别诊断”、“病理生理学”或“管理”。检索结果分别为3240篇、590篇、6904篇和5023篇。根据题目和摘要内容，共选出相关度最高的120篇论文。数据综合：目前自闭症谱系障碍的患病率为每31名8岁儿童中有1名。10-20%的自闭症患者存在遗传缺陷。增加自闭症发生可能性的环境风险因素包括父母的高龄和母亲的健康状况。表观遗传机制可能在遗传与环境因素的相互作用中起着至关重要的作用。除了语言迟缓，儿科医生还应该监测和筛查自闭症谱系障碍的几个早期迹象。鉴别诊断是复杂的，因为一些神经发育疾病表现出与ASD重叠的临床特征。药物可用于治疗合并症。结论：管理是建立在一个多学科团队的基础上的，儿科医生在协调这个团队方面处于独特的地位，因为他们与患者及其家属有着值得信赖的关系。

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引用次数: 0

The utilization of oral feeding in pediatric pancreatitis: a randomized controlled study 口服喂养在小儿胰腺炎中的应用：一项随机对照研究。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-02-06 DOI: 10.1016/j.jped.2026.101501

Yan Han, Hong Zhao, Linchen Fu, Xinyi Jia, Xiao Du, Liqun Zhou, Jindan Yu, Jie Chen, Jingan Lou

Objective

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

Methods

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

Results

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

Conclusions

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

目的：人们越来越意识到早期营养干预对急性胰腺炎（AP）儿童的益处。本研究旨在比较轻至中重度AP患者口服喂养与NG喂养。方法：于2021年9月至2024年8月进行单中心、前瞻性、随机对照试验。受试者随机分为口服喂养组和NG喂养组。主要结局是ap相关疼痛持续时间、耐受性和体重变化。结果：共纳入56例儿科患者，其中48例（每组24例）纳入最终分析。两组患者的基线特征和病因分析结果无显著差异。两组患者入院后腹痛的中位持续时间均为3 d (p = 0.104)；两组间耐受性率无差异（p = 0.489）。两组患者出院时、出院后1周、5周体重变化差异无统计学意义（p分别 = 0.658、0.502、0.927），两组患者出院后5周体重均略有增加。NG组4例出现并发症，ORAL组无并发症（p = 0.109）。结论：口服喂养对轻至中重度AP患儿的营养治疗有效，可减少侵入性手术次数，无明显不良反应。

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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 : 2026-03-01 Epub 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

Impact of electrocardiogram monitoring on the frequency of tracheal intubation at birth 出生时心电图监测对气管插管频率的影响。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-02-08 DOI: 10.1016/j.jped.2026.101504

Thalles de Souza Freire, Mandira Daripa Kawakami, Maria Fernanda de Almeida, Ruth Guinsburg

Objective

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

Methods

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

Results

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

Conclusion

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

目的：探讨新生儿正压通气（PPV）时使用心电图监护仪对产房气管插管频率的影响。方法：回顾性队列研究2014 - 2022年出生时接受PPV治疗的无先天性异常、胎龄≥23周、出生体重≥400 g的活产婴儿。新生儿按GA（< 34周或≥34周）和复苏期间使用或不使用心电图监护仪进行分层。使用逻辑回归来评估每个GA组的心电图监测与感兴趣的结果之间的关系。结果：5622例活产中，516例符合纳入标准；224例（43 %）接受监测，292例（57 %）未接受监测。气管插管频率在监测组和非监测组之间相似：≥34周- 13 %对14 %；< 34周-43 % vs. 43 %。在调整脐带夹紧时间、出生年份和出生体重后，心电图监测使出生后戴口罩≥60 秒启动PPV的几率增加2.45倍（95 % CI: 1.08-5.54）， GA≥34周时增加2.72倍（95 % CI: 1.13-6.59）。结论：心电图监护仪的使用并没有减少气管插管的频率，并且与面罩下PPV的延迟启动有关。

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引用次数: 0

PIM2, lactate, and trauma score to predict mortality in critically ill pediatric trauma patients PIM2、乳酸和创伤评分预测小儿创伤危重患者的死亡率。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-02-17 DOI: 10.1016/j.jped.2026.101509

Luciana G. Barcellos , Fernanda M. Rubin , Ana Paula P. da Silva , Júlia L. Vieira , Luciane G. da Cunha , Lucinara V. Enéas Machado , Geniara da S. Conrado , Cristian T. Tonial

