Abstract in English:

Abstract Objective: To identify the incidence, demographic characteristics, and risk factors for intraventricular hemorrhage (IVH) in preterm infants admitted to Brazilian neonatal intensive care units (NICUs). Methods: This prospective, observational cohort study was conducted over a one-year period in four NICUs in Brazil. All newborns with gestational age (GA) < 32 weeks or birth weight (BW) < 1500 g, born between September 2023 and September 2024, were included. Demographic data and short-term outcomes were collected. Multinomial logistic regression was performed to evaluate associations between clinical variables and IVH severity. Results: A total of 268 newborns were enrolled. The mean BW and GA were 1138 g (SD ±388 g) and 29 weeks and 1 day (SD ±3 weeks), respectively. Normal cUS were seen in 54.1%, mild IVH in 20.5%, severe IVH in 10.4%, and 8.2% died prior to a cUS being performed. Infants with the outcome of severe IVH or death prior to cUS exhibited lower BW, GA, Apgar scores, rates of cesarean section, fewer complete courses of antenatal steroids, and were more likely to have undergone advanced resuscitation in the delivery room and significant interventions in the early neonatal period. Hypothermia was prevalent across all groups. Infants with severe IVH had significantly higher rates of death prior to hospital discharge and longer length of stay. Conclusions: Identifying risk factors for IVH is essential for developing strategies to optimize outcomes. Implementation of a standardized IVH prevention bundle in Brazilian NICUs focusing on factors shown to adversely affect outcomes is warranted.

Abstract in English:

Abstract Objective: To assess the agreement between the Fenton and INTERGROWTH charts in classifying birth weight for gestational age in preterm infants, considering prematurity degree and small/ adequate/large-for-gestational-age (SGA/AGA/LGA) status individually and simultaneously. Methods: Retrospective cohort study including 2529 preterm infants admitted between 2018 and 2021. Gestational age was estimated from obstetric data or by the Capurro/Ballard methods. Birth weight-for-gestational-age Z-scores were calculated according to both charts. Agreement was analyzed overall and by subgroups defined by prematurity degree and SGA/AGA/LGA status using the Bland-Altman method, complemented by boxplots. Results: Overall agreement was reasonable (mean bias: -0.08; limits of agreement: -0.67 to 0.50), with slight overestimation of Z-scores by INTERGROWTH. Relevant variability was observed across subgroups. Disagreement extended across all prematurity strata with distinct patterns: greater dispersion in extremely and very preterm infants and more consistent but systematically biased differences in moderate-to-late preterm infants (bias: -0.12). The largest discrepancies occurred among SGA, especially in extremely preterm infants, among whom 50% had Z-scores beyond the limits of agreement. In this subgroup, Fenton tended to assign higher Z-scores, especially between 26 and 32 weeks of gestation, attenuating birth weight deficit severity. Agreement was considerable among AGA and LGA infants, especially in more mature preterm groups. Conclusion: Although overall agreement between the charts was acceptable, clinically relevant differences were observed across all prematurity strata, particularly among more immature SGA infants. The charts are not interchangeable at the individual level, and their use may influence nutritional diagnosis and clinical management, reinforcing the importance of consistent and context-appropriate selection of growth reference.

Abstract in English:

