Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus

ABSTRACT Objective: To evaluate sleep characteristics of children and adolescents with type 1 diabetes mellitus (T1DM) and their relationship with glycemic control. Methods: A cross-sectional study was conducted at a public hospital in São Paulo, Brazil. It included 86 patients with T1DM, aged between 10 and 18 years old, who were on insulin therapy, had performed at least three measurements of capillary blood glucose throughout the day, and had normal thyroid function. The clinical, anthropometric, and laboratory data of each patient were evaluated. The Pediatric Daytime Sleepiness Scale (PDSS) and the Munich Chronotype Questionnaire (MCTQ) were used to assess the sleep characteristics. Results: The mean level of glycated hemoglobin (HbA1c) was 9.2±2.1%, and it was higher in adolescents than in children. The mean score of PDSS was 13.9±4.7. Patients with HbA1c<7.5% had lower PDSS scores and longer sleep duration on weekdays than patients with HbA1c≥7.5%. HbA1c levels were negatively correlated with chronotype values and sleep duration on weekdays and positively correlated with social jet lag. Patients who had had T1DM for less than three years had a higher prevalence of daytime sleepiness. The regression analysis showed that higher HbA1c (≥7.5%) and shorter time since the diagnosis of T1DM increased the chance of daytime sleepiness, regardless of age and sex. Conclusions: Patients with higher HbA1c had more daytime sleepiness, a morning chronotype, shorter sleep duration on weekdays and a more significant social jet lag. The shorter diagnosis time for T1DM and greater levels of HbA1c increased the chance of daytime sleepiness.

Clinical characteristics of attention-deficit/hyperactivity disorder in children and adolescents: association with quality of life and behavioral aspects

Objective: To identify associations between clinical characteristics of children with attention-deficit/hyperactivity disorder (ADHD) and their sociodemographic aspects, quality of life, and results from the strengths and difficulties questionnaire. Methods: This is an observational analytical cross-sectional study with a non-probabilistic sample consisting of 72 children diagnosed with ADHD, aged 6 to 13 years, treated at 2 neuropediatric outpatient clinics. The instruments used were the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder – Swanson, Nolan, and Pelham, version IV (MTA-SNAP-IV), the Strengths and Difficulties Questionnaire (SDQ), the Brazilian Economic Classification Criteria (CCEB), and the Quality of Life Assessment Scale for Children and Adolescents (AUQEI). We performed descriptive, bivariate, and multivariate analyses, considering a 5% significance level. Results: SDQ results were associated with abnormal MTA-SNAP-IV results (inattentive/hyperactive/combined). A 1-point increment in the SDQ score increased by 36.5% the likelihood of the child having an abnormal MTA-SNAP-IV classification. Regarding AUQEI, 30.6% of participants perceived their quality of life as poor and 69.4% as good. Conclusions: A higher SDQ score increased the child's chance of having an abnormal MTA-SNAP-IV result.

Congenital anomalies in Santa Catarina: case distribution and trends in 2010–2018

Objective: To evaluate the distribution of cases of congenital anomalies in the state of Santa Catarina by health macro-region, to determine the frequency according to maternal and neonatal variables, to estimate the related mortality, and the trends in the period 2010–2018. Methods: An ecological time-series study with secondary data on congenital anomalies and the sociodemographic and health variables of mothers and newborns living in Santa Catarina, from 2010 to 2018. For temporal trend analysis, generalized linear regression was performed using the Prais-Winsten method with robust variance. Results: The average prevalence of congenital anomalies in the period was 8.9 cases per 1,000 live births, being 9.4 cases by 1,000 live births in 2010 and, in 2018, 8.2/1,000. The trend remained stable in the analyzed period. The major malformations were musculoskeletal, hip, and foot malformations, with a proportion ≥30%. There was a higher prevalence of congenital anomalies in low birthweight, preterm, male livebirths with Apgar≤7, born by cesarean section, mothers of older age (≥40 years), and less educated (less than eight years of study). Infant mortality due to congenital malformations was 2.6 deaths/1,000 live births, representing about 25.8% of the total infant deaths in the period. Conclusions: The frequency of congenital anomalies and the mortality with anomalies was stable in the studied period in Santa Catarina. The presence of anomalies was associated with low birth weight, prematurity, and low Apgar score. The highest proportion of congenital anomalies was in the musculoskeletal system.

