Jornal de pediatria最新文献_第5页

Fluid tolerance assessed by lung ultrasound and effect of crystalloid expansion on extravascular lung water in critically ill children with cancer 危重癌症患儿肺超声评估液体耐受性及晶体扩张对血管外肺水的影响。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-10-14 DOI: 10.1016/j.jped.2025.101456

Bruno S. Camargo, Orlei R. de Araujo, Dafne Cardoso B. da Silva

Objectives

To investigate the effect of a bolus of saline on extravascular lung water (EVLW), and to analyze correlations of EVLW with outcome.

Methods

Prospective cohort. Patients received 10 mL/kg of saline (bolus). Central venous blood gas analysis and echocardiography measurements were performed before and after. Lung ultrasound was performed with 12 measurements, repeated after expansion. Statistics included paired t-test and logistic regression models. The magnitude of the effect was assessed using Cohen's test.

Results

88 measurements were made on 83 patients. There was a response to volume in 48 measurements (54.5 %). 28 patients (33.7 %) had signs of shock, and 60 were on mechanical ventilation (MV, 72.2 %). In 68 paired measurements, there was an increase in B-lines after expansion (77.2 %). The mean number of B-lines pre- was 1.42 (SD 1.12) per intercostal space, increasing to 1.71 (SD 1.17) post-expansion (p < 0.001, Cohen's d 0.97). The mean pre-expansion cardiac index was 3.43 L/min/m2 (SD 1.05), increasing to 3.87 (SD 1.21, p < 0.001, Cohen's d = 0.8). In a multivariate model, lactate and mean pre-expansion B-lines were independent predictors of death in ICU: pre-B-lines, Odds ratio 1.87, p = 0.012; pre-lactate OR 1.59, p = 0.012. The same was observed with post-volume B-lines, in a model which also included MV: post-volume B-lines, OR 1.87, p = 0.01; post-volume lactate, OR 1.51, p = 0.03; MV, OR 4.32, p = 0.041.

Conclusions

Most patients showed signs of fluid intolerance, with increased EVLW. EVLW assessed by ultrasound is a predictor of mortality.

目的：探讨生理盐水对血管外肺水（EVLW）的影响，并分析EVLW与预后的相关性。方法：前瞻性队列研究。患者接受10 mL/kg生理盐水（丸）。前后分别进行中心静脉血气分析和超声心动图测量。肺超声12次，扩张后重复。统计包括配对t检验和逻辑回归模型。效果的大小是用科恩的测试来评估的。结果：83例患者共行88次测量。48次测量对体积有反应（54.5 %）。28例患者（33.7% %）出现休克症状，60例患者采用机械通气（MV, 72.2 %）。在68个成对测量中，扩张后b线增加（77.2% %）。每个肋间隙前平均b线数为1.42条（SD 1.12），扩张后增加到1.71条（SD 1.17）（p ）。结论：大多数患者表现出液体不耐受的迹象，EVLW增加。超声评估EVLW是死亡率的预测指标。

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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 : 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

Development and validation of entrustable professional activities in pediatric surgery for pediatricians 为儿科医生开发和验证可信赖的儿科外科专业活动。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-30 DOI: 10.1016/j.jped.2025.101444

Rodrigo Pinheiro de Abreu Miranda , Edna Regina Silva Pereira , Leopoldo Luiz dos Santos-Neto

Objective

To develop and validate entrustable professional activities (EPAs) for the training of pediatric residents on topics that interface with pediatric surgical areas in the Brazilian context.

Methods

The study was conducted in two phases. In the first phase, experts were oriented and contextualized, and they were responsible for developing the initial list of EPAs. In the second phase, the Delphi technique was applied in three rounds: the first for consensus, the second for selection according to relevance and agreement, and the third for validation and detailing of the EPAs.

