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This French multicenter, cross-sectional, observational study aimed to describe the family history of atopy in infants with cow's milk protein allergy (CMPA), and the related diagnostic approaches used by specialists in a real-life ambulatory setting. In total, 1674 infants with suspected CMPA [median age 4.5 months (range: 0.1–18.0), males 54%] were enrolled in the study by 466 private physicians (pediatricians: 97%). Family history of atopy was defined as a known history of atopy in at least one first- (father, mother, and/or sibling) and/or second-degree relative (grandparents, uncles, and aunts), as reported by parents to physicians. Atopy in a first-degree relative was more common among infants with documented or high probability of CMPA (in 84% and 80% of cases, respectively, vs. the other subgroups, P = 0.005). Most infants experienced digestive (92%) and skin (61%) symptoms suggestive of CMPA. Delayed reactions were reported in 64% of infants. According to a post-classification based on the results of previous diagnostic tests and procedures, 1133 infants (68%) had highly probable (52%) or documented CMPA (16%). In these infants, a history of atopy was reported in first- and/or second-degree relative(s) in 86% of cases (81% in first-degree relatives). Whatever the family history of atopy, the characteristics of the infants were similar, except for fewer pets in the case of negative family atopy (14% vs. 25%, P < 0.001). Atopy in a parent was more frequent in infants who presented with the first signs suggestive of CMPA within the first 6 months of life vs. those with later first symptoms (75% vs. 65%, P = 0.063). This French study confirms the high rate of family history of atopy in first-degree relatives of infants with probable or documented CMPA. [ABSTRACT FROM AUTHOR]

Background Eosinophilic gastrointestinal disorders ( EGIDs) are hypersensitivity disorders frequently triggered by food allergy and manifested by mucosal eosinophilic infiltration at any level of the gastrointestinal tract. This study established a model of gastric eosinophilia in peanut-sensitized piglets to evaluate the efficacy of epicutaneous immunotherapy ( EPIT) for its treatment. Methods Experiments were carried out in piglets first sensitized by three intra-peritoneal injections of peanut protein extract ( PPE) with adjuvant, and then given PPE orally for 10 days, a sequence leading to gastric eosinophilia assessed by endoscopy. For 3 months, eight piglets received active EPIT, using Viaskin® loaded with PPE, applied daily on the ear, while eight received placebo EPIT (Placebo). Piglets were exposed to a second 10-day period of PPE orally. Lesions were scored by endoscopy on the last day of PPE exposure. After killing, all parts of the digestive tract were analysed by a pathologist unaware of the piglets' status. IgE response was measured, and mechanistic parameters were analysed in the spleen. Results After sensitization, a significant increase of total IgE was observed in sensitized compared to naive animals (61.1 ± 13.3 vs 27.8 ± 6 ng/ mL, P < .01). Following oral intake of PPE, sensitized piglets developed moderate gastritis compared to naive piglets (1.5 vs 1.0, median score). After 3 months of immunotherapy, median IgE was significantly reduced in EPIT vs placebo piglets (61.4 ± 16.3 vs 105.9 ± 25.6 ng/ mL, P < .01). Active EPIT significantly reduced gastric mucosal lesions induced by PPE oral intake (macroscopic score 0 [0-2] vs 2 [1-3], P < .01, respectively, active vs placebo) and gastric mucosa eosinophils counts (239 eosinophils/mm2 [59-645] vs 2554 eosinophils/mm2 [462-8057], P < .01, respectively active vs placebo). GATA-3, IL-5 and eotaxin mRNA expression decreased significantly after EPIT ( P < .05). Conclusions This study describes a large animal model of gastric eosinophil in peanut-sensitized piglets. Utilizing this model, we demonstrated the efficacy of EPIT in treating peanut-induced EGIDs. [ABSTRACT FROM AUTHOR]

Summary: In occidental countries, constipation concerns almost a third of the children and is constantly increasing due to cultural context in which settled way of life and low-residue food are favoured. Constipation is mostly essential, and management is easy with good results. Nevertheless, the GP, or the paediatrician, must know how to detect organic constipation or complicated constipation cases which need more specific management. [Copyright &y& Elsevier]

