Early-life weight and weight gain as predictors of obesity in Brazilian adolescents

OBJECTIVE: To test whether weight and the weight gain rate during different age periods are associated with being overweight/obese at 10 years of age. METHODS: A nested case-control study was performed in a clinical historic cohort that was selected based on medical records from the Albert Einstein Hospital Social Program in São Paulo, Brazil. A sample of 378 eutrophic and overweight/obese children was analyzed. RESULTS: After adjusting for birth weight and gestational age, the likelihood of being overweight/obese at 10 years of age was 4.04-fold greater when progressing from one quartile of weight gain to the immediately superior quartile in the first semester of life and 3.24-fold greater when this occurred from 2-5 years of age. A one-quartile change in weight gain in the first semester was associated with a 0.5 z-score increase in BMI at age 10. A robust independent effect of weight at age 5 confirmed that earlier weight gain was an important predictor. CONCLUSIONS: The amount of weight gain during the first 6 months of life and between 2 and 5 years of age and weight at age 5 were important predictors of overweight/obesity at 10 years of age

Estudo maturacional da via auditiva em prematuros nascidos pequenos para a idade gestacional

PURPOSE:To follow up the maturation of the auditory pathway in preterm infants small for gestational age (SGA), through the study of absolute and interpeak latencies of auditory brainstem response (ABR) in the first six months of age.METHODS:This multicentric prospective cross-sectional and longitudinal study assessed 76 newborn infants, 35 SGA and 41 appropriate for gestational age (AGA), born between 33 and 36 weeks in the first evaluation. The ABR was carried out in three moments (neonatal period, three months and six months). Twenty-nine SGA and 33 AGA (62 infants), between 51 and 54 weeks (corrected age), returned for the second evaluation. In the third evaluation, 49 infants (23 SGA and 26 AGA), with age range from 63 to 65 weeks (corrected age), were assessed. The bilateral presence of Transient Evoked Otoacoustic Emissions and normal tympanogram were inclusion criteria.RESULTS:It was found interaural symmetry in both groups. The comparison between the two groups throughout the three periods studied showed no significant differences in the ABR parameters, except for the latencies of wave III in the period between three and six months. As for the maturation with tone burst 0.5 and 1 kHz, it was found that the groups did not differ.CONCLUSION:The findings suggest that, in the premature infants, the maturational process of the auditory pathway occurs in a similar rate for SGA and AGA. These results also suggest that prematurity is a more relevant factor for the maturation of the auditory pathway than birth weight.OBJETIVO:Acompanhar a maturação da via auditiva em recém-nascidos prematuros pequenos para a idade gestacional (PIG), por meio do estudo das latências absolutas e interpicos do potencial evocado auditivo de tronco encefálico (PEATE) nos primeiros seis meses de idade.MÉTODOS:Estudo transversal e longitudinal prospectivo multicêntrico, que avaliou 76 recém-nascidos, 35 PIG e 41 adequados para a idade gestacional (AIG), nascidos entre 27 e 36 semanas de gestação na primeira avaliação. O PEATE foi realizado em três momentos (período neonatal, três meses e seis meses). Retornaram para a segunda avaliação 29 PIG e 33 AIG (62 lactentes), entre 51 e 54 semanas (idade corrigida). Na terceira, retornaram 49 lactentes (23 PIG e 26 AIG), com faixa etária de 63 a 65 semanas (idade corrigida). Foi critério de inclusão a presença bilateral de emissões otoacústicas evocadas por estímulo transiente e curva timpanométrica normal.RESULTADOS:Verificou-se simetria interaural nos dois grupos. A comparação entre os dois grupos ao longo dos três períodos estudados não mostrou diferenças relevantes nos parâmetros do PEATE, exceto para as latências da onda III no período entre os três e seis meses. Quanto ao processo maturacional com tone burst 0,5 e 1 kHz, verificou-se que os grupos não se diferenciaram.CONCLUSÃO:Os resultados sugerem que, nos prematuros, o processo de maturação da via auditiva ocorre em tempo similar em PIG e AIG. Também sugerem que a prematuridade é um fator de maior relevância para a maturação da via auditiva que o fator peso ao nascer.Universidade de São Paulo School of MedicineUniversidade de São Paulo School of Medicine Department of PediatricsUniversidade Federal de São Paulo (UNIFESP) Department of PediatricsUniversidade Federal de São Paulo (UNIFESP) Department of Speech-Language Pathology and AudiologyUniversidade de São Paulo School of Medicine Department of Physical Therapy, Speech-Language Pathology and Audiology, and Occupational TherapyUNIFESP, Department of PediatricsUNIFESP, Department of Speech-Language Pathology and AudiologySciEL

