Jornal de pediatria最新文献_第3页

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

The impact of adenoid hypertrophy across pediatric age groups on maxillomandibular development and position 儿童各年龄组腺样体肥大对上颌骨发育和位置的影响。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-03-05 DOI: 10.1016/j.jped.2026.101524

Xue-Ru Zhang, Jian-Ya Zhang

Objective

Although adenoid hypertrophy (AH) is associated with malocclusion, its age-specific impact on craniofacial development across different dentition stages remains unclear. This study aimed to assess AH-related craniofacial changes across distinct phases of dental development.

Methods

This retrospective study analyzed 180 children divided into three age groups: 3–5, 5–8, and 8–11 years. Lateral cephalometric radiographs were used to evaluate sagittal skeletal relationships (SNA, SNB, ANB), dentoalveolar position (NA-Apo), occlusal plane inclination (NPo–FH), jaw lengths (ANS-Ptm, Co-Gn), and overjet. Comparisons were made between the AH and control groups within each age cohort.

Results

In the 3–5 year group, no significant craniofacial differences were found between AH and control subjects. Between 5–8 years, AH was linked to a significantly lower SNB angle and higher NA-Apo angle (p < 0.05). By 8–11 years, AH patients showed significantly reduced SNA, SNB, and NPo–FH angles, along with increased ANB, NA-Apo, and overjet values compared to controls (p < 0.05).

Conclusion

AH was associated with age-dependent craniofacial changes—such as mandibular retrusion, dental protrusion, posterior occlusal tilt, and increased overjet—without altering jaw length. Early diagnosis and timely intervention during key growth stages are crucial to prevent long-term facial abnormalities. Given the retrospective, 2D cephalometric design, causality could not be inferred, and longitudinal or treatment effects could not be assessed.

目的：虽然腺样体肥大（AH）与错牙合有关，但其对不同牙列阶段颅面发育的年龄特异性影响尚不清楚。本研究旨在评估在牙齿发育的不同阶段ah相关的颅面变化。方法：回顾性分析180名儿童，分为3-5岁、5-8岁和8-11岁三个年龄组。侧位头颅x线片用于评估矢状骨关系（SNA， SNB， ANB），牙槽位置（NA-Apo），咬合平面倾角（NPo-FH），下颌长度（ANS-Ptm, Co-Gn）和过喷。在每个年龄队列中对AH组和对照组进行比较。结果：在3-5岁组中，AH与对照组的颅面无明显差异。在5-8岁之间，AH与明显较低的SNB角和较高的NA-Apo角相关(p 结论：AH与年龄相关的颅面变化有关，如下颌后缩、牙突、后咬合倾斜和覆盖增加，而不改变下颌长度。在关键生长阶段早期诊断和及时干预是预防长期面部异常的关键。考虑到回顾性的二维头颅测量设计，无法推断因果关系，也无法评估纵向或治疗效果。

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引用次数: 0

Hyperbilirubinemia monitoring program in infants ≥ 35 weeks: a Brazilian quality improvement study ≥35周婴儿高胆红素血症监测项目：巴西质量改善研究

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-01-31 DOI: 10.1016/j.jped.2026.101502

Ana Luiza Y. Grillo , Sérgio T.M. Marba , Jamil P.S. Caldas

Objective

To implement a systematic monitoring program for hyperbilirubinemia in the first week of life in newborns ≥ 35 weeks of gestational age.

Methods

A quality assessment study was conducted with an estimated sample size of 385 newborns using a phototherapy utilization rate of 10 %. All newborns with a gestational age of ≥ 35 weeks admitted to a secondary general hospital well-baby nursery were included. Transcutaneous bilirubin (TcB) was systematically measured, and total serum bilirubin (TsB) was measured as needed. Patients with TcB levels above the 75th percentile according to the nomogram by Bhutani et al. (2021) were followed up after discharge from a specific outpatient clinic. The rates of outpatient follow-up clinic utilization, incidence of total bilirubin ≥ 15 mg/dL at discharge, readmission for phototherapy, and exchange transfusion were evaluated.

Results

Of the 432 newborns analyzed, 53 (12.3 %) were referred for follow-up, with a return rate of 83 % (44). Twelve newborns (27.2 % of those who attended the return visit and 2.7 % of the total sample) were readmitted for phototherapy for a median duration of 36 (30–48) hours. Three infants had bilirubin values ≥ 15.0 mg/dL at discharge and did not require readmission. None of the patients required an exchange transfusion.