Objective

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

Methods

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

Results

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

Conclusions

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

目的：评估巴西一家专门PICU收治的重症儿科创伤患者的儿童死亡率指数2 （PIM2）、血清乳酸和儿科创伤评分（PTS）对死亡率的预后影响。方法：在巴西一家三级创伤医院的儿科重症监护室进行回顾性病例系列。所有在2018年3月至2025年3月期间入院的年龄为1个月至18岁且住院时间为bbbb24小时的创伤患者均符合条件（n = 1495）。收集了人口统计学、临床和实验室数据，包括PIM2、初始乳酸和PTS。主要结局是全因PICU死亡率。结果：1.5%的患者死亡。对620例3项指标资料完整的患者进行ROC曲线分析。曲线下面积（auc）为：PIM2, 0.93 (95% CI, 0.91-0.95)；乳酸，0.86 (95% CI, 0.83-0.88)；PTS为0.82 （95% CI, 0.79-0.85）。在单变量logistic回归中，所有标记均与死亡率独立相关。PIM2和乳酸水平每增加10倍，死亡几率分别增加36倍和226倍，而PTS水平每增加1倍，死亡几率降低34.6%。在多变量模型中，PIM2和乳酸盐仍然是显著的预测因子。在多变量模型中，PIM2和乳酸盐仍然是显著的预测因子。结论：在入住专门PICU的儿科创伤患者中，PIM2和乳酸盐在相互调整后仍与死亡率独立相关。PTS虽然对院前分诊很有价值，但一旦重症监护开始，它的作用就很小。

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引用次数: 0

Families’ perspectives and the development of an educational program for diabetes in schools 家庭的观点和学校糖尿病教育项目的发展。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-02-28 DOI: 10.1016/j.jped.2026.101512

Laura Cudizio, Isadora R. Brambilla, Kayleigh G. Marques de Araújo, Raquel G. Lot, Tayana O. Martins, Raquel R. Biasi, Giuliane Galeote, Aline D. Costa-Riquetto, João Eduardo N. Salles, Luis Eduardo Calliari

Objective

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

Methods

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

Results

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

Conclusion

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

目的：全球1型糖尿病儿童（CwD）的数量正在上升，这增加了对学校支持的需求。本研究的主要目的是评估家长对学校CwD糖尿病护理现状的看法。第二个目标是收集对提供给参与者的综合教育计划的反馈。方法：在门诊就诊的CwD患者家庭完成了一项关于学校提供糖尿病护理的调查。开发了一个全面的糖尿病教育计划，包括移动应用程序、网站和打印的糖尿病管理计划。这个项目被呈现给这些家庭，以促进与学校工作人员的沟通。结果：共纳入107个家庭（学生平均年龄10.7 ± 3.9岁；诊断时平均年龄5.4 ± 3.3岁）。大多数人来自圣保罗大都市区（94.3%；27个城市），就读于公立学校（89.7%）。平均HbA1c为8.8%±2.1 （n = 75）。家庭成员经常在学校提供胰岛素支持（总体25.2%；55%的儿童< 6岁；p ）结论：圣保罗大都会区CwD家庭在学校环境中面临挑战。提供不同形式的教材是必要的，但需要制定策略，使学校工作人员积极参与管理。

{"title":"Families’ perspectives and the development of an educational program for diabetes in schools","authors":"Laura Cudizio, Isadora R. Brambilla, Kayleigh G. Marques de Araújo, Raquel G. Lot, Tayana O. Martins, Raquel R. Biasi, Giuliane Galeote, Aline D. Costa-Riquetto, João Eduardo N. Salles, Luis Eduardo Calliari","doi":"10.1016/j.jped.2026.101512","DOIUrl":"10.1016/j.jped.2026.101512","url":null,"abstract":"<div><h3>Objective</h3><div>The number of children with type 1 diabetes (CwD) is rising globally, increasing demand for school-based support. The primary objective was to assess parents’ perceptions of the current state of diabetes care in schools for CwD. The secondary objective was to gather feedback on a comprehensive educational program offered to participants.</div></div><div><h3>Methods</h3><div>Families of CwD attending an outpatient clinic completed a survey about diabetes care offered by schools. A comprehensive diabetes educational program was developed, comprising a mobile application, website, and printed diabetes management plan. The program was presented to the families to facilitate communication with school staff.</div></div><div><h3>Results</h3><div>A total of 107 families participated (mean age of students 10.7 ± 3.9 years; mean age at diagnosis 5.4 ± ± 3.3 years). Most were from the São Paulo metropolitan area (94.3%; 27 cities) and attended public schools (89.7%). Mean HbA1c was 8.8% ± 2.1 (75). Family members often provided in-school insulin support (25.2% overall; 55% of children < 6 years; <em>p</em> < 0.05). Nearly half of caregivers (45.8%) reduced working hours due to diabetes care (55.2% for children < 6 years; 0.05). Most families (73.8%) reported schools had little or no knowledge of diabetes, and 31.8% were dissatisfied with the care received. The possibility of having diabetes material specifically directed to schools was valued by the families and patients.</div></div><div><h3>Conclusion</h3><div>Families of CwD in the São Paulo metropolitan area face challenges in school settings. Providing educational materials in different formats is necessary, but strategies are needed to involve school staff in the management actively.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 2","pages":"Article 101512"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149851","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

