Construction and validation of the Oxford Neurodevelopment Assessment (OX-NDA) in 1-year-old Brazilian children.

BACKGROUND: Over 250 million children under 5 years, globally, are at risk of developmental delay. Interventions during the first 2 years of life have enduring positive effects if children at risk are identified, using standardized assessments, within this window. However, identifying developmental delay during infancy is challenging and there are limited infant development assessments suitable for use in low- and middle-income (LMIC) settings. Here, we describe a new tool, the Oxford Neurodevelopment Assessment (OX-NDA), measuring cognition, language, motor, and behaviour, outcomes in 1-year-old children. We present the results of its evaluation against the Bayley Scales of Infant Development IIIrd edition (BSID-III) and its psychometric properties. METHODS: Sixteen international tools measuring infant development were analysed to inform the OX-NDA's construction. Its agreement with the BSID-III, for cognitive, motor and language domains, was evaluated using intra-class correlations (ICCs, for absolute agreement), Bland-Altman analyses (for bias and limits of agreement), and sensitivity and specificity analyses (for accuracy) in 104 Brazilian children, aged 12 months (SD 8.4 days), recruited from the 2015 Pelotas Birth Cohort Study. Behaviour was not evaluated, as the BSID-III's adaptive behaviour scale was not included in the cohort's protocol. Cohen's kappas and Cronbach's alphas were calculated to determine the OX-NDA's reliability and internal consistency respectively. RESULTS: Agreement was moderate for cognition and motor outcomes (ICCs 0.63 and 0.68, p < 0.001) and low for language outcomes (ICC 0.30, p < 0.04). Bland-Altman analysis showed little to no bias between measures across domains. The OX-NDA's sensitivity and specificity for predicting moderate-to-severe delay on the BSID-III was 76, 73 and 43% and 75, 80 and 33% for cognition, motor and language outcomes, respectively. Inter-rater (k = 0.80-0.96) and test-rest (k = 0.85-0.94) reliability was high for all domains. Administration time was < 20 minutes. CONCLUSION: The OX-NDA shows moderate agreement with the BSID-III for identifying infants at risk of cognitive and motor delay; agreement was low for language delay. It is a rapid, low-cost assessment constructed specifically for use in LMIC populations. Further work is needed to evaluate its use (i) across domains in populations beyond Brazil and (ii) to identify language delays in Brazilian children.

INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study.

OBJECTIVES: To describe the construction of the international INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) standards for child development at 2 years by reporting the cognitive, language, motor and behaviour outcomes in optimally healthy and nourished children in the INTERGROWTH-21st Project. DESIGN: Population-based cohort study, the INTERGROWTH-21st Project. SETTING: Brazil, India, Italy, Kenya and the UK. PARTICIPANTS: 1181 children prospectively recruited from early fetal life according to the prescriptive WHO approach, and confirmed to be at low risk of adverse perinatal and postnatal outcomes. PRIMARY MEASURES: Scaled INTER-NDA domain scores for cognition, language, fine and gross motor skills and behaviour; vision outcomes measured on the Cardiff tests; attentional problems and emotional reactivity measured on the respective subscales of the preschool Child Behaviour Checklist; and the age of acquisition of the WHO gross motor milestones. RESULTS: Scaled INTER-NDA domain scores are presented as centiles, which were constructed according to the prescriptive WHO approach and excluded children born preterm and those with significant postnatal/neurological morbidity. For all domains, except negative behaviour, higher scores reflect better outcomes and the threshold for normality was defined as ≥10th centile. For the INTER-NDA's cognitive, fine motor, gross motor, language and positive behaviour domains these are ≥38.5, ≥25.7, ≥51.7, ≥17.8 and ≥51.4, respectively. The threshold for normality for the INTER-NDA's negative behaviour domain is ≤50.0, that is, ≤90th centile. At 22-30 months of age, the cohort overlapped with the WHO motor milestone centiles, showed low postnatal morbidity (<10%), and vision outcomes, attentional problems and emotional reactivity scores within the respective normative ranges. CONCLUSIONS: From this large, healthy and well-nourished, international cohort, we have constructed, using the WHO prescriptive methodology, international INTER-NDA standards for child development at 2 years of age. Standards, rather than references, are recommended for population-level screening and the identification of children at risk of adverse outcomes.

Late weaning and maternal closeness, associated with advanced motor and visual maturation, reinforce autonomy in healthy, 2-year-old children.

We studied neurodevelopmental outcomes and behaviours in healthy 2-year old children (N = 1306) from Brazil, India, Italy, Kenya and the UK participating in the INTERGROWTH-21st Project. There was a positive independent relationship of duration of exclusive breastfeeding (EBF) and age at weaning with gross motor development, vision and autonomic physical activities, most evident if children were exclusively breastfed for ≥7 months or weaned at ≥7 months. There was no association with cognition, language or behaviour. Children exclusively breastfed from birth to <5 months or weaned at >6 months had, in a dose-effect pattern, adjusting for confounding factors, higher scores for "emotional reactivity". The positive effect of EBF and age at weaning on gross motor, running and climbing scores was strongest among children with the highest scores in maternal closeness proxy indicators. EBF, late weaning and maternal closeness, associated with advanced motor and vision maturation, independently influence autonomous behaviours in healthy children.

