EVENTOS NACIONAIS

18- 20/03/04
Simpósio Internacional de Reanimação Neonatal
Local: Belo Horizonte – MG
Sociedade Mineira de Pediatria
Fone (031) 3224-0857 – smp@smp.org.br

19- 20/03/04
V Congresso Brasileiro de Otorrinolaringologia Pediátrica
Local: Belo Horizonte – MG
Contato: Malu Losso Relações Públicas e Eventos S/C. Ltda
Fone (11) 3865-5354 / Fax 3864-4673 / mlosso@uol.com.br

15-17/04/04
Congresso Brasileiro de Ensino e Pesquisa em Saúde da Criança e do Adolescente
Realização SBP
Local: São Paulo – SP

21- 24/04/04
V Congresso Brasileiro Integrado de Pediatria Ambulatorial, Saúde Escolar e Cuidados Primários
Local:Aracaju - SE
Sociedade Sergipana de Pediatria
sosepe@infonet.com.br

28/4/04
X Congresso Brasileiro de Pneumologia Pediátrica
Data: 28/4/2004 a 2/5/2004 Cidade: Rio de Janeiro - RJ
Telefone: (21) 2548-1999 / Patrocínio: Sociedade Brasileira de Pediatria
E-mail: clemax@vetor.com.br Site: www.sbp.com.br

11-15/05/04
IX Congresso Brasileiro de Adolescência, IV Congresso da ASBRA e X Fórum Paraibano de Adolescência
Data: 11/5/2004 a 15/5/2004 Cidade: João Pessoa - PB Telefone: (83) 225 3811 / Patrocínio: Sociedade Brasileira de Pediatria E-mail: faeventos@jpa.neoline.com.br

EVENTOS INTERNACIONAIS

SOCIETY FOR PEDIATRIC RADIOLOGY (SPR) 2004 ANNUAL MEETING
Data: 27/04 a 02/05/04
Local: Savannah, GA, United States
http://www.docguide.com/

2004 ANNUAL MEETING OF THE PEDIATRIC ACADEMIC SOCIETIES
Data: 01-04/05/04
Local: San Francisco, CA, United States
http://www.docguide.com/

2004 ANNUAL MEETING OF THE PEDIATRIC ACADEMIC SOCIETIES
Data: 01-04/05/04
Local: San Francisco, CA, United States
http://www.docguide.com/

22 ANNUAL MEETING OF THE EUROPEAN SOCIETY FOR PEDIATRIC INFECTIOUS DISEASES - ESPID
Data: 26-28/05/04
Local: Tampere, Finland
http://www.docguide.com/

Nome Evento: XXIV Congresso Internacional de Pediatria
Data: 15/8/2004 a 20/8/2004 Cidade: Cancun - México - Exterior Telefone: 52 55 5449 1500 / 52 55 5449 155 Patrocínio: Sociedade Brasileira de Pediatria
E-mail: info@icp2004.com
Site: www.ic2004.com

Poluição do ar e recém-nascidos
Grávidas de cidades muito poluídas teriam mais chance de dar à luz bebês com menos peso que as demais gestantes

Gestantes que moram em cidades com altos índices de poluição correm o risco de dar à luz crianças com baixo peso. Um estudo realizado em São Paulo pelo Departamento de Medicina Preventiva da Universidade de São Paulo revelou que as mães expostas a taxas maiores de poluentes durante o primeiro trimestre de gravidez tiveram bebês com peso menor do que o restante das gestantes. O trabalho foi publicado em janeiro no Journal of Epidemiology & Community Health.

A pesquisa foi feita com mães que moram na capital paulista e tiveram filhos em 1997. O estudo enfocou 179 mil recém-nascidos, excluídos bebês prematuros, gêmeos e crianças com muito pouco peso ou excesso de peso.