The importance of viral load in the severity of acute bronchiolitis in hospitalized infants

OBJECTIVE: The relationship between viral load and the clinical evolution of bronchiolitis is controversial. Therefore, we aimed to analyze viral loads in infants hospitalized for bronchiolitis. METHODS: We tested for the presence of human respiratory syncytial virus (HRSV) or human rhinovirus (HRV) using quantitative molecular tests of nasopharyngeal secretions and recorded severity outcomes. RESULTS: We included 70 infants [49 (70%) HRSV, 9 (13%) HRV and 12 (17%) HRSV+HRV]. There were no differences among the groups according to the outcomes analyzed individually. Clinical scores showed greater severity in the isolated HRSV infection group. A higher isolated HRSV viral load was associated with more prolonged ventilatory support, oxygen therapy, and hospitalization days, even after adjustment for the age and period of nasopharyngeal secretion collection. In the co-infection groups, there was a longer duration of oxygen therapy when the HRSV viral load was predominant. Isolated HRV infection and co-infection with a predominance of HRV were not associated with severity. CONCLUSION: Higher HRSV viral load in isolated infections and the predominance of HRSV in co-infections, independent of viral load, were associated with greater severity. These results contribute to the development of therapeutic and prophylactic approaches and a greater understanding of the pathophysiology of bronchiolitis

Estudo eletrofisiológico longitudinal da via auditiva em crianças nascidas a termo e pequenas para a idade gestacional

PURPOSE:To follow the maturation of the auditory pathway of infants born small for gestational age term, by studying absolute and interpeak latencies of Auditory Brainstem Response (ABR) in the first six months of life.METHODS:Multicentric prospective longitudinal study. The ABR was carried out in the neonatal period in 96 newborn infants, 49 small for gestational age (SGA) and 47 appropriate for gestational age (AGA). Of these, 77 infants (39 SGA and 38 AGA) returned for a second evaluation. In the third evaluation, 70 infants (35 SGA and 35 AGA) returned.RESULTS:SGA and AGA did not present significant differences in the neonatal period and at three months of life. However, at six months, there was statistical significant difference between SGA and AGA groups for the latencies of wave III and interpeak I-III. Latencies of ABR waves decreased more rapidly in the first three months than the third to the sixth month of life for the SGA. AGA group showed progressive decrease in latency of ABR waves during the six months.CONCLUSION:The findings suggest that, for SGA infants, the maturational process of the auditory pathway occurs in different rate when compared to AGA infants. The SGA infants have faster maturation especially at the first three months of life, while in infants AGA, this process occurred in a constant and gradual way throughout the six months studied.OBJETIVO:Acompanhar a maturação da via auditiva de lactentes nascidos a termo pequenos para a idade gestacional, por meio do estudo das latências absolutas e interpicos do Potencial Evocado Auditivo de Tronco Encefálico (PEATE) nos primeiros seis meses de vida.MÉTODOS:Estudo multicêntrico prospectivo longitudinal. PEATE realizado no período neonatal em 96 recém-nascidos, 49 pequenos para a idade gestacional (PIG) e 47 adequados para a idade gestacional (AIG). Destes, 77 lactentes (39 PIG e 38 AIG) retornaram para a segunda avaliação. Na terceira avaliação, retornaram 70 lactentes (35 PIG e 35 AIG).RESULTADOS:PIG e AIG não apresentaram diferenças significativas no período neonatal e aos três meses de vida. Aos seis meses, houve diferença estatística entre os grupos PIG e AIG para a onda III e interpico I-III. Latências das ondas do PEATE diminuíram mais rapidamente nos primeiros três meses que do terceiro para o sexto mês de vida para o grupo PIG. O grupo AIG mostrou diminuição progressiva da latência das ondas do PEATE durante os seis meses.CONCLUSÃO:Os resultados sugerem que a maturação da via auditiva nos PIG ocorre em ritmo diferente quando comparada aos AIG. Os PIG têm maturação mais rápida, especialmente nos três primeiros meses de vida; nas crianças AIG, esse processo ocorreu de modo constante e gradual ao longo dos seis meses estudados.Universidade de São PauloUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Electrophysiological characterization of hearing in small for gestational age premature infants

