Clinical management of fever in children in Brazil: practical recommendations from an expert panel.

The objective of this study was to answer several questions related to the assessment and treatment of fever, as well as other controversies that exist during its management in pediatric patients. First, an advisory board with medical experts was conducted to discuss the clinical journey of these patients, considering the main challenges and possible solutions. After this discussion, a non-systematic literature review was performed, between November 2019 and January 2020, to collect the most relevant evidence available in the scientific databases MEDLINE, Lilacs, and SciELO. A narrative review was carried out based on scientific evidence and on extensive experience of experts in clinical practice. The experts developed a set of recommendations and clarifications about the assessment of the severity of fever in pediatrics, the need for treatment and the choice of the most appropriate antipyretic. The most common controversies in the management of fever in pediatric patients were also addressed, such as alternating antipyretics, persistent fever, and dose equivalence. In primary management of pediatric patients, fever should be seen as a relevant symptom that requires treatment with antipyretics in potentially more complex or severe cases, when it causes discomfort to children or is associated with infectious diseases.

Clinical management of fever in children in Brazil: practical recommendations from an expert panel

ABSTRACT The objective of this study was to answer several questions related to the assessment and treatment of fever, as well as other controversies that exist during its management in pediatric patients. First, an advisory board with medical experts was conducted to discuss the clinical journey of these patients, considering the main challenges and possible solutions. After this discussion, a non-systematic literature review was performed, between November 2019 and January 2020, to collect the most relevant evidence available in the scientific databases MEDLINE, Lilacs, and SciELO. A narrative review was carried out based on scientific evidence and on extensive experience of experts in clinical practice. The experts developed a set of recommendations and clarifications about the assessment of the severity of fever in pediatrics, the need for treatment and the choice of the most appropriate antipyretic. The most common controversies in the management of fever in pediatric patients were also addressed, such as alternating antipyretics, persistent fever, and dose equivalence. In primary management of pediatric patients, fever should be seen as a relevant symptom that requires treatment with antipyretics in potentially more complex or severe cases, when it causes discomfort to children or is associated with infectious diseases.

Measuring early childhood development in Brazil: validation of the Caregiver Reported Early Development Instruments (CREDI) / Medição do desenvolvimento na primeira infância no Brasil: validação dosInstrumentos sobre o Desenvolvimento na Primeira Infância Relatado por Cuidadores(CREDI)

Abstract Objective The present study aims to analyze the psychometric properties and general validity of the Caregiver Reported Early Development Instruments (CREDI) short form for the population-level assessment of early childhood development for Brazilian children under age 3. Method The study analyzed the acceptability, test-retest reliability, internal consistency and discriminant validity of the CREDI short-form tool. The study also analyzed the concurrent validity of the CREDI with a direct observational measure (Inter-American Development Bank's Regional Project on Child Development Indicators; PRIDI). The full sample includes 1,265 Brazilian caregivers of children from 0 to 35 months (678 of which comprising an in-person sample and 587 an online sample). Results Results from qualitative interviews suggest overall high rates of acceptability. Most of the items showed adequate test-retest reliability, with an average agreement of 84%. Cronbach's alpha suggested adequate internal consistency/inter-item reliability (α > 0.80) for the CREDI within each of the six age groups (0-5, 6-11, 12-17, 18-23, 24-29 and 30-35 months of age). Multivariate analyses of construct validity showed that a significant proportion of the variance in CREDI scores could be explained by child gender and family characteristics, most importantly caregiver-reported cognitive stimulation in the home (p < 0.0001). Regarding concurrent validity, scores on the CREDI were significantly correlated with overall PRIDI scores within the in-person sample at r = 0.46 (p < 0.001). Conclusions The results suggested that the CREDI short form is a valid, reliable, and acceptable measure of early childhood development for children under the age of 3 years in Brazil.

