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- Ir para casa em segurança: car seat challenge test numa unidade de neonatologiaPublication . Prior, F; Costo, M; Félix, I; Trindade, D; Carneiro, RIntrodução: Recomenda-se o uso de um Sistema de Retenção para Crianças (SRC) adequado para o transporte do recém-nascido do hospital para casa. A permanência do recém-nascido no SRC, em especial o recém-nascido que teve necessidade de internamento em Unidade de Cuidados Intensivos Neonatais (UCIN), está associada a episódios de dessaturação, pelo que é fortemente recomentado avaliar a estabilidade hemodinâmica do recém-nascido, adequadamente sentado no SRC. O Car Seat Challenger Test (CSCT), permite rastrear situações de risco e atuar em conformidade com a situação identificada, sendo um dos métodos indicados para realizar o rastreio de apneia do recém-nascido no SRC. Objetivo: Analisar os resultados do rastreio CSCT, dos recém-nascidos com alta da Unidade de Neonatologia para casa de 1 de julho de 2021 até 31 de Julho de 2023. Métodos: Estudo descritivo, retrospetivo, observacional, não experimental. Os dados foram recolhidos do registo do procedimento e consideram as seguintes informações do recém-nascido: idade gestacional, idade corrigida, comorbilidades, ocorrência de apneia, frequência cardíaca média, saturação de oxigénio média e duração do teste. Resultados: Foram identificados 191 CSCT testes elegíveis, nos quais 189 recém-nascidos passaram na primeira avaliação, e 2 passaram à segunda avaliação. Dos 3 recém-nascidos que reprovaram o teste, 2 deles repetiram-no mais de 12 horas após o primeiro teste. Conclusão: Apesar da existência de um protocolo, verificou-se que o procedimento nem sempre é cumprido. Devido ao reduzido número de indivíduos, não é possível estabelecer uma relação entre as comorbilidades e a aprovação no CSCT.
- COVID-19: Impact of the Pandemic on Children’s LivesPublication . Roquette, M; Jonet, J; Pires, J; Paes-Vasconcellos, AIntroduction: The COVID-19 pandemic has had a considerable impact on the biopsychosocial elements of human beings, especially children and teenagers, as vulnerable groups. Social isolation can lead to psychiatric illness, obesity, and sleep disorders in adults. This study aimed to determine the impact of lockdown on children’s sleep, diet, physical activity, and behavior. Methods: This was a retrospective observational study conducted from May 1, 2020, to March 31, 2021. Data were collected from four healthcare centers in Cascais (Lisbon, Portugal) by administering a questionnaire in person and online. Descriptive statistical analysis was conducted using Microsoft Excel® and the SPSS® software (version 23). Results: In total, 790 responses were collected (median age 9 years old) without gender predominance. Family routine and behavioral changes were found in 84% and 63% of children, respectively. In addition, dietary changes were observed in 43% of them, with 62% reporting an increase in quantities and 23% reporting weight gain (more than 5 kg in 18%). Regarding physical activity, 44% exercised more than three times a week before the lockdown. Following COVID-19, 18% maintained this routine, and 48% quit sporting activities. Finally, sleep changes occurred in 42%, including nightmares and difficulty falling asleep. Discussion: Childhood and adolescence are periods of considerable social and psychomotor development, and any routine disruption can cause profound changes in personal and interpersonal experience during this period. The findings of this study revealed that lockdown caused changes in children’s behavior, diet, physical exercise, and sleep. It is essential to outline strategies to support children and teenagers with a multidisciplinary approach to reduce the effects of social isolation on their development.
- The impact of the COVID-19 pandemic on pediatric hospital admissions: a retrospective study in a Portuguese level II hospitalPublication . Garrotes, M; Ferreira, M; Condessa, L; Guimarães, C; Fialho, M; Sousa e Cunha, MIntroduction: Since the emergence of SARS-CoV-2, pediatric admissions from all causes have decreased. This was mainly due to a decrease in all common respiratory diseases, such as bronchiolitis and pneumonia. The aim of this study was to evaluate the impact of the pandemic on pediatric admissions and diagnoses in a level II hospital. Methods: A retrospective analysis was conducted, including all children admitted to a Portuguese level II hospital between March 2020 and December 2021 and the homologous period 2018-2019. The number of admissions, most common diagnoses, and demographic data were analyzed. Results: A total of 2956 admissions were included. A 44.1% decrease in pediatric hospital admissions was observed with the onset of the COVID-19 pandemic. Admissions for common communicable diseases such as acute bronchiolitis, acute gastroenteritis, varicella, and stomatitis decreased. An increase in respiratory illnesses, mainly due to respiratory syncytial virus, was observed when the pandemic restrictions ended. Conclusion: The COVID-19 pandemic had a major impact on pediatric hospital admissions. Social distancing measures and the use of masks limited the transmission of common infectious diseases previously responsible for hospital admissions. Future studies are needed to understand whether the changes in respiratory virus epidemiology were transient.
