Validation of ROPScore to predict retinopathy of prematurity among very low birth weight preterm infants in a southern Brazilian population / Validação de um escore (ROPScore) capaz de prever a ocorrência da retinopatia da prematuridade em prematuros de baixo peso no sul do Brasil

ABSTRACT Purposes: To evaluate the sensitivity, specificity, and cutoff points for the ROPScore, which is based on cumulative risk factors for the prediction of retinopathy of prematurity (ROP), in a population of very low birth weight (BW) preterm infants in southern Brazil. Methods: The medical records of all preterm infants with a very low birth weight ≤1,500 g and/or gestational age ≤32 weeks screened for retinopathy of prematurity in two Brazilian institutions between August 2009 and December 2015 were retrospectively reviewed. ROPScores were calculated using birth weight and gestational age, the use of oxygen therapy with mechanical ventilation, and weight gain proportional to birth weight, as measured at postpartum week six and the need for blood transfusions. Results: The study cohort included 322 infants with a mean birth weight of 1181.8 ± 292.5 g and mean gestational age of 29.5 ± 2.3 weeks. The incidences of any stage of retinopathy of prematurity and severe retinopathy of prematurity were 68.3% and 17%, respectively. ROPScore values ranged from 8.7 to 19.9. The best cutoff point for sensitivity and specificity was 11 for any stage of retinopathy of prematurity and 14.5 for severe retinopathy of prematurity. For any stage of retinopathy of prematurity, the sensitivity and specificity of the ROPScores were 98.6% (95% confidence interval = 97.9%-99.3%) and 35.3% (95% confidence interval= 32.3%-38.3%), with a positive predictive value of 76.6% (95% confidence interval= 74.0%-79.2%) and a negative predictive value of 92.3% (95% confidence interval= 90.6%-94.0%). For severe retinopathy of prematurity, the sensitivity was 100% and specificity was 57.3% (95% confidence interval= 54.2%-60.4%), with positive predictive value of 22% (95% confidence interval= 19.4%-24.6%) and negative predictive value of 100%. The cutoff points correctly identified all infants that developed severe retinopathy of prematurity in this cohort. Conclusions: The ROPScore was useful to identify preterm babies at risk for retinopathy of prematurity. In this population, the ROPScore detected all patients at risk for any stage retinopathy of prematurity and severe retinopathy of prematurity. The ROPScore values in this study were similar to those previously described, thereby successfully validating the ROPScore for early detection of retinopathy of prematurity in very low birth weight preterm infants.

RESUMO Objetivos: Avaliar a sensibilidade, especificidade e os valores de pontos de corte do ROPScore, um escore baseado em fatores de risco cumulativos capaz de prever a ocorrência da retinopatia da prematuridade em prematuros de baixo peso no sul do Brasil. Métodos: Estudo retrospectivo por meio de análise de prontuários de todos os prematuros com peso ao nascer ≤1500g e/ou idade gestacional ≤32 semanas selecionados para retinopatia da prematuridade em duas instituições brasileiras entre agosto de 2009 e dezembro de 2015. Resultados: O estudo incluiu 322 pacientes. A média do peso ao nascer foi de 1181,8 ± 292,5 gr e a idade gestacional média foi de 29,5 ± 2,3 semanas. A incidência de retinopatia da prematuridade em qualquer estágio e retinopatia da prematuridade grave foi de 68,3% e 17%, respectivamente. Os valores do ROPScore variaram de 8,7 a 19,9. O melhor ponto de corte para sensibilidade e especificidade foi estabelecido em 11 para retinopatia da prematuridade em qualquer estágio e 14,5 para retinopatia da prematuridade grave. Para retinopatia da prematuridade em qualquer estadiamento, o ROPScore apresentou sensibilidade de 98,6% (95%IC 97,9-99,3) e especificidade de 35,3% (95%IC 32,3-38,3), valor preditivo positivo (VPP) de 76,6% (95%IC 74,0-79,2) e valor preditivo negativo de 92,3% (IC95% 90,6-94,0). Para retinopatia da prematuridade grave, foi registrada sensibilidade de 100%, especificidade de 57,3% (95%IC 54,2-60,4), valor preditivo positivo de 22% (95%IC 19,4-24,6) e valor preditivo negativo de 100%. Os pontos de corte identificaram corretamente todos os pacientes que desenvolveram qualquer estágio ou retinopatia da prematuridade grave no estudo. Conclusão: O ROPScore foi importante para detectar pacientes prematuros com risco de retinopatia da prematuridade. Nesta população, o ROPScore detectou todos os pacientes em risco para qualquer retinopatia da prematuridade em estágio e retinopatia da prematuridade grave. Este estudo mostrou valores semelhantes aos descritos anteriormente, validando com sucesso a ROPScore para detecção precoce de retinopatia da prematuridade em prematuros de muito baixo peso.

