Baixo peso ao nascer, prematuridade e restrição de crescimento intra-uterino: resultados dos dados de base da primeira coorte de nascimentos indígenas no Brasil (coorte de nascimentos Guarani).

ABSTRATO: FUNDO: O baixo peso ao nascer (BPN) continua sendo um importante problema de saúde global, associado a uma série de resultados adversos de saúde ao longo da vida. As evidências sugerem que o BPN é um determinante relevante de morbidade e mortalidade em grupos indígenas, que geralmente têm acesso limitado às políticas públicas de saúde e nutrição. O conhecimento da prevalência de BPN e de suas causas subjacentes pode contribuir com etapas essenciais para a prevenção de seus efeitos sobre a saúde. O estudo teve como objetivo estimar as prevalências de BPN, prematuridade e restrição de crescimento intra-uterino (RCIU) e investigar seus determinantes na primeira coorte de nascimentos indígenas no Brasil. MéTODOS: Este estudo transversal utilizou dados de linha de base coletados da primeira coorte de nascimentos indígenas no Brasil, a Coorte de Nascimentos Guarani. O Brasil é um dos países com maior diversidade étnica do mundo, com 305 povos indígenas e 274 línguas nativas. Os Guarani são uma das cinco maiores etnias, com aldeias localizadas principalmente na região sul. Todos os nascimentos únicos de 1º de junho de 2014 a 31 de maio de 2016 foram selecionados em 63 aldeias indígenas Guarani nas regiões Sul e Sudeste. Foi realizada regressão logística múltipla hierárquica. RESULTADOS: As taxas de prevalência de BPN, prematuridade e RCIU foram 15,5, 15,6 e 5,7%, respectivamente. As chances de BPN foram menores em recém-nascidos de mães que vivem em casas de tijolo e argamassa (OR: 0,25; IC 95%: 0,07-0,84) e foram maiores em filhos de mães ≤20 anos de idade (OR: 2,4; IC 95%: 1,29-4,44) e com anemia crônica antes da gravidez (OR: 6,41; IC 95%: 1,70-24,16). A prematuridade foi estatisticamente associada ao tipo de fonte de energia para cozinhar (fogão a lenha - OR: 3,87; IC 95%: 1,71-8,78 e fogueiras - OR: 2,57; IC 95%: 1,31-5,01). RCIU foi associado à primiparidade (OR: 4,66; IC 95%: 1,68-12,95) e anemia materna crônica antes da gravidez (OR: 7,21; IC 95%: 1,29-40,38). CONCLUSõES: Idade materna, estado nutricional e paridade, condições de moradia e exposição à poluição interna foram associados com resultados perinatais na população indígena Guarani. Esses resultados indicam a necessidade de investir no acesso e melhoria da assistência pré-natal; também no fortalecimento do Subsistema de Saúde Indígena, e em ações intersetoriais para o desenvolvimento de políticas habitacionais e de saneamento e melhorias ambientais ajustadas às necessidades e conhecimentos dos povos indígenas.

Effect of prednisolone on linear growth in children with nephrotic syndrome.

OBJECTIVE: This study aims at determining the relationship between prednisolone cumulative dose and linear growth in pre-pubertal children with idiopathic nephrotic syndrome. METHOD: This cross-sectional study was conducted on all children with idiopathic nephrotic syndrome registered to the pediatric nephrology department at the main referral children's hospital in Southwestern Iran. Inclusion criteria included age (males <12 years; females <10 years), >6 months of use, and the minimum prednisolone cumulative dose of 152mg/kg. The exclusion criteria were individuals who had entered puberty or had other diseases affecting linear growth. Based on the prednisolone cumulative dose of ≥550mg/kg (four or more relapses), the children were divided into two groups. All data regarding age, height, and weight at disease onset and the last visit, bone age, and the parents' height were collected. Secondary variables including mid-parental target height and predicted adult height were also calculated. Height data were compared between the different rates of relapse. RESULTS: A total of 97 children (68% male) were enrolled. Their post-treatment mean height Z-score was less than that obtained before treatment (-0.584 vs. -0.158; p=0.001). Subjects with higher prednisolone cumulative doses were found to have more reduction in height Z-score (p=0.001). Post-treatment height prediction also showed less growth potential compared to pre-treatment target height (p=0.006). Thirty-three children (34.4%) had four or more relapses, among whom more mean-height Z-score decreases were found compared to those with less-frequent relapses (-0.84 vs. -0.28; p=0.04). CONCLUSION: This study showed the negative effect of cumulative dosages of prednisolone on linear growth, which was greater in children with four or more relapses.

