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Abstract: Non-accidental brain trauma (also called shaken baby syndrome) represent the main cause for morbidity and mortality in the context of child abuse. It often occur in young infants aged less than 8months. The shaking leading to brain injuries are very violent and sometimes associated with a final impact. Intracranial injuries may be isolated without skeletal trauma or bruising. In any suspicion of such a diagnosis, emergency hospitalization is indicated. Brain CT, easy to perform in emergency, is the diagnostic key. It discloses diffuse subdural hematomas in typical sites as vertex, interhemispheric space and tentorium. There is no clear background of trauma and the related story is changing over time. The 3D analysis of the skull looks for signs of recent impact as a fracture that is sometimes complex and/or a soft tissue swelling of the scalp. Intraparenchymal injuries (contusions, tearing, and overall anoxic ischemic injuries) are better analyzed with MRI. The prognosis depends on their extent. Ophtalmologic examination is systematically performed looking for retinal hemorrhages (around one third of cases) which may be very subtle. Bruising is a major diagnostic sign, but inconstantly present. A precise datation of skeletal and/or brain injuries is not possible with imaging and the only indication of use is to establish the presence of “age different lesions”. This indicates repeated trauma and thereby a high risk of recurrence. [Copyright &y& Elsevier]

Summary: We report the case of an infant who underwent surgery on the first day of life for a giant omphalocele. At the age of 16 months, he presented an acute abdominal syndrome and died a few hours later. Autopsy revealed a twisted left liver lobe (LL) including a suprahepatic vein. To our knowledge, this is the first case of giant omphalocele complicated by twisted liver lobe and fatal outcome. [Copyright &y& Elsevier]

Abstract: Objective: Despite advances in antibiotic therapy strategies and pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. To determine the factors associated with hospital mortality of children with pneumococcal meningitis. Methods: We conducted a retrospective study of 73 cases of childhood pneumococcal meningitis admitted in 4 teaching hospitals in the center of Tunisia during a 8-year period (1995–2002). Results: Hospital mortality was 13.7% (10 of 71 patients), and neurologic sequela were observed in 34.5% of survivors. Based on univariable analysis, five variables were associated with the outcome: Pediatric Risk of Mortality score (p < 0.001), coma (p =0.0009), use of mechanical ventilation (p =0.0001), convulsions (p = 0.0449), and shock (p =0.0085). In multivariable analysis, only 2 factors were independently associated with inhospital mortality: Pediatric Risk of Mortality score and the use of mechanical ventilation. 11.8% of pneumococcal isolates were intermediate and resistant to penicillin. Non-susceptible pneumococcus strains to penicillin and the use of steroids were not associated significantly with the mortality rate. Conclusions: Pneumococcal meningitis remains a devastating childhood disease. Two variables were independently associated with the in-hospital death in our series (high Pediatric Risk of Mortality score, and the use of mechanical ventilation). According to these data we may recommend the inclusion of vaccination against streptoccoccus pneumonia in the children immunization program in Tunisia. [Copyright &y& Elsevier]

Abstract: Introduction. – In case of an accessory pathway, children are exposed to severe cardiac events including sudden death. Radiofrequency ablation is a standardized procedure, which can be applied to a significant number of children although complications can still potentially occur. In this context, transesophageal evaluation of the accessory pathway evaluation can be discussed. Materials and methods. – Among 140 procedures performed in 19 years, 70 were done for accessory pathway evaluation. The preexcitation was overt in 59 children older than 5 years, which form the basis in this study. Results. – Anterograde refractory period was determined in 88% cases and was found<220 ms in 12 cases justifying an ablation procedure. Conversely, in case of a long refractory period (>250 ms), the ablation procedure was not performed in 8 asymptomatic cases and was postponed in 11/20 mildly symptomatic children. Transesophageal electrophysiologic study seems legitimate in asymptomatic or mildly symptomatic children. Conclusion. – This technique is probably less useful in case of an overt preexcitation and recurrent reciprocating tachycardia requiring long-term antiarrythmic treatment. In this case, endocavitary electrophysiological study eventually followed by an ablation procedure seems the best option. [Copyright &y& Elsevier]

Abstract: Vascular Ehlers-Danlos syndrome(EDS) is at high risk of death by arterial rupture. Case report. – A 13-year-old boy with vascular EDS and aortic dissection was admitted in pediatric emergency care unit. The children died after surgery by massive hemorrhage and prothetic rupture. Discussion. – The precocity of this vascular accident EDS is uncommon. It occured despite clinical and echocardiographic follow-up. The death of the children confirmed the difficulties in surgery of vascular manifestation, even if appropriate and rapid management was already done. Conclusion. – Patients with vascular EDS must be identified because of its lethal complications. Friability of the vessels makes surgical treatment difficult. A trial using beta blockers therapy is ongoing. [Copyright &y& Elsevier]

