Abstract Objectives In the clinical routine of pediatricians, height is the most reliable indicator for assessing growth. However, there are situations where it is not possible to measure this parameter directly, making the estimation of height or length a useful alternative. The main goal of this study is to identify which segmental measure, including upper arm length (UAL), tibial length (TL), and knee-heel length (KHL), provides the stature estimate that most closely approximates directly measured height in the study participants. Methods Analytical cross-sectional study of the anthropometric and segmental measures of 248 participants, aged 0 to 14 years old, using Stevenson's and Kihara's equations to estimate indirectly measured height. Results The segmental measure that provided a measurement that deviated the least from the actual height was the KHL, followed by TL, both calculated using Stevenson's equations. Conclusion The use of segmental measures to infer a child's stature is valuable in clinical practice, particularly in bedridden and incapacitated patients. Based on the present findings, the KHL and TL segments yielded more accurate results than the UAL pediatricians growth However alternative UAL, , (UAL) (TL) kneeheel knee heel (KHL) participants crosssectional cross sectional 24 1 old Stevensons Stevenson s Kiharas Kihara childs child practice patients findings (UAL (TL (KHL 2

Abstract Objectives To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer. Methods The authors studied 4062 surviving very preterm infants born < 32 weeks’ gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years. Results Infants’ mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: −2.0, −1.8, and −1.5; head z: −1.3, −1.2 and −1.1 for exclusive human milk, mixed and exclusive formula respectively). Conclusion Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time. dischargetransfer transfer 406 3 weeks 150 201 202 1 Units overall small vs age. . age) years 293 29 29. 113 2 % 6 z 20 0 −2.0 18 8 −1.8 −1.5 15 5 13 −1.3 −1. 11 respectively. respectively respectively) 40 −2. −1 4 −2 −

Abstract Objective It was to verify the association between the definition of sex of rearing and, clinical and cytogenetic features among patients with genital ambiguity referred without a sex assignment. Methods The sample consisted of 133 patients with genital ambiguity seen at a single reference service. These patients did not have a defined social sex at the first consultation and their etiological diagnosis was obtained during follow-up. Results A total of 133 cases were included, 74 of which were reared as males and 59 as females. No correlation was found between the year of birth and the year of the first consultation with the definition of sex of rearing. However, the definition of sex of rearing was associated with age at the first consultation, severity of genital ambiguity, presence of palpable gonad(s), presence of uterus on ultrasound, karyotype, and diagnosis. Palpable gonad(s), more virilized genitalia, absence of a uterus on ultrasound, 46, XY karyotype, or a karyotype with sex chromosome abnormalities emerged as strong predictors for defining male sex. All 77 (58 %) patients over 18 years old had a gender identity in accordance with the sex of rearing; though 9 of 77 (12 %) had homo or bisexual orientation, especially girls with Congenital Adrenal Hyperplasia. Conclusions Clinical and cytogenetic data were strongly associated with the definition of the sex of rearing of children with genital ambiguity referred to a DSD center without sex assignment. Management in a specialized center allows the establishment of a gender identity in accordance with the sex of rearing. assignment 13 service followup. followup follow up. up follow-up included 7 5 females However gonads, gonads gonad s , gonad(s) ultrasound genitalia 46 58 (5 % 1 12 (1 orientation Hyperplasia gonad(s 4 (

Abstract Objective Evaluate the level of information of pediatricians about the diagnosis and management of cryptorchidism. Method A cross-sectional observational study was conducted using a form via the "Google Forms" platform. The study population included pediatricians and pediatric residents associated with the Brazilian Society of Pediatrics. Seven hundred twenty-eight responses were recorded and analyzed using IBM SPSS v21. Results 728 valid responses were obtained. Of these answers, only 20.5 % answered that the physical examination was sufficient for the diagnosis, and 79.4 % responded that they requested ultrasound as the best test to aid in diagnosing cryptorchidism. When questioned about the ideal age for referring a patient with cryptorchidism, the survey recorded 56.3 % of the responses defending the correct age as six months old, 30.2 % shortly after birth, and 13.2 % at two years old. Other topics were addressed in the form, such as the frequency of evaluation of testicular position and investigation for DDS, among others. Still, the answers to these questions were compatible with current manuals and guidelines on cryptorchidism. Conclusion It is evident that the understanding of the professionals consulted about the diagnosis and management of cryptorchidism needs to be updated with the current practices adopted and that pediatricians, in general, must maintain periodic programs on this subject. Therefore, this topic should be part of a continuing education program with pediatric surgery. crosssectional cross sectional Google Forms platform Pediatrics twentyeight twenty eight v21 v 72 obtained 205 20 5 20. 794 79 4 79. 563 56 3 56. old 302 30 2 30. birth 132 13 13. DDS others Still general subject Therefore surgery v2 7 1

