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

{"title":"Pediatric patients with COVID‐19 admitted to intensive care units in Brazil: a prospective multicenter study","authors":"Arnaldo Prata‐Barbosa ,&nbsp;Fernanda Lima‐Setta ,&nbsp;Gustavo Rodrigues dos Santos ,&nbsp;Vanessa Soares Lanziotti ,&nbsp;Roberta Esteves Vieira de Castro ,&nbsp;Daniela Carla de Souza ,&nbsp;Carlos Eduardo Raymundo ,&nbsp;Felipe Rezende Caino de Oliveira ,&nbsp;Lucio Flavio Peixoto de Lima ,&nbsp;Cristian Tedesco Tonial ,&nbsp;José Colleti Jr. ,&nbsp;Ana Paula Novaes Bellinat ,&nbsp;Vivian Botelho Lorenzo ,&nbsp;Raquel de Seixas Zeitel ,&nbsp;Lucas Pulcheri ,&nbsp;Fernanda Ciuffo Monte da Costa ,&nbsp;Fabíola Peixoto Ferreira La Torre ,&nbsp;Elaine Augusta das Neves Figueiredo ,&nbsp;Thiago Peres da Silva ,&nbsp;Paula Marins Riveiro ,&nbsp;Maria Clara de Magalhães‐Barbosa","doi":"10.1016/j.jpedp.2020.07.002","DOIUrl":"https://doi.org/10.1016/j.jpedp.2020.07.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID‐19.</p></div><div><h3>Method</h3><p>Prospective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March–May 2020) were included. Demographic, clinical‐epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age &lt; 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity.</p></div><div><h3>Results</h3><p>Seventy‐nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% <em>vs.</em> 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length‐of‐stay was five days; there were two deaths (3%) in the non‐ multisystemic inflammatory syndrome group. Patients with comorbidities were older and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43–21.12; p<!--> <em>=</em> <!-->0.01).</p></div><div><h3>Conclusions</h3><p>In Brazilian pediatric intensive care units, COVID‐19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 582-592"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2020.07.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91984344","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":"Perinatal factors associated with amplitude‐integrated electroencephalography abnormalities in preterm infants on the first day of life","authors":"Junia Sampel de Castro,&nbsp;Ana Teresa Figueiredo Stochero Leslie,&nbsp;Ruth Guinsburg","doi":"10.1016/j.jpedp.2019.06.004","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.06.004","url":null,"abstract":"<div><h3>Objective</h3><p>Evaluate the association between perinatal factors and amplitude‐integrated electroencephalogram abnormalities in preterm infants on the first day of life.</p></div><div><h3>Methods</h3><p>This was a cross‐sectional study of 60 infants with gestational age between 23 and 32 weeks, without malformations. Infants were continuously monitored by amplitude‐integrated electroencephalogram on the first day of life, for at least 3<!--> <!-->h. The tracings were recorded and analyzed in each column for the following: burst‐suppression pattern, sleep‐wake cycle, and amplitude of the lower margin (&lt;3<!--> <!-->μV or &lt;5<!--> <!-->μV). The association of maternal complications, mode of delivery, birth weight, gestational age, neonatal sex, resuscitation procedures, hypothermia on admission, and the Score for Neonatal Acute Physiology, Perinatal Extension, Version II [SNAPPE‐II]) with amplitude‐integrated electroencephalogram alterations was assessed by multiple logistic regression.</p></div><div><h3>Results</h3><p>A discontinuous pattern occurred in 65% of infants, and a continuous pattern occurred in 23%. The burst‐suppression pattern was associated with vaginal delivery (OR: 7.6; 95% CI: 1.1–53.1) and SNAPPE‐II<!--> <!-->≥<!--> <!-->40 (OR: 13.1; 95% CI: 1.8–95.1). A lower margin of the amplitude‐integrated electroencephalogram of &lt;3<!--> <!-->μV was also associated with SNAPPE‐II<!--> <!-->≥<!--> <!-->40 (OR: 10.6, 95% CI: 2.3–49.2), while a value &lt;5<!--> <!-->μV was associated with lower GA (OR: 0.51, 95% CI: 0.34–0.76). There were no associations between the perinatal variables and the absence of a sleep‐wake cycle in amplitude‐integrated electroencephalogram recordings on the first day of life.</p></div><div><h3>Conclusion</h3><p>Biological variables and clinical severity are associated with electroencephalographic characteristics of preterm infants on the first day of life and should be considered in clinical practice when amplitude‐integrated electroencephalogram is performed.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 644-651"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.06.