Abstract Objectives: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. Methods: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. Results: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. Conclusions: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken. Objectives barriers delays Methods extension P (P years C (C databases VHLLilacs VHL Lilacs VHL/Lilacs PubMed Cochrane Scopus Science limitation Results included countries vulnerability patients Conclusions COVID19 COVID 19 COVID-1 COVID1 1 COVID-

Abstract Objective: To provide healthcare professional-friendly practical recommendations for early detection of cleft palate-related deformities in newborns and offer an overview of managing these high-prevalent congenital abnormalities. Source of data: PubMed, SciELO, Lilacs, Cochrane, ScienceDirect, and Scopus databases were reviewed for cleft- and diagnosis-related studies. Summary of the findings: Unfortunately, the global prevalence of delayed detection of cleft palate-related deformities remains unacceptably high, with over a quarter of cleft palates missed at birth. This delayed identification causes physical and psychological distress for patients and families, including feeding challenges and weight faltering. To improve cleft management, it is essential to adopt routine detailed, in-depth intraoral examination immediately after birth. It is recommended not only to finger-assisted palpate the intraoral structures but also to visually inspect the oral cavity from gingiva to uvula using a wooden tongue depressor and light-assisted examination. With timely diagnosis and referral to specialized care, pediatricians, nurses, speech therapists, and plastic surgeons provide life-changing treatments, including health care maintenance, anticipatory guidance, feeding support, primary surgical reconstruction, and age-and condition-specific protocols. Conclusions: Encouraging neonatologists and pediatricians, who are the first to examine new-borns, to actively investigate the intraoral region for cleft palate-related deformities is instrumental in optimizing therapeutic approaches and prioritizing age-phases in treatment. Their crucial role in early detection and referral can lead to transformative outcomes, impacting not only the future of the newborns by facilitating functional integration into society but also yielding positive effects on families and the health system. Objective professionalfriendly professional friendly palaterelated palate related highprevalent high prevalent abnormalities data PubMed SciELO Lilacs Cochrane ScienceDirect diagnosisrelated studies findings Unfortunately birth faltering management detailed indepth depth fingerassisted finger assisted lightassisted light pediatricians nurses therapists lifechanging life changing treatments maintenance guidance support reconstruction ageand age conditionspecific condition specific protocols Conclusions newborns, new borns, borns new-borns agephases phases treatment outcomes system

Abstract Objective: To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in pre-term infants undergoing or not the Kangaroo-Mother Care Method (KMC). Methods: A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders. Results: 115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85–109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76–0.86) compared to the non-KMC group. Conclusions: The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals. Objective lengthofstay pre term KangarooMother Kangaroo Mother KMC. . (KMC) Methods 180 center nonKMC non lengthofstay, stay, confounders Results 11 motherinfant mother infant included 7 3 analysis 6% (6 vs 32% 0.001, 0001 0.001 , 0 001 median 35 5 3.5 weeks 0.05, 005 0.05 05 0.05) 153 136 0.01, 0.01 01 0.01) 3.8% 38 8 (3.8 162 16 2 16.2% 50% 50 (50 73 73% 49.7% 497 49 (49.7 784 4 78.4% 65% 65 (65 8% days 0.001. OR 23.1 231 1 95 4,85–109,93 48510993 85 109 93 19 IDR 0.81 081 81 0.76–0.86 076086 76 86 Conclusions shortterm short hospitals (KMC 18 ( 000 0.00 00 3. 0.0 15 13 3.8 (3. 16.2 (5 49.7 (49. 78.4 23. 9 4,85–109,9 4851099 10 0.8 08 0.76–0.8 07608 0. (3 16. 49. (49 78. 4,85–109, 485109 0.76–0. 0760 (4 4,85–109 48510 0.76–0 076 4,85–10 4851 0.76– 07 4,85–1 485 0.76 4,85– 48 0.7 4,85 4,8 4,

