Jornal de pediatria最新文献

Objective: It was to develop smoothed height and weight percentiles for boys and girls with IDs between 7 and 17 years old.

Methods: The sample consisted of 1,047 young people (645 boys and 402 girls; 7-17 years old) with ID. A total of 4,059 measurements (height: n = 2,041; weight: n = 2,018) were retrospectively obtained from the period between 2013 and 2018. Smoothed height and weight percentiles were developed using the LMS method. Local and global diagnosis of percentiles were evaluated with Q statistics and detrended Q-Q plots.

Results: Percentiles (5, 10, 25, 50, 75, 90, and 95) for height-to-age and weight-to-age were developed with satisfactory modeling in boys and girls between 7 and 17 years old. Boys showed a linear trend in height up to 11 or 12 years old, an increment from 13 to 15 years old and a deceleration from 15 or 16 years old. For the girls, height was linear between the ages of 7 and 11, followed by a deceleration from the age of 12 and without substantial changes from the ages of 15 to 17. Regarding weight, girls showed a linear trend of weight gain until the age of 13 and deceleration at the age of 14 or 15. Boys, however, showed a linear tendency to gain weight from 7 to 17 years old.

Conclusion: The height and weight percentiles developed in this study can help monitor the growth of young people with ID.

Objective: Beta-lactam (BL) allergy is considered a public health issue worldwide. To date, there is no consistent data on the direct Oral Provocation Test (OPT) for BL in Brazilian children and adolescents. This study's main objective is to describe the safety profile of direct OPT in this population.

Method: A cross-sectional study was conducted with patients aged 1 to 17 years with a history of mild immediate or delayed reactions to penicillin. The European Network of Drug Allergy (ENDA) questionnaire was used. The authors performed OPTs with amoxicillin over five days. Continuous variables were described using their means and standard deviations. Bivariate analysis between test positivity and other study variables was performed using the Chi-square test, odds ratio, and their respective 95 % confidence intervals (CI 95 %). A p-value < 0.05 was considered significant.

Results: In total, 54 OPTs were performed, four were positive (7.5 %) and one was considered inconclusive. All reactors were boys and had delayed reactions, with no severe reactions, and three showed symptoms on the first day of testing.

Conclusion: >90 % of the sample was delabeled as allergic to BL. There were no severe reactions, confirming the safety of direct OPT in this age group. Among the reactors, 3 patients presented symptoms on the first day of testing before receiving the second dose and one had symptoms on 5 days, indicating that further studies are needed on the optimal duration of the OPT.

Objectives: To compare the perinatal risk factors approach for early-onset sepsis (EOS), which is based on categorical risk stratification, with the clinical observation-based approach, evaluating their impact on laboratory testing frequency, the use of antibiotic therapy, and EOS incidence.

Methods: Retrospective observational study, conducted from November 2021 to March 2022. Newborns (NB) at 34 wk of age were included and clinical data from prenatal care, birth, hospitalization, and laboratory tests were evaluated.

Results: Sample of 1,086 newborns. Ninety-seven NB (8.9 %) underwent infectious screening in the clinical observation approach versus 279 (26.5 %) in the perinatal risk factors approach, which represents a 65.2 % decrease in the clinical observation approach (p < 0.01). Under the perinatal risk factors approach, 35 (3.2 %) of NBs received empirical antibiotic therapy for EOS, versus only 22 (2.0 %) in the clinical observation approach, which would be a 37.1 % decrease in the clinical observation strategy (p < 0.01). We found no difference in the incidence of culture-confirmed EOS.

Conclusion: The clinical observation approach, when compared to the perinatal risk factors approach, reduces laboratory testing and the use of antibiotic therapy, with no impact on the incidence of EOS. Further research is required to determine the best way to systematize serial examinations of NB's and which symptoms would be the best predictors of EOS.

Objective: This article aims to assess the impact of climate change, a reality already present on the neurodevelopment of both neurotypical and atypical children.

Data sources: A narrative review of the literature was carried out based on articles available in the PubMed database, published in the last five years using the keywords neurodevelopment and climate change, as well as websites of organizations dedicated to childhood such as UNICEF, the American Academy of Pediatrics and the Center for Developing Childhood at Harvard University.

