Pub Date : 2026-01-01Epub Date: 2025-12-26DOI: 10.1016/j.jped.2025.101493
Márcia Galdino Sampaio , Cristina Barroso Hofer
Objective
To describe the caregiver adherence to the various interventions proposed by the Ministry of Health in the follow-up of children infected with or exposed to Treponema pallidum during pregnancy.
Method
This is a prospective cohort study that included 256 children treated for congenital syphilis during the neonatal period. The children were referred from maternity to a reference outpatient clinic in the state of Rio de Janeiro between 2016 and 2021. Adherence was used as the outcome variable. It was assessed in two components: clinical-laboratory adherence (basic adherence) and adherence to specialist consultations (final adherence). Factors associated with adherence were investigated using logistic regression.
Results
It was observed that 41 % of the children were followed for at least 18 months, and 68 % had two consecutive non-reactive VDRL tests. Basic adherence was 32 %, while final adherence (including specialist consultations and clinical-laboratory follow-up) was only 16 %. Additionally, 36 children presented permanent sequelae during follow-up. Factors such as higher maternal age (OR = 1.10; 95 % CI:1.03–1.20) and the presence of permanent sequelae in the children (OR = 4.87; 95 % CI: 2.29–10.35) were predictors of adherence. Loss to follow-up occurred in 68 % (173/256) of the cases.
Conclusion
This study highlights a very low level of caregiver adherence to the congenital syphilis management protocol recommended by the Brazilian Ministry of Health. The presence of sequelae in children and higher maternal age were associated with improved adherence.
{"title":"Caregiver adherence to outpatient follow-up of children infected with or exposed to syphilis during pregnancy","authors":"Márcia Galdino Sampaio , Cristina Barroso Hofer","doi":"10.1016/j.jped.2025.101493","DOIUrl":"10.1016/j.jped.2025.101493","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the caregiver adherence to the various interventions proposed by the Ministry of Health in the follow-up of children infected with or exposed to <em>Treponema pallidum</em> during pregnancy.</div></div><div><h3>Method</h3><div>This is a prospective cohort study that included 256 children treated for congenital syphilis during the neonatal period. The children were referred from maternity to a reference outpatient clinic in the state of Rio de Janeiro between 2016 and 2021. Adherence was used as the outcome variable. It was assessed in two components: clinical-laboratory adherence (basic adherence) and adherence to specialist consultations (final adherence). Factors associated with adherence were investigated using logistic regression.</div></div><div><h3>Results</h3><div>It was observed that 41 % of the children were followed for at least 18 months, and 68 % had two consecutive non-reactive VDRL tests. Basic adherence was 32 %, while final adherence (including specialist consultations and clinical-laboratory follow-up) was only 16 %. Additionally, 36 children presented permanent sequelae during follow-up. Factors such as higher maternal age (OR = 1.10; 95 % CI:1.03–1.20) and the presence of permanent sequelae in the children (OR = 4.87; 95 % CI: 2.29–10.35) were predictors of adherence. Loss to follow-up occurred in 68 % (173/256) of the cases.</div></div><div><h3>Conclusion</h3><div>This study highlights a very low level of caregiver adherence to the congenital syphilis management protocol recommended by the Brazilian Ministry of Health. The presence of sequelae in children and higher maternal age were associated with improved adherence.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101493"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781335","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}
Pub Date : 2026-01-01Epub Date: 2025-12-12DOI: 10.1016/j.jped.2025.101480
Luziane Lais Sabino Silva Luna, Sheyla Suelle dos Santos Levy, Luciana Santana Lima, Maria do Carmo Menezes Bezerra Duarte
Objective
To describe the clinical characteristics of tracheostomized children in Northeastern Brazil and to identify existing gaps in the indication and implementation of palliative care.
Methods
This retrospective descriptive study reviewed medical records of children under 15 years who underwent tracheostomy between 2008 and 2019 at a quaternary referral center.
