Flavia Garcia Frogeri, Andréa de Melo Alexandre Fraga, Fernando Augusto de Lima Marson, Antônio Gonçalves de Oliveira Filho, Márcio Lopes Miranda, Joaquim Murray Bustorff-Silva
{"title":"Narrative review and creation of an institutional protocol for the use of fibrinolytics in parapneumonic effusion in children.","authors":"Flavia Garcia Frogeri, Andréa de Melo Alexandre Fraga, Fernando Augusto de Lima Marson, Antônio Gonçalves de Oliveira Filho, Márcio Lopes Miranda, Joaquim Murray Bustorff-Silva","doi":"10.1016/j.jped.2025.01.005","DOIUrl":"10.1016/j.jped.2025.01.005","url":null,"abstract":"<p><strong>Objective: </strong>Pneumonia is the leading cause of morbidity and mortality in children under 5 years old, with an increasing incidence of parapneumonic pleural effusion. Pleural effusion is a common complication, sometimes requiring surgical intervention. A literature review was conducted on parapneumonic pleural effusion and its treatment in the pediatric population, and an institutional protocol for intrapleural fibrinolysis was developed.</p><p><strong>Data sources: </strong>Articles from the past 15 years were reviewed in the databases PubMed-MEDLINE, LILACS, Cochrane, and Scielo using the terms pleural effusion, empyema, pneumonia, fibrinolytic, and children. A protocol for intrapleural fibrinolytic use in cases of parapneumonic pleural effusion was established.</p><p><strong>Summary of findings: </strong>Fifteen studies were included in the review. Chest ultrasound was the imaging modality used for diagnosis and monitoring. Most studies evaluated and compared the use of pleural drainage combined with fibrinolytics and video-assisted thoracoscopic surgery (VATS). The most used fibrinolytics were tissue plasminogen activator and urokinase. Hospitalization duration and adverse effects were similar across groups. The therapeutic failure rate of chemical debridement ranged from 0 to 37.2%. VATS and drainage combined with fibrinolytics were safe and well-tolerated, offering advantages over simple pleural drainage.</p><p><strong>Conclusions: </strong>Chemical debridement is cost-effective and less invasive, with complication rates and hospitalization times similar to VATS, making it preferable as a first-line treatment. The created protocol will standardize institutional practices and support evidence-based decision-making.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evelyn F Rubin, Sheila C Lucena, Marcela Bhering, Lorrayne Gonçalves, Fabiana Falcão, Margareth Dalcolmo, Giovanni B Migliori, Laura Saderi, Giovanni Sotgiu, Afrânio Kritski, Anna C C Carvalho
{"title":"Tuberculosis among young contacts of patients with multidrug-resistant pulmonary tuberculosis in a reference hospital.","authors":"Evelyn F Rubin, Sheila C Lucena, Marcela Bhering, Lorrayne Gonçalves, Fabiana Falcão, Margareth Dalcolmo, Giovanni B Migliori, Laura Saderi, Giovanni Sotgiu, Afrânio Kritski, Anna C C Carvalho","doi":"10.1016/j.jped.2025.01.008","DOIUrl":"10.1016/j.jped.2025.01.008","url":null,"abstract":"<p><strong>Objectives: </strong>Young contacts of pulmonary tuberculosis (TB) patients face a higher risk of TB. Still, few studies have evaluated this risk among contacts of patients with pulmonary multidrug-resistant tuberculosis (MDR-TB). This study aimed to describe the incidence rate and the prevalence of TB infection (TBI) and TB disease (TBD) in young contacts of patients with MDR-TB.</p><p><strong>Methods: </strong>The authors retrospectively evaluated contacts of patients with pulmonary TB aged 0 to 19 for TBI and TBD in Rio de Janeiro between 2006 and 2016. Based on the drug susceptibility pattern and/or therapeutic regimen of the index case, contacts were classified into MDR-TB and non-MDR-TB contacts. A tuberculin skin test ≥ 5 mm was considered positive. Preventive therapy with isoniazid was offered to eligible contacts. Bivariate and multivariate logistic regressions estimated factors associated with TBI.</p><p><strong>Results: </strong>439 contacts were screened; 129 were MDR-TB and 310 were non-MDR-TB contacts. TBI prevalence was 68.2 % in MDR-TB vs. 61.9 % in non-MDR-TB contacts (p = 0.23). Tuberculin conversion was higher among MDR-TB contacts (45.5 % vs. 17.1 %; p = 0.04). TBD incidence rate was 47.7 in non-MDR-TB and 179.6 per 100,000 person-months in MDR-TB contacts (p = 0.65), for a total TBD prevalence of 2.5 %. The overall TPT completion rate was 67.2 %; 71.5 % in non-MDR-TB and 59 % in MDR-TB contacts (p = 0.04).</p><p><strong>Conclusion: </strong>The authors identified a high prevalence of TBI among contacts of pulmonary MDR-TB and non-MDR-TB patients, with a higher tuberculin conversion rate in MDR-TB contacts, highlighting the urgency of effective TPT regimens for young contacts of patients with pulmonary MDR-TB.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Massimo Pettoello-Mantovani, Pietro Ferrara, Ida Giardino
