Os resultados laboratoriais que mostram inflamacao e lesao hepatica indiretamente suportam a possibilidade de transmissao vertical. Embora a infeccao no momento do parto nao possa ser descartada, os anticorpos IgM geralmente nao aparecem ate 3 a 7 dias apos a infeccao.

Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA, March (online).

Vitamin A deficiency affects an estimated 190 million preschool-aged children and 10 million pregnant women in low-income countries. Prevalent cases of xerophthalmia in young children are believed to number ~5 million. Of these, 10% can be considered potentially blinding, such that this ocular condition remains the leading cause of preventable pediatric blindness in the developing world. Although there has been a significant decrease in the prevalence of vitamin A deficiency during the past couple of decades, vitamin A deficiency remains an underlying cause of at least 157,000 early childhood deaths due to diarrhea, measles, malaria, and other infections each year. Vitamin A deficiency is also recognized as a problem that reflects chronic dietary deficiency that may extend from early childhood into adolescence and adulthood, especially for women of child-bearing age. This chapter describes the chemical structure of vitamin A and its precursors, dietary sources, absorption, metabolism and functions, followed by discussions on the epidemiology of vitamin A deficiency, and its role in morbidity and mortality. The chapter concludes with insights on its diagnosis, treatment, and approaches to prevention through dietary improvement, supplementation, fortification, and biofortification.

Vitamin A Deficiency

Background
In developing countries, diarrhoea causes around 500,000 child deaths annually. Zinc supplementation during acute diarrhoea is currently recommended by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

Objectives
To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea.

Search methods
We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (the Cochrane Library 2016, Issue 5), MEDLINE, Embase, LILACS, CINAHL, mRCT, and reference lists up to 30 September 2016. We also contacted researchers.

Selection criteria
Randomized controlled trials (RCTs) that compared oral zinc supplementation with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery.

Data collection and analysis
Both review authors assessed trial eligibility and risk of bias, extracted and analysed data, and drafted the review. The primary outcomes were diarrhoea duration and severity. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses (using either a fixed-effect or random-effects model) and assessed heterogeneity.

We assessed the certainty of the evidence using the GRADE approach.

Main results
Thirty-three trials that included 10,841 children met our inclusion criteria. Most included trials were conducted in Asian countries that were at high risk of zinc deficiency.

Acute diarrhoea

There is currently not enough evidence from well-conducted RCTs to be able to say whether zinc supplementation during acute diarrhoea reduces death or number of children hospitalized (very low certainty evidence).

In children older than six months of age, zinc supplementation may shorten the average duration of diarrhoea by around half a day (MD −11.46 hours, 95% CI −19.72 to −3.19; 2581 children, 9 trials, low certainty evidence), and probably reduces the number of children whose diarrhoea persists until day seven (RR 0.73, 95% CI 0.61 to 0.88; 3865 children, 6 trials, moderate certainty evidence). In children with signs of malnutrition the effect appears greater, reducing the duration of diarrhoea by around a day (MD −26.39 hours, 95% CI −36.54 to −16.23; 419 children, 5 trials, high certainty evidence).

Conversely, in children younger than six months of age, the available evidence suggests zinc supplementation may have no effect on the mean duration of diarrhoea (MD 5.23 hours, 95% CI −4.00 to 14.45; 1334 children, 2 trials, low certainty evidence), or the number of children who still have diarrhoea on day seven (RR 1.24, 95% CI 0.99 to 1.54; 1074 children, 1 trial, low certainty evidence).

None of the included trials reported serious adverse events. However, zinc supplementation increased the risk of vomiting in both age groups (children greater than six months of age: RR 1.57, 95% CI 1.32 to 1.86; 2605 children, 6 trials, moderate certainty evidence; children less than six months of age: RR 1.54, 95% CI 1.05 to 2.24; 1334 children, 2 trials, moderate certainty evidence).

Persistent diarrhoea

In children with persistent diarrhoea, zinc supplementation probably shortens the average duration of diarrhoea by around 16 hours (MD −15.84 hours, 95% CI −25.43 to −6.24; 529 children, 5 trials, moderate certainty evidence).

Authors' conclusions
In areas where the prevalence of zinc deficiency or the prevalence of malnutrition is high, zinc may be of benefit in children aged six months or more. The current evidence does not support the use of zinc supplementation in children less six months of age, in well-nourished children, and in settings where children are at low risk of zinc deficiency.

/pdf/oral-zinc-for-treating-diarrhoea-in-children-3e69ih05cd.pdf

Oral zinc for treating diarrhoea in children

Gastrointestinal symptoms associated with COVID-19: impact on the gut microbiome.

/pdf/sunlight-and-vitamin-d-a-global-perspective-for-health-1taw4ddymb.pdf

Sunlight and vitamin D; A global perspective for health.