Growth in exclusively breastfed infants.

OBJECTIVE: To address the growth of full-term children in the first 6 months of life in exclusive breastfeeding. SOURCE OF DATA: A non-systematic review was carried out by searching the MEDLINE/PubMed, Web of Science, and Cochrane Library databases and the World Health Organization website for articles and documents on the growth of exclusively breastfed infants and their monitoring. Those documents considered to be the most relevant by the author were selected. DATA SYNTHESIS: Exclusively breastfeed infants show differentiated growth when compared to formula-fed infants. Weight loss in the first four days of life is due more to loss of fat mass rather than lean mass, including body water, and is usually lower in exclusively breastfed infants. In turn, the time for recovery of the birth weight may be longer in these infants. Formula-fed infants gain weight and increase their BMI more rapidly in the first three to six months of life than infants in exclusive or predominant breastfeeding due to a progressive increase in lean mass. The World Health Organization growth curves, which use the growth pattern of breastfed children as their standard, are used to monitor growth. CONCLUSIONS: Exclusively breastfed infants have differentiated growth when compared with formula-fed infants. This should be considered when monitoring the infant's growth. It should be emphasized that the growth pattern currently used as reference is that of the exclusively breastfed infant.

Influence of the antiretroviral therapy on the growth pattern of children and adolescents living with HIV/AIDS.

OBJECTIVE: Weight and height growth impairment is one of the most frequent manifestations in HIV-infected children and may be the first sign of disease, being considered a marker of disease progression and an independent risk factor for death. The aim of this review is to evaluate the influence of antiretroviral therapy on the growth pattern of children and adolescents living with HIV/AIDS. SOURCE OF DATA: A non-systematic review was carried out in the PubMed database, with the terms "HIV", "Weight and height growth", "ART" and "children". The most relevant publications were selected. DATA SYNTHESIS: Antiretroviral therapy has significantly reduced morbidity and mortality in HIV-infected children and is clearly associated with recovery of weight and height-for-age Z-scores, especially when started early, in the asymptomatic child still without weight-height impairment. Therapeutic strategies involving the GH/IGF-1 axis, especially for children with growth impairment, are still being studied. CONCLUSIONS: HIV-infected children show early weight-height impairment; antiretroviral therapy improves the anthropometric profile of these children.

Influence of AIDS antiretroviral therapy on the growth pattern.

OBJECTIVES: Human immunodeficiency virus infection can result in the early impairment of anthropometric indicators in children and adolescents. However, combined antiretroviral therapy has improved, in addition to the immune response and viral infection, the weight and height development in infected individuals. Therefore, the objective was to evaluate the effect of combined antiretroviral on the growth development of human immunodeficiency virus infected children and adolescents. SOURCE OF DATA: A systematic review was performed. In the study, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) strategy was used as the eligibility criterion. The MEDLINE-PubMed and LILACS databases were searched using these descriptors: HIV, children, growth, antiretroviral therapy. The objective was defined by the population, intervention, comparison/control, and outcome (PICO) technique. Inclusion and exclusion criteria were applied for study selection. SYNTHESIS OF DATA: Of the 549 studies indexed in MEDLINE-PubMed and LILACS, 73 were read in full, and 44 were included in the review (33 showed a positive impact of combined antiretroviral therapy on weight/height development, ten on weight gain, and one on height gain in children and adolescents infected with human immunodeficiency virus). However, the increase in growth was not enough to normalize the height of infected children when compared to children of the same age and gender without human immunodeficiency virus infection. CONCLUSIONS: Combined antiretroviral therapy, which is known to play a role in the improvement of viral and immunological markers, may influence in the weight and height development in children infected with human immunodeficiency virus. The earlier the infection diagnosis and, concomitantly, of malnutrition and the start of combined antiretroviral therapy, the lower the growth impairment when compared to healthy children.

Effects of Zika infection on growth.

