Prevalence of breastfeeding in the city of São Carlos, São Paulo

OBJECTIVE: To verify the prevalence of breastfeeding in the city of S?o Carlos. METHOD: For the collection and treatment of data regarding prevalence of breastfeeding we used the LACMAT 3.3 program. During Vacination National Day (1998, August 15) 3,326 persons responsible for children 2 years old or younger were interviewed. RESULTS: It was verified that 52.4% of the children under a month old were on exclusive breastfeeding. Out of 532 children under 4 months old, 73.3% were being breast fed: 37.8% exclusively breast fed and 17.3% under predominant breastfeeding. It was observed that 31.7% of the children under 4 months received some other form of nourishment, such as fruit and mush, and on the fifth month, this percentage went to 62.3%. CONCLUSIONS: The results of this study demonstrated that the situation of breastfeeding in S?o Carlos is far from what the WHO recommends, this confirming the need to implement actions of promotion, protection, and support to breastfeeding in the health public services of the municipality.     

Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo,Brazil

ObjectiveTo analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors.MethodsA cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Brazil. Specific foods consumed in the previous 24 h of the interview were considered to evaluate the consumption of ultra-processed foods. Variables related to mothers’ and children's characteristics as well as primary healthcare units were grouped into three blocks of increasingly proximal influence on the outcome. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with ultra-processed food intake.ResultsThe prevalence of ultra-processed food intake was 43.1%. Infants that were not being breastfed had a higher prevalence of ultra-processed food intake but no statistical significance was found. Lower maternal education (prevalence ratio 1.55 [1.08–2.24]) and the child's first appointment at the primary healthcare unit having happened after the first week of life (prevalence ratio 1.51 [1.01–2.27]) were factors associated with the consumption of ultra-processed foods.ConclusionsHigh consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake.     

Etiologic profile of acute diarrhea in children in São Paulo

OBJECTIVE: To evaluate the etiologic profile of acute diarrhea in socioeconomically deprived children assisted at a regional pediatric emergency care service. METHODS: During two years all children with acute diarrhea assisted at a previously established day and week time schedule were included in the study. Other selective criteria were: a) age less than 5 years; b) nonuse of antibiotics in the previous month; and c) no travel outside the city in the previous month. Stool examination was used for the detection of the following microorganisms: a) rotavirus (immunofluorescence and counterimmunoelectrophoresis); b) bacteria - culture in MacConkey agar, SS agar, Columbia agar, bright green, serotyping, detection of toxins - INV, LT,ST,SLT I, SLT II, Sereny test, detection of virulence factors- EAF, eae, BFP; and c) protozoa (Hoffman and Faust). In the same period, a control group without diarrhea was also evaluated for the same fecal pathogens. RESULTS: Between March 1994 and June 1996, 154 children with acute diarrhea (AD) and 42 control children (WAD), that is, without acute diarrhea, were selected. In the AD group, intestinal pathogens were detected in 112 (72.8%) cases, and in 9 (21.5%) cases in the WAD group. The association of two or more intestinal pathogens occurred in 47 (30.5%) cases in the AD group, and in 3 (7.1%) cases in the WAD group. The pathogens identified in the AD cases were: Rotavirus: 32 (20.8%), bacteria: 53 (34.4%), both: 25 (16.2%), and 2 (1.4%) with Giardia lamblia (in one case associated with Rotavirus and in another one associated with bacteria). In the WAD group, only bacteria were detected in 8 (19.1%) cases, and bacteria associated with Giardia lamblia in 1 (2.4%) case. Altogether, there were 105 bacteria isolated in the AD group: 90 were Escherichia coli (EPEC 27, DAEC 24, ETEC 21, EAEC 18), 12 were Shigella sp, 2 were Salmonella sp, and one was Yersinia sp. Children with mixed infections (viral and bacterial) had increased incidence of severe vomiting, dehydration and hospitalization. CONCLUSIONS: Bacteria were the most frequent pathogens detected in acute diarrhea cases, among which Escherichia coli was highly predominant. The majority of Escherichia coli strains belong to non-EPEC varieties, strains that are not routinely evaluated in clinical laboratories of pathology. Rotavirus was found in a great number of diarrhea cases, often associated with bacteria. Protozoa showed reduced importance.     

Evaluation of the Malnourished Children's Recuperation Program in the town of Embu, located in the Metropolitan Area of São Paulo

The objective of this study is to assess the anthropometric evolution of children who had been assisted by the Malnourished Children's Recuperation Program in the town of Embu, as well as to analyze some variables that interfered in this evaluation. The study included 233 children aged under five, enrolled in the program from January 1984 to December 1985. 201 (86,3%) were undernourished grade II and 32 (13,7%) grade III, according to Gomez. The percentage increase of Weight in relation to Age (W/A) and Height in relation to Age (H/A) - outcome variables, in the first and last examinations in the program - were analyzed, using the multiple linear regression. Younger children and in worse nutritional conditions showed higher W/A and H/A increases. Low birth weight, more frequent examinations, and longer stay in the program were associated to lower W/A increases. The presence of chronical pathologies jeopardized the H/A rate increases. This result strengthens the importance of developing programs for the assistance of undernourished children, due to higher risk of morbi-mortality in this group, mainly in younger children and with worse nutritional conditions.     

