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Abstract Objective: Among the mechanisms proposed for the development of bronchopulmonary dysplasia is the increase in the pulmonary inflammatory process and oxidative stress. Thus, the control of this process may result in improvements in bronchopulmonary dysplasia-related outcomes. This study aims to analyze the current scientific evidence regarding the use of budesonide, a potent anti-inflammatory drug, associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia. Methods: A systematic review of the literature was performed on the Embase and MEDLINE platforms, and studies that compared budesonide with pulmonary surfactant versus pulmonary surfactant for treating respiratory distress syndrome were included. The primary outcome was a reduction in bronchopulmonary dysplasia or death. Results: Four randomized clinical trials and two observational studies were included in this systematic review. Three of the randomized clinical trials found a reduction in bronchopulmonary dysplasia or death in the use of budesonide with the surfactant, all the other studies (1 clinical trial and 2 observational studies) found no statistical differences between the groups for the primary outcomes. The three main studies showed a reduction in the primary outcome; however, all studies showed great heterogeneity regarding the type of surfactant (poractant or beractant) and the method of administration. Conclusion: Robust clinical studies, in a heterogeneous population, using porcine surfactant associated with budesonide, with administration by a minimally invasive technique are necessary for there to be a recommendation based on scientific evidence for its widespread use.

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Abstract Objective: to assess evidence available in the literature about the use of sedation and analgesia for intratracheal intubation of newborns. Data sources: by means of an integrative literature review, the authors looked for evidence related to the theme from the last ten years, indexed in the Pubmed, Medline, Lilacs, Scielo, and Scopus databases, by combining the descriptors: newborn, intratracheal intubation, and analgesia. Articles in Portuguese, English, and Spanish that met the research purpose were included. Data summary: After applying the eligibility criteria, ten articles on the topic were obtained, predominantly narrative reviews, retrospective studies, observational studies, and only one non-randomized clinical trial, which characterizes the literature related to the topic as having a low level of scientific evidence. There is still no consensus in the literature on which medications and indications are for use in non-elective intubations, despite the ethical recommendation. Discussion: pain and its deleterious effects should not be neglected. Neonatal Intensive Care Units should have their own protocols regarding sedation and analgesia for intubation considering the individual characteristics of each patient. There is an ethical recommendation regarding the use of sedation and analgesia for intubation since it is a known painful procedure.

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Abstract Objective: To analyze the temporal tendency of stunting prevalence among children under five years of age registered in the Food and Nutritional Surveillance System (SISVAN) in the Brazilian Northern Region, from 2008 to 2017. Methods: Ecological time-series study with data from SISVAN. The annual variation rate for the prevalence of undernutrition, measured by the presence of stunting (low height-for-age index), was estimated for the Northern Region and for each of its states using the Prais-Winsten regression model with and without variable adjustment for SISVAN coverage to explore the relationship between these variables. Results: The Northern Region showed a tendency toward the reduction of chronic child stunting, with an annual variation of -5.30% (95%CI -9.64; -0.77) in the period studied. The states of Acre (-7.19%; 95%CI -12.31; -1.77), Pará (-4.86%; 95%CI -9.44; -0.03), and Tocantins (-6.22%; 95%CI -9.88; -2.41) showed a tendency to reduce the prevalence of stunting, while the other four states showed stability during the period. A strong negative correlation was found between SISVAN coverage and the prevalence of stunting in the states of Acre (beta: -0.725), Amazonas (beta: -0.874), Pará (beta: -0.841), and Tocantins (beta: -0.871), indicating that the increase in system coverage is associated with a reduction of stunting. Conclusions: There is a tendency toward a reduction in the prevalence of stunting particularly in three states and in the North Region as a whole, from 2008 to 2017. The coverage by the system was associated with a reduction in the prevalence of child stunting in four states.

