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Summary: Introduction: The French-African Pediatric Oncology group (GFAOP) has contributed to a significant improvement in the prognosis of pediatric cancers in Africa through the development of therapeutic protocols adapted to local conditions. In parallel, the development of supportive care such as pain management, is now a major priority of our group. Objective: The main objective of this study was to evaluate the management of pain in children with cancer in sub-Saharan Africa. Methodology: A questionnaire was sent to both the doctor and nurse responsible for each of the 8 pilot units (PUs). Results: All physicians and 2 nurses answered the questionnaire. Human resources (3 doctors and 4 nurses per PU) were modest compared to the size of the pediatric population (71 million) and the mean number of 102 cases of cancer/year per PU. Only six physicians had received specific training in pediatric oncology. Morphine was available in only 5 of the 8 PUs; major limitations for its prescription were mainly inconsistent availability (62.5%), fear of side effects (50%), and regulations (37.5%). During the curative phase, more than half of the parents had to buy analgesics when leaving the PU. Pain assessment relied mainly on clinical evaluation (8/8), but was generally concordant with parents’ assessment. The majority of patients experienced pain at diagnosis and at a higher degree at relapse, cancer being the predominant etiology. Pain related to other causes such as medical procedures, mucositis, and neuropathic pain was detected; however, its management remained inadequate. Only 2 of 8 PUs had a written protocol for pain management. These deficiencies can be explained by limited resources, both human and financial, but also by cultural factors such as endurance against pain still advocated by many African traditions. Conclusion: In recent years, pain prevention and relief, whatever its origin, have become a priority for all medical teams, especially for children with cancer. With its profound sociocultural changes, Africa is no exception. All teams in our group are aware of the situation and hope for major improvement in pain management in the near future through increased resources and training. [Copyright &y& Elsevier]

Résumé: L’allergie aux protéines de lait de vache évolue généralement vers l’acquisition d’une tolérance qui permet la reprise d’un régime normal. Le but de ce travail était d’analyser les pratiques de réintroduction des protéines de lait de vache en France. Un questionnaire a été adressé à 278 services de pédiatrie hospitaliers concernant les protocoles de réintroduction pour 3 types d’allergie aux protéines de lait de vache ainsi que pour l’allergie persistante. Le taux global de réponse a été de 27 %, 53 % pour les centres hospitaliers universitaires (CHU) et 23 % pour les centres hospitaliers généraux (CHG). La réintroduction se fait en moyenne à l’âge de 12mois et après 6mois d’exclusion, quel que soit le type d’allergie. Les Prick-Tests et les immunoglobulines E (IgE) spécifiques sont contrôlés avant réintroduction dans plus de 50 % des cas d’allergies immédiates et semi-retardées, tandis que les Patch-Tests sont rarement contrôlés dans l’allergie retardée. Les pratiques divergent quant au maintien ou non de la réintroduction en fonction de ces résultats. Les protocoles sont ensuite assez semblables sur le choix du lait, la vitesse de progression, le lieu de réalisation, la mise en place d’un accès veineux, le délai avant un prochain essai. Une désensibilisation est proposée par 43 % des services, principalement dans les allergies de type I, en moyenne après 2 échecs et à un âge de 2,5ans. Les protocoles utilisés sont semblables aux recommandations des tests de provocation orale à visée diagnostique mais il existe de grandes variations de pratiques. Peu nombreux sont ceux qui diffèrent dans leur prise en charge en fonction du type d’allergie. [ABSTRACT FROM AUTHOR]

Résumé: Entre le XVIIe siècle et le début du XXe siècle, le traitement du paludisme en Occident était la quinine. Dans la première moitié du XXe siècle, la synthèse de la chloroquine suscite l’espoir, rapidement déçu, d’éradiquer ce fléau. La résistance de Plasmodium falciparum à la chloroquine, d’abord en Asie du Sud-est puis en Afrique sub-saharienne, suscite des recherches qui aboutissent à la découverte ou à la redécouverte de l’halofantrine, de la méfloquine, de l’atovaquone-proguanil et des dérivés de l’artémisinine. À l’heure actuelle, il n’existe pas de traitement idéal du paludisme simple d’importation de l’enfant ; chaque équipe doit établir son protocole en fonction des molécules disponibles et de son expérience, sans perdre de vue la nécessité d’un suivi rigoureux à j3 ou j4 et à j28. Le traitement de l’accès grave doit désormais faire appel à l’artésunate intraveineux, plus efficace que la quinine. [ABSTRACT FROM AUTHOR]

