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Resume Objectif Presenter une activite sportive qui concerne une large tranche d’âge de pratiquants au sein de la population et interesse toutes les intensites de pratique, du loisir au monde professionnel. Le medecin sera amene a se prononcer sur les conditions d’aptitude, surveiller et conseiller l’entrainement, apporter ses soins au joueur malade ou blesse. Enfin, sa mission de conseil se prolongera dans la prescription de sport dans une optique « Sport Sante ». Actualite Le basket-ball est un sport collectif invente aux Etats-Unis en 1891, qui est pratique par une large partie de la population a travers le monde. Cette activite concerne a la fois les enfants, les adolescents et les adultes. Des formes nouvelles sont proposees dans le « 3 × 3 » ou les programmes « Sport Sante ». Le basket-ball sollicite la totalite des appareils de l’organisme ; les capacites aero-anaerobiques, l’equilibre, la vision sont les conditions indispensables a la creation d’aptitudes motrices les plus performantes possibles. Le developpement de la force, des capacites visio-spatiales et technico-tactiques relevent d’une preparation toujours plus affinee. La grande taille est un argument tres important, d’autant plus que le niveau de pratique est plus eleve ; la prevision de taille releve de l’avis medical. La prevention du dopage doit etre permanente selon une strategie educative elaboree conjointement par le corps medical, les educateurs et les dirigeants. Le bilan preparticipatif, quel que soit le contexte juridique, est indispensable ; tout praticien doit pouvoir le realiser ; il est base sur un examen clinique correspondant aux normes professionnelles, telles que recommandees par la SFMES. Le bilan cardiologique est un point-cle, visant a limiter au maximum le risque d’un accident cardiaque majeur subit. La pratique d’un ECG de repos est discutee meme si elle tend a se developper. La poursuite des investigations doit etre argumentee et prescrite en toute responsabilite par l’examinateur. Les contre-indications sont rares chez l’enfant a l’exception du syndrome de Marfan. Chez l’adulte, la recherche de facteurs de risques et d’une coronaropathie sont au premier plan. Les blessures sont frequentes, et ne comportent aucune particularite ; on soulignera les risques des commotions cerebrales, les fractures dentaires qui doivent etre mieux prevenues, et le risque particulier de rupture du LCA chez la jeune fille. La qualite de la prise en charge des blessures est liee a la coherence de la chaine de soins mise en place, permettant un bilan clinique immediat, argumente si besoin par des examens raisonnes. Conclusion Le basket-ball est un sport accessible a un grand public ; sa pratique necessite un bilan medical tres simple, la surveillance des pratique doit s’adapter aux niveaux concernes, permettant a tous de beneficier de ses effets benefiques et de retablir les situations pathologiques.

Given the rapid increase in the prevalence of overweight, obesity, type 2 diabetes and other obesity-related conditions across the world, despite a plethora of evidence-based guidance for clinicians, innovative campaigns aimed at the general public and widespread government public health initiatives, it is clear that a novel approach is required. The importance of fluid intake has been overlooked in campaigns and guidelines and also in the clinical setting, where the question 'what do you drink?' is often omitted. It is a significant oversight that food pyramids and healthy-eating plates across the world omit fluids from their graphics and advice. While guidelines include recommendations on changes in physical activity and diet, often little or no advice is offered on the importance of healthier hydration practices, neglecting to highlight the contribution of beverages high in sugar, alcohol or additives. An interdisciplinary group of experts in medicine, nutrition, physiology and public health discussed issues surrounding healthy-hydration practices in March 2010 in Paris to create a consensus statement on hydration and gain of body weight and provide recommendations.

Resume L’eau est le premier composant de l’organisme, 75 % a la naissance, 60 % chez l’enfant et chez l’adulte. Ses besoins, ses eliminations par voie digestive, cutanee, respiratoire et urinaire sont differents a la periode neonatale ou les fonctions renales et digestives sont encore immatures de ceux des enfants et adultes. L’apport conseille par kg ou par 24 heures est donc particulier a chaque episode de la vie, de 150 ml/kg a un mois de vie, 50 ml/kg chez l’enfant et 2 a 2,5 L chez l’adulte. Dans ces conditions et pour des volumes importants, le choix d’une eau occupe une place importante au sein des apports alimentaires quotidiens. Trois possibilites existent pour couvrir ces besoins : l’eau de distribution publique, les eaux de sources, les eaux minerales. Les eaux de distribution publique ont une composition controlee, sont desinfectees, mais des derogations sont parfois necessaires. Elles ne representent pas le meilleur choix pour le nourrisson, la femme enceinte et la femme allaitante. Les eaux de sources, dont la composition est connue, proviennent de plusieurs sources de qualite differente. Les eaux minerales naturelles, parfaitement fixes dans leur composition, de mineralisation variable, representent la meilleure des solutions, mais doivent etre choisies en fonction de l’âge des sujets et d’une eventuelle pathologie. Pour les nouveau-nes, les nourrissons et les femmes enceintes ou allaitantes, le choix le plus adapte est donc celui d’une eau minerale naturelle faiblement mineralisee (50 a 500 mg/L) ; pour les personnes âgees, les eaux moyennement mineralisees (500 a 1000 mg/L), riches en calcium et en magnesium representent une solution interessante.