Validation of ROPScore to predict retinopathy of prematurity among very low birth weight preterm infants in a southern Brazilian population.

PURPOSES: To evaluate the sensitivity, specificity, and cutoff points for the ROPScore, which is based on cumulative risk factors for the prediction of retinopathy of prematurity (ROP), in a population of very low birth weight (BW) preterm infants in southern Brazil. METHODS: The medical records of all preterm infants with a very low birth weight ≤1,500 g and/or gestational age ≤32 weeks screened for retinopathy of prematurity in two Brazilian institutions between August 2009 and December 2015 were retrospectively reviewed. ROPScores were calculated using birth weight and gestational age, the use of oxygen therapy with mechanical ventilation, and weight gain proportional to birth weight, as measured at postpartum week six and the need for blood transfusions. RESULTS: The study cohort included 322 infants with a mean birth weight of 1181.8 ± 292.5 g and mean gestational age of 29.5 ± 2.3 weeks. The incidences of any stage of retinopathy of prematurity and severe retinopathy of prematurity were 68.3% and 17%, respectively. ROPScore values ranged from 8.7 to 19.9. The best cutoff point for sensitivity and specificity was 11 for any stage of retinopathy of prematurity and 14.5 for severe retinopathy of prematurity. For any stage of retinopathy of prematurity, the sensitivity and specificity of the ROPScores were 98.6% (95% confidence interval = 97.9%-99.3%) and 35.3% (95% confidence interval= 32.3%-38.3%), with a positive predictive value of 76.6% (95% confidence interval= 74.0%-79.2%) and a negative predictive value of 92.3% (95% confidence interval= 90.6%-94.0%). For severe retinopathy of prematurity, the sensitivity was 100% and specificity was 57.3% (95% confidence interval= 54.2%-60.4%), with positive predictive value of 22% (95% confidence interval= 19.4%-24.6%) and negative predictive value of 100%. The cutoff points correctly identified all infants that developed severe retinopathy of prematurity in this cohort. CONCLUSIONS: The ROPScore was useful to identify preterm babies at risk for retinopathy of prematurity. In this population, the ROPScore detected all patients at risk for any stage retinopathy of prematurity and severe retinopathy of prematurity. The ROPScore values in this study were similar to those previously described, thereby successfully validating the ROPScore for early detection of retinopathy of prematurity in very low birth weight preterm infants.

Alterações detectadas pelo teste do reflexo vermelho / Ocular findings by using red-reflex testing

Objetivo: A leucocoria é a presença da pupila branca e deve ser investigada e diagnosticada o mais precoce possível. A realização do Teste do Reflexo Vermelho, ao nascimento, permite a triagem de patologias importantes como a catarata congênita e o retinoblastoma. Este estudo tem como objetivo avaliar a prevalência de alterações oculares diagnosticada através do teste do reflexo vermelho em pacientes nascidos em uma maternidade do sul do Brasil. Métodos: Realizado estudo retrospectivo, transversal através da análise de prontuários no período de agosto de 2007 a maio 2011. Foram avaliados 10135 pacientes recém nascidos, antes da alta da maternidade. Todos os pacientes realizaram o teste do reflexo vermelho. Foi considerado alterado o teste em que o reflexo vermelho não esteve presente. Resultados: Foram detectados 4 pacientes com catarata congênita (prevalência de 4/10.000). Também foram observados um caso de coloboma de iris e um caso de albinismo ocular. Conclusão: O estudo concluiu que a prevalência das alterações encontradas corroboram com outros estudos da literatura.

