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Background: Little is known about the use of mid-upper arm circumference for age (MUACZ) for diagnosing of severe acute malnutrition (SAM) and its correlation with WHZ (weight-for-height Z-score) in an area endemic for severe acute malnutrition (SAM) and with a high prevalence of kwashiorkor. Our study aims to analyze the concordance between the diagnostic criteria of SAM in a region presenting these characteristics., Methods: We analyzed a database of children admitted from 1987 to 2008 for the management of SAM in Eastern Democratic Republic of Congo. Anthropometric indicators (z-score) were calculated and classified into 3 categories according to WHO standards. Cohen's kappa coefficient (κ) was calculated to assess the concordance between these indicators., Results: Out of the 9969 selected children aged 6 to 59 months, 30.2% had nutritional edema, 70.1% had a height-for-age (HAZ) z-score <-2, 11.5% WHZ<-3 z-score, 14.9% had a MUAC < 115 mm and 21.8% had a MUACZ <-3 z-score. With the classic combination WHZ and MUAC, 36% of children with SAM had both criteria at the same time and MUAC alone being the indicator that recruited more children with SAM (77%) compared with 65% with WHZ only. By replacing MUAC with MUACZ, 34% of SAM children fulfilled both criteria, WHZ and MUACZ. MUACZ alone recruited more children with SAM (88%) compared with 46% with WHZ alone. Considering these three indicators together, MUACZ remained the indicator that recruited more children with SAM (85%). WHZ and MUAC showed a moderate agreement [ κ (95% CI) = 0.408(0.392-0.424)], WHZ and MUACZ a weak agreement [ κ (95% CI) = 0.363(0.347-0.379)] and MUAC and MUACZ a good agreement [ κ (95% CI) = 0.604 (0.590-0.618)]., Conclusion: Adjusting MUAC according to age improves its effectiveness in identifying severe acute malnutrition. With low concordance, MUAC and WHZ remain complementary in our context. MUACZ proves to be crucial, especially in the presence of kwashiorkor and chronic malnutrition, becoming a valuable tool for assessing severe acute malnutrition in our context., (© 2024. The Author(s).)

Background: Few studies have assessed the relationship between weight-for-height (WHZ) and mid-upper arm circumference (MUAC) with hospital mortality considering confounders. The particularity of MUAC for age (MUACZ) is less documented., Objective: This study aims to investigate this relationship in a region endemic for severe acute malnutrition (SAM)., Methods: This is a retrospective cohort based on a database of children admitted from 1987 to 2008 in South Kivu, eastern DRC. Our outcome was hospital mortality. To estimate the strength of the association between mortality and nutritional indices, the relative risk (RR) with its 95% confidence interval (95% CI) was calculated. In addition to univariate analyses, we constructed multivariate models from binomial regression., Results: A total of 9,969 children aged 6 to 59 months were selected with a median age of 23 months. 40.9% had SAM (according to the criteria WHZ < -3 and/or MUAC<115 mm and/or the presence of nutritional edema) including 30.2% with nutritional edema and 35.2% had both SAM and chronic malnutrition. The overall hospital mortality was 8.0% and was higher at the beginning of data collection (17.9% in 1987). In univariate analyses, children with a WHZ < -3 had a risk almost 3 times higher of dying than children without SAM. WHZ was more associated with in-hospital mortality than MUAC or MUACZ. Multivariate models confirmed the univariate results. The risk of death was also increased by the presence of edema., Conclusion: In our study, WHZ was the indicator more associated with hospital death compared with MUAC or MUACZ. As such, we recommend that all criteria shall continue to be used for admission to therapeutic SAM programs. Efforts should be encouraged to find simple tools allowing the community to accurately measure WHZ and MUACZ., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ngaboyeka, Bisimwa, Neven, Mwene-Batu, Kambale, Kingwayi, Chiribagula, Battisti, Dramaix and Donnen.)

