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Abstract Objective The objective of this review is to assess the use of support tools for children with asthma, based on web and mobile device technologies, and their impact on asthma control. Method This is a systematic review conducted in accordance with the PRISMA guidelines and the Joanna Briggs Institute (JBI) Manual. The research question defined by the PICO strategy was: ‘‘What are the effects of web-based and mobile device support tools on asthma control in children?’’ The search was conducted in the Medline (via PubMed), SciELO, and Embase databases between October and December 2023, with completion in July 2024. Results The systematic review analyzed 388 articles and selected 4 studies on technologies for managing asthma in children. The studies showed that mobile apps and electronic monitoring improve asthma control, treatment adherence, and caregivers’ quality of life. The meta-analysis showed a mean increase in Asthma Control Test (ACT) scores of 2.73 (95 % CI: 1.95, 3.51) with P < 0.0001, indicating a significant improvement in asthma control scores, highlighting the effectiveness of these technologies. Conclusions This study demonstrates that digital tools, such as web technologies and mobile devices, can significantly improve the management of childhood asthma, as reflected by an increase in Asthma Control Test (ACT) scores. Despite limitations, the findings are promising. Future research is needed to strengthen the evidence and guide clinical practice in pediatric asthma management.

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Abstract Objective This systematic review and meta-analysis aimed to evaluate the efficacy of surgical management, specifically total and partial tonsillectomy, for Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) syndrome, focusing on symptom resolution and recurrence reduction. Data sources A systematic search of MEDLINE, Scopus, and Cochrane databases identified randomized controlled trials (RCTs) comparing surgical to non-surgical management in children with PFAPA. Data extraction and quality assessment adhered to Cochrane guidelines and PRISMA protocols. Risk ratios (RR) and confidence intervals (CI) were calculated using random-effects models. Summary of findings After the removal of duplicates, 31 studies were screened and 3 studies were included. Pooled analysis revealed a 72% reduction in persistent symptoms following surgical interventions compared to non-surgical management (RR: 0.28, 95% CI: 0.12-0.68, I² = 22%, p = 0.005). Conclusion The findings confirm that surgical management, including total and partial tonsillectomy, is an effective therapeutic option for PFAPA, with substantial benefits in symptom resolution and quality of life improvement. While surgery offers long-term benefits, its risks, and broader immunological implications require careful consideration. The study underscores the necessity for larger, multicenter trials to validate these findings across diverse populations and optimize treatment strategies.

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Abstract Objective The objective of this article is to broaden the discussion on the factors that constitute adolescent healthcare decisional capacity, ensuring that adolescents are recognized as capable of refusing treatments or procedures. Sources Materials from different sources were analyzed, including articles from reputable databases and documents from government agencies, forming a purposefully selected sample. The research was conducted in two phases: document selection and reflective analysis, followed by a report. The discussion was approached from a phenomenological perspective, with reflections grounded in human rights principles. Summary of the findings Healthcare decisional capacity must be sufficiently robust to allow adolescents to refuse treatments or procedures. It is essential to respect the right of capable adolescents to refuse treatments and procedures. Protecting the vulnerability of adolescent patients involves honoring their growing autonomy. Data from field research regarding the refusal of treatments and procedures in adolescence are scarce, which limits the scope of the proposed discussion. Conclusions It cannot be argued that adolescents should have different abilities to refuse a treatment or procedure compared to those required to give consent. The importance of these skills seems to vary between these situations. This difference is justified by the need to consider potential harm to health, even though it could be argued that damage to health should be part of the bioethical deliberation surrounding the decision, rather than a factor in the assessment of decisional capacity.

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Abstract 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.

