Lifestyle and quality of life in children and adolescents during the covid-19 social distancing period.

OBJECTIVE: To evaluate the lifestyle and quality of life in Brazilian children and adolescents during the COVID-19 social distancing period in 2020. METHODS: This cross-sectional study evaluated children and adolescents (2-18 years of age) and their parents, who voluntarily participated in an online survey. Snowball sampling was used to recruit participants during the first 6 months of the pandemic. A questionnaire was used to characterize the study population. The PedsQL 4.0 and the EUROHIS-QOL 8-item index were used to assess the quality of life (QoL) in children/adolescents and parents, respectively. Data were analyzed using SPSS 18.0 statistical program through the ANOVA with post hoc Bonferroni analysis, student's t test, and the generalized estimating equation. RESULTS: Mean screen time increased from 2h pre-pandemic to 5h during the pandemic (p < 0.001), which was associated with a decline in PedSQL4.0 scores (from 75.7 ± 2.6 to 71.3 ± 13.7, p < 0.001). Unhealthy eating habits increased from 11% to 34% and were associated with worse QoL scores compared with improved or unchanged eating habits during the pandemic (69.7 ± 13.3 vs 72.80 ± 13.4 vs 76.4 ± 12.6; p < 0.001). Poor sleep quality increased from 9% to 31.7% and was associated with worse QoL scores compared to improved or unchanged sleep quality during the pandemic (67.3 ± 13.1 vs 74.5 ± 13.1 vs 76.8 ± 12.2; p < 0.05). Physical exercise was associated with better PedSQL4.0 scores (77.5 ± 12.3 vs 72.5 ± 14.4; p < 0.001). Children aged 2-4y old had the best QoLscores. CONCLUSIONS: Pandemic-related social distancing promoted significant lifestyle changes in children and adolescents, increasing screen time, reducing physical activity, and worsening food and sleep quality, which resulted in worse QoL scores.

Lifestyle and quality of life in children and adolescents during the covid-19 social distancing period

Abstract Objective To evaluate the lifestyle and quality of life in Brazilian children and adolescents during the COVID-19 social distancing period in 2020. Methods This cross-sectional study evaluated children and adolescents (2-18 years of age) and their parents, who voluntarily participated in an online survey. Snowball sampling was used to recruit participants during the first 6 months of the pandemic. A questionnaire was used to characterize the study population. The PedsQL 4.0 and the EUROHIS-QOL 8-item index were used to assess the quality of life (QoL) in children/adolescents and parents, respectively. Data were analyzed using SPSS 18.0 statistical program through the ANOVA with post hoc Bonferroni analysis, student's t test, and the generalized estimating equation. Results Mean screen time increased from 2h pre-pandemic to 5h during the pandemic (p <0.001), which was associated with a decline in PedSQL4.0 scores (from 75.7 ± 2.6 to 71.3 ± 13.7, p <0.001). Unhealthy eating habits increased from 11% to 34% and were associated with worse QoL scores compared with improved or unchanged eating habits during the pandemic (69.7 ± 13.3 vs 72.80 ± 13.4 vs 76.4 ± 12.6; p <0.001). Poor sleep quality increased from 9% to 31.7% and was associated with worse QoL scores compared to improved or unchanged sleep quality during the pandemic (67.3 ± 13.1 vs 74.5 ± 13.1 vs 76.8 ± 12.2; p <0.05). Physical exercise was associated with better PedSQL4.0 scores (77.5 ± 12.3 vs 72.5 ± 14.4; p <0.001). Children aged 2-4y old had the best QoLscores. Conclusions Pandemic-related social distancing promoted significant lifestyle changes in children and adolescents, increasing screen time, reducing physical activity, and worsening food and sleep quality, which resulted in worse QoL scores.

Desfechos de deglutição e alimentação associados à intubação orotraqueal e à traqueostomia em pediatria / Swallowing and feeding outcomes associated with orotracheal intubation and tracheostomy in pediatrics

