Child – ABC CARDIOL

IJCS

Editorial

The Relationship Between Obesity and the Risk of Systemic Arterial Hypertension in Children and Adolescents: Lessons Learned

One out of five children around the world is overweight or obese. This is shown in the meta-analysis published by Zhang X et al. in 2024, which included 2,033 studies from 154 different countries or regions. Although the prevalence of childhood obesity varies between global regions, it is evident that its incidence is growing significantly. According to the latest United Nations International Children’s Emergency Fund (UNICEF) and World Bank estimates, 33.6% of children and adolescents 5-19 years old are affected by overweight or obesity, as are 8% of children under the age of five. Recently, Muyulema SL et al. published the results of global childhood overweight and obesity trends over the last 20 years. In this study, they analyzed 194 countries around the world, showing that the global prevalence of childhood overweight and obesity increased from 5.4% to 5.7% between 2000 and 2022.

Inflammation, Metabolic Syndrome and Systemic Hypertension: “a dangerous and synergistic triad”: Metabolic Syndrome (MS) has been well defined in adults, and includes various conditions like Systemic Arterial Hypertension (SAH), elevated fasting blood sugar levels (greater than 100 mg/dl) or type 2 diabetes mellitus, low HDL cholesterol levels (less than 40 mg/dl in men or 50 mg/dl in women), high triglyceride concentrations (greater than 150 mg/dl), and a waist circumference greater than 101 cm (men) or 90 cm (women). It is not clearly defined in children, due to the imprecision of the various factors that compose it and the changes in different stages of life. However, risk factors like obesity, increased waist circumference (increased visceral fat), insulin resistance, and, in certain cases, lipid profile abnormalities, are compatible with MS, especially in children over the age of 10.

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Original Article

Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Area in the Backlands of Bahia

Andressa Lopes et al. Ana Luisa Vaz Valois Hanna Louise de Almeida Lisboa Alexvon Nunes Gomes … Renata Lago Camilla Almeida Menezes Ana Marice Teixeira Ladeia

Abstract

Background:

Childhood and adolescent obesity has been increasing, particularly in countries with greater social vulnerability. Given this context, assessing schoolchildren from Bahia’s backlands — a region known for its low-income population — is essential.

Objective:

To assess the frequency of overweight and obesity and their association with high blood pressure (BP) in children from urban and rural areas in four municipalities in the backlands of Bahia.

Methods:

This study is part of a project evaluating the impact of a school meal intervention on the health of children and adolescents in Bahia’s backlands. A subset of children aged five to ten from public schools in both rural and urban areas of four cities in Bahia’s backlands was selected through random and proportional sampling. The participants had their weight, height, waist circumference and BP measured using standardized protocols. The Body Mass Index (BMI) was expressed as a z-score to determine nutritional status. The Student’s t-test and Chi-square tests were used, with 5% statistical significance.

Results:

The sample consisted of 461 students, 264 (57.3%) from urban areas and 238 (51.6%) males. The prevalence of overweight was 27.9%, and that of increased waist circumference was 7.4%. High BP or hypertension had a prevalence of 8%. A significant difference (p = 0.049) was observed between rural and urban areas in relation to the increased waist circumference.

Conclusion:

The research revealed a high frequency of overweight, increased waist circumference and systemic BP in students, mainly those from urban areas.

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Original Article

Body Profile Impact on Blood Pressure and Lipid Profile in Rural and Urban Schoolchildren of a Brazilian Semiarid Region in The State of Bahia

Lívia Assis Mendonça et al. Alexvon Gomes Renata Lago Camilla Menezes … Sérgio Roberto Lemos de Carvalho Ana Marice Teixeira Ladeia

Abstract

Background:

The present study describes the prevalence of excess weight, obesity, and high blood pressure (BP) in children from a Brazilian semiarid region (Sertão) and its association with lipid profile and area of residence.

Objective:

To describe the prevalence of excess weight, obesity, and high BP in children, as well as the association between these variables, lipid profile, and area of residence.

