Pediatric Research and Reviews

  • Non-Contact Respiratory Rate Monitoring with raybaby in an NICU: An Observational Study

    Objectives: This study aimed at evaluating the reliability of respiratory rate obtained by a non-contact technology with respect to a medically validated monitor among preterm babies. Design: This observational study compared the respiratory rates from raybaby’s non-contact technology and FDA approved Earlysense unit for the same instants of time through 760 hours of monitoring. 18 preterm babies in the NICU of a paediatric specialty hospital in India were considered for the study. The raybaby device was installed in front of the incubator and the contact-free FDA approved device was placed below the mattress of the incubator. The Respiratory Rate monitored was displayed on the device’s monitoring screen. Respiratory rates from both devices were compared to calculate the agreement between the values. Correlation, Accuracy, Hit Percentage and Fit Curves for the non-contact technology of raybaby with respect to the clinically certified device. Results: With 760 hours of monitoring, 37404 breathing instances were analysed. This yielded an accuracy of 98%. 95% of the data points fell within the +/- 5 units error range which is usually followed by medical devices. Conclusions: Raybaby uses a non-contact technology for monitoring Respiratory Rate. The average breathing rate observed was 33 to 43 breaths per minute, which falls within the breathing range of 30-60 breaths per minute. From the 37404 data points analysed, raybaby® establishes further proof for the breathing range and trend found in babies. The accuracy of non-contact technology for respiratory monitoring establishes great potential for making health monitoring less intrusive and efficient for use. This renders the technology as a hopeful tool for respiratory monitoring to deploy at observation units during the pandemic.

  • Importance of Psychoanalysis of Childhood Drawings for Prediagnosis of Mental Diseases

    Psychoanalysis and its application in the biological area. The area of Psychology already presents a lot of research in the context, looking for artificial and laboratory situations; however, the importance of contextual analysis of the individual as a whole, of their daily activities and, from this, the understanding of their perceptions. Through psychoanalysis it is possible to observe widely the subject as a whole, not focusing on the presence of organic or genetic disorders, Ansermet (2003) addresses this problem by stating that “We cannot see the subject only as someone who manifests an organic or mental defect, according to the logic of disability”. The systems that compose and organize the environment, according to Bronfenbrenner (1996), are constituted by the fitting of concentric structures called microsystem, what presents itself as the most active and direct contact environments, such as family, school or social work relationships; mesosystem referring to two or more environments of active social participation; exosystem, understood as environments that influence events that take place in the immediate environment of social relationship; and macrosystem, which comprise, in addition to the behavior of individuals, the connections between other people, the nature of bonds and the direct or indirect influence on the developing individual in the contexts in which they live and act actively. The use of psychoanalysis as a tool to decipher possible mental disorders has become essential, since it is intrinsically linked to the biological look for the diagnosis of a patient. Autism, attention deficit disorder, depression and hyperactivity (ADHD), among other diseases that can be diagnosed during childhood or late they are psychosocial disorders that have their diagnoses complemented by psychoanalysis. In this way, it is possible to perceive the challenges that psychoanalysis faces in terms of complementing the diagnosis of mental disorders in children, as well as the…

  • Consequences of Covid 19 Pandemic on Children

    The Pandemic of SARS COV 2 popularly known as ‘Corona Virus19’ has affected 213 countries and territories around the world since the beginning of year 2020. All the countries have focused their attention acutely on the higher fatality rate the virus has caused among the elderly and launched a scientific enquiry on why children have emerged relatively unaffected. This pandemic has already amplified existing social fractures and inequalities and it is expected that all most all countries may take 5-10 years to return to their socio-economic status of 2019. Most importantly people are losing trust in healthcare system. As the Global tally of cases crosses 28 million cases and nearly 0.9 million deaths on 10th September 2020, with the highest daily case of 300,683 on 4 September 2020 and deaths of 8513 on 17 April 2020. However, the proportion or absolute number of cases and deaths in children is not readily available at Global, National, or even at local levels. In the beginning it was estimated that the children under 14 years contributed less than 0.5% and therefore the Children were not the face of this pandemic. The sub-national data in states reporting desegregated data in USA and India indicate that the children contribute between 0.1% to 10% in the recent weeks. The pandemic of COVID-19 initially appeared to cause only a mild illness in children and immediate health impact, or mortality rates were not alarming. A few weeks following the peak of COVID-19 epidemic in the US and the European Union, a novel systemic illness called Multisystem inflammatory syndrome in children (MIS-C) has been reported with devastating effect. Most importantly children’s risk being among its biggest victims, their lives are being changed in profound ways. What has escaped our attention is the long-term damage the cascading effect of COVID-19…

