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Despite the frequency of paediatric hand injuries, recommendations for diagnostic investigations are limited due to paucity of published guidelines. This has led to inappropriate diagnoses and therefore inappropriate management. Ultrasonography is a portable, non-ionising imaging modality that allows rapid real-time evaluation of anatomical structures at a low cost and without sedation. In the adult population, ultrasonography has already been shown to improve accuracy in hand injury diagnoses. However, in the paediatric population, only one narrative review focuses on the application of ultrasonography to diagnose hand injury. A systematic search using PubMed, Google Scholar, EMBASE, Scopus, Cochrane database of systematic reviews and University Library of York, Keele, Edinburgh and King's College London was conducted to assess literature surrounding use of ultrasonography as a diagnostic tool for paediatric hand injuries. The literature search yielded 11,860 articles and 21 studies were identified with a total of 30 patients. Ultrasonography was observed to be an accurate tool for diagnosing bone, tendon, ligament and nerve injuries in children. The results of our study suggest that ultrasonography should be considered as an early diagnostic step for paediatric hand injuries. [ABSTRACT FROM AUTHOR]

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Pour traiter l'acidocétose diabétique pédiatrique, il faut porter une attention particulière aux liquides et aux électrolytes pour limiter le risque de complications, telles qu'une lésion cérébrale, associée à une morbidité et une mortalité élevées. L'incidence d'œdème cérébral en cas d'acidocétose diabétique n'a pas diminué malgré les protocoles visant la limitation des liquides qui s'appuient sur la restriction de la réanimation liquidienne initiale. Selon de nouvelles données probantes, l'administration précoce de liquides isotoniques n'entraîne pas de risque supplémentaire et peut améliorer les résultats cliniques chez certains patients. Les protocoles et les directives cliniques sont adaptés et axés particulièrement sur la surveillance et le remplacement initiaux et continus des liquides et des électrolytes. Il est maintenant recommandé de commencer par une réanimation à l'aide de liquides isotoniques chez tous les patients dans les 20 à 30 minutes suivant leur arrivée à l'hôpital, suivie par la réplétion du déficit volumique sur une période de 36 heures, en association avec une perfusion d'insuline et des suppléments d'électrolytes, ainsi qu'avec la surveillance et la prise en charge attentives d'une éventuelle lésion cérébrale. [ABSTRACT FROM AUTHOR]

Goal: To assess knowledges and practices on iron prescription in pediatric ward in CHU Gabriel Touré of Bamako, Mali. Tools and methods: It was a prospective and transversal study canied out. We submitted questionnaire and analyzed the case history of to the children aged 1-60 months old who received iron during the study period from 1rstto 30 July 2012.The prescriptators' consent were solicited and obtained at first of all. Results: Fifty prestators were interviewed among them 10 pediatricians (20%), 31 pediatrics' resident (62 %), 2 generalists physicians (4%), 7 medical student (14%). One hundred 100 were analyzed medical records. More than half of the prestators known the need of iron in children. Thirty percent have received iron at 8 to 10mg/kg. The medication duration wasn't indicating in 92% of patients. In our context prestators well know about meaning and the needs of iron in children bout they're limited on iron food sources and iron storage. Conclusion: The well theorical knowledge on indications and prescription roules on iron in children didn't escape from miss practices in its prescription. Moreover works should analyze the reasons of discrepancies. [ABSTRACT FROM AUTHOR]

Food allergy is a growing public health problem. This increase in prevalence has notably led to greater awareness of the burden of living with a food allergy, particularly the emotional, social and financial problems it causes. In the clinic, the speech of patients' parents often revolves around the feeling of loneliness and incomprehension of those around them, the need for control and hypervigilance. Although several studies have recently been published on the impact of food allergy on quality of life, data on the mental health of patients and families remains fragmentary and vague. A qualitative study has been carried out within the Pediatric Pulmonology and Allergology at Robert-Debré Hospital in order to assess the parental psychosocial impact, and anxiety in the case linked to the child's food allergy, in the form of a focus group. These group times allow families to discuss and discuss the impact of this disease, which is often trivialized even though it requires major life adjustments (eviction diet, emergency action plan, potential hospitalizations in intensive care). The objective of this workshop is to present this multidisciplinary research work (hospital practitioner, psychologist, therapeutic education nurse) and to allow us as caregivers to better understand parental difficulties in order to offer ever more qualitative follow-up for these vulnerable families. [ABSTRACT FROM AUTHOR]

