Archives De Pediatrie最新文献_第9页

Practical implementation of the collegial decision-making procedure in case of possible unreasonable obstinacy in Neonatology 对新生儿可能出现的不合理执拗，实行合议决策程序。

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-07-01 DOI: 10.1016/j.arcped.2025.03.002

Charlotte Charbonnier , Anne Bellot , Grégoire Moutel , Mélanie Alexandre

Introduction

The withholding or withdrawal of life-sustaining treatment has become the predominant cause of death in neonatal intensive care units. The advancements in perinatal medicine have led to a re-evaluation of the necessity and relevance of initiating and maintaining those treatments in patients whose conditions are not expected to improve. This decision must be made in accordance with the codified collegial decision-making process outlined in French law. In light of the shifts in end-of-life care, a review of professional practice is crucial.

Objective

The objective of this study was to analyze the practical implementation of the collegial decision-making process in the Neonatology Department of the Caen University Hospital. The analysis focused on three key areas: the logistical setup, the compliance with the legal framework, and the deliberation mechanisms for each collegial decision-making process. To assess the implementation of the limitation of life-sustaining treatment meetings, a variety of methods were employed, including participant observation, review of medical records, and the distribution of surveys to participants.

Results

In one year, 16 collegial decision-making processes were initiated, and 20 meetings were scheduled to discuss the restrictions on life-sustaining treatment. In 2 cases, the process was initiated by parents. The primary clinical condition that prompted the implementation of a collegial procedure was neurological. The presence of an external consultant was noted in 19 times. In 3 out of 20 times, parents weren't notified of their child's meeting prior to the date but all were informed of the meeting's conclusions. Data indicate a statistically significant correlation between professional category and perceived freedom to speak and legitimacy to do so, and the influence of the legal guardian's viewpoint on the participants' thinking.

Conclusion

The legal framework was generally respected, and the culture of service facilitated the incorporation of the collegial procedure into the habits of professionals.

不接受或停止维持生命的治疗已成为新生儿重症监护病房死亡的主要原因。围产期医学的进步已经导致重新评估的必要性和相关性启动和维持这些治疗的患者的病情预计不会改善。这一决定必须按照法国法律所概述的编纂成文法的合议决策程序作出。鉴于临终关怀的转变，对专业实践的回顾至关重要。目的：本研究的目的是分析合议决策过程在卡昂大学医院新生儿科的实际实施情况。分析集中在三个关键领域：后勤设置、法律框架的遵守以及合议庭决策过程的审议机制。为了评估维持生命治疗会议限制的实施情况，采用了多种方法，包括参与者观察、医疗记录审查和向参与者分发调查问卷。结果：一年内共启动了16次合议决策程序，并安排了20次会议讨论维持生命治疗的限制。在两个案例中，这个过程是由父母发起的。促使实施合议程序的主要临床状况是神经系统。有19次指出有外部顾问在场。在20次会议中，有3次家长在会议日期之前没有得到通知，但他们都被告知了会议的结论。数据表明，职业类别与感知的言论自由和言论合法性之间存在统计学上显著的相关性，以及法定监护人的观点对参与者思维的影响。结论：法律框架普遍受到尊重，服务文化促进了合议程序融入专业人员的习惯。

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引用次数: 0

Residents’ perceptions of the on-call experience and of the supervision of their clinical reasoning skills in the paediatric emergency department: A qualitative study 住院医师对儿科急诊科随叫随到经验和临床推理技能监督的看法：一项定性研究。

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-07-01 DOI: 10.1016/j.arcped.2025.03.003

Christine Pietrement , Racha Onaisi , Hubert Maisonneuve

Background

A substantial number of residents suffer from stress, anxiety, which may be acutely exacerbated by stressful situations such as being on call. When confronted with complex situations, uncertainty, a lack of medical experience, residents experience a mismatch between their theoretical knowledge and their clinical reasoning skills. In a previous study we observed high levels of cognitive weariness and anxiety in residents being on call in the paediatric emergency department, and the reduction of their cognitive weariness by training clinician-educators in the supervision of clinical reasoning.