Profile of Patients Diagnosed with Developmental Dysplasia of the Hip.

Objective To describe the profile of patients with developmental dysplasia of the hip (DDH) diagnosed by physical and ultrasound examination, with the implementation of a protocol for the treatment and follow-up of DDH. Methods A cross-sectional study with DDH patients born between January 2014 and December 2016, in the city of Pelotas, Southern Brazil. Ethnicity, gender, birth weight, fetal presentation, affected side of the hip, gestational age, maternal age and family history were considered. The data on the medical records were compared with the characteristics of the general population described on the Brazilian National Information System on Live Births (Sistema de Informação sobre Nascidos Vivos [SINASC]). Results A total of 33 DDH patients were identified, mostly female, with a four-fold higher probability of having the condition ( p < 0.001); the left was the most affected side. No statistically significant association was found regarding the following factors: birth weight, gestational age, ethnicity, and maternal age. The newborns in breech presentation had a 15-fold higher probability of presenting DDH ( p < 0.001). A total of 21 newborns required immediate treatment of the hips, since the ultrasound showed a Graf classification of IIb or higher, or the radiography showed dislocation in DDH patients older than 6 months of age. Conclusion Screening for DDH is essential in all newborns; physical examinations revealing alterations must be complemented with ultrasound imaging to avoid the delayed diagnosis of the condition.

Profile of Patients Diagnosed with Developmental Dysplasia of the Hip / Perfil dos pacientes diagnosticados com displasia do desenvolvimento do quadril

Abstract Objective To describe the profile of patients with developmental dysplasia of the hip (DDH) diagnosed by physical and ultrasound examination, with the implementation of a protocol for the treatment and follow-up of DDH. Methods A cross-sectional study with DDH patients born between January 2014 and December 2016, in the city of Pelotas, Southern Brazil. Ethnicity, gender, birth weight, fetal presentation, affected side of the hip, gestational age, maternal age and family history were considered. The data on the medical records were compared with the characteristics of the general population described on the Brazilian National Information System on Live Births (Sistema de Informação sobre Nascidos Vivos [SINASC]). Results A total of 33 DDH patients were identified, mostly female, with a four-fold higher probability of having the condition (p < 0.001); the left was the most affected side. No statistically significant association was found regarding the following factors: birth weight, gestational age, ethnicity, and maternal age. The newborns in breech presentation had a 15-fold higher probability of presenting DDH (p < 0.001). A total of 21 newborns required immediate treatment of the hips, since the ultrasound showed a Graf classification of IIb or higher, or the radiography showed dislocation in DDH patients older than 6 months of age. Conclusion Screening for DDH is essential in all newborns; physical examinations revealing alterations must be complemented with ultrasound imaging to avoid the delayed diagnosis of the condition.

Resumo Objetivo Descrever o perfil dos pacientes com displasia do desenvolvimento do quadril (DDQ), diagnosticados por meio de exame físico e ultrassonográfico, com a implantação do protocolo de atenção e rastreio de DDQ. Métodos Estudo transversal que incluiu os portadores de DDQ nascidos de janeiro de 2014 a dezembro de 2016, na cidade de Pelotas, Sul do Brasil, que considerou os fatores etnia, sexo, peso ao nascer, posição fetal, lado de ocorrência, idade gestacional, idade materna e histórico familiar. Os dados de prontuário foram comparados com as características da população geral por meio do Sistema de Informação sobre Nascidos Vivos (Sinasc). Resultados Foram identificados 33 portadores de DDQ, a maioria do sexo feminino, que mostrou uma probabilidade quatro vezes maior de apresentar a patologia (p < 0,001), e o lado mais acometido foi o esquerdo. Os recém-nascidos com apresentação pélvica tiveram uma probabilidade 15 vezes maior de ter DDQ (p < 0,001). Não foi encontrada associação estatisticamente significativa com os seguintes fatores avaliados: peso ao nascer, idade gestacional, etnia e idade materna. Um total de 21 recém-nascidos necessitaram de tratamento imediato do quadril; a ecografia demonstrou classificação IIb ou maior, pelo método de Graf, ou a radiografia mostrou luxação nos portadores de DDQ com mais de seis meses de idade. Conclusão O rastreio de DDQ é essencial em todos os recém-nascidos, e o exame físico, quando alterado, deve ser complementado com o ultrassonográfico para evitar o diagnóstico tardio da doença.

Neurodevelopmental milestones and associated behaviours are similar among healthy children across diverse geographical locations.