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Eosinophilic oesophagitis in children is an emerging condition. The diagnosis is pathological, following upper GI endoscopy and staged biopsies of the oesophagus. A personal history of atopy is found in 50 to 60% of cases. Topical corticosteroids are effective in about three quarters of cases. The effectiveness of this first-line treatment is assessed after eight to twelve weeks or earlier if there is no clinical improvement at for weeks. A repeat digestive endoscopy with staged oesophageal biopsies is essential, as clinical improvement is not always associated with endoscopic improvement. This individualised avoidance diet may be offered as a first or second treatment, with or without drug therapy. As eosinophilic oesophagitis is a chronic disease, there is a significant risk of relapse on discontinuation of induction therapy or afterwards. Maintenance therapy should be continued, at best with the minimum effective dosage of the induction therapy. Multidisciplinary follow-up (gastro-paediatrician, allergist, dietician, psychologist, etc.) is necessary in the long term. [ABSTRACT FROM AUTHOR]

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Introduction: When their child presents a complex chronic health condition, parents take on a new role as caregivers. The dual identity of parent and caregiver exposes them to a risk of exhaustion. Objectives: We developed and assessed workshops for parent caregivers. These workshops aimed to help parents become aware of their needs and identify their helpful resources. Methods: We opted for an action-research methodology conducted in a participatory, iterative and evaluative approach, supported by a steering committee (professionals, parents and researchers). Three groups of parents (N = 18) participated in four support workshops. The data collected was processed through thematic analysis. Results: The workshops made it possible for parents to take time for themselves, to become aware of their own experiences, to support among parents, and to consider changes in their daily life. These benefits were supported by an online program, supervised by health professionals, offering support workshops to parents regardless of the characteristics of their family and their child. Discussion and conclusions: These workshops are an opportunity of encounters that preserves a personal and family balance. They could participate in preventing parental burnout. [ABSTRACT FROM AUTHOR]

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Copyright of Enfances, Familles, Generations is the property of Enfances, Familles, Generations and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La complexité des trajectoires atopiques, l'augmentation de la sévérité des maladies atopiques et l'émergence de nouvelles thérapeutiques imposent d'offrir une expertise dans ce domaine. Nous souhaitons partager notre expérience d'une consultation pluridisciplinaire « Atopie sévère de l'enfant » mise en place aux Hospices Civils de Lyon. Les dossiers des patients vus en consultation pluridisciplinaire « Atopie sévère de l'enfant » ont été revus de manière rétrospective. La consultation était menée par des pneumologues, dermatologues et immunologistes ayant une formation de pédiatres et allergologues. Au cours de cette consultation d'une heure, les atteintes atopiques des différents organes étaient évaluées et prises en considération pour une prise en charge spécifique puis, si possible, globale, avec notamment la prescription de traitements systémiques. Au total, 48 enfants ont déjà eu accès à cette consultation, tous atteints de dermatite atopique, dont 68 % sous une forme sévère. Une comorbidité atopique était retrouvée chez 83 % des patients : 56 % avaient une allergie alimentaire IgE-médiée, 58 % un asthme et 60 % une rhinoconjonctivite allergique. Un traitement systémique a été prescrit à 62 % des patients dès la première consultation, les traitements inhalés ont été optimisés et la majorité des patients allergiques alimentaires ont bénéficié d'une immunothérapie orale dans les suites de cette consultation. Cette consultation pluridisciplinaire « Atopie sévère de l'enfant » offre une prise en charge globale de ces patients et pourrait devenir pivot de la trajectoire de soin de l'atopie de l'enfant. Complexity of atopic trajectories, increased severity of atopic diseases and emergence of new therapies require expertise in atopy. Here, we would like to give feedbacks from a multidisciplinary consultation called "Severe atopy in children", set up in the Hospices Civils de Lyon. Retrospective reviews of patients' charts were conducted. The consultation "Severe atopy in children" was conducted by pulmonologists, dermatologists, and immunologists with a training background of pediatricians and allergists. During this one-hour consultation, atopic conditions of various organs were evaluated and taken into consideration for specific, and if possible, global management, including the prescription of systemic treatments. In total, 48 children have accessed this consultation, all of whom are suffering from atopic dermatitis, with 68% having a severe form. Atopy comorbidity was found in 83% of patients, including 56% having IgE-mediated food allergy, 58% having asthma, and 60% having allergic rhinoconjunctivitis. A systemic treatment was prescribed to 62% of patients during the first consultation. Inhaled treatments were also optimized for asthmatics and the majority of food-allergic patients receiving oral immunotherapy in the follow-up. The multidisciplinary consultation "Severe Atopy in Children" offers comprehensive care to children with atopic disorders and has the potential to become a cornerstone in the management of childhood atopy. [ABSTRACT FROM AUTHOR]