Results
Sixty-five tracheostomized patients with indications for palliative care were analyzed. The main reasons for palliative classification were acute life-threatening conditions (50.7 %) and chronic life-threatening conditions (20 %). The most frequent tracheostomy indications were prolonged invasive mechanical ventilation (46.1 %) and severe upper airway obstruction (23 %). The mortality rate was 30.7 %, higher among infants, severely malnourished children, those with Lansky scores below 40 % before tracheostomy, congenital heart disease, bronchopulmonary dysplasia, and multiple comorbidities. Only 10.8 % received palliative care consultations during hospitalization, all in the end-of-life care phase.
Conclusions
The results highlight a critical gap in the provision of palliative care to tracheostomized children. Early involvement of a multidisciplinary palliative care team is crucial to support clinical decision-making, family-centered care, and ensure quality of life. The proposed framework may facilitate timely referral and airway planning in the Intensive therapy, although further validation and qualitative research in various healthcare settings are needed.
{"title":"Clinical characteristics and gaps in palliative care among tracheostomized children: a retrospective observational study","authors":"Luziane Lais Sabino Silva Luna, Sheyla Suelle dos Santos Levy, Luciana Santana Lima, Maria do Carmo Menezes Bezerra Duarte","doi":"10.1016/j.jped.2025.101480","DOIUrl":"10.1016/j.jped.2025.101480","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the clinical characteristics of tracheostomized children in Northeastern Brazil and to identify existing gaps in the indication and implementation of palliative care.</div></div><div><h3>Methods</h3><div>This retrospective descriptive study reviewed medical records of children under 15 years who underwent tracheostomy between 2008 and 2019 at a quaternary referral center.</div></div><div><h3>Results</h3><div>Sixty-five tracheostomized patients with indications for palliative care were analyzed. The main reasons for palliative classification were acute life-threatening conditions (50.7 %) and chronic life-threatening conditions (20 %). The most frequent tracheostomy indications were prolonged invasive mechanical ventilation (46.1 %) and severe upper airway obstruction (23 %). The mortality rate was 30.7 %, higher among infants, severely malnourished children, those with Lansky scores below 40 % before tracheostomy, congenital heart disease, bronchopulmonary dysplasia, and multiple comorbidities. Only 10.8 % received palliative care consultations during hospitalization, all in the end-of-life care phase.</div></div><div><h3>Conclusions</h3><div>The results highlight a critical gap in the provision of palliative care to tracheostomized children. Early involvement of a multidisciplinary palliative care team is crucial to support clinical decision-making, family-centered care, and ensure quality of life. The proposed framework may facilitate timely referral and airway planning in the Intensive therapy, although further validation and qualitative research in various healthcare settings are needed.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101480"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648649","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}
Pub Date : 2026-01-01Epub Date: 2026-01-12DOI: 10.1016/j.jped.2025.101497
Jose Fuentes-Lopez , Ruben Vidal-Espinoza , Danilo Rodrigues Pereira da Silva , Dony Mamani-Velásquez , Eliseny Vargas-Ramos , Estanislao Pacompia-Cari , Wilbert Cossio-Bolaños , Marco Cossio-Bolaños , Rossana Gomez-Campos
Objective
a) To verify the applicability of anthropometric indicators to evaluate physical fitness in school children and b) Propose physical fitness reference values for Peruvian children living at high altitudes in Peru.
Methods
A cross-sectional study was carried out in children aged 6 to 12 years living at high altitude in Peru. A total of 1372 primary school children (785 males and 587 females) were evaluated. Weight, height and four physical tests [Hand grip strength (right and left HGS)], Horizontal jump (HJ), Round trip (5 × 10 repetitions), and the 6-minute walk test (6MWT)] were evaluated. Body Surface Area (BSA), Body Mass Index (BMI), and Triponderal Index (TPI) were calculated.
