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Clinical symptoms attributed to gastro-esophageal reflux disease (GERD) in healthy term infants are non-specific and overlap with age-appropriate behaviours. This practice point reviews the evidence for medically recommended management of this common condition. Current recommendations to manage GERD include feeding modifications such as thickening feeds or avoiding cow’s milk protein. There is limited evidence for pharmacological management, including acid suppressive therapy or prokinetic agents, with the risks of such treatments often outweighing possible benefits due to significant safety and side effect concerns. Acid-suppressive therapy should not be routinely used for infants with GERD and is most likely to be useful in the context of symptoms that suggest erosive esophagitis. Evidence for managing symptoms attributed to GERD in otherwise healthy term infants less than 1 year of age is presented, and the over-prescription of medications in this population is discouraged. Anticipatory guidance regarding the natural resolution of reflux symptoms is recommended.

Les symptômes cliniques attribués au reflux gastro-œsophagien pathologique chez les nourrissons nés à terme et en santé sont non spécifiques et rappellent des comportements adaptés à l’âge. Le présent point de pratique analyse les données probantes sur la prise en charge médicale recommandée de cette affection courante. Les recommandations à jour en vue de la prise en charge de ce type de reflux comprennent les modifications à l’alimentation, telles que l’épaississement des aliments ou l’évitement des protéines du lait de vache. Les données probantes à l’égard d’une prise en charge pharmacologique, y compris les traitements antiacides ou les agents procinétiques, sont limitées et démontrent que leurs risques sont souvent supérieurs à leurs éventuels avantages en raison des importantes préoccupations liées à l’innocuité et aux effets secondaires. Les traitements antiacides ne doivent pas être utilisés systématiquement chez les nourrissons présentant un reflux gastro-œsophagien pathologique. Ils sont plus susceptibles d’être utiles pour soigner des symptômes évocateurs d’une œsophagite érosive. Les données probantes sur la prise en charge des symptômes attribués à ce type de reflux chez les nourrissons de moins d’un an qui sont nés à terme et sont autrement en santé sont exposées, et la surprescription de médicaments est déconseillée dans cette population. Les conseils préventifs sur la résolution naturelle des symptômes de reflux sont recommandés.

Objectives To evaluate the effectiveness of a high-dose (HD) oral cephalexin treatment guideline for children with moderate cellulitis treated as outpatients. Methods In this retrospective cohort study, we included children who presented to the emergency department (ED) with moderate cellulitis and treated according to the institution’s HD oral cephalexin guideline over a 2-year period. All children had standardized follow-up at a medical day hospital (MDH). Treatment was considered effective in the absence of treatment failure, defined as admission, switch to IV treatment or ED visit within 2 weeks of discharge from the MDH. Safety was ascertained by recording adverse events and severe complications at follow-up. Results A total of 123 children were treated as outlined in the guideline, including 117 treated with HD oral cephalexin. The success rate was 89.7% (105/117). Among 12 (10.3%) children who had treatment failure, 10 (8.5%) required admission, 1 (0.9%) received IV antibiotics at the MDH and 1 (0.9%) had a return visit to the ED without admission. No severe complications were reported; four abscesses required drainage and one patient had a rash. The mean number of visits per child at the MDH was 1.6 (SD 1.0). Conclusions With a success rate of 89.7%, HD oral cephalexin seems effective and safe for the treatment of children with moderate cellulitis. Its use potentially reduces hospitalization rates for this condition and decreases the need for IV insertion.

L’Etat, par la mise en place des dispositifs et lieux d’accueil, tente de repondre aux besoins des migrants mais aussi de demontrer qu’il maitrise le flux de cette immigration. Cependant, d’autres formes d’accueil existent en parallele : ces initiatives associatives ou individuelles, qui relevent du benevolat et de l’action citoyenne, s’efforcent de combler les manques des politiques publiques. Ces actions relevent de parcours individuels et d’une hospitalite qui traverse le temps.

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Objective To define for women at low obstetric risk methods of management that respect the rhythm and the spontaneous course of giving birth as well as each woman's preferences. Methods These clinical practice guidelines were developed through professional consensus based on an analysis of the literature and of the French and international guidelines available on this topic. Results Labor should be monitored with a partograph (professional consensus). Digital cervical examination should be offered every 4 h during the first stage of labor, hourly during the second. The choice between continuous (cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring should be left to the woman (professional consensus). In the active phase of the first stage of labor, dilation speed is considered abnormal if it is less than 1 cm/4 h between 5 and 7 cm or less than 1 cm/2 h after 7 cm. In those cases, an amniotomy is recommended if the membranes are intact, and the administration of oxytocin if the membranes are already broken and uterine contractions are judged insufficient (professional consensus). It is recommended that pushing not begin when full dilation has been reached; rather, the fetus should be allowed to descend (grade A). Umbilical cord clamping should be delayed beyond the first 30 s in newborns who do not require resuscitation (grade C). Conclusion The establishment of these clinical practice guidelines should enable women at low obstetric risk to receive better care in conditions of optimal safety while supporting physiologic birth.

