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- ItemAcesso aberto (Open Access)Acidentes vasculares encefálicos em pediatria(Sociedade Brasileira de Pediatria, 2009-12-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Santa Catarina Unidade de Terapia Intensiva Pediátrica; Hospital Pronto-Socorro Infantil Sabará Unidade de Terapia Intensiva Pediátrica; Universidade de São Paulo (USP)OBJECTIVES: To summarize 1) the definitions and epidemiological features of stroke in children; 2) the main risk factors that can lead to stroke in pediatrics and neonatology; 3) the main pathophysiological features involved in the genesis of brain injury in stroke; 4) the clinical manifestations and imaging diagnosis; and 5) the latest recommendations concerning the support measures, treatment, and prophylaxis of stroke in children. SOURCES: A review of the literature published in PubMed, EMBASE, and SciELO databases using the search terms stroke, pediatrics, and neonatology was performed, including relevant references from the chosen texts. SUMMARY OF THE FINDINGS: Stroke in children are rare conditions, with incidence rates among two and eight per 100,000 children up to 14 years, and most cases show an underlying disease such as heart diseases, prothrombotic conditions, sickle-cell disease, and vascular malformations. There are no specific guidelines currently in place for the treatment of stroke in children, although central elements include support treatment, monitoring, and anticoagulation as secondary prevention in certain cases. Prognosis depends on the extent of brain damage and the underlying disease but recurrence rates are high in most cases. CONCLUSIONS: Early diagnosis of stroke in children is very important and pediatricians should be aware of the lack of specificity of the symptoms to avoid late sequelae and improve life quality.
- ItemAcesso aberto (Open Access)Adaptação cultural e análise da confiabilidade da versão brasileira da Escala de Equilíbrio Pediátrica (EEP)(Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia, 2012-06-01) Ries, Lílian Gerdi Kittel; Michaelsen, Stella Maris; Soares, Patrícia S. A. [UNIFESP]; Monteiro, Vanessa Costa [UNIFESP]; Allegretti, Kátia Maria Gonçalves [UNIFESP]; Universidade do Estado de Santa Catarina Postgraduate Program in Physical Therapy; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: The Pediatric Balance Scale (PBS) was developed from a modified version of the Berg Balance Scale aiming to obtain a balance scale more appropriate for the child population. OBJECTIVES: To adapt the PBS into Brazilian-Portuguese and to evaluate the intra and inter-rater reliability of the Brazilian-Portuguese version of PBS. METHODS: To perform the cross-cultural adaptation of the American version of PBS four translators were involved, who have performed two translations and their respective back-translations. Then, a review by a multidisciplinary committee and a subsequent an assessment of the equivalence of meaning between the back-translations and the original English scale were performed by 3 and 30 healthcare professionals respectively. The intra-rater reliability of the final version of the Brazilian-Portuguese PBS was evaluated using a test-retest design with one-week interval. The Brazilian-Portuguese version of the PBS was tested twice on the same day by two different raters to test the inter-rater reliability. The inter-rater reliability, which was measured from a video of the volunteers performance, was evaluated by comparing the score given by five raters independently. Reliability was evaluated by Intraclass Correlation Coefficient (ICC). Fifteen volunteers (11±2.7 years) diagnosed with Cerebral Palsy (CP) classified at level I and II on the Gross Motor Function Classification System (GMFCS) were assessed. RESULTS: The reliability of the PBS total score for both intra-rater (ICC=0.85) and inter-rater (ICC=0.91) was excellent. The inter-rater reliability (measured from the video) for the total score was also classified as excellent (ICC=0.98). CONCLUSION: The results showed adequate reliability for the PBS for pediatric population with CP diagnostic classified at level I and II on the GMFCS.
