Pub Date : 2025-11-20DOI: 10.1016/j.jped.2025.101473
Fernanda P.L.F. Veiga , Orlei R. Araujo , Alessandra S. Araujo , Marcela S. Bicalho , Maria C. Andrade , Dafne C.B. Silva
Objectives
To describe the demographic and clinical characteristics of pediatric cancer patients receiving continuous renal replacement therapy (CRRT) and to analyze its effect on biochemical markers.
Methods
The authors conducted a cohort study of patients with multiple organ dysfunction syndrome (MODS) who received CRRT in a pediatric oncology intensive care unit. Biochemical measurements were compared at CRRT initiation (D0), after 72 h (D3), and during the final 72 h of therapy.
Results
Fifty-nine cases were analyzed. Hospital mortality was 67.7 %, and the median duration of CRRT was 9 days. Fluid overload was present in 51 % of patients; the mean KDIGO score was 2 (SD: 1). Mechanical ventilation was required in 79.7 %. Among survivors, significant improvements were observed in pH (mean 7.34 on D0 vs. 7.41 on D3; p = 0.012; effect size: 0.72) and bicarbonate (mean 22.17 on D0 vs. 27.1 on D3; p = 0.003; effect size: 0.77). In non-survivors, lactate levels increased over time (mean 2.3 on D0 vs. 5.37 on the last day; p = 0.03; effect size: 0.49). Generalized estimating equation models identified bicarbonate (OR: 0.05), pH (OR: 0.92), PCO₂ (OR: 176), and lactate (OR: 9.8) as significant predictors of in-hospital death. Logistic regression showed that mechanical ventilation (OR: 8.48) and fluid overload in the final 72 h (OR: 1.15) were associated with mortality.
Conclusions
While CRRT’s impact on mortality in MODS remains uncertain, it improved biochemical markers. The findings suggest that metabolic and lactic acidosis, fluid overload, and mechanical ventilation may be modifiable targets to reduce mortality.
{"title":"The role of continuous renal replacement therapy in critically ill children with cancer and multiple organ dysfunction syndrome","authors":"Fernanda P.L.F. Veiga , Orlei R. Araujo , Alessandra S. Araujo , Marcela S. Bicalho , Maria C. Andrade , Dafne C.B. Silva","doi":"10.1016/j.jped.2025.101473","DOIUrl":"10.1016/j.jped.2025.101473","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the demographic and clinical characteristics of pediatric cancer patients receiving continuous renal replacement therapy (CRRT) and to analyze its effect on biochemical markers.</div></div><div><h3>Methods</h3><div>The authors conducted a cohort study of patients with multiple organ dysfunction syndrome (MODS) who received CRRT in a pediatric oncology intensive care unit. Biochemical measurements were compared at CRRT initiation (D0), after 72 h (D3), and during the final 72 h of therapy.</div></div><div><h3>Results</h3><div>Fifty-nine cases were analyzed. Hospital mortality was 67.7 %, and the median duration of CRRT was 9 days. Fluid overload was present in 51 % of patients; the mean KDIGO score was 2 (SD: 1). Mechanical ventilation was required in 79.7 %. Among survivors, significant improvements were observed in pH (mean 7.34 on D0 vs. 7.41 on D3; <em>p</em> = 0.012; effect size: 0.72) and bicarbonate (mean 22.17 on D0 vs. 27.1 on D3; <em>p</em> = 0.003; effect size: 0.77). In non-survivors, lactate levels increased over time (mean 2.3 on D0 vs. 5.37 on the last day; <em>p</em> = 0.03; effect size: 0.49). Generalized estimating equation models identified bicarbonate (OR: 0.05), pH (OR: 0.92), PCO₂ (OR: 176), and lactate (OR: 9.8) as significant predictors of in-hospital death. Logistic regression showed that mechanical ventilation (OR: 8.48) and fluid overload in the final 72 h (OR: 1.15) were associated with mortality.</div></div><div><h3>Conclusions</h3><div>While CRRT’s impact on mortality in MODS remains uncertain, it improved biochemical markers. The findings suggest that metabolic and lactic acidosis, fluid overload, and mechanical ventilation may be modifiable targets to reduce mortality.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101473"},"PeriodicalIF":2.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488447","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}
Pub Date : 2025-11-14DOI: 10.1016/j.jped.2025.101475
Xiaojing Lu , Bingbing Li , Shufang Li , Lihong Wang , Guangen Guo , Yanli Zhang , Jiajia Duan , Changlian Zhu
Objective
This study aimed to determine the epidemiology and clinical characteristics of EV-D68-associated respiratory diseases among Asian children.