It is unclear whether early child development is, like skeletal growth, similar across diverse regions with adequate health and nutrition. We prospectively assessed 1307 healthy, well-nourished 2-year-old children of educated mothers, enrolled in early pregnancy from urban areas without major socioeconomic or environmental constraints, in Brazil, India, Italy, Kenya and UK. We used a specially developed psychometric tool, WHO motor milestones and visual tests. Similarities across sites were measured using variance components analysis and standardised site differences (SSD). In 14 of the 16 domains, the percentage of total variance explained by between-site differences ranged from 1.3% (cognitive score) to 9.2% (behaviour score). Of the 80 SSD comparisons, only six were >±0.50 units of the pooled SD for the corresponding item. The sequence and timing of attainment of neurodevelopmental milestones and associated behaviours in early childhood are, therefore, likely innate and universal, as long as nutritional and health needs are met.

Infant sleep hygiene counseling (sleep trial): protocol of a randomized controlled trial.

BACKGROUND: Sleep problems in childhood have been found to be associated with memory and learning impairments, irritability, difficulties in mood modulation, attention and behavioral problems, hyperactivity and impulsivity. Short sleep duration has been found to be associated with overweight and obesity in childhood. This paper describes the protocol of a behavioral intervention planned to promote healthier sleep in infants. METHODS: The study is a 1:1 parallel group single-blinded randomized controlled trial enrolling a total of 552 infants at 3 months of age. The main eligibility criterion is maternal report of the infant's sleep lasting on average less than 15 h per 24 h (daytime and nighttime sleep). Following block randomization, trained fieldworkers conduct home visits of the intervention group mothers and provide standardized advice on general practices that promote infant's self-regulated sleep. A booklet with the intervention content to aid the mother in implementing the intervention was developed and is given to the mothers in the intervention arm. In the two days following the home visit the intervention mothers receive daily telephone calls for intervention reinforcement and at day 3 the fieldworkers conduct a reinforcement visit to support mothers' compliance with the intervention. The main outcome assessed is the between group difference in average nighttime self-regulated sleep duration (the maximum amount of time the child stays asleep or awake without awakening the parents), at ages 6, 12 and 24 months, evaluated by means of actigraphy, activity diary records and questionnaires. The secondary outcomes are conditional linear growth between age 3-12 and 12-24 months and neurocognitive development at ages 12 and 24 months. DISCUSSION: The negative impact of inadequate and insufficient sleep on children's physical and mental health are unquestionable, as well as its impact on cognitive function, academic performance and behavior, all of these being factors to which children in low- and middle-income countries are at higher risk. Behavioral interventions targeting mothers and young children that can be delivered inexpensively and not requiring specialized training can help prevent future issues by reducing the risk to which these children are exposed. TRIAL REGISTRATION: ClinicalTrial.gov NCT02788630 registered on 14 June 2016 (retrospectively registered).

Sedentary lifestyle and poor eating habits in childhood:a cohort study.

Worldwide, about 22 million children under five years old are overweight. Environmental factors are the main trigger for this epidemic. The purpose of this study was to evaluate the eating and physical activity habits in a cohort of eight-year-old children in Pelotas, Brazil. Eating habits were assessed based on the Ten Steps to Healthy Eating proposed by the Ministry of Health. To assess the level of physical activity, the physical activity questionnaire for children and adolescents (PAQ-C) was used. Of the 616 interviewed children at 8 years, it was observed that 50.3% were male; 70.3% were white and just over half belonged to economic class C. None of the children were classified as very active and none acceded to a daily consumption of six servings of the cereals, tubers, and roots. The steps that had higher adhesion were 8 (do not add salt to ready foods); 4 (consumption of beans, at least 5 times per week) and 1 (have 3 meals and 2 snacks per day), respectively. The high prevalence of physical inactivity and low level of healthy eating habits confirm the importance of strategies to support and encourage the practice of physical activity and healthy eating among youth.

Sedentary lifestyle and poor eating habits in childhood: a cohort study / Sedentarismo e práticas alimentares inadequadas na infância: um estudo de coorte

Abstract Worldwide, about 22 million children under five years old are overweight. Environmental factors are the main trigger for this epidemic. The purpose of this study was to evaluate the eating and physical activity habits in a cohort of eight-year-old children in Pelotas, Brazil. Eating habits were assessed based on the Ten Steps to Healthy Eating proposed by the Ministry of Health. To assess the level of physical activity, the physical activity questionnaire for children and adolescents (PAQ-C) was used. Of the 616 interviewed children at 8 years, it was observed that 50.3% were male; 70.3% were white and just over half belonged to economic class C. None of the children were classified as very active and none acceded to a daily consumption of six servings of the cereals, tubers, and roots. The steps that had higher adhesion were 8 (do not add salt to ready foods); 4 (consumption of beans, at least 5 times per week) and 1 (have 3 meals and 2 snacks per day), respectively. The high prevalence of physical inactivity and low level of healthy eating habits confirm the importance of strategies to support and encourage the practice of physical activity and healthy eating among youth.

