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Medication errors are one of the causes of iatrogenic medication use in children. The POPI tool for detecting inappropriate drug prescriptions and prescription omissions in paediatrics was the first tool to be published in this field in 2014. Our aim was to update the POPI tool for French use based on current recommendations and practice. Criteria were removed, updated or added based on recommendations from learned societies and national bodies. The two-round Delphi method was used to reach a consensus of experts. The level of agreement of the healthcare professionals' proposals was rated on a 9-point Likert scale. In the first round, only proposals with a median agreement of 7 to 9 and an agreement of more than 65% were retained. In the second round, only those with a median agreement of 7 to 9 and over 75% agreement were retained. The POPI tool now includes eight categories (various, infectiology, gastroenterology, pneumonology, dermatology, neurology/pedopsychiatry, haematology and excipients). All the criteria were supported by bibliographical references. They were submitted to 20 French healthcare professionals: 9 pharmacists and 11 doctors (17 hospital-based and 3 self-employed). After two rounds of Delphi testing, 166 criteria were retained and validated (111 inappropriate prescriptions and 55 omissions). In conclusion, this study made it possible to update the POPI tool, which is still available for assessing paediatric prescriptions., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

This article examines the diversity of pediatric emergencies in a medical office, shedding light on the complexity of some situations. To address emergencies that are both psychosocial and biomedical, the pediatrician must possess a variety of skills and have an in-depth understanding of the local medical network. Limited communication with young children requires the search for clues, generating uncertainty. This uncertainty is mitigated when the relationship with parents is of high quality. Consequently, the pediatrician must be an effective communicator to manage the triangular relationship. Regarding treatments, it is crucial to consider the latest "smarter medicine" recommendations, as well as the growing resistance to antibiotics., Competing Interests: L’auteure n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Exploring coagulation in newborns and children is a challenge due to the low levels of both procoagulant factors and inhibitors. Conventional coagulation tests might be inadequate to explore all of these changes. The aim of the study is to evaluate the thrombin generation assay, a global test to explore coagulation, in a pediatric population (n=586) compared to an adult population (n=166). The thrombin generation assays were performed using Calibrated Automated Thrombography with two different tissue factor concentrations (1 and 5 pM), with and without thrombomodulin (TM). In the absence of TM, the endogenous thrombin potential (ETP) is significantly lower in the pediatric population, reflecting the decrease in procoagulant factors. In the presence of TM, ETP values in pediatric subjects are within the reference range of adult values. The thrombin generation assay demonstrates that coagulation balance is maintained in the pediatric population.

Alkaline phosphatase activity is a parameter included in biochemical liver test. These isoenzymes are of various cellular origin inducing physiological variations on age and sex. The alkaline phosphatase activity standardization as well as numerous international studies have made it possible to standardize the pediatric reference values. The hyperphosphatasemia etiologies are very well know but the hypophosphatasemia are hardly explored and can allow the diagnosis of pathologies including hypophosphatasia, a rare treatable disease.

Introduction: The evolution of the microbial epidemiology of pleuropulmonary infections complicating community-acquired pneumonia has resulted in a change in empirical or targeted antibiotic therapy in children in the post Prevenar 13 era. The three main pathogens involved in pleural empyema in children are Streptococcus pneumoniae, Staphylococcus aureus and group A Streptococcus., Methods: A questionnaire according to the DELPHI method was sent to experts in the field (paediatric pulmonologists and infectious disease specialists) in France with the purpose of reaching a consensus on the conservative antibiotic treatment of pleural empyema in children. Two rounds were completed as part of this DELPHI process., Results: Our work has shown that in the absence of clinical signs of severity, the prescription of an intravenous monotherapy is consensual but there is no agreement on the choice of drug to use. A consensus was also reached on treatment adjustment based on the results of blood cultures, the non-systematic use of a combination therapy, the need for continued oral therapy and the lack of impact of pleural drainage on infection control. On the other hand, after the second round of DELPHI, there was no consensus on the duration of intravenous antibiotic therapy and on the treatment of severe pleural empyema, especially when caused by Staphylococci., Conclusions: The result of this work highlights the needed for new French recommendations based on the evolution of microbial epidemiology in the post PCV13 era., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background and Goal of This Study: Few available galenic formulations of drugs have pediatric doses, so that many of them are used off label in children. The influence of such pharmaceutical formulation on therapeutic adherence was evaluated in a systematic review of the literature., Materials and Methods: This search was performed in 4 data bases: Medline, the Cochrane Library, Web of Science and Science Direct. Included articles were in French or English and focused on therapeutic adherence and route of administration., Results: Overall, 51 articles were included in the study: 46 from Medline (27 selected), 1 from The Cochrane Library (1 duplicate), 61 from Web of Science (13 selected) and 23 articles from Science Direct (11 selected). The two main pharmaceutical formulations studied were liquid dosage form 51% (n=28) and solid oral form 35% (n=19)., Discussion: Easy use of liquid forms (n=18) (easy dose adjustment and administration) was associated with good adherence. Optimization of organoleptic properties was found to improve adherence (n=20). The main limitations to the use of solid oral formulations are the risk of choking in a child under 6 and difficulty adapting doses for pediatric use. Commercialization of minitablets should help solve these problems (n=3) and therapeutic education sessions could make it possible to prescribe selected pills to children aged 4 or older (n=2). A risk of misuse because of incorrect administration seems to be the reason that aerosols are underused., Conclusion: Drug formulation influences therapeutic adherence in children, which is a cornerstone for successful pharmacotherapeutic management., (Copyright © 2018. Published by Elsevier Masson SAS.)

