Jornal de pediatria最新文献_第8页

Challenges in the prophylaxis of severe respiratory syncytial virus infections 预防严重呼吸道合胞病毒感染的挑战。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-01 DOI: 10.1016/j.jped.2025.04.003

Dana C. Feitosa , Sandra E. Vieira

Objective

To analyze palivizumab prophylaxis adherence among newborns and infants, as well as identify its challenges and facilitators.

Methods

This retrospective study reviewed medical records of individuals who received palivizumab between 2008 and 2019 at a referral center in a metropolitan city in Brazil. Three adherence criteria were evaluated: an adequate number of doses received, interval between doses ≤ 35 days, and complete adherence (meeting both prior criteria). Associations between these criteria and sociodemographic/clinical variables, as well as post-prophylaxis bronchiolitis-related hospitalizations, were examined.

Results

A total of 908 participants (mean age 6.7 months,50.8 % male,57.8 % residing in the city) were analyzed. During the three-season study period, a total of 1,158 doses were prescribed, and complete adherence was observed in 44.5 % of cases. Based on both the adequate number of doses and complete adherence criteria, lower adherence was noted among those living outside the city (52.8 % vs.60.9 %, p = 0.01; and 41.5 %vs.48.5 %, p = 0.03, respectively) and infants born to mothers younger than 20 years (39.7 % vs.60.3 %,p < 0.01; and 31.5 %vs.68.5 %, p = 0.02, respectively). Infants with gestational age < 28 weeks (65.8 % vs.34.2 %, p = 0.03) and birth weight < 1000 g (67.8 % vs.32.2 %, p = 0.03) had higher adherence under the adequate number of doses criterion. No association emerged between adherence and bronchiolitis-related hospitalizations, which were predominantly linked to maternal smoking during pregnancy and chronic lung disease.

Conclusion

Adherence to palivizumab prophylaxis was low, highlighting the need to address geographic barriers and maternal age factors. Extreme prematurity and very low birth weight facilitated adherence, indicating that more targeted strategies or decentralized administration may improve outcomes in high-risk populations.

目的：分析新生儿和婴儿的帕利珠单抗预防依从性，并确定其挑战和促进因素。方法：这项回顾性研究回顾了2008年至2019年在巴西一个大城市的转诊中心接受帕利珠单抗治疗的个体的医疗记录。评估三个依从性标准：接受足够剂量，剂量间隔≤35天，完全依从性（满足先前的两个标准）。研究了这些标准与社会人口学/临床变量以及预防后毛细支气管炎相关住院之间的关系。结果：共分析了908名参与者（平均年龄6.7个月，50.8% %为男性，57.8% %居住在城市）。在三个季节的研究期间，总共开了1158剂处方，在44.5 %的病例中观察到完全遵守。基于足够剂量和完全依从性标准，居住在城市以外的人的依从性较低(52.8 % vs.60.9 %,p = 0.01；和41.5 %vs.48.5 %,p = 0.03)，以及母亲年龄小于20岁的婴儿（39.7 % vs.60.3 %,p ）。结论：帕利珠单抗预防依从性较低，强调需要解决地理障碍和母亲年龄因素。极端早产和极低的出生体重有助于依从性，表明更有针对性的策略或分散管理可能改善高危人群的结果。

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引用次数: 0

Psychometric characteristics of the Mini-TEA scale: a screening instrument for autism spectrum disorder in children 迷你tea量表的心理测量特征：儿童自闭症谱系障碍的筛查工具。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-01 DOI: 10.1016/j.jped.2025.05.006

Cassiano Mateus Forcelini , Regina Ampese , Helena Younes de Melo , Camila Pereira Neubauer Pasin , José Renato Donadussi Pádua , Itamara Danelli de Moura , Camila Boschetti Spanholo , Francine Ehrhardt Hoffmann , Júlia Breitenbach Diniz , Laís Cristine Zanella Capponi , Luiza Souza , Maxciel Zortea

Objective

Early diagnosis of autism spectrum disorder (ASD) is advisable to promote better prognosis. The Mini-TEA scale was conceived as a sensitive screening for ASD among children. The authors aimed to confirm the diagnostic accuracy of the scale in a wider population.