Objectives

Thereafter we sought to inform the findings of our previous quantitative research by exploring in depth the experience of on-call residents in the paediatric emergency department, including: the factors that impact their well-being, and how supervision of their clinical reasoning might change it.

Methods and Setting

We performed a qualitative study using semi-structured interviews. We interviewed medical residents who were on call in the paediatric emergency department, mentored by paediatricians who had received specific training in the supervision of clinical reasoning.

Results

The findings revealed two opposing profiles of how residents experience being on call and having their clinical reasoning supervised. First, there were those who expressed marked discomfort, characterized by anxiety, a strong need for supervision, a fear of being judged by the supervisor, and a major impact of physical fatigue. Residents with this profile seem to be at risk of developing burnout, or symptoms thereof. The second profile of residents expressed little unease, had a sense of self-efficacy, a feeling of personal competence, a high level of self-confidence, greater tolerance of uncertainty, and little difficulty with making decisions.

Conclusions

Supervision of clinical reasoning based on questioning techniques seems to participate to promote development towards second profile, with greater tolerance of uncertainty, ease with decision-making, and a reinforced sense of belonging to a team.

背景：相当数量的住院医生患有压力，焦虑，这可能会严重加剧压力的情况下，如值班。当面对复杂的情况、不确定性、缺乏医疗经验时，住院医生会经历理论知识和临床推理技能之间的不匹配。在之前的一项研究中，我们观察到在儿科急诊科随叫随到的住院医生中存在高水平的认知疲劳和焦虑，通过培训临床医生-教育者对临床推理的监督来减少他们的认知疲劳。目的：此后，我们试图通过深入探索儿科急诊科随叫随到的住院医生的经验来告知我们之前的定量研究结果，包括：影响他们幸福的因素，以及如何监督他们的临床推理可能会改变它。方法和背景：我们采用半结构化访谈进行定性研究。我们采访了在儿科急诊科随叫随到的住院医生，他们由接受过临床推理监督方面专门培训的儿科医生指导。结果：研究结果揭示了两种相反的概况如何居民经验是随叫随到，并有他们的临床推理监督。首先，有些人表现出明显的不适，其特征是焦虑，强烈需要监督，害怕被主管评判，以及身体疲劳的严重影响。具有这种特征的居民似乎有发展倦怠或其症状的风险。第二组居民表现出很少的不安，有自我效能感，个人能力感，高度自信，对不确定性有更大的容忍度，在做决定时没有什么困难。结论：基于质疑技术的临床推理监督似乎有助于促进第二人格的发展，对不确定性的容忍度更高，更容易做出决策，并增强对团队的归属感。

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引用次数: 0

French childminder knowledge of pediatric guidelines for screen use: An observational study 法国保育员对儿童筛查指南的了解：一项观察性研究。

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-07-01 DOI: 10.1016/j.arcped.2025.05.005

C. Allet , M. Samaille , A.D. Marq , M. Bailhache

Background

Early, excessive, and inappropriate screen exposure has negative short- and long-term effects on children. In France, registered childminders are the main source of childcare.

Objective

To explore childminder knowledge of the pediatric guidelines for screen use and the potential negative effects on children.

Participants and Setting

Registered childminders working in the French department of Gironde who had email accounts.

Methods

The maternal and child health services unit of the Gironde department distributed an anonymous online questionnaire from January 24, 2023, to February 19, 2023. Data were collected on childminder characteristics, personal screen use practices, knowledge of potential negative effects of inappropriate screen use, and knowledge of best practice recommendations for screen use. A knowledge score ranging from 0 (all wrong) to 14 (good) was constructed.

Results

A total of 1102 registered childminders participated; the median knowledge score was 9 with an InterQuartile Range of [7.5, 10.5]. A total of 95.2 % agreed that screen use should be avoided before the age of three. A minority of childminders, 13.4 % and 23.1 %, respectively, had good answers for possible short—and long-term negative effects. Childminders younger than 50 years with less experience and those who tend to use screens more had better knowledge than the others.

