Jornal de pediatria最新文献

Objective: When the expectant mother is faced with an unforeseen event during pregnancy, she may experience emotional fragility and depression. This study was carried out to test the association between the time of diagnosis of critical congenital heart disease (CCHD) and depressive symptoms in puerperal women.

Method: A case-control study. All mothers answered a semi-structured questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Pearson's correlation and multiple linear regression analysis were used to determine factors associated with depression.

Results: 50 puerperal women, 23 cases and 27 controls. The proportion of puerperal depressive symptoms was 26.1 % among mothers of infants prenatally diagnosed with CCHD and 77.8 % among mothers of infants postnatally diagnosed (p = 0.001 [OR] 9.917; 95 % CI 2.703-36.379). Multiple linear regression analysis showed that the use of psychotropic drugs and time of diagnosis were significantly associated with puerperal depressive symptoms.

Conclusion: Prenatal diagnosis of CCHD was associated with significantly lower levels of depressive symptoms.

Objective: Emergence delirium is frequently observed in pediatric patients. With advancements in video-based interventions, such as cartoons, video games, and virtual reality, these modalities may contribute to a reduced incidence of emergency delirium among children. However, robust evidence supporting their efficacy remains necessary.

Methods: The authors conducted a systematic search across multiple databases, including Embase, MEDLINE, and Cochrane Library, to identify all randomized controlled trials comparing video-based interventions with control treatments in pediatric emergence delirium. Data were aggregated and analyzed using Review Manager 5.4 to evaluate the effectiveness of video-based interventions.

Results: The analysis included eight randomized controlled trials comprising 872 children. The intervention group showed a trend toward lower Pediatric Anesthesia Emergence Delirium scores (p = 0.10) and fewer emergence delirium events (p = 0.52). Seven studies demonstrated that video-based interventions significantly reduced preoperative anxiety, as indicated by decreased scores on the modified Yale Pre-operative Anxiety Scale (p < 0.00001). Anesthesia duration did not significantly differ between the intervention and control groups (p = 0.16). Notably, subgroup analyses revealed a significant reduction in Pediatric Anesthesia Emergence Delirium scores among children under seven years of age (p = 0.001).

Conclusions: Video-based interventions were linked to lower Pediatric Anesthesia Emergence Delirium scores and a decreased incidence of emergence delirium events. However, these results did not reach statistical significance across the broader sample. Notably, in children under seven, these interventions significantly reduced the scores.

Level of evidence: III.

Objective: Spinal Muscular Atrophy linked to chromosome 5q (SMA) is an autosomal recessive neurodegenerative disease characterized by progressive proximal muscle atrophy and weakness. This study addresses the scarcity of research on novel disease-modifying therapies for SMA in Latin America by reporting a real-world experience in Southern Brazil.

Methodology: This is a single-center historical cohort that included all patients diagnosed with spinal muscular atrophy at a Regional Reference Service for rare diseases.

Results: Eighty-one patients were included, of whom 7 died during follow-up. Of the remaining 74 patients, 5.4 % were classified as pre-symptomatic, 24.3 % with SMA type 1, 28.4 % with type 2, 36.5 % with type 3, and 5.4 % with type 4. The mean follow-up time ranged from 1.8 years for pre-symptomatic cases to 8.7 years for SMA types 2 and 3. Approximately 42 % of these patients received specific disease-modifying therapy, of these, 96.8 % received Nusinersen, with 19.4 % transitioning to gene therapy using Onasemnogene Abeparvovec, and 6.4 % starting Risdiplam. Most patients with SMA type 1 were on disease-modifying treatment, whereas only slightly over a third of patients with type 2 and about 10 % of type 3 were receiving such treatments. Among treated patients, 80 % demonstrated improvement in motor performance during the follow-up, with a lesser therapeutic response being associated with late initiation of treatment and low motor function scores at baseline.

Conclusion: This real-world study reinforces the effectiveness of disease-modifying therapies for SMA in Brazil within the context of low- and middle-income countries, which is greater the earlier and the better the patient's functional status.

Objectives: to review scientific evidence on the impacts of pesticides on child health, addressing prenatal and postnatal exposures, acute and chronic effects.

Data source: narrative literature review, using databases such as PubMed, SciELO and Google Scholar. The inclusion criteria involved studies published between 2000 and 2023 that analyzed the relationship between pesticides and child health, including systematic reviews, cohort studies, case-control studies and clinical trials. The descriptors used were "pesticides," "child health," "prenatal exposure," "environmental health," and "developmental toxicity."