Acute gastroenteritis remains a frequent illness in infants and children with still important morbidity and mortality rates. Oral rehydratation solutions (ORS) and early refeeding are the main recommendations. Indication of drugs remains limited.Objective. – To evaluate the management of acute diarrhea by private practice pediatricians of France.Methods. – A questionnaire concerning ORS, dietary formula, antidiarrheal diet, antibiotherapy, antidiarrheal drugs was sent to all 2907 private pediatricians of France.Results. – Six hundred twenty-nine questionnaires were analyzed (22%). Three hundred and ninety-seven pediatricians (63%) prescribed systematically an ORS, 294 (47%) changed formula, 412 (66%) prescribed a regimen. Antibiotic was prescribed after coproculture (81%), when glairy and bloody diarrhea (65%), associated infectious disease (63%), toxi-infectious syndrome (42%) or immunodeficiency were present (28%). Most pediatricians (97%) prescribed at least one drug: diosmectite (84%), Lactobacillus acidophilus (63%), Saccharomyces boulardii (62%), racecadotril (62%), loperamide (28%), attapulgite de Mormoiron (26%), nifuroxazide (20%). Drugs were prescribed more often for their effectiveness than for comfort.Conclusion. – This study demonstrates the discrepancies that remain between recommendations and practical care in the treatment of acute diarrhea in children. Private French pediatricians often prescribe drugs. [Copyright &y& Elsevier]

Summary: Introduction: Inhalation of a laryngotracheobronchial foreign body is a common pediatric emergency situation. It is a source of morbidity and even mortality, especially among children under 3 years of age. Case report: A 14-month-old child presented suddenly combining bitonal dysphonia and dyspnea. Given the persistence of symptoms after 1.5 months and the normality of examinations requested by his doctor (pH, cervical ultrasonography, cervical and thoracic radiography), an ENT opinion was sought. An aerodigestive tract endoscopy was carried out in the emergency setting, finding a glottic foreign body associated with subglottic granulomas. The foreign body extraction led to the immediate disappearance of dyspnea. Dysphonia gradually improved under Budesonide aerosols. Conclusion: The lack of penetration syndrome in the interrogation and non specific symptoms may lead to an important diagnosis and treatment delay with dramatic consequences in case of airway foreign body. Endoscopy under general anesthesia must be practiced if there is any doubt for a thorough examination of the airways. [ABSTRACT FROM AUTHOR]

Summary: Pertussis is ranked among the leading causes of childhood mortality. The most catastrophic clinical complication of pertussis in infants, intractable pulmonary hypertension with shock, is not very well known. We describe the clinical course of a fatal case of severe pertussis complicated by refractory pulmonary hypertension and shock in a 2-month-old infant. [ABSTRACT FROM AUTHOR]

Abstract: Streptococcus pneumoniae (Sp) is an important cause of morbidity and mortality among paediatric infectious diseases. The aim of this study is to analyse specifical data on Sp meningitis out of the Bacterial Meningitis (BM) French Surveillance Network about mean age of BM cases and clinical features. Overall 367 Sp BM were reported between January 2001 to January 2004 (sex ratio M/F: 1.3), 69.7% were&#60;2 years old, median age 0.8 year (minmax 0–16.8 years). Before two years old children, 94.1% had no medical risk factor and no underlying conditions: on the other hand, after two years old, these factors were reported in 27% cases (P &#60;0.001). Mortality rate was 10.9%. On account of a Sp BM''s pic at five months, data of the BM French Surveillance Network confirm the necessity of an early vaccination. The vaccine administration at two, three, four months with a booster during the second year, recommended in the vaccinal french calendar, seems particularly adapted to the Sp BM in France. [Copyright &y& Elsevier]