Methods:

Thi work is a cross-sectional study conducted with schoolchildren, aged 6 to 10 years, from three municipalities in the countryside of Brazil. Weight, height, waist circumference (WC), and BP, together with the analysis of lipid markers, were assessed. Z-scores (BMI-Age) were used to determine the anthropometric classification. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) were meseared with eight hours of fasting. The Student’s t-test and the Mann-Whitney test were aplied. Perceptual maps were constructed through multiple correspondence analysis. A p-value<0.05 was considered statistically significant. The Institution's Ethics Committee approved this study (CAAE: 35038914.3.0000.5544).

Results:

Among 138 schoolchildren in this study, 76 (55.07%) were female and 81 (58.7%) were from urban areas. Twenty-one children (15.2%) were overweight, and 44 (31.9%) had a family history of obesity. Children from rural areas showed higher levels of TC (p = 0.041) and systolic BP (p = 0.028). The correlation between excess weight and a family history of obesity (p = 0.029), TG (p = 0.003), TG/HDL ratio (p = 0.009), systolic BP (p = 0.000), and WC (p = 0.000) were observed. In the correspondence analysis, the eutrophic group presented expected values for lipid variables.

Conclusion:

Overweight indicators are associated with cardiometabolic risk factors, reinforcing the need for early monitoring.

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Original Article

The Relationship Between Inflammatory Markers and Supraventricular Tachycardia in Children

Sevval Durgut et al. Hikmet Kıztanır Yasin Yıldız

Abstract

Background

Supraventricular tachycardia (SVT) is a common arrhythmia in pediatric patients. Emerging evidence suggests a link between systemic inflammation and cardiovascular diseases.

Objectives

This study aims to investigate the relationship between the monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) with SVT in pediatric patients. Methods: We conducted a retrospective study at Rize Education and Research Hospital’s Pediatric Health and Diseases Department, including 33 patients diagnosed with SVT and 33 control subjects without sinus tachycardia. Hemogram (CBC) parameters, electrocardiography (ECG), and echocardiography (ECHO) were evaluated. NLR and MLR were calculated. The unpaired t-test is designed to compare the means of continuous variables between two groups, while the Mann-Whitney U test was applied for data not following a normal distribution. Correlations between values were analyzed through Pearson correlation. A significance level of p <0.05 was accepted.

Results

There was no significant difference between the groups in terms of age, lymphocyte count, hemoglobin, hematocrit, platelet count, and NLR. However, leukocyte count, monocyte count, and MLR showed significant differences (p<0.05). The SVT group had higher MLR values compared to the control group.

Conclusions

Our study found that MLR was significantly higher in pediatric patients with SVT compared to controls, suggesting a potential role of inflammation in SVT pathogenesis. Further large-scale, prospective, and multicenter studies are needed to confirm these findings and clarify the relationship between inflammation markers and SVT.

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Editorial

Why is Physical Activity Important to Study in Childhood and Adolescence?

Klebia Castello Branco et al. Isabela de Carlos Back

One of the most important concerns of pediatrician in this pandemic/post-pandemic period is the damage caused by COVID-19 on children’s daily habits, especially physical activity. Children and teenagers were kept indoors during these 2 years, living their lives through digital interactions and becoming forcefully sedentary.

Studies conducted worldwide have shown that the average daily screen time of children and adolescents was greater than 2 hours a day, with the vast majority of them having a higher time than that recommended for any age.

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Original Article

HDL-Cholesterol in Children and Adolescents with Congenital Heart Disease

Matheus Alves Pacheco et al. Silvia Meyer Cardoso Michele Honicky Yara Maria Franco Moreno … Luiz Rodrigo Augustemak de Lima Camila Souza Marcos Isabela de Carlos Back

Abstract

Background

Children and adolescents with congenital heart disease may be more likely to develop atherogenic cardiovascular diseases in adulthood. Therefore, the early identification of risk factors and intervention in childhood may be crucial for a good quality of life and longevity.

Objectives

To describe the distribution of high-density lipoprotein-cholesterol (HDL-c) levels and its association with socioeconomic, clinical and cardiovascular risk factors in children and adolescents with congenital heart disease.

