Portuguese Journal of Pediatrics

Ups and Downs of Trampoline Use by Children: Risks and Current Recommendations

2022-11-22T08:57:13+00:00

The widespread increase in the recreational use of trampolines by children can be partially explained by the recent need to stay indoors during lockdowns due to the coronavirus disease 2019 pandemic. At the same time, there was a global increase in the number of pediatric accidents resulting from the domestic use of these devices. The resulting injuries may be severe, especially in younger age groups. Although the use of trampolines by children is discouraged in safety recommendations published by several scientific societies and some recent studies, there is still concern about the lack of knowledge about the risks of trampoline-related injuries. In this regard, this review article aimed to highlight the unique role of the pediatrician and / or family physician advising parents and caregivers as well as the general population to prevent trampoline-related accidents involving children.

Electroconvulsive Therapy in Child and Adolescent Psychiatry: Narrative Review

2022-04-30T00:00:33+01:00

Electroconvulsive therapy is characterized by the electrical induction of generalized and self-limited seizures and is currently available for the treatment of severe psychiatric disorders in children and adults. There are no absolute contraindications to electroconvulsive therapy in children and adolescents; however, there might be some relative contraindications. Electroconvulsive therapy is considered one of the safest procedures performed under general anesthesia. Its side effects in children are generally well tolerated, transient, similar to those reported by adults, and tend to decrease in subsequent sessions. Although considered safe and effective, it is still little used in Child and Adolescent Psychiatry. The reasons for its low use are related to the scarcity of studies, legal restrictions imposed by some countries, stigma, doubts about its effectiveness and safety, variable usage in different countries, and issues of ethical nature. Despite the fears, there is no technical, scientific, or ethical reason to justify the non-performance of electroconvulsive therapy in children and adolescents. Based on the literature review, this study seems to be the first narrative review carried out in Portugal on the use of electroconvulsive therapy in Child and Adolescent Psychiatry, and no other Portuguese studies were found. Since there is a correlation between knowledge and positive attitudes towards the use of electroconvulsive therapy, it is necessary to increase the studies, education, and practical experience in this area in Portugal. This non-systematic literature review aimed to inform health professionals about the importance of electroconvulsive therapy in the treatment of children and adolescents with severe mental illness.

Mortality in Pediatric Palliative Care in a Tertiary Center

2022-05-30T22:34:48+01:00

Introduction: Complex chronic diseases have been responsible for about a third of all pediatric deaths in Portugal in recent years. Early referral and implantation of an advance care plan are strategies that result in greater preparation on the part of families for dealing with the course of illness of these children. This study aimed to characterize the mortality data of patients followed by the pediatric palliative care in-hospital support team in a tertiary center between January 2018 and June 2021.

Methods: This retrospective study was performed using the analysis of clinical files, demographic data, nosological groups, referral dates, expectations, and place of death of patients as well as the interventions carried out by the team.

Results: In total, 64 children were followed by the pediatric palliative care in-hospital support team, 25 (39%) of whom died. More than half of the children who died had neurological pathology, which was the most frequent diagnostic area. Moreover, 14 (56%) children died less than 6 months after their referral to the team. Most of the children died during hospitalization (56%), while 28% of the deaths occurred at home.

Conclusion: The collected data suggests a late referral to pediatric palliative care, which is why it is of utmost importance to invest in the creation of specialized teams at the national level and the training of health professionals in this area. The main place of death was the hospital, as in previous studies, although with an apparent increasing trend of deaths at home.

Higher Metabolic Dysfunction in Adolescents Who Were Born Very Preterm: Case Control Study

2022-01-20T11:57:40+00:00

Introduction: Literature has shown an increase in cardiovascular risk and metabolic changes in adolescents and young adults who were born preterm. In this regard, the present study aimed to assess metabolic dysfunction in adolescents who were born at less than 32 weeks of gestational age.

Methods: This case-control study was performed on adolescents within the age range of 10-17 years and born in a level III maternity, with gestational age of < 32 weeks. Controls were healthy adolescents with gestational age of ≥ 37 weeks. Demographic data, cardiovascular risk history, and clinical data were evaluated and blood tests were performed.