O epidemiologista Nelson Gouveia, um dos condutores da pesquisa, acredita que a variação de peso esteja associada à baixa oxigenação sangüínea provocada pelos poluentes. Estudos anteriores já demonstraram relação entre poluição, prematuridade, anomalias congênitas e mortalidade fetal.

ANALES DE PEDIATRIA 1 Febrero 2004. Volumen 60 - Número 02

Morbilidad respiratoria tras el alta hositalaria en prematuros (= 32 semanas) con displasia broncopulmonar

G Pérez Péreza M Navarro Merinoa MªM Romero Péreza C Sáenz Reguerab A Pons Tubíoc J Polo Padillod

Antecedentes: La displasia broncopulmonar es la causa más frecuente de morbilidad respiratoria en los primeros 2 años en el niño pretérmino que sobrevive a los 28 días de vida.
Objetivos: Valorar la morbilidad respiratoria durante los primeros 2 años de vida en un grupo de niños pretérmino (= 32 semanas) con displasia broncopulmonar (necesidad de oxígeno a las 36 semanas de edad posconcepcional), comparándola con la de niños pretérmino (= 32 semanas) sin displasia broncopulmonar y con un grupo control de nacidos a término sin enfermedad neonatal. Comprobar si la morbilidad respiratoria en los niños con displasia broncopulmonar disminuye a partir de los 2 años de edad.
Pacientes y método: Grupo I: niños pretérmino con displasia broncopulmonar (n 5 29). Grupo II: niños pretérmino sin displasia broncopulmonar (n 5 29). Grupo III: niños de peso y edad gestacional adecuados (n 5 32). En los 3 grupos se realizó estudio longitudinal descriptivo durante 2 años, y en 17 niños del grupo I se realizó el mismo estudio hasta la edad de 4 años. Se analizaron las siguientes variables: sibilancias en al menos dos ocasiones, empleo de broncodilatadores inhalados, utilización de glucocorticoides inhalados durante más de 6 meses, ingresos hospitalarios por problemas respiratorios mediante test de chi cuadrado (x2) y test de Fischer.
Resultados: Tuvieron algún episodio de sibilancias 25 niños del grupo I (86,2 %) frente a 12 (41,4 %) del grupo II y 6 (18,8 %) del grupo III. Fueron tratados con glucocorticoides inhalados durante más de 6 meses, 19 niños del primer grupo (65,5 %) y ninguno de los otros 2 grupos (p < 0,001). Utilizaron broncodilatadores inhalados 25 niños del grupo I (86,2 %) frente a 12 (41,4 %) del grupo II y 6 (18,8 %) del grupo control (p < 0,001). Fueron hospitalizados por problemas respiratorios 12 niños del grupo I (41,3 %) frente a 8 (27,6 %) del grupo II, sin que ingresara ninguno del grupo control. De los niños con displasia broncopulmonar que recibieron profilaxis con palivizumab ninguno tuvo infección demostrada por virus respiratorio sincitial (VRS).
Se evaluaron hasta los 4 años de edad 17 niños con displasia broncopulmonar. Los episodios de sibilancias disminuyeron del 88,2 % en el primer año al 41 % entre el tercer y cuarto años (p < 0,001). Recibieron tratamiento con glucocorticoides inhalados durante más de 6 meses el 88,2 % en el primer año, el 41,2 % entre el primer y segundo años y ninguno a partir del segundo año (p < 0,001). Los ingresos hospitalarios por problemas respiratorios descendieron del 52,9 % en el primer año al 17,6 % en el segundo, y ningún niño necesitó ingreso a partir de los 2 años (p < 0,001).
Conclusiones: Durante los primeros 2 años, los niños con displasia broncopulmonar tienen mayor número de ingresos, más episodios de sibilancias y más necesidad de tratamiento médico; mejoran con la edad, aunque a los 4 años el 40 % tienen episodios repetidos de sibilancias.