Conclusions

French childminders interviewed in Gironde have relatively good knowledge of pediatric guidelines for screen use.

背景：过早、过度和不适当的屏幕暴露对儿童有短期和长期的负面影响。在法国，注册保育员是儿童保育的主要来源。目的：了解保育员对儿童筛查使用指南的了解情况及其对儿童的潜在负面影响。参与者和环境：在法国吉伦特省工作的注册保育员，他们有电子邮件帐户。方法：吉伦特省妇幼保健服务单位于2023年1月24日至2023年2月19日在线发放匿名调查问卷。收集了关于保育员特征、个人屏幕使用习惯、对不适当使用屏幕的潜在负面影响的了解，以及对屏幕使用最佳实践建议的了解等方面的数据。知识评分范围从0（全部错误）到14（良好）。结果：共有1102名注册保育员参与调查；知识得分中位数为9，四分位数差为[7.5,10.5]。共有95.2%的人同意在三岁之前避免使用屏幕。少数保育员（分别为13.4%和23.1%）对可能产生的短期和长期负面影响回答良好。年龄小于50岁、经验较少的保育员和倾向于更多使用屏幕的保育员的知识比其他人更好。结论：在吉伦特接受采访的法国保育员对儿童筛查使用指南的了解相对较好。

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引用次数: 0

Galactorrhoea and amenorrhea as first symptoms of acute myeloid leukaemia: a case report and literature review 乳溢和闭经是急性髓性白血病的首发症状：1例报告并文献复习。

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-07-01 DOI: 10.1016/j.arcped.2025.04.003

Kevin Perge , Anne-Laure Peugnet , Sara Cabet , Sandrine Girard , Carine Villanueva , Cecile Renard , Antony Ceraulo

Background

Acute leukaemia is typically identified through clinical signs of cytopenia and/or a tumour syndrome, while paraneoplastic syndromes are rare in this context. We report a unique case of a 10-year-old girl who initially presented with inflammatory joint pain, night sweats, weight loss, amenorrhea, breast swelling, and galactorrhoea.

Observation

At diagnosis, she had an elevated prolactin (PRL) level (260.5 μg/L, reference < 25 μg/L) and biological evidence of hypogonadism. Blood counts revealed anaemia, thrombocytopenia, and 11 % circulating blasts. Bone marrow aspiration confirmed acute leukaemia, classified as FAB M5, with a KAT6A:CREBBP fusion transcript.

Discussion

Cerebrospinal fluid analysis was negative for blasts, and brain magnetic resonance imaging showed no leukemic infiltration of the pituitary gland or a concomitant pituitary tumour. PRL level normalized following chemotherapy.

Conclusion

In the absence of central nervous system involvement, ectopic PRL secretion by leukemic blasts appears to be the most plausible explanation for the elevated PRL levels in this case.

背景：急性白血病通常通过细胞减少和/或肿瘤综合征的临床症状来识别，而副肿瘤综合征在这种情况下很少见。我们报告一个独特的情况下，一个10岁的女孩谁最初提出炎性关节痛，盗汗，体重减轻，闭经，乳房肿胀和乳漏。观察：诊断时，患者泌乳素（PRL）水平升高（260.5 μg/L，参考值< 25 μg/L），生物学证据显示性腺功能减退。血球计数显示贫血、血小板减少症和11%的循环原细胞。骨髓穿刺证实急性白血病，分类为FAB M5，具有KAT6A:CREBBP融合转录物。讨论：脑脊液分析为阴性，脑磁共振成像显示脑垂体无白血病浸润或伴发垂体瘤。化疗后PRL水平恢复正常。结论：在没有中枢神经系统受累的情况下，白血病母细胞分泌异位PRL似乎是本病例中PRL水平升高的最合理解释。