Results
The BSA presented a better comparative structure in relation to BMI and TPI with all physical tests. In males, HGS was related between r = 0.64 and 0.66; HJ (r = 0.26), agility (r = -0.31) and 6MWT (r = 0.30). In females, HGS was related between r = 0.63 and 0.64; HJ (r = 0.36), agility (r = -0.36), and 6MWT (r = 0.21). The predictive power in the four physical tests ranged from R2 = 9% to 43% in males, and from 5% to 41% in females. Percentiles by age and sex were proposed for BSA, HGS (right and left), HJ, agility, and 6MWT.
Conclusion
BSA is the best predictor of physical fitness in schoolchildren from high altitude areas in Peru, surpassing BMI and TPI. In addition, reference values were proposed to evaluate physical fitness in these children.
{"title":"Applicability of anthropometric indicators to assess physical fitness: proposal of percentiles for schoolchildren living at high altitude in Peru","authors":"Jose Fuentes-Lopez , Ruben Vidal-Espinoza , Danilo Rodrigues Pereira da Silva , Dony Mamani-Velásquez , Eliseny Vargas-Ramos , Estanislao Pacompia-Cari , Wilbert Cossio-Bolaños , Marco Cossio-Bolaños , Rossana Gomez-Campos","doi":"10.1016/j.jped.2025.101497","DOIUrl":"10.1016/j.jped.2025.101497","url":null,"abstract":"<div><h3>Objective</h3><div>a) To verify the applicability of anthropometric indicators to evaluate physical fitness in school children and b) Propose physical fitness reference values for Peruvian children living at high altitudes in Peru.</div></div><div><h3>Methods</h3><div>A cross-sectional study was carried out in children aged 6 to 12 years living at high altitude in Peru. A total of 1372 primary school children (785 males and 587 females) were evaluated. Weight, height and four physical tests [Hand grip strength (right and left HGS)], Horizontal jump (HJ), Round trip (5 × 10 repetitions), and the 6-minute walk test (6MWT)] were evaluated. Body Surface Area (BSA), Body Mass Index (BMI), and Triponderal Index (TPI) were calculated.</div></div><div><h3>Results</h3><div>The BSA presented a better comparative structure in relation to BMI and TPI with all physical tests. In males, HGS was related between <em>r</em> = 0.64 and 0.66; HJ (<em>r</em> = 0.26), agility (<em>r</em> = -0.31) and 6MWT (<em>r</em> = 0.30). In females, HGS was related between <em>r</em> = 0.63 and 0.64; HJ (<em>r</em> = 0.36), agility (<em>r</em> = -0.36), and 6MWT (<em>r</em> = 0.21). The predictive power in the four physical tests ranged from R<sup>2</sup> = 9% to 43% in males, and from 5% to 41% in females. Percentiles by age and sex were proposed for BSA, HGS (right and left), HJ, agility, and 6MWT.</div></div><div><h3>Conclusion</h3><div>BSA is the best predictor of physical fitness in schoolchildren from high altitude areas in Peru, surpassing BMI and TPI. In addition, reference values were proposed to evaluate physical fitness in these children.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"102 1","pages":"Article 101497"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850104","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}
Pub Date : 2025-11-01Epub Date: 2025-10-31DOI: 10.1016/j.jped.2025.101461
Thiago T. Panizzi , Katharine A. de Souza , Gabriela B. Stutz , Fernanda M.C.F. Lemos , Marta C.F. Rodrigues , Rozana G. de Almeida , Luciane A. da Rocha , Flavio R. Sztajnbok , Adriana R. Fonseca , Nathalie J.M. Bravo-Valenzuela
Objectives
To describe clinical and cardiologic findings in patients with multisystem inflammatory syndrome in children (MIS-C) in a follow-up of up to 3 years.
