Archives De Pediatrie最新文献

Objective: Glomerular hyperfiltration is an early indicator of obesity-related glomerular disease. However, in adolescents, there are no quantifiable indicators of obesity and glomerular hyperfiltration. This study investigates the association between visceral adipose tissue and glomerular hyperfiltration in adolescents.

Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES; 2011-2018), and adolescents aged 12-17 years were included. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) formed the independent variables while estimated glomerular filtration rate (eGFR) acted as the dependent variable. Their association was assessed using unadjusted and multivariate regression analyses, as well as subgroup and interaction analyses.

Results: Multivariate regression analysis revealed that VAT was positively associated with eGFR and glomerular hyperfiltration among adolescents. The incidence of glomerular hyperfiltration increased by 99 % in boys and 56 % in girls per 100 g of VAT increase. Additionally, VAT and eGFR exhibited a linear relationship in both boys (β = 5.63, p < 0.001) and girls (β = 2.72, p < 0.001).

Conclusions: In US adolescents aged 12-17 years, VAT was positively correlated with eGFR and glomerular hyperfiltration.

Introduction: Requests for hormonal transition in minors are increasing. To date, there is no national recommendation to guide these practices in France. Therefore, the SFEDP (French Society of Pediatric Endocrinology and Diabetology) has commissioned a group of experts to draft the first national consensus on this topic.

Method: Each chapter was prepared by one to three authors who conducted a literature review, and it was then reviewed and revised by the group as many times as necessary to achieve a consensus position. The final document was reviewed by a group of external experts.

Results: A consensus position was reached regarding the multi-professional nature of support for trans youth, the prescription of molecules aimed at inhibiting endogenous hormone secretion, and the use of gender-affirming hormone therapies, as well as the importance of offering gamete preservation. Non-hormonal aspects of support and various considerations, including ethical ones, were also discussed.

Conclusion: This work constitutes an initial set of recommendations for professionals involved in the hormonal transition of trans youth. Additional recommendations under the auspices of the French High Authority for Health would be worthy of being drafted, involving all relevant stakeholders to establish comprehensive official national guidelines that would secure the support and rights of these young individuals, especially those under 16 years old, as well as the professionals involved in their care.

Management of patent ductus arteriosus (PDA) in preterm newborns has been debated extensively for more than six decades. Some authors affirm that PDA is only an innocent mirror of infant immaturity, without specific health consequences. They also underline the futility, even danger, of treating it. Others are concerned about the hemodynamic effects of this left-right shunt, resulting in high pulmonary blood flow and low systemic output, which can contribute to the occurrence of severe morbidities - including pulmonary hemorrhage, intraventricular hemorrhage, bronchopulmonary dysplasia and necrotizing enterocolitis -and may increase the risk of death. Many management strategies have been described, ranging from expectant management to nontargeted prophylaxis, but there is currently no consensus about who to treat, when, and how.

Background: During 2020-2021, in the context of increasing SARS-CoV-2 transmission in the general population, French authorities made the decision to keep schools open and set up massive screening campaigns for students. Here, we describe the impact of this strategy on the circulation of SARS-COV-2 among children and adolescents during this period.

Methods: We analyzed SARS-COV-2 surveillance data provided by the French National Public Health Agency for the 2020-2021 school year along with the results of school-based screening campaigns implemented by the Ministry of National Education.

Results: The proportion of 0-17-year-olds among confirmed cases and tested individuals increased throughout the school year, with children and adolescents reaching a maximum of 24 % of confirmed cases in 2021 week (W) 22. During the first semester of 2021 (W3-W22), >2.6 million tests were performed in schools, with a positivity rate of 0.32 % among students. Considering only symptomatic cases, higher incidence rates occurred among children and adolescents during the 2021 wave from W9 to W17 compared with that in 2020 from W40 to W48. The incidence rate did not significantly change following the school closure periods.

Conclusion: The higher contribution of children and adolescents to viral circulation during the 2020-2021 school year seems more related to the emergence of the alpha variant than to France's decision to keep schools open. Considering the negative impact of school closures on children's mental health, these results support the decision to keep schools open when accompanied by appropriate control measures.

Infections claim the lives of over half a million newborns annually and expose survivors to the risk of lifelong disability. The challenge to clinicians is to identify newborns with invasive infections rapidly, promptly initiate antimicrobial treatment, and take measures to prevent and treat organ dysfunction. Moreover, excessive antibiotic use is a global public health problem. Despite considerable research on clinical and laboratory markers of neonatal sepsis, the effective translation into clinical practice remains limited. There is no single clinical or laboratory marker, nor any combination of markers that definitively confirms or rules out neonatal sepsis. The interpretation of these markers should take into account their diagnostic value for a given patient, along with their added value to the clinical decision-making process. The digitalization of health care systems, combined with increased computational power and advances in machine learning, offers the possibility of developing accurate predictive algorithms for early detection of neonatal sepsis.