RESUMO Objetivo verificar os desfechos de deglutição e alimentação de pacientes pediátricos submetidos à intubação orotraqueal (IOT) prolongada, considerando aqueles que evoluíram para traqueostomia após. Métodos estudo de coorte retrospectivo, realizado por meio da análise de prontuários de pacientes admitidos em Unidade de Terapia Intensiva Pediátrica e acompanhados até a alta hospitalar, entre março de 2017 e dezembro de 2018. Resultados dos 51 pacientes incluídos, 64,7% eram do gênero masculino e a mediana de idade foi de 6,7 meses. Pacientes submetidos à IOT por mediana de sete dias apresentaram disfagia orofaríngea (DOF) leve e, quando submetidos a mais de 14 dias, apresentaram DOF moderada/grave, distúrbio alimentar pediátrico (DAP) com características de recusa alimentar e contraindicação de alimentação por via oral na alta hospitalar. Dentre os pacientes, 74,5% foram submetidos apenas à IOT e 25,5% evoluíram para traqueostomia, após. Pacientes traqueostomizados apresentaram maior ocorrência de alta hospitalar com DOF moderada/grave, DAP com características de recusa alimentar e uso de via alternativa de alimentação, em comparação a pacientes sem traqueostomia (p=0,001). Comparado ao diagnóstico inicial, pacientes não traqueostomizados tiveram diagnóstico final com graus mais leves de disfagia (p<0,001). Conclusão o tempo de IOT e a presença de traqueostomia são fatores associados ao diagnóstico fonoaudiológico de DOF moderada/grave, à presença de sinais de DAP com características de recusa alimentar e à necessidade de via alternativa de alimentação, persistentes até a alta hospitalar, sendo achados fonoaudiológicos frequentes entre os desfechos de deglutição/alimentação em pediatria.

ABSTRACT Purpose To verify the swallowing and feeding outcomes of pediatric patients undergoing prolonged OTI, considering those who progressed to tracheostomy afterward. Methods Retrospective cohort study, carried out by analyzing the medical records of patients admitted to the Pediatric ICU and followed up until hospital discharge, between 03/2017 and 12/2018. Results Of the 51 patients included, 64.7% were male and the median age 6.7 months. Patients undergoing OTI for a median of 7 days had mild dysphagia and when submitted for more than 14 days had moderate/severe dysphagia and PFD with characteristics of food refusal, with contraindication to oral feeding at hospital discharge. 74.5% of the patients underwent OTI only and 25.5% progressed to tracheostomy afterward. Tracheostomized patients had a higher occurrence of hospital discharge with moderate/ severe oropharyngeal dysphagia, pediatric feeding disorder (PFD) with characteristics of food refusal and alternative method of feeding compared to patients without tracheostomy (p=0.001). Non-tracheostomized patients had a final diagnosis with milder degrees of dysphagia when compared to the initial diagnosis (p<0.001). Conclusion The time of OTI and the presence of tracheostomy are factors associated with the speech-language pathology diagnosis of moderate/severe oropharyngeal dysphagia, presence of signs of PFD with characteristics of food refusal and the need for an alternative method of feeding that persists until hospital discharge, being frequent findings among the swallowing/feeding outcomes in pediatrics.

Two-Thumb Technique Is Superior to Two-Finger Technique in Cardiopulmonary Resuscitation of Simulated Out-of-Hospital Cardiac Arrest in Infants.

Background To compare the 2-finger and 2-thumb chest compression techniques on infant manikins in an out-of-hospital setting regarding efficiency of compressions, ventilation, and rescuer pain and fatigue. Methods and Results In a randomized crossover design, 78 medical students performed 2 minutes of cardiopulmonary resuscitation with mouth-to-nose ventilation at a 30:2 rate on a Resusci Baby QCPR infant manikin (Laerdal, Stavanger, Norway), using a barrier device and the 2-finger and 2-thumb compression techniques. Frequency and depth of chest compressions, proper hand position, complete chest recoil at each compression, hands-off time, tidal volume, and number of ventilations were evaluated through manikin-embedded SkillReporting software. After the interventions, standard Likert questionnaires and analog scales for pain and fatigue were applied. The variables were compared by a paired t-test or Wilcoxon test as suitable. Seventy-eight students participated in the study and performed 156 complete interventions. The 2-thumb technique resulted in a greater depth of chest compressions (42 versus 39.7 mm; P<0.01), and a higher percentage of chest compressions with adequate depth (89.5% versus 77%; P<0.01). There were no differences in ventilatory parameters or hands-off time between techniques. Pain and fatigue scores were higher for the 2-finger technique (5.2 versus 1.8 and 3.8 versus 2.6, respectively; P<0.01). Conclusions In a simulation of out-of-hospital, single-rescuer infant cardiopulmonary resuscitation, the 2-thumb technique achieves better quality of chest compressions without interfering with ventilation and causes less rescuer pain and fatigue.

Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support.

