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From 2015 to 2017, 3197 interpretable Bordetella polymerase chain reaction (PCR) tests were performed for 2760 children presenting to our tertiary university hospital. Requests mainly came from the emergency department (62%) and for children older than 1 year (68%). Only 32 PCR (1%) results were positive, mainly in children younger than 1 year (n = 29/32, 90.6%; p

International audience; Non accidental intoxication due to child abuse is rare and its frequency is likely underestimated because it is difficult to diagnose. Here, we report a case of voluntary repeated exposure to lithium in an infant, for whom the clinical manifestations were convulsions. Toxicological analysis was very helpful for documenting lithium exposure during the assumed period of time. Interpreting the results of hair analysis, a simple and minimally invasive examination, is tricky at this age, but it can facilitate the differentiation of acute versus chronic exposure. Although infrequent and underestimated, lithium should be considered as a cause of intoxication in a previously healthy child with acute seizure.

Resume Le piercing se pratique sur des sites corporels divers parmi lesquels les oreilles et notamment le cartilage ont un franc succes. Nous rapportons deux cas d’adolescentes ayant presente une chondrite a Pseudomonas aeruginosa liee a ces piercings.

We report the case of an 18-month-old infant with severe serotype 3 adenovirus pneumonia, exceptionally associated with hemophagocytic syndrome. Treatment included cidofovir and mechanical ventilation for 13 days. The child developed chronic respiratory insufficiency due to bronchiectasis and bronchiolitis obliterans. (C) 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

International audience; Hamartoma is the most common benign pulmonary tumor in adults, but is rarely described in the pediatric population. Giant chondromatous and progressive forms are even rarer. We report the novel case of a 13-month-old infant hospitalized for giant pulmonary chondromatous hamartoma discovered during a septic episode, rapidly progressive, with severe multifocal lesions, without clear response to several cytotoxic therapies. No predisposition syndrome was identified.

Objective. A management protocol for infants hospitalized for acute bronchiolitis, established after the study conducted in our unit in 2012, recommends a chest X-ray when the clinical course is unusual or if a differential diagnosis is suspected. The goal of this study was to evaluate professional practices after the introduction of this new management protocol. Study design. Retrospective descriptive study in two pediatric units from October 2013 to March 2015, including infants (0-23 months) hospitalized for their first episode of acute bronchiolitis without any underlying chronic condition. Result. Overall, 599 infants were included (median age, 3.7 months, 54 % boys). Nearly six out of ten (n = 355, 59.3 %) had at least one chest radiograph (38.5 % fewer than in 2012). It was abnormal in 96.3 % of cases, revealing distension and/or bronchial wall thickening (56.7 %), focal opacity (23.5 %), or atelectasis (19.5 %). An X-ray was performed out of the recommendations in 42.5 % of cases. The chest X-ray result led to management changes in 52 infants with prescription of antibiotics for pneumonia (86.5 %) and allowed the diagnosis of heart disease in one case (0.2 %). Management of acute bronchiolitis (X-ray and antibiotics) was statistically different between the two pediatric units. Discussion. This protocol led to a significant decrease in the number of chest X-rays. However, many are still performed out of the recommendations, resulting in an increase of antibiotic use for pneumonia. Conclusion. The decrease in use of chest X-rays in acute bronchiolitis for hospitalized infants was significant but remains insufficient. (C) 2016 Elsevier Masson SAS. All rights reserved.

Introduction. Even if there are HAS (French National Health Authority) guidelines on shaken baby syndrome, many other child abuse situations are not included in these recommendations. The aim of this study was to invent the complementary exams in cases of child abuse in France and compare the practice to existing guidelines. Material and methods. This was a multicenter study by email to 128 French hospitals (35 university hospitals and 93 general hospitals) that receives children in emergency and hospitalization settings. Three child abuse clinical situations were included in a clinical case multiple-choice format concerning the further explorations. We described the main results and evaluated their adherence to the HAS protocol for case 1. Results. Of 128 hospitals surveyed, 104 responded, for an 81% response rate, which corresponded to 274 doctors. Analysis of the results showed great heterogeneity in practices. The majority of physicians (99%) performed systematic explorations in the situation of physical abuse, while only 27% undertook such exams in situations of serious neglect. The situation of sexual abuse was the most consensual in terms of diagnostic tests for the detection of sexually transmitted diseases, but other types of associated abuse were not sought. In the first case, the HAS guidelines were respected in less than half of the cases for all complementary exams except the eye fundus exam. Abdominal imaging was insufficiently performed (40% of cases). Examinations that were not indicated were still prescribed. Moreover, siblings under 2 years of age were examined in only one-third of cases (n = 88/274; 32%). Practices were not influenced by the age of the child. Conclusion. This study illustrates the heterogeneity in the use of complementary exams in cases of child abuse in France. Common protocols throughout the country would be useful, standardizing the most relevant exams for potential medical-legal issues, and facilitating exchanges concerning practices between different centers. (C) 2016 Elsevier Masson SAS. All rights reserved.

