Archives De Pediatrie最新文献

Background: Motor control of the upper limb is very important for play, personal care, and daily living activities. Losing the motor function of the hand limits the daily life activities, educational, and social participation of children with cerebral palsy (CP).

Objective: To compare the effects of constraint-induced movement therapy (CIMT) with virtual reality (CIMT+VR) use, only CIMT use, and traditional therapy (TT) on hand functions in children with hemiparetic Cerebral Palsy (h-CP).

Material and methods: Children who were h-CP would be divided into three groups randomly (TT (tradit, CIMT, CIMT+VR groups). Hand function and performance were evaluated with the Jebsen-Taylor and Moberg pick-up tests.

Results: Forty-five children participated in the present study. There were no differences in sex, affected side, age, hand function, or performance between groups. After six weeks of therapy, a difference in hand function was observed between groups. However, there were no differences in the functional performance of the hemiparetic hand after therapy.

Conclusion: Using CIMT and VR together improved hand functions, while there was no change in the functional performance of the hand.

Background: Increasing physical activity and reducing sedentary time in children and adolescents with chronic illness is a critical challenge. Despite several studies supporting the benefits of exercise programmes for improving physical and psychological health, such programmes remain relatively uncommon in the care of children and adolescents with chronic disease.

Objectives: To evaluate the feasibility and acceptability of integrating an Adapted Physical Activity (APA) programme into routine paediatric outpatient care, aiming to bridge the gap between strong scientific findings and everyday clinical practice of paediatricians.

Methods and setting: Adolescents with congenital heart disease, obesity, or sickle cell anemia voluntarily participated in a supervised 2-month APA program in the pediatric department of Nantes University Hospital. Feasibility and acceptability were assessed using study-specific questionnaires. The efficacy and benefits of the APA program were evaluated with performance measures including changes in aerobic fitness through VO2 measurements, muscle mass and fat mass, the five-times sit-to-stand test and six-minute walk test, and pediatric quality of life scores.

Results: Among the 17 included adolescents (11-17 years old), 13 (76 %) completed the 2-month APA program. The mean attendance was 79.4 % (18/24 sessions); 91 % enjoyed this activity; and 83 % of parents reported that this program was helpful for their adolescent. Following the intervention, patients experienced no adverse effects, reported a 7 % improvement in quality of life (p = 0.02), and demonstrated enhanced functional motor activities, including increased aerobic exercise capacity and functional performance on the six-minute walking test (+15.3 %; p < 0.01).

Conclusion: These preliminary findings suggest that APA interventions are highly implementable in children with chronic diseases. We report a significant benefit on the quality of life and physical performance. Larger APA programs implementation is needed to confirm, with a high level of evidence, the importance of integration of APA programmes into routine paediatric care.

Background: Physical activity in preschoolers is essential for their development, but screen media use could displace free active play. Due to the sporadic nature of young children's movements advancements in classifying sedentary and non-sedentary behavior are crucial for understanding the potential impact of screen media use on their development.

Objectives: To investigate cross-sectional and 18-month prospective associations between leisure screen media use and leisure accelerometry-based non-sedentary time, body positions and physical activity types in preschoolers.

Methods and setting: A population-based sample (n = 442) of Danish preschoolers 3-6 years from 30 public preschools having parent reported screen time use and also wore two three-axis accelerometers for six days at baseline (2016) and follow-up (2018). The average amount of time spent in non-sedentary activities, i.e. standing, standing that includes minor movements, walking, running, and cycling, were calculated at the two time points. Multivariable adjusted linear mixed-effect relationships were computed.

Results: Cross sectional analyses showed that daily screen media use (hours) was negatively associated with daily mean non-sedentary time (beta = -3.1 min/day; 95% confidence interval, -6.1 to -0.1, p = .042), also evident during weekends. Screen media use was also associated with sitting (positively) and standing (negatively) during both weekdays and weekend days. Moreover, screen media use was positively associated with time spent standing that includes minor movements on weekdays. No associations were found in the prospective analyses (n = 142).

Conclusion: Leisure screen media use was negatively associated with leisure non-sedentary time on both weekdays and weekend days. In addition, screen media use was consistently related to less standing and more sitting. No associations were found in the prospective analyses.

Background: Allergic diseases are rapidly increasing worldwide, with considerable regional variations. In Belgium, studies on paediatric aeroallergen sensitisation have been lacking.

Methods: This multicentre, epidemiological study analysed aeroallergen sensitisation patterns in children across seven hospitals in Southern Belgium, using retrospective skin prick tests data from 2023. Its secondary objective was to identify the most relevant aeroallergens and define a region-specific minimal panel optimising diagnostic efficiency.

Results: A total of 3297 patients were included, with respiratory symptoms being the primary indication for testing. The overall skin prick test positivity rate was 46.2 %, with significant age-related variations, including a notably lower rate in children under 3 years (16.6 %). The most common allergens identified were house dust mites (63.9 %), grass pollen (43.5 %), Betulaceae pollen (35.9 %), and cat dander (31.1 %). Over 63 % of sensitised children exhibited polysensitisation, with its prevalence increasing with age. Two distinct five-allergen panels, one for children under 3 years and one for older children, capture over 95 % of sensitisation.

Conclusion: This study provides a real-life overview of aeroallergen sensitisation based on a large cohort of Belgian children. Two minimal five-allergen panels offer a cost-effective and region-specific diagnostic tool. Findings also highlight the limited positivity of skin prick tests in children under 3 years, underscoring the importance of adequate test performance and interpretation in this age group to ensure reliable results.

