Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo最新文献

{"title":"Congenital cataract in children: Age at surgery and diagnosis-treatment interval in the Brazilian Unified Health System in Salvador (BA), Brazil.","authors":"Igor Mello do Nascimento, Pollyanna Santos Suzart, Dayse Cury de Almeida Oliveira","doi":"10.1590/1984-0462/2026/44/2025337","DOIUrl":"https://doi.org/10.1590/1984-0462/2026/44/2025337","url":null,"abstract":"<p><strong>Objective: </strong>To determine the age at first congenital cataract surgery and the diagnosis-to-treatment interval at a specialized service in Salvador, Brazil, quantifying treatment delay and characterizing the clinical-epidemiological profile of the population.</p><p><strong>Methods: </strong>Retrospective, observational case series with an exploratory analytical component, including pediatric patients who underwent congenital cataract surgery through the Brazilian Unified Health System between 2015 and 2024. The primary outcomes were age at first surgery and the diagnosis-to-treatment interval; as a secondary, exploratory aim, factors associated with surgical age were examined. Student's t-test, the Mann-Whitney U test, and linear regression were used, with estimates reported as coefficients and 95% confidence intervals - 95%CIs (p<0.05).</p><p><strong>Results: </strong>A total of 187 patients (274 eyes) were included, predominantly male (60.4%) and bilateral (54.5%). The median age at surgery was four years (interquartile range [IQR] 2.0-6.0), and no child was operated on within the recommended window; only 13 (7.0%) underwent surgery before one year of age. The diagnosis-to-treatment interval was adequate in 48.1% and delayed in 51.9%. In the exploratory adjusted model, no variable was independently associated with surgical age (adjusted R2=0.029). The median remained 4.0 years even in the absolute-surgical-indication subgroup, indicating that greater clinical severity did not translate into earlier surgery.</p><p><strong>Conclusions: </strong>Surgery occurred well beyond the recommended window. As the in-hospital interval was relatively efficient, the delay appears to lie upstream of referral, reinforcing the need to strengthen neonatal screening and early detection in primary care.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2025337"},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247664","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":"Instruments and scales for assessment, screening, and psychoeducational diagnosis of children and adolescents with autism spectrum disorder: a scoping review.","authors":"Kleonara Santos Oliveira, Denise Brandão de Oliveira E Britto, Graziela Nunes Alfenas Fernandes, Stela Maris Aguiar Lemos","doi":"10.1590/1984-0462/2026/44/2025083","DOIUrl":"https://doi.org/10.1590/1984-0462/2026/44/2025083","url":null,"abstract":"<p><strong>Objective: </strong>To investigate instruments and scales for psychoeducational assessment, screening, and diagnosis of children and adolescents with autism spectrum disorder.</p><p><strong>Data source: </strong>This review followed the methodological procedures recommended by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR). Its research question was, \"What are the main instruments and scales for psychoeducational assessment, screening, and diagnosis of children and adolescents with autism spectrum disorder in school?\".</p><p><strong>Data synthesis: </strong>The study included 16 articles that investigated instruments for psychoeducational assessment, screening, and diagnosis of children and adolescents with autism spectrum disorder. The instruments found were the Psychoeducational Profile - Revised (PEP-R), Psychoeducational Profile 3 (PEP-3), and the Wechsler Intelligence Scale for Children (WISC-IV). This indicates a scarcity of instruments and scales for the psychoeducational assessment, screening, and diagnosis of children and adolescents with autism spectrum disorder.</p><p><strong>Conclusions: </strong>The most used instruments to assess the psychoeducational profile of schoolchildren with autism spectrum disorder include the Revised Psychoeducational Profile (PEP-R) and the Psychoeducational Profile, 3rd Edition (PEP-3), according to scientific literature. There is a scarcity of instruments and scales for the psychoeducational assessment, screening, and diagnosis of children and adolescents with autism spectrum disorder, suggesting the need for further research on the subject.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2025083"},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247751","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":"Umbilical cord blood miR-125b-5p: a diagnostic and prognostic biomarker for neonatal respiratory distress syndrome.","authors":"Yang Zhang, Zhiqiang Liu, Yanchun Zhang, Yanan Hou, Lushuang Sun","doi":"10.1590/1984-0462/2026/44/2025344","DOIUrl":"https://doi.org/10.1590/1984-0462/2026/44/2025344","url":null,"abstract":"<p><strong>Objective: </strong>Neonatal respiratory distress syndrome (NRDS) is a common respiratory disease. This study aimed to detect the expression of miR-125b-5p in the umbilical cord blood of NRDS patients and to evaluate its diagnostic and prognostic value.</p><p><strong>Methods: </strong>Fluorescence-based real-time quantitative polymerase chain reaction was used to detect miR-125b-5p expression in the umbilical cord blood of NRDS patients and controls. The correlation between miR-125b-5p expression and NRDS clinical data was analyzed. Survival was analyzed using the Kaplan-Meier method. Cox regression identified risk factors for adverse outcomes, and the ROC curve evaluated diagnostic and prognostic accuracy.