Summary of findings: Children and adolescents are more directly affected by the effects of climate change due to their developmental stage and greater vulnerability. Prolonged exposure to air pollutants can affect brain development, resulting in cognitive and behavioral problems. Extreme weather events, such as floods, cyclones, and heat waves, can destroy essential infrastructure such as schools and hospitals, interrupting the educational process and access to health care. Changes in rainfall patterns and extreme droughts can affect food production, leading to malnutrition and food insecurity. Direct experience of natural disasters can cause stress and psychological trauma, affecting children's emotional and mental well-being.

Conclusions: Studies clearly demonstrate the potential impact of climate change on the neurodevelopment and mental health of children and adolescents. This topic should be part of the current agenda of pediatricians, not only treating the resulting illnesses but mainly acting on the front line and supporting proposals to attenuate the environmental disaster that has already occurred.

Objective: Besides socioeconomic factors, environmental pollution, and climate change are contemporary threats to health. In this review, the authors present results from a recent comprehensive synthesis of existing research on the effects of air pollution and climate change on gestation, fetal development, and postnatal health.

Data sources: Findings from systematic reviews conducted over the past five years and available in PubMed were used.

Summary of findings: A vast and robust evidence exists on the association between air pollution exposures and negative outcomes. Gestational diabetes, hypertensive disorders of pregnancy, preeclampsia, spontaneous abortion, and maternal postpartum depression are reported. Fetal development and postnatal health are also impaired by exposures; low birth weight is a common finding from studies worldwide, but there are increased risks for malformations and impairments in neurodevelopment. While there are fewer studies on factors related to climate change, there is sufficient evidence regarding the direct and indirect effects on maternal health and fetal development. Increased risks for prematurity, low birth, and emergency room visits are associated with higher temperatures. Asthma incidence and infectious respiratory disease risks are also influenced by extreme weather events. It is essential to recognize the profound impact that environmental factors, such as air pollution and climate change can have on maternal health, fetal development, and neonatal health.

Conclusion: The data presented underscores the significant risks that environmental pollution poses during gestation, influencing not only maternal health but also the short- and long-term well-being of the child.

Objective: Three decades of evidence compiled by the Intergovernmental Panel on Climate Change (IPCC) reports is clear about the unequivocal impacts of humans on the global climate system are unequivocal and the wide range of effects on natural, social, and economic systems. Studies on impacts, vulnerability, and adaptation present the current impact on health and future consequences under different climate and greenhouse gas emissions scenarios. This article discusses some of the impacts of climate change on children's health which represents one of the most vulnerable groups.

Sources: Evidence was sourced from recent scientific papers and reports referring to the potential impacts on children's health associated with the extreme events in Brazil observed in Brazil between 2023 and 2024 (heat waves and droughts, wildfires, and floods).

Summary of the findings: Besides global warming, climate change is associated with more frequent and intense extreme events such as droughts, floods, and wildfires. Children and adolescents are particularly vulnerable due to physiological characteristics, interaction with exposure factors, and because they will live longer under changing conditions. Climate change projections and the intensification of impacts for Brazil highlight the adaptation challenges related to the protection of children under a changing climate and the role of the preparation of the country's health system, educators, and parents.

Conclusions: The article underscores the need for collaboration among policymakers, health professionals, and educators, as well as the communities, to effectively address the adaptation challenges and build resilience to protect children against the impacts of climate change.

Objective: To assess the impact of microplastics/nanoplastics (MiP/NP) on human health.

Data source: The authors conducted a narrative review of articles published in English, Portuguese, French and Spanish in the last decade in the following databases: PubMed, Google Scholar, EMBASE and SciELO. The keywords used in this search were: microplastics OR nanoplastics OR marine litter OR toxicology OR additives AND human health OR children OR adults.

Data synthesis: MiP is a group of emerging contaminants that have attracted increasing scientific interest and attention from society in the last decade due to their ubiquitous detection in all environments. Humans can be mainly exposed to MiP and NP orally, by inhalation, by dermal contact, as well as through systemic routes and cannot be neglected, especially in young children. The possible toxic effects in different systems are due to plastic particles, often combined with leachable additives and adsorbed contaminants.