BACKGROUND: Acute viral bronchiolitis (AVB) is a very frequent disease that affects the lower airways of young children increasing the inspiratory and expiratory resistance in variable degree as well as reducing the pulmonary compliance. It would be desirable to know whether these variables are associated with the outcome. OBJECTIVES: To evaluate the respiratory mechanics in infants with AVB requiring mechanical ventilation (MV) support and to evaluate if respiratory mechanics predict outcomes in children with AVB supported on MV. To evaluate the respiratory mechanics in infants with AVB submitted to MV. MATERIALS AND METHODS: A prospective observational study was conducted in two pediatric intensive care units (PICUs) between February 2016 and March 2017. Included were infants (1 month to 1 year old) admitted with AVB and requiring MV for >48 hours. Auto-PEEP, dynamic compliance (Cdyn), static compliance (Cstat), expiratory resistance (ExRes), and inspiratory resistance (InRes) were evaluated once daily on the second and third day of MV. RESULTS: A total of 64 infants (median age of 2.8 months and a mean weight of 4.8 ± 1.7 kg) were evaluated. A mean positive inspiratory pressure (PIP) of 31.5 ± 5.2 cmH2O, positive end-expiratory pressure (PEEP) of 5.5 ± 1.4 cmH2O, resulting in a mean airway pressure (MAP) of 12.5 ± 2.2 cmH2O and delta pressure of 22.5 ± 4.4 cmH2O without difference between the two hospitals. Measurements of respiratory mechanics showed high values of InRes and ExRes (median 142 [IQ25-75 106-180] cmH2O/L/s and 158 [IQ25-75 130-195.3] cmH2O/L/s, respectively), accompanied by decreased Cdyn and Cstat (0.46 ± 0.19 and 0.81 ± 0.25 mL/kg/cmH2O, respectively). None of the variables was associated with mortality, length of MV, or length of PICU stay. CONCLUSION: Infants with AVB requiring MV support present very high InRes and ExRes values. These findings might be the reason for the aggressive ventilatory parameters, especially PIP, required to ventilate this group of children with lower airway obstruction. CLINICAL SIGNIFICANCE: Monitoring respiratory mechanics could represent a useful tool to guide the ventilatory strategy to be adopted in patients with AVB. HOW TO CITE THIS ARTICLE: Andreolio C, Piva JP, Bruno F, da Rocha TS, Garcia PCR. Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support. Indian J Crit Care Med 2021;25(1):88-93.

Early fluid overload was associated with prolonged mechanical ventilation and more aggressive parameters in critically ill paediatric patients.

AIM: We evaluated the influence of early fluid overload on critically ill children admitted to a paediatric intensive care unit by examining mechanical ventilation (MV), mortality, length of stay and renal replacement therapy. METHODS: This retrospective cohort study covered January 2015 to December 2016 and focused on all episodes of MV support that exceeded 24 hours. The fluid overload percentage (FO%) was calculated daily for the first 72 hours and we estimated its effect on outcomes. RESULTS: We included 186 MV episodes in 154 patients. The median age was 13.8 months, with an interquartile range (IQR) of 3.8-34.0 months, and the mortality rate was 12.4%. The median FO% in the first 72 hours was 8.0% (IQR 3.6%-11.2%). An FO% of ≥10% was associated with higher ventilatory parameters, namely peak inspiratory pressure (P = .023) and positive end expiratory pressure (P = .003), and renal replacement therapy (P = .02) and higher mortality (8.8% vs 19.7%). In a multivariate Cox regression model, FO ≥ 10% at 72 hours was independently associated with longer MV support, but not mortality (P = .001). CONCLUSION: In a heterogeneous paediatric population given MV, an early cumulative FO of ≥10% was associated with more aggressive ventilatory parameters and prolonged length of MV, but not mortality.

Vancomycin-associated Nephrotoxicity and Risk Factors in Critically Ill Children Without Preexisting Renal Injury.

BACKGROUND: A recent systematic review concluded that critically ill pediatric patients have higher odds of vancomycin-related nephrotoxicity [odds ratio (OR): 3.61, 95% CI: 1.21-10.74]. We aimed to assess the incidence and risk factors for vancomycin-associated nephrotoxicity in critically ill children without preexisting renal injury. METHODS: A cohort of children admitted to a pediatric intensive care unit, from 2011 to 2016 treated with vancomycin without preexisting renal injury. The main diagnosis, therapeutic interventions and medications administered in this period were evaluated. Generalized estimating equation models were used to assess the association between clinical covariates and the dependent variable pediatric risk, injury, failure, loss, end-stage renal disease (pRIFLE). RESULTS: Hundred ten patients, representing 1177 vancomycin days, were analyzed. Vancomycin-associated nephrotoxicity was seen in 11.8%. In a multivariate model, higher vancomycin doses were not associated with poorer renal function (P = 0.08). Higher serum vancomycin levels were weakly associated with pRIFLE classification (OR: 1.05, 95% CI: 1.02-1.07). Furosemide or amphotericin B in addition to the vancomycin treatment was associated with impaired renal function (OR: 2.56, 95% CI: 1.38-4.8 and OR: 7.7 95% CI: 2.55-23, respectively). CONCLUSIONS: Vancomycin-associated nephrotoxicity in acute ill children without preexisting renal injury, measured with pRIFLE, is close to 11.8%. Furosemide and amphotericin B in addition to the vancomycin treatment are strong predictors of worse pRIFLE scores. The influence of acute kidney injury status at pediatric intensive care unit admission and the method used for renal function assessment might influence the incidence of vancomycin-associated nephrotoxicity and its associated risk factors.