{"title":"Exploring the relationship between exanthematous diseases and early-onset type 1 diabetes in children.","authors":"Massimo Pettoello-Mantovani, Pietro Ferrara, Ida Giardino","doi":"10.1016/j.jped.2025.03.001","DOIUrl":"10.1016/j.jped.2025.03.001","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eduardo Antonio de Sousa Orlandin, Thais Iwashita-Lages, Luis Kanhiti Oharomari-Junior, Milena Ramos Tomé, Mariana Tosato Zinher, Sofia Oliveira Dias, Walusa Assad Gonçalves-Ferri
{"title":"Volume-targeted on high-frequency oscillatory ventilation in preterm infants: a systematic review.","authors":"Eduardo Antonio de Sousa Orlandin, Thais Iwashita-Lages, Luis Kanhiti Oharomari-Junior, Milena Ramos Tomé, Mariana Tosato Zinher, Sofia Oliveira Dias, Walusa Assad Gonçalves-Ferri","doi":"10.1016/j.jped.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.jped.2025.01.012","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aimed to analyze, in neonates, the effects of high-frequency oscillatory ventilation (HFOV) with volume-targeted (VT) compared with conventional HFOV.</p><p><strong>Sources: </strong>The authors searched PubMed, EMBASE, Cochrane, and ClinicalTrials.gov from inception until August 4th, 2024, to identify studies comparing HFOV with and without VT in neonates under 44 weeks corrected age. Outcomes analyzed were VThf, amplitude and carbon dioxide partial pressure (PCO<sub>2</sub>) variability, episodes of hypoxemia, hypocarbia or hypercarbia, duration of mechanical ventilation, rates of bronchopulmonary dysplasia (BPD) or intraventricular hemorrhage (IVH), and mortality. ROB-2 and ROBINS were used for risk of bias assessment.</p><p><strong>Summary of the findings: </strong>This systematic review included 260 preterm infants from two crossover and four cohort studies. Five studies were considered as having a relevant risk of bias. Meta-analysis could not be performed, due to the differences in study design and incomplete reporting. The report of included studies indicates that HFOV with VT, compared with HFOV, may reduce VThf variability, hypocarbia and hypercarbia incidence. Findings on hypoxemia incidence and mechanical ventilation duration are mixed. Two studies found no difference in BPD rates, while one noted higher survival without BPD grades 2-3 under HFOV with VT. IVH, leukomalacia, and mortality outcomes were similar.</p><p><strong>Conclusions: </strong>Inclusion of VT during HFOV may reduce VThf variability, hypocarbia and hypercarbia incidence. However, there is a need for randomized trials to compare clinical outcomes from both ventilatory strategies.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wládia Gislaynne de Sousa Tavares, Roberio Dias Leite, Denise Maria Christofolini
{"title":"Chikungunya fever in hospitalized children and adolescents: clinical and epidemiological aspects in a region of northeastern Brazil.","authors":"Wládia Gislaynne de Sousa Tavares, Roberio Dias Leite, Denise Maria Christofolini","doi":"10.1016/j.jped.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.jped.2025.01.010","url":null,"abstract":"<p><strong>Objective: </strong>To describe the clinical spectrum of pediatric and adolescent patients infected with Chikungunya.</p><p><strong>Methods: </strong>Cross-sectional study with patients aged 0 to 17 years hospitalized with a Chikungunya Fever diagnosis in Ceará, in 2017. Data were collected on the clinical manifestations associated with the condition; significant differences were considered when p < 0.05.</p><p><strong>Results: </strong>Fever (100%), erythrodermic rash (90.48%), and arthralgia (52.38%) were the most frequent symptoms. Arthralgia was more prevalent in children older than over five years (86.36%), and irritability and the bullous rash were predominant in children younger than five years (p < 0.05). The most predominant non-specific manifestations were: myalgia (28.57%), oral lesions (28.57%), and abdominal pain (26.19%). Neurological complications were observed in 14.29% of the patients, bacterial complications in 11.90%, Kawasaki disease in 4.76%, and one death (2.38% of the population).