Search

Unlabelled: 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 24h 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., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Recurrent tracheoesophageal fistula (TEF) is possible after repair of congenital esophageal atresia. The frequency of recurrent TEF is observed in about 10% of the cases. Within a cohort of 67 children with type III esophageal atresia repaired between 1998 and 2009, we aimed to identify the number of children with recurrent TEF, the risk factors for this condition, and the treatment proposed. The sex ratio was 1.7. Surgery was performed between 4 and 36 hours of life. Five children (7.5%) had a recurrent TEF, usually during the first 3 months, revealed by respiratory symptoms related to feeding in some cases. We noted that recurrent TEF was more frequent with anastomotic leakage (P=0.09) or postsurgical pneumothorax (P<0.01). The diagnosis was made in four cases out of five by a methylene blue test performed during a tracheobronchial endoscopy. Surgical treatment was noted in four children, with three postsurgical secondary effects. One child was treated by endoscopy and an esophageal clip. With a median follow-up of 52 months, no recurrence was noted. The recurrence of TEF may be linked to postsurgical events. Diagnosis is not easy and treatment is not clearly codified. Endoscopic treatment may be an advantageous option to surgery, likely with less morbidity., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

We report on the case of a 15-year-old boy with massive hemoptysis caused by anastomosis between bronchial and pulmonary arteries, successfully treated with embolization. No similar case was found in the literature, likely because of the high mortality rate of this type of malformation., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Nicolau syndrome is a rare, potentially severe complication that may occur after any drug injection, particularly after intramuscular injection. It is characterized by the acute onset of cutaneous and soft-tissue aseptic necrosis. Here, we report the case of a 14-year-old boy diagnosed with Nicolau syndrome on the right lower limb, after a benzathine-penicillin intramuscular injection for suspected rheumatic fever. The short-term progression was marked by uncomplicated rhabdomyolysis and the constitution of homolateral testicular torsion. The cutaneous-muscular disorders evolved favorably under symptomatic treatment. We discuss this insufficiently known complication of intramuscular injection, which may motivate reduced use of this route of drug administration in children and strict adherence to the procedure. Furthermore, it is important to note that Nicolau syndrome may evolve to homolateral testicular torsion, as, to the best of our knowledge, is reported for the first time in this case., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

In the past few years some new inhaled drugs and inhalation devices have been proposed for the treatment of cystic fibrosis. Breath-controlled nebulizers allow increased pulmonary deposition, with a lower variability and a shorter delivery time. The new dry powder formulations of tobramycin, colistine and mannitol require a change in the inhalation technique which must be slow and deep. In the field of the inhaled mucolytic drugs, hypertonic saline and mannitol have an indication in some patients. With regard to antibiotics, dry-powder tobramycin and colistine can be substituted for the same drug delivered by nebulization. Nebulized aztreonam needs more studies to determine its place. These new treatments represent a definite advance for cystic fibrosis patients and need to be known by all practitioners. Their position in our therapeutic arsenal remains to be accurately defined., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Recommendations for the use of diagnostic testing in low respiratory infection in children older than 3 months were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP(2)A). The Haute Autorité de santé (HAS) methodology, based on formalized consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text is available on the SP(2)A website., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The working group on aerosol therapy (GAT) of the Société de pneumologie de langue française (SPLF) organized its third "Aerosolstorming" in 2012. During the course of one day, different aspects of inhaled therapy were discussed, and these will be treated separately in two articles, this one being the first. Inhaled products represent a large volume of prescriptions both in the community and in hospital settings and they involve various specialties particularly ENT and respiratory care. Technical aspects of the development of these products, their mode of administration and compliance with their indications are key elements for the effective therapeutic use of inhaled treatments. In this first article, we will review issues concerning generic inhaled products, the existence of inhaled antidotes, new anti-infective agents and indications for inhaled pentamidine., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The emergence of multidrug-resistant (MDR) bacteria in cystic fibrosis (CF) patients has led to the use of colistin drug and the emergence of colistin-resistant Gram-negative bacteria. The aim of this study was to compare the disk diffusion and Etest methods for colistin susceptibility testing on MDR bacteria associated with CF from Marseille, France. Forty-nine MDR clinical isolates (27 Stenotrophomonas maltophilia, 22 Achromobacter xylosoxidans) were used in this study. Disk diffusion and Etest assays were used to assess the reliability of these two techniques. For S. maltophilia, 25 out of 27 isolates had low minimum inhibitory concentrations (MICs, 0.125-0.75 mg/L), whereas two isolates displayed high MICs (32 mg/L). Similarly, 19 out of 22 A. xylosoxidans isolates had low MICs (0.75-3.0 mg/L), whereas three isolates had high MICs (32-256 mg/L). The diameters of zone inhibition with a 50-μg colistin disk displayed a good correlation with the MICs obtained by the Etest. Susceptible and resistant strains were eventually separated using a disk diffusion assay at a cut-off of ≤ 12 mm for a 50-μg disk. Colistin displayed excellent activity against S. maltophilia and A. xylosoxidans and the disk diffusion assay could be confidently used to determine the susceptibility to colistin for MDR Gram-negative bacteria in the context of CF.