LiCoO2 (LCO) dominates the industry of high energy density Li-batteries cathodes, with almost 20% of market share. Since its introduction in 1980, scientific community produced a rich literature; in particular, several studies suggest maximizing the loaded weight of active material as an interesting route for energy density increase: over the whole weight of the cell, the impact of electrolyte, current collectors, and anode decreases, determining an increase in volumetric and gravimetric energy density. Notwithstanding, unclear correlation between electrode thickness and delivered capacity, altogether with an extremely short cycle-life and poor rate-capability, reported for cathode thicker than 10µm [1], are now halting the development of cells with thick electrodes for both solid-state deposited (PVD, pulse laser, electroplating) and tape-casted cathode. We focused our work on unveiling the causal link between thickness and available capacity in LCO cathode, providing a simple formula to relate the latter with cathode dimension, discharge current, and temperature. We propose solid-state thin-film configuration in a lithium-free battery as a test vehicle to study pure LCO cathode. This configuration introduces no additional dynamic limitation like grain-to-grain diffusion. We exploited both model and experimental results to delve into the understanding of interfacial lithium accumulation during discharge and we linked the related capacity loss to phase separation occurring around 75% of intercalated lithium [2-3]. In order to interpret both dynamic and static results we have implemented a 1D model based on Cahn-Hilliard equation [4] and solved it using COMSOL. We will provide results to foster a division of LCO cathode into two domain: from 50% to 75% of lithium intercalation, a high-rate zone, which capacity can be delivered at high C-rate without any limitation for any considered LCO thickness; from 75% to 100%, a low-rate zone, which can provide capacity only at very low C-rate. We validated the model realizing 5, 10, 20 and 30µm thick LCO cathode in a thin-film all-solid-state configuration, with LIPON as solid electrolyte, tested for discharge current density from 0.2 to 2 mAcm-2. We also present the 30µm thick LCO cathode with the highest capacity reported for thin-film configuration so far (>1mAhcm-2) and provide strong evidences of linear correlation between delivered capacity and cathode thickness. The results obtained for all-solid-state thin-film cells, can be extended to all LCO cathode, whatever the deposition technique used, as long as the particle size is the same order of the present work and the main limiting factor from the dynamic point of view is the solid diffusion in the cathode. References [1] Y. Matsuda, N. Kuwata, and J. Kawamura, “Thin-film lithium batteries with 0.3–30 μm thick LiCoO2 films fabricated by high-rate pulsed laser deposition,” Solid State Ion., vol. 320, pp. 38–44, Jul. 2018, doi: 10.1016/j.ssi.2018.02.024. [2] J. N. Reimers and J. R. Dahn, “Electrochemical and In Situ X‐Ray Diffraction Studies of Lithium Intercalation in Li x CoO2,” J. Electrochem. Soc., vol. 139, no. 8, pp. 2091–2097, Aug. 1992, doi: 10.1149/1.2221184. [3] A. Van der Ven, M. K. Aydinol, G. Ceder, G. Kresse, and J. Hafner, “First-principles investigation of phase stability in Li x CoO 2,” Phys. Rev. B, vol. 58, no. 6, pp. 2975–2987, Aug. 1998, doi: 10.1103/PhysRevB.58.2975. [4] J. F. Rodrigues, Ed., Mathematical Models for Phase Change Problems. Basel: Birkhäuser Basel, 1989. doi: 10.1007/978-3-0348-9148-6. Figure 1

On-chip solid-state micro-supercapacitors (MSCs) have gained widespread attention owing to their versatile benefits, including high power density and long cycle life1,2. Recently asymmetric hybrid microsupercapacitors (AsHMSCs) introducing a charge storage mechanism based on both faradaic reaction and electric double-layer phenomena have been considered to increase the energy density. Within this context, the selection of electrode materials and their interaction at the interface with the electrolyte is a key issue to optimize the AsHMSC electrochemical performance. In this work, nanometric (5-20 nm thick) amorphous TiO2 films have been elaborated and characterized in liquid and solid-state electrolyte (LiPON) half-cell configurations. Interestingly, TiO2 films after LiPON deposition exhibited a constant initial amount of intercalated lithium ions for all considered thicknesses and did not require a first activation process, in comparison to the liquid electrolyte configuration. For all considered configurations, the specific capacity extracted from cyclic voltammetry and galvanostatic cycling within [0.5-3V] potential range correspond to the theoretical value expected for the Lix=1TiO2 phase at low current density. Furthermore, the cooperative effects of high Li ion intercalation kinetics and Low interfacial charge transfer resistance for 5nm TiO2 electrode (extracted from electrochemical impedance spectroscopy analysis) exhibit an outstanding specific capacity of 2mC.cm-2 at 1µA.cm-2, and high rate performance with 60% capacity holding ratio at 100µA.cm-2, thus highlighting the extrinsic pseudo-capacitive behavior of the sub 10nm electrodes. A TiO2 5nm/LiPON 100nm/Pt AsHMSC is successfully fabricated, which achieves an operating voltage window of 3V and a specific capacity of 0.3mC.cm-2 at 1mA.cm-2.In addition, the device also exhibited a 100% coulombic efficiency even after cycling for 6000 continuous charge-discharge cycles. This work offers an approach to tune the Li ion storage properties of TiO2 by nano-engineering and gives insights into the enhancement of pseudocapacitance-assisted lithium-storage capacity. References Kyeremateng et al., Nature Nanotech 12, 7–15 (2017). https://doi.org/10.1038/nnano.2016.196 Sallaz et al., J. Power Sources 451, 227786 (2020), doi: 10.1016/j.jpowsour.2020.227786. Figure 1