</p><p><strong>Results: </strong>The level of miR-125b-5p in NRDS patients was higher than that in controls. High miR-125b-5p expression was correlated with C-reactive protein levels, umbilical artery blood gas parameters, and the lung ultrasound score. Patients with high miR-125b-5p expression had significantly shorter event-free survival (HR 2.358, 95%CI 1.345-4.133, p<0.05) and long-term survival (HR 2.489, 95%CI 1.201-5.161, p<0.05). Cox regression identified high miR-125b-5p expression, high lung ultrasound score, high PaCO₂, and high PaO₂ as prognostic factors.</p><p><strong>Conclusions: </strong>Umbilical cord blood miR-125b-5p is highly expressed in NRDS. It may serve as a biomarker for the diagnosis and prognosis of NRDS.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2025344"},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247712","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":"Development and validation of a health education e-book on scoliosis for adolescents.","authors":"Beatriz Dos Santos Oliveira, Ana Paula Oliveira Carnevalli de Miranda, Sílvia Maria Amado João, Patrícia Jundi Penha","doi":"10.1590/1984-0462/2026/44/2025352","DOIUrl":"https://doi.org/10.1590/1984-0462/2026/44/2025352","url":null,"abstract":"<p><strong>Objective: </strong>To describe the development and validation of a health education e-book for adolescents on adolescent idiopathic scoliosis.</p><p><strong>Methods: </strong>A methodological study divided into three phases: bibliographic survey and interviews for content analysis; development; and validation of the e-book by 36 adolescents (18 in each group: with and without adolescent idiopathic scoliosis). The e-book was validated using a questionnaire assessing four domains: comprehension and language, structure and illustration, reading motivation, and relevance. Descriptive statistical analysis was performed, and an agreement rate of 85% or higher was considered indicative of adequate e-book evaluation.</p><p><strong>Results: </strong>The e-book \"Adolescent idiopathic scoliosis: What is it and how to treat it?\" is digital, has 20 pages in the A5 half-page format, and was organized into topics. It is available for free. The domains assessed and the agreement percentages across the groups with and without adolescent idiopathic scoliosis, respectively, were text and language comprehension (92.1% and 100%), structure and illustrations (100% and 98.1%), motivation for reading (100% and 88.9%), and relevance (96.3% and 100%). Agreement was higher than 85% for all the domains assessed, showing a positive assessment.</p><p><strong>Conclusions: </strong>The health education e-book for adolescents on adolescent idiopathic scoliosis was considered valid.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2025352"},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247671","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":"Excess weight and its association with cardiometabolic risk in adolescents: comparative analysis of national and international classifications.","authors":"Maria Dinara de Araújo Nogueira, Luis Felipe Nunes de Oliveira, Géssica de Souza Martins, Ribanna Aparecida Marques Braga, Eric Wenda Ribeiro Lourenço, Ilana Nogueira Bezerra, Carla Soraya Costa Maia","doi":"10.1590/1984-0462/2026/44/2025342","DOIUrl":"https://doi.org/10.1590/1984-0462/2026/44/2025342","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the agreement between the overweight and obesity classifications of the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the Brazilian Reference (BR) proposed by Conde and Monteiro in adolescents, and to verify the association of these classifications with cardiometabolic risk (CMR).</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 823 adolescents (aged 10-19 years) from municipal schools in Fortaleza, Ceará. Nutritional status was classified according to three body mass index references. CMR was defined by the simultaneous presence of insulin resistance, identified by the waist-to-height ratio, and dyslipidemia, assessed by biochemical tests (total cholesterol, HDL-c, LDL-c, and triglycerides). Agreement between classifications was assessed using the Kappa (κ) statistic, and the association with CMR was analyzed using Poisson regression.</p><p><strong>Results: </strong>All classifications showed excellent agreement, with weighted κ values ranging from 0.85 to 0.95. The highest agreement was between WHO and IOTF references (κ=0.95; 95%CI 0.93-0.97), while the lowest was between WHO and BR (κ=0.85; 95%CI 0.82-0.88). Despite the lower agreement, the diagnosis of obesity according to the BR reference demonstrated strong clinical relevance, being associated with an 8.51-fold higher prevalence of CMR in adolescents (95%CI 6.38-11.35).</p><p><strong>Conclusions: </strong>BR showed a stronger association with CMR. The inclusion of this classification may optimize the early detection of CMR in Brazilian health services, helping to prevent cardiometabolic disorders in this population.