Results

In the first phase of the study, 9 experts listed 88 EPAs, which were applied in the Delphi method. In the first round of Delphi, the consensus of these experts defined 31 EPAs, with CVI ≥ 0.80, and ICC of 0.893 (95 % CI 0.823–0.945). In the second round, 25 coordinators of Medical Residency Programs selected 17 EPAs by agreement and relevance (CVI ≥ 0.80, and ICC of 0.851–95 % CI 0.753 to 0.924). In the third round, 50 preceptors from all over Brazil validated 14 EPAs with CVI ≥ 0.965 and ICC 0.866 (95 % CI 0.804–0.915), which were organized and detailed into 7 final EPAs.

Conclusion

Seven pediatric surgery EPAs were developed, consensualized, selected, and validated by experts for the work of pediatricians in Brazil through the Delphi method. The great participation and interest of medical residency preceptors with a wide geographical coverage in Brazil were strong points of this study, and these EPAs can be applied, reviewed, and updated.

目的：开发和验证可信赖的专业活动（EPAs），培训儿科住院医师的主题，与巴西儿科外科领域的接口。方法：研究分两期进行。在第一阶段，以专家为导向，结合具体情况，他们负责制定初步的环境保护措施清单。在第二阶段，德尔菲技术被应用于三轮：第一轮达成共识，第二轮根据相关性和一致性进行选择，第三轮对epa进行验证和详细说明。结果：在第一阶段的研究中，9位专家列出了88个EPAs，采用德尔菲法。在第一轮德尔菲中，这些专家的共识定义了31个EPAs， CVI≥0.80，ICC为0.893（95 % CI 0.823-0.945）。在第二轮中，25名住院医师项目协调员根据一致性和相关性（CVI≥0.80，ICC为0.851-95 % CI 0.753至0.924）选择了17个EPAs。在第三轮中，来自巴西各地的50位预言家对14个CVI≥0.965、ICC 0.866（95 % CI 0.804-0.915）的EPAs进行了验证，并将其组织细化为7个最终EPAs。结论：通过德尔菲法，为巴西儿科医生的工作制定了7个儿科外科EPAs，经专家协商一致、选择和验证。巴西住院医师导师的高度参与和广泛的地理覆盖是本研究的优势，这些EPAs可以应用、审查和更新。

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引用次数: 0

Sleep disorder assessment in children and adolescents with neurodevelopmental disorders 患有神经发育障碍的儿童和青少年的睡眠障碍评估。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-26 DOI: 10.1016/j.jped.2025.101441

Camila dos Santos El Halal , Magda Lahorgue Nunes

Objective

To review the associations between various neurodevelopmental disorders and the most prevalent sleep disorders in children and adolescents, focusing on clinical characteristics and diagnostic approaches.

Data sources

A literature review was conducted using the PubMed database, employing the search terms “neurodevelopmental disorders” and “sleep disorders,” including “insomnia,” “sleep-related breathing disorders,” “circadian rhythm sleep-wake disorders,” “sleep-related movement disorders,” “parasomnias,” and “central disorders of hypersomnolence.” Specific diagnostic terms related to neurodevelopmental and sleep disorders were also utilized. Additionally, the reference lists of selected manuscripts were manually reviewed to identify further relevant publications.

Data synthesis

Sleep disorders are frequently associated with neurodevelopmental disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability, as well as genetic syndromes known to predispose individuals to sleep disturbances, including Down syndrome, Smith-Magenis syndrome, Prader-Willi syndrome, and mucopolysaccharidosis type II. These associations are mediated by anatomical, biological, and behavioral mechanisms. Diagnostic evaluation should be guided by clinical suspicion and typically involves a comprehensive clinical history, sleep diaries, standardized questionnaires, and, when indicated, additional diagnostic procedures.

Conclusions

Sleep disorders are more prevalent in children and adolescents with neurodevelopmental disorders. A thorough understanding of the most commonly associated sleep disturbances and the implementation of targeted diagnostic strategies are essential for appropriate clinical management and for improving long-term outcomes in this population.

