Pediatric Research and Reviews

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…

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

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…

Objective: To analyse the frequency of haemoglobin variants detected in the neonatal screening program in the state of Pernambuco from January / 2015 to July / 2016. Methodology: Descriptive study based on data provided by the health secretary of the state of Pernambuco referring to newborns submitted to the Guthrie’s test between 01/01/2015 to 07/31/2016. Results: During the period included in the study, 162,236 children participated in the neonatal screening program to evaluate haemoglobinopathies through the health department. From these, 5,997 (3.69%) presented some haemoglobin variant, being 5.019 (3.09%) carrying HbS in hetero or homozygous. Conclusions: It was possible to observe a high incidence of children diagnosed as having haemoglobin variants, especially HbS, showing the importance of performing this test so that all children can be assisted from the beginning of their lives.

Depression is a disorder that interferes in lives of human beings in a broad and comprehensive manner in several respects. Objectives: To assess the presence of depressive symptoms in children and make a comparison between two different groups. The research is a pilot study, who is results of a Masters dissertation who is in development. It counted on two types of samples totaling 36 children. Was realized analyzes mean comparison between samples using the Student t test for independent samples. After accomplish the analyzes between the groups previously discriminated against in the survey, it was found that there was no statistically significant difference in the total score for the instrument of depressive symptoms between the clinical and the school group. However, when the analysis was redone and the groups were outlined by a median, it was found that there was statistically significant difference in the total score for the instrument of depressive symptoms between the upper and lower group. At the end of the study it was concluded that their main objective was successfully achieved. Nevertheless, this is still an early study, which needs to be given continuity and enhanced in order to obtain even more scathing informations.

Introduction: Vaccination is the most effective means of combating and preventing immunoprevolutionary diseases. This is only possible through vaccination, actions that represent one of the most important public health interventions in the control of pathologies generated by immunizable agents. which strengthens the effectiveness of vaccines. Objective: To report the experiences of nursing students in a supervised activity of the discipline Child Health on the importance and benefits of childhood vaccination and the factors that lead to vaccine delay. Methodology: Descriptive study of the type of experience report, carried out in a Basic Health Unit in the city of Maceió from March to June 2018. Outcome: During the period of the Child Health discipline, it was possible to observe the importance of childhood and the benefits that the vaccine brings, because the child who has the vaccination card in the daytime hardly gets sick by immunoprevolution. Having all the benefits of vaccination can still have a child who is not up to date with the passbook due to some factors such as: lack of information from parents about the importance of updated vaccination, logistical problems, among others. Thus, leaving children vulnerable to disease that can be prevented through the practice of vaccination. Conclusion: In the face of everything it is perceived that vaccination is a form of public health intervention in the fight against disease that can be avoided through the vaccine and also a way to reduce the costs of hospitalizations in hospitals.