Introduction: Les méningites restent un problème préoccupant de la santé au Maroc, malgré les progrès thérapeutiques du fait de la mortalité élevé et des séquelles neurosensorielles. Le but de travail: Analyser le profil épidémiologique, clinique, biologique et la prise en charge thérapeutique des méningites. Matériel et Méthodes: Nous rapportons les résultats d’une étude rétrospective menée au service de pédiatrie durant l’année 2009, colligeant les différents types de méningites. Résultats: Nous colligeons 88 cas, 58 garçons et 30 filles, dont l’âge varie de 3 mois à 14 ans. Cliniquement, 17 malades ont été admis dans un tableau de convulsion avec fièvre, 38 présentaient des taches purpuriques. La ponction lombaire a trouvé un LCR clair chez 32 malades,et purulent chez 41malades. Les méningites bactériennes représentent 75 % des cas. L’étude bactériologique a confirmé 9 cas de méningites à méningocoque, 7 cas à pneumocoque et 1 seule à Hémophilus influenzae. Les méningites virales représentent 25 % des cas. L’évolution été favorable dans la majorité des cas avec 7 cas d’hydrocéphalie, 4 cas d’empyème cérébral, et 2 cas de thrombophlébite cérébrale. On déplore un décès. Conclusion: Les méningites restent fréquentes dans notre contexte d’où l’intérêt de la prophylaxie et de la vaccination. [ABSTRACT FROM AUTHOR]

Résumé: La coqueluche est une toxi infection bactérienne due au Bordetelle pertussis, c’est la principale cause infectieuse de mortalité du nourrisson de moins de deux mois en France. Notre objectif est de déterminer que la prévention est plus que jamais essentielle. Matériels et méthodes: Étude rétrospective faite sur des dossiers de malades recrutés du 01/04/2008 au 31/07/2008. Cette étude porte sur les données épidémiologiques, cliniques, thérapeutiques et pronostic évolutif. Résultats: Fréquence d’âge < 02 mois, le sexe féminin est plus touché la majorité des enfants ne sont pas vaccinés et contaminés par des adultes. Deux cas de coqueluche maligne. La thrombocytose est présente chez la majorité des malades. Un décès : mort subite. Conclusion: La coqueluche était et reste menaçante et parfois mortelle d’où l’intérêt de la prévention. [ABSTRACT FROM AUTHOR]

Pour des raisons d’ordre social, culturel, financier ou autres beaucoup d’enfants meurent en dehors des formations sanitaires à Madagascar. Objectif: Évaluer la prévalence des décès des enfants de 28 jours à moins de 5 ans dans la commune urbaine d’Antananarivo qui surviennent en dehors des formations sanitaires. Matériels et Méthodes: Enquête prospective du 1er Mars 2007 au 31 Août 2007 concernant les décès des enfants de 28 jours à moins de 5 ans survenant hors formations sanitaires. Les paramètres analysés étant l’âge, le sexe, le quartier de résidence, le niveau d’éducation de la mère, le statut vaccinal, la durée d’évolution de la maladie et la notion de consultation médicale ainsi que le diagnostic présumé du décès. La collecte des données et les résultats ont été effectués avec le logiciel Microsoft office Excel 2003. Résultats: Pendant la période d’étude 3997 décès ont été enregistrés, 847 concernent les enfants de moins de 15 ans (21,19 %). 347 enfants (40,74 %) sont décédés hors formations sanitaires. 249 enfants (29,4 %) répondaient aux critères d’inclusion de l’étude. Beaucoup d’efforts restent à entreprendre au niveau communautaire, et dans les centres de santé de base pour que les enfants puissent bénéficier des soins adéquats. [ABSTRACT FROM AUTHOR]

Summary: Listeriosis is a serious invasive disease which affects mainly pregnant women, newborns and immunocompromised adults. Objective: To analyze specifically the epidemiological and clinical data of the meningitis due to Listeria monocytogenes (Lm), from the French Network of Surveillance of Bacterial Meningitis in childhood. Patients and methods: Patients were aged 0 to 18 years. The diagnosis was based on a combination of a feverish meningeal syndrome and a positive culture of cerebrospinal fluid (CSF) and/or a positive PCR in the CSF and/or positive blood culture associated with a pleiocytose. Results: Among 2539 cases of bacterial meningitis recorded in 6 years (2001 to 2006), 18 cases were due to Lm (0.7 %) (sex ratio M / F : 0.8). The average of age was 2.5 years (median : 0.5 ; ext : 0-15.1). The serotype of Lm was 4B in half of the cases. Most cases have occured in summer and autumn. Two patients presented an acquired or congenital immunodeficiency. Fifty-six percent (n=10) were younger than 1 year, among them, 7 were newborns. The CSF direct microbiologic investigation was suggestive of Lm (Gram positive bacilli) only in two cases, but the culture of CSF was positive for 16 patients and the blood culture was positive for 2 other patients. Three of 18 patients died between 7 and 13 days after admittance : a premature baby of 25 weeks’gestational age, two full-term newborns of 2 days and 1.5 months old. The mortality rate was 16.7 % before the age of 1 year (no death after this age). Conclusion: Meningitis due to Lm remains a rare disease, including in neonatal period. The recent increase of cases in adults requires to maintain vigilance in children especially since direct examination of CSF can rarely allow the diagnosis. [Copyright &y& Elsevier]