Results: In total, 110 preterm and 48 controls were enrolled in the study. Based on the results, mean systolic (118.8 vs 112.6 mmHg, p = 0.001) and diastolic (61.7 vs 58.5 mmHg, p = 0.014) blood pressures were statistically higher in preterm infants, compared to the controls. The preterm adolescents had a higher waist-to-height ratio, fat mass, fasting blood glucose, insulin, homeostasis model assessment for insulin resistance, total cholesterol, low-density lipoprotein, and apolipoprotein B100, compared to the controls. However, none of these differences were statistically significant. It was found that preterm adolescents had more metabolic dysfunction risk factors, compared to the controls (p = 0.007).

Discussion: Prematurity contributes to higher cardiovascular risk and metabolic dysfunction. Moreover, higher arterial blood pressure seems to be the most important clinical finding in this study. Close monitoring of risk factors, particularly blood pressure, in adolescents who were born at less than 32 weeks is important for the prevention and early diagnosis of metabolic and cardiovascular comorbidities in adulthood.

Nutritional Risk Screening in Children with Cerebral Palsy

2022-08-08T07:24:42+01:00

Introduction: Validated and practical tools for nutritional risk screening are essential for the early recognition of children who would benefit from a complete nutritional assessment and subsequent nutritional interventions. In this regard, this study aimed to apply different nutritional risk screening tools for children with cerebral palsy and recognize the most appropriate tool.

Methods: In total, 30 children with cerebral palsy were involved in this cross-sectional study, from two Azores islands (where 60% of the total population live, in the Azores), Portugal. Children were assisted at a level III hospital unit and at the local cerebral palsy association. Clinical, sociodemographic, and anthropometric data were collected, and five nutritional risk screening tools were indirectly applied: screening tool for risk on nutritional status and growth, screening tool developed by Bell, cerebral palsy-malnutrition screening tool, screening tool developed by Bushell, and malnutrition risk score. Moreover, as a comparative method to define the most appropriate tool, two nutritional status classification instruments were applied (developed by World Health Organization and subjective global nutrition assessment).

Results: The screening tool for risk on nutritional status and growth showed high sensitivity and no specificity. Similarly, the screening tool developed by Bushell and cerebral palsy-malnutrition screening tool had high sensitivity and low specificity. The screening tool developed by Bell revealed high specificity and low sensitivity. The malnutrition risk score tool showed high sensitivity (> 87%) and specificity (> 71%) as well as the highest positive and negative predictive values (77.8% and > 83%, respectively) and also a kappa statistic value higher than 0.59.

Conclusion: Based on the results, malnutrition risk score seems to be the most appropriate tool for nutritional risk screening in children with cerebral palsy.

The Effect of Screen Time on Growth, Development, Behavior, and Sleep in Preschool Children: A Cross-Sectional Study

2022-10-30T06:40:07+00:00

Introduction: This study aimed to determine the prevalence of screen time and its impact on growth, development, behavior, and sleep in children less than five years old.

Methods: Children between six months to five years, attending the outpatient department of our hospital, were included consecutively. Screen exposure details were collected in a predesigned validated semi-structured questionnaire. Development was screened by the ages and stages-3 questionnaire. Growth was assessed as per World Health Organization guidelines. Data were analyzed using STATA version 12. Multivariate logistic regression analysis was conducted to ascertain the association between screen time and growth, development, behavior, and sleep, after adjusting for confounders.

Results: There were 437 participants. The prevalence of excess screen time was 61.5% and 72.8% in children aged 6-23 months and 24-60 months respectively. Excess screen time did not significantly impact growth and development. The odds of having temper tantrums - adjusted odds ratio = 10.61 (2.57-43.80), p = 0.001 - and breath-holding spells - adjusted odds ratio = 61.39 (3.28-1151.09), p = 0.001) were significantly more in children aged 6-23 months with excess screen time, while children aged 2-5 years of age with excess screen time, had a significantly higher occurrence of nightmares - adjusted odds ratio = 5.26 (1.12-72.70), p = 0.04) and delayed bed time (beyond 10:00 PM) - adjusted odds ratio = 4.42 (1.46-13.36), p = 0.008).