- ItemAcesso aberto (Open Access)Anastomoses vasculares no transplante renal pediátrico e uma nova estratégia para anastomoses em crianças de baixo peso(Universidade Federal de São Paulo (UNIFESP), 2014-09-30) Gomes, Adriano Luis [UNIFESP]; Silva, Jose Carlos Costa Baptista da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: The technical aspects of renal transplantation (RT) performed in children should be specific, particularly with regard to vascular anastomoses (VA) in those that are lower-weight. Objectives: To assess the main VA options in paediatric renal transplantations and propose a new strategy for renal artery trajectory when using the aorta (Ao) and the inferior vena cava (iVC) on the right side. Methods: Data were obtained through a retrospective review of medical records. The sample was represented by 81 patients consecutively undergoing transplantation at Hospital Samaritano in the city of São Paulo, who were classified into two groups: Group 1 (G1) consisted of children under 16 kg, and Group 2 (G2) with children weighing 16 kg or more. Results: The smaller children (G1) received the graft predominantly on Ao and iVC (63%), while the options used for VA varied in children weighing 16 kg or more (G2), predominanting the anastomoses on the common iliac vessels (46%). In the first group, when the Ao was the selected vessel for anastomosis on the right side, the trajectory adopted for the transplanted kidney artery was posterior to the iVC. No vascular complications related to the surgical technique were observed. Conclusions: The Ao and the iVC were the main options for the VA in G1, while the common iliac artery and vein were commonly used in G2. The trajectory for the renal artery posterior to the iVC is feasible and can eliminate one of the possibilities of compression of this vein, and also allows the reconstitution of the usual anatomical pathway of the renal artery on the right side.
- ItemAcesso aberto (Open Access)Audição: abordagem do pediatra acerca dessa temática(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2006-10-01) Zocoli, Angela Maria Fontana; Riechel, Fabiana Coelho; Zeigelboim, Bianca Simone [UNIFESP]; Marques, Jair Mendes; Universidade Tuiuti do Paraná; Universidade Federal de São Paulo (UNIFESP); Universidade Tuiuti do Paraná Programa de Mestrado em Distúrbios da Comunicação; Universidade Federal do Paraná; Universidade Tuiuti do Paraná Programa de Pós-Graduação em Distúrbios da ComunicaçãoHearing plays a fundamental role in a child s global development; however, some professionals do not realize how much they may contribute to mitigate the sequelae caused by hearing impairment. AIM: to collect data on pediatricians approaches in a city in the country side of Santa Catarina State, regarding the early detection of hearing impairment and identify the methodology utilized for its diagnosis. STUDY DESING: Historical Cohort with Cross-Sectional Cohort. MATERIALS AND METHODS: Analysis of questionnaires with nine multiple choice questions and ten open questions. RESULTS: 62% reported that their training in hearing disorders happened during their medical course; high risk patients are referred to the otorhinolaryngologist (92%); 83% said they are aware of the evaluation techniques; 55% stated they were not aware of the different types of hearing loss; only 25% reported they knew about the levels of hearing loss and 42% of the interviewees believe a child may have fruitful use of a hearing aid before six months of age. CONCLUSION: There is the need of more information about the importance of early diagnosis, as well as the methods used for this end.
- ItemAcesso aberto (Open Access)Efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito orocecal e colônico total e segmentar(Sociedade Brasileira de Pediatria, 2009-08-01) Soares, Ana Cristina Fontenele [UNIFESP]; Tahan, Soraia [UNIFESP]; Morais, Mauro Batista de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the effects of conventional treatment of chronic functional constipation on total and segmental colonic transit times and on orocecal transit time. METHODS: A total of 34 consecutive patients with functional constipation attending a specialized outpatient clinic were included in the study. Total and segmental colonic transit times were assessed using radiopaque markers. Hydrogen breath test was used to evaluate lactulose and bean orocecal transit times. Treatment consisted of disimpaction, general and dietary fiber intake instruction, and mineral oil administration. RESULTS: At admission, colonic dysmotility was found in 71.9% (23/32) of patients. All patients who complied with the treatment showed improvement of clinical symptoms after 6 weeks of treatment, when 82.6% (19/23) of those with dysmotility at admission returned to normal or reduced the severity of colonic transit patterns. Transit time decreased (medians) between admission and eighth week of treatment: lactulose orocecal transit (from 70 to 50 minutes, p = 0.002), bean orocecal transit (from 240 to 220 minutes, p = 0.002), and total colonic transit (from 69.5 to 37.0 hours, p = 0.001). The need for mineral oil therapy for constipation after a 12-month treatment was associated with persistence of total colonic transit higher than 62 hours at the eighth week of treatment (p = 0.014). CONCLUSION: The conventional therapeutic approach yielded good results regardless of the presence or not of colonic dysmotility at inclusion in the study. Digestive tract motility abnormalities in functionally constipated children may be reversed, and may be secondary to constipation.