Accidental strangulation in children by the automatic closing of a car window. / Estrangulamento acidental em crianças por fechamento automático de vidro de carro.

Among the main causes of death in our country are car accidents, drowning and accidental burns. Strangulation is a potentially fatal injury and an important cause of homicide and suicide among adults and adolescents. In children, its occurrence is usually accidental. However, in recent years, several cases of accidental strangulation in children around the world have been reported. A 2-year-old male patient was strangled in a car window. The patient was admitted to the pediatric intensive care unit with a Glasgow Coma Scale score of 8 and presented with progressive worsening of respiratory dysfunction and torpor. The patient also presented acute respiratory distress syndrome, acute pulmonary edema and shock. He was managed with protective mechanical ventilation, vasoactive drugs and antibiotic therapy. He was discharged from the intensive care unit without neurological or pulmonary sequelae. After 12 days of hospitalization, he was discharged from the hospital, and his state was very good. The incidence of automobile window strangulation is rare but of high morbidity and mortality due to the resulting choking mechanism. Fortunately, newer cars have devices that stop the automatic closing of the windows if resistance is encountered. However, considering the severity of complications strangulated patients experience, the intensive neuro-ventilatory and hemodynamic management of the pathologies involved is important to reduce morbidity and mortality, as is the need to implement new campaigns for the education of parents and caregivers of children, aiming to avoid easily preventable accidents and to optimize safety mechanisms in cars with electric windows.

Estrangulamento acidental em crianças por fechamento automático de vidro de carro / Accidental strangulation in children by the automatic closing of a car window

RESUMO Entre as principais causas de morte em nosso meio, situam-se acidentes automobilísticos, afogamento e queimaduras acidentais. O estrangulamento é uma injúria potencialmente fatal, além de importante causa de homicídio e suicídio em adultos e adolescentes. Em crianças, sua ocorrência é usualmente acidental. No entanto, nos últimos anos, vários casos de estrangulamento acidental em crianças ao redor do mundo têm sido reportados. Paciente masculino de 2 anos de idade foi vítima de estrangulamento em vidro do carro. Admitido na unidade de terapia intensiva pediátrica com Escala de Coma de Glasgow de 8, piora progressiva da disfunção respiratória e torpor. Paciente apresentou quadro de Síndrome da Angústia Respiratória Aguda, edema agudo de pulmão e choque. Foi manejado com ventilação mecânica protetora, drogas vosoativas e antibioticoterapia. Recebeu alta da unidade de terapia intensiva sem sequelas neurológicas ou pulmonares. Após 12 dias de internação, teve hospitalar alta para casa em ótimo estado. A incidência de estrangulamento por vidro de automóvel é rara, mas de alta morbimortalidade, devido ao mecanismo de asfixia ocasionado. Felizmente, os automóveis mais modernos dispõem de dispositivos que interrompem o fechamento automático dos vidros se for encontrada alguma resistência. No entanto, visto a gravidade das complicações de pacientes vítimas de estrangulamento, é significativamente relevante o manejo intensivo neuroventilatório e hemodinâmico das patologias envolvidas, para redução da morbimortalidade, assim como é necessário implementar novas campanhas para educação dos pais e cuidadores das crianças, visando evitar acidentes facilmente preveníveis e otimizar os mecanismos de segurança nos automóveis com vidros elétricos.

