Jornal de pediatria最新文献_第9页

Biparametric score as a new tool for early indication of surfactant in preterm infants 双参数评分作为早产儿表面活性剂早期指征的新工具。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-18 DOI: 10.1016/j.jped.2025.101425

Ana Román Fernández, Jessica Gómez Ávila

Objective

To investigate whether the use of a biparametric score, based on lung ultrasound (LUS) and oxygen saturation/fraction of inspired oxygen ratio (SF ratio), in preterm infants with respiratory distress syndrome (RDS) allows earlier surfactant therapy (first 3 hours of life) compared to classic FiO₂ criteria.

Material and methods

Before-after design study, performed in a tertiary neonatal intensive care unit. Inclusion criteria were newborns with gestational age < 34 weeks with clinical RDS and respiratory support with noninvasive ventilation. The patients were divided into two groups, the control group, with surfactant indication according to classic criteria, collected retrospectively, and the new protocol group, with surfactant criteria according to biparametric score.

Results

61 patients were included. The new protocol group received surfactant earlier (all patients in the first 3 hours, p 0.013). Likewise, after surfactant treatment, newborns in this group required lower FiO₂ (p 0.001) and a better pulmonary ultrasound evolution according to LUS (p 0.008).

Conclusions

Biparametric scoring allowed earlier surfactant therapy and reduced post-treatment oxygen requirement. This protocol offers a more personalized approach tailored to the patient's needs, which helps us in decision-making.

目的：探讨与经典FiO2标准相比，基于肺超声（LUS）和氧饱和度/吸入氧比（SF比）的双参数评分是否允许呼吸窘迫综合征（RDS）早产儿更早（生命前3小时）接受表面活性剂治疗。材料和方法：在一个三级新生儿重症监护室进行的前后设计研究。纳入标准为胎龄< 34周且临床RDS和无创通气呼吸支持的新生儿。将患者分为两组，对照组根据回顾性收集的经典标准给予表面活性剂适应症，新方案组根据双参数评分给予表面活性剂适应症。结果：纳入61例患者。新方案组较早接受表面活性剂治疗（所有患者均在前3小时，p < 0.013）。同样，经表面活性剂治疗后，该组新生儿FiO2较低（p 0.001），肺超声发展较好（p 0.008）。结论：双参数评分允许早期表面活性剂治疗和减少治疗后的需氧量。该方案提供了一种针对患者需求的更个性化的方法，这有助于我们做出决策。

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引用次数: 0

The expression of ferroptosis-related proteins GPX4 and PTGS2 in colonic tissues of pediatric Crohn’s disease 铁中毒相关蛋白GPX4和PTGS2在儿童克罗恩病结肠组织中的表达

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-18 DOI: 10.1016/j.jped.2025.101431

Shuanghong Zhang , Chunzhi Kang , Xiaoxiao He , Hui Huang , Qian Xiao

Objective

To investigate the expression of ferroptosis-related proteins GPX4 and PTGS2 in pediatric Crohn’s disease (CD).

Methods

Pediatric CD colonic tissues by colonoscopy biopsy were selected as the subjects. The Pediatric Crohn’s Disease Activity Index (PCDAI) was used to assess the disease activity of CD. Immunohistochemistry was used to detect the expression of GPX4 and PTGS2.

Results

30 CD cases were collected, with an average age of 12.36±2.65 years, including 9 in the mild activity phase, 8 in the moderate activity phase, and 13 in the severe activity phase. The positive expression rate of GPX4 in CD colonic tissues was lower than that in normal colonic tissues (p = 0.02); PTGS2 in CD colonic tissues was higher than that in normal colonic tissues (p = 0.004). Based on the average optical density (AOD) values of the positive reactants, the relative expression levels of GPX4 in CD colonic tissues were lower than those in normal colonic tissues (p = 0.02); PTGS2 in CD colonic tissues were higher than those in normal colonic tissues (p = 0.000). The staining scores of GPX4 decreased with increasing CD disease activity (p < 0.001); PTGS2 increased with increasing CD disease activity (p < 0.001). GPX4 was negatively correlated with CD disease activity (r = −0.326); PTGS2 was positively correlated with CD disease activity (r = 0.299).