Method

279 children from 2.5 to 12 yo were recruited, most of them under evaluation for possible ASD in the APAE of Passo Fundo/RS, as well as children with other diagnoses and normal children. Their parents/relatives answered the 48 binary questions (yes/no) of the Mini-TEA scale, divided into 15 items, which resulted in a score from 0 to 15. After that, the children were evaluated regarding the diagnostic criteria of ASD by experienced raters (gold standard) who had previously submitted to a concordance test and remained unaware of the children’s scores. Sensitivity and specificity Figs. were obtained. Factor analysis and Item Response Theory approaches were used for validity evidence.

Results

115 children were diagnosed with ASD. Scores ≥9 had 98.3 % of sensitivity and 62.2 % of specificity for the diagnosis. Two cases with the typical presentation of Asperger’s syndrome scored lower than 9. The mean time for screening was about 8.5 min. The validation model presented excellent coefficients of factorability. The analysis showed that the total variance of the scores of the scale through the 15 items was explained only by the set of ASD symptoms (unidimensionality).

Conclusion

The Mini-TEA scale is a very sensitive tool to screen for ASD and has high internal consistency for assessing typical autistic symptoms.

目的：早期诊断自闭症谱系障碍（ASD）有助于改善预后。Mini-TEA量表被认为是对儿童自闭症谱系障碍的一种敏感筛查。作者的目的是在更广泛的人群中确认该量表的诊断准确性。方法：招募279名2.5 ~ 12岁的儿童，其中大部分为Passo Fundo/RS APAE中可能存在ASD的儿童，以及其他诊断的儿童和正常儿童。他们的父母/亲戚回答了Mini-TEA量表的48个二元问题（是/否），分为15个项目，得分从0到15。在那之后，孩子们根据ASD的诊断标准由经验丰富的评分者（金标准）进行评估，这些评分者之前已经提交了一个一致性测试，并且不知道孩子们的分数。灵敏度和特异性被获得。效度证据采用因子分析和项目反应理论方法。结果：115例患儿被诊断为ASD。评分≥9分的诊断敏感性为98.3% %，特异性为62.2 %。有两个亚斯伯格综合症典型表现的病例得分低于9分。平均筛选时间约为8.5 min，验证模型具有良好的因子性系数。分析表明，量表15个项目得分的总方差仅由ASD症状集（单维性）来解释。结论：mini-TEA量表是一种非常灵敏的筛查ASD的工具，在评估典型自闭症症状方面具有很高的内在一致性。

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引用次数: 0

Serum hsa-miR-21 expression and its clinical value in pediatric patients with fulminant myocarditis 小儿暴发性心肌炎患者血清hsa-miR-21表达及其临床价值

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-09-01 DOI: 10.1016/j.jped.2025.04.007

Wenwen Wang, Jingmin Sun, Jing Li

Objective

Fulminant myocarditis (FM) is a distinct and rare form of myocarditis. This study probed hsa-miR-21 expression in FM pediatric patients and its clinical value.

Methods

This study enrolled 88 FM pediatric patients and 90 healthy children (normal controls), with serum sample hsa-miR-21 levels measured by RT-qPCR. FM children were categorized into the good and poor prognosis groups. Correlations of hsa-miR-21 expression with myocardial injury markers [cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB)], and independent risk factors and predictive value of hsa-miR-21 expression for FM patients’ poor prognoses were analyzed by Pearson’s, logistic regression, and receiver operating characteristic (ROC) curve analyses.

Results

Serum hsa-miR-21 levels were elevated in FM children relative to the healthy controls and linked with poor prognoses. hsa-miR-21 levels positively correlated with myoglobin (MYO), B-type natriuretic peptide (BNP), cTnI, and CK-MB levels. Elevated hsa-miR-21, CK-MB, left ventricular ejection fraction, C-reactive protein, lactate dehydrogenase, and lactate were independent risk factors for FM children’s poor prognoses. Serum hsa-miR-21 levels yielded an area under the ROC curve of 0.790 in predicting FM pediatric patients’ poor prognoses (58.1 % sensitivity, 87.7 % specificity), with positive and negative predictive values of 74.07 % and 81.97 %, respectively, demonstrating that hsa-miR-21 aided in predicting FM pediatric patients’ poor prognoses to some extent.