Materials and methods
A retrospective-prospective, observational, longitudinal study was conducted, including children and adolescents up to 18 years diagnosed with MIS-C (WHO criteria), at a university center between March 2020 and December 2024. Demographic, clinical, and laboratory data, electrocardiograms, and transthoracic echocardiograms were analyzed at admission and at 12 months and left ventricular global longitudinal strain (LV-GLS) three years after diagnosis. Statistical analysis used frequencies for categorical variables, and means with standard deviations or medians with interquartile ranges for continuous variables. Differences in proportions between patients with and without cardiovascular abnormalities were assessed using Fisher's exact test, Chi-squared, or Wilcoxon rank-sum test (significant p-value < 0.05). T-test was used to compare left ventricular ejection fraction (LVEF) and coronary artery Z scores.
Results
Thirty-six patients were included (males 69.4%), with a median age at diagnosis of 2.15 years (IQR 3.3). At admission, 41.7% presented with clinical or echocardiographic abnormalities, which were absent at 1-year follow-up. However, three years after diagnosis, among the 11 patients evaluated with LV-GLS, 10 showed changes indicating subclinical dysfunction not detected by conventional electrocardiogram or echocardiography.
Conclusion
Clinical and echocardiographic cardiovascular abnormalities are common in the acute phase of MIS-C. Although most patients showed clinical and echocardiographic resolution, LV-GLS proved valuable for detecting subclinical myocardial dysfunction not identified by conventional evaluation, highlighting its potential as a screening tool in short- and long-term follow-up.
{"title":"Cardiac manifestations in children and adolescents diagnosed with pediatric multisystem inflammatory syndrome related to COVID-19","authors":"Thiago T. Panizzi , Katharine A. de Souza , Gabriela B. Stutz , Fernanda M.C.F. Lemos , Marta C.F. Rodrigues , Rozana G. de Almeida , Luciane A. da Rocha , Flavio R. Sztajnbok , Adriana R. Fonseca , Nathalie J.M. Bravo-Valenzuela","doi":"10.1016/j.jped.2025.101461","DOIUrl":"10.1016/j.jped.2025.101461","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe clinical and cardiologic findings in patients with multisystem inflammatory syndrome in children (MIS-C) in a follow-up of up to 3 years.</div></div><div><h3>Materials and methods</h3><div>A retrospective-prospective, observational, longitudinal study was conducted, including children and adolescents up to 18 years diagnosed with MIS-C (WHO criteria), at a university center between March 2020 and December 2024. Demographic, clinical, and laboratory data, electrocardiograms, and transthoracic echocardiograms were analyzed at admission and at 12 months and left ventricular global longitudinal strain (LV-GLS) three years after diagnosis. Statistical analysis used frequencies for categorical variables, and means with standard deviations or medians with interquartile ranges for continuous variables. Differences in proportions between patients with and without cardiovascular abnormalities were assessed using Fisher's exact test, Chi-squared, or Wilcoxon rank-sum test (significant p-value < 0.05). T-test was used to compare left ventricular ejection fraction (LVEF) and coronary artery Z scores.</div></div><div><h3>Results</h3><div>Thirty-six patients were included (males 69.4%), with a median age at diagnosis of 2.15 years (IQR 3.3). At admission, 41.7% presented with clinical or echocardiographic abnormalities, which were absent at 1-year follow-up. However, three years after diagnosis, among the 11 patients evaluated with LV-GLS, 10 showed changes indicating subclinical dysfunction not detected by conventional electrocardiogram or echocardiography.</div></div><div><h3>Conclusion</h3><div>Clinical and echocardiographic cardiovascular abnormalities are common in the acute phase of MIS-C. Although most patients showed clinical and echocardiographic resolution, LV-GLS proved valuable for detecting subclinical myocardial dysfunction not identified by conventional evaluation, highlighting its potential as a screening tool in short- and long-term follow-up.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101461"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367987","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}