Conclusion

GPX4 and PTGS2 may be involved in the process of ferroptosis in CD intestinal epithelial cells and are correlated with the severity of pediatric CD.

目的：探讨铁中毒相关蛋白GPX4和PTGS2在儿童克罗恩病（CD）中的表达。方法：选择经结肠镜活检的儿童CD结肠组织作为研究对象。采用儿童克罗恩病活跃性指数（PCDAI）评估CD的疾病活跃性。采用免疫组化检测GPX4和PTGS2的表达。结果：共收集CD病例30例，平均年龄12.36±2.65岁，其中轻度活动期9例，中度活动期8例，重度活动期13例。GPX4在CD结肠组织中的阳性表达率低于正常结肠组织（p = 0.02）；PTGS2在CD结肠组织中的表达高于正常结肠组织（p = 0.004）。从阳性反应物的平均光密度（AOD）值来看，GPX4在CD结肠组织中的相对表达量低于正常结肠组织（p = 0.02）；PTGS2在CD结肠组织中的表达高于正常结肠组织（p = 0.000）。结论：GPX4和PTGS2可能参与了CD肠上皮细胞铁凋亡的过程，并与儿童CD的严重程度相关。

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引用次数: 0

Predictive value of clinical indicators in children with community-acquired pneumonia complicated with Kawasaki disease 社区获得性肺炎合并川崎病患儿临床指标的预测价值

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-12 DOI: 10.1016/j.jped.2025.101424

Yuanhui Duan, Yuexu Ou, Xiaoming Gan, Jieling Li, Jie Cao

Objective

This study aimed to investigate the predictive value of clinical indicators in community-acquired pneumonia (CAP) complicated with Kawasaki disease (KD).

Methods

A retrospective analysis was conducted on the clinical data of inpatients with KD (39 cases), CAP (40 cases), and CAP complicated with KD (CAPKD, 32 cases) at the Children's Hospital of Chongqing Medical University from February 2021 to October 2022. The clinical indicators examined included serum cytokines (IL-2, IL-4, IL-6, IL-10, IL-17A, TNF-α, IFN-γ), White Blood Cell (WBC), Neutrophilic granulocyte percentage(NEU%), blood platelet(PLT), Red Blood Cell (RBC), Hemoglobin(Hb), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), procalcitonin(PCT), alanine aminotransferase(ALT), alkaline phosphatase(ALP), Gamma-glutamyl transferase (γ-GT), Aspartate aminotransferase (AST), albumin(Alb), Lactate dehydrogenase (LDH), globulin(Glb), and Total Protein(TP) in patients with KD, CAP, and CAPKD were compared.

Results

The present findings showed that IL-6 > 55.4pg/mL, IL-10 > 9.15pg/mL, PCT > 0.19ng/mL, and ALT > 22.5 U/L were important predictors of CAPKD. Additionally, Hb > 103.5 g /L, and TP > 63.85 g/L have predictive values for CAP without KD. The authors also observed a positive correlation between PCT and IL-6, IL-10. However, Hb and TP were negatively correlated with IL-6 and IL-10.

Conclusion

From the perspective of cytokine levels, IL-6 > 55.4 pg/mL and IL-10 > 9.15 pg/mL have important predictive values for CAPKD.

目的：探讨临床指标对社区获得性肺炎（CAP）合并川崎病（KD）的预测价值。方法：回顾性分析重庆医科大学附属儿童医院2021年2月至2022年10月住院的KD（39例）、CAP（40例）及CAP合并KD （CAPKD， 32例）患者的临床资料。临床指标包括血清细胞因子（IL-2、IL-4、IL-6、IL-10、IL-17A、TNF-α、IFN-γ）、白细胞（WBC）、中性粒细胞百分比（NEU%）、血小板（PLT）、红细胞（RBC）、血红蛋白（Hb）、红细胞沉降率（ESR）、c反应蛋白（CRP）、降钙素原（PCT）、丙氨酸转氨酶（ALT）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（γ-GT）、天冬氨酸转氨酶（AST）、白蛋白（Alb）、乳酸脱氢酶（LDH）、球蛋白（Glb）、比较KD、CAP和CAPKD患者的总蛋白（TP）。结果：IL-6 > 55.4pg/mL、IL-10 > 9.15pg/mL、PCT > 0.19ng/mL、ALT > 22.5 U/L是CAPKD的重要预测因子。此外，Hb > 103.5 g /L和TP > 63.85 g/L对无KD的CAP具有预测值。作者还观察到PCT与IL-6、IL-10呈正相关。而Hb、TP与IL-6、IL-10呈负相关。结论：从细胞因子水平来看，IL-6 > 55.4 pg/mL和IL-10 > 9.15 pg/mL对CAPKD有重要的预测价值。