OBJECTIVES: To present the currently available evidence of the effects of congenital Zika virus infection on infant growth, to discuss possible intervening factors, and to describe preliminary data on this growth in a cohort of exposed children. SOURCE OF DATA: Non-systematic review in PubMed, BVS, CAPES, Scopus, Web of Science, Cochrane and Google Scholar databases in the last 5 years, using the terms infection/disease by Zika virus and growth/nutrition/nutritional status/infant nutrition and nutritional needs. Additionally, the anthropometric data of the first 2.5 years of a cohort of children exposed to the Zika virus during pregnancy were reviewed. SYNTHESIS OF DATA: Both intrauterine growth restriction and low birth weight were reported in series of cases of children with congenital Zika syndrome. The postnatal growth deficit of these children appears to be directly proportional to the degree of neurological impairment. The etiology is multifactorial, and nutritional and non-nutritional factors are probably involved. The data from the present cohort show that the head circumference evolution depends on this measurement at birth and that weight-height growth has a trend toward lower weight and length in children with congenital microcephaly and normocephalic at birth who develop some neurological abnormality. CONCLUSIONS: The few existing data suggest that, in children with congenital Zika, the greater the degree of neurological impairment, the greater the impact on growth, whether or not associated with microcephaly at birth.

Effects of physical activity on children's growth.

OBJECTIVE: To describe the current scientific knowledge on the effects of physical exercise on the growth of children and adolescents since intrauterine life. SOURCE OF DATA: A search was carried out in the Medline, Embase, Scielo, and Cochrane databases of studies published from 1990 to 2018. The authors included studies with different designs: clinical trials, cohort, cross-sectional and review studies. SYNTHESIS OF DATA: Studies that addressed the subject of physical exercise or physical activity, and weight-height growth or bone or muscle tissue growth were identified. These studies were analyzed, classified, and presented by age group: fetuses, preterm newborns, preschoolers, schoolchildren, and adolescents. It was observed that almost all studies indicated the safety of physical exercises, of mild to moderate intensity, for pregnant women, as well as children and adolescents, including both aerobic and anaerobic exercises. The retrieve studies did not demonstrate that the practice of physical exercises or certain sports, especially basketball and floor gymnastics, influenced the linear growth of children or adolescents. Some studies showed an increase in bone and muscle tissue growth in child and adolescent athletes. CONCLUSIONS: Despite the small number of studies with adequate methodology, especially randomized clinical trials, evidence appears to indicate that physical exercise is safe for both the pregnant woman and the child, from fetal life to adolescence. Physical exercise does not appear to impair the child's linear growth and contributes to the ideal shaping of bone and muscle tissues, ensuring possible beneficial effects throughout life.

The impact of asthma and its treatment on growth: an evidence-based review.

OBJECTIVES: To assess the impact of asthma and its treatment (inhaled corticosteroids and other control medications) on growth. DATA SOURCES: The authors searched PubMed (up to August 24, 2018) and screened the reference lists of retrieved articles. Systematic reviews and meta-analysis were selected. If there was no such article, the authors selected either randomized clinical trials or observational studies. DATA SYNTHESIS: A total of 37 articles were included in this review. The findings from 21 studies suggest that asthma per se, especially more severe and/or uncontrolled cases, can transitorily impair child's growth. Two Cochrane reviews of randomized clinical trials showed a small mean reduction in linear growth (-0.91cm/year for beclomethasone, -0.59cm/year for budesonide, and -0.39cm/year for fluticasone) in the first year of treatment with inhaled corticosteroids in prepubertal children with persistent asthma. The effects were likely to be molecule- and dose-dependent. A recent review showed that most of "real-life" observational studies had not found significant effects of inhaled corticosteroids on growth in asthmatic children. Fifteen studies showed that the maintenance systemic corticosteroids could cause a dose-dependent growth suppression in children with severe asthma, but other controllers (cromones, montelukast, salmeterol, and theophylline) had no significant adverse effects no growth. CONCLUSIONS: Severe and/or uncontrolled asthma can transitorily impair child's growth. Regular use of inhaled corticosteroids may cause a small reduction in linear growth in children with asthma, but the well-established benefits of inhaled corticosteroids in controlling asthma outweigh the potential adverse effects on growth. Use of the minimally effective dose of inhaled corticosteroids and regular monitoring of child's height during inhaled corticosteroids therapy are recommended.

Preterm newborn's postnatal growth patterns: how to evaluate them.

OBJECTIVES: There are several factors that influence the postnatal growth of preterm infants. It is crucial to define how to evaluate the growth rate of each preterm child and its individual trajectory, the type of growth curve, either with parameters of prescriptive curves for healthy preterm infants with no morbidities or, in the case of preterm infants and their "bundle of vulnerabilities", growth curves that may represent how they are actually growing, with the aim of directing appropriate nutritional care to each gestational age range. DATA SOURCES: The main studies with growth curves for growth monitoring and the appropriate nutritional adjustments that prioritized the individual trajectory of postnatal growth rate were reviewed. PubMed and Google Scholar were searched. DATA SYNTHESIS: The use of longitudinal neonatal data with different gestational ages and considering high and medium-risk pregnancies will probably be essential to evaluate the optimal growth pattern. CONCLUSIONS: Prioritizing and knowing the individual growth trajectory of each preterm child is an alternative for preterm infants with less than 33 weeks of gestational age. For larger preterm infants born at gestational age >33 weeks, the Intergrowth 21st curves are adequate.