Objetive: Leukocoria is the presence of the white pupil and should be investigated and diagnosed as early as possible . The Red Reflex Test should be done at birth because it allows the screening of important diseases such as congenital cataract and retinoblastoma. This study aims to evaluate the prevalence of ocular abnormalities using the red reflex test in patients born in a maternity hospital in southern Brazil. Methods: Retrospective, transversal study through analysis of medical records from August 2007 to May 2011. We analysed 10135 medical records. All newborn patients were submitted to Red-Reflex examination before leaving the hospital. The testing was considered abnormal when the red reflex was not present. Results: During the period of the study, congenital cataract was detected in 4 patients (prevalence of 4/10.000). We were also observed 1 case of coloboma of iris and 1 case of ocular albinism. Conclusions: The study concluded that prevalence of ocular findings corroborate with other studies in the literature.

Impact of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on childhood pneumonia hospitalizations in Brazil two years after introduction.

INTRODUCTION: Pneumococcal disease is a major public health problem worldwide. From March to September of 2010, 10-valent pneumococcal non-typeable Haemophilus influenzae protein conjugate vaccine (PHiD-CV) was introduced in the Brazilian childhood National Immunization Program (NIP) in all 27 Brazilian states. The aim of the present study is to report national time-trends in incidence of hospital admissions for childhood pneumonia in Brazil before and after two years of introduction of this new pneumococcal conjugate vaccine. METHODS: Analysis of hospitalization data of children aged 0-4 years in Brazilian public health system with an admission diagnosis of pneumonia from 2002 to 2012 was performed comparing pre (2002-2009) and post-vaccination periods (2011-2012). Hospital number of admission due to pneumonia and all non-respiratory diseases were obtained from DATASUS, the Brazilian government open-access public health database system. Incidence of pneumonia hospitalization was compared to incidence of all non-respiratory admissions. RESULTS: Admission rates for pneumonia decreased steadily from 2010 to 2012. In children aged less than four years, incidence of pneumonia hospitalizations decreased 12.65% when pre (2002-2009) and post-vaccination introduction periods (2011-2012) were compared and adjusted for seasonality and secular-trend (p<0.001). On the other hand, non-respiratory admission rates remained stable comparing both periods (p=0.39). CONCLUSION: Childhood pneumonia hospitalization rates were fluctuating prior to 2010 and decreased significantly in the two years after PHiD-CV introduction. Conversely, rate of non-respiratory admissions has shown no decrease. These data are an evidence of the effectiveness and public health impact of this new pneumococcal vaccine.

Perfil epidemiológico dos pacientes acompanhados em um ambulatório de pneumologia pediátrica de hospital terciário / Epidemiologic profile of outpatients followed in a respiratory pediatric center of tertiary hospital

Objetivos: Descrever o perfil epidemiológico dos pacientesacompanhados em um ambulatório de pneumologiapediátrica em um hospital terciário de Joinville, noperíodo entre abril e dezembro de 2009. Métodos: Osdados foram coletados nas consultas de ambulatório decada paciente e foram calculadas medidas de tendênciacentral e prevalências com relação às principais patologias,faixa etária, uso de corticoterapia inalada, presençade tabagismo ativo/passivo dentre outros. Resultados:O principal diagnóstico detectado foi Asma Brônquica,a faixa etária mais acometida pelas patologias em geralfoi abaixo dos quatro anos de idade, quase um terçodos pacientes apresentavam relato de tabagismo ativo/passivo, cerca de 66% dos pacientes utilizava corticoterapiainalada e em sua grande maioria procediam deJoinville. Conclusão: A elevada prevalência de pacientescom asma e tabagimos ativo/passivo reforça a importânciade investimentos na capacitação de pediatras geraispara seguimento desta condição, bem como necessidadeurgente de ampliação dos programas municipais de tratamentode doenças crônicas como a asma pediátrica epolíticas de controle do tabagismo.

Objectives: To describe the profile of outpatients clinicsof a respiratory pediatric Center in Joinville, from Aprilto December 2009 Methodology: Data were obtained ineach visit and frequencies and means were then calculated.The main variables were: principal diagnosis, age,continuous therapy with inhaled corticosteroids, active/passive smoking Results: Asthma was the commonestdisease, children under 4 years were the most affectedgroup, almost one third of the patients had a smokinghistory, 66% used continuous inhaled corticosteroid andthe almost all were from Joinville Conclusions: The highprevalence of Asthma and smoking history reflects theimportance of develop a specific approach to generalpediatrics, as the urgent improvement in health publicprograms of chronic diseases and cessation strategies ofsmoking.