Incidencia, contaminación ambiental y factores de riesgo de otitis media aguda en el primer año de vida: estudio prospectivo

MªJ Cáceres Udinaa JA Álvarez Martínezb J Argente del Castilloc MªA Chumilla Valderasd E Fernández Álvareze A Garrido Romeraf F Sánchez Gascóng L García-Marcosh

Antecedentes: Los estudios epidemiológicos sobre la otitis media aguda (OMA) son muy escasos y en España no existe ninguno de tipo prospectivo.
Objetivos: Describir la incidencia de la OMA durante el primer año de vida y sus factores de riesgo, con especial atención a la contaminación ambiental.
Métodos: Estudio de una cohorte prospectiva de 229 recién nacidos durante el primer año de vida estratificados por zonas de contaminación, seguidos por sus pediatras en el centro de salud. La OMA de definió clínicamente. Se aplicó un cuestionario con los factores de riesgo/protectores, incluyendo sexo, hermanos mayores, hábito de fumar, lactancia materna, nivel socioeconómico, nivel de estudios y situación laboral de la madre.
Resultados: La incidencia de episodios de OMA durante el primer año fue del 45 % y la proporción de niños con al menos un episodio fue del 32 %. Los factores de riesgo independientes fueron el sexo varón (odds ratio ajustada [ORa], 2,03; intervalo de confianza del 95 % [IC 95 %], 1,09-3,7) y vivir en una zona contaminada (ORa, 2,01; IC 95 %, 1,05-3,84). Fueron factores protectores independientes nacer en primavera (ORa, 0,41; IC 95 %, 0,19-0,88) y que la madre tuviera al menos estudios primarios (ORa, 0,53; IC 95 %, 0,24-1,15). Los marcadores socioeconómicos indicaron un menor nivel medio entre las familias cuyos niños tuvieron al menos un episodio de OMA.
Conclusiones: La contaminación ambiental y el bajo nivel socioeconómico son factores de riesgo de OMA mayores que tener hermanos o que los padres fumen. Un nivel cultural mínimo reduce el riesgo de OMA. Es posible disminuir en parte la incidencia de OMA actuando sobre algunos factores ambientales.

ARTÍCULO ESPECIAL

Litiasis biliar en la infancia: actitudes terapéuticas

H Escobar Castroa MªD García Novob P Olivaresc

Hasta hace pocos años, la litiasis biliar en la infancia se consideraba una enfermedad infrecuente. Según su composición, los cálculos biliares se clasifican en cálculos de colesterol y cálculos de pigmento. Los cálculos de pigmento están formados mayoritariamente por sales cálcicas de bilirrubina no conjugada y se subdividen en negros duros y marrones blandos. En los niños, el 75 % de los cálculos son de pigmento. Con frecuencia, los cálculos en los niños no tienen una causa conocida. La litiasis biliar en el niño presenta peculiaridades diferentes de la del adulto y existe poca literatura médica sobre los procedimientos terapéuticos más idóneos. Los cálculos asintomáticos tienen una evolución benigna y no precisan tratamiento médico ni quirúrgico. Las manifestaciones clínicas de la litiasis suelen ser poco específicas, incluyen molestias como dispepsias o dolores abdominales crónicos por los que los niños son estudiados ecográficamente, encontrándose los cálculos en la vesícula biliar. El tratamiento definitivo de la litiasis es la colecistectomía, pero esto no significa que siempre haya que optar por un tratamiento quirúrgico definitivo. El tratamiento médico con ácido ursodesoxicólico (AUDC) está indicado en las litiasis asintomáticas y oligosintomáticas con cálculos transparentes, blandos, ricos en colesterol y vesícula funcionante y en los casos con alto riesgo quirúrgico.