Lymphoproliferative diseases arise when the physiological mechanisms that control the proliferation of T and B lymphocytes are disrupted, resulting in an uncontrolled and autonomous increase in immune cells leading to lymphocytosis and lymphadenopathy, and often to the involvement of extranodal sites. The differential diagnosis of malignant T cell tumors involves other neoplasms and non-clonal T cell proliferations. Immunological markers are essential, as a first step, to distinguish between T-cell and non-T-cell disorders. It must be established based on the configuration of the genes of the TCR chain to rule out that the picture is not reactive to other underlying diseases. This clinical review and accompanying case reports highlight the diagnostic challenges associated with indolent lymphoproliferative T-cell disorders, which in many cases may represent the clinical manifestation of a single disease. Particularly we focus on gastrointestinal manifestations that could be expression either of lymphoproliferative disorder either of autoimmune disease either of both. The correct interpretation of the different clinical situations can help in the diagnostic and therapeutic process., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Low birth weight (LBW) is one of the leading causes of perinatal and infant morbidity and mortality, as well as of impaired growth and neurocognitive development. This study aimed to evaluate the evolution of anthropometric parameters and the nutritional status of LBW infants and to analyze factors influencing the growth failure during their first 6 months of life (or adjusted age)., Methods: This was a prospective cohort study for 6 months, including 100 infants born with LBW and 100 infants born at full-term and with normal weight. The z-scores weight for age, height for age, head circumference for age and weight for height were computed with the software Epinut and WHO Anthro 2005. Descriptive statistics, bivariate analysis and multivariable logistic regression analyses were employed to identify factors associated with growth failure. Growth failure was defined as a decrease in weight z-score (standard deviation score) of over 0.67 during one of the study's periods. The statistical significance threshold was fixed at 0.05., Findings: At 6 months of life (or adjusted age), 15.3% of LBW were underweight, 51.4% were stunted, 4.2% had an emaciation and 25% had a head circumference for age<-2 z-scores. Risk factor for growth failure was male sex (OR=1.56 [95% CI: 1.03-2.23]). The symmetrical intra-uterine growth retardation was a protector factor for growth failure (OR=0.49 [95% CI: 0.25-0.98])., Conclusion: In the short term, LBW infants may have growth disorders. It is necessary to emphasize the importance of growth assessment of LBW children and proper education of their mothers about nutrition of their children for early and timely diagnosis and management of growth retardation and prevention of subsequent problems., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Timely initiation of breastfeeding can decrease neonatal mortality. However, about 50% of newborns are not breastfeed within 1 h of birth in the Democratic Republic of Congo. The aim of this study was to identify factors associated with delayed initiation of breastfeeding in an urban and rural area of Bukavu, South Kivu province, Democratic Republic of Congo., Methods: We interviewed 396 mother-newborn pairs (185 in the urban area and 211 in the rural area) between 20 July and 10 October 2016. We used descriptive statistics to demonstrate the prevalence of early initiation of breastfeeding. Variables that showed association with delayed initiation of breastfeeding in the bivariate models were entered in a multivariable logistic model., Results: Overall, the rate of early initiation of breastfeeding was 65.9% (69.7% in the rural area, 61.6% in the rural area). Two hundred and seventy-four (62.9%) mothers (159 in rural area and 115 in urban area) were counselled on early initiation of breastfeeding during prenatal care. Most mothers, 65.2% received counselling by a health professional. On multivariable regression analyses after adjusting for other variables in the model, unmarried mothers [Odds Ratio (OR): 1.5 (95% Confidence Interval (CI): 1.13, 1.95)], cesarean delivery [OR: 2.24 (95% CI: 1.74, 2.88)], no counselling on timely initiation of breastfeeding [OR: 1.71 (95% CI: 1.29, 2.20)] and counselling by a non-health professional [OR: 1.84 (95% CI: 1.08, 3.12)] were associated with delayed initiation of breastfeeding., Conclusion: Systemic changes are needed for women having caesarean births to experience skin-to-skin and early initiation. In addition, information, education and communication on the importance of timely initiation of breastfeeding must be supported to improve maternal and infant wellbeing., Competing Interests: Informed verbal consent was secured from study participants in their own language explaining the purpose of the study and benefits of partaking in the study and the right to leave the study any time. The participants were also assured about the confidentiality of the data. Ethical approval was granted by the Ethical Committee of the Catholic University of Bukavu, DRC.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The ALTE (Apparent Life Threatening Event) of the infant is a frequent presenting complaint. The clinical presentation is varied, ranging from an innocuous event (as a change in skin color) to something as tragic as a sudden infant death. In all circumstances, it is always a very worrying event for the parents and the family circle. Many etiologies can explain the ALTE, and their investigation can be complicated. In this paper, the etiologies and diagnostic tests will be briefly introduced, with a reminder of the sudden infant death syndrome.