Les lymphomes lymphoblastiques pré-B (PBLL) sont une entité rare qui représentent 15 % des lymphomes lymphoblastiques ou 4,5 % des lymphomes malins non hodgkiniens de l’enfant. Objectif de l’étude: Décrire les caractéristiques cliniques et l’évolution thérapeutique des PBLL inclus dans les protocoles français LMT96 et francobelges EORTC 58881, 58951. Patients: De 1990 à 2008, 53 enfants (âge médian 7,75 ans) ont été inclus et traités selon un schéma directement dérivé de celui des leucémies aiguës lymphoblastiques (LAL). Résultats: La classification de Murphy retrouvait 10 stades I, 9 stades II, 9 stades III et 25 stades IV (23 atteintes médullaires et 3 atteintes méningées). La plupart des localisations principales étaient extra-nodales (majoritairement osseuses et cutanées). À J70, 51 patients avaient une réponse complète. Lors du dernier suivi (médiane à 77,5 mois), 45 enfants étaient toujours en rémission (2 d’entre eux ayant eu un 2nd cancer) et 8 (7 stades IV et 1 stade III) étaient décédés. Le stade de la maladie a un impact pronostic significatif, l’OS et l’EFS étant supérieures pour les stades I à III (EFS à 93 % ; OS à 96 %) par rapport aux stades IV (EFS à 71 % ; 0S à 73 %). Conclusion: Un traitement prolongé de type LAL est efficace (EFS et OS à 5 ans de 82 et 85 %). [ABSTRACT FROM AUTHOR]

The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders and researchers, developed the first Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years). These national guidelines were created in response to an urgent call from public health, health care, child care and fitness practitioners for healthy active living guidance for the early years. The guideline development process was informed by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and the evidence assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The recommendations are informed by evidence from a systematic review that examined the relationships between physical activity and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development and cardio-metabolic disease risk factors) for three age groups (infants aged <1 year; toddlers aged 1-2 years; preschoolers aged 3-4 years). The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from an extensive on-line consultation process with input from over 900 domestic and international stakeholders, end-users and key informants. The final guideline recommendations state that for healthy growth and development, infants (aged <1 year) should be physically active several times daily - particularly through interactive floor-based play. Toddlers (aged 1-2 years) and preschoolers (aged 3-4 years) should accumulate at least 180 min of physical activity at any intensity spread throughout the day, including a variety of activities in different environments, activities that develop movement skills, and progression toward at least 60 min of energetic play by 5 years of age. More daily physical activity provides greater benefits. [ABSTRACT FROM AUTHOR]

Les tératomes foetaux cervico-faciaux sont des tumeurs rares, de découvertes anténatales ou néonatales, souvent bénins. Ils peuvent toutefois engager le pronostic vital à la naissance par obstruction des voies aériennes. Ces tumeurs sont le plus fréquemment isolées, mais de rares cas d’anomalies cranio-faciales associées sont décrits. Nous rapportons l’observation clinique d’une petite fille qui présentait à la naissance une fente palatine, ainsi qu’une lésion de 15×10mm d’allure kystique cervicale droite faisant suspecter un lymphangiome kystique. Selon le protocole du service et devant la stabilité de la lésion cervicale, il est décidé de réaliser la fermeture de la fente, sans geste sur la lésion cervicale. À 18 mois, devant la persistance d’une fistule palatine résiduelle, une reprise chirurgicale est décidée. Lors de ce geste l’exérèse de la lésion cervicale droite évolutive est réalisée. De plus, au décours de la chirurgie palatine, est découvert une lésion pédiculisée du cavum. L’examen anatomopathologique retrouvait un tératome mature kystique (tissu bronchique, gastrique et musculaire) en cervical et tératome mature, solide et polypoïde au niveau du cavum. Nous discuterons sur le plan clinique et thérapeutique, à l’aide de la littérature, cette association rare. [ABSTRACT FROM AUTHOR]