The aim of this study was to analyze the histological characteristics according to the updated Sydney classification (intensity of gastritis, degree of activity, gastric atrophy, intestinal metaplasia, and Helicobacter pylori) in symptomatic children referred for upper gastrointestinal endoscopy. A 4-year retrospective descriptive study was carried out in 619 children (282 females and 337 males), median age 3.75 years (15 days to 17.3 years) referred for endoscopy. Six gastric biopsies were done (three antrum and three corpus) for histological analysis (n = 4), direct examination and H. pylori culture (n = 2). H. pylori status was considered positive if at least two out of three tests were positive and negative if all three tests were negative. The results showed that only 66 children (10.66%) were H. pylori positive. Histological antral and corpus gastritis was detected in, respectively, 53.95% and 59.12% of all cases, most of them of mild grade 1. Antral and corpus activity was grade 1 in 18.57% and 20.03% of cases. H. pylori-positive versus H. pylori-negative children did differ in terms of moderate and marked histological gastritis and grade 2 or 3 activities. One girl had moderate gastric atrophy and another one moderate intestinal metaplasia, both being H. pylori negative. The findings indicate that primary antrum and corpus gastritis is 5.3 and 6.9 times, respectively, more frequent than H. pylori gastritis in French children, with usually mild histological gastritis and activity. Gastric atrophy and intestinal metaplasia are rare. [ABSTRACT FROM AUTHOR]

Abstract: Aim of the study. – To assess the place of ibuprofen in the treatment of fever in children. Patients and methods. – An anonymous self-questionnaire was submitted to the parents of 156 children aged less than 15 years and 3 months consulting for a fever in a pediatric emergency care unit. Questions related antipyretic drugs availability at home and their administration modality to the febrile child. Results. – Acetaminophen (liquid or rectal) was the first drug owned by families (N =149, 96%). Ibuprofen was owned by 79 families (51%). The antipyretic drug administered as a first intention treatment was acetaminophen in 131 children (77%), ibuprofen in 27 (17%) and aspirin in 6 children (4%). An antipyretic bitherapy was received by 58 children (35%), nearly always acetaminophen and ibuprofen (N =48, 87%). The use of a bitherapy was more frequent when ibuprofen was the first drug used. Children who received an antipyretic bitherapy as compared to those who received a monotherapy exhibited significantly a higher fever level and long lasting fever period. Antipyretic drugs given to the sick children were prescribed by a physician in more than 90% of cases. Conclusion. – Ibuprofen was largely used in febrile children. This drug has almost always been prescribed by a physician. However, due to its side effects, ibuprofen should be used only in high and badly tolerated fever that is not altered by a well conducted acetaminophen monotherapy. [Copyright &y& Elsevier]

The purpose of this cross-sectional study was to describe the evolution of total IgE and food-specific IgE titers in children seen in consultation for the first time for suspected food allergyPatients and methods. – Nine hundred and twenty five children (455 girls and 470 boys) with a mean age of 8.9 ± 9.1 years (range 15 days–18 years) who were investigated for food allergy in 1997 were included. Their sera were assayed for total IgE and for IgE antibodies specific for six major children’s food allergens (cow’s milk proteins, egg white, peanut, soy, wheat and fish) with the RAST Fx5® Cap System (Pharmacia & Upjohn Diagnostics AB®, Uppsala, Sweden). The results are expressed as a percent of the reference values by age.Results. – Total serum IgE increased significantly with age (r = 0.22, P = 0.0001). The percentage of children with a total IgE level above the normal range for age increased with age, going from 10.3% above the reference value at 0–6 months, reaching 38.2% at 1–2 years and peaking at 56.9% at 4–6 years. It then leveled off at 48.1% at 8–12 years (ns vs. 4–6 yrs) and 41.3% at >12 years (ns). RAST Fx5® values increased in a parallel manner until 4–6 years and then showed a progressive decrease from 6–8 years, differing significantly from total IgE: 31.9% vs. 52.9% (P < 0.01) at 6–8 years, 32.2% vs. 48.1% (P < 0.03) at 8–12 years, and 21.8% vs. 41.3% (P 0.05) at >12 years.Conclusion. – In this large group of children investigated for possible food allergy, an increase with age in the percentage of those with a high total IgE contrasted with the progressive decrease from age 4–6 years in the percentage of those with an elevated RAST Fx5® titer. This finding correlates well with the progressive decrease of clinically important food allergy in the developing child. [Copyright &y& Elsevier]

A high prevalence and early colonization of Helicobacter pylori (H. pylori) infection in childhood characterizes the developing countries in contrast to developed ones. Upper gastrointestinal endoscopy including gastric biopsies is the diagnostic gold standard method. Non invasive tests can be used in children, including serology, 13C-urea breath test and immunoassay enzyme stool antigen test (HpSA). They present good performance in adults, but less in children under 6 years of age. They can be used for screening, epidemiological studies. Only the 13C-urea breath test and the immunoassay enzyme stool antigen test (HpSA) are recommended for the control of eradication. The infection remains often asymptomatic in children and the role of this bacterium in clinical manifestations is the subject of conflicting reports. The treatment of H. pylori infection is influenced by the resistance to the antibiotics used. We suggest that eradication of H. pylori infection should take place only after susceptibility testing since the resistance rate for the metronidazole is of 43% and for the clarithromycine 21% in France. The association of proton pump inhibitor and two antibiotics for 1–2 weeks seems to give the best eradication rates. The crucial question is whether asymptomatic children should be treated to prevent cancer in the future. [Copyright &y& Elsevier]