Conclusion

Serum hsa-miR-21 was up-regulated in FM pediatric patients, and positively correlated with MYO, BNP, cTnI, and CK-MB. hsa-miR-21 expression was an independent risk factor for FM pediatric patients' poor prognosis, and predicted prognoses to some extent; however, the diagnostic accuracy was limited.

目的：暴发性心肌炎（FM）是一种独特而罕见的心肌炎。本研究探讨hsa-miR-21在小儿FM患者中的表达及其临床价值。方法：本研究纳入88例FM患儿和90例健康儿童（正常对照），采用RT-qPCR检测血清样本hsa-miR-21水平。将FM患儿分为预后良好组和预后不良组。通过Pearson’s、logistic回归和受试者工作特征（ROC）曲线分析，分析hsa-miR-21表达与心肌损伤标志物[心肌肌钙蛋白I （cTnI）、肌酸激酶同工酶（CK-MB）]、独立危险因素以及hsa-miR-21表达对FM患者不良预后的预测价值的相关性。结果：与健康对照组相比，FM儿童血清hsa-miR-21水平升高，并与预后不良有关。hsa-miR-21水平与肌红蛋白（MYO）、b型利钠肽（BNP）、cTnI和CK-MB水平呈正相关。hsa-miR-21、CK-MB、左室射血分数、c反应蛋白、乳酸脱氢酶和乳酸水平升高是FM患儿预后不良的独立危险因素。血清hsa-miR-21水平预测FM患儿不良预后的ROC曲线下面积为0.790（敏感性为58.1% %，特异性为87.7 %），阳性预测值为74.07 %，阴性预测值为81.97 %，说明hsa-miR-21在一定程度上有助于预测FM患儿不良预后。结论：小儿FM患者血清hsa-miR-21表达上调，且与MYO、BNP、cTnI、CK-MB呈正相关。hsa-miR-21的表达是小儿FM患者预后不良的独立危险因素，并在一定程度上预测预后；然而，诊断的准确性是有限的。

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引用次数: 0

Evaluation of stretched penile length (SPL), postnatal penile growth evolution, and micropenis in Brazilian preterm newborns 巴西早产儿阴茎伸展长度、出生后阴茎生长演变和小阴茎的评估。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-27 DOI: 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。

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引用次数: 0

X-ray is not inferior to CT in terms of F1 score in the diagnosis of foreign body aspiration: a recall, precision and F1 score performance analysis based on bronchoscopically proven cases x线在诊断异物吸入方面并不逊色：基于支气管镜证实病例的召回率、精确度和F1评分表现分析。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-22 DOI: 10.1016/j.jped.2025.101430

Fatma Sarac, Mehmet Yazici

Objective

In this study, we aimed to evaluate the diagnostic accuracy of X-ray and CT by using the F1 score with its non-inferiority margin in patients who underwent bronchoscopy with suspected diagnoses of foreign body aspiration (FBA).

Methods

All children aged under 18 who underwent bronchoscopy with suspected diagnoses of FBA between June 2020 and December 2023 were included. The patient’s medical records were examined retrospectively.

Results

A total of 310 patients were included. Foreign bodies were most frequently located in the right main bronchus (47.52 %). The bronchoscopy (-) rate was 18 % in patients who had X-ray (+), 24 % in those who had CT (+), and 15 % in those who had X-ray (+) and CT (+). Chest x-rays were found to exhibit 42 % sensitivity, 74 % specificity, a positive predictive value (PPV) of 61 %, a negative predictive value (NPV) of 51 %, accuracy of 66 %, precision: 0.63, recall: 0.82, and F1 score: 0.71. Analysis showed that CT exhibited 82 % sensitivity, 37 % specificity, a PPV of 75 %, NPV of 47 %, an accuracy rate of 69 %, precision: 0.83, recall: 0.76, and F1 score: 0.79. In the present study, the diagnostic F1 score was calculated as 0.79 for CT and 0.71 for X-ray.

Conclusion

Despite a negative bronchoscopy rate of 34.83 % in this study, since the authors observed no severe complications or mortality, the authors recommend that it be performed on all patients with suspected foreign body aspiration. When a 10 % non-inferiority margin was applied, X-ray was found to be not inferior to CT in terms of F1 score.

