Objective Opioids are essential for analgesia and sedation in pediatric inpatient care, particularly in perioperative and intensive care settings. However, their use requires careful monitoring because children, especially infants and critically ill patients, may be vulnerable to respiratory, cardiovascular, and neurological adverse effects. Methods This retrospective observational study evaluated opioid administration records and naloxone-identified suspected opioid-related adverse-event episodes at a tertiary pediatric hospital in Brazil from January 2019 to September 2024. Opioid administration records were identified from hospital pharmacy dispensing data. Medical records of patients with naloxone administration records were reviewed to classify naloxone indication, opioid involvement, clinical manifestations, hospital setting, underlying conditions, and short-term outcomes. Results During the study period, 154,867 opioid administration records were identified. A total of 284 naloxone administration records were screened. After medical record review, 171 naloxone administrations did not meet criteria for suspected opioid-related adverse-event episodes and were excluded from the main adverse-event analysis. The final naloxone-identified sample included 112 episodes. Events occurred predominantly in intensive care settings, especially the cardiac intensive care unit. The most frequently documented manifestations were bradycardia, oxygen desaturation, apnea, chest wall rigidity, drowsiness/somnolence, and worsened respiratory pattern. Most episodes improved after naloxone administration. Conclusion Naloxone-identified suspected opioid-related adverse-event episodes were uncommon relative to the total volume of opioid administration records and were concentrated in clinically complex pediatric inpatients. These findings support risk-stratified monitoring, standardized documentation of naloxone indications, and continued opioid stewardship in tertiary pediatric care.
Objective To identify the evidence and recommendations regarding pediatric eosinophilic esophagitis (EoE), including its diagnosis, treatment, and follow-up. Sources Narrative review based on a comprehensive and structured search of the MEDLINE (PubMed), EMBASE (Ovid), LILACS, and SciELO databases using the terms “diagnosis” OR “clinical manifestations” OR “treatment” OR “follow-up” AND “eosinophilic esophagitis” AND “children” through March 2026. Data obtained from the Brazilian Consensus (Brazilian Society of Pediatrics/Brazilian Association of Allergy and Immunology) were incorporated. Summary of the findings EoE is a chronic and emerging disease, and a significant cause of esophageal dysfunction. Early and accurate diagnosis is fundamental to avoid complications, such as fibrostenotic sequelae. Treatment can be performed with proton pump inhibitors, topical corticosteroids, and empirical diets, chosen according to clinical profile, adherence, and socioeconomic context. In refractory cases, dupilumab is an effective option. Allergy tests should not guide elimination diets. Endoscopic follow-up with biopsies is essential for evaluating response and maintenance, as the relapse rate is high, even in asymptomatic patients. Reassessment intervals should be individualized, but post-induction control between 8 and 12 weeks and periodic reviews during maintenance are recommended. Conclusions The dissociation between symptoms and histological inflammation represents one of the greatest clinical challenges, in addition to the heterogeneity of therapeutic response and limitations of long-term studies. Changes in follow-up and treatment algorithms are expected, especially with the inclusion of dupilumab. The Brazilian consensus represents an attempt to standardize diagnostic criteria, approach, and treatment.
Objective This analysis aimed to evaluate the association between dietary live microbial consumption and hypertension risk in children and adolescents. Methods This cross-sectional analysis comprised data on children and adolescents (aged 8–17 years) from the NHANES database 2009–2023. The association between dietary live microbial consumption and hypertension risk was analyzed using logistic regression analyses. The combined effect of dietary live microbial consumption and overweight/obesity on hypertension risk was examined using interaction analysis. Results Of these 9342 enrolled children and adolescents, 433 had hypertension, and 8909 did not. Individuals in the high-MedHi (foods containing medium and high live microbes) consumption group (vs. low-MedHi) [OR = 0.70 (0.50–0.98), P = 0.039] were associated with lower odds of hypertension, and this association persisted after further adjustment for overweight/obesity [OR = 0.71 (0.51–0.99), P = 0.046]. In the joint effect analysis of live microbial consumption (low, high) and overweight/obesity (no, yes), individuals in the high-MedHi and overweight/obesity group [OR = 0.60 (0.39–0.92)], the low-MedHi and non-overweight/obesity group [OR = 0.29 (0.20–0.42)], and the high-MedHi and non-overweight/obesity group [OR = 0.28 (0.16–0.49)] were linked to lower odds of hypertension versus the low-MedHi and overweight/obesity group, and there was a significant trend in these joint effect terms (Ptrend = 0.019). Conclusion High live microbial consumption was associated with reduced odds of hypertension among children and adolescents, and live microbial intake and overweight/obesity exerted a joint effect on the odds of hypertension.
Objective The objective was to evaluate the associations of environmental tobacco smoke exposure with acute bronchiolitis and its severity among hospitalized children. Methods This case-control study with prospective follow-up was conducted at a tertiary care hospital (February 2017-December 2021). Infants hospitalized for bronchiolitis were enrolled as cases, and hospitalized children < 2 years of age without respiratory disease were recruited as controls. Serum cotinine was measured in all participants. Demographic and clinical data and household smoking habits were collected through parental interviews. Logistic regression was used to assess the association between environmental tobacco smoke exposure and bronchiolitis. Additionally, whether serum cotinine concentration was associated with admission to the pediatric intensive care unit and length of hospital stay in infants with bronchiolitis was investigated. Results In total, 251 infants (151 cases, 100 controls) were included; 52.6% of participants were exposed to environmental tobacco smoke, with a higher prevalence among the bronchiolitis group (59.6%vs. 42%; p = 0.006). Multivariate analysis revealed that environmental tobacco smoke exposure (OR: 1.93; 95% CI: 1.04–3.56) and prenatal maternal smoking (OR: 3.49; 95% CI: 1.22–9.95) were independently associated with hospitalization for bronchiolitis. Among the cases, serum cotinine levels > 5 ng/mL predicted prolonged length of hospital stay (OR: 4.99; 95% CI: 1.70–15.7), whereas prenatal smoking increased the risk for pediatric intensive care unit admission (OR: 4.73; 95% CI: 1.68–13.3). Conclusions Pre- and postnatal environmental tobacco smoke exposure was associated with bronchiolitis and disease severity. Developing effective public health strategies to reduce such exposures among children is a priority.
