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Resume Le rotavirus est la cause la plus frequente de gastro-enterite (GEA) necessitant une hospitalisation chez l’enfant. C’est un virus tres resistant et contagieux a l’origine de nombreuses GEA nosocomiales (GEAN). En France, le vaccin contre le rotavirus est disponible depuis 2006, mais il n’est pas recommande. Le but de cette etude retrospective etait de decrire les GEAN a rotavirus et d’evaluer leur incidence chez les enfants hospitalises dans le service de pediatrie generale de l’hopital Robert-Debre (Paris) entre le 1 er janvier 2009 et le 31 decembre 2013. Nous avons evalue si ces enfants auraient pu beneficier de la vaccination contre le rotavirus. Resultats Au total, 136 enfants ont presente une GEAN a rotavirus, soit une incidence de 2,5 cas pour 1000 jours d’hospitalisation. Cette incidence est restee stable entre 2009 et 2013 malgre le renforcement des mesures d’hygiene. L’âge moyen des enfants etait de 7 mois (entre 0,5 et 111 mois). Les GEAN a rotavirus etaient survenues chez des enfants hospitalises le plus souvent pour une pathologie respiratoire aigue (65 %) et necessitant une hospitalisation prolongee (mediane = 18 jours). Un quart des enfants etaient nes prematures (25 %). L’hydratation a ete orale pour 80 enfants (59 %), par perfusion intraveineuse pour 18 (13 %) et par voie intra-osseuse pour 1 enfant. La moitie des patients etait âgee de moins de 5 mois et aurait pu beneficier de la protection fournie par la vaccination. Conclusion Les GEAN rotavirus sont frequentes. La vaccination des nourrissons contre le rotavirus permettrait de diminuer les hospitalisations pour gastro-enterite communautaire a rotavirus et, indirectement, de proteger les enfants porteurs de pathologies sous-jacentes trop jeunes pour etre vaccines.

BackgroundMycophenolate mofetil (MMF) is increasingly used in children with systemic lupus erythematosus (SLE). Monitoring of its active metabolite, mycophenolic acid (MPA), is performed for individual dosage adjustment of MMF and is based on determination of area under the plasma concentration-time curve (AUC12h) of MPA. The objective of this monocentric study is to describe the pharmacokinetics (PK) of MPA in paediatric patients with SLE or lupus nephritis.MethodsPatients with lupus treated by MMF between January 2009 and July 2018 were included. MPA plasma concentrations (T0, T0.5h, T1h, T2h, T3h, T8h and T12h) were determined by EMIT (enzyme-multiplied immunotechnique) and MPA AUC12h calculated according to trapezoid rule.ResultsTwenty-two patients were diagnosed with lupus at 11.5 ± 2.9 years. Clinical presentation was SLE (n=18) or isolated lupus nephritis (n=4). Treatments prior to MMF were steroids and/or immunosuppressants (endoxan, rituximab). Age at initiation of MMF (Cellcept®n=20, Myfortic®n=2) was 12.9 ± 2.6 years.PK of MPA was performed after 8.2 ± 14.8 months of treatment, under MMF dose of 840 ± 218 mg (577 ± 98 mg/m2). A large interindividual variability in MPA concentration-time profiles was observed with the following mean parameters: Cmax=4.60 ± 11.70 µg/mL, tmax=80 ± 77 min, trough plasma concentration (C0) = 2.30 ± 1.60 µg/mL and AUC0-12h=46.29 ± 17.39 µg*h/mL.ConclusionData on the PK of MPA in lupus children are limited. Our results show the high interindividual variability in MPA exposure after oral administration of MMF. Monitoring of exposure based on AUC in combination with immunological disease parameters will allow to individualise treatment to optimiseDisclosure(s)Nothing to disclose

