RN&C: Ano de 2023
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- Five years of universal newborn hearing screening: An incidence studyLeal, Bárbara; Lopes, Ana Cristina; Peixoto, Daniela; Correia, Laura; Almiro, Maria Miguel; Vilar, João; Azevedo, Maria Luísa; Bicho, Maria AdelaideIntroduction: Universal newborn hearing screening (UNHS) is an essential tool for early diagnosis and prognosis of hearing loss. The aims of this study were to estimate the incidence of sensorineural hearing loss (SNHL) in the Baixo Vouga region, to evaluate the importance of first-degree parental consanguinity (FDPC) as a risk factor for hearing loss in the UNHS program of Centro Hospitalar do Baixo Vouga (CHBV), and to determine the quality of hearing screening program and the main difficulties experienced in its implementation. Methods: Retrospective incidence study of all newborns born in a level II hospital between 2014 and 2018. According to the presence or absence of risk factors (RF) for early childhood hearing loss, each newborn was included in one of two groups: with RF and without RF. FDPC was included in addition to the recommended RF. All newborns underwent hearing screening. Those with abnormal screening or with RF also performed diagnostic audiologic evaluation.Results: Eight thousand seven hundred and twenty-seven newborns were evaluated, of whom 90.88% had no RF. The incidence rate of SNHL was 2.4/1000 infants without RF and 27.6/1000 infants with RF. Screening had an effectiveness of 99.86%, a false positive rate of 0.34%, and a referral rate to an otolaryngologist of 1.24%. FDPC was the third most common RF and the first in infants with SNHL. The missed diagnostic evaluation rate was 44.56%.Discussion: The reported incidence of SNHL is similar to that reported in the literature. The CHBV UNHS program meets national guidelines for quality screening. FDPC is an important RF in this population. The rate of missed diagnostic evaluations was identified as a priority area for improvement.
- Serotonin selective reuptake inhibitors and suicide risk in a Portuguese adolescent sampleDuarte, Nuno; Amaral, Sarah; Abrantes, MartaBackground: The adolescent population is at high risk for depressive disorders, and suicide is a leading cause of death in this age group worldwide. Selective serotonin reuptake inhibitors (SSRIs) remain the only approved pharmacological approach, despite concerns about suicidality.Objectives: This study aimed to understand the relationship between antidepressant use and suicidality in an adolescent population from an Adolescent Psychiatric unit in Lisbon, Portugal. Methods: A total of 296 medical reports of adolescent patients with depressive symptoms in psychiatric follow-up at the considered unit were reviewed. Two demographically and clinically similar samples were obtained, one exposed to SSRI treatment and one control group. Results: A risk of suicide attempt of 0.006 was found in the group exposed to SSRIs versus 0.025 in the control group, corresponding to a relative risk of suicidality of 0.248. This difference did not reach statistical significance, despite a Bayes factor of 4.57 and a Pearson’s r of -0.078. Conclusions: The study results suggest that SSRIs do not increase the risk of suicide attempt in adolescents with depressive symptoms.
- Nijmegen breakage syndrome: The importance of follow-upLeite, Sara; Lemos, Cláudia; Dias, Rita; Faria, Raquel; Marques, LauraNijmegen breakage syndrome (NBS) is a rare genetic disorder caused by mutations in the NBN gene, which is inherited in an autosomal recessive pattern. The condition results in inadequate DNA repair and is characterized by immunodeficiency with recurrent sinopulmonary infections, increased radiosensitivity, and predisposition to malignancy, particularly of lymphoid origin. The main clinical feature is progressive and severe microcephaly, which affects the facial phenotype, characterized by prominent midface, sloping forehead, and retrognathia. Mild to moderate intellectual impairment is often present and female patients usually develop primary ovarian failure. The diagnosis requires a high index of suspicion and is confirmed by molecular genetic testing. Herein are presented two cases of Nijmegen breakage syndrome followed in a tertiary center.