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引用次数: 0

Sleep and breathing in children with cerebral palsy: it’s complicated….!* 脑瘫儿童的睡眠和呼吸：这很复杂....！

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-11 DOI: 10.1016/j.jped.2025.101434

David Gozal

引用次数: 0

Use of simulation in the evaluation of airway clearance devices 在气道间隙装置评估中的模拟应用。

IF 2.5 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-08-11 DOI: 10.1016/j.jped.2025.101435

Maria Lucia S. Hristonof , Marina C. Amantéa , Fernando J. Lazzaretti , Marina M. Bernardes , Luiza F. Xavier , Sergio Luis Amantéa

引用次数: 0

Exclusive breastfeeding modifies the association between maternal education and child development: a cross-sectional study nested in a cohort 纯母乳喂养改变了母亲教育和儿童发展之间的关系：一项嵌套在队列中的横断面研究。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.02.004

Luiza Alves Ford , Gabriela Buccini , Amanda Castelo Saragosa , Isadora de Araújo Martins , Janaína Matos Moreira , Stela Maris Aguiar Lemos , Claudia Regina Lindgren Alves , Vivian Mara Gonçalves de Oliveira Azevedo

Objective

Low maternal education is a risk factor for early childhood development (ECD), while exclusive breastfeeding (EBF) is a protective factor. This study examined the association between maternal education and ECD outcomes such as cognitive, language, and motor domains and whether EBF modifies this association in Brazil.

Methods

This cross-sectional study analyzed data from a non-probabilistic sample of 12-month-old infants born during the COVID-19. Moderation analyses using the Mann-Whitney test examined the effect of EBF at 6 months (effect modifier) on the relationship between Bayley-III cognitive, language, and motor scores as well as Bayley Global Score (BGS) (outcomes) and maternal education (independent variable). The effect size (r) from the sensitivity analysis of the effect modifier was estimated.

Results

A total of 269 full-term infants were evaluated. Higher maternal education was associated with better cognitive, language, and BGS (p < 0.00). EBF was associated with higher cognitive (p < 0.01), language (p < 0.02), and BGS (p < 0.00). EBF modified the effect of low maternal education (<10 years; and 10–12 years) on cognitive score and BGS. Among mothers with >10 years of education, a large effect size of EBF was observed on the BGS (r = 0.51), and a medium effect size was noted in the cognitive domain (r = 0.38).

Conclusion

Higher maternal education is associated with better scores on Bayley-III domains, and EBF can modify the effect of lower maternal education on ECD in Brazil. This is the first study to identify EBF as a mechanism to protect ECD in adverse conditions such as low maternal education.

目的：母亲受教育程度低是儿童早期发育（ECD）的危险因素，而纯母乳喂养（EBF）是保护因素。本研究考察了母亲教育与ECD结果（如认知、语言和运动领域）之间的关系，以及EBF是否改变了巴西的这种关系。方法：本横断面研究分析了COVID-19期间出生的12个月大婴儿的非概率样本数据。使用Mann-Whitney检验的适度分析检验了6个月时EBF（效果调节剂）对Bayley- iii认知、语言和运动评分以及Bayley全局评分（BGS）（结果）和母亲教育（自变量）之间关系的影响。从效应调节剂的敏感性分析中估计效应量(r)。结果：共对269例足月儿进行了评估。较高的母亲教育程度与更好的认知、语言和BGS相关（p ），10年教育，EBF对BGS有较大的效应量（r = 0.51），认知领域有中等效应量（r = 0.38）。结论：较高的母亲教育程度与较高的Bayley-III域得分相关，EBF可以修正巴西较低的母亲教育程度对ECD的影响。这是首次确定EBF是在不利条件下（如产妇教育程度低）保护ECD的机制。

