WERTHER BRUNOW DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)(2023) EMERIAUD, Guillaume; LOPEZ-FERNANDEZ, Yolanda; IYER, Narayan Prabhu; BEMBEA, Melania M.; AGULNIK, Asya; BARBARO, Ryan P.; BAUDIN, Florent; BHALLA, Anoopindar; CARVALHO, Werther Brunow de; CARROLL, Christopher L.; CHEIFETZ, Ira M.; CHISTI, Mohammod J.; CRUCES, Pablo; CURLEY, Martha A. Q.; DAHMER, Mary K.; DALTON, Heidi J.; ERICKSON, Simon J.; ESSOURI, Sandrine; FERNANDEZ, Analia; FLORI, Heidi R.; GRUNWELL, Jocelyn R.; JOUVET, Philippe; KILLIEN, Elizabeth Y.; KNEYBER, Martin C. J.; KUDCHADKAR, Sapna R.; KORANG, Steven Kwasi; LEE, Jan Hau; MACRAE, Duncan J.; MADDUX, Aline; I, Vicent M. Alapont; MORROW, Brenda M.; NADKARNI, Vinay M.; NAPOLITANO, Natalie; NEWTH, Christopher J. L.; PONS-ODENA, Marti; QUASNEY, Michael W.; RAJAPREYAR, Prakadeshwari; RAMBAUD, Jerome; RANDOLPH, Adrienne G.; RIMENSBERGER, Peter; ROWAN, Courtney M.; SANCHEZ-PINTO, L. Nelson; SAPRU, Anil; SAUTHIER, Michael; SHEIN, Steve L.; SMITH, Lincoln S.; STEFFEN, Katerine; TAKEUCHI, Muneyuki; THOMAS, Neal J.; TSE, Sze Man; VALENTINE, Stacey; WARD, Shan; WATSON, R. Scott; YEHYA, Nadir; ZIMMERMAN, Jerry J.; KHEMANI, Robinder G.OBJECTIVES:We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. DESIGN:International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. SETTING:Not applicable. PATIENTS:Patients with or at risk for PARDS. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. CONCLUSIONS:PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.
- Born into an isolating world: family-centred care for babies born to mothers with COVID-19(2023) DOWSE, G.; PERKINS, E. J.; STEIN, H. M.; CHIDINI, G.; DANHAIVE, O.; ELSAYE, Y. N.; CARVALHO, W. B.; ALNAQEEB, N.; ROOZE, S.; CETINKAYA, M.; VETTER-LARACY, S.; PILAR-ORIVE, F. J.; TORPIANO, P.; FERRI, W. A. Goncalves; BUONSENSO, D.; ROGDO, B.; MEDINA, A.; POLITO, A.; BROUWER, C. N. M.; KNEYBER, M. C. J.; LUCA, D. De; TINGAY, D. G.; REGISTRY, Espnic Covid-Paediatric Neonatal E. P. I. C. E. M. T. R. E.Background The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic. Methods Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the 'EsPnIC Covid paEdiatric NeonaTal REgistry' (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines. Findings 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March-June 2020 to 74% in January-March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March-June 2020 and January-March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth. Interpretation This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed.
- Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C(2022) FINK, Ericka L.; ROBERTSON, Courtney L.; WAINWRIGHT, Mark S.; ROA, Juan D.; LOVETT, Marlina E.; STULCE, Casey; YACOUB, Mais; POTERA, Renee M.; ZIVICK, Elizabeth; HOLLOWAY, Adrian; NAGPAL, Ashish; WELLNITZ, Kari; CZECH, Theresa; EVEN, Katelyn M.; CARVALHO, Werther Brunow de; RODRIGUEZ, Isadora Souza; SCHWARTZ, Stephanie P.; WALKER, Tracie C.; CAMPOS-MINO, Santiago; DERVAN, Leslie A.; GENESLAW, Andrew S.; SEWELL, Taylor B.; PRYCE, Patrice; SILVER, Wendy G.; LIN, Jieru Egeria; VARGAS, Wendy S.; TOPJIAN, Alexis; ALCAMO, Alicia M.; MCGUIRE, Jennifer L.; ROJAS, Jesus Angel Dominguez; MUNOZ, Jaime Tasayco; HONG, Sue J.; MULLER, William J.; DOERFLER, Matthew; WILLIAMS, Cydni N.; DRURY, Kurt; BHAGAT, Dhristie; NELSON, Aaron; PRICE, Dana; DAPUL, Heda; SANTOS, Laura; KAHOUD, Robert; FRANCOEUR, Conall; APPAVU, Brian; GUILLIAMS, Kristin P.; AGNER, Shannon C.; WALSON, Karen H.; RASMUSSEN, Lindsey; JANAS, Anna; FERRAZZANO, Peter; FARIAS-MOELLER, Raquel; SNOOKS, Kellie C.; CHANG, Chung-Chou H.; YUN, James; SCHOBER, Michelle E.Background: Our objective was to characterize the frequency, early impact, and risk factors for neuro-logical manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C). Methods: Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition be-tween January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neuro-logical manifestations was performed. Results: Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological mani-festation. The most common neurological findings in children with acute SARS-CoV-2 and MIS-C diag-nosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both P < 0.05. Children with neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05. Conclusions: In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuro-protective strategies are vitally needed.
- Point-of-care lung ultrasound imaging in pediatric COVID-19(2020) GIORNO, Eliana P. C.; PAULIS, Milena De; SAMESHIMA, Yoshino T.; WEERDENBURG, Kirstin; SAVOIA, Paulo; NANBU, Danilo Y.; COUTO, Thomaz B.; SA, Fernanda V. M.; FARHAT, Sylvia C. L.; CARVALHO, Werther B.; PRETO-ZAMPERLINI, Marcela; SCHVARTSMAN, ClaudioBackground: There has been limited data regarding the usefulness of lung ultrasound (US) in children with COVID-19. Objective: To describe lung US imaging findings and aeration score of 34 children with COVID-19. Methods: This study included 0-16-year-old patients with confirmed COVID-19, who were admitted between April 19 and June 18, 2020 in two hospitals in the city of Sao Paulo, Brazil. Lung US was performed as part of the routine evaluation by a skilled Pediatric Emergency physician. Clinical and laboratory data were collected and severity classifications were done according to an available clinical definition. The lung US findings were described for each lung field and a validated ultrasound lung aeration score was calculated. Data obtained was correlated with clinical information and other imaging modalities available for each case. Results: Thirty-four confirmed COVID-19 patients had a lung US performed during this period. Eighteen (18/34) had abnormalities on the lung US, but eight of them (8/18) had a normal chest radiograph. Ultrasound lung aeration score medians for severe/critical, moderate, and mild disease were 17.5 (2-30), 4 (range 0-14), 0 (range 0-15), respectively (p=0.001). Twelve patients (12/34) also had a chest computed tomography (CT) performed; both the findings and topography of lung compromise on the CT were consistent with the information obtained by lung US. Conclusion: Point-of-care lung US may have a key role in assessing lung injury in children with COVID-19.
- A Core Outcome Set for Pediatric Critical Care*(2020) FINK, Ericka L.; MADDUX, Aline B.; PINTO, Neethi; SORENSON, Samuel; NOTTERMAN, Daniel; DEAN, J. Michael; CARCILLO, Joseph A.; BERG, Robert A.; ZUPPA, Athena; POLLACK, Murray M.; MEERT, Kathleen L.; HALL, Mark W.; SAPRU, Anil; MCQUILLEN, Patrick S.; MOURANI, Peter M.; WESSEL, David; AMEY, Deborah; ARGENT, Andrew; CARVALHO, Werther Brunow de; BUTT, Warwick; CHOONG, Karen; CURLEY, Martha A. Q.; LOPEZ, Maria del Pilar Arias; DEMIRKOL, Demet; GROSSKREUZ, Ruth; HOUTROW, Amy J.; KNOESTER, Hennie; LEE, Jan Hau; LONG, Debbie; MANNING, Joseph C.; MORROW, Brenda; SANKAR, Jhuma; SLOMINE, Beth S.; SMITH, McKenna; OLSON, Lenora M.; WATSON, R. ScottObjectives: More children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs. Design: A two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% ""critical"" and less than 15% ""not important"" advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components. Setting: Multinational survey. Patients: Stakeholder participants from six continents representing clinicians, researchers, and family/advocates. Measurements and Main Results: Overall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% ""critical"" and less than 15% ""not important"" and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set-extended. Conclusions: The PICU core outcome set and PICU core outcome set-extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families.