La intervencion nutricional sobre los ninos deportistas de alto nivel es compleja. Se basa obligatoriamente en la anamnesis dietetica, la exploracion fisica y de laboratorio. En funcion del nivel de actividad fisica, puede proponerse una dieta especial para cada tipo de actividad y precisar su distribucion a lo largo del dia. Las recomendaciones deben tambien referirse al ritmo de vida. La aplicacion del conjunto de estas medidas es indispensable para todo deportista de alto nivel, es decir, que practique mas de ocho o diez horas semanales, segun la edad.

OBJECTIVES: An intravenous formulation of paracetamol and an intravenous formulation of propacetamol (prodrug of paracetamol) were compared in children with acute fever due to infection in order to determine the antipyretic efficacy and safety during the 6-hour period after administration. METHODS: A total of 67 patients aged 1 month to 12 years and with a rectal body temperature between 38.5 degrees C and 41 degrees C, were randomized to receive either intravenous paracetamol 15 mg/kg (n = 35) or propacetamol 30 mg/kg (n = 32) under double-blind conditions. RESULTS: The non-inferiority of intravenous paracetamol compared to propacetamol was demonstrated (non-inferiority margin = 0.5 degrees C) by the median body temperature reduction of 1.9 degrees C in the intravenous paracetamol group and the reduction of 2.05 degrees C in the propacetamol group. The difference in the incidence of local adverse events was statistically significant (p = 0.0134) with more local adverse events in the propacetamol group (9, 28.1%) than in the intravenous paracetamol group (2, 5.7%). CONCLUSION: This double-blind, randomized, clinical trial demonstrates the non-inferiority of a single administration of 15 mg/kg intravenous paracetamol in comparison to 30 mg/kg propacetamol in terms of body temperature reduction in children aged 1 month to 12 years with acute fever due to infection. It confirms the better local safety of intravenous paracetamol in comparison to propacetamol.

Resume Les leucotrienes sont de puissants inducteurs de la bronchoconstriction et des mediateurs de l'inflammation, ils favorisent l'augmentation de la permeabilite microvasculaire et la production de mucus. Ces molecules potentialisent l'influx de cellules inflammatoires dans les voies aeriennes des patients souffrant d'asthme. Les inhibiteurs de la synthese et les antagonistes des recepteurs des leucotrienes sont apparus recemment dans l'arsenal therapeutique. Les etudes cliniques publiees chez le jeune enfant sont particulierement rares. Malgre des effets benefiques significatifs lors du traitement de l'asthme chronique voire des sifflements viro-induits, il reste tres difficile a ce jour de determiner leur place effective dans la prise en charge de l'asthme de l'enfant prescolaire. Une evaluation et une expertise clinique complementaire permettraient de bien les placer parmi les options therapeutiques pediatriques.

Resume La prevalence de l'obesite de l'enfant est en progression constante ; de nombreux travaux ont mis en evidence les risques qui lui sont lies, au premier rang desquels celui de devenir un adulte obese ainsi que la resistance a l'insuline et ses complications cardiovasculaires. Des progres ont ete faits dans la connaissance des facteurs favorisant le developpement de la surcharge ponderale : il s'agit d'une pathologie multifactorielle impliquant toujours un exces d'apports compare aux depenses energetiques ; le psychisme de l'enfant et son environnement familial jouent un grand role. La prise en charge a des resultats souvent mediocres, surtout si elle ne prend en compte que l'aspect dietetique du probleme. La promotion systematique de l'exercice physique et un accompagnement psychologique de l'enfant et de sa famille semblent ameliorer l'efficacite du traitement ; celle ci depend pour une grande part de sa precocite, incitant a developper un depistage precoce. Des actions de prevention sont a definir.

Nimuhona L, Laloum D, Rolland M-O, Read M-H. Guillois B, Duhamel JF. An intestinal obstruction in an eight-month-old child suffering from mevalonic aciduria. This report describes a case of mevalonate kinase deficiency diagnosed at I mo of age. Soon after delivery, symptoms were suggestive of congenital infection. An intestinal occlusion occurred towards the age of 8 mo. Conclusion: Mevalonate kinase deficiency has variable clinical and biological signs which can lead to a delay in diagnosis This is the first reported occurrence of bowel obstruction in this disease and the resemblance to a congenital infection in the neonatal period must be emphasized.

Objective: This prospective study was designed to assess the relationship between variations of serum Aluminium levels and bone mineralization, which is one of its target tissues, in healthy premature (PT) and fullterm (FT) infants. Study design: Lumbar spine bone mineral density (BMD) and content (BMC) studied by dual energy X-ray absorptiometry were compared to serum aluminium (S-Al), Ca (S-Ca), P (S-P), osteocalcin, alkaline phosphatase activity (S-AP), and 25 OH Vitamin D (25 OH D) by simple and multiple regressions in healthy PT (n=44) following their hospital discharge and FT (n=82). PT (gestational age at birth (mean±1 s.d.) 32±2 weeks) and FT were 43±39 and 36±32 weeks old respectively. Results: In PT multiple stepwise regression analysis including gestational age at birth, postconceptional age and postnatal age displayed only a significant correlation between BMD or BMC and postnatal age and a negative one with S-Al. In FT correlations were found between BMD or BMC and age and S-Ca. Conclusions: In PT, variations in blood Al are associated with developmental delays. Care should be taken to lessen Al levels, even in healthy PT babies.