The aim of this study was to evaluate the medium-term outcome (health status, medical and surgical French National Health Authority-recommended follow-up, and quality of life) of children born with type III esophageal atresia (EA). Previous events (during the perinatal period, associated abnormalities, respiratory and digestive complications) of children treated for type III EA at the Marseille university hospitals between 1999 and 2009 were noted. Parents completed a standardized questionnaire concerning the health of their children during the previous year, and a quality-of-life questionnaire (PedsQL 4.0) was also completed by children aged more than 8 years. Among the 68 children treated, 44 responded to our solicitation (mean age, 7.6 years; range, 3-12.8 years). Previous important events were : pneumonia(s) (65%), asthma before the age of 3 years (66%), hospitalization for a respiratory event (45%), fundoplication (20%), and esophageal dilatation (45%). We noted current chronic cough (16%), asthma (30%), dysphagia (39%), and symptomatic gastroesophageal reflux (9%). National guidelines were not respected, except for the surgical indications in children aged less than 6 years. The quality-of-life scores (n=43 children) were similar to healthy controls but were negatively influenced by a gastrostomy procedure (P=0.020), pneumonia (P=0.013), and hospitalization due to a respiratory event (P=0.006) or a digestive event (P=0.010), and also by current asthma (P=0.004). In conclusion, despite recurrent respiratory or digestive symptoms and inadequate recommended follow-up, the quality of life of children treated for type III of EA is good., (Copyright © 2013. Published by Elsevier SAS.)

The working group on aerosol therapy (GAT) of the Société de Pneumologie de Langue Française (SPLF) has organized its third Aerosolstorming in 2012. During one single day, different aspects of inhaled therapies have been treated and are detailed in two articles, this one being the second. This text deals with the indications of inhaled corticosteroids in ENT, the development and technical challenges of powder inhalers, the advantages and disadvantages of each type of technologies to measure the particle sizes of inhaled treatments., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Three different devices are available for inhaled medications in children: the pressurized metered dose inhalers (pMDIs, breath-actuator synchronized pMDI, and valved holding spacers), the dry powder inhalers, and the nebulizers. To choose the better device for a particular patient, a perfect knowledge of the available devices, of their mode of use, of their advantages and inconvenient is required. The use of a pMDI coupled to a valved holding spacer is the first mode of delivery to propose in children aged less than 6 years. After 6 years old, the DPIs may be proposed depending on the child's competences. At last, the nebulizations are indicated in some particular and severe indications, but new indications are appearing because of recent progresses., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

We report the case of late vitamin K deficiency bleeding (VLDB), with appropriate but insufficient prophylaxis, secondary to extrahepatic cholestasis. Late VKDB is rare today but serious, with a risk of intracranial hemorrhage in more than half of the cases. The diagnosis, causes and prevention of this disease are discussed., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Communications from the 2011 meeting of the GAT are reported in this second article on the practical management of bronchial provocation tests and infectious risks associated with the use of nebulization. Recent advances on the role of nebulized hypertonic saline in the treatment of acute bronchiolitis in infants and of the nebulization in sinusal diseases are also reported., (© 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

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., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

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 © 2012 Elsevier Masson SAS. All rights reserved.)