- Feeding and eating difficulties in early childhood – Characterization of a child psychiatry consultationCarvalho e Marques, Pedro; Monteiro, Maria do Rosário; Rodrigues, Márcia; Fernandes, Graça; Martins, VâniaIntroduction: Feeding difficulties in early childhood are among the most common problems reported by parents and may reflect the child’s own characteristics or a relational problem. They are associated with problems in later life, such as behavioral disorders, cognitive deficits, and eating disorders. Materials and Methods: This study was a retrospective, descriptive analysis of sociodemographic and clinical data of children under six years of age with feeding or eating problems evaluated at a first consultation in a child psychiatry unit of a tertiary hospital between January 2019 and May 2021. Children with a diagnosis or suspected diagnosis of autism spectrum disorder were excluded. Results: Of a total of 647 children evaluated, 57 (8.81%) were classified as having feeding difficulties. Their median age was 24.5 months. Food selectivity was the most frequently reported problem (45.6%), followed by difficulties in self-regulation at mealtimes (43.9%) and decreased appetite (33.3%). Among the mothers, 21% had a history of depressive disorders and 7% had a history of anxiety disorders.Forty-nine percent of children had patterns of interaction with their primary caregiver that were considered worrisome or disruptive. Fifty-four percent of the therapeutic interventions provided were child-parent psychotherapy.Conclusions: Early identification and intervention are needed for children with feeding problems. Feeding problems are common in early childhood and a multidisciplinary approach must always be considered as they can affect several domains of the child’s health and development.
- Immunoglobulin A vasculitis (Henoch-Schönlein purpura) in children - A Literature ReviewSousa, Patrícia; de Oliveira, Susana Correia; Dias, Ângela; Tavares, CláudiaImmunoglobulin A vasculitis (IgAV) is a small-vessel vasculitis that primarily affects children. Major manifestations include purpuric rash, proteinuria/hematuria, arthralgia, and abdominal pain. In this article, the authors review data on the epidemiology, diagnosis, and treatment of IgAV in children. IgAV affects 10 to 56 children per 100,000 per year. The mean age at presentation is six years. Both genetic and environmental factors contribute to its pathogenesis, but the deposition of immune complexes containing abnormal glycosylated immunoglobulin (Ig) A1 plays a predominant role. The course of the disease is usually benign and supportive care is sufficient. Short-term complications are mostly related to gastrointestinal involvement, including the risk of perforation and bleeding. Long-term morbidity is due to chronic kidney disease and hypertension. Corticosteroids are not recommended for prevention of renal involvement, but may be useful as a treatment strategy, as well as more aggressive immunosuppressive drugs.
- Decoding the Human GenomeRocha, Diogo Fernandes de; Rocha, Gustavo; Louro, PedroThe neonatologist is often the first clinician to identify genetic disorders without prenatal diagnosis. Technological advances in genetics over the past few decades have opened up possibilities never before imagined. Gone are the days when we could offer our patients little more than a peripheral blood karyotype. Newer methods, such as comparative genomic hybridization or Sanger sequencing and next-generation sequencing, allow a more detailed analysis of the human genome, both at the level of large rearrangements (deletions, duplications) and potentially pathogenic point variants. High-tech technologies have been useful in uncovering genes involved in diseases that have long been known to have a genetic origin, but whose etiology has remained elusive. Despite the promise of these technologies, no method is self-sufficient, and all have limitations. The aim of this review is to update clinicians on the genetic tests that are currently available and in use. Given that the first human genome was sequenced just over twenty years ago, what news will the next twenty years bring?
- Urinary tract infections in a Pediatric Emergency Department – Etiology and antibiotic susceptibility patternsSantos, Paula; Nascimento, Ana Sofia; Santos, Filomena; Ribeiro, Catarina; Morais, JulietaIntroduction: Urinary tract infections are common in children. The decision to start empiric antibiotic therapy before isolation of the causative agent must be made based on the clinical presentation and antimicrobial resistance profile of each population. The aim of the present study was to identify the most common etiological agents in urinary tract infections in children and adolescents attending the Pediatric Emergency Department of a level II hospital and the antimicrobial susceptibility pattern, in order to optimize the use of empiric and prophylactic therapy.Material and Methods: A retrospective analysis of urine cultures with a positive result between January 2019 and December 2021 was performed.Results: A total of 774 urine cultures were evaluated. The most frequently isolated etiological agents were Escherichia coli (68.5%), Proteus mirabilis (18.1%), and Staphylococcus saprophyticus (4.7%). Escherichia coli showed 4.9% resistance to cefuroxime and 26.2% resistance to amoxicillin-clavulanic acid. Proteus mirabilis showed an adequate susceptibility profile to all empirically used antibiotics. In adolescents, 26.8% of urinary tract infections were caused by Staphylococcus saprophyticus. Ten cases (1.3%) of extended-spectrum beta-lactamase-producing Enterobacteriaceae were identified.Discussion: Cefuroxime showed an adequate susceptibility profile for all microorganisms. Escherichia coli showed a high resistance rate to amoxicillin-clavulanic acid, exceeding the acceptable resistance threshold for empirical antibiotic therapy. The results suggest an increase in the incidence of urinary tract infections caused by Staphylococcus saprophyticus, which means that the prescription of fosfomycin as first-line empirical therapy for female adolescents should be discouraged.