ARCHIVES OF PEDIATRICS AND ADOLESCENT MEDICINE VOL. 158 Nº 2 FEV2004

A Randomized Trial of Nebulized Epinephrine vs Albuterol in the Emergency Department Treatment of Bronchiolitis
Colette C. Mull, MD; Richard J. Scarfone, MD; Lara R. Ferri, MD; Teresa Carlin, MD; Christy Salvaggio, MD; Kirsten A. Bechtel, MD; Mary Ann Hanes Trephan, MD; Raquel L. Rissman, MD; Edward J. Gracely, PhD
Arch Pediatr Adolesc Med. 2004;158:113-118.
Objective To determine if nebulized epinephrine is more efficacious than nebulized albuterol in the emergency department (ED) treatment of moderately ill infants with bronchiolitis.
Methods Sixty-six patients between 0 and 12 months of age with new-onset wheezing, an antecedent upper respiratory tract infection, and a clinical score (Respiratory Distress Assessment Instrument) of 8 to 15 were randomized in a double-blind fashion to receive either 0.9 mg/kg of nebulized 2.25% racemic epinephrine (n = 34) or 0.15 mg/kg of nebulized 0.5% albuterol sulfate (n = 32) at 0, 30, and 60 minutes.
Main Outcome Measures Primary outcome measures were clinical score and respiratory rate. Secondary outcome measures were room air oxygen saturation, elapsed time to meeting clinical criteria for ED discharge, hospitalization rate, and proportion of patients relapsed within 72 hours of ED discharge (relapse rate).
Results Both treatment groups experienced a similar pattern of change in mean clinical score, respiratory rate, and room air saturation over time. There were no significant differences between the groups by these same measures at any time. The median time at which infants were well enough for ED discharge was 90 minutes in the epinephrine-treated group vs 120 minutes in the albuterol-treated group (P = .01). Sixteen infants (47.1%) in the epinephrine-treated group were hospitalized compared with 12 infants (37.5%) in the albuterol-treated group (relative risk, 1.25; 95% confidence interval, 0.71-2.22). Relapse rate was 18.8% (3/16) in the epinephrine-treated group and 42.1% (8/19) in the albuterol-treated group (relative risk, 0.45; 95% confidence interval, 0.14-1.41). Adverse effects occurred infrequently.
Conclusions Although the patients treated with epinephrine were judged well enough for ED discharge significantly earlier than the patients treated with albuterol, epinephrine was not found to be more efficacious than albuterol in treating moderately ill infants with bronchiolitis.

Diagnosis and Testing in Bronchiolitis
A Systematic Review
W. Clayton Bordley, MD, MPH; Meera Viswanathan, PhD; Valerie J. King, MD, MPH; Sonya F. Sutton, BSPH; Anne M. Jackman, MSW; Laura Sterling, MD, MPH; Kathleen N. Lohr, PhD
Arch Pediatr Adolesc Med. 2004;158:119-126.
Background The diagnosis of bronchiolitis is based on typical history and results of a physical examination. The indications for and utility of diagnostic and supportive laboratory testing (eg, chest x-ray films, complete blood cell counts, and respiratory syncytial virus testing) are unclear.
Objectives To review systematically the data on diagnostic and supportive testing in the management of bronchiolitis and to assess the utility of such testing.
Design In conjunction with an expert panel, we generated admissibility criteria and derived relevant terms to search the literature published from 1980 to November 2002 in MEDLINE and the Cochrane Collaboration Database of Controlled Clinical Trials. Trained abstractors completed detailed data collection forms for each article. We summarized the data in tables after performing data integrity checks.
Results Of the 797 abstracts identified, we present evidence from 82 trials that met our inclusion criteria (17 are primary articles on diagnosis of bronchiolitis and 65are reports of treatment or prevention trials). Numerous studies demonstrate that rapid respiratory syncytial virus tests have acceptable sensitivity and specificity, but no data show that respiratory syncytial virus testing affects clinical outcomes in typical cases of the disease. Seventeen studies presented chest x-ray film data. Abnormalities on chest x-ray films ranged from 20% to 96%. Insufficient data exist to show that chest x-ray films reliably distinguish between viral and bacterial disease or predict severity of disease. Ten studies included complete blood cell counts, but most did not present specific results. In one study, white blood cell counts correlated with radiologically defined disease categories of bronchiolitis.
Conclusions A large number of studies include diagnostic and supportive testing data. However, these studies do not define clear indications for such testing or the impact of testing on relevant patient outcomes. Given the high prevalence of this disease, prospective studies of the utility of such testing are needed and feasible.