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?, (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Aim: Pentamidine is a drug generally used for the prophylactic treatment of Pneumocystis pneumonia in immunocompromised patients. The Respirgard II® jet nebulizer has been recommended for pentamidine administration, but this device is no longer available. The aim of our study was to review current clinical practice for pentamidine nebulisation in paediatric hospitals., Methods: A survey was sent to the departments of Haematology and Pneumology of university hospitals all over France. We collected information about treatment indications, the number of treated children in 2010, side effects and delivery devices used for nebulization., Results: Out of the 62 interviewed departments, 36 responses were obtained (58 %). Half the respondents, mostly Haematology departments (n=15/18), used nebulized pentamidine in immunocompromised patients aged 5 to 15 years old who were unable to tolerate sulfamethoxazole-trimethoprim. Sixty-three percent of them treated less than ten children per year, with monthly 150 to 300mg doses administered over a period of 9 to 12 months. Few side effects were reported. In 61 % of the cases, the nebulizer used was unknown or not adapted (1 ultrasonic and 1 mesh nebulizer). In the remaining cases, pentamidine was nebulized with approved jet nebulizers (Isoneb®, Respiromed CR01®, and Microcirrus®)., Conclusion: Nebulized pentamidine is not used frequently in children. Better information about the appropriateness of nebulizer usage is needed., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Aerosoltherapy is a first-line treatment for chronic obstructive respiratory diseases such as asthma and COPD. Treatment modalities and devices are varied and the choice of the device must be adapted to and optimized for every patient. Spacers can be used for some categories of patients for whom the use of other devices turns out to be complicated. The improvement of these treatments requires the optimization of the lung deposition of inhaled particles; lung modeling plays an essential role in the understanding of the mechanisms of flow in the airways. Regulations must frame prescription of inhaled treatments to optimize its quality and, thus, the care for these chronic diseases. Many generally-accepted ideas concerning these treatments turn out to be false. Inhaled treatments are constantly evolving, both pharmacologically and technologically., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

We report the case of a 10-month-old girl hospitalized with RSV acute bronchiolitis who developed necrotizing pneumonia with pyopneumothorax due to Panton-Valentine leukocidin-secreting Staphylococcus aureus. The outcome was fortunately favorable with antibiotics and pleural drainage., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

We report on 2 recent and misleading cases of infants hospitalized for Chlamydia trachomatis pneumonia: the first one, 29 days old, had a clinically relevant presentation but was born by caesarean section; the second one, 43 days old, presented with acute respiratory distress. Microbiological diagnosis was achieved by the specific detection of C. trachomatis by molecular biology from a nasopharyngeal sample. These 2 clinical cases illustrate the need to systematically look for C. trachomatis during bacterial-like pneumonia in infants under 3 months of age., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

We report 2 cases of children with group A streptococcus pyogenes pleuropneumonia, in one child associated with Kawasaki disease and in the other with streptococcal toxic shock syndrome. These 2 features, with theoretically well-defined clinical and biological criteria, are difficult to differentiate in clinical practice, however, likely due to their pathophysiological links. In case of clinical doubt, an echocardiography needs to be performed to search for coronary involvement and treatment including intravenous immunoglobulins, and an antibiotic with an anti-toxin effect such as clindamycin has to be started early., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: Between 5 and 7% of babies are born prematurely. In the paediatric age group, the respiratory morbidity of these patients is well known, particularly in cases of bronchopulmonary dysplasia (BPD). On the other hand, very few data are available concerning their adult respiratory status., Background: There are currently three different groups of ex-premature babies: (1) those with no BPD who are usually not considered as respiratory high-risk adults but have not been well studied; (2) ex-premature babies with BPD who have an increased risk of asthma, respiratory infections, bronchial obstruction aggravated by smoking, and non-atopic bronchial hyperreactivity; this group has been well studied but not beyond 30 years of age; (3) the babies born very prematurely and affected with a new form of BPD due to neonatal intensive care at a very immature stage of pulmonary development, and for whom the future in adult life is unknown but worrying because of reduced lung volumes since birth., Viewpoints and Conclusions: The respiratory physician must be aware of these groups of adults who he may encounter and who may develop, sooner or later, a certain type of chronic obstructive pulmonary disease., (Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Mushroom intoxication due to Amanita proxima poisoning is characterized by moderate gastrointestinal symptoms, followed by severe acute renal failure and sometimes by hepatic cytolysis. This syndrome was described in the 1990s in the southeast of France; we report here the first pediatric case, requiring dialysis but achieving complete recovery. The mother of this 11-year-old boy, who had eaten the same mushrooms but in smaller quantities, had only biological renal and hepatic involvement., (Copyright © 2011. Published by Elsevier SAS.)

