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Outdoor pollution is a complex mix of more than 200 air contaminants. Among these pollutants, ozone, nitrogen dioxide and fine particles may generate bronchial inflammation and hyperreactivity. The hypothesis that pollution contributes to the development of asthma in children is based on epidemiological, clinical and experimental data. Many risk factors during the in utero and postnatal period have been identified in the aetiology of childhood asthma. During pregnancy, outdoor pollution was identified as a causal factor of respiratory disease in neonatal cohort studies. Several epidemiological studies also demonstrate that outdoor pollution is a trigger of asthma exacerbations. This review aims to highlight the current knowledge on outdoor pollution and asthma. [ABSTRACT FROM AUTHOR]

Résumé Le piercing se pratique sur des sites corporels divers parmi lesquels les oreilles et notamment le cartilage ont un franc succès. Nous rapportons deux cas d’adolescentes ayant présenté une chondrite à Pseudomonas aeruginosa liée à ces piercings . Summary The frequency of body piercing has increased in France over the past few years, particularly among teenagers. Piercing can be performed at different sites on the body, especially in the cartilage of the ears. We relate two cases of Pseudomonas aeruginosa chondritis. A 10-year retrospective study at the Marseille University Hospital found no additional pediatric cases. These infectious complications can sometimes be necrotizing. It is therefore important to inform the medical staff on the hygiene measures that need to be respected and the patients on the treatment to follow after the piercing as well as the signs to watch for, possibly indicating chondritis. The esthetic consequences depend on early diagnosis. [ABSTRACT FROM AUTHOR]

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Summary: In vitro assays that measure the interferon gamma production by T cells incubated with specific antigen of Mycobacterium tuberculosis may be useful in the diagnosis of tuberculosis in children. Compared to Mantoux test, these tests are easier to perform and have a greater specificity, especially because they do not cross-react with BCG vaccine and with most of environmental Mycobacteria. However, their sensitivity is not well evaluated in children. To date in pediatrics, they can be associated with Mantoux test for the diagnosis of active tuberculosis. In the diagnosis of latent tuberculosis infection, larger studies with commercial kits are required. [Copyright &y& Elsevier]

Abstract: Nebulisation provides a means to administer drugs directly into the airways and requires little cooperation on the part of the child. Nevertheless, this route of administration is still not very well known. Used especially in the treatment of asthma and cystic fibrosis, also sometimes in treatment of AIDS, it has undergone a number of developments including the type of molecules used to improve the system of nebulisation. Here are some practical recommendations to consider that are aimed at assuring a certain efficacy of this form of treatment: (1) prescribe a facial mask for children up to three years of age and an oral adapter for children older than three years of age; (2) always control the compatibility of the compressor–nebuliser and the drug used; (3) avoid mixtures of drugs (except salbutamol and ipratropium); (4) in asthma, replace nebulisation as soon as possible with a metered dose inhaler coupled to an inhalation chamber; (5) discuss disinfection procedures with the patient. [Copyright &y& Elsevier]

Abstract: Community-acquired pleural infection is a life-threatening complication of pneumonia in children. It seems to be more prevalent actually. This pathology is associated with an high morbidity and frequently requires prolonged hospitalization and invasives procedures. However, there is no consensus on its management in pediatrics, especially because of the lack of trials. To improve the quality of the future studies and to compare the series, a child-adapted classification is required. To date, in attempt of evidence, chest drainage or thoracocentesis-thoracoscopy are questionable. For treatment, high regimens of synergic and intravenously-delivered antibiotics seem to be the better choice. [Copyright &y& Elsevier]

Abstract: Aerosol delivery systems have progressed considerably in recent years. Soon, only hydrofluoroalkane-134a will be used as propellant in pressurized metered-dose inhalers. Some of them are now equipped with a dose counter. New mechanical and electrostatic devices will soon be available. A large variety of inhalation chambers is also becoming available; now, even a vertical one exists. The challenge for manufacturers of dry powder inhalers is to design devices that deliver the powder directly into the airways, thereby reducing the patient''s need for inspiratory effort; they are working actively on the formulation and production of such devices. Small, silent membrane-vibrating nebulizers with rapid delivery are becoming available. Other devices are being designed to control the patient''s respiration totally during nebulization; when used with inhaled fibrous aerosol particles, these devices may be the ideal aerosol delivery systems with optimal efficacy. [Copyright &y& Elsevier]

Numerous advances have been made during these last years for the optimization of inhaled therapy in children. The use of the best device adapted to the age of the child, the decrease of the electrostatic forces inherent to the plastic walls of the spacer devices, the importance of the right combination of drug and device for generating droplets susceptible to be deposited into the lungs, and the knowledge of drug that can be inhaled once daily have improved the efficacy of inhaled therapy. Development of novel devices that address the limitations of conventional devices is a new step. Novel liquid-based devices (pressurized metered-dose inhaler and nebulizer) can be grouped into three types: mechanical (mechanical energy is generated with a piston or a spring), vibrational (reservoir of fluid or membrane which vibrates at ultrasonic frequencies), and electrostatic (use of an electric field for transforming liquid to fine particles spray). Re-usable dry powder inhaler, allowing the delivery of different drugs, is currently tested. Such improvements in the inhaled therapy permit to treat respiratory diseases of course, but also other extra-pulmonary diseases like diabetes mellitus, pulmonary hypertension, dolor, and even to deliver vaccines. [Copyright &y& Elsevier]

Abstract: The revival of nebulization as a drug delivery route is real. The current delivery systems respond to the new European norms, the new mesh-vibrating nebulizers allow delivering drugs more quickly, other nebulizers, more performant because of less drug losses and of a better lung deposition of the drug, are in progress. Only 12 drugs are commercialized for nebulization. All are available in dispensaries, some requiring a first prescription by a physician working in a hospital (cystic fibrosis drugs), others requiring a prescription from only some specialists as paediatricians or pulmonologists (bronchodilators). Works are in progress concerning the diameter and shape of the drug particles (nanotechnology) and also concerning the use of nebulized drugs for a systemic effect (vaccines, insulin, cyclosporine, anticancerous agents, etc.). [Copyright &y& Elsevier]