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Abstract Objective To assess the effects of a neonatal resuscitation training program using traditional training and partial distance learning. Method Through an open cluster-randomized trial, the authors compared a traditional approach involving face-to-face theory and practice sessions using information and communication technology to offer theory and distance examination, followed by face-to-face practice. Twelve health facilities were allocated by blocked randomization. Comparisons were made adjusting for clustering in qualitative and quantitative data. The primary outcome was the percentage of infants with heart rates ≥100 per minute at the second minute after birth. The authors performed a cluster-level analysis for cluster randomized trials, simplifying the adjustment for individual- and cluster-level covariates. Results The authors trained 403 health professionals in two arms in twelve facilities. After six months, the authors assessed 2180 birth deliveries, 966 newborns in the traditional training group (TT), and 1214 in the partial distance learning training group (pDL). The authors found no statistical evidence favoring any of the two trial arms (RR = 0.9859, CI 95 % = 0.9446; 1.0292, p = 0.4819). Conclusions The authors found no statistical evidence favoring traditional or distance learning methods for neonatal resuscitation training. Further research could assess improved online platforms to enable sustainable virtual reality instructor/provider interaction for theory, practice and testing, addressed to health cadres of rural and remote areas.

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Abstract Objective To characterize the clinical and nutritional profile of children and adolescents with ASD in Brazil and their eating problems. Method This is a cross-sectional study using a national online survey, with a sample of 613 children and adolescents with ASD aged between 2 and 17 years. Data analysis consisted of descriptive analysis, followed by Pearson's chi-square test with a statistical significance of 0.05 and a 95% confidence interval. Results Food allergy was reported by 33.8% of the participants, the most frequent being cow's milk (70.2%), among those who reported gastrointestinal problems, constipation was the most frequent (54.1%). The presence of pica was reported by 25% and food selectivity was present in 77.2%, with greater refusal of fruit, vegetables and pasty textures. Most of the participants do not have follow-ups with a nutritionist and 44.5% are on some special diet, excluding gluten/wheat (75.4%) and without casein/animal milk (76.1%). More than half of the participants did not eat fruit (50.6%), vegetables (68.1%), or leafy greens (83.6%) frequently. A positive correlation was found between food selectivity and gastrointestinal symptoms (p-value < 0.050); food allergy and gastrointestinal symptoms (p-value < 0.001) and pica and gastrointestinal symptoms (p-value < 0.001). Conclusions The results of this study show changes in food consumption and increased risk of nutritional deficiencies for children and adolescents with ASD in Brazil.

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Abstract Objective Neurodevelopmental disorders are frequently and heterogeneously diagnosed among patients with dystrophinopathies. The authors aimed to evaluate how the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), or Autism Spectrum Disorder (ASD), and genotype are related to DMD genotype. Methods In an observational cross-sectional study, standardized instruments were applied to 50 participants and their caregivers, mainly from a reference center for rare diseases in Southern Brazil (n = 38) or other Brazilian centers (n = 12). Participants were divided according to genotype and affected dystrophin isoforms. Results The overall diagnostic rate of symptoms of ASD was 34 %, similar to OCD (35.5 %), with half of the participants (51.4 %) having symptoms compatible with ADHD. Cerebral isoforms were affected in more than half of the participants (52 %). Symptoms compatible with ASD and OCD, and Childhood Autism Rating Scale (CARS) scores were associated with genotype and impairment of cerebral isoforms of dystrophin. Conclusions The prevalence of symptoms compatible with ASD (and higher CARS scores) and OCD among patients with dystrophinopathies are related to the position of the causal variant in DMD and the consequent involvement of cerebral isoforms, indicating an important genotype-phenotype correlation. The diagnosis of a patient with a genotype that affects these isoforms indicates the need for neuropsychological assessment and multidisciplinary follow-up.

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Abstract Objective This study aimed to understand the prevalence of screen time in hospitalized children and identify factors predicting excessive screen use during hospitalization. Methods This cross-sectional quantitative study was conducted with patients from the Pediatric Inpatient Unit of a Brazilian hospital, from March 2022 to April 2023. A total of 260 children were included. Family members completed questionnaires about screen time during hospitalization and at home, as well as providing information on physical activity and functionality. Socioeconomic and demographic details were obtained from electronic records. Results During hospitalization, children spent a median of 270 min per day on screens, significantly more than at home. Excessive screen time at home, better patient functionality, and lower caregiver education levels were significant predictors of excessive screen use during hospitalization. Conclusion Excessive use of screen devices among hospitalized children, with only a minority adhering to the World Health Organization’s screen time recommendations. Key predictors of excessive screen use included high screen time at home, lower caregiver education levels, and preserved child functionality.

