Jornal de Pediatria (Vers?o em Português)最新文献

{"title":"The challenges of neonatal sepsis management","authors":"Renato Soibelmann Procianoy,&nbsp;Rita C. Silveira","doi":"10.1016/j.jpedp.2019.10.004","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.10.004","url":null,"abstract":"<div><h3>Objectives</h3><p>To present current evidence on the etiology, risk factors, diagnosis, and management of early and late neonatal sepsis.</p></div><div><h3>Source of data</h3><p>Non‐systematic review of the Medline (PubMed), Scopus, Web of Science, Cochrane, and Google Scholar databases regarding the following terms: neonatal sepsis, early neonatal sepsis, late neonatal sepsis, empirical antibiotic therapy, sepsis calculator, vancomycin, newborn, preterm newborn.</p></div><div><h3>Data synthesis</h3><p>Neonatal sepsis is a frequent cause of neonatal morbidity and mortality. Its diagnosis is difficult. Continuous observation of the patient is critical to diagnostic suspicion. When neonatal sepsis is suspected, bacteriological tests should be collected. Vancomycin should not be routinely using in the empirical antibiotic regimen in late neonatal sepsis, and the main protective mechanisms against neonatal sepsis are handwashing and the use of breast milk.</p></div><div><h3>Conclusions</h3><p>Newborns constitute a group that is more vulnerable to sepsis. Knowledge of risk factors and etiological agents allows a better approach to the newborn with sepsis.<br></p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 ","pages":"Pages 80-86"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137131954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infections in children with diabetes","authors":"Luis Eduardo Calliari ,&nbsp;Flávia J. Almeida ,&nbsp;Renata Maria Noronha","doi":"10.1016/j.jpedp.2019.09.004","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.09.004","url":null,"abstract":"<div><h3>Objective</h3><p>The association between diabetes mellitus and infections is very common. These infections, even when mild, interfere with blood glucose control. The aim of this review is to describe infections that occur in children and adolescents with DM, as well as to provide recommendations on glycemia management during these episodes.</p></div><div><h3>Source of data</h3><p>A non‐systematic review was carried out in the PubMed database, using the terms “diabetes mellitus,” “infection,” “children,” and “adolescents.” The most relevant publications were selected.</p></div><div><h3>Synthesis of data</h3><p>In addition to the usual community diseases, some infections may occur predominantly in diabetic patients, especially when there is inadequate glycemic control, and common infections can be more severe in these patients. Alterations caused by the disease itself and the immune response are responsible for the risk of higher frequency and severity of infections. During infections, an increase in blood glucose occurs and usually an increase in insulin dose is required.</p></div><div><h3>Conclusions</h3><p>Pediatric patients with diabetes have some immune system disorders that, when associated with high glycemia, increase the risk of infections and their severity, and should be promptly identified and treated. The presence of an infectious condition, in turn, raises blood glucose and increases the risk of decompensation, and pediatricians should be cautioned to intensify monitoring and insulin therapy, and to avoid the risk of DKA. It should also be noted that many infections are preventable and can be avoided with adequate vaccine coverage.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 ","pages":"Pages 39-46"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.09.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137132041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunistic infections in pediatrics: when to suspect and how to approach","authors":"Maria Isabel de Moraes-Pinto,&nbsp;Maria Aparecida Gadiani Ferrarini","doi":"10.1016/j.jpedp.2019.09.007","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.09.007","url":null,"abstract":"<div><h3>Objectives</h3><p>To describe the characteristics of opportunistic infections in pediatrics regarding their clinical aspects, as well as the diagnostic strategy and treatment.</p></div><div><h3>Source of data</h3><p>Non‐systematic review of literature studies in the PubMed database.</p></div><div><h3>Synthesis of data</h3><p>Opportunistic infections caused by non‐tuberculous mycobacteria, fungi, Herpesvirae, and infections affecting individuals using immunobiological agents are analyzed. Because these are severe diseases with a rapid evolution, diagnostic suspicion should be early, associated with the patient's clinical assessment and history pointing to opportunistic infections. Whenever possible, samples of secretions, blood, and other fluids and tissues should be collected, with early therapy implementation.</p></div><div><h3>Conclusions</h3><p>Despite the improved diagnosis of opportunistic infections in recent years, they remain a challenge for pediatricians who are not used to these infections. They should raise the suspicion and start treating the case, but should also resort to specialists in the management of these infections to provide a better outcome for these patients, who still have high mortality.