Abstract Objective Childhood standing height has been estimated from arm span-related (heightAS) models. The authors aimed to develop and cross-validate a heightAS model in individuals with spina bifida (SB) and examine the accuracy of existing heightAS models. Methods Participants were individuals with sacral and low-lumbar SB (n = 14) and non-SB (n = 83), 7-16 years old. Arm span, age, sex, and group (SB vs. non-SB) were candidate height predictors. Sequential regression and leave-one-out cross-validation approaches were used for the model development (M1) and cross-validation (M1-M5). Existing models were: an SB-specific model from Polfuss et al. (M2) and non-SB specific models from Gauld et al. (M3), Mulu et al. (M4), and Zverev et al. (M5) studies. Results Arm span and group explained 95 % of the variance in height (R2 = 0.95; p < 0.001; SEE = 3.666 cm) and were included in the M1. Mean differences between actual and estimated height were 0.0 cm (M1), 0.4 cm (M2), and 0.5 cm (M5), all not significant (p > 0.05). However, Bland-Altman analysis revealed some variability in the predictability of the models across participants with limits of agreement ranging from 7.4 to 10.9 cm. Considerable errors were observed with M3 (mean diff: −5.58 cm, 95 % CI: −1.6, −20.2 cm), and M4 (mean diff: 10.5 cm, 95 % CI: −13.8, −27.3 cm). Conclusions Models (M1, M2 and M5) may accurately estimate standing height in groups of children with SB. However, due to the wide limits of agreement, caution is recommended when applying these models for individual height estimations. spanrelated related (heightAS crossvalidate cross validate lowlumbar low lumbar n 14 nonSB non 83, 83 , 83) 716 7 16 7-1 old age sex vs predictors leaveoneout leave one out crossvalidation validation M1 M (M1 M1M5. M1M5 MM M5 . (M1-M5) SBspecific al (M2 M3, (M3) M4, (M4) (M5 studies 9 R2 R (R 0.95 095 0 0.001 0001 001 3666 3 666 3.66 00 0. M1, 04 4 M2, 05 5 M5, 0.05. 005 0.05 0.05) However BlandAltman Bland Altman 74 7. 109 10 10. mean diff 558 58 −5.5 CI 1 6 −1.6 202 20 2 −20. 105 138 13 8 −13.8 273 27 −27. estimations 71 7- (M M1M (M1-M5 (M3 (M4 0.9 09 0.00 000 366 66 3.6 55 −5. −1. −20 −13. −27 (M1-M 36 3. −5 −1 −2 −13 −

Abstract Objective Individuals with Down Syndrome (DS) exhibit a higher susceptibility to infections, suggesting potential immunological alterations within this population. Consequently, this study aims to assess the immune response profile in children with DS to identify potential immune dysfunctions associated with recurrent infections. Methods The authors conducted a retrospective analysis involving 49 DS patients, examining various epidemiological, clinical, cytogenetic, and laboratory variables. The studyʼs sample comprised patients aged 2-20 years, with a predominance of males. These patients were categorized into two groups based on the presence or absence of recurrent infections, as indicated by the Jeffrey Modell Foundation alert signs. Results Immunoglobulin (Ig) A, G, and M levels were deemed normal, although individuals with DS experiencing recurrent infections exhibited significantly lower IgA levels. Additionally, CD3, CD4, CD8, and CD19 lymphocyte counts were found to be within normal ranges, with no significant differences between the two groups. While overall data indicated normal seroconversion levels of pneumococcal polysaccharide antibodies, a notable impairment in seroconversion was observed among DS patients with recurrent infections compared to those without such infections. Conclusion The deficiency of anti-polysaccharide antibodies in individuals with DS may constitute an important immunological comorbidity. Therefore, it warrants further investigation, particularly among individuals with recurrent infections. (DS population Consequently 4 epidemiological clinical cytogenetic variables 220 2 20 2-2 years males signs Ig (Ig A G Additionally CD3 CD CD4 CD8 CD1 ranges antipolysaccharide anti comorbidity Therefore investigation 22 2-