We experimentally demonstrated for the first time in 2019 LiCoO2 all solid-state thin-film batteries with high electrochemical density storage of 0.89 mA.h.cm-2 [1]. Despite these excellent performances, some devices may be defective and fail during cycling. Therefore, in the context of industrial production of such devices, there is a need to reliably assess the functionality of the cells on the wafer scale. The most straightforward approach consists in simply cycling the batteries as well as performing complementary short tests such as Open-Circuit Voltage measurement (OCV) and Electrochemical Impedance Spectroscopy (EIS). However, with 14 000+ cells per wafer said approach is too time consuming. Moreover tested batteries would not be suitable for further commercialization as the electrodes have already been solicited, which could affect their shelf life. We therefore have investigated on the ability of a short – i.e. with a duration in the order of the minute – pulsed test to predict the failure of our dies, using machine learning. This Electrical Wafer Sorting (EWS) or screening protocol consists in inducing a partial charge for 1 min and then to observe the relaxation by measuring the OCV for 10 s. OCV and EIS are also measured before and after the pulse. Certain features are extracted from profiles collected during the EWS protocol (shown in Figure a)), such as the mean OCV or the real part of the impedance at 1 kHz. 1122 devices were screened using this protocol and then cycled for 1 cycle (1 full charge 1 full discharge). The batteries were then classified in binary categories, according to the outcome of the cycling test: fail or pass. Fail category encompasses all failure modes: (e.g. open-circuit, short-circuit). The features extracted during the EWS were used to build the prediction model, whose target is the cycling categorization. Foremost, the data was split in a training set and a test set. In a first step, variable selection was achieved using a simple decision tree model. It enabled us to choose the combination of parameters leading to a maximization of the f1-scores (from 68 to 73 %). However, the learning curves revealed that this simple model clearly overfitted and was unable to generalize. In a second step, a variety of models were trained using the selected features, including Random Forest, Support Vector Machines, and Logistic Regression. The three models leading to best f1-scores were kept and their hyperparameters have been further optimized following a grid search approach. The algorithm giving the highest scores is the Random Forest classifier. Although it was not possible to increase its accuracy (still at 73%) the optimization step helped to significantly reduce the overfitting, reinforcing the ability of the model to be equally accurate on new data. The corresponding confusion matrix and learning curves are displayed on Figure b). Figure c) shows respectively predicted and actual wafermaps for data present in the dataset used to build the model. An example of predicted wafermap on a complete wafer is presented on Figure d). Achieved performance provide an interesting base for investigations in a research context. It is shown that the functionality of the thin film batteries can be predicted with reasonable confidence. Nevertheless, far better scores (above 90%) are required for production application. Thus further work will focus on collecting new data to check on generalizability and if it helps to improve the model accuracy when used for training. All the work presented in this abstract has been carried out using scikit-learn Python package [2]. [1] S. Oukassi et al., “Millimeter scale thin film batteries for integrated high energy density storage,” 2019, vol. 2019-December. doi: 10.1109/IEDM19573.2019.8993483. [2] F. Pedregosa et al., “Scikit-learn: Machine Learning in Python,” Journal of Machine Learning Research, vol. 12, no. 85, pp. 2825–2830, 2011. Figure 1

Hypernatremic dehydration is well described in exclusively breastfed neonates, although life-threatening complications are rarely reported.The present article describes a case of severe hypernatremic dehydration in a previously healthy term neonate. Other published cases of severe complications of hypernatremic dehydration are discussed.The exclusively breastfed neonate described had severe hypernatremic dehydration because of inadequate milk intake, with disseminated intravascular coagulation and right lower limb gangrene that required amputation of all five toes and surgical debridement of the metatarsals. The usual etiology of hypernatremic dehydration in this age group is insufficient breast milk intake. Here, the infant's mother was treated for bipolar disorder with lamotrigine 250 mg orally once daily, aripiprazole 15 mg orally once daily, and sertraline 100 mg orally once daily.Awareness of these complications should prompt close follow-up of the infant with poor weight gain. The role of maternal medication as a risk factor for hypernatremic dehydration among exclusively breastfed infants needs to be further explored.

for the first time, we experimentally demonstrated thin film batteries (TFBs) with very high electrochemical energy density storage of 0.89 mAh.cm−2 at the device level. The 3.1×1.7 mm² TFBs of 95μm total thickness show a discharge capacity of 25μAh and maintain 60% of this value at 0.25mA. Upon cycling, TFBs exhibit excellent capacity retention, with an average loss of 0.05% per cycle. Results at 37°C present similar performance, thus highlighting the great potential of these TFBs as integrated energy storage solution in particular for medical implantable, injectable and wearable solutions

Dans un contexte de rationalisation de l’action sociale, les mutations de l’intervention sociale imposent de nouvelles pratiques professionnelles tant dans l’accompagnement individuel que dans l’action collective. La question du mode de management des equipes medico-sociales est au cœur des evolutions des metiers et du changement a conduire dans l’action sociale. Notre article s’appuie sur une experience menee par une auteure de l’article, il analyse le role du cadre manager engage dans l’elaboration et la mise en œuvre d’un projet de D.S.L. innovant, comme un developpeur de son territoire et de son equipe.