- The impact of the COVID-19 pandemic on adolescent Emergency Department visitsMartins, Inês Aires; Queirós, Joana Carvalho; Lira, Sónia; Ribeiro, Maria do CéuIntroduction: Adolescence is a unique period of physical and emotional growth. During the COVID-19 pandemic, several countries decided to close schools, with yet unclear consequences for mental health. Stressful life events may affect adolescents’ quality of life and precipitate psychiatric emergencies. This study aimed to compare the reasons for Emergency Department (ED) visits among adolescents before the COVID-19 pandemic and after the relief of social distancing measures. Methods: A retrospective cohort study was conducted, including individuals aged 13-18 years admitted to the ED of a Portuguese level II hospital between January and June 2019 (Group 1) and January and June 2022 (Group 2). Data were collected from electronic medical records. Descriptive and inferential statistical analyses were performed.Results: A total of 5135 adolescents were included in the two groups, with no demographic differences between them. Infectious diseases were the most common diagnosis overall. Group 2 showed a significant increase in mental health conditions such as anxiety (odds ratio [OR] 1.354) and feeding or eating disorders (OR 12.380), and its population was generally younger, especially in the feeding or eating disorders and intentional self-harm subgroups. No differences were found between groups regarding preexisting mental health conditions, except for intentional self-harm due to exposure to harmful substance effects, which were significantly more common in Group 2 (OR 4.267).Conclusions: Although acute infectious diseases remain the most common cause of ED admissions, this study showed a significant increase in ED visits for mental health disorders, reflecting the impact of the COVID-19 pandemic. Protecting adolescents from adversity, promoting psychological well-being, and ensuring access to mental health care are critical to adolescent health.
- Anaphylaxis in the Pediatric Emergency Department of a central hospitalCoelho, Cristina; Pereira, Liliana Patrícia; Santa, Cátia; Pedrosa, CláudiaAnaphylaxis is a potentially life-threatening medical emergency. Early diagnosis and treatment are crucial. In children, the diagnosis is complicated by some unique features of the pediatric population. Food is the most common etiology in pediatric patients.The aim of this study was to characterize the episodes of anaphylaxis identified in the Pediatric Emergency Department (ED) of a central hospital between 2012 and 2021 according to the 2014 EAACI guidelines. Seventy-eight anaphylaxis episodes were included, 44 of which were first episodes. Children’s median age was 9.5 years (range 6 months-17 years) and 62.8% were male. A history of atopy was present in 52.6% of cases and asthma and/or allergic rhinitis in 50.9%.The most common trigger was food (74.4%) and the most common food was milk (27.6%).Mucocutaneous manifestations occurred in 94.9%, respiratory manifestations in 80.8%, gastrointestinal manifestations in 38.5%, and cardiovascular manifestations in 21.8%.Epinephrine treatment was administered in 83.3% of episodes. Patients with an epinephrine autoinjector (EAI) used it in 52.9% of episodes. The median (range) monitoring time was 13 (3-26) hours.At discharge, EAI was prescribed in 84.1% of first episodes, and 95.5% were referred for specialty consultation.As reported in the literature, food etiology prevailed in the described anaphylaxis cases. Epinephrine was the first-line treatment in most cases. EAI was used in approximately half of patients. Despite growing awareness, it is essential to alert patients and health professionals to the importance of epinephrine in the management of these cases.
- Growing through grief. Bereavement after parental suicide in a child with autism spectrum disorder: A clinical casede LIz, Mariana Ferraz; Lopes, Ana Filipa; Antunes, Marta Pereira; Falcão, Mariana Lima; Araújo, Sara; Santos, Maria do CarmoThe impact of suicide on children remains unclear. Herein is reported the case of a seven-year-old boy who was referred for consultation for behavioral changes after witnessing his mother’s suicide. The main complaints were constant questions about death, emotional lability, and motor agitation. During bereavement-focused psychotherapy, some particularities in social functioning were noted, leading to the diagnosis of autism spectrum disorder (ASD). The bereavement process following parental suicide is modulated by several factors. Understanding these factors in the context of the particularities of the ASD population has allowed for a better understanding of the individual challenges of children that warrant specific interventions.Much remains to be understood about suicide imprinting in surviving offspring, particularly in children with ASD for whom the bereave-ment process may be overlooked.