Introduction: Inhaled therapy is the mainstay of asthma treatment due to its local and rapid action. However, its efficiency relies on the teaching of a good inhalation technique by health care providers. We assessed health care providers' knowledge and practical skills in the use of inhalation devices., Methods: An observational multicenter study was conducted in the pulmonology and paediatric wards in Marseille. The departments' common practices, theoretical knowledge and practical skills were assessed through a questionnaire and a demonstration using a spacer device., Results: Forty health care providers were interviewed (9 attending physicians, 14 residents, 16 nurses and 1 physiotherapist), in 8 different pulmonology and paediatric wards. A total of 42.5% reported previous training in inhalation device technique. When evaluating theoretical knowledge, we found a mean of 54% correct answers. Attending physicians did significantly better than residents and nurses. With regard to practical skills, we found a mean of 1.12 failed steps out of 7. Here again attending physicians did significantly better than residents and nurses., Conclusion: Based on the results of our study, we recommend that attending physicians provide training of inhalation technique to nurses and residents, as they did significantly better theoretically and practically., (Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Since 2005, forgoing live-support (FLS) is allowed by the French law (known as the Leonetti law) for end-of-life patients only. This study aims at describing the variations over time in the use of the following methods to end life: FLS, brain death and cardiopulmonary resuscitation failure (CPR failure). It is a single retrospective study from 2007 to 2012. The Cochran-Armitage trend test is used in the statistical analysis. Over six years, 263 of the 5100 children who were hospitalized in our intensive care unit died, which represents a 5.2% mortality rate. FLS increased yearly from 31% of the deaths in 2007, to 71% in 2012 (P=0.0008). The rate of CPR failure decreased over the same period (P=0.0015). The rate of brain death remained constant. Following to the Leonetti law, FLS increase, and palliative cares develop without any increase of mortality., (Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Background: In adults, the Post-Anesthetic Discharge Scoring System (PADSS) was built to secure the discharge after outpatient surgery. We evaluate a pediatric adaptation: the Pediatric-PADSS (Ped-PADSS)., Study Design: Prospective cohort., Methods: This was a prospective, observational, monocentric study for ambulatory patients. Ped-PADSS is built on 5 items each quoted 0, 1, or 2: hemodynamics, state of awakening, nausea/vomiting, pain and bleeding. A result ≥9/10 validated discharge if the anesthetist did not wish to review the patient, if the parents did not wish to revisit the anesthetist or if there was no hoarseness or dyspnea. The discharge was validated by the anesthetist and the surgeon. Ped-PADSS was made without the knowledge of the nursing team, one hour after return in service and repeated hourly. Addition of patient demographic data, the collection included the hours of leave by the anesthetist, surgeon and Ped-PADSS, the duration of hospital stay post procedure., Results: On 150 patients, 148 patients were allowed to go out with the Ped-PADSS, one patient was released despite a Ped-PADSS<9. One patient was hospitalized for a surgical bleeding in agreement with the anesthetist, surgeon and the Ped-PADSS. Ninety-five percent of patients had a Ped-PADSS ≥9 after 2hours monitoring in the ambulatory unit., Conclusion: The majority of the children have met the criteria for discharge at the end of 2hours postoperative monitoring. The use of this score could reduce the hospitalization time in ambulatory unit., (Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

An increasingly amount of evidence suggests that lung ultrasonography constitutes a relevant complementary diagnostic tool for adults patient in acute respiratory failure. A comprehensive and standardized ultrasonographic semiology has been described, relying on accurate and reproducible data directly obtained at patient's bedside. Therefore, pleural effusion, pneumothorax, pulmonary consolidation and interstitial lung disease can be diagnosed in a critical care environment with a similar level of performance than when reference diagnosis methods such as thoracic CT-scan are employed. Furthermore, lung ultrasonography seems to be able to contribute to an early therapeutic decision based on such online physiopathological data. Pioneers works in this field have suggested an attractive similarity between the ultrasonographic patterns described in adults and children. Nevertheless, the clinical usefulness of lung ultrasonographic approach in the pediatric critical care medicine still needs to be confirmed by specifically designed studies., (Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