目的：回顾各种神经发育障碍与儿童和青少年中最常见的睡眠障碍之间的关系，重点介绍临床特征和诊断方法。数据来源：使用PubMed数据库进行文献综述，使用搜索词“神经发育障碍”和“睡眠障碍”，包括“失眠”、“睡眠相关呼吸障碍”、“昼夜节律睡眠-觉醒障碍”、“睡眠相关运动障碍”、“睡眠异常”和“嗜睡中枢性障碍”。还使用了与神经发育和睡眠障碍有关的特定诊断术语。此外，还对选定手稿的参考书目进行了人工审查，以确定进一步的相关出版物。数据综合：睡眠障碍通常与神经发育障碍有关，如自闭症谱系障碍、注意力缺陷/多动障碍和智力残疾，以及已知易使个体发生睡眠障碍的遗传综合征，包括唐氏综合征、史密斯-马格尼斯综合征、普雷德-威利综合征和II型粘多糖病。这些关联是由解剖学、生物学和行为学机制介导的。诊断评估应以临床怀疑为指导，通常包括全面的临床病史、睡眠日记、标准化问卷，并在必要时进行额外的诊断程序。结论：睡眠障碍在患有神经发育障碍的儿童和青少年中更为普遍。彻底了解最常见的相关睡眠障碍和实施有针对性的诊断策略对于适当的临床管理和改善这一人群的长期预后至关重要。

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引用次数: 0

Factors associated with weight Z-score in very low birth weight and extremely low birth weight preterm infants during hospitalization 住院期间极低出生体重和极低出生体重早产儿体重z评分的相关因素

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-25 DOI: 10.1016/j.jped.2025.101443

Eduarda Couto Plácido Nunes , Eduarda Silva , Eduarda Dallmann Lopes Pereira , Karla Pereira Machado , Sandra Costa Valle

Objective

To investigate the behavior of weight-for-age z-score (WAZ) and associated factors in preterm newborns (PTNB) with very low birth weight (VLBW) and extremely low birth weight (ELBW), comparing them to low birth weight (LBW) during four weeks (wk.) of hospitalization in a neonatal intensive care unit (NICU).

Methods

Longitudinal study conducted using data from PTNB records in the southern Brazil NICU, between January 2017 and December 2020. Non-twin PTNB with gestational age of ≥ 24 and < 37 wk. and a birth weight (BW) ≥ 500 g were included. The outcome was WAZ, and the exposure was the PTNB’s BW, categorized as VLBW/ELBW (< 1500 g) and LBW (≥ 1500 g up to 2500 g). Energy (kcal/kg/day) and protein (g/kg/day) intakes were also evaluated. Two-way ANOVA and multiple linear regression were used to assess the association between demographic, clinical, and nutritional factors and the WAZ.

Results

The majority of PTNB were male (60 %) and had a birth weight ≥1500 g (65 %). A significant interaction was between the BW category and the length of hospitalization on WAZ (F = 4.0; p = 0.003). In the VLBW and ELBW, the WAZ was significantly lower in the first wk. compared to the LBW [−1.05 (−1.34;−0.75) vs −0.34 (−0.49;−0.18)]. Factors such as male sex, sepsis, initiation of enteral nutrition (EN), and protein intake were associated with WAZ behavior.

Conclusion

The downward trend of the WAZ curve was associated with the interaction between birth weight and length of hospitalization, especially in PTNB with VLBW and ELBW. The study concluded that male sex and sepsis contributed to the observed decline.

