Exclusive breastfeeding and length of hospital stay in premature infants at a Brazilian reference center for kangaroo mother care

Abstract Objective: To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in pre-term infants undergoing or not the Kangaroo-Mother Care Method (KMC). Methods: A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders. Results: 115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85-109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76-0.86) compared to the non-KMC group. Conclusions: The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals.

High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study

Abstract Objective: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. Methods: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge'sg. Results: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). Conclusion: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.

A percepção do estudante de medicina sobre a simulação realística em pediatria / The perception of the medical student about realistic simulation in pediatrics

Resumo Introdução: O uso de simulação realística em emergências pediátricas é particularmente valioso, pois permite o treinamento de habilidades técnicas, atitudinais e cognitivas, ajudando a garantir a segurança do paciente. Objetivo: Este estudo tem como objetivo descrever a percepção do aluno sobre o uso da Simulação Realista de Alta Fidelidade nos módulos de emergência pediátrica durante o internato de medicina. Métodos: Estudo observacional, descritivo, com abordagem quantitativa e qualitativa. Um questionário semiestruturado foi aplicado aos estudantes do sexto ano de medicina ao final dos módulos de internato pediátrico, com oito semanas de duração, de agosto a dezembro de 2020. Todos participaram de dois tipos de atividades sobre 14 temas: simulação de alta fidelidade (SRAF) e discussão estruturada de casos clínicos (DCC). Resultados: Dos 33 participantes, 29 responderam ao questionário. A média de idade foi de 24 ± 1,8 anos, sendo 58,6% do sexo feminino. Todos concordaram que a experiência com SRAF contribuiu para um desempenho mais seguro em emergências pediátricas, considerado ótimo por 76% e bom para os demais. A maioria achava que a associação de SRAF e DCC era o método ideal (96%). A análise de conteúdo das respostas sobre a SRAF destacou unidades temáticas em cinco categorias: aprendizagem significativa, contribuição para a formação profissional, habilidades, atitude/comportamento e qualidade da atividade. Conclusões: A reação dos estudantes ao uso da SRAF em emergências pediátricas foi muito positiva, e sua associação com a DCC foi considerada o método de ensino ideal. Conhecer as reações dos alunos ajuda os professores a planejarem suas atividades para melhorar o método de ensino-aprendizagem.

Abstract Introduction: The use of realistic simulation in pediatric emergencies is particularly valuable, as it allows the training of technical, attitudinal, and cognitive skills, helping to ensure patient safety. Objective: This study aims to describe the student's perception of using the High-Fidelity Realistic Simulation in the pediatric emergency modules during the internship. Methods: Observational, descriptive study with a quantitative and qualitative approach. A semi-structured questionnaire was applied to sixth-year medical students at the end of the pediatric internship modules, which lasted eight weeks, from August to December 2020. All of them participated in two types of activities on 14 topics: high-fidelity simulation (HFS) and structured discussion of clinical cases (SDCC). Results: Of the 33 participants, 29 answered the questionnaire. The mean age was 24 ± 1.8 years, and 58.6% were female. All agreed that the experience with HFS contributed to safer performance in pediatric emergencies, considered optimal by 76% and good for the remainder. Most thought the association of HFS and SDCC was the ideal method (96%). The content analysis of the responses on HFS highlighted thematic units in five categories: significant learning, contribution to professional training, skills, attitude/behavior, and quality of the activity. Conclusions: Students' reaction to using HFS in pediatric emergencies was very positive, and its association with SDCC was considered the ideal teaching method. Knowing the students' reactions helps teachers plan their activities to improve the teaching-learning method.

Maternal-fetal and neonatal characteristics associated with Kangaroo-Mother Care Method adherence.