Objective To identify factors that contribute to the increased susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences. Sources Studies published between 2000 and 2020 in the PubMed, MEDLINE, Scopus, SciELO, and Cochrane databases. Summary of findings Obesity is a highly prevalent comorbidity in severe cases of COVID-19 in children and adolescents; social isolation may lead to increase fat accumulation. Excessive adipose tissue, deficit in lean mass, insulin resistance, dyslipidemia, hypertension, high levels of proinflammatory cytokines, and low intake of essential nutrients are factors that compromise the functioning of organs and systems in obese individuals. These factors are associated with damage to immune, cardiovascular, respiratory, and urinary systems, along with modification of the intestinal microbiota (dysbiosis). In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response. Conclusions The need for social isolation can have the effect of causing or worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. Facing children with suspected or confirmed COVID-19, health professionals should 1) diagnose excess weight; 2) advise on health care in times of isolation; 3) screen for comorbidities, ensuring that treatment is not interrupted; 4) measure levels of immunonutrients; 5) guide the family in understanding the specifics of the situation; and 6) refer to units qualified to care for obese children and adolescents when necessary.

http://www.scielo.br/pdf/jped/v96n5/0021-7557-jped-96-05-0546.pdf

COVID-19 and obesity in childhood and adolescence: a clinical review.

This paper suggests a proposal of Child Health Care, to children and adolescents, to be developed in the Family Health Care Programs.

/pdf/o-programa-de-saude-da-familia-e-a-puericultura-y2nvnwf0cc.pdf

O Programa de Saúde da Família e a Puericultura

OBJETIVO: Estimar a carencia de ferro na populacao estudada e verificar se isso se associa a falta de vitamina A. METODOS: Foram estudadas 179 criancas com idade > 24 meses e < 72 meses, sem diarreia e/ou febre no momento da coleta. A identificacao da deficiencia de vitamina A foi realizada atraves do teste de resposta serica de 30 dias. Foram obtidas amostras de sangue periferico em jejum para dosagem dos niveis de hemoglobina, ferro serico e capacidade latente de fixacao de ferro, alem de informacao sobre a presenca de diarreia ou febre nos 15 dias precedentes a pesquisa. RESULTADOS: 35,8% (64/179) das criancas apresentaram carencia de ferro; 75,4% (135/179), deficiencia de vitamina A; e 29,1% (52/179) apresentaram carencia de ferro e deficiencia de vitamina A, concomitantemente. A carencia de ferro nao apresentou associacao com a deficiencia de vitamina A, nem tampouco com cada indice hematimetrico analisado separadamente. As criancas entre 24 e 36 meses de idade apresentaram significativamente maior prevalencia da carencia de ferro (p = 0,0005), como tambem as criancas com episodios febris ou diarreicos nos 15 dias precedentes a entrada no estudo (p = 0,003). CONCLUSOES: Apesar de a carencia de ferro nao apresentar associacao a deficiencia de vitamina A, ambas as carencias apresentaram prevalencias elevadas em uma populacao saudavel e com baixo indice de desnutricao. Tal situacao e conhecida como fome oculta. As criancas mais jovens apresentaram maior risco de portar carencia de ferro, como tambem as criancas com episodios febris ou diarreicos nos 15 dias precedentes a entrada no estudo.

http://www.scielo.br/pdf/jped/v81n2/en_v81n02a14.pdf

Prevalence of iron deficiency and its association with vitamin A deficiency in preschool children

Vitamin A deficiency in children aged 6 to 24 months in S~ao Paulo State, Brazil

OBJECTIVES: to determine the secular trend of breastfeeding and the average breastfeeding period among children in the Child and Mother Program of a primary health care clinic. METHODS: a retrospective survey of the medical files of children under one year old, enrolled in the Child Care Program of the Vila Lobato Community and Social Center in 1970, 1980, 1990 and 2000 followed up for at least one year. RESULTS: seven hundred and twenty eight children, 118 from 1970, 193 from 1980, 201 from 1990 and 216 from 2000 respectively. Breastfeeding, low in 1970, increased in the following years not only among the same age group in each one of the years as well as during the six first months of the year during the three years of the study. Reduction in breastfeeding frequencies during the first six months of age was higher in the first two months of age in 1970, in the first four months in 2000 and of five months in 1980 and 1990. CONCLUSIONS: Child Care Programs as in the Vila Lobato Community are an important tool to consolidade and promote breastfeeding practices.

/pdf/tendencia-secular-do-aleitamento-materno-em-uma-unidade-de-1x1i7qg9gk.pdf

Ivan Savioli Ferraz

Papers

COVID-19 and obesity in childhood and adolescence: a clinical review.

O Programa de Saúde da Família e a Puericultura

Prevalence of iron deficiency and its association with vitamin A deficiency in preschool children

Vitamin A deficiency in children aged 6 to 24 months in S~ao Paulo State, Brazil

Tendência secular do aleitamento materno em uma unidade de atenção primária à saúde materno-infantil em Ribeirão Preto, São Paulo