Resumo Objetivo O presente estudo visa analisar as propriedades psicométricas e a validade geral do formulário curto dos Instrumentos sobre o Desenvolvimento na Primeira Infância Relatado por Cuidados (CREDI) para avaliação em nível populacional do desenvolvimento na primeira infância de crianças brasileiras com menos de três anos. Método O estudo analisou a aceitabilidade, a confiabilidade teste-reteste, a consistência interna e a validade discriminante da ferramenta CREDI. O estudo também analisou a validade concorrente do CREDI com uma medida observacional direta (Projeto Regional sobre os Indicadores de Desenvolvimento na Infância do Banco Interamericano de Desenvolvimento; PRIDI). A amostra total inclui 1.265 cuidadores brasileiros de crianças de 0 a 35 meses (678 em uma amostra presencial e 587 em uma amostra on-line). Resultados Os resultados das entrevistas qualitativas sugerem altas taxas gerais de aceitabilidade. A maior parte dos itens mostrou confiabilidade teste-reteste adequada, com concordância média de 84%. O coeficiente alfa de Cronbach sugeriu consistência interna/confiabilidade entre itens (α > 0,80) para o CREDI em cada uma das seis faixas etárias (0-5 α = 6-11, 12-17, 18-23, 24-29 e 30-35 meses de idade). As análises multivariadas da validade do constructo mostraram que uma proporção significativa da variação nas pontuações do CREDI pode ser explicada pelo sexo da criança e pelas características familiares, mais importante o estímulo cognitivo em casa relatado pelo cuidador (p < 0,0001). Com relação à validade concorrente, as pontuações do CREDI foram significativamente correlacionadas às pontuações gerais do PRIDI na amostra presencial em r = 0,46 (p < 0,001). Conclusões Os resultados sugerem que o formulário curto CREDI é uma medida válida, confiável e aceitável de desenvolvimento na primeira infância para crianças com menos de três anos no Brasil.

Measuring early childhood development in Brazil: validation of the Caregiver Reported Early Development Instruments (CREDI).

OBJECTIVE: The present study aims to analyze the psychometric properties and general validity of the Caregiver Reported Early Development Instruments (CREDI) short form for the population-level assessment of early childhood development for Brazilian children under age 3. METHOD: The study analyzed the acceptability, test-retest reliability, internal consistency and discriminant validity of the CREDI short-form tool. The study also analyzed the concurrent validity of the CREDI with a direct observational measure (Inter-American Development Bank's Regional Project on Child Development Indicators; PRIDI). The full sample includes 1,265 Brazilian caregivers of children from 0 to 35 months (678 of which comprising an in-person sample and 587 an online sample). RESULTS: Results from qualitative interviews suggest overall high rates of acceptability. Most of the items showed adequate test-retest reliability, with an average agreement of 84%. Cronbach's alpha suggested adequate internal consistency/inter-item reliability (α>0.80) for the CREDI within each of the six age groups (0-5, 6-11, 12-17, 18-23, 24-29 and 30-35 months of age). Multivariate analyses of construct validity showed that a significant proportion of the variance in CREDI scores could be explained by child gender and family characteristics, most importantly caregiver-reported cognitive stimulation in the home (p<0.0001). Regarding concurrent validity, scores on the CREDI were significantly correlated with overall PRIDI scores within the in-person sample at r=0.46 (p<0.001). CONCLUSIONS: The results suggested that the CREDI short form is a valid, reliable, and acceptable measure of early childhood development for children under the age of 3 years in Brazil.

Associação entre sinais de sofrimento psíquico até dezoito meses e rebaixamento da qualidade de vida aos seis anos de idade / Association between signs of psychological distress up to 18 months and decrease in quality of life at six years of age / Association entre des signaux de détresse psychologique jusqu'à dix-huit mois et qualité de vie inférieure à six ans / Asociación entre las señales del sufrimiento psíquico hasta los dieciocho meses y la disminución de la calidad de vida en los seis años de edad

