Archives De Pediatrie最新文献

Background: Unnecessary dietary eliminations may impair quality of life, affect children's growth, and negatively impact healthcare costs. Previous studies reported that around 11 % to 28 % of children continue a food-avoidance diet despite a negative oral food challenge (OFC).

Objectives: This study aimed to evaluate the actual consumption at home of the tested food after a negative OFC and the reasons reported by families in the case of persistent avoidance.

Methods and settings: A retrospective study was conducted in the Pediatric Gastro-Enterology and Pneumo-Allergology Departments of Robert Debré Hospital (Paris), involving patients who had a negative OFC. Data were collected from the patients' medical files and supplemented by a telephone survey.

Results: 101 families completed the telephone survey, corresponding to 129 OFCs with full data available. The tested foods were tree nuts for 29.5 % (38/129), milk for 28.7 % (37/129), and egg for 21 % (27/129). Persistent avoidance represented 17.1 % of the OFCs (22/129), and partial consumption 4.6 % (6/129). Consumption of the tested food was inversely correlated with child's age and length of avoidance period. Consumption was more frequent in the case of ubiquitous allergens (milk, egg). The main causes mentioned for non-consumption were family habits (72.7 %, 16/22) or the child's disgust for the tested food (54.5 %, 12/22).

Conclusion: A negative OFC does not always result in actual consumption of the tested food at home. These results underline the importance of performing an OFC as early as possible in the patient's life. Monitoring and supporting patients who have a negative OFC is key for successful consumption at home.

Objectives: Chest pain is a common symptom in pediatric emergency department. The causes are mostly benign without any sign on chest x-ray (CXR). However, CXR is one of the most ordered tests in this situation. Our main objective was to assess the current management of CXR by physicians in this context, according to the algorithm proposed by the French Society of Pediatrics (FSP).

Materials and methods: We conducted a retrospective study in two French pediatric emergency departments. We reviewed the medical records of children who presented with chest pain between 2018, July 1rst to 2021, July 31th. We collected data from history and clinical examination. The prescription of CXR and its interpretation were collected.

Results: Overall, 599 children were enrolled. The algorithm was followed in 57,1 % of cases, and 8,2 % of abnormal CXR were noted. On univariate analysis, medical history with a significant OR greater than 2 included cardiological history (as defined by FSP), neoplasia, pneumonia and sickle cell disease. Right lateralized pain, pain that worsens with respiration, fever and cough were also symptoms significantly associated with an abnormal CXR result. On physical finding, tachycardia, tachypnea, abnormal cardiac and pulmonary clinical examination (as defined by the FSP) were significantly associated with pathological CXR. However, the multivariate logistic regression model could not be carried out due to too many significant variables in univariate analysis, and too few number of abnormal CXR reported.

Conclusion: CXR remains the cornerstone of chest pain management in pediatric emergencies, even though the rate of abnormal CXR appears low. The appropriateness of CXR prescribing can be improved by guidelines focusing on the clinical etiologies of chest pain visible on CXR. A similar prospective study may identify risk factors for pathological CXR and clarify the decision tree for the indication of CXR in chest pain.

Background: The time for newborn discharge from the maternity ward has been shortened in recent decades with consequences that are still debated.

Objectives: The primary objective of this study was to establish whether early discharge could be a risk factor for rehospitalization in the neonatal period. Second, we aimed to study the incidence of neonatal hospitalizations and their causes. Next, we tried to determine other possible risk factors for rehospitalization after discharge.

Methods and setting: This is a retrospective, single-center, case-control study collecting data on newborns rehospitalized in the first 28 days of life at Nancy University Hospital, after their discharge from the maternity ward. These newborns were born between 01/06/2021 and 31/05/2022 and were matched with two healthy infants who did not require rehospitalization according to term and month of birth. A logistic regression model was used to evaluate the association between early discharge and risk of hospitalization.

Results: 2,054 healthy full-term babies were born during the study period; 108 (5%) were rehospitalized and compared to 219 randomly selected newborns who did not required hospitalization. Among the 108 cases included, 42 (38.9%) obtained early discharge versus 91 out of 219 (41.6%) controls. Multivariate logistic regression showed no significant association between early discharge and risk of hospitalization (ORa=1.1 [95%CI: 0.7 to 1.8], p = 0.69). However, phototherapy treatment during the maternity ward stay was a significant risk factor for rehospitalization (ORa=5.O [2.5 to 9.9], p < 0.0001). The main causes of hospitalization were jaundice and respiratory infections.

Conclusion: Early discharge from the maternity ward does not constitute a risk factor for readmission in the neonatal period in this study. Changes in perinatal practices, such as ambulatory delivery and very early discharge, should be included in revised recommendations.

Background: To evaluate a nurse-driven respiratory support discontinuation protocol in infants with bronchiolitis admitted in paediatric intensive care units.

Methods: A retrospective single-center study with pre-versus-post comparative design in a tertiary center.

Results: In total, 187 infants (95 with standard and 92 with nurse-driven protocols) were included. There was no difference in terms of weaning failure between the two periods (11 (12 %) versus 14 (15 %), p = 0.46). During the nurse-driven protocol period, discontinuation of the ventilatory support was performed later (at 44 hrs (IQR 29-67) versus 33 hrs (IQR 19-46), p = 0.001), but the weaning process duration was shorter than before protocol implementation (24 h (IQR 0-60) versus 39 (IQR 18-64), p = 0.01). The total duration of ventilation (excluding time on BiPAP) was similar before and after protocol (53 (IQR 37-81) versus 55 h (IQR 28-81), p = 0.46). The PICU and hospital lengths of stay did not differ between the two periods.