The aim of this study was to determine type, prevalence and risk factors for infectious diseases in internationally adopted children. The number of internationally adopted children is still increasing and the countries of origin change with time. Regular reassessment of the epidemiology of infectious diseases is essential in order to recommend appropriate screening and treatment for these children. A retrospective cohort study was conducted between 01/01/1998 and 12/31/2001. Of 552 children evaluated, 77% were females. Median age was 13 months. Children originated mainly from China (n = 319, 57.8%) and other Asian countries (n = 112, 20.3%). Overall, 105 children (19.0%) were found to have at least one type of infection diagnosed on initial screening. In our cohort, 57 of 342 children (16.7%) were infected with one or more pathogenic intestinal parasites; the most common was Giardia lamblia, found in 44 of 342 tested children (12.8%). Increasing age was associated with an increased risk of parasitic infection, with children 12–24 months (adjusted OR: 7.9; 95% CI: 2.6–24.5), and children > 24 months (adjusted OR: 25.3; 95% CI: 7.7–83.1) being significantly more at risk than children

L’Economie sociale et solidaire (ess) concurrencee par le prive s’ouvre a des perspectives lucratives pour se developper. Les societes cooperatives sont liees a des projets de territoires innovants. La reussite de ces projets d’interet collectif repose non seulement sur des dispositifs, mais egalement sur la qualite des negociations et des rapports sociaux entre les acteurs locaux. L’interet commun des partenaires impliques autour du projet impulse l’innovation.Au-dela de la creation de nouveaux outils de developpement de l’ess, il est essentiel d’accompagner la transformation d’acteurs concernes en acteurs impliques, participatifs et entreprenants.

BACKGROUND: Children with moderate cellulitis are often treated with IV antibiotics in the hospital setting, as per recommendations, since the safety and efficacy of oral treatment is still not well established. Previously in our hospital, a protocol using daily IV ceftriaxone with follow-up at the day treatment center (DTC) was used to avoid admission. In 2013, a new institutional protocol was implanted and suggested the use of high dose (HD) oral cephalexin with follow-up at the DTC for those patients.

Novel electronic devices related to the internet of things (IoTs) are reshaping our world in several ways. The emergence of these devices is creating an increasing demand for disruptive innovations, among which high performance on-chip integrated energy storage solutions are the most frequently cited. In this regard, thin film batteries (TFBs) are recognized as one of the most propitious electrochemical devices to meet applications’ demands, considering attractive advantages such as excellent cycle life and miniaturization.1,2 Nevertheless, the commercial widespread application of TFBs and the demonstration of effective on-chip integration have been hindered by (i) a low areal energy density and (ii) encapsulation issues related to metallic lithium anode integration. Recently, great efforts have been made to study the interrelationship between materials, architectures, electrochemical performance and integration; the prevailing tendency has been towards Li-free TFBs, where Li anode is formed in-situ during charging. Despite achieving promising electrochemical performance at the full TFB device, significant capacity decay with cycling is usually reported, thus limiting further applications. In the present work, we report on the development of all solid inorganic thin film lithium ion batteries (TFBs) with an amorphous silicon anode solution. The TFBs were realized on 8’’ substrate with a structure integrating a LiCoO2/LiPON/Si active stack (Figure 1.a, inset). The fabrication process flow was carried out in a clean room environment using the TINY platform. The LiCoO2 thickness was kept constant at 20µm whereas several submicron thick silicon anodes were considered (0, 10, 50, 100, 200, 350, and 1000 nm). It was observed no effect of Si anode thickness on the first cycle charge and discharge capacities. Upon cycling, TFBs with the thinnest Si anodes exhibited excellent capacity retention, with an initial discharge capacity of 680µAh.cm-2 and an average loss of 0.1% per cycle. When increasing Si thickness, an abrupt capacity decay was observed at the early stages of cycling, and was correlated to the anode thickness (Fig 1.a). This behavior was correlated to the electrochemical reactions occurring at the anode level: (i) during the first charge, Li ion exchange between LiCoO2 and Si took place, resulting from LiCoO2 delithiation into Li1−xCoO2 and Li−Si alloying. At higher potentials, Li plating occurred at the negative electrode side, and the potential thereby corresponded to that of LiCoO2 vs Li. (ii) during discharge, Li stripping took place at the anode, concomitant with Li ion insertion into Li1−xCoO2. Upon further discharging, Li ion extraction from Li−Si alloys occurred (Fig. 1-b, c). Accordingly, it is concluded that thinner Si films acted as a uniform and homogeneous seed layer to the initial Li plating reaction, thus enhanced the subsequent cycling stability in comparison to Li-free configuration, and thicker Si films lead to severe mechanical delamination within the active stack, and induced TFB capacity decrease (Fig.1-bc). Furthermore, cycling within specific voltage ranges allowed stabilizing the discharge capacity for thicker Si anodes. These results were validated by ToF-SIMS and FIB-SEM characterization. References (1) Lee, H. S.; Kim, S.; Kim, K. B.; Choi, J. W. Scalable Fabrication of Flexible Thin-Film Batteries for Smart Lens Applications. Nano Energy 2018, 53 (August), 225–231. (2) Liu, L.; Weng, Q.; Lu, X.; Sun, X.; Zhang, L.; Schmidt, O. G. Advances on Microsized On-Chip Lithium-Ion Batteries. Small 2017, 13 (45), 1–12. Figure 1