Conclusion: There was a high prevalence of excess screen time in preschoolers. Increased screen time did not significantly affect growth and development. There was a higher occurrence of temper tantrums, breath-holding spells, nightmares, and a bedtime beyond 10:00 PM in children with excess screen time.

Impact of Poverty and Inequality in Children and Youth Health: A Permanent Challenge

2023-03-11T17:50:47+00:00

When Kidney Mirrors the Eye: Tubulointerstitial Nephritis and Uveitis Syndrome - Case Report

2022-08-26T08:06:56+01:00

Tubulointerstitial nephritis and uveitis syndrome is an underdiagnosed condition, characterized by the involvement of the kidney and the eye that affects mostly young people. Its pathophysiology remains poorly understood; however, pediatric morbidity is mostly associated with recurrences of uveitis. This article aimed to describe two clinical cases of tubulointerstitial nephritis and uveitis syndrome, with distinct presentations and clinical courses, illustrative of the diversity of this entity.

Case1: An 11-year-old male was admitted to the hospital due to a non-oliguric acute kidney injury. A 24-hour urine examination revealed a tubular lesion, and two months later, he was diagnosed with bilateral anterior uveitis. He was started on steroids, with a favorable response. After six weeks, renal function and urine parameters returned to normal.

Case 2: A 12-year-old male was admitted to the hospital with complaints of bilateral red eyes. He was diagnosed with bilateral anterior uveitis and treated with topical steroids with transient improvement. At the same time, the clinical investigation detected a tubular lesion. Four months later, due to a uveitis hypertensive flare with macular edema, methotrexate was added to his treatment, which had a favorable response. Six months later, the urinary abnormalities disappeared. The tubulointerstitial nephritis and uveitis syndrome should be actively searched in the presence of tubular renal abnormalities or uveitis in pediatric patients.

Valentino Syndrome: Case Report

2021-07-30T08:27:33+01:00

Abdominal pain is a common complaint in the pediatric emergency department. Perforation of a peptic ulcer is a rare occurrence in children and is a commonly overlooked etiology. This study presents a case of a previously healthy 16-yearold male presenting with right lower quadrant abdominal pain. Physical examination, laboratory test, and ultrasound results were suggestive of acute appendicitis. The laparoscopy results, which showed a normal appendix, and the following clinical findings, led to the diagnosis of a perforated pre-pyloric ulcer. Valentino syndrome occurs when a patient with a perforated ulcer presents with pain in the right lower quadrant, which mimics appendicitis, a far more common condition.

Bronchial Mucoepidermoid Carcinoma: A Rare Cause of Chronic Respiratory Symptoms in Children - Case Report

2022-07-31T07:54:09+01:00

Primary pulmonary tumors are uncommon in children. Mucoepidermoid carcinoma accounts for approximately 10% of all primary pulmonary neoplasms. This study reported the case of a 6-year-old male patient who presented with fever, cough, and wheezing, and had a history of choking and recurrent respiratory infections. Chest radiography showed a hyperinflated left lung, and bronchoscopy revealed a friable polypoid mass obstructing more than 90% of the left primary bronchus. Moreover, a chest computed tomography scan showed no lymphadenopathies. Endoscopic resection of the mass and posterior surgical resection of its remainder were performed. Histological examination revealed a low-grade mucoepidermoid carcinoma. Due to its rarity and the non-specific nature of symptoms, the diagnosis of mucoepidermoid carcinoma is usually delayed. In the presence of chronic respiratory symptoms and signs of bronchial obstruction on imaging exams, mucoepidermoid carcinoma should be included in the differential diagnosis, along with other more frequent conditions.

Recognition of Kabuki Syndrome

2022-05-17T12:05:23+01:00

Beyond an Extensive Dermal Melanocytosis: A Case of Phacomatosis Pigmentovascularis of Cesioflammea Type

2022-05-28T06:34:54+01:00

Molluscum Contagiosum with Pseudo-Koebner Phenomenon

2022-09-02T07:18:24+01:00

Neonatal Neurofibromatosis: Diagnosis at Birth

2022-05-24T11:54:21+01:00

Tooth Luxation as the First Clue to an Epilepsy Diagnosis

2022-11-17T10:54:52+00:00

The Art of Music and the Art of Medicine

2023-01-23T12:27:13+00:00