Methods

Cross-sectional study with children and adolescents aged between 5 and 18 years, with congenital heart disease. Socioeconomic, clinical and cardiovascular risk factors were evaluated. HDL-c concentrations were evaluated by the direct method and categorized as desirable (>45 mg/dL), borderline (40-45 mg/dL) and low (<40 mg/dL). We also assessed the “undesirable” levels, consisting of the sum of “borderline” and “low” values for comparative purposes. The multivariate logistic regression analysis was used to evaluate the factor associated with undesirable HDL-c levels. A p<0.05 value was adopted as statistically significant.

Results

Mean HDL-c was 51.2 mg/dL (SD 12.6), with a prevalence of 33.2% of undesirable HDL-c. In the multivariate analysis, C-reactive protein levels ≥ 3mg/dL (OR 3.26; 95% CI 1.32-8.04), age ≥ 10 years old (OR: 2.11; 95% CI 1.12-3.99) and undesirable levels of triglycerides (OR 2.21; 95% CI 1.13-4.75) were associated with undesirable HDL-c.

Conclusion

In this sample of children and adolescents with congenital heart disease, almost one third presented low or borderline HDL-c levels. Age ≥10 years, C-reactive protein and triglycerides were associated with undesirable HDL-c levels. These factors should be considered in the prevention of cerebrovascular diseases in adulthood in this population.

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Original Article

Efficacy and Risks of Therapeutic Hypothermia after Pediatric Cardiac Arrest: A Systematic Review

Anna Luíza Machado Nogueira et al. Ana Luísa dos Santos Maciel Amanda Campos Querubino Roberta Teixeira Prado Jussara Regina Martins

Abstract

Background:

Therapeutic hypothermia is used in adults and neonates after cardiac arrest, but its efficiency in children under 18 years old is still uncertain.

Objective:

To evaluate the effectiveness and risks of therapeutic hypothermia after cardiac arrest in children under 18 years of age through a systematic review.

Methods:

A systematic review was performed in January 2022 in the MEDLINE, SciELO, Cochrane, and LILACS databases. Inclusion criteria: randomized controlled trials (RCTs) performed in humans. Articles from other typologies, published more than 10 years ago, or with volunteers over 18 years old were excluded.

Results:

Four studies were identified, of which 3 were analyzed; all of them were of moderate quality according to the Jadad Scale and the Cochrane Collaboration tool. The studies indicated that lowering the temperature did not improve data on mortality and adverse events. Two studies did not identify statistically significant differences (p > 0.05) considering hypothermia in relation to normothermia in terms of survival, safety, and global neurobehavioral and cognitive function. The other study did not show improved serum biomarker concentrations.

Conclusion:

The results found in this review do not support the use of therapeutic hypothermia after pediatric cardiac arrest, as this intervention did not provide any apparent benefits in terms of safety, adverse events, survival, and neurological impact. We recommend the conduction of new RCTs using the measurement of serum biomarkers to better evaluate the effectiveness of the intervention.

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Editorial

What have we Learned about the Different COVID-19 Phenotypes in the Pediatric Population so Far?

Andressa Mussi Soares et al. Bernardo Mussi Soares

The understanding of SARS-CoV-2 related syndromes in the pediatric population needs to grow worldwide. In its severe presentation, COVID-19 is a systemic disease characterized by hyperinflammation, cytokine storm and increased myocardial injury markers. Cardiac involvement in seen in 20-30% of hospitalized adult patients and accounts for about 40% of deaths.

An intriguing aspect of the COVID-19 is the fact that most children and adolescents have mild or asymptomatic forms of the disease, perhaps related to a lower expression of virus receptors, recent exposure to other coronaviruses generating cross-protection, more developed innate immunity, among others. In fact, it is known that 40% of individuals under the age of 18 exposed to the virus get infected and that only 20-30% of children and adolescents infected with SARS-Cov-2 have symptoms.