Kawasaki disease is a well-known disease in young children. However, it can also affect older children. The aim of this study was to determine the different characteristics of Kawasaki disease in older children and young adults. This is a descriptive, retrospective, and multicenter study including all cases of Kawasaki disease occurring in children over 8 years and adults hospitalized at children's or adult Hospitals, in Marseille, France, between 1999 and 2009. The clinical, biological, prognostic, and therapeutic data were reviewed for each case. Over a 10-year period, 98 patients were hospitalized for Kawasaki disease. Six cases were aged between 8 years and 1 month and 21 years and 7 months. All patients showed a classic form of the disease with associated organ damage in 5 patients. A cardiac problem was present in 5 cases with 2 patients needing intensive care. The median time to diagnosis and treatment was 11.2 days, with all patients initially diagnosed erroneously. Current treatment guidelines were applied in 2 patients. Kawasaki disease in children over 8 years and adults under 30 years has a worse prognosis than in young children even though clinical features are atypical. It is rarely seen by clinicians in this age group, causing a delay in diagnosis, the main factor of the poor prognosis. The diagnosis of Kawasaki disease must be raised when predisposing factors are present in this group., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Intralobar pulmonary sequestration (ILPS) and bronchogenic cyst are rare congenital diseases. We present the first case of the association between an ILPS located in the upper lobe and a bronchogenic cyst. This association has been discovered antenatally in a girl. The cystic lesion has been shown by a fetal MRI and confirmed by a CT scan at 3 weeks of life. She underwent a left upper lobectomy by thoracoscopy at the age of 5 months. Postoperative course was uneventfull. This case confirms the congenital origin of pulmonary sequestration and shows the interest of an early surgery., (Copyright © 2010 Wiley-Liss, Inc.)