PURPOSE: To characterize the Auditory Brainstem Response (ABR) of small for gestational age preterm newborns and to compare the findings to those of appropriate for gestational age premature newborns in order to verify whether the small for gestational age condition is a risk factor for hearing loss. METHODS: This prospective cross-sectional multicenter study evaluated 72 preterm newborns of both genders (35 small and 37 appropriate for gestational age), who were born at 30 to 36 weeks of gestational age and were evaluated before hospital discharge. Only newborns with present transient evoked otoacoustic emissions and tympanometry type A were included. The ABR was performed with click stimuli. The quantitative data analysis was performed using mean and standard deviation measures for each group. For qualitative analysis, the ABR results were classified as normal or altered according to the absolute latencies of waves I, III, V and interpeaks I-III, III-V, I-V. The analysis was carried out considering the age of the newborn at the time of examination. RESULTS: Alterations were evident in 32 newborns (44.44%), being 15 small (43%) and 17 appropriate for gestational age (46%), with no between-groups difference. Of the 15 small for gestational age newborns with altered ABR, six presented as auditory risk only the small for gestational age condition. In the group of adequate for gestational age newborns, there was a higher occurrence of alteration in males. CONCLUSION: There was no difference in responses of auditory evoked potential between small and appropriate for gestational age preterm newborns. Therefore, the condition does not behave as a risk factor for retrocochlear impairment.OBJETIVO: Caracterizar as respostas do Potencial Evocado Auditivo de Tronco Encefálico em recém-nascidos pré-termo pequenos para idade gestacional, comparando-as às de recém-nascidos pré-termo adequados para idade gestacional, verificando se a condição de pequeno para a idade gestacional é indicador de risco para alteração auditiva retrococlear. MÉTODOS: Estudo multicêntrico transversal prospectivo. Avaliou-se 72 recém-nascidos pré-termo, 35 pequenos e 37 adequados para idade gestacional de ambos os gêneros, com idade gestacional de 30 a 36 semanas e avaliados na pré-alta hospitalar, com presença de emissões otoacústicas evocadas por estímulo transiente e timpanometria tipo A. A análise quantitativa dos dados foi feita baseada na média e desvio-padrão das latências das ondas I, III, V e interpicos I-III, III-V, I-V para cada grupo. Para análise qualitativa, os resultados dos potenciais evocados auditivos foram classificados em alterado ou normal mediante a análise das latências absolutas das ondas I, III, V e dos interpicos I-III, III-V, I-V, considerando-se a faixa etária no momento do exame. RESULTADOS: Evidenciaram-se alterações em 32 crianças (44,44% do total), sendo 15 recém-nascidos pequenos (43%) e 17 adequados (46%), não havendo diferença entre os grupos. Dos 15 recém-nascidos pequenos com potencial evocado auditivo alterado, seis tiveram como risco auditivo apenas o fato de ser pequeno para a idade gestacional. No grupo adequado para idade gestacional, houve maior ocorrência de alterações no gênero masculino. CONCLUSÃO: Não houve diferença nas respostas do potencial evocado auditivo entre os recém-nascidos pré-termo pequenos e adequados, de forma que a condição pequeno não se revelou risco para alteração retrococlear.Universidade de São Paulo Faculdade de Medicina Departamento de Fisioterapia, Fonoaudiologia e Terapia OcupacionalUniversidade Federal de São Paulo (UNIFESP) Departamento de FonoaudiologiaUniversidade de São Paulo Faculdade de Medicina Departamento de Pediatria, Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUNIFESP, Depto. de Fonoaudiologia, UNIFESP, Depto. de PediatriaSciEL