- ItemSomente MetadadadosExperiência no tratamento de meduloblastoma de baixo risco em criança e adolescente(Universidade Federal de São Paulo (UNIFESP), 2015-12-16) Martins, Flavia Delgado [UNIFESP]; Petrilli, Antonio Sergio Petrilli [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objetivo: Estimar a sobrevida livre de eventos de crianças e adolescentes com meduloblastoma classificados como baixo risco de recidiva entre 3 e 21 anos de idade submetidas a ressecção tumoral, seguida de irradiação crânio-espinhal e concomitante uso de quimioterápicos (etoposido oral diário e vincristina semanal), seguido de quimioterapia de manutenção com cisplatina, vincristina e ciclofosfamida. Material e Método: Quarenta e um pacientes foram tratados de acordo com o ?Estudo prospectivo de radioterapia crânio-espinhal seguido de quimioterapia adjuvante em crianças recém diagnosticadas por meduloblastoma de baixo risco?. Dados de 20 pacientes admitidos entre janeiro de 2002 e junho de 2006 foram coletados retrospectivamente e dados dos 21 pacientes restante, admitidos de julho de 2006 a dezembro de 2014, foram coletados de forma prospectiva. As variáveis pesquisadas como fatores prognósticos foram sexo, o intervalo entre a cirurgia e o início da radioterapia e a duração da radioterapia, avaliadas em análise univariada. Resultados: A sobrevida global e a sobrevida livre de eventos em 5 anos foi de 67% (erro padrão de 8%) e 59% (erro padrão de 10%) respectivamente. Quanto às hipóteses testadas como fatores de risco para pior prognóstico, regressões de Cox retornaram falta de evidências para todas as variáveis testadas. Conclusão: a sobrevida global em 5 anos foi de 67% e a sobrevida livre de eventos de 56%. O protocolo aplicado foi bem tolerado e a maioria dos pacientes tratados concluiu o tratamento, sendo que poucos tiveram a terapia modificada ou suspensa por toxicidade. Não houve relação entre o prognóstico e as variáveis intervalo entre a cirurgia e o início da radioterapia, a duração da radioterapia e o sexo masculino
- ItemAcesso aberto (Open Access)Family presence during cardiopulmonary resuscitation and invasive procedures in children(Sociedade de Pediatria de São Paulo, 2014-03-01) Ferreira, Cristiana Araujo G.; Balbino, Flávia Simphronio [UNIFESP]; Balieiro, Maria Magda Ferreira Gomes [UNIFESP]; Pettengill, Myriam Aparecida Mandetta [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective:To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units.Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords family, invasive procedures, cardiopulmonary resuscitation, health staff, and Pediatrics. Articles that did not refer to the presence of the family in cardiopulmonary resuscitation and invasive procedures were excluded. Therefore, 15 articles were analyzed.Data synthesis : Most articles were published in the United States (80%), in Medicine and Nursing (46%), and were surveys (72%) with healthcare team members (67%) as participants. From the critical analysis, four themes related to the actions to promote family's presence in invasive procedures and cardiopulmonary resuscitation were obtained: a) to develop a sensitizing program for healthcare team; b) to educate the healthcare team to include the family in these circumstances; c) to develop a written institutional policy; d) to ensure the attendance of family's needs.Conclusions:Researches on these issues must be encouraged in order to help healthcare team to modify their practice, implementing the principles of the Patient and Family Centered Care model, especially during critical episodes.
