Motor performance evaluation of newborns with gastroschisis after surgical correction / Avaliação do desempenho motor de recém-nascidos com gastrosquise após correção cirúrgica

INTRODUCTION: Gastroschisis is a congenital malformation that has risk factors for delayed neuropsychomotor development. That is why it is important to recognize early developmental changes in these newborns during hospitalization in the Neonatal Intensive Care UnitOBJECTIVE: To evaluate the motor performance of newborns with gastroschisis after surgical correctionMETHODS: An observational and retrospective study was carried out with newborns with gastroschisis, assessed by the Test of Infant Motor Performance at the Neonatal Intensive Care Center 2 of the Instituto da Criança e do Adolescente. The test allows the classification of the risk for developmental delay in 4 categories: within the average for age, low average, below average, and well below average. Maternal, neonatal, surgical, and motor assessment data were collected through electronic medical recordsRESULTS: Motor assessment was performed on 17 newborns, where 88.23% were classified as "below average" for age. The mean maternal age was 20 years, and the average gestational age and birth weight were 36.38 weeks and 2343.9 grams, respectively, with the majority being female. Simple gastroschisis accounted for 64.71%, and primary closure was possible in 82.35%. The average hospital stay of 53.24 days, and sepsis was the most frequent complication (64.71%CONCLUSION: Newborns with gastroschisis remain hospitalized for a long time and are susceptible to complications. It was possible to identify the delay in the development of these newborns early during hospitalization, which allows intervention by physiotherapy before the delay worsens

INTRODUÇÃO: A gastrosquise é uma malformação congênita que possui fatores de risco para o atraso no desenvolvimento neuropsicomotor. Por isso é importante o reconhecimento precoce das alterações do desenvolvimento nesses recém-nascidos durante a internação na Unidade de Terapia Intensiva NeonatalOBJETIVO: Avaliar o desempenho motor de recém-nascidos com gastrosquise após correção cirúrgicaMÉTODO: Foi realizado um estudo observacional e retrospectivo com recém-nascidos com gastrosquise, avaliados pelo Test of Infant Motor Performance no Centro de Tratamento Intensivo Neonatal 2 do Instituto da Criança e do Adolescente. O teste permite a classificação do risco para o atraso do desenvolvimento em 4 categorias: dentro da média para idade, média baixa, abaixo da média e muito abaixo da média. Foram coletados dados maternos, neonatais, cirúrgicos e da avaliação motora, através de prontuários eletrônicosRESULTADOS: A avaliação motora foi realizada em 17 recém-nascidos, onde 88,23% foram classificados como "abaixo da média" para idade. A idade média materna foi de 20 anos e a média de idade gestacional e peso ao nascimento de 36,38 semanas e 2343,9 gramas, respectivamente, sendo a maioria do sexo feminino. As gastrosquises simples representaram 64,71% e o fechamento primário foi possível em 82,35%. A média de permanência hospitalar de 53,24 dias e a sepse foi a complicação mais frequente (64,71%CONCLUSÃO: Os recém-nascidos com gastrosquise permanecem internados por tempo prolongado e estão suscetíveis a complicações. Foi possível a identificação precoce do atraso no desenvolvimento desses recém-nascidos durante a internação

Six-minute walk test in children and adolescents with renal diseases: tolerance, reproducibility and comparison with healthy subjects.

OBJECTIVES: To evaluate exercise tolerance and the reproducibility of the six-minute walk test in Brazilian children and adolescents with chronic kidney disease and to compare their functional exercise capacities with reference values for healthy children. METHODS: This cross-sectional study assessed the use of the six-minute walk test in children and adolescents aged 6-16 with stage V chronic kidney disease. For statistical analysis of exercise tolerance, including examinations of correlations and comparisons with reference values, the longest walked distances were considered. The reproducibility of the six-minute walk test was assessed using intraclass correlation coefficients. RESULTS: A total of 38 patients (14 females and 24 males) were evaluated, including 5 on peritoneal dialysis, 12 on hemodialysis and 21 who had undergone renal transplantation, with a median age of 11.2 years (6.5-16). The median walked distance was 538.5 meters (413-685) and the six-minute walk test was found to be reproducible. The walked distance was significantly correlated with age (r=0.66), weight (r=0.76), height (r=0.82), the height Z score (r=0.41), hemoglobin (r=0.46), hematocrit (r=0.47) and post-test systolic blood pressure (r=0.39). The chronic kidney disease patients predicted walked distance was 84.1% of the reference value according to age, 90.6% according to age-corrected height and 87.4% according to a predictive equation. CONCLUSIONS: The stage V chronic kidney disease patients had a significantly decreased functional exercise capacity, as measured by the six-minute walk test, compared with the healthy pediatric reference values. In addition, the six-minute walk test was shown to be well tolerated, reliable and applicable as a low-cost tool to monitor functional exercise capacity in patients with renal disease.