ABSTRACT Among the main causes of death in our country are car accidents, drowning and accidental burns. Strangulation is a potentially fatal injury and an important cause of homicide and suicide among adults and adolescents. In children, its occurrence is usually accidental. However, in recent years, several cases of accidental strangulation in children around the world have been reported. A 2-year-old male patient was strangled in a car window. The patient was admitted to the pediatric intensive care unit with a Glasgow Coma Scale score of 8 and presented with progressive worsening of respiratory dysfunction and torpor. The patient also presented acute respiratory distress syndrome, acute pulmonary edema and shock. He was managed with protective mechanical ventilation, vasoactive drugs and antibiotic therapy. He was discharged from the intensive care unit without neurological or pulmonary sequelae. After 12 days of hospitalization, he was discharged from the hospital, and his state was very good. The incidence of automobile window strangulation is rare but of high morbidity and mortality due to the resulting choking mechanism. Fortunately, newer cars have devices that stop the automatic closing of the windows if resistance is encountered. However, considering the severity of complications strangulated patients experience, the intensive neuro-ventilatory and hemodynamic management of the pathologies involved is important to reduce morbidity and mortality, as is the need to implement new campaigns for the education of parents and caregivers of children, aiming to avoid easily preventable accidents and to optimize safety mechanisms in cars with electric windows.

Ventilação oscilatória de alta frequência em crianças com síndrome da angústia respiratória aguda: experiência de um centro de tratamento intensivo pediátrico / High-frequency oscillatory ventilation in children with acute respiratory distress syndrome: experience of a pediatric intensive care unit

OBJETIVO: Descrever os efeitos da aplicação da ventilação de alta frequência oscilatória como suporte ventilatório de resgate em uma série de pacientes pediátricos com síndrome da angústia respiratória aguda (SARA). MÉTODOS: Participaram do estudo 25 crianças(> 1mês e < 17 anos) internadas em uma UTI pediátrica universitária com SARA e submetidas à ventilação de alta frequência oscilatória (VAFO) por um mínimo de 48 horas, após falha da ventilação mecânica convencional. RESULTADOS: A taxa de mortalidade foi de 52% (13/25) 28 dias após o início da SARA. Ao longo de 48 horas, a aplicação da VAFO reduziu o índice de oxigenação [38 (31-50) vs. 17 (10-27)] e aumentou a relação pressão arterial parcial de O2/fração inspirada de O2 [65 (44-80) vs. 152 (106-213)]. A pressão arterial parcial de CO2 [54 (45-74) vs. 48 (39-58) mmHg] manteve-se inalterada. A pressão média de vias aéreas oscilou entre 23 e 29 cmH2O. A VAFO não comprometeu a hemodinâmica e observou-se uma redução da frequência cardíaca (141 ± 32 vs. 119 ± 22 bat/min), a pressão arterial média (66 ± 20 vs. 71 ± 17 mmHg) e o escore inotrópico [44 (17-130) vs. 20 (16-75)] mantiveram-se estáveis nesse período. Nenhum sobrevivente ficou dependente de oxigênio. CONCLUSÃO: VAFO melhora a oxigenação de pacientes pediátricos com SARA grave e hipoxemia refratária ao suporte ventilatório convencional.

OBJECTIVE: To describe the effects of high-frequency oscillatory ventilation (HFOV) as a rescue Acute respiratory distress syndrome ventilatory support in pediatric patients with acute respiratory distress syndrome (ARDS). METHODS: Twenty-five children (1 month < age < 17 years) admitted to a university hospital pediatric intensive care unit (ICU) with ARDS and submitted to HFOV for a minimum of 48 hours after failure of conventional mechanical ventilation were assessed. RESULTS: Twenty eight days after the onset of ARDS, the mortality rate was 52% (13/25). Over the course of 48 hours, the use of HFOV reduced the oxygenation index [38 (31-50) vs. 17 (10-27)] and increased the ratio of partial arterial pressure O2 and fraction of inspired O2 [65 [44-80) vs. 152 (106-213)]. Arterial CO2 partial pressure [54 (45-74) vs. 48 (39-58) mmHg] remained unchanged. The mean airway pressure ranged between 23 and 29 cmH2O. HFOV did not compromise hemodynamics, and a reduction in heart rate was observed (141±32 vs. 119±22 beats/min), whereas mean arterial pressure (66±20 vs. 71±17mmHg) and inotropic score [44 (17-130) vs. 20 (16-75)] remained stable during this period. No survivors were dependent on oxygen. CONCLUSION: HFOV improves oxygenation in pediatric patients with ARDS and severe hypoxemia refractory to conventional ventilatory support.

High-frequency oscillatory ventilation in children with acute respiratory distress syndrome: experience of a pediatric intensive care unit.