Abstract Objective: To examine the mental health status and related factors in children and adolescents, and to assess age groups and sexes differences in factors influencing mental health. Methods: This cross-sectional study was performed on Chinese children aged 6-18 years from November 2021 to January 2022. Mental health difficulties were accessed by the Strengths and Difficulties Questionnaire. Multivariate logistic regression was used to analyze factors associated with mental health status. Multiple linear regression was used to evaluate factors associated with the scores of the Strengths and Difficulties Questionnaire. Results: The prevalence of mental health difficulties was 12.98% (n =1348). Age (OR, 0.909, [95%CI, 0.830-0.996]), sex (OR, 1.424, [95%CI, 1.033-1.963]) and screen time on weekdays (“≥2” h/d vs “< 1” h/d: OR, 2.001, [95%CI, 1.300-3.080]) were related factors for mental health difficulties. For children (year ≤ 12), the strongest related factor for mental health difficulties was screen time on weekdays (“≥ 2” h/d vs “< 1” h/d: OR, 1.821 [95%CI, 1.203-2.755]). The risk of mental health difficulties in females with ≥ 2 h/d screen time on weekends was 3.420 times higher than those with < 1 h/d (OR, 3.420, [95%CI, 1.923-6.081]). Conclusion: The prevalence of mental health difficulties among children and adolescents was relatively high. The lower age, female sex and excessive screen time were associated with a higher risk of mental health difficulties. The factors influencing mental health varied by different age groups and sexes. Thus, specific measures for different age groups and sexes should be adopted to mitigate the impact. Objective Methods crosssectional cross sectional 618 6 18 6-1 202 2022 Questionnaire Results 1298 12 98 12.98 n =1348. 1348 =1348 . =1348) OR (OR 0909 0 909 0.909 95%CI, 95CI CI 95 [95%CI 0.8300.996, 08300996 0.830 0.996 , 830 996 0.830-0.996]) 1424 424 1.424 1.0331.963 10331963 1.033 1.963 033 963 1.033-1.963] ≥2 (“≥2 hd h d “ 2001 001 2.001 1.3003.080 13003080 1.300 3.080 300 3 080 1.300-3.080] year 12, 12) (“ 1821 821 1.82 1.2032.755. 12032755 1.203 2.755 203 755 1.203-2.755]) 3420 420 3.42 1.9236.081. 19236081 1.923 6.081 923 081 1.923-6.081]) Conclusion high Thus impact 61 6- 20 129 9 12.9 134 =134 090 90 0.90 95%CI 8300 0.8300.996 0830099 0830 0.83 0996 0.99 83 99 0.830-0.996] 142 42 1.42 0331 1.0331.96 1033196 1033 1.03 1963 1.96 03 96 1.033-1.963 200 00 2.00 3003 1.3003.08 1300308 1300 1.30 3080 3.08 30 08 1.300-3.080 ( 182 82 1.8 2032 1.2032.755 1203275 1203 1.20 2755 2.75 75 1.203-2.755] 342 3.4 9236 1.9236.081 1923608 1923 1.92 6081 6.08 92 1.923-6.081] 12. 13 =13 09 0.9 0.8300.99 083009 083 0.8 099 8 0.830-0.996 14 4 1.4 1.0331.9 103319 103 1.0 196 1.9 1.033-1.96 2.0 1.3003.0 130030 130 1.3 308 3.0 1.300-3.08 1. 1.2032.75 120327 120 1.2 275 2.7 7 1.203-2.755 34 3. 1.9236.08 192360 192 608 6.0 1.923-6.081 =1 0. 0.8300.9 08300 0.830-0.99 1.0331. 10331 10 19 1.033-1.9 2. 1.3003. 13003 1.300-3.0 1.2032.7 12032 27 1.203-2.75 1.9236.0 19236 60 6. 1.923-6.08 = 0.8300. 0.830-0.9 1.0331 1.033-1. 1.3003 1.300-3. 1.2032. 1.203-2.7 1.9236. 1.923-6.0 0.8300 0.830-0. 1.033-1 1.300-3 1.2032 1.203-2. 1.9236 1.923-6. 0.830-0 1.033- 1.300- 1.203-2 1.923-6 0.830- 1.203- 1.923-