Resume Le chrome (Cr) a ete dose dans des solutes de nutrition parenterale (NP) pediatriques (34,1 ± 9,8 μg/l) et adultes (6,8 ± 1,8 μg/l) (m ± 1 DS). Cet ecart de concentration en Cr3+ est du a l'utilisation chez l'enfant de solutes de base (oligo-elements, acides amines…) riches en Cr3+ en proportions plus importantes que chez l'adulte refletant les differences de besoins nutritionnels. Les taux seriques de Cr ont ete correles positivement avec les concentrations urinaires du Cr (p = 0,01) et negativement avec les valeurs seriques du Fe (p = 0,001). Les enfants etaient en bilan positif pour le Cr. L'attention doit etre portee sur les apports de Cr realises par la NP de facon a ne pas depasser les apports recommandes.

In a double-blind, randomized, controlled, multicentric study, the study compared the efficacy of a specific adapted formula (lactose-free, high-mineral, low-osmolarity formula, containing rice and pectin fortified with Saccharomyces boulardii) in the management of infants with acute diarrhea with a standard formula used to feed healthy infants from birth.Seventy infants with an average age of 163 days+/-11.7 suffering from acute diarrhea with an average of 6.6+/-0.4 stools per day received, after randomization, either a standard (control) formula (n=36) or an adapted lactose-free formula fortified with S. boulardii (26mg/100ml; n=34). The duration of the diarrhea was defined as the time needed until the occurrence of the first normal stool after the last liquid stool.At inclusion, the age, weight, and number of stools per day were the same in the two groups. There were 15 infants with rotavirus in the treated group and 13 in the control group. The duration of the diarrhea from time of inclusion was significantly reduced in the treated group (35.4+/-3.7h) versus the control group (67.1+/-5h; p0.001), In both groups, with or without rotavirus, the duration of diarrhea did not depend on the presence or absence of rotavirus but only on the treatment. The average daily weight gain was significantly higher in the treated group compared with the control group (74.2+/-26.4g versus 23.7+/-6.7g; p0.05). The oral rehydration solution consumption was, however, higher in the control group than in the treated group; the consumption of formula was higher in the treated group, but these differences were not significant. The number of stools as of Day 4 remained significantly higher in the control group than in the treated group. After 6.5 days, almost no S. boulardii was found in the stools.In moderately dehydrated infants (10 %), the use of a specially designed formula, containing S. boulardii (Novalac AD+/Diarinova+), significantly shortens the duration of diarrhea and allows quicker weight regain than a standard formula.

Resume Individualise par Davidsonet Wasserman [1], le colon irritable reste difficile a definir [2]. C'est la cause la plus frequente de diarrhee chronique du nourrisson et du jeune enfant [3]; elle correspond theoriquement a une atteinte colique isolee sans etilogie organique; il s'agit donc d'un diagnostic d'elimination remarquable par la bonne tolerance clinique de l'affection.

Pseudomonas aeruginosa (Pa) is the most common virulent respiratory pathogen in cystic fibrosis and is characterized by an important capacity of adaptation, adherence and communication. The factors of virulence of Pa play a major part in adherence with the respiratory epithelial cells and in occurrence of infectious episodes. The factors responsible for the transition of first Pa acquisition to the chronic infection are not elucidated yet. The system of secretion of type III and the quorum sensing (QS) play an important role. The QS would intervene in the maturation of the biofilm of Pa, responsible for the "mucoid" phenotype of Pa, associated to a degradation of the respiratory function. We made a retrospective study on the period 1984-2005 within the Center of Cystic fibrosis of Caen allow to determine the percentage of firstly-colonized and chronic infected patients with Pa according to age. At 6 months of life, 11% of the infants were colonized with Pa reaching 48% to 7 years and 85% at the 18 years age. The percentage of chronic children carrying Pa was 0% at 1 year, 11% at 4 years, 44% at 12 years and 74% at 18 years according to the method of Kaplan-Meier. Comparing the period 1984-1994 with that of 1995-2005, the firstly-colonization and the chronic carrying of Pa occurred earlier and significantly during the second period. The current objective, beside the respiratory care, comprises the maintenance of an optimal nutritional statute and, waiting for an effective vaccine, the development of new therapeutic targets in order to attenuate the virulence of the stocks of Pa and as much as possible to delay the age of firstly-colonization and the age of chronic colonization with mucoid Pa.