Cellular composition of induced sputum in healthy adults.

OBJECTIVE: To establish reference values for cellularity in induced sputum samples collected from healthy adults. METHODS: Induced sputum samples were obtained from 88 healthy adult never-smokers (39 males). The mean age was 36 years (range, 18-68 years). The participants had been residing in the city of Florianópolis, Brazil (a medium-sized non-industrial city) for at least two years. After the samples had been processed, we obtained total and differential cell counts. RESULTS: The mean total cell count was 4.8 ± 4.2 × 10(6) cells/g. There was a predominance of macrophages (mean, 77.5 ± 14.7%) and neutrophils (mean, 23.4 ± 14.3%). Eosinophils were virtually absent (mean, 0.1 ± 0.3%). Lymphocytes and bronchial epithelial cells were scarce. Neither age nor atopy had any effect on the total or differential cell counts. CONCLUSIONS: In the induced sputum of this healthy adult population, macrophages and neutrophils predominated. However, the proportion of neutrophils was lower than that reported in previous studies, which suggests that reference values might vary depending on geographic location.

Composição celular do escarro induzido em adultos saudáveis / Cellular composition of induced sputum in healthy adults

OBJETIVO: Estabelecer valores de referência para a celularidade de amostras de escarro induzido coletadas de indivíduos adultos saudáveis. MÉTODOS: O escarro induzido foi obtido de 88 adultos saudáveis que nunca fumaram (39 homens) com média de idade de 36 anos (variação: 18-68 anos) residentes há pelo menos dois anos em Florianópolis, uma cidade brasileira não industrial e de tamanho médio. As amostras foram processadas, e foi realizada a contagem total e diferencial das células. RESULTADOS: A média da contagem celular total foi de 4,8 ± 4,2 × 10(6) células/g. Houve predomínio de macrófagos (média de 77,5 ± 14,7 por cento) e de neutrófilos (média de 23,4 ± 14,3 por cento). Os eosinófilos estiveram virtualmente ausentes (média de 0,1 ± 0,3 por cento). A proporção de linfócitos e de células broncoepiteliais foi pequena. Não houve efeito da idade ou de atopia sobre a contagem celular total ou diferencial. CONCLUSÕES: Nesta população de indivíduos saudáveis, macrófagos e neutrófilos foram as células predominantes no escarro induzido. Contudo, a proporção de neutrófilos foi inferior à previamente relatada, sugerindo que os valores de normalidade podem variar de acordo com o local onde ele é amostrado.

OBJECTIVE: To establish reference values for cellularity in induced sputum samples collected from healthy adults. METHODS: Induced sputum samples were obtained from 88 healthy adult never-smokers (39 males). The mean age was 36 years (range, 18-68 years). The participants had been residing in the city of Florianópolis, Brazil (a medium-sized non-industrial city) for at least two years. After the samples had been processed, we obtained total and differential cell counts. RESULTS: The mean total cell count was 4.8 ± 4.2 × 10(6) cells/g. There was a predominance of macrophages (mean, 77.5 ± 14.7 percent) and neutrophils (mean, 23.4 ± 14.3 percent). Eosinophils were virtually absent (mean, 0.1 ± 0.3 percent). Lymphocytes and bronchial epithelial cells were scarce. Neither age nor atopy had any effect on the total or differential cell counts. CONCLUSIONS: In the induced sputum of this healthy adult population, macrophages and neutrophils predominated. However, the proportion of neutrophils was lower than that reported in previous studies, which suggests that reference values might vary depending on geographic location.

Feasibility of spirometry in preschool children.

OBJECTIVE: To determine the rate at which satisfactory spirometry results are obtained (spirometry success rate) in preschool children. METHODS: We analyzed the spirometry results of children ≤ 6 years of age. All tests were conducted between June of 2009 and February of 2010 in the Pulmonary Function Laboratory of the Hospital Infantil Jeser Amarante Faria, located in the city of Joinville, Brazil. The spirometry program employed features an animated incentive (soap bubbles). The procedures were performed by a pediatric pulmonologist, in accordance with the reproducibility and acceptability criteria recommended by the American Thoracic Society. We attempted to achieve an expiratory time of at least 1 s. The following parameters were measured: FVC, FEV0.5, FEV1, and the FEV1/FVC ratio. RESULTS: Our sample comprised 74 children. The spirometry success rate was 82%. Although the performance improved with age, the difference between younger and older children was not significant (p > 0.05). An average of 6.6 attempts/test were needed in order to achieve acceptable, reproducible curves. All 61 successful tests produced satisfactory FEV0.5 and FEV1 values. By calculating Z scores, we found that 21.6% of the children presented with an obstructive pattern. CONCLUSIONS: In our sample, the spirometry success rate was high, showing that spirometry is a valid method for assessing pulmonary function in preschool children. The high success rate in our sample might be attributable to the use of an incentive and to the fact that the tests were performed by professionals specializing in pediatrics.