Abstract: Inhaled drug-delivery devices have undergone considerable improvement in recent years. For one thing, chlorofluorocarbon propellants are being replaced by hydrofluoroalkane propellants. Metered-dose inhalers are now available. Such devices are being used as first choice for the treatment of mild to moderate asthma attacks in infants, and they can be used to deliver treatment to sleeping infants. Devices with a vertical chamber will soon be available. Dry-powder inhalers, where the powder disaggregates either with or without an inspiratory effort, are being studied. Devices that have a vibrating membrane have been marketed recently. These devices are small, quite and reduce the duration of nebulization. Finally, whatever the device, to limit the loss of drug and to avoid making the child cry, the patient''s age must be taken into consideration. [Copyright &y& Elsevier]

Objectifs L’objectif principal est de mesurer l’impact des particules en suspension (PM), estimé à proximité du domicile des enfants, sur les admissions pour exacerbation d’asthme aux urgences dans le département des Bouches-du-Rhône en 2013 chez l’enfant. Matériel et méthodes Un cas témoins emboîté dans une cohorte est réalisé chez les enfants de 3 à 18 ans. L’appariement était aléatoire sur le jour de la consultation aux urgences. L’exposition aux PM 10 et PM 2,5, les données météorologiques, polliniques et virologiques du jour de consultation étaient corrélées au code géographique du domicile du patient et analysées par rapport au motif de consultation. Résultats principaux Notre étude concernait 68 897 consultations, dont 1182 asthmatiques. L’exposition à court terme aux PM 10 était associée à un excès de risque de consultation pour asthme (RR = 1,02, IC 95 % :1,01–1,04 ; p = 0,02). Le sexe masculin, le jeune âge et la température étaient également des facteurs de risque. Par contre, le vent était retrouvé comme facteur protecteur. Conclusion Les PM 10 et certains facteurs météorologiques, estimés au plus proche du domicile des enfants, augmentent le risque de consultation aux urgences pour exacerbation d’asthme chez les enfants de 3 à 18 ans dans les Bouches-du- Rhône. [ABSTRACT FROM AUTHOR]

Abstract Introduction There are few studies that have investigated the long-term outcome of children who have been victims of shaken baby syndrome (SBS). However, the consequences appear to be significant and the data available from a social point of view are scarce. The main objective of this study was to define the medical and social outcome in 2016 of the infants who were victims of SBS and admitted to one of the Marseille university hospitals. The number of patients followed by a specialized team was evaluated along with their clinical state, living conditions, and whether a social support system such as the Child welfare system had been put into place. Method The study was retrospective and descriptive. Patients under 1 year of age who were hospitalized between January 2005 and December 2013 and manifested clinical and paraclinical characteristics enabling the diagnosis of SBS were included in the study. The diagnosis was certain, probable, or possible according to the definitions given by the consensus of the 2011 shaken baby health authority conference (HAS). Results Eighty babies qualified for the study, three of whom died in intensive care. Only ten of these patients (12.9%) had regular (annual) neuropediatric check-up during the whole study period. Thirty-seven patients (48%) had an annual neuropediatric check-up during the first 2 years only following the diagnosis. Only 12 of the children (15.6%) were still being followed after the age of 6. The children were followed up on average for 2.5 years (29.6 months). In 24 cases (31%), the last medical visit revealed an abnormal neurological examination including multiple disabilities due to spastic quadriplegia and severe intellectual deficit, which led to total dependency in half of these cases. Forty-four patients (57%) had a normal neurological examination. Concerning the babies' social outcome, 50 patients (64.9%) had returned home, 12 (15.6%) benefited, from educational assistance at the patient's home (AEMO) following the ruling of a children's judge, and 19 (24.7%) were still placed in foster care (ASE). The average foster care placement lasted 34.7 months. Discussion and conclusion Long-term medical follow-up for children having sustained serious head injury as a result of abuse is inadequate. Sequelae such as multiple disabilities are less frequent than described in the literature. According to this study, a longer-term follow-up is necessary for children suffering from sequelae such as learning disabilities than what is actually possible in our center. [ABSTRACT FROM AUTHOR]