LiPON films are prepared by Radio Frequency sputtering on 200 mm silicon wafers. LiPON elemental composition is investigated by RBS and NRA. Ionic conductivity is measured by impedance spectroscopy and electronic conductivity from Isothermal Transient Ionic Current (ITIC) in the temperature range 80 K–380 K on MIM cells. The ionic and electronic conductivities at room temperature are 1.2 × 10− 6 S/cm and 8 × 10− 14 S/cm respectively. Charge carrier concentration, mobility and Li ion diffusion coefficient are calculated. Temperature dependence of conduction mechanism in LiPON is described.

Acute bronchiolitis has been associated with an increasing hospitalization rate over the past decades. The aim of this paper was to estimate the impact of home oxygen therapy (HOT) on hospital stay for infants with acute bronchiolitis. A retrospective cohort study was done including all children aged ≤12 months discharged from a pediatric tertiary-care center with a diagnosis of bronchiolitis, between November 2007 and March 2008. Oxygen was administered according to a standardized protocol. We assumed children with the following criteria could have been sent home with O2, instead of being kept in hospital: age ≥2 months, distance between home and hospital

Following the implementation of a government-sponsored reduced three-dose (2 + 1) heptavalent conjugate pneumococcal vaccine (PCV7) program, we report a 61.4% decrease in the number of cases of invasive pneumococcal diseases (IPD) treated at our institution. Four years after the implementation of the three-dose reduced vaccine program, only 7.4% of IPD were caused by PCV7 serotypes, and there was an increase in the proportion of IPD caused by nonPCV7 serotypes; serotype 19A represented 40.7% of the strains isolated during the last year of the study. These results, similar to those previously observed with a regular four-dose (3 + 1) PCV7 schedule, are reassuring as to the effectiveness of a reduced three-dose (2 + 1) PCV7 program. Increasing numbers of IPD caused by nonPCV7 serotypes warrant the use of a new conjugate pneumococcal vaccine that contains serotype 19A.

Objective: To determine the effect of a clinical practice guideline (CPG) on the use of ceftriaxone for the treatment of refractory acute otitis media (AOM) at a tertiary care pediatric hospital. Methods: Charts of all patients aged 3 to 60 months referred from an emergency department to a day treatment center for management of refractory AOM with ceftriaxone were reviewed. Data were collected during two 18-month periods before and after implementation of a CPG developed by a local group of experts. Ceftriaxone was indicated for children with symptomatic AOM despite 48 hours of treatment with high-dosage amoxicillin or amoxicillin-clavulanate (>75 mg/kg per day) or despite receiving 1 of these 2 antibiotics over the previous month. Overall treatment was considered adequate if patients met these indications for ceftriaxone, if at least 3 daily doses had been prescribed, and if all doses were within the 40- to 60-mg/kg range. Results: Thirty-two emergency physicians referred 127 patients to the day treatment center (60 preimplementation and 67 postimplementation of the CPG). The mean (SD) patient ages were 16.7 (7.4) and 19.7 (12.4) months in the preimplementation and postimplementation groups, respectively. Indications for prescription of ceftriaxone were adequate in 16.7% of the preguideline and 22.4% of the postguideline groups (P = 0.4). Physicians were twice as likely to use ceftriaxone adequately after the guideline's implementation, but this result was not statistically significant (crude odds ratio, 2.2; 95% confidence interval, 0.5-9.0). Conclusions: Implementation of a CPG for the treatment of refractory AOM with ceftriaxone did not improve indications for its use.