Diagnosis and prognosis of wheezing disorders in young children in the city of São Paulo, Southeast Brazil

Three‐hundred‐and‐ninety‐seven children aged 2–59 mo presenting to the paediatric emergency departments of five public hospitals in São Paulo, Brazil, with an acute episode of lower respiratory disease were examined. The children were classified into the following diagnostic categories: acute bronchitis, acute bronchiolitis, pneumonia, asthma, post‐bronchiolitis wheezing and wheezing of uncertain aetiology. Three years after the initial study, the homes of the children diagnosed as asthmatic or as having wheezing of uncertain aetiology were visited to collect information on subsequent episodes of lower respiratory disease. This paper reports the proportional incidence of different categories of lower respiratory disease and the results of an analysis to investigate clinical features that might distinguish wheezing children between those with asthma and those with an infectious disease. The predictions made for children with wheezing of uncertain aetiology were then compared with the follow‐up data. Recurrent wheezing disorders (asthma, post‐bronchiolitis wheezing) were common in the study sample (47% of children). Thirty‐six percent of children with an initial diagnosis of wheezing of uncertain aetiology were diagnosed as asthmatic by another doctor over the next 3 y. We were unable to identify any clinical features that were useful in identifying those children likely to be diagnosed subsequently as asthmatic. Conclusions: The use of a diagnostic category similar to that which we have called “wheezing of uncertain aetiology” might help to alert physicians early to the possibility of asthma without interfering in the management of the illness. Such a classification might also be useful in epidemiological investigations of the aetiology of lower respiratory diseases.     

Congenital and neonatal measles during an epidemic in São Paulo, Brazil in 1997

During a measles outbreak, 2 mothers with measles gave birth at University Hospital in S?o Paulo City, Brazil. Blood, saliva and urine were collected from the mothers and newborns. Measles virus genome and IgM antibodies against measles were detected. In 1 infant, measles virus genome persisted in peripheral blood mononuclear cells for 157 days after birth.     

Perinatal factors related to the morbidity and mortality of newborns in nine neonatal care units in the city of São Paulo

This study was carried out in nine hospitals in the city of S?o Paulo, in 1991 (between July 1 and November 30), when 10,235 live children were born. The aim of this study was to analyze the characteristics of the 1975 pathologic newborn (PNB) who were put into those neonatal care units (NCU) of the hospitals; besides that, the most common morbidity conditions, breast feeding prevalent and therapies were studied. It was calculated the odds ratio, its confidence interval and the c(2) test in order to evaluate the association between the variables and the death of the PNB. The results have demonstrated that the low weight PNB lethality (especially those with weight <1500 g) was higher than those PNB whose weight was > or = 2500 g. The lethality for both premature PNB and small for gestational age PNB was higher than the other categories of babies. The PNB with hypoxia until the 5th minute had the worst prognostic: their lethality was 10 times higher than the other category. The PNB who had Apgar < or =7 until the 5th minute had twice as much lethality when compared with PNB who had Apgar < or =7 just until the 1st minute. Conventional therapies have been used and only 25.4% have received breast feeding. Several risk factors (maternal, delivery, newborn) were associated with the PNB mortality, as well as most of the morbidity conditions. Those factors reflect the perinatal assistance in our environment.     

Urinary stone disease in the first year of life: is it dangerous?

Purpose

We have evaluated the clinical, radiological and metabolic features of infantile urolithiasis (UL).

Materials and methods

We have reviewed the medical records of 93 children who were diagnosed as having UL before 1 year of age. We recorded patient demographics, the age at diagnosis, presenting symptoms, family history, the localizations and dimensions of stones, urinary metabolic examinations, as well as physical, laboratory, and radiologic findings. Our secondary objective was to compare some features of this group with those of older children with UL followed-up in the same clinic which were previously reported.

Results

We evaluated 93 children referred to our pediatric nephrology clinics. A family history of UL was 56.2 % in the study group. Resolution of stones was observed in 30.1 % of the cases. Urinary tract infections (UTIs) were detected in 65.9 % of females and 46.2 % of males. At least one urinary metabolic abnormality was found in 79.5 % of all the children. Most commonly seen metabolic abnormality was hypercalciuria. In all patients stones were located in kidneys except one infant who had an ureteral stone together with a kidney stone. Fifteen (16.1 %) children had an accompanying systemic disorder.

Conclusions

Among pediatric urinary stone diseases infantile UL can be regarded as a separate clinical entity. Coexistence of systemic disorders and anatomic anomalies at high frequencies may indicate a role of distinct pathogenetic mechanisms. In addition, high rates of UTIs and metabolic abnormalities in this age group justify screening for these parameters during follow-up of these children.     