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Abstract Objective This study aimed to evaluate the intestinal microbiota development in the first week of life of preterm newborns (PTNB) treated at a public hospital in a municipality in the Brazilian Northeast. Methods This is an observational, longitudinal, and descriptive study with 23 PTNBs. Two stool samples were collected from each neonate (fasting/meconium and seventh day of life) for stool microbiota analysis by 16S rRNA gene sequencing. The authors analyzed alpha diversity (Chao1, Shannon, and Simpson indices) and principal coordinates of beta diversity. Results Forty-six stool samples from 23 PTNBs were analyzed at the taxonomic level. Microbiota's development was dynamic with low diversity. The authors observed a statistical association with the genera Enterobacterales, Streptococcus, Bacteroides, Clostridium_sensu_stricto_1, Enterococcus, and Bifidobacterium in the fasting samples when compared to the day-7 samples. The genus Staphylococcus also dominated at both times. Conclusion Dynamics were observed in the intestinal microbiota development, with an alpha diversity decrease in the stool samples collected at fasting/meconium and on the seventh day of life.

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Abstract 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 (CAH-NBS) 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 CAH-NBS 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 CAH-NBS 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 CAH-NBS programs while minimizing unnecessary costs and parental distress.

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Abstract Objective: Patients with selective IgA deficiency (SIgAD) present elevated morbidity associated with infections, allergic conditions, autoimmune disorders, and neoplasms. This study aims to characterize clinical manifestations, disease progression, and laboratory findings in a cohort of pediatric patients with SIgAD. Methods: The study included patients with confirmed SIgAD and a clinical history of at least 5 years. Data encompassed clinical manifestations of the disease, patient outcomes, and laboratory findings, including IgA, IgG, IgM, IgE levels and complete blood count. Results: A total of 51 patients (1.2:1 female-to-male ratio) were included, with a median age at diagnosis of 6 years. Infections were the most common clinical manifestations of SIgAD (98 %), with pneumonia being the most frequent (94 %), followed by sinusitis (70 %). Additionally, 47 patients (92.1 %) exhibited allergic manifestations, including rhinitis or asthma. Autoimmune conditions were identified in 10 patients, predominantly thyroiditis (60 %), while neoplasms were observed in 3 patients. The sequence of disease onset revealed a natural progression, beginning with infectious diseases, followed significantly by allergic and autoimmune conditions. Elevated immunoglobulin levels (IgM or IgG) were observed in 25 patients, with hypergammaglobulinemia significantly associated with autoimmune conditions or the presence of autoantibodies (p < 0.05). Conclusions: SIgAD is a clinically significant condition. Understanding its natural history deepens our knowledge of the disease and helps early detection and diagnosis of comorbidities that may arise at various stages of a patient’s life. Monitoring other immunoglobulin levels may offer potential biomarkers for predicting autoimmune conditions; however, larger studies are needed to validate these biomarkers.