目的：在本研究中，作者旨在评估x线和CT对疑似异物吸入（FBA）支气管镜检查患者的F1评分及其非效缘的诊断准确性。方法：纳入2020年6月至2023年12月期间接受支气管镜检查并疑似诊断为FBA的所有18岁以下儿童。对病人的医疗记录进行了回顾性检查。结果：共纳入310例患者。异物多见于右侧主支气管（47.52 %）。支气管镜检查（-）率x线（+）组为18 %，CT（+）组为24 %，x线(+)+ CT（+）组为15 %。胸部x线片的敏感性为42 %，特异性为74 %，阳性预测值（PPV）为61 %，阴性预测值（NPV）为51 %，准确率为66 %，精密度为0.63，召回率为0.82，F1评分为0.71。分析显示，CT的敏感性为82 %，特异性为37 %，PPV为75 %，NPV为47 %，准确率为69 %，精密度为0.83，召回率为0.76，F1评分为0.79。在本研究中，CT和x线的诊断F1评分分别为0.79和0.71。结论：尽管本研究支气管镜检查阴性率为34.83 %，但由于作者未观察到严重并发症或死亡，作者建议对所有疑似异物吸入的患者进行支气管镜检查。当应用10 %的非劣效裕度时，发现x线在F1评分方面不低于CT。

{"title":"X-ray is not inferior to CT in terms of F1 score in the diagnosis of foreign body aspiration: a recall, precision and F1 score performance analysis based on bronchoscopically proven cases","authors":"Fatma Sarac, Mehmet Yazici","doi":"10.1016/j.jped.2025.101430","DOIUrl":"10.1016/j.jped.2025.101430","url":null,"abstract":"<div><h3>Objective</h3><div>In this study, we aimed to evaluate the diagnostic accuracy of X-ray and CT by using the F1 score with its non-inferiority margin in patients who underwent bronchoscopy with suspected diagnoses of foreign body aspiration (FBA).</div></div><div><h3>Methods</h3><div>All children aged under 18 who underwent bronchoscopy with suspected diagnoses of FBA between June 2020 and December 2023 were included. The patient’s medical records were examined retrospectively.</div></div><div><h3>Results</h3><div>A total of 310 patients were included. Foreign bodies were most frequently located in the right main bronchus (47.52 %). The bronchoscopy (-) rate was 18 % in patients who had X-ray (+), 24 % in those who had CT (+), and 15 % in those who had X-ray (+) and CT (+). Chest x-rays were found to exhibit 42 % sensitivity, 74 % specificity, a positive predictive value (PPV) of 61 %, a negative predictive value (NPV) of 51 %, accuracy of 66 %, precision: 0.63, recall: 0.82, and F1 score: 0.71. Analysis showed that CT exhibited 82 % sensitivity, 37 % specificity, a PPV of 75 %, NPV of 47 %, an accuracy rate of 69 %, precision: 0.83, recall: 0.76, and F1 score: 0.79. In the present study, the diagnostic F1 score was calculated as 0.79 for CT and 0.71 for X-ray.</div></div><div><h3>Conclusion</h3><div>Despite a negative bronchoscopy rate of 34.83 % in this study, since the authors observed no severe complications or mortality, the authors recommend that it be performed on all patients with suspected foreign body aspiration. When a 10 % non-inferiority margin was applied, X-ray was found to be not inferior to CT in terms of F1 score.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 5","pages":"Article 101430"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816710","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

Remimazolam for preventing sevoflurane-induced emergence delirium after pediatric laparoscopic inguinal hernia repair: a placebo-controlled randomized clinical trial 雷马唑仑预防小儿腹腔镜腹股沟疝修补术后七氟醚所致突发性谵妄：一项安慰剂对照随机临床试验

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-22 DOI: 10.1016/j.jped.2025.101423

Yiwen Lu , Guangbin Liang , Yan Lu , Jingjing Wang , Jianhang Mo , Zhiyuan Chen , Ruizhao Shao , Kui Hu , Ping Pang , Xiaoxia Gu

Objective

To investigate the effectiveness and safety of remimazolam in preventing the emergence of delirium in children undergoing pediatric laparoscopic inguinal hernia surgery under combined intravenous and inhalation anesthesia.