Aims. – To assess the frequency of acquisition of secondary Helicobacter pylori resistant-strains after a first course of antimicrobial treatment.Patients and methods. – A retrospective study was performed during the 1994-2000 period, in 15 girls and eight boys, mean age 10.9 ± 4.8 years (1.4–17 years), with Helicobacter pylori gastritis (culture and antimicrobial susceptibility) presenting a failure of first course treatment, with during one week a proton pump inhibitor and amoxicillin together with either clarithromycin (n=14) or metronidazole (n=9). Two endoscopies were performed, the first at the time of diagnosis and the second after the failure of bacterial eradication demonstrated by a positive 13C urea breath test six weeks after the end of treatment. Antimicrobial susceptibility of all Helicobacter pylori strains was tested after each endoscopy and before starting a second course of the treatment.Results. – Comparison of antimicrobial susceptibility before and after the first course of treatment showed that Helicobacter pylori strains were all sensitive to amoxicillin, clarithromycin-resistant in eight children (34.7%) before treatment vs 12 (52.1%) after treatment, p=0.42, ns, metronidazole-resistant in 13 (56.5%) vs 12 (52.1%), p=0.80, ns, and both clarithromycin and metronidazole-resistant in four (17.3%) vs seven (30.4%), p=0.63, ns. Among the 14 children treated by a triple therapy including clarithromycin, three (21.4%) developed a secondary resistance to clarithromycin and in one metronidazole resistance was no more detected. Among the nine children treated with a triple therapy including metronidazole, none developed a secondary resistance to metronidazole and one developed a secondary resistance to clarithromycin.Conclusion. – This study shows the absence of amoxicillin-resistant strains, a high initial clarithromycin-resistant strains level (primary resistance), increasing after a first course of treatment, and for metronidazole a high initial level of resistance not influenced by treatment. Secondary clarithromycin-resistance of Helicobacter pylori strains following the first course of treatment could account for failure of bacterial eradication and suggests the importance of antimicrobial susceptibility. [Copyright &y& Elsevier]

Objective: To analyse to what extent age may alter intestinal permeability (IP) in children and to assess its reliability according to clinical manifestations in cow's milk allergy (CMA). Design: A routine prospective study was performed in 200 children (12.5 ± 23 mo, 0.5-168 mo) presenting with clinical manifestations suggesting CMA. Controls (n = 105) were those with a negative cow's milk challenge, whereas CMA children (n = 95) fulfilled ESPGHAN criteria. Permeability was measured as a percentage of urinary excretion of lactitol (L, %) and mannitol (M, %) (0.1 g/kg for each, oral absorption after a 6 h fast, 5 h urine collection, analysis by gas chromatography) and determination of the L/M ratio (L/M, %). Results: In control children, L/M correlated negatively with age (r -0.33, p = 0.0006), whereas in those with CMA no correlation was found. Median L/M was significantly higher in CMA children (n = 95) than in controls (n = 105), 4.35 ± 7.57% (95% CI 5.30-8.39%) vs 1.97 ± 0.87% (95% CI 1.76-2.09%), (p = 0.0001). With a L/M cut-off value defined as mean + 2 SD of controls, in CMA IP exhibited a 68% sensitivity and a 77% negative predictive value. The highest sensitivity (70%) was seen at ages 6-12 mo and the lowest (58%) at age more than 3 y. An abnormal IP was seen in 80% of CMA children with digestive manifestations, in 43% with extra-digestive, 68% with mixed and 40% with anaphylactic manifestations. Conclusion: IP correlates negatively with age in control children and is altered in children with CMA. The test is at its most accurate in the diagnosis of CMA when done at ages 6-12 mo, when there are digestive manifestations. [ABSTRACT FROM AUTHOR]

Objectif Évaluer chez l’enfant les performances d’un test de diagnostic d’infection à H. pylori non invasif rapide immuno-chromatographique (ALERE ® , Jouy-En-Josas, France). Sujets/matériels & méthodes Cent cinquante-huit enfants (89 filles, 69 garçons) présentant des signes cliniques évocateurs de gastrite étaient inclus. Une endoscopie digestive haute était réalisée avec des biopsies antrales & fundiques (histologie, test rapide à l’uréase [RUT], culture bactérienne avec antibiogramme, PCR quantitative en temps réel [qPCR]). Des selles étaient obtenues pour la recherche d’antigènes H. pylori dans les selles (SD-test). Les performances du SD-test étaient évaluées par rapport à la méthode de référence. Résultats Parmi 158 enfants inclus (âge médian : 8,5 ans [8 m–17 ans]), 23 enfants étaient H. pylori positifs (14,6 %). Parmi les 23 enfants H. pylori positifs, le SD-test 25 cas (2 faux-négatifs et 4 faux-positifs) avec des performances : 95 % IC sensibilité 91,3 % (86,9–95,6), spécificité 97 % (94,3–99,6), VPP 84 % (78,2–89,7), VPN 98,5 % (96,6–100). La précision du test était de 96,2 % (93,2–99,1). Conclusion La recherche d’antigène dans les selles est un test concordant, fiable, rapide et spécifique pour le diagnostic de l’infection à H. pylori chez l’enfant. [ABSTRACT FROM AUTHOR]

