Archives De Pediatrie最新文献

Introduction: There is no consensus on indications and modalities of drainage procedures for bacterial pleuropneumonia in children. This study aimed to analyze the clinical course following drainage procedures and the different techniques used.

Method: This retrospective single-center study included children with drained bacterial pleuropneumonia at a French University Hospital, from January 1, 2011, to December 31, 2023.

Results: Thirty-three children were included, with a median age of 3.3 years. The most frequently identified pathogens were Staphylococcus aureus (n = 13; 39 %), Streptococcus pyogenes (GAS) (n = 9; 27 %), and Streptococcus pneumoniae (n = 5; 15 %). Indications for pleural drainage included respiratory distress (n = 16; 48 %) and persistent/abundant pleural effusion (n = 7; 21 %). 73 % of cases presented mediastinal deviation. Percutaneous drainage was performed for 23 patients (70 %) and surgical drainage for 10 patients (30 %). Drainage cultures were positive in 14/27 cases (52 %) after a median of 3 days (IQR: 1.2-5.5) of antibiotics. After drainage, the median durations of fever, intravenous antibiotics, and hospitalization were 8 (IQR: 4.2-14), 11 (IQR: 8.5-15), and 15.5 days (IQR: 8.7-18.5), respectively. Univariate analysis showed that children with percutaneous drainage had longer post drainage fever (12 vs. 5.3 days, p = 0.01) and ventilation durations (7 vs. 2.25 days, p = 0.02) than those with surgical drainage.

Conclusion: The cohort had severe cases, with percutaneous drainage more commonly used. Positive drainage cultures highlighted the challenges of antibiotic penetration and supported the role of drainage in selected cases. Despite favorable medium-term outcomes, post-drainage recovery was prolonged, with extended durations of hospitalization, persistent fever, and prolonged antibiotic treatment.

Background: Pediatric allergic diseases are a growing global public health concern due to their increasing prevalence and impact on children's quality of life. In Tunisia, the incidence of these conditions has risen markedly, with evolving clinical and allergenic patterns over time.

Aims: This study aims to describe the epidemiological evolution of clinical and allergenic profiles in atopic children in Tunisia over a 30-year period.

Methods: We conducted a retrospective study of children aged 1-16 years who were referred for allergic manifestations to the allergy clinic of the Internal Security Forces Hospital (FSI), La Marsa, and underwent skin prick testing (SPT) between 1992 and 2022. Trends were compared across three decades (D1:1992-2001, D2: 2002-2011, and D3:2012-2022) for the entire cohort and within three age groups (preschool, school-aged, and adolescents.

Results: A total of 4313 children were included (mean age: 7.7 ± 3.5 years; sex ratio: 1.39). A family history of atopy was reported in 58.9 % of cases. Rhinitis (76.4 %) and asthma (63.9 %) were the most common presentations. Multiple allergic manifestations were more frequent than isolated ones (58.8 % vs. 41.1 %). SPTs were positive in 57.4 % of cases; dust mites were the most frequent allergen (66.6 %), followed by animal dander and pollens. Polysensitization was observed in 49.7 % of children, most frequently involving dust mites in combination with other allergens. Over the three decades, there was a marked increase in the prevalence of multiple allergic manifestations (from 51.4 % in D1 to 68.5 % in D3; p < 0.001) and polysensitization among sensitized children (from 35.5 % in D1 to 61.1 % in D3; p < 0.001). The age-stratified analysis revealed that this trend towards complexity begins in early childhood, with the rate of polysensitization in preschoolers (1-5 years) soaring from 27.0 % to 62.0 % (p < 0.001). In adolescents (≥12 years), asthma prevalence remained stable (p = 0.124), while rhinitis, rhinoconjunctivitis, and polysensitization continued to increase significantly.

Conclusion: This study highlights significant changes towards greater frequency and complexity of pediatric allergic diseases over the past 30 years, characterized by a rise in multiple manifestations and polysensitization. These trends, particularly pronounced in preschoolers, suggest an accelerated allergic march, warranting adapted clinical and public health strategies.

Background: Cancer diagnosis in the child is stressful for the family caregiver and could have a major impact on his/her mental health, including depression and anxiety, especially during the harsh current Lebanese economic crisis. This study aims at evaluating the correlates of depression and anxiety among family caregivers of pediatric cancer patients in Lebanon.

Methods: It is a cross-sectional study, using a convenience sample of 193 caregivers of pediatric patients with cancer. Depression, anxiety, and work fatigue were assessed using the Patient Health Questionnaire-9, Lebanese Anxiety Scale, and 3D-Work Fatigue Inventory respectively.

Results: The results showed that 18.1 % of the participants have moderately severe depression, whereas 22.2 % show severe depression. Moreover, 79.8 % had anxiety. Having a shortage of medications (Beta = 2.38) and more mental work fatigue (Beta = 0.36) were significantly associated with more depression. Higher physical (Beta = 0.32) and mental (Beta = 0.37) work fatigue were significantly associated with more anxiety.

Conclusion: The study results should raise concerns and make physicians in Lebanon aware of the psychological status of the family caregivers and encourage them to provide adequate support. The results underscore the urgent need for advocacy to improve conditions for families and enhance access to care for children with cancer and their families.