We report the case of a 21-month-old child suffering from pulmonary fibrosis, who presented with acute respiratory distress and liver damage, due to an accidental overdose of intravenous lipid emulsion. This poisoning is a rare entity, whose potential severity and almost exclusive iatrogenic effect deserve to be remembered.

Resume Introduction Parallelement a la decroissance du nombre d’adoptions internationales en France, les enfants adoptes sont de plus en plus âges et parfois en mauvaise sante. Face a ce phenomene, nous assistons depuis quelques annees a une augmentation des demandes de consultations de specialistes avant l’adoption. Cette etude analyse les raisons de telles consultations. Methode Etude descriptive multicentrique prospective allant du 1 er janvier au 31 decembre 2013. Resultats Dix centres ont participe a l’etude, pour un total de 196 consultations pre-adoption. Dans 88 % des cas, le motif principal etait un avis medical sur dossier pour un enfant identifie (32 %) ou un avis sur les particularites sanitaires d’un pays, que celui-ci soit identifie (34 %) ou non (23 %). Dans 6 % des cas, le motif etait surtout socio-familial et pour les 5 % restant, l’obtention d’informations sur l’adoption en general et ses procedures. Dans plus de 40 % des cas, que ce soit l’enfant ou le pays qui soit identifie, la Russie etait l’objet de la consultation du fait de dossiers complexes et tres charges et du syndrome d’alcoolisation fœtale redoute et souvent non evoque. Conclusion La degradation de la sante des enfants adoptes est une preoccupation de plus pour les futurs postulants a l’adoption et il convient d’avoir une grande experience de l’adoption avant de se lancer dans ce type de consultation pour informer au mieux les postulants sans choisir a leur place.

We report on the case of a 3-year-old child presenting bilateral bronchiectasis due to recurrent pneumonia with esophageal achalasia. The final diagnosis was triple A syndrome. This presentation is particularly atypical and rare at this age.

Resume Chaque hiver, la bronchiolite aigue du nourrisson est responsable d’un grand nombre d’hospitalisations. Son traitement est avant tout symptomatique et a ete codifie lors d’une conference de consensus de la Haute Autorite de sante (HAS) en 2000. La kinesitherapie respiratoire y avait ete mise en avant pour lutter contre l’encombrement et l’obstruction bronchique. Meme si les techniques different d’un pays a l’autre, elle est devenue quasi systematique dans la prise en charge de la bronchiolite aigue du nourrisson. Mais qu’en est-il reellement de son efficacite ou de sa legitimite ? L’objectif de notre etude etait de faire la revue de la litterature sur ce sujet. Peu d’etudes sont disponibles avec de faibles niveaux de preuve. Elles tendent a montrer que la kinesitherapie respiratoire n’aurait qu’un faible interet dans la prise en charge de la bronchiolite aigue du nourrisson ne modifiant pas l’histoire naturelle de la maladie ou la duree d’hospitalisation. Au total, on ne peut recommander de maniere systematique la kinesitherapie chez les nourrissons hospitalises pour bronchiolite aigue.

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.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.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.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.

Resume Nous rapportons le cas d’une maladie hemorragique tardive par carence en vitamine K, avec une prophylaxie adaptee mais insuffisante, secondaire a une cholestase extrahepatique. Cette forme tardive est devenue rare mais elle s’accompagne d’un risque d’hemorragie intracrânienne dans plus de la moitie des cas. Diagnostic, causes et prevention de cette maladie sont discutes.

The frequency of body piercing has increased in France over the past few years, particularly among teenagers. Piercing can be performed at different sites on the body, especially in the cartilage of the ears. We relate two cases of Pseudomonas aeruginosa chondritis. A 10-year retrospective study at the Marseille University Hospital found no additional pediatric cases. These infectious complications can sometimes be necrotizing. It is therefore important to inform the medical staff on the hygiene measures that need to be respected and the patients on the treatment to follow after the piercing as well as the signs to watch for, possibly indicating chondritis. The esthetic consequences depend on early diagnosis.

A management protocol for infants hospitalized for acute bronchiolitis, established after the study conducted in our unit in 2012, recommends a chest X-ray when the clinical course is unusual or if a differential diagnosis is suspected. The goal of this study was to evaluate professional practices after the introduction of this new management protocol.Retrospective descriptive study in two pediatric units from October 2013 to March 2015, including infants (0-23 months) hospitalized for their first episode of acute bronchiolitis without any underlying chronic condition.Overall, 599 infants were included (median age, 3.7 months, 54 % boys). Nearly six out of ten (n=355, 59.3 %) had at least one chest radiograph (38.5 % fewer than in 2012). It was abnormal in 96.3 % of cases, revealing distension and/or bronchial wall thickening (56.7 %), focal opacity (23.5 %), or atelectasis (19.5 %). An X-ray was performed out of the recommendations in 42.5 % of cases. The chest X-ray result led to management changes in 52 infants with prescription of antibiotics for pneumonia (86.5 %) and allowed the diagnosis of heart disease in one case (0.2 %). Management of acute bronchiolitis (X-ray and antibiotics) was statistically different between the two pediatric units.This protocol led to a significant decrease in the number of chest X-rays. However, many are still performed out of the recommendations, resulting in an increase of antibiotic use for pneumonia.The decrease in use of chest X-rays in acute bronchiolitis for hospitalized infants was significant but remains insufficient.

