Jornal de pediatria最新文献_第7页

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 : 2025-11-01 Epub 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

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 : 2025-11-01 Epub 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

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 : 2025-11-01 Epub 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。

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引用次数: 0

Quality improvement initiative to reduce late-onset sepsis in very low birth weight preterm infants: a multicenter study from the Brazilian network on neonatal research 质量改善倡议，以减少迟发性脓毒症在极低出生体重早产儿：一项多中心研究从巴西网络新生儿研究。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-01 Epub Date: 2025-10-15 DOI: 10.1016/j.jped.2025.101459

Ligia Maria Suppo de Souza Rugolo , Maria Regina Bentlin , Fernanda Pegoraro de Godoi Melo , Maria Eduarda Gurgel , Gabriella Miranda Martins , Suely Dornellas do Nascimento , Edna Maria de Albuquerque Diniz , Renata Yoshida , Jamil Pedro de Siqueira Caldas , Silvia Cwajg , Marcia Pereira Alves de Souza , Clarissa Gutierrez Carvalho , Daniela Marques de Lima Mota Ferreira

Objective

To evaluate the impact of a quality improvement project (QI) on reducing proven late-onset sepsis (LOS) in centers of the Brazilian Network Neonatal Research (BNNR).

Method

An interventional study conducted in 12 BNNR centers from 2021 to 2023. Included preterm infants (PT) born at 22–36 weeks' gestational age, weighing 400–1499 grams, without malformations, and admitted to the NICU for > 72 h. QI tools were used and four process indicators were defined: central catheter complication (≤ 20 %); antibiotic discontinuation ≤48 h in non-infected infants (≥ 80 %); breast milk expression within the first 48 h and enteral feeding within the first 24 h of life (≥ 80 %); full enteral feeding without parenteral nutrition by day 11 (≥ 70 %). The outcome was the proportional reduction of LOS according to each center’s baseline (2020). Indicators were analyzed descriptively across three periods.

Results

A total of 1993 PT < 1500 grams were included. Half of the centers achieved the target for umbilical catheter complications, and 92 % for percutaneous catheters. Antibiotics were discontinued within 48 h in 67 % of non-infected infants. Early breast milk expression and enteral feeding were achieved in 44 % and 75 % of cases, respectively. 58 % achieved full enteral nutrition without parenteral support by day 11. LOS incidence declined in 67 % of centers, and half met their targets, with an overall 18.5 % reduction.

Conclusions

The project reduced LOS in most centers, although some clinical practices still need improvement. It demonstrates a reproducible, low-cost strategy with the potential to guide other neonatal units facing high sepsis incidence.

目的：评估巴西新生儿研究网络（BNNR）中心的质量改进项目（QI）对减少已证实的晚发型脓毒症（LOS）的影响。方法：于2021 - 2023年在12个BNNR中心进行介入研究。纳入胎龄22-36周出生、体重400-1499克、无畸形、入住NICU时间为bb0 72 h的早产儿（PT）。采用QI工具，定义4个过程指标：中心导管并发症（≤20 %）；未感染婴儿停药≤48 h(≥80 %)；出生后48小时内母乳表达和24小时内肠内喂养（≥80 %）；第11天完全肠内喂养，不进行肠外营养（≥70 %）。结果是根据每个中心的基线（2020年）按比例降低LOS。对三个时期的指标进行了描述性分析。结果：共纳入PT < 1500 g者1993例。一半的中心达到了脐导管并发症的目标，92%的中心达到了经皮导管的目标 %。67% %未感染婴儿在48小时内停用抗生素。早期母乳表达率为44. %，肠内喂养率为75. %。58% %在第11天达到完全肠内营养，无需肠外支持。在67% %的中心，LOS发生率下降，其中一半达到了目标，总体降低18.5% %。结论：该项目降低了大多数中心的LOS，尽管一些临床实践仍需改进。它展示了一种可重复的、低成本的策略，有可能指导其他面临高脓毒症发病率的新生儿单位。

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引用次数: 0

Reply to the letter ‘Beyond overdiagnosis: reframing autism prevalence’ 回复“超越过度诊断：重塑自闭症流行”这封信。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-01 Epub Date: 2025-11-08 DOI: 10.1016/j.jped.2025.101469