A pedido do Ministério da Saúde foi desenvolvido e validado um protocolo de Indicadores clínicos de Risco para o Desenvolvimento Infantil (IRDI) para detectar riscos para transtornos psíquicos de desenvolvimento em bebês de 0 a 18 meses. Este trabalho teve como objetivo verificar a validade preditiva do IRDI, a partir de sua relação com dois instrumentos: o Autoquestionnaire Qualité de Vie Enfant Imagé (AUQUEI) e o Child Health Questionnaire (CHQ), ambos já validados no Brasil e aplicados aos seis anos de vida. A amostra foi composta por 46 crianças de três centros de saúde de São Paulo. Os resultados indicaram que o IRDI não se mostrou sensível à avaliação de qualidade de vida obtida com o uso do AUQUEI. No entanto, a associação estatisticamente significante encontrada entre resultados obtidos no IRDI e no CHQ mostrou maior capacidade do IRDI para predizer qualidade de vida relacionada ao índice psicossocial do que ao índice físico do mesmo instrumento.(AU)

At the request of the Ministry of Health, a protocol of Clinical Risk Indicators for Child Development (IRDI) capable of detecting risk for psychic development disorders in infants aged between 0 and 18 months was developed and validated. This study aimed to verify the degree of association between IRDI and two other instruments for assessing quality of life: Autoquestionnaire Qualité de Vie Enfant Image - AUQUEI and Child Health Questionnaire - CHQ, both already validated in Brazil and applied at the age of six years. The sample comprised 46 children from three health centers in São Paulo, Brazil. The results indicated that IRDI was not sensitive to the assessment of quality of life achieved by using AUQUEI. However, a statistically significant association found between the results of IRDI and CHQ showed higher capacity of IRDI to predict quality of life related to psychosocial index than the physical index of the same instrument.(AU)

À la demande du Ministère de la Santé, un groupe de psychanalystes a développé et validé un protocole d'Indicateurs de Risque Cliniques pour le Développement de l'Enfant (IRDI), capable de détecter les risques de troubles dans le développement mentaux chez bébés d'âge entre 0 et 18 mois. Cette étude visait à déterminer le degré d'association entre l'IRDI et des deux autres instruments qui évaluent la qualité de vie : l'Autoquestionnaire Qualité de Vie Enfant Imagé (AUQUEI) et le Child Health Qtuestionnaire (CHQ). Les deux ont été validés au Brésil et on été appliqués aux enfants à l'áge de six ans. L'échantillon comprenait 46 enfants hospitalisés dans trois centres de santé à São Paulo, au Brésil. Les résultats indiquent que l'IRDI n'est pas sensible à l'évaluation de la qualité de vie obtenue par l'AUQUEI. Cependant, l'association statistiquement significatif trouvée dans les résultats a montrée une capacité du IRDI de prédire la qualité de vie liée à l'index psychosocial plus grande que de laquelle liée à l'index physique du même instrument.(AU)

Un protocolo de Indicadores clínicos de Riesgo para el Desarrollo Infantil (IRDI) fue desarrollado y validado a demanda del Ministerio de Salud para detectar los riesgos de trastornos psíquicos de desarrollo en los niños de 0 a 18 meses. Este estudio tuvo como objetivo determinar el grado de asociación entre el IRDI y otros dos instrumentos que evalúan la calidad de vida: el Autoquestionnaire Qualité de Vie Enfant Imagen (AUQUEI) y el Child Health Questionnaire (CHQ), ambos ya validados en Brasil y aplicados a los seis años de edad. La muestra consta de 46 niños de tres centros de salud de São Paulo. Los resultados indicaron que el IRDI no se mostró sensible a la evaluación de la calidad de vida obtenida mediante el uso del AUQUEI. Sin embargo, la asociación estadísticamente significativa encontrada entre los resultados obtenidos en el IRDI y CHQ mostró una mayor capacidad del IRDI para predecir la calidad de vida relacionada al índice psicosocial que al físico del mismo instrumento.(AU)

Associação entre sinais de sofrimento psíquico até dezoito meses e rebaixamento da qualidade de vida aos seis anos de idade / Association between signs of psychological distress up to 18 months and decrease in quality of life at six years of age / Association entre des signaux de détresse psychologique jusqu'à dix-huit mois et qualité de vie inférieure à six ans / Asociación entre las señales del sufrimiento psíquico hasta los dieciocho meses y la disminución de la calidad de vida en los seis años de edad

