[…]

Congenital diaphragmatic hernia (CDH) is a severe defect with an estimated incidence of 1:3000 live births (). This anomalous condition is characterized by an absence of separation between the thoracic and abdominal cavities during fetal development. Some of the first hypotheses about this congenital defect postulated that the presence of abdominal viscera in the thoracic cavity caused pulmonary hypoplasia by pushing the abdominal contents into the developing lungs (,). After several studies in animal models, a new theory was presented […]

To the Editor, Human milk is the external secretion with the highest immunoglobulin A (IgA) concentrations, mostly produced in the lamina propria of mammary glands by plasma cells (). The milk antibody repertoire is quite similar to the one observed in the blood; however, the levels of antibodies against enteric and respiratory pathogens are usually higher in the colostrum and mature milk than in the serum. Maternal immunization can elicit systemic immunoglobulin G (IgG) and mucosal IgA, IgM, and IgG […]

Hemostasis in children and adolescents: ontogenetic characteristics and impact on pediatric thromboembolism During phylogenetic evolution, living beings develop a regulatory hemostatic system for protecting the cardiovascular system. In humans, the hemostatic system has a peculiar ontogenesis, which consists of a dynamic evolutionary process deeply influenced by age. The term “developmental hemostasis” has been used since the 1990s to describe age-dependent changes in the hemostatic system, as seen in (). Children are physiologically protected from thromboembolic events due to a decreased […]

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a pandemic in March 2020, affecting millions of people worldwide. However, COVID-19 in pediatric patients represents 1-5% of all cases, and the risk for developing severe disease and critical illness is much lower in children with COVID-19 than in adults. Multisystem inflammatory syndrome in children (MIS-C), a possible complication of COVID-19, has been described as a hyperinflammatory condition with multiorgan involvement similar to that in Kawasaki disease […]

The most common symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children are fever and cough, which are present in approximately 59% of cases (). Other symptoms include bloating, nausea, vomiting, diarrhea, and abdominal pain. Although the evolution is generally benign, the clinical picture of SARS-CoV-2 infection in neonates is still poorly understood (). It is always necessary to consider that severe respiratory distress can also occur in other conditions that are inherent to pulmonary immaturity at […]

SARS-CoV-2 shares nearly 80% of its’ genomic sequence with SARS-CoV and MERS-CoV, both viruses known to cause respiratory symptoms and liver impairment. The emergence of pediatric cases of multisystem inflammatory syndrome related to the SARS-CoV-2 infection (PIM-TS) has raised concerns over the issue of hepatic damage and liver enzyme elevation in the critically ill pediatric population with COVID-19. Some retrospective cohorts and case series have shown various degrees of ALT/AST elevation in SARS-CoV-2 infections. A limited number of liver histopathological […]

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 (age50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p

The repercussions of infection by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pregnant women and newborns are still not well known, with little scientific evidence about their manifestation in the mother-child binomial. Vertical transmission seems possible but has not been documented (,). Furthermore, the virus has not been detected in human milk, enabling breastfeeding with protection or the use of expressed milk from the mother (-). Several studies (,-) published to date suggest the possibility of […]

This article presents expert recommendations for assisting newborn children of mothers with suspected or diagnosed coronavirus disease 2019 (COVID-19). The consensus was developed by five experts with an average of 20 years of experience in neonatal intensive care working at a reference university hospital in Brazil for the care of pregnant women and newborns with suspected or confirmed COVID-19. Despite the lack of scientific evidence regarding the potential for viral transmission to their fetus in pregnant mothers diagnosed with or […]

This review aims to verify the main epidemiologic, clinical, laboratory-related, and therapeutic aspects of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients. An extensive review of the medical literature on COVID-19 was performed, mainly focusing on the critical care of pediatric patients, considering expert opinions and recent reports related to this new disease. Experts from a large Brazilian public university analyzed all recently published material to produce a report aiming to standardize the care of critically ill children and […]

OBJECTIVES: Developing malnutrition during hospitalization is well recognized worldwide, and children are at a relatively higher risk for malnutrition than adults. Malnutrition can lead to immune dysfunction, which is associated with a higher mortality rate due to sepsis, the most frequent cause of death in pediatric intensive care units (PICUs). The aim of this study was to investigate whether malnourished patients are more likely to have relative or absolute lymphopenia and, consequently, worse prognoses. METHODS: We enrolled 14 consecutive patients […]

OBJECTIVE: To analyze the nutritional status of pediatric patients after orthotopic liver transplantation and the relationship with short-term clinical outcome. METHOD: Anthropometric evaluations of 60 children and adolescents after orthotopic liver transplantation, during the first 24 hours in a tertiary pediatric intensive care unit. Nutritional status was determined from the Z score for the following indices: weight/age height/age or length/age, weight/height or weight/length, body mass index/age, arm circumference/age and triceps skinfold/age. The severity of liver disease was evaluated using one […]