Annales de pediatrie最新文献

A splenectomized three-year-old developed fulminant pneumococcal septicemia despite immunization and chemoprophylaxis. The course was rapidly fatal. Fulminant pneumococcal septicemia mainly affects splenectomized individuals and is associated with very substantial mortality. Immunization prior to splenectomy and daily prophylactic oral penicillin have partial preventive efficacy. Other useful measures include carrying a health status card and inpatient antimicrobial therapy in the event of fever. The need for these precautions should be repeatedly discussed with the child's parents and physician.

Between 1982 and 1992, 89 patients aged six months to 15 years were treated for acute renal failure at the Ibn Rochd Teaching Hospital. There were 51 males (57%) and 38 females (43%). All patients received conservative treatment. Fifty-eight patients (65%) required dialysis at the acute phase. The dialysis technique used was peritoneal dialysis in 22 cases (25%) and hemodialysis in 36 (40%). Twenty-nine patients received emergency dialysis for severe sodium and water overload and/or severe hyperkalemia. In the other cases, dialysis was initiated because of high blood urea and creatinine levels; before dialysis, blood urea exceeded 33 mmol/l (2 g/l) in every case and mean urea level was 51 mmol/l. Causes of acute renal failure included glomerulonephritis (n = 46), hemolytic uremic syndrome (n = 12), acute interstitial nephritis (n = 9), urinary tract obstruction (n = 5), and renal hypoperfusion (n = 11); in six cases, no cause was identified. Mortality rate was 17%. Recovery rate was higher in the subgroup of patients without anuria. Outcome was favorable in 65.5% of patients with glomerular disease. Most patients in this study did not require intensive care and none had post-cardiac surgery or neonatal acute renal failure which are known to carry a poor prognosis.

As part of a study of the clinical evaluation of infantile autism, interviews of parents of autistic, Down's syndrome, or normal children were subjected to content analysis. Parental representations in the three groups were determined. Parents often (81%) described their autistic children as "nervous" and felt distressed by their perceived failure to understand their child (62%). These findings suggest working hypotheses in the fields of care and research.

Three cases of behavioral disorders in children previously treated for a diencephalic tumor are reported. In such cases, classical psychiatric evaluation is difficult because reference data on childhood psycho-organic syndromes are lacking. Another complicating feature is that multiple factors contribute to the impairment of social interactions, including maladaptive reactions to disease-related stress, sensory deficits, and cognitive disorders. A structured evaluation should be performed in order to assess the child's behavior, the psychological and educational environment, and impairment of neuropsychological and neurophysiological function.

Although there has been concern about the use of psychoactive drugs in children, evidence is accumulating that these drugs are beneficial. The various groups of currently available drugs are reviewed with their pharmacological characteristics, adverse effects, dosages, and uses in children. Benzodiazepines, both widely used and severely criticized, are effective when used correctly, in particular for the shortest possible length of time. Antidepressants are indicated in many conditions including depression, obsessive-compulsive disorders, and anxiety; some of their indications are specific to children, such as separation anxiety, enuresis, and school phobia. Neuroleptics have a less well defined role and are usually given as symptomatic treatment, although their use is limited by their side effects. This is also true of lithium, despite fairly good tolerability in children. Carbamazepine was introduced in psychiatry too recently to allow valid evaluation. Psychostimulants are viewed with fear in France despite their documented efficacy in hyperkinetic children. A few other drugs used in other fields of medicine are currently being investigated in psychiatry (beta-blockers, clonidine, naloxone). A debate on drugs used in child psychiatry is much needed in particular to overcome the methodological and ethical problems raised by controlled trials of which few have been conducted to date. Drug therapy should be combined with psychotherapy to place the target symptoms in perspective with regard to the child's overall make-up.

Epidemiologic studies have consistently found that use of alcohol is increasing among teenagers and that children who have their first drink before the age of ten years are at increased risk for alcohol use during adolescence. In this study, a questionnaire was completed by 351 children (185 boys and 166 girls) aged 7 to 11 years in eight different schools in the Lille area (northern France). Most respondents (70.8%) reported previous experience with alcoholic beverages. Regular use of alcohol was reported by 8.7% of respondents and at least one episode of acute over-drinking by 23.6%. Attitudes towards alcohol and reasons for alcohol use varied across age groups. Use of alcohol produced guilt in the youngest children but was viewed as normal in the older age groups. Although some awareness of alcohol-related hazards was found, misconceptions were common. Use of alcohol was related to age and awareness: among the younger children, the level of awareness was significantly higher in regular users than in non-users, whereas the opposite was true in the older respondents. A positive correlation was found between current alcohol use and the children's predictions of future use. These data highlight the value of epidemiologic surveys for developing strategies aimed at preventing alcohol use in youngsters.

Many epidemiological studies have demonstrated the exceptionally high incidence of autism in children with the fragile X syndrome, and autism is often considered a "behavioral phenotype" of this syndrome. However, the discrepancies between the results of these studies disclosed strong effects of methodological flaws and demonstrated the need for gathering clinical data. Atypical "autistic-like" behaviors were then found to be common, early symptoms of the syndrome occurring against the background of early manifestations of mental retardation. These behaviors reflect these children's exquisite reactivity to change and contact with others. Avoidance of eye contact is the most significant feature. The appropriate diagnosis is not autism but phobia of social relationships. This highly specific vulnerability, which may be inherited, probably leads some of these patients to experience the fate of autistic children. It highlights the influence of environment on the clinical course and indirectly supports the role of early specialized care.

Maternal depression remains a public health problem as indicated by many studies focusing on depression in mothers of young children. Although the high prevalence of depression in mothers of infants and young children is now a recognized fact, the detection and management of maternal depression in everyday practice still raises significant problems. This initial review centers on studies providing diagnostic guidelines. The problem of maternal depression and of its impact on the offspring is relevant to the issue of how qualities, abilities, and vulnerabilities are transmitted from one generation to the next. Psychoanalysts, infant psychiatrists, and developmental psychologists show great interest in this field. The current review was restricted to recent Anglo-Saxon studies on depression-related changes in early maternal behavior. The most striking findings are as follows: although depression affects maternal behavior overall, there is considerable variation across mothers; timing alterations (in terms of micro and macro sequences) in mother-child interactions occur in every case and are among the obstacles to harmony and synchronization; subtle alterations in the mother's response to her baby's signals preclude flexibility and anticipation.

Recent epidemiological studies have evaluated the concomitant occurrence of several disorders in children. Over the last few years there have been reports from Anglo-Saxon investigators that many children with attention deficit disorder-hyperactivity also have anxiety disorders. This is the first French study addressing this issue. The prevalence and types of anxiety disorders were determined in 50 children with attention deficit disorder-hyperactivity using a questionnaire and a semi-structured interview. Over 40% of subjects had at least one concomitant anxiety disorder meeting DSM-III-R criteria. Hyperanxiety and separation anxiety were the most common anxiety disorders. Among patients with anxiety, over 40% had more than one anxiety disorder. These data are consistent with earlier Anglo-Saxon reports. Symptoms of anxiety which discriminated hyperactive children with and without anxiety disorders were identified.

Neurophysiological studies have demonstrated that processing of information is defective in hyperactive children. Converging lines of evidence suggest that both perception and attention are normal in these patients. In contrast, there are alterations in motor processes and in the regulation of energy resources used for motor output. The clinical and therapeutic implications of clinical research data are discussed.