BRITISH MEDICAL JOURNAL 7 February 2004 (Vol 328, No 7435)

NOTÍCIAS

Occult coeliac disease can be detected in childhood
At age 7 years, 1% of children may have subclinical coeliac disease, but few have a gluten-free diet. In two-stage screening of 5470 children participating in the Avon longitudinal study of parents and children, Bingley and colleagues (p 322) tested for antibodies to tissue transglutaminase and then IgA antiendomysial. The 54 children who tested positive for the second enzyme were shorter and weighed less than age and geographically matched controls who had tested negative in the first stage; half had diarrhoea, and more were girls. Less than 10% of children with suspected coeliac disease were receiving a gluten-free diet. The benefit of early diagnosis of subclinical coeliac disease remains unproved, but the disease can be diagnosed in childhood.

Poliovirus spreads beyond Nigeria after vaccine uptake drops
London Stephen Pincock
The poliovirus circulating in northern Nigeria has now infected people in seven neighbouring countries that were previously free of the disease, prompting grave concern among international health agencies.
The World Health Organization and its partners in the Global Polio Eradication Initiative have set themselves the target of halting transmission of the disease worldwide by next year. After a 15 year effort, there remain six countries where polio is still endemic—Nigeria, India, Pakistan, Niger, Afghanistan, and Egypt.
Almost all cases are now restricted to hotspots in Pakistan, India, and Nigeria, and most concern is focused on the populous African nation because immunisation campaigns there have been suspended since August last year.
The suspension was imposed in the northern state of Kano after rumours began to spread suggesting that the vaccine caused infertility or transmitted HIV. The result was an increase in the number of new cases in Nigeria, and the appearance of cases with the virus linked to Nigerian strains in Benin (1 case), Burkina Faso (7), Cameroon (1), Chad (5), Ghana (8), and Togo (1).

ARTIGO

Editor's choice

The sudden death of a child

" The sudden unexpected death of an infant or child is one of the worst events to happen to any family." This is the opening line of a review by authors from Bristol of how best to investigate such deaths and care for bereaved families (p 331). Such a death presents great difficulties to doctors, social workers, and the police, and the difficulties have been increased by the publicity surrounding wrongful conviction of parents of murder. Every primary care trust is supposed to have a "designated doctor" to serve on child protection teams, but a third of these posts are unfilled (p 307).
The management of sudden deaths of infants would be extremely testing even if the doctors could be confident that they were all due to natural causes. But they can't be. A study of 456 deaths and 1800 age matched surviving controls showed that 21 deaths (nearly 5%) were directly due to non-accidental injury. In another 22 deaths maltreatment—through either commission or omission—was thought to have contributed. How can investigators distinguish the 10% of cases where abuse may be a factor from the 90% where it is not?
The first aim of the investigators, writes the Bristol team, must be to recognise the needs of the family, including the need for information. Next they must identify any underlying medical cause that might have genetic or public health implications. There must also be a thorough investigation to exclude unnatural causes of death. Other children must be protected. But families must also be protected from false or inappropriate accusations.
Success in these investigations depends on doctors, social workers, and police working closely together. The Bristol team has systematically reviewed the evidence in order to devise an optimum protocol for investigation. The first step is for all the investigators to meet together as soon as possible after the death to plan the investigation. The paediatrician and police officer then usually see the family together in the emergency department. Next they make a joint home visit with the family doctor or health visitor. A full history is needed together with a careful review of the circumstances and scene of the death.
A careful postmortem is essential, and this has been made more difficult by public reaction to previous practices of tissue or organ retention. An evidence based protocol has now been devised which combines a minimum number of tissue samples with radiological, microbiological, and biochemical investigations. If major concerns are raised about child protection then police or social workers take the lead, but the doctors stay involved.
Two to three months after the death all the professionals meet and reach conclusions. The family is give a written explanation in plain English of the cause of death and the results of pathology investigations—and a chance to discuss the findings.
This is enormously important work, and it's in the interest of everybody that there are good people to do it and that it's done optimally.
Richard Smith, editor

Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families: an integrated multiagency approach
ARTIGO DISPONÍVEL NA ÍNTEGRA NO www.bmj.bmjournals.com
Peter J Fleming, professor of infant health and developmental physiology1, Peter S Blair, edical statistician1, Peter D Sidebotham, consultant paediatrician2, Tracy Hayler, detective superintendent3

BIOMEDCENTRALPEDIATRICS.COM FEV 2004

Benign afebrile cluster convulsions with gastroenteritis: an observational cohort study
Hassib Narchi mailto:hassibnarchi@hotmail.com mailto:hassibnarchi@hotmail.com
BMC Pediatrics 2004, 4:2 (published 5 February 2004)

Abstract (provisional)
Backround The occurrence of afebrile seizures in association with viral gastroenteritis, without dehydration or electrolyte imbalance, is virtually unknown outside Asia. They are reported to have a benign prognosis and not to require specific investigations or therapy.
Methods
We report the occurrence of such afebrile convulsions in association with viral gastroenteritis without dehydration or electrolyte imbalance, over a 3-year period, in a cohort of 14 British children.
Results
The children (5 males and 9 females, 10 Caucasians and 4 Asians) were aged 9 to 60 months (median 14.5 months). All 14 had a normal neurological examination and normal serum biochemistry. Twelve children had generalised seizures and 2 had, in addition, absence seizures. The number of seizures per child ranged from 1 to 8. Most convulsions were short with 85.7% of children having the longest seizure not longer than 4 minutes. The longest duration for a seizure was 10 minutes and occurred in 2 children. Convulsions did not recur after the first day in 10 children, 3 children had recurrences the second day and one child on the fourth day. No convulsions recurred after 4 days. Cerebrospinal fluid studies, computed tomography and electroencephalogram (EEG) were performed on two children who had prolonged seizures and the results were normal. No pathogenic bacteria were grown in any of the stools. Enzyme immunoassay detection of Rotavirus in the stools was positive in 7 of the 10 children where it was tested. All 14 children recovered spontaneously within a few days. On long-term follow of up to 31 months (median 16 months), none had further convulsions and all had normal development milestones.
Conclusions
Afebrile seizures in association with viral gastroenteritis do also occur outside Asia. Recognition of this entity should lead to reassurance of the parents. As in previously published series, investigations such as lumbar puncture, neuroimaging and EEG are usually normal and may not be necessary in most cases. Likewise, published data indicate that long-term anticonvulsant therapy is not usually warranted and the prognosis seems to be reassuring.

CONTEMPORARY PEDIATRICS Jan/2004
ARTIGOS DISPONÍVEIS NA ÍNTEGRA NO www.cp.pdr.net
Varicoceles in adolescents: When to observe, when to intervene
Some varicoceles that appear during adolescence impair fertility later on; most do not. How do you decide which ones to refer for treatment? And what treatments are most effective?

How an assistance dog can enhance the life of a child with a disability
The role of dogs in the care of children is surprisingly broader today than just the familiar guide animals for the blind. Do you have a patient whose autism or ADHD or other disability might benefit from "paws-on" attention?

Getting into adolescent heads: An essential update
For today’s teenagers, a psychosocial review of systems is at least as important as the physical exam. The popular and effective HEADSS method of interviewing has been expanded.