Data synthesis: In this review, an association was observed between exposure to pesticides and the development of neurological and endocrinological diseases, childhood cancer and immunological diseases.

Conclusions: Pesticides represent a significant risk to children's health, with impacts ranging from neurological alterations to chronic diseases. It is essential to promote regulatory changes and encourage agricultural practices that are less dependent on chemical substances, in addition to investing in research that explores long-term impacts and mitigation strategies.

Objective: To describe the complications and risks associated with BCG (Bacillus Calmette-Guérin) vaccination in patients diagnosed with SCID (Severe Combined Immunodeficiency).

Methods: This is a descriptive case series study. Medical charts were retrospectively reviewed for demographics, clinical manifestation, laboratory findings at diagnosis, outcome, and diagnosis of BCG vaccine-associated complications.

Results: Eleven patients diagnosed with SCID were enrolled. Ten were male. Seven (64 %) were considered probable SCID, while four (36 %) were considered definite SCID (genetically confirmed). The median age at the onset of symptoms was one month; the median age at SCID diagnosis was four months. Respiratory symptoms were the most frequent. Eight patients were vaccinated within seven days of life. Seven (87 %) of these patients experienced BCG vaccine-associated complications (86 % disseminated reactions; 14 % localized reactions). BCG vaccine-associated complications were the first clinical manifestation in 75 % of the vaccinated patients. Less than half of the patients (36 %) underwent hematopoietic stem cell transplantation. The overall death rate was elevated (73 %); the death rate related to BCG vaccination was 25 %.

Conclusions: Patients with SCID can present a high rate of BCG vaccine-associated complications, which negatively impact the clinical outcome and mortality. Pediatricians must be aware that BCG vaccine-associated complications can be the first presentation and a warning sign of SCID. Implementing newborn screening for SCID in Brazil may represent a worthy opportunity to impact the health outcomes of affected infants significantly.

Objective: Air pollution emission associated with wildfires is a global concern, contributing to air quality deterioration and severely impacting public health. This narrative review aims to provide an overview of wildfire smoke (WFS) characteristics and associated impacts on adults' and children's health.

Data source: Literature review based on a bibliographic survey in PubMed (National Library of Medicine, United States), SciELO (Scientific Electronic Library Online), and Google Scholar databases. Observational, cross-sectional, longitudinal, and review studies were considered, prioritizing peer-reviewed articles published in the last 10 years (2014-2024).

Data synthesis: Wildfire smoke (WFS) contributes to the deterioration of air quality, resulting in increased exposure to air pollution especially in wildland-urban interfaces. WFS contains particulate matter (PM) in a range of sizes and chemical compositions, as well as multiple toxic gasses. The health impacts of WFS are systemic, affecting the respiratory, cardiovascular, and neurological systems. Exposure to WFS is associated with inflammatory and oxidative stress, DNA damage, epigenetic modulations, and stress-disorders in adults and children. Children may be at an increased risk of WFS respiratory impacts, due to their smaller airways and developing lungs.

Conclusion: Wildfires are increasing in frequency and intensity, resulting in thousands of premature deaths and hospitalizations worldwide, each year. Preventive measures against wildfire spread must be reinforced, considering the increasing trends of global warming and extreme weather events. Adaptation strategies should be undertaken especially in wildland-urban interface regions, including the improvement of early warning systems, improvement of health care facilities and household preparedness and promotion of risk communication campaigns.

Objective: This review discusses the impact of climate change on sleep, anxiety, and eating in the pediatric population.

Data source: This is a nonsystematic literature review based on a search using PubMed and MeSH terms in titles and abstracts with these keywords: climate change, sleep, greenhouse effect, children, and adolescents.

Data synthesis: Climate change events are associated with human intervention in the ecosystem, having a strong impact on cognitive functions, physical and mental health, as well as subjective well-being, particularly in youth. Climate change is caused by human activity with changes in the composition of the global atmosphere caused by emissions of gases, such as carbon dioxide, which increase the greenhouse effect. This review discusses the impact of climate change on sleep, anxiety, and feeding in the pediatric population.

Conclusions: Early detection of vulnerability conditions, along with adaptation strategies is necessary to address climate stressors with a focus on healthy sleep and eco-anxiety. Pediatrics has an important role to play in protecting healthy sleep in children.