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137091818","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":"Audiological assessment of children with HIV/AIDS: a meta‐analysis","authors":"Janaina Oliveira Bentivi ,&nbsp;Conceição de Maria Pedrozo e Silva de Azevedo ,&nbsp;Monique Kelly Duarte Lopes ,&nbsp;Savya Cybelle Milhomem Rocha ,&nbsp;Paula Cristina Ribeiro e Silva ,&nbsp;Valeria Maciel Costa ,&nbsp;Ana Beatriz Sousa Costa","doi":"10.1016/j.jpedp.2020.01.003","DOIUrl":"https://doi.org/10.1016/j.jpedp.2020.01.003","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the results of the audiological evaluation of children with HIV and AIDS.</p></div><div><h3>Data collection</h3><p>Systematic review carried out in May 2019 in the Web of Science, PubMed, SciELO, and Scopus databases. Case reports and original articles were included, with no limi‐tationsregarding country or year of publication.</p></div><div><h3>Data synthesis</h3><p>278 articles were identified; 26 were included, in which HIV/AIDS was shown to be a risk factor for hearing loss (OR = 5.364; p = 0.00). The studies used different audiological exams, with varying methodologies. There was no difference regarding the type of hearing loss (p = 0.119).</p></div><div><h3>Conclusion</h3><p>Longitudinal studies using the same type of examination at all stages are suggested, to allow better monitoring of the effects of HIV on the child's hearing, and studies that provide more methodological details. The knowledge of the influence of HIV on the child's auditory system may lead to the promotion of measures that minimize the prevalence of hearing loss, allow an early diagnosis and timely rehabilitation, so as not to compromise child development.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 537-545"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2020.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137091395","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":"Day‐1 PELOD‐2 and day‐1 “quick” PELOD‐2 scores in children with sepsis in the PICU","authors":"Mianling Zhong,&nbsp;Yuge Huang,&nbsp;Tufeng Li,&nbsp;Lu Xiong,&nbsp;Ting Lin,&nbsp;Miaofen Li,&nbsp;Dongqiang He","doi":"10.1016/j.jpedp.2019.07.007","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.07.007","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aimed to evaluate the predictive validity of the day‐1 PELOD‐2 and day‐1 “quick” PELOD‐2 (qPELOD‐2) scores for in‐hospital mortality in children with sepsis in a pediatric intensive care unit (PICU) of a developing country.</p></div><div><h3>Methods</h3><p>The data of 516 children diagnosed as sepsis were retrospectively analyzed. The children were divided into survival group and non‐survival group, according to the clinical outcome 28 days after admission. Day‐1 PELOD‐2, day‐1 qPELOD‐2, pediatric SOFA (pSOFA), and P‐MODS were collected and scored. Receiver operating characteristic (ROC) curves were plotted, and the efficiency of the day‐1 PELOD‐2, day‐1 qPELOD‐2 score, pSOFA, and P‐MODS for predicting death were evaluated by the area under the ROC curve (AUC).</p></div><div><h3>Results</h3><p>The day‐1 PELOD‐2 score, day‐1 qPELOD‐2 score, pSOFA, and P‐MODS in the non‐survivor group were significantly higher than those in the survivor group. ROC curve analysis showed that the AUCs of the day‐1 PELOD‐2 score, day‐1 qPELOD‐2 score, pSOFA, and P‐MODS for predicting the prognosis of children with sepsis in the PICU were 0.916, 0.802, 0.937, and 0.761, respectively (all p &lt; 0.05).</p></div><div><h3>Conclusions</h3><p>Both the day‐1 PELOD‐2 score and day‐1 qPELOD‐2 score were effective and able to assess the prognosis of children with sepsis in a PICU of a developing country. Additionally, the day‐1 PELOD‐2 score was superior to the day‐1 qPELOD‐2 score. Further studies are needed to verify the usefulness of the day‐1 qPELOD‐2 score, particularly outside of the PICU.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 660-665"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.07.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137091833","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":"Impact of the development of acute kidney injury on patients admitted to the pediatric intensive care unit","authors":"Marina Catuta de Rezende Ferreira ,&nbsp;Emerson Quintino Lima","doi":"10.1016/j.jpedp.2019.05.025","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.05.025","url":null,"abstract":"<div><h3>Objective</h3><p>To identify the risk factors for the development of acute kidney injury and for short and long‐term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit.</p></div><div><h3>Materials and methods</h3><p>Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in‐hospital, and long‐term mortality were obtained through multivariate logistic regression analysis. Long‐term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients’ family members.</p></div><div><h3>Results</h3><p>A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24 hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in‐hospital mortality. Long‐term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long‐term mortality after admission to the Pediatric Intensive Care Unit.</p></div><div><h3>Conclusion</h3><p>Acute kidney injury was a frequent, early event, and was associated with in‐hospital mortality and long‐term mortality after admission to the Pediatric Intensive Care Unit.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 576-581"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.05.025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91984343","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":"Vitamin D deficiency in pediatric patients using antiepileptic drugs: systematic review with meta‐analysis","authors":"Cíntia Junges ,&nbsp;Tania Diniz Machado ,&nbsp;Paulo Ricardo Santos Nunes Filho ,&nbsp;Rudimar Riesgo ,&nbsp;Elza Daniel de Mello","doi":"10.1016/j.jpedp.2020.06.001","DOIUrl":"https://doi.org/10.1016/j.jpedp.2020.06.001","url":null,"abstract":"<div><h3>Objectives</h3><p>To measure the prevalence of vitamin D deficiency (through the 25‐hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs.</p></div><div><h3>Source of data</h3><p>Meta‐analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019.</p></div><div><h3>Summary of data</h3><p>A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI<!--> <!-->=<!--> <!-->0.25 ‐ 0.41; I² <!-->=<!--> <!-->92%, p<!--> <!-->&lt;<!--> <!-->0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450‐inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI<!--> <!-->=<!--> <!-->0.21 ‐ 0.47; I² <!-->=<!--> <!-->86%, p<!--> <!-->&lt;<!--> <!-->0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI<!--> <!-->=<!--> <!-->0.40 ‐ 0.64; I² <!-->=<!--> <!-->76%, p<!--> <!-->&lt;<!--> <!-->0.01).</p></div><div><h3>Conclusions</h3><p>Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25‐hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present<em>.</em></p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 559-568"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2020.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91984345","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":"Congenital diaphragmatic hernia: 25 years of shared knowledge; what about survival?","authors":"Satyan Lakshminrusimha,&nbsp;Payam Vali","doi":"10.1016/j.jpedp.2019.10.003","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.10.003","url":null,"abstract":"","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 527-532"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136834927","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":"Functional echocardiography training in the neonatal intensive care unit: comparing measurements and results with the pediatric cardiologist","authors":"Marina Maccagnano Zamith ,&nbsp;Simone de Araujo Negreiros Figueira ,&nbsp;Allan Chiaratti de Oliveira ,&nbsp;Cristiane Metolina ,&nbsp;Junia Sampel de Castro ,&nbsp;Cristina Nunes dos Santos ,&nbsp;Ana Leticia de Oliveira Abrahão de Capo ,&nbsp;Valdir Ambrósio Moisés","doi":"10.1016/j.jpedp.2019.04.014","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.04.014","url":null,"abstract":"<div><h3>Objectives</h3><p>Functional echocardiography is a valuable tool in the neonatal intensive care unit, but training programs are not standardized. The aim was to report an functional echocardiography training program for neonatologists and to describe the agreement of their measurements with the pediatric cardiologist.</p></div><div><h3>Methods</h3><p>Functional echocardiography training lasted 32<!--> <!-->h. After training program, the neonatologists performed functional echocardiography in the neonatal intensive care unit and were required to measure left cardiac chambers dimensions, left ventricle systolic function, right and left ventricular output, ductus arteriosus diameter, and flow pattern. Images were recorded by the equipment and reviewed offline by the pediatric cardiologist. The Bland–Altman test was used for quantitative variables and the kappa test, for qualitative variables.