- ItemAcesso aberto (Open Access)Fatores associados à adesão ao tratamento de crianças e adolescentes com doenças reumáticas crônicas(Sociedade Brasileira de Pediatria, 2012-12-01) Bugni, Vanessa Miotto [UNIFESP]; Ozaki, Luciana da Silva [UNIFESP]; Okamoto, Karine Yoshiye Kajiyama [UNIFESP]; Barbosa, Cassia Maria Passarelli Lupoli [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: There are several factors that contribute to poor adherence to treatment in children and adolescents with chronic rheumatic diseases, worsening their quality of life and prognosis. Our aim was to assess the rates of adherence to treatment and to identify the socioeconomic and clinical factors associated. METHODS: The sample included 99 patients with juvenile idiopathic arthritis, systemic erythematosus lupus, dermatomyositis or juvenile scleroderma. All patients were followed at the outpatient pediatric rheumatology for a minimum period of 6 months. To assess adherence, a questionnaire was administered to the providers, which included three blocks: 1) demographic, clinical and laboratory data; 2) medication adherence; and 3) attending follow-up appointments, examinations and use of orthoses. A value lower than or equal to 80% of the prescribed was considered poor adherence. RESULTS: A total of 53% of patients showed good overall adherence, observed when the caregiver lived in a stable union marital status (p = 0.006); 20 patients (20.2%) presented poor medication adherence, related to the use of three or more medications daily (p = 0.047). The causes of poor adherence were forgetfulness, refusal, incorrect dose or lack of medication, personal problems, and financial difficulties. CONCLUSIONS: We observed good overall treatment adherence in patients whose providers lived in stable union and poor adherence to medication in patients who used more than three types of medication daily. There was no association between the adherence rates and sex, age, time since diagnosis and disease activity.
- ItemAcesso aberto (Open Access)Indicações de transplante de células-tronco hematopoéticas em pediatria: consenso apresentado no I Encontro de Diretrizes Brasileiras em Transplante de Células-Tronco Hematopoéticas - Sociedade Brasileira de Transplante de Medula Óssea, Rio de Janeiro, 2009(Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2010-01-01) Seber, Adriana [UNIFESP]; Bonfim, Carmem Maria S.; Daudt, Liane E.; Gouveia, Roseane Vasconcelos [UNIFESP]; Ginani, Valéria C. [UNIFESP]; Mauad, Marcos; Castro Jr, Claudio G.; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Paraná; UFRGS; Hospital Amaral Carvalho; Hospital de Clínicas de Porto AlegreThe Brazilian Bone Marrow Transplant Society (SBTMO) held its First Meeting on Bone Marrow Transplant Guidelines in 2009. A working group of hematologists and oncologists with experience in pediatrics was formed to review evidence-based indications for pediatric transplants. Scientific publications were carefully assessed and, for each disease, the evidence for recommendation (from A to C) and the quality of the evidence (from 1 to 3) were defined. The recommendations include malignant and non-malignant hematological diseases, solid tumors, immunodeficiency, and storage diseases treated with hematopoietic stem cell transplants: either autologous or allogeneic from matched sibling donors or unrelated donors (adults or umbilical cord blood). Guidelines for reduced-intensity transplants, manipulated grafts or partially compatible donors were not included as there are no uniformly accepted recommendations. All indications are based on the best current knowledge which may change over time. Thus, this review should not be directly applied to patient care without taking into account the disease, donor and patient characteristics. Additionally, this paper should not be used as a document to limit patient access to transplant if correctly indicated. In this review we also point out differences between transplantation in adults and children and make some specific recommendations for pediatric transplants.