A pedido do Ministério da Saúde foi desenvolvido e validado um protocolo de Indicadores clínicos de Risco para o Desenvolvimento Infantil (IRDI) para detectar riscos para transtornos psíquicos de desenvolvimento em bebês de 0 a 18 meses. Este trabalho teve como objetivo verificar a validade preditiva do IRDI, a partir de sua relação com dois instrumentos: o Autoquestionnaire Qualité de Vie Enfant Imagé (AUQUEI) e o Child Health Questionnaire (CHQ), ambos já validados no Brasil e aplicados aos seis anos de vida. A amostra foi composta por 46 crianças de três centros de saúde de São Paulo. Os resultados indicaram que o IRDI não se mostrou sensível à avaliação de qualidade de vida obtida com o uso do AUQUEI. No entanto, a associação estatisticamente significante encontrada entre resultados obtidos no IRDI e no CHQ mostrou maior capacidade do IRDI para predizer qualidade de vida relacionada ao índice psicossocial do que ao índice físico do mesmo instrumento.

At the request of the Ministry of Health, a protocol of Clinical Risk Indicators for Child Development (IRDI) capable of detecting risk for psychic development disorders in infants aged between 0 and 18 months was developed and validated. This study aimed to verify the degree of association between IRDI and two other instruments for assessing quality of life: Autoquestionnaire Qualité de Vie Enfant Image - AUQUEI and Child Health Questionnaire - CHQ, both already validated in Brazil and applied at the age of six years. The sample comprised 46 children from three health centers in São Paulo, Brazil. The results indicated that IRDI was not sensitive to the assessment of quality of life achieved by using AUQUEI. However, a statistically significant association found between the results of IRDI and CHQ showed higher capacity of IRDI to predict quality of life related to psychosocial index than the physical index of the same instrument.

À la demande du Ministère de la Santé, un groupe de psychanalystes a développé et validé un protocole d'Indicateurs de Risque Cliniques pour le Développement de l'Enfant (IRDI), capable de détecter les risques de troubles dans le développement mentaux chez bébés d'âge entre 0 et 18 mois. Cette étude visait à déterminer le degré d'association entre l'IRDI et des deux autres instruments qui évaluent la qualité de vie : l'Autoquestionnaire Qualité de Vie Enfant Imagé (AUQUEI) et le Child Health Qtuestionnaire (CHQ). Les deux ont été validés au Brésil et on été appliqués aux enfants à l'áge de six ans. L'échantillon comprenait 46 enfants hospitalisés dans trois centres de santé à São Paulo, au Brésil. Les résultats indiquent que l'IRDI n'est pas sensible à l'évaluation de la qualité de vie obtenue par l'AUQUEI. Cependant, l'association statistiquement significatif trouvée dans les résultats a montrée une capacité du IRDI de prédire la qualité de vie liée à l'index psychosocial plus grande que de laquelle liée à l'index physique du même instrument.

Un protocolo de Indicadores clínicos de Riesgo para el Desarrollo Infantil (IRDI) fue desarrollado y validado a demanda del Ministerio de Salud para detectar los riesgos de trastornos psíquicos de desarrollo en los niños de 0 a 18 meses. Este estudio tuvo como objetivo determinar el grado de asociación entre el IRDI y otros dos instrumentos que evalúan la calidad de vida: el Autoquestionnaire Qualité de Vie Enfant Imagen (AUQUEI) y el Child Health Questionnaire (CHQ), ambos ya validados en Brasil y aplicados a los seis años de edad. La muestra consta de 46 niños de tres centros de salud de São Paulo. Los resultados indicaron que el IRDI no se mostró sensible a la evaluación de la calidad de vida obtenida mediante el uso del AUQUEI. Sin embargo, la asociación estadísticamente significativa encontrada entre los resultados obtenidos en el IRDI y CHQ mostró una mayor capacidad del IRDI para predecir la calidad de vida relacionada al índice psicosocial que al físico del mismo instrumento.

The intergenerational effects on birth weight and its relations to maternal conditions, São Paulo, Brazil.