OBJECTIVE: To describe the association of maternal and neonatal characteristics with the adherence status to the in-hospital stages of the Kangaroo-Mother Care Method - KMC (full, partial, and no-adherence). METHODS: Retrospective cohort study including infants < 2500 g admitted to a reference maternity hospital for the KMC in Rio de Janeiro from January to December 2018. Maternal and neonatal characteristics were distributed according to the adherence status to the KMC in-hospital stages. In the first stage, KMC is performed in Neonatal Intensive Care Unit and Conventional Neonatal Intermediate Care Unit. The second stage is completed in Kangaroo Neonatal Intermediate Care Unit. Multinomial multiple regression was performed with KMC adherence as a three-category dependent variable and maternal and neonatal characteristics as independent variables. RESULTS: Of 166 dyads, 102 (61.5%) participated in two stages. Those who did not participate in any stage (n = 52; 31.3%) had a lower level of education, a higher frequency of adverse conditions, and were more often single mothers; mothers who participated only in the first stage (n = 12; 7,2%) had more premature and sick infants. Conditions associated with adherence to the two stages compared to no adherence were: high school education (OR = 2.34; 95% CI = 1.08-5.07), presence of a partner (OR = 3.82; 95% CI = 1.7-8.61), no adverse conditions (OR = 3.54; 95% CI = 1.59-7.89) and no neonatal resuscitation (OR = 2.73; 95% CI = 1.22-6.1). CONCLUSIONS: The study identified maternal and neonatal conditions associated with adherence status to the KMC. The results suggest opportunities to improve adherence.

Maternal-fetal and neonatal characteristics associated with Kangaroo-Mother Care Method adherence

Abstract Objective To describe the association of maternal and neonatal characteristics with the adherence status to the in-hospital stages of the Kangaroo-Mother Care Method - KMC (full, partial, and no-adherence). Methods Retrospective cohort study including infants < 2500 g admitted to a reference maternity hospital for the KMC in Rio de Janeiro from January to December 2018. Maternal and neonatal characteristics were distributed according to the adherence status to the KMC in-hospital stages. In the first stage, KMC is performed in Neonatal Intensive Care Unit and Conventional Neonatal Intermediate Care Unit. The second stage is completed in Kangaroo Neonatal Intermediate Care Unit. Multinomial multiple regression was performed with KMC adherence as a three-category dependent variable and maternal and neonatal characteristics as independent variables. Results Of 166 dyads, 102 (61.5%) participated in two stages. Those who did not participate in any stage (n = 52; 31.3%) had a lower level of education, a higher frequency of adverse conditions, and were more often single mothers; mothers who participated only in the first stage (n = 12; 7,2%) had more premature and sick infants. Conditions associated with adherence to the two stages compared to no adherence were: high school education (OR = 2.34; 95% CI = 1.08-5.07), presence of a partner (OR = 3.82; 95% CI = 1.7-8.61), no adverse conditions (OR = 3.54; 95% CI = 1.59-7.89) and no neonatal resuscitation (OR = 2.73; 95% CI = 1.22-6.1). Conclusions The study identified maternal and neonatal conditions associated with adherence status to the KMC. The results suggest opportunities to improve adherence.

Validity of the computerized version of the pediatric triage system CLARIPED for emergency care

