Archives De Pediatrie最新文献

Background: Foreign body aspiration (FBA) is a critical paediatric emergency that requires prompt recognition and management to avoid severe complications. Diagnosis is challenging due to variable clinical presentations, requiring a combination of history, physical examination, and imaging. Rigid bronchoscopy remains the gold standard for diagnosis and treatment but is associated with a significant proportion of negative procedures.

Methods: We conducted a retrospective, single-centre review of paediatric bronchoscopies for suspected FBA over 30 years at CHU UCL Namur, Godinne, Belgium. Clinical, radiological, and procedural data were analysed, including symptomatology, foreign body characteristics, and follow-up outcomes.

Results: Among 99 bronchoscopies performed for suspected FBA, a foreign body was confirmed in 58 cases (59%). The highest incidence occurred in children aged 1-3 years (69%). Penetration syndrome was a strong predictor (sensitivity: 90%, Odds ratio (OR): 26.9; 95% CI:8.9-81.2, negative predictive value (NPV): 0.84). Asymmetric auscultation was the most discriminative clinical sign of FBA (specificity: 98%, OR: 42.9; 95% CI: 5.5-332.9, positive predictive value (PPV): 0.97). Unilateral hyperinflation was the most specific radiological sign (specificity: 88%, OR: 16.0; 95% CI: 5.4-47.5, PPV: 0.89). Organic foreign bodies, mainly nuts (74%), were the most common. Rigid bronchoscopy was used in 36% of cases, flexible in 37%, and both in the remaining cases. Complications occurred in 48% per-procedurally and 35% post-procedurally, but no fatalities were reported. Complete clinical recovery was achieved at 6-month follow-up.

Conclusion: Diagnosis of FBA relies on clinical examination, detailed medical history, and radiological findings, with both rigid and flexible bronchoscopy remaining essential for diagnosis and management.

Background: The burden of antimicrobial resistance is a significant public health challenge, especially in young children, driven by antibiotic misuse.

Objective: This study aimed to assess the impact of repeated prospective clinical audits, with a systematic feedback design, on enhancing antibiotic prescribing practices among outpatients visiting the Pediatric Emergency Department of a teaching hospital located in the north-eastern region of France.

Methods and setting: We conducted a before-and-after study design over 13 months (2021-2023), performing clinical audits to assess antibiotic prescribing practices. The standards were based on guidelines from French scientific societies. We implemented a multimodal improvement plan, including regular meetings with prescribers. After each educational session, we reassessed antibiotic prescription patterns and provided rapid feedback to encourage timely adjustments.

Results: Outpatients accounted for 79% of emergency visits. Over 13 months, we retained 1477 prescriptions. The distribution of diseases remained consistent throughout periods. The overall guideline adherence rate was 75% during the preintervention period and remained stable throughout the study. In situations where antibiotics were recommended, this rate was 51.6% at baseline and 50% in the postintervention period. Nonetheless, adherence to treatment initiation guidelines increased significantly, from 88.9% to 96.6%. Furthermore, the proportion of appropriate antibiotic selections increased from 82.2% to 93.2% (p = 0.001). Additional analysis indicated a reduction in antibiotic consumption among pediatric outpatients during the study period.

Conclusion: These results show that implementing an antibiotic stewardship program in pediatric emergency departments can improve adherence to antibiotic guidelines. These findings support the need to expand antimicrobial stewardship programs in pediatric settings.

Background: The deficiency of interleukin-36 receptor antagonist (DITRA) is a monogenic autoinflammatory condition associated with generalized pustular psoriasis (GPP). Diagnostic criteria and treatment recommendations for DITRA are inadequate. The diagnosis is established by detecting a biallelic loss-of-function mutation in IL36RN, which leads to activation of the IL36 pathway.

Observation and discussion: We present a pediatric case of GPP with a novel IL36RN mutation that supports the diagnosis of DITRA. In patients with DITRA unresponsive to IL-1 targeted therapies, favorable results may be achieved with the administration of TNF-α inhibitors, particularly IL-36 pathway inhibitors. Twenty-nine papers, encompassing 55 pediatric cases, were synthesized to contextualize treatment responses.

Conclusion: Novel DITRA-associated mutations continue to be discovered. Given the rarity of the disease, it will be possible to reveal the genotype-phenotype relationship in the future with the publication of larger DITRA case series.

Bac kground: Total hip arthroplasty (THA) is a rare procedure in pediatric patients. Although it shows excellent results in adults, the presence of growth plates, the limited longevity of implants, and the hip-spine biomechanics involved during growth make the outcomes of THA in children uncertain.

