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Context: Hyperglycemia has been described in severe scorpion envenomation, we wanted to analyze if it was applicable to viper bites in children.Aim: To describe clinical, biological, and therapeutic characteristics of 83 children bitten by European viper (Viperaspp.) and to confirm that hyperglycemia is a risk factor for high-grade envenomation.Material and methods: A retrospective study was conducted between 2001 and 2014 in the pediatric emergency department of a tertiary level children’s hospital. Collected data were: age and sex of children; day and time of admission; day, time and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; laboratory abnormalities, use of specific immunotherapy, associated treatments; length of stay; hospital course.Results: Eighty-three children were included (62 boys, 21 girls). The mean age was 7.4 ± 3.9 years. Bites were most often located on the lower extremities (66%). The classification of envenomation was: 83% low grade (absent or minor envenomation) and 17% high grade (moderate to severe envenomation). All high-grade envenomations received specific immunotherapy (ViperfavTM, (Aventis Pasteur, MSD, Lyon, France). Being bitten on an upper extremity (odds ratio [OR] 51.1 95% class interval [CI] [6.1–424], p < 0.0001), during the afternoon (OR 13.4 95% CI [1.7–107.9], p = 0.015), feeling violent pain (OR 4.2 95% CI [1.1–16.5], p = 0.023), and high initial plasma glucose level (6.5 ± 1.7 mmol/L versus 5.0 ± 0.9 mmol/L, p = 0.027) were associated with a significant risk of high-grade envenomation.Conclusion: We have confirmed a potential link between initial hyperglycemia and the risk of progression to high-grade envenomation as well as its association with other published predictive factors. [ABSTRACT FROM AUTHOR]

Competing Interests: JMM declares that AAZ Laboratory supplied rapid immunochromatographic All In Triplex devices. EDH, CB, IC, and PT declare no competing interests.

Background: Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis, resulting in 3 million hospitalizations each year worldwide. Nirsevimab is a monoclonal antibody against RSV that has an extended half-life. Its postlicensure real-world effectiveness against RSV-associated bronchiolitis is unclear., Methods: We conducted a prospective, multicenter, matched case-control study to analyze the effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis in infants younger than 12 months of age. Case patients were infants younger than 12 months of age who were hospitalized for RSV-associated bronchiolitis between October 15 and December 10, 2023. Control patients were infants with clinical visits to the same hospitals for conditions unrelated to RSV infection. Case patients were matched to control patients in a 2:1 ratio on the basis of age, date of hospital visit, and study center. We calculated the effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis (primary outcome) by means of a multivariate conditional logistic-regression model with adjustment for confounders. Several sensitivity analyses were performed., Results: The study included 1035 infants, of whom 690 were case patients (median age, 3.1 months; interquartile range, 1.8 to 5.3) and 345 were matched control patients (median age, 3.4 months; interquartile range, 1.6 to 5.6). Overall, 60 case patients (8.7%) and 97 control patients (28.1%) had received nirsevimab previously. The estimated adjusted effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis was 83.0% (95% confidence interval [CI], 73.4 to 89.2). Sensitivity analyses gave results similar to those of the primary analysis. The effectiveness of nirsevimab therapy against RSV-associated bronchiolitis resulting in critical care was 69.6% (95% CI, 42.9 to 83.8) (27 of 193 case patients [14.0%] vs. 47 of 146 matched control patients [32.2%]) and against RSV-associated bronchiolitis resulting in ventilatory support was 67.2% (95% CI, 38.6 to 82.5) (27 of 189 case patients [14.3%] vs. 46 of 151 matched control patients [30.5%])., Conclusions: In a real-world setting, nirsevimab therapy was effective in reducing the risk of hospitalized RSV-associated bronchiolitis. (Funded by the National Agency for AIDS Research-Emerging Infectious Disease and others; ENVIE ClinicalTrials.gov number, NCT06030505.)., (Copyright © 2024 Massachusetts Medical Society.)