The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO) at the Children's Hospital of Eastern Ontario Research Institute, and in collaboration with ParticipACTION, and others, has developed the Canadian Sedentary Behaviour Guidelines for Children (aged 5-11 years) and Youth (aged 12-17 years). The guidelines include a preamble to provide context, followed by the specific recommendations for sedentary behaviour. The entire development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process and the recommendations are based on evidence from a systematic review and interpretation of the research evidence. The final guidelines benefitted from an extensive online consultation process with 230 domestic and international stakeholders and key informants. The final guideline recommendations state that for health benefits, children (aged 5-11 years) and youth (aged 12-17 years) should minimize the time that they spend being sedentary each day. This may be achieved by (i) limiting recreational screen time to no more than 2 h per day - lower levels are associated with additional health benefits; and (ii) limiting sedentary (motorized) transport, extended sitting time, and time spent indoors throughout the day. These are the first evidence-based Canadian Sedentary Behaviour Guidelines for Children and Youth and provide important and timely recommendations for the advancement of public health based on a systematic synthesis, interpretation, and application of the current scientific evidence. [ABSTRACT FROM AUTHOR]

Summary: Background: A whole-body hypothermia protocol for term infants with hypoxic-ischemic encephalopathy (HIE) was implemented in our network in May 2004. The main objective of this study was to assess the feasibility of the protocol. The impact on the outcome was also assessed. Methods: Monocentric retrospective study of all term infants admitted for HIE after the implementation of the protocol. The feasibility of the protocol was evaluated by its observance during the first 72h. The neurodevelopmental outcome at 12 months of age of this population was compared with a historical control group. Results: Twenty-five children were included. The protocol was not correctly applied for 8 children. The target temperature (33–34°C) was not reached for 3 infants. Four infants were admitted after 6h of age. In 1 infant, HIE was not diagnosed at admission. In the 17 patients with a good protocol observance, rectal temperature fell to the target temperature on average at 6.4h of age. The long-term follow-up rate was improved after the implementation of the protocol (100 % versus 92 % before protocol implementation). Death or neurodevelopmental disability occurred in 40 % during the protocol period versus 87 % before protocol implementation (p <0.01). Conclusions: The main limiting factor for implementation of whole-body hypothermia in infants with HIE is admission delay. The follow-up and the rate of death or disability in infants with HIE improved after implementing the protocol. [ABSTRACT FROM AUTHOR]

Summary: The process of weaning from mechanical ventilation (WMV) is the same in children as in adults. In the pediatric literature, weaning failure rate ranges from 1.4 to 34%. So far, no indices of weaning success have been demonstrated to be sufficiently accurate. The criteria for assessing readiness to wean, which must be screened daily, have neither been validated nor adapted to the pediatric population. The spontaneous breathing test (SBT), the reference screening test for weaning, precedes extubation; it can be achieved with pressure support ventilation or spontaneous breathing (T piece or canopy or flow-inflating bag). A standardized weaning protocol (which can be computer driven) was used in only three pediatric studies and the impact on shortening the duration of mechanical ventilation has not yet been demonstrated. It should be paired with a sedative interruption protocol. Weaning criteria, SBT criteria, and/or protocol tolerance are guides, but clinicians must individualize decisions to use these criteria. The use of noninvasive ventilation is increasing and its place in weaning protocols for children needs to be determined; it might modify the definitions of weaning failure and weaning success in the future. [Copyright &y& Elsevier]

Faced with the problem of resistance to chloroquine and sulfadoxine-pyrimethamine, the Ministry of Public Health of Burundi decided to study the efficacy of two artemisinin-based combinations, the fixed combination of artemether-lumefantrine and the combination of amodiaquine + artesunate. The efficacy of these combinations for the treatment of uncomplicated falciparum malaria was studied in two sites representative of the country, in Kigobe neighbourhood of Bujumbura, the capital city, and in Buhiga, a rural area. The study followed the standardized WHO protocol from October 2001 to November 2002. A total of 295 children under 5 years were included; 153 children were treated with artesunate and amodiaquine (77 at Buhiga and 76 at Kigobe), and 142 children with the combination of artemether-lumefantrine (64 at Buhiga and 78 at Kigobe). Among the 295 children, 290 were followed up to 14 days. In the group of 149 children treated with artesunate and amodiaquine, 142 (95.3%, 95% CI: 91.9–98.7%) presented with adequate clinical and parasitological response, five (3.3%) with late parasitological failure, one (0.7%) with late clinical failure and one (0.7%) with early treatment failure. Among the 141 children treated with artemether-lumefantrine, 140 (99.3%, 95% CI: 97.9–100%) presented with adequate clinical and parasitological response and one (0.7%) with late parasitological failure at Buhiga. Side-effects were comparable in both groups except for the vomiting. Vomiting was more frequent in the artesunate + amodiaquine on D1 and D2. Both treatments decreased the gametocyte carriage but without getting full clearance in all the patients. During a consensus workshop, the Ministry of Public Health agreed on the combination of artesunate and amodiaquine as the first line drug for the treatment of uncomplicated falciparum malaria in Burundi including epidemic outbreak. [ABSTRACT FROM AUTHOR]