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Abstract Objectives: To explain the high mortality of septic shock in children with cancer. Methods: A retrospective cohort from 2016 to 2020, of children aged 0 to 18 years, and septic shock. Results: The authors included 139 patients. Acute lymphocytic leukemia was the most frequent diagnosis (16.5%), and Gram-negative bacteria were the most frequent blood culture isolates (22.3%). There were 57 deaths in ICU (41%), 10 in the first 24 hours of shock (early death). A LASSO model with variables: neutropenia (coefficient 0.215), respiratory (0.81), hematological (1.41), and neurological (0.72) dysfunctions, age (-0.002) and solid tumor recurrence (0.34) generated AUC = 0.79 for the early death outcome. Survivors had significant differences in the PRISM-IV score (mean ± SD 10.9 ± 6.2 in the survivors, 14.1 ± 6.5 in the deceased, p = 0.004), and in the mean number of organ dysfunctions (3.2 ± 1.1 in the survivors, 3.8 ± 6.5 in the deceased, p < 0.001). A positive fluid balance in the first 24 hours of sepsis between 2% and 6% of body weight showed a reduction effect on the probability of death in ICU (hazard ratio 0.47, 95% CI 0.24–0.92, p = 0.027). The recurrence of any cancer was a predictor of in-hospital death, regardless of severity. Conclusions: Recurrence of any cancer is an important risk of sepsis-related death. A positive fluid balance between 20 and 60 mL/kg or 2% and 6% of body weight in the first 24 hours after the onset of sepsis is related to lower mortality.

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Abstract Objective: To investigate the predictive validity and cut-off point of the Turkish version of the Infant Colic Scale (ICS) in the diagnosis of colic. Methods: This methodological study was carried out in a pediatric outpatient clinic of a university hospital in Turkey with infants aged 6–16 weeks (n = 133). The data were collected using the Mother-Infant Description Form, the ICS, and the Rome IV criteria form. The scale is a 6-point Likert-type scale consisting of 19 items in total. A low total mean score obtained from it indicates that the probability of colic increases, while a high mean score indicates that the probability of colic decreases. The Rome IV criteria were used as the gold standard. Results: The mean score obtained from the ICS was 59.4 ± 13.7. According to the Rome IV criteria, 26.3% of the infants had colic. The area under the ROC curve was 87.4% (95% CI = 0.815–0.934, SE = 0.30, p = 0.001), and the cut-off point for the best sensitivity value (88.6%) and the best specificity value (70.5%) of the ICS was determined to be 60.5. According to the cut-off point, the positive predictive value was 51%, and the negative predictive value was 94%. Conclusion: The predictive validity of the Turkish version of the ICS was found to be at a good level with high sensitivity and acceptable specificity for a cut-off point of 60.5. Healthcare professionals working in the child field can use the ICS to exclude colic in infants.

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Abstract Objective: To investigate the effects of different physical exercise programs and polymorphisms of the FTO (fat mass and obesity-associated gene) on body composition and cardiovascular risk factors in adolescents with overweight and obesity. Methods: A randomized, parallel, double-blind clinical trial consisting of the adolescent overweight from the state public network, in a simple representative random sample, who participated in an aerobic exercise or weight training intervention for 10 weeks. Anthropometry, body composition, biochemical markers, sexual maturation, and rs9939609 polymorphism in the FTO gene were assessed. 347 adolescents had their characterization of nutritional status. 72 individuals with overweight and obesity were invited to participate. 39 remained for the start of the program and were randomly allocated to both types of intervention. In the end, 26 subjects participated in the intervention programs, with 12 and 14 in the aerobic and weight training programs, respectively. Results: Heterozygous and homozygous bearers of risk allele A participating in the aerobic program showed improvements in glycemia (p = 0.002) and total cholesterol (p = 0.023) and a reduction in body fat mass (p = 0.041). The weight training program reduced glycemia in patients with the risk allele A (p = 0.027). Cameron’s stage four sexual maturation participants were 2.1 times more likely to improve their body fat (CI = 1.31–3.39). Conclusion: Aerobic exercises produced exclusively a significant decrease in fat mass and total cholesterol in patients with risk allele A. Distinct physical exercise programs may cause diverse changes in risk variables related to the health of adolescents.

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Abstract Objective: To verify the prevalence of reported cases and the factors associated with physical violence against the child. Methods: Cross-sectional study with data from reported cases of physical violence against children from 2011 to 2018 in the state of Espírito Santo, Brazil. The characteristics of the victim, author and aggression were studied, and the associations were analyzed using Poisson regression. Results: In the period, were notified of 3,127 cases of violence against children. The frequency of physical violence was 23.6% (CI95%: 22.2-25.2), more prevalent in males; for the age group of 6 to 9 years; in rural areas; among aggressors over 20 years of age; outside the residence, and night/dawn shift. Conclusions: Physical violence affects an expressive number of children, mainly committed by adult individuals, probably being the result of an asymmetric relationship of power. Thus, it is important to highlight the need for child protection actions together with cultural and structural changes in our society.