Objective: We hypothesized that THA yields satisfactory results for children suffering from unmanageable pain due to hip joint osteoarthrosis.

Methods and settings: 27 patients aged <18 years who underwent THA for hip joint osteoarthritis at our hospital between 2015 and 2022 were retrospectively included. Primary outcomes included two clinical scales: the Postel Merle d'Aubigné (PMA) and Oxford scale. Secondary outcomes included chronic pain relief and complications.

Results: Mean age at surgery was 13.7± 1.7 years (min11, max 17). The mean follow-up was 5.4±2.4 years (min 3, max 10). Etiology of osteoarthrosis was slipped capital femoral epiphysis (n=13), idiopathic hip chondrolysis (n=4), femoral neck fracture (n=3), developmental hip dysplasia (n=3), hip joint infection (n=2), aseptic osteonecrosis secondary to drepanocytosis (n=1), and Legg-Calvé-Perthes disease (n=1). The average Oxford score was 43.2±4.8, and the mean PMA score was 15.9±0.6. Pain relief was achieved in 96.3% of patients. Six patients had major complications (22.2%), with three (11.1%) requiring unplanned surgeries.

Limitations: The main limitations were a small sample size and the absence of a control group.

Conclusion: To date, no study has specifically evaluated THA clinical outcomes in children with non-inflammatory hip joint osteoarthritis. This study demonstrates satisfactory outcomes following THA in children with hip joint osteoarthritis. THA should be considered a viable option for selected pediatric patients.

Background: Although the management of acute intoxications is well codified, managing accidental cannabis poisoning in children remains a challenge.

Observation and discussion: Consider a toxic etiology in toddlers means firstly thinking about it, and secondly knowing the main symptoms that can reveal cannabis intoxication in children.

Results and conclusion: In this case report, we sought to highlight the importance of good healthcare providers' management regarding unintentional cannabis exposure in toddlers.

Background: Pediatric telephone triage is an extremely challenging task, requiring the Emergency Medical Services (EMS) physicians to be supported by the most reliable tools. Real-time video conference has been implemented in the Loire-Atlantique's dispatch center (France) since 2016. No data are available regarding pediatric dispatch or the use of video for this purpose.

Objective: The aim of our study is to assess the utility and reliability of this tool for the triage of pediatric respiratory distress.

Method and settings: The study was conducted over one year, between the 2nd of February 2021 and the 23rd of February 2022, at our local dispatch center. Children between the ages of 0 and 16 years were included if they presented with respiratory distress and if the EMS physician felt the need to use the video conferencing system. The primary outcome was a score between 0 and 10, assessed by the EMS physician after the call, evaluating the usefulness of real-time video support. Secondary outcomes focused on the impact of video use on the final triage decision as well as the reliability of the tool.

Results: A total of 296 calls were included. EMS physicians gave an average score of 8.5/10 (IC = 95 % [8.4;8.7]) for the support provided by the video tool. Its implementation reduced the number of patients referred to emergency rooms by 17.2 %. Among these, 7.9 % eventually visited the pediatric emergency services for specific care within the 7 days following triage.

Conclusion: The real-time video system is considered a useful tool to support EMS physicians in the tele-triage of pediatric respiratory distress cases and may help reduce overcrowding in pediatric emergency departments. While the tool appears to be reliable, it cannot replace an extended physical examination in cases of persistent doubt or parental concern.

Objective: The main objective of this study is to develop a protocol for the safe use of b-CPAP in children under five years with severe pneumonia or bronchiolitis in Senegal, based on evidence from a review of the literature.

Methods: We conducted a literature review on the use of b-CPAP in pneumonia and bronchiolitis in resource-limited countries. We included only randomized studies and meta-analyses in children under five years of age with pneumonia or bronchiolitis.

Results: Out of a total of 27 studies identified in our search, we included four randomized trials, including a total of 2181 patients. The age of patients was 28 days-59 months in three studies, and less than 12 months in one study. Overall, the use of b-CPAP was associated with improvements in clinical outcomes: reduced mortality, fewer signs of respiratory distress, and shorter hospitalization lengths, except for one study that identified a worse outcome when b-CPAP was used without medical supervision. Based on these data, we have developed a management protocol that we plan to test and roll out in Senegal.

Conclusion: We propose an evidence-based protocol that should be feasible, safe, and applicable in remote regions of Senegal. However, its effectiveness should be monitored and evaluated based on the clinical outcomes observed after implantation.

