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Introduction: Tracheostomy is a procedure that can be performed in any age group, including children under 1year of age. Unfortunately health professionals in Brazil have great difficulty dealing with this condition due to the lack of standard care orientation., Objective: This clinical consensus by Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) and Sociedade Brasileira de Pediatria (SBP) aims to generate national recommendations on the care concerning tracheostomized children., Methods: A group of experts experienced in pediatric tracheostomy (otorhinolaryngologists, intensive care pediatricians, endoscopists, and pediatric pulmonologists) were selected, taking into account the different regions of Brazil and following inclusion and exclusion criteria., Results: The results generated from this document were based on the agreement of the majority of participants regarding the indications, type of cannula, surgical techniques, care, and general guidelines and decannulation., Conclusion: These guidelines can be used as directives for a wide range of health professionals across the country that deal with tracheostomized children., (Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Unlabelled: Sinusitis, acute otitis media and tonsillitis are very frequent in children. Most of these infections are caused by viruses, but are generally treated with antibiotics. Inappropriate use of antibiotics favors the selection, growth and spread of resistant bacteria; these bacteria colonize the airways and affect the entire community. With the emergence of antibiotic-resistant bacteria, respiratory infections have become more difficult to treat. Effective strategies are needed to restrict the use of antibiotics without harming children that truly need these drugs., Aim: to present a critical analysis of the results of randomized and controlled studies on clinical and laboratory criteria used in diagnosing and treating tonsillitis, sinusitis and otitis., Methods: a review of randomized and controlled studies about these conditions published in MEDLINE and SCIELO from 2000 to 2006., Conclusions: Given that most of these infections progress favorably without antibiotics, the use of these drugs should be avoided unless the child belongs to a high risk group for complications, or symptoms persist or worsen with despite symptomatic treatment. Physicians and laypersons should have better knowledge about the natural evolution of acute respiratory infections.

Between 1990 and 1995, a total of 300 children, ages 2 months to 5 years, received diagnoses of acute otitis media (AOM) in a hospital emergency room in São Paulo, Brazil, and were recruited for this study. The investigation was undertaken, first, to identify microorganisms and antimicrobial susceptibilities of pathogens from AOM in Brazilian children; next, to ascertain, by comparison, whether the isolates of Streptococcus pneumoniae have the same serotypes as those included in the new conjugated heptavalent pneumococcal vaccine; and last, to determine whether additional and/or different serotypes are needed in the vaccine to ensure an immunogenic response against pneumococcal pathogens for the indigenous children in this study. Microorganisms were isolated from ear fluid of 192 patients (64%). The 5 most prevalent pathogens were S pneumoniae (48 isolates; 16%), Haemophilus influenzae (21 isolates; 7%), Moraxella catarhalis (15 isolates; 5%), Pseudomonas aeruginosa (6 isolates; 2%), and Staphylococcus aureus (3 isolates; 1%). These 5 represented 93 of the 192 total isolates. Resistance to antibiotics was found in the 3 primary pathogens. No high-level resistance of S pneumoniae to penicillin was found; instead, there was high-level resistance to trimethoprim-sulfamethoxazole. Ten serotypes of S pneumoniae were isolated: 6B, 9V, 11A, 16, 18C, 19A, 19F, 23A, 23B, and 23F. Only 5 of the 10 serotypes isolated were included in the conjugated heptavalent pneumococcal vaccine. Therefore, the other 5 serotypes (24 of 48 strains) should be considered in selecting antigens for the new vaccine.

Objective: The purpose of this study is to demonstrate the prevalence of lower respiratory airway diseases in children exposed to different sources of environmental pollutants., Methods: An epidemiological survey (using a questionnaire) was conducted in São Paulo State with three groups of children (1000 in each group): in the city of São Paulo, urban pollution; in Piracicaba, sugar cane burning area; and in Tupã and Batatais, pollution-free rural zone., Results: As for asthma/bronchitis and/or pneumonia, children from Piracicaba and São Paulo presented rates of 14 and 11% respectively, compared with 10% in Tupã and Batatais. Absenteeism from school was 17% in Piracicaba, 11% in São Paulo and 9% in Tupã and Batatais. Hospitalizations due to respiratory complications (asthma/ bronchitis or pneumonia) was 4% in São Paulo, 3% in Piracicaba and 2% in Tupã and Batatais. All the above results had statistical significance (p < 5)., Conclusions: High prevalence of lower respiratory airways infections and their complications in children exposed to different sources of environmental air-pollutants demonstrate the need for a more efficacious control environment pollution.