Inattention symptoms in early pregnancy predict parenting skills and infant maltreatment during the first year of life

Objective: Maternal attention-deficit/hyperactivity disorder has not been investigated in relation to parenting skills in adolescent mothers. This study investigated whether maternal inattention and hyperactivity/ impulsivity symptoms early in pregnancy predict poorer parenting skills and infant maltreatment during the first year of life in adolescent mothers living in adverse environmental conditions. Methods: The participants in this study were 80 adolescent mothers aged 14-19 years and their babies who were taking part in a randomized controlled trial on the effects of a home-visiting program on infant development. Symptoms of maternal attention-deficit/hyperactivity disorder were assessed in the first trimester of pregnancy. Parenting skills (maternal competence, attachment to the baby, home environment) and child maltreatment were assessed when the infants were aged 6 and 12 months. Multilevel linear regression models were constructed to test the extent to which prenatal maternal inattention and hyperactivity/impulsivity symptoms predicted these parenting variables during the first year of the infant’s life. Results: Prenatal inattention symptoms significantly predicted lower maternal competence and attachment, a poorer home environment, and greater maltreatment during the first year of life. Hyperactivity did not significantly predict parenting skills or maltreatment. Conclusions: Our findings suggest that inattention symptoms may interfere with parenting abilities in adolescent mothers and should be considered in early intervention programs

Diversidades socioeconômicas e o desenvolvimento infantil de 6 a 9 meses no estado de São Paulo, Brasil

Introduction: The effects of socioeconomic disparities on cognitive development tend to emerge early in infancy and to widen throughout childhood, and may perpetuate later in life. Although the study of how poverty affects early childhood has increased in the last 20 years, many of the effects remain largely unknown, especially during the first year of life. Aim: To investigate the influence of socioeconomic status (SES) and maternal education on infants’ language, motor and cognitive development. Methods: The cognitive, language and motor skills of 444 infants aged 6 to 9 months selected from a poor neighborhood in São Paulo, Brazil, were evaluated using the Bayley Scales of Infant Development. A questionnaire on socioeconomic background was administered to the participants’ families. Results: A positive association was found between SES and infants’ performance on language and motor scales. Additionally, higher maternal education was associated with higher language and cognitive scores. Conclusion: Our findings indicate that SES effects are detectable very early in infancy. This result has implications for the timing of both screening and intervention efforts to help children overcome the consequences of living in poverty.Introdução: Os efeitos das disparidades socioeconômicas no desenvolvimento cognitivo tendem a surgir no início da primeira infância e a se ampliar ao longo da infância, e podem perpetuar-se mais tardiamente. Embora estudos mostrando os efeitos deletérios de um menor nível socioeconômico (NSE) no desenvolvimento na primeira infância tenham aumentado nos últimos 20 anos, muitos desses efeitos ainda permanecem desconhecidos, especialmente durante o primeiro ano de vida. Objetivo: Investigar a influência do NSE e da escolaridade materna no desenvolvimento linguístico, motor e cognitivo do bebê. Método: Foram avaliadas as habilidades cognitivas, linguísticas e motoras de 444 lactentes com 6 a 9 meses de idade selecionados em um bairro de baixo NSE na zona oeste de São Paulo, Brasil, utilizando-se as Escalas Bayley de Desenvolvimento Infantil. Um questionário também foi administrado para coletar dados sobre o background socioeconômico das famílias das crianças participantes. Resultado: Foi observada uma associação positiva entre NSE e o desempenho dos lactentes nas escalas de linguagem e desenvolvimento motor. Adicionalmente, maior educação materna esteve associada a escores mais altos nas escalas de desenvolvimento linguístico e cognitivo. Conclusão: Os resultados deste estudo indicam que os efeitos do NSE são detectáveis muito cedo na primeira infância. Este resultado tem implicações para o timing de avaliações e intervenções que possam ajudar as crianças a superar as consequências de viver na pobreza