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 © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Introduction: In France, nearly 600 children, aged 1-14 years, die from chronic diseases every year. A law passed the 22nd of April 2005 provides the legal framework for end-of-life situations. However, is this law and the position adopted by the scientific pediatric societies known and applied by pediatricians dealing with these children at the end of life? Our objective was to describe the current practices and needs, an essential preliminary assessment for the development of shared concepts among pediatricians., Method: A long-term study based on a qualitative and semi-quantitative questionnaire was conducted on pediatricians throughout the French academic hospitals via interviews., Results: A 25.2% response rate was obtained. All of the pediatric disciplines were affected by end-of-life care for children. Decisions for limitation of treatment conformed to a collegial process in 88.9%; 48.1% of the pediatricians expressed the need for dedicated beds for these children. The Léonetti law appeared to be diversely known and appreciated: 19.6% declared no or poor knowledge of this law, 23.5% were neutral in their response, 15.7% considered its significant progress, and 41.2% criticized its insufficiencies. However, for most of the doctors interviewed, this law supplied a legal framework, but some doctors emphasized the challenges in applying it to pediatrics: vagueness of the law regarding the parents and the desires of the minor child and insufficiency in developing pediatric palliative care. Above all, some ignorance or confusion in the terms used was notable., Conclusion: Our survey, emphasizing the difficulties encountered by pediatricians dealing with dying children and their families, emphasizes the need for concepts shared by the entire profession; this reflection could define the terms used in the debate., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Stroke in children is not rare. Although there are no randomized trials on childhood stroke, except in sickle cell disease patients, several international guidelines have described quality criteria for stroke management in children. Age-adapted management is required, involving collaboration with a pediatric neurologist and hospitalization in a pediatric intensive care or continuous care unit. All symptomatic treatments used in adults can be recommended in children, including homeostasis assessment and maintenance or blood exchange in sickle cell disease patients. Specific treatments such as thrombolysis or mechanical thrombectomy are not recommended in children, except in the framework of clinical trials, but can be beneficial in adolescents. Multidisciplinary decision-making should be the rule in such situations. Adolescents may be managed in adult stroke units. Indications for surgery in children are adapted from adult guidelines. Appropriate management of cerebral venous thrombosis in children is similar to that in adults. The best management possible can be achieved through a multidisciplinary dialogue between the pediatric neurologist and the adult intensivist or neurologist., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

When a new drug is labelled, before deciding its integration in the therapeutic strategy, the doctor has to know the degree of innovation of the drug, i.e. its actual benefit and the improvement of actual benefit, also called added value over other available drugs. For each new medicine in France, after drug approval by the French Drug Agency, the French National Authority for Health thought its "Commission de transparence" (Transparency Commission) issues an opinion about the degree of innovation of the drug, which is independent of the marketing authorization. The added value over other available drugs is quantified by five levels of improvement: level I, major progress to level V, no progress. The complete opinion of the Transparency Commission and its synthesis (one page) is online http://www.has-sante.fr/. Between 2006 and 2008, no paediatric drug has obtained a level I of improvement (major progress), ten have obtained a level II (significant progress), 11 a level III (moderate progress), 12 a level IV (minor progress) and for 38 drugs, no progress has been retained. The need to know and to follow therapeutic recommendations is the evidence based medicine. The opinions of the Transparency Commission are one of those recommendations., (Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.)

Objective: To present the effective applications of paediatric medical simulation in terms of education, evaluation, density, development, goals and constraints., Study Design: Survey realized within 38 paediatric simulation centres (PSC) in Europe, identified by Web search and through the Society in Europe for Simulation Applied to Medicine (SESAM., Results: Twenty centers answered the questionnaire (52%). Ninety-four percent of the PSC had beforehand acquired an experience of adult medical simulation, 94.6% of the PSC were created before 2006. Ninety percent of the PSC owned at least one high-fidelity pediatric simulator. The 80% of the PSC indicated multiple funding sources. Eighty percent of the PSC had at least one specific instructor for the paediatric simulation (average=2.7 paediatric instructors per centre). The PCS reported to get onto various topics: neonatology (25% of the PCS), prehospital medicine (36.8%), paediatric anaesthesiology (74%) and paediatric intensive care (89%). Simulation allowed 70% of the centers to lead some research project. Ninety-five percent of the centers agreed about an European collaboration on research projects or about the mutualization of the created scenarios., Conclusion: The material, financial and human means of the interviewed centres are consequential but heterogeneous in Europe. MSP offers numerous and various application fields and generates some research activity.