Aims: To describe attitudes of paediatricians and paediatric nephrologists regarding antibiotic prophylaxis for urinary tract infection (UTI) and determine the factors associated with its use. Method: A self-administered questionnaire was mailed to Canadian paediatricians (1136) and paediatric nephrologists (42). Results: The response rate was 58.1% (684 physicians); 436 who had made a decision about antibiotic prophylaxis for childhood UTI in the previous year were included in the analysis. Of these, 407 (93.3%) were certified in paediatrics and 29 (6.7%) were paediatric nephrologists. Most respondents prescribed prophylaxis for children with grade III-V vesicoureteral reflux (VUR) (96.5%–98%); 69.8 and 92.8% prescribed it for children with grades I and II VUR, respectively. Factors significantly associated with use of prophylaxis for children with grade I VUR were frequency of decision-making about prophylaxis, city size and province. Fifteen percent of physicians felt that their practice regarding antibiotic prophylaxis for children with VUR was evidence based. A hundred one respondents (24.3%) prescribed prophylaxis for infants with a first febrile UTI in the absence of VUR. Nineteen percent felt that their practice regarding antibiotic prophylaxis for these infants was evidence based. Prescription of prophylaxis for children >12 months with recurrent UTI in the absence of VUR was influenced by frequency of pyelonephritis (88.5% of respondents) and presence of voiding dysfunction (53.8%). Nine percent of physicians felt that their practice for these children was evidence based. Conclusion: Opinions of Canadian paediatricians and paediatric nephrologists regarding antibiotic prophylaxis for UTI in children vary widely, probably because of the paucity of solid evidence about prophylaxis.

Aim: To assess the clinical outcome of patients with moderate to severe cellulitis managed at a paediatric day treatment centre (DTC). Methods: Prospective observational study of all patients (3 months to 18 years) with a presumed diagnosis of moderate to severe cellulitis made in a university-affiliated paediatric emergency department (ED) (September 2003 to September 2005). Patients treated at the DTC were given ceftriaxone or clindamycin. Results: During the study period, a presumed diagnosis of moderate to severe cellulitis was made in 224 patients in the ED. Ninety-two patients were treated at the DTC (41%). The cellulitis had a median width of 7.0 cm (range: 1.0–50.0 cm) and a median length of 6.5 cm (range: 1.0–40.0 cm). Blood cultures were performed in 95.7%; one was positive for Staphylococcus aureus. After a mean of 2.5 days of intravenous therapy (first injection in the ED and a mean of 1.5 days at the DTC), 73 patients (79.3%) were successfully discharged from the DTC and switched to an oral agent. For these patients no relapse occurred. Nineteen patients (20.7%) required inpatient admission for further therapy. No patient was diagnosed with necrotizing fasciitis in the course of therapy. Seventy-eight satisfaction questionnaires were handed in and revealed very good to excellent parental satisfaction with treatment at the DTC in 94.8%. Conclusion: Treatment with parenteral antibiotic at a DTC is a viable alternative to hospitalisation for moderate to severe cellulitis in children.

OBJECTIVES. We sought to determine the clinical spectrum, survival, and long-term functional outcome of a cohort of pediatric patients with mitochondrial diseases and to identify prognostic factors. METHODS. Medical charts were reviewed for 73 children diagnosed between 1985 and 2005. The functional status of living patients was assessed prospectively by using the standardized Functional Independence Measure scales. RESULTS. Patients fell into 7 phenotypic categories: neonatal-onset lactic acidosis (10%), Leigh syndrome (18%), nonspecific encephalopathy (32%), mitochondrial (encephalo)myopathy (19%), intermittent neurologic (5%), visceral (11%), and Leber hereditary optic neuropathy (5%). Age at first symptoms ranged from prenatal to 16 years (median: 7 months). Neurologic symptoms were the most common (90%). Visceral involvement was observed in 29% of the patients. A biochemical or molecular diagnosis was identified for 81% of the patients as follows: deficiency of complex IV (27%), of pyruvate dehydrogenase or complex I (25% each), of multiple complexes (13%), and of pyruvate carboxylase (5%) or complexes II+III (5%). A mitochondrial DNA mutation was found in 20% of patients. At present, 46% of patients have died (median age: 13 months), 80% of whom were 5 years (n = 32), 62% had Functional Independence Measure quotients of >0.75. CONCLUSIONS. Mitochondrial diseases in children span a wide range of symptoms and severities. Age at first symptoms is the strongest predictor mortality. Despite a high mortality rate in the cohort, 62% of patients aged >5 years have only mild impairment or normal functional outcome.