目的：探讨极低出生体重（VLBW）和极低出生体重（ELBW）早产儿（PTNB）在新生儿重症监护病房（NICU）住院4周（周）与低出生体重（LBW）的体重年龄比值z-score （WAZ）及其相关因素的行为。方法：使用2017年1月至2020年12月期间巴西南部NICU PTNB记录的数据进行纵向研究。胎龄≥24周和< 37周的非双胎PTNB。出生体重(BW)≥500 g。结果为WAZ，暴露为PTNB的体重，分为VLBW/ELBW（< 1500 g）和LBW（≥1500 g至2500 g）。能量（千卡/公斤/天）和蛋白质（克/公斤/天）摄入量也进行了评估。采用双向方差分析和多元线性回归来评估人口统计学、临床和营养因素与WAZ之间的关系。结果：PTNB以男性居多（60 %），出生体重≥1500 g（65 %）。BW类别与WAZ住院时间之间存在显著的交互作用（F = 4.0;p = 0.003）。在VLBW和ELBW中，WAZ在第一周显著降低。激光焊相比[-1.05(-1.34,-0.75)和-0.34(-0.49,-0.18)]。男性、败血症、开始肠内营养（EN）和蛋白质摄入等因素与WAZ行为相关。结论：WAZ曲线的下降趋势与出生体重和住院时间的相互作用有关，特别是PTNB合并VLBW和ELBW。该研究得出结论，男性和败血症导致了观察到的下降。

{"title":"Factors associated with weight Z-score in very low birth weight and extremely low birth weight preterm infants during hospitalization","authors":"Eduarda Couto Plácido Nunes , Eduarda Silva , Eduarda Dallmann Lopes Pereira , Karla Pereira Machado , Sandra Costa Valle","doi":"10.1016/j.jped.2025.101443","DOIUrl":"10.1016/j.jped.2025.101443","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the behavior of weight-for-age z-score (WAZ) and associated factors in preterm newborns (PTNB) with very low birth weight (VLBW) and extremely low birth weight (ELBW), comparing them to low birth weight (LBW) during four weeks (wk.) of hospitalization in a neonatal intensive care unit (NICU).</div></div><div><h3>Methods</h3><div>Longitudinal study conducted using data from PTNB records in the southern Brazil NICU, between January 2017 and December 2020. Non-twin PTNB with gestational age of ≥ 24 and < 37 wk. and a birth weight (BW) ≥ 500 g were included. The outcome was WAZ, and the exposure was the PTNB’s BW, categorized as VLBW/ELBW (< 1500 g) and LBW (≥ 1500 g up to 2500 g). Energy (kcal/kg/day) and protein (g/kg/day) intakes were also evaluated. Two-way ANOVA and multiple linear regression were used to assess the association between demographic, clinical, and nutritional factors and the WAZ.</div></div><div><h3>Results</h3><div>The majority of PTNB were male (60 %) and had a birth weight ≥1500 g (65 %). A significant interaction was between the BW category and the length of hospitalization on WAZ (<em>F</em> = 4.0; <em>p</em> = 0.003). In the VLBW and ELBW, the WAZ was significantly lower in the first wk. compared to the LBW [−1.05 (−1.34;−0.75) vs −0.34 (−0.49;−0.18)]. Factors such as male sex, sepsis, initiation of enteral nutrition (EN), and protein intake were associated with WAZ behavior.</div></div><div><h3>Conclusion</h3><div>The downward trend of the WAZ curve was associated with the interaction between birth weight and length of hospitalization, especially in PTNB with VLBW and ELBW. The study concluded that male sex and sepsis contributed to the observed decline.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101443"},"PeriodicalIF":2.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040176","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}

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 : 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。

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引用次数: 0

Analysis of the main characteristics of children's skin moisturizers in the Brazilian market 分析巴西市场儿童润肤霜的主要特点。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-20 DOI: 10.1016/j.jped.2025.101438

Bruna Rocha Reolon Branchi , Ana Elisa Kiszewski , Renan Rangel Bonamigo

Objective

One of the possible causes of skin microbiome imbalance is the use of dermocosmetics with inadequate pH. This study aims to critically evaluate several children's moisturizers regarding their characteristics so that we can verify the tendency of the products available on the market and whether they are slightly acidic. The importance of dermocosmetics formulated without ingredients with allergenic potential is also discussed in this work.

