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Abstract Objective This study aims to evaluate risk factors for infection/colonization by resistant bacteria among patients in Neonatal Intensive Care Units (NICU). Methods This systematic review is reported according to PRISMA. The search occurred by consulting the PubMed, Embase, Cochrane, SciELO, and Scopus databases. Inclusion criteria considered studies with Neonatal population admitted to the Neonatal Intensive Care Unit (P); Risk factors for resistant bacterial infection (E); No risk factors for resistant bacterial infection (C); Isolation of resistant bacteria in an outbreak (O), Observational studies (S). For Meta-Analysis, data were transformed to a logarithmic scale to directly calculate the standard error from the confidence intervals. The quality of studies was assessed Critical Appraisal Tools recommended by JBI. Results A total of 21 articles were eligible and presented a sample size ranging from 10 to 263 newborns (a total of 1979 neonates). Six (28.6 %) studies evaluated infection, five (23.8) evaluated colonization, and 10 (47.6 %) evaluated colonization and infection, covering Gram-positive (n = 8; 38 %) and Gram-negative (n = 13; 62 %) bacteria. In the meta-analysis, the use of venous access (OR: 1.58; 95 %CI 1.14-2.20), mechanical ventilation (OR: 7.55 95 %CI 4.27-13.36), and parenteral nutrition (OR: 4.79; 95 %CI 2.23-10.29) increased the chance of colonization/infection by multiresistant microorganisms. The included studies were considered as having adequate quality. Conclusion The main risk factors in outbreaks of infection/colonization by resistant microorganisms in Neonatal Units are the use of invasive devices and parenteral nutrition, which leads to the identification of newborns at risk, targeting the development of preventive measures.

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Abstract Objectives This study aimed to verify the prevalence of asthma in Brazilian adolescents and its geographic pattern carried through a systematic review and meta-analysis. Sources A survey of databases (Pubmed, Chocrane, LILACS, SCIELO and SCOPUS) was carried out, following the PRISMA statement, between the years 2013 and 2023 (PROSPERO-ID-CRD42023427988). Articles that presented a measure relative to the prevalence of asthma in adolescents were included. The methodological quality regarding risk of bias was assessed according to the approach proposed by the Joanna Brigg Institute. Summary of the findings Ten of a total of 3140 studies were included. Six studies were collected before 2015. The prevalence of active asthma, severe asthma, and diagnosed asthma were 18 %, 6 %, and 14 %, respectively. The studies were presented in large urban centers and capitals, had a high methodological quality, and showed high heterogeneity. Subgroup analysis was carried out, separating the cities according to the different regions of Brazil (north, northeast, center-west, south, and southeast). The northeast was the region with the lowest prevalence of active asthma (14 %, 95 % CI = 12-17 %, p < 0.001). There was no difference between regions in terms of diagnosed asthma and severity. Conclusion A high proportion of Brazilian adolescents reported having active asthma, with the northeast region having the lowest prevalence. Most of the studies were collected more than eight years ago and regard capitals and large urban centers. The high heterogeneity found demonstrates uncertainty in asthma prevalence in Brazil and highlights the need for clearer protocols addressing the multifactorial nature of the disease.

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Abstract Objective 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. Data sources 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. Summary of findings 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. Conclusions 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.

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Abstract Objective This systematic review aimed to analyze, in neonates, the effects of high-frequency oscillatory ventilation (HFOV) with volume-targeted (VT) compared with conventional HFOV. Sources 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 (PCO2) 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. Summary of the findings 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. Conclusions 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.

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Abstract Objective This is a 10-year period, descriptive and retrospective evaluation of a Brazilian State NBS-CAH public program, bringing light to the prior discussion concerning its implementation, by sharing the screening-240,000 babies annually practices. Methods The Minas Gerais (MG) NBS program has been coordinated by NUPAD, a neonatal screening, monitoring care, and genetics center at the Federal University of Minas Gerais (UFMG), intermediating all necessary actions, under the management of the State Health Administration, and following the Brazilian universal program. The dataset was used to calculate sensitivity, specificity, positive predictive value (PPV), incidence, number of carriers, and false-positive rates. Results About 2,094,588 newborns were screened, and the incidence was 1:14,647; PPV was 10.5%. Most samples were collected on the fifth day after birth (interquartile range 4-6 days); 1352 babies were referred for clinical evaluation; 1210 were false positives (0.06%), and 142 presented the classic form; 22% of newborns were hospitalized due to salt-loss symptoms before or at the first visit. Conclusions The MG NBS-CAH success as a public program comes from the Brazilian unified public health system, with integrated care, and from the newborn screening center offering timely referred screened positive cases and its outstanding state coverage. Appropriate cutoffs and close monitoring of hospitalized newborns have been pivotal for reducing the high false-positive rates.