Methods

A total of 184 pediatric patients aged 3–14 years who were undergoing laparoscopic inguinal hernia surgery were included. Patients were randomly assigned to receive either 0.1 mg/kg remimazolam (experimental group, n = 92) or 0.9 % normal saline (control group, n = 92) after the procedure. The primary outcome was the incidence of emergence delirium, which would manifest as a difference in the pediatric anesthesia emergence delirium (PAED) score between the two groups. The secondary outcomes included postoperative pain severity, duration of postanesthesia care unit (PACU) stay, sufentanil usage, parental satisfaction, mean arterial pressure (MAP), blood oxygen saturation (SpO₂), and heart rate (HR).

Results

The experimental group showed significantly lower overall PAED scores (mean difference = −2.28, 95 % CI:2.73 to −1.82; Cohen's d = 1.12, p < 0.001) and emergence delirium incidence (7.61 % vs 41.30 %; risk difference = 33.69 %, 95 % CI 21.60 % to 45.10 %; relative risk = 0.18, 95 % CI 0.09–0.37; p < 0.001). They also showed better hemodynamic stability (lower MAP/HR, higher SpO₂), reduced pain, shorter PACU stay, less sufentanil use, and higher parental satisfaction (all p < 0.05).

Conclusion

Administration of 0.1 mg/kg remimazolam after pediatric laparoscopic inguinal hernia surgery could contribute to preventing the development of emergence delirium by smoothing hemodynamic changes and alleviating postoperative pain.

目的：探讨雷马唑仑预防小儿腹腔镜腹股沟疝手术静脉、吸入联合麻醉下谵妄发生的有效性和安全性。方法：对184例3 ~ 14岁行腹腔镜腹股沟疝手术的患儿进行分析。术后患者被随机分配接受0.1 mg/kg雷马唑仑（实验组，n = 92）或0.9 %生理盐水（对照组，n = 92）治疗。主要结局是出现性谵妄的发生率，这将表现为两组儿童麻醉出现性谵妄（PAED）评分的差异。次要结局包括术后疼痛严重程度、麻醉后护理单位（PACU）停留时间、舒芬太尼使用情况、父母满意度、平均动脉压（MAP）、血氧饱和度（SpO₂）和心率（HR）。结果：实验组患者PAED总分显著低于对照组(平均差异 = -2.28,95 % CI:2.73 ~ -1.82；Cohen’s d = 1.12，p 结论：小儿腹腔镜腹股沟疝手术后给予0.1 mg/kg雷马唑仑可通过平滑血流动力学变化和减轻术后疼痛来预防出现性谵妄的发生。

{"title":"Remimazolam for preventing sevoflurane-induced emergence delirium after pediatric laparoscopic inguinal hernia repair: a placebo-controlled randomized clinical trial","authors":"Yiwen Lu , Guangbin Liang , Yan Lu , Jingjing Wang , Jianhang Mo , Zhiyuan Chen , Ruizhao Shao , Kui Hu , Ping Pang , Xiaoxia Gu","doi":"10.1016/j.jped.2025.101423","DOIUrl":"10.1016/j.jped.2025.101423","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effectiveness and safety of remimazolam in preventing the emergence of delirium in children undergoing pediatric laparoscopic inguinal hernia surgery under combined intravenous and inhalation anesthesia.</div></div><div><h3>Methods</h3><div>A total of 184 pediatric patients aged 3–14 years who were undergoing laparoscopic inguinal hernia surgery were included. Patients were randomly assigned to receive either 0.1 mg/kg remimazolam (experimental group, <em>n</em> = 92) or 0.9 % normal saline (control group, <em>n</em> = 92) after the procedure. The primary outcome was the incidence of emergence delirium, which would manifest as a difference in the pediatric anesthesia emergence delirium (PAED) score between the two groups. The secondary outcomes included postoperative pain severity, duration of postanesthesia care unit (PACU) stay, sufentanil usage, parental satisfaction, mean arterial pressure (MAP), blood oxygen saturation (SpO₂), and heart rate (HR).</div></div><div><h3>Results</h3><div>The experimental group showed significantly lower overall PAED scores (mean difference = −2.28, 95 % CI:2.73 to −1.82; Cohen's <em>d</em> = 1.12, <em>p</em> < 0.001) and emergence delirium incidence (7.61 % vs 41.30 %; risk difference = 33.69 %, 95 % CI 21.60 % to 45.10 %; relative risk = 0.18, 95 % CI 0.09–0.37; <em>p</em> < 0.001). They also showed better hemodynamic stability (lower MAP/HR, higher SpO₂), reduced pain, shorter PACU stay, less sufentanil use, and higher parental satisfaction (all <em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Administration of 0.1 mg/kg remimazolam after pediatric laparoscopic inguinal hernia surgery could contribute to preventing the development of emergence delirium by smoothing hemodynamic changes and alleviating postoperative pain.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 5","pages":"Article 101423"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816708","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