Kamila Castro , Rudimar Riesgo , Carlos Gadia

引用次数: 0

Jornal de Pediatria at a turning point: four years of growth and the road ahead in the age of AI 转折点上的儿科杂志：人工智能时代的四年成长和未来之路

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-01 Epub Date: 2025-12-04 DOI: 10.1016/j.jped.2025.101481

Renato Soibelmann Procianoy

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 : 2025-11-01 Epub 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

Peripheral immune indicators and their predictive value in disease progression or relapse of pediatric Langerhans cell histiocytosis 外周免疫指标及其在儿童朗格汉斯细胞组织细胞增多症疾病进展或复发中的预测价值

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-11-01 Epub Date: 2025-11-02 DOI: 10.1016/j.jped.2025.101466

Hua-Lin Li , Hong-Yun Lian , Wen-Yu Gong , Shuo Tian , Wei-Jing Li , Qing Zhang , Chan-Juan Wang , Hong-Hao Ma , Dong Wang , Yun-Ze Zhao , Zi-Jing Zhao , Jia-Jia Dong , Zhi-Gang Li , Rui Zhang , Lei Cui

Objective

Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasm in which the inflammatory microenvironment plays a crucial role in the development and progression of disease. The prognostic value of circulating lymphocyte subsets and cytokines remains uncertain.

Methods

The authors retrospectively analyzed baseline peripheral lymphocyte subsets and serum cytokines in 330 consecutive pediatric patients. Immune profiles were compared across disease extent, clinical events, and biological features. Prognostic associations with progression-free survival (PFS) were tested using univariable and multivariable models.

Results

Peripheral immune profiles varied with disease extent. Patients with multisystem risk-organ involvement (MS RO⁺) had fewer total T and Th1 cells, more CD4⁺ T and B cells, and higher IL-6, IL-10, and IFN-γ. Patients who progressed or relapsed showed a similar pattern, and non-survivors had particularly high IL-10. In the first-line cohort, the proportions of T, B, CD4⁺ T, CD8⁺ T, and Th1 cells, ratios of CD4/CD8 and Th1/Th2, and levels of IL-6, IL-10 predicted progression/relapse, and Youden-derived cut-offs dichotomized with distinct PFS. On multivariable Cox, IL-6, IL-10, Th1/Th2 ratio, RO status, and week-6 responses were independent predictors, and a nomogram model with good predictive capability was formed. IL-10 remained independently prognostic in multisystem LCH; the immune indices were not prognostic in single-system LCH. External validation in 103 patients confirmed risk stratification and model performance with well-calibrated PFS estimates.

Conclusion

Baseline peripheral lymphocyte subsets and cytokines carried prognostic information in pediatric LCH. The IL-6, IL-10, and Th1/Th2 profile supported risk stratification and may inform treatment planning.

目的：朗格汉斯细胞组织细胞增多症（LCH）是一种罕见的炎性髓系肿瘤，炎症微环境在疾病的发生和进展中起着至关重要的作用。循环淋巴细胞亚群和细胞因子的预后价值仍不确定。方法：作者回顾性分析330例连续儿科患者的基线外周血淋巴细胞亚群和血清细胞因子。通过疾病程度、临床事件和生物学特征比较免疫谱。使用单变量和多变量模型测试与无进展生存期（PFS）的预后关联。结果：外周免疫谱随疾病程度而变化。多系统危险器官受累（MS RO+）患者总T和Th1细胞较少，CD4 + T和B细胞较多，IL-6、IL-10和IFN-γ较高。进展或复发的患者表现出类似的模式，非幸存者的IL-10特别高。在一线队列中，T、B、CD4 + T、CD8 + T和Th1细胞的比例、CD4/CD8和Th1/Th2的比值以及IL-6、IL-10的水平预测了进展/复发，并且youden衍生的截断值具有不同的PFS。在多变量Cox上，IL-6、IL-10、Th1/Th2比值、RO状态、第6周反应为独立预测因子，形成了预测能力较好的nomogram模型。IL-10仍然是多系统LCH的独立预后因素；单系统LCH的免疫指标不能预测预后。103例患者的外部验证证实了风险分层和模型性能，校准良好的PFS估计。结论：基线外周淋巴细胞亚群和细胞因子承载着儿童LCH的预后信息。IL-6、IL-10和Th1/Th2谱支持风险分层，并可能为治疗计划提供信息。

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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 : 2025-11-01 Epub 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 : 2025-11-01 Epub 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