Anemia em crianças menores de dois anos atendidas nas unidades básicas de saúde no Estado de São Paulo, Brasil

The present study sought to determine the prevalence of anemia in 2,992 children, aged between 6 and 23 months, who voluntarily attended 160 Basis Health Care Units, located in 63 cities of the 5 Regional Health Coordinating areas of the State of S. Paulo, Brazil. Blood samples were collected by venous puncture and hemoglobin was measured by the cianometahemoglobin method. The WHO criteria for the diagnosis of anemia (Hb < 11.0 g/dl) were used: 59.1% of the children were shown to be anemic, with prevalence varying from 47.8% to 68.7% in the 5 RHCs. RHC 1, which comprises the Greater S. Paulo Region, presented a prevalence of anemia significantly lower than the other 4 RHCs, which cover the rest of the State. Hemoglobin levels 9.5 g/dl were found in 25.1% of the children. Anemia was more frequent in male children in male children, in those born, with a weight of less than 3,000 gr, in those who were breastfed for less than 2 months and in those that who presented some degree of energy deficient proteic malnutrition, according to Gomez's criteria. This is the first of a series of 4 articles whose purpose is the determining the prevalence of anemia in the State of S. Paulo and of testing the intervention alternatives with a view to curtailing the incidence of this pathology which today is the most prevalent nutritional disturbance in the world.

Gut intraepithelial lymphocyte counts in neonates, infants and children

Intraepithelial lymphocyte (IEL) counts were histologically assessed in the jejunum, ileum and appendix of 39 neonates (0-28 days), 32 infants (1-9 months) and 13 children (1-9 years). Small intestinal mucosa samples were obtained from 73 autopsies, and from 8 surgical and 3 aspirative biopsies. IEL counts of specimens from the jejunum, ileum and appendix gave similar results in the same patient. The number of IEL counts was significantly lower in neonates for all three segments. The difference between infants and children was more marked in the jejunum than in the ileum, although this was not significant. In the appendix, there was no difference between the different age groups. Our results indicate that postnatal expansion of IEL occurs homogeneously along the gut after the neonatal period.

Fístula arteriovenosa pulmonar maciça. Causa rara, potencialmente curável de hipóxia neonatal.

The case of a six-day-old neonate admitted in an emergency situation because of dyspnea and increasing cyanosis is reported. Despite abnormal opacification on the chest X-ray and left ventricular overload on the electrocardiogram and echocardiogram, features compatible with the disease, the diagnosis of massive pulmonary arteriovenous fistula affecting the whole left superior lobe, was made possible only after necroscopic examination.

Natal teeth: Case report

The natal teeth are defined as the presence of teeth at birth and the etiology is rather obscure. Clinically, the teeth show normal size and shape, although they reveal an immature appearance. The histological aspect show enamel with the possibility of presenting normal mineralization or being hypoplastic. The dentin may show alterations. The incidence of natal teeth varies greatly, with a predisposition for the female sex. This paper relates a case report of two partially erupted natal teeth in a female baby 9 days-old. The presence of teeth made the parents anxious. In their mind, that meant the child was abnormal. On the radiograph the erupted teeth showed little radioopacity, without a radicular formation. The therapy utilized was the keeping of the teeth and a periodic monitoring, cleaning and daily topical applications sodium fluoride. The case was monitored by monthly consultations. At 9 months of age the primary central lower did not present mobility. On the radiograph examination incomplete radicular formation was observed.

The structure of the human temporomandibular joint disc: A scanning electron microscopy study

The articular disc of the temporomandibular joint was studied in fetuses (16 to 39 weeks of intrauterine life), infants (up to 4 months of age), dentulous adults (aged 30 to 39 years), and completely edentulous adults (aged 60 to 69 years) by scanning electron microscopy. The constituent bundles of collagen fibers were stratified and were oriented anteroposteriorly, laterolaterally, and obliquely in the middle portion of the disc. A ring of laterolateral bundles constituted the main feature of the thick posterior portion. In the anterior portion of the disc, the fibers were anteroposteriorly and obliquely oriented. On the superior and inferior surfaces of the disc, a thin layer of perpendicularly arranged collagen fibers covered the underlying, thick, laterolateral oriented collagen fibers.

Natal and neonatal teeth: Review of the literature

Child development from conception through the first years of life is marked by many changes. Tooth eruption follows a chronology corresponding to the date when the tooth erupts into the oral cavity. These dates have been established in the literature and are subjected to small variations depending on hereditary, endocrine and environmental features. At times, however, the chronology of tooth eruption suffers a more significant alteration in terms of onset, and the first teeth may be present at birth or arise during the first month of life. The expectations about the eruption of the first teeth are great and even greater when the teeth appear early in the oral cavity. The objective of the present study was to present a review of the literature with important aspects about natal and neonatal teeth.