Asthma prevalence has increased significantly; this increase appears to be relatively recent. The observed increases in this prevalence cannot be genetic in origin; on the other hand lifestyles have changed in many ways for environment or feeding. The hygiene hypothesis must be distinguished in terms whether one is addressing asthma or atopy. Although there are associations between asthma and atopy, they are not interchangeable. The pathogenic links between childhood infections and asthma require an undisputed definition of asthma. But many wheezing syndromes have been recognized in the pediatric age group, some overlap exists between these various phenotypes. The age at first severe infection seems to be crucial in determining the outcome of reinfection and suggests that the environment of the neonatal lung is a major determinant of disease and allergic patterns in later life.

Hepatic abscesses in childhood are rarely observed in Europe. The aim of this word was to study how to diagnose and how to treat an hepatic abscess.Between 1985 and 2003, we recensed retrospectively 33 cases of hepatic abscesses hospitalised in the paediatric unit of Noumea.Children were mainly melanesians (79%), 7 years old on average, having abdominal pains, a clinical and biological infectious syndrome, and abscesses images on ultrasonography or computed tomography. The identified micro-organisms included Entamoeba histolytica in 30% (10 cases); Staphylococcus aureus in 15% (five cases), Staphylococcus coagulase negative in 6% (two cases), Streptococcus D in 3% (one case); Bartonella henselae in 9% (three cases); ascaris in 6% (two cases); Mycobacterium tuberculosis in 6% (two cases). In eight cases no bacteria was identified (24%) but the good evolution after antibiotics and the negative amoebic serology looked like pyogenic abscesses. Two abscesses were aspirated, two were drained, one child had a surgical intervention. There was no death. Following a mean duration of 1 month for antibiotics treatment, outcome was always favourable.Diagnosis of hepatic abscess can be difficult. Ultrasonography shows the abscess but not the causal agent. The amoebic serology is sensible, consequently, its negativity leads to evoke a pyogenic agent. Early antibiotic treatment against pyogenic, anaerobic bacteria, and Entamoeba histolytica is required. Hepatic abscesses in ascaridiosis, tuberculosis and cat-scratch disease are less frequently encountered. If diagnosis remains doubtful or clinical evolution worsens, or if abscess volume increases, a percutaneous aspiration or drainage is needed.

Résumé Objectifs. – Les rhinovirus sont les principaux agents du rhume, mais la fréquence et la gravité de leurs autres atteintes sont mal connues. Le but de ce travail est d’étudier l’expression clinique et la gravité potentielle des infections à rhinovirus de l’enfant hospitalisé. Méthodes. – De septembre 1998 à octobre 2000, nous avons étudié rétrospectivement une cohorte hospitalière de 211 enfants infectés par un rhinovirus, celui-ci étant recherché par culture ou RT-PCR. Résultats. – Chez les enfants infectés par un rhinovirus, 60 cas (28,4 %) d’atteintes ORL, 81 cas (38,4 %) de bronchiolites, 25 cas (11,9 %) de pneumopathies et 12 cas (4,7 %) de crises d’asthme aiguës ont été identifiés. Parmi les signes cliniques on relève 32 % de râles sibilants, 37 % de râles bronchiques et 29 % de signes de détresse respiratoire ; 40 % des radiographies pulmonaires sont anormales. Huit enfants ont été transférés en réanimation et deux sont décédés. Vingt-cinq enfants (11,8 %) avaient une infection à rhinovirus d’origine nosocomiale. Dans 19 cas le rhinovirus (9 %) était associé à un autre virus : 3 VRS, 2 virus influenza, 8 virus para-influenza, 2 adénovirus, 4 entérovirus ; 19 enfants (9 %) présentent une surinfection bactérienne. L’identification virologique des 211 cas d’infections à rhinovirus a été faite par isolement en culture dans 112 cas (53 %) et lorsque celui-ci était négatif par RT-PCR dans 99 cas (47 %). Conclusion. – En éliminant les cas de co-infections virales et bactériennes, les tableaux cliniques des infections à rhinovirus isolées de l’enfant sont dans notre étude les suivants : 25,6 % d’infections ORL, 25,6 % de bronchiolites ou bronchites, 6,2 % de pneumopathies et 5,7 % de crises d’asthme. Le diagnostic virologique est beaucoup amélioré par les outils moléculaires.

Wheezing associated with upper respiratory tract infections is common in children. Using conventional techniques (viral culture and immunofluorescence) and molecular techniques (PCR), we studied the prevalence of viral, Chlamydia pneumoniae (CP) and Mycoplasma pneumoniae (MP) infections in 118 children hospitalised for acute asthma exacerbation. A virus was identified by conventional techniques in 40 of the 118 nasal swabs (34%), while PCR allowed identification of virus CP and MP in 80 samples (68%). Combination of both techniques allowed identification of an infectious agent in 91 cases (77%). More than one agent was isolated in 15 cases (23%). Rhinovirus (RV) (45%) were prevalent, followed by respiratory syncytial virus (RSV) (28%) and enterovirus (8.5%). RV and RSV have a similar prevalence (42% and 36% respectively) before two years of age, as compared with 66% and 27% respectively in older children. CP and MP were identified by PCR in only 6 cases. Molecular techniques of identification demonstrated a clear advantage in sensitivity compared with conventional techniques. The high prevalence of RV and RSV infections is remarkable, while CP and MP do not seem particularly involved in children acute asthma exacerbation.