Conclusions

The outpatient follow-up program for jaundice demonstrated high adherence, safety, and effectiveness, and reduced the rate of phototherapy use threefold.

目的：对≥35孕周的新生儿实施1周高胆红素血症的系统监测。方法：采用光疗使用率为10% %的方法，对385例新生儿进行质量评估研究。所有孕周≥35周的新生儿被纳入二级综合医院的健康婴儿托儿所。系统测定经皮胆红素（TcB），必要时测定血清总胆红素（TsB）。根据Bhutani等人（2021）的nomogram量表，TcB水平高于第75百分位的患者在特定门诊出院后接受随访。评估门诊随访使用率、出院时总胆红素≥15 mg/dL的发生率、再入院光疗率和换血率。结果：在432例新生儿中，53例（12.3 %）转介随访，复诊率为83 %（44）。12名新生儿（27.2% %参加回访的新生儿和2.7 %的总样本）再次入院接受光疗，平均持续时间为36（30-48）小时。3名婴儿出院时胆红素值≥15.0 mg/dL，不需要再入院。没有病人需要换血。结论：黄疸门诊随访方案表现出高依从性、安全性和有效性，并将光疗使用率降低了三倍。

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引用次数: 0

How to identify depression and anxiety in children and adolescents 如何识别儿童和青少年的抑郁和焦虑。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2025-11-09 DOI: 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.

目的：回顾儿童和青少年最常见的焦虑和抑郁障碍的流行病学、诊断标准和治疗选择。数据来源：在PubMed、SciELO和谷歌Scholar数据库中进行了非系统评价。诊断标准根据精神疾病诊断与统计手册（DSM-5-TR）和最新的儿童和青少年精神病学教科书定义。数据总结：诊断需要全面的临床评估，考虑年龄特异性表现，并将预期的发育性情绪反应与病理状况区分开来。结论：治疗依赖于心理教育和心理治疗干预，特别是认知行为治疗，在中度至重度病例中，选择性血清素再摄取抑制剂的药物治疗，最好与心理治疗相结合。早期识别，特别是在儿科护理水平，是必不可少的，以减少发病率，防止复发，促进健康发展。

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引用次数: 0

Myths and facts in the treatment of neurodevelopmental disorders – other therapies 治疗神经发育障碍的神话和事实-其他疗法。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2025-10-29 DOI: 10.1016/j.jped.2025.101452

Chaves Livio Francisco S. , Pessoa Fabio Borges , Marques Pedro Henrique Resende

Objective

To critically examine the effectiveness of complementary and alternative therapies (CATs) in the treatment of neurodevelopmental disorders, distinguishing myths from evidence-based practices and supporting informed therapeutic decision-making for healthcare professionals, educators, and families.

Data sources

Evidence was collected from PubMed, Scopus, and Web of Science up to August 2025. Systematic reviews, meta-analyses, and international consensus statements addressing attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), specific learning disorders, communication and language disorders, intellectual disability, and developmental coordination disorder were included.

Summary of findings

Interest in interventions such as neurofeedback, transcranial direct current stimulation, music therapy, equine-assisted therapy, virtual reality, and gamification has grown substantially. However, most of these approaches lack methodological standardization and robust evidence to justify their use as primary treatments. Some demonstrate modest benefits as adjunctive strategies, especially when integrated into structured programs and supervised by multidisciplinary teams. Conversely, therapies including acupuncture, ozone therapy, and hyperbaric oxygen therapy present insufficient scientific support and should not be considered substitutes for validated methods.

Conclusion

Complementary and alternative therapies remain a topic of significant debate in the management of neurodevelopmental disorders. While certain approaches may offer limited adjunctive benefits, their clinical use should be carefully evaluated within evidence-based frameworks. The development of rigorous evaluations, standardized protocols, and the safe integration of innovative technologies is essential to optimize therapeutic outcomes without compromising access to scientifically validated interventions.