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Abstract Objective To evaluate and compare whether hydrotherapy and hammock positioning techniques assist in the weight gain of premature newborns. Methodology A single-blind randomized clinical trial was conducted at Santa Casa de Misericórdia Hospital in Sobral, between July 2022 and October 2023. The trial included 16 months of data collection and involved seventy-six premature newborns with low birth weight, of which only sixty were included after meeting the inclusion criteria. These newborns were randomly divided into four groups: one control group and three groups that received different intervention techniques (hydrotherapy, hammock positioning, and a combined group of hydrotherapy and hammock positioning). The newborns were monitored for clinical stability and specific signs before and after the interventions. The techniques were applied daily for 15 days. Results During the 15-day follow-up, the control group had a mean weight gain of 305 g. The group that received hydrotherapy gained 346 g, but without significance. The hammock group and the combined hydrotherapy and hammock group showed significant weight gains: the hammock group had an increase of 360 g (p = 0.011), while the combined group achieved a gain of 616 g (p = 0.0001). Significant increases in arm circumferences were observed in the hammock group and the hydrotherapy combined with the hammock positioning group. Conclusion The results indicate that the combination of hydrotherapy and hammock positioning leads to a significant increase in weight gain in premature newborns. The isolated use of hammock positioning also showed positive effects, but the isolated use of hydrotherapy did not yield significant results (Brazilian Registry of Clinical Trials RBR-6 g5f4jz).

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Abstract Objective Human milk has a dynamic composition that is ideal for the needs of infants. However, the factors that affect the nutritional content of human milk are still unclear. This study aimed to evaluate the immediate effect of maternal food intake (lunch) on the macronutrient composition of colostrum. Methods This prospective study performed a paired analysis of macronutrient concentrations in the colostrum of healthy postpartum women. Three milliliters of colostrum were collected from 65 participants 30 min before and 2 h after a meal (lunch) by manual expression. The nutritional content of the meal was similar for all mothers. Colostrum analysis was performed using a Human Milk Analyzer (Miris®). Results The fat content was significantly higher in colostrum samples collected 2 h after lunch than in those collected 30 mins before lunch (2.3 ± 1.1 vs. 2.8 ± 1.4 g %, p = 0.002). No significant differences were observed in the protein (1.9 ± 0.7 vs. 1.9 ± 1.0) and carbohydrate (6.4 ± 0.8 vs. 6.4 ± 0.8) content. Conclusions Two hours after the mother had lunch, the colostrum fat concentration increased by 20 %.

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Abstract Objective Bioelectrical impedance analysis is a method used to assess body composition; a noninvasive test performed using an easy-to-handle portable device used in clinical practice. However, nonstandard methods in neonates hinder external validation and reliability. Currently, bioimpedance analysis is performed in newborns with electrodes positioned on the right side of the body; however, the use of medical devices, including vascular access, can prevent its use. Methods An uncontrolled before-after clinical trial comparing resistance and reactance measurements by bioelectrical impedance analysis on both sides was conducted. Measurements were performed immediately after the randomization of the initial measurement side. The sample size was calculated by considering a 10% deviation from the mean resistance and reactance values of previous studies with alpha and beta errors of 10% and 20%, respectively. Binary linear regression was used to quantify the correlation. Results A significant difference was observed between resistance (672.88 ± 136.30 vs. 649.22 ± 119.59) and reactance (46.34 ± 17.99 vs. 44.439 ± 19.42) values measured on the right and left sides, respectively. However, when measured on both sides of the body, resistance and reactance values showed a good correlation (0.98 for both models, p < 0.001). Positioning the electrodes on the left side significantly affected the resistance and reactance values measured by bioelectrical impedance analysis compared with those on the right side. Conclusion Electrodes positioned on opposite sides of the body generated different resistance and reactance values, implying the need to use the right side exclusively for standard positioning. This restriction can create difficulties for the routine use of this technique in newborns.

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Abstract Objective To evaluate the prognosis of benign ovarian tumors and develop a postoperative surveillance strategy for children based on the findings. Methods The clinical data of children with benign ovarian tumors treated in the hospital from January 2014 to December 2021 were retrospectively analyzed. Results A total of 404 patients were included in this study, with an average age of 9.1 ± 3.1 years. All patients underwent a total of 423 procedures, including 61 oophorectomy and 362 ovary-sparing surgeries. 67 patients were lost to follow-up after surgery. The remaining 337 patients were followed up for a period ranging from 3 months to 9 years (mean 1.6 ± 1.8 years). The ovarian preservation rate for patients undergoing ovary-sparing surgery for the first time was 94.4% (271/287). The overall recurrence rate of benign ovarian tumors was 3.9% (13/337). Of the 13 patients with recurrence, 10 had regular imaging examinations and did not develop symptoms. Three patients had irregular follow-up after surgery and returned to the hospital due to symptoms. The first recurrence interval of these 13 patients after surgery ranged from 0.6 to 5.3 years (mean 2.0 ± 1.4 years). 84.6% (11/13) of the recurrence cases developed within 3 years after surgery. Conclusion Ovary-sparing surgery for benign ovarian tumors has a favorable prognosis and a high rate of ovarian preservation. Regular follow-up after surgery for benign ovarian tumors is necessary. Annual imaging follow-up for at least 3 years postoperative can detect most recurrence cases.