Resume Objectifs Decrire l’interet de la radiographie thoracique systematiquement realisee chez les nourrissons hospitalises pour bronchiolite aigue et etudier son impact sur la prise en charge de ces enfants. Patients et methodes Etude retrospective (octobre 2010 a mars 2012) portant sur tout nourrisson hospitalise dans notre unite, pour un 1 er episode de bronchiolite aigue sans pathologie chronique sous-jacente. Resultats Deux cent trente-deux enfants ont ete inclus (âge median de 2,2 mois, 56 % de garcons, 73,4 % positifs pour le virus respiratoire syncytial [VRS]). Parmi eux, 227 enfants (97,8 %) avaient eu une radiographie thoracique systematique revelant une distension ou un syndrome bronchique isoles (62,4 %), un foyer de condensation (19,9 %) ou une atelectasie (17,7 %). Cette radiographie avait entraine la prescription d’une antibiotherapie dans 6 cas (2,6 %) et permis le diagnostic d’anomalie vasculaire dans 1 cas (0,4 %). Trente-cinq enfants (15,4 %) avaient eu une 2 e radiographie thoracique lors de leur hospitalisation en raison d’une oxygeno-dependance prolongee ( n = 21), d’une detresse respiratoire ( n = 11), d’une fievre persistante ( n = 2), ou sans justification ( n = 1). Une pneumonie ( n = 7) ou une atelectasie ( n = 15) avait alors ete revelee dans 62,9 % des cas. Une modification de la prise en charge (antibiotherapie, mesures posturales) avait ete effective dans 6 cas (17,1 %). Discussion La radiographie thoracique systematique ne contribue que tres partiellement a la prise en charge d’un nourrisson hospitalise pour bronchiolite aigue. En revanche, son interet est reel en l’absence d’amelioration ou en cas d’aggravation clinique de l’enfant. Conclusion L’indication de radiographie thoracique chez le nourrisson hospitalise pour bronchiolite aigue doit etre discutee au cas par cas.

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.

Postmeningitis subdural empyema is rare in infants. It can have a severe clinical course with possible serious long-term consequences and 10% mortality. Diagnosis is often difficult. Postmeningitis subdural empyema must be discussed in cases of atypical progression of well-treated meningitis. We report the case of an 18-month-old infant presenting subdural empyema with an insidious course following Neisseria meningitidis group C meningitis.

Resume La bronchiolite aigue du nourrisson est une affection virale frequente et potentiellement grave dont le traitement n’est a l’heure actuelle que symptomatique. Le serum sale hypertonique (SSH) en luttant contre la deshydratation viro-induite de la surface des voies aeriennes est apparu recemment comme une possibilite therapeutique seduisante. Grâce a son pouvoir osmotique, il attire l’eau des cellules epitheliales, diminue l’œdeme sous-muqueux, restaure une hydratation de la surface liquidienne et ameliore la clairance muco-ciliaire. Cinq etudes randomisees en double insu menees chez le nourrisson hospitalise pour bronchiolite aigue ont montre que des nebulisations repetees de SSH a 3 % amelioraient de 20 % le score clinique de gravite a 48 h et diminuaient la duree d’hospitalisation de 24 h. La tolerance etait excellente. Cependant, plusieurs questions telles que la concentration optimale en sel, le nebuliseur recommande, le rythme d’administration ideal, l’utilisation en ambulatoire ou l’adjonction systematique d’une kinesitherapie respiratoire restent encore en suspens.

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.

Resume Nous rapportons le cas d’un nourrisson de 10 mois hospitalise pour une bronchiolite aigue a virus respiratoire syncitial (VRS) compliquee d’une pneumonie necrosante a Staphylococcus aureus, secreteur de leucocidine de Panton-Valentine (LPV), avec pyopneumothorax. L’evolution etait favorable sous biantibiotherapie et drainage pleural.

Scurvy is the clinical manifestation of a deficiency in vitamin C, which is present in fresh fruits and vegetables. It is historically linked to the era of great maritime expeditions. Manifestations are misleading in children, in contrast with adults: bone disease and hemorrhagic syndrome are the earliest and most frequent manifestations due to a collagen biosynthesis defect. Scurvy is an old, potentially fatal disease but is easily curable with ascorbic acid. It can be prevented with vitamin C treatment in pediatric populations with unusual eating habits. We describe two cases of pediatric scurvy in two 7-year-old boys who had dietary restrictions stemming from developmental disorders.

