Abstract in English:

Abstract Objective: To provide cutting-edge information on the impact and risks of using Electronic Nicotine Delivery Systems (ENDS) by children and adolescents, based on the latest evidence published in the literature. Data source: A comprehensive search was carried out on PubMed, using the expressions “electronic cigarettes” OR “electronic nicotine delivery systems” OR “vaping” AND “adolescent” AND “risks” AND “acute lung injury’. All retrieved articles had their titles and abstracts read to identify and fully read the papers reporting the most recent evidence on each subject. Summary of findings: The use of ENDS has alarmingly increased in Brazil and around the world. The possibility of customizing use, the choice of flavors and nicotine content, and the general notion that these devices are harmless when compared to conventional cigarettes are some of the factors responsible for this increase. Numerous scientific studies have proven that electronic cigarettes have serious consequences for the respiratory system, such as EVALI (E-cigarette or Vaping-Associated Lung Injury) and difficult-to-control asthma, as well as harmful effects on the neurological, cardiovascular, gastrointestinal, and immunological systems. High concentrations of nicotine make many young people addicted to this substance. In Brazil, commercialization, import, and advertising are prohibited. The viable interventions to address the use of these devices in children and adolescents are prevention and behavioral counseling. Conclusion: There is clear scientific evidence that these devices pose a risk to the physical and mental health of children and adolescents.

Abstract in English:

Abstract Objective: There is a pressing need for public health practitioners to understand cultural values influencing parents on the uptake of human papillomavirus (HPV) vaccination for their daughters, which is presenting a growing challenge to close the immunization gap worldwide. Parental decisions were predominantly shaped by cultural norms and values. This systematic review encompasses parental perspectives on the influence of cultural values on the uptake of HPV vaccination by their daughters. Method: This systematic review was registered on PROSPERO CRD42020211324. Eligible articles were selected from CINAHL, PsyclNFO, EMBASE, PubMed and Science Direct. Original qualitative studies exploring parental perspectives on the influence of cultural values on the uptake of HPV vaccination by their daughters under the age of 18, published in the English language with no restriction dates were reviewed. Two authors independently screened abstracts, conducted the fill-text review, extracted information using a standardized form, and assessed study quality. A third author is needed to resolve the disagreements if necessary. Results: Of the 1552 citations, 22 were included, with information on 639 parents. Five themes emerged from the data: sexuality-related concerns; upbringing and moral values; obligation to protect; external influences; and vaccine-related concerns. Conclusion: This systematic review is beneficial to identify and understand the culturally related facilitators and barriers to HPV vaccination among young women for the development of strategies to optimize HPV vaccine coverage among this population group by the policymakers. © 2024 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

Abstract in English:

Abstract Objective: To provide a theoretical study and model for the bioethical foundations of the factors that influence adolescents’ healthcare decisional capacity. Sources: Materials from diverse sources, including indexed articles in recognized databases and official government documents, were examined for a purposefully selected sample. The research consisted of two stages: selection of documents and reflective thematic analysis, followed by the preparation of a report. The analysis adopted a phenomenological stance and a reflective view compatible with human rights. To reduce bias and ensure the robustness of the results, measures such as data triangulation were employed. Ethical measures were taken to ensure data integrity, including considerations of anonymity and conflicts of interest in the selected studies. Summary of the findings: It was possible to list intrinsic and extrinsic factors of the adolescent patient that influence their decisional capacity regarding health. A theoretical model was developed to discuss these factors for evaluation by means of an infographic. Conclusions: It seems clear that the evaluation of healthcare decisional capacity of adolescents must position itself ethically regarding the tension between the moral duty to respect the self-determination of the able subject and the need to protect adolescents decidedly unable to make a specific health decision at a given time.