Résumé Introduction S’il existe des recommandations de la Haute Autorité de santé (HAS) de prise en charge concernant le syndrome du bébé secoué (SBS), beaucoup d’autres situations d’enfant en danger n’entrent pas dans ce cadre et le bilan à réaliser dans ces circonstances n’est pas défini. L’objectif de notre étude était de faire un état des lieux de la prise en charge paraclinique de l’enfant en danger en France et d’évaluer son adéquation aux recommandations quand elles existent. Méthodes Il s’est agi d’une étude multicentrique observationnelle réalisée sur 5 mois (18 février 2015 au 1 er juillet 2015) effectuée par courriel auprès de 128 centres hospitaliers français (35 centres hospitaliers [CH] universitaires et 93 CH généraux) prenant en charge des enfants en urgence et en hospitalisation. Trois situations cliniques d’enfance en danger ont été soumises sous forme de cas clinique-questionnaire à choix multiples concernant la prescription d’examens paracliniques. Le cas 1 portait sur une situation de maltraitance physique, le cas 2 traitait d’une situation de négligence lourde et le cas 3 d’une agression sexuelle chez une jeune adolescente. Nous avons décrit les principaux résultats, puis évalué leur adéquation au protocole HAS pour le cas 1. Résultats Sur les 128 CH interrogés, 104 (81 %) ont répondu, correspondant à 274 médecins. L’analyse des résultats a montré une grande hétérogénéité dans les pratiques. La majorité des médecins (99 %) proposaient de réaliser un bilan systématique dans le cas 1 et seulement 27 % dans le cas 2. Le cas 3 a été le plus consensuel avec la recherche de maladie sexuellement transmissible mais l’association d’autres sévices n’était pas recherchée. Pour la première situation, l’indication des examens était en adéquation avec les recommandations de la HAS dans moins de 50 % des cas hormis pour le FO. L’imagerie abdominale était peu réalisée (40 % des cas) mais des examens non recommandés étaient encore prescrits. Par ailleurs, la fratrie de moins de 2 ans était explorée dans seulement 32 % des cas et les pratiques n’étaient pas influencées par l’âge de l’enfant. Conclusion Cette enquête illustre l’hétérogénéité de la prescription des explorations complémentaires devant une situation d’enfant en danger en France. Il semble donc utile d’aboutir à des protocoles communs sur le territoire national, guidant la réalisation des examens les plus pertinents pour établir un diagnostic précis et la prise en charge médicolégale qui peut en découler, mais également d’échanger sur nos pratiques entre les différents centres. Summary Introduction Even if there are HAS (French National Health Authority) guidelines on shaken baby syndrome, many other child abuse situations are not included in these recommendations. The aim of this study was to invent the complementary exams in cases of child abuse in France and compare the practice to existing guidelines. Material and methods This was a multicenter study by email to 128 French hospitals (35 university hospitals and 93 general hospitals) that receives children in emergency and hospitalization settings. Three child abuse clinical situations were included in a clinical case multiple-choice format concerning the further explorations. We described the main results and evaluated their adherence to the HAS protocol for case 1. Results Of 128 hospitals surveyed, 104 responded, for an 81 % response rate, which corresponded to 274 doctors. Analysis of the results showed great heterogeneity in practices. The majority of physicians (99 %) performed systematic explorations in the situation of physical abuse, while only 27 % undertook such exams in situations of serious neglect. The situation of sexual abuse was the most consensual in terms of diagnostic tests for the detection of sexually transmitted diseases, but other types of associated abuse were not sought. In the first case, the HAS guidelines were respected in less than half of the cases for all complementary exams except the eye fundus exam. Abdominal imaging was insufficiently performed (40 % of cases). Examinations that were not indicated were still prescribed. Moreover, siblings under 2 years of age were examined in only one-third of cases ( n = 88/274; 32 %). Practices were not influenced by the age of the child. Conclusion This study illustrates the heterogeneity in the use of complementary exams in cases of child abuse in France. Common protocols throughout the country would be useful, standardizing the most relevant exams for potential medical-legal issues, and facilitating exchanges concerning practices between different centers. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’obésité de l’enfant expose à des complications multiples, notamment cardiovasculaires et métaboliques à l’âge adulte. Elle peut aussi occasionner des troubles respiratoires, encore insuffisamment recherchés. L’objectif de cette étude était de faire une évaluation des pratiques pour le dépistage et le diagnostic des troubles respiratoires des enfants obèses adressés dans un centre spécialisé pédiatrique de l’obésité. Patients et méthodes Étude rétrospective des enfants atteints d’obésité sévère non syndromique ou explorés en hospitalisation (durée de recueil : 21 mois). Les caractéristiques cliniques (antécédents, paramètres anthropométriques, habitudes alimentaires, acanthosis nigricans, symptômes de syndrome d’apnées obstructives du sommeil [SAOS]), paracliniques (bilan endocrinien, gazométrie, enregistrement du sommeil) et la prise en charge ont été relevées. Résultats Parmi 102 enfants inclus (âge moyen de 10,5 ± 3,3 ans, Z -score d’indice de masse corporelle [IMC] moyen de 4,52 DS ± 1,5), 30 présentaient une symptomatologie de SAOS et 9 avaient une polysomnographie pathologique confirmant le SAOS. Huit d’entre eux ont été ventilés : ces enfants avaient une obésité plus sévère avec un rebond d’adiposité plus précoce (2,17 ± 1,2 ans vs 4,0 ± 2,2 ans, p = 0,01) et un Z -score plus élevé (7,2 DS ± 2,3 vs 4,3 DS ± 1,1, p = 0,027). Un syndrome obésité-hypoventilation (SOH) a été diagnostiqué pour 4 d’entre eux. Conclusion Les diagnostics du SAOS et du SOH, souvent méconnus chez l’enfant obèse, nécessitent une démarche systématique et précoce de dépistage clinique des troubles respiratoires. Une meilleure accessibilité aux explorations respiratoires permettrait d’améliorer la qualité de prise en charge de ces enfants particulièrement préoccupants. Summary Pediatric obesity may induce multiple complications, including cardiovascular and metabolic problems in adulthood. It may also cause respiratory disorders, which are not usually the first-intention diagnosis by physicians. The aim of this study was to evaluate how investigations had been performed in obese children referred to Timone Pediatric Hospital. Patients and methods A retrospective study of children referred to our department for severe non-syndromic obesity was conducted. The clinical features comprised history, anthropometric parameters, dietary habits, acanthosis nigricans, symptoms of obstructive sleep apnea syndrome (OSAS) as well as the paraclinical endocrine markers, blood gases, and sleep recordings. Results Of 102 patients (mean age, 10.5 ± 3.3 years; BMI Z -score, 4.52 ± 1.5), 29.4% had OSAS symptoms ( n = 30). Nine had a pathological polysomnography confirming OSAS. Eight of them required ventilation: these children were the most severe with an earlier weight gain (2.17 ± 1.2 years vs. 4.0 ± 2.2 years; P = 0.01) and a higher BMI Z -score (7.2 ± 2.3 vs. 4.3 ± 1.1; P = 0.027). Obesity hypoventilation syndrome (OHS) was diagnosed in 3.9% of these children ( n = 4). Conclusion Diagnosis of OSAS and OHS, often overlooked in obese children, requires a systematic approach and early clinical detection of respiratory disorders. Better accessibility to sleep respiratory explorations would improve quality of care for these children. [ABSTRACT FROM AUTHOR]