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引用次数: 0

Factors associated with developmental delay in late preterm infants: the BRISA cohort 晚期早产儿发育迟缓的相关因素：BRISA队列

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.04.002

Paulo Ricardo Higassiaraguti Rocha , Gabriela Pap da Silva , Otávio Augusto Gratão , Marco Antonio Barbieri , Viviane Cunha Cardoso , Maria da Conceição Pereira Saraiva , Heloisa Bettiol

Objective

To investigate the association of sociodemographic characteristics, gestational factors, and birth outcomes with developmental delay from the second year of life in late preterm (LPT) infants.

Method

This study included 327 LPT infants from a cohort started in 2010. Developmental performance was assessed using the Bayley-III screening test. The covariates were obtained with questionnaires and from the maternity records. Hierarchical multiple logistic regression was used for analysis.

Results

Smoking during pregnancy was associated with fine motor and cognitive delays (OR = 2.27, 95 %CI 1.05–4.93 and OR = 2.22, 95 %CI 1.05–4.68, respectively). Living without a partner (OR = 2.98, 95 %CI 1.36–6.52) and intrauterine growth restriction of the child (OR = 2.63, 95 %CI 1.32–5.24) were associated with fine motor delay and neonatal intensive care unit admission with cognitive delay (OR = 2.11, 95 %CI 1.01–4.44).

Conclusions

These factors must be considered when implementing strategies for the diagnosis of possible developmental delays and when designing interventions for LPT children.

目的：探讨晚早产儿（LPT） 2岁起发育迟缓与社会人口学特征、妊娠因素和出生结局的关系。方法：本研究从2010年开始的队列中纳入327例LPT婴儿。采用Bayley-III筛选试验评估发育表现。协变量通过问卷调查和产妇记录获得。采用层次多元逻辑回归进行分析。结果：怀孕期间吸烟与精细运动和认知延迟相关（OR = 2.27,95 %CI 1.05-4.93, OR = 2.22,95 %CI 1.05-4.68）。生活没有一个伙伴(或 = 2.98,95 %可信区间1.36 - -6.52),宫内生长受限的孩子(或 = 2.63 95 %可信区间1.32 - -5.24)与动作有关延迟和新生儿重症监护室承认与认知延迟(或 = 2.11 95 %可信区间1.01 - -4.44)。结论：在实施可能的发育迟缓诊断策略和设计LPT儿童干预措施时，必须考虑这些因素。

{"title":"Factors associated with developmental delay in late preterm infants: the BRISA cohort","authors":"Paulo Ricardo Higassiaraguti Rocha , Gabriela Pap da Silva , Otávio Augusto Gratão , Marco Antonio Barbieri , Viviane Cunha Cardoso , Maria da Conceição Pereira Saraiva , Heloisa Bettiol","doi":"10.1016/j.jped.2025.04.002","DOIUrl":"10.1016/j.jped.2025.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association of sociodemographic characteristics, gestational factors, and birth outcomes with developmental delay from the second year of life in late preterm (LPT) infants.</div></div><div><h3>Method</h3><div>This study included 327 LPT infants from a cohort started in 2010. Developmental performance was assessed using the Bayley-III screening test. The covariates were obtained with questionnaires and from the maternity records. Hierarchical multiple logistic regression was used for analysis.</div></div><div><h3>Results</h3><div>Smoking during pregnancy was associated with fine motor and cognitive delays (OR = 2.27, 95 %CI 1.05–4.93 and OR = 2.22, 95 %CI 1.05–4.68, respectively). Living without a partner (OR = 2.98, 95 %CI 1.36–6.52) and intrauterine growth restriction of the child (OR = 2.63, 95 %CI 1.32–5.24) were associated with fine motor delay and neonatal intensive care unit admission with cognitive delay (OR = 2.11, 95 %CI 1.01–4.44).</div></div><div><h3>Conclusions</h3><div>These factors must be considered when implementing strategies for the diagnosis of possible developmental delays and when designing interventions for LPT children.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 657-664"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013671","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