The aim of the article Year 2023 in Paediatric anaesthesia and intensive care is to provide a brief overview of the most important publications in this field over the last year. The selected publications, in addition to their high quality, can provide readers with knowledge that will enable them to improve their daily clinical practice in anaesthesia and intensive care. [ABSTRACT FROM AUTHOR]

L'évaluation et le traitement de la douleur sont des aspects essentiels des soins pédiatriques. L'évaluation de la douleur adaptée au développement représente une première étape importante pour en optimiser la prise en charge. L'autoévaluation de la douleur est à prioriser. Si c'est impossible, des outils appropriés d'évaluation du comportement, adaptés au développement, doivent être utilisés. Des directives et stratégies de prise en charge et de prévention de la douleur aiguë, qui combinent des approches physiques, psychologiques et pharmacologiques, doivent être accessibles dans tous les milieux de soins. Le meilleur traitement de la douleur chronique fait appel à une combinaison de modalités thérapeutiques et de counseling, dans l'objectif premier d'obtenir une amélioration fonctionnelle. La planification et la mise en œuvre de stratégies de prise en charge de la douleur chez les enfants doivent toujours être personnalisées et axées sur la famille. [ABSTRACT FROM AUTHOR]

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Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La radiothérapie pédiatrique se démarque largement de sa pratique chez l'adulte essentiellement en raison de l'âge (âge médian 6 ans), qui pose le problème de l'irradiation des tissus sains chez un organisme en croissance, à l'origine de séquelles, de l'observance parfois difficile et de la gestion des parents. Ces particularités nécessitent une formation dédiée et une organisation spécifique qui s'est progressivement mise en place concernant les indications les contrôles qualité, le recueil exhaustif des dosimétries natives, le suivi à long terme et la recherche clinique et translationnelle, ainsi que les agréments pour pratiquer la radiothérapie pédiatrique, en liens étroits avec la société française des cancers et des leucémies de l'enfant et de l'adolescent (SFCE), sous l'égide du Groupe français de radiothérapie pédiatrique (GFRP). Cette organisation est pionnière dans l'élaboration des contrôles qualité, qui deviennent la norme à l'échelle européenne, dans le recueil des dosimétries natives intégré au suivi des éventuelles séquelles, constituant la plus importante base de données internationale. Paediatric radiotherapy differs greatly from its practice in adults mainly because of the age (median age 6 years), which poses the problem of irradiation of healthy tissues in a growing organism, causing sequelae, difficult compliance and management of parents. These particularities require a dedicated education and specific organisation that was set progressively concerning indications, quality control, exhaustive collection of native dosimetry, long-term follow-up and clinical and translational research, as well as accreditations to practice paediatric radiotherapy, in close collaboration with the French society of child and adolescent cancer and leukaemia (SFCE), under the aegis of the French group of paediatric radiotherapy (GFRP). This organization is a pioneer in the development of pediatric radiotherapy quality controls, which are becoming the European standard and in the collection of native dosimetry integrated with the follow-up of possible late-effects, constituting the most important international database. [ABSTRACT FROM AUTHOR]