Abstract in English:

Abstract Objective: This study aimed to assess the prevalence of the double burden of malnutrition (DBM) at the individual level in children and adolescents through a comprehensive literature review. Sources: Electronic databases, including PubMed, Scopus, and Web of Science, were searched for articles published up until September 9, 2022. Studies reporting individual-level DBM in children and adolescents were included, and meta-regression models were used to investigate potential causes of heterogeneity across studies. Summary of the findings: Of the 784 articles initially retrieved, 11 met the inclusion criteria. The overweight/obesity prevalence ranges from 8.1 % to 37.0 %, and the undernutrition (stunting, micronutrient deficiency, or anemia) from 4.2 % and 73.0 %. The prevalence of DBM ranged from 1 % to 35.4 %, with the highest rates observed in low- and middle-income countries. Among children, Asia reported the highest DBM prevalence, while in adolescents, Latin America had the highest rates. The review revealed significant variability in DBM prevalence across studies, with a notable increase in research on this topic over the past decade (2013-2022). Conclusion: These findings underscore the concerning global prevalence of the double burden of malnutrition in children and adolescents, particularly in low- and middle-income countries. Standardized definitions and methods are urgently needed to improve comparability, along with further research to identify the specific drivers of DBM and inform effective prevention strategies. CRD42022333424.

Abstract in English:

Abstract Objective: To assess the frequency and potential influencing factors of the remission phase (RP) in Type 1 Diabetes (T1D) as well as the associations between various criteria used for its definition. Methods: This was a retrospective cohort study based on data collected from medical records. Three criteria were used to evaluate RP: (1) Glycated hemoglobin (HbA1c) < 7.5 % with an insulin dose < 0.5 U/Kg/day, (2) HbA1c < 7 % with an insulin dose < 0.5 U/Kg/day, and (3) Insulin Dose Adjusted A1c (IDAA1c) < 9, calculated as IDAA1c = HbA1c (%) + [4 x insulin dose (U/Kg/day)]. Statistical analyses included the Mann-Whitney U Test, Chi-Square Test, and Spearman Correlation. Results: The sample consisted of 144 T1D patients, with a mean age of 26.22 ± 8.30 years and a mean age of onset of 13.30 ± 8.50 years. Of these, 52.9 % were female, 60.3 % were Caucasoid, and 31 % experienced diabetic ketoacidosis (DKA) at disease onset. One year after diagnosis, the occurrence of RP ranged from 27.2 % to 46.8 %, depending on the criteria used. Three patients experienced RP even after seven years, according to criterion 3. No association was found between RP and age, DKA, or pubertal status at onset. The three RP criteria were highly associated with each other (p < 0.001). Conclusion: A significant proportion of patients in this sample experienced RP within 12 months of diagnosis. The three criteria for defining RP were strongly associated, indicating their reliability in both clinical and research contexts.

Abstract in English:

Abstract Objective: Investigate the association between the age of treatment onset and confirmatory TSH level (as an indicator of severity) with a greater risk of developmental delay in infants with congenital hypothyroidism (CH). Method: The authors conducted a cross-sectional, observational, unmatched case-control study at a Brazilian neonatal screening reference center. Seventy-seven infants with CH (mean age: 12 ± 6.4 months) were examined. The authors evaluated their performance using the Bayley-III Screening Test and categorized them as “LOWER RISK” (competent category) or “GREATER RISK” (combined at-risk + emergent categories) for developmental delay based on the 25th percentile cutoff. Results: Infants with CH are at a higher risk of non-competent performance in cognition, receptive language, fine motor skills, and gross motor skills when compared to infants without CH. This risk is more pronounced in infants with more severe indications of CH (TSH > 30 μUI/L in the confirmatory test) for cognition (OR = 5.64; p = 0.01), receptive language (OR = 14.68; p = 0.000), fine motor skills (OR = 8.25; p = 0.000), and gross motor skills (OR = 5.00; p = 0.011). Conclusion: The level of TSH in the confirmatory test can be a good indicator for identifying infants with CH who are at a higher risk of non-competent performance in cognition, receptive language, and motor skills. Monitoring development, early detection of delays, and intervention programs are particularly important for infants with CH.