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 ","pages":"Pages 47-57"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.09.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137132042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis in childhood and adolescence: a view from different perspectives","authors":"Tony T. Tahan ,&nbsp;Betina M.A. Gabardo ,&nbsp;Andrea M.O. Rossoni","doi":"10.1016/j.jpedp.2019.11.002","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.11.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the epidemiological situation of tuberculosis in children under 19 years of age in Brazil and to review the latest publications on disease risk, diagnosis, treatment, and prevention.</p></div><div><h3>Source of data</h3><p>Notifiable Diseases Information System (2018), World Health Organization estimates, and PubMed articles selected using the descriptor “Tuberculosis,” delimited by type of study, period, age, and language.</p></div><div><h3>Synthesis of data</h3><p>In 2018, in Brazil, 9.4% of notifications were in children under 19 years. The pulmonary form predominated in 80.1% of the cases. The cure rate was 76.8%, lethality was 0.8%, and abandonment was 10.4%. The prevalence of drug‐resistant tuberculosis (2011 to 2016) was 0.5%.It has been found that the risk of disease can reach up to 56% in children under 5 years, influenced by helminth co‐infections, malaria, chronic viral infections, live attenuated virus vaccines, and hypovitaminosis D. Exposure to a bacilliferous patient for periods shorter than 30 minutes is sufficient for the development of infection and/or disease. In Brazil, microbiological screening is recommended, but the use of the scoring system, modified in 2019, has been maintained. Studies on infection detection have supported the use of the tuberculin skin test. In the treatment, the great advance was the introduction of dispersible formulations, adjustment of the recommended doses, and shortened regimens for latent infection. Several vaccine studies (stages 1–3) are ongoing, but no BCG‐licensed substitute has been implemented yet.</p></div><div><h3>Conclusions</h3><p>There has been progress in treatment, but major challenges need to be overcome to improve diagnosis, monitoring, and outcome of cases, aiming to eliminate tuberculosis.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 ","pages":"Pages 99-110"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.11.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137132046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of intrauterine latent iron deficiency on auditory neural maturation in full‐term newborns","authors":"Leticia Valerio Pallone,&nbsp;Felipe Alves de Jesus,&nbsp;Gleice Aline Gonçalves,&nbsp;Laura Carvalho Navarra,&nbsp;Débora Gusmão Melo,&nbsp;Rodrigo Alves Ferreira,&nbsp;Carla Maria Ramos Germano","doi":"10.1016/j.jpedp.2018.11.006","DOIUrl":"https://doi.org/10.1016/j.jpedp.2018.11.006","url":null,"abstract":"<div><h3>Objective</h3><p>This study analyzed the relationship between latent iron deficiency evaluated by ferritin, and the myelination of the central nervous system evaluated through the brainstem evoked response audiometry test.</p></div><div><h3>Method</h3><p>A total of 109 full‐term newborns, born without anemia and risk factor for hearing deficiency, were enrolled. After delivery, umbilical cord blood was collected to determine ferritin and hematocrit levels. The brainstem evoked response audiometry test was carried out in the first 28 days of life. Analysis was performed between the control group (<em>n</em> <!-->=<!--> <!-->71) with ferritin greater than 75<!--> <!-->ng/mL, and the latent iron deficiency group (<em>n</em> <!-->=<!--> <!-->38) with ferritin between 11 and 75<!--> <!-->ng/mL. Results were presented as mean<!--> <!-->±<!--> <!-->standard deviation. Statistical analysis was performed using GraphPad prism7 and SPSS with a significance level of 5%.</p></div><div><h3>Results</h3><p>A significant higher V‐wave (<em>p</em> <!-->=<!--> <!-->0.02) and interpeak intervals I–III (<em>p</em> <!-->=<!--> <!-->0.014), I–V (<em>p</em> <!-->=<!--> <!-->0.0003), and III‐V (<em>p</em> <!-->=<!--> <!-->0.0002) latencies were found in the latent iron deficiency group, as well as a significant inversely proportional correlation between ferritin and the same wave and intervals (<em>p</em> <!-->=<!--> <!-->0.003, <em>p</em> <!-->=<!--> <!-->0.0013, <em>p</em> <!-->=<!--> <!-->0.0002, <em>p</em> <!-->=<!--> <!-->0.009, respectively). Multiple correlation analysis showed a significant correlation of latent iron deficiency with all interpeak intervals, even taking into account newborn gestational age.</p></div><div><h3>Conclusion</h3><p>Iron deficiency anemia is a prevalent pathology; this study showed auditory delayed maturation associated to intrauterine iron deficiency, even in its latent form. This reinforces the importance of adopting effective measures, on a global scale, to prevent and treat this pathology in different life periods, especially in the most vulnerable population.