Resumo Mundialmente, cerca de 22 milhões de crianças menores de cinco anos têm excesso de peso, sendo que fatores ambientais são os principais desencadeadores da epidemia. O objetivo deste trabalho foi verificar os hábitos alimentares e de atividade física em crianças de oito anos de idade, pertencentes a uma coorte de Pelotas, Brasil. Os hábitos alimentares foram avaliados com base nos Dez Passos para Alimentação Saudável, propostos pelo Ministério da Saúde. Para avaliar o nível de atividade física, utilizou-se o questionário de atividade física para crianças e adolescentes (PAQ-C). Das 616 crianças avaliadas aos 8 anos, observou-se que 50,3% eram do sexo masculino; 70,3% de cor branca e pouco mais de metade pertencia à classe econômica C. Nenhuma das crianças foi classificada como muito ativa ou aderiu ao consumo diário de 6 porções do grupo de cereais, tubérculos e raízes. Os passos de maior adesão foram o 8 (não adicionar sal aos alimentos prontos); o 4 (consumo de feijão, pelo menos, 5 vezes por semana) e o 1 (realização de 3 refeições e 2 lanches por dia), respectivamente. A alta prevalência de inatividade física e o baixo nível de hábitos alimentares saudáveis, confirmam a importância de estratégias para apoiar e incentivar a prática de atividade física e alimentação saudável entre os jovens.

PREVALENCE OF FACTORS ASSOCIATED TO METABOLIC SYNDROME IN A COHORT OF CHILDREN IN SOUTH BRAZIL.

INTRODUCTION: the Metabolic Syndrome is a group of disorders and it has gaining importance due to its association with the subsequent development of cardiovascular diseases. OBJECTIVES: to determine the prevalence of risk factors associated to the metabolic syndrome in children from a cohort in Southern Brazil. METHODS: a prospective cohort study with hospital screening of all births (2741) occurred from September 2002 to May 2003, monitoring a random sample of 30.0% at one, three and six months and eight years old. During the visit at the age of eight years, a questionnaire containing questions related to nutrition, physical activity and family history of chronic diseases. Also, weight, height and the waist circumference were measured. Descriptive and bivariate analyzes between independent variables and the outcome were performed. Results y discussion: from the 616 studied children, 51.3% were male, 70.3% had white, about half belonged to the economic class C, 20.5% were overweight and 16.9% were obese. There was high prevalence of family history for hypertension (81.5%), and was observed that 20.7% of the eutrophic children showed elevated waist circumference. CONCLUSION: the high prevalence of risk factors for the metabolic syndrome found in the studied children reinforces the importance of proper medical history including family history. It is suggested to include the measurement of waist circumference in routine pediatric care.

Introducción: el síndrome metabólico es un grupo de enfermedades que ha ido ganando importancia debido a la asociación con el desarrollo posterior de enfermedades cardiovasculares. Objetivo: verificar la prevalencia de factores de riesgo asociados con el síndrome metabólico en niños de una cohorte del sur de Brasil. Métodos: estudio de cohorte prospectivo con el hospital de todos los nacimientos (2.741) que tuvieron lugar en el mes de septiembre/2002 a mayo/2003 y seguimiento de una muestra aleatoria de 30,0% con uno, tres y seis meses y ocho años de edad. En una visita a los ocho años de edad se utilizó un cuestionario con preguntas relacionadas con la nutrición, la actividad física y la historia familiar de enfermedades crónicas, y se midieron peso, talla y circunferencia de la cintura. Se realizaron análisis descriptivos y bivariados entre las variables independientes y los resultados obtenidos. Resultados y discusión: de 616 niños estudiados, el 51,3% fueron varones, el 70,3% blancos, cerca de la mitad pertenecían a la clase económica C, el 20,6% tenían sobrepeso y el 17,0% eran obesos. Mostró una alta prevalencia de historia familiar de hipertensión arterial (81,5%), y se observó que el 20,7% de los niños eutróficos tenían una circunferencia de cintura elevada. Conclusión: la alta prevalencia de factores de riesgo para el síndrome metabólico en los niños estudiados refuerza la importancia de una adecuada anamnesis: historia familiar. Se sugiere medir la circunferencia de la cintura en la rutina de cuidados pediátricos.

Neonatal ventilatory support and respiratory diseases in children up to six years of age: the 2004 Pelotas (Brazil) Birth Cohort study.

The study's objective was to evaluate the association between neonatal ventilatory support and the subsequent occurrence of respiratory diseases in children up to six years of age. This was a population-based birth cohort study. The main exposure was ventilatory support at birth, defined as the use of nasal continuous positive airway pressure (NCPAP) and/or mechanical ventilation (MV) for more than three hours from the time of hospitalization at birth until the first 28 days of life. Outcomes were: chest wheezing in the twelve months prior to the follow-up interview, medical diagnosis of asthma any time in the child´s life, and occurrence of pneumonia up to six years of age. Crude and adjusted analyses for potential confounding variables were performed using Poisson regression. 3,624 children were analyzed. NCPAP plus MV or MV alone was associated with higher frequency of medical diagnosis of asthma, even after adjusting for maternal and child characteristics (PR = 2.24; 95%CI: 1.27-3.99). The results highlight medium-term respiratory complications associated with neonatal ventilatory support.