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Abstract Objective To assess the association between exanthematous diseases, and an earlier age at Type 1 diabetes mellitus diagnosis (T1DM) in a cohort of Brazilian patients. Methods This was a retrospective cohort study including 812 patients diagnosed with T1DM in Bauru, São Paulo, Brazil, between 1981 and 2023. Data regarding sociodemographic parameters such as age, sex, ethnicity, socioeconomic status, as well as the occurrence of a previous exanthematous diseases, such as chickenpox, measles, rubella, mumps and scarlet fever were collected. An adapted survival analysis was performed to evaluate the impact of each variable on the age of T1DM diagnosis. Results Overall, 596 patients were evaluated. Their average age at T1DM diagnosis was 12 ± 7.69 years. It was found that presenting rubella, measles, and mumps, as well as belonging to non-high socioeconomic class, were associated with 35%, 40%, 39%, and 34% lower age at T1DM diagnosis, respectively. Conclusions This study has found that rubella, measles, mumps, and belonging to non-high socioeconomic classes were significantly associated with earlier age at T1DM diagnosis in a cohort of Brazilian patients with T1DM. Future studies with other populations are warranted to confirm our findings.

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Abstract Objective Headaches are common in children and adolescents as well as in adults. Due to the fact that the primary medical concern for children presenting with headache complaints is the possibility of intracranial pathology, nowadays, imaging methods are frequently used in those patients. Methods Retrospective data analysis was performed on the records of children who attended the Pediatric Neurology Outpatient Clinic between June 01, 2018, and December 01, 2018, complaining of headaches. Children who had a headache for longer than four weeks and had brain magnetic resonance imaging were included in the study. Brain MRI findings were classified as (1) headache-related and requiring definitive intervention, (2) possibly headache-related abnormalities, (3) headache-related abnormalities that did not require intervention, and (4) normal. Results The 387 patients included in the study were between the ages of 2 and 17, with a median age of 10.5 years. Of the patients, 234 were female and 153 were male. The duration of the headache was a median of 12 months. According to brain MRI findings, 253 patients (65%) were in group 4, 79 patients (20%) were in group 2, 54 patients (14%) were in group 3, and 1 patient (0.3%) was in group 1. Conclusion The probability of detecting significant abnormalities with brain MRI in children with chronic headaches with normal neurological examination is found to be low. Imaging methods should be kept in mind that they may be useful in diagnosis in selected cases.

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Abstract Objective Nonalcoholic Fatty Pancreas Disease (NAFPD) is characterized by excessive lipid accumulation within the pancreas in the absence of alcohol intake, potentially leading to pancreatic dysfunction and metabolic complications, including type 2 diabetes mellitus, acute and chronic pancreatitis, and pancreatic carcinoma. The authors aim to estimate the prevalence of NAFPD and its association with anthropometric parameters in a cohort of Chilean adolescents. Method The authors conducted a cross-sectional analysis of the "Growth and Obesity Chilean Cohort Study" (GOCS), a longitudinal study involving nearly 1000 children, followed yearly since 2006. All participants underwent anthropometric measurements and abdominal ultrasonography. Results A total of 741 adolescents were included; 30 exhibited ultrasonography findings compatible with fatty pancreas (4 %). Adolescents with NAFPD had higher BMI z-score (2.33 (1.52-2.69) vs 0.67 (-0.2-1.4), p < 0.001), waist circumference (WC) (90.9 (81.53-98.58) vs 72.2 (67.55-79.83), p < 0.001), waist-to-height ratio (0.55 (0.48-0.6) vs 0.44 (0.41-0.49), p < 0.001), triponderal index (17.35 (15.14-19.25) vs 13.62 (12.07-15.54), p < 0.001), subcutaneous fat (32.4 (21.77-44.95) vs 16.2 (9.3 - 25.3), p < 0.001), visceral fat (45.15 (36.92-62.08) vs 35.5 (28.55-44.25), p < 0.001), systolic blood pressure (p = 0.009), and diastolic blood pressure but only in boys (p = 0.004) compared with controls. The prevalence of liver steatosis was significantly higher in the NAFPD group (63.3% vs 5.2 %, p < 0.001). After adjusting for sex and BMI, only the association with waist circumference and liver steatosis remains statistically significant. Conclusion In adolescents, NAFPD has a prevalence of 4 % and is associated with a higher BMI z-score, WC, superficial fat, and blood pressure levels. Liver steatosis exhibited a strong association with NAFPD.