Pub Date : 2025-11-01Epub Date: 2025-11-13DOI: 10.1016/j.jped.2025.101467
Simone Hauck , Luciana Terra de Oliveira
{"title":"Beyond overdiagnosis: reframing autism prevalence through a neurodivergent phenotype lens","authors":"Simone Hauck , Luciana Terra de Oliveira","doi":"10.1016/j.jped.2025.101467","DOIUrl":"10.1016/j.jped.2025.101467","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101467"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421904","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}
Pub Date : 2025-11-01Epub Date: 2025-12-04DOI: 10.1016/j.jped.2025.101483
Samuel Kunz , Luregn Jan Schlapbach , Fábio Joly Campos
{"title":"From the Sound of Silence to Ultrasound of Life?","authors":"Samuel Kunz , Luregn Jan Schlapbach , Fábio Joly Campos","doi":"10.1016/j.jped.2025.101483","DOIUrl":"10.1016/j.jped.2025.101483","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101483"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680986","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}
Pub Date : 2025-11-01Epub Date: 2025-06-12DOI: 10.1016/j.jped.2025.05.002
Ana Clara Valente de Alencar , Athus Graziani Apollaro Rego , Carolina Soares Chady , Alisson Gabriel Maués Miranda , Lara Fernanda Alves de Souza , João Vitor Martins Pinto , Bárbara de Souza Maia do Nascimento , Camili Giseli Oliveira de Menezes , Isa Mendes Moreira , José Carlos Favacho Furlan , Ester Carolina Vieira Maia , Maria Fernanda Nakayama Martins , Nayara Cristina Cardoso da Silva , Paula do Socorro de Oliveira da Costa Laurindo , Luis Edilson de Azevedo Ferreira , Antônio Rafael Quadros Gomes , Heliton Patrick Cordovil Brígido
Objective
This systematic review aimed to evaluate the efficacy and safety of alternative antibiotics and different standard treatment regimens for bacterial meningitis in children, considering the increasing antimicrobial resistance and the need for adapted therapeutic options. To justify the use of alternative antibiotics, the authors analyzed the specific efficacy of ampicillin, chloramphenicol, cefuroxime and meropenem, which showed potential to overcome cases of antimicrobial resistance.
Data sources
A search was performed in databases such as PubMed, Scopus, Web of Science and Cochrane Library, without data restrictions, including planned clinical trials that compared alternative antibiotics and different standard treatment regimens, such as ceftriaxone, in children with bacterial meningitis. Inclusion criteria include studies reporting cure rates, complications and safety of treatments.
Summary of results
An analysis of 14 studies, totaling 2,014 children, indicated that antibiotics such as ampicillin, chloramphenicol, cefuroxime and meropenem had comparable efficacy and safety to standard treatment regimens. The review showed that, in many cases, alternative regimens and shorter treatment durations could be effective, without significantly increasing complications or mortality.
Conclusion
The results suggest that alternatives to standard treatment, such as ampicillin, chloramphenicol, cefuroxime and meropenem, are viable and safe options for the treatment of bacterial meningitis in children. These results help to adapt clinical practices, especially in settings with high antimicrobial resistance and resource limitations, by providing evidence for shorter and equally effective treatment regimens.
