Nível de ruídos na unidade neonatal / Noise level in the neonatal unit / Nivel de ruido en la unidad neonatal

Objetivo: verificar os níveis de pressão sonora, a influência do turno e das ocorrências nesses níveis em uma unidade neonatal do Rio de Janeiro. Método: estudo longitudinal, exploratório, descritivo, com dados coletados entre novembro de 2021 e janeiro de 2022. As variáveis categóricas foram descritas por meio de frequências absoluta e relativa. A aderência à distribuição normal foi verificada pelo teste Shapiro-Wilk. Para a análise da associação entre variáveis de exposição e desfecho, utilizou-se teste Mann-Whitney, Kruskal Wallis e Qui-quadrado. Considerou-se estatisticamente significativos resultados de p<0,05. Resultados: foram coletados 10.122 registros de decibéis e 56 eventos relacionados as atividades, que ocorreram predominantemente no período diurno. Houve variação de 38,6 a 93,1 decibéis (dB). Em 96,3% do período observado, os níveis de pressão sonora estiveram acima do recomendado. Na comparação entre os períodos, o noturno apresentou menores níveis (p=0,000). Conclusão: os níveis de pressão sonora registrados estão acima do recomendado para um ambiente seguro.

Objective: to verify the sound pressure levels (SPL) and the influence of the shift and the occurrences in these levels in a neonatal unit in Rio de Janeiro. Method: longitudinal, exploratory, descriptive study. Collected from November 2021 to January 2022. Categorical variables were described using absolute and relative frequencies. To verify adherence to the normal distribution, the Shapiro-Wilk test was used. For the association between exposure and outcome variables, the Mann-Whitney, Kruskal Wallis and Qui-square tests were used. Results of p < 0.05 were considered statistically significant. Results: 10,122 decibel records and 56 events related to activities were collected, these occurred predominantly during the day. There was a variation from 38.6 to 93.1 decibels (dB). In 96.3% of the observed period, the NPS were above the recommended. Comparing the periods, nighttime had lower SPL (p=0.000). Conclusion: the registered NPS are above the recommended for a safe environment.

Objetivo: Verificar los niveles de presión sonora y la influencia del turno y de las incidencias en esos niveles en una unidad neonatal en Rio de Janeiro. Método: Estudio longitudinal, exploratorio, descriptivo, cuyos datos se recopilaron de noviembre de 2021 a enero de 2022. Las variables categóricas se describieron mediante frecuencias absoluta y relativa. Para verificar la adherencia a la distribución normal se utilizó la prueba de Shapiro-Wilk. Para el análisis de la asociación entre variables de exposición y de resultado se utilizaron las pruebas de Mann-Whitney, Kruskal Wallis y Qui-quadrado. Los resultados de p < 0,05 se consideraron estadísticamente significativos. Resultados: se recolectaron 10.122 registros de decibelios y 56 eventos relacionados con actividades, que ocurrieron predominantemente durante el día. Hubo una variación de 38,6 a 93,1 decibelios (dB). En el 96,3% del período observado, los niveles de presión sonora estuvieron por encima de lo recomendado. Comparando los períodos, el nocturno presentó niveles más bajos (p=0,000). Conclusión: Los niveles de presión sonora registrados están por encima de lo recomendado para un ambiente seguro.

Are pediatricians familiar with hereditary angioedema?

Background: Hereditary angioedema (HAE) is an autosomal dominant disease characterized by recurrent episodes of subcutaneous or mucosal edema caused by excess bradykinin. The aim of the present study was to assess the knowledge of pediatricians about hereditary angioedema. Methods: An online survey with 12 HAE-related and 14 demographics-related questions was e-mailed to all pediatricians who were members of the Brazilian Society of Pediatrics (n = 17 145) once a week during the months of June and July 2021. The electronic questionnaire assessed clinical manifestations, diagnosis, and treatment of hereditary angioedema in children and adolescents. Results: Four hundred and fifty-five pediatricians responded to the questionnaire (2.6%), of whom 55 (12.1%) were board certified in Allergy and Immunology (A/I), while 400 (87.9%) were not (N-A/I). Three hundred and sixty-eight (80.9%) were female, 289 (55.7%) were under 50 years of age, 286 (62.9%) graduated from Medical School more than 10 years previously, 83 (18.2%) held an MSc/PhD degree, and 253 (55.6%) were living in the Southeast Region of Brazil. The median number of correct answers to the questions related to HAE among A/I was 7 out of 12 (58.3%), with median ranging from 4.5 to 8 correct answers, while for N-A/I it was 3 (25%), with median ranging from 2.5 to 4 correct answers (p < 0.001). Conclusion: Knowledge about HAE among Brazilian pediatricians, whether board certified in Allergy and Immunology or not, was unsatisfactory. HAE is a rare disease, largely unknown among physicians; therefore, increasing awareness may lead to improvement in diagnosis and treatment.