Obstructive sleep apnea syndrome in children with cerebral palsy in Brazil: a multicenter study 巴西脑瘫患儿的阻塞性睡眠呼吸暂停综合征：一项多中心研究

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-22 DOI: 10.1016/j.jped.2025.101432

Bruno Leonardo Scofano Dias, Fernanda Marinho de Lima, Daniela Fava, Fernanda Jordão Pinto Marques, Frederico José de Carvalho Godinho, Alessandra Lemos de Carvalho, Sara Virgínia Paiva Santos, Fernanda de Lourdes da Cunha Pinto, Danielle Bruno Jardim, Wilerson Marques Bessa

Objectives

To evaluate the prevalence of high risk for obstructive sleep apnea syndrome (HR-OSAS) in Brazilian children with cerebral palsy (CP) using the Pediatric Obstructive Sleep Apnea Screening Tool (PosaST) and to analyze its association with demographic, clinical and functional (Gross Motor Function Classification System [GMFCS]) variables.

Methods

Multicenter, cross-sectional, exploratory study.

Results

There were 312 children (median age 6.0 years, IQR 5.0–8.0) included. The prevalence of HR-OSAS in GMFCS I-V was 9.0 %. The prevalence of HR-OSAS in GMFCS V (14.7 %) was significantly higher compared to GMFCS I-IV (6.4 %) and to the frequency of OSAS in typically developing (TD) children assessed by polysomnography (5.8 %) according to literature data. Significantly higher frequencies of palatine tonsil hypertrophy, hospitalizations and outpatient antibiotic use for respiratory causes (last 12 months), gastroesophageal reflux disease, drooling and epilepsy were found in GMFCS V. Palatine tonsil hypertrophy was significantly associated with HR-OSAS. GMFCS V was significantly correlated with HR-OSAS at the expense of its significantly higher prevalence of palatine tonsil hypertrophy.

Conclusions

The prevalence of HR-OSAS in Brazilian children with CP (GMFCS V) was higher than the frequency of OSAS in TD children assessed by polysomnography. HR-OSAS was significantly more prevalent in GMFCS V compared with GMFCS I-IV. Palatine tonsil hypertrophy was significantly associated with HR-OSAS. GMFCS V was significantly correlated with HR-OSAS due to its significantly higher prevalence of palatine tonsil hypertrophy. PosaST may be a reliable questionnaire for Brazilian children with CP, but studies are needed to define the HR-OSAS cutoff score in this population.

目的：利用儿童阻塞性睡眠呼吸暂停筛查工具（PosaST）评估巴西脑瘫（CP）儿童中阻塞性睡眠呼吸暂停综合征（HR-OSAS）的高危患病率，并分析其与人口统计学、临床和功能（大运动功能分类系统[GMFCS]）变量的关系。方法：多中心、横断面、探索性研究。结果：共纳入312例患儿，中位年龄6.0岁，IQR 5.0 ~ 8.0。HR-OSAS在GMFCS I-V中的患病率为9.0 %。根据文献资料，GMFCS V组HR-OSAS患病率（14.7 %）明显高于GMFCS I-IV组（6.4 %），也高于多导睡眠图评估的典型发育（TD）儿童（5.8 %）。在GMFCS中，腭扁桃体肥大、住院和门诊因呼吸道原因使用抗生素（过去12个月）、胃食管反流疾病、流口水和癫痫的频率明显更高。GMFCS V与HR-OSAS显著相关，其代价是其明显较高的腭扁桃体肥大患病率。结论：巴西CP患儿（GMFCS V）的HR-OSAS患病率高于多导睡眠图评估的TD患儿的OSAS发生率。与GMFCS I-IV相比，HR-OSAS在GMFCS V中更为普遍。腭扁桃体肥大与HR-OSAS显著相关。GMFCS V型与HR-OSAS显著相关，因为其腭扁桃体肥大的患病率明显较高。PosaST可能是巴西CP患儿的可靠问卷，但需要研究来确定这一人群的HR-OSAS分值。

