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Jornal de Pediatria, Volume: 99, Número: 1, Publicado: 2023
  • Making good use of ultrasound for abdominal tumors in children Editorial

    Stein, Nina Rodrigues; VanHouwelingen, Lisa
  • Systematic review on fecal calprotectin in cystic fibrosis Review Article

    Lazzarotto, Eduarda Sampaio; Vasco, Jannaina Ferreira de Melo; Führ, Fabiane; Riedi, Carlos Antônio; Rosário Filho, Nelson Augusto

    Resumo em Inglês:

    Abstract Objectives: Fecal calprotectin is an inflammatory marker used for monitoring intestinal diseases. It has been studied as a marker of intestinal inflammation in cystic fibrosis (CF), a multi-systemic genetic disease caused by alterations to the CFTR gene. Manifestations of the disease favor a systemic inflammation not limited to the respiratory tract, therefore, calprotectin is a non-invasive and effective diagnostic method. The aim of the study was to perform a systematic review of the literature with a qualitative synthesis of studies. Sources: The articles were selected from PubMed, Web of Science, Scielo and Lilacs. Summary of the findings: Nine studies were selected for that qualitative synthesis, one was a randomized clinical trial, and eight were case-control or cohort designs. Most studies have indicated that calprotectin is a marker of systemic inflammation in CF and not just intestinal inflammation. Calprotectin is an aid in monitoring inflammatory bowel conditions in patients with cystic fibrosis. Conclusion: Further studies should be conducted to investigate the role of this marker in the systemic inflammation of CF.
  • Potential relationship between Tourette syndrome and gut microbiome Review-Article

    Geng, Junze; Liu, Can; Xu, Jingyu; Wang, Xiaoge; Li, Xinmin

    Resumo em Inglês:

    Abstract Objective: In this article, the author aims to discuss and review the relationship between gut microbiota and Tourette syndrome, and whether the change in gut microbiota can affect the severity of Tourette syndrome. Sources: Literature from PubMed, Google Scholar, and China National Knowledge Infrastructure was mainly reviewed. Both original studies and review articles were discussed. The articles were required to be published as of May 2022. Summary of the findings: Current studies on the gut microbiome have found that the gut microbiome and brain seem to interact. It is named the brain-gut-axis. The relationship between the brain-gut axis and neurological and psychiatric disorders has been a topic of intense interest. Tourette syndrome is a chronic neurological disease that seriously affects the quality of life of children, and there appears to be an increase in Ruminococcaceae and Bacteroides in the gut of patients with Tourette syndrome. After clinical observation and animal experiments, there appear to be particular gut microbiota changes in Tourette syndrome. It provides a new possible idea for the treatment of Tourette syndrome. Probiotics and fecal microbial transplantation have been tried to treat Tourette syndrome, especially Tourette syndrome which is not sensitive to drugs, and some results have been achieved. Conclusions: The relationship between gut microbiota and Tourette syndrome and how to alleviate Tourette syndrome by improving gut microbiota are new topics, more in-depth and larger sample size research is still needed.
  • A comparison between ultrasonography and single-phase computed tomography for preoperative assessment of solid abdominal tumors in children Original Article

    Lucena, Iara Regina Siqueira; Chedid, Márcio Fernandes; Isolan, Paola Santis; Takamatu, Eliziane Emy; Lucena, Ronaldo Albé; Feier, Flavia Heinz; Furtado, Álvaro Porto Alegre; Fraga, Jose Carlos Soares de

    Resumo em Inglês:

    Abstract Objective: This study aimed to estimate the performance of single-phase-enhanced computed tomography and ultrasonography examinations in the preoperative evaluation of solid abdominal tumors and their relationship with relevant adjacent structures in children. Methods: This retrospective study included 50 pediatric patients with malignant solid abdominal tumors treated with surgical resection between 2009-2017. Preoperative computed tomography and ultrasonography were compared to operative findings (gold standard) in the diagnosis of invasion or encasement of adjacent structures. Accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated. Results: Renal (20.4%) and neuroblastic (19.4%) tumors were the most common. Complete surgical resection with negative margins was achieved in 44 (88%) patients. The comparison between single-phase-enhanced computed tomography and ultrasonography findings showed the following results: sensitivity = 90.3% vs 86.6%, specificity = 86.8% vs 94.6%, negative predictive value = 95.3% vs 94.4%, positive predictive value = 75.3% vs 86.9%, and accuracy = 87.9% vs 92.2%. The correlation (kappa index) between computed tomography and ultrasonography examinations was 0.72 (p < 0.001). In 14% (7/50) of the patients, the invasion of adjacent structures was diagnosed by ultrasonography but not by computed tomography (1 patient had 2 invaded structures).
  • Five-year performance analysis of a cystic fibrosis newborn screening program in northeastern Brazil Original Article

    Godoy, Carolina; Paixão, Danielle C.; Boa-Sorte, Ney C.A.; Amorim, Tatiana; da Silva Filho, Luiz Vicente R.F.; Souza Filho, Edna Lúcia

    Resumo em Inglês:

    Abstract Objective: To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state. Methods: A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn’s age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child’s age at diagnosis of disease. Results: The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3–7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th–75th) of 9.0 (7.0–13.0) days. Conclusions: The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.
  • Pediatric inflammatory multisystemic syndrome in Brazil: sociodemographic characteristics and risk factors to death Original Article

    Barros, Laura Abi Faiçal; Oliveira, Vinicius da Silva; Morais, Walison José de; Dias, Lara Araújo; Almeida, Julia Português; Soares, Marcela Batista; Aquino, Erika Carvalho de; Pinto, Renata Machado

    Resumo em Inglês:

    Abstract Objective: To determine the incidence of MIS-C in Brazil, describe the clinical and sociodemographic characteristics of the pediatric population affected by MIS-C and compare mortality and lethality outcomes with isolated Covid-19 and MIS-C cases. Methods: Observational and retrospective cohort study of cases of MIS-C associated with Covid-19 in the Brazilian population between 04/01/2020 and 04/17/2021. Data from the Ministry of Health's epidemiological bulletin up to the 15th epidemiological week of 2021, were used. The analyzes were descriptive through absolute and relative frequencies. The significance level is 5% in Stata 16.0 package. Results: Between 04/01/2020 and 04/07/2021, 903 cases of MIS-C associated with Covid-19 were notified in Brazil, of which, the largest part (55.26%) were male, between 0 and 4 years old (45.29%), from the Southeast region (38.76%). The deaths (61; 6.7%) were higher in the female gender, between 0 and 4 years old (47.54%) and in the Southeast region (34.43%). It was identified that the risk of death by MIS-C related to Covid-19 is 5.29 (CI = 2.83; 9.87 and P-value = <0.001) times higher in adolescents from 15-19 years old than in other age groups when compared to 0-4 years old children. Also, the residency in North region was as risk factor to death (RR = 3.72, IC = 1.29; 10.74 e P-value = 0.008). Conclusion: In this study, despite the numbers showing more deaths from zero to 4 years old, the risk for teenagers is notably higher. In addition, Brazil's Northern region is a risk factor that reaffirms social inequality and poor access to health.
  • Fat-free mass and maturity status are determinants of physical fitness performance in schoolchildren and adolescents Original Article

    Avcin, Paz Pezoa-Fuentes; Cossio-Bolaños, Marco; Urra-Albornoz, Camilo; Alvear-Vasquez, Fernando; Lazari, Evandro; Urzua-Alul, Luis; Campos, Luis Felipe Castelli Correia de; Gomez-Campos, Rossana

    Resumo em Inglês:

    Abstract Objectives: The objective of the study was to verify whether (FFM), maturity status (MS) and chronological age (CA) are determinants of physical fitness performance, and to analyze FFM and physical performance aligned by CA and MS in children and adolescents. Methods: A descriptive correlational study was carried out in 863 schoolchildren. Weight, height, and waist circumference (WC) were evaluated. Body mass index (BMI), FFM, fat mass (FM), MS (Age at peak height velocity, APHV) were calculated. The physical tests of velocity 20 m, agility 5 m × 10rep, and horizontal jump (HJ) were evaluated. Results: The APHV was estimated in boys at 14.0 ± 0.36APHV and in girls at 11.96 ± 0.49APHV. The relationships between CA and APHV with FFM was r = 0.80 in boys and r = 0.44 to 0.45 in girls. The relationships between FFM and physical tests in boys were [HJ (r = 0.70), agility 5m × 10rep (r = -0.68), velocity (r = -0.61)] and in girls [HJ (r = 0.42), agility 5m × 10rep (r = -0.52), velocity (r = -0.20)]. The differences in FFM and physical fitness tests were more pronounced when aligned by APHV than by CA. Conclusion: It was verified that both FFM, CA, and APHV are determinants of physical fitness performance. In addition, the APHV should be introduced in physical education as a means of ranking physical performance among schoolchildren.
  • Association between abdominal obesity, screen time and sleep in adolescents Original Article

    Oliveira, Isabela dos Reis de; Maciel, Nathália Maximiano Soares; Costa, Bianca Tomaz da; Soares, Anne Danieli Nascimento; Gomes, Júnia Maria Geraldo

    Resumo em Inglês:

    Abstract Objective: To assess the association between abdominal obesity, food intake, sleep deprivation, and screen time in adolescents. Methods: This cross-sectional study was conducted with 432 adolescents aged 14–19 years, from public and private schools. Anthropometric and body composition measures included body weight, waist circumference, body mass index for age, waist-to-hip ratio, waist-to-height ratio, and body fat percentage. Abdominal obesity was defined by age and sex specific cut-off points for waist circumference. Food intake, screen time, sexual maturation, and sleep duration were evaluated by self-administered questionnaires. Results: The prevalence of excess body weight and abdominal obesity was 16.7% and 27.5%, respectively. Students in the adult phase (post-puberty), with inadequate waist-to-height ratio, high body fat percentage, and screen time ≥ 3 h/day were, respectively, 2.5 (95% CI 1.40–4.46), 7.44 (95% CI 1.08-51.46), 2.79 (95% CI 1.04-7.50), and 1.43 (95% CI 1.24-3.89) more likely to have abdominal obesity. Low intake of unprocessed or minimally processed foods was associated with inadequate sleep duration, while high intake of ultra-processed foods was associated with high screen time. Conclusions: Abdominal obesity was associated with the adult phase, short sleep duration and high screen time. The degree of food processing was associated with screen time and sleep duration. Assessing the risk factors of abdominal obesity may be a useful strategy for preventing cardiovascular disease in adolescents.
  • Use of prophylactic phototherapy for RhD neonatal disease in a referral service Original Article

    Rodrigues, Joyce Marques da Silva Robalinho; Méio, Maria Dalva Barbosa Baker; Santos, Maria Cristina Pessoa dos; Costa, Ana Carolina Carioca da; Moreira, Maria Elisabeth Lopes

    Resumo em Inglês:

    Abstract Objective: This study aimed to describe the effect of prophylactic phototherapy in the treatment of infants with Neonatal Hemolytic Disease. Method: A retrospective cohort study was carried out with 199 RhD-positive infants, born to RhD-negative mothers, alloimmunized for RhD antigen, between January 2009 and December 2018. Results: The incidence of exchange transfusions in the study population was 9.5%, with a mean maximum bilirubin value of 11.3 mg % (± 4.3mg %). Bilirubin’s maximum peak was achieved with a mean of 119.2 life hours (± 70.6h). Conclusions: The low incidence of exchange transfusion, the extended maximum bilirubin peak for later ages, and the low mean of the maximum bilirubin values may indicate a positive effect of prophylactic phototherapy in the treatment of this disease. Further studies must be carried out to confirm these findings.
  • Increased expression of matrix metalloproteinases 2 and 9 as poor prognosis factor for Hodgkin’s lymphoma patients Original Article