Abstract Objective: To evaluate the validity of the computerized version of the pediatric triage system CLARIPED. Methods: Prospective, observational study in a tertiary emergency department (ED) from Jan-2018 to Jan-2019. A convenience sample of patients aged 0-18 years who had computerized triage and outcome variables registered. Construct validity was assessed through the association between urgency levels and patient outcomes. Sensitivity, specificity, positive and negative predictive values (PPVand NPV), undertriage, and overtriage rates were assessed. Results: 19,122 of 38,321 visits were analyzed. The urgency levels were: RED (emergency) 0.02%, ORANGE (high urgency) 3.21%, YELLOW (urgency) 35.69%, GREEN (low urgency) 58.46%, and BLUE (no urgency) 2.62%. The following outcomes increased according to the increase in the level of urgency: hospital admission (0.4%, 0.6%, 3.1%, 11.9% and 25%), stay in the ED observation room (2.8%, 4.7%, 15.9%, 40.4%, 50%), ≥ 2 diagnostic or therapeutic resources (7.8%, 16.5%, 33.7%, 60.6%, 75%), and ED length of stay in minutes (18, 24, 67,120, 260). The odds of using ≥ 2 resources or being hospitalized were significantly greater in the most urgent patients (Red, Orange, and Yellow) compared to the least urgent (Green and Blue): OR 7.88 (95%CI: 5.35-11.6) and OR 2.85 (95%CI: 2.63-3.09), respectively. The sensitivity to identify urgency was 0.82 (95%CI: 0.77-0.85); specificity, 0.62 (95%CI: 0.61-0.6; NPV, 0.99 (95%CI: 0.99-1.00); overtriage rate, 4.28% and undertriage, 18.41%. Conclusion: The computerized version of CLARIPED is a valid and safe pediatric triage system, with a significant correlation with clinical outcomes, good sensitivity, and low undertriage rate.

Toxic stress, epigenetics and child development

Abstract Objectives: To describe the concept of toxic stress, present the basics of epigenetics and discuss their relationship with child development. Data source: Narrative literature review through a search in the SciELO, Lilacs, Medline databases using the terms Adverse Childhood Experience OR Early Life Stress, Epigenomic OR Epigenetic, Child Development OR Infant Development. Data synthesis: Continuing stress response, known as toxic stress, can occur when a child experiences intense, frequent, and/or prolonged adversity-such as physical or emotional abuse, chronic neglect, for example-without adequate adult support. This toxic stress can have harmful effects on learning, behavior, and health throughout life. Epigenetics, an emerging scientific research area, shows how environmental influences affect gene expressions and explains how early experiences can impact throughout life. Conclusions: Toxic stress causes changes in the human body response systems that can be explained in part by epigenetic changes, which can be temporary or long-lasting. Pediatricians must be aware of these mechanisms and their consequences, seeking to prevent them and thus promote the health, well-being, and quality of life of children, contributing to their full development.

Correlation between quality of life and the clinical results of patients with leprosy with drop foot after tendon transfer / Avaliação de pacientes com hanseníase pós transposição tendínea para pé caído e sua correlação com a qualidade de vida

ABSTRACT Objective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score. Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson's correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores. Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = −0.83) and AOFAS and social participation (r = −0.78). Average dorsiflexion was 5.4 degrees. Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.

RESUMO Objetivo: Avaliar o resultado funcional da cirurgia de correção de pé caído em pacientes hansênicos e comparar as escalas Screening of Activity Limitation and Safety Awareness (SALSA) e de Participação social pós-operatórias com o escore da American Orthopaedic Foot and Ankle Society (AOFAS). Métodos: Avaliamos 22 pacientes submetidos à transposição do tibial posterior para o dorso do pé com mínimo de seguimento de 12 e máximo de 131 meses operados entre janeiro de 2013 e dezembro de 2017. Utilizamos o coeficiente de Pearson (r) para medir o grau de correlação entre as escalas funcionais e consideramos o valor de p < 0,05 na análise dos valores pré e pós-operatórios da AOFAS. Resultados: A média da AOFAS foi de 59,6 no pré-op (mín 35, máx 74) e 77,2 no pós-op (mín 36, máx 97) (p < 0,0001) e das escalas SALSA e participação social de 30,6 e 22,5 no pós-operatório. A análise estatística demonstrou correlação positiva forte (r = −0,83) com as escalas SALSA e de participação social (r = −0,78) quando comparadas ao AOFAS. O grau de dorsiflexão atingido foi de 5,4 graus em média. Linha de pesquisa: Evidência clínica e organizacional, modelos assistenciais, educacionais e avaliação de qualidade em APS - Pós-graduação em Clínica Médica da Faculdade de Medicina da UFRJ. Conclusão: A melhora da função através da correção cirúrgica do pé caído possui correlação direta na melhora da qualidade de vida dos pacientes portadores de hanseníase. Nível de Evidência III, Estudo Retrospectivo.