Background: Necrotizing pneumonia (NP) is a serious and rare disease in children. Pediatric data on NP are limited and the impact of the 13-valent pneumococcal conjugate vaccine has been very poorly evaluated., Patients and Methods: We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study., Results: The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae, five of Staphylococcus aureus, two of Streptococcus pyogenes, and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae., Conclusion: Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years., Competing Interests: Declaration of competing interest none for M. Cathalau, M. Michelet, A. Rancé, G. Martin-Blondel, O. Abbo, D. Dubois, G. Labouret, E. Grouteau, I. Claudet, L. Ricco, L. Roditis, JM. Mansuy, S. Simon, and C. Bréhin, (Copyright © 2024 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Most osteoarticular infections (OAI) occur via the hematogenous route, affect children under 5 years of age old, and include osteomyelitis, septic arthritis, osteoarthritis and spondylodiscitis. Early diagnosis and prompt treatment are needed to avoid complications. Children with suspected OAI should be hospitalized at the start of therapy. Surgical drainage is indicated in patients with septic arthritis or periosteal abscess. Staphylococcus aureus is implicated in OAI in children at all ages; Kingella kingae is a very common causative pathogen in children from 6 months to 4 years old. The French Pediatric Infectious Disease Group recommends empirical antibiotic therapy with appropriate coverage against methicillin-sensitive S. aureus (MSSA) with high doses (150 mg/kg/d) of intravenous cefazolin. In most children presenting uncomplicated OAI with favorable outcome (disappearance of fever and pain), short intravenous antibiotic therapy during 3 days can be followed by oral therapy. In the absence of bacteriological identification, oral relay is carried out with the amoxicillin/clavulanate combination (80 mg/kg/d of amoxicillin) or cefalexin (150 mg/kg/d). If the bacterial species is identified, antibiotic therapy will be adapted to antibiotic susceptibility. The minimum total duration of antibiotic therapy should be 14 days for septic arthritis, 3 weeks for osteomyelitis and 4-6 weeks for OAI of the pelvis, spondylodiscitis and more severe OAI, and those evolving slowly under treatment or with an underlying medical condition (neonate, infant under 3 months of old, immunocompromised patients). Treatment of spondylodiscitis and severe OAI requires systematic orthopedic advice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: The success rate of non-operative treatment (NOT) of acute uncomplicated appendicitis (AUA) in children varies from 65% to 95%. There are no recommendations on the appropriate antibiotic therapy., Objective: To determine the clinical efficacy of amoxicillin-clavulanic acid for NOT of AUA in children., Methods: Design: Cross-sectional study in a single medical centre., Settings: Emergency department and Paediatric Visceral Surgery department of the Children Hospital in Toulouse, France., Patients: Patients 5-15 years old who were diagnosed with appendicitis, (1) With abdominal pain and a first episode of acute appendicitis, (2) With no radiological or ultrasound evidence of appendicolith, appendiceal perforation, pelvic abscess nor peritonitis, and (3) With non-septic general aspect, were included., Interventions: NOT consisted of hospital admission. The antibiotic treatment was a combination of amoxicillin and clavulanic acid (80 mg/kg/day of amoxicillin): intravenous regimen during 48 hours followed by oral route during 7 days., Main Outcome Measure: Success rate of amoxicillin-clavulanic acid NOT in children with AUA at 2 years., Results: The initial success rate of amoxicillin-clavulanic acid NOT in children with AUA was 100% (104/104 patients). The success rate at 2 years was 85.6% (89/104) at discharge. None of the 15 patients who underwent surgery after recurrence of appendicitis presented with peritonitis, appendiceal perforation nor pelvic abscess., Conclusion: Narrowed antibiotic therapy with amoxicillin and clavulanic acid seems to be an alternative to surgery in children with AUA. It is necessary to wait for the results of ongoing studies to confirm these results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Objective: In the European Union, the record of cocaine-related seizures indicates an expanding supply. The purity has also been increasing. The health impact of these trends remains poorly documented, in particular, the changes and clinical manifestations of intoxication in young children. We attempted to evaluate the trend in French pediatric admissions for cocaine intoxication/exposure over an 11-year period (2010-2020)., Methods: A retrospective, national, multicenter, study of a pediatric cohort. All children less than 15 years of age admitted to a tertiary-level pediatric emergency unit for proven cocaine intoxication (compatible symptoms and positive toxicological screening) during the reference period were included., Results: Seventy-four children were included. Forty-six percent were less than 6 years old. Annual admissions increased by a factor of 8 over 11 years (+700%) and 57% of all cases were admitted in the last two years. The main clinical signs were neurologic (59%) followed by cardiovascular symptoms (34%). Twelve patients were transferred to the pediatric intensive care unit. Factors significantly associated with the risk of being transferred to the pediatric intensive care unit were initial admission to the pediatric resuscitation area ( P  < 0.001), respiratory impairment ( P  < 0.01), mydriasis ( P  < 0.01), cardiovascular symptoms ( P  = 0.014), age of less than 2 years ( P  = 0.014). Blood and/or urine toxicological screening isolated eighteen other substances besides cocaine in 46 children (66%)., Conclusion: Children are collateral victims of the changing trends in cocaine availability, use and purity. Admissions of intoxicated children to pediatric emergency departments are more frequent and there is an increase in severe presentations. Therefore, this is a growing public health concern.