Resume Depuis quelques annees, on observe une augmentation importante de l’obesite et des anomalies metaboliques qui l’accompagnent, ainsi que des maladies cardiovasculaires. Des etudes recentes montrent que les facteurs de risque de maladies cardiovasculaires apparaissent des l’enfance. Ces atteintes sont dans de nombreuses situations programmees tres tot pendant la vie embryonnaire et fœtale. C’est le concept du determinisme fœtal ou « programming » des anglo-saxons. Les premieres etudes sur ce sujet ont souligne le lien entre la restriction de croissance fœtale et le risque de developper des troubles nutritionnels et metaboliques a l’âge adulte. Mais, il apparait a l’heure actuelle que l’exces d’apports nutritionnels in utero avec un exces de croissance a la naissance comme cela se produit en cas de diabete maternel expose aux memes risques. L’ensemble des anomalies qui constituent les facteurs de risque de maladies cardiovasculaires est regroupe sous le terme de syndrome metabolique ou syndrome X. Ce syndrome initialement decrit chez l’adulte a fait l’objet d’etudes de plus en plus nombreuses chez l’enfant et l’adolescent car dans des populations a risque, des elements de ce syndrome sont observes des les periodes precoces de la vie. L’alteration du milieu intra-uterin entraine des modifications au cours du developpement qui sont des mecanismes d’adaptation a court terme et qui se transmettent de generation en generation. Ce phenomene transgenerationnel contribue a l’extension rapide des anomalies metaboliques et des maladies cardiovasculaires. De nombreux arguments existent en faveur de mecanismes epigenetiques a l’origine de ces modifications et de leur transmission transgenerationnelle. Un des defis dans les annees a venir sera de mettre en place des programmes de prevention permettant d’enrayer les consequences a long terme du determinisme fœtal.

We hereby report the third case of antenatal diagnosis of congenital cyst of the pancreas. It is a very rare lesion and could present as a differential diagnosis of any intra-abdominal cystic mass. Early treatment is easy and prevents complications such as ascites and pancreatitis in case of intra-pancreatic enteric duplication.

In right congenital diaphragmatic hernia (RCDH), several clinical diagnostic pitfalls are possible and should be known to those caring for infants and children with this disorder. The records of the 18 patients at Hotel Dieu de France Hospital with a history of CDH between 1990 and 1999 were collected; those of the ten who had a RCDH were reviewed retrospectively. The mean age at diagnosis was 6 months; the male-to-female ratio was 2:3. The delay between the first symptom and the diagnosis ranged between 0 and 10.5 months (mean 4.5 months). An acute presentation was observed in four cases, consisting of respiratory distress in three; the 4th presented with gastric volvulus and intestinal obstruction. The presenting symptoms were mild in four cases; recurrent respiratory infections in three and failure to thrive in one. The diagnosis was incidental in two cases during the evaluation of respiratory symptoms attributed to an atrial septal defect. The radiologic findings provided by a chest radiograph (CxR) were sufficient to make an accurate diagnosis in eight cases and peritoneography was useful in one. In six cases, the presenting CxR had been misinterpreted as normal or acute lobar pneumonia. Pathologic findings at surgery consisted of lateral and posterior right diaphragmatic defects in nine cases; the defect was lateral and anterior in one. A hernia sac was found in seven cases; malrotation was present in three. Surgical correction was done by an abdominal approach in nine cases and a thoracic approach in one. The diaphragmatic defect was repaired by transverse closure in six cases, diaphragm plication in three and prosthetic closure in one. The postoperative outcome was uneventful in eight cases. Two patients died. Thus, RCDH seems to cause less severe symptoms than left-sided LCDH. It usually manifests beyond the neonatal period as respiratory or gastrointestinal symptoms. The diagnosis should be made easily by a CxR. The presence of a hernia sac correlated with a mild presentation. An abdominal surgical approach is preferred.

We hereby report the second case of antenatally diagnosed "neurenteric cyst" in the literature. The patient we describe presented as a neonatal respiratory distress syndrome (NRDS) which did not respond to a vigorous resuscitation. Anomaly of the antenatal ultrasonography and of the initial chest x-ray added to the non-response to therapy, led us to an urgent thoracic scan and to a lifesaving thoracotomy. We think that every posterior mediastinal cystic mass, with or without vertebral malformations, diagnosed antenatally, should raise the possibility of neurenteric cyst. The perinatal management of the newborn to be, will thus be simplified. This will lead to a better outcome.