The nutritional care of children and adolescents who practice sports more than 10 h/weeks is an important task. Advices must be adapted to the child according to his sport, his age, his gender, his weight and to the intensity of his physical activity; they intend to provide him, in addition to his basal requirements, those due to the extra expenses of water, energy, minerals and vitamins. The aim of the physician is to allow these children an adequate growth and the normal development of puberty, to prevent deficiencies and to concur with other specialists to the prevention of muscle, joint and bone wounds who can affect a growing organism. This ambitious program relies on a thorough knowledge in pediatrics, nutrition and sport in order to adapt the advice to the specific way of life of the child, taking into account the schedules of school time, training and competition. Such an approach needs that every child undergoes a medical examination 3-4 times/year, a biological check up at least once a year, a careful follow up of growth and pubertal maturation. Every time it is possible parents and coaches are encouraged to attend the visit when everything is OK and even more when difficulties occur, whether they are due to somatic or psychological trouble or in case of poor performance induced discouragement. A balanced nutrition, an adequate counseling and an adapted follow up are essential for the success of athletes; they do not make champions from them but decrease the hazard of wounds, underperformances and make easier blossoming for children.

To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein.A retrospective (1990-2000) survey was carried out in pediatric hospital centers.Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30% of the cases, vancella lesions were associated; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey.Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.

The neonatal screening programme in Normandy (France) allowed the formation of a homogenous cystic fibrosis (CF) cohort of 150 children diagnosed between 1980 and 1997. At the time of this retrospective study, 11 were deceased, out of which nine had meconium ileus (eight deaths after surgery, one at 5 years of age). Sixty children born between 1980 and 1993 in the Basse-Normandie region were followed up during a mean 80 months following similar protocols. The mean age at diagnosis was 41 days (SD = 27 d) for infants without meconium ileus. The occurrence of Pseudomonas aeruginosa (P. aeruginosa) infection and chronic colonization was studied using a monovariate followed by a multivariate analysis including the following variables: sex; meconium ileus; anthropometric data at birth and at diagnosis; pancreatic insufficiency; radiological data (Brasfield score); microbiology data at diagnosis; and genetic data. P. aeruginosa infection appeared earlier in children with pancreatic insufficiency (OR = 2.2; p0.05) or with radiological abnormalities (Brasfield score21) at diagnosis (OR = 3.9; p0.05). Meconium ileus (OR = 5.3; p0.01), pancreatic insufficiency (OR = 3.8; p0.01) and Brasfield score21 at diagnosis (OR = 5.6; p0.001) were prognosis factors for early chronic P. aeruginosa colonization. In CF children without meconium ileus, the major risk factor found through multivariate analysis for earlier infection and for earlier chronic colonization by P. aeruginosa was a diagnosis delay40 days (respectively OR = 4.6; p0.001 and OR = 10.4; p0.005). These results must be compared with the lower Brasfield score at diagnosis in infants diagnosed after 40 days of life (p0.01).

Cystic fibrosis (CF) is the most common severe autosomal recessive disorder amongst Caucasian populations. We have learned a great deal on CF during the past 20 years, mainly with the identification of the CFTR gene in 1989. In the same time, improvements in the therapeutic management dramatically changed its clinical outcome: while in 1946 the median survival was 4-5 years, in 2,000, it reaches 30 years in reference centers. Since the prognosis depends on respiratory functions, a large number of clinical trials were designed to improve them; medical, physiotherapic, and surgical interventions such as a bipulmonary grafts allowed to slow the natural decline of respiratory functions. Early diagnosis and maintaining optimal nutrition such as bipulmonary grafts allowed to slow the natural decline of respiratory functions. Early diagnosis and maintaining optimal nutrition are two other determining factors of prognosis. Nowadays the next step is to resolve the problem of the benefit of gene therapy but no significant progress was observed in that field for the past five years.

High aluminum levels have been reported in sick and intravenously fed premature infants; however, aluminum is a ubiquitous pollutant of food. This study compares the usual aluminum levels of healthy newborns from birth to the third month of life with those of enterally fed premature infants free of renal failure. Plasma and urine concentrations were determined 66 times in full-term newborns (n = 58), 56 times in a group of preterm infants whose gestational age at birth was 28 to 32 weeks (n = 36) and 54 times in another group of preterm infants whose gestational age at birth was 33 to 36 weeks (n = 50). Daily aluminum intakes (+/- SE) of the full-term infants and the two groups of preterm infants were 0.42 +/- 0.05, 0.64 +/- 0.03, and 0.52 +/- 0.03 mumol/kg per day, respectively (p = .05). Plasma aluminum levels were 0.29 +/- 0.05, 0.49 +/- 0.06, and 0.39 +/- 0.05 mumol/L (p = .007); urine excretion levels were 0.80 +/- 0.12, 0.77 +/- 0.21, and 0.78 +/- 0.2 mumol of aluminum/mmol of creatinine (p value not significant). Although the metabolic consequences of the high aluminum intakes and blood levels we have observed in very low birth weight infants remain to be assessed, these results suggest that more attention should be paid to the aluminum status and intake of healthy premature babies.