Introduction: Bronchoscopy is an invasive procedure that can be difficult for patients to tolerate, especially if the operator is inexperienced. Simulation enables trainees to perfect their skills, while adhering to an ethical approach: "never the first time on a patient". The main aim of our study is to demonstrate the benefits of simulation in learning how to perform bronchial endoscopy, in terms of dexterity, speed of execution and anatomical recognition by the operator., Methods: Prospective, monocentric study conducted at SIMU SANTE in the Amiens university hospital. Our study population consisted of volunteer interns or young doctors who were new to bronchoscopy. After filling out a questionnaire and undergoing theoretical training, participants completed three training sessions at regular intervals. We compared three groups according to the interval between sessions (group A: 15 days, group B: 30 days, group C: 60 days). Regarding judgment criteria, we observed several parameters: dexterity, speed and anatomical recognition by the operator., Results: In terms of speed, median procedure time was reduced by 40% after three sessions. Dexterity improved in the 15-day interval group, with a significant reduction in wall contact. Concerning the precision parameter, we observed a significant difference between the three groups, with greater improvement in the identification score in the 15-day interval group., Conclusion: Simulation has made it possible to acquire basic skills in bronchoscopy. Training sessions with a short time interval (one session every 15 days) most rapidly increase operators' speed, dexterity and precision., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

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.)

The transition of young type 1 diabetic patients from pediatrics to adult diabetes services is a delicate stage, with the risk of a break in the care pathway. These adolescents are apprehensive about leaving the pediatric sector, and often experience the change as an abandonment. It is therefore vital to prepare them and support them during and after the transfer, in order to improve their experience., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: To determine the incidence and outcomes of uveitis following coronavirus (COVID-19) vaccination in the pediatric population., Methods: A case series of all patients under the age of 18years diagnosed with uveitis within 28days of COVID-19 vaccination., Results: Out of 33 patients under the age of 18years who presented with uveitis from July 2021 until May 2022, eight (24.2%) developed uveitis following COVID-19 vaccination within 28days. Four had a previous history of uveitis. The mean time interval from COVID-19 vaccination to uveitis diagnosis was 14.75days. The most common anatomic diagnosis was anterior uveitis in four children, followed by panuveitis in two and posterior uveitis in two. Seven children were treated with systemic steroids/immunomodulatory agents. Improved or unaffected visual acuity was noted in all children at the final follow-up., Conclusion: The pediatric population may demonstrate uveitis following COVID-19 vaccination. All children were treated successfully, and good final visual acuity was achieved., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objectives: This paper aims to highlight the evolution of informed consent in medical practice in general and pediatric practice in particular, as well as current international regulations on the involvement of children in decision-making. Material and methods: A literature review was conducted from Pub Med, Proquest Central, Scopus Elsevier, and Springer Link Journal databases for the period 2001 - 2022. Outcomes: Informed consent is the process by which clinical staff obtains patients' permission to perform invasive procedures. Serious discussions about the meaning and ethics of informed consent began in medicine, research, law, and philosophy only around 1972. For a pediatric patient, a natural response in medical decision making is to delegate authority to the parent or caregiver who is supervising them. In recent years there has been an increasing emphasis on involving the child in decisionmaking. The principle of autonomy is essential when discussing informed consent. Leading organizations in Australia, the UK, and the US have developed recommendations on involving children in decision-making. Pediatricians should share medical information with children and their families in ways that are helpful and empowering. This information should be complete, honest, and unbiased. However, these recommendations have no specific, non-prescriptive references, which demonstrate that in practice there is very little established practice of telling children the truth. Conclusions: this subject will always remain an extremely sensitive and challenging one for professionals, who will have to use all their knowledge and skills to ensure high-quality care for children. [ABSTRACT FROM AUTHOR]