Use of antenatal corticosteroids in Brazil: data analysis from the National Survey Nascer no Brasil.

OBJECTIVE: To estimate the rate of the use of antenatal corticosteroids (ANC) among pregnant women and to identify the conditions associated with their non-use in Brazil. METHODS: Secondary data analysis from "Birth in Brazil", a national hospital-based survey carried out in 2011-2012 on childbirth and birth. The sample was characterized regarding maternal age, marital status and maternal education, parity, mode of delivery and place of residence. The association of ANC use with gestational age and type of delivery was analyzed. The studied maternal complications were the presence of hypertension, pre-eclampsia/eclampsia, and pyelonephritis, infection by the HIV virus or acquired immune deficiency syndrome. RESULTS: 2,623 pregnant women with less than 37 weeks of gestational age were identified, and, of these, 835 (31.8%) received ANC. The frequency of ANC use was higher among women with gestational ages between 26-34 weeks (481 cases; 48.73%). In pregnancies with less than 37 weeks, the use of ANC was 23.9% in spontaneous deliveries, 20.6% in induced deliveries and 43.8% among those who did not go into labor. The variables vaginal delivery (OR 2.5; 95%CI 1.8-3.4) and living in the countryside were associated with not using ANC, and the occurrence of pre-eclampsia/eclampsia (OR 1.8; 95%CI 1.2-2.9) was associated with the use of ANC. CONCLUSIONS: The use of ANC among Brazilian pregnant women was low. Interventions to increase its use are necessary and can contribute to reduce neonatal mortality and morbidity. ANC should be promoted in pregnancies of less than 37 weeks, especially in cases of vaginal delivery and for those living in the countryside.

Improvement of 1st-hour bundle compliance and sepsis mortality in pediatrics after the implementation of the surviving sepsis campaign guidelines

Abstract Objectives To study the impact of the implementation of the Pediatric Surviving Sepsis Campaign protocol on early recognition of sepsis, 1 -h treatment bundle and mortality. Methods Retrospective, single-center study, before and after the implementation of the sepsis protocol. Outcomes: sepsis recognition, compliance with the 1 -h bundle (fluid resuscitation, blood culture, antibiotics), time interval to fluid resuscitation and antibiotics administration, and mortality. Patients with febrile neutropenia were excluded. The comparisons between the periods were performed using non-parametric tests and odds ratios or relative risk were calculated. Results We studied 84 patients before and 103 after the protocol implementation. There was an increase in sepsis recognition (OR 21.5 [95% CI: 10.1-45.7]), in the compliance with the 1 -h bundle as a whole (62% x 0%), and with its three components: fluid resuscitation (OR 31.1 [95% CI: 3.9−247.2]), blood culture (OR 15.9 [95% CI: 3.9−65.2]), and antibiotics (OR 35.6 [95% CI: 8.9−143.2]). Significant reduction between sepsis recognition to fluid resuscitation (152min × 12min, p < 0.001) and to antibiotics administration (137min × 30min) also occurred. The risk of death before protocol implementation was four times greater (RR 4.1 [95% CI: 1.2-14.4]), and the absolute death risk reduction was 9%. Conclusion Even if we considered the low precision of some estimates, the lower limits of the Confidence Intervals show that the implementation of the Pediatric Surviving Sepsis Campaign guidelines alongside a qualitive assurance initiative has led to improvements in sepsis recognition, compliance with the 1 -h treatment bundle, reduction in the time interval to fluid resuscitation and antibiotics, and reduction in sepsis mortality.

Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy.

Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions.

Cross-cultural adaptation of the Richmond Agitation-Sedation Scale to Brazilian Portuguese for the evaluation of sedation in pediatric intensive care. / Adaptação transcultural para o Brasil da Richmond Agitation-Sedation Scale para avaliação da sedação em terapia intensiva pediátrica.