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. Language: fr

Resume Streptococcus pyogenes ou streptocoque du groupe A (SGA) peut etre responsable d’infections invasives graves avec risque d’infection secondaire chez les sujets contacts plus eleve que dans la population generale. Peu de cas groupes, notamment intrafamiliaux, d’infection invasive ont ete decrits malgre une augmentation recente de la frequence des infections invasives a SGA. Nous rapportons les observations de deux freres, l’un âge de 8 ans et demi ayant presente un syndrome de choc toxique sans germe identifie et l’autre, âge de 14 ans et demi, hospitalise une semaine plus tard pour une septicemie a SGA. La survenue dans un laps de temps aussi court d’un cas certain d’infection invasive a SGA et d’un cas probable repond a la definition de cas groupes. Ces deux freres ne presentaient aucun facteur de risque d’infection invasive et aucune porte d’entree notamment cutanee n’a pu etre retrouvee. Une antibioprophylaxie familiale a ete instauree comme recommande par le Conseil superieur d’hygiene publique de France (CSHPF).

Resume La maladie de Kawasaki (MK) est bien connue chez l’enfant de moins de 6 ans. Neanmoins, elle peut egalement toucher des enfants plus âges. L’objectif de notre etude etait de decrire les caracteristiques de la MK chez des grands enfants et des adultes jeunes. Il s’est agi d’une etude retrospective, multicentrique, descriptive, recensant tous les enfants de plus de 8 ans hospitalises dans un service de pediatrie et tous les adultes hospitalises dans un service de medecine interne ou de cardiologie de tout hopital marseillais pour MK entre 1999 et 2009. Les donnees cliniques, paracliniques, pronostiques et therapeutiques ont ete recueillies pour chaque cas. Sur la periode etudiee, 98 patients ont ete recenses dont 6 avaient entre 8 ans 1 mois et 21 ans 7 mois. Ces 6 cas presentaient une forme typique de la maladie avec des atteintes d’organes associees chez 5 d’entre eux. L’atteinte cardiologique etait presente chez 5 patients, 2 ayant necessite un sejour en reanimation pour defaillance cardiaque. Les delais diagnostique et therapeutique etaient de 11,2 j avec, pour tous, un autre diagnostic evoque initialement. Les recommandations therapeutiques en vigueur n’ont ete appliquees que chez 2 patients. Le pronostic de la MK chez le grand enfant et l’adulte jeune differe de celui du jeune enfant en raison de l’errance diagnostique initiale. Le retard diagnostique est un facteur pronostique pejoratif favorisant l’atteinte cardiaque. Toute fievre prolongee de plus de 5 j doit donc faire evoquer une MK, quel que soit l’âge du patient.

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.

Resume Objectifs L’obligation vaccinale par le bacille de Calmette-Guerin (BCG), suspendue en juillet 2007, a ete remplacee par une vaccination ciblee chez les enfants a risque eleve de tuberculose. Notre etude avait pour but d’estimer la couverture vaccinale (CV) par le BCG chez des nourrissons habitant Marseille et sa banlieue et ayant des criteres de vaccination. Materiel et methodes Etude prospective par questionnaire menee, avec l’aide des medecins urgentistes, aupres des parents d’enfants nes apres la suspension de l’obligation vaccinale et consultant dans le service d’accueil des urgences pediatriques du centre hospitalo-universitaire (CHU) Timone-Enfants entre le 01 decembre 2008 et le 31 mars 2009. Pour chaque enfant etaient notes les donnees demographiques, les criteres d’eligibilite au BCG, le statut vaccinal, et, chez les non vaccines mais a risque, les informations recues par la famille sur le vaccin. Resultats Au total, 224 enfants sur 271 eligibles ont ete inclus (82,6 % ; âge moyen 7,1 ± 4,9 mois) parmi lesquels 157 nourrissons avaient au moins un critere de vaccination par le BCG, 116 d’entre eux etant vaccines (73,9 %). Le nombre de criteres pour etre vaccine n’influencait pas la CV. Les familles des enfants a risque non vaccines ( n = 41) avaient recu une information dans 39 % des cas. Une vaccination etait programmee chez 11 d’entre eux. Conclusion Dix-huit mois apres la levee de l’obligation vaccinale, nos resultats sont encourageants mais soulignent la necessite d’ameliorer l’information des familles concernees par cette nouvelle politique vaccinale.

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.

Resume Probleme La bronchiolite aigue du nourrisson a fait l’objet d’une Conference de consensus (CC) en 2000. Objectifs Notre etude propose d’evaluer son application en medecine generale a 5 ans d’intervalle. Materiel et methodes Deux cas cliniques standardises de bronchiolite aigue du nourrisson (forme moderee et grave) ont ete adresses a 762 (2003) et 800 (2008) medecins generalistes tires au sort. On attendait : bon diagnostic et traitement symptomatique exclusif a domicile pour la forme moderee ; bon diagnostic et hospitalisation pour la forme grave. Les traitements inutiles (bronchodilatateurs, corticoides, antibiotiques) ou deleteres (fluidifiants, antitussifs), la connaissance des recommandations, le mode d’acces a ces recommandations etaient aussi evalues. Les donnees 2003–2008 ont ete comparees par test t de Student ou test du Chi2. Les facteurs de bonne adhesion a la CC ont ete evalues en analyse multivariee. Resultats Le taux de reponse etait similaire en 2003 et 2008 (25 % et 23 %). La prise en charge conforme des 2 cas etait de 6 % en 2003 vs 20 % en 2008 (p Discussion La prise en charge de la bronchiolite aigue du nourrisson reste delicate, avec encore sur-traitement des formes moderees. Conclusion Meme a distance de la publication de recommandations, leur application reste difficile.