BACKGROUND AND OBJECTIVES: Parents' birth weight acts as a predictor for the descendant birth weight, with the correlation more strongly transmitted through maternal line. The present research aims to study the correlation between the child's low or increased birth weight, the mother's birth weight, and maternal conditions. METHODS: 773 mother-infant binomials were identified with information on both the baby's and the mother's birth weight recorded. Group studies were constituted, dividing the sample according to birth weight (<2,500 grams (g) and ≥3,500 grams (g)). The length at birth was also studied in children ≤47.5 cm (lower quartile). Chi(2) test or Fisher's exact test, Spearman's Rho, and odds ratio were performed in order to investigate the relation between the children's weight and length at birth and the mothers' and children's variables. RESULTS: The girls were heavier at birth than their mothers, with an average increase at birth weight between the generations of 79 g. The child's birth weight <2,500 g did not show any correlation with maternal birth weight <2,500 g (Fisher 0.264; Spearman's Rho 0.048; OR 2.1 and OR lower 0.7) or with maternal stature below the lower quartile (<157 cm) (Chi (2) sig 0.323; with Spearman's Rho 0.036; OR 1.5 and OR lower 0.7). The child's low birth weight (<2,500 g) was lightly correlated with drug use by the mother during pregnancy (Fisher 0.083; Spearman's Rho 0.080; OR 4.9 and OR lower 1.0). The child's birth weight <2,500 g showed increased correlation with gestational age lower than 38 weeks and 3 days (Chi (2) sig 0.002; Spearman's Rho 0.113; OR 3.2 and OR lower 1.5). The child's weight at birth ≥3,500 g showed strong correlation with maternal weight at birth ≥3,500 g (Chi (2) sig 0; Spearman's Rho +0.142; OR 0.5 and OR upper 0.7). It was also revealed that the higher the maternal prepregnancy BMI, the stronger the correlation with child's birth weight ≥3,500 g ((maternal prepregnancy BMI > 25.0 with Chi (2) sig 0.013; Spearman's Rho 0.09; OR 1.54 and OR upper 2.17) and (maternal prepregnancy BMI > 30.0 with Chi (2) sig 0 Spearman's Rho 0.137; OR 2.58 and OR upper 4.26)). The child's length at birth in the lower quartile (≤47.5 cm) showed strong correlation with drug use by the mother during pregnancy (Chi (2) sig 0.004; Spearman's Rho 0.105; OR 4.3 and OR lower 1.5). CONCLUSIONS: The mother's increased weight at birth and the prenatal overweight or obesity were correlated with increased weight and length at birth of the newborn, coupled with the tendency of increasing birth weight between generations of mothers and daughters. Also, descendants with smaller length at birth are the children of women with the lowest statures.

No association between low birth weight and cardiovascular risk factors in early adulthood: evidence from São Paulo, Brazil.

BACKGROUND: A growing literature suggests that low birth weight increases the risk of poor health outcomes in adulthood. We tested this hypothesis among young adults living in São Paulo State, Brazil. METHODS AND FINDINGS: To identify the effects of low birth weight on young adulthood outcomes, a medical assessment of 297 individuals born between 1977 and 1989 was conducted at a primary care unit in São Paulo State, Brazil. We analyzed body mass index (BMI), waist-hip ratio, blood pressure, fasting glucose and total cholesterol levels using linear and logistic regressions. Low birth was negatively associated with BMI (ß = -2.0, 95% CI: -3.69, -0.27, p = 0.02), fasting glucose levels (ß = -1.9, 95% CI: -3.9, -0.07, p = 0.05), waist-hip ratio (ß = -0.03, 95% CI: -0.07, -0.01, p = 0.10), systolic blood pressure (ß = -3.32, 95% CI: -7.60, 0.96, p = 0.12), and total cholesterol levels (ß = -3.19, 95% CI: -16.43, 10.05, p = 0.636). Low birth weight was also associated with lower odds of young adults being overweight and obese, but neither association was statistically significant. Weight gain in the first 12 months of life was associated with higher adult BMI (ß = 0.79, 95% CI: -0.0455, 1.623, p = 0.064) and blood pressure (ß = 2.79, 95% CI: 0.22, 5.35, p = 0.034). No associations were found between low birth weight and early life (catch-up) growth. CONCLUSIONS: Low birth weight was not associated with poor health outcomes among young adults in Brazil. These results appear inconsistent with the original Barker hypothesis, but will need to be corroborated in larger samples with longer follow-ups to allow a more general evaluation of the validity of the hypothesis in low and middle income countries.