- ItemAcesso aberto (Open Access)Leucemia Mielóide Crônica em pediatria: perspectivas atuais(Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2008-04-01) Lee, Maria Lúcia de Martino [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Chronic myeloid leukemia (CML) is a rare event in childhood, comprising of less than 5% of all leukemia cases in this age group. CML is characterized by the presence of a specific molecular marker, the Ph+ chromosome, which is responsible for almost all etiopathogenesis, hence, it has clinical and course characteristics that do not differ from the adult population. In pediatrics the therapeutic approach is based mainly on the experience obtained with adult protocols. With bone marrow transplantation (BMT) being the only cure option, this procedure is more effective in patients with compatible related donors and performed during the initial chronic phase of the disease. The great anti-leukemic efficacy seen with imatinib mesylate was responsible for the approval of this drug in pediatric use for intolerant or refractory -interferon treated patients or relapsed patients after BMT. Currently, its use in pediatric patients with recently diagnosed CML, who have a compatible donor, has become a great dilemma. There is no agreement yet on which is the best way to use this drug or even whether it will ever replace BMT. Further studies with longer follow-up periods are still needed.
- ItemAcesso aberto (Open Access)Lipodistrofia em crianças e adolescentes com síndrome da imunodeficiência adquirida e sua relação com a terapia antirretroviral empregada(Sociedade Brasileira de Pediatria, 2009-08-01) Sarni, Roseli Oselka Saccardo [UNIFESP]; Souza, Fabíola Isabel Suano de [UNIFESP]; Battistini, Tânia Regina Beraldo; Pitta, Tassiana Sacchi; Fernandes, Ana Paula; Tardini, Priscila Chemiotti; Fonseca, Fernando Luiz Affonso [UNIFESP]; Santos, Valter Pinho dos [UNIFESP]; Lopez, Fábio Ancona [UNIFESP]; Faculdade de Medicina do ABC Departamento de Pediatria Serviço de Nutrologia; Universidade Federal de São Paulo (UNIFESP); FMABC Departamento de Pediatria Serviço de Nutrologia; FMABC Serviço de Nutrologia, Departamento de Pediatria; FMABC; Universidade de São Paulo (USP); FMABC Departamento de PediatriaOBJECTIVE: To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance. METHODS: This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis. RESULTS: All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80% were on three drugs in combination (highly active therapy) and 30% were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60% of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7%; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance. CONCLUSIONS: The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems.
- ItemAcesso aberto (Open Access)Manejo do paciente no período perioperatório em neurocirurgia pediátrica(Associação Médica Brasileira, 2012-06-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); UPA Hospital Israelita Albert Einstein; Hospital Santa Catarina; Hospital Santa Catarina Unidade de Terapia Intensiva PediátricaOBJECTIVES: To describe the main pathophysiological differences in neurosurgical procedures between children and adults; the main complications and adverse events resulting from pediatric neurosurgery reported in studies; the singularities in anesthetic and intraoperative management in several neurosurgical diseases; the more specific and common complications and their management in the most frequent pediatric neurosurgical procedures, as well as causes and treatment for the main complications found in children undergoing neurosurgery. METHODS: A non-systematic review in literature databases PubMed, EMBASE, and SciELO was performed by using the keywords pediatrics, children, neurosurgery, risk factors, intraoperative complications, and postoperative period, as well as their matches in Portuguese and Spanish from January 2001 to January 2011, in addition to using important references from the selected material over any period of time. RESULTS: The three procedures most commonly performed in children are hydrocephalus, craniostenosis repair, and brain tumor resection. Complications as fever, bleeding, metabolic disturbances (hyponatremia and hyperglycemia), brain swelling, and transient focal deficits (limb weakness, speech and swallowing disorders) are frequent, but their course is often towards prompt improvement. Up to 50% of children may have an uneventful evolution over the postoperative period. Special attention must be given to the prevention of postoperative infections and seizures with the use of a drug therapy that suits each case. CONCLUSION: The complexity of neurosurgical procedures in children is increasing, and observation and recognition of complications in pediatric intensive care units are fundamental. Anticipating complications in order to achieve an early treatment and adverse event prophylaxis can contribute to reduced morbidity and mortality and increased patients' safety.