Abstract in English:

Abstract Objective: To compare the perinatal outcomes of women with Gestational Diabetes Mellitus (GDM), between pregnant treated only with lifestyle changes and pregnant treated with insulin and lifestyle changes. Methods: Prospective cohort study with follow-up of 64 women with GDM during the prenatal care and postpartum period until hospital discharge, divided into a control group (43) and an insulin group (21), with collection of sociodemographic, clinical, glycemic control and perinatal outcome data. Fetal macrosomia (≥ 4 Kg), or large-for-gestational-age newborns were considered the primary outcome of the research. Results: Pre-pregnancy BMI (31.2 ± 3.9 versus 28.8 ± 5.5), diastolic blood pressure (75 ± 8.7 versus 69 ± 6.9) and postprandial blood glucose (136.6 versus 115.4) were higher in the insulin group, respectively. The control group had an average birth weight of 3058 g and an incidence of preterm birth of 11.6 %, while the insulin group had an average birth weight of 3203 g, with an incidence of preterm birth of 4.8 %. The majority of newborns had an adequate weight for their gestational age. Even all participants met glycemic goals, in the insulin group the Apgar score at the 5th minute and exclusive breastfeeding was lower, had 100 % of resuscitation cases, and a longer inpatient period. Conclusion: These data reinforce that even during prenatal care with lifestyle changes, new-borns of women with GDM treated with insulin had worse outcomes, including clinical complications and less exclusive breastfeeding. It is important in prenatal care to identify neonates with risk for prevention and health promotion measures.

Abstract in English:

Abstract Objective: The aim of this study was to assess whether the micronutrients zinc and copper, provided by human milk additives, are sufficient for very low birth weight preterm infants. Method: A phase 1 randomized double-blind controlled trial was conducted with very low birth weight preterm infants. This is a secondary analysis of copper and zinc. Sixty-six newborns were part of the initial sample, with forty participating and reaching the final stage of the study. Inclusion criteria were: gestational age less than 37 weeks, birth weight greater than or equal to 750 g and less than or equal to 1500 g, small or appropriate for gestational age, exclusively receiving human milk at a volume greater than or equal to 100 mL per kilogram per day, and hemodynamically stable. Participants were randomly assigned to two groups: intervention, Lioneo (received human milk with additive based on lyophilized human milk), n = 20, and control, HMCA (received human milk with commercial additive based on cow’s milk protein), n = 20, and their serum levels of zinc and copper were measured on the first and twenty-first days. Results: There was a reduction in intragroup zinc serum levels from the first to the twenty-first day of the study (p < 0.01). There was no intergroup difference. No difference was found in serum copper levels. Conclusion: Human milk additives were not sufficient to maintain adequate zinc serum levels in very low birth weight newborns. It was not possible to affirm whether human milk additives were sufficient to maintain adequate serum copper levels in the studied sample. UTN: U1111—1220—0550.

Abstract in English:

Abstract Objective: Langerhans cell histiocytosis (LCH) is a rare myeloid neoplasm with inflammatory characteristics. This study aims to investigate the correlation between sCD25 levels and clinical characteristics, as well as prognosis, in pediatric LCH. Methods: Serum sCD25 levels were measured in 370 LCH patients under 18 years old using ELISA assays. The patients were divided into two cohorts based on different treatment regimens. We further assessed the predictive value for the prognosis impact of sCD25 in a test cohort, which was validated in the independent validation cohort. Results: The median serum sCD25 level at diagnosis was 3908 pg/ml (range: 231–44 000pg/ml). sCD25 level was significantly higher in multi-system and risk organ positive (MS RO+) LCH patients compared to single-system(SS) LCH patients (p < 0.001). Patients with elevated sCD25 were more likely to have involvement of risk organs, skin, lung, lymph nodes, or pituitary (all p < 0.05). sCD25 level could predict LCH progression and relapse, with an area under the ROC curve of 60.6 %. The optimal cutoff value was determined at 2921 pg/ml. Patients in the high-sCD25 group had significantly worse progression-free survival compared to those in the low-sCD25 group (p < 0.05). Conclusion: Elevated serum sCD25 level at initial diagnosis was associated with high-risk clinical features and worse prognosis. sCD25 level can predict the progression/recurrence of LCH following first-line chemotherapy.