OBJECTIVE: To perform a cross-cultural adaptation of the Richmond Agitation-Sedation Scale (RASS) to Brazilian Portuguese for the evaluation of sedation in pediatric intensive care. METHODS: Cross-cultural adaptation process including the conceptual, item, semantic and operational equivalence stages according to current recommendations. RESULTS: Pretests, divided into two stages, included 30 professionals from the pediatric intensive care unit of a university hospital, who administered the translated RASS to patients aged 29 days to 18 years. The pretests showed a content validity index above 0.90 for all items: 0.97 in the first stage of pretests and 0.99 in the second. CONCLUSION: The cross-cultural adaptation of RASS to Brazilian Portuguese resulted in a version with excellent comprehensibility and acceptability in a pediatric intensive care setting. Reliability and validity studies should be performed to evaluate the psychometric properties of the Brazilian Portuguese version of the RASS.

OBJETIVO: Realizar adaptação transcultural para o Brasil da Richmond Agitation-Sedation Scale (RASS) para avaliação da sedação em terapia intensiva pediátrica. MÉTODOS: Processo de adaptação transcultural incluindo as etapas de equivalência conceitual, de itens, semântica e operacional, de acordo com recomendações atuais. RESULTADOS: Pré-testes, divididos em duas etapas, incluíram 30 profissionais da unidade de terapia intensiva pediátrica de um hospital universitário, que aplicaram a RASS traduzida em pacientes de 29 dias a 18 anos. Os pré-testes mostraram Índice de Validade de Conteúdo acima de 0,90 para todos os itens: 0,97 na primeira etapa de pré-testes e 0,99 na segunda. CONCLUSÃO: A adaptação transcultural da RASS para o português do Brasil resultou em versão com excelente compreensão e aceitabilidade em cenário de terapia intensiva pediátrica. Estudos de confiabilidade e de validade devem ser realizados para avaliar as propriedades psicométricas da versão adaptada para o português do Brasil da RASS.

Point-of-care ultrasound by the pediatrician in the diagnosis and follow-up of community-acquired pneumonia

Abstract Objectives: To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired pneumonia (CAP), aiming to facilitate its potential inclusion into pediatric clinical reference guidelines. Source of data: A non-systematic research was carried out in the MEDLINE (PubMed), LILACS, and SciELO databases, from January 1985 to September 2019. The articles that were considered the most relevant were selected. Synthesis of data: CAP is a relevant cause of morbidity and mortality in pediatrics and its clinical management remains a major challenge. The systematic use of chest X-ray for its diagnosis is controversial because it exposes the child to ionizing radiation and there are interobserver differences in its interpretation. Recently, the use of point-of-care pulmonary ultrasound by the pediatrician has been presented as an alternative for the diagnosis and monitoring of CAP. A great deal of evidence has disclosed its high sensitivity and diagnostic specificity, with the advantages of no ionizing radiation, relatively low cost, immediate results, portability, and the possibility of repetition according to the requirements of disease evolution. Moreover, its use can help rule out possible bacterial etiology and thus prevent inappropriate antibiotic treatments that favor bacterial resistance. Conclusions: Point-of-care ultrasonography represents an opportunity to improve the diagnosis and monitoring of CAP. However, as an operator-dependent technique, training is required for adequate image acquisition, correct interpretation, and integration with clinical data for correct decision-making.

Adaptação transcultural para o Brasil da Richmond Agitation-Sedation Scale para avaliação da sedação em terapia intensiva pediátrica / Cross-cultural adaptation of the Richmond Agitation-Sedation Scale to Brazilian Portuguese for the evaluation of sedation in pediatric intensive care