Environmental enteric dysfunction and growth.

OBJECTIVE: To describe the current indicators of environmental enteric dysfunction and its association with linear growth deficit and the height-for-age anthropometric indicator. DATA SOURCES: Narrative review with articles identified in PubMed and Scopus databases using combinations of the following words: environmental, enteric, dysfunction, enteropathy, and growth, as well as the authors' personal records. DATA SYNTHESIS: In the last 15 years, new non-invasive markers have been investigated to characterize environmental enteric dysfunction; however, the best tests to be used have not yet been identified. There is evidence that, in environmental enteric dysfunction, a systemic inflammatory process may also occur as a consequence of increased intestinal permeability, in addition to intestinal mucosa abnormalities. Bacterial overgrowth in the small intestine and changes in fecal microbiota profile have also been identified. There is evidence indicating that environmental enteric dysfunction can impair not only full growth but also the neuropsychomotor development and response to orally administered vaccines. It is important to emphasize that the environmental enteric dysfunction is not a justification for not carrying out vaccination, which must follow the regular schedule. Another aspect to emphasize is the greater risk for those children who had height impairment in early childhood, possibly associated with environmental enteric dysfunction, to present overweight and obesity in adulthood when exposed to a high calorie diet, which has been called "triple burden." CONCLUSIONS: According to the analyzed evidence, the control of environmental enteric dysfunction is very important for the full expression of growth, development, and vaccine response in the pediatric age group.

Early stimulation for neuropsychomotor development in children with microcephaly: a systematic review / Estimulação precoce para o desenvolvimento neuropsicomotor de crianças com microcefalia: uma revisão sistemática

ABSTRACT Objective: To systematically review studies on the effects of early stimulation on the neuropsychomotor development of children with microcephaly. Data source: A systematic review was conducted in PubMed/MEDLINE, Virtual Health Library, and Cochrane Library databases. Studies that addressed the use of early stimulation in playful and interactive environments in children with microcephaly were included. There were no restrictions on the publication date or language of the studies. The outcomes assessed were muscle tone, social interaction, fine and gross motor skills, intelligence quotient, socioemotional and adaptive behavior of the child. The methodological quality and the scientific evidence level were assessed using the Risk of Bias in Non-randomized Studies of Interventions, the Revised Cochrane risk of bias tool for randomized trials and the Grading of Recommendations Assessment, Development and Evaluation. Data synthesis: 264 articles were identified, but only 7 met the eligibility criteria. The included studies had a total population of 125 individuals, with sample sizes ranging from 1 to 71 participants. Conclusions: The studies showed low evidence of an effect of early intervention on the outcomes muscle tone, social interaction, fine and gross motor skills, intelligence quotient, and socioemotional and adaptive behavior in children with microcephaly. However, further randomized clinical trials are needed.

RESUMO Objetivo: Revisar, de forma sistemática, estudos sobre a interferência da estimulação precoce no desenvolvimento neuropsicomotor de crianças com microcefalia. Fontes de dados: Trata-se de uma revisão sistemática realizada nas bases de dados United States National Library of Medicine/ Medical Literature Analysis and Retrieval System Online (PubMed/MEDLINE), Biblioteca Virtual em Saúde (BVS) e Cochrane Library. Foram incluídos estudos que abordassem o uso de estímulo precoce em ambientes lúdicos e interativos em crianças com microcefalia. Não foram impostas restrições quanto à data de publicação e ao idioma dos estudos. Como desfechos, avaliaram-se tônus muscular, interação social, habilidades motoras fina e grossa, quociente de inteligência, comportamento socioemocional e adaptativo da criança. A qualidade metodológica dos estudos e o nível de evidência científica foram avaliados pelo Risk of bias in non-randomized studies of interventions, Revised Cochrane risk of bias tool for randomized trials e Grading of recommendations assessment, development and evaluation. Síntese dos dados: Foram identificados 264 artigos, entretanto apenas sete atenderam aos critérios de elegibilidade. Os estudos incluídos totalizam uma população de 125 indivíduos, com amostras que variaram de um a 71 participantes. Conclusões: Os estudos demonstraram a existência de baixa evidência quanto à interferência da intervenção precoce nos desfechos tônus muscular, interação social, habilidades motoras finas e grossas, quociente de inteligência e comportamento socioemocional e adaptativo em crianças com microcefalia. No entanto, novos ensaios clínicos randomizados ainda são necessários.