    Silva, Bárbara de Oliveira; Medeiros, Jonathan Wagner; Albuquerque, Giwellington Silva; Valderrama, Pavel Medina; Barbosa, Athos Henrique de Quevedo; Souza, Juliana Maria de; Oliveira, Renata Santos; Morais, Adriana Lins; Silva Neto, Jacinto da Costa; Muniz, Maria Tereza Cartaxo

    Resumo em Inglês:

    Abstract Objective: The aim of our study was to evaluate the expression of MMP-2 and MMP-9 as a prognostic factor in patients diagnosed with Hodgkin Lymphoma (HL). Methods: In the present study, 45 paraffin biopsies from patients up to 19 years old diagnosed with HL were used in two referral hospitals in the state of Pernambuco, Brazil. Risk groups were classified into favorable and unfavorable, according to Ann Arbor. The expression of matrix metalloproteinases 2 and 9 and their inhibitors was performed by immunohistochemistry (IHC). Data were analyzed using the GraphPad Prism 5 program. Results: MMP-2 intensity pattern was stronger (> 10% of the total field) in patients with stage III/ IV and B symptoms. MMP-2 showed an association with the risk group (p = 0.0388). That is, the stronger the MMP-2 marking, the greater the unfavorable risk. However, for MMP-9 there was no difference in the stronger intensity pattern in relation to stages I/II and III/IV, only in the presence of B symptoms. MMP-9 showed an association with B Symptoms (p = 0.0411). Therefore, patients with B symptoms have higher MMP-9 expression. Conclusion: Our results suggest that MMP-2 expression is associated with HL progression. While MMP-9 expression is related to the clinical worsening of these patients. However, further studies are needed to evaluate the exact role of these proteins in hematologic malignancies.
  • Clinical implications of Golgi protein 73 and granulocyte colony-stimulating factor and their related factors in children with bronchopneumonia Original Article

    Li, Baofa; Liu, Xin

    Resumo em Inglês:

    Abstract Objective: To investigate the clinical implications of Golgi glycoprotein 73 (GP73) and granulocyte colony-stimulating factor (G-CSF) in children with bronchopneumonia (BP). Methods: Seventy-two children with BP (observation group) and 81 healthy children (control group) consecutively brought to the present study's hospital between June 2019 and October 2020 were enrolled. GP73 and G-CSF levels were determined to analyze their diagnostic value for pediatric BP. High-sensitivity C-reactive protein (hs-CRP) was also measured. The clinical implications of GP73 and G-CSF in pediatric BP complicated with respiratory failure and their connections with the inflammatory response were discussed. Results: GP73 and G-CSF levels were remarkably higher in the observation group (p< 0.05). The sensitivity and specificity of combined detection (GP73+G-CSF) in predicting pediatric BP were 72.22% and 86.42%, respectively (p < 0.001 ). GP73 and G-CSF, which are closely related to X-ray classification and complications in the observation group, decreased after treatment and were positively correlated with hs-CRP (p < 0.05), especially in children complicated with respiratory failure. Regression analysis identified the independence of the course of the disease, hs-CRP, X-ray classification, GP73, and G-CSF as influencing factors of respiratory failure in children with BP (p < 0.05). Conclusion: GP73 and G-CSF, with elevated levels in children with BP, are strongly linked to disease progression and are independent influencing factors of respiratory failure, which may be the key to diagnosing and treating pediatric BP in the future.
  • Trends in consuming alcoholic beverages among adolescents and young adults of school age: sexes differences Original Article

    Mola, Rachel; Araújo, Rodrigo Cappato de; Barbosa, Shayra Anny; Almeida, Layane Sá; Pitangui, Ana Carolina Rodarti

    Resumo em Inglês:

    Abstract Objective: To analyze the tendency of alcoholic beverage consumption among adolescents and young adults at school age according to their sexes. Methods: This is a trend research study in public schools of the municipality of Petrolina, between 2014 and 2016, with 3146 students aged between 12 and 24 years old. The instrument was constituted by socio-economic inquiry and the Youth Risk Behavior Survey. Trends were assessed using the Centers for Disease Control and Prevention recommended approach. The analyses were conducted using logistic regression, with a statistical significance of 0.05. Results: Close to 56% of the adolescents had already tried some alcoholic beverage, most of which had contact after 13 years of age. The prevalence of binge drinking ranged between 17% and 25%. The percentage of girls who tried alcohol before 13 years old remained similar over the three years (p = 0.943). The prevalence of this behavior was stabilized at around 20%. There was a trend to decrease in the prevalence of boys who reported having tried alcohol before 13 years old (p = 0.014). The percentage of boys who reported involvement in binge drinking in the past 30 days remained stable at around 20% over the years (p = 0.951 ). The girls’ data revealed a significant decrease in binge drinking (p = 0.019). Conclusions: The general analysis suggests a trend towards stabilization of consumption among boys, and an increase among girls.
  • Prevalence of thyroid dysfunction in neonates receiving parenteral nutrition in the intensive care unit Original Article

    Pérsico, Raquel Stocker; Silveira, Rita de Cassia dos Santos; Gazal, Claudia Hallal Alves; Viana, Luciana Verçoza

    Resumo em Inglês:

    Abstract Objective: The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN. Methods: Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L. Results: Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol’s solution and six levothyroxine. Thirteen patients received prophylactic Lugol’s solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02). Conclusions: The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroid-ism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary.
  • Growth phenotypes of very low birth weight infants for prediction of neonatal outcomes from a Brazilian cohort: comparison with INTERGROWTH Original Article

    Cardoso, Viviane Cunha; Grandi, Carlos; Silveira, Rita C.; Duarte, José Luiz Bandeira; Viana, Maria Cândida Ferrarez Bouzada; Ferreira, Daniela Marques de Lima Mota; Alves Junior, José Mariano Sales; Embrizi, Laís Furlan; Gimenes, Carolina Boschi; Mello e Silva, Nathalia Moura de; Melo, Fernanda Pegoraro de Godoi; Venzon, Paulyne Stadler; Gomez, Dafne Barcala; Vale, Marynéa Silva do; Bentlin, Maria Regina; Barros, Marina Carvalho de Moraes; Bigélli, Laura Emilia Monteiro; Diniz, Edna Maria de Albuquerque; Luz, Jorge Hecker; Marba, Sérgio Tadeu Martins; Almeida, João Henrique Carvalho Leme de; Aragon, Davi Casale; Carmona, Fabio

    Resumo em Inglês:

    Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92–2.31)/1.60 (1.27–2.02) for SGA; 0.90 (0.55–1.47)/1.05 (0.55–1.99) for LGA; 1.65 (1.08–2.51)/1.58 (1.28–1.96) for stunting; and 1.48 (1.02–2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.
  • Functional status of individuals with osteogenesis imperfecta: data from a reference center Original Article

    Carvalho, Patricia de Abreu Farias; Regis, Taiane Sousa; Faiçal, Adriana Virgínia Barros; Lago, Renata Maria Rabello da Silva; Terse-Ramos, Regina; Acosta, Angelina Xavier

    Resumo em Inglês:

    Abstract Objective: To evaluate the functional status of individuals with Osteogenesis Imperfecta (OI) followed up at a reference center in the state of Bahia. Materials and methods: This is an observational, cross-sectional, descriptive study, which evaluated individuals with OI, based on a non-probabilistic sampling. To assess motor function, the Motor Function Measure (MFM) score was used, in addition to the measurement of muscle strength using the Medical Research Council (MRC) score. Functional performance was measured using the Pediatric Assessment of Disability Inventory, Computerized Adaptive Testing (PEDI-CAT). Results: Thirty-one individuals aged between two and 18 years old were evaluated. The overall score of MFM was 74.2%, and the lowest score was found in participants with type III OI (56.3%). The median of the MRC index was 80. The mobility domain was the most affected in the PEDI-CATevaluation, with a mean T score of 23.9, (14.2 in type III OI). Conclusions: Among the evaluated individuals, functional alterations were identified, reduced global gross motor functionality and muscle strength, impacting the mobility domain, with the most relevant findings in individuals with type III OI.
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