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Abstract Objective The authors aim to evaluate characteristics of children with fUTI and results of renal bladder ultrasonography (RBUS) and late dimercaptosuccinicacid (DMSA) scan. Methods This study is designed as retrospective analysis of RBUS and DMSA reports of children with fUTI. Age, gender, number of fUTI, presence of constipation and vesicouretheral reflux (VUR) were recorded. Results The study included 160 children with fUTI with a median age of 7 years (6 months 18 years old). The majority of children in this study were girls (86.3 %), older than 60 months (73.1 %) and had one episode of fUTI. The recurrence rates of UTI were similar in both girls and boys. The total rate of constipation was 21.9 %. The rate of renal scarring on DMSA was 16.9 %. The rates of renal scarring were similar at three age groups and both genders. The rate of renal scarring was higher in children with recurrent UTI compared to those with one episode of fUTI (26.4 % and 12.5 %, respectively; p = 0.04). The rate of constipation in children with renal scarring and normal DMSA was similar (p = 0.07). The rate of trabeculation and thick bladder wall was higher in children with renal scarring at DMSA than children with no renal scarring (p = 0.03). Conclusion The present study demonstrated that 16.9 % of children with fUTI had renal scarring. The rates of renal scarring were similar in both gender and age groups. Children with recurrent UTI and abnormal bladder results at RBUS had higher rates of renal scarring.

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Abstract Objectives To compare the perinatal risk factors approach for early-onset sepsis (EOS), which is based on categorical risk stratification, with the clinical observation-based approach, evaluating their impact on laboratory testing frequency, the use of antibiotic therapy, and EOS incidence. Methods Retrospective observational study, conducted from November 2021 to March 2022. Newborns (NB) at 34 wk of age were included and clinical data from prenatal care, birth, hospitalization, and laboratory tests were evaluated. Results Sample of 1,086 newborns. Ninety-seven NB (8.9 %) underwent infectious screening in the clinical observation approach versus 279 (26.5 %) in the perinatal risk factors approach, which represents a 65.2 % decrease in the clinical observation approach (p < 0.01). Under the perinatal risk factors approach, 35 (3.2 %) of NBs received empirical antibiotic therapy for EOS, versus only 22 (2.0 %) in the clinical observation approach, which would be a 37.1 % decrease in the clinical observation strategy (p < 0.01). We found no difference in the incidence of culture-confirmed EOS. Conclusion The clinical observation approach, when compared to the perinatal risk factors approach, reduces laboratory testing and the use of antibiotic therapy, with no impact on the incidence of EOS. Further research is required to determine the best way to systematize serial examinations of NB's and which symptoms would be the best predictors of EOS.

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Abstract Objective Beta-lactam (BL) allergy is considered a public health issue worldwide. To date, there is no consistent data on the direct Oral Provocation Test (OPT) for BL in Brazilian children and adolescents. This study's main objective is to describe the safety profile of direct OPT in this population. Method A cross-sectional study was conducted with patients aged 1 to 17 years with a history of mild immediate or delayed reactions to penicillin. The European Network of Drug Allergy (ENDA) questionnaire was used. The authors performed OPTs with amoxicillin over five days. Continuous variables were described using their means and standard deviations. Bivariate analysis between test positivity and other study variables was performed using the Chi-square test, odds ratio, and their respective 95 % confidence intervals (CI 95 %). A p-value < 0.05 was considered significant. Results In total, 54 OPTs were performed, four were positive (7.5 %) and one was considered inconclusive. All reactors were boys and had delayed reactions, with no severe reactions, and three showed symptoms on the first day of testing. Conclusion >90 % of the sample was delabeled as allergic to BL. There were no severe reactions, confirming the safety of direct OPT in this age group. Among the reactors, 3 patients presented symptoms on the first day of testing before receiving the second dose and one had symptoms on 5 days, indicating that further studies are needed on the optimal duration of the OPT.