Abstract Objective: Urogenital congenital anomalies (UGCAs), including congenital anomalies of the kidney and urinary tract and external genital malformations, are major causes of early-life morbidity, preventable mortality, and long-term disability, particularly in low-resource settings. This study assessed the global burden, temporal trends, regional disparities, and future projections of UGCAs in children under 9 years using the Global Burden of Disease (GBD) 2021 dataset. Methods: GBD 2021 data were used to estimate incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in children aged 0-8 years. Analyses were stratified by sex, age, Socio-demographic Index (SDI), region, and country. Age-standardized rates (ASRs), SDI associations, and decomposition analyses were conducted, and future trends were projected using ARIMA and Holt-Winters models. Estimates are presented with 95% uncertainty intervals (UIs). Results: From 1990 to 2021, global age-standardized incidence (ASIR) and prevalence rates (ASPR) remained stable, whereas mortality and DALY rates declined. In 2021, incidence was 2026,032 (95% UI: 1417, 198-2787,372), prevalence 3360,751 (2594,010-4411,084), DALYs 5122,959 (4069,356-6172,763), and deaths 58,906 (46, 861-70,940). ASRs were 150.46 per 100,000 for incidence, 248.91 for prevalence, 384.10 for DALYs, and 4.41 for deaths. Females had higher ASIRs and ASPRs, while males showed higher mortality and DALY rates. Incidence and prevalence increased with age, whereas mortality declined. With increasing SDI, incidence and prevalence rose, while mortality decreased. The burden is increasingly concentrated in low-SDI regions; Southern Sub-Saharan Africa was the only region with rising mortality. CAKUT remained the predominant subtype globally. Projections indicate continued declines in mortality, with stable incidence and prevalence. Conclusion: Although global mortality and DALYs from UGCAs have declined, the growing burden in low-SDI regions highlights persistent inequalities and the need for targeted interventions. © 2026 The Author(s). Published by Elsevier España, S.L.U. on behalf of Sociedade Brasileira de Pediatria. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

Abstract in English:

Abstract Objective: To evaluate ChatGPT's performance in responding to questions related to short stature and growth failure, which are common concerns in clinical practice. Methods: Answers provided by the GPT-4 and GPT-4o models to a 36-item questionnaire administered at three different time points (baseline, after 3 months, and after 1 year) were assessed. Each response was rated on a 0-6 Likert scale according to their agreement with those given by pediatric endocrinology specialists. Results: ChatGPT showed an overall satisfactory performance, with high agreement in conceptual questions and in respect of common causes, but lower accuracy in diagnostic and therapeutic topics that require more specialized knowledge. The mean score was 4.6 (SD = 1.3), with a mode of 6. Using a threshold of scores 3-6 as correct, 96.9% of responses were classified as satisfactory; applying stricter thresholds of scores 4-6 and 5-6 yielded rates of 77.2% and 46.3%, respectively. An improvement was observed after the update to GPT-4o, suggesting model evolution over time. However, there was a significant decrease in recommendations to seek medical care in the more recent model. Conclusion: ChatGPT demonstrated high reliability and potential as a supportive tool for issues related to short stature; however, its lower accuracy in therapeutic topics and reduced emphasis on the importance of seeking professional medical advice highlight the need for further improvements to ensure its safe use in healthcare. Both professionals and lay users be aware of the limitations of AI and verify information through reliable medical sources.

Abstract in English:

Abstract Objective: to validate maturity status classification, based on %PAH, relative to SA, in a sample of Portuguese children and adolescents of both sexes. Methods: BA was measured by the Tanner-Whitehouse-3 method, the PAH and %PAH were estimated by the Tanner-Whitehouse-3 method (BA- PAH, % BA-PAH) and the Khamis-Roche method (KR- PAH, %KR- PAH) in 371 children (171 girls). Intraclass Correlation Coefficients and Bland-Alt-man plots were performance between BA-PAH / BA-%PAH and KR- PAH/%KR- PAH methods. Two-way Analysis of Variance (ANOVA) was made to evaluate the effect of sex and maturity status. Results: The average mean differences between BA-PAH and KR-PAH was 0.2 ± 4.2 cm in boys and 0.6 ± 3.1 cm in girls (p > 0.05) and between BA-% PAH and KR-% PAH was -0.1 ± 2.1% in boys and 0.4 ± 1.8% in girls (p > 0.05). A high interclass correlation coefficient was higher than 0.91 for BA-% PAH and KR-% PAH. Early maturity status was related to negative differences between BA- KR PAH. Conclusion: KR % PAH presented a good agreement and might be a valid estimate of biological maturity status in average maturing children and adolescents.