Mental health issues in adolescent mothers and young adult mothers: the Brazilian context 青少年母亲和年轻成年母亲的心理健康问题：巴西情况。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.03.011

Amanda Ferreira de Carvalho , Daniela Dal Forno Kinalski Guaranha , Bruna Marmett , Júlia Mathias Reis , Carmem Lisiane Escouto de Souza , Bruna Silveira da Rosa , Tiago Chagas Dalcin , Sérgio Luis Amantea

Objective

To analyze anxiety and depression levels in adolescent and young adult mothers.

Methods

This multicenter cross-sectional study was conducted across Brazil’s five regions. A non-probabilistic sample of 1177 adolescent (10–19 years) and young adult (20–29 years) mothers was selected proportionally based on regional live birth rates. Data collection (August 2022–May 2023) involved a structured questionnaire assessing mental health (DASS-21), family support, and quality of life. Statistical analyses were performed using RStudio©, with p-values < 0.05 considered significant. The study was approved by the Research Ethics Committee (CAAE: 55465822.0.2003.5086).

Results

Depression or anxiety was reported by 22.7 % of both adolescent and young adult mothers, with 7.55 % and 7.07 % diagnosed during pregnancy, respectively. Among affected adolescents, 66.67 % did not seek follow-up care, primarily due to limited healthcare access (29.55 %). Adolescent mothers showed a higher prevalence of depression (p < 0.001), anxiety (p < 0.001), and stress (p = 0.027) postpartum. Depression was associated with a lack of emotional support from the child’s father (p = 0.096), insufficient family caregiving support (p = 0.014), and low perceived quality of life.

Conclusion

Adolescent mothers exhibit greater vulnerability to mental disorders, emphasizing the need for targeted psychological and social support during the perinatal period.

目的：分析青少年和青年母亲的焦虑和抑郁水平。方法：这项多中心横断面研究在巴西的五个地区进行。根据地区活产率按比例选择了1177名青少年（10-19岁）和年轻成人（20-29岁）母亲的非概率样本。数据收集（2022年8月至2023年5月）包括一份评估心理健康（DASS-21）、家庭支持和生活质量的结构化问卷。采用RStudio©进行统计学分析，p值< 0.05为差异有统计学意义。本研究已获得研究伦理委员会批准（CAAE: 55465822.0.2003.5086）。结果：22.7% %的青春期和年轻成年母亲报告抑郁或焦虑，其中7.55% %和7.07 %分别在怀孕期间被诊断。在受影响的青少年中，66.67 %没有寻求后续护理，主要是由于有限的医疗保健机会（29.55 %）。结论：青少年母亲更容易出现精神障碍，强调在围产期需要有针对性的心理和社会支持。

{"title":"Mental health issues in adolescent mothers and young adult mothers: the Brazilian context","authors":"Amanda Ferreira de Carvalho , Daniela Dal Forno Kinalski Guaranha , Bruna Marmett , Júlia Mathias Reis , Carmem Lisiane Escouto de Souza , Bruna Silveira da Rosa , Tiago Chagas Dalcin , Sérgio Luis Amantea","doi":"10.1016/j.jped.2025.03.011","DOIUrl":"10.1016/j.jped.2025.03.011","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze anxiety and depression levels in adolescent and young adult mothers.</div></div><div><h3>Methods</h3><div>This multicenter cross-sectional study was conducted across Brazil’s five regions. A non-probabilistic sample of 1177 adolescent (10–19 years) and young adult (20–29 years) mothers was selected proportionally based on regional live birth rates. Data collection (August 2022–May 2023) involved a structured questionnaire assessing mental health (DASS-21), family support, and quality of life. Statistical analyses were performed using RStudio©, with p-values < 0.05 considered significant. The study was approved by the Research Ethics Committee (CAAE: 55465822.0.2003.5086).</div></div><div><h3>Results</h3><div>Depression or anxiety was reported by 22.7 % of both adolescent and young adult mothers, with 7.55 % and 7.07 % diagnosed during pregnancy, respectively. Among affected adolescents, 66.67 % did not seek follow-up care, primarily due to limited healthcare access (29.55 %). Adolescent mothers showed a higher prevalence of depression (<em>p</em> < 0.001), anxiety (<em>p</em> < 0.001), and stress (<em>p</em> = 0.027) postpartum. Depression was associated with a lack of emotional support from the child’s father (<em>p</em> = 0.096), insufficient family caregiving support (<em>p</em> = 0.014), and low perceived quality of life.</div></div><div><h3>Conclusion</h3><div>Adolescent mothers exhibit greater vulnerability to mental disorders, emphasizing the need for targeted psychological and social support during the perinatal period.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 4","pages":"Pages 608-615"},"PeriodicalIF":2.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015554","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