Abstract in English:

Abstract Objective: To investigate the association between allergic diseases and the tendency to self-harm in adolescents, considering the role of sedentary behavior. Methods: This was a population-based cross-sectional study, carried out in 2022, with 727 adolescents aged 12 to 19 years, from a capital in the Northeast of Brazil. The authors evaluated the association between each allergic disease (asthma, rhinitis and eczema) and self-harm, sedentary behavior and other variables. The authors performed an adjusted analysis of the associations between each allergy disease and the tendency to self-harm and then adjusted to the presence of family members and sedentary behavior. Results: The prevalence of asthma, rhinitis and eczema were 18.76%, 36.21% and 12.86%, respectively. Sedentary behavior and tendency to self-harm were more frequently reported in asthmatics (PR 2.16; 95% CI: 1.55 – 3.00 and PR 1.98; 95% CI: 1.47 – 2.68, for sedentary behavior and self-harm respectively), rhinitis (PR 1.53; 95% CI: 1.25 – 1.88 and PR 1.33; 95% CI: 1.09 – 1.62, respectively) and eczema (PR 2.35; 95% CI: 1.54 – 3.58 and PR 1.55; 95% CI: 1.05 – 2.28, respectively). There was a reduction in the strength of this association in the three conditions, which included a loss of association. Conclusion: High rates of sedentary behavior and self-harm in those with asthma, rhinitis and eczema. Physical activity attenuated the risk for self-harm. It warns about the urgency in detecting these factors, whether in the diagnosis or in the implementation of therapy, seeking to reduce their harmful consequences in the short and long term.

Abstract in English:

Abstract Objectives: Septo-optic dysplasia (SOD) is a relatively rare clinical condition. However, there has been a significant increase in its incidence over the years. Diagnosis is clinical and made when there are at least 2 components of the classic triad: Optic nerve hypoplasia (ONH), midline malformation, and pituitary dysfunction. This study aims to describe the clinical and complementary exam characteristics of patients with SOD. Methods: A retrospective study of review of medical records of 48 patients cohort (24 female) with SOD followed to 2023. Results: The average age at diagnosis was 3.90 ± 3.85 years. Maternal age was ≤ 25 years at the time of delivery in 50% (24/48) of cases. Visual and developmental impairment was observed in 21 (43.7%) and nystagmus in 15 patients. Fourteen of them developed short stature. Regarding the diagnostic criteria for SOD: 92.6% (38/41) had ONH (78.9% bilaterally), 95.3% (41/43) had structural midline abnormalities, 85.7% (24/28) had hypothalamic-pituitary region alterations, and 73% had at least one hormonal deficiency, of which 2/3 had multiple pituitary dysfunctions. The most frequent deficiencies were thyroid-stimulating hormone and growth hormone, and the average age at diagnosis of the first dysfunction was 4.25 ± 3.71 years. Conclusion: Clinical manifestations that most led to early suspicion were developmental delay, nystagmus and visual impairment. More than 1/3 of the patients had the complete triad and 2/3 developed multiple pituitary deficiencies, with TSH deficiency being the most prevalent followed by GH deficiency. Patients with ONH or midline structural changes should undergo endocrine evaluation.

Abstract in English:

Abstract Objective: Assess the occurrence of vaccine hesitancy among pediatricians and their patients and identify potential predictors to mitigate hesitancy among them. Methods: The study is a cross-sectional survey using an online questionnaire sent to pediatricians affiliated with the Brazilian Society of Pediatrics. The data was analyzed using statistical methods such as exploratory factor analysis, principal component analysis, correspondence analysis, and generalized linear mixed models. Results: A total of 982 respondents, with a majority being females (77.4%), participated in the research. Among them, the proportion of pediatricians with complete vaccine status was 41.14%, while 90.6% had undergone medical residency. Furthermore, 9.3% worked in public healthcare settings, 30.4% in private settings, and 60.3% in mixed healthcare settings. The analysis revealed a significant association between vaccine status and pediatricians’ misconceptions about COVID-19 vaccines, with those having complete vaccine status showing lower misconceptions (mean difference of -0.15, p = 0.010). Moreover, pediatricians with medical residency experience exhibited fewer misconceptions about COVID-19 vaccines (mean difference of -0.33, p = 0.002). Additionally, correspondence analysis unveiled the presence of two distinct profiles among pediatricians, showcasing variations in vaccine education, professional experience, and vaccine confidence perceptions. Conclusion: The study highlights the influence of vaccine status and medical residency experience on pediatricians’ attitudes and misconceptions about vaccines, emphasizing the need for targeted educational interventions to promote vaccine confidence and combat hesitancy within the healthcare provider community.