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引用次数: 0

Thyroidectomy in children and adolescents: distinguishing benign from malignant thyroid nodules 儿童和青少年甲状腺切除术：区分良性和恶性甲状腺结节。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-21 DOI: 10.1016/j.jped.2025.101426

Mário Sérgio Rocha Macedo , Jônatas Catunda de Freitas , Débora Cabral Coutinho , Carina Marques Barroso , Sandra Regina Geroldo , Rhuce Pedrosa Carvalho , Letícia Siqueira Monte Alverne , Tamyres Ferreira Campos , Lívia Rolim Fernades Macedo , José Huygens Parente Garcia , Wellington Alves Filho

Objectives

The research aimed to analyze the clinical, epidemiological, laboratory, imaging, and pathological characteristics of pediatric patients who underwent surgery for thyroid nodules, distinguishing and comparing malignant and benign conditions.

Methodology

A retrospective and descriptive analysis was conducted on patients aged 0–18 years who underwent thyroidectomy. The following variables were evaluated: gender, previous and current pathological history, laboratory thyroid hormone levels, ultrasonography, cytology, and histopathological findings.

Results

A total of 91 children underwent thyroidectomy from January 2013 to May 2023. The average age was 13 years, and 68 patients were female. Ultrasonography evaluation revealed that 62 children had unimodular disease. Histopathology reports showed benign tumors in 54 patients and malignant tumors in 37. The factors associated with a higher incidence of cancer in univariate analysis were age < 10 years (p = 0.025), the presence of nodules on ultrasound with microcalcification (p < 0.001), and hypoechogenic nodules (p = 0.007). On multivariate analysis, only age under 10 years (OR = 5.69; p = 0.028) and the presence of microcalcifications (OR = 28.44 and p = 0.002) were significantly associated with malignancy.

Conclusion

The medical community is becoming increasingly aware of the differences in the clinical, epidemiological, pathological, and molecular presentations of benign and malignant thyroid diseases, highlighting the need for further training in this area.

目的：分析小儿甲状腺结节手术患者的临床、流行病学、实验室、影像学及病理特点，区分并比较甲状腺结节的良恶性。方法：对0-18岁行甲状腺切除术的患者进行回顾性和描述性分析。评估以下变量：性别、既往和当前病理史、实验室甲状腺激素水平、超声检查、细胞学检查和组织病理学检查结果。结果：2013年1月至2023年5月，共有91名儿童接受了甲状腺切除术。平均年龄13岁，女性68例。超声检查显示62例患儿为单模病变。组织病理学报告显示良性肿瘤54例，恶性肿瘤37例。在单变量分析中，与癌症高发病率相关的因素是年龄< 10岁（p = 0.025）、超声检查结节伴微钙化（p ）。结论：医学界越来越意识到良性和恶性甲状腺疾病在临床、流行病学、病理和分子表现上的差异，强调需要在这一领域进行进一步的培训。

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引用次数: 0

A comparative study of serum and fecal calprotectin levels in necrotizing enterocolitis 坏死性小肠结肠炎患者血清和粪便钙保护蛋白水平的比较研究。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-21 DOI: 10.1016/j.jped.2025.101428

Sara Erol , Cuneyt Tayman , Sabriye Korkut , Ufuk Çakir , Abdullah Kurt , Ismail Koyuncu

Objectives

Necrotizing enterocolitis is a significant cause of morbidity and mortality in premature infants. Various fecal, urinary, and serum biomarkers have all been investigated for their potential in the prediction and early detection of necrotizing enterocolitis. This pilot study aimed to explore the feasibility and clinical utility of measuring serum and fecal calprotectin levels in preterm infants with necrotizing enterocolitis.

Methods

This prospective pilot study included preterm infants born at < 32 weeks’ gestation with a birth weight of ≤ 1500 g, consisting of patients diagnosed with necrotizing enterocolitis stage II or III and a randomly selected control group without necrotizing enterocolitis. The relationship between serum and fecal calprotectin concentrations and necrotizing enterocolitis severity, need for surgical intervention, and mortality was systematically analyzed.

Results

A total of 39 necrotizing enterocolitis patients (25 with stage II, 14 with stage III) and 20 randomly selected preterm infants were included as the control group. Serum and fecal calprotectin levels were significantly higher in necrotizing enterocolitis stage III and in infants who required surgery or died (p < 0.05), indicating their potential to predict disease severity and poor outcomes.