Résumé Introduction L’objectif de cette étude était d’évaluer les connaissances et le vécu des parents d’enfants asthmatiques âgés de 2 à 15 ans consultant en service d’accueil des urgences (SAU) pour une exacerbation et d’en déduire les éléments éducatifs à améliorer. Matériel et méthodes Il s’est agi d’une étude qualitative descriptive multicentrique basée sur un auto-questionnaire et réalisée sur 9 mois. Résultats Quatre-vingt-huit enfants ont été inclus sur les 1472 venus aux SAU pour une exacerbation (6 %). Soixante-neuf pourcent présentaient un asthme partiellement ou non contrôlé, 50 % n’avaient ni traitement de fond ni de suivi médical suffisant. La moitié des parents n’avaient pas reçu d’information sur l’asthme. La majorité (86 %) ne savait pas que c’était une maladie inflammatoire ; 30 % ne reconnaissaient pas les signes de gravité d’une exacerbation ; 17 % n’utilisaient pas de protocole d’urgence. D’après les parents, le vécu de la maladie était plutôt simple pour 2/3 des enfants et seulement la moitié de ces parents était d’accord avec cette perception. La moitié également craignait les effets secondaires du traitement et ne constatait pas de répercussions dans la vie quotidienne. Discussion La connaissance des parents et de leurs enfants asthmatiques est insuffisante pour un contrôle optimal. L’amélioration de la reconnaissance des signes de gravité, du suivi, de l’utilisation du protocole d’urgence devraient être privilégiée, diminuant ainsi le recours aux SAU. Conclusion Le médecin a un rôle de communication primordial à jouer pour améliorer les connaissances sur l’asthme, la qualité du traitement et du suivi, et dans l’éducation thérapeutique. Les structures d’éducation thérapeutique devraient être renforcées. Summary Introduction This study aimed at assessing parents’ knowledge and perception in relation to their child's condition when arriving at the emergency ward following an asthma attack. The overall objective was to determine how parent education could be improved. Materials and methods This study was conducted over 9 months as a multicenter descriptive and qualitative study based on a self-administered questionnaire for parents of asthmatic children, aged 2–15 years. Results The questionnaire was delivered to 88 children out of 1472 (6%). Approximately 69% of the children included in the study presented with partially controlled or uncontrolled asthma. Fifty percent of the patients were insufficiently monitored and without therapy. Half of the parents said they had never received any information concerning their child's condition. The majority (86%) did not know the basic cause of the disease, 30% percent were unable to detect the features of clinical exacerbation, and 17% were not using an adequate emergency protocol. The illness experience was relatively easy for two-thirds of the children and the parents’ perceptions were in line in 50% of the cases. Discussion Knowledge of parents and their children suffering from asthma is insufficient for optimal control and disease management. Instructions on detecting the signs of asthma severity as well as the establishment of an individualized emergency protocol and medical follow-up should be of prime concern and could reduce emergency department use. Conclusion Doctors have a key role to play in educating and explaining disease characteristics to patients and their families. Therapeutic education also needs to be intensified. [ABSTRACT FROM AUTHOR]

Summary: Aims: In the past few years, survival has increased for people with cystic fibrosis (CF). Diabetes is an important complication of CF caused by pancreatic insufficiency, which reduces insulin secretion. Because of increased longevity of patients with CF, the prevalence of CF-related diabetes (CFRD) has increased. CFRD is associated with increased mortality and morbidity. Several studies have reported a decline in nutritional and pulmonary status 2–4 years before the diagnosis of CFRD. The introduction of insulin treatment can produce clinical improvement in weight and lung function. The oral glucose tolerance test is currently the reference method in screening for CFRD, but the current definition of diabetes based on the 2-h post-load plasma glucose level may not be the most accurate method for early detection of glucose tolerance abnormalities in CF. The continuous glucose monitoring system (CGMS) has been described as a useful tool for early detection of hyperglycemia in the CF patient. We tested the CGMS in CF patients with unexplained alteration of their general status. The aim of this study was to assess the value of the CGMS in this population. Methods: An annual OGTT (following World Health Organization recommendations) was conducted as a screening test to identify CFRD in patients aged over 10 years or patients aged under 10 years with a poorer clinical status. The CGMS was performed in patients with unexplained worsened clinical status and without diabetes in OGTT. Results: Forty-two patients aged from 8.5 to 19 years were screened using OGTT for CFRD. According to ADA criteria, 23 patients (54.8%) displayed normal glucose tolerance, 14 (33.3%) impaired glucose tolerance, and 5 diabetes (11.9%). Out of 37 nondiabetic, the CGMS was used in 20 patients with unexplained altered general status. The CGMS revealed peaks of glucose values greater than 2g/L in 16 patients, 9 patients with normal glucose tolerance, and 7 patients with impaired glucose tolerance. The mean CGMS glucose and time of glycemic monitoring above 1.4g/L increased in patients with peaks greater than 2g/L compared to patients without peaks (p =0.0016 and p =0.0069 respectively). After analysis of the CGMS, the prevalence of diabetes increased from 11.9 to 50%. Three patients aged less than 10 years with a normal OGTT profile presented glycemic peaks greater than 2g/L during CGMS. Conclusion: CGMS revealed more glucose metabolism abnormalities than OGTT in patients with unexplained altered general status. [Copyright &y& Elsevier]

Summary: Introduction: The aim of the study was to analyze the data of the NUAGES survey (a survey on the practice of nebulization in France), concerning the prescriptions of nebulized steroids from 514 pediatricians. Material and methods: The reason why nebulization was chosen as a delivery route, the diseases motivating the prescription, the age of the patients, the kind of drug used, and the prescription and device modalities were studied. Results: Efficacy in treating various respiratory diseases was the main reason cited for using nebulization, in particular severe persistent asthma (76%). Pediatricians prescribed nebulization mainly to infants (60%). The most frequently used drug was budesonide suspension (89%), but the intravenous route for steroids (18%) and drug admixtures (62%) were also proposed by nebulization. A specific prescription for the nebulizer was given in 75% of the cases, with the type of interface to use specified in 66%. Discussion: Pediatricians consider that nebulization is well adapted to young children. Although the proper steroid is usually chosen, unfortunately, it is often prescribed with other drugs, with 1 prescription out of 4 not following the recommendations. Prescription of the device is not optimal and may compromise the efficacy of the treatment. Conclusion: Nebulization is a potential mode of delivery for steroids that is difficult to prescribe and warrants improved pediatrician training. [Copyright &y& Elsevier]

We aimed to describe the real-life role of high-flow nasal cannula (HFNC) for bronchiolitis in infants under 3 months of age admitted to three general pediatric departments during the 2017–2018 epidemic period. We retrospectively assessed the clinical severity (Wang score) for every 24-h period of treatment (H0–H24 and H24–H48) according to the initiated medical care (HFNC, oxygen via nasal cannula, or supportive treatments only), the child's discomfort (EDIN score), and transfer to the pediatric intensive care unit (PICU). A total of 138 infants were included: 47 ± 53 days old, 4661 ± 851.9 g, 70 boys (50.7%), 58 with hypoxemia (42%), Wang score of 6.67 ± 2.58, 110 (79.7%) staying for 48 consecutive hours in the same ward. During the H0–H24 period, only patients treated with HFNC had a statistically significant decrease in the severity score (n = 21/110; −2 points, P = 0.002) and an improvement in the discomfort score (n = 15/63; −3.8 points, P < 0.0001). There was no difference between groups during the H24–H48 period. The rate of admission to the PICU was 2.9% for patients treated for at least 24 h with HFNC (n = 34/138, 44% with oxygen) versus 16.3% for the others (P = 0.033). Early use of HFNC improves both clinical status and discomfort in infants younger than 3 months admitted for moderately severe bronchiolitis, whatever their oxygen status. [ABSTRACT FROM AUTHOR]