Abstract in English:

Abstract Objective: To describe the complications and risks associated with BCG (Bacillus Calmette-Guérin) vaccination in patients diagnosed with SCID (Severe Combined Immunodeficiency). Methods: This is a descriptive case series study. Medical charts were retrospectively reviewed for demographics, clinical manifestation, laboratory findings at diagnosis, outcome, and diagnosis of BCG vaccine-associated complications. Results: Eleven patients diagnosed with SCID were enrolled. Ten were male. Seven (64 %) were considered probable SCID, while four (36 %) were considered definite SCID (genetically confirmed). The median age at the onset of symptoms was one month; the median age at SCID diagnosis was four months. Respiratory symptoms were the most frequent. Eight patients were vaccinated within seven days of life. Seven (87 %) of these patients experienced BCG vaccineassociated complications (86 % disseminated reactions; 14 % localized reactions). BCG vaccineassociated complications were the first clinical manifestation in 75 % of the vaccinated patients. Less than half of the patients (36 %) underwent hematopoietic stem cell transplantation. The overall death rate was elevated (73 %); the death rate related to BCG vaccination was 25 %. Conclusions: Patients with SCID can present a high rate of BCG vaccine-associated complications, which negatively impact the clinical outcome and mortality. Pediatricians must be aware that BCG vaccine-associated complications can be the first presentation and a warning sign of SCID. Implementing newborn screening for SCID in Brazil may represent a worthy opportunity to impact the health outcomes of affected infants significantly.

Abstract in English:

Abstract Objective: The development of specific growth charts for Turner Syndrome (TS) promotes adequate assessment of growth and weight gain, and earlier diagnosis of comorbidities, and may help to analyze the effectiveness of treatments to promote growth and puberty. The aim of this study was to construct a growth chart with the largest possible series of patients with a cyto-genetic diagnosis of TS from a Brazilian reference center. Methods: This is a longitudinal study, with 259 cases of TS born between 1957 and 2014 and followed between 1975 and 2019, without the use of GH or oxandrolone. 3,160 height measurements and 2,918 wt measurements were used, with subsequent calculation of the Body Mass Index (BMI). For data analysis, the “GAMLSS” package of the “R” software was used. Results: The mean target height was 157.8 cm (standard deviation 5.2; median 160.4 cm). The mean height of patients with TS at 20 years of age was 145.6 cm (standard deviation 5.9; median 146.7 cm). Height, weight, and BMI by age graphs were developed for TS girls between 2 and 20 years. Conclusion: These growth charts may be used to monitor the growth of girls with TS and to verify the effect of adjuvant treatments on promoting growth.

Abstract in English:

Abstract Objective: The present study’s objective is to assess whether sleep duration affects Early Childhood Development (ECD). A prospective cohort study was carried out with 278 mother-child dyads in the city of Fortaleza, northeastern Brazil, with data collection every 6 months. Method: The data used in this study are from the third (18 months) and fourth (24 months) survey waves. Information on sleep duration was collected using the Brief Infant Sleep Questionnaire (BISQ) and information on ECD using the Caregiver Reported Early Development Instrument (CREDI). Crude and adjusted regression models were run for each CREDI domain as an outcome with 5 % significance. Results: The authors found that after adjusting for maternal age and schooling, family income, and the presence of other children in the house, night sleep duration was associated with better ECD scores (cognitive: coef. 0.14; 95 % CI 0.04,0.24; language: coef. 0.10; 95 % CI 0.01,0.19; motor: coef. 0.10; 95 % CI 0.03,0.18; socio-emotional: coef. 0.16; 95 % CI 0.06,0.25; overall: coef. 0.14; 95 % CI 0.04,0.24), and the time awake at night associated with worse scores (cognitive: coef. -0.12; 95 % CI -0.23,0.02; motor: coef. -0.09; 95 % CI -0.17,-0.01; socio-emotional: coef. -0.11; 95 % CI -0.21,-0.01; overall: coef. -0.11; 95 % CI -0.21,-0.01). Conclusions: Nocturnal sleep duration affects ECD as expressed in all CREDI scores (cognitive, language, motor, social-emotional, and overall).