Conocimiento de los padres de familia sobre prevención de infecciones respiratorias agudas

Muchos países toman como estrategia la educación de salud, para incrementar los conocimientos de la población en la prevención de enfermedades, en caso de los niños menores de 5 años quienes son vulnerables a las infecciones respiratorias agudas (IRA), son sus padres a quienes se evalúa el conocimiento en medidas preventivas de las IRA. Objetivo: determinar el nivel de conocimiento de los padres de familia sobre prevención de IRA de un distrito del Perú. Materiales y métodos: Estudio de tipo básico, nivel descriptivo, transversal y prospectivo. Con una muestra de 210 padres de familia, los cuales fueron escogidos por conveniencia. La técnica de recolección de datos fue la encuesta y el instrumento un cuestionario con sus dos dimensiones, la primera dimensión el de medidas preventivas de CRED (Crecimiento y desarrollo) e inmunizaciones, la segunda dimensión sobre medidas preventivas de las condiciones ambientales, mencionado instrumento paso por el proceso de validez y confiabilidad, luego se entregó el consentimiento informado antes de aplicar el instrumento a la muestra en estudio. Resultados: Las edades de los padres de familia en un 71,43% lo conforman de 18 a 33 años, el nivel de conocimiento de los padres de familia sobre prevención de IRA fue considerado alto con 45,24%, en nivel regular con 31,90% y en nivel deficiente con 22,86%. Conclusión: El nivel de conocimiento de los padres de familia de niños menores de 5 años sobre prevención de IRA fue alto en menos del 50%, siendo mayor en la sumatoria de deficiente y regular.

Many countries take health education as a strategy to increase the population's knowledge of disease prevention. In the case of children under 5 years of age who are vulnerable to acute respiratory infections (ARI), it is their parents who are evaluates knowledge of preventive measures for ARI. Objective: determine the level of knowledge of parents about ARI prevention in a district of Peru. Materials and methods: Basic type study, descriptive, transversal and prospective level. With a sample of 210 parents, who were chosen by convenience. The data collection technique was the survey and the instrument was a questionnaire with its two dimensions, the first dimension on preventive measures of CRED (Growth and Development) and immunizations, the second dimension on preventive measures of environmental conditions, mentioned instrument step through the validity and reliability process, then informed consent was given before applying the instrument to the study sample. Results: The ages of the parents in 71.43% are between 18 and 33 years old, the level of knowledge of the parents about ARI prevention was considered high with 45.24%, at a regular level with 31.90% and at a deficient level with 22.86%. Conclusion: The level of knowledge of parents of children under 5 years of age about ARI prevention was high at less than 50%, being higher in the sum of deficient and regular.

Muitos países tomam a educação em saúde como estratégia para aumentar o conhecimento da população sobre a prevenção de doenças. No caso de crianças menores de 5 anos vulneráveis às infecções respiratórias agudas (IRA), são os pais que avaliam o conhecimento das medidas preventivas. IRA. Objetivo: determinar o nível de conhecimento dos pais sobre prevenção de IRA em um distrito do Peru. Materiais e métodos: Estudo do tipo básico, nível descritivo, transversal e prospectivo. Com uma amostra de 210 pais, escolhidos por conveniência. A técnica de coleta de dados foi a pesquisa e o instrumento foi um questionário com suas duas dimensões, a primeira dimensão sobre medidas preventivas de CRED (Crescimento e Desenvolvimento) e imunizações, a segunda dimensão sobre medidas preventivas de condições ambientais, mencionada etapa do instrumento através da validade e processo de confiabilidade, foi dado consentimento informado antes da aplicação do instrumento na amostra do estudo. Resultados: A idade dos pais em 71,43% está entre 18 e 33 anos, o nível de conhecimento dos pais sobre prevenção de IRA foi considerado alto com 45,24%, nível regular com 31,90% e nível deficiente com 22,86%. Conclusão: O nível de conhecimento dos pais de crianças menores de 5 anos sobre prevenção de IRA foi elevado, inferior a 50%, sendo maior na soma de deficiente e regular.