Six-minute walk test in children and adolescents with renal diseases: tolerance, reproducibility and comparison with healthy subjects

OBJECTIVES: To evaluate exercise tolerance and the reproducibility of the six-minute walk test in Brazilian children and adolescents with chronic kidney disease and to compare their functional exercise capacities with reference values for healthy children. METHODS: This cross-sectional study assessed the use of the six-minute walk test in children and adolescents aged 6-16 with stage V chronic kidney disease. For statistical analysis of exercise tolerance, including examinations of correlations and comparisons with reference values, the longest walked distances were considered. The reproducibility of the six-minute walk test was assessed using intraclass correlation coefficients. RESULTS: A total of 38 patients (14 females and 24 males) were evaluated, including 5 on peritoneal dialysis, 12 on hemodialysis and 21 who had undergone renal transplantation, with a median age of 11.2 years (6.5-16). The median walked distance was 538.5 meters (413-685) and the six-minute walk test was found to be reproducible. The walked distance was significantly correlated with age (r=0.66), weight (r=0.76), height (r=0.82), the height Z score (r=0.41), hemoglobin (r=0.46), hematocrit (r=0.47) and post-test systolic blood pressure (r=0.39). The chronic kidney disease patients predicted walked distance was 84.1% of the reference value according to age, 90.6% according to age-corrected height and 87.4% according to a predictive equation. CONCLUSIONS: The stage V chronic kidney disease patients had a significantly decreased functional exercise capacity, as measured by the six-minute walk test, compared with the healthy pediatric reference values. In addition, the six-minute walk test was shown to be well tolerated, reliable and applicable as a low-cost tool to monitor functional exercise capacity in patients with renal disease.

Teste de caminhada de seis minutos (TC6') em criança obesa: relato de caso / Six minutes walk test (6'WT) in an obese child: case report

Avaliar a capacidade física de uma criança com obesidade exógena. Relato de caso: Paciente com 8 anos, obesa, com crise asmática e cansaço aos esforços. Foi submetida a quatro avaliações do teste de caminhada de seis minutos (TC6’), com intervalo de seis meses entre as consultas, para avaliação da capacidade física, com subseqüentes orientações para a realização de exercícios físicos e caminhadas diárias. Em cada avaliação, a criança foi submetida ao TC6’ e considerado o teste de maior distância percorrida. Discussão: Após o término do estudo, observou-se que o TC6´ pode ser uma importante ferramenta clínica na avaliação cardiorrespiratória de crianças obesas pré e pós um programa de exercícios...

To evaluate the physical capacity of a child with exogenous obesity. Case report: Eight year-old female patient, obese, with asthmatic crisis and uncomfortable with physical activities. She undertook four evaluations of the six minute walk test (6’WT), within 6-month intervals between each consultation, in order to evaluate her physical capacity after recommendations of physical exercises and daily walks. In each evaluation, the child was submitted to the 6’WT, considering that with the highest distance. Discussion: This study shows that the 6’WT can be an important clinical tool to the cardiorespiratory evaluation of obese children before and after an exercise program...

Impacto hemodinâmico e respiratório da técnica da hiperinsuflação manual em crianças sob ventilação mecânica / Hemodynamic and respiratory impact determined by manual hyperinsuflation to mechanically ventilated children / Impacto hemodinámico y respiratório causado por la técnica de hiperinsuflación manual sobre niños em ventilación mecanica

Objetivo: avaliar os efeitos da manobra de bag squeezing em pacientes com insuficiência respiratória. Métodos: foi realizado um estudo prospectivo durante 4 meses em uma unidade de terapia intensiva pediátrica universitária.Foram selecionados pacientes com idade entre 1 mês e 18 anos com insuficiência respiratória, em ventilação mecânica por 12 horas ou mais, sem choque, sangramento maciço, e arritmia cardíaca. Os 23 casos selecionados tinham média de idade de 96,5 meses, 7 tinham um ano ou menos, 15 (65,2%) apresentavam doença respiratória e 7 (34,8%) tinham doenças neuromusculares/neurológicas. A manobra de bag squeezing foi realizada com um ambú com hiperinsuflador manual com reservatório (ProtecR). Foram monitoradas e comparadas: afreqüência cardíaca (FC), freqüência respiratória (FR), pressão arterial (PA) e saturação de oxigênio no pulso (SpO2), antes da execução da manobra, e após a mesma, no 1º e 5º minutos.Resultados: a FC, FR, PAS (pressão arterial sistólica), PAD (pressão arterial diastólica), e a PAM (pressão arterial média) não diferiram na avaliação pré e pós manobra. A SpO2 tendeu à melhora após a manobra de HM. Conclusões:a HM foi segura para pacientes em ventilação mecânica quanto aos parâmetros hemodinâmicos. Houve uma tendência à melhora da saturaçãoarterial de oxigênio.