Abstract Objective: To investigate the incidence, clinical and genetic characteristics of pediatric lymphoma patients of China with inborn errors of immunity (IEI)-related gene mutations, which have not been fully studied. Method: From Jan. 2020 to Mar. 2023, IEI-related genetic mutations were retrospectively explored in 108 children with lymphomas admitted to Beijing Children’s Hospital by NGS. Genetic rule and clinical characteristics as well as treatment outcomes were compared between patients with or without IEI-related gene mutations. Results: A total of 17 patients (15.7 %) harbored IEI-associated mutations, including 4 cases with X-linked lymphoproliferative syndrome (XLP), 3 cases had mutations in tumor necrosis factor receptor superfamily 13B (TNFRSF13B), 2 cases with Activated p110 syndrome (APDS). Patients with IEI all had alteration of immunocompetence with decreased levels of immunoglobulin and lymphocyte subsets. Recurrent infection existed in 41.2 % of patients. The 18-month event-free survival (EFS) and the overall response rate (ORR) of patients with IEI are significantly lower than those without IEI (33.86% vs. 73.26 %, p = 0.011; 52.94% vs. 87.91 %, p = 0.002, respectively). In addition, patients with IEI had a higher progression disease (PD) rate of 23.5 % than those without IEI of 4.4% (p = 0.006). Conclusion: The present study demonstrated that IEI-associated lymphomas were much more common than originally appreciated in pediatric lymphomas, and those were insensitive to treatment and more likely to progress or relapse. The genomic analysis and a thorough review of the medical history of IEI can be used to distinguish them from pediatric lymphomas without IEI, which are beneficial for the early diagnosis and direct intervention. Objective incidence IEIrelated related studied Method Jan 202 Mar 2023 10 Childrens Children s NGS Results 1 15.7 157 15 7 (15. IEIassociated associated Xlinked X linked XLP, XLP , (XLP) B TNFRSF13B, TNFRSF13B TNFRSFB TNFRSF (TNFRSF13B) p11 APDS. APDS . (APDS) subsets 412 41 41. 18month month 18 eventfree event free EFS (EFS ORR (ORR 33.86% 3386 33 86 (33.86 vs 7326 73 26 73.2 0.011 0011 0 011 5294 52 94 52.94 8791 87 91 87.9 0002 002 0.002 respectively. respectively respectively) addition PD (PD 235 23 5 23. 44 4.4 0.006. 0006 0.006 006 0.006) Conclusion relapse intervention 20 15. (15 (XLP (TNFRSF13B p1 (APDS 33.86 338 8 (33.8 732 73. 0.01 001 01 529 9 52.9 879 87. 000 00 0.00 4. (1 33.8 (33. 0.0 52. ( 33. (33 0. (3

Abstract Objective: To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology. Methods: A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conductedin73publicmiddleschoolsinthreeBrazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; Mage = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention). Results: The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems. Conclusions: Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations. Objective COVID19 COVID 19 COVID-1 AprilAugust April August 2021, 2021 , 2021) symptomatology Methods clusterrandomized cluster randomized trial conductedinpublicmiddleschoolsinthreeBrazilian conductedin publicmiddleschoolsinthreeBrazilian cities program 53 61% 61 (61 girls 152 15 2 15. years. years . years) preintervention pre intervention FebruaryMarch February March 2019, 2019 2019) NovemberDecember November December school alcohol, (alcohol drinking tobacco inhalants marijuana cocaine crack periods sex age status city control intervention. intervention) Results pastyear pastmonth but decelerating However initiated maintained Mainly problems hyperactivity Conclusions period factors manifestations COVID1 1 COVID- 202 5 6 (6 201 20 (

Abstract Objective: To estimate the direct costs of treating excess body weight in children and adolescents attending a public children’s hospital. Methods: This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital’s finance department. Results: Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R $1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5–18 years compared to children aged 2–5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2–5 and 5–18 years, respectively. Conclusion: The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment. Objective childrens s hospital Methods (SUS 2221 2 221 2,22 approach 200 2019 Procedures Medications OrthosesProstheses Orthoses Prostheses Orthoses/Prostheses hospitals department Results 506 50 6 50.6 R$703,503.00 R70350300 R 703 503 00 (R$703,503.00 $1,388,449.40 138844940 1 388 449 40 investigated 118 11 8 11. 518 18 5–1 25 2– Additionally 4 0 4. 63 3 6. respectively Conclusion R13884500 138 845 R$138,845.00 effectiveness investment 222 22 2,2 20 201 50. R$703,503.0 R7035030 70 (R$703,503.0 $1,388,449.4 13884494 38 44 51 5– R1388450 13 84 R$138,845.0 2, R$703,503. R703503 7 (R$703,503. $1,388,449. 1388449 R138845 R$138,845. R$703,503 R70350 (R$703,503 $1,388,449 138844 R13884 R$138,845 R$703,50 R7035 (R$703,50 $1,388,44 13884 R1388 R$138,84 R$703,5 R703 (R$703,5 $1,388,4 1388 R138 R$138,8 R$703, R70 (R$703, $1,388, R13 R$138, R$703 R7 (R$703 $1,388 R1 R$138 R$70 (R$70 $1,38 R$13 R$7 (R$7 $1,3 R$1 R$ (R$ $1, $1 $

