Jornal de pediatria最新文献

Objective: To investigate the association between allergic diseases and the tendency to self-harm in adolescents, considering the role of sedentary behavior.

Methods: This was a population-based cross-sectional study, carried out in 2022, with 727 adolescents aged 12 to 19 years, from a capital in the Northeast of Brazil. The authors evaluated the association between each allergic disease (asthma, rhinitis and eczema) and self-harm, sedentary behavior and other variables. The authors performed an adjusted analysis of the associations between each allergy disease and the tendency to self-harm and then adjusted to the presence of family members and sedentary behavior.

Results: The prevalence of asthma, rhinitis and eczema were 18.76%, 36.21% and 12.86%, respectively. Sedentary behavior and tendency to self-harm were more frequently reported in asthmatics (PR 2.16; 95% CI: 1.55 - 3.00 and PR 1.98; 95% CI: 1.47 - 2.68, for sedentary behavior and self-harm respectively), rhinitis (PR 1.53; 95% CI: 1.25 - 1.88 and PR 1.33; 95% CI: 1.09 - 1.62, respectively) and eczema (PR 2.35; 95% CI: 1.54 - 3.58 and PR 1.55; 95% CI: 1.05 - 2.28, respectively). There was a reduction in the strength of this association in the three conditions, which included a loss of association.

Conclusion: High rates of sedentary behavior and self-harm in those with asthma, rhinitis and eczema. Physical activity attenuated the risk for self-harm. It warns about the urgency in detecting these factors, whether in the diagnosis or in the implementation of therapy, seeking to reduce their harmful consequences in the short and long term.

Objective: This study aimed to prove the effectiveness of physiological flexion swaddling and oromotor interventions in terms of the duration needed to achieve the oral feeding ability of preterm infants in the NICU.

Methods: A randomized clinical trial in five Neonatal intensive care units (NICU) was performed involving 70 preterm infants born at 28-34 weeks gestational age. Participants were allocated to 1) the experimental group (n = 39) received physiological flexion swaddling and oromotor interventions, and 2) the control group (n = 31) received conventional swaddling and oromotor interventions. Mann-Whitney U analysis was used to determine the effectiveness of each group according to the duration needed to achieve oral feeding ability, while Kaplan-Meier survival analysis was applied to compare the duration of both groups.

Results: The experimental group had a significantly shorter duration in achieving oral feeding ability [4 (1-15) vs. 7 (2-22) days; p = 0.02]. The Kaplan-Meier survival curve analysis showed that infants in the experimental group achieved full oral feeding ability earlier than those in the control group (15 vs. 22 days).

Conclusions: Physiological flexion swaddling and oromotor interventions have been proven to be effective in shortening the number of days needed to achieve the oral feeding ability of preterm infants in the NICU.

Objective: To provide cutting-edge information on the impact and risks of using Electronic Nicotine Delivery Systems (ENDS) by children and adolescents, based on the latest evidence published in the literature.

Data source: A comprehensive search was carried out on PubMed, using the expressions ''electronic cigarettes'' OR ''electronic nicotine delivery systems" OR "vaping" AND ''adolescent'' AND "risks" AND ''acute lung injury'. All retrieved articles had their titles and abstracts read to identify and fully read the papers reporting the most recent evidence on each subject.

Summary of findings: The use of ENDS has alarmingly increased in Brazil and around the world. The possibility of customizing use, the choice of flavors and nicotine content, and the general notion that these devices are harmless when compared to conventional cigarettes are some of the factors responsible for this increase. Numerous scientific studies have proven that electronic cigarettes have serious consequences for the respiratory system, such as EVALI (E-cigarette or Vaping-Associated Lung Injury) and difficult-to-control asthma, as well as harmful effects on the neurological, cardiovascular, gastrointestinal, and immunological systems. High concentrations of nicotine make many young people addicted to this substance. In Brazil, commercialization, import, and advertising are prohibited. The viable interventions to address the use of these devices in children and adolescents are prevention and behavioral counseling.

Conclusion: There is clear scientific evidence that these devices pose a risk to the physical and mental health of children and adolescents.

Objective: This study aims to evaluate the central auditory system of children and adolescents with cystic fibrosis through behavioral assessment of central auditory processing and electrophysiological tests to investigate short and long-latency auditory potentials, comparing them with the results obtained in the control group.

Methods: 117 from 7 to 21 years old patients were evaluated, 57 of them with cystic fibrosis and 60 of the control group, using behavioral evaluation of central auditory processing, auditory brainstem response and long latency auditory evoked potential. The comparison of the research groups was performed using ANOVA for Auditory Brain Response and P300 responses and Wilcoxon and Mann-Whitney tests for Central Auditory Processing responses.