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Abstract Objective In Panama, the 13-valent pneumococcal conjugate vaccine (PCV13) was included in the primary immunization schedule in 2010 with a 3-dose schedule. The authors evaluated the effectiveness of PCV13 against severe community-acquired pneumonia in children of Panama after its introduction into the national immunization program. Methods A retrospective matched case-control study was conducted at Hospital del Niño Doctor José Renán Esquivel, collecting data from children 2 to 59 months of age in years subsequent to the introduction of the PCV13 vaccine (2013-2015). Cases of severe community-acquired pneumonia had radiographically confirmed pneumonia (consolidated or with pleural effusion) or pneumonia with “other infiltrate” associated with CRP ≥ 40 mg/L with severity criteria according to the 2013 World Health Organization definition. Controls were children hospitalized for non-immune-preventable diseases matched by cases' age and admission date. Vaccine effectiveness was estimated as (1 - odds ratio) × 100 % with 95 % confidence intervals. Results 78 paired cases with 198 controls were included. In the cases, the mean age was 13.7 ± 10.3 SD months, and the hospital stay was 9.7 + 6.1 days. Overall, the effectiveness of PCV13 against severe community-acquired pneumonia was 54.0 % (95 % CI 25.0-72.0 %, p < 0.05). Vaccine effectiveness among children under 1 year was 61 % (95 % CI: 23.0-81.0 %) and 43 % (95 % CI:16.0-74.0 %) for children 1 to 4 years. For children who received at least 1 PCV13 dose was 17.2 % (95 % CI: 8.8-33.7 %). Overcrowding and lack of vaccination against influenza were risk factors for lower vaccine effectiveness. Conclusions PCV13 was effective in preventing severe cases of community-acquired pneumonia in children in Panama.

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Abstract 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.

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Abstract Objective The objective of this study was to assess the potential mediating role of mental health in the association between cardiorespiratory fitness (CRF) and academic performance in European schoolchildren. Method The study followed a cross-sectional design. 507 schoolchildren (51.5 % girls, 7.4 ± 0.4 years) from 20 schools in five European countries were included in the analyses. Academic performance was assessed using school grades, mental health was assessed through the Strengths and Difficulties Questionnaire (SDQ) for parents, and CRF was estimated through the multistage 20-m shuttle run test. Linear regression and mediation analyses were conducted to test these hypotheses. Results Mental health difficulties were associated with worse performance on academic indicators (β ranging from -0.121 to -0.324, p < 0.05). Further, mental health difficulties were associated with lower CRF (β ranging from -0.121 to -0.189, p < 0.05). Mediation analyses revealed that the association between CRF and academic performance indicators was partially mediated (from 8 % to 25 %) by mental health [except for conduct and peer problems (β ranging from -0.025 to -0.080, p > 0.05). Conclusion The present results highlight that mental health is a possible mediator in the association between CRF and academic performance. These findings might support the importance of improving CRF levels to reduce mental health difficulties with subsequent potential benefits on academic performance.