Objective: To identify clinical, chronobiological, and electroencephalographic (EEG) predictors of seizure freedom in pediatric patients with juvenile myoclonic epilepsy (JME), and to evaluate the prognostic utility of both classic and novel markers in a real-world setting.

Methods: We conducted a retrospective cohort study of 71 pediatric JME patients (mean age at diagnosis 16.1 ± 1.05 years; 76.1 % female) diagnosed at a single tertiary center between January 2023 and January 2025. Data collected included demographic variables, seizure characteristics, academic performance, comorbidities, antiseizure medication use, and detailed EEG findings. Classic (e.g., seizure type, academic achievement) and novel predictors (e.g., chronodependency) were assessed for their association with seizure outcome. Chronodependency was defined as a pattern of seizures predominantly occurring after awakening or during specific circadian periods. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed.

Results: At last follow-up, 63.4 % (n = 45) of patients achieved seizure freedom. High academic performance (OR=42.00, p < 0.001) and initial myoclonic seizure type (OR=6.96, p < 0.001) were strongly associated with seizure freedom, whereas high initial frequency of generalized tonic-clonic seizures (OR=0.05, p < 0.001) and failure of at least two appropriate antiseizure medications (OR=0.07, p < 0.001) predicted poor outcomes. Among novel predictors, chronodependency (OR=0.29, p = 0.025), major focal EEG abnormalities (OR=0.30, p = 0.038), and EEG hyperventilation response (OR=0.35, p = 0.025) were independent negative prognostic factors. The full multivariate model, integrating classic and novel predictors, demonstrated excellent discriminative performance (AUC=0.96). Levetiracetam was the most frequently prescribed monotherapy, reflecting the predominance of adolescent and female patients; multidrug regimens were linked to poor seizure control.

Conclusion: Seizure outcome in pediatric JME is influenced by a complex interplay of cognitive, chronobiological, and electrographic factors. Integrating academic performance, seizure type, chronodependency, and advanced EEG findings enhances prognostication and supports a personalized, multidimensional approach to management. Early identification of at-risk patients may inform tailored interventions and improve long-term outcomes.

Backgound: Annular skin lesions are ring-shaped manifestations characterized by an erythematous margin and a preserved or atrophic center. Their pathophysiology involves mechanisms such as peripheral inflammatory mediator expansion or immune tolerance at the center of the lesions.

Methods: This article reviews some of the most common annular lesions observed in pediatric populations within our setting.

Results: We included urticarial vasculitis, childhood cutaneous lupus erythematous, Still's disease, annular granuloma, centriphugal annular erythema, pigmentary dermatoses, erythema migrans, multiform urticaria, acute hemorrhagic edema of the infancy, infectious dermatoses such as dermatophyte infections, and blistering conditions like linear IgA dermatosis, highlighting their clinical presentations, diagnostic approaches, and treatment options, emphasizing the importance of clinical correlation, biopsy findings, and appropriate therapeutic strategies.

Conclusion: This review will assist clinicians in diagnosing diseases associated with annular skin lesions.

Objective: This study seeks to establish the therapeutic reference range for tacrolimus blood concentrations in pediatric patients diagnosed with Henoch-Schönlein purpura nephritis (HSPN) and to evaluate the factors influencing tacrolimus pharmacokinetics in this population.

Methods: Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal therapeutic threshold for tacrolimus concentration. Comparative analyses were conducted to assess clinical efficacy and adverse event profiles across four groups of tacrolimus concentrations [Group A(<3 ng·mL^-1), Group B (3-<5 ng·mL^-1), Group C (5-<10 ng·mL^-1), and Group D (≥10 ng·mL^-1)], thereby establishing a reference therapeutic range. Kaplan-Meier survival analysis was employed to evaluate differences in continuous remission survival rate and remission duration among four distinct concentration groups, validating the precision of the target trough concentration range. Additionally, multivariate linear regression analysis was performed to identify significant factors influencing tacrolimus concentrations.

Results: A cohort of 105 pediatric patients diagnosed with HSPN were enrolled in this study. After six months of tacrolimus therapy, the ROC curve analysis revealed that the tacrolimus trough concentration had significant diagnostic value for clinical efficacy, with an area under the curve (AUC) of 0.816 (P < 0.01), and an optimal cutoff value of 3.02 ng·mL^-1. Comparative analysis of clinical efficacy across four groups demonstrated that Group A exhibited significantly lower efficacy compared to the other groups. After 12 months of tacrolimus treatment, the diagnostic utility of the ROC curve was further confirmed, with an AUC of 0.798 (P > 0.05), indicating limited predictive performance. Although no significant differences in adverse event rates were observed among the four groups, Group D displayed a notably higher incidence of nephrotoxicity relative to the other groups. Multivariate linear regression analysis identified serum creatinine level as a significant determinant of tacrolimus concentration (P < 0.05).

Conclusion: In pediatric patients with HSPN in China, maintaining tacrolimus trough concentrations within the therapeutic range of 3-5 ng·mL^-1 has been demonstrated to achieve optimal therapeutic efficacy.