Introduction: les manifestations cliniques cutanées ou digestives faisant évoquer une forme retardée de l’allergie aux protéines de lait de vache (APLV) sont fréquemment rencontrées au cours de la prise en charge des nourrissons en pratique pédiatrique quotidienne. Parmi les outils du diagnostic, les patch-tests (APT) prêts à l’emploi sont de réalization simple et adaptée à la pratique médicale quotidienne de la pédiatrie. Le but de ce travail est d’en apprécier la pertinence chez le jeune enfant et le nourrisson. Méthodes: 58 enfants d’âge moyen 34,14 (4-134 mois), présentant des manifestations cliniques digestives (29,3 %) ou cutanées (20,6) ou mixtes (50.1 %) évoquant une APLV dans sa forme retardée telle que définie par Sampson et al. ont été inclus dans une étude prospective multi-centrique en France. Après bilan allergologique comprenant APT (Diallertest®), Prick Test (SPT), et dosage des IgE spécifiques du lait de vache (sIgE), tous les enfants recevaient pendant une période moyenne de un mois un régime à base de protéines de lait de vache hydrolysées et un test de provocation était réalisé. Résultats: Seuls 38 enfants ont suivi l’ensemble du protocole. Parmi eux, les APT, les SPT et les sIgE étaient positifs respectivement dans 36,8 %, 10,5 %, et 5,2 % des cas. Comparés aux résultats du test de provocation, considéré comme « gold standard », la sensibilité des trois tests étaient respectivement 68,4%, 18,8%, 13,3%, spécificité 94,7 %, 94,4%, 100 %, VPP 92,9%, 75 %, 100% et VPN 75%, 56,7%, 53,6%. Les résultats des tests étaient similaires quelle que soit la symptomatologie retardée. Les APT étaient plus fiable que les autres tests quelque soit l’âge avec une précision du test respectivement de 81,5 % vs 58,8 % et 56,6% (p < 0,005). Les résultats de sensibilité et de spécificité des APT étaient meilleurs avant deux ans (sensibilité, 77.8 %, spécificité, 100 %). Conclusion: 1– Le niveau de fiabilité des APT est meilleur avant deux ans. 2– Au cours des formes retardées de l’APLV, Diallertest® possède un meilleur niveau de fiabilité que les autres tests quelque soit la symptomatologie et la tranche d’âge et peut s’avérer efficace en pratique pédiatrique quotidienne. [Copyright &y& Elsevier]

The role of Helicobater pylori (H. pylori) remains unclear in children with non ulcer dyspepsia (NUD). The purpose of this study was to characterize the symptoms in non-ulcer dyspeptic H. pylori-infected children in order to make decision for endoscopy. Patients & methods: A prospective, bi-centric, double blind study was carded out between March 2001 and April 2002, in children ≥ 6 yr-old with NUD addressed for upper GI endoscopy for epigastric pain. A standardized questionnaire was administered blindly by a pediatric gastroenterologist to all subjects, describing the characteristics of epigastric pain: nature, intensity (EVA score), frequency, diurnal or nocturnal awakening, epigastric tenderness, meals relationship, relief of pain by food, post-prandial fullness, discomfort, early satiety, nausea, vomiting, anorexia, halitosis, weight lost, haematemesis, drugs taken, school absence, and positive family history of peptic ulcer disease. Ethnic background, mothers' education and fathers' socio-economic levels were also noted. The infection was proved with positive culture and histological examination of gastric mucosa. Results: 94 children were enrolled, 22 infected (11.4 ± 2.6 yr-old, 11 females), and 72 non infected (10.4 ± 3.1 yr-old, 43 females), ns. There was no difference in regards to symtom characteristics comparing infected to non infected children except for torsion-like epigastric pain that was more frequently found in infected ones [6 (27.2%) vs 6 (8.3%), p = 0.01]. Non infected children exhibited more frequently epigastric pain during meals and early satiety [17 (23.6%) vs 1 (4.5%), p = 0.04]. As already known, H. pylori infection was more frequent in non Caucasian children [12 (54.5%) vs 9 (12.5%), p = 0.0003] and Iow education and socio-economic levels outcome [22 (100%) and 15 (68%) vs 60 (83.3%) and 32 (44.4%), respectively p ≤ 0.05]. Conclusion: This study did not revealed specific characteristics of symptoms in... [ABSTRACT FROM AUTHOR]

Examines the use of spiramycin as an alternative to amoxicillin treatment associated with lansoprazole/metronidazole for Helicobacter pylori infection in children. Details of the increasing resistance rate to metronidazole; Information on spiramycin; Description of a study carried out in children with Helicobacter pylori gastric infection.