Introduction: New Caledonia is situated in the western South Pacific 20000 km from France. In this Overseas Territory (pays d'outre-mer [POM]) the prevalence of tobacco smoking is very high and estimated at 30% among men and 34% among women. Experimenting with cannabis is also very widespread. The incidence of chronic respiratory illness and lung cancer remains high in the Territory. Modern laws protecting non-smokers still do not exist. This study aims at describing the behaviour of young people from 14 to 18 years old, at school in the public sector of Noumea, with respect to tobacco and marijuana consumption. This survey examines the way this behaviour varies according to age, sex, community, place of residence and socioeconomic conditions, in order to identify the most exposed groups. Finally, we study the effect of this consumption on the respiratory health of young school people., Methods: The enquiry was undertaken from May 4th to 15th 2009 in 16 classes drawn randomly from the colleges and secondary schools of Noumea (439 pupils). The survey consisted of an anonymous questionnaire containing 48 questions grouped into five subjects: a sociodemographic description of the subject and his/her family, the family lifestyle, tobacco consumption, marijuana consumption and a respiratory questionnaire. The completion of the questionnaires took, on average, 25 minutes and took place in class in the presence of the doctor undertaking the survey. The data were analysed with Ethnos-4 software. The analysis was made in two stages: a descriptive study after uni- and bivariate analysis and an analytical study to identify the risk factors of the addictive practices. The statistical tests used were Pearson's chi(2) test and the Hosmer-Lemeshow test for calculation of odds ratio., Results: The participation rate was 95.2% (n = 415). The sample was predominantly female (56.6%) and 31% of the pupils were less than 16 years old. The number of tobacco smokers was considerable at 41.1%, 27.3% were regular daily smokers including 38.5% who smoked more than six cigarettes a day. The results were dependent on sex (female predominence) but independent of ethnic origin and socioeconomic factors. The number of cannabis smokers was 48% among whom 32% were regular consumers. The daily smokers were uniquely boys and the custom was more frequent among the Melanesian population. Only 11% of the pupils were worried about their consumption and, among them, only the regular smokers were more at risk of bronchial infection., Conclusions: In New Caledonia, tobacco consumption levels are higher than those in developed countries. We did not find a falling trend compared with previous data. The use of cannabis remains very widespread at an early age, with a male predominance for daily consumption. For both, these addictions the perception of the risk and the desire to stop are weak. The population studied is representative of teenagers in the public sector schools in Grand-Noumea but probably does not reflect the situation on the whole territory. The results obtained suggest the value of a study of the whole of New Caledonia, the eventual purpose being to guide the public health authorities towards policies that help the young people of the country., (Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Setting: Drug-resistant tuberculosis (DR-TB) is increasing worldwide and may be a source of diagnostic and therapeutic problems in young exposed children. In France exposed children are systematically treated with 3-month isoniazid-rifampicin prophylaxis., Objective: To describe the characteristics and management of children aged <2 years in contact with an adult case of DR-TB in France over a 5-year period (2004-2008)., Methods: Children were retrospectively identified by sending questionnaires to all the members of the Paediatric Infectious Diseases Group and the Paediatric Pulmonology Group of the French Paediatric Society., Results: Ten children, all infants, in contact with an adult case of DR-TB were identified: six cases of DR-TB (mean age 4.6 months), one case of TB infection and three cases of exposure (mean age 3.1 months). The children were mainly in contact with poly- or multidrug-resistant TB. Time to initiation of appropriate treatment was 39 days for TB disease and 58 days for TB infection or exposure. One child with TB infection developed TB disease due to failure to adapt prophylaxis. Treatment was variable and centre-dependent. Short-term follow-up showed complete recovery of all children., Conclusion: Management of young children in contact with adult DR-TB requires rapid identification of the drug resistance profile. Molecular techniques should be used to reduce delays in initiating appropriate treatment.

We report a case of spontaneous hemothorax in a 9-year-old boy due to costal exostosis in the context of hereditary multiple exostosis disease. This is an unusual complication, whose pathophysiology remains unclear., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Botryomycosis is an uncommon bacterial infection. It occurs in two forms: cutaneous and visceral. Fewer than 30 pediatric cases have been reported. We present the first case of a 14-day-old newborn with botryomycosis revealed by four tumefactions located in the inguinal and popliteal hollows, without a biological inflammatory syndrome. Pathological examination of the sample demonstrated botryomycosis. The culture collection found Staphylococcus aureus. Progression was favorable with appropriate prolonged antibiotic therapy. Predicting factors such as immunodeficiency or cystic fibrosis were excluded., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objectives: The obligation for BCG vaccination, suspended in July 2007, was replaced by a vaccination targeting children with a high risk of tuberculosis. The purpose of this study was to assess the vaccination rate of infants living Marseilles and its suburbs who had criteria for BCG vaccination., Material and Methods: This observational study consisted in interviewing the parents of children born after the suspension of the obligatory BCG vaccination and admitted for a medical visit at the Pediatric Emergency Department of the Timone-Enfants University Hospital between 1 December 2008 and 31 March 2009. For each child, we noted the demographic data, the criteria for BCG eligibility, the vaccination status, and, when the child was not vaccinated but at risk for tuberculosis, the information received by the family on the vaccination., Results: A total of 224 out of 271 eligible children were included (82.6%; mean age, 7.1 ± 4.9 months). One hundred and fifty-seven infants had at least one criterion for BCG vaccination; 116 of them were vaccinated (73.9%). The number of criteria for the vaccination did not influence the vaccine rate. Families of non-vaccinated high-risk children (n=41) had been informed about BCG in 39% of the cases. BCG was planned in 11 of these 41 infants., Conclusion: Eighteen months after suspension of the obligation for BCG vaccination, our results are encouraging but underline the need for improving information to families concerned by this new vaccination policy., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

We report the case of a 5-year-old girl with persistent chest X-ray abnormalities following an episode of pneumonia who has a complex congenital pulmonary malformation comprising of a congenital pulmonary airway malformation, an intralobar sequestration and two bronchogenic cysts, all present within the same lobe. The observation suggests a common embryological origin of these malformations., (Copyright 2010 Wiley-Liss, Inc.)