Objective: Our objective was to improve the organization and management of care facilities for children suffering from cancer or leukaemia and to be aligned with the legislation in force in France., Methods: Our report is on the successive steps for the implementation of a quality assurance system, methods used, motivations, cost, difficulties encountered as well as the advantages obtained. In the Regional Centre for Paediatric Oncology (CRCP) at the CHU in Clermont-Ferrand, we launched a quality programme based on ISO9001/2000 standards. The implementation of the quality assurance system was conducted as a research project and an established medical project with the support of the Management Team. The mission was divided into several "processes", an approach consisting of considering the clinical service in terms of flow and successions of transformations (reception, care, support, accompaniment, etc.) which produce added-value (services and products adapted to the needs of the "customers": children, families, correspondents)., Results: We singled out ten physical processes or "job specializations" such as "diagnosis", "care" or "project for the child". The cartography which is the systematic representation of the processes and the interactions between them made it possible to draw up a global vision of the CRCP "care" activity., Conclusion: The ISO9001/2000 standard is a tool designed to help organization and management. The benefit obtained in implementing it in a clinic was perceived in organisational terms and lead to a true team spirit, a standardization of the professional practices and the enhancement of the role of each person. The advantages appear at three levels: the child and his/her family, the medical and paramedical teams, and the administrative supervisory bodies.

Objective: The authors had for aim to describe the management of varicella and its complications in French ambulatory care., Methods: A descriptive prospective national survey was carried out in France on patients visiting a random sample of French GPs and pediatricians (investigators) having diagnosed varicella. During an inclusion period of 4 months, the investigators enrolled all patients (adults-children) who presented with varicella or varicella related complications, and who had not previously visited the investigator for this episode. Three questionnaires were used to record the data., Results: One thousand two hundred patients were enrolled by 393 physicians 75% of whom were GPs. Ninety-four percent of patients were children under 13 years of age (group I). The sex ratio (M/F) was 1.1. The mean age was 3.5 years in group I and 23.8 years in patients over 13 years of age (group II). The mean length of the varicella episode was about 10.7 days. Most patients were given a pharmaceutical prescription on inclusion, 1% were also prescribed medical procedures, 0.3% were given local treatment, and 0.09% underwent physical therapy sessions. A proportion of 12.6% of patients visited their physician twice or more for the same episode. Six group I children were hospitalized. Eighty-seven patients presented with at least one complication i.e. 7.8% (95%CI=6.3-9.3) of all episodes, mainly bacterial superinfections., Conclusions: The rate of complications associated with varicella infection was higher than usually reported in France but in the same order of magnitude as in other developed countries. Bacterial superinfections were found to be the most frequent complications of varicella.

Despite new understandings in pathophysiology, sepsis mortality remains high in children. Recently, it has been demonstrated that early goal directed therapy may decrease septic shock mortality. The aim of this paper is to propose practical clinical guidelines based on earlier consensus recommendations. Septic shock must be rapidly suspected and early recognized. Bases of treatment are maintenance of adequate oxygenation with use of artificial ventilation if necessary, larger and faster volume resuscitation than recommended before, empiric antibiotherapy and early use of vasopressive agents associated with corticosteroids in particular situations. Treatment efficacy must be regularly assessed during first hours of resuscitation. Taking into account pediatric particularities and results of adult studies, pediatricians who take care of children at beginning of septic shock may reasonably hope to decrease mortality if they keep in mind specific therapeutic goals.

Unlabelled: 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.

Childhood-onset systemic lupus erythematosus (SLE) is often severe and has a serious long-term morbidity. Pediatric guidelines about its management do not exist. The French study group of childhood-onset SLE proposes recommendations about the investigation which are needed at diagnosis and during follow-up of SLE, in order to adjust the treatment according to the severity of the disease and to avoid unnecessary investigations.

Since 1947 (the Nuremberg Code), the ethics of experimentation on human beings is based on the principle of the informed consent of the subjects participating in the research. In this context, research in paediatrics raised particular and difficult problems. International regulations have evolved in a way that has permitted paediatric research, within strict limits. However, recent studies have shown that the level of clinical paediatric research remains weak. There are economic reasons for this. But it also reveals the persistence of an ethical conflict: some people fear that a relativisation of the principle of consent (proxy consent) will lead to weakened protection for the most vulnerable subjects, including children. The ethics of responsibility requires a balance between the protection of the child as an individual (who should never become a medical guinea-pig) and the protection of children as a group (who should never be deprived of the benefits of the medical research).