Summary: From the experience of clinicians who work in SOS-Enfants teams, this article aims to provide some technical and practical issues raised by the space dedicated to the facts falling on the first interviews with children presumed victims of sexual abuse. The intention of this article is to relay questions about a specific methodology to which a few clinicians were trained: the French translation of the interview protocol non-suggestive investigation, NICHD. The challenge of such a protocol is the collection of accurate factual informations answering the necessities of child protection. From a practical point of view, the research for an unveiling in a protectionnal concern is usually conflictual with a listening willing to be therapeutic. Thus, if the investigation of the facts is a legitimate objective, we shall support that it is convenient to clarify the subjective relationship the child has with the facts. This shift implies to deviate from the strict application of a protocol and to refer to techniques stemming from psychotherapeutic modelizations. [Copyright &y& Elsevier]

The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stakeholders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian Physical Activity Guidelines for Children (aged 5-11 years), Youth (aged 12-17 years), Adults (aged 18-64 years), and Older Adults (aged >=65 years). The new guidelines include a preamble to provide context and specific guidelines for each age group. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process; we based the recommendations herein on evidence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultation process with hundreds of stakeholders and key informants, both domestic and international. Since 2006, the products of our efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectively guided this work. The process that Canadian researchers undertook to update the national physical activity guidelines represents the most current synthesis, interpretation, and application of the scientific evidence to date. [ABSTRACT FROM AUTHOR]

Objectif: Évaluer l’impact du traitement sur la prise de poids, la fonte tumorale et le délai avant irradiation. Méthode: 35 pts (âge médian 10 mois) ont reçu le BBSFOP qui consiste en l’alternance de 6 drogues pendant 16 mois. Résultats: 4 ont une NF1. Le diagnostic histologique est astrocytome pilocytique (19) ou astrocytome de bas grade NOS (4). 9 ont une dissémination leptoméningée. 18 ont reçu la totalité du protocole. La meilleure réponse a été BRP (2), RP (5), RO (5) MS(14) et MP(9). 13 ont pris du poids, sans corrélation avec la réponse. 34 ont ensuite progressé (délai médian: 22,5 mois [2-137]). 17 ont été irradiés (gain de temps médian : 54 mois [21-114]). La survie globale (SG) à 5 ans est de 83% [67-92], la survie sans événements (SSE) 8,6% [3-22] (suivi médian de 89 mois). 11 sont décédés (7 progressions tumorales et 4 toxicités des autres lignes). La SSE est moins bonne que celle des pts avec un GVO sans CD (34%), surtout pour les moins de 6 mois (p = 0,01), mais la SG est comparable. En fin de suivi, 10 sont obèses, 8 ont un déficit en GH et 19 ont des troubles pubertaires. Conclusion: le but de cette stratégie qui était de retarder l’irradiation a été atteint. La chimiothérapie est donc efficace dans le contrôle tumoral mais les résultats à long terme sont décevants. [ABSTRACT FROM AUTHOR]

Abstract: This short review is aimed at describing the particularities of consent in paediatric patients. For routine procedures, the consent of one of the parents is required whereas both parents should sign the consent for research protocols. In case of difficulties such as Jehovah witnesses or parental opposite opinions, doctors should ask the question to the judge in charge of protection of children. Consent or at least assent of minors enrolled in research protocols should be obtained provided their maturity is sufficient to understand correctly the purpose of clinical research. [Copyright &y& Elsevier]