Efeito da posição do prematuro no desmame da ventilação mecânica

Objective: the purpose of this study was to determine the effects of prone positioning on cardiorespiratory stability and weaning outcome of preterm infants during weaning from mechanical ventilation. Methods: from January to December 1999, a sample of 42 preterm infants, with birthweight < 2,000 g, mechanically ventilated in the first week of life, were randomly divided, in the beginning of the weaning process, in two groups according to the position: supine position (n = 21) or prone position (n = 21). Heart rate, respiratory rate, transcutaneous oxygen saturation and ventilatory parameters were recorded every one hour. Length of the weaning process and complications were also assessed. Results: in both groups the mean gestational age was 29 weeks, most of the patients presented very low birthweight and respiratory distress syndrome. The mean length of the weaning process was 2 days. There were no differences between the groups regarding respiratory rate, heart rate and transcutaneous oxygen saturation, however, oxygen desaturation episodes were more frequent in supine position (p = 0.009). Ventilatory parameters decreased faster and reintubation was less frequent in the prone group (4% versus 33%). No adverse effects of prone positioning were observed. Conclusion: these results suggest that prone position is a safe and beneficial procedure during the weaning from mechanical ventilation and may contribute to weaning success in preterm infants.

Behavioral evaluation during dental care in children ages 0 to 3 years

Purpose: Many studies concluded that the behavior of babies complicated dental care because of child immaturity or the difficulty of establishing acceptable communication and comprehension. Methods: The records of 696 babies were randomly selected from the baby clinic of Araçatuba in Brazil. Patient age ranged from 0 to 36 months. They were divided into 6 groups according to age: Group I-0 to 6 months; Group II-7 to 12 months; Group III-13 to 18 months; Group IV-19 to 24 months; Group V-25 to 30 months; Group VI-31 to 36 months. The behavior of the child was evaluated upon entrance in the dental office and during the first 4 clinical appointments with a clinical exam and oral physiotherapy. The baby was classified as collaborator (C) or noncollaborator (NC). Statistical analysis was performed using Pearson's chi-square method (P< .05). Results: The percentage of NC for Groups II, III, IV, and V (66%), was significantly higher than for groups I (30%) and VI (50%). Conclusions: Babies from 0 to 6 months showed a collaborative behavior; babies from 7 to 30 months showed noncollaborative behavior; and babies from 31 to 36 months showed no statistically significant difference between the percentage of C and NC.

Uso do óxido nítrico em pediatria

Objective: To review the literature on inhaled nitric oxide and to describe its main clinical applications in pediatrics. Sources of data: A 10 year literature review with selection of the most important publications on inhaled nitric oxide, using the Medline and Cochrane Systematic Review databases. Summary of the findings: This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning; precautions and side-effects. Inhaled nitric oxide use was described in persistent pulmonary hypertension and hypoxia of the newborn, acute respiratory distress syndrome, primary pulmonary hypertension, heart surgery, chronic obstructive pulmonary disease, sickle cell anemia, and bronchospastic disease. Conclusions: Inhaled nitric oxide is a therapeutic approach with wide clinical applications in pediatrics. Its use is safe when administered in pediatric intensive care units under strict monitoring. As a pulmonary vasodilator, nitric oxide has beneficial effects on gas exchange and ventilation. Controlled trials, focusing on early gas administration should be performed under many clinical conditions, especially acute respiratory distress syndrome.

Natal maxillary primary molars: Case report

An unusual case of a newborn with two immature natal maxillary molars is presented. Clinical and histological examination showed that the teeth were rootless and incompletely mineralized. The patient was followed up during one year and we confirmed that the natal teeth were from normal primary series.

Acute and sustained effects of early administration of inhaled nitric oxide to children with acute respiratory distress syndrome

OBJECTIVE: To determine the acute and sustained effects of early inhaled nitric oxide on some oxygenation indexes and ventilator settings and to compare inhaled nitric oxide administration and conventional therapy on mortality rate, length of stay in intensive care, and duration of mechanical ventilation in children with acute respiratory distress syndrome. DESIGN: Observational study. SETTING: Pediatric intensive care unit at a university-affiliated hospital. PATIENTS: Children with acute respiratory distress syndrome, aged between 1 month and 12 yrs. INTERVENTIONS: Two groups were studied: an inhaled nitric oxide group (iNOG, n = 18) composed of patients prospectively enrolled from November 2000 to November 2002, and a conventional therapy group (CTG, n = 21) consisting of historical control patients admitted from August 1998 to August 2000. MEASUREMENTS AND MAIN RESULTS: Therapy with inhaled nitric oxide was introduced as early as 1.5 hrs after acute respiratory distress syndrome diagnosis with acute improvements in Pao(2)/Fio(2) ratio (83.7%) and oxygenation index (46.7%). Study groups were of similar ages, gender, primary diagnoses, pediatric risk of mortality score, and mean airway pressure. Pao(2)/Fio(2) ratio was lower (CTG, 116.9 +/- 34.5; iNOG, 62.5 +/- 12.8, p <.0001) and oxygenation index higher (CTG, 15.2 [range, 7.2-32.2]; iNOG, 24.3 [range, 16.3-70.4], p <.0001) in the iNOG. Prolonged treatment was associated with improved oxygenation, so that Fio(2) and peak inspiratory pressure could be quickly and significantly reduced. Mortality rate for inhaled nitric oxide-patients was lower (CTG, ten of 21, 47.6%; iNOG, three of 18, 16.6%, p <.001). There was no difference in intensive care stay (CTG, 10 days [range, 2-49]; iNOG, 12 [range, 6-26], p >.05) or duration of mechanical ventilation (TCG, 9 days [range, 2-47]; iNOG, 10 [range, 4-25], p >.05). CONCLUSIONS: Early treatment with inhaled nitric oxide causes acute and sustained improvement in oxygenation, with earlier reduction of ventilator settings, which might contribute to reduce the mortality rate in children with acute respiratory distress syndrome. Length of stay in intensive care and duration of mechanical ventilation are not changed. Prospective trials of inhaled nitric oxide early in the setting of acute lung injury in children are needed.