- ItemSomente MetadadadosO papel da tomografia computadorizada na avaliação das complicações pulmonares de crianças submetidas a transplante autólogo e alogênico de medula ósseaArtigo(Universidade Federal de São Paulo (UNIFESP), 2013-10-30) Pinto, Luciana Muniz [UNIFESP]; Lederman, Henrique Manoel Lederman [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objetivo: Demonstrar a importância da tomografia computadorizada (TC) de tórax no diagnóstico das complicações pulmonares após transplante autólogo e alogênico de medula óssea em pacientes da faixa etária pediátrica. Métodos: O estudo incluiu 158 pacientes submetidos a transplante autólogo e alogênico de medula óssea no período de Janeiro de 2008 a Outubro de 2011. Foram analisados os exames de TC de tórax realizados nessa população em um período de até 6 meses pós-transplante por um radiologista com experiência em radiologia oncológica pediátrica. Os achados de imagem avaliados foram correlacionados com a doença de base, o tipo de transplante (autólogo x alogênico) e o tempo pós-transplante. Após a confirmação diagnóstica foi realizada a análise estatística Kappa para avaliar a concordância dos diagnósticos inicialmente propostos pelo radiologista com os diagnósticos finais confirmados. Resultados: Após o transplante, 63 (39,9%) pacientes evoluíram com complicação pulmonar. As doenças de base mais frequentes observadas entre os pacientes foram as leucemias (32,9%) e linfoma não-Hodgkin (15,8%), com relação estatisticamente significante entre leucemia e a evolução com complicação pulmonar (p<0,030). Complicação pulmonar nos primeiros 30 dias foi observada em 31 (56,4%) pacientes. Os diagnósticos pela TC mais frequentes foram edema pulmonar em 29 (52,7%) pacientes, infecção fúngica em 7 (12,7%) e infecção viral em 6 (10,9%). Entre os achados pulmonares na TC, a presença de vidro fosco (p=0,050), derrame pleural (p<0,001), consolidação (p<0,001), nódulo (p=0,001), halo em vidro fosco (p=0,015) e o tempo após transplante (p=0,037) foram relevantes para o diagnóstico da complicação. A análise de concordância Kappa entre os diagnósticos propostos inicialmente e os diagnósticos finais confirmados foi de 0,675. Conclusão: A TC de tórax provou-se como importante método auxiliar para identificação da causa das complicações pulmonares.
- ItemAcesso aberto (Open Access)Perfil das crianças submetidas à correção de cardiopatia congênita e análise das complicações respiratórias(Sociedade de Pediatria de São Paulo, 2012-01-01) Oliveira, Priscila Mara N. [UNIFESP]; Held, Priscila Antonichelli de; Grande, Rosângela Aparecida A.; Ribeiro, Maria Ângela Gonçalves de Oliveira; Bobbio, Tatiana Godoy; Schivinski, Camila Isabel S.; Universidade Federal de São Paulo (UNIFESP); Pontifícia Universidade Católica de Campinas Hospital Celso Pierro; Universidade Estadual de Campinas (UNICAMP); Universidade do Estado de Santa Catarina; UdescOBJECTIVE: To describe the profile of children that undergo surgical correction of congenital heart disease (CHD) in a university hospital and to compare patients with and without postoperative respiratory complications. METHOD: This observational analytical study reviewed the records of children that underwent corrective surgery for CHD a Brazilian University Hospital during 11 months. The following demographic variables were collected: age, sex, body mass index, comorbidities, and CHD types. Demographic variables and data about the intra- and postoperative care were compared for patients with and without postoperative respiratory complications. The Mann-Whitney and the Fisher exact tests were used, and the level of significance was set at p<0.05. RESULTS: The sample consisted of 55 children (49% boys) whose median age was 37.5 months. Three or more CHD were found in 29.1%, and 53% of all cases had comorbidities. The analysis of postoperative respiratory complications revealed that 31% of the patients had atelectasis and pleural effusion and 5.5% had laryngitis, pneumomediastinum or lung injury. Non-respiratory complications were identified in 24% of the patients. Survival was 89%. Children with postoperative respiratory complications received mechanical ventilation for a longer time and had a prolonged hospital stay (p<0.001). CONCLUSION: The association between respiratory complications, longer mechanical ventilation and longer hospital stay reinforced the need to avoid such complications to reduce costs of a prolonged hospital stay.