OBJECTIVE: To describe the effects of high-frequency oscillatory ventilation (HFOV) as a rescue ventilatory support in pediatric patients with acute respiratory distress syndrome (ARDS). METHODS: Twenty-five children (1 month < age < 17 years) admitted to a university hospital pediatric intensive care unit (ICU) with ARDS and submitted to HFOV for a minimum of 48 hours after failure of conventional mechanical ventilation were assessed. RESULTS: Twenty eight days after the onset of ARDS, the mortality rate was 52% (13/25). Over the course of 48 hours, the use of HFOV reduced the oxygenation index [38 (31-50) vs. 17 (10-27)] and increased the ratio of partial arterial pressure O2 and fraction of inspired O2 [65 [44-80) vs. 152 (106-213)]. Arterial CO2 partial pressure [54 (45-74) vs. 48 (39-58) mmHg] remained unchanged. The mean airway pressure ranged between 23 and 29 cmH2O. HFOV did not compromise hemodynamics, and a reduction in heart rate was observed (141±32 vs. 119±22 beats/min), whereas mean arterial pressure (66±20 vs. 71±17 mmHg) and inotropic score [44 (17-130) vs. 20 (16-75)] remained stable during this period. No survivors were dependent on oxygen. CONCLUSION: HFOV improves oxygenation in pediatric patients with ARDS and severe hypoxemia refractory to conventional ventilatory support.

Extradural hematoma in children: case series of 33 patients.

BACKGROUND: Conservative management of extradural hematomas (EDH) is relatively recent in the literature and there are few papers reporting on the pediatric population. OBJECTIVE: We conduct a 20-month assessment of the treatment administered for EDH at a pediatric intensive care unit (PICU). METHODS: A retrospective case series in the period described above. The main variables studied were the weight and age of the patients, the Pediatric Trauma Score, the mechanism of injury, clinical features, CT findings and the Glasgow Coma Scale score on arrival, and after 12 and 24 h. Also analyzed was whether during primary care either surgical intervention or initial conservative management was recommended. RESULTS: In the 20 months analyzed, 33 EDH patients were admitted to the PICU. Patients had a mean age of 7.42 ± 4.66 years, mean weight of 31.16 ± 16.16 kg and mean Pediatric Trauma Scores of 7.03 ± 3.71. Out of the total sample, surgery was indicated in 12 patients (36.4%) in primary care and 21 patients (63.6%) were treated with initial conservative management. Most of the patients who were given conservative treatment had a Glasgow Coma Scale score of 15 on arrival and maintained this level throughout the hospital stay. The most prevalent sites of the hematomas were the temporal and parietal regions and the most common associated injury was skull fracture. CONCLUSION: In this case series, conservative treatment of EDH was most frequent; however, which factors are involved in this decision has to be better studied.

Escalas psicométricas como instrumentos de rastreamento para depressão em estudantes do ensino médio / Depression rating scales as screening tools for depression in high school students

CONTEXTO: A depressão é uma importante causa de suicídio em adolescentes. Portanto, são necessários instrumentos adequados para o rastreamento da depressão nessa população. OBJETIVO: Avaliar escalas de depressão como instrumentos de rastreamento para depressão em estudantes brasileiros do ensino médio. MÉTODOS: Estudo transversal. Três escalas (BDI, CES-D, e CRS) e um teste para avaliar sintomas psiquiátricos gerais (SRQ) foram aplicados individualmente a 503 estudantes do ensino médio com idades entre 15 e 17 anos. Os resultados foram comparados aos obtidos com os critérios de depressão maior do manual diagnóstico e estatístico de transtornos mentais (DSM-IV). RESULTADOS: A prevalência de depressão maior utilizando-se os critérios do DSM-IV foi de 10,9%. Adolescentes com depressão maior apresentaram escores significativamente mais altos (p = 0,001) no SRQ e nas três escalas avaliadas em comparação ao grupo sem depressão. A sensibilidade e a especificidade para identificar depressão pelo BDI, CES-D e CRS foram, respectivamente, 0,77 e 0,70, 0,75 e 0,73 e 0,82 e 0,71 (curva ROC). Os melhores pontos de corte foram 9 para o BDI, 10 para a CRS e 14 para a CES-D. A frequência de sintomas depressivos foi maior em meninas (aproximadamente 2:1). CONCLUSÃO: Esses achados indicam o uso do BDI, da CES-D e da CRS apenas para o rastreamento, ou como uma avaliação sintomática adicional, da depressão em estudantes do ensino médio. A diferença entre meninos e meninas com relação aos escores nas escalas alerta contra o uso dos mesmos valores de corte para ambos os sexos.