目的：严格检查补充和替代疗法（cat）治疗神经发育障碍的有效性，从循证实践中区分神话，并为医疗保健专业人员、教育工作者和家庭提供知情的治疗决策支持。数据来源：证据收集自PubMed、Scopus和Web of Science，截止到2025年8月。包括针对注意缺陷/多动障碍（ADHD）、自闭症谱系障碍（ASD）、特定学习障碍、沟通和语言障碍、智力残疾和发育协调障碍的系统综述、荟萃分析和国际共识声明。研究结果总结：对神经反馈、经颅直流电刺激、音乐治疗、马辅助治疗、虚拟现实和游戏化等干预措施的兴趣大幅增长。然而，这些方法大多缺乏方法学的标准化和强有力的证据来证明它们作为主要治疗的合理性。一些辅助策略显示出适度的好处，特别是当整合到结构化项目中并由多学科团队监督时。相反，包括针灸、臭氧治疗和高压氧治疗在内的治疗方法缺乏科学依据，不应被视为有效方法的替代品。结论：在神经发育障碍的治疗中，补充和替代疗法仍然是一个有重大争议的话题。虽然某些方法可能提供有限的辅助益处，但应在循证框架内仔细评估其临床应用。制定严格的评估、标准化的方案和创新技术的安全整合对于优化治疗结果而不影响获得科学验证的干预措施至关重要。

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引用次数: 0

Dietary and nutritional interventions in the treatment of childhood neuropsychiatric disorders: evidence and myths 饮食和营养干预治疗儿童神经精神疾病：证据和神话。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2025-10-30 DOI: 10.1016/j.jped.2025.101465

Regina Torres Duarte Kostenko , Nathalia Ferreira Antunes de Almeida , Juliana Fernandez Santana e Meneses

Objective

To analyze the current scientific literature on the main dietary and nutritional interventions proposed for children and adolescents with neuropsychiatric disorders and describe their efficacy and safety, differentiating evidence-based practices from common myths.

Data source

The search was conducted using PubMed, SciELO, Cochrane, and Web of Science databases (2019–2025). The specific terms used in the search were formulated to encompass dietary interventions in children and adolescents with neuropsychiatric disorders and their outcomes.

Data synthesis

Gluten-free and casein-free (GFCF) diets did not reduce ASD symptoms and should be reserved for confirmed allergy or intolerance. Probiotics have shown inconsistent results for core ASD/ADHD symptoms, although they may alleviate gastrointestinal complaints in subgroups. Omega-3 s have shown modest and heterogeneous effects; In ADHD, high-dose EPA may improve attention when baseline levels are low, without consistent benefit in other domains. N-acetylcysteine reduced irritability in some trials, with no consistent effect on core symptoms. Folinic acid showed benefits in subgroups defined by biomarkers (folate receptor autoantibodies) and in ASD with language impairment, but this needs to be confirmed in larger studies. For vitamin D, high rates of insufficiency and possible modest gains in sub-outcomes were observed, with methodological heterogeneity.

Conclusions

This literature review showed that there is no scientific support for generalized dietary interventions, such as restrictive diets or nutritional supplementation, in the treatment of childhood neuropsychiatric disorders. Current evidence suggests the need for individualization and continuous monitoring. Specific interventions are justified only in the case of documented nutritional deficiencies.

目的：分析目前关于儿童和青少年神经精神障碍的主要饮食和营养干预措施的科学文献，描述其有效性和安全性，区分循证实践和常见神话。数据来源：检索使用PubMed、SciELO、Cochrane和Web of Science数据库（2019-2025）。在搜索中使用的具体术语是制定的，以涵盖患有神经精神疾病的儿童和青少年的饮食干预及其结果。数据综合：无麸质和无酪蛋白（GFCF）饮食不能减轻ASD症状，应保留给确认过敏或不耐受的患者。益生菌对核心ASD/ADHD症状的治疗结果不一致，尽管它们可能减轻亚组的胃肠道症状。Omega-3 显示出适度和异质性的影响；在ADHD中，当基线水平较低时，大剂量EPA可能会改善注意力，但在其他领域没有一致的益处。n -乙酰半胱氨酸在一些试验中减少了易怒，但对核心症状没有一致的影响。叶酸在生物标志物（叶酸受体自身抗体）定义的亚组和伴有语言障碍的ASD中显示出益处，但这需要在更大规模的研究中得到证实。对于维生素D，观察到较高的不足率和可能适度的亚结局，方法上存在异质性。结论：本文献综述显示，在儿童神经精神疾病的治疗中，没有科学支持广泛的饮食干预，如限制性饮食或营养补充。目前的证据表明需要个体化和持续监测。具体的干预措施只有在有记录的营养缺乏的情况下才有理由。

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引用次数: 0

Behavioral approach to autism spectrum disorder: quality versus quantity in interventions 自闭症谱系障碍的行为方法：干预的质量与数量。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2025-10-07 DOI: 10.1016/j.jped.2025.101451

Jaime Lin , Júlio César Claudino dos Santos , Cinara Ludvig Gonçalves

Objective

To discuss the importance of balancing quality versus quantity in behavioral interventions for individuals with Autism Spectrum Disorder (ASD), highlighting evidence-based approaches and the role of therapist training.