  • The Use of a Rapid Fluid Infusion System in Children

    Fluid resuscitation is the cornerstone of treatment for pediatric shock caused by conditions such as sepsis, dehydration, trauma, and anaphylaxis. Children presenting to the Emergency Department (ED) in shock have a high risk of mortality, and each hour of delay in shock reversal doubles the odds of death1,2. Pediatric Advanced Life Support (PALS) guidelines emphasize the importance of providing rapid fluid resuscitation to prevent the progression to hypotensive or refractory shock3. PALS and other septic shock guidelines recommend that patients receive a 20 mL/kg bolus of crystalloid immediately upon recognition of hypovolemic or distributive shock, with 20 mL/kg to be delivered within 5 minutes and up to 60 mL/kg within the first 15-60 minutes3-6. Studies based on these guidelines show that earlier fluid delivery directed at reversal of shock reversal leads to decreased morbidity7-9, mortality2,7,9-12, and hospital length of stay (LOS)9,11-13. Unfortunately, timely fluid delivery is often not achieved due to the technical challenges of obtaining adequate vascular access and delivering fluid boluses quickly in patients with shock or hypotension11,14-16. Current methods of fluid bolus delivery in the pediatric emergency care setting include infusion pumps, gravity drip, pressure bags, rapid infusers, and the push-pull syringe technique17,18. Each of these methods are limited by speed, ease of use, or safety concerns. Infusion pumps provide a maximum rate of 999 mL per hour, which for a 25kg child would provide a 60 mL/kg bolus in 90 minutes. In most patients, infusion pumps are therefore too slow to provide adequate fluid resuscitation. Gravity drip rates are unpredictable and inadequate for the treatment of shock and hypotension. For example, up to 50 minutes are required for one liter of fluid to flow through a 22G intravenous (IV) line, and up to 200 minutes via the intraosseous (IO) route19-22. A pressure cuff may speed flow…

  • Maternal obesity and first trimester iodine levels are associated with the risk of congenital malformations in Assam, Northeast India

    Purpose of the study: To assess body mass index (BMI) and trimester specific iodine status among pregnant women of Assam and study their association with congenital malformations (CM). Methods: Anthropometric, obstetric and socioeconomic data was obtained from pregnant women and apparently healthy women attending Assam Medical College and Hospital, Dibrugarh. Urinary iodine (UI) level was estimated in each trimester. BMI was classified based on Asian criteria suggested by WHO and the iodine intake was classified using WHO reference medians. Student’s t-test and univariate logistic regression analysis were used to determine the risk factors. Results: 156 pregnant women (age 18-35 years) and 160 controls were enrolled in the study. 55.8% pregnant women were underweight and 3.8% were overweight. Malformations were observed in 16 babies. The median urinary iodine concentration (MUIC) of pregnant women in their 1st trimester was 170 µg/l (IQR 100 µg/l) which increased to 275 µg/l (IQR 166 µg/l) during the 2nd trimester and decreased to 265 µg/l (IQR 160 µg/l) at the 3rd trimester. In the univariate analysis, maternal BMI > 23 kg/m2 (OR 3.67, 95% CI 0.20-67.65) and MUIC

  • Nutritional Disorders: Infant Protein-Energy Malnutrition

    Malnutrition is characterized as a deficiency of food and nutrients, mainly affecting children of preschool age (up to 5 years). Responsible for 30% of the world’s child deaths, malnutrition can compromise the child’s physical and mental development. The objective of this study was to present, through a literature review, information on energy-protective malnutrition; to expose the effects of malnutrition on the development and growth of the child and the immune system. Consequently, to discuss ways of diagnosis and treatment in order to reduce the high rates of child morbidity caused by malnutrition.


    Introduction: Drug poisonings arise due to complex mechanisms and the high rate of these events in our country is multifactorial, among them a wide variety of formulations, the proliferation of drugstores, prescription errors and pharmaceutical dispensing, allied to a weakness in the ability to supervise. Objective: To evaluate the occurrence of drug poisoning in children, identifying the main classes and factors involved. Methodology: This was a descriptive study, such as literature review. The following search descriptors “intoxication”, “medicines” and “children” were searched, integrated in the SCIELO and MEDLINE databases. Results: Cases of drug poisoning in children aged 0 to 9 years represent 33% of the total cases. Although the main cause is attempted suicide in the child population, the highest incidence was due to accidents, or after a medical prescription, with errors in administration. The main drugs involved were nasal decongestants, bronchodilators, analgesics and anti-inflammatories. Conclusion: The occurrence of drug intoxications is frequently recorded in health systems, and the percentages are higher in children, so it is of utmost importance that the teaching about the use of medicines is carried out from the earliest years of life.