Television viewing habits and their influence on physical activity and childhood overweight / Hábito de assistir a televisão e sua influência sobre a atividade física e o excesso de peso infantis

OBJECTIVES: To assess the prevalence of television (TV) viewing habits and their association with childhood sedentary lifestyle and overweight in 8-year-old children, from a cohort in a city in Southern Brazil.METHODS: A prospective cohort study with hospital screening of all births that occurred from September of 2002 to May of 2003. This study refers to a cross-sectional analysis of data collected during the cohort's follow-up conducted at 8 years of age. To evaluate the level of physical activity, a physical activity questionnaire for children and adolescents was used (PAQ-C), during the consultation at 8 years of age.RESULTS: Of the 616 interviewed children, a prevalence of sedentary lifestyle > 70% was found, as well as the habit of watching TV for more than two hours a day in 60% of the sample, regardless of gender (p = 0.30), income (p = 0.57), or family socioeconomic level (p = 0.90). The daily time spent watching TV was inversely associated with physical activity (p < 0.05) and positively associated with excess weight (p < 0.01). Regarding physical activity, running was the most frequently practiced sports modality among the population.CONCLUSIONS: Considering the high prevalence of sedentary lifestyle and children who watch TV for an excessive period of time, it is necessary to motivate such individuals to perform interactive activities, as well as promote a more active lifestyle, by decreasing the time children spend in front of the TV.

OBJETIVOS: Avaliar a prevalência do hábito de assistir a televisão (TV) e sua relação com o sedentarismo infantil e o excesso de peso em crianças aos oito anos pertencentes a uma coorte de uma cidade do Sul do Brasil.MÉTODOS: Estudo de coorte prospectivo, com triagem hospitalar de todos os nascimentos ocorridos entre setembro de 2002 e maio de 2003. O presente estudo refere-se a uma análise transversal dos dados coletados no acompanhamento da coorte ocorrido aos oito anos. Para avaliar o nível de atividade física, um questionário de atividade física para crianças e adolescentes foi usado (PAQ-C), durante a visita aos oito anos.RESULTADOS: Nas 616 crianças entrevistadas, encontrou-se uma prevalência de sedentarismo superior a 70% e o hábito de assistir a TV por um período superior a duas horas diárias em 60% da amostra, independentemente do gênero (p = 0,30), renda (p = 0,57) ou nível socioeconômico (p = 0,90). O tempo diário assistindo a televisão associou-se inversamente à prática de atividade física (p < 0,05) e positivamente ao excesso de peso (p < 0,01). Com relação à atividade física, corrida foi a prática esportiva mais frequente na população.CONCLUSÕES: Diante da elevada prevalência de sedentarismo e de jovens que assistem a TV por um período excessivo, faz-se necessário o estímulo a atividades interativas, bem como a promoção de um estilo de vida mais ativo, com a redução do tempo que jovens dispensam em frente à TV.

Prevalence of factors associated to metabolic syndrome in a cohort of children in South Brazil / Prevalencia de factores de riesgo asociados con el síndrome metabólico de los niños en una cohorte en el sur de Brasil

Introduction: the Metabolic Syndrome is a group of disorders and it has gaining importance due to its association with the subsequent development of cardiovascular diseases. Objectives: to determine the prevalence of risk factors associated to the metabolic syndrome in children from a cohort in Southern Brazil. Methods: a prospective cohort study with hospital screening of all births (2741) occurred from September 2002 to May 2003, monitoring a random sample of 30.0% at one, three and six months and eight years old. During the visit at the age of eight years, a questionnaire containing questions related to nutrition, physical activity and family history of chronic diseases. Also, weight, height and the waist circumference were measured. Descriptive and bivariate analyzes between independent variables and the outcome were performed. Results y discussion: from the 616 studied children, 51.3% were male, 70.3% had white, about half belonged to the economic class C, 20.5% were overweight and 16.9% were obese. There was high prevalence of family history for hypertension (81.5%), and was observed that 20.7% of the eutrophic children showed elevated waist circumference. Conclusion: the high prevalence of risk factors for the metabolic syndrome found in the studied children reinforces the importance of proper medical history including family history. It is suggested to include the measurement of waist circumference in routine pediatric care (AU)