- Extracorporeal Membrane Oxygenation in an Adolescent with Multisystem Inflammatory Syndrome in ChildrenPublication . Gago, C; Lorenzo, C; Pinto, S; R. Sousa, A; Camilo, C; Abecasis, FMultisystem inflammatory syndrome in children is a rare and potentially life-threatening disease that is associated with SARS-CoV-2 infection, character-ized by hyperinflammation and multiorgan involvement. Cardiovascular involvement is common, including myocardial dysfunction often leading to cardio-genic shock. We present the case of a 17-year-old boy with fever, odynophagia, maculopapular rash and abdominal pain who developed a cardiogenic shock. Due to progressive deterioration of cardiac function despite optimized vasoactive support, veno-arterial extracorporeal membrane oxygenation support was initiated 12 hours after admission, with successful decannulation after seven days and discharge after 23 days, with normal cardiac function. The patient received corticosteroids and intravenous immunoglobulin. Early recognition and intensive care support are crucial for ensuring a successful outcome in severe cases of multisystem inflammatory syndrome. In cases of severe cardiogenic shock, extracorporeal membrane oxygenation support can be critical for survival and rapid recovery.
- An unusual manifestation of severe edema in nephrotic syndromePublication . Garrotes, M; Mota, M; Deuchande, S; Theias-Manso, R; Costa-Reis, P; Rita-Sandes, AKeypoints What is known – Ascites is a common finding in nephrotic syndrome. – Adherence to treatment is important to prevent nephrotic syndrome complications. What is added – Transudation of ascitic fluid through the abdominal wall is a rare complication of nephrotic syndrome. – The treatment of transudation of ascitic fluid and skin lesions is challenging and improvement may take several weeks.
- The challenges of maintaining patient confidentiality in pediatric settings: Letter to the editorPublication . Guerreiro, G; Pereira, D
- An Analysis From a Tertiary Pediatric Hospital: Does Physical Activity Play a Role in the Management of Children and Young Adults With Osteogenesis Imperfecta?Publication . Galhardo Saraiva, F; Jonet, J; Roquette, M; Ovídio, J; Pires, MS; Lameiras Campagnolo, JIntroduction: Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by reduced bone density and increased proneness to fractures. It manifests across a varied clinical spectrum of expressions in children and young adults. It is crucial for children with OI to have a multidisciplinary follow-up, including orthopedics, pediatrics, and physical medicine and rehabilitation. Although exercise may have no effect on the disease itself, it might improve the autonomy, self-esteem, and fitness of these children. Methods: Retrospective cohort analysis of children and young adults aged three or more years old followed-up in a Level III Pediatric Hospital between 1995 and 2020. Demographic and clinical data were obtained from the hospital records and from the caregivers via phone calls. To our knowledge, this is the first national case series published assessing exercise habits in children with this condition. Results: Among the 21 patients studied, the median age was 14 years, with no gender predominance. Eighteen (86%) practiced regular physical activity, while the remaining three (14%), all of whom were type III OI, were totally dependent. Of the aforementioned 18 children, 12 (67%) considered practicing the same level of physical activity compared to their healthy peers, although most of them needed adaptations. The most reported extracurricular activity was swimming, in 50% of the cases. About 39% engaged in physical activity two times or less per week, and 89% practiced for one hour or less per session. Discussion: Over the years, it has become clear that physical activity is an important part of OI management. While awareness of the importance of exercise already exists, proper planning, follow-up, and monitoring are essential.