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Original Article

Lifestyle Intervention in Reducing Cardiometabolic Risk Factors in Students with Dyslipidemia and Abdominal Obesity: A Randomized Study

Heloisa Pamplona-Cunha et al. Nilton Rosini Roberta Caetano Marcos José Machado Edson Luiz da Silva

Abstract

Background

The long incubation periods of cardiovascular diseases offer opportunities for controlling risk factors. In addition, preventive interventions in childhood are more likely to succeed because lifestyle habits become ingrained as they are repeated.

Objective

To investigate the effects of recreational physical activities, in combination or not with a qualitative nutritional counseling, in cardiometabolic risk factors of students with dyslipidemia and abdominal obesity.

Methods

Students (8-14 years old) were randomly divided into three groups (n=23 each): i ) Control; ii ) PANC, students undergoing Physical Activity and Nutritional Counseling, and iii ) PA, students submitted to Physical Activity, only. Blood samples (12-h fasting) were collected for biochemical analysis and anthropometric markers were also assessed. Two-Way RM-ANOVA and Holm-Sidak’s test, and Friedman ANOVA on Ranks and Dunn’s test were applied. P ≤ 0.05 was considered significant. Effect sizes were evaluated by Hedges’ g and Cliff’s δ for normal and non-Gaussian data, respectively.

Results

Compared to the control group and to baseline values, both interventions caused significant average reductions in total cholesterol (11%; p <0.001), LDL-c (19%; p=0.002), and non-HDL-c (19%; p=0.003). Furthermore, students in the PANC group also experienced a significant decrease in body fat compared to baseline (p=0.005) and to control (5.2%; g=0.541).

Conclusions

The proposed strategies were effective to reduce cardiometabolic risk factors in children and adolescents. The low cost of these interventions allows the implementation of health care programs in schools to improve the students’ quality of life.

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Case Report

Surgical Repair of a Ruptured Giant Abdominal Aortic Aneurysm in a 16-Year-Old with Takayasu’s Arteritis: Case Report and Etiological Review

José Maciel Caldas dos Reis et al. Glauco dos Santos Melo Murilo Vasconcelos de Oliveira Felipe Eduardo de Oliveira Santos … Tereza Maria Meireles Fernandes da Silva Hugo Luis da Silva Ferreira

Abstract

Takayasu’s arteritis is a type of primary systemic vasculitis that affects medium and large arteries, including the aorta and its main branches, as well as the pulmonary and coronary arteries. Although rare in children, it is the third most common vasculitis in the pediatric population, often with delayed diagnosis due to the nonspecific presentation of clinical symptoms in its initial phase. This is a case of a 16-year-old girl with a giant ruptured abdominal aortic aneurysm, who needed surgery on an emergency basis. The etiological aspects involved in aneurysms in young patients are also addressed.

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Viewpoint

Home Physical Activity Programs for Children and Adolescents as a Healthy Strategy During Social Isolation Caused by COVID-19: viewpoint

Rafaela Catherine da Silva Cunha de Medeiros et al. Isis Kelly dos Santos Jason Azevedo de Medeiros Ricardo Ney Cobucci … Tatiane Andreza Lima da Silva Juliany de Souza Araujo Phelipe Wilde de Alcântara Varela Breno Guilherme de Araújo Tinoco Cabral Paulo Moreira Silva Dantas

Background

The recent outbreak of coronavirus disease (COVID-19) is considered a global health emergency. The global impact of this viral infection is of great concern to everyone. As the COVID-19 outbreak continues to appear unstoppable, preventive and hygiene measures have been implemented to safeguard against infection. Among these precautions, social isolation is considered to have the greatest potential for reducing contagion, at least until a vaccine becomes available. This isolation measure works as a kind of “necessary evil” for preventing a wide-reaching disaster. Thus, social distancing and staying home remain the most effective restrictive measures to prevent the exponential increase in contagion.

One of the crucial focal points of this strategy was oriented toward the closure of schools, thus affecting thousands of children and adolescents, who comprise approximately half of the global student population. The closure of educational institutions could have a significant impact on their lives, requiring them to adapt to new routines. Considering that they are now being confined to their homes due to the new situation generated by the pandemic, this cohort may experience moments of stress.