- Early Empiric Antibiotic Use Is Associated With Delayed Feeding Tolerance in Preterm Infants: A Retrospective Analysis(2017) MARTINEZ, Francisco E.; FERRI, Walusa A. G.; LEONE, Clea R.; ALMEIDA, Maria Fernanda Branco de; GUINSBURG, Ruth; MENESES, Jucille do Amaral; VALE, Marynea Silva do; MARBA, Sergio Tadeu Martins; CARVALHO, Werther Brunow de; RUGOLO, Ligia Maria Suppo de Souza; LOPES, Jose Maria de Andrade; RIBEIRO, Manoel A.; PROCIANOY, Renato S.; DUARTE, Jose Luiz Muniz Bandeira; BOUZADA, Maria Candida Ferrarez; FERREIRA, Daniela Marques de Lima Mota; ALVES FILHO, Navantino; DINIZ, Edna Maria de Albuquerque; ZANARDI, Dulce Maria Toledo; TESTONI, Daniela; SANTOS, Cristina Nunes dos; GOMZALEZ, Maria Rafaela Conde; VENZON, Paulyne Stadler; BELIK, JaquesThe causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants' enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants' total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4-fold greater prevalence of NEC was seen in the early empiric antibiotic-exposed neonates, when compared with control infants (P<0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.
- Leveraging Clinical Informatics and Data Science to Improve Care and Facilitate Research in Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference(2023) SANCHEZ-PINTO, L. Nelson; SAUTHIER, Michael; RAJAPREYAR, Prakadeshwari; CARVALHO, Werther Brunow de; JOUVET, Philippe; NEWTH, ChristopherOBJECTIVES: The use of electronic algorithms, clinical decision support systems, and other clinical informatics interventions is increasing in critical care. Pediatric acute respiratory distress syndrome (PARDS) is a complex, dynamic condition associated with large amounts of clinical data and frequent decisions at the bedside. Novel data-driven technologies that can help screen, prompt, and support clinician decision-making could have a significant impact on patient outcomes. We sought to identify and summarize relevant evidence related to clinical informatics interventions in both PARDS and adult respiratory distress syndrome (ARDS), for the second Pediatric Acute Lung Injury Consensus Conference. DATA SOURCES: MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost). STUDY SELECTION: We included studies of pediatric or adult critically ill patients with or at risk of ARDS that examined automated screening tools, electronic algorithms, or clinical decision support systems. DATA EXTRACTION: Title/abstract review, full text review, and data extraction using a standardized data extraction form. DATA SYNTHESIS: The Grading of Recommendations Assessment, Development and Evaluation approach was used to identify and summarize evidence and develop recommendations. Twenty-six studies were identified for full text extraction to address the Patient/Intervention/Comparator/Outcome questions, and 14 were used for the recommendations/statements. Two clinical recommendations were generated, related to the use of electronic screening tools and automated monitoring of compliance with best practice guidelines. Two research statements were generated, related to the development of multicenter data collaborations and the design of generalizable algorithms and electronic tools. One policy statement was generated, related to the provision of material and human resources by healthcare organizations to empower clinicians to develop clinical informatics interventions to improve the care of patients with PARDS. CONCLUSIONS: We present two clinical recommendations and three statements (two research one policy) for the use of electronic algorithms and clinical informatics tools for patients with PARDS based on a systematic review of the literature and expert consensus.