Prática de avaliação da dor na unidade de terapia intensiva neonatal: estudo transversal / Práctica de evaluación del dolor en las unidades de cuidados intensivos neonatales: un estudio transversal / Pain assessment practice in a neonatal intensive care unit: a cross-sectional study

Objetivo: Analisar a prática dos profissionais de enfermagem quanto à avaliação da dor do recém-nascido internado na unidade neonatal. Métodos: Estudo transversal, analítico, realizado com profissionais de enfermagem no período de março a maio de 2018. Utilizou-se questionário autoaplicável. Fez-se análise da associação de variáveis categóricas com a prática profissional utilizando-se os testes Qui-quadrado e Exato de Fisher, com adoção do nível de significância de 5%. Resultados: Participaram do estudo 35 profissionais de enfermagem. O tempo de trabalho na unidade, a experiência profissional e a satisfação com as condições de trabalho influenciaram estatisticamente a prática adequada. O uso de escalas para avaliar a dor em recém-nascidos foi informado por 17,1% dos profissionais. Conclusão: A avaliação da dor neonatal ainda não está sedimentada na prática profissional de enfermagem. Recomendam-se ações de intervenção na prática, com avaliação de resultados de forma contínua, alinhados com os gestores e as diretrizes institucionais

Objective: To analyze the practice of nursing professionals regarding pain assessment in newborns hospitalized in a neonatal care unit. Method: This cross-sectional, analytical study was conducted with nursing professionals from March to May 2018. A self-administered questionnaire was applied. The association of categorical variables with professional practice was analyzed considering both the chi-squared and Fisher's exact tests, at a 0.05 significance level. Results: In total, 35 nursing professionals participated in the study. Factors such as time working in the unit, length of professional experience and satisfaction with working conditions statistically showed influence on appropriate practice. We found that 17,1% of professionals reported using scales to assess pain in newborns. Conclusion: Professional nursing practices still lack the required assessment of neonatal pain. This study recommends interventions in work practice in accordance with institutional guidelines and managers, as well as continuous evaluation of its results

Objetivo: analizar la práctica de los profesionales de enfermería con relación a la evaluación del dolor del recién nacido internado en unidad neonatal. Método: estudio transversal, analítico, realizado con profesionales de enfermería en el periodo de marzo a mayo de 2018. Se utilizó un cuestionario autoaplicado. La asociación de variables categóricas con la práctica profesional se analizó mediante las pruebas de chi cuadrado y exacta de Fisher, con adopción del nivel de significancia del 5%. Resultados: en el estudio participaron 35 profesionales de enfermería. El tiempo de trabajo en la unidad, el tiempo de experiencia profesional y la satisfacción con las condiciones de trabajo influenciaron estadísticamente en una práctica adecuada. El uso de escalas para evaluar el dolor en recién nacidos fue relatado por el 17,1% de los profesionales. Conclusión: La evaluación del dolor neonatal aún no está establecida em la práctica profesional de enfermería. Se recomiendan acciones de intervención en la práctica, con evaluación continua de resultados, alineadas con los gestores y directrices institucionales

Prática dos profissionais da saúde em aleitamento materno e fatores associados: estudo transversal / Health professionals' breastfeeding practices and associated factors: a cross-sectional study

OBJETIVO: Analisar a prática dos profissionais da saúde da atenção básica quanto ao aleitamento materno e fatores associados. MÉTODO: Estudo transversal, analítico, realizado com todos os profissionais da saúde atuantes em aleitamento materno de cinco unidades da atenção básica através de questionário autoaplicável. Para análise da associação das variáveis categóricas com a prática profissional, utilizou-se teste Qui-quadrado com nível de significância de 5%. RESULTADOS: Participaram 38 profissionais. Houve associação estatística significativa (p=0.04597) entre a variável atualização em aleitamento materno nos últimos cinco anos e a prática de implementação em grupos de apoio. O manejo clínico, a orientação quanto aos direitos maternos e o apoio para a resolução de dificuldades na amamentação foram menos informados. CONCLUSÃO: A prática dos profissionais da saúde apresentou fragilidades evidenciando a necessidade de valorização do tema por profissionais e gestores através de estratégias que incluam capacitação contínua e monitoramento do aleitamento materno na rede de atenção básica.

OBJECTIVE: To analyze primary care health professionals' breastfeeding practices and associated factors. METHOD: A cross-sectional and analytical study was carried out with all health professionals working in breastfeeding support in five primary healthcare units, through a self-administered questionnaire. The chi-square test was used with a significance level of 5% to analyze the association of categorical variables with professional practice. RESULTS: Thirty-eight professionals participated. There was a statistically significant association (p=0.04597) between the variable update on breastfeeding in the last five years and the practice of implementing breastfeeding through support groups. Clinical management, guidance on maternal rights, and support for resolving difficulties in breastfeeding were less reported. CONCLUSION: The practice of health professionals showed weaknesses, highlighting the need for professionals and managers to value the breastfeeding issue through strategies that include continuous training and monitoring of breastfeeding in the primary healthcare network.

Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity

Abstract Objective: To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. Methods: This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. Results: Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). Conclusion: Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.

Prevalence of Functional Gastrointestinal Disorders in Brazilian Infants Seen in Private Pediatric Practices and Their Associated Factors.

OBJECTIVES: To assess the prevalence of the most frequent functional gastrointestinal disorders (FGIDs) in Brazilian infants seen in private pediatric clinics and their relationship with cesarean delivery, breastfeeding, and history of prematurity. METHODS: This cross-sectional study enrolled 5080 infants under 12 months old with routine visits in private pediatric clinics in Brazil. The mothers answered questions about the type of delivery, type of feeding (breast milk, infant formula, cow milk, mixed feeding), history of prematurity, and gastrointestinal symptoms. Rome IV criteria were used to diagnose FGIDs. RESULTS: The prevalence of infant regurgitation was 10.7% (487/4560); infant colic, 6.1% (131/2162); infant dyschezia, 4.0% (157/3895); functional constipation, 7.6% (341/4506); and functional diarrhea, 0.09% (2/2186). Prematurity was associated ( P < 0.05) with infant regurgitation (odds ratio [OR] = 1.41; 95% confidence interval [CI]: 1.05, 1.90), infant colic (OR = 1.97; 95% CI: 1.19, 3.24), infant dyschezia (OR = 1.64, 95% CI: 1.02, 2.64), and functional constipation (OR = 1.44; 95% CI: 1.02, 2.02). Prematurity was associated ( P < 0.001) with two or more FGIDs between 21 days and 150 days of age (OR = 3.06; 95% CI: 1.74, 5.37). CONCLUSION: FGIDs are common in infants seen in the private pediatric practice in Brazil. History of prematurity was associated with infant regurgitation, infant colic, functional dyschezia, and functional constipation.