Sources
The PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), VIP, WanFang, and SinoMed electronic databases were searched from inception to February 28, 2025, to identify relevant articles. Studies reporting the detection rate of enterovirus D68 (EV-D68) in pediatric patients with respiratory tract infections were included. The methodological quality regarding the risk of bias was assessed according to the approach proposed by the Joanna Briggs Institute.
Summary of the findings
Twenty studies involving 47,451 participants were included; additionally, 450 participants were positive for EV-D68 infection. The detection rate of EV-D68 ranged from 0.23 % to 10.56 %, with a pooled prevalence of 1.29 % (95 % CI 0.88–1.78 %), but significant heterogeneity (I² = 94.20 %, p < 0.001) indicated that this estimate was context-dependent. Subgroup analyses revealed that detection rates varied substantially by country, study period, and income level. Pneumonia is the most common respiratory disease presentation. EV-D68 is most prevalent during the summer and autumn.
Conclusion
This is the first review to focus specifically on Asian children, which suggests that EV-D68 detection rates vary significantly across Asian populations and are especially influenced by geographic location and surveillance timing. EV-D68 infection in children is most frequently associated with pneumonia. These findings support targeted regional surveillance networks during the summer-autumn seasons to improve clinical diagnostics and public health responses.
{"title":"Epidemiological and clinical characteristics associated with enterovirus D68 respiratory diseases in Asian children: a systematic review and meta-analysis","authors":"Xiaojing Lu , Bingbing Li , Shufang Li , Lihong Wang , Guangen Guo , Yanli Zhang , Jiajia Duan , Changlian Zhu","doi":"10.1016/j.jped.2025.101475","DOIUrl":"10.1016/j.jped.2025.101475","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to determine the epidemiology and clinical characteristics of EV-D68-associated respiratory diseases among Asian children.</div></div><div><h3>Sources</h3><div>The PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), VIP, WanFang, and SinoMed electronic databases were searched from inception to February 28, 2025, to identify relevant articles. Studies reporting the detection rate of enterovirus D68 (EV-D68) in pediatric patients with respiratory tract infections were included. The methodological quality regarding the risk of bias was assessed according to the approach proposed by the Joanna Briggs Institute.</div></div><div><h3>Summary of the findings</h3><div>Twenty studies involving 47,451 participants were included; additionally, 450 participants were positive for EV-D68 infection. The detection rate of EV-D68 ranged from 0.23 % to 10.56 %, with a pooled prevalence of 1.29 % (95 % CI 0.88–1.78 %), but significant heterogeneity (<em>I</em>² = 94.20 %, <em>p</em> < 0.001) indicated that this estimate was context-dependent. Subgroup analyses revealed that detection rates varied substantially by country, study period, and income level. Pneumonia is the most common respiratory disease presentation. EV-D68 is most prevalent during the summer and autumn.</div></div><div><h3>Conclusion</h3><div>This is the first review to focus specifically on Asian children, which suggests that EV-D68 detection rates vary significantly across Asian populations and are especially influenced by geographic location and surveillance timing. EV-D68 infection in children is most frequently associated with pneumonia. These findings support targeted regional surveillance networks during the summer-autumn seasons to improve clinical diagnostics and public health responses.</div></div><div><h3>Trial Registration</h3><div>PROSPERO Identifier: CRD42023449889.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101475"},"PeriodicalIF":2.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488441","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}
Pub Date : 2025-11-11DOI: 10.1016/j.jped.2025.101471
Qing He , Ziwen Sun , Ruixin Li , Yanling Wang , Haoru Li , Desheng Song , Bei Du , Lin Liu , Ruihua Wei
Objective
Given the increasing incidence of dry eye in children and the established role of sleep as a key health determinant, this study aimed to examine the prevalence of dry eye in children and its association with sleep, adjusting for confounders.
Method
This study included 169,080 children aged 6–12 years. Dry eye syndromes (DEs) were assessed using the 5-Item Dry Eye Questionnaire, whereas sleep quality was evaluated using the Children's Sleep Habits Questionnaire. Logistic and linear regression analyses were performed.