- ItemAcesso aberto (Open Access)Prevenção da aterosclerose e tratamento medicamentoso de anormalidades lipídicas de alto risco em crianças e adolescentes(Sociedade Brasileira de Pediatria, 2009-02-01) Castro, Priscilla Severino Gonçalves De [UNIFESP]; Oliveira, Fernanda Luisa Ceragioli [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To discuss risk factors of atherosclerosis in pediatrics, dietary and physical activity guidelines, and, mainly, drug treatment of high-risk lipid abnormalities. SOURCES: Data were obtained from articles indexed in MEDLINE, published over the last 5 years. SUMMARY OF THE FINDINGS: Children with severe dyslipidemia or additional risk factors such as family history of early cardiovascular disease or other signs of metabolic syndrome may need treatment with hypolipidemic drugs. New recommendations from the U.S. guidelines indicate drug treatment before the age of 10 years according to the magnitude of the additional risk factors for cardiovascular disease. Pediatricians should know when to diagnose dyslipidemia, when to indicate drug treatment and which medication can be used in children and adolescents with the least risk or harm to their development. CONCLUSIONS: The first-line treatment of dyslipidemia consists of lifestyle changes, focusing on prevention. Children with high-risk lipid abnormalities should be considered for drug treatment. Decisions to be made together with the parents must be evaluated taking into consideration risks and benefits of the medication to the patient.
- ItemAcesso aberto (Open Access)Refluxo Vesicoureteral primário na infância: tratamento conservador versus intervenção cirúrgica(Sociedade Brasileira de Nefrologia, 2014-03-01) Teixeira, Camila Borges Bezerra; Cancado, Maria Aparecida de Paula; Carvalhaes, João Tomás de Abreu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction:The relationship between urinary tract infections and primary vesicoureteral reflux may lead to permanent renal damage. In the literature an increasing number of spontaneous cure of vesicoureteral reflux in children and the significant decrease in surgical therapy has been observed.Objective:To study the evolution of primary vesicoureteral reflux associated with recurring urinary tract infections settings in patients of the Pediatric Nephrology department of our institution, evaluating cases in which cure was achieved through conservative therapy only and those in which surgical intervention was required.Methods: We analyzed records and collected data refers to parameters: sex, age upon the diagnosis of primary urinary infection, age upon diagnosis of vesicoureteral reflux, number of urinary tract infections, vesicoureteral reflux grade; renal function, renal scaring, other malformation of urinary tract, and surgical or conservative intervention. Statistical analysis was descriptive and conducted with the SPSS program.Results:Within the subgroup of patients with grade IV and V, 63.6% of the cases evolved to surgical intervention and 36.4% to conservative intervention. In those with grades I, II, and III, 38.5% evolved to surgical treatment against 61.5% for conservative approach. Among those with bilateral vesicoureteral reflux, 72.7% had to undergo surgical intervention. No relationship was observed between the vesicoureteral reflux grade and the presence of renal scaring.Conclusion: Patients with low grade vesicoureteral reflux and recurring urinary tract infections tend to experience spontaneous reflux resolution with good renal evolution in the long term in a way that surgical intervention becomes limited to high grade reflux or when followed by other clinical issues.