Development and validation of an instrument for nursing consultation with pediatric patients in the preoperative period.

OBJECTIVE: To develop and validate an instrument for nursing consultation with pediatric patients in the preoperative period. METHOD: This is a methodological study, consisting of five steps: identification of nursing diagnoses, discussion and evaluation of diagnoses with nurses from the institution, instrument development, instrument content validation with experts through the Delphi Technique, and instrument restructuring. The Nursing Minimum Data Set, Wanda Horta's human needs, and the NANDA-NOC-NIC connections were used as theoretical framework. RESULTS: In its final version, the instrument includes an assessment of psychobiological, psychosocial, and psychospiritual human needs, 38 nursing diagnoses, 65 nursing interventions, 113 nursing activities, and 62 nursing outcomes. The instrument obtained a content validity index between 0.90 and 1.0 in the first round, and suggestions, validated in the second round, obtained agreement from 70 to 100%. CONCLUSION: The instrument developed can be a tool for use in nursing consultations in the preoperative period for children, providing greater assertiveness to nursing actions for this clientele.

Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity.

OBJECTIVE: To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. METHODS: This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. RESULTS: Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). CONCLUSION: Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.

Neuropsychomotor development and functional skills in preschool children with liver diseases / Desenvolvimento neuropsicomotor e habilidades funcionais em pré-escolares com doenças hepáticas

Abstract Introduction Children with chronic liver diseases are exposed to biological and/or environmental risk factors that can compromise their neuromotor acquisition and development of functional skills. Objective To describe the neuropsychomotor development (NPMD) and functional skills of children with chronic liver diseases. Methods Cross-sectional, descriptive and exploratory study carried out with children up to 6 years old who were selected at a reference hospital in the state of Bahia, Brazil, from November 2019 to March 2020. Children in outpatient care with clinical, laboratory and histological diagnosis compatible with chronic liver disease were considered eligible. The instrument for assessing neuropsychomotor development was Denver II. Functional skills were obtained by applying the Pediatric Evaluation of Disability Inventory computer-adaptive test (PEDI-CAT) to parents or primary caregivers, Speedy version (Speedy-CAT). Results Of the 34 children with chronic liver disease, 52.9% were female, aged between 4 and 6 years (64%). The results of the Denver II test showed that 68.7% (22/32) of the sample were at risk for NPMD. In the PEDI-CAT, the scores of children with liver disease at risk for NPMD were 60.7 ± 9.1 in the daily activity domains, 57.6 ± 11.8 in mobility and 48.3 ± 6.2 in the social/cognitive domains. Conclusion Children with chronic liver disease are at risk for NPMD, although not presenting impaired functional skills when evaluated by the PEDI-CAT.

Resumo Introdução Crianças com doenças hepáticas crônicas são expostas a fatores de risco biológicos e/ou ambientais que podem comprometer suas aquisições neuromotoras e o desenvolvimento de suas habilidades funcionais. Objetivo Descrever o desenvolvimento neuropsicomotor (DNPM) e habilidades funcionais de crianças com doenças hepáticas crônicas. Métodos Estudo seccional, descritivo e exploratório realizado com crianças de até 6 anos, que foram selecionadas em um hospital de referência do estado da Bahia, Brasil, no período de novembro de 2019 a março de 2020. Foram consideradas elegíveis para o estudo crianças em atendimento ambulatorial, com diagnóstico clínico, laboratorial e histológico compatíveis com doença hepática crônica. O instrumento de avaliação do desenvolvimento neuropsicomotor foi o Denver II. As habilidades funcionais foram obtidas pela aplicação do Inventário de Avaliação Pediátrica de Incapacidade Testagem Computadorizada Adaptativa (PEDI-CAT) aos pais ou cuidadores principais, versão rápida (Speedy-CAT). Resultados Das 34 crianças com hepatopatias crônicas, 52,9% eram do sexo feminino, com idade entre 4 e 6 anos (64%). Os resultados do teste de Denver II demonstraram que 68,7% (22/32) da amostra apresentaram risco para DNPM. No PEDI-CAT, os escores das crianças hepatopatas com risco para DNPM foram de 60,7 ± 9,1 nos domínios atividade diária, 57,6 ± 11,8 em mobilidade e 48,3 ± 6,2 em social/cognitivo. Conclusão Crianças com hepatopatias crônicas apresentam risco para DNPM, apesar de não possuírem comprometimento de suas habilidades funcionais quando avaliadas pelo PEDI-CAT.

Development and validation of an instrument for nursing consultation with pediatric patients in the preoperative period / Elaboración y validez de instrumento para consulta de enfermería al paciente pediátrico en preoperatorio / Elaboração e validação de instrumento para consulta de enfermagem ao paciente pediátrico em pré-operatório

ABSTRACT Objective: To develop and validate an instrument for nursing consultation with pediatric patients in the preoperative period. Method: This is a methodological study, consisting of five steps: identification of nursing diagnoses, discussion and evaluation of diagnoses with nurses from the institution, instrument development, instrument content validation with experts through the Delphi Technique, and instrument restructuring. The Nursing Minimum Data Set, Wanda Horta's human needs, and the NANDA-NOC-NIC connections were used as theoretical framework. Results: In its final version, the instrument includes an assessment of psychobiological, psychosocial, and psychospiritual human needs, 38 nursing diagnoses, 65 nursing interventions, 113 nursing activities, and 62 nursing outcomes. The instrument obtained a content validity index between 0.90 and 1.0 in the first round, and suggestions, validated in the second round, obtained agreement from 70 to 100%. Conclusion: The instrument developed can be a tool for use in nursing consultations in the preoperative period for children, providing greater assertiveness to nursing actions for this clientele.