Background: Acute bronchiolitis is a common viral infection in infants, with severe cases requiring admission to pediatric intensive care units (PICU). While bacterial co-infections are rare, timely diagnosis and management are essential. Updated guidelines from the French-speaking Group of Pediatric Intensive and Emergency Care (GFRUP) aim to standardize the standard of care, reducing unnecessary interventions.

Objectives: This study evaluated the impact of updated bronchiolitis management guidelines on sepsis incidence, diagnostic test use, and antibiotic prescriptions in a single center.

Methods and settings: A retrospective study compared two epidemic periods (2022-2023 and 2023-2024) at the PICU, Necker-Enfants Malades Hospital. Clinical and microbiological data, including sepsis incidence, bacterial co-infections, diagnostic tests, and antibiotic use, were analyzed.

Results: Among 257 infants admitted for bronchiolitis, sepsis incidence remained low (8% vs. 7%). Implementation of the guidelines led to a significant reduction in additional diagnostic tests (65% vs. 49%, p = 0.013). Antibiotic prescription rates were unchanged, but a narrower spectrum of antibiotics was observed, with decreased amoxicillin/clavulanate use and increased amoxicillin prescriptions. Lung infections were the most frequent bacterial co-infections, with no rise in bacterial infection rates.

Conclusions: Implementation of updated guidelines reduced unnecessary diagnostic tests and promoted narrower-spectrum antibiotic use without increasing sepsis incidence. These findings highlight the potential of evidence-based guidelines to optimize care, support antibiotic stewardship, and minimize unnecessary interventions in pediatric critical care.

Objective: This study aimed to describe data of patients included in the in-hospital pediatric stroke alert and compare it to published data.

Methods: This bicentric retrospective study includes all children aged one month to 18 years who underwent an MRI (magnetic resonance imaging) for an acute neurological deficit according to the stroke alert protocol established at Nantes and Angers University Hospitals between January 2017 and July 2021. Demographic characteristics, time from stroke onset to imaging, diagnosis, treatments if any, and outcomes were collected.

Results: Seventy-eight children were included. The stroke alert procedure led to early stroke detection in 16 children (21%). Four of them received acute recanalization therapy. Other diagnoses needing specific management were identified in 12% of cases. Migraine was the most common diagnosis, affecting more than half of the patients.

Conclusions: This stroke alert protocol allowed children presenting with acute neurological deficit to have rapid access to brain MRI, which confirmed the diagnosis of stroke or other acute neurological disorder necessitating specific management in one-third of the cases.

Background: Dangerous games are playful activities engaged in by children and adolescents, posing significant risks to their health. Various types exist, aggressive games, challenge games, and asphyxiation games, with the 'Choking game' (where individuals attempt strangulation) being the most well-known. The prevalence of dangerous games among adolescents is increasing, yet it remains a little-known and studied societal issue among healthcare professionals.

Objective: To assess physicians' role in the prevention and management of dangerous games.

Methods and settings: Qualitative semi-structured interviews with general practitioners, pediatricians, and psychiatrists were performed. All data were transcribed verbatim and analyzed using a content analysis approach.

Results: We interviewed 6 general practitioners, 6 psychiatrists, and 5 pediatricians practicing in the Paris region. Three main themes emerged from the data: 1) physicians' lack of knowledge about the topic due to insufficient training, 2) players' profiles characterized by psychological vulnerability, influence of peer pressure and social media, with no clear suicidal intent, and 3) the need to primarily focus on screening, prevention, and management at the school level.

Conclusion: This study highlights a critical public health issue. Physicians' roles are essential for identifying psychological vulnerabilities and raising awareness among youth of the associated risks. However, prevention requires close collaboration between the educational sector and healthcare professionals, who could benefit from targeted training and regular interventions within educational institutions.

Background: Accurately targeting newborns suspected of early-onset bacterial neonatal infection (EONI) and optimizing the administration of antibiotics is challenging. French clinical guidelines (HAS/SFN) on the management of newborns over 34 weeks at risk of EONI were deployed in September 2017.

Objective: Our objective was to assess their implementation 3 years later in the Paris area, representing approximately 180,000 births.

Methods and settings: We conducted an observational study in all maternity units of the Ile-de-France region from July 2020 to January 2021. We sent a self-administered questionnaire on the application of the new guidelines by email addressed to a pediatrician in each maternity unit.

Results: Out of the 80 maternity units in the Ile-de-France region, 78 participated. Among the participating units, 40 (51 %) reported applying the new clinical guidelines fully, 28 (36 %) partially, while 10 (13 %) reported not applying them. Among participants, 45 (66 %) maternity units found the implementation of the clinical guidelines feasible, and nearly 80 % of them observed that applying them resulted in fewer additional tests, such as blood samples or peripheral bacteriological tests. Only 35 % of maternity units no longer collect gastric fluid sample, even though this practice is no longer recommended. Among the difficulties identified by the 10 centers that reported not implementing the guidelines were a lack of equipment, insufficient numbers of competent personnel, and insufficient time to train relevant professionals.

Conclusion: Three years after the publication of the French clinical guidelines (HAS/SFN) on the management of newborns over 34 weeks at risk of EONI, this study showed that over 85 % of responding maternity units in the Ile-de-France region reported have implemented the guidelines either fully or partially.