- Eutectic mixture of local anesthetics’ dosage in newborns: a scoping review.Publication . Prior, F; Querido, D; Santos, IIntrodução: A Mistura Eutética de Anestésico Local (EMLA) está facilmente disponível, não sendo amplamente utilizado na população neonatal por falta de evidência quanto a uma dose adequada para administração. Objetivos: Identificar como o creme EMLA é utilizado para reduzir a dor, sem reação adversa, nos recém-nascidos sujeitos a procedimentos dolorosos. Métodos: Revisão scoping para mapear a literatura respeitante à população, conceito e contexto (PCC) em estudo, considerando literatura obtida de bases de dados científicas e literatura cinzenta publicada entre 2002 e 2021, com texto completo disponível e sem restrições de linguagem. Resultados: Doze documentos respeitantes a 2661 recém-nascidos – desde as 28 semanas de idade gestacional até recémnascidos de termo – considerando a eficácia e descrevendo a quantidade e tempo de contacto com a pele do EMLA creme. Oito protocolos recomendam o uso de penso oclusivo. Um documento descreveu reações de palidez e eritema na pele Conclusão: O EMLA é eficaz quando utilizado em recém-nascidos sujeitos a procedimentos dolorosos. A quantidade mais utilizada é de 0,5g em recém-nascidos pré-termo e 1g nos recém-nascidos de termo. O tempo mais frequente de contato com a pele é de 60 minutos. Sendo estas as dosagens mais frequentes, o intervalo identificado é de 0,5 a 2g na quantidade utilizada, e o tempo de contato com a pele de 3 a 180 minutos. A utilização de penso oclusivo é descrita na maioria dos protocolos.
- Programa de Treino de Suporte Básico de Vida Pediátrico: uma experiência de prática simuladaPublication . Prior, F; Monteiro, F; Costa, M; Carneiro, R; Hneriques, Pntrodução: A equipa de enfermagem da Unidade de Cuidados Intermédios de Pediatria identificou a necessidade de aumentar a confiança da equipa na realização de manobras de reanimação à criança em estado crítico, tendo sido criado um Programa de Treino em Suporte Básico de Vida Pediátrico em 2 fases.Objetivo: Treinar em contexto de simulação clínica competências de Suporte Básico de Vida em pediatria.Métodos: Desenvolvimento de um programa de treino para a prática de competências de reanimação e treino do algoritmo do Suporte Básico de Vida Pediátrico.Resultados: Participaram no programa 94 formandos: 57 enfermeiros da Unidade de Cuidados Intermédios Pediátricos, Serviço de Obstetrícia e Pediatria; 5 estudantes da licenciatura em enfermagem; 1 estudante de ensino pós-graduado em enfermagem; e 31 assistentes operacionais da Unidade de Cuidados Intermédios de Pediatria, Serviço de Obstetrícia e Pediatria.Conclusão: Os formandos reconhecem a utilidade do conteúdo do Programa de Treino em Suporte Básico de Vida Pediátrico na sua prática quotidiana e a adequação dos seus conteúdos.
- Bronchopulmonary Dysplasia: A Five-Year Retrospective Cohort Study on Differences in Clinical Characteristics and Morbidities According to Severity GradingPublication . Kakoo Brioso, E; Moscoso, J; Malveiro, D; Aguiar, M; Tuna, MIntroduction: Bronchopulmonary dysplasia (BPD) is the most common complication associated with extreme prematurity. Although several criteria defining severity were developed over time, there are a few studies describing the differences in BPD phenotype and neonatal morbidities and complications between severity groups. We aimed to describe these differences in BPD patients of a neonatal intensive care unit (NICU). Methods: We conducted an observational retrospective cohort study through a medical record review over a five-year period. Participants were newborns admitted to an NICU who were diagnosed with BPD. We performed a descriptive statistical analysis of gestational complications and the use of antenatal corticosteroid therapy, birth-related data, and complications throughout the NICU stay, as well as the respiratory support used. We also compared different severity groups across these variables. The patients were divided into severe and non-severe BPD using the severity criteria of the 2001 NICHD/NHLBI/ORD consensus workshop. Results: A total of 101 newborns with BPD participated in the study and 73 had data on BPD severity. The median gestational age was 27 weeks, ranging from 23 to 32 weeks. Of these 73 newborns, 36 had mild BPD (49.3%), 10 had moderate BPD (13.7%), and 27 had severe BPD (37.0%). When comparing severe and non-severe BPD, we found that extreme prematurity, extremely low birth weight, and small size for gestational age were more frequent in the severe BPD group (p-value=0.012, p-value<0.001, and p-value=0.012, respectively). Infants with severe BPD had a longer duration of invasive ventilation than those with mild or moderate BPD (p-value<0.001). Late sepsis, necrotizing enterocolitis, severe brain injury, and retinopathy of prematurity were more frequent in severe BPD (p-value=0.017, p-value=0.045, p-value=0.033, p-value=0.003, respectively). Discussion: Previously published evidence describing causal links between BPD development and comorbidities exists but data on their impact on BPD severity are scarce. In our study, severe BPD seemed to be associated with a higher frequency of comorbidities and complications. Further studies are needed to ascertain the impact of each morbidity on the severity of BPD and if measures to prevent them could lead to potentially milder BPD disease.