BACKGROUND: Depression is a major cause of suicide among adolescents. Therefore, it is crucial to find suitable depression screening tools for this population. OBJECTIVE: To evaluate the use of depression rating scales as screening tools for depression in a sample of Brazilian high school students. METHODS: A cross-sectional study. Three scales (BDI, CES-D, and CRS) and a screening test for general psychiatric symptoms (SRQ) were administered to a sample of 503 high school students aged between 15 to 17 years. The results were compared to those obtained with the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). RESULTS: The prevalence of major depression using DSM-IV criteria was 10.9%. Adolescents with major depression had significantly higher (p = 0.001) scores in the SRQ and in the three scales analyzed compared to the group without depression. The sensitivity and specificity of BDI, CES-D, and CRS were 0.77 and 0.70, 0.75 and 0.73, and 0.82 and 0.71, respectively, to screen for major depression (ROC curve). The best cutoff values to suggest depression were 9 for BDI, 10 for CSR, and 14 for CES-D. The frequency of depressive symptoms was higher in girls (approximately 2:1). DISCUSSION: The present findings support the use of the BDI, the CES-D and the CRS only for screening or as an additional symptomatic evaluation of depression in high school student. The difference in scale scores between boys and girls warns against the use of the same cutoff values for both sexes.

Serum lactate as mortality and morbidity marker in infants after Jatene's operation.

OBJECTIVE: To assess the morbidity and mortality after Jatene's operation using lactate as the main marker. METHODS: We performed a historical cohort with infants admitted in a pediatric intensive care unit during 1995 to 2005 who underwent this surgery. We assessed the preoperative, immediate (IPD), third hour (3h), six hour (6h) and first day (POD1) serum lactate as well as other factors such as sepsis, increased bleeding, low cardiac output syndrome, renal insufficiency, pulmonary hypertension, cardiac arrythmias, chylothorax, myocardial ischemia, seizures, presence of other complication, and also information about length of PICU stay and death. RESULTS: The mean age of 76 patients was 14.59± 19.09 days, birth weight 3.128± 0.48 kg Forty-four patients had the diagnosis of simple transposition of great arteries. The circulatory bypass time was 143.78± 28.77 minutes and aortic clamping time of 87.68± 22.3 minutes and LOS of 20.28 ± 15.62 days. Twenty four (31.58%) died during hospital stay. Lactate increased in IPD, returning to baseline at 24 hours. Patients who died raised and maintained IPD lactate higher. The 3h lactate best discriminated mortality with area under the curve of 0.68 (CI 0.54 to 0.83) P = 0.035. However, considering a cutoff point for lactate greater or equal to 5.8 mmol/dl in the 3-h PO, we obtained only 67% sensitivity and specificity of 64% for mortality. There is positive correlation between number of complications and lactate. The low cardiac output syndrome with an odds ratio (OR) of 7.67 (2.38-24), increased bleeding with OR 2.91 (1.07-7.94) and respiratory complication with OR 1.67 (1.35-2.05) are risk factors when combined. CONCLUSION: After Jatene's operation, morbidity and mortality can be assessed with the serum lactate levels, suggesting increased values in the third hour is suggestive of a worse prognosis.

Lactato sérico como marcador de morbimortalidade no pós-operatório de operação de Jatene em lactentes / Serum lactate as mortality and morbidity marker in infants after Jatene's operation

OBJETIVO: Avaliar a morbidade e mortalidade após a operação de Jatene utilizando a dosagem de lactato sérico como principal marcador. MÉTODOS: Foi realizada uma coorte histórica com lactentes da UTI no período de 1995 a 2005 submetidos a essa cirurgia. Foram avaliados o lactato do pré-operatório, pós-operatório imediato (POI), da terceira hora de PO (3ªh), sexta hora (6ªh) de PO e do 1º dia de PO; bem como outros fatores como sepse, sangramento aumentado, síndrome de baixo débito, insuficiência renal, hipertensão pulmonar, arritmias cardíacas, quilotórax, isquemia miocárdica, convulsões e outras complicações. Também foram coletadas informações referentes ao tempo de internação na UTI e ao desfecho (se o paciente morreu ou teve alta da UTI). RESULTADOS: A média de idade dos 76 pacientes foi de 14,59 ± 19,09 dias, peso ao nascimento de 3,128 ± 0,48 kg. Quarenta e quatro pacientes tinham o diagnóstico anatômico exclusivo de transposição de grandes artérias. O tempo médio de CEC foi de 143,78 ± 28,77 minutos, de pinçamento de 87,68 ± 22,3 minutos e de internação na UTI de 20,28 ± 15,62 dias. Vinte quatro (31,58 por cento) pacientes foram a óbito. O lactato aumentou no POI, retornando aos níveis basais em 24h. Os pacientes que foram a óbito apresentaram e mantiveram a partir do POI níveis de lactato mais elevados. O lactato da 3ªh foi o que melhor discriminou mortalidade, área sob a curva 0,68 (IC 0,54-0,83) P=0,035. Entretanto, considerando um ponto de corte para o lactato maior ou igual a 5,8 mmol/dl na 3ªh de PO, obteve-se apenas sensibilidade de 67 por cento e especificidade de 64 por cento para mortalidade. Existe correlação positiva entre o número de complicações e os níveis de lactato. A síndrome de baixo débito com odds ratio (OR) de 7,67 (2,38-24), sangramento aumentado com OR de 2,91 (1,07-7,94) e complicações respiratórias com OR de 1,67 (1,35-2,05) são fatores de risco de óbito quando somados. CONCLUSÃO: Após a operação de Jatene, a morbidade e a mortalidade podem ser avaliadas com auxílio da dosagem de lactato sérico, sugerindo que valores aumentados na terceira hora são sugestivos de pior prognóstico.