Introducción: el síndrome metabólico es un grupo de enfermedades que ha ido ganando importancia debido a la asociación con el desarrollo posterior de enfermedades cardiovasculares. Objetivo: verificar la prevalencia de factores de riesgo asociados con el síndrome metabólico en niños de una cohorte del sur de Brasil. Métodos: estudio de cohorte prospectivo con el hospital de todos los nacimientos (2.741) que tuvieron lugar en el mes de septiembre/2002 a mayo/2003 y seguimiento de una muestra aleatoria de 30,0% con uno, tres y seis meses y ocho años de edad. En una visita a los ocho años de edad se utilizó un cuestionario con preguntas relacionadas con la nutrición, la actividad física y la historia familiar de enfermedades crónicas, y se midieron peso, talla y circunferencia de la cintura. Se realizaron análisis descriptivos y bivariados entre las variables independientes y los resultados obtenidos. Resultados y discusión: de 616 niños estudiados, el 51,3% fueron varones, el 70,3% blancos, cerca de la mitad pertenecían a la clase económica C, el 20,6% tenían sobrepeso y el 17,0% eran obesos. Mostró una alta prevalencia de historia familiar de hipertensión arterial (81,5%), y se observó que el 20,7% de los niños eutróficos tenían una circunferencia de cintura elevada. Conclusión: la alta prevalencia de factores de riesgo para el síndrome metabólico en los niños estudiados refuerza la importancia de una adecuada anamnesis: historia familiar. Se sugiere medir la circunferencia de la cintura en la rutina de cuidados pediátricos (AU)

Suporte ventilatório ao nascer e associação com doenças respiratórias aos seis anos: Coorte de Nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004 / Soporte ventilatorio en el período neonatal y enfermedades respiratorias en los seis primeros años de vida: Cohorte de Nacimientos de Pelotas, Rio Grande do Sul, Brasil, 2004 / Neonatal ventilatory support and respiratory diseases in children up to six years of age: the 2004 Pelotas (Brazil) Birth Cohort study

O objetivo do estudo foi avaliar a associação entre suporte ventilatório no período neonatal e doenças respiratórias até os seis anos de idade. Estudo de coorte de nascimentos de base populacional. A exposição principal foi o suporte ventilatório ao nascimento, definido como o uso de pressão contínua positiva nasal (CPAPn) e/ou ventilação mecânica (VM) por mais de três horas, desde o momento da hospitalização ao nascimento até os 28 dias. Os desfechos foram chiado no peito nos últimos 12 meses, diagnóstico médico de asma alguma vez na vida e episódio de pneumonia ocorrido até os seis anos de idade. Foram realizadas análises brutas e ajustadas para potenciais variáveis de confusão, usando regressão de Poisson. Foram analisadas 3.624 crianças. O uso de CPAPn e VM ou unicamente VM esteve associado com maior frequência de diagnóstico médico de asma, mesmo após ajuste para características maternas e das crianças (RP = 2,24; IC95%: 1,27-3,99). Os resultados do presente estudo alertam para as complicações respiratórias, em médio prazo, decorrentes do suporte ventilatório realizado no período neonatal.

El objetivo del estudio fue evaluar la asociación entre el soporte ventilatorio durante el período neonatal y las enfermedades respiratorias durante los seis primeros años de vida. Se trata de un estudio de cohorte de nacimiento con base poblacional. La exposición principal, soporte ventilatorio al nacimiento, fue definida como el uso de presión positiva nasal (CPAPn) y/o ventilación mecánica (VM) durante más de tres horas, desde la hospitalización al nacimiento, hasta los 28 días de vida. Los resultados analizados fueron: broncoespasmo en los últimos doce meses, diagnóstico médico de asma - realizado alguna vez en la vida- y episodio de neumonía ocurrido hasta los seis años de edad. Se realizaron análisis brutos y ajustados para potenciales variables de confusión, usando la regresión de Poisson. Fueron estudiados 3.624 niños. El uso de soporte ventilatorio estuvo asociado con una mayor frecuencia de diagnóstico médico de asma, incluso tras ajustar las características maternas y de los niños (RP = 2,24; IC95%: 1,27-3,99). Los resultados alertan sobre las complicaciones respiratorias a medio plazo tras el soporte ventilatorio realizado en el período neonatal.

The study's objective was to evaluate the association between neonatal ventilatory support and the subsequent occurrence of respiratory diseases in children up to six years of age. This was a population-based birth cohort study. The main exposure was ventilatory support at birth, defined as the use of nasal continuous positive airway pressure (NCPAP) and/or mechanical ventilation (MV) for more than three hours from the time of hospitalization at birth until the first 28 days of life. Outcomes were: chest wheezing in the twelve months prior to the follow-up interview, medical diagnosis of asthma any time in the child´s life, and occurrence of pneumonia up to six years of age. Crude and adjusted analyses for potential confounding variables were performed using Poisson regression. 3,624 children were analyzed. NCPAP plus MV or MV alone was associated with higher frequency of medical diagnosis of asthma, even after adjusting for maternal and child characteristics (PR = 2.24; 95%CI: 1.27-3.99). The results highlight medium-term respiratory complications associated with neonatal ventilatory support.