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.

Resume La varicelle est une affection virale reputee benigne mais pouvant parfois se compliquer de surinfections bacteriennes, notamment a streptocoque du groupe A. Si les infections cutanees sont bien decrites, les pleuropneumopathies bacteriennes sont rarement rapportees. Objectif Decrire les caracteristiques cliniques et paracliniques des pleuropneumopathies bacteriennes survenant au cours d’une varicelle. Materiels et methodes Il s’agit d’une etude retrospective descriptive multicentrique sur 1 an, par recueil de questionnaires envoyes via Internet a 30 services de pneumopediatrie et de medecine infantile hospitaliers francais. Resultats Quatre cas de pleuropneumopathie bacterienne concomitante de l’eruption vesiculeuse ont ete recenses chez des enfants d’âge moyen de 19 mois. Le delai moyen de diagnostic etait de 4,5 j apres le debut de l’eruption vesiculeuse. Tous les enfants etaient febriles a l’admission et la saturation pulsee en oxygene etait en moyenne de 87 %. Le syndrome inflammatoire biologique etait constant avec une proteine C reactive moyenne a 253 mg/l. Le streptocoque du groupe A etait le germe retrouve dans 3 cas sur 4. Une hospitalisation en reanimation etait necessaire pour 3 enfants, avec une ventilation assistee pour l’un d’entre eux. Aucune sequelle clinique ou radiologique n’a ete decrite avec un recul de 1 an. Conclusion Les pleuropneumopathies bacteriennes sont une complication peu frequente de la varicelle. Il faut cependant y penser devant tout tableau de fievre ou d’alteration de l’etat general survenant pendant la phase eruptive.

Resume Nous rapportons les cas de 2 jeunes enfants immunocompetents qui ont presente un tableau respiratoire aigu similaire, associant une toux spastique extremement invalidante et une hypoxemie majeure. Chez les 2 patients, une primo-infection a virus d’Epstein-Barr (EBV), quoique rare, a ete evoquee en raison de la presence d’EBV dans les secretions nasales et d’une serologie positive avec presence d’IgM anti-VCA. En depit de ces donnees, le diagnostic a finalement ete infirme dans les 2 cas. Nous revenons donc sur la difficulte de retenir la responsabilite de l’EBV dans les affections respiratoires aigues et sur les pieges lies aux techniques de mise en evidence de ce virus.

Resume Le pneumomediastin spontane est une affection rare chez l’enfant, plus particulierement encore chez le nourrisson en bas âge. Nous rapportons ici le cas d’un nourrisson ayant presente un pneumomediastin spontane particulierement etendu dans les suites d’une bronchiolite aigue a un âge precoce (4 mois). Devant l’absence d’amelioration clinique a j6, la mise en place d’un traitement par codeine a visee antitussive et denitrogenation peripherique sous enceinte a permis une guerison rapide. Dans la litterature, les cas de pneumomediastin spontane survenant a un âge aussi precoce sont exceptionnels. L’utilisation d’un antitussif central dans ce contexte n’est pas mentionnee, et le traitement par denitrogenation peripherique semble peu utilise du fait du manque de donnees concernant son efficacite reelle.

The origin of contamination in pertussis of young infants is generally the close relatives. From 2000 to 2004, only serology and culture were available in our hospital. The families of 16 young infants (age below one year) hospitalized for pertussis were screened using serological tests: 21/48 contacts were positive. After 2004, PCR was available for exploration of index cases and families: 35/85 contacts were positive. Of the mothers tested 23/46 were positive compared to 14/41 fathers. Only one parent presented with a typical paroxystic pertussis cough, 60% presented with a nonparoxystic cough having lasted for more than five days and 40% of positive adults did not present with cough. Despite official recommendations, none of these young parents had received an antipertussis booster vaccination. This study shows the high frequency of atypical or nonsymptomatic pertussis in adults in the close family of infected young infants. These adults contribute to spreading the disease.

Introduction En France, la vaccination annuelle contre la grippe est recommandee chez les professionnels de sante, mais peu de donnees concernant leur couverture vaccinale (CV) existent. L’objectif de cette etude etait d’evaluer la CV grippe des soignants des Centres de Ressources et de Competences de la Mucoviscidose (CRCM) du Grand-Sud de la France. Methodes Une enquete telephonique observationnelle descriptive conduite de fevrier a avril 2006 a recueilli le statut vaccinal vis-a-vis de la grippe de l’ensemble des soignants des 12 CRCM des reseaux Muco-Sud et Muco-Med. Resultats La CV en 2005-2006 des 128 soignants etait de 59,4 %. Elle variait selon la profession entre 81,4 % (medecins) et 16,7 % (assistants sociaux). La vaccination etait generalement effectuee en octobre (42,1 %) ou novembre (39,5 %) par la medecine du travail (65,8 %). Le principal motif de non-vaccination cite etait « vaccin inutile car maladie benigne » (36,7 %). Conclusion La CV des soignants des 12 CRCM du Grand-Sud de la France est elevee, mais insuffisante eu egard a la possible gravite de l’infection grippale chez les patients atteints de mucoviscidose et a l’un des objectifs de la loi de sante publique (S75% de CV pour les professionnels de sante d’ici 2008).