But: Évaluer l’incidence et analyser les facteurs de risques des ulcères et des érosions gastroduodénales chez l’enfant. Patients & Méthodes: Étude prospective réalisée simultanément pendant 1 mois dans 20 centres de 14 pays Européens. Les indications, la présence des ulcères et des érosions gastroduodénales avec leurs facteurs de risques ont été rapportés chez tous les enfants bénéficiant d’une endoscopie digestive haute. Résultats: Parmi les 1443 enfants inclus 638 filles, âge médian 8,1 ans, 1 mois – 18 ans, des ulcères ou des érosions ont été observés chez 153 enfants 10,6 % variant de 0–22 % dans les différents centres. Les indications principales ont été ; douleurs épigastriques et abdominales 24 % ou suspicion de reflux gastro-œsophagien 15 %. Les enfants ayant des ulcères ou des érosions sont significativement plus âgés que ceux sans lésions (10,5+5,4 vs 7,9+5,7 ans, p 0.002). La distribution est identique dans les deux groupes pour : sexe, manifestations cliniques, infection à H. pylori, histoire familiale d’ulcère, pays d’origine de l’enfant ou de sa mère, niveau d’éducation du père ou de la mère, prise médicamenteuse, alcool et drogues. Cependant, l’infection à H. pylori, a été fréquemment rencontrée chez les enfants institutionnalisés par rapport à ceux non institutionnalisés : 98,9 % vs 25,4 %, p<0,001. Conclusion: L’incidence des ulcères ou des érosions gastroduodénales dans cette large étude Européenne pilote a été retrouvée chez 10,6 % des enfants, survenant principalement dans la deuxième décade de la vie. Une prévalence élevé d’infection à H. pylori a été retrouvée chez les enfants institutionnalisés contrasté avec une incidence élevé des ulcères/ érosions H. pylori-négatives chez les enfants non institutionnalisés. Il n’a pas été trouvé de corrélation significative entre les ulcère/érosions et les différents facteurs de risques étudiés. [Copyright &y& Elsevier]

The purpose of our study was to evaluate the prevalence of primary amoxicillin, metronidazole and clarithromycin resistant Helicobacter pylori (H. pylori) strains in adults and children and to assess their evolution with time. Patients & methods: a prospective study was carried out between 1996 and 2001 in 220 H. pylori-positive children (116 girls and 104 boys, aged 11.25 ± 3.9 year) and 120 H. pylori-positive adults (64 females and 56 males, aged 47.5 ± 11.2 year). The infection was proved in the course of diagnosis evaluation of clinical gastritis by upper gastrointestinal endoscopy with positive culture and histological examination of gastric mucosa. The strains were considered amoxicillin-, metronidazole- and clarithromycin-resistant with MICs above 0.5 mg/l, 8 mg/l and 1 mg/l, respectively. Results: strains were sensitive to amoxicillin in all children samples and in all adults' except one (MICs 1 mg/l). For metronidazole and clarithromycin, resistance was significantly lower in children than in adults, respectively 38.2% vs 70%, OR 3.78, 95%IC 2.34-6.11, p0.0001, and 22.7% vs 38.2%, OR 2.11, 95%IC 1.30-3.46, p0.002. Both metronidazoleand clarithromycin-resistant H. pylori strains were seen in 15 children (6.8%) and 34 adults (28.3%), OR 5.40, 95%IC 2.83-10.38, p0.00008. Both metronidazole and clarithromycin-sensitive H. pylori strains occurred in 120 children (54.5%) and 22 adults (18.3%), OR 5.35, 95% IC 3.16-9.12, p0.0001. Overall resistance against metronidazole declined variably according to years in children, 15-53%, with a significant decrease after 1999, p < 0.01, while remaining stable in adults, 64-80%. Resistance to clarithromycin did not change significantly during the same period, 14-32% in children vs 13-48% in adults. Conclusion: this study confirms the generalized high primary metronidazole and clarithromycin resistance in H. pylori strains obtained in adults as compared to children and highlights the need to determine... [ABSTRACT FROM AUTHOR]

Summary: We describe the case of a 4-year-old child with Mediterranean fever characterized by cutaneous features. Familial Mediterranean fever is an autosomal recessive disorder characterized by recurrent attacks of fever and polyserositis including peritonitis, pleuritis, and arthritis. Skin involvement is less common. In our case, the successively patient presented erysipelas-like erythema, edemas of the palmar and plantar regions, and purpuric lesions. From these clinical observations, several diagnoses were raised: infectious erysipelas, Kawasaki disease, Henoch-Schönlein purpura, and familial Mediterranean fever. Only the latter diagnosis was confirmed after exploration and then confirmed with genetic analysis, which found a M694V homozygous mutation. Erysipelas-like erythema is the most frequent cutaneous sign reported in the literature and the only one to be associated with the M694V homozygous mutation. The originality of this case is the dominancy and polymorphism of the skin lesions. [ABSTRACT FROM AUTHOR]