Aims: To determine the epidemiological profile of newborn dermatitis and to describe the different clinical aspects of the observed neonatal dermatitis. Procedure: The study took place at the University Hospital of Cocody (Abidjan). The study was cross-sectional, descriptive and analytical, carried out on the basis of prospective recruitment. The study included newborns who were seen in outpatient or inpatient settings by 4 april 2018 to 23 August 2018 and in whom the pediatrician had observed cutaneous and/or mucosal lesions. The diagnosis was made with the collaboration of a dermatologist. Results: During the study period, 116 newborns were identified. The age of the patients seen in pediatrics with dermatitis varied from 1 to 28 days, with a mean of 16.86 ± 8.4 days. The median age was 19 days. The most representative age range (32.8%) was 24-28 days. The sex ratio (M/F) was 1. In almost 2/3 of the cases, the children were born at term, 29.3% were premature and 5.2% were born after term. In almost 2/3 of the cases (63.8%), the newborns had a birth weight of more than 2500 g. Only 3.4% of newborns seen in pediatric consultations were referred for a dermatitis. The age of the lesions at the time of consultation varied from 1 to 26 days, with a mean of 06.19 days ± 5.13. In more than half (53.5%) of the cases, the lesions had evolved for less than 5 days. Transient dermatitis was more frequent (51.7%), followed by infectious dermatitis (32.8%). Transient dermatitis of the newborn was dominated by sweaty miliaria (40%). Infectious dermatitis were mainly represented by mycotic (68.4%) and bacterial (31.9%) infections. Bacterial dermatitis were composed of neonatal impetigo (83.3%) and folliculitis (16.7%). In almost half of the cases (46.1%) the mycotic dermatitis were represented by candidosis intertrigo and in 38.5% of the cases there was oral candidiasis. The other neonatal dermatitis observed were dominated by diaper rash (64.3%) (Photo 2) and congenital nevi (21.5%). More than half (57.1%) of the cases of toxic erythema neonatorum occurred between days 6 and 10 of life. Nearly half (41.6%) of the cases of sudoral miliaria occurred between birth and day 5 of life. More than half (57.1%) of the cases of sebaceous hyperplasia occurred before the 5th day of life. All cases of neonatal scaling and mongoloid spots were already present between birth and day 5 of life. The mean age of patients with transient dermatitis was 14.31 days compared with 19.41 days for those with the other dermatitis. The difference in age was statistically significant (p < 0.05). The transient dermatitis predominated in male neonates while the other dermatitis predominated in females, however the difference observed at the level of sex was not statistically significant (p > 0.05). Conclusion: The diagnosis of neonatal dermatitis is not always obvious, especially on black skin where few publications have been published. [ABSTRACT FROM AUTHOR]