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 2","pages":"Pages 202-209"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2018.11.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137162114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Septic shock in pediatrics: the state‐of‐the‐art","authors":"Pedro Celiny Ramos Garcia ,&nbsp;Cristian Tedesco Tonial ,&nbsp;Jefferson Pedro Piva","doi":"10.1016/j.jpedp.2019.10.007","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.10.007","url":null,"abstract":"<div><h3>Objective</h3><p>Review the main aspects of the definition, diagnosis, and management of pediatric patients with sepsis and septic shock.</p></div><div><h3>Source of data</h3><p>A search was carried out in the MEDLINE and Embase databases. The articles were chosen according to the authors’ interest, prioritizing those published in the last five years.</p></div><div><h3>Synthesis of data</h3><p>Sepsis remains a major cause of mortality in pediatric patients. The variability of clinical presentations makes it difficult to attain a precise definition in pediatrics. Airway stabilization with adequate oxygenation and ventilation if necessary, initial volume resuscitation, antibiotic administration, and cardiovascular support are the basis of sepsis treatment. In resource‐poor settings, attention should be paid to the risks of fluid overload when administrating fluids. Administration of vasoactive drugs such as epinephrine or norepinephrine is necessary in the absence of volume response within the first hour. Follow‐up of shock treatment should adhere to targets such as restoring vital and clinical signs of shock and controlling the focus of infection. A multimodal evaluation with bedside ultrasound for management after the first hours is recommended. In refractory shock, attention should be given to situations such as cardiac tamponade, hypothyroidism, adrenal insufficiency, abdominal catastrophe, and focus of uncontrolled infection.</p></div><div><h3>Conclusions</h3><p>The implementation of protocols and advanced technologies have reduced sepsis mortality. In resource‐poor settings, good practices such as early sepsis identification, antibiotic administration, and careful fluid infusion are the cornerstones of sepsis management.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 ","pages":"Pages 87-98"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.10.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137132045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rational use of antimicrobials in the treatment of upper airway infections","authors":"Santiago Alfayate Miguélez ,&nbsp;Luis Garcia‐Marcos","doi":"10.1016/j.jpedp.2019.11.003","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.11.003","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self‐limited, and typically viral condition: upper airway respiratory infections.</p></div><div><h3>Sources</h3><p>Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients.</p></div><div><h3>Summary of the findings</h3><p>Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones.</p></div><div><h3>Conclusions</h3><p>Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 ","pages":"Pages 111-119"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137132053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex and age disparities in physical activity among Brazilian adolescents: nature or nurture?","authors":"Deborah Salvo ,&nbsp;Nicolas Aguilar‐Farias ,&nbsp;Alejandra Jauregui ,&nbsp;Andrea Ramirez Varela","doi":"10.1016/j.jpedp.2019.04.010","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.04.010","url":null,"abstract":"","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 1","pages":"Pages 4-7"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.04.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91599239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TyG in insulin resistance prediction","authors":"Wendell Arthur Lopes,&nbsp;Gustavo Henrique de Oliveira,&nbsp;João Carlos Locateli,&nbsp;Caroline Ferraz Simões","doi":"10.1016/j.jpedp.2019.09.003","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.09.003","url":null,"abstract":"","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 1","pages":"Pages 132-133"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.09.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91599250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Answer to the Letter “TyG in insulin resistance prediction”","authors":"Sarah A. Vieira‐Ribeiro ,&nbsp;Poliana C.A. Fonseca ,&nbsp;Cristiana S. Andreoli ,&nbsp;Andréia Q. Ribeiro ,&nbsp;Helen H.M. Hermsdorff ,&nbsp;Patrícia F. Pereira ,&nbsp;Silvia E. Priore ,&nbsp;Sylvia C.C. Franceschini","doi":"10.1016/j.jpedp.2019.10.002","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.10.002","url":null,"abstract":"","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 1","pages":"Pages 133-134"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91599251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}