Results
Overall, 13.12% of the children exhibited DEs, and 66.25% experienced poor sleep. Children with poor sleep quality had a significantly higher prevalence of DEs (15.97%, 17,889/112,018) than those with normal sleep quality (7.53%, 4296/57,062) (P < 0.001). The prevalence of poor sleep was 80.64% (17,889/22,185) in children with DEs, compared to 64.08% (94,129/146,895) in those without DEs (P < 0.001). After adjusting for age, sex, body mass index, and other risk factors, poor sleepers had a higher risk of developing DEs than good sleepers (odds ratio [OR] = 2.005; 95% confidence interval [CI]: 1.933–2.080). Children who slept for < 10 h were more likely to have DEs (OR = 1.236l; 95% CI: 1.167–1.310). In logistic regression analyses stratified by age and sex, poor sleepers showed a high risk of DEs. Moreover, the three dry eye symptoms and sleep were related (P < 0.001).
Conclusions
This large-scale study revealed that all domains of sleep were significantly poorer in participants with DEs in children, and these associations remained significant after adjusting for comorbidities.
{"title":"Unraveling the relationship between childhood dry eye symptoms and sleep patterns","authors":"Qing He , Ziwen Sun , Ruixin Li , Yanling Wang , Haoru Li , Desheng Song , Bei Du , Lin Liu , Ruihua Wei","doi":"10.1016/j.jped.2025.101471","DOIUrl":"10.1016/j.jped.2025.101471","url":null,"abstract":"<div><h3>Objective</h3><div>Given the increasing incidence of dry eye in children and the established role of sleep as a key health determinant, this study aimed to examine the prevalence of dry eye in children and its association with sleep, adjusting for confounders.</div></div><div><h3>Method</h3><div>This study included 169,080 children aged 6–12 years. Dry eye syndromes (DEs) were assessed using the 5-Item Dry Eye Questionnaire, whereas sleep quality was evaluated using the Children's Sleep Habits Questionnaire. Logistic and linear regression analyses were performed.</div></div><div><h3>Results</h3><div>Overall, 13.12% of the children exhibited DEs, and 66.25% experienced poor sleep. Children with poor sleep quality had a significantly higher prevalence of DEs (15.97%, 17,889/112,018) than those with normal sleep quality (7.53%, 4296/57,062) (<em>P</em> < 0.001). The prevalence of poor sleep was 80.64% (17,889/22,185) in children with DEs, compared to 64.08% (94,129/146,895) in those without DEs (<em>P</em> < 0.001). After adjusting for age, sex, body mass index, and other risk factors, poor sleepers had a higher risk of developing DEs than good sleepers (odds ratio [OR] = 2.005; 95% confidence interval [CI]: 1.933–2.080). Children who slept for < 10 h were more likely to have DEs (OR = 1.236l; 95% CI: 1.167–1.310). In logistic regression analyses stratified by age and sex, poor sleepers showed a high risk of DEs. Moreover, the three dry eye symptoms and sleep were related (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>This large-scale study revealed that all domains of sleep were significantly poorer in participants with DEs in children, and these associations remained significant after adjusting for comorbidities.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101471"},"PeriodicalIF":2.5,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470961","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}
Pub Date : 2025-11-09DOI: 10.1016/j.jped.2025.101462
Coraima A. Linan, Gibsi MP Rocha, Marta K. Lucion
Objective
To review the epidemiology, diagnostic criteria, and therapeutic options for the most prevalent anxiety and depressive disorders in childhood and adolescence.
Sources of data
A non-systematic review was conducted in the PubMed, SciELO, and Google Scholar databases. Diagnostic criteria were defined according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and updated textbooks on child and adolescent psychiatry.
Summary of the data
Diagnosis requires a comprehensive clinical assessment, considering age-specific manifestations and differentiating expected developmental emotional responses from pathological conditions.
Conclusions
Management relies on psychoeducation and psychotherapeutic interventions—particularly cognitive-behavioral therapy—and, in moderate to severe cases, pharmacotherapy with selective serotonin reuptake inhibitors, preferably combined with psychotherapy. Early identification, especially at the pediatric care level, is essential to reduce morbidity, prevent recurrence, and promote healthy development.