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引用次数: 0

Description of the use of Vitamin D in children aged 0–18 months 0-18个月儿童维生素D使用的描述。

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-07-01 DOI: 10.1016/j.arcped.2025.01.006

Margot Vrignaud , Stéphanie Provôt , Fabienne Aubin , Bénédicte Vrignaud , Josselin Bernard , Sonia Prot-Labarthe

Following the alerts issued by the French health authorities and the craze among parents wishing to use natural medicine, many cases of intoxication have occurred in recent years. We aimed to describe vitamin D intake by patients under 18 months of age in three hospitals in the Great West of France and via social networks.

Data were collected on the caregivers (age, place of residence, vitamin D supplementation during mother's pregnancy, opinion on vitamin D), the patient (age, place in sibling group, diet), and the drug (prescriber, origin, form prescribed versus administered, dosage, medication or dietary supplement, number of omissions, reason for non-administration if any). Five hundred six responses were collected, highlighting a disparity in vitamin D administration in drug and dietary supplement form. Vitamin D was not administered in 7 % of the responses collected because there was no initial or renewed prescription). Food supplement was given to 77, i.e., 16 % of respondents. Only 43 % of mothers received supplementation during pregnancy. One person mentioned being very careful with the dosage as there had been a case of overdosing in their family. There were many different opinions expressed on the usefulness of supplementation: from "no interest," "gives colic," and "questionable composition," to "I am confused," and also "essential" or "I have complete confidence in my doctor."

Misinformation about vitamin D supplementation persists in the French population and leads us to consider how to educate the population about the role of vitamin D: handing out leaflets in maternity wards, increasing communication in magazines accessible to the general public, a media campaign, etc.

在法国卫生当局发出警告以及希望使用天然药物的父母的热潮之后，近年来发生了许多中毒病例。我们的目的是通过社交网络描述法国大西部三家医院18个月以下患者的维生素D摄入量。收集了护理人员（年龄、居住地、母亲怀孕期间维生素D补充情况、对维生素D的看法）、患者（年龄、在兄弟姐妹组中的位置、饮食）和药物（开处方者、来源、处方与给药形式、剂量、药物或膳食补充剂、遗漏次数、不给药原因（如果有的话））的数据。研究人员收集了560份反馈，突出了维生素D在药物和膳食补充剂形式中的应用差异。在收集到的回复中，有7%的人没有服用维生素D，因为没有初始处方或更新处方)。有77人，即16%的受访者得到了食物补充。只有43%的母亲在怀孕期间服用了补充剂。一个人提到要非常小心剂量，因为在他们的家庭中有一个过量服用的案例。关于补充剂的作用，人们表达了许多不同的意见：从“不感兴趣”、“引起绞痛”、“成分可疑”到“我很困惑”，还有“必不可少”或“我完全信任我的医生”。关于补充维生素D的错误信息一直存在于法国民众中，这促使我们考虑如何教育民众了解维生素D的作用：在产科病房分发传单，在公众可获得的杂志上增加交流，开展媒体宣传活动等。