Viabilidade da realização de espirometria em pré-escolares / Feasibility of spirometry in preschool children

OBJETIVO: Determinar a taxa de sucesso na obtenção de resultados adequados de espirometria em pacientes pré-escolares. MÉTODOS: Foram analisados os resultados de espirometrias de crianças menores que 6 anos. Todos os testes foram realizados no Laboratório de Função Pulmonar do Hospital Infantil Jeser Amarante Faria, em Joinville (SC) entre junho de 2009 e fevereiro de 2010. O programa utilizado continha um incentivo de animação (bolhas de sabão).Os procedimentos foram realizados por um pneumologista infantil e obedeceram aos critérios de reprodutibilidade e aceitabilidade preconizados pela American Thoracic Society. Buscou-se atingir um tempo expiratório de pelo menos 1 s. Os seguintes parâmetros foram registrados: CVF, VEF0,5, VEF1 e relação VEF1/CVF. RESULTADOS: Nossa amostra consistiu de 74 crianças. A taxa de sucesso foi de 82 por cento, com melhora no desempenho do teste em idades mais avançadas, mas sem significado estatístico (p > 0,05). Em média, foram necessárias 6,6 tentativas durante o exame para a obtenção de curvas aceitáveis e reprodutíveis. Todos os 61 testes bem sucedidos tiveram resultados de VEF0,5 e VEF1 satisfatórios. Através de escore Z, constatou-se que 21,6 por cento das crianças apresentavam com padrão obstrutivo. CONCLUSÕES: A taxa de sucesso da espirometria foi alta em nossa amostra, mostrando que esse é um método válido de avaliação da função pulmonar em pré-escolares. O uso de métodos de incentivo e a realização do teste por profissionais treinados no trabalho com crianças podem estar associados à elevada taxa de sucesso em nossa amostra.

OBJECTIVE: To determine the rate at which satisfactory spirometry results are obtained (spirometry success rate) in preschool children. METHODS: We analyzed the spirometry results of children < 6 years of age. All tests were conducted between June of 2009 and February of 2010 in the Pulmonary Function Laboratory of the Hospital Infantil Jeser Amarante Faria, located in the city of Joinville, Brazil. The spirometry program employed features an animated incentive (soap bubbles). The procedures were performed by a pediatric pulmonologist, in accordance with the reproducibility and acceptability criteria recommended by the American Thoracic Society. We attempted to achieve an expiratory time of at least 1 s. The following parameters were measured: FVC, FEV0.5, FEV1, and the FEV1/FVC ratio. RESULTS: Our sample comprised 74 children. The spirometry success rate was 82 percent. Although the performance improved with age, the difference between younger and older children was not significant (p > 0.05). An average of 6.6 attempts/test were needed in order to achieve acceptable, reproducible curves. All 61 successful tests produced satisfactory FEV0.5 and FEV1 values. By calculating Z scores, we found that 21.6 percent of the children presented with an obstructive pattern. CONCLUSIONS: In our sample, the spirometry success rate was high, showing that spirometry is a valid method for assessing pulmonary function in preschool children. The high success rate in our sample might be attributable to the use of an incentive and to the fact that the tests were performed by professionals specializing in pediatrics.