The nature of viral infection was prospectively investigated in 202 immunocompetent infants with bronchiolitis. Nasal aspirates were evaluated by immunofluorescence assay, viral isolation technique and polymerase-chain-reaction-hybridization assay. In 55 infants (27%) more than one respiratory virus were detected. A Rotavirus was found in 40 infants (20%), without any relationship with the respiratory viral status, respiratory syncytial virus being the main virus (46/55), and the association of respiratory syncytial virus and adenovirus being the most frequent (21/55). No difference was found between monoviral infections on the one hand and simultaneous viral infections on the other hand according to age, weight, neonatal disease, past history of personal or familial atopy, central temperature, Silverman's index, oxygen dependency, length of hospitalization, microbiology data. There was no indication that simultaneous virus infections were associated with an increased severity of the bronchiolitis in immunocompetent infants.

Recent studies have shown a high prevalence of calcium and vitamin D deficiencies in adolescents. The aim of this present study was to follow the changes in calcium status and 25 hydroxyvitamin D (25[OH]D) and parathyroid hormone (iPTH) levels during winter in preadolescents and adolescents from four university hospitals in northern France.Two groups of teenagers and adolescents (range: 10-15 years) were followed from October 1996 to June 1997. They were given either 100,000 IU of vitamin D (treated group n = 33) or a placebo (control group n = 35) in October, January and April. Serum calcium, phosphate, 25(OH)D and iPTH levels were measured at inclusion and every three months thereafter.At inclusion, plasma or serum 25(OH)D levels wereor = 10 ng/mL in 16 subjects and6 ng/mL in six. In control children, no significant change in 25(OH)D occurred during the study, while plasma or serum iPTH levels increased to 34 +/- 11 pg/mL. In the treated groups, 25(OH)D levels remained20 ng/mL in every subject; no hypercalcemia was observed; and the mean plasma or serum iPTH level was 25 +/- 14 pg/mL at the end of the study.Teenagers presented with a high prevalence of biological vitamin D deficiency at the end of summer. The increase of iPTH during winter in the unsupplemented group suggests that this has secondary consequences on their calcium homeostasis unless they are supplemented with vitamin D. We advocate a sufficient calcium supply and a 100,000 IU vitamin D supplement given two or three times during winter to preadolescents and adolescents living in northern France.

The molybdenum (Mo) levels in the plasma and urine of 30 premature and 15 full-term infants have been compared with the Mo intakes and urine uric acid excretion (uric acid/creatinine ratio) produced by the Mo enzyme xanthine oxidase. The Mo intakes of full-term infants were 41 ± 14 nmol/kg/day (mean ± SEM). In the premature group breast milk supplied significantly less Mo (4.3 ± 0.4 nmol/kg/day) than infant formulas (101 ± 31 nmol/kg/day) or premature formula (255 ± 13 nmol/kg/day). When fed breast milk, the preterm infants displayed similar or higher plasma and urine Mo and urine uric acid levels than formula-fed infants. For the whole preterm group a significant correlation was determined for urine Mo levels and Mo intakes as well as for plasma Mo and uric acid excretion. The bioavaibility of breast milk Mo seems to be higher than formula Mo according to the Mo levels and to their statistical link with uric acid excretion which could be proposed as a functional index of Mo status. These parameters displayed similar values in breast milk-fed prematures and control full-term infants. The Mo needs of formula-fed premature newborns remain to be defined using complete balance trials.

Although signs and symptoms may become severe, most viral respiratory infections of infancy are self-limited and improvement usually occurs within several days. Patients hospitalized with viral pneumonia usually require supportive therapy, including oxygen and fluids, and eventually mechanical ventilation. Bacterial superinfection can occur, accompanied by purulent sputum production and isolation of pathogenic bacteria from sputum. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus are the most common secondary invaders. Appropriate antibiotherapy must be administrated after cultures. There is no evidence that prophylactic antibiotherapy is of any use to prevent bacterial superinfection in viral pneumonia.

Two hundred and nineteen children (boys: 56%, girls: 44%) were included in a randomized, double-blind, multicentre (4 centres) controlled trial designed to assess the efficacy and safety of ibuprofen (IBU) in the treatment of 1 to 6 year-old children with otoscopically proven acute otitis media (AOM), either unilateral or bilateral. They randomly received 10 mg/kg IBU (n = 71), or acetaminophen (PARA) (n = 73) or placebo (PLA) (n = 75), orally, tid, for 48 hours. All received oral cefaclor (Alfatil, Lilly, France) for seven days. They were evaluated before (D0) and at the end of treatment (D2). The main criterion of response was the aspect (landmarks and color) of the tympanic membrane assessed on a semi-quantitative scale from 0 to 6. Other criteria, assessed on semi-quantitative scales, included relief of pain (0 or 1), rectal temperature (0 to 2), and overall evaluation by parents of the improvement of quality of life on three items: appetite (0 to 2), sleep (0 to 2), and playing activity (0 to 2). The results at D2 were as follows: there was no significant difference between treatment groups as to the main criterion, but only a trend for IBU and PARA to do better than PLA but not for IBU to do better than PARA. From these data there is no argument to emphasize the utility of non-steroidal anti-inflammatory drugs (NSAIDs) in treating the inflammatory signs of the tympanic membrane in otitis. There was a statistically significant difference between treatment groups at D2 for pain, IBU being superior to PLA (P < 0.01): 7%, 10% and 25% of the children were still suffering at D2 in the IBU, PARA and PLA treatment groups, respectively. The difference between PARA and PLA for pain was not statistically significant. There was no significant difference between treatment groups for the other criteria. All treatments were well and equally tolerated. Although no significant difference was found between the treatment groups on the aspect of the tympanic membrane, the efficacy of IBU was evidenced on the relief of pain, the symptom that most disturbs the child.