Background: Sudden unexpected infant death (SUID) remains the leading cause of postnatal mortality in many countries. French and international guidelines recommend a thorough examination with toxicology studies., Objectives: The main objective was to determine the prevalence of toxic detection and positive analyses. The secondary objectives were to describe the different toxics and compare children with positive (Tox+) and negative results (Tox-) with other SUID risk factors., Design and Methods: We used the data registered from May 2015 to December 2018 by the French national SUID registry (OMIN). It collects data for all SUID cases admitted to any of the 35 participating French SUID referral centers., Results: Of the 624 SUID cases registered in the OMIN, a post-mortem toxicological analysis was performed in 398 infants. Thirty-six patients (9%) were positives for expected (Etox+ ( n  = 19 [53%], e.g., resuscitation drugs, regular treatments) and unexpected (UTox+) ( n  = 17 [47%]) toxics. The unexpected toxics were opioids ( n  = 8), cannabis ( n  = 4), cocaine ( n  = 3), cotinine ( n  = 2), carbon monoxide ( n  = 2), caffeine ( n  = 2), alcohol ( n  = 1) and GHB ( n  = 1). UTox + infants had a different seasonal distribution ( p  = .03), a higher incidence of inappropriate sleeping position and bedding at the time of death (respectively OR 3.8, p  = .037 - OR 5.4, p  = .026); inadequate body hygiene (OR 10.6, p  = .0005), a younger maternal age ( p  = .045) and a higher rate of maternal drug abuse (OR 21.9, p  = .0008)., Conclusion: The high rate of positive results warrants routine toxicology testing. The imputability of identified molecules is complicated by the presence of other known risk factors for SUID.

Background: We report a case of geometrical skin lesions in a teenage patient., Case: A previously healthy 14-year-old boy presented in our pediatric emergency department with unusual skin lesions on his left forearm. The patient said the lesions started 2 weeks earlier following a spider bite. His physical examination revealed an otherwise healthy child with no medical history with raised square lesions of the left forearm. The lesions were in different stages of healing and resembled second-degree burns. Examination showed no other lesions. Vital signs were normal. The patient was discharged after the lesions were dressed with antibiotic ointment. A follow-up consultation was scheduled a week later, but the patient did not attend the follow-up consultation. A senior emergency physician called the family and learned that the lesions were progressively healing and no other lesions appeared. The teen admitted he played the "salt and ice challenge.", Discussion: The salt and ice challenge involves putting salt on the skin and then applying and/or pressing ice cubes on top of the salt. The challenge is to resist the pain consecutive to frostbite for as long as possible. The result is often second-degree burns and possible partial third-degree burns., Conclusions: Because of the current popularity of this practice, emergency or family physicians, pediatricians, dermatologists, and burn or orthopedic surgery units might encounter these injuries. When young patients present with geometrical burn injuries and unexplained or bizarre circumstances, self-inflicted burn "challenges" should be considered., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Pediatricians working in an emergency environment are confronted with children admitted to emergency departments for intoxication on a daily basis. We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014. Twenty-nine children under the age of 3 were admitted with a positive cannabis urine test. Eighty-seven percent of intoxications occurred at the family home. Resin was the main form of ingested cannabis (69%). The mean age was 16.5 ± 5.2 months, and mean weight was 11.1 ± 2.1 Kg. Sixty percent of admissions occurred between 2012 and 2014. More severe presentations, based on Poisoning Severity Score, occurred over the past 2 years. Four children experienced seizures before admission. Ten children (34%) had a decreased level of consciousness (GCS <12) and were admitted to a pediatric intensive care unit for 12-24 h. All of them had ingested hashish (resin). The majority (70%) of children suffering from neurological impairment were admitted in the last year, of whom three required assisted ventilation. There were no cases with major outcomes and no deaths. Parents were not assessed regarding their cannabis consumption., Conclusion: This study supports the impression that accidental child poisonings with cannabis have been more serious than previously thought for 2 years. This observation may be explained by (1) the increased THC concentration in cannabis and (2) the widespread use in young adults, even after they become parents. Introducing an addiction team inside the PED could help to improve the care links with these parents. What is Known: • Cases of unintentional cannabis intoxication in children have been increasing for many years due to an increase of potency. What is New: • We highlight an increase in more severe presentations in children under the age of 3 occurring over the past 2 years, which will indicate the importance of assessing cannabis abuse in parents by a specialized addiction team.

To warn physicians and parents about the risk of macaque bites, we present two pediatric cases (a 4-year-old boy and a 10-year-old girl) of bites sustained while on holiday. The young boy developed febrile dermohypodermitis and was hospitalized for IV antibiotic treatment. He received an initial antirabies vaccine while still in the holiday destination. Except for local wound disinfection and antibiotic ointment, the girl did not receive any specific treatment while abroad. Both were negative for simian herpes PCR. When travelling in countries or cities with endemic simian herpes virus, parents should keep children away from monkeys. Travel agencies, pediatricians and family physicians should better inform families about the zoonotic risk., (© International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.)