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Levy M, Naudin J, Geslain G, Maroni A, Koehl B, Le Bourgeois F, Poncelet G, Chomton M, Deho A, Julliand S, Dauger S, Sommet J. Factors associated with adverse outcome among children with sickle cell disease admitted to the pediatric intensive care unit: an observational cohort. Ann Intensive Care 2024; 14:55. [PMID: 38594419 PMCID: PMC11003929 DOI: 10.1186/s13613-024-01283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/27/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is one of the most frequent inherited diseases in the world. Over the last decades, in high-income countries, an important decrease in mortality have been observed due to the improvement of care. However, children with SCD can become critically ill and require admission in Pediatric Intensive Care Units (PICU). The purpose of this study was to describe the epidemiology of children with SCD admitted to PICU for acute crisis and to identify factors associated with adverse outcome (AO). METHODS We conducted a retrospective study in a Tertiary Hospital in France including all consecutive children with SCD admitted to PICU between January 1st, 2009 and December 31, 2019. We collected baseline patient's characteristics, clinical and biological data as well as treatments and life sustaining therapies used in the PICU. Patients were defined as experiencing AO in case of death during stay and/or need for invasive mechanical ventilation (MV) and/or for non-invasive ventilation (NIV) for more than 3 days and/or need for vasopressors and/or need for renal replacement therapy. RESULTS We included 579 admissions in 395 patients, mainly of SS genotype (90%) with a median age of 9.2 years [5.5-13.4] and a median baseline hemoglobin of 8.0 g/dl (7.5-8.8). The two main reasons for admission were acute chest syndrome (ACS) (n = 331, 57%) and vaso-occlusive crisis refractory to first line therapy (n = 99, 17%). Half of patients required NIV and 47 (8%) required MV. The overall length of stay was 3 days [1-4] and seven (1%) patients died during PICU stay.There was a total of 113 (20%) admissions with AO and on multivariable analysis, baseline hemoglobin < 8 g/dL, history of bronchial obstruction and admission for ACS were associated with AO. There was no difference in the proportion of hydroxyurea treatment or exchange transfusion program between patients with AO and the other patients. CONCLUSIONS Baseline hemoglobin < 8 g/dL, history of bronchial obstruction and admission for ACS were the strongest risk factors for severe evolution in SCD children admitted to PICU. These factors could be taken into consideration when choosing the adequate therapeutic options.
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Affiliation(s)
- Michaël Levy
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France.
| | - Jérôme Naudin
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Guillaume Geslain
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Arielle Maroni
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Bérengère Koehl
- Reference Center for Sickle-Cell Disease, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U1134, Université Paris Cité, Paris, France
| | - Fleur Le Bourgeois
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Géraldine Poncelet
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Maryline Chomton
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Anna Deho
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Sébastien Julliand
- Pediatric Mobile Emergency Unit, Robert-Debré University Hospital, Assistance Publique- Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Julie Sommet
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
- General Pediatrics, Pediatric infectious disease and Internal Medicine, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, ECEVE UMR 1123, Paris, France
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Maurice L, Julliand S, Polak M, Bismuth E, Storey C, Renolleau S, Dauger S, Le Bourgeois F. Management of severe inaugural diabetic ketoacidosis in paediatric intensive care: retrospective comparison of two protocols. Eur J Pediatr 2022; 181:1497-1506. [PMID: 34993625 DOI: 10.1007/s00431-021-04332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/24/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022]
Abstract
UNLABELLED The best protocol for severe inaugural diabetic ketoacidosis (DKA) in children remains unclear. We compared two protocols by assessing effects during the first 24 h on osmolality, serum sodium, and glucose variations, which are associated with the risk of cerebral oedema, the most dreaded complication of DKA. We also recorded complications. We retrospectively included children aged 28 days to 18 years and admitted for severe DKA to either of two paediatric intensive care units (PICUs) in Paris (France). The two protocols differed regarding hydration volume, glucose intake, and sodium intake. From 17 June 2010 to 17 June 2015, 93 patients were included, 29 at one PICU, and 64 at the other. We compared severe glycaemic drops (> 5.5 mmol/L/h), mean glycaemia variations, serum sodium, serum osmolality, and the occurrence of cerebral oedema (CE) during the first 24 h after PICU admission. Severe glycaemic drops occurred in 70% of patients, with no between-group difference. Blood glucose, serum sodium, and serum osmolality variations were comparable. Seven (7.5%) patients were treated for suspected CE, (4 [10.3%)] and 3 [6.3%]) in each PICU; none had major residual impairments. CONCLUSION The two paediatric DKA-management protocols differing in terms of fluid-volume, glucose, and sodium intakes had comparable effects on clinical and laboratory-test changes within 24 h. Major drops in glycaemia and osmolality were common with both protocols. No patients had residual neurological impairments. WHAT IS KNOWN • Cerebral oedema is the most severe complication of diabteic ketoacidosis in children.The risk of cerebral oedema is dependant on both patient related and treatment-related factors. • The optimal protocol for managing severe inaugural diabetic ketoacidosis in children remains unclear, and few studies have targeted this specific population. WHAT IS NEW • Two management protocols that complied with ISPAD guidelines but differed regarding the amounts of fluids, glucose, and sodium administered produced similar outcomes in children with severe inaugural diabetic ketoacidosis. • Cerebral oedema was rare with both protocols and caused no lasting impairments.