Abstract Objectives: Age at menarche (MA) is a proxy for biological maturation and a parameter of socioeconomic changes. Worldwide, anticipation of menarche is associated with nutritional transition and excess weight. The objective of this study was to evaluate the MA in Amazonian students and its association with nutritional status, ethnicity, and socioeconomic level. Methods: Cross-sectional study with 1,017 students aged 6 to 17 living in the city of Manaus, Brazil. MA was analyzed by status quo and recall; its association with body mass index (BMI), race, socioeconomic status, and adult height was examined. Results: 559 (51.9%) participants had already experienced menarche. In 91.7%, menarche occurred between 10 and 14 years of age; the mean age at the onset of menarche was 11.9 years. Overweight (11.6 years) and obese (11.4 years) participants reached menarche earlier than those with normal weight (12 years) and lean (12.7 years) participants. The associations between MA and nutritional status showed that overweight and obesity are risk factors for the early occurrence of menarche. MA was not associated with socioeconomic status/parental education or race. However, excess weight was associated with earlier MA in all races and social classes. The adult height was slightly lower in girls with menarche before 12 years old (157.9 vs 159.4 cm). Conclusion: Regardless of socioeconomic level or ethnicity, excess weight was associated with earlier menarche in Amazonian students. Objectives (MA changes Worldwide ethnicity Methods Crosssectional Cross sectional 1017 1 017 1,01 Manaus Brazil recall BMI, BMI , (BMI) race examined Results 55 51.9% 519 51 9 (51.9% 917 91 7 91.7% 119 11 11. 11.6 116 (11. 11.4 114 4 (1 12.7 127 (12. statusparental parental However classes 157.9 1579 157 (157. 1594 159 159. cm. cm . cm) Conclusion 101 01 1,0 (BMI 5 51.9 (51.9 91.7 (11 ( 12. 157. 15 (157 0 1, 51. (51. 91. (15 (51 (5

Abstract Objective: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. Methods: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge’sg. Results: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). Conclusion: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge. highfidelity high fidelity casebased case based selfconfidence, selfconfidence self confidence, confidence reasoning communication attitude Methods 3 methods HFS, 18 CBD, (CBD 15. 15 . 15) Selfconfidence Self mixedeffect regressions Hedgesg. Hedgesg Hedge sg. sg Hedge’sg Results 591 59 1 59. 936 93 6 93.6 0.001 0001 0 001 505 50 5 50. 882 88 2 88.2 451 45 45. 632 63 63.2 435 43 43. 567 56 7 56.7 pvalue value 0.01, 0.01 , 01 0.01) group*time grouptime ranking 06565 6565 0.656 03331 3331 0.3331 respectively. respectively respectively) Hedges 115 1.1 2.20. 220 2.20 20 2.20) Conclusion care 9 93. 0.00 000 00 8 88. 4 63. 56. 0.0 0656 656 0.65 0333 333 0.333 11 1. 22 2.2 0. 065 65 0.6 033 0.33 2. 06 03 0.3

Abstract Objective: Ovarian torsion (OT) represents a severe gynecological emergency in female pediatric patients, necessitating immediate surgical intervention to prevent ovarian ischemia and preserve fertility. Prompt diagnosis is, therefore, paramount. This retrospective study set out to assess the utility of combined clinical, ultrasound, and laboratory features in diagnosing OT. Methods: The authors included 326 female pediatric patients aged under 14 years who underwent surgical confirmation of OT over a five-year period. Logistic regression analysis was employed to pinpoint factors linked with OT, and the authors compared clinical presentation, laboratory results, and ultrasound characteristics between patients with OT (OT group) and without OT (N-OT group). The authors conducted receiver operating characteristic (ROC) curve analysis to gauge the predictive capacity of the combined features. Results: Among 326, OTwas confirmed in 24.23 % (79 cases) of the patients. The OT group had a higher incidence of prenatal ovarian masses than the N-OT (22 cases versus 7 cases) (p < 0.0001). Similarly, the authors observed significant differences in the presence of lower abdominal pain, suspected torsion on transabdominal ultrasound, and a high neutrophil-lymphocyte ratio (NLR > 3) between the OTand non-OT groups (p < 0.05). Furthermore, when these parameters were combined, the resulting area under the curve (AUC) was 0.868, demonstrating their potential utility in OT diagnosis. Conclusion: This study demonstrates a prediction model integrating clinical, laboratory, and ultrasound findings that can support the preoperative diagnosis of ovarian torsion, thereby enhancing diagnostic precision and improving patient management. Future prospective studies should concentrate on developing clinical predictive models for OTin pediatric patients. Objective fertility is therefore paramount Methods 32 1 fiveyear five year period presentation results NOT N group. . ROC (ROC Results 2423 24 23 24.2 79 (7 22 (2 p 0.0001. 00001 0.0001 0 0001 0.0001) Similarly pain neutrophillymphocyte neutrophil lymphocyte NLR 3 nonOT non 0.05. 005 0.05 05 0.05) Furthermore AUC (AUC 0868 868 0.868 Conclusion management 242 2 24. ( 0000 0.000 000 00 0.0 086 86 0.86 0.00 0. 08 8 0.8