{"title":"How to identify depression and anxiety in children and adolescents","authors":"Coraima A. Linan, Gibsi MP Rocha, Marta K. Lucion","doi":"10.1016/j.jped.2025.101462","DOIUrl":"10.1016/j.jped.2025.101462","url":null,"abstract":"<div><h3>Objective</h3><div>To review the epidemiology, diagnostic criteria, and therapeutic options for the most prevalent anxiety and depressive disorders in childhood and adolescence.</div></div><div><h3>Sources of data</h3><div>A non-systematic review was conducted in the PubMed, SciELO, and Google Scholar databases. Diagnostic criteria were defined according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and updated textbooks on child and adolescent psychiatry.</div></div><div><h3>Summary of the data</h3><div>Diagnosis requires a comprehensive clinical assessment, considering age-specific manifestations and differentiating expected developmental emotional responses from pathological conditions.</div></div><div><h3>Conclusions</h3><div>Management relies on psychoeducation and psychotherapeutic interventions—particularly cognitive-behavioral therapy—and, in moderate to severe cases, pharmacotherapy with selective serotonin reuptake inhibitors, preferably combined with psychotherapy. Early identification, especially at the pediatric care level, is essential to reduce morbidity, prevent recurrence, and promote healthy development.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 ","pages":"Article 101462"},"PeriodicalIF":2.5,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370310","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}
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.
{"title":"Unveiling autism spectrum disorder for the pediatrician","authors":"Marcio Moacyr Vasconcelos , Luciana Gonçalves Azevedo Vasconcelos , Adriana Rocha Brito","doi":"10.1016/j.jped.2025.101458","DOIUrl":"10.1016/j.jped.2025.101458","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Data sources</h3><div>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.</div></div><div><h3>Data synthesis</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 ","pages":"Article 101458"},"PeriodicalIF":2.5,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307823","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}
Pub Date : 2025-11-01DOI: 10.1016/j.jped.2025.101461
Thiago T. Panizzi , Katharine A. de Souza , Gabriela B. Stutz , Fernanda M.C.F. Lemos , Marta C.F. Rodrigues , Rozana G. de Almeida , Luciane A. da Rocha , Flavio R. Sztajnbok , Adriana R. Fonseca , Nathalie J.M. Bravo-Valenzuela
Objectives
To describe clinical and cardiologic findings in patients with multisystem inflammatory syndrome in children (MIS-C) in a follow-up of up to 3 years.
Materials and methods
A retrospective-prospective, observational, longitudinal study was conducted, including children and adolescents up to 18 years diagnosed with MIS-C (WHO criteria), at a university center between March 2020 and December 2024. Demographic, clinical, and laboratory data, electrocardiograms, and transthoracic echocardiograms were analyzed at admission and at 12 months and left ventricular global longitudinal strain (LV-GLS) three years after diagnosis. Statistical analysis used frequencies for categorical variables, and means with standard deviations or medians with interquartile ranges for continuous variables. Differences in proportions between patients with and without cardiovascular abnormalities were assessed using Fisher's exact test, Chi-squared, or Wilcoxon rank-sum test (significant p-value < 0.05). T-test was used to compare left ventricular ejection fraction (LVEF) and coronary artery Z scores.
Results
Thirty-six patients were included (males 69.4%), with a median age at diagnosis of 2.15 years (IQR 3.3). At admission, 41.7% presented with clinical or echocardiographic abnormalities, which were absent at 1-year follow-up. However, three years after diagnosis, among the 11 patients evaluated with LV-GLS, 10 showed changes indicating subclinical dysfunction not detected by conventional electrocardiogram or echocardiography.
Conclusion
Clinical and echocardiographic cardiovascular abnormalities are common in the acute phase of MIS-C. Although most patients showed clinical and echocardiographic resolution, LV-GLS proved valuable for detecting subclinical myocardial dysfunction not identified by conventional evaluation, highlighting its potential as a screening tool in short- and long-term follow-up.
