EMC - Pédiatrie最新文献

Amblyopia is the most frequent aetiology of unilateral poor vision in childhood. It is related to abnormal development during the first years of life. Some cases are secondary to a malformation of the globe, but most of the amblyopias are functional, related to a refractive error or strabismus. Early detection is essential to the success of the treatment. This treatment has to be undertaken before the age of seven, and the paediatrician is the first-line actor in the detection of amblyopia. As soon the first months of life, observation of a strabismus, a nystagmus, and some simple examination signs must lead to an ophthalmologic examination in order to exclude any organic disease and to begin a treatment. In older children, vision testing with optotypes is simple and efficient for the detection of amblyopia. Basic of treatment principales are the correction of any refractive trouble by spectacles, patching of the good eye and penalization methods.

Psychosis is a major concern for adolescent-specialized psychiatrists who face great difficulties in making diagnosis in case of acute or torpid symptomatology since at this age, such symptoms are not systematically correlated with a specific mental disorder. This symptomatology is relatively frequent as a polymorph expression of psychic suffering due to adolescence process. Adolescence is a period characterized by many deep internal and external changes, and it is also the preferential age period for the onset of most chronic mental disorders. At their beginning, most of these disorders have not yet the typical recognizable form they will have latter on, allowing at that time easier diagnosis. More than at other life periods, the clinician has to go beyond the descriptive symptomatology to find out the underlying psychopathological organisation that may be more informative on the observed disorder in terms of diagnosis and prognosis, with the awareness that schizophrenia begins frequently at this age. Similarly, we should not forget that this age corresponds also with the onset of mood disorders, often associated with psychotic positive symptoms that may lead to misdiagnosis. We should also distinguish, among pre-morbid symptoms, vulnerability factors or prodromal manifestations that induce important consequences in terms of therapeutic strategies.

Prenatal diagnosis of foetal infections has been greatly improved these last years since new molecular biology techniques became available, allowing to establish rapid and reliable diagnosis using polymerase chain reaction on amniotic fluid. In France, toxoplasmosis is the most frequently observed congenital parasitic infection. Any occurrence of maternal seroconversion (ascertained or very suspected) during pregnancy constitutes an indication for early clinical and biological check-up of the newborn. A chemo-prophylactic combination of chloroquine and proguanil (Savarine^®) should be recommended in a pregnant woman going to endemic areas, in order to prevent the risk of congenital malaria and its clinical consequences. The cytomegalovirus (CMV)- induced infection is the most frequent maternal-foetal infection. It constitutes the first cause of neuro-sensorial handicaps acquired during intrauterine life. CMV-induced primary infection in a pregnant woman is therefore a situation with major pathological risk for the foetus. The foetal contamination is principally due to hematogenous trans-placental transmission, inducing viral proliferation in the foetus. The B19 parvovirus is commonly considered responsible for the megalerythema, or fifth disease. Embryo-foetopathies associated to parvovirus infections are now better understood: the rate of maternal-foetal transmission and the risk of complications are better identified. Rubella which is a benignant infection occurring during early childhood was the first infectious disease identified as responsible for embryo-foetopathies. The Australian ophthalmologist MacAlister Gregg was the first to hypothesise, in 1941, a relationship between the onset of a per gravidic rubella and congenital cataract. The serological screening for rubella which is mandatory on early pregnancy allows to identify the initial serological status of the pregnant woman. Potential embryo-foetopathy should therefore be suspected in case any delayed intrauterine growth associated to a heart abnormality is observed in the foetus. Chickenpox is an uncommon disease in women during pregnancy. For the mother, complications are mainly of pulmonary type (in about 10% of the cases), and potentially life-threatening. Before 24-week amenorrhoea, the fœtal transmission (estimated to approximate 6%) may be responsible for a congenital varicella syndrome in about 2% of cases. Perinatal chickenpox due to peripartum transmission induces in about 25% of the cases a neonatal chickenpox potentially serious and sometimes fatal; this risk is essentially associated to an eruption in the mother, occurring during the period from 5 days before delivery to 2 days after. Bacterial infections remain the major concern for paediatric obstetricians since they always constitute a frequent risk for perinatal morbidity and mortality (3^rd cause of mortality). In all studies on maternal-foetal bacterial infections, the streptococcus B was