We report the case of an 18-month-old infant with severe serotype 3 adenovirus pneumonia, exceptionally associated with hemophagocytic syndrome. Treatment included cidofovir and mechanical ventilation for 13 days. The child developed chronic respiratory insufficiency due to bronchiectasis and bronchiolitis obliterans. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Un protocole local de prise en charge des enfants hospitalisés pour bronchiolite aiguë, établi dans les suites d’une étude réalisée en 2012, recommande la réalisation d’une radiographie thoracique en cas d’évolution inhabituelle ou de suspicion de diagnostic différentiel. L’objectif de notre étude était d’évaluer nos pratiques professionnelles après diffusion de ce protocole. Matériel et méthodes Étude rétrospective descriptive réalisée sur les 2 sites de pédiatrie générale du centre hospitalier universitaire (CHU) de Marseille entre octobre 2013 et mars 2015, incluant tout nourrisson hospitalisé pour un premier épisode de bronchiolite aiguë sans pathologie chronique sous-jacente. Résultats Sur 599 nourrissons inclus (âge médian de 3,7 mois, 54 % de garçons), 355 (59,3 %) avaient eu au moins une radiographie thoracique (soit une baisse de 38,5 % en 3 ans). Elle était anormale dans 96,3 % des cas : syndrome bronchique ou distension thoracique (56,7 %), foyer de condensation (23,5 %), trouble ventilatoire (19,5 %). Une prescription hors protocole a été notée dans 42,5 % des cas. Le résultat de cet examen avait modifié la prise en charge pour 52 nourrissons : antibiothérapie pour pneumonie (86,5 %), diagnostic d’une cardiopathie (0,2 %). L’utilisation de la radiographie et de l’antibiothérapie avait été statistiquement différente d’un centre à l’autre. Discussion Notre protocole a permis une réduction significative du nombre de radiographies thoraciques. Un grand nombre reste réalisé en dehors de nos recommandations, débouchant sur une prescription d’antibiotique pour pneumonie encore large. Conclusion La diminution du nombre de radiographies thoraciques dans le cadre d’une hospitalisation pour bronchiolite reste insuffisante. Summary Objective A management protocol for infants hospitalized for acute bronchiolitis, established after the study conducted in our unit in 2012, recommends a chest X-ray when the clinical course is unusual or if a differential diagnosis is suspected. The goal of this study was to evaluate professional practices after the introduction of this new management protocol. Study design Retrospective descriptive study in two pediatric units from October 2013 to March 2015, including infants (0–23 months) hospitalized for their first episode of acute bronchiolitis without any underlying chronic condition. Result Overall, 599 infants were included (median age, 3.7 months, 54 % boys). Nearly six out of ten ( n = 355, 59.3 %) had at least one chest radiograph (38.5 % fewer than in 2012). It was abnormal in 96.3 % of cases, revealing distension and/or bronchial wall thickening (56.7 %), focal opacity (23.5 %), or atelectasis (19.5 %). An X-ray was performed out of the recommendations in 42.5 % of cases. The chest X-ray result led to management changes in 52 infants with prescription of antibiotics for pneumonia (86.5 %) and allowed the diagnosis of heart disease in one case (0.2 %). Management of acute bronchiolitis (X-ray and antibiotics) was statistically different between the two pediatric units. Discussion This protocol led to a significant decrease in the number of chest X-rays. However, many are still performed out of the recommendations, resulting in an increase of antibiotic use for pneumonia. Conclusion The decrease in use of chest X-rays in acute bronchiolitis for hospitalized infants was significant but remains insufficient. [ABSTRACT FROM AUTHOR]

Résumé Nous rapportons le cas d’un nourrisson de 21 mois, atteint de fibrose pulmonaire, qui a présenté une détresse respiratoire aiguë sévère et une atteinte hépatique par surdosage accidentel en émulsion lipidique intraveineuse. Cette intoxication rare a une gravité potentielle et un caractère quasi-exclusivement iatrogène qui méritent d’être rappelés. Summary We report the case of a 21-month-old child suffering from pulmonary fibrosis, who presented with acute respiratory distress and liver damage, due to an accidental overdose of intravenous lipid emulsion. This poisoning is a rare entity, whose potential severity and almost exclusive iatrogenic effect deserve to be remembered. [ABSTRACT FROM AUTHOR]

Résumé Introduction Il existe peu d’études concernant les problèmes médicaux rencontrés chez les enfants placés à l’Aide sociale à l’enfance (ASE). L’objectif de notre étude était de décrire la population des mineurs placés à l’ASE et ayant fait l’objet d’une notification à la MDPH (Maison départementale des personnes handicapées) des Bouches-du-Rhône au 1 er janvier 2014. Patients et méthodes Le registre informatique de l’ASE et celui de la MDPH ont été croisés afin d’en extraire les données administratives. Après une analyse des dossiers médicaux MDPH, les informations sur les enfants placés (âge gestationnel, déficiences, pathologies) ont été codées. Résultats Parmi les 2965 mineurs placés (0,7 % des mineurs de notre région), 506 (17 %) avaient une notification à la MDPH, contre 2,5 % en population générale. Parmi eux, 80,2 % avaient été confiés suite à une mesure de placement et 50 % des notifications MDPH concernaient les orientations vers un établissement scolaire et médico-social. On a noté 2,1 déficiences par enfant, dont 35,9 % étaient des déficiences du psychisme, 26,4 % des déficiences du langage et de la parole et 21,6 % des déficiences intellectuelles cognitives. Les pathologies rencontrées étaient pour 71 % des troubles mentaux et du comportement. Les enfants les plus jeunes et placés en famille d’accueil présentaient plus de pathologies et de déficiences d’organe et peu d’atteintes du psychisme. Les enfants présentant des troubles du comportement étaient en général plus âgés et placés en foyer. Discussion Le taux de notification MDPH est 7 fois plus élevé parmi les enfants placés qu’en population générale. Ce lien entre enfance en danger et handicap est difficile à expliquer, et la psychopathologie des enfants placés complexe. Ces résultats illustrent la nécessité d’un suivi adapté aux besoins spécifiques de ces enfants. Summary Introduction By the end of 2011, 275,000 children in France were included in the Aide sociale à l’enfance (ASE, Child Welfare System). Half of these children were entrusted to public care. There is limited data on these children. The MDPH (Maison départementale des personnes handicapées) is an administrative body assisting in the care of disabled children, through material, financial, and human means. Analyzing MDPH medical records can provide medical information about these children. The aim of this study was to describe the characteristics of children left to the ASE with a record at MDPH in Bouches-du-Rhône. Methods We extracted administrative data from two registers, the ASE register and the MDPH register. The MDPH medical files of each patient were analyzed and their medical information was coded: gestational age, deficiencies, and pathologies. Results In Bouches-du-Rhône, 2965 children were entrusted, 506 (17%) of whom were known by the MDPH: 30.6% of the entrusted children known by MDPH were taken into foster care and 48% were in residential group homes. Half of the MDPH notifications concerned a referral to a school or medico-social institution. By analyzing the medical data, we observed an average of 2.1 deficiencies per child. The types of deficiencies were distributed as follows: 35.9% were psychological deficiencies, 26.4% were speech deficiencies, and 21.6% were intellectual cognitive deficiencies. The most common pathology was mental and behavioral disorder (71% of diagnoses). Discussion The MDPH notification rate in children entrusted to public care was seven times higher than in the general population. Overall, explaining the relation between child abuse and neglect and disability is difficult. The psychopathology of these children is complex. These results show the importance of specific medical monitoring for these children. [ABSTRACT FROM AUTHOR]