Indoor concentrations of particulate matter 2.5 in a pediatric emergency service

Objective: To evaluate air quality in the waiting room of a pediatric emergency service considering the serial concentrations of particulate matter (PM2.5), and to determine if the number of people present in the room can have an influence on the pollutant concentrations. Methods: Cross-sectional study, carried out in the waiting room of a reference pediatric hospital in the city of Porto Alegre, conducted in a one-year period, in a continuous-time sample including all of the four seasons of the year. The monitoring of PM2.5 was performed using a real-time aerosol monitor (DustTrak II). The number of people in the room was determined every hour and the climatic characteristics per daily mean. The concentration of PM2.5 and the number of people were expressed by mean and standard deviation. The means were compared by Analysis of Variance and Pearson's correlation coefficient. Results: There was a significant increase in the concentration of PM2.5 in the autumn, when compared to other seasons (p<0.001). The pollutant increase, in this season, was accompanied by the higher number of people in the emergency room (p=0.026). The association between PM2.5 and the number of people is confirmed by the positive correlation between these two variables (r=0.738; p<0.001). Conclusions: The pediatric emergency waiting room showed elevated PM2.5 in all seasons. The number of people in the room had a positive correlation with the concentration of the pollutant in the environment.

Early neonatal sepsis: prevalence, complications and outcomes in newborns with 35 weeks of gestational age or more

ABSTRACT Objective: To analyze the incidence, complications, and hospital discharge status in newborns with ≥35 weeks of gestational age with early neonatal sepsis. Methods: This is a cross-sectional, retrospective study. Cases of early-onset sepsis registered from January 2016 to December 2019 in neonates with gestational age of 35 weeks or more were reviewed in a level III neonatal unit. The diagnoses were performed based on the criteria by the Brazilian Health Regulatory Agency (Anvisa), and the episodes were classified according to microbiological classification and site of infection. The following complications were evaluated: shock, coagulation disorders, and sequelae of the central nervous system. The conditions at hospital discharge were also assessed. The collected data were analyzed with the descriptive analysis. Results: In the period, early neonatal sepsis occurred in 46 newborns, corresponding to 1.8% of all newborns admitted to the neonatal unit, with a prevalence of 4/1,000 live births. Culture confirmed sepsis ocurred in three patients (0.3/1,000 live births), with the following agents: S. pneumoniae, S. epidermidis and S. agalactiae. As to site of infection, there were 35 cases of primary bloodstream infection, seven cases of pneumonia and four cases of meningitis. Most patients (78.3%) had at least one risk factor for sepsis, and all were symptomatic at admission. There were no deaths. Complications occurred in 28.2% of the cases, especially shock (10 cases – 21.7%). Conclusions: The prevalence of proven early neonatal sepsis was low. Despite the common occurrence of complications, there were no deaths.

Nutritional deviations in children: comparative analysis of data from the food and nutrition surveillance system and those obtained by anthropometrists

ABSTRACT Objective: To compare the prevalence rates of nutritional deviations in children under five years of age according to data from the Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar e Nutricional — SISVAN) and those obtained by trained anthropometrists. Methods: This is a descriptive cross-sectional study based on data from 10 municipalities and 2 sources: i) SISVAN Web (secondary database) and ii) an investigation that evaluated the implementation of food and nutrition actions in the Family Health Strategy in the state of Paraíba (primary database), with 24,137 and 897 individuals, respectively. Proportions of overweight — according to weight/age (W/A), weight/height (W/H), and body mass index/age (BMI/A) — and stunting — according to the height/age (H/A) index — based on classifications of SISVAN Web and those obtained by trained anthropometrists were compared using the two-proportion Z-test. Results: Frequencies of overweight, according to W/A (10.0 vs. 7.8%), W/H (17.2 vs. 14.3%), and BMI/A (18.1 vs. 14.4%), as well as stunting (12.3 vs. 8.6%), were higher on data from SISVAN Web than on those obtained by trained anthropometrists, and the differences were significant. Conclusions: The findings point to distortions in the nutritional classification of children under five years of age monitored by SISVAN Web.