Resume Introduction Un des enjeux majeur du controle de la tuberculose est le diagnostic et le traitement des formes latentes de la maladie. Etats des connaissances Actuellement, ce diagnostic repose sur un faisceau d’arguments et sur les resultats de l’intradermoreaction a la tuberculine (IDR). La specificite de l’IDR est faible, sa sensibilite mediocre et sa realisation n’est pas facile. Perspectives Deux tests diagnostiques in vitro bases sur la production d’interferon gamma ont ete recemment commercialises. Ils presentent un certain nombre d’avantages par rapport a l’IDR. Leur realisation est facile et les resultats sont moins subjectifs. Leur specificite est bien superieure puisqu’il n’existe pas de reaction croisee avec les souches vaccinales et la plupart des mycobacteries atypiques. La sensibilite de ces tests est meilleure que celle de l’IDR pour le diagnostic de tuberculose maladie. Dans le cadre de la tuberculose infection, ces tests ont montre une meilleure correlation au degre d’exposition que les tests cutanes a la tuberculine. L’immunosuppression (en particulier iatrogene) semble affecter de maniere significative leur sensibilite. Conclusions Les deux tests in vitro sont un outil supplementaire dans la lutte contre la tuberculose. Leur realisation est plus facile et les resultats sont moins subjectifs que l’IDR. Leur evaluation doit etre poursuivie par des etudes de grande envergure sur des populations representatives de celles qui sont habituellement exposees au risque de tuberculose.

We report the case of a 21-month-old child suffering from pulmonary fibrosis, who presented with acute respiratory distress and liver damage, due to an accidental overdose of intravenous lipid emulsion. This poisoning is a rare entity, whose potential severity and almost exclusive iatrogenic effect deserve to be remembered.

Even if there are HAS (French National Health Authority) guidelines on shaken baby syndrome, many other child abuse situations are not included in these recommendations. The aim of this study was to invent the complementary exams in cases of child abuse in France and compare the practice to existing guidelines.This was a multicenter study by email to 128 French hospitals (35 university hospitals and 93 general hospitals) that receives children in emergency and hospitalization settings. Three child abuse clinical situations were included in a clinical case multiple-choice format concerning the further explorations. We described the main results and evaluated their adherence to the HAS protocol for case 1.Of 128 hospitals surveyed, 104 responded, for an 81 % response rate, which corresponded to 274 doctors. Analysis of the results showed great heterogeneity in practices. The majority of physicians (99 %) performed systematic explorations in the situation of physical abuse, while only 27 % undertook such exams in situations of serious neglect. The situation of sexual abuse was the most consensual in terms of diagnostic tests for the detection of sexually transmitted diseases, but other types of associated abuse were not sought. In the first case, the HAS guidelines were respected in less than half of the cases for all complementary exams except the eye fundus exam. Abdominal imaging was insufficiently performed (40 % of cases). Examinations that were not indicated were still prescribed. Moreover, siblings under 2 years of age were examined in only one-third of cases (n=88/274; 32 %). Practices were not influenced by the age of the child.This study illustrates the heterogeneity in the use of complementary exams in cases of child abuse in France. Common protocols throughout the country would be useful, standardizing the most relevant exams for potential medical-legal issues, and facilitating exchanges concerning practices between different centers.

Resume Introduction Le tabagisme demeure un sujet preoccupant. On peut estimer que la moitie des enfants qui naissent actuellement en France a ete, est ou sera exposee aux effets nocifs du tabagisme passif. Cette revue propose de faire le point sur les connaissances des effets du tabagisme passif ex et in utero. Etats des connaissances Le tabagisme passif ex utero est implique dans de nombreuses pathologies respiratoires (asthme, allergie, infections…) et non respiratoires (tumorales, dentaires, ophtalmologiques, digestives, cardio-vasculaires et infectieuses…). Le tabagisme in-utero est encore plus deletere en induisant des anomalies du developpement de la grossesse (anomalies placentaires, prematurite…), du fœtus (troubles comportementaux, malformations…) et des perturbations a long terme sur la sante de l’enfant a naitre. Sur le plan respiratoire, le tabagisme passif est responsable d’anomalies morphologiques pulmonaires (hypoplasie pulmonaire, diminution de la quantite d’elastine, augmentation des depots de collagene, alteration de la structure alveolaire) et de troubles fonctionnels (diminution de la compliance, augmentation des resistances des voies aeriennes, hyperreactivite bronchique). Enfin, il induit une perturbation de la commande de la respiration, remplissant ainsi tous les criteres pour favoriser la mort subite du nourrisson. Conclusion Les mefaits du tabagisme passif justifient pleinement d’informer et sensibiliser le corps medical sur son devoir de lutter contre ce fleau.