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Abstract Objectives To assess the frequency of diagnostic investigation for inborn errors of immunity (IEI) in the presence of warning signs and clinical outcomes of children hospitalized in the pediatric intensive care unit (PICU) according to age group. Material and methods This retrospective cross-sectional study included children hospitalized in the PICU of a referral hospital over two years. Warning signs were collected according to age group (up to and over one year), and sociodemographic and clinical variables, basic investigation of IEI, follow-up by the immunology service, and hospital discharge and death were also assessed. Results Of 680 included children, 330 (48.5%) were aged up to one year, and 350 (51.5%) were over one year. Among those aged up to one year, 108 (32.7%) had two or more warning signs, and only 22 (20.4%) were investigated for IEI. Considering the group aged over one year, 48 (13.7%) had two or more warning signs, and 21 (43.8%) were investigated for IEI. The highest number of deaths occurred among children aged up to one year with two or more warning signs (58.8%). Conclusions Few children with warning signs were investigated for IEI, representing missed opportunities to timely diagnose IEI, which may impact the risk of death.

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Abstract Objective The purpose of the study was to evaluate the acquisition and retention of non-technical skills by pediatric residents who participated in an interprofessional simulated pediatric cardiopulmonary resuscitation scenario through simulation-based training. Method This prospective cohort study was conducted at a simulation center of a Pediatric Hospital. Ninety-six residents of pediatrics and nursing were divided into 16 interprofessional teams and participated in a cardiopulmonary resuscitation simulated scenario followed by a debriefing session. It was conducted twice on the same day and repeated after a period of time that ranged from 107 to 161 days. Groups were evaluated for the acquisition and retention of non-technical skills and global non-technical performance through a valid and reliable tool for measuring teamwork in medical emergencies. Results Participants demonstrated an improvement in leadership, teamwork, task management, and overall performance of the team after the first intervention. However, when evaluated during the second intervention, retention of leadership and teamwork were noted, but not for task management and overall performance. Conclusion Learning non-technical skills is complex and requires training, ideally with short periodicity, since it demands frequent practice for its acquisition and retention. The present research showed that non-technical skills can be acquired through simulation-based training. However, it was noted that the retention of these skills is more complex, requiring repeated simulations over a longer period of time. Therefore, further research on the learning curve, time to acquisition, and retention of non-technical skills trained with simulation-based education is warranted.

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Abstract Objective To identify factors, particularly neonatal acute kidney injury, associated with an increased risk of developing chronic kidney disease (CKD) within the first 10 years of life in children with a history of prematurity and very low birth weight (VLBW). Methods This nested case-control study was conducted on VLBW infants (> 500 g and < 1.500 g) born between 2012 and 2022. The population (n = 119) included children who developed CKD (n = 55) and controls with normal findings (n = 64). CKD was defined by abnormal blood pressure, reduced glomerular filtration rate, or elevated urinary albumin excretion. Data on neonatal and maternal factors were analyzed using logistic regression to identify predictors of CKD. Results Of the 267 eligible children 119 were included, with a median age of 32 months, and median gestational age and birth weight of 30 weeks and 1170 g, respectively. Children with CKD had lower birth weight Z-scores (-1.06 vs. -0.89), a higher occurrence of extrauterine growth restriction (EUGR) (72 % vs. 51 %), and an increased likelihood of maternal preeclampsia exposure. Maternal preeclampsia was identified as an independent predictor of CKD, associated with a 5 % increase in the odds of developing the condition (OR 1.05, 95 % CI 1.01-1.66). Conclusion Maternal preeclampsia was associated with CKD in children with a history of VLBW. This finding highlights the importance of long-term follow-up and early identification of at-risk individuals.

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Abstract Objective 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. Methods 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. Results 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. Conclusion Asthma was associated with several determinants in Brazilian adolescents, but the association with CMD deserves special attention in this age group.