Neonatal mortality trends in the 21st century: findings from the Global Burden of Disease Study 2021 21世纪新生儿死亡率趋势：2021年全球疾病负担研究结果

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-02-17 DOI: 10.1016/j.jped.2026.101519

Dongqing Gu , Xiaofei Zheng , Yan Zhou , Fengjie Tan , Rui Gui , Linna Wei , Lubin Liu

Objective

Neonatal mortality remains a significant global health challenge, particularly in low- and middle-income countries. This study aimed to analyze the trends and causes of neonatal mortality from 2000 to 2021.

Methods

Data on all-cause and cause-specific mortality were obtained from the Global Burden of Disease Study 2021. Joinpoint regressions were employed to calculate the annual percentage change and the average annual percentage change. Pearson's correlation was utilized to estimate the relationships between mortality rates and the Human Development Index.

Results

The global all-cause neonatal mortality rate has declined by an average of 2.1% per year since 2000, while the absolute number of neonatal deaths remained at 2.19 million globally in 2021. Neonatal disorders continued to be the leading cause of death among neonates in 2021, followed by congenital birth defects, lower respiratory infections, sexually transmitted infections excluding HIV, diarrheal diseases, and malaria. The neonatal mortality rate varied significantly across different countries and territories, ranging from 0.61 per 1000 livebirths in Andorra to 55.35 per 1000 livebirths in South Sudan. By 2021, 120 countries (58.8%) had achieved the Sustainable Development Goal 3.2 target. Additionally, strong negative correlations were found between mortality rates and Human Development Index (r = -0.867, P < 0.001).

Conclusions

Despite significant progress, regional disparities persist; only half of the countries achieved the Sustainable Development Goal 3.2 target by 2021. These findings emphasize prioritized interventions for neonatal disorders in low/middle-income countries and highlight socioeconomic development as critical to equitable mortality reduction within public health frameworks.

目的：新生儿死亡率仍然是一个重大的全球健康挑战，特别是在低收入和中等收入国家。本研究旨在分析2000年至2021年新生儿死亡率的趋势和原因。方法：全因死亡率和原因特异性死亡率数据来自2021年全球疾病负担研究。采用结合点回归计算年变化百分比和平均年变化百分比。使用Pearson相关来估计死亡率与人类发展指数之间的关系。结果：自2000年以来，全球新生儿全因死亡率平均每年下降2.1%，而2021年全球新生儿死亡绝对人数保持在219万。新生儿疾病仍然是2021年新生儿死亡的主要原因，其次是先天性出生缺陷、下呼吸道感染、不包括艾滋病毒的性传播感染、腹泻病和疟疾。不同国家和地区的新生儿死亡率差别很大，从安道尔的0.61‰到南苏丹的55.35‰不等。到2021年，120个国家（58.8%）实现了可持续发展目标3.2的具体目标。此外，死亡率与人类发展指数之间存在很强的负相关性（r = -0.867,p ）。结论：尽管取得了重大进展，但区域差异仍然存在；只有一半的国家到2021年实现了可持续发展目标3.2的具体目标。这些研究结果强调在低收入/中等收入国家对新生儿疾病采取优先干预措施，并强调社会经济发展对于在公共卫生框架内公平降低死亡率至关重要。

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引用次数: 0

Unraveling ADHD for the pediatrician 为儿科医生解读多动症。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2025-11-01 DOI: 10.1016/j.jped.2025.101464

Erasmo Barbante Casella, Beatriz Borba Casella

Objective

To review current evidence on the pathophysiology, clinical features, differential diagnosis, and therapeutic management of Attention-Deficit/Hyperactivity Disorder (ADHD), emphasizing the pediatrician’s role in diagnostic recognition and coordination of multidisciplinary care.

Data sources

Narrative synthesis of the contemporary literature addressing genetic and neurobiological underpinnings, diagnostic criteria, comorbidities, and treatment strategies relevant to pediatric practice.

Summary of findings

ADHD is a multifactorial neurodevelopmental disorder involving genetic predisposition and neurobiological alterations, particularly in cortico-subcortical circuits related to dopaminergic and noradrenergic modulation. Clinical presentation varies with age and context and may be accompanied by comorbidities such as learning disorders, anxiety, and depression. Diagnosis is clinical, based on standardized criteria and assessment across multiple settings, and requires exclusion of conditions that mimic ADHD. Management is multimodal, encompassing psychosocial interventions, school-based support, and, when indicated, pharmacological therapy. Pediatricians serve as the first point of contact and play a central role in early identification, family guidance, and integration of healthcare and educational teams.