- ItemSomente MetadadadosRevisão de pares cranianos com ênfase em neurologia infantil(Universidade Federal de São Paulo (UNIFESP), 2016-07-27) Krueger, Mariana Braatz [UNIFESP]; Rodrigues, Marcelo Masruha Rodrigues [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In health education, pedagogical processes must meet the needs of A qualified professional, up to date with the newest knowledge in his area of ??expertise and Critical thinking to do the best for the society in which it is embedded. Within this approach, the training units of health professionals have a large Responsibility, not only with the development of undergraduate and graduate programs Appropriate to the national reality, as well as Continuing education programs so that these health professionals continue to be Qualified staff. For the formation of the health professional, especially the physician, a bibliographic review Complete on relevant and routine subjects, is essential, helping in daily practice and With this in mind, a treaty in neuropediatrics with a Updated review of key issues in this area. The dissemination throughout Brazil of a Complete and up-to-date on cranial nerves, with an emphasis on children's neurology, besides being Pioneer in the country, assists in the diffusion of knowledge. Once these objectives have been achieved, Contribute to the practice of prevention of neurological disorders, as well as assisting in the Treatment, recovery and due referrals of patients in need.
- ItemAcesso aberto (Open Access)Soluções hipertônicas em pediatria(Sociedade Brasileira de Pediatria, 2003-11-01) Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Santa Catarina; Beneficência Portuguesa de São PauloOBJECTIVE: To describe the current knowledge and indications for use of hypertonic saline solutions in pediatrics patients. SOURCE OF DATA: Medline recent review articles and personal files. SUMMARY OF THE FINDINGS: Basic physiologic principles were reviewed concerning the distribution of fluid inside the intravascular, interstitial and intracellular compartments. We also reviewed the findings concerning the mechanisms responsible for the rapid onset of cardiocirculatory effects and the additional effect of the colloid component. Finally, we present the medical terms used in the context of small-volume resuscitation, the indications for clinical use, the evidence from clinical research (hemorrhagic shock, preclinical trauma care, septic shock, and head trauma), and the disadvantages and potential adverse effects of small-volume resuscitation. CONCLUSIONS: Resuscitation by means of hypertonic saline solutions associated or not with colloid solutions is one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. Currently, the spectrum of potential indications involves not only prehospital trauma care, but also perioperative and intensive care therapy. However, additional randomized double-blind studies are required with both children and adult patients to confirm the advantages of the method in terms of survival.
- ItemAcesso aberto (Open Access)Tradução para a língua portuguesa e validação da escala de Braden Q para avaliar o risco de úlcera por pressão em crianças(Sociedade de Pediatria de São Paulo, 2011-09-01) Maia, Ana Claudia Amoroso Ribeiro de [UNIFESP]; Pellegrino, Donata M. S; Blanes, Leila; Dini, Gal Moreira [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To translate and culturally adapt the Braden Q scale into a Portuguese version and to test its properties (reliability and validity). METHODS: The Braden Q scale was translated and adapted according to internationally accepted methodology. The instrument was forward and back translated, and the translations were reviewed by a multidisciplinary committee. In the cultural adaptation process, three groups of ten nurses each interpreted the Brazilian version of the Braden Q scale until they fully understood the instrument. In order to evaluate the reliability of the Brazilian version, two other nurses administered the tool to pediatric ICU patients at different time points; the first nurse administered the instrument also in a second time. Statistical analysis was performed using Cronbach's α to evaluate the internal consistency of the scale, and the Spearman and intra-class correlation coefficients were calculated as a measure of reliability. RESULTS: There were no differences between scales translated by different translators during the forward and back translation process. All items of the scale culturally adapted by the 30 nurses were considered relevant. Cronbach's α for internal consistency was 0.936; intra-class correlation coefficient for intra-rater reliability was 0.995 and for inter-rater reliability was 0.998, both indicating high reliability. CONCLUSIONS: The Braden Q scale was successfully translated and adapted, and demonstrated validity and reliability.
- ItemAcesso aberto (Open Access)O transplante de células-tronco hematopoéticas na infância: situação atual e perspectivas(Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2009-05-01) Seber, Adriana [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Hematopoietic stem cell transplantation is a treatment option for a large number of children with malignant and non-malignant diseases. The objective of this article is to present the current status of hematopoietic stem cell transplantation in the treatment of malignant hematological diseases in pediatrics, including results in Brazil, and future perspectives.