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Abstract Objective To develop a YouthFit Index, a comprehensive and easily interpretable measure of youth health-related quality of life (HRQoL). Method A repeated cross-sectional design was employed to develop and validate the YouthFIt index using the Pediatric Quality of Life Inventory (PedsQL). Activity level and sleep data were collected by a wearable device, Actigraph. Questionnaires were used to gather demographic information and PedsQL data. Multiple-factor analysis of mixed data was employed to identify principal components (PCs) of the modifiable lifestyle variables. The YouthFit Index was calculated by summing the weighted PCs. Logistic regression models were used to assess the odds ratios for risks associated with the YouthFIt Index. Results A total of 1,867 students were recruited for the study. The findings showed that having YouthFit Index scores greater than 5 was significantly associated with a lower risk of identifying with special health care needs. Compared to the group with YouthFit Index scores below or equal to 5, the group with scores above the cut-off demonstrated a significant 43 % reduction in the risk of PedsQL total score. The results also revealed that increased sleep duration and physical activity are associated with better HRQoL, while longer sedentary periods and later bedtimes are linked to worse HRQoL. Conclusions The YouthFit Index is a user-friendly tool for assessing the HRQoL of Hong Kong Chinese children between the ages of 6 and 17. It can help raise awareness about healthy quality of life and promote health and well-being among children in Hong Kong.

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Abstract Objective 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. Methods 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. Results 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. Conclusions 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.

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Abstract Objective The objective of this study was to determine the incidence of congenital hypothyroidism (CH) in Minas Gerais, Brazil, and evaluate the development of the Minas Gerais Neonatal Screening Program (PTN-MG) over the past 30 years. Method This was a retrospective longitudinal cohort study since the implementation of neonatal screening for CH, in 1994. Bloodspots on filter paper are collected, between the third and fifth day of life, at primary healthcare units, with a TSH threshold of 10 mIU/L. The identification of an abnormal result triggers an active search for the child to confirm the diagnosis. The incidence of CH and its variation over the years, the percentage of permanent cases, and the age at sample collection and treatment initiation were analyzed. Results The incidence of CH was 1:3,298 live births among 6,864,719 newborns screened, with no trend of change over the years (p = 0.08). The median age at sample collection decreased from 11 to 5 days (p < 0.01) and at treatment initiation from 88 to 16 days (p < 0.01). Among the confirmed patients, 77 % had permanent CH, thyroid dysgenesis accounted for 43.6 % of cases, gland-in-situ for 56.3 %. Conclusion The incidence of CH has remained stable in Minas Gerais over the past 28 years. The PTN-MG is a public health program with an active monitoring and control sector that has shown significant improvements in its indicators since its implementation. The experience of the program has shown that rigorous monitoring and follow-up of infants have been an essential strategy for achieving satisfactory results.

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Abstract Objective This study aimed to evaluate the perioperative inflammatory cytokines in pediatric patients with pulmonary arterial hypertension secondary to congenital heart disease and also sought to investigate the correlation between preoperative echocardiographic pulmonary artery systolic pressure and inflammatory factors after cardiopulmonary bypass in these patients. Methods A retrospective observational study was conducted involving 59 children under 2 years old. Echocardiography was used to measure tricuspid annular peak systolic velocity. The levels of perioperative inflammatory cytokines in the plasma, including IL-6, IL-8, IL-10, IL-1β, and TNF-α, were measured. Additionally, postoperative ventilation time, length of intensive care unit stay, and ward stay were recorded. Results Patients with pulmonary hypertension experience longer postoperative ventilation time, intensive care unit stay, and ward stay. Although no significant differences were observed in the cardiopulmonary bypass and aortic cross-clamping, there was a more pronounced increase in postoperative inflammatory cytokines, including IL-6, IL-8, and IL-10, in these patients following cardiopulmonary bypass (p < 0.05). Preoperative echocardiographic pulmonary artery systolic pressure was found to be associated with the levels of IL-6 and IL-10 after surgery in pulmonary hypertension patients. A pulmonary artery systolic pressure greater than 52 mmHg was able to predict a postoperative ventilation time exceeding 21 h. Conclusion Higher levels of inflammatory cytokines were observed in pediatric patients with pulmonary hypertension secondary to congenital heart disease following cardiopulmonary bypass. Additionally, preoperative elevation in echocardiographic pulmonary artery systolic pressure was associated with increased postoperative inflammatory markers, suggesting a potential correlation with adverse early postoperative clinical outcomes.