Resume Les systemes d'inhalation font l'objet d'avancees considerables. Les aerosols doseurs pressurises ne seront bientot plus propulses que par l'hydrofluoroalkane-134a. Certains d'entre eux s'equipent d'un compteur de doses. De nouveaux dispositifs, mecaniques ou electrostatiques, sont prochainement attendus. Les chambres d'inhalation sont de plus en plus nombreuses et une est meme verticale. Les inhalateurs de poudre seche cherchent essentiellement a s'affranchir du debit inspiratoire du patient pour une delivrance directe de la poudre dont la production et la formulation font l'objet de nombreuses recherches. Les nebuliseurs progressent eux aussi avec mise a disposition des nouveaux nebuliseurs a tamis qui sont petits, silencieux, et rapides. D'autres appareillages cherchent quant a eux a controler la facon de respirer du patient le temps de la nebulisation. Couples avec l'inhalation de particules medicamenteuses sous forme de fibres, ils pourraient representer le dispositif ideal pour une efficacite optimale.

Lambert-Eaton myasthenic syndrome is a paraneoplasic syndrome which can reveal a primitive tumor. Frequently, the first diagnosis is myasthenia gravis. This disease is extremely rare in children. Only 10 cases have been reported in the last 35 years. We report 2 new observations occurring in very young patients, aged 2 and 3 years, with a ganglioneurobastoma as primitive tumor.

Hemolymphangioma is a benign malformation of the lymphatic vessels. Cervical localisation is the most frequent. Mediastinal localisation is rare, but may be life-threatening because of airway compression. We report on a four-month-old boy who presented, in a context of epidemics, with clinical signs of acute bronchiolitis requiring mechanical ventilation for several days. Chest X-rays showed an important mediastinal mass with airways compression. Diagnosis was evoked on CT-scan aspects and confirmed by histology. Surgery allowed complete resolution, but dysphonia and oropharyngeal disorders persisted for several months. This rare congenital malformation is reviewed.

Resume Introduction Il existe peu d’etudes concernant les problemes medicaux rencontres chez les enfants places a l’Aide sociale a l’enfance (ASE). L’objectif de notre etude etait de decrire la population des mineurs places a l’ASE et ayant fait l’objet d’une notification a la MDPH (Maison departementale des personnes handicapees) des Bouches-du-Rhone au 1er janvier 2014. Patients et methodes Le registre informatique de l’ASE et celui de la MDPH ont ete croises afin d’en extraire les donnees administratives. Apres une analyse des dossiers medicaux MDPH, les informations sur les enfants places (âge gestationnel, deficiences, pathologies) ont ete codees. Resultats Parmi les 2965 mineurs places (0,7 % des mineurs de notre region), 506 (17 %) avaient une notification a la MDPH, contre 2,5 % en population generale. Parmi eux, 80,2 % avaient ete confies suite a une mesure de placement et 50 % des notifications MDPH concernaient les orientations vers un etablissement scolaire et medico-social. On a note 2,1 deficiences par enfant, dont 35,9 % etaient des deficiences du psychisme, 26,4 % des deficiences du langage et de la parole et 21,6 % des deficiences intellectuelles cognitives. Les pathologies rencontrees etaient pour 71 % des troubles mentaux et du comportement. Les enfants les plus jeunes et places en famille d’accueil presentaient plus de pathologies et de deficiences d’organe et peu d’atteintes du psychisme. Les enfants presentant des troubles du comportement etaient en general plus âges et places en foyer. Discussion Le taux de notification MDPH est 7 fois plus eleve parmi les enfants places qu’en population generale. Ce lien entre enfance en danger et handicap est difficile a expliquer, et la psychopathologie des enfants places complexe. Ces resultats illustrent la necessite d’un suivi adapte aux besoins specifiques de ces enfants.