JOURNAL OF TROPICAL PEDIATRICS Volume 50, Issue 1, February 2004

Early-onset Bacterial Infection in Brazilian Neonates with Respiratory Distress: A Hospital-based Study
Marisa M. Mussi-Pinhata1, Rivianny A. Nobre1, Francisco Eulógio Martinez1, Salim Moyses Jorge1, Maria Lúcia Silveira Ferlin1 and Arthur Lopes Gonçalves1
1Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

We investigated infants with respiratory distress within 4 days of birth whose mothers had not received antibiotic prophylaxis to evaluate the frequency and etiology of bacterial infection and associated risk factors. The study was conducted on 261 infants suffering respiratory distress admitted to a Brazilian neonatal intensive care unit, 94 per cent of whom were born prematurely. Gestational and delivery history; bacteriological cultures of blood, cerebrospinal fluid, tracheal aspirates and urine; complete and differential blood counts; a urinary group B streptococcal latex antigen test; and a chest radiograph were analysed. Indications of infection were found in 38.7 per cent and confirmed in 11.9 per cent of the neonates. Gram-positive (70.9 per cent) and Gram-negative bacteria (29.1 per cent) were found in 31 cases of confirmed early bacteremia. Group B Streptococcus was the predominant causative agent (19.4 per cent) in infants exhibiting confirmed infection. Culture-proven infection was more frequent among infants delivered vaginally (adjusted OR = 2.53, p = 0.05) or born to mothers with signs of intra-amniotic infection (adjusted OR = 2.83, p = 0.04). Preventive measures against early bacterial infection in preterm infants from this population are strongly warranted.

Congenital Toxoplasmosis in Uberlândia, MG, Brazil
Gesmar Rodrigues Silva Segundo1, Deise Aparecida Oliveira Silva1, José Roberto Mineo1 and Marcelo Simão Ferreira2
1Laboratório de Imunologia, Instituto de Ciências Biomédicas, Brazil
2Serviço de Moléstias Infecciosas, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil

Almost all babies suffering from congenital toxoplasmosis, if undiagnosed and untreated, will develop visual or neurological impairments by adulthood. The aim of this study was to investigate the occurrence of congenital toxoplasmosis in two hospitals from Uberlândia, Brazil. A total of 805 serum samples of cord blood were collected, 500 from public hospital and 305 from private hospital, and all patients answered a questionnaire about pregnancy and newborns. ELISA was accomplished to detect IgG antibodies to Toxoplasma gondii and positive sera were re-tested to verify specific IgM and IgA antibodies in a capture ELISA. Seroprevalence of IgG antibodies against T. gondii was 51.6 per cent in the hospitals, while the frequency of congenital toxoplasmosis was 0.5 per cent, with specific IgM and/or IgA antibodies. The main clinical alteration was chorioretinitis (an inflammatory process of the retina and uveal tract). The high seroprevalence in this population and expressive rate of congenital disease show the requirement of screening programmes for toxoplasmosis during pregnancy.

JOURNAL OF CHILDREN´S MEMORIAL HOSPITAL

Clinical Management of Childhood Overweight:
Evaluation, Intervention and Prevention
Rebecca Unger, MD, Adolfo Ariza, MD, Linda Somers, RD, Wendy Brickman, MD, Timothy Sentongo, MD
Multidisciplinary authors provide practical approaches to confronting the epidemic of childhood overweight, in reference to a case seen at the Nutrition Evaluation Clinic at Children’s Memorial Hospital.

The number of overweight children and adolescents continues to rise, with alarming consequences. These children are at increased risk for overweight-related medical conditions and psychosocial difficulties. Particularly with the emergence of type 2 diabetes in the pediatric population, overweight can no longer be dismissed as purely an issue of appearance. Today, children tend to consume more junk food and sugary drinks, while spending more hours watching television and less time being active—a lifestyle that contributes to the development of overweight. Experts have found that parental role modeling of unhealthy eating habits and insufficient physical activity may strongly influence and perpetuate the behavioral patterns that lead to overweight and the associated medical problems.