Data sources

Narrative review of the literature examining evidence-based behavioral approaches for ASD, the tension between intervention intensity and quality, factors influencing individualized treatment planning, and the importance of professional qualification.

Summary of findings

Evidence indicates that more hours of therapy do not necessarily result in better outcomes, with studies showing no consistent dose–response relationship. Individual learning rates, comorbid conditions, and quality of implementation significantly influence results. High-quality, individualized planning, consistent execution, family engagement, and well-trained professionals are essential. Lack of regulation and standardized training, particularly in contexts without professional certification systems, poses challenges to delivering effective, evidence-based care.

Conclusion

Behavioral interventions for ASD must prioritize quality over quantity, ensuring evidence-based, individualized, and well-supervised treatment plans delivered by qualified professionals to achieve meaningful outcomes.

目的：探讨在自闭症谱系障碍（ASD）个体行为干预中平衡质与量的重要性，强调循证方法和治疗师培训的作用。数据来源：对ASD循证行为治疗方法、干预强度与质量之间的紧张关系、影响个体化治疗计划的因素以及专业资格的重要性的文献进行叙述性回顾。研究结果总结：有证据表明，治疗时间更长并不一定导致更好的结果，研究显示没有一致的剂量-反应关系。个体学习率、共病条件和实施质量显著影响结果。高质量、个性化的计划、一致的执行、家庭参与和训练有素的专业人员是必不可少的。缺乏监管和标准化培训，特别是在没有专业认证制度的情况下，对提供有效的循证护理构成挑战。结论：ASD的行为干预必须优先考虑质量而不是数量，确保由合格的专业人员提供循证、个性化和良好监督的治疗计划，以取得有意义的结果。

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引用次数: 0

Determinants and spatial distribution of early newborn care in Somalia: evidence from the 2020 Somalia health and demographic survey 索马里早期新生儿护理的决定因素和空间分布：来自2020年索马里卫生和人口调查的证据。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2026-01-06 DOI: 10.1016/j.jped.2025.101496

Abdirahman Omer Ali , Awo Mohamed Kahie , Nura Mohamed Omer , Muhyadin Yusuf Dahir , Abdisalam Mahdi Hassan , Hodo Abdi Abdillahi , Md. Moyazzem Hossain

Objective

Early newborn care (ENC) is important for reducing neonatal mortality; however, the rate of receiving adequate newborn care is low in Somalia. Therefore, this study aimed to identify the individual, household, and community-level determinants and map the spatial patterns of ENC in Somalia to take the required actions and policies.

Methods

This study considered a weighted sample of 15,024 mother-newborn pairs extracted from a countrywide cross-sectional survey, the 2020 Somali Health and Demographic Survey (SHDS). Multilevel logistic regression was employed to identify factors associated with receiving adequate ENC within two days of birth. Global Moran’s I and Getis-Ord Gi* statistics were used for spatial analysis.

Results

The prevalence of adequate ENC was critically low (5.23%). Findings revealed that delivery in a health facility (vs. home: Adjusted Odds Ratio (AOR) = 0.22, 95% CI: 0.18-0.26), higher household wealth (richest vs. poorest: AOR = 2.02, 95% CI: 1.59-2.57), and higher birth order were influential predictors of receiving ENC. However, having multiple or a higher number of living children was associated with significantly lower odds of receiving ENC. Spatial analysis identified a statistically significant hot spot of higher ENC coverage in the northwestern regions and cold spots of extremely low coverage in the south.

Conclusion

In Somalia, early neonatal care is shockingly insufficient, and significant social and regional disparities. To achieve Sustainable Development Goal 3, interventions must be implemented based on identified cold spots, prioritizing the strengthening of access to skilled care at birth, and addressing the economic vulnerabilities of families.