Method

Observational, analytical, cross-sectional and quantitative study. Several brands of children's moisturizers were selected and divided into two groups: group 1 (G1), with moisturizers focused on the care of children with normal skin; and group 2 (G2), with moisturizers with a therapeutic focus on atopic children. We analyzed the pH of each one of the moisturizers, as well as cost, presence of potentially allergenic components and other data contained in the packaging.

Results

The members of G1 had an average pH of 5.81 ± 0.35, while the members of G2 had an average pH of 5.42 ± 0.28, with this difference being considered statistically significant (p ≤ 0.001). G1 differed in terms of cost, which was more affordable for the user, when compared to G2 (p ≤ 0.001), but with a predominance of potential allergens in its composition (p = 0.018).

Conclusion

This study demonstrates that all moisturizers analyzed in this study respected the acidic pH; however, the group of moisturizers with a therapeutic focus on atopic children had an even lower pH and lower allergenic potential in their composition compared to the group of moisturizers focused on care of children with normal skin.

目的：皮肤微生物群失衡的可能原因之一是使用ph值不足的皮肤化妆品。本研究旨在批判性地评估几种儿童保湿产品的特性，以便我们验证市场上可用的产品的趋势以及它们是否呈微酸性。本文还讨论了不含致敏成分的皮肤化妆品的重要性。方法：观察、分析、横断面、定量研究。选取多个品牌的儿童润肤霜，分为两组：第一组（G1），重点护理皮肤正常的儿童；第二组（G2），使用以特应性儿童为治疗重点的保湿霜。我们分析了每一款保湿霜的pH值，以及价格、潜在致敏成分的存在以及包装上包含的其他数据。结果：G1组平均pH值为5.81 ± 0.35，G2组平均pH值为5.42 ± 0.28，差异具有统计学意义（p ≤ 0.001）。G1在成本方面有所不同，与G2相比，用户更负担得起（p ≤ 0.001），但其成分中潜在过敏原占主导地位（p = 0.018）。结论：本研究表明，本研究分析的所有保湿剂都尊重酸性pH值；然而，与专注于正常皮肤的儿童的润肤霜组相比，专注于治疗特应性儿童的润肤霜组的成分中pH值更低，致敏潜力更低。

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引用次数: 0

Boys with constitutional delay of growth and puberty developed spontaneous puberty and reached standard adult height without pharmacological therapy 发育迟缓和青春期发育迟缓的男孩在没有药物治疗的情况下自发发育并达到标准成人身高。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-19 DOI: 10.1016/j.jped.2025.101429

Thais Milioni Luciano, Mônica Freire Stechinni, Sonir Roberto Rauber Antonini

Objectives

To evaluate the patterns of pubertal development, growth, and adult height in untreated male patients with CDGP.

Methods

A retrospective study was conducted at a tertiary care center from 1984 to 2019. Medical records of 46 boys diagnosed with CDGP (after excluding those with hypogonadism) were included for further analysis.

Results

Most patients were born at term (78%) and appropriate for gestational age (85%). A family history of delayed puberty was noted in 50%. The median age at initial evaluation was 14.3 years (range: 4.8–16.2 years). Short stature before puberty was the main reason for seeking medical attention (48%). Short stature was common at the first evaluation (93%) but improved over time; at the final assessment, only 17% of the patients remained short. For those who reached adult height, the height Z-scores were comparable to target height. Predictions using the Bayley-Pinneau method often overestimated adult height. Delayed bone age was present in 82% of patients at initial evaluation. The median age of spontaneous pubertal onset was 15 years, with a median duration of 2.1 years (range: 1.2–4.8 years, n = 33). None of the patients received pharmacological treatment. The median age at Tanner stage G5 was 17.1 years.