RESUMEN Objetivo: Elaborar y validar un instrumento para consulta de enfermería al paciente pediátrico en preoperatorio. Método: Estudio metodológico, compuesto por cinco etapas: identificación de los diagnósticos de enfermería, discusión y evaluación de los diagnósticos con enfermeros de la institución, elaboración del instrumento, validez del contenido del instrumento con expertos por la Técnica Delphi y reestructuración del instrumento. Se utilizaron el Conjunto de Datos Mínimos de Enfermería, las necesidades humanas de Wanda Horta y la nomenclatura NANDA-NOC-NIC. Resultados: En su versión final, el instrumento contempla evaluación de las necesidades humanas psicobiológicas, psicosociales y psicoespirituales, 38 diagnósticos de enfermería, 65 intervenciones, 113 actividades y 62 resultados de enfermería. El instrumento obtuvo índice de validez de contenido entre 0,90 y 1,0 70 en la primera etapa, y sugerencias, validadas en la segunda etapa que obtuvieron concordancia de 70 a 100%. Conclusión: El instrumento elaborado puede ser una herramienta para uso en consulta de enfermería en el preoperatorio infantil, proporcionando más seguridad en las acciones de enfermería a ese público.

RESUMO Objetivo: Elaborar e validar um instrumento para consulta de enfermagem ao paciente pediátrico em pré-operatório. Método: Estudo metodológico, composto por cinco etapas: identificação dos diagnósticos de enfermagem, discussão e avaliação dos diagnósticos com enfermeiros da instituição, elaboração do instrumento, validação do conteúdo do instrumento com experts pela Técnica Delphi e reestruturação do instrumento. Foram utilizados o Conjunto de Dados Mínimos de Enfermagem, as necessidades humanas de Wanda Horta e as ligações NANDA-NOC-NIC como referencial teórico. Resultados: Em sua versão final, o instrumento contempla avaliação das necessidades humanas psicobiológicas, psicossociais e psicoespirituais, 38 diagnósticos de enfermagem, 65 intervenções, 113 atividades e 62 resultados de enfermagem. O instrumento obteve índice de validade de conteúdo entre 0,90 e 1,0 na primeira rodada, e sugestões, validadas na segunda rodada, obtendo concordância de 70 a 100%. Conclusão: O instrumento elaborado pode ser uma ferramenta para uso em consulta de enfermagem no pré-operatório infantil, conferindo maior assertividade nas ações de enfermagem a essa clientela.

Estado antropométrico de pacientes pediátricos com doença inflamatória intestinal / Anthropometric status of pediatric patients with inflammatory bowel disease

Introdução: a Doença Inflamatória Intestinal (DII) é decorrente de vários fatores que provocam alteração na homeostase do microbioma na resposta imune e no aumento da permeabilidade intestinal. O estado nutricional inadequado, principalmente em pacientes pediátricos com DII, representa prognóstico ruim e pode influenciar na resposta ao tratamento, à morbidade e à mortalidade. Objetivo: esse estudo teve objetivo de caracterizar o estado antropométrico de pacientes pediátricos atendidos em um ambulatório referência para DII. Metodologia: a amostra foi constituída por pacientes atendidos em primeira consulta no ambulatório, de junho de 2020 até fevereiro de 2021. Foram incluídos pacientes com diagnóstico clínico de Doença de Cronh e Colite Ulcerativa, de ambos sexos, com idade entre 2 a 19 anos. Resultados: dos pacientes com CU, 54,7% apresentaram adequado estado nutricional e 45,3% dos pacientes com DC. O percentual de déficit de massa muscular foi de 47,6% dos pacientes com CU e 52,4% dos pacientes com DC. A baixa estatura foi de 37,5% nos pacientes com CU e 62,5% com DC. Conclusão: a avaliação nutricional de crianças e adolescentes portadores de doenças inflamatórias intestinais deve fazer parte da rotina de atendimento, para que sejam promovidas práticas alimentares saudáveis que favoreçam o crescimento, recuperação ponderal e manutenção de massa muscular.

Background: Inflammatory Bowel Disease (IBD) is due to several factors that cause changes in microbiome homeostasis, immune response and increased intestinal permeability. Inadequate nutritional status, especially in pediatric patients with IBD, represents a poor prognosis and can influence treatment response, morbidity and mortality. Objective: the aim of this study was to characterize the anthropometric status of pediatric patients seen at the reference outpatient clinic for IBD. Methods: the sample consisted of patients seen in the first consultation at the clinic, from June 2020 to February 2021. Patients with a clinical diagnosis of Cronh's Disease and Ulcerative Colitis, of both genders, aged between 2 and 19 years were included. Results: of patients with UC 54.7% had an adequate nutritional status and 45.3% of patients with CD. The percentage of muscle mass deficit was 47.6% of patients with UC and 52.4% of patients with CD. Short stature was 37.5% in patients with UC and 62.5% with CD. Conclusion: nutritional assessment of children and adolescents with inflammatory bowel diseases should be part of the routine of care, so that healthy eating practices that favor growth, weight recovery and maintenance of muscle mass are promoted.