[Hospital costs related to streptococcal meningitis among children in São José dos Campos, São Paulo State, Brazil]. / Custos hospitalares da meningite causada por Streptococcus pneumoniae na cidade de São José dos Campos, São Paulo, Brasil.

Knowledge of hospital costs is highly important for public health decision-making. This study aimed to estimate direct hospital costs related to pneumococcal meningitis in children 13 years or younger in the city of São José dos Campos, São Paulo State, Brazil, from January 1999 to December 2008. Data were obtained from medical records. Hospital costs were calculated according to the mixed method for measurement of quantities of items with identified costs and value attribution to items consumed (micro-costing and gross-costing). All costs were calculated according to monetary values for November 2009 and in Brazilian currency (Real). Epi Info 3.5.1 was used for frequencies and means analysis. Forty-one cases were reported. Direct hospital costs varied from R$ 1,277.90 to R$ 19,887.56 (mean = R$ 5,666.43), or 10 to 20 times the mean cost of hospitalization for other diseases. Hospital staff labor was the highest cost, followed by medication, procedures, supplies, and lab tests.

Custos hospitalares da meningite causada por Streptococcus pneumoniae na cidade de São José dos Campos, São Paulo, Brasil / Hospital costs related to streptococcal meningitis among children in São José dos Campos, São Paulo State, Brazil

O conhecimento dos custos hospitalares é de grande importância para os processos de tomada de decisão em saúde pública. O objetivo deste estudo foi estimar os custos hospitalares diretos relacionados à meningite pneumocócica em crianças com até 13 anos (inclusive), na cidade de São José dos Campos, São Paulo, Brasil, de janeiro de 1999 a dezembro de 2008. Foram obtidos dados de prontuários médicos. O cálculo foi realizado pelo método misto de mensuração das quantidades dos itens de custos e atribuição de valor aos itens consumidos (micro-costing e gross-costing). Os valores monetários referem-se a novembro de 2009, sendo expressos em reais. A análise das frequências e médias foi realizada pelo programa Epi Info versão 3.5.1. Foram notificados 41 casos. Os custos hospitalares diretos variaram de R$ 1.277,90 a R$ 19.887,56 (média = R$ 5.666,43), ou seja, 10 a 20 vezes maiores que o custo médio de internações pago pelo SUS. Os custos dos honorários profissionais foram os mais relevantes, seguidos pelos custos dos medicamentos, procedimentos, materiais e exames laboratoriais.

Knowledge of hospital costs is highly important for public health decision-making. This study aimed to estimate direct hospital costs related to pneumococcal meningitis in children 13 years or younger in the city of São José dos Campos, São Paulo State, Brazil, from January 1999 to December 2008. Data were obtained from medical records. Hospital costs were calculated according to the mixed method for measurement of quantities of items with identified costs and value attribution to items consumed (micro-costing and gross-costing). All costs were calculated according to monetary values for November 2009 and in Brazilian currency (Real). Epi Info 3.5.1 was used for frequencies and means analysis. Forty-one cases were reported. Direct hospital costs varied from R$ 1,277.90 to R$ 19,887.56 (mean = R$ 5,666.43), or 10 to 20 times the mean cost of hospitalization for other diseases. Hospital staff labor was the highest cost, followed by medication, procedures, supplies, and lab tests.