DELEÇÃO 14q24.1: características fenotípicas e resposta ao uso hormônio do crescimento recombinante humano / 14q24.1 DELETION: phenotypic characteristics and response to the use of recombinant human growth hormone

As alterações cromossômicas estruturais no cromossomo 14 são incomuns e podem levar a um espectro variado de manifestações clínicas, incluindo hipotonia, atraso no desenvolvimento psicomotor, déficits cognitivos e dismorfismos faciais. O fenótipo específico é influenciado pela localização, extensão e pontos de interrupção da deleção. Este relato de caso tem como objetivo detalhar o fenótipo e genótipo de uma pré-escolar com deleção 14q24.1, além de documentar a resposta ao tratamento com hormônio do crescimento recombinante humano (rhGH). A paciente, uma prematura nascida com medidas adequadas para a idade gestacional e filha de pais não consanguíneos, apresentou desconforto respiratório e dificuldades de deglutição no período neonatal, necessitando de gastrostomia até o primeiro ano de vida. Entre o nascimento e os dois anos e seis meses, ela apresentou uma redução da velocidade de crescimento e baixa estatura desproporcional. Foram observados também inclinação palpebral superior bilateral, baixa inserção das orelhas, fissura palatina posterior, dentição irregular, micrognatia, retrognatia, escoliose, encurtamento do fêmur direito com marcha antálgica, agenesia do rim esquerdo e posicionamento pélvico do rim direito. Além disso, a paciente exibiu atraso no desenvolvimento neuropsicomotor. A análise genética revelou uma deleção no braço longo do cromossomo 14 de aproximadamente 231 Kb. Com o tratamento com rhGH, observou-se melhora na taxa de crescimento e na estatura final. A evolução clínica do caso indica que a administração de rhGH, associada ao acompanhamento clínico rigoroso e ao tratamento das comorbidades, pode contribuir para a melhoria dos parâmetros antropométricos.

Structural chromosomal changes on chromosome 14 are uncommon and can lead to a diverse spectrum of clinical manifestations, including hypotonia, delayed psychomotor development, cognitive deficits, and facial dysmorphisms. The specific phenotype is influenced by the location, extent, and breakpoints of the deletion. This case report aims to detail the phenotype and genotype of a preschooler with 14q24.1 deletion, in addition to documenting the response to treatment with recombinant human growth hormone (rhGH). The patient, a premature female, born with appropriate measurements for gestational age and daughter of non-consanguineous parents, presented respiratory discomfort and swallowing difficulties in the neonatal period, requiring gastrostomy until the first year of life. Between birth and two years and six months, she presented a reduction in growth speed and disproportionate short stature. Bilateral upper eyelid tilt, low ear insertion, posterior cleft palate, irregular dentition, micrognathia, retrognathia, scoliosis, shortening of the right femur with antalgic gait, agenesis of the left kidney and pelvic positioning of the right kidney were also observed. Furthermore, the patient exhibited delayed neuropsychomotor development. Genetic analysis revealed a deletion on the long arm of chromosome 14 of approximately 231 Kb. With rhGH treatment, an improvement in growth rate and final height was observed. The clinical evolution of the case indicates that the administration of rhGH, associated with strict clinical monitoring and treatment of comorbidities, can contribute to the improvement of anthropometric parameters.

Repercussions of inborn errors of immunity on growth.

OBJECTIVES: This study aimed to review the literature on the repercussions of the different inborn errors of immunity on growth, drawing attention to the diagnosis of this group of diseases in patients with growth disorders, as well as to enable the identification of the different causes of growth disorders in patients with inborn errors of immunity, which can help in their treatment. DATA SOURCES: Non-systematic review of the literature, searching articles since 2000 in PubMed with the terms "growth", "growth disorders", "failure to thrive", or "short stature" AND "immunologic deficiency syndromes", "immune deficiency disease", or "immune deficiency" NOT HIV. The Online Mendelian Inheritance in Man (OMIN) database was searched for immunodeficiencies and short stature or failure to thrive. DATA SUMMARY: Inborn errors of immunity can affect growth in different ways, and some of them can change growth through multiple simultaneous mechanisms: genetic syndromes; disorders of the osteoarticular system; disorders of the endocrine system; reduction in caloric intake; catabolic processes; loss of nutrients; and inflammatory and/or infectious conditions. CONCLUSIONS: The type of inborn errors of immunity allows anticipating what type of growth disorder can be expected. The type of growth disorder can help in the diagnosis of clinical conditions related to inborn errors of immunity. In many inborn errors of immunity, the causes of poor growth are mixed, involving more than one factor. In many cases, impaired growth can be adjusted with proper inborn errors of immunity treatment or proper approach to the mechanism of growth impairment.