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Abstract Objectives Diabetic ketoacidosis is one of the main complications of type 1 diabetes mellitus and the leading cause of death among children and adolescents with the disease. The objective of this study was to characterize the cases of diabetic ketoacidosis treated in a University Hospital reference in pediatric endocrinology and identify their most frequent complications. Methods A cross-sectional descriptive study was carried out, based on the review of medical records of patients aged 0-16 years with a diagnosis of diabetic ketoacidosis treated between January 2016 and August 2020. Insulin therapy was performed subcutaneously as part of the hospital's protocol. Results Seventy-seven (77) admissions were analyzed and 55.8 % were diagnosed with a new case of type 1 diabetes. Adolescents (54.5 %) were the most affected. An increase of 90.9 % of cases between 2016 and 2020 was visualized. Severe DKA was more frequent in school-aged children. An increase in the dose of insulin was related to the severity of diabetic ketoacidosis. Hypokalemia was the most frequent complication. Cerebral edema occurred in 11.7 % of cases, and it was the cause of the only death, corresponding to a mortality rate of 1.3 %. Conclusions Rising DKA incidence aligns with global trends, with poor adherence driving cases in previously diagnosed adolescents. High rates of hypokalemia and cerebral edema were found, but with lower mortality, showing the effectiveness of subcutaneous insulin for treatment. Future studies should confirm findings, address adherence issues, and refine hydration, insulin dosing, and monitoring practices to reduce complications.

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Abstract Objectives 1) To assess the level of physical activity of children and adolescents with IMRD (juvenile idiopathic arthritis - JIA, juvenile systemic lupus erythematosus—JSLE, or juvenile dermatomyositis - JDM) throughout the COVID-19 pandemic in a tertiary reference service, and 2) To assess the HRQoL and fatigue in these patients. Methods The authors included 57 children and adolescents with JIA, JSLE, and JDM, who were clinically inactive according to the assisting physician evaluation. The control group consisted of healthy children. Data was collected during the period of social isolation. The instruments used for the assessments were the International Physical Activity Questionnaire (IPAQ), the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), and the Pediatric Quality of Life Inventory - Fatigue Module (PedsQL - Fatigue Module). Results About 68.5 % of patients and 79.3 % of controls were considered active regarding physical activity, without any difference between physical activity intensity scores between the groups. Regarding HRQoL, the authors observed lower scores in patients' physical, social, and school functioning domains. The authors observed that patients had higher levels of fatigue according to parents and caregivers. Conclusion The impact on physical activity levels of children and adolescents with IMRD throughout the COVID-19 pandemic was positive, with the majority of patients being classified as active, according to the IPAQ questionnaire. Furthermore, the patients engaged in moderate and light physical activities, similar to healthy controls. Regarding HRQoL, the present data showed that patients had lower scores in most of the dimensions assessed.

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Abstract Objectives 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. Methods 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. Results 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). Conclusion 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.

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Abstract Objective To describe the clinical spectrum of pediatric and adolescent patients infected with Chikungunya. Methods 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. Results 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). Conclusion 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.

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Abstract Objectives Foreign body airway obstruction is a significant cause of morbidity and mortality, especially in infants and young children. This study aims to compare the efficacy of the Heimlich maneuver and LifeVac® in a simulated environment. Methods A prospective experimental study was conducted using the Choking Charlie (Laerdal®) mannequin, which simulates the trunk from an adult male and is considered suitable for simulating choking events in young children. The study involved four operators: one Pediatric Advanced Life Support (PALS) instructor and professor of Trauma and Emergency Medicine, along with three members of the university's Pediatric Academic League, all previously trained in Basic Life Support (BLS). The primary outcome was the success rate of foreign body removal. Intracavitary pressures generated during the maneuvers were measured using a digital manometer. Results A total of 200 anti-choking maneuvers were performed, and both techniques successfully relieved airway obstruction in all cases. The LifeVac® device generated significantly lower intracavitary pressure differentials compared to the Heimlich maneuver (p < 0.000). Additionally, both techniques exhibited significant variability in applied pressure among different examiners (p < 0.000). Conclusions Both the Heimlich maneuver and LifeVac® are effective in relieving foreign body airway obstruction when performed by specialists in a simulated environment. Heimlich generated higher positive pressure gradients, while LifeVac® produced lower negative pressure gradients.