目的：新生儿早期护理对降低新生儿死亡率具有重要意义；然而，索马里获得适当新生儿护理的比率很低。因此，本研究旨在确定索马里ENC的个人、家庭和社区层面的决定因素，并绘制ENC的空间格局，以采取必要的行动和政策。方法：本研究考虑了从2020年索马里健康和人口调查（SHDS）全国横断面调查中提取的15,024对母亲-新生儿加权样本。采用多水平逻辑回归来确定与出生2天内接受足够ENC相关的因素。采用Global Moran’s I和Getis-Ord Gi*统计进行空间分析。结果：适足ENC的患病率极低（5.23%）。调查结果显示，在卫生机构分娩（相对于在家：调整优势比（AOR） = 0.22,95% CI: 0.18-0.26），较高的家庭财富(最富有vs最贫穷：AOR = 2.02,95% CI：出生顺序高是ENC接受的影响因素，而多胞胎或多胞胎儿童接受ENC的几率显著降低。空间分析发现，西北地区ENC覆盖率较高的热点地区和南方极低覆盖率的冷区具有统计学意义。结论：在索马里，早期新生儿护理严重不足，而且存在显著的社会和地区差异。为实现可持续发展目标3，必须根据已确定的冷点实施干预措施，优先加强在出生时获得熟练护理的机会，并解决家庭的经济脆弱性。

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引用次数: 0

Effects of hydrotherapy and hammock positioning on pain reduction in preterm neonates 水疗法和吊床定位对减轻早产儿疼痛的影响。

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.2026.101503

Ana Talita Vasconcelos Arcanjo Ribeiro da Silva, Francisco Plácido Nogueira Arcanjo, Jeferson de Sousa Justino, Lizandro de Andrade Teles, Ana Kelly Melo de Aquino

Objective

To evaluate the effects of hydrotherapy and hammock positioning, applied individually or in combination, on pain reduction in preterm neonates.

Methods

This randomized clinical trial included 45 preterm neonates under 37 weeks of gestation and weighing less than 2,500g, admitted to the neonatal intensive care unit or intermediate care unit at Santa Casa Hospital in Sobral, Brazil. Palliative interventions were performed during routine invasive and painful procedures, specifically heel lances and handling of the orogastric tube during feeding. Neonates were randomized into three groups: hydrotherapy, hammock positioning, or a combined intervention, with 15 participants per group. Interventions were applied once daily for 15 consecutive days. Pain was assessed using the Neonatal Facial Coding System before and after each session, totaling 1,350 evaluations. Continuous variables were analyzed using Student’s t-test, and categorical variables were analyzed using Fisher’s exact test. The study was registered in the Brazilian Registry of Clinical Trials.

Results

The sample consisted of 53.3% male neonates, with a mean gestational age of 32.4±2.1 weeks. Hydrotherapy significantly reduced pain scores and pain prevalence. Hammock positioning also produced significant reductions in pain scores and prevalence. The combined intervention resulted in the greatest reduction in pain scores and pain prevalence. All within-group comparisons showed statistically significant improvements. No statistically significant differences were observed when the three intervention groups were compared directly.

Conclusion

Hydrotherapy and hammock positioning, applied individually or in combination, are effective, safe, and feasible strategies for reducing pain in preterm neonates and may complement standard neonatal care in NICUs.

目的：评价水疗法和吊床定位单独或联合应用对减轻早产儿疼痛的效果。方法：这项随机临床试验纳入了45名妊娠37周以下、体重小于2500克的早产儿，这些早产儿住在巴西索布拉尔Santa Casa医院的新生儿重症监护室或中级监护室。姑息性干预是在常规的侵入性和痛苦的过程中进行的，特别是在喂食过程中进行足跟穿刺和处理口胃管。新生儿被随机分为三组：水疗、吊床放置或联合干预，每组15名参与者。干预措施每天1次，连续15天。每次治疗前后使用新生儿面部编码系统对疼痛进行评估，共计1350次评估。连续变量分析采用Student's t检验，分类变量分析采用Fisher精确检验。该研究已在巴西临床试验登记处注册。结果：新生儿男婴占53.3%，平均胎龄32.4±2.1周。水疗法显著降低疼痛评分和疼痛发生率。吊床位置也能显著降低疼痛评分和患病率。联合干预导致疼痛评分和疼痛患病率的最大降低。所有组内比较均显示统计学上显著的改善。三个干预组直接比较，差异无统计学意义。结论：水疗法和吊床定位，单独或联合应用，是有效、安全、可行的策略，可以减轻早产儿的疼痛，并可补充新生儿重症监护病房的标准新生儿护理。