The aim of our study was to determine the different characteristics of infective endocarditis in children without underlying heart disease. This was a descriptive, retrospective study including all cases of infective endocarditis without underlying heart disease occurring in children under 18 years of age, hospitalized at the Timone Children's Hospital in Marseille, France, between 1997 and 2008. The clinical, microbiological, and echocardiography data; treatment; and outcome were reviewed for each case. Over an 11-year period, 26 children were hospitalized with infective endocarditis. Eleven children (7 boys) had no underlying heart disease (42 %). Their mean age was 8 years and 3 months. Underlying conditions including neoplasm, preterm birth, and central venous catheter were found in 6 cases. A heart murmur was observed in 82 % of the children. A microorganism was isolated in 10 children (91 %). Staphylococcus aureus was the most common agent (45 %), followed by fungi (18 %). Echocardiography detected cardiac complications in 7 cases (64 %). Ninety-one percent of the children received intravenous antibiotics for a mean duration of 45 days. Eighty-two percent of our patients required surgical intervention. In our series, 91 % of the patients met the modified Duke criteria defining infective endocarditis. In-hospital mortality was 11 %. Embolic complications were seen in 5 cases (45 %), patients whose cultures yielded S. aureus or fungal organisms were more likely to present complications. Infective endocarditis without heart disease has particular features that differ from those of congenital heart disease. This diagnosis must be considered when predisposing factors are present., (Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.)