目的：本系统综述旨在评估替代抗生素和不同标准治疗方案对儿童细菌性脑膜炎的有效性和安全性，考虑到抗生素耐药性的增加和适应治疗方案的需要。为了证明使用替代抗生素的合理性，作者分析了氨苄西林、氯霉素、头孢呋辛和美罗培南的具体疗效，这些药物显示出克服抗菌素耐药性病例的潜力。数据来源：在PubMed、Scopus、Web of Science和Cochrane Library等数据库中进行检索，没有数据限制，包括计划的临床试验，比较替代抗生素和不同的标准治疗方案，如头孢曲松，治疗细菌性脑膜炎儿童。纳入标准包括报告治愈率、并发症和治疗安全性的研究。结果总结：一项涉及2014名儿童的14项研究的分析表明，氨苄西林、氯霉素、头孢呋辛和美罗培南等抗生素与标准治疗方案的疗效和安全性相当。回顾显示，在许多情况下，替代方案和较短的治疗时间可能有效，而不会显著增加并发症或死亡率。结论：结果提示，氨苄西林、氯霉素、头孢呋辛、美罗培南等标准治疗方案是治疗儿童细菌性脑膜炎可行且安全的选择。这些结果通过为更短和同样有效的治疗方案提供证据，有助于适应临床实践，特别是在抗菌素耐药性高和资源有限的环境中。
{"title":"Alternative antibiotics for the treatment of bacterial meningitis in children: a systematic review of efficacy and safety","authors":"Ana Clara Valente de Alencar , Athus Graziani Apollaro Rego , Carolina Soares Chady , Alisson Gabriel Maués Miranda , Lara Fernanda Alves de Souza , João Vitor Martins Pinto , Bárbara de Souza Maia do Nascimento , Camili Giseli Oliveira de Menezes , Isa Mendes Moreira , José Carlos Favacho Furlan , Ester Carolina Vieira Maia , Maria Fernanda Nakayama Martins , Nayara Cristina Cardoso da Silva , Paula do Socorro de Oliveira da Costa Laurindo , Luis Edilson de Azevedo Ferreira , Antônio Rafael Quadros Gomes , Heliton Patrick Cordovil Brígido","doi":"10.1016/j.jped.2025.05.002","DOIUrl":"10.1016/j.jped.2025.05.002","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review aimed to evaluate the efficacy and safety of alternative antibiotics and different standard treatment regimens for bacterial meningitis in children, considering the increasing antimicrobial resistance and the need for adapted therapeutic options. To justify the use of alternative antibiotics, the authors analyzed the specific efficacy of ampicillin, chloramphenicol, cefuroxime and meropenem, which showed potential to overcome cases of antimicrobial resistance.</div></div><div><h3>Data sources</h3><div>A search was performed in databases such as PubMed, Scopus, Web of Science and Cochrane Library, without data restrictions, including planned clinical trials that compared alternative antibiotics and different standard treatment regimens, such as ceftriaxone, in children with bacterial meningitis. Inclusion criteria include studies reporting cure rates, complications and safety of treatments.</div></div><div><h3>Summary of results</h3><div>An analysis of 14 studies, totaling 2,014 children, indicated that antibiotics such as ampicillin, chloramphenicol, cefuroxime and meropenem had comparable efficacy and safety to standard treatment regimens. The review showed that, in many cases, alternative regimens and shorter treatment durations could be effective, without significantly increasing complications or mortality.</div></div><div><h3>Conclusion</h3><div>The results suggest that alternatives to standard treatment, such as ampicillin, chloramphenicol, cefuroxime and meropenem, are viable and safe options for the treatment of bacterial meningitis in children. These results help to adapt clinical practices, especially in settings with high antimicrobial resistance and resource limitations, by providing evidence for shorter and equally effective treatment regimens.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101414"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208609","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}
Pub Date : 2025-11-01Epub Date: 2025-09-30DOI: 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。
{"title":"Development and validation of entrustable professional activities in pediatric surgery for pediatricians","authors":"Rodrigo Pinheiro de Abreu Miranda , Edna Regina Silva Pereira , Leopoldo Luiz dos Santos-Neto","doi":"10.1016/j.jped.2025.101444","DOIUrl":"10.1016/j.jped.2025.101444","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101444"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086305","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}
Pub Date : 2025-11-01Epub Date: 2025-10-17DOI: 10.1016/j.jped.2025.101450
M. Carla Criado-Muriel , Ramón Arroyo-Ruiz , Elena Marcos-Vadillo , María Justel-Rodriguez , Lydia Alcubilla-García , María Isidoro-García , Pablo Prieto-Matos
Objective
This study aims to analyze the diagnostic yield of aCGH in pediatric patients with suspected rare diseases, focusing on its diagnostic value and effectiveness depending on different clinical symptoms.