Summary: Objective: The group B streptococcal meningitis (GBS) remains an important cause of child''s morbidity and mortality. The purposes of this work were to appreciate the GBS place among the bacterial meningitis, to define clinical and biological factors associated with death and to study the immediate complications. Patients and methods: This study concerned 276 GBS meningitis listed by the observatory of GPIP/ACTIV on the child''s bacterial meningitis in France from January, 2001 to December, 2005. This report is one of the biggest series of child''s GBS meningitis published to this day. Results: The GBS was the third germ in frequency responsible for bacterial meningitis at every age (13 %) : 65 % of the GBS meningitis affected infants less than one month of age, 29 % infants between 1 month and 3 months of age and only 6 % infants more than 3 months of age. The male/female ratio in GBS meningitis was nearly equal (51 % vs 49 %). There was no variation of the GBS meningitis number according to the season. The serotype III was mostly involved in this cohort (81 %) followed by the serotype I (13 %). Statistically we observed a significant decline in the number of early onset meningitis from 2001 to 2004 whereas the number of late meningitis and the total meningitis cases were stable. The biological results mostly present in child''s GBS meningitis were a high CSF protein level (95 %), a CSF neutrophil count more than fifteen percent (90 %), a low CSF glucose level (83.5 %), leukopenia (49 %) or a normal blood level leukocyte (38 %). Eighty three percent of the children affected by GBS meningitis were term infants. However, the prematurity seemed to be a risk factor to develop late meningitis (age between 7 days and 3 months) and very late meningitis (after 3 months) but no early onset meningitis. Prematurity, convulsions, shock, coma, assisted ventilation, high CSF protein level, weak CSF cell level and leukopenia seemed to be factors associated with death in the GBS meningitis. The mortality of the GBS meningitis was still 14 % and the immediate complications were observed in 62 % of cases, the most frequent being convulsions (45 %). Conclusion: The GBS meningitis in children remains a frequent problem in pediatrics despite intra partum antibioprophylaxy and thus must encourage to strengthen the prevention of these meningitis. [Copyright &y& Elsevier]

Summary: Background: Pneumococcal meningitis represents one major cause of morbidity and mortality in children in France. The GPIP/ACTIV (Groupe de Pathologie Infectieuse Pédiatrique and Association Clinique et Thérapeutique Infantile du Val de Marne) set up an active surveillance network to analyze the clinical and biological features of pneumococcal meningitis and the impact of 7-valent pneumococcal conjugate vaccine (PCV7). Methods: From 2001 to 2007, 252 French pediatric wards working with 168 microbiology laboratories enrolled all children (0-18 years old) with bacterial meningitis. Risk factors, signs and symptoms, vaccination status, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. Results: Within the 7 years study period, 832 pneumococcal meningitis were reported among 2951 bacterial meningitis. In 2001 as in 2007, excluding the neonatal period, pneumococal meningitis represented nearly 1/3 of bacterial meningitis without significant decline in the number of reported cases (less than 30% for children under 2 years old). The peak of incidence was at 5 months of age and 61.7% of cases occured in children 2 to 24 months old. PCV7 vaccinated patients represented 154 cases from 2003 to 2007. In the vaccinated population, serotypes were identified in 136 cases. Few vaccine serotypes (VT) were identified (n=18). The most important was serotype 19F (n=8) followed by 6B (n=4) and 14 (n=3). Three vaccine failures (case occurring after complete vaccination) were observed (serotypes 6B, 4 and 19F). Remaining cases (n=118) were mainly due to non vaccine serotypes (NVT): serotypes 19A, 15B/C and 7F. In 2007, the serotype 19A, more often intermediary strains to cytoxin, represented about 20% of cases. Among non vaccinated children, VT decreased between 2001 and 2007 (59/92 in 2001 vs 15/39 in 2007). Case fatality rate was stable around 11.4%. Conclusion: In France, probably because of the insufficient vaccination coverage and the slow implementation of the PCV7, the expected decline in the number of cases of pneumococcal meningitis has not been observed. The impact of PCV7 appeared clearly since only few cases of VT pneumococcal meningitis were reported in vaccinated children. [Copyright &y& Elsevier]