Objective. Urinary tract infections (UTIs) are common among infants and toddlers. Children can be treated effectively with short courses (2–4 days) of intravenous (IV) therapy followed by oral therapy. If IV therapy is chosen, use of once-daily dosing may allow outpatient management instead of hospital admission. However, no description of ambulatory treatment with IV antibiotics of UTI among febrile children has been reported to date. We aimed to describe the feasibility and complications of outpatient management with IV antibiotics of UTI among febrile children, at the day treatment center (DTC) of a tertiary-care pediatric hospital. Methods. Between April 1, 2002, and March 31, 2003, a prospective cohort of patients 3 months to 5 years of age who were examined in the emergency department (ED) and diagnosed as having presumed febrile UTI were treated according to a clinical protocol. Patients were treated at the DTC unless they met exclusion criteria, in which case they were hospitalized. The DTC was open 7 days per week, including holidays, from 8:30 am to 4:30 pm. At the DTC, patients were initially treated with a daily dose of IV gentamicin, until the child had been afebrile for at least 24 hours, and with oral amoxicillin, until preliminary urine culture results were available. Children allergic to penicillin received gentamicin only. IV antibiotics were administered through peripheral IV access; the IV catheter’s patency was maintained with injection of 50 U of heparin once daily throughout the treatment period. Parental satisfaction with the DTC experience was assessed with an anonymous, self-administered questionnaire. Results. Two hundred ninety-one episodes of presumed febrile UTI were diagnosed in the ED, of which 212 (72.9%) were sent to the DTC. There were 71 hospital admissions (24.4%); in 9 of these instances, the child was admitted because parents refused or were unable to comply with DTC treatment. Adherence to the treatment protocol in the ED was excellent; in 92.1% of presumed febrile UTI episodes (268 of 291 episodes), the patient was referred to the appropriate setting for treatment. In 8 instances, patients who met an exclusion criterion were sent to the DTC. They should have been hospitalized, according to the protocol. At the DTC, a final diagnosis of UTI was made in 178 of the 212 episodes (84%). Patients treated at the DTC, with a final diagnosis of UTI, had a median age of 12.0 months (range: 3–68 months), and their mean initial temperature was 39.2°C (SD: 1.1°C). Patients were afebrile by 24 hours in 52% of UTI episodes and by 48 hours in 82%. Minor problems with IV access occurred in 9.0% of cases. The duration of IV antibiotic therapy at the DTC was 1.9 days (SD: 0.9 day). The mean number of visits to the DTC, including appointments for renal ultrasound and voiding cystourethrography evaluations, was 3.5 (SD: 0.9). Parents were present at all scheduled visits in 98.9% of cases. Four patients needed to be hospitalized from the DTC, but in only 1 case was hospital admission related to UTI treatment. Four patients with UTI treated in the DTC had positive blood cultures, 2 with Escherichia coli (both successfully treated at the DTC) and 2 with contaminants. For 4 children treated at the DTC, UTI was caused by gentamicin-resistant E coli. One patient became afebrile within 24 hours after treatment initiation with IV gentamicin; he was then treated with oral cefixime. A second patient was treated with IV ceftriaxone, administered at the DTC once culture results were available, and remained febrile for Conclusions. Our data show that ambulatory treatment with IV antibiotics, at a DTC, may be used for at least three-fourths of UTIs among febrile children 3 months to 5 years of age. It is safe and feasible and appears very satisfactory to parents. Although ambulatory treatment with IV antibiotics is more invasive than oral therapy during the initiation of UTI treatment, it ensures almost full compliance, allows close medical supervision, and facilitates investigations related to the UTI. It is an interesting alternative to hospitalization.

Introduction: Children with moderate cellulitis are often treated with IV antibiotics in the hospital setting, as per recommendations. Previously in our hospital, a protocol using daily IV ceftriaxone with follow-up at the day treatment center (DTC) was used to avoid admission. In 2013, a new protocol was implanted and suggested the use of high dose (HD) oral cephalexin with follow-up at the DTC for those patients. The aim of this study was to evaluate the safety and efficacy of the HD cephalexin protocol to treat moderate cellulitis in children as outpatient. Methods: A retrospective chart review was conducted. Children were included if they presented to the ED between January 2014 and 2016 and were diagnosed with a moderate cellulitis sufficiently severe to request a follow up at DTC and who were treated according to the standard of care with the HD oral cephalexin (100 mg/kg/day) protocol. Descriptive statistics for clinical characteristics of patients upon presentation, as well as for treatment characteristics in the ED and DTC were analyzed. Treatment failure was defined as: need for admission at the time of DTC evaluation, change for IV treatment in DTC or return visit to the ED. Outcomes were compared to historic controls treated with IV ceftriaxone at the DTC, where admission was avoided in 80% of cases. Results: During the study period, 682 children with cellulitis were diagnosed in our ED. Of these, 117 patients were treated using the oral HD cephalexin outpatient protocol. Success rate was 89.5% (102/114); 3 patients had an alternative diagnosis at DTC. Treatment failure was reported in 12 cases; 10 patients (8.8%) required admission, one (0.9%) received IV antibiotics at DTC, and one (0.9%) had a return visit to the ED without admission or change to the treatment. This compares favorably with the previous study using IV ceftriaxone (success rate of 80%). No severe deep infections were reported or missed; 4 patients required drainage. The mean number of visits per patient required at the DTC was 1.6. Conclusion: Treatment of moderate cellulitis requiring a follow-up in a DTC, using an oral outpatient protocol with HD cephalexin is a secure and effective option. By reducing hospitalization rate and avoiding the need for painful IV insertion, HD cephalexin is a favourable option in the management of moderate cellulitis for pediatric patients, when no criteria of toxicity are present.