Abstract in English:

Abstract Objectives: To identify the dietary patterns of Brazilian adolescents and to verify their associated factors. Methods: Cross-sectional study with data from the 2019 National Survey of School Health. Students aged 13 to 17 participated in the survey, totaling a sample of 125,123 adolescents. The variables were divided into two groups: healthy and unhealthy diet. Principal component analysis was used to identify the dietary patterns. To evaluate the association, logistic regression was used, estimated by the Odds Ratio, with the respective 95 % confidence intervals. Results: Two main components were identified: first related to regular consumption of fruits, vegetables, and beans; the second related to non-regular consumption of sweet treats, soft drinks, and fast food. The highest likelihood of regularly consuming the first was observed among adolescents residing in the Central-West and Southeast regions, with higher maternal education, who abstained from alcohol, engaged in physical activity, were not sedentary, ate breakfast, had lunch or dinner with their parents, refrained from eating while engaging in other activities, and participated in school meal programs. The lowest likelihood of not regularly consuming the second was found among male adolescents aged 16 to 17, attending public schools, who abstained from alcohol, and were not sedentary. Conclusions: This study identified two dietary patterns, both linked to socioeconomic factors and healthy lifestyle habits. Recognizing these patterns among adolescents enables health surveillance efforts aimed at reducing diseases and health problems.

Abstract in English:

Abstract Objective: Discontinuation of growth hormone therapy (rhGH) upon completion of linear growth may adversely affect bone mineral density and content (BMD/BMC) in adolescents with childhood-onset GH deficiency (CO-GHD) and predisposition to osteoporosis. Although the benefits of weight-dependent somatropin high doses over bone gain are established, little is known about fixed low doses. We analyzed the impact of non-weight-based low-dose somatropin on bone accrual during the transition among CO-DGH patients, treated since childhood. Methods: Lumbar spine (LS) and whole-body (WB) BMD and BMC were measured at baseline and after 18 months in 54 adolescents (age: 16.8 ± 1.6 years). They were retested and reclassified as GH sufficient (GHS, n = 28) and GH insufficient. The last group was later randomized to use rhGH (GH on; n = 15) or no treatment (GH off, n = 11) in this single-center open-label study. The average dose of rhGH was 0.5 ± 0.18 mg/day. Results: When comparing the groups, the GH off group had a lower percentage change in LS BMD than the GHS (0.53 % ± 5.9 vs. 4.42 % ± 4.1, respectively, p < 0.04). However, in the analysis of the GH on and off subgroups, the LS BMC percentage change was higher in the GH on (11.02 % ± 10.12 vs. 2.05 % ± 10.31, respectively, p < 0.04). Conclusion: Non-weight-based low-dose somatropin withdrawal for 18 months limits bone accrual in LS of CO-DGH subjects in transition, predisposing them to osteoporosis in adult life.

Abstract in English:

Abstract Objective: Adverse Childhood Experiences (ACEs) have been associated with negative health outcomes. Screening for ACEs is crucial for improving health results, however, there is a shortage of standardized tools designed for children in Brazilian Portuguese. This study aimed to translate, culturally adapt, and validate the Pediatrics ACES and Related Life Event Screener (PEARLS) for use in Brazil. Method: The study followed a methodological design for cross-cultural adaptation and psychometric evaluation. The PEARLS was translated and culturally adapted following a methodology that includes translation, synthesis, expert committee evaluation, target audience evaluation, and back-translation. After adaptation, a pilot cross-sectional study was conducted at a Multidis-ciplinary Health Care Clinical Center and a General Hospital-Reference Center for Child and Adolescent Care to assess the instrument’s internal consistency, convergent validity, content validity and test-retest reliability. Results: The PEARLS-Br versions for Children, Teens, and Teen Self-Report were developed and subjected to pilot testing with 202 subjects. Participants demonstrated excellent comprehension, with Verbal Rating Scale median scores of 4 (IQR 4−5). Internal consistency was high, with Cronbach’s alpha coefficients ranging from 0.78 to 0.81. Content validity, assessed by Kappa, indicated slight to almost perfect agreement across constructs. Test-retest reliability, assessed by Spearman’s correlation coefficient, ranged from 0.89 to 0.94. Conclusions: PEARLS-BR (Child, teen, and teen self-report versions) were successfully translated, culturally adapted, and validated for assessing ACEs in Brazilian children and adolescents. This tool fills a crucial gap in ACE assessment in the Brazilian context, aligning with global recommendations for screening ACEs to improve overall health outcomes.