Respiratory muscle strength and exercise capacity of children and adolescents with chronic liver diseases / Força muscular respiratória e capacidade de exercício de crianças e adolescentes com hepatopatias crônicas

Introdution: Chronic liver diseases are characterized by inflammatory and fibrotic lesions of the liver that cause systemic complications. These complications can negatively interfere with the respiratory muscle strength and exercise capacity of developing children and adolescents. Objectives: to compare respiratory muscle strength and exercise capacity in children and adolescents with chronic hepatopathy, using predicted values from healthy individuals of the same age. Methodology: a cross-sectional study was performed. Children and adolescents from 6 to 16 years old with chronic hepatopathies were included. For the evaluation of respiratory muscle strength, the maximal respiratory pressures were measured through manovacuometry. A six-minute walk test was used to assess exercise capacity. The Wilcoxon test was used to verify the difference between the evaluated and predicted values of the distance traveled. Results: In total, 40 subjects were analyzed; 57.5% of the subjects were female, and the subjects had a mean age of 11.68±2.82 years. In the comparison between the measured and predicted maximal respiratory pressures, a median (IQR) difference of -21,47 (33-95) cmH2O (p< 0.001) was found for the maximal inspiratory pressure, and a mean difference of 30.68±17,16 cmH2O (p< 0.001) was found for the maximal expiratory pressure. Regarding exercise capacity, the measured average distance traveled was 346.46±49.21 m, which was 185.54±63,90 m (p< 0.001) less than the predicted value. Conclusion: Children and adolescents with chronic liver disease have reduced respiratory muscle function and exercise capacity.

Introdução: as doenças hepáticas crônicas são caracterizadas por lesões inflamatórias e fibróticas do fígado que causam complicações sistêmicas. Essas complicações podem interferir negativamente na força muscular respiratória e na capacidade de exercício de crianças e adolescentes em desenvolvimento. Objetivo: comparar a força muscular respiratória e a capacidade de exercício em crianças e adolescentes com hepatopatia crônica, utilizando valores preditos de indivíduos saudáveis da mesma idade. Metodologia: trata-se de um estudo transversal. Foram incluídas crianças e adolescentes de 6 a 16 anos com hepatopatias crônicas. Para a avaliação da força muscular respiratória, as pressões respiratórias máximas foram medidas por meio da manovacuometria. Teste de caminhada de seis minutos foi usado para avaliar a capacidade de exercício. O teste de Wilcoxon foi utilizado para verificar a diferença entre os valores avaliados e previstos da distância percorrida. Resultados: no total, 40 sujeitos foram analisados; 57,5% dos sujeitos eram do sexo feminino, idade média de 11,68±2,82 anos. Na comparação entre as pressões respiratórias máximas medidas e previstas, foi encontrada diferença mediana (IQ) de -21,47 (33-95) cmH2O (p<0,001) para a pressão inspiratória máxima e diferença média de 30,68±17,16 cmH2O (p<0,001) para a pressão expiratória máxima. Em relação à capacidade de exercício, a distância média percorrida foi 346,46±49,21 m, média 185,54±63,90 m (p<0,001) inferior ao valor previsto. Conclusão: crianças e adolescentes com doença hepática crônica apresentam redução da função muscular respiratória e da capacidade de exercício.

Percepção das mães em relação ao desenvolvimento neuropsicomotor de seus filhos com doenças hepáticas: um estudo qualitativo / Mothers' perception of the neuropsychomotor development of their children liver diseases: a qualitative study

INTRODUÇÃO: Muito se sabe sobre o quanto as doenças hepáticas impactam no desenvolvimento cognitivo, motor e social infantil. Entretanto, saber o que as mães pensam sobre o desenvolvimento de seus filhos e os aspectos que elas consideram mais importantes constituem temas pouco explorados. OBJETIVO: Investigar as percepções das mães de crianças hepatopatas acerca do desenvolvimento de seus filhos. MÉTODO: Trata-se de uma pesquisa qualitativa, descritivoexploratória, realizada com 12 mães de crianças (até 6 anos de idade) com hepatopatias crônicas, acompanhadas num centro de referência da Bahia. Realizou-se entrevista narrativa para coleta dos dados, que foram posteriormente transcritas e processadas conforme a análise de conteúdo temático categorial de Bardin. Foi comparado a percepção das mães acerca do desenvolvimento de seus filhos com os resultados obtidos na avaliação com o Teste de triagem de Denver II (TTDII) de suas crianças. RESULTADOS: Há concordância na maioria dos resultados da avaliação para suspeita ou risco do desenvolvimento neuropsicomotor, demonstrando que essas mães conseguem identificar comportamentos típicos e atípicos. As falas maternas são de superproteção e amenização do processo do adoecimento, bem como autoconfiança e superioridade como uma atitude de defesa, na tentativa de escamotear o sentimento de fragilidade frente a doença. CONCLUSÕES: A percepção das mães acerca do desenvolvimento de seus filhos foi convergente com os resultados do TTDII. As mães e as crianças precisam de acompanhamento multiprofissional para melhor manejo terapêutico e neurodesenvolvimento, bem como suporte familiar.

| INTRODUCTION: Much is known about the impact of liver diseases on children's cognitive, motor, and social development. However, knowing what mothers think about their children's development and the aspects they consider most important are issues that have been little explored. OBJECTIVE: To investigate the perceptions of mothers of hepatopathy children about the development of their children. METHOD: This is a qualitative, descriptive-exploratory research conducted with 12 mothers of children (up to 6 years of age) with chronic liver diseases, followed by a reference center in Bahia, Brazil. A narrative interview was conducted to collect the data, later transcribed and processed according to Bardin's analysis of the category thematic content. The perception of mothers about the development of their children was compared with the results obtained in the evaluation with the Denver II screening test (TTDII) of their children. RESULTS: There is an agreement in most evaluation results for suspicion or risk of neuropsychomotor development, demonstrating that these mothers can identify typical and atypical behaviors. The maternal statements are of overprotection and softening of the disease process and self-confidence and superiority as an attitude of defense in an attempt to conceal the feeling of fragility in the face of the disease. CONCLUSIONS: The mothers' perception of their children's development was in line with the TDDII results. Mothers and children need multi-professional follow-up for better therapeutic management and neurodevelopment, as well as family support.