Profile of health professionals who completed a master’s, doctoral, or post-doctoral degree in one Brazilian pediatric program

OBJECTIVE: This study aimed to determine the personal and professional characteristics, and the physical, psychiatric/psychological, and professional issues that exist among master’s-, doctoral-, and post-doctoral-level health professionals. METHODS: A cross-sectional, online, self-reported survey of 452 postgraduates who completed master’s, doctoral, or post-doctoral degrees in one graduate program in pediatrics in Sa˜o Paulo, Brazil, was conducted. RESULTS: The response rate was 47% (211/453). The majority of participants were women (78%) and physicians (74%), and the median age was 47 years (28-71). Master’s, doctoral, and post-doctoral degrees were reported by 73%, 53%, and 3%, respectively. High workload (440 hours/week) occurred in 59%, and 45% earned X15 minimum wages/month. At least one participation in scientific meeting in the past year was reported by 91%, and 79% had published their research. Thirty-nine percent served as a member of a faculty of an institution of higher learning. The data were analyzed by two age groups: participants aged p48 years (group 1) and participants aged 448 years (group 2). The median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (1-10), p=0.0113]; workload 440 hours/week (53% vs. 68%, p=0.034); and X15 minimum wages/month (37% vs. 56%, p=0.0083) were significantly lower in group 1. Further analysis by gender revealed that the median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (3-10), p=0.0015], workload 440 hours/week (53% vs. 83%, p=0.0002), and X15 minimum wages/month (37% vs. 74%, p=0.0001) were significantly lower in women compared with men. The median rating of overall satisfaction with the mentorship supervision provided was significantly higher among the women 10 (5-10) vs. 10 (2-10), p=0.0324]. CONCLUSIONS: The majority of master’s-, doctoral-, and post-doctoral-level health professionals were women and physicians, and had published their thesis. Younger postgraduates and women reported low salaries, less likelihood of working 440 hours/week, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are warranted to assess career trajectories after graduation

Promoting healthy feeding practices among 0-5 year old children: the contribution of lay community health workers

The prevalence of overweight and obesity is increasing both in the world and in Brazil towards an epidemic level. There are pieces of evidence that suggest that the larger the weight gain between 0 to 5 years of age the greater the risk for future obesity. National studies have shown that preschool children have high level of hydro carbonate intake. However interventions on this topic are mainly punctual in time. Investing in capacity building and supervision of Community Health Workers (CHW) of the Family Health Strategy could help promoting an adequate nutrition in the population. An example: in 2012 a group of students in the Primary Health Care course of the first year of the Medical School of the University of Sao Paulo chose to work with healthy toddler nutrition as a project within the course. CHW were trained to answer questions on this theme that the population could have and to identify diet mistakes. The post-intervention assessment showed that the trained CHW had a better performance in comparison to a control group.A prevalência de sobrepeso e obesidade tem aumentado no mundo e no Brasil em caráter epidêmico. Há evidências de que quanto maior o ganho de peso entre 0 a 5 anos de idade, maior o risco de obesidade futura. Estudos nacionais mostram que nossas crianças pré-escolares ingerem um alto percentual de carboidrato. Mesmo diante desses fatos os trabalhos de intervenção nutricional existentes são, na sua maioria, ações pontuais. Investir na capacitação e supervisão contínua dos Agentes Comunitários de Saúde (ACSs) da Estratégia de Saúde da Família pode auxiliar na promoção de uma nutrição adequada da população. Um exemplo: no ano de 2012 um grupo de alunos da disciplina de Atenção Primária do primeiro ano médico da Faculdade de Medicina da Universidade de São Paulo (FMUSP) optou por trabalhar, como projeto de intervenção obrigatório da disciplina, com o tema alimentação saudável na infância e escolheu treinar ACSs, capacitando-os para saber responder perguntas que lhes fossem feitas pela comunidade e também para identificar erros dietéticos. A avaliação pós-intervenção mostrou que esses ACSs tiveram melhor desempenho em comparação com um grupo controle