{"title":"Description of the use of Vitamin D in children aged 0–18 months","authors":"Margot Vrignaud , Stéphanie Provôt , Fabienne Aubin , Bénédicte Vrignaud , Josselin Bernard , Sonia Prot-Labarthe","doi":"10.1016/j.arcped.2025.01.006","DOIUrl":"10.1016/j.arcped.2025.01.006","url":null,"abstract":"<div><div>Following the alerts issued by the French health authorities and the craze among parents wishing to use natural medicine, many cases of intoxication have occurred in recent years. We aimed to describe vitamin D intake by patients under 18 months of age in three hospitals in the Great West of France and via social networks.</div><div>Data were collected on the caregivers (age, place of residence, vitamin D supplementation during mother's pregnancy, opinion on vitamin D), the patient (age, place in sibling group, diet), and the drug (prescriber, origin, form prescribed versus administered, dosage, medication or dietary supplement, number of omissions, reason for non-administration if any). Five hundred six responses were collected, highlighting a disparity in vitamin D administration in drug and dietary supplement form. Vitamin D was not administered in 7 % of the responses collected because there was no initial or renewed prescription). Food supplement was given to 77, i.e., 16 % of respondents. Only 43 % of mothers received supplementation during pregnancy. One person mentioned being very careful with the dosage as there had been a case of overdosing in their family. There were many different opinions expressed on the usefulness of supplementation: from \"no interest,\" \"gives colic,\" and \"questionable composition,\" to \"I am confused,\" and also \"essential\" or \"I have complete confidence in my doctor.\"</div><div>Misinformation about vitamin D supplementation persists in the French population and leads us to consider how to educate the population about the role of vitamin D: handing out leaflets in maternity wards, increasing communication in magazines accessible to the general public, a media campaign, etc.</div></div>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":"32 5","pages":"Pages 295-300"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Severe urological involvement in junctional epidermolysis bullosa justifying bladder enlargement by sigmoidocystoplasty and Mitrofanoff appendicovesicostomy 大疱性结缔组织表皮松解严重累及泌尿系统，证明乙状结肠膀胱成形术和米特罗凡诺夫阑尾膀胱造口术可扩大膀胱。

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-05-01 DOI: 10.1016/j.arcped.2025.01.002

Marielle Ehilé-Kacou , Pierre Yves Mure , Delphine Demede , Alice Phan , Justine Bacchetta , Valeska Bidault , Bruno Ranchin

The urological complications of junctional epidermolysis bullosa (JEB) are difficult to manage because of the fragility of the skin and mucosa, and are not the subject of any recommendations. We report on 2 cases of chronic lower urinary tract dysfunction causing chronic kidney disease, treated by bladder enlargement with sigmoidocystoplasty and Mitrofanoff appendicovesicostomy after failure of medical treatment and suprapubic catheterisation several times a day. Follow-up was favourable in both children, with kidney function preservation and significant improvement of quality of life.

交界性表皮松解症（JEB）的泌尿系统并发症很难处理，因为皮肤和粘膜很脆弱，而且没有任何建议。我们报告了两例慢性下尿路功能障碍导致慢性肾病的病例，在药物治疗和每天数次耻骨上导尿失败后，通过乙状结肠膀胱成形术和米特罗法诺夫阑尾造口术扩大膀胱。两名患儿的后续治疗效果良好，肾功能得以保留，生活质量显著提高。

引用次数: 0

Anxiety disorders and major depressive disorders in 299 adolescents hospitalized for assessment of common obesity: A retrospective cohort study 299名因评估常见肥胖而住院的青少年的焦虑障碍和重度抑郁障碍：一项回顾性队列研究

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-05-01 DOI: 10.1016/j.arcped.2025.01.004

Morgan Seyler , Caroline Barry , Alexandra Loisel , Marie Rose Moro , Jonathan Lachal , Hervé Lefèvre

Background

Obesity has major psychosocial impacts in adolescents. Anxiety and depression are the most common psychiatric conditions in adolescents suffering from obesity.

Objectives

To measure and discuss the prevalence of psychiatric disorders in adolescents hospitalized for biopsychosocial assessment of common obesity during multidisciplinary care.

Methods

This retrospective monocentric study describes mental disorders over a decade (2012–2021) in 299 adolescents with obesity hospitalized for a global somatic and psychiatric assessment. Patients aged 11–18 were included. Sociodemographic data, psychiatric diagnosis, self-report questionnaires (CDI, Children's Depression Inventory, STAIC, State-Trait Anxiety Inventory for children, BES, Binge Eating Scale) were analyzed.

Results

27,4 % of adolescents had an anxiety disorder (AD), 18,7 % had a major depressive disorder (MDD) and 49,2 % had no mental disorder. In multiple regression models, exposure to physical violence (p < 0.01), and the BES score (p < 0.05) were also associated with a risk of AD. Exposure to physical violence, year of admission and the BES score were risk factors for MDD (p < 0.05).