Summary: Aim: This study investigated the health of gypsy children, aged 0–6 years. We focused on pregnancy, birth, medical care, growth, and vaccinations. Patients and methods: This study was conducted between May and December 2004, comparing a gypsy population group (GP) to a sedentary control group with a relatively low socioeconomic level. Both groups were covered by the CMU (French universal health coverage). This study was based on an oral investigation and each child''s health records. Results: The population consisted of 241 children: 120 GP children and 121 CMU children. In the GP children, pregnancy care was lacking, whereas the CMU group received consistent care at regional university hospital centers. For both populations, 85% of births occurred after a mean 38 weeks and 5 days of amenorrhea by ordinary delivery. GP infants were more often transferred to neonatology centers. They were born and were shorter and weighed less than the CMU infants until 6 years of age. They were breast fed more often. They were hospitalized more often, usually for ORL and gastrointestinal infections. Siblings were more numerous. GP child medical care was deemed satisfactory in 40% of cases vs. 70% for CMU children. The vaccinations status was insufficient, particularly in the GP children. Conclusion: Follow-up of GP should be improved. [Copyright &y& Elsevier]

A systematic analysis of weekly nasal and rectal swabs was carried out in a neonatal unit in order to detect colonization with multiresistant bacteria (MRB).Patients and methods. – During a 6-month period, rectal and nasal samples were taken in 187 consecutively hospitalized newborns, the day of the admission (day 0) and every week until discharge, in order to detect MRB, mainly methicillin-resistant coagulase negative staphylococci (MRCoNS), Staphylococcus aureus and multi-resistant Gram-negative bacilli.Results. – Among 187 infants, 50 were already colonized at entrance and excluded from the study. In others, 49 (35%) were colonized by at least one MRB, with a total of 71 strains isolated. The most frequent was MRCoNS, especially Staphylococcus epidermidis (66.1%). Gram-negative bacilli accounted for 9.8%. Colonization began earlier with MRCoNS than with Gram-negative bacilli, 7.8 ± 6 vs. 15.5 ± 16 days, P = 0.004, and finished earlier 22.7 ± 15 vs. 38.5 ± 16 days, P = 0.03. Colonized children exhibited by univariate analysis a lower birth weight, more frequent parenteral nutrition or previous hospitalization in a neonatal unit and a younger age at admission. Odds ratio for colonization were 4.06 for prematurity and 43.83 for a previous hospitalization. MRCoNS at days 15 (P < 0.05) and 22 (P < 0.05) were correlated with the empiric use of antibiotics. No nosocomial infection occurred during the study.Conclusion. – A high rate of newborns were colonized with MRB in our unit, especially MRCoNS, acquired earlier than Gram-negative bacilli, with a favoring action of empiric antibiotherapy. [Copyright &y& Elsevier]

Background: Calprotectin, a major component of soluble cytosolic proteins in human neutrophil granulocytes, is excreted in excess in stools during inflammatory bowel disease in adults and children. Faecal calprotectin concentrations are also higher during the first year of life than in adults. Objectives: To measure faecal calprotectin concentrations in the neonatal period and define reference values according to the mode of feeding: standard infant formula, prebiotic infant formula (Calisma, Blédina SA, France), or breast feeding. Patients and methods: A prospective study was carried out over three months in 69 full term, healthy newborns with a median gestational age of 39.8 weeks (range 37-41.5) and a birth weight of 3300 g (range 2600-4460). Three groups were formed depending on the mode of feeding: group 1 (n = 18) received a standard infant formula, group 2 (n = 19) the prebiotic infant formula, and group 3 (n = 32) was breast fed. One stool sample was taken from each newborn on day 4 (3-7), and faecal calprotectin analysed using a commercial enzyme linked immunoassay (Calprest, Eurospital, Italy). Results: Faecal calprotectin concentrations (median 167 μg/g) were higher than reference values in healthy adults. The concentration was below the upper reference limit for adults (50 μg/g) for three infants only, one fed the standard formula and two fed the prebiotic formula. Concentrations did not differ significantly according to method of feeding. Conclusions: Compared with healthy adults, newborns have high calprotectin concentrations in the first days of life. There is no obvious influence of the mode of feeding. [ABSTRACT FROM AUTHOR]