Prevalence of factors related to the bone mass formation of children from a cohort in Southern Brazil / Prevalencia de los factores relacionados con la formación de la masa ósea de los niños en una cohorte en el sur de Brasil

Introduction: The amount of bone mass acquired in the early stages of life is an important determinant of its peak and future risk of osteoporosis and fractures. Objective: To describe the prevalence of factors that contributes to the formation of bone mass in children of a Southern Brazil cohort. Methods: A retrospective cohort study with hospital screening of all births (2741) occurred from September/2002 to May/2003 and monitoring of a random sample of 30.0% of these (one, three and six months and eight years old). During the eight years old visit, a questionnaire containing questions related to food and physical activity was applied. Results e Discussion: Of the 616 children studied, 51.3% were male, 70.3% Caucasian, about half belonged to economic class C, 20.5% were overweight, 16.9% were obese and 71.2% were sedentary. As for food intake low consumption of fruits, vegetables, dairy products, meat, cereals and tubers was noticed. Vitamin D administration in the first six months of life was followed by 14.1% of premature, 16.1% of infants with low birth weight, 24.2% of weaned in the first month and only 16.4% at three months. Conclusion: The evaluated children have low nutrients consumption, including calcium, inappropriate vitamin D administration in the first semester of life, little regular physical activity and high prevalence of overweight and obesity are factors that can impair the formation of bone mass (AU)

Introducción: La cantidad de masa ósea adquirida en las primeras etapas de la vida es un importante factor determinante de su pico y el riesgo futuro de osteoporosis y fracturas. Objetivo: Describir la prevalencia de factores que contribuye a la formación de la masa ósea en niños de una cohorte del sur de Brasil. Métodos: Estudio de cohorte retrospectiva con el hospital de todos los nacimientos (2741) se produjo en septiembre / 2002 a mayo / 2003 y el seguimiento de una muestra aleatoria de un 30,0% de los mismos (uno, tres y seis meses y ocho años de edad). En una visita a los ocho años de edad, aplicó un cuestionario con preguntas relacionadas con la alimentación y la actividad física. Resultados y Discusión: De los 616 niños, el 51,3% eran hombres, el 70,3% de raza caucásica, cerca de la mitad pertenecían a la clase económica C, 20,5% tenían sobrepeso, el 16,9% eran obesos y 71,2% sedentarios. La ingesta de alimentos es bajo consumo de frutas, verduras, productos lácteos, carne, los cereales y los tubérculos. La administración de vitamina D en los primeros seis meses de vida fue seguido por 14,1% de los prematuros, el 16,1% de los recién nacidos con bajo peso al nacer, el 24,2% de destete en el primer mes y sólo el 16,4% a los tres meses. Conclusión: Los niños evaluados tienen un bajo consumo de nutrientes, entre ellos el calcio, deficiente administración de vitamina D en el primer semestre de vida, poco actividad física regular y la alta prevalencia del sobrepeso y la obesidad son factores que pueden afectar a la formación de masa ósea (AU)

Television viewing habits and their influence on physical activity and childhood overweight.

OBJECTIVES: To assess the prevalence of television (TV) viewing habits and their association with childhood sedentary lifestyle and overweight in 8-year-old children, from a cohort in a city in Southern Brazil. METHODS: A prospective cohort study with hospital screening of all births that occurred from September of 2002 to May of 2003. This study refers to a cross-sectional analysis of data collected during the cohort's follow-up conducted at 8 years of age. To evaluate the level of physical activity, a physical activity questionnaire for children and adolescents was used (PAQ-C), during the consultation at 8 years of age. RESULTS: Of the 616 interviewed children, a prevalence of sedentary lifestyle>70% was found, as well as the habit of watching TV for more than two hours a day in 60% of the sample, regardless of gender (p=0.30), income (p=0.57), or family socioeconomic level (p=0.90). The daily time spent watching TV was inversely associated with physical activity (p<0.05) and positively associated with excess weight (p<0.01). Regarding physical activity, running was the most frequently practiced sports modality among the population. CONCLUSIONS: Considering the high prevalence of sedentary lifestyle and children who watch TV for an excessive period of time, it is necessary to motivate such individuals to perform interactive activities, as well as promote a more active lifestyle, by decreasing the time children spend in front of the TV.

Impacto do aleitamento materno no coeficiente de inteligência de crianças de oito anos de idade / Impact of breastfeeding on the intelligence quotient of eight-year-old children