Résumé Nous rapportons le cas d’un enfant de 3 ans présentant un syndrome du triple A (achalasie, alacrymie et insuffisance surrénalienne) dont le point d’appel clinique a été de façon tout à fait exceptionnelle une dilatation de bronches. Summary We report on the case of a 3-year-old child presenting bilateral bronchiectasis due to recurrent pneumonia with esophageal achalasia. The final diagnosis was triple A syndrome. This presentation is particularly atypical and rare at this age. [ABSTRACT FROM AUTHOR]

Résumé Des critères d’hospitalisation pour la bronchiolite aiguë du nourrisson ont été établis lors de la conférence de consensus de 2000. Cette étude avait pour objectif d’évaluer leur impact sur l’hospitalisation dans les services d’accueil des urgences pédiatriques (SAUP). Matériel et méthodes Il s’est agi d’une enquête observationnelle multicentrique un jour donné dans 66 SAUP répartis sur l’ensemble du territoire. Le questionnaire portait sur la structure évaluée et étudiait le parcours de soin, l’état clinique, la prise en charge et le devenir de chaque nourrisson présentant un premier épisode de dyspnée sifflante. Une question ouverte permettait de détailler sur quel(s) critère(s) l’hospitalisation était décidée. Le modèle de régression logistique a été utilisé pour identifier des critères cliniques indépendants conduisant à l’hospitalisation. Les données ont été comparées par le test t de Student ou le test de Chi 2 . Résultats Pour 338 enfants inclus, 145 ont été hospitalisés (45,1 %). Les critères ayant le plus de poids dans le choix d’hospitalisation ont été un aspect toxique (OR: 3 [IC 95 %: 1,0–8,5], p = 0,04), une fréquence respiratoire supérieure à 60/minute (OR: 3,4 [IC 95 %: 1,3–8,8], p = 0,02), un âge inférieur à 6 semaines (OR: 29,8 [IC 95 %: 7,0–125,4], p < 0,001), une saturation pulsée en oxygène inférieure à 94 % (OR: 15,8 [IC 95 %: 4,2–60,1], p < 0,001), une prise alimentaire de moins de la moitié de la ration habituelle (OR: 4,9 [2,2–9,9,10], p < 0,001), et un âge compris entre 6 semaines et 3 mois (OR: 3,2 [1,2,4–7], p = 0,007). Conclusion Les critères cliniques de gravité de la conférence de consensus de 2000 influencent la décision d’hospitalisation. Cependant d’autres critères sont retenus dans près de 1/3 des cas. Summary The 2000 French guidelines for acute viral bronchiolitis management underlined clinical criteria for hospitalization. We aimed to assess the impact of these guidelines on admission rates in pediatric emergency departments. Methods A prospective multicentric observational study was conducted over 24 h in 66 pediatric emergency departments. Questions were asked about the structure, the course of care, clinical data, resource utilization, and hospitalization or discharge of every patient under 2 years of age with acute viral bronchiolitis. An open-ended question allowed clinicians to explain the reason for hospitalization. Multivariable logistic regression analyses were performed to identify independent risk factors for severe disease to assess potential clinical factors associated with hospitalization. Responses were compared using the Student t -test and the Chi 2 test. Results Of 338 patients enrolled, 145 (45.1%) were admitted. Clinical criteria were associated with hospitalization: clinical deterioration (OR: 3 [95% CI: 1.0–8.5], p = 0.04), respiratory rate more than 60/min (OR: 3.4 [95% CI: 1.3–8.8], p = 0.02), age under 6 weeks (OR: 29.8 [95% CI: 7.0–125.4], p < 0.001), oxygen saturation less than 94% (OR: 15.8 [95% CI: 4.2–60.1], p < 0.001), food intake less than 50% of the usual intake (OR: 4.9 [95% CI: 2.2–10.9], p < 0.001), and age between 6 weeks and 3 months (OR: 3.2 [95% CI: 1.4–7.2], p = 0.007). Conclusion The clinical criteria of the 2000 French guidelines influence hospitalization for acute viral bronchiolitis in pediatric emergency departments. However, other criteria are cited in about one-third of the patients. [ABSTRACT FROM AUTHOR]