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Background: Clinical practices regarding duration of antibiotics used for Community Acquired Pneumonia (CAP) in children vary between settings. This could contribute to adverse drug reactions, treatment failure and antimicrobial resistance. Methods: The following search tools were used for the review: PubMed, TRIP, and Medline/Ovid. Keywords included were "pneumonia", "pediatric", "treatment", "duration", "child", "days", "community acquired pneumonia", "short", "non-severe", "amoxicillin dose", and "pneumonia children" and the selection of articles was limited to the last 10 years from 2011 to 2021. Results: We found 15 studies that assessed short (3 or 5 days) versus longer (7 or 10 days) duration of antibiotic treatment in pediatric outpatient CAP. Of these we selected 8 studies: 5 completed Randomized Controlled Trials (RCTs), 2 ongoing RCTs, and 1 retrospective cohort study. Discussion: Our review shows that short-course antimicrobial therapy for outpatient pediatric CAP is a promising option for maximizing efficacy, while also minimizing adverse effects, non-adherence, and antimicrobial resistance. Half of RCTs showed that a short-course treatment with oral amoxicillin, the antibiotic of reference, had a comparable efficacy to longer course treatment. However, in these studies bacterial CAP was not easily established, and there was considerable variability in the diagnosis and interpretation of radiological findings. Conclusion: The results from the studies included in this narrative review are informative and add to our understanding of outpatient pediatric CAP. They highlight the importance of maintaining an effective balance, where a clinician can aim to minimize antimicrobial overuse and risk of resistance while maximizing efficacy. Although these studies look promising, future research is required in pediatric patients with CAP, and these studies must be capable of addressing the limitations listed in this paper. [ABSTRACT FROM AUTHOR]

La leptospirose est une anthropozoonose dont le tableau clinique est polymorph e et de gravité variable, allant du syndrome pseudo-grippal à l'insuffisance rénale aiguë menaçante. Cette maladie à forte incidence dans les régions tropicales voit son incidence augmenter en France métropolitaine et à la Réunion. L'objectif de cette étude était d'identifier les caractéristiques épidémiologiques, cliniques, biologiques et thérapeutiques des formes pédiatriques de la leptospirose en France métropolitaine et à la Réunion. Nous avons mené une étude de cohorte des cas de leptospirose pédiatriques hospitalisés dans les centres hospitaliers dans lesquels exercent des membres de la Société de néphrologie pédiatrique (SNP) entre janvier 2008 et décembre 2020. Parmi les centres répondeurs, six avaient eu des cas de leptospirose, un centre en avait eu un en consultation mais dont les données étaient insuffisantes, et dix n'en ont pas retrouvés. Vingt-et-un cas ont été recensés dans six centres hospitalo-universitaires français (âge moyen 13,4 ± 3,4 ans), majoritairement des garçons (ratio 6:1). Parmi les 21 enfants, 95 % avaient de la fièvre, 71 % avaient des myalgies, 81 % avaient une thrombopénie et 76 % ont présenté des symptômes digestifs. Sur le plan rénal, 18 patients (86 %) présentaient une insuffisance rénale, dont 19 % avec oligoanurie, mais aucun n'a nécessité de dialyse. Environ 30 % des patients présentaient des signes biologiques de tubulopathie comprenant une hypophosphatémie, une hypokaliémie ou une protéinurie tubulaire. Il n'y a eu aucun décès. La prise en charge thérapeutique correspondait aux recommandations avec une antibiothérapie par amoxicilline ou céphalosporine de 3e génération associée à un traitement symptomatique de l'atteinte rénale. Lorsqu'il y a eu un contrôle biologique après la sortie, on observait une décroissance de la créatinine. Dans