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Case Report

Aborted Sudden Death Due to Severe Ventricular Arrhythmia in Timothy Syndrome

Erivelton Nascimento et al. Carollina Fernandes Tinoco Camila Diniz Silva Fabiana Ferreira Mitidieri Cortez Renato Kaufman

Abstract

Timothy Syndrome is a rare autosomal dominant multisystem genetic condition. The CACNA1C gene, codifier of the CaV1.2 calcium channel, is affected, resulting in the loss of voltage-dependent calcium channel inactivation. Relevant clinical characteristics: (1) corrected QT interval greater than 480ms; (2) syndactyly. Death often occurs during childhood, and results from ventricular tachyarrhythmias. This study presents the case of a female newborn who suffered a cardiorespiratory arrest, secondary to ventricular arrhythmia. A prolonged QT interval, combined with 2:1 AV block, was also identified, requiring a definitive cardiac pacemaker implant that, during inpatient care, developed pulmonary sepsis, followed by death.

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Editorial

Elevated Lipoprotein(A) in Children and Adolescents: Early Identification is Key for Successful Intervention

Sergio Emanuel Kaiser

Over the last decades, numerous studies have demonstrated that elevated lipoprotein (Lp)(a) is a powerful and independent risk factor for coronary heart disease,^, ischemic stroke, and calcific aortic stenosis. Even in patients treated with statins who achieve LDL-cholesterol goals below 70 mg/dL, elevated Lp(a) levels remain independently related to an increased risk of atherosclerotic events.

The LDL particle has a unique molecular structure, as exemplified by its covalent bond with an apolipoprotein(a) that bears resemblance to plasminogen and may well represent an evolutionary deviation of this well-known plasmin precursor. Lp(a) is synthesized by the liver and the amount of circulating particles in the bloodstream is almost exclusively determined by inheritance, leaving very little space for environmental influence. The distribution of Lp(a) levels in the population is highly skewed with approximately 80% of people exhibiting plasma concentrations below 50 mg/dL, and the remaining 20% with a wide range of values above that limit.

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Original Article

Factors Predicting Heart Failure in Children Admitted to a Pediatric Emergency Ward in a Developing Country

Uchenna Onubogu

Abstract

Background

Heart failure is an important cause of morbidity and mortality in children.

Objective

To determine the clinical characteristics of children with acute heart failure syndrome in the emergency ward of River state university teaching hospital, Nigeria and identify factors associated with poor outcomes.

Methods

This was an 18month retrospective review of the acute heart failure register. Poor outcome measures were defined as the persistence of heart failure after 4 days on admission or death.

Results

Ninety-two (4.1%) of 2,244 children admitted were in heart failure, Non-cardiac disorders [bronchopneumonia 32(36%), sepsis 21(24%), severe malaria 10(11%), sickle cell anaemia 8(9%) and tuberculosis 3(3%)] contributed to 74(83%) while congenital heart disease(CHD) was 15(17%). Seventy-four (83%) were discharged, 10(11%) died and 4(5%) left against medical advice. The median time to resolution of heart failure was significantly 24 hours longer for malnourished children than those with normal-nutritional status, 72Vs48hrs, log rank:0.001. Those with modified Ross score of >7 and sepsis were more likely to die, OR,8.8(95% CI,1.2 to 72.5,p = 0.02) and 3.9(95% CI,1.01 to 15.2;p =0.04). Age <2yrs(OR,3.1,CI,1.2 to 8.5,p = 0.02), and CHD (OR 3.6,95% CI,1.1 to 12,P=0.02) were associated with a higher likelihood of having a poor outcome. Each unit increase in weight for age Z score of 1, decreased the odds of having a poor outcome, OR,0.77 (95% CI,0.63 to 0.95)p=0.016.

Conclusion

Heart failure in our setting is predominantly caused by non-cardiac disorders. Modified Ross score of >7 and sepsis are risk factors for mortality in children with heart failure. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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