</p></div><div><h3>Results</h3><p>Twenty‐two trained neonatologists performed 100 functional echocardiography exams. Ductus arteriosus identification and flow pattern had substantial agreement (kappa<!--> <!-->=<!--> <!-->0.91 and 0.88, respectively), as well as its diameter (mean difference<!--> <!-->=<!--> <!-->0.04<!--> <!-->mm). The mean difference for the aortic root was −1.2<!--> <!-->mm; left atrium, 0.60<!--> <!-->mm; left ventricle diastolic diameter, −0.90<!--> <!-->mm; left ventricle systolic diameter, −0.30<!--> <!-->mm. Shortening fraction and ejection fraction correlated well with broad limits of agreement, −2.96% (14.88; −20.82%) and −‐3.43% (15.54; −22.40%), respectively. Right and left ventricular output had broad limits of agreement, 16.69<!--> <!-->mL/kg/min (222.76; −189.37) and 23.57<!--> <!-->mL/kg/min (157.88; −110), respectively. There was good agreement between interpretations of normal or low cardiac output (76.7% for right ventricular output; 75.7% for left ventricular output).</p></div><div><h3>Conclusion</h3><p>This functional echocardiography training program enabled neonatologists to obtain adequate skills in performing the images, obtaining good agreement with the cardiologist in simple hemodynamic measurements and ductus arteriosus evaluation.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 614-620"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.04.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137091396","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":"Palliative extubation: five‐year experience in a pediatric hospital","authors":"Carolina de Araújo Affonseca ,&nbsp;Luís Fernando Andrade de Carvalho ,&nbsp;Renata de Pinho Barroso Quinet ,&nbsp;Maíla Cristina da Cunha Guimarães ,&nbsp;Verônica Ferreira Cury ,&nbsp;Alexandre Tellechea Rotta","doi":"10.1016/j.jpedp.2019.07.004","DOIUrl":"https://doi.org/10.1016/j.jpedp.2019.07.004","url":null,"abstract":"<div><h3>Objective</h3><p>To present the characteristics of pediatric patients with chronic and irreversible diseases submitted to palliative extubation.</p></div><div><h3>Method</h3><p>This is a descriptive analysis of a series of patients admitted to a pediatric public hospital, with chronic and irreversible diseases, permanently dependent on ventilatory support, who were submitted to palliative extubation between April 2014 and May 2019. The following information was collected from the medical records: demographic data, diagnosis, duration and type of mechanical ventilation; date, time, and place of palliative extubation; medications used; symptoms observed; and hospital outcome.</p></div><div><h3>Results</h3><p>A total of 19 patients with a mean age of 2.2 years were submitted to palliative extubation. 68.4% of extubations were performed in the ICU; 11 patients (57.9%) died in the hospital. The time between mechanical ventilation withdrawal and in‐hospital death ranged from 15<!--> <!-->minutes to five days. Thirteen patients used an orotracheal tube and the others used tracheostomy. The main symptoms were dyspnea and pain, and the main drugs used to control symptoms were opioids and benzodiazepines.</p></div><div><h3>Conclusions</h3><p>It was not possible to identify predictors of in‐hospital death after ventilatory support withdrawal. Palliative extubation requires specialized care, with the presence and availability of a multidisciplinary team with adequate training in symptom control and palliative care.</p></div>","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 652-659"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2019.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137091819","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":"The long and the short of it – the impact of acute kidney injury in critically ill children","authors":"Michael Zappitelli,&nbsp;Damien Noone","doi":"10.1016/j.jpedp.2020.01.004","DOIUrl":"https://doi.org/10.1016/j.jpedp.2020.01.004","url":null,"abstract":"","PeriodicalId":100742,"journal":{"name":"Jornal de Pediatria (Vers?o em Português)","volume":"96 5","pages":"Pages 533-536"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jpedp.2020.01.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136855225","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}