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2025342"},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247755","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":"Diagnostic odyssey and healthcare access challenges in Rett Syndrome: perspectives from Brazilian families.","authors":"Gabriella Almeida Santos de Santana, Lindinês de Jesus Sousa, Maria José Souza Silva, Narciso DiLorenzo Machado Dias, Gabriela Garcia de Carvalho Laguna, Larissa Alves Fernandes, Cintia Rodrigues Marques, Patrícia da Silva Oliveira","doi":"10.1590/1984-0462/2026/44/2025329","DOIUrl":"https://doi.org/10.1590/1984-0462/2026/44/2025329","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the challenges in the diagnosis and care of Rett Syndrome based on the experiences of caregivers in Brazil.</p><p><strong>Methods: </strong>This study employed a convergent mixed-methods approach. Data were collected from 14 primary caregivers of children with genetically confirmed Rett Syndrome. Data collection included thematic analysis of semi-structured interviews and descriptive statistics from sociodemographic questionnaires.</p><p><strong>Results: </strong>The mean diagnostic delay was 3.6 years (standard deviation - SD=1.4 years; range, 2-6 years), with a median of 3.5 years. The distribution was assessed and deemed suitable for reporting the mean. Most cases (92.8%) were initially attributed to autism spectrum disorder. The main barriers were limited knowledge among professionals (78.6%), delays in genetic testing (92.8%), and difficulties accessing therapies. Caregivers (12 mothers, 2 fathers; mean age, 38.0 years [SD, 4.1]; 57.1% with a college degree) reported a significant physical and emotional burden, with 92.8% providing full-time care without institutional support. The qualitative analysis revealed four themes: the diagnostic journey, the battle for therapy, the impact on family life, and the burden of care.</p><p><strong>Conclusions: </strong>Diagnosis and care are hindered by knowledge gaps, systemic inefficiencies, and limited support. The findings highlight the need to improve education on rare diseases, streamline access to genetic testing and therapies, and implement support programs for caregivers.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2025329"},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119866","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":"Incidence and factors associated with bronchopulmonary dysplasia: a cohort study in a high-risk Colombian neonatal intensive care unit.","authors":"Andrea Jaramillo-Cerezo, Sofía Castrillón-Acosta, Daniela Ortiz-Piedrahita, Laura Rodriguez-León, María Camila Paniagua-López, Libia Rodriguez-Padilla, Natalia Pérez-Doncel, Wendy Meyer Martínez, Andrea Parra-Buitrago","doi":"10.1590/1984-0462/2026/44/2026003","DOIUrl":"10.1590/1984-0462/2026/44/2026003","url":null,"abstract":"<p><strong>Objective: </strong>To determine the incidence, severity, and factors associated with bronchopulmonary dysplasia (BPD) using the Jensen definition in a high-risk preterm infant cohort from a middle-income country.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted, including babies born at <32 weeks of gestational age between 2021 and 2023 at a tertiary neonatal intensive care unit in Colombia. BPD was defined as the need for supplemental oxygen or respiratory support at 36 weeks' postmenstrual age (PMA) or at discharge. Demographic, perinatal, and clinical variables were obtained from medical records. Factors associated with BPD were evaluated using bivariate analyses and multivariable Poisson regression with robust variance.</p><p><strong>Results: </strong>Of 395 eligible neonates, 338 were included; 299 (88.4%) survived to 36 weeks PMA or hospital discharge and were evaluable for BPD. The overall incidence of BPD was 76.3%. Most BPD cases were classified as grade 1 (92.1%). Potentially fatal BPD (positive-pressure support or pulmonary vasodilators at 38 weeks PMA) was identified in 4.8% of patients. Overall mortality in the cohort was 13.0%. In the multivariable analysis, BPD was independently associated with extreme prematurity, requirement for invasive mechanical ventilation during hospitalization, diuretic use for fluid overload, documented infection requiring antimicrobial therapy, maternal thyroid disease, and exposure to antenatal corticosteroids, all of which were statistically significant (p<0.05).</p><p><strong>Conclusions: </strong>BPD incidence was high in this neonatal cohort. Although mild disease predominated, a relevant proportion of severe and potentially fatal cases was observed. The identification of modifiable postnatal factors highlights opportunities to optimize respiratory management, infection prevention, and fluid strategies in similar middle-income settings.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2026003"},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042590","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":"Prognostic implications of lactate dehydrogenase-to-albumin ratio in pediatric intensive care unit patients: a single-center prospective study.","authors":"Aya Osama Mohamed, Yomna Ahmed Hosni","doi":"10.1590/1984-0462/2026/44/2025380","DOIUrl":"10.1590/1984-0462/2026/44/2025380","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the lactate dehydrogenase-albumin ratio (LAR) as a mortality predictor in critically ill children.</p><p><strong>Methods: </strong>This study included 102 patients (aged 1 month to 14 years) admitted to the Pediatric Intensive Care Unit with critical illness, failure of one or more organ systems, over 6 months after exclusions. Initial labs included complete blood count, C-reactive protein, liver function tests, lactate-dehydrogenase (LDH), and albumin; subsequently, LAR was calculated. LDH, albumin, and LAR were correlated with the pediatric Sequential Organ Failure Assessment (pSOFA) score and mortality. Descriptive statistics, comparative tests, receiver operating characteristic (ROC) curve analysis, and logistic regression were performed.