Aspectos diagnósticos da otite média com derrame na faixa etária pediátrica: [revisão] / Diagnostic aspects of otitis media with effusion in children: [review]

OBJETIVOS: apresentar e discutir aspectos diagnósticos da otite média com derrame (OMD) na prática clínica da atenção primária à saúde. MÉTODOS: foram pesquisadas as bases de dados Medline, Lilacs e SciELO (1994-2004). Identificados 523 artigos, dos quais 30 foram considerados para o presente trabalho. RESULTADOS: os estudos revelaram disparidade entre as definições, inconsistência no quadro clínico e falta de padronização dos critérios diagnósticos. Isto contribuiu para a inadequação diagnóstica da OMD. As evidências que levaram ao diagnóstico de efusão foram: a) pelo menos duas anormalidades do tímpano relacionadas à coloração, opacificação e mobilidade; e/ou b) membrana timpânica (MT) tipicamente retraída, côncava, e com alteração da coloração; e/ou c) mobilidade reduzida ou ausente na otoscopia pneumática (OP). A OP mostrou ser mais acurada que a otoscopia simples (OS), sendo considerada como método de escolha para o diagnóstico clínico da OMD. Quando houver dúvida na otoscopia pneumática, pode-se indicar a timpanometria, que aumenta a acurácia deste diagnóstico. CONCLUSÕES: na prática clínica, o diagnóstico da OMD deve ser realizado, primariamente pela otoscopia pneumática, em toda criança com suspeita de OMD. Em caso de dúvida deve-se indicar a timpanometria.

OBJECTIVES: to present and discuss diagnostic aspects of middle ear infection with effusion at a primary health care clinic. METHODS: research was carried out using the Medline, Lilacs and SciELO databases (1994-2004). Five hundred and twenty-three articles were found, of which 30 were considered for this review. RESULTS: the study revealed considerable disparity with regard to definitions, inconsistency in terms of clinical profile and a lack of standardization of diagnostic criteria. This has contributed to inadequate diagnosis of otitis media with effusion (OME). Evidence leading to a diagnosis of effusion were: a) at least two eardrum abnormalities relating to discoloration, darkening and mobility; and/or b) tympanic membrane (MT) typically retracted, concave, and with altered coloration; and/or c) reduced mobility or absence of mobility on pneumatic otoscopy (PO). The PO was shown to be more accurate than simple otoscopy (SO), which is considered the method of choice for diagnosis of OME. When the pneumatic otoscopy is inconclusive, tympanometry may recommended, as this increases the accuracy of the diagnosis. CONCLUSIONS: in clinical practice, diagnosis of OME should be carried out principally by way of pneumatic otoscopy, to which all children suspected of having OME should be submitted. Where there is doubt, tympanometry is recommended.

Fever without source: evaluation of a guideline.

OBJECTIVE: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). METHODS: Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. RESULTS: We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 degrees C. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. CONCLUSION: The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.

Febre sem sinais localizatórios: avaliação de um protocolo de atendimento / Fever without source: evaluation of a guideline

OBJETIVO: Avaliar a aplicabilidade de um protocolo de atendimento padronizado para crianças de até 36 meses de idade com febre sem sinais localizatórios (FSSL). MÉTODOS: Estudo de coorte prospectivo em crianças com FSSL atendidas no Pronto-Socorro do Hospital Universitário da Universidade de São Paulo, São Paulo (SP), de junho de 2006 a maio de 2007. O protocolo estratifica o risco de infecção bacteriana grave (IBG) de acordo com a presença ou não de toxemia, idade e valor da temperatura. Conforme avaliação de risco, indicava-se triagem laboratorial: hemograma, hemocultura, sedimento urinário, urocultura e, se necessário, radiografia torácica, liquor e coprocultura. RESULTADOS: Foram estudadas 251 crianças das quais 215 foram acompanhadas até o diagnóstico final. Vinte crianças apresentavam toxemia, e 195 estavam em bom estado geral (30 com idade de até 3 meses, e 165, de 3 a 36 meses). Nas crianças de 3 a 36 meses não toxêmicas, 95 tinham temperatura axilar > 39 ºC. Em 107 crianças (49,8 por cento), houve melhora espontânea do quadro febril; em 88 (40,9 por cento), foi identificada doença benigna autolimitada; e em 20 (9,3 por cento), IBG. Dentre as IBG, identificamos 16 infecções urinárias, três pneumonias e uma bacteremia oculta. Das 215, 129 (60 por cento) não receberam qualquer antibioticoterapia, e 86 receberam antibiótico em algum momento (45, empiricamente). O antibiótico empírico foi mantido por, em média, 72 horas. CONCLUSÃO: O protocolo aplicado mostrou-se adequado para o seguimento destas crianças que fizeram coleta de exames simples e passíveis de serem realizados na maioria dos serviços. A infecção urinária foi a IBG mais frequente nas crianças com FSSL.