Abstract in English:

Abstract Objective: It was to develop smoothed height and weight percentiles for boys and girls with IDs between 7 and 17 years old. Methods: The sample consisted of 1,047 young people (645 boys and 402 girls; 7-17 years old) with ID. A total of 4,059 measurements (height: n = 2,041; weight: n = 2,018) were retrospectively obtained from the period between 2013 and 2018. Smoothed height and weight percentiles were developed using the LMS method. Local and global diagnosis of percentiles were evaluated with Q statistics and detrended Q-Q plots. Results: Percentiles (5, 10, 25, 50, 75, 90, and 95) for height-to-age and weight-to-age were developed with satisfactory modeling in boys and girls between 7 and 17 years old. Boys showed a linear trend in height up to 11 or 12 years old, an increment from 13 to 15 years old and a deceleration from 15 or 16 years old. For the girls, height was linear between the ages of 7 and 11, followed by a deceleration from the age of 12 and without substantial changes from the ages of 15 to 17. Regarding weight, girls showed a linear trend of weight gain until the age of 13 and deceleration at the age of 14 or 15. Boys, however, showed a linear tendency to gain weight from 7 to 17 years old. Conclusion: The height and weight percentiles developed in this study can help monitor the growth of young people with ID.

Abstract in English:

Abstract Objective: To describe features and habits of diaper area care and compare the frequency of diaper dermatitis in infants using cloth diapers with those using disposable diapers. Methods: Questionnaires were administered to families with infants who had not started potty training, to assess the frequency of diaper rash in two groups: babies who use exclusively cloth diapers (CD), and others with exclusively disposable diapers (DD). The hygiene methods of the perineal region and the skin lesions frequency were evaluated. The study was approved by the Ethics Committee. Results: 1389 participants were included, 53 % male, with a median age of 16 (7–24) months, 1269 (91.4 %) in DD and 120 (8.6 %) in CD. Mild diaper rash occurred a few times a year in 47.0 % and 47.5 % in the DD and CD groups, respectively (p = 0.47). Severe diaper rash occurred a few times a year in 13 % and 10.7 % in the DD and CD groups, respectively (p = 0.66). In the DD, the most used hygiene method was wet wipes (61.5 %), whereas in the CD it was cotton/cloth with water (62.2 %; p < 0.001). Conclusion: Disposable diapers continue to be more used; hygiene habits differ between the groups and the use of cloth diapers did not increase the frequency of diaper dermatitis when compared to the use of disposable diapers.

Abstract in English:

Abstract Objective: This study aimed to develop a predictive model using a random forest algorithm to determine the likelihood of postoperative adhesive small bowel obstruction (ASBO) in infants under 3 months with intestinal malrotation. Methods: A machine learning model was used to predict postoperative adhesive small bowel obstruction using comprehensive clinical data extracted from 107 patients with a follow-up of at least 24 months. The Boruta algorithm was used for selecting clinical features, and nested cross-validation tuned and selected hyper-parameters for the random forest model. The model’s performance was validated with 1000 bootstrap samples and assessed using receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC), sensitivity, specificity, precision, and F1 score. Results: The random forest model demonstrated high diagnostic accuracy with an AUC of 0.960. Significant predictors of ASBO included pre-operative white blood cell count (pre-WBC), mechanical ventilation (MV) duration, surgery duration, and post-operative albumin levels (post-ALB). Partial dependence plots showed non-linear relationships and threshold effects for these variables. The model achieved high sensitivity (0.805) and specificity (0.952), along with excellent precision (0.809) and a robust F1 score (0.799), indicating balanced recall and precision performance. Conclusion: This study presents a machine learning model to accurately predict postoperative ASBO in infants with intestinal malrotation. Demonstrating high accuracy and robustness, this model shows great promise for enhancing clinical decision-making and patient outcomes in pediat-ric surgery.