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Affiliation(s)
- Laure Maurice
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Sébastien Julliand
- Paediatric Mobile Emergency Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michel Polak
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, IMAGINE Affiliate, Necker Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Elise Bismuth
- Department of Paediatric Endocrinology and Diabetology, Robert Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Storey
- Department of Paediatric Endocrinology and Diabetology, Robert Debré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvain Renolleau
- Paediatric Intensive Care Unit, Necker Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Stéphane Dauger
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Fleur Le Bourgeois
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Martin A, Lepers R, Julliand V, Julliand S. 31 Performance of exercised trotters fed high-cereal or high-alfalfa diets. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Julliand S, Julliand V, Grimm P. 66 In vitro comparison of six raw materials on gastric ecosystem activity and acidity. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Buttet M, Omphalius C, Milojevic V, Julliand V, Julliand S. 11 Assessment of the impact of age on fecal microbial ecosystem in horses. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Julliand S, Buttet M, Hermange T, Julliand V. 93 Effect of replacing part of concentrates with pelleted alfalfa on squamous gastric ulcers in exercised trotters. J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Collinet A, Grimm P, Julliand S, Julliand V. Oral administration of antibiotics alters fecal ecosystem of adult horses in the long-term. J Equine Vet Sci 2019. [DOI: 10.1016/j.jevs.2019.03.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Collinet A, Grimm P, Julliand S, Julliand V. Antibiotics challenge, dysbiosis, and immunoglobulin A response in horses. J Equine Vet Sci 2019. [DOI: 10.1016/j.jevs.2019.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grimm P, Julliand V, Julliand S. In vitro effect of alfalfa composition on gastric ecosystem activity. J Equine Vet Sci 2019. [DOI: 10.1016/j.jevs.2019.03.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Soichot M, Julliand S, Filatriau J, Hurbain A, Bourgogne E, Mihoubi A, Gourlain H, Delhotal-Landes B. Diagnosis of Heroin Overdose in an 8-Year-Old Boy: Reliable Contribution of Toxicological Investigations. J Anal Toxicol 2018; 42:255-264. [PMID: 29301012 DOI: 10.1093/jat/bkx111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Indexed: 11/12/2022] Open
Abstract
Toxicological investigations are often required by clinicians in comatose patients with suspected poisoning. However, the usefulness of toxicological analyses to support a diagnosis of acute poisoning is debated among clinicians and the interpretation of laboratory tests is challenging given the wide diversity of analytical techniques available. We report the case of an 8-year-old boy who was admitted to an intensive care unit with severe respiratory depression and neurological impairment. In order to formulate appropriate hypothesizes about the diagnosis and circumstances of intoxication, clinicians consulted toxicologists for a comprehensive toxicological screening. Routine blood immunoassays were negative for common toxicants but urine tests were positive for opiates. A general unknown screening using liquid and gas chromatography combined with mass spectrometry detection confirmed the presence of morphine, codeine and related glucuronides metabolites in plasma and urine. Subsequently, morphine and codeine were quantified in plasma samples by online-SPE-LC-MS-MS. In addition, analyses performed with GC-MS and LC-MSn identified compounds used as markers when profiling illicit heroin, namely noscapine, dextromethorphan and codeine. In conjunction with the patient's history, clinical picture and circumstances of intoxication, toxicological findings strongly suggested an acute pediatric opioid overdose as a collateral damage of parental heroin abuse in the home. This case highlights the significant contribution of toxicological investigations in sensitive legal cases and the critical role of communications between clinicians and toxicologists.
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Affiliation(s)
- M Soichot
- Service de Toxicologie, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, Paris 75010, France
| | - S Julliand
- Service Mobile d'Urgence et de Réanimation (SMUR), Hôpital Robert Debré, AP-HP, 48 Boulevard Sérurier, Paris 75019, France
| | - J Filatriau
- Service de Réanimation Pédiatrique, Hôpital Robert Debré, AP-HP, 48 Boulevard Sérurier, Paris 75019, France
| | - A Hurbain
- Bruker Daltonics, 34 Rue de l'Industrie, Wissembourg 67160, France
| | - E Bourgogne
- Service de Toxicologie, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, Paris 75010, France.,UMR 8638, Université Paris Descartes, 4 Avenue de l'Observatoire, Paris 75006, France
| | - A Mihoubi
- Service de Toxicologie, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, Paris 75010, France
| | - H Gourlain
- Service de Toxicologie, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, Paris 75010, France
| | - B Delhotal-Landes
- Service de Toxicologie, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, Paris 75010, France
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Abstract
The paediatric mobile emergency and intensive care service care teams have expertise in taking care of children in life-threatening circumstances. At the Robert-Debré Hospital in Paris, the paediatric Smur is multi-skilled, specialising particularly in transporting neonates and infants with severe cardiac or respiratory difficulties. The pathologies handled are very varied and include both neonatal pathologies and trauma pathologies in older children.