Results: A statistically significant difference was found in the results of the GIN test between the groups and in the auditory brainstem response latency responses in waves I and V in the comparison between the groups with higher latencies in the study group. A difference was also found between latencies in the interpeak intervals I-III and III-V. The long latency auditory evoked potential analysis shows a statistically significant difference in the latency of the P300 potential, with higher latencies in the study group.

Conclusion: Cystic fibrosis participants presented worse performance in the gaps-in-noise test compared to the control group in the evaluation of central auditory processing, which indicates impairment of temporal resolution auditory ability. They also showed increased latency in I and V waves of auditory brainstem response, as well as an increase P300 latency in long latency auditory evoked potential.

Objective: To provide a theoretical study and model for the bioethical foundations of the factors that influence adolescents' healthcare decisional capacity.

Sources: Materials from diverse sources, including indexed articles in recognized databases and official government documents, were examined for a purposefully selected sample. The research consisted of two stages: selection of documents and reflective thematic analysis, followed by the preparation of a report. The analysis adopted a phenomenological stance and a reflective view compatible with human rights. To reduce bias and ensure the robustness of the results, measures such as data triangulation were employed. Ethical measures were taken to ensure data integrity, including considerations of anonymity and conflicts of interest in the selected studies.

Summary of the findings: It was possible to list intrinsic and extrinsic factors of the adolescent patient that influence their decisional capacity regarding health. A theoretical model was developed to discuss these factors for evaluation by means of an infographic.

Conclusions: It seems clear that the evaluation of healthcare decisional capacity of adolescents must position itself ethically regarding the tension between the moral duty to respect the self-determination of the able subject and the need to protect adolescents decidedly unable to make a specific health decision at a given time.

Objectives: This study aimed to investigate changes in the blood metabolic profiles of newborns with varying intrauterine growth conditions. Specifically, we analyzed the levels of amino acids, carnitine, and succinylacetone among full-term newborns, including small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). We aim to identify differential metabolites and metabolic pathways that may offer insights into clinical interventions.

Methods: A total of 5106 full-term newborns were included in the study. Blood samples were obtained from all newborns between 3 and 5 days after birth and analyzed using tandem mass spectrometry to detect blood metabolites. Subsequently, we screened for different metabolites and metabolic pathways among the groups using the MetaboAnalystR package (Version 1.0.1) in R software (R-3.6.0).

Results: The levels of blood amino acids and carnitine metabolism differed significantly among newborns with varying intrauterine growth conditions. Full-term SGA newborns exhibited a decrease in multiple amino acids and an increase in multiple carnitines, while full-term LGA newborns showed an increase in multiple amino acids and acylcarnitines.

Conclusion: Continuous monitoring of the short-term and long-term growth and metabolic status of full-term SGA and LGA newborns is warranted with individualized dietary and nutritional adjustments to promote healthy growth in a timely manner. The findings of this research contribute to the broader understanding of SGA/LGA and shall inform future research on metabolomics, interventions, and long-term outcomes.

Objective: The analysis of abdominal radiography is essential for the diagnosis and management of necrotizing enterocolitis (NEC) in newborns (NB). Studies, however, show a lack of agreement among physicians in the interpretation of images. This study aims to evaluate the agreement in the radiological interpretation of the NEC between examiners from different specialties (interexaminer analysis) and between the same examiner at different times (intraexaminer analysis).

Methods: Cross-sectional study for concordance analysis using plain radiographs of the abdomen of NB with suspected or confirmed NEC. The study included two neonatologists (Neo), two surgeons (SU), and two radiologists (RD). The participants filled out a form with questions about the radiographic findings; regarding the presence of intestinal loop distension, the specialists answered subjectively (yes or no) and objectively (calculation of the ratio between loop diameter and lumbar vertebrae measurements). Kappa coefficients were calculated for agreement analysis.

Results: A total of 90 radiological images were analyzed. For the interexaminer evaluation, the agreement was low (kappa<0.4) in 30 % of the answers (Neo versus SU), 38 % (Neo versus RD), and 46 % (SU versus RD). In the intraexaminer evaluation, the neonatologist and the surgeon presented substantial or almost perfect agreement in 92 % of the answers, and the radiologist in 77 %. In the evaluation of intestinal loop distention, the greatest agreement between the specialties occurred when done objectively.

Conclusion: The results confirmed the low intra- and interexaminer agreement in the radiological analysis of the NEC, reinforcing the importance of standardizing the methods of radiological interpretation of the disease.