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引用次数: 0

Autism spectrum disorder: overdiagnosis or a new pandemic? 自闭症谱系障碍：过度诊断还是我们面临新的大流行？

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2026-03-01 Epub Date: 2025-09-22 DOI: 10.1016/j.jped.2025.101439

Kamila Castro , Rudimar Riesgo , Carlos Gadia

Objective

To critically analyze the factors influencing prevalence estimates of Autism Spectrum Disorder (ASD), considering methodological, clinical, etiological, and sociocultural determinants that shape epidemiological data and diagnostic practices.

Data synthesis

In recent decades, a substantial increase in ASD prevalence has been observed globally. This phenomenon is shaped by a combination of factors, including changes in diagnostic criteria, improved detection methods, expanded access to health services, and greater public awareness. However, it also raises concerns about possible overdiagnosis, particularly in complex clinical contexts. The interpretation of prevalence data is influenced by methodological designs, population characteristics, and sociocultural dynamics.

Summary of the findings

The absence of biological markers, the high rate of psychiatric comorbidities, and disparities in access to qualified professionals further complicate the diagnostic process. These elements highlight the need for caution when comparing data across studies, time periods, or geographic regions.

Conclusion

The ASD prevalence reflects a multifaceted process that demands careful and comprehensive interpretation. A deeper understanding of this scenario requires critical reflection on how diagnoses are established, interpreted, and applied. Strengthening diagnostic practices and epidemiological approaches is essential for ensure more accurate data and support informed decision-making in health policies.

目的：批判性地分析影响自闭症谱系障碍（ASD）患病率估计的因素，考虑影响流行病学数据和诊断实践的方法学、临床、病因学和社会文化因素。数据综合：近几十年来，全球范围内观察到ASD患病率大幅增加。这一现象是由多种因素共同造成的，包括诊断标准的变化、检测方法的改进、获得保健服务的机会的扩大以及公众认识的提高。然而，它也引起了对可能的过度诊断的担忧，特别是在复杂的临床环境中。流行率数据的解释受方法设计、人口特征和社会文化动态的影响。研究结果总结：生物标记物的缺乏、精神合并症的高发率以及获得合格专业人员的机会的差异进一步使诊断过程复杂化。这些因素强调了在比较不同研究、时间段或地理区域的数据时需要谨慎。结论：自闭症谱系障碍的发病是一个多方面的过程，需要仔细和全面的解释。要更深入地了解这种情况，就需要对诊断是如何建立、解释和应用进行批判性反思。加强诊断做法和流行病学方法对于确保更准确的数据和支持卫生政策的知情决策至关重要。

{"title":"Autism spectrum disorder: overdiagnosis or a new pandemic?","authors":"Kamila Castro , Rudimar Riesgo , Carlos Gadia","doi":"10.1016/j.jped.2025.101439","DOIUrl":"10.1016/j.jped.2025.101439","url":null,"abstract":"<div><h3>Objective</h3><div>To critically analyze the factors influencing prevalence estimates of Autism Spectrum Disorder (ASD), considering methodological, clinical, etiological, and sociocultural determinants that shape epidemiological data and diagnostic practices.</div></div><div><h3>Data synthesis</h3><div>In recent decades, a substantial increase in ASD prevalence has been observed globally. This phenomenon is shaped by a combination of factors, including changes in diagnostic criteria, improved detection methods, expanded access to health services, and greater public awareness. However, it also raises concerns about possible overdiagnosis, particularly in complex clinical contexts. The interpretation of prevalence data is influenced by methodological designs, population characteristics, and sociocultural dynamics.</div></div><div><h3>Summary of the findings</h3><div>The absence of biological markers, the high rate of psychiatric comorbidities, and disparities in access to qualified professionals further complicate the diagnostic process. These elements highlight the need for caution when comparing data across studies, time periods, or geographic regions.</div></div><div><h3>Conclusion</h3><div>The ASD prevalence reflects a multifaceted process that demands careful and comprehensive interpretation. A deeper understanding of this scenario requires critical reflection on how diagnoses are established, interpreted, and applied. Strengthening diagnostic practices and epidemiological approaches is essential for ensure more accurate data and support informed decision-making in health policies.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 ","pages":"Article 101439"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954973","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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