Perfil epidemiológico de pacientes pediátricos internados com pneumonia / Epidemiological profile of pediatric in patients with pneumonia

Objetivos: descrever o perfil clínico-epidemiológico de pacientes pediátricos internados por pneumonia.Métodos: estudo transversal que incluiu pacientes menores de 18 anos, internados com pneumonia entre janeiro e dezembro de 2009, em um hospital pediátrico de Joinville, Santa Catarina, na região sul do Brasil. Foram analisadosdados demográficos, calendário vacinal, exposição a tabagismo ativo/passivo, duração e mês da internação, passagem pela unidade de tratamento intensivo, uso de ventilação mecânica, desfecho, diagnóstico principal, alteração radiológica principal, uso de antibiótico, uso de oxigênio suplementar, procedência do paciente e coleta de hemocultura.Resultados: em 2009 foram internadas 93 crianças e adolescentes com pneumonia, com predomínio do sexo masculino (2:1), em sua maioria procedentes de Joinville. A idade média dos pacientes foi de 3,1 anos (mediana 2 anos). A duração média das internações foi de 7,5 dias, sendo maior nos pacientes com passagem pela unidade de tratamento intensivo.O período de junho a agosto foi o período com maior número de internações (34,4%). O antibiótico mais usado foi penicilina cristalina e a principal alteração radiológica encontrada foi condensação alveolar em lobo superior direito.Em 27% dos pacientes foi necessário uso de oxigênio suplementar e 9% tiveram passagem pela unidade de tratamento intensivo. Seis pacientes (6,7%) apresentaram derrame pleural. Em 56% dos pacientes internados com pneumonia não houve coleta de hemocultura e em nenhuma das culturas coletadas houve crescimento bacteriano.Conclusões: houve um predomínio das internações por pneumonia no período do inverno e em pacientes do sexo masculino, com baixa taxa de complicações, como derrame pleural. A ausência de positividade nas hemoculturas, bem como o baixo índice de solicitação das mesmas, alertam para a necessidade de incentivo para criação de protocolos e capacitação dos pediatras envolvidos no atendimento desses pacientes.

Objectives: to describe the epidemiologic and clinical profile of children hospitalized by pneumonia.Methods: A cross-sectional study included patients younger than 18 years, hospitalized with pneumonia between January and December 2009 in a pediatric hospital in Joinville, Santa Catarina, in southern Brazil. Demographic data, immunization schedule, tobacco exposure, length of stay, need of intensive care and/or mechanical ventilation, outcomes, clinical diagnosis, radiological findings, use of antibiotics and oxygen, patient origin and the need of blood cultures have been analyzed.Results: In 2009, 93 children and adolescents were hospitalized with pneumonia, predominantly male (2:1), mostly coming from Joinville. The average age of patients was 3.1 years (median 2 years). The length of hospitalization was 7.5 days, increasing in patients with passage through the intensive care unit. In the period from June to August occurred the highest number of admissions (34.4%). The most commonly used antibiotic was penicillin and the main radiology finding was alveolar condensation in the right upper lobe. Twenty seven per cent of patients required supplemental oxygen and 9% were admitted to the intensive care unit. Six patients (6.7%) had pleural effusion. Blood cultures were not performed in 56% of admitted patients and no bacterial growth was detected in those collected.Conclusions: the admissions were more frequent in winter season, with male predominance and low rates of complications, as pleural effusions. The low rates of blood cultures collected and its negative results suggest the need for local guidelines and continuous training of pediatric physicians.

Características de crianças hospitalizadas com asma grave no sul do Brasil / Characteristics of children hospitalized with severe asthma in southern Brazil

Objetivos: descrever a casuística de internações pediátricas por asma, discutindo fatores clínicos e epide-miológicos.Métodos: foi realizado um estudo transversal, retrospectivo, sobre as internações por asma aguda em pacientes menores de 18 anos, de janeiro a dezembro de 2009, no Hospital Infantil Jeser Amarante Faria, de Joinville, Santa Catarina. Foram revisadas as características dos pacientes, dados da internação, medicações utilizadas e desfechos nesse período.Resultados: durante o período estudado foram internadas 74 crianças com asma grave, cuja idade média foi de 3,2 anos (desvio padrão 2,8), sendo 59,5% do sexo masculino. Verificou-se que 12% das crianças utilizavam profilaxia com corticóide inalado regularmente e 21% faziam acompanhamento com pneumologista infantil. A duração média das internações foi de seis dias (desvio padrão 7,8), com período máximo de 50 dias. A maior parte das internações aconteceu no mês de agosto (28,4%). No inverno foram constatadas 32 internações (43,2%). Houve um óbito no período.Conclusões: a principal faixa etária dos pacientes internados por exacerbação de asma foi abaixo de três anos, com predomínio do sexo masculino e frequência aumentada no inverno. Constatou-se baixo índice de acompanhamento ambulatorial e uso de medicação preventiva. O seguimento preventivo, educação em asma e uso de profilaxia com corticóides inalados deve ser incentivado para diminuir as taxas de hospitalização por asma no Brasil.