The healthy adult is protected from aluminum (Al) accumulation by a low (< 1%) digestive absorption of ingested intake and by the renal excretion of the absorbed fraction (1). The main target organs for (Al) are bone, brain, liver and the hematopoietic system (1). In the premature infant (PT), tissue Al loading has been described at necropsy of critically ill subjects, due to IV feeding and renal failure (2–5). However, increased Al plasma levels have been described in healthy PT or fullterm infants (6–8). The functional relationship between such variations of serum Al and biological functions remains to be defined in the infant inasmuch as it has been claimed that Al blood levels might be of poor interest in adult subjects (1).

Infants suffering from respiratory syncytial virus (RSV) infection can have severe responses that require intensive care. This study compares the epidemiologic patterns and the severity of respiratory diseases produced by RSV strain subtypes A and B.The prevalence of RSV subgroups was studied over 8 consecutive outbreaks from 1982 to 1990. The files of 73 infants aged from 1 to 24 months admitted because of RSV infection between October 1987 and March 1990 were studied. The criteria of severity were tachypnea and/or the use of the accessory muscles for respiration, apnea and/or cyanosis, hospitalization for8 days, hypercapnia and/or acidosis, oxygen therapy, use of corticosteroids and/or bronchodilators, nutritional difficulties.A total of 374 RSV strains were isolated: 142 were group A and were 232 group B. Subtype A predominated during the winter 1987-1988 and subtype B during 1983-1984, 1984-1985 and 1989-1990. Some indicators of severity, such as degree of respiratory distress, duration of hospitalization and levels of oxygen saturation, were correlated with A subgroup infections, but the difference in the severity index for the two subtypes was not statistically significant.The results are not consistent with other previous reports, perhaps because different indicators of severity were used in this study and infants less than one month old or having other underlying diseases were excluded.

Chromium (Cr) dosage was assayed in i.v. nutrition, serum, and losses of five children on total parenteral nutrition for > or = 4 weeks. The Cr supply (4.7 +/- 1.2 micrograms/kg/day) was above recommended levels (0.5 microgram/kg/day). Serum (18.2 +/- 1.8 micrograms/L) and urine (37.4 +/- 10.5 micrograms/L) were also higher than control values (0.7-0.9 microgram/L and 0.2-0.8 microgram/L, respectively). Serum and urine Cr concentrations displayed a positive correlation. Serum Cr and Fe showed a negative correlation. These results confirm the potential toxicity of Cr previously reported in animals. Cr levels of i.v. nutrition solutes should be checked thoroughly.

SUMMARY The pharmacokinetics of fusidic acid (Fucidine®, Leo Laboratories) were studied in 10 children after single oral dosing with 20 mg/kg of a new bananaflavoured paediatric suspension (titrating at 50 mg/ ml). Nine blood samples were drawn from each child at 0, 1, 2, 3, 6, 8, 12, 24 and 48 h following dosing with the antibiotic. Serum fusidic acid levels were measured by high–performance liquid chromatography (HPLC). A model–independent method was used for the pharmacokinetic analysis. Results were compared with those obtained after dosing eight healthy adult volunteers with 500 mg of sodium fusidate by parenteral administration (infusion) then per os. The acceptability of the single dose was good. The terminal elimination half–life t1/2 (h) and the mean residence time (MRT, h) of fusidate were similar to those determined in healthy adults after oral dosing, i.e. 16–0 ± 14–5 versus 16–0 ± 3–5 and 17–7 ± 12–1 versus 17–7 ± 2–5, respectively. In contrast, the oral bioavailability of the suspension (Fapprox, %) was relatively low: of the order of 225 versus 91–0% for tablets in the healthy adult, which justifies the use of a relatively higher dose in the child. This led to the calculation of an estimated total clearance (CIest, ml/min) significantly less than that in the healthy adults, while the estimated apparent volume of distribution (Vd, litre/kg) was significantly increased (104 ± 91 versus 218 ± 21 and 073 ± 053 versus 030 ± 004, respectively). Fusidic acid is normally excreted in metabolized form (98%). The decrease in clearance could be attributed to the almost immediate saturation of liver enzymes in immature infants. An increased initial volume of distribution could result from less protein binding of fusidic acid. Graphic simulations show that the administration of a dose of 20 mg/kg every 12 h results in effective serum levels being obtained from the outset. A treatment schedule involving three doses per day (08.00, 12.00, 20.00 hours) is also theoretically satisfactory.