Abstract Objective To analyze risk factors (maternal, obstetric and demographic) associated with congenital syphilis and the clinical characteristics of the newborns. Method A cross-sectional study carried out in ten public maternity hospitals in Fortaleza, Ceará, Brazil that included cases of live births reported with congenital syphilis in 2015. Results 469 cases were analyzed; 199 (42.4 %) showed some sign or symptom suggestive of congenital syphilis; of these, 65 (32.7 %) were preterm, 87 (43.7 %) had low birth weight, 116 (58.3 %) had jaundice that required phototherapy, 13 (6.5 %) had hepatomegaly, 10 (5 %) had skin lesions, eight (4.0 %) had splenomegaly and one (0.5 %) had limb pseudoparalysis. Records of other clinical changes were identified in 36 (7.7 %) children. Children whose mothers were not treated or who received a drug other than penicillin and those whose mothers had a VDRL titer ≥ 1:16 at birth were 3.7 and 3.2 times more likely to be born with signs of congenital syphilis (p < 0.001- 95 % CI 2.41-5.58; p < 0.001 - 95 % CI 2.41-5.58) respectively. Conclusions The findings of this study draw attention to the importance of improving the quality of prenatal care and the development of studies aimed at finding alternative drugs for the treatment of syphilis in pregnant women and the prevention of congenital syphilis. maternal, maternal (maternal demographic newborns crosssectional cross sectional Fortaleza Ceará 2015 46 analyzed 19 42.4 424 42 4 (42. these 6 32.7 327 32 7 (32. preterm 8 43.7 437 43 (43. weight 11 58.3 583 58 3 (58. phototherapy 1 6.5 5 (6. hepatomegaly ( lesions 4.0 40 0 (4. 0.5 05 (0. pseudoparalysis 7.7 77 (7. children 16 1:1 37 3. 2 0001 001 9 2.415.58 241558 2.41 5.58 41 2.41-5.58 0.00 respectively 201 42. (42 32. (32 43. (43 58. (58 6. (6 4. (4 0. (0 7. (7 1: 000 00 415 2.415.5 24155 241 2.4 558 5.5 2.41-5.5 0.0 20 (3 2.415. 2415 24 2. 55 5. 2.41-5. 2.415 2.41-5 2.41-