Conclusions

Prevalence of mental disorders is high and increasing, confirming the psychological suffering in adolescent with obesity. Some present with incomplete clinical profiles. MDD and AD are associated with a personal history of violence and a high BES score, reflecting in some adolescents a phenomenon of compensatory binge eating.

背景：肥胖对青少年有重大的社会心理影响。焦虑和抑郁是肥胖青少年最常见的精神疾病。目的：测量和讨论在多学科治疗中接受常见肥胖生物心理社会评估的青少年精神疾病的患病率。方法：这项回顾性单中心研究描述了299名肥胖青少年住院治疗十多年（2012-2021）的精神障碍，并进行了全球躯体和精神评估。纳入了11-18岁的患者。分析社会人口学资料、精神病学诊断、自我报告问卷（CDI、儿童抑郁量表、STAIC、儿童状态-特质焦虑量表、BES、暴食量表）。结果：27.4%的青少年患有焦虑症（AD）， 18.7%的青少年患有重度抑郁症（MDD）， 49.2%的青少年无精神障碍。在多元回归模型中，暴露于身体暴力（p < 0.01）和BES评分（p < 0.05）也与AD的风险相关。身体暴力暴露、入院时间、BES评分是MDD的危险因素（p < 0.05）。结论：青少年肥胖患者的精神障碍患病率高且呈上升趋势，证实了青少年肥胖患者的心理痛苦。部分患者临床表现不完整。重度抑郁症和AD与个人暴力史和高BES分数有关，反映了一些青少年的代偿性暴饮暴食现象。

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引用次数: 0

Adverse events associated with intravenous immunoglobulin infusions in pediatric patients with primary immunodeficiency: A 10-year single-center study 儿童原发性免疫缺陷患者静脉注射免疫球蛋白相关的不良事件：一项为期10年的单中心研究

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-05-01 DOI: 10.1016/j.arcped.2025.01.008

Murat Özer, Seher Tekeli, Selçuk Doğan, Sema Çetin, Rıdvan Selen, Caner Aytekin

Background

Intravenous immunoglobulin G (IVIg) is used as a replacement therapy in primary immunodeficiency disorders (PIDs). Although IVIg is generally accepted as a safe treatment, the incidence of adverse events (AEs), most of which are mild and transient, varies between 1 % and 81 %. The aim of this study was to determine the adverse effects and influencing factors associated with IVIg replacement therapy in pediatric patients with PID.

Materials and Methods

Children with PID who received IVIg replacement therapy between January 1, 2012 and December 31, 2021, at Dr. Sami Ulus Children's Hospital were included in our study.

Results

Overall, 69 (52 male, 17 female) patients who received a total of 2,025 IVIg infusions were evaluated. AEs were observed in 40.6 % of the patients and in 8.9 % of the infusions. All AEs encountered in the study were mild to moderate. Immediate-onset AEs were observed in 3.5 % of the infusions and delayed-onset AEs in 5.4 %. Late-onset AEs were not observed. The most commonly observed AEs were headache (n = 50, 2.5 %), fever (n = 37, 1.8 %), and malaise (n = 19, 0.9 %). The most common immediate AE was fever (n = 28, 1.4 %), while the most common delayed AE was headache (n = 44, 2.2 %).

Conclusion

AEs encountered in patients with PID receiving IVIg infusions are mild to moderate. Pediatric patients should be followed up for delayed AEs by contacting their families after the infusion is completed and should be questioned before the next infusion. IVIg replacement is a safe treatment when given with an appropriate premedication and infusion rate.