Buts du travail: Les biopsies par aspiration de la muqueuse rectale, effectuées en consultation externe, permettent de mettre en évidence une anomalie d’innervation de la paroi rectale attestant par exemple une maladie de Hirschsprung. La pince à biopsie rectale dite « de Noblett », par aspiration de la muqueuse, mise au point il y a une quarantaine d’année est de moins en moins utilisée. La pince de Scheye permet en outre un changement de la partie distale pour chaque patient, en respect des normes actuelles de sécurité et d’efficacité (mors neuf à chaque utilisation). Les profondeurs de coupe de biopsies rectales prélevées par aspiration muqueuse avec les pince de Noblett et de Scheye sont comparées dans ce travail. Méthodes employées: Cette étude de comparaison rétrospective a été menée d’une part chez 13 filles et 20 garçons âgés de 13 + 30 mois explorés pour suspicion de maladie de Hirschsprung entre 2001-2004 avec la sonde de Noblett et, d’autre part, chez 19 filles et 21 garçons âgés de 8 + 19 mois explorés pour les mêmes motifs et ayant bénéficié entre 2005-2007 d’une biopsie rectale avec la sonde de Scheye (poignée réutilisable, gaine et mors jetables, Medtronic®). Toutes les biopsies, obtenues de façon rétrospective, ont été revues en aveugle par un anatomopathologiste. L’épaisseur totale de la biopsie et l’épaisseur de la sous muqueuse ont été comparées. Résultats: L’épaisseur totale de la biopsie rectale prélevée avec la sonde de Scheye est significativement supérieure à celle prélevée avec la sonde de Noblett (1,74mm + 0,46 versus 0,67mm + 0,2, p < 0,0001). L’épaisseur de la sous muqueuse est aussi significativement plus élevée dans le groupe des biopsies prélevées par la pince de Scheye (1,12mm + 0,4 versus 0,14 + 0,17, p < 0,0001). Il n’y a eu aucune complication clinique après biopsie dans les 2 groupes. Le montage et l’utilisation de la pince de Scheye est simple par rapport à celui de la pince de Noblett. Conclusion: L’épaisseur totale des biopsies rectales par aspiration muqueuse à l’aide de la pince de Scheye est significativement supérieure à celle obtenue avec la pince de Noblett. Un travail ultérieur permettra de comparer les deux techniques pour la fiabilité de mise en évidence des structures nerveuses. [Copyright &y& Elsevier]

We report on six cases of Pasteurella multocida ( P. multocida) meningitis occurring between 2001 and 2011 by a French nationwide active surveillance network of paediatric bacterial meningitis (ACTIV/GPIP). The cases accounted for 0.15 % of the paediatric meningitis cases reported between 2001 and 2011 in France, all in infants <4 months old. A review of the literature allowed us to gather information on 42 other cases of P. multocida meningitis in infants <1 year old reported since 1963. Among all 48 cases, 44 % were newborns. An animal source of the infection, including 39 household dogs and cats, was suspected or identified in 42 of 48 cases. A traumatic contact between the child and a pet occurred in 8 % of cases, and a vertical transmission from mother to child during birth in 10.4 %. Most of the time, the infection resulted from non-traumatic contact between the child and the pet, through licking or sniffing. The absence of host risk factors suggests that an immature immune system is responsible, given the young age of the children. Although complications, especially neurological lesions, were not rare (37.5 %), the long-term outcome was usually good. Four infants died of meningitis. This rare disease could be prevented by reducing contact between infants and household pets, and by performing simple hygiene measures before handling babies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the vaccine coverage of Prevenar®, follow its evolution since its universal recommendation from 2006 and search the influence of certain socio-economic factors. Method: A prospective descriptive study by a questionnaire enrolled the first 250 children born after 2001 and aged more than 2 months admitted at our hospital emergency room with their health record. Results: 77.11 % of children from any age merged received the first dose of Prevenar®; 89.51 % of those less than 24 months versus 60.38 % of those more than 24 months, p <0.0001. The follow-up by a paediatrician and the high mother educational level influenced positively the vaccination by Prevenar®. Conclusion: Prevenar® vaccine coverage evolved well since its universal recommendation achieving a 89.51 % rate for the first dose. The chase of a brought closer follow-up seems important to assess the impact of this new vaccine strategy. [ABSTRACT FROM AUTHOR]