Abstract Objective To assess the outcome of patients with cancer-related sepsis requiring continuous renal replacement therapy (CRRT) in a single-center pediatric intensive care unit (PICU). Method Children with sepsis who necessitate CRRT from January 2017 to December 2021 were enrolled. The patients with leukemia/lymphoma or solid tumors were defined as underlying cancer. Multivariate logistic regression analysis was performed to identify the death risk factors in patients with cancer-related sepsis. Results A total of 146 patients were qualified for inclusion. Forty-six (31.5%) patients with cancer-related sepsis and 100 (68.5%) non-cancer-related sepsis. The overall PICU mortality was 28.1% (41/146), and mortality was significantly higher in cancer-related sepsis patients compared with non-cancer patients (41.3% vs. 22.0%, p = 0.016). Need mechanical ventilation, p-SOFA, acute liver failure, higher fluid overload at CRRT initiation, hypoalbuminemia, and high inotropic support were associated with PICU mortality in cancer-related sepsis patients. Moreover, levels of IL-6, total bilirubin, creatinine, blood urea nitrogen, and international normalized ratio were significantly higher in non-survivors than survivors. In multivariate logistic regression analysis, pediatric sequential organ failure assessment (p-SOFA) score (OR:1.805 [95%CI: 1.047-3.113]) and serum albumin level (OR: 0.758 [95%CI: 0.581 -0.988]) were death risk factors in cancer-related sepsis receiving CRRT, and the AUC of combined index of p-SOFA and albumin was 0.852 (95% CI: 0.730-0.974). Conclusion The overall PICU mortality is high in cancer-related sepsis necessitating CRRT. Higher p-SOFA and lower albumin were independent risk factors for PICU mortality. cancerrelated cancer related (CRRT singlecenter single center PICU. . (PICU) 201 202 enrolled leukemialymphoma leukemia lymphoma 14 inclusion Fortysix Forty six 31.5% 315 31 5 (31.5% 10 68.5% 685 68 (68.5% noncancerrelated non 281 28 1 28.1 41/146, 41146 41/146 , 41 (41/146) noncancer 41.3% 413 3 (41.3 vs 220 22 0 22.0% 0.016. 0016 0.016 016 0.016) ventilation pSOFA, pSOFA SOFA, SOFA initiation hypoalbuminemia Moreover IL6, IL6 IL 6, 6 IL-6 bilirubin creatinine nitrogen nonsurvivors survivors (p-SOFA OR1.805 OR1805 OR 1.805 805 (OR:1.80 95%CI 95CI CI 95 [95%CI 1.0473.113 10473113 1.047 3.113 047 113 1.047-3.113] (OR 0758 758 0.75 0581 581 0.58 0.988 0988 988 -0.988] 0852 852 0.85 95% (95 0.7300.974. 07300974 0.730 0.974 730 974 0.730-0.974) (PICU 20 31.5 (31.5 68.5 (68.5 2 28. 4114 41/14 4 (41/146 41.3 (41. 22.0 001 0.01 01 IL- OR1 OR1.80 OR180 1805 1.80 80 (OR:1.8 9 0473 1.0473.11 1047311 1047 1.04 3113 3.11 04 11 1.047-3.113 075 75 0.7 058 58 0.5 0.98 098 98 -0.988 085 85 0.8 (9 7300 0.7300.974 0730097 0730 0.73 0974 0.97 73 97 0.730-0.974 31. (31. 68. (68. 411 41/1 (41/14 41. (41 22. 00 0.0 OR1.8 OR18 180 1.8 8 (OR:1. 1.0473.1 104731 104 1.0 311 3.1 1.047-3.11 07 7 0. 05 0.9 09 -0.98 08 ( 0.7300.97 073009 073 097 0.730-0.97 (31 (68 41/ (41/1 (4 OR1. 18 1. (OR:1 1.0473. 10473 3. 1.047-3.1 -0.9 0.7300.9 07300 0.730-0.9 (3 (6 (41/ 1.0473 1.047-3. -0. 0.7300. 0.730-0. 1.047-3 -0 0.7300 0.730-0 1.047- - 0.730-

Abstract Objective Empirical evidence underscores an association between parental stress and emotional and behavioral problems in offspring. However, a comprehensive systematic review or meta-analysis on this topic is lacking. Thus, this study aims to address the scientific inquiry: Is there a relationship between parental stress and emotional/behavioral problems in children? Sources This systematic review with a meta-analysis surveyed PubMed, PsycINFO, and the Biblioteca Virtual em Saúde between August and September 2021. The present search combined terms (school-age children) AND (parental stress OR parenting stress OR family stress) AND (emotional and behavioral problems OR internalizing and externalizing problems). Eligibility criteria encompassed cross-sectional, cohort, and case-control studies published within the last five years, exploring the association between parental stress (stressful life events and parenthood-related stress disorders) and emotional/behavioral problems in school-age children. PROSPERO ID CRD42022274034. Summary of the findings Of the 24 studies meeting all inclusion criteria (n = 31,183) for the systematic review, nine were eligible for inclusion in the meta-analysis. The meta-analysis revealed an association between parental stress and emotional problems (COR: 0.46 [95 % CI: 0.27 - 0.61], p < 0.001, Heterogeneity = 89 %) as well as behavioral problems (COR: 0.37 [95 % CI: 0.27 - 0.46], p < 0.001, Heterogeneity = 76 %). Conclusions These findings indicate that parental stress predicts emotional/behavioral problems in school-age children. Since these problems are related to long-term negative effects in adulthood, these results are crucial for preventing mental health problems in offspring and for screening and managing parental stress. However metaanalysis meta analysis lacking Thus inquiry emotionalbehavioral children PubMed PsycINFO 2021 schoolage school age problems. . problems) crosssectional, crosssectional cross sectional, sectional cross-sectional cohort casecontrol case control years stressful parenthoodrelated parenthood disorders CRD42022274034 CRD 2 n 31,183 31183 31 183 metaanalysis. analysis. COR (COR 046 0 46 0.4 95 [9 CI 027 27 0.2 0.61, 061 0.61 , 61 0.61] 0001 001 0.001 8 037 37 0.3 0.46, 0.46] 7 %. longterm long term adulthood 202 CRD4202227403 31,18 3118 3 18 04 4 0. 9 [ 02 06 0.6 6 000 00 0.00 03 20 CRD420222740 31,1 311 1 0.0 CRD42022274 31, CRD4202227 CRD420222 CRD42022 CRD4202 CRD420 CRD42 CRD4