The arrival of a newborn in a family brings with it many worries, together with baby-related tasks to keep family members busy, and sometimes paradoxically withdrawal. Funding from UNICEF enabled us to conduct an original anthropological study in five countries of sub-Saharan Africa (Benin, Burkina Faso, Mali, Mauritania, Togo), studying newborn care from birth to the seventh day of life. We focused on the various kinds of care provided to these babies and on their diverse meanings. We examined how the social status of newborns induced forms of care and of interpretations of particular disorders. This work shows that the conceptions of the newborn: vulnerable beings of uncertain social integration - engendered less investment by health care professionals at birth, but inversely, strong mobilization by members of the extended family. Despite the generalization of hospital births, care during the first days of life remained associated with the domestic household universe and was barely if at all medicalized. The heterogeneous integration of medical recommendations for newborn care in the first days of life can be analyzed as arising from divergent intentions around the birth and the reception of the newborn. This study also examined how changes in neonatal care may generate conflicts of influence and intrafamily power struggles and thus allowed us to explain how the adoption of some recommended neonatal care was compromised and how they need to be adapted locally. It thus showed how some changes in neonatal care helped to bring about the reexamination of family roles. This will lead us to discuss how to define "respectful care" for these subjects who cannot speak. Beyond quality of care based on good practice guidelines, it is important to underline how respect in the care relationship is indissociable from the local cultural construction of newborns.

Objective: Adolescent pregnancies are categorized as high risk due to their adverse obstetric and neonatal outcomes. The aim of our study was to investigate the well-being of pregnant adolescents by assessing pregnancy complications, depression, anxiety, social support, and adaptation to pregnancy.

Methods: Pregnant adolescents who presented to the Obstetrics and Gynecology Outpatient Clinic of Hatay Training and Research Hospital between July 2022 and January 2023 were included in the study. Pregnant adults were also included as a control group during the same period. All participants were assessed using the Beck Depression Inventory, Multidimensional Scale of Perceived Social Support, Perinatal Anxiety Screening Scale, and Prenatal Self-Evaluation Questionnaire.

Results: A total of 61 pregnant adolescents were enrolled in the study and were compared with 116 adults. Our findings indicate that pregnant adolescents tend to exhibit a higher rate of pregnancy complications in comparison with pregnant adults, with complication rates of 14.8 % and 6.1 %, respectively (p = 0.057). The presence of complications had a negative impact on the acceptance of pregnancy in adolescents unlike in adults (p = 0.022). The relationship of pregnant adolescents with their partners was negatively affected by pregnancy complications (p = 0.046). Perceived social support (especially that of a partner) significantly reduced depression and anxiety scores in pregnant adolescents during the prenatal period (p = 0.002) CONCLUSION: Adolescent pregnancies have negative psychiatric consequences even in traditional societies where child marriage is accepted. Future studies should consider variables that may reduce the impact of sociocultural factors on adolescent pregnancy.

Purpose: Mood symptoms and disordered eating behaviors are common in adolescents with overweight and obesity. This study aimed to investigate the relationships between mood symptoms, difficulties in emotion regulation, and emotional eating behaviors in adolescents with overweight and obesity.

Methods: In this cross-sectional study, adolescents with normal weight (N = 45), overweight (N = 45), or obesity (N = 55) were assessed using semi-structured clinical interviews and self-report scales. Path analysis was used to examine factors contributing to emotional eating behaviors, considering psychiatric comorbidities, mood symptoms, emotional/binge/restrictive eating behaviors, difficulties in emotion regulation, and self-esteem.

Results: Adolescents with overweight and obesity exhibited more depressive, anxiety, and anger symptoms; restrictive, emotional, and external eating behaviors; and psychopathologies such as mood disorders, anxiety disorders, and attention-deficit/hyperactivity disorder (ADHD) compared with normal-weight adolescents. ADHD diagnosis, difficulties in emotion regulation, hypomanic/manic symptoms, and anger symptoms directly predicted emotional eating behavior, while self-esteem was an indirect predictor.

Conclusion: Adolescents with overweight and obesity tend to exhibit similar psychological characteristics, including increased mood symptoms and maladaptive eating behaviors associated with higher rates of anxiety and mood disorders, compared with their normal-weight peers. The most significant predictors of emotional eating behaviors were ADHD and difficulties in emotion regulation. Given the frequency of psychological comorbidities in obesity, their detection and management should be encouraged.

Background: Teledermatology has been widely deployed over the past decade in France, becoming an indispensable tool in daily practice. Pediatric dermatology is a subspecialty of dermatology limited to a small number of specialists. In 2013, the Argenteuil Hospital developed a structured store-and-forward (SAF) service that is particularly well-suited for the field of pediatric dermatology. We report on our 10-year experience using the SAF approach in pediatric dermatology, focusing on the acceptability and efficiency of the service.

Method: All pediatric (<18 years) cases submitted to the SAF service from 2013 to 2022 were analyzed to evaluate SAF performance (refusals, response times, and information quality); patient demographics; pathologies (diagnostic certainty, types); and management.

Results: A total of 922 cases, from eight centers (six hospitals, two penitentiaries, and one health center) and 52 physicians, were analyzed. An increase in requests was noted over the years. No families refused to use the service. In 83 % and 94 % of cases, the quality of the photos and information was considered good or very good, respectively. The median response time was 1.5 h. The mean age of the children was 5 years (sex ratio: 1:1), with 26 % of cases involving newborns (<1 month). The median disease duration was 6 days (48 % <5 days). In 65 % of cases, the diagnosis was "certain," whereas in 34 % of cases a "diagnostic hypothesis" was made. Examinations were recommended in 35 % of cases and treatment was proposed in 62 % of cases. Dermatological follow-up was proposed in 32 % of cases.

Conclusion: Our 10-year review of the SAF network showed that this pediatric teledermatology service has been accepted by parents and physicians. The information transmitted was of high quality, although additional clarification requests were sometimes required. The service enabled rapid responses in the majority of cases, including a wide variety of situations: one-quarter of cases involved newborns and 48 % of cases involved recently developed dermatoses (<5 days) requiring urgent management. This pediatric dermatology SAF-based tele-expertise service was therefore shown to be efficient and very well accepted, and is currently being deployed among private practitioners.