Asthma is the most common chronic respiratory disease in childhood. An acute crisis can occur during an episode of exacerbation or may be the onset of the disease in a non-asthmatic child. Acute asthma is most often manifested by signs of respiratory distress that will lead the child to the doctor. Regardless of the context, the crisis has to be quickly and efficiently handled. The assessment of the crisis severity, immediate care, treatment and monitoring will be discussed in this article.

Nosocomial infections (NI) remain a major problem of public health, giving rise to a serious morbi-mortality and significant costs. They represent a consequence of the medical progress and of the misuse of broad-spectrum antibiotics. Obviously, premature newborn of low birth weight present an increased risk of NI related to their degree of immaturity, as well as the invasive procedures use, and long-lasting hospitalizations.. Epidemiological data concerning NI in neonatology remain imprecise due to diagnostic difficulties. Responsible germs are related to the territory and its local ecology. Bacterial NI are the most frequent even if viral and Candida NI are widely underestimated and gradually gain ground.The medical and economic consequences of these infections justify prevention measures such as prematurity prevention and management of pregnancy taking into account the NI risk. Finally, simple measures such as a strict hygiene in newborn care and the limitation of invasive procedures in terms of frequency and duration have to be a priority.

Septic arthritis is not a frequent, but quite classical pathology in children. It can be followed by a severe outcome in case of delayed and/or inadequate treatment. The drainage of the infected joint associated with a prompt and adapted antibiotherapy are together the cornerstones of this treatment. The isolation and identification of the causative microorganism is also of the highest importance. Up to now, unfortunately, a large proportion of septic arthritis are treated by antibiotics although all culture remain negative. This paper has two objectives: one is to present the different steps to optimize the assessment and diagnosis; the second, to increase the sensitivity of the pathogen identification. At last, we present our proposal for empirical antibiotherapy.

About nine children out of ten present at least one episode of otitis media with effusion (OME) before school age and near a third suffer from persistent or repetitive OME, which involves a higher risk of speech difficulties and of reduced learning abilities. The care of children with repeated or persistent OME remains a debated topic. The assessment of the risk of speech difficulties should go beyond the quantification of the hearing deficit. It should also take into account the context in which the disorder has developped and detect any comorbidity from which the child might suffer. Based on these various considerations, it will be necessary to assess the value of an immediate surgical treatment as opposed to the risks of a prolonged observation period.

Sleeping disorders are frequently encountered in infants and adolescents. They often induce a distress in the family, an individual sadness possibly leaving at time to maltreatment. In the normal infant or the medically fragile infant due to prematurity or an acute episode, complaints from the patient or family sources force the medical team to find an explanation or a treatment, which are not always adequate. In other conditions such as asthma, obesity, anorexia nervosa, autism, cerebral palsy, hyperactivity, the sleeping disorders may be so unnoticed or remain insufficiently investigated. Globally, in this domain, the clinical description is often imprecise and sleep studies underused. A more accurate assessment should lead to a better educative approach and more appropriate therapy.

Asthma is a chronic disease the control of which often requires a day-to-day treatment. The compliance in childhood asthma is estimated at 50%. It is therefore mandatory to resort to strategies for good compliance. Starting from a literature review and the concept of Guided Self-Management defined in the GINA 2009 report, our pneumo-paediatric unit offers a local, useful and efficient strategy based on close collaboration with the family doctor, an Internet asthma school or DVD and the edition of a clear asthma treatment plan, which can easily be filled in by the physicians.

The discovery of a cervical mass in a child suggests several possible diagnoses ranging from benign conditions to more severe pathologies, even cancer. Parents often worry and consult a physician when such a mass fails to regress after a few weeks. Palpation of small and solid lymph nodes is commonplace and generally trivial in children. A detailed clinical history and a careful examination often allow a distinction to be made between a benign and a serious condition. Additional tests are needed in case of doubt or in the prospect of reaching an precise aetiological diagnosis. These exams should be selected according to a decision algorithm. The investigation remains delicate. When the physician is convinced of the benign nature of the lymphadenopathy, there is no real need to identify the aetiology with the greatest precision, especially in acute cases with bilateral nodes that are commonly benign and spontaneously resolve.