Osteochondritis dissecans of the hip in legg-calvé-perthes disease: case report and review / Osteocondrite dissecante do quadril na doença de legg-calvé-perthes: relato de caso e revisão

ABSTRACT Introduction: Legg-Calvé-Perthes disease (LCPD) is the idiopathic osteonecrosis of the capital femoral epiphysis in children. It is a self-healing condition, and the morphology of the hip may vary according to the severity of the disease, among several other factors. The treatment focuses on attempts to prevent femoral head collapse, obtain functional hip motion recovery, and reduce pain. Osteochondritis Dissecans (OCD) of the femoral head has been reported in 2% to 7% of patients diagnosed with healed LCPD. Although OCD may remain asymptomatic, the osteochondral fragment has the potential to become unstable, evolving into symptoms of pain, locking, catching, and snapping. Case report: We present a case report of a ten-year-old boy with an OCD lesion following LCPD who underwent effective osteochondral fixation through the surgical hip dislocation approach. The patient evolved to excellent functional recovery at 1 year post-operatively. Discussion: The surgical hip dislocation approach allows anatomical fixation of the OCD fragment, as well as improvement of hip biomechanics, decreasing pain, improving range of motion and joint congruency, and preserving the native articular cartilage. It also gives the surgeon the opportunity to assess hip stability, femoroacetabular impingement and labral tears, allowing a wide variety of options for the treatment of the healed LCPD. Level of Evidence IV; Type of study Case Report.

RESUMO Introdução: A Doença de Legg-Calvé-Perthes (DLCP) é a osteonecrose idiopática da epífise femoral proximal em crianças. É uma condição auto resolutiva, porém a morfologia final do quadril pode variar de acordo com a gravidade da doença. O tratamento concentra-se na tentativa de prevenir o colapso da cabeça femoral, obtendo recuperação funcional do movimento do quadril e redução da dor. A osteocondrite dissecante (OCD) da cabeça femoral foi relatada em 2% a 7% dos pacientes diagnosticados com DLCP já curada. Embora a OCD possa permanecer assintomática, o fragmento osteocondral tem potencial para se tornar instável, evoluindo para sintomas de dor, bloqueio, impacto e estalido. Relato de caso: Apresentamos o relato de caso de um menino de 10 anos com OCD da cabeça femoral após DLCP, submetido à fixação osteocondral do fragmento por meio da abordagem cirúrgica de luxação do quadril. O paciente evoluiu com excelente recuperação funcional 1 ano após a cirurgia. Discussão: A abordagem cirúrgica da luxação do quadril permite a fixação anatômica do fragmento da OCD, bem como a melhora da biomecânica do quadril, diminuindo a dor, melhorando a amplitude de movimento e a congruência articular e preservando a cartilagem articular nativa. Também dá ao cirurgião a oportunidade de avaliar a estabilidade do quadril, impacto femoroacetabular e lesões labrais, permitindo uma ampla variedade de opções para o tratamento das sequelas da DLCP. Nível de evidência IV; tipo de estudo Relato de Casos.

Growth charts of Brazilian youngs: 20-years data of 95,000 children and adolescents from "Projeto Esporte Brasil" / Curvas de crescimento de jovens brasileiros: dados de 20 anos com 95.000 crianças e adolescentes do "Projeto Esporte Brasil"

Abstract This article aims to present growth curves for height, weight, and BMI of 95,000 Brazilian youths aged 6 to 17 years, including the five regions of the country, the Amazon region, and indigenous populations, and compare them with the World Health Organization (WHO) growth references. The final sample consisted of 52,729 boys and 42,731 girls from the "Projeto Esporte Brasil" database. Body mass and height information were used to derive the curves. The generalized additive model for location, scale, and shape was employed. In this study, we present smoothed weight-for-age, height-for-age, and BMI-for-age curves for boys and girls. Differences were observed between the results of the Brazilian curves and the WHO growth references. The developed curves will be valuable for professionals in medicine, public health, nutrition, physical education, and other related fields, regarding the assessment of physical growth in Brazilian children and adolescents and monitoring the nutritional status of this population. Additionally, these curves will facilitate the identification of individuals or subgroups at risk of diseases and delayed growth, with a greater focus on specific country-related factors.

