Mariana Costa

O microorganismo Mycoplasma pneumoniae é uma causa frequente de infeções respiratórias adquiridas na comunidade em idade pediátrica, mas também pode provocar complicações neurológicas. Apresentamos o caso de uma menina de 9 anos que desenvolveu dor cervical, seguida de hemiparésia e perda sensitiva contralateral, compatíveis com uma síndrome de Brown-Séquard. A ressonância magnética (RM) cerebral era normal e o estudo da coluna cervical revelou uma lesão focal hiperintensa em T2, lateralizada à direita, entre C2–C4, sem captação de contraste, compatível com mielite. O estudo microbiológico (multiplex respiratório por PCR e serologia) suportou o diagnóstico de infeção recente por M. pneumoniae. A menina apresentou melhoria substancial após terapêutica com corticosteróides, antibióticos dirigidos e reabilitação, com recuperação funcional quase completa e sem recorrência da doença. Os anticorpos MOG-IgG e AQP4-IgG foram negativos e a neuroimagem não revelou características típicas de MOGAD ou NMOSD, ajudando a excluir doença desmielinizante primária. Este caso evidencia a possibilidade de mielite por M. pneumoniae se manifestar como síndrome de Brown-Séquard em idade pediátrica e reforça a importância de um diagnóstico diferencial estruturado para orientar uma abordagem terapêutica oportuna e etiologicamente direcionada.

Objectives: to assess the COVID-19 pandemic impact on breastfeeding rates during birth hospitalization in a Baby-Friendly certified perinatal hospital in Portugal. Methods: observational retrospective study comparing pre-pandemic (2019) and pandemic (April-December 2020) periods. A total of 900 healthy term mother-newborn dyads in rooming-in were included. Maternal and neonatal variables associated with breastfeeding at discharge were analyzed using chi-square, Student’s t-test, and multivariable logistic regression (p<0.05). Results: breastfeeding rates were higher in the pandemic period (99.3%) than in the pre-pandemic period (97.6%; p=0.031). Exclusive breastfeeding (80.2% vs. 81.6%; p=0.611) and skin-to-skin contact (56.2% vs. 58.0%; p=0.590) did not differ significantly. Exclusive breastfeeding was associated with vaginal delivery (pre-pandemic OR=3.07; 95%CI=1.83-5.13; p<0.001; pandemic OR=2.29; 95%CI=1.39-3.77; p=0.001), weight loss <10% (p<0.001), and absence of phototherapy in the pre-pandemic period (OR=3.38; 95%CI=1.96-7.12; p<0.001). No associations were found with maternal age, parity, sex, or gestational age. Conclusions: exclusive breastfeeding rates were not negatively affected by pandemic restrictions. Maintaining Baby-Friendly practices preserved essential breastfeeding support.

Acute cerebellitis is a rare disease resulting from dysfunction of the cerebellum or its connections, with infectious or inflammatory causes, varied clinical manifestations, and evidence of predominantly cerebellar inflammation on magnetic resonance imaging (MRI). It belongs to the spectrum of acute post-infectious cerebellar ataxia, a self-limited disease whose therapeutic approach is individualized. Three clinical cases of cerebellar ataxia in pediatric age are described. In case 1, there is a post-infectious context associated with Epstein-Barr virus. In case 2, there is a possible Mycoplasma pneumoniae post-infectious context, with MRI revealing cerebellar inflammation. Steroids were used in both cases. Case 3 presents severe cerebellar post-infection symptoms associated with varicella zoster virus, and human immunoglobulin was given. Evolution was favorable in all. These cases demonstrate the variable spectrum of post-infectious cerebellar ataxia and the different therapeutic options used, depending on the clinical presentation and individual characteristics of affected children.