OBJECTIVE: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). METHODS: Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. RESULTS: We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8 percent) children, there was spontaneous resolution of fever; in 88 (40.9 percent), benign self-limited disease was identified; and in 20 (9.3 percent), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60 percent) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. CONCLUSION: The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.

Clinical indicators of child development in the capitals of nine Brazilian states: the influence of regional cultural factors.

OBJECTIVE: Evaluating the interaction between mother or caregiver and infant through the Clinical Indicators of Risks in Infant Development and investigating whether local and cultural influences during infant development affect these clinical indicators. INTRODUCTION: The Clinical Indicators of Risks in Infant Development was created in order to fully assess infants' development and the subjective relationship between the babies and their caregivers. The absence of two or more Clinical Indicators of Risks in Infant Developments suggests a possibly inadequate mental development. Given the continental size of Brazil and its accentuated cultural differences, one might question how trustworthy these indicators can be when applied to each of the geographical regions of the country. METHODS: This was a cross-sectional study with 737 infants from the capitals of 9 Brazilian states. The size of the initial sample population was based on a pilot study carried out in the cities of São Paulo and Brasília. The ages of children were grouped: 0-3 months, 4-7 months, 8-11 months and 12-18 months. The chi-square test was used together with analyses by the statistical software SPSS 13.0. RESULTS: Statistical analysis of results from the different municipalities against the total sample did not reveal any statistically significant differences. Municipalities represented were Belém (p=0.486), Brasília (p=0.371), Porto Alegre (p=0.987), Fortaleza (p=0.259), Recife (p=0.630), Salvador (0.370), São Paulo (p=0.238), Curitiba (p=0.870), and Rio de Janeiro (p= 0.06). DISCUSSION: Care for mental development should be considered a public health issue. Its evaluation and follow-up should be part of the already available mother-child assistance programs, which would then be considered to provide "full" care to children. CONCLUSIONS: Local habits and culture did not affect the results of the Clinical Indicators of Risks in Infant Development indicators. Clinical Indicators of Risks in Infant Development proved to be robust despite the specificities of each region.

Clinical indicators of child development in the capitals of nine Brazilian states: the influence of regional cultural factors

OBJECTIVE: Evaluating the interaction between mother or caregiver and infant through the Clinical Indicators of Risks in Infant Development and investigating whether local and cultural influences during infant development affect these clinical indicators. INTRODUCTION: The Clinical Indicators of Risks in Infant Development was created in order to fully assess infants' development and the subjective relationship between the babies and their caregivers. The absence of two or more Clinical Indicators of Risks in Infant Developments suggests a possibly inadequate mental development. Given the continental size of Brazil and its accentuated cultural differences, one might question how trustworthy these indicators can be when applied to each of the geographical regions of the country. METHODS: This was a cross-sectional study with 737 infants from the capitals of 9 Brazilian states. The size of the initial sample population was based on a pilot study carried out in the cities of São Paulo and Brasília. The ages of children were grouped: 0-3 months, 4-7 months, 8-11 months and 12-18 months. The chi-square test was used together with analyses by the statistical software SPSS 13.0. RESULTS: Statistical analysis of results from the different municipalities against the total sample did not reveal any statistically significant differences. Municipalities represented were Belém (p=0.486), Brasília (p=0.371), Porto Alegre (p=0.987), Fortaleza (p=0.259), Recife (p=0.630), Salvador (0.370), São Paulo (p=0.238), Curitiba (p=0.870), and Rio de Janeiro (p= 0.06). DISCUSSION: Care for mental development should be considered a public health issue. Its evaluation and follow-up should be part of the already available mother-child assistance programs, which would then be considered to provide "full" care to children. CONCLUSIONS: Local habits and culture did not affect the results of the Clinical Indicators of Risks in Infant Development indicators. Clinical...