OCULO-AURICULO-VERTEBRAL SPECTRUM ASSOCIATED WITH ABERRANT SUBCLAVIAN ARTERY IN AN INFANT WITH RECURRENT RESPIRATORY DISTRESS

ABSTRACT Objective: To describe an infant with craniofacial microsomia and recurrent respiratory distress associated with aberrant right subclavian artery in order to review its most frequent congenital anomalies and alert the pediatrician to its rarer and more severe complications. Case description: This case report involves an 18-month-old male infant, only son of non-consanguineous parents. At birth, the child presented craniofacial dysmorphisms (facial asymmetry, maxillary and mandibular hypoplasia, macrostomia, grade 3 microtia, and accessory preauricular tag) restricted to the right side of the face. Additional tests showed asymmetric hypoplasia of facial structures and thoracic hemivertebrae. No cytogenetic or cytogenomic abnormalities were identified. The patient progressed to several episodes of respiratory distress, stridor, and nausea, even after undergoing gastrostomy and tracheostomy in the neonatal period. Investigation guided by respiratory symptoms identified compression of the esophagus and trachea by an aberrant right subclavian artery. After surgical correction of this anomaly, the infant has not presented respiratory symptoms and remains under multidisciplinary follow-up, seeking rehabilitation. Comments: Craniofacial microsomia presents a wide phenotypic variability compared to both craniofacial and extracraniofacial malformations. The latter, similarly to the aberrant right subclavian artery, is rarer and associated with morbidity and mortality. The main contribution of this case report was the identification of a rare anomaly, integrating a set of malformations of a relatively common condition, responsible for a very frequent complaint in pediatric care.

Neuropsychomotor development in children born preterm at 6 and 12 months of corrected gestational age

ABSTRACT Objective: To assess the incidence of neuropsychomotor developmental delay at 6 and 12 months of corrected gestational age in children born at 32 gestational weeks or less. Methods: A descriptive and prospective study was carried out at two public maternity hospitals. Between April 2017 and January 2019, we assessed 133 children without any known risk factors for neuropsychomotor developmental delay. The Bayley III scale was used to evaluate cognitive and motor development. The p value of the numerical variables was calculated using the Mann-Whitney test, whereas proportions of categorical variables were compared using the Z-test. Results: The mean maternal age was 26±6.9 years,78.8% were from middle and lower economic classes, and 57.1% of the analyzed children were female. Children presented with a higher incidence of delay at 12 months than at 6 months (10.3 and 2.3% at 12 and 6 months, respectively, for the cognitive score; 22.7 and 12% at 12 and 6 months, respectively, for the composite motor score; and 24.7 and 8.4% at 12 and 6 months, respectively, for the fine motor score). Conclusions: Cognitive and motor developmental delays were significant, with the highest incidence at 12 months. The results of this study encourage further research on this topic, since the exclusion criteria were comprehensive and the delays in neuropsychomotor development were significant.

Anemia and nutritional aspects in adolescent athletes: a cross-sectional study in a reference sport organization

ABSTRACT Objective: To assess the association between anemia and nutritional aspects in adolescent athletes from a large sport club. Methods: This is a cross-sectional study, involving 298 athletes aged between 10 and 17 years, submitted to measurement of skin folds, weight and height, and collection of capillary blood in duplicate to determine hemoglobin values. It was carried out in a random sample composed of athletes from eight sport modalities. Results: Regarding nutritional status, 10.1% of athletes were overweight based on body mass index and 70 (23.5%) athletes had a percentage of body fat classified as high or very high. The prevalence of anemia was 16.4%, being more prevalent in judo (37.1%), basketball (34%) and futsal (20.5%) athletes. Low hemoglobin levels were significantly associated with shorter stature (p=0.006). Conclusions: There was a significant association between anemia and short stature, suggesting that the athlete's height-weight development may be affected in suboptimal conditions of oxygen distribution.

Factors associated with the incomplete opportune vaccination schedule up to 12 months of age, Rondonópolis, Mato Grosso

Objective: To analyze factors associated with the incomplete timely vaccination schedule up to 12 months of age, in children born in 2015, in the municipality of Rondonópolis, Mato Grosso. Methods: Population survey, August/2017 to February/2018, which used the method proposed by the World Health Organization to collect information about routine vaccination. For analysis of the associated factors, the recommendations of the National Immunization Program of the Ministry of Health were considered. Univariate analysis was performed, and the factors associated with p<0.20 entered in the multiple analysis, with hierarchical entry of individual variables and contextual indicator of concentration of the income extremes. Results: The incomplete timely vaccination schedule up to 12 months was 82.03% (95%CI 78.41–86.63). In the final model, the following remained independently associated: having one or more siblings at home (OR 3.18; 95%CI 1.75–5.76) and not receiving a visit from a community health worker in the last 30 days (OR 1.93; 95%CI 1.04–3.57). Conclusions: It is necessary to implement an active search for children with vaccination delay in relation to the recommended interval for each vaccine, in addition to the need to strengthen the link of the family health strategy and child caregivers.