cette étude rétrospective multicentrique, nous rapportons 21 cas d'infection par leptospirose, avec une proportion importante d'insuffisance rénale, dont l'évolution était favorable. L'évolution vers l'insuffisance rénale chronique ne semble pas être le cas chez les enfants, mais le suivi à distance n'a pas été systématiquement réalisé. Par rapport à des études menées chez les adultes, le pronostic global est meilleur et l'ictère est plus rare. Par rapport à d'autres études pédiatriques, la conjonctivite n'est pas un signe fréquent, mais les atteintes rénales et la survie sont similaires. On pourrait parler de formes rénales anictériques révélatrices. Le recueil de cas n'était pas exhaustif et ne comprenait pas les autres territoires d'outre-mer alors qu'ils regroupent la plus grande proportion d'infection par la leptospirose. La leptospirose est une infection qui peut être responsable d'une défaillance multiviscérale avec une atteinte rénale conditionnant le pronostic vital. Malgré un meilleur pronostic chez l'enfant, il reste important de diagnostiquer rapidement cette infection afin de mettre en place l'antibiothérapie adaptée et un suivi néphrologique en cas d'atteinte rénale. Leptospirosis is an anthropozoonosis with polymorphic clinical symptoms and a high variability of severity, ranging from flu-like syndrome to severe acute kidney injury. This disease is highly incident in tropical regions but there is a trend towards increasing incidence in metropolitan France and in Reunion Island. The objective of this study was to describe the epidemiological, clinical, laboratory and therapeutic characteristics of the pediatric leptospirosis in metropolitan France and in Reunion Island. We performed a retrospective analysis of leptospirosis cases hospitalized in University hospitals where members of the Paediatric Nephrology Society work in France between January 2008 and December 2020, 6 centers reported leptospirosis cases, one center had one patient in consultation but lack of available data and 10 centers did not find any case. A total of 21 cases were reported (mean age 13.4 ± 3.4 years), mostly boys (ratio 6:1). Out of 21 patients, 95% had fever, 71% were presenting with myalgia, 81% with thrombocytopenia, and 76% with gastrointestinal symptoms. Regarding kidney impairment, 18 patients (86%) had acute kidney injury, including 4 (19%) with oligoanuria, but none of them required acute dialysis. About 30% of patients had biological signs of tubulopathy including hypophosphatemia, hypokalemia, or tubular proteinuria. No death due to the disease occurred. The therapeutic management followed the current guidelines with the use of antibiotic therapy by amoxicillin or 3rd generation cephalosporins with symptomatic treatment. When there was biological control after exit, creatinine decreased. In this multicenter retrospective study, we report 21 children with leptospirosis with a significant proportion of acute kidney injury, the outcome was favorable. Children do not seem to be at high risk of chronic kidney disease progression but nephrology follow-up has not been systematically carried out. Compared to studies performed in adults, the prognosis was better and hepatic impairment was rare. Compared to other pediatric studies, conjunctivitis was not a common symptom but kidney injury and survival appeared to be similar. Children were presenting with anicteric renal presentation. The casebook wasn't exhaustive and didn't include the other overseas territories, which account for the highest proportion of leptospirosis infection. Leptospirosis is an infection which may lead to multivisceral failure with kidney involvement conditioning the outcome. Despite a better prognosis in children, it remains important to quickly diagnose this infection in order to start appropriate antibiotic therapy and perform a kidney function monitoring. [ABSTRACT FROM AUTHOR]