Methods
This observational study analyzed 600 aCGH tests performed in a pediatric unit (2018–2022) for patients with suspected rare diseases. DNA was extracted from peripheral blood; aCGH resolution was adjusted to clinical features. CNVs were classified per international guidelines. Forty sociodemographic, clinical, and genetic variables were analyzed using IBM SPSS v.26.
Results
Of the 600 patients analyzed, 543 were included in the final study. The median age was 4.7 years (IQR: 6.36 years), and 66.3% were male. Most referrals came from pediatric neurology (84.3%), and the most common clinical manifestations were altered phenotype (38.6%), autism spectrum disorder (ASD) (38.6%), dysmorphia (28.2%), global developmental delay (GDD) (27.1%), and intellectual disability (21.0%). Among 543 patients, 30.4% presented CNVs, with 12.4% identified as pathogenic and 18.1% as variants of uncertain significance. Diagnostic yield was 12.2%, with 66 conclusive results — 90.9% of which were pathogenic. CNVs were most frequently detected on chromosomes 15 and 16. The highest yield was observed in clinical features such as coordination problems (35.7%), learning disorders (28.6%), and microcephaly (22.6%).
Conclusion
The diagnostic yield of aCGH in this study was 12.2%. The test demonstrated higher diagnostic value in patients with multiple clinical manifestations, highlighting the importance of aCGH as a first-line diagnostic tool for rare diseases. This technique enables earlier diagnosis, improves clinical management, and provides better counseling for affected families.
{"title":"Diagnostic yield of array-CGH in children with suspected rare disease","authors":"M. Carla Criado-Muriel , Ramón Arroyo-Ruiz , Elena Marcos-Vadillo , María Justel-Rodriguez , Lydia Alcubilla-García , María Isidoro-García , Pablo Prieto-Matos","doi":"10.1016/j.jped.2025.101450","DOIUrl":"10.1016/j.jped.2025.101450","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to analyze the diagnostic yield of aCGH in pediatric patients with suspected rare diseases, focusing on its diagnostic value and effectiveness depending on different clinical symptoms.</div></div><div><h3>Methods</h3><div>This observational study analyzed 600 aCGH tests performed in a pediatric unit (2018–2022) for patients with suspected rare diseases. DNA was extracted from peripheral blood; aCGH resolution was adjusted to clinical features. CNVs were classified per international guidelines. Forty sociodemographic, clinical, and genetic variables were analyzed using IBM SPSS v.26.</div></div><div><h3>Results</h3><div>Of the 600 patients analyzed, 543 were included in the final study. The median age was 4.7 years (IQR: 6.36 years), and 66.3% were male. Most referrals came from pediatric neurology (84.3%), and the most common clinical manifestations were altered phenotype (38.6%), autism spectrum disorder (ASD) (38.6%), dysmorphia (28.2%), global developmental delay (GDD) (27.1%), and intellectual disability (21.0%). Among 543 patients, 30.4% presented CNVs, with 12.4% identified as pathogenic and 18.1% as variants of uncertain significance. Diagnostic yield was 12.2%, with 66 conclusive results — 90.9% of which were pathogenic. CNVs were most frequently detected on chromosomes 15 and 16. The highest yield was observed in clinical features such as coordination problems (35.7%), learning disorders (28.6%), and microcephaly (22.6%).</div></div><div><h3>Conclusion</h3><div>The diagnostic yield of aCGH in this study was 12.2%. The test demonstrated higher diagnostic value in patients with multiple clinical manifestations, highlighting the importance of aCGH as a first-line diagnostic tool for rare diseases. This technique enables earlier diagnosis, improves clinical management, and provides better counseling for affected families.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101450"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149065","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}
Pub Date : 2025-11-01Epub Date: 2025-08-27DOI: 10.1016/j.jped.2025.101437
Bárbara Reis Krämmer , Rita C. Silveira , Eduardo Correa Costa , Matheus Lourenço Mendes , Renato S. Procianoy , Guilherme Guaragna Filho
Objective
to develop a reference curve for SPL in Brazilian preterm newborns, assessing their postnatal growth adjusted for corrected gestational age (cGA).