</p><p><strong>Conclusion: </strong>Chikungunya fever is a disease that can manifest differently according to age group. The diagnosis must be made early to mitigate possible injuries and complications.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adriana Banhos Carneiro Yamaguchi, Adriana Aparecida Siviero-Miachon, Paola Matiko Martins Okuda, Lívia Cristina Oliveira E Silva, Talita de Faria Bustamante, Angela Maria Spinola-Castro
{"title":"Transforming tallness: how sex steroids influence final height in Marfan syndrome.","authors":"Adriana Banhos Carneiro Yamaguchi, Adriana Aparecida Siviero-Miachon, Paola Matiko Martins Okuda, Lívia Cristina Oliveira E Silva, Talita de Faria Bustamante, Angela Maria Spinola-Castro","doi":"10.1016/j.jped.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.jped.2025.01.007","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of hormonal treatment with sex steroids on the final height of patients with tall stature, including those diagnosed with Marfan Syndrome (MS), over 15 years in an outpatient setting.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed the medical records of patients referred for tall stature. Descriptive statistics characterized the samples, while independent and paired t-tests assessed changes in final height (FH) and height at the start of treatment (HTS). One-way analysis of variance (ANOVA) evaluated the impact of chronological age at the initiation of therapy, bone age at the start of treatment, and pubertal stage on FH and HTS.</p><p><strong>Results: </strong>A total of 55 individuals with tall stature (51 % male) were included, among whom 35 (64 %) had clinically confirmed MS. Of these, 34 (62 %) received low-dose steroid treatment. Patients treated during pre-puberty exhibited an average height increase of 25.56 cm (95 %CI 20.40-30.73; p < 0.001; d = 2.86), while those treated during puberty showed an average gain of 11.93 cm (95 %CI 8.69-15.18; p < 0.001; d = 1.72). Early treatment before the age of 10 resulted in height gains of 13.92 cm (95 %CI 4.90-22.93; p = 0.006; d = 1.82) with estrogen and 6.8 cm (95 %CI 1.71-11.88; p = 0.010; d = 0.73) with testosterone.</p><p><strong>Conclusions: </strong>Early intervention with low doses of steroids significantly reduced final height in individuals with tall stature, including those with MS, while also minimizing dose-dependent adverse effects.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A public health success: newborn screening for congenital adrenal hyperplasia in a middle-income Brazilian state.","authors":"Scott D Grosses","doi":"10.1016/j.jped.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.jped.2025.02.001","url":null,"abstract":"","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mara Morelo Rocha Felix, Fábio Chigres Kuschnir, Érica Azevedo de Oliveira Costa Jordão, Bernardo Rangel Tura, Dirceu Solé, Maria Cristina Caetano Kuschnir
{"title":"Linking common mental disorders and asthma in Brazilian adolescents: a cross-sectional analysis of the ERICA study.","authors":"Mara Morelo Rocha Felix, Fábio Chigres Kuschnir, Érica Azevedo de Oliveira Costa Jordão, Bernardo Rangel Tura, Dirceu Solé, Maria Cristina Caetano Kuschnir","doi":"10.1016/j.jped.2025.01.003","DOIUrl":"10.1016/j.jped.2025.01.003","url":null,"abstract":"<p><strong>Objective: </strong>Asthma is a heterogeneous chronic disease of the airways, affecting all age groups, especially children and adolescents. The aim of this study was to evaluate several factors associated with asthma in Brazilian adolescents.</p><p><strong>Methods: </strong>Cross-sectional study of a national representative sample of school-based adolescents aged 12-17 years from The Study of Cardiovascular Risk in Adolescents (ERICA) stratified by region and conglomerate by schools. The authors studied the following variables: sociodemographic characteristics, lifestyle, smoking, eating habits, sleeping and mental conditions.