Minerals in the nutrition of extremely low birth weight infants

Objective: To review the literature on the role of calcium, phosphorus and trace elements in the nutrition of extremely low birth weight infants, considering their importance for metabolism, bone mineralization and as dietary components. Sources of data: MEDLINE, the Cochrane Database of Systematic Reviews and books on nutrition were searched between 1994 and 2004. Original research studies and reviews were selected. Summary of the findings: Extremely preterm infants are frequently growth-restricted at hospital discharge as a consequence of difficulties in the provision of adequate nutrition. The long-term effects of this growth restriction need to be determined. There is a paucity of studies about the role of minerals, especially micronutrients, in the nutrition of extremely preterm infants. The principal focus of this review was on calcium and phosphorus metabolism, bone mineralization and parenteral and enteral supplementation. A critical evaluation of post-discharge nutrition and its influence upon growth and bone mineralization was presented. Selenium and zinc requirements and the role of selenium as an antioxidant with possible effects on free radical diseases of the preterm infant were discussed. Conclusions: Extremely preterm infants have low mineral reserves and, as a consequence, may have deficiencies in the postnatal period if they do not receive parenteral or enteral supplementation. More studies are needed to elucidate the actual requirements and the appropriate supplementation of micronutrients. There are controversies about the outcome and the influence of post-discharge nutrition on bone disease of prematurity. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Secretion of middle ear in infants - Occurrence, recurrence and related factors

Objective: The present study aimed at evaluating the occurrence and recurrence of middle ear effusion and possible associated factors in the first two years of life of 190 newborns and infants, participants in the interdisciplinary prevention, detection, and intervention program at the Clínica de Educação para Saúde of Universidade do Sagrado Coração, Methods: Newborns and infants were monthly submitted to anamneses, otoscopy, behavioral hearing assessment using sound instruments and pure tones (pediatric audiometry) and tympanometry. Results: The results revealed that 68.4% of infants presented one or more episodes of middle ear effusion during their two first years, with more recurrence among males. Peak occurrence was between four and 12 months of age and, the earlier the first episode, the higher the probability of recurrence. Greatest incidence was during May and August. It was found that, of the variables investigated, the period of exclusive breastfeeding actuated as a protector factor. With respect of risk factors, it was observed that passive smoking, gastro-esophageal reflux and respiratory allergy were related with the recurrences of effusion. Conclusion: Findings revealed the importance of periodic auditory follow-up for infants during their first two years of life, considered to be the critical period of auditory system maturation, during which sensory deprivation can be responsible for damage to the development of speech, language and other auditory abilities. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Sildenafil for pulmonary hypertension treatment after cardiac surgery

Objective: To report on the use of sildenafil for pulmonary hypertension treatment of a newborn patient after cardiac surgery. Description: A female, full term newborn infant with diagnosis of double outlet right ventricle, pulmonary hypoplasia and subaortic ventricular septal defect, was submitted to Blalock surgery in the first week of life. In postoperative the newborn had pulmonary hypertension and persistent hypoxia, without response to nitric oxide, but with improved oxygenation after continuous intravenous infusion of prostaglandin E1. After several failed attempts to discontinue prostaglandin E1, oral sildenafil was used. There was a decrease in pulmonary vascular resistance with consequent oxygenation improvement and 48 hours later it was possible to discontinue prostaglandin E1 infusion. Comments: Sildenafil can be an alternative therapy for pulmonary hypertension, especially when there is no response to conventional therapy. Copyright © 2005 by Sociedade Brasileira de Pediatria.

Estudo quantitativo da lágrima pelo teste de fenol vermelho na população brasileira

Purpose: To detect normal values of red phenol thread test in the Brazilian population and compare it between different races, age and sex. Methods: 280 white individuals (560 eyes) and 280 non-white individuals (560 eyes) were analyzed regarding sex and age, and analyzed using the Phenol Red test. Individuals with ocular diseases, contact lens or ocular drug users were excluded from this study. Results: Of the 1,120 evaluated eyes, the mean ± standard deviation result was 19,77±7,90 mm. Conclusion: The mean result found in this study was an intermediate value compared to the previously studied populations (Japanese and American).