Materials and Methods
This is a prospective cohort study conducted in southern Brazil. Newborns who were born below 37 weeks of gestational age were selected at tertiary care hospital during the first 3 days of life were selected over a one-year period. SPL was measured weekly until the participants reached 37 weeks of cGA or were discharged from the hospital. Statistical analysis included the Lambda Mu Sigma (LMS) method for growth curve construction and the Bland-Altman test to assess measurement agreement.
Results
A total of 290 SPL measurements were collected from 140 participants. Reference curves were developed for cGA between 26 and 37 weeks. Bland-Altman analysis suggested agreement between measurements taken immediately after birth and those taken during follow-up, inferring that preterm newborns may exhibit penile growth patterns similar to those exhibited during the intrauterine period.
Conclusion
hypothalamic-pituitary-gonadal axis integrity appears to be the primary determinant of post-natal penile growth. The proposed reference curves aid in the early diagnosis of hormonal and genetic alterations, allowing for timely medical interventions.
目的：建立巴西早产儿SPL的参考曲线，评估其校正胎龄（cGA）调整后的出生后生长。材料和方法：这是一项在巴西南部进行的前瞻性队列研究。在出生后的头3天在三级保健医院选择小于37周胎龄的新生儿，在一年的时间内进行选择。SPL每周测量一次，直到受试者达到37周cGA或出院。统计分析包括Lambda Mu Sigma （LMS）法构建生长曲线，Bland-Altman检验评估测量一致性。结果：140名受试者共收集到290个SPL测量值。在26 ~ 37周建立cGA参考曲线。Bland-Altman分析表明，在出生后立即进行的测量与在随访期间进行的测量是一致的，推断早产新生儿可能表现出与宫内时期相似的阴茎生长模式。结论：下丘脑-垂体-性腺轴的完整性似乎是产后阴茎生长的主要决定因素。提出的参考曲线有助于激素和基因改变的早期诊断，允许及时的医疗干预。
{"title":"Evaluation of stretched penile length (SPL), postnatal penile growth evolution, and micropenis in Brazilian preterm newborns","authors":"Bárbara Reis Krämmer , Rita C. Silveira , Eduardo Correa Costa , Matheus Lourenço Mendes , Renato S. Procianoy , Guilherme Guaragna Filho","doi":"10.1016/j.jped.2025.101437","DOIUrl":"10.1016/j.jped.2025.101437","url":null,"abstract":"<div><h3>Objective</h3><div>to develop a reference curve for SPL in Brazilian preterm newborns, assessing their postnatal growth adjusted for corrected gestational age (cGA).</div></div><div><h3>Materials and Methods</h3><div>This is a prospective cohort study conducted in southern Brazil. Newborns who were born below 37 weeks of gestational age were selected at tertiary care hospital during the first 3 days of life were selected over a one-year period. SPL was measured weekly until the participants reached 37 weeks of cGA or were discharged from the hospital. Statistical analysis included the Lambda Mu Sigma (LMS) method for growth curve construction and the Bland-Altman test to assess measurement agreement.</div></div><div><h3>Results</h3><div>A total of 290 SPL measurements were collected from 140 participants. Reference curves were developed for cGA between 26 and 37 weeks. Bland-Altman analysis suggested agreement between measurements taken immediately after birth and those taken during follow-up, inferring that preterm newborns may exhibit penile growth patterns similar to those exhibited during the intrauterine period.</div></div><div><h3>Conclusion</h3><div>hypothalamic-pituitary-gonadal axis integrity appears to be the primary determinant of post-natal penile growth. The proposed reference curves aid in the early diagnosis of hormonal and genetic alterations, allowing for timely medical interventions.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 6","pages":"Article 101437"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873288","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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