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Abstract Objective: The objective of this study was to analyze masticatory characteristics in children from 7 to 10 years, and to compare these characteristics among normal weight, overweight and obese children. Methods: This is a cross-sectional study, conducted in northeast Brazil, with a sample of 160 children, aged 7 to 10 years. The authors evaluated: nutritional and dental status; food intake; masticatory parameters and orofacial myofunctional characteristics. The children were divided according to nutritional status into normal weight (n = 101), overweight (n = 33) and obesity (n = 26) groups. Results: The results showed that Obese children had a larger bite size (g) (median = 6.0, Q1-Q3 = 4.0-9.0, p = 0.049) and performed fewer masticatory sequences (median = 3.0, Q1-Q3 = 2.0-3.2, p = 0.024) than children with normal weight (median = 5.0, Q1-Q3 = 4.0-7.0; median = 4.0, Q1-Q3 = 3.0-5.0). Furthermore, obese children finished feeding in a shorter time (s) (median = 62.5, Q1-Q3 = 50.5-70.0, p = 0.039) than normal weight children (median = 66.0, Q1-Q3 = 56.5-78.0) and overweight children (median = 66.0, Q1-Q3 = 58.0-81.5). Conclusions: The present results suggest that obese children present changes in mastication, evidenced by larger bite-size, performing fewer masticatory sequences and rapid mastication, which may contribute to increased food consumption and the development of excess weight.

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Abstract Objective: To investigate the optimal timing of initial intravenous immunoglobulin (IVIG) treatment in Kawasaki disease (KD) patients. Methods: KD patients were classified as the early group (day 1-4), conventional group (day 5-7), conventional group (day 8-10), and late group (after day 10). Differences among the groups were analyzed by ANOVA and Chi-square analysis. Predictors of IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analyses and receiver operating characteristic (ROC) curve analysis. Results: There were no significant differences in IVIG resistance among the 4 groups (p = 0.335). The sensitivity analysis also confirmed no difference in the IVIG resistance between those who started the initial IVIG ≤ day 7 of illness and those who received IVIG >day 7 of illness (p = 0.761). In addition, patients who received IVIG administration more than 7 days from the onset had a higher proportion of coronary artery abnormalities (p = 0.034) and longer length of hospitalization (p = 0.033) than those who started IVIG administration less than 7 days. The optimal cut-off value of initial IVIG administration time for predicting IVIG resistance was >7 days, with a sensitivity of 75.25% and specificity of 82.41%. Conclusions: IVIG therapy within 7 days of illness is found to be more effective for reducing the risk of coronary artery abnormalities than those who received IVIG >day 7 of illness. IVIG treatment within the 7 days of illness seems to be the optimal therapeutic window of IVIG. However, further prospective studies with long-term follow-up are required.

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Abstract Objective: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. Methods: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. Results: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. Conclusion: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring

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Abstract Objective: This study aimed to investigate non-alcoholic fatty liver disease (NAFLD) occurrence and factors associated with the disease in phenylketonuria (PKU) patients undergoing exclusive dietary treatment. Method: This cross-sectional study included 101 adolescents 10 to < 20 years of age with PKU, who were undergoing exclusive dietary treatment and monitored since early diagnosis at a single reference service. Anthropometric and biochemical assessments were performed and food intake was documented, and an ultrasound diagnosis of NAFLD was established. Data were evaluated using the Student’s t-test for continuous variables, the chi-square for categorical variables, and logistic regression using the Wald chi-squared test; differences with p < 0.05 were considered to be statistically significant. Results: NAFLD was detected in 26 (25.7%) teenagers. There was no difference in prevalence between the sexes or nutritional status. The final logistic regression model revealed low sensitivity (26.1%) and high specificity (94.7%). The specificity suggested a lower likelihood of NAFLD in older adolescents, in the presence of normal or high levels of alkaline phosphatase, lower carbohydrate intake, and adequate protein and lipid intake. Conclusions: The prevalence of NAFLD in adolescents with PKU was higher than that found in healthy Brazilian adolescents and similar to that found in obese Brazilian children, suggesting a higher risk for NAFLD in patients with PKU treated exclusively by dietary modification.