NEUROPSYCHOMOTOR DEVELOPMENT IN CHILDREN AND ADOLESCENTS WITH LIVER DISEASES: SYSTEMATIC REVIEW WITH META-ANALYSIS.

BACKGROUND: The nature of liver disease, the evolutionary course and duration of liver diseases, as well as the degree of severity and disability can trigger multiple outcomes with repercussions on neuromotor acquisition and development. OBJECTIVE: To systematically review and conduct a meta-analysis to evaluate the effects of liver disease on the neuropsychomotor development of children and adolescents with their native livers and those who underwent liver transplantation. METHODS: Observational studies published since the early 1980s until June 2019 were sought in the PubMed and Scopus databases. An α value of 0.05 was considered significant. The statistical heterogeneity of the treatment effect between the studies was assessed by the Cochran's Q test and the I2 inconsistency test, in which values above 25 and 50% were considered indicative of moderate and high heterogeneity, respectively. Analyses were performed with Review Manager 5.3. RESULTS: Twenty-five studies met the eligibility criteria, including 909 children and adolescents with liver disease. Meta-analyses showed deficits in total IQ -0.41 (95%CI: -0.51 to -0.32; N: 9,973), verbal IQ -0.38 (95%CI: -0.57 to -0.18; N: 10,284) and receptive language -0.85 (95%CI: -1.16 to -0.53; N: 921) in liver transplantation, and those with native livers who had symptoms early had total and verbal IQ scores (85±8.8; 86.3±10.6 respectively) lower than the scores of those with late manifestations (99.5±13.8; 96.2±9.2). Gross motor skill was reduced -46.29 (95%CI: -81.55 to -11.03; N: 3,746). CONCLUSION: Acute or chronic liver disease can cause declines in cognitive, motor and language functions. Although the scores improve after liver transplantation, children remain below average when compared to healthy children.

Desenvolvimento neuropsicomotor em crianças e adolescentes com doenças hepáticas: revisão sistemática com meta-análise / Neuropsychomotor development in children and adolescents with liver diseases: systematic review with meta-analysis

ABSTRACT BACKGROUND: The nature of liver disease, the evolutionary course and duration of liver diseases, as well as the degree of severity and disability can trigger multiple outcomes with repercussions on neuromotor acquisition and development. OBJECTIVE: To systematically review and conduct a meta-analysis to evaluate the effects of liver disease on the neuropsychomotor development of children and adolescents with their native livers and those who underwent liver transplantation. METHODS: Observational studies published since the early 1980s until June 2019 were sought in the PubMed and Scopus databases. An α value of 0.05 was considered significant. The statistical heterogeneity of the treatment effect between the studies was assessed by the Cochran's Q test and the I2 inconsistency test, in which values above 25 and 50% were considered indicative of moderate and high heterogeneity, respectively. Analyses were performed with Review Manager 5.3. RESULTS: Twenty-five studies met the eligibility criteria, including 909 children and adolescents with liver disease. Meta-analyses showed deficits in total IQ -0.41 (95%CI: -0.51 to -0.32; N: 9,973), verbal IQ -0.38 (95%CI: -0.57 to -0.18; N: 10,284) and receptive language -0.85 (95%CI: -1.16 to -0.53; N: 921) in liver transplantation, and those with native livers who had symptoms early had total and verbal IQ scores (85±8.8; 86.3±10.6 respectively) lower than the scores of those with late manifestations (99.5±13.8; 96.2±9.2). Gross motor skill was reduced -46.29 (95%CI: -81.55 to -11.03; N: 3,746). CONCLUSION: Acute or chronic liver disease can cause declines in cognitive, motor and language functions. Although the scores improve after liver transplantation, children remain below average when compared to healthy children.

RESUMO CONTEXTO: A natureza da doença hepática, curso evolutivo e duração das hepatopatias, bem como grau de severidade e incapacidade podem desencadear desfechos múltiplos e com repercussões na aquisição e desenvolvimento neuromotores. OBJETIVO: Revisar sistematicamente e avaliar por meta-análise os efeitos da doença hepática sobre o desenvolvimento neuropsicomotor de crianças e adolescentes com seus fígados nativos e aquelas que realizaram transplante hepático. MÉTODOS: As buscas foram realizadas nas bases de dados PubMed e periódicos Scopus desde as primeiras publicações na década de 1980 até junho de 2019, de estudos observacionais. Um valor de 0,05 foi considerado significativo. A heterogeneidade estatística do efeito do tratamento entre os estudos foi avaliada pelo teste Q de Cochran e o teste de inconsistência I2, no qual valores acima de 25 e 50% foram considerados indicativos de heterogeneidade moderada e alta, respectivamente. As análises foram realizadas com o Review Manager 5.3. RESULTADOS Vinte e cinco estudos preencheram os critérios de elegibilidade, incluindo 909 crianças e adolescentes com doenças hepáticas. As meta-análises mostraram déficits QI total -0,41 (IC 95%: -0,51 até -0,32; N: 9.973), QI verbal -0,38 (IC 95%; -0,57 até -0,18; N: 10.284) e linguagem receptiva -0,85 IC 95%: -1,16 até -0,53; N: 921) nos transplantes hepáticos e as com fígados nativos que apresentaram sintomas precocemente tinham escores de QI total e verbal (85±8,8; 86,3±10,6 respectivamente) menores do que aquelas com manifestações tardias (99,5±13,8; 96,2±9,2). Habilidade motora grossa apresentou-se reduzida -46,29 (IC 95%: -81,55 até -11,03; N: 3.746). CONCLUSÃO: A doença hepática aguda ou crônica pode determinar declínios nas funções cognitivas, motoras e de linguagem. Muito embora, os escores melhorem após transplante hepático, as crianças continuam abaixo da média quando comparadas às crianças sadias.