Conclusions

In boys with CDGP, transient short stature improved spontaneously during puberty. Most achieved their target height without growth-promoting therapy. However, adult height predictions based on the Bayley-Pinneau method were often overestimated. Spontaneous puberty initiation and completion occurred at approximately 15 and 17 years of age, respectively.

目的：评价未经治疗的男性CDGP患者青春期发育、生长和成人身高的模式。方法：对1984 - 2019年在某三级保健中心进行回顾性研究。46名诊断为CDGP的男孩（排除性腺功能减退者后）的医疗记录被纳入进一步分析。结果：多数患者足月出生（78%），与胎龄相符（85%）。50%的人有青春期延迟的家族史。初次评估时的中位年龄为14.3岁（范围：4.8-16.2岁）。青春期前身材矮小是就医的主要原因（48%）。身材矮小在第一次评估时很常见（93%），但随着时间的推移有所改善；在最后的评估中，只有17%的患者仍然很短。对于那些达到成人身高的人，身高z分数与目标身高相当。使用贝利-平诺方法的预测往往高估了成年人的身高。在最初的评估中，82%的患者存在骨龄延迟。青春期自发发病的中位年龄为15岁，中位病程为2.1年（范围：1.2 ~ 4.8年，n = 33）。所有患者均未接受药物治疗。Tanner阶段G5的中位年龄为17.1岁。结论：在患有CDGP的男孩中，短暂性身材矮小在青春期自发改善。大多数人在没有接受促生长治疗的情况下达到了目标身高。然而，基于Bayley-Pinneau方法的成人身高预测经常被高估。青春期的自发开始和完成分别发生在大约15岁和17岁。

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引用次数: 0

Impact of skin-to-skin contact on acute procedural pain in newborns: a systematic review and meta-analysis 皮肤接触对新生儿急性程序性疼痛的影响：一项系统综述和荟萃分析。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-11 DOI: 10.1016/j.jped.2025.101442

Lizandro de Andrade Teles, Francisco Plácido Nogueira Arcanjo, Kailane Martins Cardoso, Jeferson de Sousa Justino

Objective

To systematically evaluate the effectiveness of Skin-to-Skin Contact (SSC) in reducing procedural pain in neonates, compared to standard care and other non-pharmacological interventions.

Data Sources

A comprehensive search was conducted in major electronic databases and gray literature up to July 2025. The review followed PRISMA and MECIR guidelines and included randomized controlled trials (RCTs) that used validated neonatal pain scales. Risk of bias was assessed using RoB 2.0, and the certainty of evidence was rated using the GRADE approach.

Summary of Findings

Twenty-nine RCTs involving 2995 neonates were included. SSC significantly reduced procedural pain compared to standard care (SMD = −1.13; 95 % CI: −1.54 to −0.72; p < 0.00001), although heterogeneity was high (I² = 93 %). Subgroup analyses suggested that heterogeneity was partially due to differences in pain assessment timing and study design. Compared to other interventions, SSC showed similar efficacy to carbohydrate solutions (SMD = 0.05; 95 % CI: −0.34 to 0.23), superior efficacy to swaddling (SMD = −0.86; 95 % CI: −1.38 to −0.34), and inferior efficacy to breastfeeding (SMD = 0.44; 95 % CI: 0.21 to 0.66).

Conclusion

SSC is an effective intervention for reducing procedural pain in neonates, particularly when compared to standard care and swaddling. However, its equivalence to carbohydrate solutions and inferiority to breastfeeding should be interpreted with caution due to methodological limitations and variability across studies. Further high-quality, large-scale RCTs are needed to improve the certainty of the evidence and guide clinical practice.