OBJECTIVE: To assess the morbidity and mortality after Jatene's operation using lactate as the main marker. METHODS: We performed a historical cohort with infants admitted in a pediatric intensive care unit during 1995 to 2005 who underwent this surgery. We assessed the preoperative, immediate (IPD), third hour (3h), six hour (6h) and first day (POD1) serum lactate as well as other factors such as sepsis, increased bleeding, low cardiac output syndrome, renal insufficiency, pulmonary hypertension, cardiac arrythmias, chylothorax, myocardial ischemia, seizures, presence of other complication, and also information about length of PICU stay and death. RESULTS: The mean age of 76 patients was 14.59± 19.09 days, birth weight 3.128± 0.48 kg Forty-four patients had the diagnosis of simple transposition of great arteries. The circulatory bypass time was 143.78± 28.77 minutes and aortic clamping time of 87.68± 22.3 minutes and LOS of 20.28±15.62 days. Twenty four (31.58 percent) died during hospital stay. Lactate increased in IPD, returning to baseline at 24 hours. Patients who died raised and maintained IPD lactate higher. The 3h lactate best discriminated mortality with area under the curve of 0.68 (CI 0.54 to 0.83) P = 0.035. However, considering a cutoff point for lactate greater or equal to 5.8 mmol/dl in the 3-h PO, we obtained only 67 percent sensitivity and specificity of 64 percent for mortality. There is positive correlation between number of complications and lactate. The low cardiac output syndrome with an odds ratio (OR) of 7.67 (2.38-24), increased bleeding with OR 2.91 (1.07-7.94) and respiratory complication with OR 1.67 (1.35-2.05) are risk factors when combined. CONCLUSION: After Jatene's operation, morbidity and mortality can be assessed with the serum lactate levels, suggesting increased values in the third hour is suggestive of a worse prognosis.

Neuropsychomotor development before and after open-heart surgery in infants.

There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenty infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%). The mean circulatory bypass time was 67 +/- 23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.

Neuropsychomotor development before and after open-heart surgery in infants / Desenvolvimento neuropsicomotor de lactentes antes e após cirurgia cardíaca

There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55 percent). The mean circulatory bypass time was 67 ± 23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.

As alterações neurológicas em lactentes com cardiopatia congênita podem agravar seu quadro clínico e levar a seqüelas permanentes. Foi realizada uma coorte prospectiva, com 20 lactentes, com idade média de 6,7 ± 4,2 meses, avaliando-se o perfil de desenvolvimento e o estado nutricional. Utilizou-se o exame neurológico e o teste de Denver II. Os testes foram aplicados 24h antes da cirurgia, na alta da unidade de terapia intensiva e 3 a 6 meses após. Os defeitos septais ocorreram em 11 casos (55 por cento). O tempo médio de circulação extra-corpórea foi de 67ffl23,6 minutos. Quinze crianças tinham exame neurológico alterado e atraso no desenvolvimento neuropsicomotor antes da cirurgia, cuja normalização foi observada somente em seis após 6 meses .Quanto aos índices de Denver II, houve aumento em todos domínios, exceto o pessoal-social. O escore Z médio para peso antes da cirurgia foi -2,814 ± 1,98 e após -1,08 ± 1,47 (p<0.05), o qual foi realizado em média 5.2 ± 1.5 meses após a alta hospitalar. Melhora precoce tanto no desenvolvimento como no estado nutricional pôde ser observada neste grupo de lactentes após a correção cirúrgica.