Abstract Objective: To estimate the prevalence of vitamin D deficiency and severe deficiency in children and adolescents, in a large Brazilian sample. Methodology: Results of 413,988 25(OH)D measurements in children and adolescents aged 0 to 18 years collected between 01/2014 and 10/2018 were obtained from the database of a Clinical Laboratory. In this population, 25 hydroxyvitamin D concentrations below 20 ng/mL are considered deficient, and below 12 ng/mL as severe deficiency. All measurements were performed by immunoassay and the results were distributed by gender, age group, seasonality, and latitude. Results: The mean of 25(OH)D levels was 29.2 ng/mL with a standard deviation of 9.2 ng/mL. Of the total samples, 0.8% had a concentration < 12 ng/mL, and 12.5% of the samples had a concentration < 20 ng/mL, with a higher prevalence in females. Children under 2 years of age had the lowest prevalence. The effects of latitude and seasonality were quite evident. In samples of female adolescents from the southern region in winter, 36% of vitamin D deficiency and 5% of severe deficiency were found. Conclusion: In this large number of measurements of 25(OH)D in children and adolescents, 12.5% had a deficiency and 0.8% had severe deficiency. A greater deficiency was observed among adolescents, especially females, which raises questions about the need for supplementation during this period of life. Objective sample Methodology 413988 413 988 413,98 25OHD OHD OH 1 012014 01 2014 01/201 102018 10 2018 10/201 Laboratory population ngmL ng mL deficient gender group 292 29 29. 92 9 9. 08 8 0.8 125 5 12.5 females evident winter 36 found Conclusion life 41398 41 98 413,9 01201 201 01/20 10201 10/20 0. 12. 3 4139 4 413, 0120 01/2 1020 10/2 012 01/ 102 10/

Abstract Objective: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. Method: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. Results: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. Conclusions: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities. Objective fullterm full term Method crosssectional cross sectional Brazilian BRISA, BRISA , BRISA) 201 2011 mothers BW/PW BWPW BW PW ratio) 25th th age wasted INTERGROWTH21 INTERGROWTH 21 INTERGROWTH-2 standard Graphs Results 72 motherplacentachild mother placenta child studied 32 3 2 3. smallforgestationalage SGA, (SGA) 65 6 5 6. %largeforgestationalage largeforgestationalage %large LGA, (LGA) 57 7 5. had 027 0 27 0.2 OR 2.8295 28295 2.82 82 2.82;9 1.057.57, 105757 1.05 7.57 1 05 1.05-7.57) 2.23 223 23 9 1.074.65, 107465 1.07 4.65 07 4 1.07-4.65) 8.22 822 8 22 1.9634.37. 1963437 1.96 34.37 . 96 34 37 1.96-34.37) Conclusions smallforgestationalage, health comorbidities 20 INTERGROWTH2 INTERGROWTH- (SGA (LGA 02 0. 8295 2.829 2829 282 2.8 2.82; 057 1.057.57 10575 105 1.0 757 7.5 1.05-7.57 2.2 074 1.074.65 10746 107 465 4.6 1.07-4.65 8.2 9634 1.9634.37 196343 196 1.9 3437 34.3 1.96-34.37 829 28 2. 1.057.5 1057 10 1. 75 7. 1.05-7.5 1.074.6 1074 46 4. 1.07-4.6 8. 963 1.9634.3 19634 19 343 34. 1.96-34.3 1.057. 1.05-7. 1.074. 1.07-4. 1.9634. 1963 1.96-34. 1.057 1.05-7 1.074 1.07-4 1.9634 1.96-34 1.05- 1.07- 1.963 1.96-3 1.96-

Abstract Objective: Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis. Methods: A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1–12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature. Results: Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001). Conclusion: Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups. Objective earlystage early stage unnoticed Methods 028 0 28 (0-2 old 94 1–12 112 1 12 (1–1 415 complications outcomes tabulated literature Results p 0.0001, 00001 0.0001 , 0001 0.0021, 00021 0.0021 0021 0.0021) 0.0016, 00016 0.0016 0016 0.0016) 0.0039 00039 0039 0.0001. . Conclusion groups 02 2 (0- 9 1–1 11 (1– 41 0000 0.000 000 0002 0.002 002 0.001 001 0.003 0003 003 (0 1– (1 4 0.00 00 ( 0.0 0.