Relational experiences during infancy and early childhood are key drivers for building health, social emotional development, and learning capacities, each vital for wellbeing. The U.S. child health sectors share a commitment to universal health promotion, prevention and early intervention, and a growing enthusiasm for the research‐affirmed primacy of caregiver‐child interactions during the critical first 1000 days of life. Given our nation's growing children's mental health crisis, racial justice awakening and the need to reimagine equitable supports for young families post‐COVID19, the child health sectors seek new tools and clinical approaches that blend science‐to‐practice innovations with co‐developed activities that are meaningful to families. This special section brings together papers about a journey of co‐discovery between researchers, clinicians, and parents during the development and refinement of new video‐ and interview‐based dyadic relational screening and monitoring tools. The collection of papers addresses a range of topics including early relational health (ERH), development and validation of the Early Relational Health Screen, its application within research and clinical settings, and thoughtful discussions from multiple perspectives. Informed by the diversity informed tenets, this journey highlights not only science‐informed approaches, but also co‐development with families of equitable approaches to understanding and serving children and their caregivers. [ABSTRACT FROM AUTHOR]

There is limited research regarding management of temporomandibular disorders (TMD) in adolescents with imaging signs of juvenile idiopathic arthritis (JIA). An 11-year-old girl presented to a hospital-based chiropractor for evaluation of a 1.5-year history of unilateral temporomandibular joint (TMJ) pain and trismus. Previously, pediatric rheumatologists diagnosed JIA after contrast-enhanced magnetic resonance imaging revealed edema, effusion, and bilateral anterior disc displacement, and recommended methotrexate, corticosteroid injection, and arthrocentesis. The chiropractor questioned the JIA diagnosis, instead relating symptoms to a mechanical TMD/disc origin. Manual therapy, TMJ exercises, and acupuncture improved TMJ pain and opening. Invasive medical JIA interventions were avoided without long-term recurrence, further questioning the preceding JIA diagnosis. The success of this case suggests that stepped care, beginning with conservative treatment, has value for adolescents with TMD suspect for JIA. Integration of chiropractors and acupuncturists into healthcare institutions may facilitate this care model by affording nonpharmacologic interventions earlier in patient care. [ABSTRACT FROM AUTHOR]

L'infection urinaire fébrile est l'infection bactérienne la plus fréquente chez l'enfant, pouvant aboutir à des complications sévères infectieuses et rénales, nécessitant un diagnostic précoce et une antibiothérapie ciblée. Notre objectif était d'étudier l'épidémiologie bactérienne locale et le profil de résistance aux antibiotiques chez les enfants hospitalisés pour infection urinaire fébrile dans deux centres pédiatriques du grand-est. L'étude incluait les enfants admis aux urgences pédiatriques du Centre hospitalier universitaire de Strasbourg et du Centre hospitalier de Saverne pour infection urinaire fébrile de janvier 2019 à décembre 2020. Les bactéries isolées et le profil de résistance étaient étudiés à partir des examens cytobactériologiques des urines. Nous avons analysé 214 examens cytobactériologiques des urines réalisés chez 208 patients. Les bactéries principalement retrouvées étaient Escherichia coli (82 %), dont bêtalactamase de spectre étendu (2,8 %), Enterococcus faecalis (7 %), Klebsiella spp (5 %) et Proteus mirabilis (2 %). L' E. coli était résistant dans respectivement 43, 33 et 14 % des cas à l'amoxicilline, l'amoxicilline/acide clavulanique et au cotrimoxazole, et sensible au céfixime et ceftriaxone dans 99 % des cas. Une céphalosporine de 3e génération (C3G) était utilisée en intraveineux dans 98 % des cas en traitement probabiliste. Moins de 2 % des patients eurent un traitement per os par céfixime dès l'initiation de l'antibiothérapie. Nous avons documenté le spectre des uropathogènes et le profil de résistance de l' E. coli dans les infections urinaires fébriles pédiatriques prises en charge dans 2 centres. Un protocole local d'antibiothérapie probabiliste basé sur nos résultats a été rédigé en accord avec les recommandations nationales. Febrile urinary tract infection (UTI) is a common health issue in pediatrics that can lead to serious infectious and renal complications, it requires early diagnosis and a targeted use of antibiotics. The aim of our study was to describe local bacterial agents causing febrile UTIs and their resistance patterns and confront the results with currently used empirical antibacterial therapy in pediatrics emergency departments in Strasbourg and Saverne. We used billing codes (international classification of diseases) to identify all inpatients treated for febrile UTIs in two French pediatric emergency departments between January 2019 and December 2020. Microbial results of urine cultures were retrieved from the laboratory information system. Among 214 microbial results from 208 patients, the distribution of uropathogens was 82% Escherichia coli , with extended-spectrum beta-lactamase in 2.8%, 7% Enterococcus faecalis, 5% Klebsiella , 2% Proteus mirabilis. E. coli was resistant respectively to amoxicillin, amoxicillin/clavulanic acid and cotrimoxazol in 43, 33 and 14% of samples. A third-generation cephalosporin administered intravenously was mainly used (98%) as empirical treatment. Less than 2% of patients were treated with oral cephalosporin from the start. We present the spectrum of uropathogens and susceptibility test results in pediatric UTIs as well as the susceptibility pattern of E. coli , a local treatment protocol was designed based on our results in conformity with national guidelines. [ABSTRACT FROM AUTHOR]