{"title":"Cardiac manifestations in children and adolescents diagnosed with pediatric multisystem inflammatory syndrome related to COVID-19","authors":"Thiago T. Panizzi , Katharine A. de Souza , Gabriela B. Stutz , Fernanda M.C.F. Lemos , Marta C.F. Rodrigues , Rozana G. de Almeida , Luciane A. da Rocha , Flavio R. Sztajnbok , Adriana R. Fonseca , Nathalie J.M. Bravo-Valenzuela","doi":"10.1016/j.jped.2025.101461","DOIUrl":"10.1016/j.jped.2025.101461","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe clinical and cardiologic findings in patients with multisystem inflammatory syndrome in children (MIS-C) in a follow-up of up to 3 years.</div></div><div><h3>Materials and methods</h3><div>A retrospective-prospective, observational, longitudinal study was conducted, including children and adolescents up to 18 years diagnosed with MIS-C (WHO criteria), at a university center between March 2020 and December 2024. Demographic, clinical, and laboratory data, electrocardiograms, and transthoracic echocardiograms were analyzed at admission and at 12 months and left ventricular global longitudinal strain (LV-GLS) three years after diagnosis. Statistical analysis used frequencies for categorical variables, and means with standard deviations or medians with interquartile ranges for continuous variables. Differences in proportions between patients with and without cardiovascular abnormalities were assessed using Fisher's exact test, Chi-squared, or Wilcoxon rank-sum test (significant p-value < 0.05). T-test was used to compare left ventricular ejection fraction (LVEF) and coronary artery Z scores.</div></div><div><h3>Results</h3><div>Thirty-six patients were included (males 69.4%), with a median age at diagnosis of 2.15 years (IQR 3.3). At admission, 41.7% presented with clinical or echocardiographic abnormalities, which were absent at 1-year follow-up. However, three years after diagnosis, among the 11 patients evaluated with LV-GLS, 10 showed changes indicating subclinical dysfunction not detected by conventional electrocardiogram or echocardiography.</div></div><div><h3>Conclusion</h3><div>Clinical and echocardiographic cardiovascular abnormalities are common in the acute phase of MIS-C. Although most patients showed clinical and echocardiographic resolution, LV-GLS proved valuable for detecting subclinical myocardial dysfunction not identified by conventional evaluation, highlighting its potential as a screening tool in short- and long-term follow-up.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101461"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367987","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}
Pub Date : 2025-11-01DOI: 10.1016/j.jped.2025.101467
Simone Hauck , Luciana Terra de Oliveira
{"title":"Beyond overdiagnosis: reframing autism prevalence through a neurodivergent phenotype lens","authors":"Simone Hauck , Luciana Terra de Oliveira","doi":"10.1016/j.jped.2025.101467","DOIUrl":"10.1016/j.jped.2025.101467","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101467"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421904","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}
Pub Date : 2025-11-01DOI: 10.1016/j.jped.2025.05.002
Ana Clara Valente de Alencar , Athus Graziani Apollaro Rego , Carolina Soares Chady , Alisson Gabriel Maués Miranda , Lara Fernanda Alves de Souza , João Vitor Martins Pinto , Bárbara de Souza Maia do Nascimento , Camili Giseli Oliveira de Menezes , Isa Mendes Moreira , José Carlos Favacho Furlan , Ester Carolina Vieira Maia , Maria Fernanda Nakayama Martins , Nayara Cristina Cardoso da Silva , Paula do Socorro de Oliveira da Costa Laurindo , Luis Edilson de Azevedo Ferreira , Antônio Rafael Quadros Gomes , Heliton Patrick Cordovil Brígido
Objective
This systematic review aimed to evaluate the efficacy and safety of alternative antibiotics and different standard treatment regimens for bacterial meningitis in children, considering the increasing antimicrobial resistance and the need for adapted therapeutic options. To justify the use of alternative antibiotics, the authors analyzed the specific efficacy of ampicillin, chloramphenicol, cefuroxime and meropenem, which showed potential to overcome cases of antimicrobial resistance.
Data sources
A search was performed in databases such as PubMed, Scopus, Web of Science and Cochrane Library, without data restrictions, including planned clinical trials that compared alternative antibiotics and different standard treatment regimens, such as ceftriaxone, in children with bacterial meningitis. Inclusion criteria include studies reporting cure rates, complications and safety of treatments.
Summary of results
An analysis of 14 studies, totaling 2,014 children, indicated that antibiotics such as ampicillin, chloramphenicol, cefuroxime and meropenem had comparable efficacy and safety to standard treatment regimens. The review showed that, in many cases, alternative regimens and shorter treatment durations could be effective, without significantly increasing complications or mortality.
Conclusion
The results suggest that alternatives to standard treatment, such as ampicillin, chloramphenicol, cefuroxime and meropenem, are viable and safe options for the treatment of bacterial meningitis in children. These results help to adapt clinical practices, especially in settings with high antimicrobial resistance and resource limitations, by providing evidence for shorter and equally effective treatment regimens.