Background: Data are lacking for lung evaluation after hematopoietic cell stem transplantation (HSCT) in children under the age of six, as this population cannot be included in respiratory function monitoring protocols.

Methods and settings: The RESPPEDHEM cohort included individuals under the age of 18 who underwent HSCT between January 2014 and November 2017. The eligible population for this study consisted of children from the RESPEDHEM cohort, who underwent HSCT before the age of 6, were still alive in October 2023 and had pulmonary function tests (PFTs) performed more than 3 years after HSCT. The primary objective of our multicenter study was to describe long-term PFT outcomes in children who received HSCT before the age of six, as included in the RESPEDDHEM cohort. The secondary objective was to identify clinical, radiological and transplant-related factors associated with abnormal lung function. Pulmonary abnormalities were defined according to the guidelines of the American Thoracic Society (ATS), the European Respiratory Society (ERS), and Global Lung Initiative (GLI).

Results: Among the 40 children, the mean (SD) age at transplantation was 3.7 ± 1.4 years; 50 % had undergone PFT before HSCT. The last follow-up lung function test was performed at 10.2 ± 2.2 years. Twelve individuals (30 %; 95 %CI: 17-47 %) had abnormal lung function at the end of the study, based on the recent ERS/ATS technical standard on interpretive strategies for routine lung function tests. The main anomalies were obstructive defect (n=4) and restrictive defect (n=4).

Conclusion: This study is the first lung function analysis of children undergoing HSCT before the age of six. Abnormalities persist in about one-third of the population, and 42 % of these children were asymptomatic. Therefore, systematic and long-term respiratory monitoring is needed even if the absence of clinical symptoms. However, half of the cohort did not undergo pre-HSCT pulmonary function testing, which limits the ability to attribute abnormalities solely to the transplant.

Background: The clinical value of thrombophilia testing in pediatric patients remains debated, especially in the absence of clear, age-specific guidelines. We aimed to assess the real-life indications, results, and clinical impact of thrombophilia testing in a French tertiary pediatric center.

Methods: We conducted a retrospective, single-center study of all children (<18 years) who underwent hereditary thrombophilia testing at Armand Trousseau Hospital (AP-HP.Sorbonne Université) during 2019. Clinical indications, test results, thrombotic events, and their consequences for clinical management were analyzed.

Results: A total of 129 patients (median age 6.7 years; 39.5% female) were included. The five most frequent indications were hematologic malignancy (55.0%), suspected or confirmed thrombotic events (18.6%), pre-kidney transplant evaluation (6.2%), family history of thrombophilia or thrombosis (6.2%), and preoperative assessment (3.9%). At least one abnormality was identified in 29.5% of patients, but only 10 had confirmed hereditary thrombophilia: protein S deficiency (n = 1), factor V Leiden mutation (homozygous n = 2; heterozygous n = 4), and heterozygous prothrombin G20210A mutation (n = 3). Most natural anticoagulant deficiencies were observed in children with leukemia and were not retested, thus remaining unconfirmed. Eleven patients (8.5%) experienced a venous thromboembolism (VTE); ten had at least one transient risk factor. Thrombophilia testing led to a change in clinical management in five patients (3.9%). Among patients with confirmed thrombophilia, preventive counseling was inconsistently documented.

Conclusion: Thrombophilia testing in children should be carefully targeted, guided by established recommendations, and reserved for situations with clear clinical relevance. Testing should be deferred during acute illness, repeated to confirm lifelong diagnoses, and, if confirmed, accompanied by appropriate preventive counseling. Efforts should also focus on providing standardized, practical advice when a thrombophilia is identified.

Background: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an uncommon clinico-radiological entity, mostly described in children in association with viral or atypical bacterial infections. Mycoplasma pneumoniae (MP) is a rare but recognized trigger. Kawasaki disease (KD) may also present with neurological involvement.

Observation and discussion: We report the case of a 14-year-old boy with acute encephalopathy, Mycoplasma pneumoniae infection, and features of incomplete KD. Brain MRI showed a reversible lesion in the splenium of the corpus callosum consistent with MERS. The patient developed mucocutaneous signs and transient coronary artery dilatation. He improved with antibiotic and anti-inflammatory therapy.

Conclusion: This case highlights a rare overlap between MERS, Mycoplasma pneumoniae, and incomplete KD, suggesting shared inflammatory pathways. Clinicians should consider this association when encountering pediatric encephalopathy with systemic inflammatory features.