Hepatorenal tyrosinemia (HT1, fumarylacetoacetate hydrolase deficiency, MIM 276700) can cause severe hepatic, renal and peripheral nerve damage. In Québec, HT1 is frequent and neonatal HT1 screening is practiced. Nitisinone (NTBC, Orfadin ®) inhibits tyrosine degradation prior to the formation of toxic metabolites like succinylacetone and has been offered to HT1 patients in Québec since 1994.We recorded the clinical course of 78 Québec HT1 patients born between 1984 and 2004. There were three groups: those who never received nitisinone (28 patients), those who were first treated after 1 month of age (26 patients) and those treated before 1 month (24 patients). Retrospective chart review was performed for events before 1994, when nitisinone treatment began, and prospective data collection thereafter.No hospitalizations for acute complications of HT1 occurred during 5731 months of nitisinone treatment, versus 184 during 1312 months without treatment (p0.001). Liver transplantation was performed in 20 non-nitisinone-treated patients (71%) at a median age of 26 months, versus 7 late-treated patients (26%, p0.001), and no early-treated patient (p0.001). No early-treated patient has developed detectable liver disease after more than 5 years. Ten deaths occurred in non-nitisinone treated patients versus two in treated patients (p0.01). Both of the latter deaths were from complications of transplantation unrelated to HT1. One probable nitisinone-related event occurred, transient corneal crystals with photophobia.Nitisinone treatment abolishes the acute complications of HT1. Some patients with established liver disease before nitisinone treatment eventually require hepatic transplantation. Patients who receive nitisinone treatment before 1 month had no detectable liver disease after more than 5 years.

La reforme des rythmes scolaires repose sur une coordination multi-acteurs : Education nationale, collectivites territoriales et associations. Elle vise a mieux articuler les temps scolaires et periscolaires et a permettre a chaque enfant de s’epanouir dans son parcours educatif et son integration dans la societe. Pour les communes, cette reforme a un cout qui risque de renforcer la fracture territoriale.Des synergies sont possibles autour des projets educatifs de territoires associant enseignants, parents et animateurs, on parle de « coeducation », mais les interets particuliers peuvent prevaloir sur l’interet de l’enfant. L’une des conditions de reussite est la presence d’un « traducteur » en capacite de comprendre les enjeux respectifs et de favoriser la cooperation entre acteurs.

Aims: To evaluate the prevalence of positive tuberculin skin tests (TST) in internationally adopted and immigrant children. To identify risk factors for positive TST in these populations. Methods: The study was a retrospective medical record review in a tertiary care pediatric hospital. All children evaluated at the International Adoption and Immigrant Health Clinic of CHU Sainte-Justine in Montreal, Canada, between 01-01-1998 and 31-12-2001 were included. Demographic and anthropometrical data, BCG vaccination, TST, chest X-ray results and treatment were extracted from the medical records of the patients and analyzed. Positive TST was defined as induration = 10 mm, 48 to 72 hours after injection of five tuberculin units of purified protein derivate. Results: Our population included 670 children: 112 immigrants and 558 adoptees. Median age was 6.9 years for immigrants and 1.1 years for adopted children. Overall incidence of positive TST was 12.2% in our cohort: 31% in the immigrant and 8% in the adopted children groups. There was one case of active tuberculosis. Older age on arrival in Canada and BCG vaccination were identified as risk factors for positive TST in our multivariate model. For each one-year increase in age on arrival in Canada, there was a 1.2 times greater risk for positive TST. Conclusions: Latent tuberculosis is a frequent problem in foreign-born children. The higher incidence in immigrant children can be explained by older age on arrival.

To the Editor .— We read with interest the article by Leroy et al1 regarding procalcitonin as a predictor of vesicoureteral reflux (VUR) in children. The authors address an important issue: the prevention of unnecessary voiding cystourethrograms in children. As they point out, the use of sterile bags to collect specimens for urine culture raises the possibility of selection bias in their study. We disagree with the authors, who state that selection bias does not explain their results. The specificity of bag urine specimens is poor and may lead …

Objectives: To describe clinical course of children hospitalized for a first episode of acute unilateral infectious adenitis and to identify factors predictive of surgical lymph node drainage. Methods: We reviewed medical records of children from 0 to 17 years of age discharged from a tertiary care pediatric center with a diagnosis of adenitis between 1 April 1996 and 31 March 2001. Patients were included if they had acute (≤10 days) unilateral lymph node swelling greater or equal to 2.5 cm on initial physical examination. Exclusion criteria were: bilateral adenitis or adenitis at more than one site; prior adenitis; underlying chronic disease. Results: Two hundred and eighty-four patients were included in this study. The mean age was 4.0 years (3.1 SD). Twenty-three per cent of infected nodes were >5 cm in size and 92.6% were cervical. Thirteen of 252 blood cultures were positive (5.2%), of which one showed Streptococcus pneumoniae and 12 contaminants. Mean length of stay was 4.2 days (2.2 SD). Surgical node drainage was performed in 60 (21.1%) patients. Factors significantly associated with increased risk of surgical drainage were age 48 h (adjusted OR: 2.9; 95% CI: 1.2–7.2). There were no major complications. Follow-up was documented in 183 patients, of whom 92.3% achieved complete healing. Conclusions: Children hospitalized for a first episode of acute unilateral infectious adenitis generally do well. Younger patients and those with longer duration of node involvement before admission have an increased risk of surgical node drainage.