Conclusions: In patients with bronchiolitis supported by noninvasive respiratory support, the nurse-driven discontinuation management - as opposed to physician-driven - was associated with a later discontinuation of the ventilatory support, while the weaning process duration was shorter than before protocol implementation.

Background: In March 2020, several countries, including France, implemented a total lockdown policy to combat the spread of the COVID-19 epidemic, involving the closure of schools. This measure required children to stay at home for an extended period of time. Several studies have shown an increase in the number or proportion and severity of domestic accidents in children during this period. Santé Publique France and the paediatric emergency department of Toulouse University Hospital conducted a study on the impact of the first lockdown on the use of the emergency department due to domestic accidents in children under 15 years of age in France.

Methods: The study was conducted using data from nine French emergency departments participating in the Enquête permanente sur les accidents de la vie courante [Permanent Survey on Home and leisure injuries] (EPAC), which involves the exhaustive collection of data on emergency admissions following home and leisure injuries. The frequencies and characteristics of emergency department admissions due to domestic accidents were analysed over the period from 17 March to 11 May 2020, and compared to those over the same period in 2016-2019.

Results: During the lockdown period, an increase in the proportion of emergency department admissions due to domestic accidents is observed in boys and children aged [2-5[years. This study showed an increase in the proportion of hospital admissions during this period. These accidents were mainly falls in outside living spaces (balcony, patio, garden, etc.). The results showed an increase in admissions for fractures and upper limb injuries.

Conclusion: This study shows that health policies must take into account the collateral effects of certain measures put in place to manage an epidemic. Prevention messages for parents of young children need to be strengthened and their attention drawn to the risk of certain kinds of accidents, such as falls.

Background and objective: In 2022, recommendations for vitamin D supplementation in children were updated in France. The objective of this study was to assess real-life practices of vitamin D supplementation in children following these recommendations.

Methods: A thirty-three-question questionnaire was distributed to members of the scientific societies of paediatrics and general medicine via an online platform.

Results: There were 966 respondents, of whom 87 % were paediatricians and 13 % were general practitioners. About half of the physicians (47 %) were in private practice, 49 % worked in a hospital centre and 6 % worked in a maternal and child health centre. As recommended and regardless of the professional practice, vitamin D supplementation was almost systematically prescribed in all age groups (over 90 % of respondents), in daily doses up to 2 years of age (97 % of all respondents) and then every 3 months in older children (year-round in 38 % and winter/spring only in 40 %). Contrary to the new recommendations, loading doses of 200,000 units of vitamin D were prescribed by 5 % of respondents and non-pharmaceutical forms of vitamin D (e.g. unlicensed food supplements) were prescribed by 10 % of respondents. Although risk factors such as low sun exposure and dark skin were well known by respondents (75 % and 74 % respectively), obesity and veganism were only reported by half the respondents (40 % and 53 % respectively). Two-thirds (61 %) of respondents reported assessing calcium intakes when following children; however, only 10 % of them use specific questionnaires or calcium equivalence tables. Finally, the calcium content of foods and its bioavailability appeared to be poorly understood by health professionals.

Conclusion: This survey shows that the practice of paediatricians and general practitioners are in accordance with the new recommendations for vitamin D supplementation in very young children. The identification by this survey of knowledge gaps will allow targeted information campaigns.

Background: Spinal muscular atrophy is a severe, progressive autosomal recessive neuromuscular disorder associated with neuromuscular scoliosis. When bracing is not sufficient to control the deformity, early spinal surgery is required. To the best of our knowledge, no work in the literature have assessed modifications in spinal and thigh muscles of subjects with type 2 spinal muscular atrophy (SMA2) following spinal surgery.

Objective: This study aimed to better understand modifications in the spinal and thigh muscles of subjects with SMA2 and early onset scoliosis, before and after minimally invasive fusionless surgery.

Methods and settings: 20 SMA2 patients with confirmed scoliosis on bi-planar low-dose X-ray were included: 10 preoperative and 10 postoperative patients with a minimal follow-up of 5 years after surgery. The surgery consisted of a bilateral sliding rod construct extended from T1 to the sacrum, through a minimally invasive approach. All subjects had fat/water separation muscle magnetic resonance imaging from the spine to the thigh. The percentage of fat degeneration was compared before and after surgery. A quality-of-life survey was performed.

Results: Fat infiltration was diffuse and symmetric in both groups of patients, and on average six times more compared to control subjects previously published at thigh level. Adductors, sartorius, and gracilis were less affected with respectively, 51%, 56%, and 57% of fat fraction before surgery. Comparing the preoperative and postoperative groups, fat infiltration was higher in sartorius and multifidus after surgery (p < 0.05). No significant difference was found for the other muscles studied. These results did not affect quality of life.

Conclusion: This is the first study to compare fat infiltration of spinal and thigh muscles of SMA2 patients before and after minimally invasive surgery. Our results demonstrate that muscles were globally preserved apart from multifidus and sartorius which were more affected.