RESUMO Objetivo: Realizar adaptação transcultural para o Brasil da Richmond Agitation-Sedation Scale (RASS) para avaliação da sedação em terapia intensiva pediátrica Métodos: Processo de adaptação transcultural incluindo as etapas de equivalência conceitual, de itens, semântica e operacional, de acordo com recomendações atuais. Resultados: Pré-testes, divididos em duas etapas, incluíram 30 profissionais da unidade de terapia intensiva pediátrica de um hospital universitário, que aplicaram a RASS traduzida em pacientes de 29 dias a 18 anos. Os pré-testes mostraram Índice de Validade de Conteúdo acima de 0,90 para todos os itens: 0,97 na primeira etapa de pré-testes e 0,99 na segunda. Conclusão: A adaptação transcultural da RASS para o português do Brasil resultou em versão com excelente compreensão e aceitabilidade em cenário de terapia intensiva pediátrica. Estudos de confiabilidade e de validade devem ser realizados para avaliar as propriedades psicométricas da versão adaptada para o português do Brasil da RASS.

ABSTRACT Objective: To perform a cross-cultural adaptation of the Richmond Agitation-Sedation Scale (RASS) to Brazilian Portuguese for the evaluation of sedation in pediatric intensive care. Methods: Cross-cultural adaptation process including the conceptual, item, semantic and operational equivalence stages according to current recommendations. Results: Pretests, divided into two stages, included 30 professionals from the pediatric intensive care unit of a university hospital, who administered the translated RASS to patients aged 29 days to 18 years. The pretests showed a content validity index above 0.90 for all items: 0.97 in the first stage of pretests and 0.99 in the second. Conclusion: The cross-cultural adaptation of RASS to Brazilian Portuguese resulted in a version with excellent comprehensibility and acceptability in a pediatric intensive care setting. Reliability and validity studies should be performed to evaluate the psychometric properties of the Brazilian Portuguese version of the RASS.

Point-of-care ultrasound by the pediatrician in the diagnosis and follow-up of community-acquired pneumonia.

OBJECTIVES: To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired pneumonia (CAP), aiming to facilitate its potential inclusion into pediatric clinical reference guidelines. SOURCE OF DATA: A non-systematic research was carried out in the MEDLINE (PubMed), LILACS, and SciELO databases, from January 1985 to September 2019. The articles that were considered the most relevant were selected. SYNTHESIS OF DATA: CAP is a relevant cause of morbidity and mortality in pediatrics and its clinical management remains a major challenge. The systematic use of chest X-ray for its diagnosis is controversial because it exposes the child to ionizing radiation and there are interobserver differences in its interpretation. Recently, the use of point-of-care pulmonary ultrasound by the pediatrician has been presented as an alternative for the diagnosis and monitoring of CAP. A great deal of evidence has disclosed its high sensitivity and diagnostic specificity, with the advantages of no ionizing radiation, relatively low cost, immediate results, portability, and the possibility of repetition according to the requirements of disease evolution. Moreover, its use can help rule out possible bacterial etiology and thus prevent inappropriate antibiotic treatments that favor bacterial resistance. CONCLUSIONS: Point-of-care ultrasonography represents an opportunity to improve the diagnosis and monitoring of CAP. However, as an operator-dependent technique, training is required for adequate image acquisition, correct interpretation, and integration with clinical data for correct decision-making.

Zika virus in Brazil and worldwide: a narrative review.