Child behavior during the social distancing in the COVID-19 pandemic.

OBJECTIVE: To describe the daily activities performed by children from 6 to 12 years of age incomplete and analyze children's behavior during social distancing in the face of the COVID-19 pandemic. METHODS: Cross-sectional study with children in a learning stage living in Brazil. The data were collected via online form. Fisher's exact test was applied to analyze the association of categorical variables with child behavior; when significant, it was used the odds ratio. It was considered results considered statistically significant those presenting values of p < 0.05. RESULTS: Data from 530 children were analyzed: 50.3% female, 71.3% from the Southeast Region, 73% in fulltime social distancing, 52% presented anxiety, which was significantly associated with changes in sleep and appetite. CONCLUSION: The results indicate the need for parents/caretakers to stimulate moments for the child to express themselves, not minimizing their feelings and providing emotional support to mitigate the negative impact of these feelings on the child's mental and physical health.

Imunizações em pacientes com doenças raras ­ Posicionamento conjunto da Sociedade Brasileira de Imunizações (SBIm), Associação Brasileira de Alergia e Imunologia (ASBAI) e Sociedade Brasileira de Pediatria (SBP) / Immunizations in patients with rare diseases ­ A joint position statement of the Brazilian Society of Immunizations (SBIm), Brazilian Association of Allergy and Immunology (ASBAI), and Brazilian Society of Pediatrics (SBP)

Introdução: De acordo com a Organização Mundial da Saúde, a prevalência de doenças raras (abaixo de 65 casos/100.000 habitantes) é de 6%, e variável na dependência da população em estudo. Há 6.172 doenças raras (DR) catalogadas. Esquemas vacinais específicos para DR não estão disponíveis no Brasil, e esta orientação é limitada na maioria dos países. Objetivos: Identificar e propor esquemas específicos de imunização para pacientes com DR, tendo-se em conta segurança e eficácia. Fonte de dados: Revisão não sistemática da literatura, com busca de artigos de 2000 a 2020 no PubMed, Google Scholar, SciELO e Orphanet usando os termos "rare diseases" ou "inborn errors of metabolism" ou "cystic fibrosis" ou "inborn errors of immunity" e "vaccines" ou "immunization" ou "vaccination", nos idiomas inglês, francês, espanhol e português. Conclusões: A imunização de pessoas com DR é tema complexo, com poucas recomendações publicadas a este respeito, e na maioria das vezes realizada de modo empírico. É importante que a equipe médica que acompanha esses pacientes tenha um olhar abrangente e proporcione a prevenção mais completa possível.

Background: According to the World Health Organization, the prevalence of rare diseases (below 65 cases/100 000 population) is 6% and may vary depending on the study population. There are 6172 rare diseases (RD) listed. RD-specific vaccine schemes are not available in Brazil, and guidance is limited in most countries. Objectives: To identify and propose specific immunization schemes for RD patients, valuing safety and efficacy. Data source: A nonsystematic literature review was conducted, with search for articles from 2000 to 2020 on PubMed, Google Scholar, SciELO, and Orphanet with the terms "rare diseases" or "inborn errors of metabolism" or "cystic fibrosis" or "inborn errors of immunity" and "vaccines" or "immunization" or "vaccination," in English, French, Spanish, and Portuguese languages. Conclusions: Immunization of RD patients is a complex topic with few published recommendations, most often produced empirically. The medical teams following up these patients should have a more comprehensive insight and provide the most complete prevention possible.

Child behavior during the social distancing in the COVID-19 pandemic / Conducta infantil durante el aislamiento social en la pandemia de COVID-19 / Comportamento infantil durante o distanciamento social na pandemia de COVID-19

ABSTRACT Objective: To describe the daily activities performed by children from 6 to 12 years of age incomplete and analyze children's behavior during social distancing in the face of the COVID-19 pandemic. Methods: Cross-sectional study with children in a learning stage living in Brazil. The data were collected via online form. Fisher's exact test was applied to analyze the association of categorical variables with child behavior; when significant, it was used the odds ratio. It was considered results considered statistically significant those presenting values of p < 0.05. Results: Data from 530 children were analyzed: 50.3% female, 71.3% from the Southeast Region, 73% in fulltime social distancing, 52% presented anxiety, which was significantly associated with changes in sleep and appetite. Conclusion: The results indicate the need for parents/caretakers to stimulate moments for the child to express themselves, not minimizing their feelings and providing emotional support to mitigate the negative impact of these feelings on the child's mental and physical health.