Objetivo: O objetivo deste estudo foi determinar a influencia do aleitamento materno na capacidade intelectual de crianças pertencentes a uma coorte de um país em desenvolvimento, controlando para os principais fatores de confusão. Métodos: Foi realizado um estudo de coorte prospectiva com todos os recém-nascidos nos hospitais de uma cidade de porte médio e acompanhou-se uma amostra aleatória destes aos 30, 90 e 180 dias de vida e aos 8 anos. No acompanhamento foram avaliados diversos aspectos da amamentação e, aos 8 anos, foi realizada avaliação da capacidade intelectual geral aplicando-se o Teste de Raven. As análises estatísticas utilizaram Teste T, ANOVA e regressão linear e logística, considerando como associações estatisticamente significativas aquelas cujo valor de p foi inferior a 0,05. Resultados: Aos 8 anos 560 crianças participaram da avaliação com o Teste de Raven. A média da pontuação das crianças no teste foi de 22,56 pontos com desvio padrão de 5,93. A diferença de médias entre os grupos em aleitamento materno ou não, aos seis meses, foi de 1,33 (p = 0,008). Permaneceram associadas ao desfecho, após regressão linear e logística, a cor materna e da criança, classe socioeconômica, escolaridade e tabagismo maternos e o aleitamento materno aos 6 meses de idade (p = 0,007). Conclusões: As crianças que mamaram por seis meses ou mais tiveram melhor desempenho na avaliação intelectual geral, mesmo após ajuste para os principais fatores de confundimento.

Objective: This study aimed to determine the influence of breastfeeding on the intellectual capacity of children from a cohort in a developing country, with a control for the main confounding factors. Methods: A prospective cohort study was performed including all infants born in the hospitals of a medium-size city, and a random sample of these newborns was monito-red at 30, 90, and 180 days of life, and at age 8 years. Several aspects of breastfeeding were assessed inthe follow-up and, at 8 years, general intellectual capacity was assessed through the Raven's Colored Progressive Matrices test. The statistical analyses used Student's t-test, ANOVA, and linear regression and logistics, considering p-values less than 0.05 as statistically significant associations. Results: At age 8 years, 560 children were assessed with Raven's Colored Progressive Matrices test. The average score was 22.56 points, with a standard deviation of 5.93. The difference inthe averages foundbetweenthe breastfed and non-breastfed groups at six months of age was 1.33 (p = 0.008). Mother's and child's skin color, social and economic class, maternal education and smoking, and breastfeeding at six months of age (p = 0.007) were still associated with the outcome. Conclusions: Children that were breastfed for six months or more had better performance in the general intellectual assessment, even after adjusting for the main confounding factors.

Comportamento da mortalidade infantil no extremo sul do Rio Grande do Sul, Brasil, anos 2005-2012 / Infant mortality in the southernmost region of Rio Grande do Sul, Brazil, years 2005-2012

Introdução: O índice de mortalidade infantil é um parâmetro importante para avaliar o nível de desenvolvimento de um país ou uma região. O controle da mortalidade infantil é fundamental quando se pretende atingir níveis de desenvolvimento comparáveis aos de países mais desenvolvidos. O objetivo deste estudo foi determinar o perfil epidemiológico da mortalidade infantil entre os anos 2005 e 2012. Métodos: Analisados todos os nascimentos vivos e óbitos menores de um ano de idade dos 22 municípios da 3ª Coordenadoria Estadual de Saúde (3ª CRS-RS) entre 1º de janeiro de 2005 e 31 de dezembro de 2012. Resultados: Houve uma redução nos nascimentos entre os anos 2005 e 2012, sendo a mais expressiva entre 2008 e 2010. Em relação ao número de óbitos infantis, observa-se uma redução importante entre os anos 2006 e 2007, retornando a patamares maiores e praticamente constantes nos anos seguintes. O maior índice de mortalidade ocorre no período neonatal e, dentro deste, a neonatal precoce é a predominante. A mortalidade pós-neonatal sofre uma pequena redução de 5,5 para 4,9 mortes por mil nascidos vivos entre os anos 2005 e 2012, e o coeficiente da mortalidade infantil apresentam uma leve diminuição entre os oito anos analisados de 17,5/mil em 2005 para 15,5/mil em 2012. Conclusão: O coeficiente de mortalidade infantil nesta região permanece maior que a média do Estado. É necessário direcionar esforços para reduzir o nascimento de prematuro e baixo peso, que são os fatores mais importantes na mortalidade infantil.

Introduction: The infant mortality rate is a major parameter to evaluate the development level of a country or region. Infant mortality control is key when you want to achieve development levels comparable to those of more developed countries. The aim of this study was to determine the regional epidemiology of infant mortality between 2005 and 2012. Methods: We analyzed all live births and deaths under one year of age in the 22 cities of the 3rd State Health Coordination Office (3ª CRS-RS) between Jan 1, 2005 and December 31, 2012. Results: There was a reduction in births between 2005 and 2012, being most significant between 2008 and 2010. As regards the number of child deaths there was a significant reduction between 2006 and 2007, returning to higher and almost constant levels over the following years. The highest mortality rate occurs in the neonatal period, and within this, early neonatal death is predominant. Post-neonatal mortality showed a slight decrease from 5.5 to 4.9 deaths per thousand live births between 2005 and 2012, and the coefficient of infant mortality decreased slightly over the eight years studied, from 17.5/thousand in 2005 to 15.5/thousand in 2012. Conclusion: The infant mortality rate in this region remains higher than the state average. Efforts should be made to reduce premature birth and low birth weight, which are the most important factors in infant mortality.