Objectif Rapporter un cas d’intoxication aigue avec une dose potentiellement letale d’isoniazide suite a une erreur therapeutique chez un nourrisson de 21 mois. Description Un enfant de 21 mois, pesant 13 kg, aux antecedents d’asthme avec bronchiolites a repetition, dont le pere est atteint de tuberculose pulmonaire, se voit prescrire un traitement prophylactique par isoniazide (Rimifon ® comprimes) 100 mg 1 fois par jour et rifampicine (Rifadine ® suspension buvable). L’enfant, souffrant depuis 2 j d’une toux associee a une asthenie, recoit en une seule fois 30 cps de Rimifon ® 50 mg, soit 115 mg/kg (cps ecrases puis dilues dans l’eau), sa mere n’ayant pas compris la posologie. Trente minutes plus tard, l’enfant presente des tremblements et une hypotonie. A son arrivee aux urgences pediatriques a H1, il est en etat de mal epileptique, avec un coma Glasgow 4 et une acidose respiratoire (pH = 6,8, pCO 2 = 129 mmHg, pO 2 = 71 mmHg, HCO 3 = 22 mmol/L, lactates = 4,9 mmol/L). Il est intube (H2), transfere en service de reanimation, ou il est traite par anticonvulsivants (diazepam, clonazepam, midazolam) et vitamine B6 (pyridoxine) sur les conseils du centre antipoison de Marseille. La concentration d’isoniazide a H4 est a 76,1 μg/mL (HPLC-UV). Le lendemain, a J1, les convulsions ont cesse, l’EEG ne retrouve pas d’anomalie, les bilans biologiques hepatiques et renaux sont normaux, il n’y a pas de rhabdomyolyse, l’enfant est extube sans complication, puis transfere en neuropediatrie ou l’evolution clinique est favorable. A J3, la concentration d’isoniazide est inferieure a 0,3 μg/mL, le bilan hepatique objective une cytolyse moderee (ASAT/ALAT = 161/39 UI/L) et l’enfant rentre a domicile. Une consultation de controle effectuee a J5 retrouve un test tuberculinique negatif et une cytolyse en voie de regression (ASAT/ALAT = 52/66 UI/L). Compte tenu du risque toujours important de contage via le pere de l’enfant, il est decide de reintroduire le traitement prophylactique avec isoniazide forme buvable, qui est sous ATU, toujours associe a la rifampicine. La mere est sensibilisee aux modalites d’administration des medicaments. Discussion L’intoxication aigue a l’isoniazide se caracterise par une triade de symptomes : convulsions par carence en pyridoxine cerebrale, resistantes aux traitements conventionnels, acidose metabolique secondaire aux convulsions et coma. Notre patient a bien developpe la triade pathognomonique mais avec une acidose plutot respiratoire probablement du fait de ses antecedents pulmonaires. Une intoxication severe est caracterisee par une concentration superieure a 3,2 μg/mL a H2 ou superieure a 0,2 μg/mL a H6 [1] . Une dose d’isoniazide superieure a 80 mg/kg peut etre fatale [2] . Le traitement est symptomatique associe a l’antidote, la vitamine B6 administree a dose equivalente a la dose d’isoniazide supposee ingeree. Conclusion Bien que l’incidence de la tuberculose soit faible en France, sa prise en charge est toujours d’actualite. Comme l’illustre notre cas, le risque d’erreur therapeutique est important car cette maladie touche essentiellement les populations en situation de precarite telles que les migrants qui ne maitrisent pas toujours completement la langue francaise.

By the end of 2011, 275,000 children in France were included in the Aide sociale à l'enfance (ASE, Child Welfare System). Half of these children were entrusted to public care. There is limited data on these children. The MDPH (Maison départementale des personnes handicapées) is an administrative body assisting in the care of disabled children, through material, financial, and human means. Analyzing MDPH medical records can provide medical information about these children. The aim of this study was to describe the characteristics of children left to the ASE with a record at MDPH in Bouches-du-Rhône.We extracted administrative data from two registers, the ASE register and the MDPH register. The MDPH medical files of each patient were analyzed and their medical information was coded: gestational age, deficiencies, and pathologies.In Bouches-du-Rhône, 2965 children were entrusted, 506 (17%) of whom were known by the MDPH: 30.6% of the entrusted children known by MDPH were taken into foster care and 48% were in residential group homes. Half of the MDPH notifications concerned a referral to a school or medico-social institution. By analyzing the medical data, we observed an average of 2.1 deficiencies per child. The types of deficiencies were distributed as follows: 35.9% were psychological deficiencies, 26.4% were speech deficiencies, and 21.6% were intellectual cognitive deficiencies. The most common pathology was mental and behavioral disorder (71% of diagnoses).The MDPH notification rate in children entrusted to public care was seven times higher than in the general population. Overall, explaining the relation between child abuse and neglect and disability is difficult. The psychopathology of these children is complex. These results show the importance of specific medical monitoring for these children.

We report on the case of a 3-year-old child presenting bilateral bronchiectasis due to recurrent pneumonia with esophageal achalasia. The final diagnosis was triple A syndrome. This presentation is particularly atypical and rare at this age.

Scurvy is the clinical manifestation of a deficiency in vitamin C, which is present in fresh fruits and vegetables. It is historically linked to the era of great maritime expeditions. Manifestations are misleading in children, in contrast with adults: bone disease and hemorrhagic syndrome are the earliest and most frequent manifestations due to a collagen biosynthesis defect. Scurvy is an old, potentially fatal disease but is easily curable with ascorbic acid. It can be prevented with vitamin C treatment in pediatric populations with unusual eating habits. We describe two cases of pediatric scurvy in two 7-year-old boys who had dietary restrictions stemming from developmental disorders.

Pleuropulmonary blastoma is a rare childhood intrathoracic neoplasm, associated with a poor outcome. We report the case of a 7 week-old boy with a pleuropulmonary blastoma classified as type I. Disease was discovered at a chest X-ray performed as a work-up for a benign acute viral bronchiolitis. The final diagnosis was brought by pathology: a bronchopulmonary malformation had not been ruled out by clinical, radiological and macroscopic findings. Pleuropulmonary blastoma is a rare childhood intrathoracic neoplasm, for which the poor outcome and tough diagnosis justify a surgical attitude when an intrathoracic bullous lesion is found in an infant.