Aims: To describe the cases of pediatric hospitalizations for asthma, discussing clinical and epidemiological factors involved.Methods: A retrospective cross-sectional study of hospitalizations in patients younger than 18 years of age, with acute asthma, between January and December 2009, at Hospital Infantil Jeser Amarante Faria, from Joinville, Santa Catarina, Brazil, was performed. Characteristics of the patients, hospitalization data, medications, and outcomes were recorded.Results: Seventy-four children were hospitalized with severe asthma, with a median age of 3.2 years (SD: 2.8), and of whom 59.5% were male. We observed that 12% of children used regular therapy with inhaled corticosteroids and 21% had outpatient follow-up with a pediatric pulmonologist. The median length of hospital stay was six days (SD: 7.8), with a maximun of 50 days. Most hospitalizations occurred in August (28.4%). Thirty-two hospitalizations (43.2%) occurred in winter. There was one death in the study period.Conclusions: There was a predominance of hospitalizations in children under three years and the incidence was increased in winter. Low rates of outpatient regular follow-up and use of preventive medication were found. Preventive therapy and educational programs must be encouraged to decrease the incidence of pediatric hospitalization for asthma in Brazil.

Use of virtual bronchoscopy in children with suspected foreign body aspiration.

Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children, especially in those under three years of age. Preliminary radiological evaluation reveals normal chest X-rays in nearly 30% of such patients. Tomography-generated virtual bronchoscopy (VB) can facilitate the early diagnosis and rapid management of these cases. The definitive treatment is the removal of the foreign body by means of rigid bronchoscopy under general anesthesia. The objective of this study was to describe the use of VB in two patients with suspicion of FBA, as well as to review the literature regarding this topic. The two patients presented with sudden onset of respiratory symptoms and history of cough or choking with foods before these symptoms. Both patients were submitted to VB. In both cases, we detected an endobronchial foreign body, which was then removed by conventional rigid bronchoscopy in one of the cases. Only recently developed, VB is a noninvasive imaging method that has potential for use in detecting foreign bodies in the airways of children. In select cases, VB can indicate the exact location of the foreign body and even preclude the need to submit patients to rigid bronchoscopy in the absence of a foreign body.

Uso da broncoscopia virtual em pacientes pediátricos com suspeita de aspiração de corpo estranho / Use of virtual bronchoscopy in children with suspected foreign body aspiration

A aspiração de corpo estranho (ACE) para o trato respiratório é um problema comum em pacientes pediátricos, em especial abaixo dos três anos de idade. Na avaliação radiológica inicial, cerca de 30 por cento dos pacientes apresentam radiograma de tórax normal. A tomografia com broncoscopia virtual (BV) pode auxiliar no diagnóstico precoce desse quadro e seu pronto manejo. O tratamento definitivo se dá com a retirada do corpo estranho através de broncoscopia rígida e mediante anestesia geral. O objetivo deste trabalho foi descrever o uso da BV na abordagem de dois pacientes com suspeita de ACE e realizar uma revisão da literatura sobre este tópico. Os dois pacientes tiveram início súbito de sintomas respiratórios e relato de tosse ou engasgo com alimentos antecedendo o quadro. Os pacientes foram submetidos à BV, e foi detectada a presença de corpo estranho endobrônquico em ambos os casos, com remoção posterior por broncoscopia rígida convencional em um caso. A BV é um método não-invasivo recente e com potencial para detectar a presença de corpo estranho na via respiratória em crianças. Em casos selecionados, BV pode auxiliar na localização correta do corpo estranho e até mesmo evitar o procedimento de broncoscopia rígida na ausência de corpo estranho.

Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children, especially in those under three years of age. Preliminary radiological evaluation reveals normal chest X-rays in nearly 30 percent of such patients. Tomography-generated virtual bronchoscopy (VB) can facilitate the early diagnosis and rapid management of these cases. The definitive treatment is the removal of the foreign body by means of rigid bronchoscopy under general anesthesia. The objective of this study was to describe the use of VB in two patients with suspicion of FBA, as well as to review the literature regarding this topic. The two patients presented with sudden onset of respiratory symptoms and history of cough or choking with foods before these symptoms. Both patients were submitted to VB. In both cases, we detected an endobronchial foreign body, which was then removed by conventional rigid bronchoscopy in one of the cases. Only recently developed, VB is a noninvasive imaging method that has potential for use in detecting foreign bodies in the airways of children. In select cases, VB can indicate the exact location of the foreign body and even preclude the need to submit patients to rigid bronchoscopy in the absence of a foreign body.

Tuberculose com apresentação inicial de eritema nodoso em criança: relato de caso e revisão da literatura / Tuberculosis presenting as erythema nodosum in childhood: case report and review of literature

Objetivos: o eritema nodoso é uma rara manifestação dermatológica em crianças, em especial quando secundário à tuberculose, tendo sido descritos somente três casos na população pediátrica brasileira. Este relato refere-se a uma criança com apresentação inicial de eritemanodoso e diagnóstico concomitante de tuberculose. Descrição do caso: um paciente masculino com oito anos de idade foi hospitalizado para tratamento de nódulos eritematosos em ambas as pernas, com diagnóstico inicial de celulite. Exames radiológicos elaboratoriais eram normais. Apresentava história de contato com um adulto com diagnóstico recente de tuberculose. O teste tuberculínico mostrou reator forte.Recebeu terapia tríplice para tuberculose e evoluiu com importante melhora clínica. Conclusões: apesar de infrequente em nosso meio, a associação entre eritema nodoso e tuberculose deve ser suspeitada através do exame clínico e da anamnese minuciosos. É preciso pesquisar outras possíveis causas para essa manifestação dermatológica, que pode apresentar várias etiologias cujo tratamento já é bem estabelecido.São necessários mais estudos para aperfeiçoar a abordagem e gerar mais evidências no seu manejo na infância.

Aims: Erythema nodosum is a rare dermatologic condition in children, especially when associated with tuberculosis. There are only three cases described in brazilian pediatric population. This case describes a child with signs of initial erythema nodosum and concomitant diagnosis oftuberculosis. Case description: A male child, eight years-old, was hospitalized to treat erythematous nodules in both legs, with a first hypothesis of cellulitis. Laboratory and radiologic exams were normal. The child had close contact with an adult with recent tuberculosis diagnosis. Tuberculin testwas positive. The patient received adequate triple antituberculosistherapy and had significant improvement.Conclusions: Despite of its low frequency, the association between erythema nodosum and tuberculosis must be considered through a detailed anamnesis and physical examination. It is necessary to investigate other conditions associated with this dermatologic manifestation, since different etiologies have specific approaches. Further studies are required to better understand this illness and the treatment of this condition in childhood.

Broncoscopia flexível em recém-nascidos / Flexible bronchoscopy in newborns

Objetivos: descrever a casuística de broncoscopia flexível realizada em recém-nascidos com obstrução das vias aéreas superiores, discutindo suas indicações, riscos e benefícios. Métodos: estudo retorspectivos sobre os casos de broncoscopia flexível realizada em recém-nascidos (idade = 30 dias) com suspeita de obstrução das vias aéreas superiores, entre abril de 1998 e dezembro de 2005. Foram revisadas as características dos pacientee, indicações, complicações e resultados dos procedimentos realizados durante esse período. Resultados: foram realizados 29 exames de broncoscopia flexível em pacientes recém nascidos, nos quais predominou o sexo masculino (2:1). A principal indicação do exame foi estridor congênito (12 pacientes) e o principal achado foi laringomalacia (14 pacientes, 48,2 dos casos). Faringomalacia foi diagnosticada em cinco pacientes (17,2), associada com estenose subglótica em dois casos em dois casos. Não houve nehuma complicação significativa decorrente do procedimento. Conclusões: o principal achado em broncoscopia flexível nos recém-nascidos com obstrução de vias aéreas superiores. Tais anormalidades apresentam uma prevalência elevada nesse grupo de pacientes, devendo ser ser sempre incluídas no diagnóstico diferencial de broncoscopia flexível no período neonatal deve ser intenincentivado, pois, além de apresentar baixo risco de complicações, pode excluir doenças de pior prognóstico das vias aéreas e contribuir com mudanças de conduta terapêutica.