Archives De Pediatrie最新文献

Background: Cranial positional deformities occur frequently in the first months of life.

Objective: To evaluate the effectiveness of osteopathic manipulative treatment (OMT) in preventing the onset of positional plagiocephaly and brachycephaly at 4 months in at-risk newborns.

Methods: This single-center, randomized, controlled open-label study, with blinded assessment of the endpoints, was carried out at the maternity unit of Montpellier University Hospital (France) between 2019 and 2022. Newborns aged between 3 and 10 days with at least one risk factor for cranial deformity were included and randomized into a group receiving OMT in addition to advice for the prevention of cranial deformities or a group receiving advice alone (standard care). OMT included an osteopathic assessment, osteopathic treatment, and at least one follow-up session. The primary outcome was the occurrence of plagiocephaly (cranial asymmetry index ≥106 %) or brachycephaly (cranial index ≥93 %) at 4 months after birth.

Results: The trial terminated early due to enrolment issues (56.1 % of planned recruitment). Among the 101 patients included, 35 in the OMT group and 30 in the control group completed the study and were analyzed. At 4 months, no significant difference was observed in the rates of brachycephaly (relative risk [RR] of the control group vs. OMT: 1.55, 95 % confidence interval [CI]: [0.38, 6.39], p = 0.54), or plagiocephaly (RR=1.64, 95 % CI [0.34, 8.00], p = 0.54). A trend toward more frequent cases of severe brachycephaly or plagiocephaly was observed in the control group (n = 5) compared with the OMT group (n = 1; p = 0.09). No adverse effects were reported.

Conclusions: This study did not find any significant effect of OMT on the occurrence of cranial positional deformities. However, recruitment and follow-up difficulties, partly linked to the COVID-19 pandemic, resulted in an underpowered study that does not allow definitive conclusions to be drawn on potential benefits of OMT.

Background: Primary adrenal insufficiency (PAI) is a rare but potentially life-threatening condition. Congenital adrenal hyperplasia (CAH) is the most common cause of PAI in children. To date, numerous non-CAH causes have been identified through genetic analysis but they remain poorly characterized.

Objective: We aimed to describe the clinical presentation, etiology, genetic analysis, and long-term outcome of non-CAH PAI in children.

Methods: We retrospectively collected clinical and laboratory data from patients with non-CAH PAI who were followed up during a period of 33 years (1988-2020) at the pediatric department of a university hospital center in southern Tunisia.

Results: We identified 52 patients with non-CAH PAI (35 boys and 17 girls). The mean age at diagnosis was 4.8 years (0.05-18.7 years). Hyperpigmentation was the most frequent symptom at diagnosis (92.3%), followed by asthenia (84.6%), weight loss (57.7%), recurrent vomiting (53.8%), and dehydration (42.3%). The most prominent biochemical findings were hyponatremia (60.4%), hypoglycemia (35.4%), and hyperkalemia (16.6%). A total of 21patients (40.4%) presented with adrenal crisis at disease onset. The most common causes of non-CAH PAI were inherited genetic conditions and included Allgrove syndrome (n=15), X-linked adrenoleukodystrophy (n=10), autoimmune polyglandular syndrome (APS) type 2 (n=2), familial glucocorticoid deficiency type 1 (n=1), MCM4 mutation responsible for DNA repair defect (n=1), SF1 deficiency (n=1), APS type 1 (n=1), and autoimmune PAI (n=3). The cause of PAI remained unknown in 34.6% of cases. During follow-up, 24 patients (46.2%) presented with statural growth delay, and eight patients (15.4%) developed obesity.

Conclusion: Allgrove syndrome was the most common etiology of non-CAH PAI in our study, followed by X-linked adrenoleukodystrophy. Today, advanced molecular analysis can be useful for diagnostic investigations, especially in patients with no specific diagnostic features.

Background: Child Sexual Abuse (CSA) is a growing healthcare issue worldwide. However, the acquittance rape is one of the underrepresented phenomena due to certain social and cultural concerns. Consequently, the role of parents is of greater significance to ensure the safety of their children outside and insider of their homes.

Aims: This research investigated the parents' awareness, identification, and communication practices about acquaintance rapes against Pakistani children.

Methods: Data was gathered from 314 respondents having one or more children below sixteen years of age and further analyzed using Statistical Package for Social Sciences (SPSS).

Findings: Results showed that a majority of parents (70 %) were aware of child sexual abuse (CSA), especially acquaintance rape, as a prevalent phenomenon. However, they stayed neutral (50 %) about the possibility of female acquaintances as the possible cause of CSA and male children as victims of sexual abuse. They further reported physical and psychological signs to help identify acquaintance rape among children, with consensus ranging from 50 % to 60 %. Further, they showed different communication approaches, including telling children about CSA (50 %), their private body parts (around 45 %), abstaining from accepting gifts (50 %) and cautioning against going anywhere, even with someone they know (50 %), implying actively educating children about CSA as an effective strategy.

Conclusions: Effective communication between parents and children about sexual abuse is critical for deterrence. Continued efforts to challenge stereotypes, promote inclusive attitudes, and encourage comprehensive prevention approaches are important to creating safer environments for children in Pakistani society.