RESUMEN Objetivo: Describir las actividades diarias realizadas por niños de 6 a 12 años incompletos y analizar la conducta infantil durante aislamiento social frente a la pandemia de COVID-19. Métodos: Estudio transversal con niños en fase escolar, residentes en Brasil. Los datos recogidos vía formulario online. Para análisis de la relación de variables categóricas con conducta infantil, se aplicó test exacto de Fisher; cuando significante, se utilizó el odds ratio. Considerados resultados estadísticamente significantes valores de p < 0,05. Resultados: Analizados datos de 530 niños: 50,3% del sexo femenino, 71,3% de la Región Sudeste, 73% en aislamiento social integral; 52% presentaron ansiedad, y esta se relacionó significativamente con alteraciones en el sueño y apetito. Conclusión: Resultados apuntan la necesidad de padres/responsables estimularen momentos para el niño expresarse, no minimizando sus sentimientos y proveyendo suporte emocional para atenuarse el impacto negativo de esos sentimientos sobre la salud mental y física del niño.

RESUMO Objetivo: Descrever as atividades diárias realizadas por crianças de 6 a 12 anos incompletos e analisar o comportamento infantil durante distanciamento social diante da pandemia de COVID-19. Métodos: Estudo transversal com crianças em fase escolar, residentes no Brasil. Os dados foram coletados via formulário on-line. Para análise da associação de variáveis categóricas com comportamento infantil, aplicou-se teste exato de Fisher; quando significante, utilizou-se o odds ratio. Foram considerados resultados estatisticamente significantes valores de p < 0,05. Resultados: Analisados dados de 530 crianças: 50,3% do sexo feminino, 71,3% da Região Sudeste, 73% em distanciamento social integral; 52% apresentaram ansiedade, e esta associou-se significativamente com alterações no sono e apetite. Conclusão: Os resultados apontam a necessidade de pais/responsáveis estimularem momentos para a criança se expressar, não minimizando seus sentimentos e provendo suporte emocional a fim de se atenuar o impacto negativo desses sentimentos sobre a saúde mental e física da criança.

Guia prático de aerossolterapia na criança e no adolescente: Documento conjunto da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria / Practical guide to aerosol therapy in children and adolescents: Joint document from the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

A via inalatória é a mais adequada para o tratamento das doenças respiratórias. Muitos fatores influenciam na deposição pulmonar do fármaco inalado, e, consequentemente, no sucesso terapêutico, desde fatores relacionados ao indivíduo, como questões anatômicas das vias aéreas, dinâmica respiratória, doença de base e técnica correta, até situações relacionadas às questões aerodinâmicas das partículas que compõem o aerossol, como o tamanho (diâmetro aerodinâmico mediano de massa) e a homogeneidade das partículas (desvio padrão geométrico). Nos últimos anos os dispositivos inalatórios se aperfeiçoaram, buscando atender às características necessárias que garantam uma deposição pulmonar satisfatória dos fármacos. A escolha do dispositivo inalatório deve ser individualizada, e o conhecimento das particularidades de cada dispositivo e das vantagens e desvantagens instrumentaliza o profissional na decisão, e impacta diretamente no sucesso terapêutico da medicação utilizada.

The inhalation route is the most adequate for the treatment of respiratory diseases. Many factors influence pulmonary deposition of the inhaled drug and, consequently, therapeutic success. They include individual factors such as airway anatomy, respiratory dynamics, underlying disease, and correct technique, as well as factors related to the aerodynamics of aerosol particles such as size (mass median aerodynamic diameter) and homogeneity of the particles (geometric standard deviation). In recent years, inhalation devices have improved to comply with the necessary characteristics that guarantee a satisfactory pulmonary deposition of drugs. The choice of the inhalation device must be individualized, and the knowledge about the features of each device and their advantages and disadvantages instrumentalizes health professionals in the decision and impacts directly the therapeutic success of the medication used.

Effect of working memory load on tactile n-back task / Efeito da carga de memória operacional na tarefa n-back tátil / Efecto de la carga de memoria de trabajo en la tarea táctil n-back

The present study investigated the characteristics of tactile working memory using the N-Back Task. The participants (n = 16), all sighted, performed the task with working memory loads equivalent to maintaining one, two, or three letters in the working memory (N-Back 1, N-Back 2, and N-Back 3). The frequency of commission and omission errors was analyzed as a function of memory load. The results indicate an increase in the frequency of omission errors due to this factor. The working memory load did not significantly influence commission errors. In general, our results suggest that the tactile N-Back task may represent a promising method for the assessment of working memory in blind and sighted participants.

O presente estudo investigou as características da memória de trabalho tátil por meio da Tarefa N-Back. Os participantes (n = 16), todos videntes, executaram a tarefa com cargas mnemônicas equivalentes a manutenção de uma, dois ou três letras na memória de trabalho (N-Back 1, N-Back 2 e N-Back 3). Foram analisadas a frequência de erros de comissão e a omissão em função da carga mnemônica. Os resultados apontam um aumento na frequência dos erros de omissão em função desse fator. As comissões não foram influenciadas significativamente pela carga da memória de trabalho. Em linhas gerais, nossos resultados sugerem que a tarefa N-Back tátil pode representar um método promissor para a avaliação da memória de trabalho em participantes videntes e não videntes.

El presente estudio investigó las características de la memoria táctil de trabajo utilizando la Tarea N-Back. Los participantes (n = 16), todos videntes, realizaron la tarea con cargas equivalentes a una, dos o tres letras en la memoria de trabajo (N-Back 1, N-Back 2 y N-Back 3). Los errores de comisión y omisión se analizó de acuerdo con la carga de trabajo. Los resultados indican un aumento en la frecuencia de errores de omisión debido a este factor. Las comisiones no fueron influenciadas significativamente por la carga de memoria de trabajo. En general, nuestros resultados sugieren que la tarea N-Back táctil puede representar un método prometedor para la evaluación de la memoria de trabajo en participantes videntes y no videntes.