Parental predictors of childhood vaccination adherence in border areas of Southern Vietnam: a first look at minority communities 越南南部边境地区儿童疫苗接种依从性的父母预测因素：首先看少数民族社区。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.04.005

An Dai Tran , Charuai Suwanbamrung , Muhammad Haroon Stanikzai , Nirachon Chutipattana , Shamarina Shohaimin , Patthanasak Khammaneechan , Le Minh Luan , Tran Phu Dien , Truong Thanh Nam , Phan Thanh Tung , Cua Ngoc Le

Objectives

Suboptimal timeliness and coverage of childhood vaccination programs undermined their effectiveness in achieving population-level immunity. This issue is particularly concerning among minority populations, where disparities in vaccination adherence persist. To address this gap, the study assessed the extent of parental adherence to age-appropriate childhood vaccination and its predictors among the minority children under five years of age.

Methods

This cross-sectional study was conducted in three districts of Dong Thap Province, Vietnam, and neighboring Cambodia. A total of 449 ethnic minority parents with children under five years old participated. Data were gathered through face-to-face household interviews using a structured questionnaire, complemented by direct observation of the children’s vaccination cards to verify adherence. Binary logistic regression was used to identify predictors of vaccination adherence.

Results

The adherence rate to childhood vaccination among children in the minority population was 18.9 %. Parental adherence was significantly higher for children under one year of age (aOR = 2.54, 95 % CI: 1.29–5.03) and for firstborn children (aOR = 3.48, 95 % CI: 1.36–9.92). Within the Health Belief Model framework, greater perceived barriers were associated with lower adherence (aOR = 0.32, 95 % CI: 0.21–0.49), while higher parental self-efficacy was linked to increased adherence (aOR = 1.84, 95 % CI: 1.11–3.11).

Conclusion

This study revealed a low parental adherence rate (18.9 %) to childhood vaccination. A child’s age, birth order, perceived barriers, and parental self-efficacy influenced adherence. These findings emphasize the need to incorporate these factors into targeted policies and interventions for improving immunization rates in minority populations and comparable settings.

目的：儿童疫苗接种计划的及时性和覆盖率不理想，破坏了其在实现人口水平免疫方面的有效性。这一问题在少数民族人群中尤其令人关切，因为他们在坚持接种疫苗方面仍然存在差异。为了解决这一差距，该研究评估了父母遵守适龄儿童疫苗接种的程度及其在五岁以下少数民族儿童中的预测因素。方法：横断面研究在越南同塔省的三个地区和邻近的柬埔寨进行。共有449名有5岁以下子女的少数民族家长参与了调查。通过使用结构化问卷进行面对面的家庭访谈收集数据，并通过直接观察儿童的疫苗接种卡来验证依从性。二元逻辑回归用于确定疫苗接种依从性的预测因子。结果：少数民族儿童儿童疫苗接种率为18.9 %。1岁以下儿童（aOR = 2.54,95 % CI: 1.29-5.03）和头胎儿童（aOR = 3.48,95 % CI: 1.36-9.92）的父母依从性显著较高。在健康信念模型框架内，更大的感知障碍与更低的依从性相关（aOR = 0.32,95 % CI: 0.21-0.49），而更高的父母自我效能与更高的依从性相关（aOR = 1.84,95 % CI: 1.11-3.11）。结论：本研究显示儿童接种疫苗的家长依从率较低（18.9 %）。儿童年龄、出生顺序、感知障碍和父母自我效能影响依从性。这些发现强调需要将这些因素纳入有针对性的政策和干预措施中，以提高少数群体和类似环境中的免疫接种率。