Young high-level athletes are frequently exposed to deficiencies, the most frequent origin of which is dietary. Supervision must be clinical, biological and dietary. Recommendations should be made individually, based on the nature and intensity of the exercise, and are calculated from the recommended supplements for the paediatric population. Protein, glucid and lipid supplements must represent approximately 12, 60 and 28% of the daily energetic intake respectively, the glucid ratio reaching 70% under certain conditions of prolonged exercise. Liquids must be controlled when exercise takes place in a warm atmosphere because young athletes are rapidly exposed to dehydration, the osmolarity of the selected drink being below 250 mosm/l. Mineral and vitamin supplementations are recommended. For minerals, perspiration losses may be associated with dietary deficiency. Possible vitamin deficiencies concern B1, B2, B6, B9, B12, C and D vitamins. The daily mineral supplements are estimated at 10 mg for iron, 5 mg for zinc and 1 mg for copper, and have to be prescribed in regular treatment after biological control.

Twenty-four infants, 1 to 18 months-old, who were referred to four centers for suspected gastroesophageal reflux and whose esophageal pH after a standard formula meal given at 9 to 10 am (Ho-day 1) fulfilled the criterion of being < 4 for more than 5% of the time between H1 and H6, entered a double-blind placebo-controlled dose-response trial of metoclopramide (M). Twenty-four hours later (day 2), patients were randomly assigned to receive either placebo or a single 0.1, 0.2, or 0.4 mg/kg dose of metoclopramide, 30 min before the formula meal (n = 6/group) and the procedure was repeated. Metoclopramide plasma concentration was measured 1 h after dosing (C1h). On day 1, the time during which the esophageal pH was < 4 (time pH < 4), and five other parameters, were not significantly different in the treatment groups. On day 2, time pH < 4 (m(SD)) decreased from 33(13) to 30(33), 39(27), to 36(47), 42(15) to 18(13) and 48(25) to 31(46) min in the placebo, 0.1, 0.2, and 0.4 mg/kg metoclopramide groups, respectively. Possibly due to the large interindividual variability, no significant differences in parameters were observed between the different groups. None of the parameters correlated with the metoclopramide dose. Time pH < 4 expressed as the difference between day 1 and day 2, relative to day 1, decreased significantly as a function of C1h. No side effects were observed. A similar study should be performed after repeated dosing regimen.

Respiratory syncytial viral (RSV) infection can be rapidly differentiated from influenza viral infection by immunofluorescence techniques. These tests were used to identify some epidemiological and clinical characteristics of both infections.77 RSV and 22 influenza viral infections were detected during an outbreak (November 1989 to March 1990) in 210 children less than 6 years admitted for lower respiration tract infections. The fluorescent antibody assay was performed on nasal aspirates.The RSV outbreak ran from November to March, while the influenza outbreak was shorter, during December and January. The patients infected with RSV were younger (mean age: 6.7 months) than those infected with influenza virus (mean age: 20.9 months) (p0.001). Those with influenza virus infection presented with higher temperatures, more often had initial seizures (p0.05) and displayed fewer clinical or X-ray respiratory symptoms (p0.001). Mean durations of hospitalization were 9.9 days for RSV infection and 7.7 days for influenza virus infection. The therapeutic use of bronchial dilators, oxygen and steroids was correlated with the degree and duration of respiratory manifestations. A 3 month follow-up was insufficient to show any difference between recurrences or complications in the two groups.The clinical and radiological differences in these two groups of patients viral-infected are similar to those described in the literature. Variability from one outbreak to another precludes any extrapolation to other populations and justifies the systematic use of the fluorescent antibody assay, especially when a specific antiviral therapy is considered.

In order to obtain reference values from normal babies, Cr status of full-term newborns has been studied. Plasma and urine values were (mean +/- SEM) 0.7 +/- 0.1 micrograms/L and 0.9 +/- 0.3 micrograms/L, respectively, for the first month of life (n = 19), and 0.6 +/- 0.1 micrograms/L and 0.8 +/- 0.2 micrograms/L for the second-to-third-month period (n = 31). Premature newborns (gestational age 28-36 wk) were compared to these control values; concentrations were 0.9 +/- 0.1 micrograms/L and 1.1 +/- 0.2 micrograms/L for the first month (n = 47), and 1.0 +/- 0.2 micrograms/L and 1.5 +/- 0.3 micrograms/L for the second to third months (n = 27). For the whole group, there was a positive correlation between plasma and urine concentrations (p = 0.0001); multiple regression analysis was performed between plasma levels and gestational age at birth (p = -0.002) and postnatal age (NS). Plasma levels of prematures and full terms were statistically different (p = 0.03) only for the second- to third-month period. It is suggested that these high Cr levels result from high dietary intakes and/or high absorption rates.

Plasma Cr concentrations have been studied in normal children aged 0-14 yr. Levels ranged from 0.65 to 0.88 microgram/l and did not change with age. Plasma concentrations of CF patients given 0.5-0.75 microgram Cr/kg/d in addition to their diet were similar to normal values. There was no correlation between these plasma values and growth retardation.