Background: In the past 5 years, the Zika virus (ZIKV) has gone from being associated with mild infection to one of the most studied viruses worldwide. Between 2015 and 2016, the first reports of pregnant women with confirmed and/or suspected ZIKV infection described fetuses and newborns with severe congenital malformations, in particular microcephaly and central nervous system malformations, leading to a strong suspicion of its association with the virus. Despite all the knowledge rapidly acquired since the beginning of the ZIKV outbreak, many questions are still to be answered and further studies on the infection and its consequences are required.Aim: To present the currently available evidence on the epidemiological and clinical aspects of ZIKV infection.Methods: Non-systematic review carried out in MEDLINE (PubMed), LILACS (VHL), Scopus, Web of Science, Cochrane and CAPES Portal databases for the past five years using the search terms arboviruses, flavivirus, Zika and ZIKV.Results: The acute clinical of ZIKV infection in children seems very similar to that in adults, with fever (usully low), rash maculopapular and pruritus. Neurological complication associated with ZIKV reported in the literature include Guillain-Barré syndrome and meningoencephalitis. More recently, the term congenital Zika syndrome (CZS) has been adopted to describe a set of symptoms and signs in children whose mothers had ZIKV infection confirmed during pregnancy.Conclusions: More detailed knowledge of ZIKV infection in children allows the pediatrician to diagnose earlier, implement the correct treatment, monitor warnings signs for the most severe forms, and especially establish effective preventive measures.Abbreviations:: CDC, Centers for Disease Control; CZS, congenital Zika syndrome; DEET, N, N-diethyl-3-methylbenzamide; GBS, Guillain-Barré syndrome; PRNT, plaque reduction neutralisation test; RNA, ribonucleic acid; RT-PCR, reverse transcriptase polymerase chain reaction; STX, saxitoxin; ZIKV, Zika virus.

Clinical and laboratory characteristics of sars-cov-2 infection in children and adolescents / Características clínicas e laboratoriais da infecção por sars-cov-2 em crianças e adolescentes

ABSTRACT Objective: To present the current evidence on clinical and laboratory characteristics of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during childhood and adolescence. Data source: This is a narrative review conducted in the databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Latin American and Caribbean Health Sciences Literature in the Virtual Health Library (LILACS/VHL), Scopus, Web of Science, Cochrane Library, portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The terms used were SARS-CoV-2, COVID-19, novel coronavirus, child, newborn, and adolescent. Data synthesis: Unlike adults, most children infected by SARS-CoV-2 have mild or asymptomatic clinical presentations. Symptomatic children mainly have low fever and cough, with some associated gastrointestinal symptoms. Severe cases are rare and occur especially in infants under one year of age. Detection of viral particles in feces seems to be more persistent in children and can be used as a tool for diagnosis and control of the quarantine period. Different from adults, children can present distinct inflammatory responses, as has happened in new cases of Kawasaki-like syndrome associated with SARS-CoV-2 infection. Conclusions: Most children have asymptomatic or mild presentations, with a prevalence of fever, cough, and gastrointestinal symptoms. New cases with different systemic inflammatory reactions in children have been reported, with clinical manifestations distinct from those typically found in adults.

RESUMO Objetivo: Apresentar as atuais evidências sobre as características clínicas e laboratoriais da infecção pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) durante a infância e a adolescência. Fonte de dados: Revisão narrativa realizada nas bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde na Biblioteca Virtual em Saúde (LILACS/BVS), Scopus, Web of Science, Cochrane Library, portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect e Cumulative Index to Nursing and Allied Health Literature (CINAHL), com o uso dos termos SARS-CoV-2, COVID-19 e novo coronavírus e criança, recém-nascido e adolescente. Síntese dos dados: Diferentemente dos adultos, as crianças infectadas pelo SARS-CoV-2 apresentam formas clínicas leves ou assintomáticas na maior parte dos casos. As crianças sintomáticas apresentam predominantemente febre baixa e tosse, com alguns sintomas gastrointestinais associados. Casos graves são a minoria e ocorrem especialmente abaixo de um ano de idade. A detecção de partículas virais em fezes parece ser mais persistente em crianças, podendo servir como ferramenta diagnóstica e de controle do tempo de quarentena. Diferentemente dos adultos, as crianças podem apresentar respostas inflamatórias distintas, como tem ocorrido nos novos casos de síndrome de Kawasaki-like associada à infecção pelo SARS-CoV-2. Conclusões: Crianças, na sua maioria, apresentam quadros assintomáticos ou leves, com predomínio de febre, tosse e sintomas gastrointestinais. Novos relatos de diferentes reações sistêmicas inflamatórias em crianças têm sido notados, com manifestações clínicas distintas daquelas tipicamente observadas em adultos.