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引用次数: 0

Cutoff levels for newborn screening of 21-OH deficiency in a Brazilian metropolitan area 巴西大都市地区新生儿21-OH缺乏筛查的临界值

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2025-07-01 DOI: 10.1016/j.jped.2025.03.003

Kallianna Paula Duarte Gameleira , Juliana de Vasconcellos Thomas , Vitor Guilherme Brito de Araújo , Cláudia Vicari Bolognani , Sérgio Eduardo Soares Fernandes , Fábio Ferreira Amorim

Objective

To evaluate the accuracy of neonatal 17-hydroxyprogesterone (N17OHP) levels adjusted for birth weight (BW) and time of the sample collection (TC) and propose optimized cutoff values to improve the effectiveness of newborn screening tests for congenital adrenal hyperplasia (CAHNBS) programs, utilizing a comprehensive dataset encompassing all newborn screening tests for 21-hydroxylase deficiency (21OHD) conducted over a decade in a Brazilian metropolitan region.

Methods

A cross-sectional study analyzed all CAHNBS tests from newborns aged 2 to 7 days in the Federal District, Brazil, from January 2012 to September 2022. The accuracy of cutoff values based on the 99.5th percentile (99.5P) for BW and TC was compared to the CAHNBS program of São Paulo and a threshold of ≥20 mg/dL. New cutoff values were proposed to enhance screening effectiveness.

Results

Among the 340,291 newborns screened, CAH-21OHD was confirmed in 11 cases. The N17OHP cutoff in this sample reduced false positives for neonates ≤ 2500 g but increased them for those > 2500 g The proposed cutoff values based on 99.5P from the sample for neonates ≤ 2500 g, combined with a fixed cutoff ≥ 20 mg/dL for those > 2500 g, showed superior specificity (99.83 %, 95 % CI: 99.81–99.84 %), LR+ (579.16, 95 % CI: 524.23–627.87), PPV (1.84, 95 %CI: 1.70–1.99), and accuracy (99.83 %, 95 %CI: 99.81–99.84 %) than prior criteria.

Conclusion

The proposed 17OHP cutoff strategy effectively reduced false positives, improving specificity, LR+, PPV, and accuracy Thus, it optimized CAHNBS programs while minimizing unnecessary costs and parental distress.

目的：评估新生儿17-羟孕酮（N17OHP）水平根据出生体重（BW）和样本采集时间（TC）调整的准确性，并提出优化的截止值，以提高先天性肾上腺增生（CAHNBS）项目新生儿筛查试验的有效性，利用一个综合数据集，包括在巴西大都市地区进行的超过十年的所有21-羟化酶缺乏症（21OHD）新生儿筛查试验。方法：一项横断面研究分析了2012年1月至2022年9月期间巴西联邦区2至7天新生儿的所有CAHNBS检测结果。基于BW和TC的99.5百分位（99.5P）截断值的准确性与圣保罗的CAHNBS程序和≥20 mg/dL的阈值进行比较。为了提高筛选效果，提出了新的临界值。结果：在340,291例筛查的新生儿中，11例确诊为CAH-21OHD。N17OHP截止在这个示例减少假阳性的新生儿≤2500 g,但增加他们对那些> 2500克提出的截止值基于样本的99.5便士新生儿≤2500 g,加上一个固定截止≥20 为> 2500 mg / dL g,显示优越的特异性(99.83 %、95 % CI: 99.81 - -99.84 %),LR +(579.16, 95 % CI: 524.23 - -627.87), PPV(1.84, 95 % CI: 1.70 - -1.99),和准确性(99.83 %、95 % CI: 99.81 - -99.84 %)比之前的标准。结论：提出的17OHP切断策略有效地减少了假阳性，提高了特异性、LR+、PPV和准确性，从而优化了CAHNBS方案，同时最大限度地减少了不必要的成本和父母的痛苦。

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引用次数: 0