Objective: to assess the bag squeezing effects over patients committed by respiratory insuficiency. Methods: during four months a prospectiveclinical trial was conducted in a university pediatric intensive care unit. Patients aged between one month and 18 years committed by respiratoryinsuffiency under mechanical ventilationfor at least 12 hours, without choc, severe bleeding or cardiac arritmia were selected. The 23 cases selected age 96.5 months (media), and 7 were under one year old, 15 (62.5%) had respiratory disease and 7 (34.8%) had neuromuscular/ neurologic sickness. The bag squeezing was proceded with ambu, hyperinsuflator with reservoir(ProtecR). Were monitored and compared the cardiac rate (FR), blood pressure (PA), and arterial oxygen saturation (SpO2), before and afterthe procedure - 1 and 5 minutes. Results: FC, FR, PAS (systolic PA), PAM (medium PA) didn´t differ between pre and pos maneuver. The SpO2 had atendency to increase after the HM maneuver. Conclusions: the HM had no haemodinamic adverse effects in pediatric patients under mechanicalventilation. There was a favorable tendency in blood oxygenation.

Objetivo: evaluar el efecto de la manobra de bag squeezing (HM) en pacientes pediátricos com insuficiênciarespiratória. Métodos: fue realizado unoestúdio prospectivo durante 4 meses en una unidad de terapia intensiva universitária pediátrica. Fueran seleccionados pacientes entre 1 mês y 18 años com insuficiência respiratória, em ventilación mecânica por 12 horas o más, sin choque, sangramiento o arritmia cardíaca. Los 23 casos seleccionados tenian média de idad de 96,5 meses, 7 menos de un año, 15 (62,5%) presentaban doença respiratória y 7 (34,8%) tenian patologia neuromuscular o neurológica.La manuebra de HM fue realizada comambu, hiperinsuflador manual com reservatorio (ProtecR). Fueran registradas y conparadas lãs medidasde: frecuência cardíaca (FC), frecuência respiratória (FR), presson arterial (PA), y saturacion del oxigênio em el pulso (SpO2), antes da execución y despues de la manuebra, em el 1º y 5º minutos.Resultados: la FC, FR, PAS (pressión arterial sistólica), PAD (pression arterial diastólica), e a PAM (pression arterial média) no diferiran entre la evaluación pré y pós manuebra. La SpO2 tubo uma tendência de mejorar despues de la manuebra de HM.Conclusiones: la HM fue segura para pacientes en ventilación mecânica en relación a los parâmetros hemodinâmicos. Una tendência a mejorar la saturación oxigênio arterial fue observada.

Six-minute walk test in children and adolescents with cystic fibrosis.

The 6-min walk test is a simple, rapid, and low-cost method that determines tolerance to exercise. We examined the reproducibility of the 6-min walk test in 16 children with cystic fibrosis (11 female, 5 male; age range, 11.0 +/- 1.9 years). We related the distance walked and the work performed (distance walked x body weight) with nutritional (body mass index and respiratory muscle strength) and clinical (degree of bronchial obstruction and Shwachman score) status. Patients were asked to walk as far as possible upon verbal command on two occasions. There was no statistical difference between distances walked (582.3 +/- 60 and 598.2 +/- 56.8 m, P = 0.31), heart rate, respiratory rate, pulse oxygen saturation, arterial blood pressure, dyspnea, and percentage of maximal heart rate for age in the two tests. Distance walked correlated (Pearson) with maximal expiratory pressure (98.6 +/- 28.1 cmH2O, r = 0.60, P < 0.01), maximal heart rate (157.9 +/- 10.1 bpm, r = 0.59, P < 0.02), Borg dyspnea scale (1.7 +/- 2.4, r = 0.55, P < 0.03), and double product (blood pressure x heart rate; r = 0.59, P < 0.02). The product of distance walked and body weight (work) correlated (Pearson) with height (r = 0.83, P = 0.000), maximal expiratory pressure (r = 0.64, P < 0.01), systolic blood pressure (r = 0.56, P < 0.02), and diastolic blood pressure (r = 0.55, P < 0.03). We conclude that the 6-min walk test is reproducible and easy to perform in children and adolescents with cystic fibrosis. The distance walked was related to the clinical variables studied. Work in the 6-min walk test may be an additional parameter in the determination of physical capacity.