Abstract Objective The current study delves into the accessibility of genetic evaluations for individuals with orofacial clefts (OC), comparing data between genetics and treatment centers across Brazil. Methods This cross-sectional retrospective study analyzed primary data from 1463 OC individuals registered in the Brazilian Database of Craniofacial Anomalies (BDCA) between 2008 and 2018 without age or sex selection. Diagnostic exam results stemming from research projects until 2023 were considered. Results Of the 1463 individuals with typical OC, 987 were non-syndromic, 462 were syndromic (SOC), 10 presented atypical forms, and three were not specified OC cases. The average age for accessing laboratory diagnosis was 8.5 years among SOC individuals. Notably, more SOC cases were registered in genetics centers than treatment and rehabilitation centers (37.1 % vs. 29 %, p = 0.0015). Those originating from genetics centers accessed diagnosis at an average age of 7.3 years, while those from treatment and rehabilitation centers experienced delays with an average age of 10.7 years (p = 0.0581). Conclusions Irrespective of the center of origin, the data highlight delayed diagnosis and challenges in accessing genetic tests for the syndromic group. Given the widespread reliance on the public health system by most of the Brazilian population, disseminating this data can significantly contribute to shaping an informed perspective on healthcare access. These insights can improve public policies tailored to the unique needs of individuals with OC. , (OC) Brazil crosssectional cross sectional 146 BDCA (BDCA 200 201 selection 202 considered 98 nonsyndromic, nonsyndromic non syndromic, non-syndromic 46 SOC, (SOC) 1 forms 85 8 5 8. Notably 37.1 371 37 (37. vs 2 0.0015. 00015 0.0015 . 0 0015 0.0015) 73 7 3 7. 107 10. 0.0581. 00581 0.0581 0581 0.0581) origin group population access (OC 14 20 9 4 (SOC 37. (37 0001 0.001 001 0058 0.058 058 (3 000 0.00 00 005 0.05 05 ( 0.0 0.

Abstract Objectives To survey, analyze and discuss the scientific evidence supporting the use of acupuncture and related techniques in the management of chronic pain in the pediatric population. Sources A survey of databases (MEDLINE, Scopus and Scielo) was carried out with search strategies, following the PRISMA statement, without limits on publication dates and languages. Clinical studies (clinical trials, single-arm, and case series) were accepted for review if they included participants aged up to 22 years. Study quality was assessed by MMAT, and the randomized clinical trial was analyzed under the STRICTA criteria. Summary of the findings 2369 articles were retrieved. After excluding repetitions, 1335 underwent the initial selection. Only 16 articles were selected for full reading, of which 5 were included in the review, being two case series, two single-arm studies, and one randomized clinical trial. The articles were considered of good quality by the adopted criteria. Conclusion The analyzed studies showed important clinical results such as the reduction of pain intensity, and improvement in school attendance and social life. However, there are many limitations in study design and sample size. Therefore, there is weak evidence to support the use of acupuncture in the context of pediatric chronic pain, but the positive results reinforce the need for further investigation of the topic with the conduct of larger and well-designed studies, to obtain more data and greater scientific conviction of the findings. population MEDLINE, MEDLINE (MEDLINE Scielo strategies statement languages trials singlearm, singlearm single arm, arm series 2 years MMAT criteria 236 retrieved repetitions 133 selection 1 reading intensity life However size Therefore welldesigned well designed 23 13