目的：系统评价皮肤接触（SSC）在减少新生儿程序性疼痛方面的有效性，并与标准护理和其他非药物干预措施进行比较。数据来源：全面检索截至2025年7月的主要电子数据库和灰色文献。该综述遵循PRISMA和MECIR指南，纳入了使用经过验证的新生儿疼痛量表的随机对照试验（rct）。使用RoB 2.0评估偏倚风险，使用GRADE方法评估证据的确定性。研究结果总结：纳入29项随机对照试验，涉及2995名新生儿。与标准护理相比，SSC显著减少了新生儿手术性疼痛（SMD = -1.13;95% % CI: -1.54至-0.72;p ）结论：SSC是减少新生儿手术性疼痛的有效干预措施，特别是与标准护理和襁褓相比。然而，由于方法学的局限性和研究的可变性，应谨慎解释其与碳水化合物溶液的等效性和母乳喂养的劣势。需要进一步高质量、大规模的随机对照试验来提高证据的确定性并指导临床实践。

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引用次数: 0

Associations between adverse childhood experiences and perinatal outcomes 不良童年经历与围产期结局之间的关系。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-05 DOI: 10.1016/j.jped.2025.101433

Nina de Siqueira Kuperman , Maria Clara Magalhães-Barbosa , Fernanda de Carvalho Lima , Mariana Barros Genuino de Oliveira , Jaqueline Rodrigues Robaina , Margarida dos Santos Salú , Arnaldo Prata-Barbosa , Antônio José Ledo Alves da Cunha

Objective

To determine the frequency of adverse childhood experiences (ACE) among a cohort of pregnant women (primary outcome) and explore their association with prematurity, pre-eclampsia, and fetal growth restriction (secondary outcomes).

Methods

The Adverse Childhood Experiences International Questionnaire - ACE-IQ was applied to patients during prenatal visits. Information on perinatal outcomes was collected from medical records. The proportion of total ACE and its different domains was estimated. Multiple logistic regressions were performed to assess the association between ACE and outcomes, after adjusting for possible confounding factors.

Results

A cohort of 307 pregnant women completed the ACE-IQ. The results in the binary and frequency versions were, respectively: mean (SD) scores of 5.84 (2.87) and 3.55 (2.73); the proportion of ACE 4 of 75% and 44%; the most prevalent ACE domains were home dysfunction (89.6 and 86.6%) and exposure to community violence (76.5 and 50%). For fetal growth restriction, pregnant women with ACE ≥ 4 had 2.32 times (95% CI: 1.04–5.37; p = 0.042) higher chance of this outcome. For preterm birth, the odds ratio was 1.1 (95% CI: 0.5–2.6; p = 0.886), indicating no statistically significant association. There was no significant association between the total ACE score, or its domains, and the other perinatal outcomes studied.

Conclusions

The frequency of ACE was high in this cohort of pregnant women, and exposure to community violence was associated with fetal growth restriction. The investigation of the association with other perinatal outcomes should be extended to a general population of pregnant women.

目的：确定一组孕妇的不良童年经历（ACE）发生率（主要结局），并探讨其与早产、先兆子痫和胎儿生长受限（次要结局）的关系。方法：采用ACE-IQ国际不良童年经历问卷对患者进行产前访视。从医疗记录中收集了有关围产期结局的信息。估计总ACE及其不同区域的比例。在调整了可能的混杂因素后，进行了多重逻辑回归来评估ACE与结果之间的关系。结果：307名孕妇完成了ACE-IQ测试。二值版本和频率版本的结果分别为：平均（SD）评分为5.84（2.87）和3.55 (2.73)；ACE 4的比例分别为75%和44%；最常见的ACE领域是家庭功能障碍（89.6和86.6%）和接触社区暴力（76.5和50%）。对于胎儿生长受限，ACE≥4的孕妇有2.32倍(95% CI: 1.04-5.37；P = 0.042)。早产的优势比为1.1 (95% CI: 0.5-2.6；P = 0.886)，无统计学意义。ACE总分或其范围与研究的其他围产期结局之间没有显著关联。结论：ACE在该队列孕妇中发生率较高，暴露于社区暴力与胎儿生长受限有关。与其他围产期结局的关联调查应扩展到一般孕妇人群。

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引用次数: 0