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Abstract Objective: To evaluate the conservative management of newborns born at ≥35 weeks of gestational age, at risk for early-onset neonatal sepsis (EOS). Methods: Retrospective, analytic cohort study (2016 to 2019), including newborns ≥35 weeks of gestational at risk of EOS, asymptomatic at birth, managed conservatively in full rooming-in: serial physical examination and clinical observation for at least 48 h. They were classified into three groups, according to the clinical course: asymptomatic (group A), symptomatic for other reasons (group B), and with sepsis (group C). Risk factors, clinical signs and differential diagnoses of sepsis, length of stay, and discharge conditions were evaluated. Results: The authors evaluated 769 asymptomatic newborns at risk of EOS. (mean birth weight 2999 ± 485 g and gestational age 37.6 ± 1.7 weeks, respectively) corresponding to 12.2% of rooming-in admissions. The most prevalent risk factors were colonization by Group B Streptococcus (29%), prolonged rupture membrane duration (21.9%) and preterm labor (21.4%). Most of all of them (53.9%) remained asymptomatic (group A). Group B corresponded for 45.3%, and the most common clinical signs were hypothermia (24.5%), tremors (8.7%) and vomiting (8%). Environmental dysthermia (50.7%), prematurity (20.0%), and feeding intolerance (15.7%) were common in Group B. Laboratory tests were performed in 3.5%. Five patients (one confirmed) comprised group C (0.8/1,000 live births). There were no deaths. The median length of stay was 64 h (IQR 50-93). Conclusion: The rate of clinical/confirmed EOS was low. Most of the symptomatic patients only needed clinical evaluation to rule out sepsis. Management was shown to be safe.

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Abstract Objective: This study aimed to evaluate the role of miRNA-492 in the progression of mycoplasma pneumoniae (MP) infection in pediatric patients. Methods: Forty-six children admitted to the present study’s hospital and diagnosed with mycoplasma pneumonia were recruited as the study group from March 2018 to August 2019, and 40 healthy children were selected as the control group. Results: The expression levels of miRNA-492, TNF-α, IL-6 and IL-18 in the study group were significantly higher than those in the control group (p < 0.05). There was no significant correlation between miRNA-492 and most of the immune-correlated indicators in the study group, except for IL-6, IL-18 and HMGB1. Meanwhile, overexpression of miRNA-492 increased IL-6 secretion in PMA-activated monocytes (p < 0.01). Conclusion: The present study’s results suggested that miRNA-492 might play a role in the pathogenesis of mycoplasma pneumoniae pneumonia in children by regulating the secretion of immune-inflammatory factors such as IL-6 and IL-18 in the mononuclear macrophages.

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Abstract Objective: To investigate the association between emotional and behavioral difficulties in schoolchildren and maternal educational practices. Methods: Participants and Setting: 631 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. Cross-sectional study carried out between 2013 and 2014. It integrates a prospective cohort study designed to investigate the consequences of intimate partner violence that occurred during pregnancy, postpartum, and seven years after birth for the physical and mental health of women and their children. Maternal educational practices were assessed using the Parent-Child Conflict Tactics Scale (CTSPC – mother-child version) and the child’s behavioral and emotional disorders through the Strengths and Difficulties Questionnaire (SDQ) mother-version. The association was estimated through crude and adjusted prevalence ratios, using Poisson regression considering the 95% confidence interval. Results: The prevalence of violent maternal educational practices was 91.8% (572/631) being 89.7% (566/631) of psychological aggression and 75.6% of physical aggression, subdivided into corporal punishment (73.5%), physical maltreatment (35.8%) and severe physical maltreatment (1.7%). Corporal punishment (Adjusted PR 1.5; CI 95%: 1.1–2.1; p = 0.010) and severe physical maltreatment (Adjusted PR 1.9; CI 95%: 1.3–2.8; p = 0.002) were associated with emotional and behavioral difficulties in schoolchildren. Conclusion: The high prevalence of violent maternal educational practices, especially corporal punishment and severe physical maltreatment is associated with emotional and behavioral disorders in children. Therefore, it is necessary to interventions that promote parental support and effective use of non-violent discipline in conducting the educational process to establish healthier family relationships and to prevent/mitigate the impact of emotional and behavioral problems in children. © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).