Résumé Chaque hiver, la bronchiolite aiguë du nourrisson est responsable d’un grand nombre d’hospitalisations. Son traitement est avant tout symptomatique et a été codifié lors d’une conférence de consensus de la Haute Autorité de santé (HAS) en 2000. La kinésithérapie respiratoire y avait été mise en avant pour lutter contre l’encombrement et l’obstruction bronchique. Même si les techniques diffèrent d’un pays à l’autre, elle est devenue quasi systématique dans la prise en charge de la bronchiolite aiguë du nourrisson. Mais qu’en est-il réellement de son efficacité ou de sa légitimité ? L’objectif de notre étude était de faire la revue de la littérature sur ce sujet. Peu d’études sont disponibles avec de faibles niveaux de preuve. Elles tendent à montrer que la kinésithérapie respiratoire n’aurait qu’un faible intérêt dans la prise en charge de la bronchiolite aiguë du nourrisson ne modifiant pas l’histoire naturelle de la maladie ou la durée d’hospitalisation. Au total, on ne peut recommander de manière systématique la kinésithérapie chez les nourrissons hospitalisés pour bronchiolite aiguë. Summary Every winter, numerous infants are hospitalized for acute bronchiolitis. The severity criteria and symptomatic treatment are well known, with chest physiotherapy codified in 2000 by the French Health Authority (HAS) consensus conference (with techniques varying from one country to another) and becoming nearly systematic for the treatment of bronchial obstruction in infants. However, is this treatment really effective and legitimate for acute bronchiolitis? The objective of this study was to review the main studies on this subject. Few studies are available and most have a low level of evidence. However, they all tend to agree that chest physiotherapy does not change the natural history of the disease and most particularly the duration of hospitalization. Therefore, it does not seem that the prescription of chest physiotherapy in infant acute bronchiolitis is recommended. [ABSTRACT FROM AUTHOR]

Résumé Introduction Chez l’enfant les exacerbations d’asthme sont le plus souvent déclenchées par une infection respiratoire. L’objectif de cette étude était d’évaluer l’intérêt de l’identification des pathogènes respiratoires chez les enfants hospitalisés pour une exacerbation d’asthme. Patients et méthodes Il s’agit d’une étude rétrospective incluant tout enfant hospitalisé pour une exacerbation d’asthme dans notre unité entre janvier 2010 et décembre 2011 et analysant la prescription des examens microbiologiques, leurs indications, leur rendement, leur impact sur la prise en charge médicale et leur coût. Résultats Cent quatre-vingt-dix-sept enfants ont été inclus. Une recherche d’agent pathogène respiratoire avait été réalisée chez 157 enfants (79,7 %), surtout en cas d’infection oto-rhino-laryngologique (ORL), d’hypoxémie ou de pneumonie. Un virus avait été identifié chez 30 (23,8 %) des 126 enfants prélevés. Les analyses bactériologiques avaient eu un rendement faible puisque seulement 3,2 % des analyses par amplification génique (PCR) pour Mycoplasma pneumoniae avaient été positives ( n = 4/125). Aucune autre bactérie n’avait été identifiée. Aucun lien n’a pu être établi entre les résultats microbiologiques et la gravité de l’exacerbation. La prise en charge thérapeutique avait été peu modifiée par ces résultats. Le coût global avait été de plus de 40 400 euros pour les 2 ans d’étude. Conclusion D’après nos résultats la recherche de pathogènes respiratoires au cours des exacerbations d’asthme a un intérêt modéré en dehors de l’aspect épidémiologique. L’impact du rhinovirus, du coronavirus, du bocavirus et de l’entérovirus, non recherchés en routine hospitalière, reste cependant à préciser. Summary Background Asthma is the most common chronic disease in childhood. With its high economic burden, it is considered a disease of major public health importance by the World Health Organization. The link between respiratory tract infections and acute exacerbation has been recognized for a long time. The aim of this retrospective study in routine care was to evaluate our practices concerning microbiological prescriptions in children hospitalized for asthma exacerbation. Study design All children aged from 2 to 15 years hospitalized for asthma exacerbation between January 2010 and December 2011 in our unit were included in the study. Microbiological prescriptions, their indications, their results, and their cost were studied. Results One hundred ninety-seven children were included in the study. A potential causative agent was sought in 79.7% of the children ( n = 157) by immunofluorescence assay (IFA) and/or polymerase chain reaction (PCR). The main indications were upper airway infections, hypoxemia, and pneumonia. Viruses were detected in 23.8% of them (30/126). Mycoplasma pneumoniae was detected by PCR in only 3.2% of these patients (4/125). No other bacterial agent was identified. There was no correlation between the severity of asthma exacerbation and the microbiological diagnosis of infection. The results did not influence the therapy given. These prescriptions represented a substantial cost for each child. Conclusion These analyses do not seem to have a real advantage for the patient except for epidemiology. It would be important to conduct a new study analyzing the role of rhinovirus, and of other viruses such as coronavirus, bocavirus, and enterovirus, not routinely investigated in our hospital, and to question the value of these costly microbiological tests. [ABSTRACT FROM AUTHOR]

Résumé: La reperméation de fistule œso-trachéale (FOT) est une complication secondaire possible de l’atrésie de l’œsophage (AO) opérée observée dans environ 10 % des cas. À partir d’une cohorte de 67 enfants opérés d’une AO de type III entre 1998 et 2009, nous avons voulu préciser le nombre d’enfants ayant présenté une reperméation de FOT, les facteurs de risque de reperméation et les traitements entrepris. Le sex-ratio était de 1,7. La cure chirurgicale initiale avait eu lieu entre 4 et 36heures de vie. Cinq enfants (7,5 %) avaient présenté une récidive fistulaire, la plupart dans les 3 premiers mois de vie, se révélant par des symptômes respiratoires rythmés ou non par l’alimentation. Cette reperméation était plus fréquente en cas de fuite anastomotique (p =0,09) ou de pneumothorax (p <0,01) postopératoire. Le diagnostic avait été posé 4 fois sur 5 par endoscopie trachéo-bronchique avec test au bleu de méthylène. Le traitement avait été chirurgical pour 4 enfants, avec 3 complications postopératoires. Un enfant avait bénéficié de la pose endoscopique d’un clip sur le versant œsophagien. Avec un recul médian de 52mois après traitement, aucune FOT ne s’était de nouveau reperméabilisée. La reperméation de FOT semble liée à certaines caractéristiques postopératoires. Son diagnostic n’est pas aisé et son traitement mal codifié. Il faut évaluer les alternatives à une reprise chirurgicale qui pourraient peut-être diminuer à l’avenir la morbidité. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons le cas d’un adolescent hospitalisé pour une hémoptysie massive secondaire à des anastomoses systémo-pulmonaires directes traitées avec succès par embolisation. À notre connaissance, aucun autre cas n’a été rapporté dans la littérature, probablement du fait du caractère létal de ce type de malformation. [ABSTRACT FROM AUTHOR]