背景：静脉注射免疫球蛋白G （IVIg）被用作原发性免疫缺陷疾病（pid）的替代疗法。尽管IVIg通常被认为是一种安全的治疗方法，但不良事件（ae）的发生率（大多数是轻微和短暂的）在1%至81%之间变化。本研究的目的是确定儿童PID患者IVIg替代治疗的不良反应及影响因素。材料和方法：2012年1月1日至2021年12月31日在Dr. Sami Ulus儿童医院接受IVIg替代治疗的PID患儿纳入我们的研究。结果：总共评估了69例患者（52例男性，17例女性），共接受了2025次IVIg输注。40.6%的患者和8.9%的输注者出现不良反应。研究中遇到的所有不良事件均为轻度至中度。立即发作的不良反应发生率为3.5%，延迟发作的不良反应发生率为5.4%。未观察到迟发性不良事件。最常见的ae是头痛（n = 50, 2.5%）、发热（n = 37, 1.8%）和不适（n = 19, 0.9%）。最常见的即刻AE是发热（n = 28, 1.4%），最常见的延迟AE是头痛（n = 44, 2.2%）。结论：接受IVIg输注的PID患者发生的不良反应为轻至中度。儿科患者应在输注完成后通过联系其家人对延迟性ae进行随访，并应在下次输注前进行询问。如果给予适当的预用药和输注速率，IVIg替代是一种安全的治疗方法。

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引用次数: 0

Role of early MRI in predicting the risk of hippocampal sclerosis in children with febrile status epilepticus 早期MRI在预测发热性癫痫持续状态儿童海马硬化风险中的作用。

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-05-01 DOI: 10.1016/j.arcped.2024.12.007

Rose Germain , Mathilde Le Floch , Marine Dubois , Pauline Cloarec , Raphaël Chouteau , Bertrand Bruneau

Background

Epilepsy is the main complication of febrile status epilepticus (FSE) in children. The association between FSE and the development of hippocampal sclerosis (HS) and mesial temporal lobe epilepsy (MTLE) is controversial.

Objectives

This study primarily aimed to evaluate the role of magnetic resonance imaging (MRI) in diffusion-weighted imaging (DWI) sequence during the acute phase of FSE in predicting long-term development of HS and epilepsy. The secondary objective was to assess the value of arterial spin labeling (ASL) perfusion MRI in the acute phase of FSE.

Methods and settings

Patients with a first episode of FSE between 6 months and 5 years of age who underwent early MRI were retrospectively included. MRI analysis focused on the DWI signal and the presence of perfusion abnormalities on ASL imaging. We also examined the first electroencephalogram (EEG) during the acute phase. Long-term follow-up analysis assessed the occurrence of HS on MRI scans and the development of epilepsy.

Results

A total of 15 children were included. The presence of restricted diffusion areas on MRIs performed in the acute phase after FSE was significantly associated with the later development of HS. However, the association between restricted diffusion areas on early MRIs and the development of pharmaco-resistant epilepsy on follow-up, found in 3 patients, was not statistically significant. There was a trend for an association between early ASL perfusion MRI changes and EEG findings when both examinations were performed closely.

Conclusion

Early DWI-MRI seems to play a major role in the prognostic evaluation of FSE in children. It may help to determine hippocampal involvement and assess the risk of subsequent HS. However, the study data are insufficient to conclude on the association between diffusion abnormalities and the development of MTLE. Although ASL perfusion may provide additional insight, more data are needed.

背景：癫痫是儿童发热性癫痫持续状态（FSE）的主要并发症。FSE与海马硬化（HS）和内侧颞叶癫痫（MTLE）的发展之间的关系是有争议的。目的：本研究主要旨在评价FSE急性期磁共振成像（MRI）弥散加权成像（DWI）序列在预测HS和癫痫长期发展中的作用。次要目的是评估动脉自旋标记（ASL）灌注MRI在FSE急性期的价值。方法和背景：回顾性纳入6个月至5岁之间首次发作的FSE患者，并进行早期MRI检查。MRI分析主要集中在ASL成像的DWI信号和灌注异常的存在。我们还检查了急性期的第一次脑电图（EEG）。长期随访分析评估HS在MRI扫描上的发生和癫痫的发展。结果：共纳入15例患儿。在FSE后急性期mri上出现的受限扩散区与HS的后期发展显著相关。然而，在随访中发现的3例患者中，早期mri上受限扩散区域与耐药癫痫的发展之间的相关性无统计学意义。早期ASL灌注MRI变化与脑电图结果有密切联系的趋势。结论：早期DWI-MRI似乎在儿童FSE的预后评估中起着重要作用。它可能有助于确定海马受累和评估随后HS的风险。然而，研究数据不足以得出弥散异常与MTLE发展之间的关系。虽然ASL灌注可能提供额外的见解，但需要更多的数据。