In France, half of hospital admissions for asthma concern children and the rates of hospitalization, decreasing in adults, are stable in children. Most admissions for asthma exacerbation are avoidable with appropriate disease management. The objective of this study was to describe the characteristics of children admitted for asthma. The study was carried out in 14 pediatric units over 1 year. Children aged 3 years and over who were hospitalized for an asthma exacerbation were included. Data from 727 hospitalizations were collected. In 48% of the hospitalizations, children were 3-5 years old. Asthma was undiagnosed at the time of the admission in 27%. Among children with diagnosed asthma, 57% had already been admitted to the hospital for asthma exacerbation, 37% had been admitted to the hospital or emergency department during the last year, and the control of asthma in the previous month was unacceptable in 46%; 11% had received an oral and written self-management action plan. This study underlines the need to strengthen the efforts to encourage improvement of the therapeutic education of asthmatic children in order to decrease the risk of hospitalization for exacerbation of asthma., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Background: The 2000 French Consensus Conference for Acute Viral Bronchiolitis management underlined clinical practice recommendations., Objective: To assess the impact of these guidelines on management of acute bronchiolitis, 3 and 8 years after publication., Methods: A standardized questionnaire was mailed to 762 general practitioners (GPs) in 2003 and 800 GPs in 2008. It described two clinical case scenarios (moderate acute viral bronchiolitis and severe acute bronchiolitis) and inquired about the physician's conduct in each case. The primary outcome was the percentage of responders who described patient management in accordance with current guidelines: correct diagnosis and treating the patient symptomatically in an outpatient setting in the first case and correct diagnosis in addition to requiring an inpatient setting for the second case. Secondary outcome was the percentage of responders who would have given unnecessary or potentially harmful treatments. Physician responses in 2003 and 2008 were compared using the Student t-test and the Chi(2) test. Multivariate analysis was conducted to assess the potential factors associated with good adherence to guidelines., Results: Nearly 25% of the questionnaires were returned in 2003 and 2008. Patient management was described in accordance with the guidelines in only 6% in 2003 and 20% in 2008 (p< or =0.001). Unnecessary treatments were prescribed in 77% in 2003 vs 60% in 2008 (p<0.001) and potentially dangerous treatments in 38% in 2003 vs 22 % in 2008 (p=0.006). Using multivariate analysis, the GP's age was inversely correlated with adherence to clinical recommendations (adjusted odds ratio [adOR]=0.93; 95% CI=0.87-0.98; p=0.01). Fifty-four percent of GPs reported knowing these guidelines, but only 57% of them declared that the latter has modified their practice., Discussion: GPs are still prescribing unnecessary or even potentially dangerous treatments for bronchiolitis. On the other hand, severe cases are correctly diagnosed and well managed in an inpatient setting., Conclusion: Three and 8 years after their publication, adherence to guidelines is insufficient., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Accidental drownings are severe and sometimes mortal events in children. Our study aims to better clarify the epidemiology and the respiratory complications of these accidents in our hospital. We led a retrospective study over 10 years concerning the children hospitalized for accidental drowning in our hospital centre. Age at the moment of the accident, sex, history of accident, hospitable care, thoracic imaging and neurological outcome of the children were studied. In total, 83 children were hospitalized (5 years on average, 70% being boys). The drowning especially took place in fresh water (71%), particularly in swimming pools (51.8%). Stages III and IV of drowning concerned 40.9% of the population. The coverage was the following one: admittance in ICU 57.8%, mechanical ventilation 34.9%, oxygen therapy 16.9%, antibiotics 87.9%. A normal chest x-ray was present in 45.7% of the cases. Drowning in fresh water, especially in contaminated fresh water (canal, WC, etc.), induced atelectasis (10.8%), whereas drowning in sea water induced diffuse infiltrates (8.4%). Aspiration pneumonia (33.7%) was present in both cases and a pulmonary oedema (6%) was only noticed during stage IV drowning. The secondary infections were rare (1 case was suspected and another probable). A child presented a secondary acute respiratory distress syndrome (1.2 %). Finally, 7 deaths (8.4%) and 1 case with severe neurological sequelae (1.2%) were noted. Accidental drowning causes important consequences in children. The long-term respiratory outcomes have not been properly studied. Prevention of such accidents is based on parental vigilance during their child's bathe., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

The in vitro assessment of the aerosol fine particle 'respirable' fraction and the aerodynamic particle size distribution on cascade impactors is necessary to meet the demands of regulatory authorities but does not predict lung deposition of an inhaled drug notably in patients with chronic obstructive airway diseases. Total drug delivery to the lung can be assessed using pharmacokinetic methods. Pharmacokinetic studies are easier to conduct in patients with chronic obstructive diseases than imaging studies using two- or three-dimensional scintigraphic methods. For fast acting inhaled drugs, such as bronchodilators, the relationship between lung deposition and clinical efficacy can be established by modeling of the pharmacokinetic - pharmacodynamic (bronchodilation) relationship. Improvement of lung deposition is usually associated with a reduction of the dose required for clinical efficacy but the change in the dose-response relationship is not proportionally related to the increase in lung deposition. Aerosols delivering small particles improve lung deposition, by distributing drug diffusely throughout the lungs, in particular by reaching peripheral airways. These aerosols do not improve clinical efficacy as evaluated on classical spirometric or clinical criteria but often permit a reduction in dosage. Also, they can minimize oropharyngeal deposition, reduce variability in lung deposition and spirometric response related to change in inspiratory flows.

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 2 g/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 1.4 g/L increased in patients with peaks greater than 2 g/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 2 g/L during CGMS., Conclusion: CGMS revealed more glucose metabolism abnormalities than OGTT in patients with unexplained altered general status.

The treatment of asthma in children should not be fixed but rather must be regularly adapted to keep the condition under control defined according to clinical and functional criteria. In a child whose asthma is controlled, a step down in therapy should be carried out every 3 to 6 months to achieve the minimal effective level of treatment. In a child whose asthma appears not to be controlled, it is necessary initially to evaluate compliance with therapy and to seek aggravating factors which may include allergic rhinitis, multiple sensitisation, tobacco exposure, psychological factors, obesity, gastro- oesophageal reflux and infection. Where control of asthma is poor the main therapeutic strategy rests on an increase in the dose of inhaled corticosteroid and on the addition of other anti-asthmatic treatments--inhaled long--acting beta 2 agonists and oral leukotriene antagonists.