Conclusions

This pilot study suggests that dual assessment of serum and fecal calprotectin may provide insight into necrotizing enterocolitis severity and outcomes. Larger studies are needed to validate these findings and determine clinical applicability.

Trial Registration

This study was registered with the ClinicalTrials.gov database under the registration number NCT06693154 on November 15, 2024.

目的：坏死性小肠结肠炎是早产儿发病和死亡的重要原因。各种粪便、尿液和血清生物标志物都被研究用于预测和早期发现坏死性小肠结肠炎的潜力。本初步研究旨在探讨测定坏死性小肠结肠炎早产儿血清和粪便钙保护蛋白水平的可行性和临床应用。方法：本前瞻性先导研究纳入妊娠< 32周，出生体重≤1500 g的早产儿，包括诊断为坏死性小肠结肠炎II期或III期的患者和随机选择无坏死性小肠结肠炎的对照组。系统分析血清和粪便钙保护蛋白浓度与坏死性小肠结肠炎严重程度、手术干预需求和死亡率的关系。结果：共纳入坏死性小肠结肠炎患者39例（II期25例，III期14例），随机抽取早产儿20例作为对照组。在坏死性小肠结肠炎III期和需要手术或死亡的婴儿中，血清和粪便钙保护蛋白水平显著升高（p ）。结论：这项初步研究表明，血清和粪便钙保护蛋白的双重评估可能有助于了解坏死性小肠结肠炎的严重程度和结局。需要更大规模的研究来验证这些发现并确定临床适用性。试验注册：本研究于2024年11月15日在ClinicalTrials.gov数据库注册，注册号为NCT06693154。

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引用次数: 0

Prognostic nutritional index as a biomarker for identifying coronary artery lesions in Kawasaki disease 预后营养指数作为鉴别川崎病冠状动脉病变的生物标志物。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-18 DOI: 10.1016/j.jped.2025.101436

Chao Zhang , Guoshun Mao , Guosheng Hu

Objective

To evaluate the Prognostic Nutritional Index as a biomarker for identifying coronary artery lesions in Kawasaki disease.

Methods

The clinicopathological and laboratory characteristics of 241 patients with Kawasaki disease were collected from patients who were hospitalized in Fuyang People's Hospital from January 2018 to December 2024. Logistic regression analysis was conducted to evaluate the relationship between Prognostic Nutritional Index and coronary artery lesions. The critical levels of hematological parameters were determined by receiver operating characteristic analysis.

Results

The incidence of coronary artery lesions was 10.3 %. The optimal cut-off point for the Prognostic Nutritional Index was defined as 46.575. Prognostic Nutritional Index was negatively correlated with coronary artery diameter (r = −0.260, p < 0.001). Patients with low Prognostic Nutritional Index levels (Prognostic Nutritional Index < 46.575) were 4.25 times more likely to have coronary artery lesions compared to those with high Prognostic Nutritional Index levels (Prognostic Nutritional Index ≥ 46.575) (OR = 4.25, 95 % CI: 1.688 - 10.697, p < 0.001). The area under the receiver operating characteristic curve for Prognostic Nutritional Index in predicting coronary artery lesions was 0.702 (95 % CI: 0.584 - 0.821, p = 0.001), indicating moderate diagnostic efficacy.

Conclusion

Prognostic Nutritional Index may be a biomarker for children with Kawasaki disease complicated with coronary artery lesions, and it may help identify high-risk patients of coronary artery lesions among children with Kawasaki disease.

目的：评价预后营养指数作为鉴别川崎病冠状动脉病变的生物标志物。方法：收集2018年1月至2024年12月阜阳市人民医院住院的241例川崎病患者的临床病理和实验室特征。采用Logistic回归分析评价预后营养指数与冠状动脉病变的关系。通过受试者工作特征分析确定血液学参数的临界水平。结果：冠状动脉病变发生率为10.3 %。预后营养指数的最佳分界点为46.575。预后营养指数与冠状动脉直径呈负相关（r = -0.260,p ）结论：预后营养指数可能是川崎病患儿合并冠状动脉病变的生物标志物，有助于川崎病患儿中冠状动脉病变高危患者的识别。

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引用次数: 0