</p><p><strong>Results: </strong>Median age was 2 years, and 56.9% were male. Pulmonary causes were the main admission diagnosis (33.3%). Non-survivors had lower median albumin, higher median LDH and LAR levels, and higher rates of ventilation and inotrope use. The median LAR was higher in patients requiring ventilation and inotropes. LAR positively correlated with the pSOFA score and C-reactive protein levels. Logistic analysis showed LAR as a mortality predictor (AUC=0.82, cut-off 244.48, OR 1.004, 95%CI 1.002-1.006; p=0.001).</p><p><strong>Conclusions: </strong>In the Pediatric Intensive Care Unit, LAR could be used as a prognostic tool, especially in resource-limited countries, as it is accessible from routine laboratory tests.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2025380"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042558","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":"Factors associated with musculoskeletal pain in the spinal column of children and adolescents: a cross-sectional study with network analysis.","authors":"Marcella Veronnica Pereira Gomes, Ruth Stefany Monteiro Belém, Amanda Vitória Gomes Pantoja, Beatriz Dos Santos Costa, Naina Yuki Vieira Jardim, Alex Harley Crisp, Maurício Oliveira Magalhães","doi":"10.1590/1984-0462/2026/44/2026040","DOIUrl":"10.1590/1984-0462/2026/44/2026040","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to analyze the relationship between musculoskeletal spinal pain and individual, behavioral, and contextual factors in children and adolescents.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 189 children and adolescents (10-16 years), of both genders, enrolled in public and private schools in Belém, Pará, Brazil. Musculoskeletal pain and postural habits were assessed using the Back Pain and Posture Evaluation Instrument for Children and Adolescents, a validated questionnaire for this population. Network analysis using the EBICglasso estimator explored associations between individual (age, gender), behavioral (physical activity in school and leisure contexts), and contextual factors (school type and postural habits related to daily activities and electronic device use) and the presence of neck and low back pain.</p><p><strong>Results: </strong>The prevalence of low back pain was 62.6% and neck pain 65.4%. Low back pain was negatively associated with family history of pain (r=-0.14) and positively associated with female gender (r=0.19) and neck pain (r=0.12). Sitting posture during electronic device use was negatively associated with neck pain (r=-0.19). Gender and age showed higher centrality, indicating greater influence within the network, while physical activity showed a negative influence on pain outcomes.</p><p><strong>Conclusions: </strong>Musculoskeletal spinal pain was highly prevalent and associated with multiple interrelated factors. Network analysis highlights its multifactorial nature and provides relevant insights into key variables that may guide integrated health promotion and early prevention strategies in pediatric populations.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2026040"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042605","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":"Cardiac autonomic dysfunction in children and adolescents with obesity: a systematic review and meta-analysis.","authors":"Thales da Fonseca Dornelles, Júlia Lima Barrozo","doi":"10.1590/1984-0462/2026/44/2026017","DOIUrl":"10.1590/1984-0462/2026/44/2026017","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between excess weight and cardiac autonomic modulation in children and adolescents.</p><p><strong>Data source: </strong>PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to April 2, 2026 for observational studies comparing short-term resting heart rate variability between children and adolescents with excess weight and normal-weight controls. The protocol was registered in PROSPERO (CRD420251005501).</p><p><strong>Data synthesis: </strong>Eighteen studies comprising 1,590 participants were included. Random-effects meta-analyses using standardized mean differences showed lower root mean square of successive differences of RR intervals (RMSSD -1.00; 95% confidence interval [95%CI] -1.68 to -0.31), lower percentage of successive normal-to-normal intervals differing by more than 50 ms (pNN50 -0.48; 95%CI -0.68 to -0.28), and higher low-frequency/high-frequency ratio (LF/HF 0.70; 95%CI 0.30 to 1.10) in the excess weight group. No significant differences were observed for the standard deviation or mean of normal-to-normal intervals. Leave-one-out analyses supported directional robustness, and between-group body mass index difference significantly moderated LF/HF (β=-0.15; p=0.045), but not RMSSD.</p><p><strong>Conclusions: </strong>Pediatric excess weight appears to be associated with impaired cardiac autonomic modulation, mainly characterized by lower parasympathetic-related heart rate variability indices. Among the evaluated parameters, pNN50 showed the most consistent reduction, whereas RMSSD showed the largest pooled effect.</p>","PeriodicalId":74721,"journal":{"name":"Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo","volume":"44 ","pages":"e2026017"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042568","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}