</p><p><strong>Results: </strong>Data from 66,567 adolescents were analyzed, 50.2 % of whom were female. Of the total, 52.7 % were between 12 and 14 years old. The overall prevalence of asthma was 14.5 % (95 %CI: 13.6-15.5). Asthma was associated with female sex (PR 1.35; 95 %CI: 1.15-1.57), white skin color (PR 1.25; 95 %CI: 1.04-1.50), private school (PR 1.26; 95 %CI: 1.05-1.52), smoking (PR 1.93; 95 %CI: 1.54-2.38); and alcohol consumption (PR 1.74; 95 %CI: 1.52-2.03). Excessive screen time (PR 1.19; 95 %CI 1.01-1.42) and short sleep duration (PR 1.28; 95 %CI 1.05-1.57) were also associated. Healthy eating habits, such as adolescents who ate breakfast, drank water, and ate meals with their parents, were associated with a lower prevalence of asthma. In relation to comorbidities, asthma was associated with common mental disorders (CMD) (PR 1.94; 95 %CI 1.64-2.27; p < 0,00001), but not with overweight or obesity (PR 1.09; 95 %CI 0.87-1.38). In the correspondence analysis, CMD was the strongest factor associated with asthma.</p><p><strong>Conclusion: </strong>Asthma was associated with several determinants in Brazilian adolescents, but the association with CMD deserves special attention in this age group.</p>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marilyn Urrutia-Pereira , Paulo Augusto Camargos , Dirceu Solé
{"title":"Microplastics: the hidden danger","authors":"Marilyn Urrutia-Pereira , Paulo Augusto Camargos , Dirceu Solé","doi":"10.1016/j.jped.2024.10.004","DOIUrl":"10.1016/j.jped.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the impact of microplastics/nanoplastics (MiP/NP) on human health.</div></div><div><h3>Data source</h3><div>The authors conducted a narrative review of articles published in English, Portuguese, French and Spanish in the last decade in the following databases: PubMed, Google Scholar, EMBASE and SciELO. The keywords used in this search were: microplastics OR nanoplastics OR marine litter OR toxicology OR additives AND human health OR children OR adults.</div></div><div><h3>Data synthesis</h3><div>MiP is a group of emerging contaminants that have attracted increasing scientific interest and attention from society in the last decade due to their ubiquitous detection in all environments. Humans can be mainly exposed to MiP and NP orally, by inhalation, by dermal contact, as well as through systemic routes and cannot be neglected, especially in young children. The possible toxic effects in different systems are due to plastic particles, often combined with leachable additives and adsorbed contaminants.</div></div><div><h3>Conclusions</h3><div>Unless the plastics value chain is transformed in the next two decades, the risks to species, marine ecosystems, climate, health, economies and communities will become unmanageable. However, alongside these risks lie unique opportunities to lead the transition to a more sustainable world.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 ","pages":"Pages S10-S17"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Climate change and its impact on children and adolescents sleep","authors":"Maria Cecilia Lopes","doi":"10.1016/j.jped.2024.10.009","DOIUrl":"10.1016/j.jped.2024.10.009","url":null,"abstract":"<div><h3>Objective</h3><div>This review discusses the impact of climate change on sleep, anxiety, and eating in the pediatric population.</div></div><div><h3>Data source</h3><div>This is a nonsystematic literature review based on a search using PubMed and MeSH terms in titles and abstracts with these keywords: climate change, sleep, greenhouse effect, children, and adolescents.</div></div><div><h3>Data synthesis</h3><div>Climate change events are associated with human intervention in the ecosystem, having a strong impact on cognitive functions, physical and mental health, as well as subjective well-being, particularly in youth. Climate change is caused by human activity with changes in the composition of the global atmosphere caused by emissions of gases, such as carbon dioxide, which increase the greenhouse effect. This review discusses the impact of climate change on sleep, anxiety, and feeding in the pediatric population.</div></div><div><h3>Conclusions</h3><div>Early detection of vulnerability conditions, along with adaptation strategies is necessary to address climate stressors with a focus on healthy sleep and eco-anxiety. Pediatrics has an important role to play in protecting healthy sleep in children.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"101 ","pages":"Pages S40-S47"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}