Conclusion

Proactive pediatrician involvement is essential for early diagnosis and effective management of ADHD, supporting better prognosis and the child’s overall development.

目的：回顾目前关于注意缺陷多动障碍（ADHD）的病理生理、临床特征、鉴别诊断和治疗管理的证据，强调儿科医生在诊断识别和多学科护理协调中的作用。数据来源：当代文献的叙事综合解决遗传和神经生物学基础，诊断标准，合并症，和治疗策略相关的儿科实践。研究结果总结：ADHD是一种多因素神经发育障碍，涉及遗传易感性和神经生物学改变，特别是与多巴胺能和去甲肾上腺素能调节相关的皮质-皮质下回路。临床表现因年龄和环境而异，并可能伴有合并症，如学习障碍、焦虑和抑郁。诊断是临床的，基于标准化的标准和跨多种环境的评估，并要求排除类似ADHD的条件。管理是多模式的，包括社会心理干预、学校支持和必要时的药物治疗。儿科医生作为第一个接触点，在早期识别、家庭指导以及医疗保健和教育团队的整合方面发挥核心作用。结论：儿科医生的积极参与对ADHD的早期诊断和有效治疗至关重要，有助于患儿更好的预后和全面发展。

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引用次数: 0

Warning signs for identifying neurodevelopmental disorders: a systematic literature review 识别神经发育障碍的警告信号：系统的文献综述。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-01-20 DOI: 10.1016/j.jped.2025.101478

Liubiana Arantes de Araújo

Objective

To synthesize the most consistent warning signs (“red flags”) for NDDs: autism spectrum disorder, cerebral palsy, intellectual disability, language development disorder, coordination developmental disorder, attention deficit hyperactivity disorder, and global developmental delay.

Data source

Review in PubMed/Medline, Cochrane Library, SciELO, CAPES, and BVS, 2003-2025. Methodological quality was assessed with NOS, CASP, and AMSTAR.

Data summary

54 studies were included. The most consistent early signs were grouped by NPMD domains: Motor: delay to sit ≥ 9 m, absence of independent walking 18 m, absence of pincer grasp 10 m, and asymmetrical motor patterns 12 m; Language: absence of babbling at 9–12 m, lack of words until 15–18 m, and absence of two-word combination 24 m; Social: absence of social smile, poor eye contact, deficits in shared attention and communicative gestures; Cognitive and behavioral: regression of skills, repetitive behaviors, absence of symbolic play, and irritability or inattention; Others: atypical sensory responses, sleep disturbances, and feeding difficulties. Instruments such as M-CHAT-R/F, ASQ, Bayley, and HINE increased the accuracy of screening and reduced referral delays.

Conclusion

Early recognition of warning signs for NPMD disorder associated with complementary examinations and formal assessment should be integrated into routine pediatric care.

目的：综合ndd最一致的预警信号（“红旗”）：自闭症谱系障碍、脑瘫、智力残疾、语言发育障碍、协调发育障碍、注意缺陷多动障碍和整体发育迟缓。数据来源：PubMed/Medline综述，Cochrane图书馆，SciELO， CAPES和BVS， 2003-2025。采用NOS、CASP和AMSTAR评价方法学质量。资料摘要：纳入54项研究。最一致的早期症状根据NPMD域进行分类：运动：静坐延迟≥9 m，缺乏独立行走18 m，缺乏钳抓10 m，不对称运动模式12 m；语言：9-12 m没有咿呀学语，15-18 m之前没有单词，24 m之前没有两个单词组合；社交性：缺乏社交性微笑，缺乏眼神交流，缺乏共同注意力和交流手势；认知和行为：技能退化、重复行为、缺乏象征性游戏、易怒或注意力不集中；其他：非典型感觉反应、睡眠障碍和进食困难。M-CHAT-R/F、ASQ、Bayley和HINE等仪器提高了筛查的准确性，减少了转诊延误。结论：应将早期识别NPMD障碍的预警信号与补充检查和正式评估相结合，纳入常规儿科护理。

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引用次数: 0

Letter to the editor regarding “Development of a machine learning-based predictive model for long-term adverse outcomes in neonatal bacterial meningitis” 关于“开发基于机器学习的新生儿细菌性脑膜炎长期不良后果预测模型”的致编辑的信。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-03-13 DOI: 10.1016/j.jped.2026.101523

Rafael Gomes de Melo D’Elia, Angélica Saiuri de Aurélio Penteado

引用次数: 0