    Introduction: Gene signaling is an essential input for successful embryonic events. Through gene transport pathways, such as the Wnt / β-catenin pathway, embryonic developments are orchestrated harmoniously with the other physiological functions. Objective: This is an integrative literature review in order to analyze the scientific evidence the participation of the Wnt family in embryonic events. Methodology: An extensive review was performed on the Lilacs, PubMed and SciELO databases with full articles published in Portuguese, English and Spanish. Results and Discussion: Wingless (Wnt) belongs to the group of molecular flags, from a family of genes that act in various embryonic processes. The phenotypes of mutant embryos revealed that these genes act on the morphogenesis of numerous tissues and organs. Wnts are part of a family of signaling proteins and participate in autocrine and paracrine mechanisms, determination of gonads, cancer, glioblastoma, as well as the pathway involved in cellular communication, environmental micro-modulation and immune response. Conclusion: Cellular and molecular events depend on signaling pathways that are controlled by the Wnt family of genes, which participate in prenatal and postnatal embryonic events.


    INTRODUCTION: Epstein’s pearls and Bohn’s nodules are characterized as inclusion cysts of the newborn, resulting from epithelial remnants that were trapped during the fusion of palatal processes. They are asymptomatic and transient cystic lesions and, therefore, do not require treatment by means of drugs or surgical intervention. This issue is problematic, since dental or pediatric professionals find it difficult to accurately identify and diagnose the cyst, failing to inform parents who are often distressed to realize the pathology. OBJECTIVE: The purpose of this paper is to develop an integrative literature review to analyze whether, in fact, Bohn’s nodules and Epstein pearls are the most common congenital oral lesions in newborns. METHODOLOGY: Articles indexed in SciELO, PubMed / Medline and Lilacs. The keywords used were: Epstein’s pearls, Bohn’s nodules, newborn, prevalence, palatine cysts, gingival cysts. As inclusion criteria, complete articles published in the last 10 years, in the Portuguese and English languages and that answered the research question. We found 23 articles and after applying the inclusion criteria, we selected 17 articles, 9 of which formed the present abstract, using them to explore the content. RESULTS AND DISCUSSION: Epstein’s pearls and Bohn’s nodules appeared in the literature as high frequency oral abnormalities among newborns. The data obtained in the base articles took age, location and gender as criteria, with differences between their percentages. Despite this dissonance, research has always resulted in about 50% more cases, compared to other congenital oral abnormalities. Thus, there is a comparative table between the studies that shows the results more easily in order to make explicit the prevalence of these cystic oral lesions. No evidence was found on causes related to these pathologies, only embryological origin, and further research is needed. CONCLUSION: Based on the findings, it is noticeable the prevalence of Epstein Pearls and Bohn’s…


    Background: Child hospitalization has a direct impact on the life of children who move away from a school, leisure and social routine, experiencing biopsychosocial repercussions. University extension projects in the hospital context can contribute to humanization and mental health prevention actions, as well as to develop professional skills of undergraduate health extension students. Objective: To develop reflections on the contribution of the Storytelling Project in pediatrics in a Recife hospital to train medical students. Methodology: Experience report. Results and discussion: In the project in question, medical students interact with students from pharmacy, psychology, nursing from the training activity and in the experience exchange meetings. In the child’s approach to storytelling in the ward and pediatric emergency room, they experienced welcoming each other, dedicating their time to the patient, making choices when selecting books and narrating them, the ability to communicate and interact. inserting the child in the plot read. This was an activity that required calmness, availability for the other, adjusting their time to the rhythm, physical conditions and illness of the patient. Thinking of a professional future as doctors, it was reflected that it will be necessary to welcome and tell “stories” to patients, whether as surgeries happened, or as a treatment, or what is a disease. This experience posed the students facing the challenge of dealing with the other’s cognitive and emotional reaction, dealing with resistance to participate, facing competition from the technological world, which makes it difficult to perform calmly in the hospital, as people are always in a hurry and involved in our world of chores and social networking. Final Considerations: Thus, it is believed that in the future, this project will impact the formation of students from various areas of higher health courses, highlighting the need to devote attention, welcome and fully care for the…