Aim: To prospectively assess the antibacterial resistance rate in Helicobacter pylori strains obtained from symptomatic children in Europe. Methods: During a 4-year period, 17 paediatric centres from 14 European countries reported prospectively on patients infected with H pylori, for whom antibiotic susceptibility was tested. Results: A total of 1233 patients were reported from Northern (3%), Western (70%), Eastern (9%) and Southern Europe (18%); 41% originated from outside Europe as indicated by mother's birth-country; 13% were <6 years of age, 43% 6-11 years of age and 44% >11 years of age. Testing was carried out before the first treatment (group A, n = 1037), and after treatment failure (group B, n = 196). Overall resistance to clarithromycin was detected in 24% (mean, A: 20%, B: 42%). The primary clarithromycin resistance rate was higher in boys (odds ratio (OR) 1.58; 1.12 to 2.24, p = 0.01), in children <6 years compared with >12 years (OR 1.82, 1.10 to 3.03, p = 0.020) and in patients living in Southern Europe compared with those living in Northern Europe (OR 2.25; 1.52 to 3.30, p<0.001). Overall resistance rate to metronidazole was 25% (A: 23%, B: 35%) and higher in children born outside Europe (A: adjusted. OR 2.42, 95% CI: 1.61 to 3.66, p<0.001). Resistance to both antibiotics occurred in 6.9% (A: 5.3%, B: 15.3%). Resistance to amoxicillin was exceptional (0.6%). Children with peptic ulcer disease (80/1180, 6.8%) were older than patients without ulcer (p=0.001). Conclusion: The primary resistance rate of H pylori strains obtained from unselected children in Europe is high. The use of antibiotics for other indications seems to be the major risk factor for development of primary resistance. [ABSTRACT FROM AUTHOR]

Objectif: l’Inlet Patch (IP) est une hétérotopie de muqueuse gastrique située dans la partie proximale de l’œsophage. Le but de cette étude était d’évaluer les caractéristiques cliniques de l’IP en pédiatrie et son évolution. Patients: Cette étude rétrospective, multi-centrique incluait les observations d’IP recensées dans 7 centres francophones de gastroentérologie pédiatriques. Les données cliniques, thérapeutiques et évolutives étaient recueillies. Résultats: 15 enfants (8 garçons, 7 filles) étaient inclus. L’âge médian au diagnostic était de 9,5 ans (3,3 à 15 ans). Cinq enfants avaient des antécédents d’atrésie de l’œsophage et 9 un reflux gastro-oesophagien. Un patient était asymptomatique. Des symptômes digestifs étaient notés chez 14 enfants (dysphagie, blocages), des signes respiratoires et/ou oto-rhino-laryngés chez 6 d’entre eux. Un inhibiteur de la pompe à protons était prescrit chez 14 enfants pour une durée moyenne de 4,7 mois (1 à 12 mois). Une amélioration était notée chez 8 patients. Conclusion: l’IP semble rare mais probablement sous diagnostiqué en pédiatrie. Il pourrait être responsable d’une symptomatologie digestive et respiratoire. Des études longitudinales sont nécessaires afin de préciser son implication clinique et son devenir à long terme. [ABSTRACT FROM AUTHOR]

But de l’étude: L’entéropathie et l’entérocolite ulcéro-nécrosante (ECUN) sont les manifestations digestives les plus fréquentes du nouveau-né prématuré. Le diagnostic est basé sur les données cliniques et radiologiques. La calprotectine fécale est un marqueur reconnu de l’inflammation digestive chez l’adulte et chez l’enfant. Le but de ce travail a été d’évaluer la calprotectine fécale comme marqueur de souffrance digestive chez le prématuré. Méthodes: Il s’agit d’une étude multicentrique et rétrospective incluant 99 prématurés (59 garçons, 40 filles) d’âge gestationnel médian de 33 SA (limites 27-35 SA) avec un poids de naissance de 1780 g (750-2 750 g). La calprotectine fécale a été dosée chaque semaine, de la 1re semaine de vie à la fin du 1er mois, et à chaque événement digestif. Les échantillons ont été immédiatement congelés à –80 °C et analysés par ELISA (Calprest®, Eurospital, Italie). Résultats: Soixante dix nouveau-nés (191 échantillons) n’ayant jamais développé de pathologie digestive ont été considérés comme témoins. Des manifestations intestinales sont apparues chez 29 nouveau-nés (29 %) : entéropathie (distension abdominale, rectorragie ou tout autre symptômes digestifs entraînant un arrêt alimentaire) chez 22 (42 échantillons) et ECUN chez 7 (18 échantillons). Chez les témoins, le taux median de calprotectine est de 223 μg/g (21-827 μg/g). En cas d’entéropathie ou d’ECUN, les taux de calprotectine fécale sont respectivement de 383 μg/g (91-925 μg/g) et 832 μg/g (209-4 443 μg/g). Les courbes ROC montrent des taux seuils de calprotectine de 379 μg/g (sensibilité 0,62, spécificite 0,81) pour la probabilité d’entéropathie et de 636 μg/g (sensibilité 0,72, spécifi cité 0,91) pour la probabilité d’ECUN. Discussion, Conclusion: Malgré une grande variabilité inter-individuelle chez le prématuré, la calprotectine fécale peut être utilisée comme marqueur non invasif de souffrance digestive durant le 1er mois de vie avec un taux corrélé à l’activité de la maladie intestinale. Des études sur un plus grand nombre d’enfant sont nécessaires pour confirmer ces taux seuils, et tenter de determiner des taux prédictifs de l’apparition de manifestations digestives. [Copyright &y& Elsevier]