Sonographic assessment of renal length in the first year of life: the problem of “spurious nephromegaly”

Purpose. Interest in the potential diagnostic or prognostic implications of nephromegaly as evidence for compensatory renal hypertrophy has recently been emphasized in a variety of clinical settings. This project was designed to compare the results of linear and nonlinear sonographic models in the interpretation of renal size and growth during the first year of life.¶Materials and methods. We identified all renal and abdominal ultrasound examinations that were performed between March 1994 and October 1997 in full-term infants under age 1 year during which (1) both renal lengths were measured and (2) both kidneys appeared anatomically normal. Using three different computerized algorithms based on published standards for sonographic renal length in relation to age, we calculated z-scores for the renal lengths and compared the results of the three methods: in method A the standards at birth, 1 week, 4 months, 8 months, and 1 year were all used; in method B the 1-week standard was omitted; in method C the standards at 1 week, 4 months, and 8 months were omitted.¶Results. We evaluated 1,234 renal measurements in 617 patients (293 boys, 324 girls; mean age 0.24 year). Compared with method A, z-scores were significantly increased when either method B or C was used (P < 0.0001). The mean increment in z-score was + 0.433 for method B and + 1.135 for method C. The prevalence of “nephromegaly” (z > + 2) was significantly increased when subannual standards were omitted (P < 0.0001): using method A, 20 (1.6 %) kidneys were large for age compared with 74 (6.0 %) using method B, and 214 (17.3 %) using method C. All kidneys that were large for age based on method A were also large for age using both methods B and C. The rate of false-positive diagnosis of nephromegaly was 73 % (54/74 kidneys) with method B and 91 % (194/214 kidneys) with method C.¶Conclusions. Although the use of multiple subannual standards for renal length in infants less than 1 year of age is time consuming and mathematically more complicated, omission of these standards results in a statistically significant increase in the frequency of “spurious” nephromegaly.¶Learning objectives. Precise application of published standards is important in the interpretation of sonographic measurements of renal length. Omission of the subannual standards for renal length in children who are less than 1 year of age can result in an incorrect impression of nephromegaly.     

Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in São Paulo, Brazil

BACKGROUND: To compare bone mineral density (BMD) in children and adolescents with celiac disease (CD) and control subjects and to evaluate diet adequacy and calcium metabolism in patients with CD. METHODS: Thirty patients with asymptomatic CD (17 children, 13 adolescents), on a gluten-free diet, and 23 healthy subjects were studied. BMD of the lumbar spine (dual energy x-ray absorptiometry) was performed on all patients and control subjects. In patients, food diaries for nine nonconsecutive days were obtained and analyzed. In patients, laboratory tests pertaining to calcium balance were obtained. RESULTS: The mean weight and height of the adolescents with CD were lower than those of control subjects (weight: 45.8 +/- 10.5 kg v 55.3 +/- 10.5 kg, P = 0.037; height: 153.0 +/- 11.0 cm v 167 +/- 12.0 cm, P = 0.007). The mean BMD in adolescents with CD was significantly lower than that of the control subjects (0.917 +/- 0.116 g/cm2 v 1.060 +/- 0.158 g/cm2, P = 0.015), whereas no significant difference was found between children with CD and control subjects (P = 0.595). A multiple-regression model shows that increases in BMD relative to height were lower in adolescents with CD than in control subjects. The proportion of adolescents who had started a gluten-free diet after 2 years of age was higher than that of children with CD (P < 0.001). High percentages of magnesium, calcium, and phosphorous deficiencies were present in CD patients' diets. The serum levels of ionized and total calcium and parathormone were normal. CONCLUSIONS: The BMD of adolescents with CD was lower than that of the control subjects, whereas no difference was found between the BMD of children with CD and that of control subjects.     

Growth analysis of 566 children from the fourteen day care centers of Paulínia (São Paulo, Brazil), with ages ranging from 3 months to 3 years

To study the growth of 566 children (273 males and 293 females) from fourteen day care centers of Paulínia (S?o Paulo, Brazil), with ages ranging from 3 months to 3 years, admitted from March 1st to May 31st, 1993, the authors analyzed the z-score distribution of height for age and weight for height in relation to age group, per capita family income, social class levels, mothers education level and child birth weight. The Kruskal-Wallis test and the Multiple Comparison test were used in the statistical analysis. The children with less than 24 months or with birth weight less than 3000 g as the children with mothers education level less than four years, presented left deviated distribution in the height for age z-score. The weight for height score was less satisfactory in the group with per capita income less than one salary, in the group with birth weight less than 3000 g, and in the group with ages superior to 18 months.Therefore, institutional actions concerning the children and their parents are recommended in order to attenuate these factors.     

What is the role of the prevention of allergy in the first period of life?

The widespread increase in the prevalence of allergic disease, which has occurred over the last 20 y, has created general concern in Europe and in the rest of the world. The reason for this increase is still partially unknown. In this period, despite a greater understanding of the pathogenesis and risk factors of allergies plus the greater efficacy of drugs to control the symptoms, the cost of intervention and the socio-economic impact are still very high. For these reasons, prevention in the first period of life represents a goal for both developed and developing countries in order to reduce this upward trend.