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Abstract Objective To evaluate the influence of genetic, gestational, birth, and socioeconomic factors on Rapid Weight Gain (RWG) in children between birth and six months. Methods This is a cohort study with 267 children, information on individual and sociodemographics was obtained from the medical record. RWG was identified when the z-score difference in weight-for-age between two child assessments was > +0.67. The rs9939609 was assessed by Real-Time Polymerase Chain Reaction Taqman. The exploratory analysis of the cumulative incidence rate curves of RWG used the Kaplan-Meier, as well as the Log-Rank test to perform comparisons between the groups. To estimate the hazard ratio, the Cox semi-parametric model was used, to verify the quality of the fit of the proposed model the generalized Cox-Snell residuals were used. Results The RWG between birth and six months was 31.84% and the incidence rate was estimated to be 2.31 cases/1000 person-days. The children who were born with inadequate weight or low weight had 1.88 times the risk of having RWG between birth and six months. In multivariate analysis, a higher risk of RWG in the first six months of life was found for children who were born weighing < 3000 g and whose mothers were overweight/obese in the pregestational phase, adjusted for the variables sex, rs 9939,609 and paternal education, rs9939609 was not associated with RWG. Conclusions Children with lower birth weight and with mothers overweight/obese before pregnancy presented a higher risk of RWG in the first six months and rs 9939,609 was not associated with RWG.

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Abstract Objective This study aimed to evaluate the validity of models using Procalcitonin (PCT) alone and PCT combined with other biomarkers to predict early infection after pediatric open-heart surgery with cardiopulmonary bypass (CPB). Methods A prospective observational study was conducted on children undergoing open-heart surgery with CPB, without preoperative infection. Procalcitonin, C-reactive protein (CRP), and white blood cell (WBC) count were measured preoperatively and on postoperative days 1 and 3. Postoperative infection was defined according to the Centers for Disease Control and Prevention 2008 criteria. Results Fifty eligible cases were included, comprising 46 % males with a median age of 7 months (4-17). The AUC (area under the curve) for PCT on postoperative day 3 was 0.67 (0.51-0.82) (p = 0.085). The AUCs for the models combining PCT + CRP and PCT + WBC were 0.71 (0.57-0.86) (p = 0.014) and 0.72 (0.55-0.86) (p = 0.014), respectively. The AUC for the model combining PCT + CRP + WBC was 0.81 (0.69-0.93) (p = 0.002). The combination of PCT > 4.15 ng/ml, CRP > 22.03 mg/l, and WBC > 15.3 × 103/µl predicted infection with a hazard ratio 9.66 times (2.94-31.72) higher than PCT > 4.15 ng/ml alone (p < 0.05). Conclusions PCT measurement on the third postoperative day alone cannot predict infection in pediatric open-heart surgery with CPB. The combination of PCT with CRP and WBC may enhance early infection prediction, although further validation in larger, multicenter cohorts is warranted.

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Abstract 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.

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Abstract Objective This study aimed to determine if there was a rise in new T1DM cases in children during the pandemic in a large metropolitan area in Brazil. Methods The authors conducted a cross-sectional study at five public tertiary care centers that specialize in diabetes in children, comparing all new T1DM cases (ages 0.5-18y) diagnosed from March 2020 to December 2021 (pandemic period, PP) with those from March 2018 to December 2019 (historical period, HP). Results There were 167 new cases in the PP compared to 99 in the HP, reflecting a 68.7 % rise, with a notable peak observed in the third quarter of 2020 (p = 0.006). The average age of diagnosis was 8.4 ± 4.2 years in the PP and 7.5 ± 3.6 years in the HP, with no significant difference (p = 0.06). The gender distribution, BMI Z scores, and duration of diabetes symptoms before diagnosis were similar. The incidence of diabetic ketoacidosis (DKA) at onset was elevated but did not increase during the pandemic (62.6 % historical vs. 59.3 % pandemic period). During the PP, 24 % of patients reported symptoms of SARS-CoV-2 infection before the diagnosis of T1DM or at admission, and 13 % (7/53) of tested patients were positive for SARS-CoV-2. Conclusions The present findings indicate a significant rise in new T1DM cases among children during the COVID-19 pandemic compared to prior years, without differences in DKA at onset.

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Abstract 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.