Palivizumab (Synagis) is a monoclonal antibody directed against the respiratory syncytial virus (RSV), for reducing mortality and morbidity in infants at risk of cardio-respiratory impairement due to bronchiolitis: 1. prematurity less than 28 weeks and less than 1 year of age; 2. between 28 and 32 weeks plus mechanical ventilation and less than 6 months of age; 3. chronic lung deficiency and less than 2 years of age; 4. congenital cardiopathy with either desaturation, pulmonary hypertension or cardiac failure. Another group of infants is those having a severe imnnunodeficiency. These infants are listed in a hospital recognized to have a competence in neonatal intensive care or a cardio-thoracic care program. The specialist in those disciplines prescribe the palivizumab which is delivered by the pharmacy of the competent hospital. The infant receives it by IM route at a dose of 15 mg/kg, monthly between October or November and February or March. Reduction of mortality and morbidity have been observed in the infants at risk. However, this costly pharmacological preventive approach needs to come after other simple preventive measures such as avoiding contact with potential carriers of nasal viruses and passive smoking, for bronchiolitis is not solely due to RSV.

Background: The bactericidal efficacy of aminoglycosides is directly related to peak serum concentration (Cmax), particularly the first one. Transitory high concentrations of aminoglycosides do not result in such a high drug uptake by renal and cochlear tissues because of the saturation of cell binding sites. These observations have led to the concept that less frequent administration of relatively larger doses of aminoglycosides would be of interest in treating infectious diseases., Objective: Prospective evaluation of a dosing chart of amikacin (Ak) in high-risk neonates suspected of infection within the first 2 days of life. This dosing chart was based on a previous pharmacokinetic population study published elsewhere, treated accordingly to the new once-daily concept of aminoglycoside administration., Study Design: One hundred and seventy-seven neonates (69 females and 108 males; mean gestational age (GA +/-SD: 33.6 +/- 4.1 weeks (W) received Ak regimen dosage according to the following dosing chart: Group (Gr) 1a GA <28 W: 20 mg/kg/42 h; Gr 1b GA 28 /= 37 W: 15.5 mg/kg/24 h. In case of asphyxia, hypoxic episode and intercourse treatment with indomethacin, the interval was systemically increased by 6 h whatever the GA groups. The mean duration time of Ak treatment (+/- 1 SD) was 5.00 +/- 2.01 days (range 2-13). Ak serum concentrations 1 h after completion of 30 min infusion (C1h), and successive Ak serum concentrations just before next administration depending on the difference of interval between each group (so defined minimum serum concentration (Cmin)), were determined in each neonate. Creatininemia during the fist postnatal weeks was used as an index of glomerular filtration rate; brainstem auditory evoked potentials (BEAPs) were used in 139 babies when reaching a postconceptional age of >/= 36 weeks to assess possible ototoxicity, and were compared to values from a group of term and a group of preterm babies, previously defined as our reference control groups., Results: At day 1 of treatment, there was no correlation between the Ak C1hS and the GA at birth (mean 27.8 +/- 5.21 microgram/ml (+/- 1 SD); median 28; r = -0.003; range 10-40). In the same way, there was no correlation between the first Ak CminS and the GA at birth (mean 3.7 +/- 2.0 microgram/ml (+/- 1 SD); median 3.0; r = -0.33; range 0-10). The lack of correlation between these first observed C1hS and CminS and the GA at birth suggests the validity of our previous established dose regimen recommendations. Analyzing the data between groups, the mean value +/- 1 SD of Ak C1hS at day 1 of treatment was not significantly different (p > 0.05). Concerning the first Ak CminS, a significant difference (p < 0.01) was only observed when comparing groups 1a, 1b and 2 to group 4. However, this significant difference disappeared when comparing the successive next Ak CminS between groups while each interval remained the same, suggesting a positive postnatal maturation of the renal clearance. In the same way, creatininemia showed a significant and normal decrease (p < 0.01) in each group during the first postnatal weeks. Threshold values of BEAPs at 30 dB showed no significant difference (p > 0.05) between the treated groups (preterm group and term group) and the corresponding control groups. While the primary aim of the study was not to test the bactericidal efficacy of this new regimen, the recovery was excellent in 37 babies with proven or highly suspected infectious disease, except in 1 of them who died from septic shock (group B Streptococcus). After 5 years of using this kind of Ak administration in the unit, minimal inhibitory concentration profiles tested in 43 successive bacterial strains collected from inborn patients remained adequate. (ABSTRACT TRUNCATED)

Increasing survival of very preterm and sick neonates has lead to more concern about development outcome. Risk factors include antenatal, perinatal and socioeconomic factors. Developmental assessment has to be repeated during infancy till late school age (at term 3, 6, 12, 18, 42 months corrected age ...). Neurological examination, sensorial assessment and cognitive evaluation with special attention to visuo-spatial factors are mandatory.