Resumo O objetivo do artigo é apresentar curvas de crescimento de altura, peso e IMC de 95.000 jovens brasileiros com idades entre 6 e 17 anos, incluindo as cinco regiões do país, a região da Amazônia e os povos indígenas, e comparar com as referências de crescimento da Organização Mundial da Saúde (OMS). A amostra final foi composta por 52.729 meninos e 42.731 meninas provenientes do banco de dados do "Projeto Esporte Brasil". As informações de massa corporal e estatura foram utilizadas para derivar as curvas. O modelo aditivo generalizado para localização, escala e forma foi usado. neste estudo, apresentamos as curvas suavizadas de peso-idade, altura-idade e IMC-idade para meninos e meninas. Foram observadas diferenças entre os resultados das curvas brasileiras e as referências de crescimento da OMS. As curvas desenvolvidas serão úteis para profissionais da medicina, saúde pública, nutrição, educação física, entre outros, no que diz respeito a avaliação do crescimento físico de crianças e adolescentes brasileiros e para monitorar o estado nutricional desta população. Além disso, essas curvas permitirão a detecção de indivíduos ou subgrupos em risco de doenças e crescimento retardado, com um foco maior em fatores específicos do país.

Linear growth and bone metabolism in pediatric patients with inflammatory bowel disease.

OBJECTIVE: To review the pathophysiology and evaluation methods of linear growth and bone mineral density in children and adolescents diagnosed with inflammatory bowel disease. SOURCE OF DATA: Narrative review carried out in the PubMed and Scopus databases through an active search of the terms: inflammatory bowel disease, growth, failure to thrive, bone health, bone mineral density, and children and adolescents, related to the last ten years, searching in the title, abstract, or keyword fields. SYNTHESIS OF FINDINGS: Inflammatory bowel diseases of childhood onset may present as part of the clinical picture of delayed linear growth in addition to low bone mineral density. The presence of a chronic inflammatory process with elevated serum levels of inflammatory cytokines negatively interferes with the growth rate and bone metabolism regulation, in addition to increasing energy expenditure, compromising nutrient absorption, and favoring intestinal protein losses. Another important factor is the chronic use of glucocorticoids, which decreases the secretion of growth hormone and the gonadotrophin pulses, causing pubertal and growth spurt delay. In addition to these effects, they inhibit the replication of osteoblastic lineage cells and stimulate osteoclastogenesis. CONCLUSION: Insufficient growth and low bone mineral density in pediatric patients with inflammatory bowel disease are complex problems that result from multiple factors including chronic inflammation, malnutrition, decreased physical activity, late puberty, genetic susceptibility, and immunosuppressive therapies, such as glucocorticoids.

Growth and mouth breathers.

OBJECTIVE: To assess the relationship between mouth breathing and growth disorders among children and teenagers. DATA SOURCE: Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar hypertrophy", "allergic rhinitis", "sleep disturbance" AND "growth impairment", "growth hormone", "failure to thrive", "short stature", or "failure to thrive". DATA SUMMARY: A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical). CONCLUSIONS: Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.

Sleep and weight-height development.

OBJECTIVES: To describe the association between sleep duration and weight-height development in children and adolescents. SOURCE OF DATA: A non-systematic search in the MEDLINE database was performed using the terms anthropometry, body composition, overweight, obesity, body mass index, growth, length, short stature, sleep, children, and infants and adolescents, limited to the last 5 years. The references cited in the revised articles were also reviewed, when relevant. SYNTHESIS OF DATA: Sleep disorders are prevalent in the pediatric population. Among them, insomnia, which leads to a reduction in total sleep time, is the most prevalent disorder. Evidence found in the current literature allows the conclusion that sleep time reduction has a role in the current pandemic of overweight and obesity. Studies associating sleep deprivation and deficit in height growth are still insufficient. CONCLUSIONS: The association between shorter sleep duration and risk of overweight and obesity is well established for all pediatric age groups. However, more evidence is needed to establish an association between insufficient sleep duration and height growth deficit. Pediatricians should include the encouragement of healthy sleep habits in their routine guidelines as an adjuvant in the prevention and management of excess weight.

Geographic altitude and prevalence of underweight, stunting and wasting in newborns with the INTERGROWTH-21st standard.

OBJECTIVE: To assess the prevalence and risks of underweight, stunting and wasting by gestational age in newborns of the Jujuy Province, Argentina at different altitude levels. METHODS: Live newborns (n=48,656) born from 2009-2014 in public facilities with a gestational age between 24+0 to 42+6 weeks. Phenotypes of underweight (2.000m.a.s.l. Maternal age, body mass index >35kg/m2, hypertension, congenital malformations, and prematurity were more strongly associated with underweight rather than stunting or wasting at ≥2.000m.a.s.l. CONCLUSIONS: Underweight, stunting, and wasting risks were higher at a higher altitude, and were associated with recognized maternal and fetal conditions. The use of those three phenotypes will help prioritize preventive interventions and focus the management of fetal undernutrition.