Résumé: Nous décrivons le cas d’un adolescent de 14ans qui a présenté un syndrome de Nicolau du membre inférieur droit. Ce syndrome faisait suite à une injection intramusculaire glutéale homolatérale de benzathine-pénicilline associée à de la lidocaïne, liée à une suspicion de rhumatisme articulaire aigu. Outre la rareté de ce syndrome, nous rapportons une association particulière à une torsion testiculaire aiguë. [ABSTRACT FROM AUTHOR]

Résumé: Le but de ce travail était d’évaluer le devenir (état de santé, suivi médicochirurgical recommandé par le centre de référence de l’atrésie de l’œsophage [AO] et la Haute Autorité de santé [HAS], et qualité de vie) d’enfants après cure chirurgicale d’une AO de type III. Les antécédents (période périnatale, malformations associées, complications respiratoires/digestives) des enfants opérés au centre hospitalier universitaire (CHU) de Marseille entre 1999 et 2009 ont été notés. Les parents devaient renseigner un questionnaire standardisé sur l’état de santé de leur enfant dans l’année précédente ainsi qu’un questionnaire de qualité de vie PedsL® 4.0 (rempli également par écrit par les enfants de plus de 8ans). Sur les 68 enfants opérés, 44 ont pu être contactés entre 3 et 12,8ans (âge moyen 7,6ans). Les antécédents notables étaient : pneumonie(s) (65 %), asthme du jeune enfant (66 %), hospitalisation pour motif respiratoire (45 %), chirurgie antireflux (20 %), dilatation œsophagienne (45 %). Au moment de l’enquête, on notait : toux chronique (16 %), asthme (30 %), dysphagie (39 %), et reflux gastro-œsophagien (RGO) clinique (9 %). Les recommandations de suivi clinique et paraclinique n’étaient pas respectées, excepté le suivi chirurgical jusque 6ans. Les scores de qualité de vie (n =43 enfants) étaient superposables à ceux d’enfants sains, mais diminuaient en cas de : gastrostomie (p =0,020), pneumonie (p =0,013), hospitalisation (motif respiratoire, p =0,006 ; digestif, p =0,01) ou asthme actuel (p =0,004). En conclusion, malgré des symptômes respiratoires ou digestifs fréquents et un suivi médicochirurgical non conforme aux recommandations, la qualité de vie des enfants opérés d’une AO de type III est satisfaisante. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons le cas d’une maladie hémorragique tardive par carence en vitamine K, avec une prophylaxie adaptée mais insuffisante, secondaire à une cholestase extrahépatique. Cette forme tardive est devenue rare mais elle s’accompagne d’un risque d’hémorragie intracrânienne dans plus de la moitié des cas. Diagnostic, causes et prévention de cette maladie sont discutés. [ABSTRACT FROM AUTHOR]

Summary: Objective: To describe the chest radiographs of infants hospitalized for acute bronchiolitis and to assess whether patient management changed after radiography. Study design: All infants hospitalized in our pediatric unit with a first episode of acute bronchiolitis from October 2010 to March 2012 were included in the study. Infants with chronic disease or transferred from a pediatric intensive care unit were excluded. The following data were collected: sex, age, neonatal history, atopy, tobacco exposure, admission criteria, treatment, laboratory parameters, ultrasonography and its outcome, results of chest radiography on admittance, the reason for a second chest radiograph, change in management as a result of the radiograph. Results: The study comprised 232 infants (median age 2.2 months, boys 56%, positive respiratory syncytial virus 73.4%). Among them, 227 children had a routine chest radiograph revealing distension and/or bronchial wall thickening (n =141, 62.4%), focal opacity (19.9%), or atelectasis (17.7%). This radiograph led to the prescription of antibiotics in six patients (2.6%) and allowed the diagnosis of vascular abnormality to be made in one case (0.4%). Thirty-five patients (15.4%) had a second chest radiograph during their hospitalization owing to oxygen dependency (n =21), respiratory distress (n =11), persistent fever (n =2), or no reason specified (n =1). Pneumonia (n =7) and/or atelectasis (n =15) were then found in 62.9%. Patient management (antibiotics, postural maneuvers) was modified in six patients (17.1%). Conclusions: Routine chest radiographs contribute only partially to the treatment of infants hospitalized for acute bronchiolitis. However, radiography is useful when the hospitalized child does not improve at the expected rate or if the disease is severe. The indication of chest radiography in infants hospitalized for acute bronchiolitis should be discussed on a case by a case basis. [ABSTRACT FROM AUTHOR]

Summary: Airplanes are widely used by families and their children and pediatricians are increasingly asked to answer questions on this subject. The main purpose of this study was to evaluate the knowledge of pediatricians in this field except for medical transportation. Pediatricians belonging to the AFPA, the SFP, the SNPEH, or the SP2A were emailed a questionnaire on the physiological particularities of airborne transportation, contraindications to flight related to diseases (infections, diabetes, sickle-cell anemia, respiratory diseases, etc.) and the possible medication intake on board. Among the 232 responders, 82.3% had an exclusive hospital practice and 65% were specialized in more than one area of medicine. Regarding contraindications to flying, the rate of correct answers varied from 14 to 84% with divided opinions regarding respiratory and hematological pathologies. However, contraindications related to infections were well known. Items related to oxygen therapy raised questions as 35–68% of pediatricians stated that they could not answer. On the whole, this work demonstrated very fragmented knowledge on this topic. [Copyright &y& Elsevier]

Summary: Acute viral bronchiolitis affects infants, is frequent, and can be severe. Its treatment is only based on symptoms. Hypertonic saline (HS) may act favorably in this situation by fighting virus-induced dehydration of the airway liquid surface. Because of an osmotic action, HS attracts the water from the epithelial cells and improves mucociliary clearance. Five double-blind placebo-controlled studies concerning hospitalized infants with acute viral bronchiolitis showed that repeated nebulizations of 3% HS induce a 20% improvement in the clinical severity score and reduced the hospital length of stay by 24h. Tolerance is excellent. On the other hand, a few questions remain unresolved: what is the optimal salt concentration? What is the recommended nebulizer? What is the best frequency for nebulizer use? Can nebulized HS be used at home? What are the results with systematic physiotherapy when HS is used? [ABSTRACT FROM AUTHOR]