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Affiliation(s)
- Sébastien Julliand
- Réanimation, unité de surveillance continue et Smur pédiatriques, Hôpital Universitaire Robert-Debré, 48 boulevard Sérurier, 75019 Paris, France.
| | - Noëlla Lodé
- Smur pédiatrique, Hôpital Universitaire Robert-Debré, 48 boulevard Sérurier, 75019 Paris, France
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Julliand S, Martin A, Julliand V. In vitro impact of two commercially available complementary feeds on gastric content buffering capacity. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.03.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Soichot M, Julliand S, Filatriau J, Lehnert A, Desnous B, Laprévote O, Mihoubi A, Bourgogne E, Gourlain H, Delhotal-Landes B. Intoxication sévère aux opiacés chez un enfant de 8ans : la piste de l’héroïne. Toxicologie Analytique et Clinique 2016. [DOI: 10.1016/j.toxac.2016.03.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dauger S, Lachaussée N, Angoulvant F, Julliand S, Prot-Labarthe S. [Management of acute asthma]. Arch Pediatr 2016; 22:161-2. [PMID: 26112571 DOI: 10.1016/s0929-693x(15)30080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S Dauger
- Service de Réanimation et Surveillance Continue Pédiatriques, Hôpital Robert-Debré, AP-HP, Université Paris Diderot, Paris 7, France.
| | - N Lachaussée
- Service de Réanimation et Surveillance Continue Pédiatriques, Hôpital Robert-Debré, AP-HP, Université Paris Diderot, Paris 7, France
| | - F Angoulvant
- Service des Urgences Pédiatriques Médico-chirurgicales, Hôpital Necker-Enfants Malades, AP-HP, Université René Descartes, Paris 5, France
| | - S Julliand
- Service de Réanimation et Surveillance Continue Pédiatriques, Hôpital Robert-Debré, AP-HP, Université Paris Diderot, Paris 7, France
| | - S Prot-Labarthe
- Service de Pharmacie, Hôpital Robert-Debré, AP-HP, INSERM U1123, ECEVE, France
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Hérissé AL, Hogan J, Lebourgeois F, Julliand S, Dauger S. Intoxication accidentelle au gamma-hydroxybutyrate chez un nourrisson. Arch Pediatr 2016; 23:109. [DOI: 10.1016/j.arcped.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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Pelc R, Redant S, Julliand S, Llor J, Lorrot M, Oostenbrink R, Gajdos V, Angoulvant F. Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland. BMC Pediatr 2014; 14:125. [PMID: 24884619 PMCID: PMC4045874 DOI: 10.1186/1471-2431-14-125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Based on European recommendations of ESPGHAN/ESPID from 2008, first line therapy for dehydration caused by acute gastroenteritis (AGE) is oral rehydration solution (ORS). In case of oral route failure, nasogastric tube enteral rehydration is as efficient as intra-venous rehydration and seems to lead to fewer adverse events. The primary objective was to describe rehydration strategies used in cases of AGE in pediatric emergency departments (PEDs) in Belgium, France, The Netherlands, and Switzerland. METHODS An electronic survey describing a scenario in which a toddler had moderate dehydration caused by AGE was sent to physicians working in pediatric emergency departments. Analytical data were analyzed with descriptive statistics and Kruskal -Wallis Rank test. RESULTS We analyzed 68 responses, distributed as follows: Belgium N = 10, France N = 37, The Netherlands N = 7, and Switzerland N = 14. Oral rehydration with ORS was the first line of treatment for 90% of the respondents. In case of first line treatment failure, intravenous rehydration was preferred by 95% of respondents from France, whereas nasogastric route was more likely to be used by those from Belgium (80%), The Netherlands (100%) and Switzerland (86%). Serum electrolyte measurements were more frequently prescribed in France (92%) and Belgium (80%) than in The Netherlands (43%) and Switzerland (29%). Racecadotril was more frequently used in France, and ondansetron was more frequently used in Switzerland. No respondent suggested routine use of antibiotics. CONCLUSION We found variations in practices in terms of invasiveness and testing. Our study supports the need for further evaluation and implementation strategies of ESPGHAN/ESPID guidelines. We plan to extend the study throughout Europe with support of the Young ESPID Group.
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Affiliation(s)
| | | | | | | | | | | | | | - François Angoulvant
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, Villejuif, France.
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Julliand S, Omphalius C, Orard M, Parodi O, Villot C, Warren H, Julliand V. Relating sensory characteristics with biochemical analyses of hays fed to horses. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Julliand S, Boulé M, Baujat G, Ramirez A, Couloigner V, Beydon N, Zerah M, di Rocco F, Lemerrer M, Cormier-Daire V, Fauroux B. Lung function, diagnosis, and treatment of sleep-disordered breathing in children with achondroplasia. Am J Med Genet A 2012; 158A:1987-93. [DOI: 10.1002/ajmg.a.35441] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 03/22/2012] [Indexed: 11/11/2022]
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