目的：本系统综述旨在评估替代抗生素和不同标准治疗方案对儿童细菌性脑膜炎的有效性和安全性，考虑到抗生素耐药性的增加和适应治疗方案的需要。为了证明使用替代抗生素的合理性，作者分析了氨苄西林、氯霉素、头孢呋辛和美罗培南的具体疗效，这些药物显示出克服抗菌素耐药性病例的潜力。数据来源：在PubMed、Scopus、Web of Science和Cochrane Library等数据库中进行检索，没有数据限制，包括计划的临床试验，比较替代抗生素和不同的标准治疗方案，如头孢曲松，治疗细菌性脑膜炎儿童。纳入标准包括报告治愈率、并发症和治疗安全性的研究。结果总结：一项涉及2014名儿童的14项研究的分析表明，氨苄西林、氯霉素、头孢呋辛和美罗培南等抗生素与标准治疗方案的疗效和安全性相当。回顾显示，在许多情况下，替代方案和较短的治疗时间可能有效，而不会显著增加并发症或死亡率。结论：结果提示，氨苄西林、氯霉素、头孢呋辛、美罗培南等标准治疗方案是治疗儿童细菌性脑膜炎可行且安全的选择。这些结果通过为更短和同样有效的治疗方案提供证据，有助于适应临床实践，特别是在抗菌素耐药性高和资源有限的环境中。
{"title":"Alternative antibiotics for the treatment of bacterial meningitis in children: a systematic review of efficacy and safety","authors":"Ana Clara Valente de Alencar , Athus Graziani Apollaro Rego , Carolina Soares Chady , Alisson Gabriel Maués Miranda , Lara Fernanda Alves de Souza , João Vitor Martins Pinto , Bárbara de Souza Maia do Nascimento , Camili Giseli Oliveira de Menezes , Isa Mendes Moreira , José Carlos Favacho Furlan , Ester Carolina Vieira Maia , Maria Fernanda Nakayama Martins , Nayara Cristina Cardoso da Silva , Paula do Socorro de Oliveira da Costa Laurindo , Luis Edilson de Azevedo Ferreira , Antônio Rafael Quadros Gomes , Heliton Patrick Cordovil Brígido","doi":"10.1016/j.jped.2025.05.002","DOIUrl":"10.1016/j.jped.2025.05.002","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review aimed to evaluate the efficacy and safety of alternative antibiotics and different standard treatment regimens for bacterial meningitis in children, considering the increasing antimicrobial resistance and the need for adapted therapeutic options. To justify the use of alternative antibiotics, the authors analyzed the specific efficacy of ampicillin, chloramphenicol, cefuroxime and meropenem, which showed potential to overcome cases of antimicrobial resistance.</div></div><div><h3>Data sources</h3><div>A search was performed in databases such as PubMed, Scopus, Web of Science and Cochrane Library, without data restrictions, including planned clinical trials that compared alternative antibiotics and different standard treatment regimens, such as ceftriaxone, in children with bacterial meningitis. Inclusion criteria include studies reporting cure rates, complications and safety of treatments.</div></div><div><h3>Summary of results</h3><div>An analysis of 14 studies, totaling 2,014 children, indicated that antibiotics such as ampicillin, chloramphenicol, cefuroxime and meropenem had comparable efficacy and safety to standard treatment regimens. The review showed that, in many cases, alternative regimens and shorter treatment durations could be effective, without significantly increasing complications or mortality.</div></div><div><h3>Conclusion</h3><div>The results suggest that alternatives to standard treatment, such as ampicillin, chloramphenicol, cefuroxime and meropenem, are viable and safe options for the treatment of bacterial meningitis in children. These results help to adapt clinical practices, especially in settings with high antimicrobial resistance and resource limitations, by providing evidence for shorter and equally effective treatment regimens.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101414"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208609","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}
Pub Date : 2025-11-01DOI: 10.1016/j.jped.2025.101483
Samuel Kunz , Luregn Jan Schlapbach , Fábio Joly Campos
{"title":"From the Sound of Silence to Ultrasound of Life?","authors":"Samuel Kunz , Luregn Jan Schlapbach , Fábio Joly Campos","doi":"10.1016/j.jped.2025.101483","DOIUrl":"10.1016/j.jped.2025.101483","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101483"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680986","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}
Pub Date : 2025-11-01DOI: 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.
{"title":"Unraveling ADHD for the pediatrician","authors":"Erasmo Barbante Casella, Beatriz Borba Casella","doi":"10.1016/j.jped.2025.101464","DOIUrl":"10.1016/j.jped.2025.101464","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Data sources</h3><div>Narrative synthesis of the contemporary literature addressing genetic and neurobiological underpinnings, diagnostic criteria, comorbidities, and treatment strategies relevant to pediatric practice.</div></div><div><h3>Summary of findings</h3><div>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.</div></div><div><h3>Conclusion</h3><div>Proactive pediatrician involvement is essential for early diagnosis and effective management of ADHD, supporting better prognosis and the child’s overall development.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 ","pages":"Article 101464"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336883","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}
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