Parental smoking patterns and their association with wheezing in children

OBJECTIVE: To investigate parental smoking patterns and their association with wheezing in children. METHODS: We performed a case-control study that included 105 children between 6 and 23 months of age who were divided into two groups: cases (children with 3 previous episodes of wheezing) and controls (healthy children without wheezing). The children's exposure to cigarette smoking was estimated using a questionnaire completed by the mothers and by the children's urinary cotinine levels. RESULTS: Based on both the questionnaire results and cotinine levels, exposure to cigarette smoking was higher in the households of cases in which the incidence of maternal smoking was significantly higher than that of paternal smoking. Children in this group were more affected by maternal smoking and by the total number of cigarettes smoked inside the house. Additionally, the questionnaire results indicated that the risk of wheezing was dose dependent. The presence of allergic components, such as atopic dermatitis and siblings with allergic rhinitis and asthma, greatly increased the odds ratio when wheezing was associated with cotinine levels. CONCLUSION: Children exposed to tobacco smoke have an increased risk of developing wheezing syndrome. This risk increases in association with the number of cigarettes smoked inside the house and the presence of other allergic components in the family

How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency

Introduction: The exponential growth of telehealth services during the COVID-19 pandemic led to the implementation of a telemedicine care service in a tertiary university pediatric hospital. It brought the need to develop a training aimed at remote care within the pediatric emergency rotation program. Objective: To describe the implementation of a telemedicine training for pediatric residents and present the preliminary results. Methods: Descriptive prospective study (pre and post), with 40 resident physicians of the first year of pediatrics. Reaction Assessments were applied before and after training, in addition to a resident physician perception questionnaire at the end of the training. Results: There was a significant difference in the resident's perception of experience and safety after initial training. Most rated the proposal as good or excellent, considered teaching telemedicine relevant and that this experience contributed to their learning on the subject. Conclusion: This study describes an innovative proposal for training in telemedicine. The preliminary results were encouraging, demonstrating the program's potential in training future pediatricians

Impacto na saúde mental de enfermeiros pediátricos: um estudo transversal em hospital pediátrico terciário durante a pandemia de COVID-19

Objetivo: evaluar los problemas de salud mental en enfermerospediátricos durante la pandemia del coronavirus 2019. Método:estudio transversal realizado con enfermeros pediátricos del Institutoda Criança e do Adolescente mediante una encuesta de autoevaluaciónen línea sobre la práctica clínica y el impacto en la salud mental durantela pandemia de COVID-19. Se evaluaron escalas de autoevaluaciónvalidadas para ansiedad, depresión y burnout. Resultados: respondieron107/298 (36%) de los enfermeros, de los cuales 90% eran del sexofemenino, la mediana de edad actual fue de 41 (23-64) años, 68%trabajaban con adolescentes, 66% trabajaban en primera línea. Burnout,ansiedad y depresión moderada/grave ocurrieron en 65%, 72% y 74%de los enfermeros, respectivamente. Falta de protocolo de tratamientoestandarizado en las enfermerías (27% vs. 10%, p=0,049), depresiónmoderada/grave (74% vs. 16%, p=0,002) y burnout (82% vs. 58%,p=0,01) fueron significativamente mayores en enfermeros pediátricoscon ansiedad en comparación con enfermeros sin esta condición. Losenfermeros pediátricos que trabajaban con adolescentes presentaronmayor frecuencia de burnout en comparación con los que no trabajabancon adolescentes (77% vs. 32%, p=0,0001). El análisis multivariadoreveló que el adecuado cumplimiento de la cuarentena aumentó4,6 veces la presencia de ansiedad [OR 4.6(IC 1,1-20,2), p=0,04].Conclusión: La mayoría de los enfermeros pediátricos trabajaban enla primera línea de la COVID-19, en condiciones precarias, trabajandocon un equipo reducido y enfrentando importantes pérdidas de ingresos.La ansiedad actual fue un tema relevante y el burnout también fueuna condición mental importante para estos profesionales, reforzandola cultura del buen trabajo en equipo, las prácticas colaborativas y laatención psicológica/psiquiátrica.Objective: to assess mental health issues in pediatric nurses duringcoronavirus pandemic in 2019. Method: cross-sectional study wasconducted with pediatric nurses at the Instituto da Criança e doAdolescente based on online self-rated survey about clinical practiceand mental health impact during COVID-19 pandemic. Validatedself-reported scales for anxiety, depression and burnout were usedfor assessing these professionals. Results: 107/298 (36%) nursesanswered, 90% were female, median age was 41(23-64) years,68% worked with adolescents, 66% in frontline. Burnout, anxietyand moderate/severe depression occurred in 65%, 72% and 74%,respectively. Lack of standardized treatment protocol for nurses(27%vs.10%, p=0.049), moderate/severe depression (74% vs. 16%,p=0.002) and burnout (82% vs. 58%, p=0.01) were significantlyhigher in pediatric nurses with anxiety compared to those without.Pediatric nurses that worked with adolescents compared to those thatdid not showed higher frequency of burnout in the former group (77%vs. 32%, p=0.0001). Multivariable analysis revealed that adequatequarantine adherence increased the presence of anxiety in 4.6 times[OR4.6(CI 1.1-20.2), p=0.04]. Conclusion: most pediatric nurseswho had worked in the frontline of COVID-19 were under precariousconditions, working with reduced team, and with an expressivechanges in their monthly income. Current anxiety was a relevantissue, burnout was also an important mental condition for theseprofessionals, reinforcing culture of good teamwork, collaborationpractices and psychological/psychiatric approach.Objetivo: avaliar problemas de saúde mental em enfermeiros pediátricosdurante a pandemia causada pelo coronavírus 2019. Método: estudotransversal realizado com enfermeiros pediátricos do Instituto da Criançae do Adolescente, por meio de uma pesquisa online de autoavaliaçãosobre prática clínica e impacto na saúde mental, durante a pandemiade COVID-19. Foram avaliadas escalas de autoavaliação validadaspara ansiedade, depressão e burnout. Resultados: 107/298(36%)enfermeiros responderam, dos quais 90% eram do sexo feminino,a mediana de idade atual era 41(23-64) anos, 68% trabalhavamcom adolescentes, 66% trabalhavam na linha de frente. Burnout,ansiedade e depressão moderada/grave ocorreram em 65%, 72%e 74% dos enfermeiros, respectivamente. Falta de protocolo detratamento padronizado nas enfermarias (27% vs. 10%, p=0,049),depressão moderada/grave (74% vs. 16%, p=0,002) e burnout (82%vs. 58%, p=0,01) foram significativamente maiores em enfermeirospediátricos com ansiedade, em comparação com enfermeiros sem essacondição. Os enfermeiros pediátricos que trabalhavam com adolescentesapresentaram maior frequência de burnout, quando comparados aos quenão trabalhavam com esse grupo (77% vs. 32%, p=0,0001). A análisemultivariada revelou que o cumprimento adequado da quarentenaaumentou a presença de ansiedade em 4,6 vezes [OR 4.6(IC 1,1-20,2),p=0,04]. Conclusão: A maioria dos enfermeiros pediátricos atuavana linha de frente da COVID-19, em condições precárias, trabalhandocom equipe reduzida e enfrentando perdas expressivas de renda. Aansiedade atual foi um tema relevante e o burnout também foi umacondição mental importante para esses profissionais, reforçando acultura do bom trabalho em equipe, das práticas de colaboração e docuidado psicológico/psiquiátrico

Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (ageo18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels 450 mg/L (83% vs. 25%, p=0.008) and D-dimer levels 41000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (po0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, po0.001), vasoactive agent use (83% vs. 3%, po0.001), shock (83% vs. 5%, po0.001), cardiac abnormalities (100% vs. 2%, po0.001), and death (67% vs. 3%, po0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, po0.001), aspirin therapy (50% vs. 0%, po0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39- 526.79; po0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia

Air pollution and children's health: sickle cell disease

The hallmarks of sickle cell disease are anemia and vasculopathy. The aim of this study was to assess the association between air pollution and children's emergency room visits of sickle cell patients. We adopted a case-crossover design. Daily counts of children's and adolescents' sickle cell disease emergency room visits from the pediatric emergency unit in São Paulo, Brazil, were evaluated from September 1999 to December 2004, matching by temperature, humidity and controlling for day of the week. Interquartile range increases of the four-day moving averages of PM10, NO2, SO2, CO, and O3 were associated with increases of 18.9% (95%CI: 11.2-26.5), 19% (95%CI: 8.3-29.6), 14.4% (95%CI: 6.5-22.4), 16,5% (95%CI: 8.9-24.0), and 9.8% (95%CI: 1.1-18.6) in total sickle cell emergency room visits, respectively. When the analyses were stratified by pain, PM10 was found to be 40.3% higher than in sickle cell patients without pain symptoms. Exposure to air pollution can affect the cardiovascular health of children and may promote a significant health burden in a sensitive group

SARS-CoV-2 and rhinovirus infections: are there differences in clinical presentation, laboratory abnormalities, and outcomes in the pediatric population?

This study aims to assess COVID-19 and other respiratory viruses in pediatric patients. Between April 17 and September 30, 2020, we collected 1,566 respiratory samples from 1,044 symptomatic patients who were younger than 18 years old to assess SARS-CoV-2 infection. Of these, 919 were analyzed for other respiratory pathogens (ORP). Patients with laboratory-confirmed COVID-19 or ORP were included. We evaluated 76 pediatric COVID-19 infections and 157 other respiratory virus infections. Rhinovirus occurred in 132/157 (84%). COVID-19 patients who were significantly older, had more fevers, headaches and pneumonia than those with ORP. The median white blood cell count was lower in patients with SARS-CoV-2 than in those with ORP (6,470 versus 8,170; p=0.02). COVID-19 patients had significantly worse symptoms than those with ORP