Recent studies using 16S rRNA gene amplification followed by clonal Sanger sequencing in cystic fibrosis demonstrated that cultured microorganisms are only part of the infecting flora. The purpose of this paper was to compare pyrosequencing and clonal Sanger sequencing on sputum. The sputum of a patient with cystic fibrosis was analysed by culture, Sanger clone sequencing and pyrosequencing after 16S rRNA gene amplification. A total of 4,499 sequencing reads were obtained, which could be attributed to six consensus sequences, but the length of reads leads to fastidious data analysis. Compared to clonal Sanger sequencing and to cultivation results, pyrosequencing recovers greater species richness and gives a more reliable estimate of the relative abundance of bacterial species. The 16S pyrosequencing approach expands our knowledge of the microbial diversity of cystic fibrosis sputum. The current lack of phylogenetic resolution at the species level for the GS 20 sequencing reads will be overcome with the next generation of pyrosequencing apparatus.

Introduction: Prospective studies of paediatric cohorts contribute to our knowledge of changes in pulmonary function in children with asthma., State of the Art: Asthma is associated with a significant impairment of the distal airways which is more pronounced when asthma has started early, before 5 years of age, or when asthma is persistent. In utero exposure to tobacco smoke allergenic sensitization and persistent bronchial hyperresponsiveness are the main factors associated with an unfavourable respiratory function outcome. This impairment may persist despite the disappearance of symptoms. Distal airway alterations are also poorly responsive to conventional inhaled corticosteroid therapy. This could be due to early remodelling phenomenon or non-optimal deposition of the drugs on distal airways., Perspectives and Conclusions: The medium and long term clinical implications of distal airway involvement in paediatric asthma and the impact of treatment need to be evaluated.

We report the cases of two young immunocompetent children with bronchopneumonia associating disabling, spastic cough and severe hypoxemia. In both patients, a primary Epstein-Barr Virus (EBV) infection had been suggested based on EBV presence in nasal secretions and a positive serology with anti-VCA immunoglobulin M. Nevertheless, the diagnosis was not confirmed. We discuss the problems confirming EBV responsibility in acute respiratory infections and the pitfalls of diagnostic tests.

Unlabelled: Chicken pox is usually considered a benign viral affection; however, possible infectious complications are observed. Although cutaneous infections are well described, bacterial pneumonia with empyema is more exceptionally reported., Purpose: To describe the clinical characteristics of bacterial pneumonia with empyema associated with chicken pox., Methods: This descriptive multicenter retrospective study was based on a questionnaire sent by Internet to 30 French pediatric and pediatric respiratory hospital wards., Results: We found 4 cases of children (mean age, 19 months) presenting during the chicken pox eruption concomitant bacterial pneumonia with empyema. The average time of diagnosis was 4.5 days after the beginning of the eruption. All the children were febrile and had an average pulsed oxygen saturation of 87%. The inflammatory syndrome was constant with a mean C reactive protein of 253 mg/l. Group A Streptococcus was identified in 3 cases out of 4. Admission to an intensive care unit was necessary for 3 children, 1 of them requiring mechanical ventilation. No clinical or radiological sequelae were observed during the complete year of follow-up., Conclusion: Bacterial pneumoniae with empyema are not current complications of chicken pox but have to be sought when prolonged fever and/or alteration of the health status occurs during chicken pox eruption.

Spontaneous pneumomediastinum is a rare entity in children, especially in young infants. We report the case of a 4-month-old infant with a massive spontaneous pneumomediastinum caused by acute viral bronchiolitis. Treatment including bed rest, codeine for its antitussive action, and nitrogen washout resolved the pneumomediastinum within 3 days. In the literature, cases of pneumomediastinum in very young infants are exceptional. To our knowledge, codeine has never been used in this situation. Nitrogen washout is also rarely used because of poorly demonstrated efficacy.