Conclusions: Unless the plastics value chain is transformed in the next two decades, the risks to species, marine ecosystems, climate, health, economies and communities will become unmanageable. However, alongside these risks lie unique opportunities to lead the transition to a more sustainable world.

Objectives: To identify the dietary patterns of Brazilian adolescents and to verify their associated factors.

Methods: Cross-sectional study with data from the 2019 National Survey of School Health. Students aged 13 to 17 participated in the survey, totaling a sample of 125,123 adolescents. The variables were divided into two groups: healthy and unhealthy diet. Principal component analysis was used to identify the dietary patterns. To evaluate the association, logistic regression was used, estimated by the Odds Ratio, with the respective 95 % confidence intervals.

Results: Two main components were identified: first related to regular consumption of fruits, vegetables, and beans; the second related to non-regular consumption of sweet treats, soft drinks, and fast food. The highest likelihood of regularly consuming the first was observed among adolescents residing in the Central-West and Southeast regions, with higher maternal education, who abstained from alcohol, engaged in physical activity, were not sedentary, ate breakfast, had lunch or dinner with their parents, refrained from eating while engaging in other activities, and participated in school meal programs. The lowest likelihood of not regularly consuming the second was found among male adolescents aged 16 to 17, attending public schools, who abstained from alcohol, and were not sedentary.

Conclusions: This study identified two dietary patterns, both linked to socioeconomic factors and healthy lifestyle habits. Recognizing these patterns among adolescents enables health surveillance efforts aimed at reducing diseases and health problems.

Objective: There is a pressing need for public health practitioners to understand cultural values influencing parents on the uptake of human papillomavirus (HPV) vaccination for their daughters, which is presenting a growing challenge to close the immunization gap worldwide. Parental decisions were predominantly shaped by cultural norms and values. This systematic review encompasses parental perspectives on the influence of cultural values on the uptake of HPV vaccination by their daughters.

Method: This systematic review was registered on PROSPERO CRD42020211324. Eligible articles were selected from CINAHL, PsycINFO, EMBASE, PubMed and Science Direct. Original qualitative studies exploring parental perspectives on the influence of cultural values on the uptake of HPV vaccination by their daughters under the age of 18, published in the English language with no restriction dates were reviewed. Two authors independently screened abstracts, conducted the fill-text review, extracted information using a standardized form, and assessed study quality. A third author is needed to resolve the disagreements if necessary.

Results: Of the 1552 citations, 22 were included, with information on 639 parents. Five themes emerged from the data: sexuality-related concerns; upbringing and moral values; obligation to protect; external influences; and vaccine-related concerns.

Conclusion: This systematic review is beneficial to identify and understand the culturally related facilitators and barriers to HPV vaccination among young women for the development of strategies to optimize HPV vaccine coverage among this population group by the policymakers.

Objective: To assess the frequency and potential influencing factors of the remission phase (RP) in Type 1 Diabetes (T1D) as well as the associations between various criteria used for its definition.

Methods: This was a retrospective cohort study based on data collected from medical records. Three criteria were used to evaluate RP: (1) Glycated hemoglobin (HbA1c) < 7.5 % with an insulin dose < 0.5 U/Kg/day, (2) HbA1c < 7 % with an insulin dose < 0.5 U/Kg/day, and (3) Insulin Dose Adjusted A1c (IDAA1c) ≤ 9, calculated as IDAA1c = HbA1c (%) + [4 x insulin dose (U/Kg/day)]. Statistical analyses included the Mann-Whitney U Test, Chi-Square Test, and Spearman Correlation.

Results: The sample consisted of 144 T1D patients, with a mean age of 26.22 ± 8.30 years and a mean age of onset of 13.30 ± 8.50 years. Of these, 52.9 % were female, 60.3 % were Caucasoid, and 31 % experienced diabetic ketoacidosis (DKA) at disease onset. One year after diagnosis, the occurrence of RP ranged from 27.2 % to 46.8 %, depending on the criteria used. Three patients experienced RP even after seven years, according to criterion 3. No association was found between RP and age, DKA, or pubertal status at onset. The three RP criteria were highly associated with each other (p < 0.001).

Conclusion: A significant proportion of patients in this sample experienced RP within 12 months of diagnosis. The three criteria for defining RP were strongly associated, indicating their reliability in both clinical and research contexts.