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引用次数: 0

Behavioral parenting intervention for parents of preschool-aged children born moderately and late preterm: An experimental study 行为育儿干预对中重度早产学龄前儿童父母的影响：实验研究

IF 1.3 4区医学 Q3 PEDIATRICS

Archives De Pediatrie

Pub Date : 2025-05-01 DOI: 10.1016/j.arcped.2025.03.001

Géraldine Maigret, Edouard Gentaz, Fleur Lejeune

Background

Prematurity can be associated with difficulties in emotional and behavioral regulation in children, leading to short- and long-term impacts on parental dynamics. However, moderate-late preterm children and their parents rarely receive follow-up care.

Objectives

The aim of this current study was to evaluate a Behavioral Parenting Intervention (BPI) specifically developed for parents of preschool-aged moderate-late preterm children, to prevent their potential difficulties in emotional and behavioral regulation.

Method

Thirty-eight families participated in a program consisting of 7 therapy sessions. Each experimental group was matched with a control group; the control group would become the experimental group in the following session. Parents completed questionnaires one week before the start of the program (T1) and at the end of the 7th therapy session to measure immediate effects (T2). Social validity measures were also added to this study to assess the feasibility and acceptability of our program.

Results

We primarily observed positive effects on the Parental Stress Index total (PSI) in the population 1. For the control group, there was no significant difference between PSI Total scores at T1 (M = 101.1, SD = 22.2) and T2 (M = 101.5, SD = 19.8). In contrast, the experimental group showed a significant reduction in PSI total scores from T1 (M = 105, SD = 23.2) to T2 (M = 93.3, SD = 21.3), with p < .001. Similar effects were observed for both the Parent Distress and the Difficult Child subscales.

Conclusion

While our results are modest, the measures of social validity and our high satisfaction rates indicate the importance and necessity of a parenting intervention aimed at moderately preterm children beyond the initial phase of early development. Future research should aim to facilitate access and increase family engagement to improve the effectiveness of this type of intervention.

背景：早产可能与儿童情绪和行为调节困难有关，导致对父母动态的短期和长期影响。然而，中晚期早产儿及其父母很少接受后续护理。本研究的目的是评估一种专门为学龄前中晚期早产儿父母开发的行为父母干预（BPI），以预防他们在情绪和行为调节方面的潜在困难。方法对38个家庭进行7次治疗。每个实验组与一个对照组相匹配；对照组将成为下一阶段的实验组。家长在项目开始前一周（T1）和第七次治疗结束时完成问卷调查，以衡量即时效果（T2）。本研究还加入了社会效度测量来评估我们的计划的可行性和可接受性。结果本研究主要观察到对群体父母压力指数（PSI）的积极影响。对照组在T1 （M = 101.1, SD = 22.2）和T2 （M = 101.5, SD = 19.8）时PSI总分比较，差异无统计学意义。相比之下，实验组PSI总分从T1 （M = 105, SD = 23.2）到T2 （M = 93.3, SD = 21.3）显著降低，p <；措施。类似的效果也被观察到出现在“父母苦恼”和“困难儿童”两个分量表中。结论虽然我们的研究结果并不明显，但社会效度和高满意度的测量表明，针对早期发展初期以上的中度早产儿童进行父母干预的重要性和必要性。未来的研究应旨在促进获取和增加家庭参与，以提高这类干预的有效性。

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