The adjusted effect of maternal body mass index, energy and macronutrient intakes during pregnancy, and gestational weight gain on body composition of full-term neonates.

OBJECTIVE: To evaluate the effect of prepregnancy body mass index (BMI), energy and macronutrient intakes during pregnancy, and gestational weight gain (GWG) on the body composition of full-term appropriate-for-gestational age neonates. STUDY DESIGN: This is a cross-sectional study of a systematically recruited convenience sample of mother-infant pairs. Food intake during pregnancy was assessed by food frequency questionnaire and its nutritional value by the Food Processor Plus (ESHA Research Inc, Salem, OR). Neonatal body composition was assessed both by anthropometry and air displacement plethysmography. Explanatory models for neonatal body composition were tested by multiple linear regression analysis. RESULTS: A total of 100 mother-infant pairs were included. Prepregnancy overweight was positively associated with offspring weight, weight/length, BMI, and fat-free mass in the whole sample; in males, it was also positively associated with midarm circumference, ponderal index, and fat mass. Higher energy intake from carbohydrate was positively associated with midarm circumference and weight/length in the whole sample. Higher GWG was positively associated with weight, length, and midarm circumference in females. CONCLUSION: Positive adjusted associations were found between both prepregnancy BMI and energy intake from carbohydrate and offspring body size in the whole sample. Positive adjusted associations were also found between prepregnancy overweight and adiposity in males, and between GWG and body size in females.

[Iatrogeny in paediatrics: reconsider attitudes]. / Iatrogenia em pediatria: repensar atitudes.

Iatrogeny is a pathologic condition caused in a patient in the different stages of a medical act. In the United States, it is the fourth cause of death but in Portugal, data are not yet available. Though different from medical error, it is still a taboo subject for health care providers. The authors report a case of relational, diagnostic and therapeutic iatrogeny with serious consequences for the patient. Doctors have a fundamental role in reducing morbidity and mortality due to iatrogenic causes; they have the duty to question and reconsider diagnosis and treatments, keeping an alert attitude and self-criticism in order to identify potential iatrogenic interventions or to correct it as soon as possible.

Severe megaloblastic anaemia in an infant.

Vitamin B(12) or cobalamin deficiency, a rare clinical entity in pediatric age, is found most exclusively in breastfed infants, whose mothers are strictly vegetarian non-supplemented or with pernicious anaemia. In this article, the authors describe a 10-month-old infant admitted for vomiting, refusal to eat and prostration. The infant was exclusively breastfed and difficulties in introduction of new foods were reported. Failure to thrive since 5 months of age was also noticed. Laboratory evaluation revealed severe normocytic normochromic anaemia and cobalamin deficit. A diagnosis of α-thalassemia trait was also made. Maternal investigation showed autoimmune pernicious anaemia. This case shows the severity of vitamin B(12) deficiency and the importance of adopting adequate and precocious measures in order to prevent potentially irreversible neurologic damage.

[Anticonvulsant hypersensitivity syndrome in children]. / Síndrome de hipersensibilidade aos antiepilépticos na criança.

Anticonvulsant hypersensitivity syndrome, or DRESS (Drug Rash with Eosinophilia and Systemic Symptoms), is a rare multisystem disorder, potentially fatal, that occurs after exposure to antiepileptic drugs, mainly aromatic ones. Clinically, this condition is recognized by the classic triad of fever, rash and internal organ involvement that usually develops 1 to 12 weeks after initiation of therapy. We report a case of a child treated with sodium valproate for epilepsy that showed a febrile rash 4 weeks after being medicated with phenobarbital. Laboratory testing revealed leukocytosis with eosinophilia elevated C-reactive protein and liver enzymes. Phenobarbital was suspended, with slow full recovery. This syndrome may mimic infectious, immunologic and neoplastic conditions, which may delay the correct diagnosis, but must be excluded in the presence of characteristic clinical features and drug exposition.

Kawasaki disease.

INTRODUCTION: Kawasaki disease (KD) is the leading cause of acquired heart disease among children in developed nations. Its incidence has risen in recent years and 20% of untreated patients develop coronary artery abnormalities. OBJECTIVES: To analyze the epidemiological, clinical, laboratory and echocardiographic data of cases diagnosed in Hospital Fernando Fonseca and to identify factors that may influence prognosis. POPULATION AND METHODS: A retrospective study was performed of all children admitted to Hospital Fernando Fonseca with Kawasaki disease between June 1996 and December 2003. Diagnosis was based on the presence of fever plus four of the classic criteria or three of them in association with coronary aneurysms. Demographic and clinical features, laboratory and imaging findings, therapeutic measures and evolution were analyzed. SPSS for Windows was used for statistical analysis, applying the Mann-Whitney and Fisher's exact tests. RESULTS: A total of 23 children were admitted. The incidence was 8.2 per 100 000 children under 5. Their ages ranged from 6 months to five years (median 20 months). Half of the patients were aged < 2 years, and 21 (91%) were under 5. Most were male (74%) and white (83%). Nine children lived in the same area and ten (43%) had a concomitant infectious disease (parvovirus, Chlamydia pneumoniae, respiratory syncytial virus, enterovirus and herpesvirus 6). Twenty children had typical Kawasaki disease. Twenty-two received combined therapy with aspirin and high dose immunoglobulin, which was administered, on average, on the seventh day of the disease. Coronary disease was diagnosed in seven (30%) children. The frequency of cardiac lesions was highest in the youngest age group (< 2 years). The mean follow-up was 16 months. There was no mortality and aneurysmal changes persisted in only one patient. CONCLUSIONS: Cardiac disorders were more frequent in the youngest age group, as has been reported elsewhere. The common geographic origin and the evidence of several infectious agents suggest that infection may trigger the immunopathogenesis of KD.