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"Baby-led weaning" - Progress in infant feeding or risky trend? Arch Pediatr 2022; 29:516-525. [PMID: 36109286 DOI: 10.1016/j.arcped.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/12/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
Baby-led weaning (BLW), proposed as a new form of complementary feeding, has emerged as a real trend phenomenon in the media. Infants are seated at the family table from the age of 6 months, facing the foods they grab and bring to their mouth: they decide which foods they want to eat and what amount. The consumption of mashed foods and the use of a spoon are totally discouraged. BLW is increasingly used in nurseries and centers of young children. A bibliographic search carried out between 2000 and 2021 found 423 articles, of which 38 were selected. The clinical studies selected are 11 cross-sectional observational studies and two randomized controlled studies. BLW promotes breastfeeding, the early introduction of morsels, the respect of the child's appetite, the use of unprocessed foods, and the choice of "homemade" and friendliness. These benefits can nonetheless be reached with usual complementary feeding (SCF), according to current recommendations. Other benefits are claimed without scientific evidence such as easier achievement of dietary complementary feeding and an optimal growth with prevention of excess weight gain. BLW has some obvious downsides. The infant may not get enough energy, iron, zinc, vitamins, and other nutrients, or too much protein, saturated fat, salt, or sugar. The risk of choking, which must be distinguished from the physiological gagging reflex, has not been ruled out by scientific studies. Currently, the Nutrition Committee of the French Pediatric Society considers that the data published to date in terms of benefits and risks of BLW do not lend themselves to advice for this practice in preference over SCF carried out according to current recommendations.
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Augmentation des taux plasmatiques d’histamine chez les patients atteints de drépanocytose. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Évolution épidémiologique des infections bactériennes sévères communautaires de l’enfant : l’exception française. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Infections bactériennes sévères communautaires de l’enfant : fréquence et conséquences des soins suboptimaux initiaux. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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5
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[Risks associated with the use of non-steroidal anti-inflammatory drugs during pneumonia]. Rev Mal Respir 2018; 35:430-440. [PMID: 29754841 DOI: 10.1016/j.rmr.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/10/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Outpatient treatment of community-acquired pneumonia (CAP) patients with non-steroidal anti-inflammatory drugs (NSAIDs) is frequent, although this is not based on clinical recommendations and there is no scientific evidence supporting better symptom relief in comparison to acetaminophen. STATE OF THE ART Experimental data suggest that NSAIDs alter the intrinsic functions of neutrophils, limit their locoregional recruitment, alter bacterial clearance and delay the resolution of inflammatory processes during acute bacterial pulmonary challenge. In hospitalized children and adults with CAP, observational data suggest a strong and independent association between the outpatient exposure to NSAIDs and the occurrence of pleuropulmonary complications (pleural empyema, excavation, and abscess). In the only study taking into account possible protopathic bias, the association still persists. Other markers of morbidity have been described, including delay in hospital management, prolonged antibiotic therapy, and higher transfer rate to an intensive care unit. PERSPECTIVES Data describing the role of self-medication and the biological mechanisms involved are needed. CONCLUSIONS Intake of NSAIDs during outpatient treatment of CAP is probably the second modifiable factor of morbidity after inadequate antibiotic therapy. In light of existing data in children and adults, health authorities should urgently reassess the risk-benefit ratio of NSAIDS in CAP.
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New insights on the anatomy and function of the retina in sickle cell disease. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Hemoglobinopathies, thalassemia and sickle cell disease are among the most frequent monogenic diseases in the world. Transfusion has improved dramatically their prognosis, but provokes iron overload, which induces multiple organ damages. Iron overload is related to accumulation of iron released from hemolysis and transfused red cell, but also, in thalassemic patients, secondary to ineffective erythropoiesis, which increases intestinal iron absorption via decreased hepcidin production. Transfusion-related cardiac iron overload remains a main cause of death in thalassemia in well-resourced countries, and is responsible for severe hepatic damages in sickle cell disease. Regular monitoring by Magnetic Resonance Imaging (MRI) using myocardial T2* (ms) and Liver Iron Content (LIC) (mg of iron/g dry weight) are now standards of care in chronically transfused patients. Serum ferritin level measurements and record of the total number of transfused erythrocyte concentrates are also helpful tools. Three iron chelators are currently available, deferoxamine, which must be injected subcutaneously or intravenously, and two oral chelators, deferiprone and deferasirox. We will review the main characteristics of these drugs and their indications.
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Intérêt du (1,3)-béta-D-glucane pour le diagnostic de candidose invasive chez le nouveau-né. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Traitement conservateur des infections à Staphylococcus aureus liées aux cathéters veineux centraux de longue durée en pédiatrie. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Clinicians should not be forced to use likelihood ratios when comparing tests. Eur J Clin Microbiol Infect Dis 2016; 36:195-196. [PMID: 27696235 DOI: 10.1007/s10096-016-2800-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
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11
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[Bias and factors of variation in diagnostic studies]. Arch Pediatr 2015; 22:188-9. [PMID: 26112585 DOI: 10.1016/s0929-693x(15)30094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Markers of a recent bocavirus infection in children with Kawasaki disease: "a year prospective study". ACTA ACUST UNITED AC 2014; 62:365-8. [PMID: 25193448 DOI: 10.1016/j.patbio.2014.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Retrospective studies and case-reports have suggested the possible role of various viruses in the pathogenesis of the Kawasaki disease. OBJECTIVES To determine prospectively the incidence of Kawasaki diseases associated with a recent bocavirus infection in the course of a year. STUDY DESIGN Thirty-two children with Kawasaki disease were enrolled in a 13 months prospective study to assess the frequency of human bocavirus type 1 infections. Seasonal shedding of virus, markers of recent infection such as viraemia, viral load, and serum interferon alpha were analyzed. RESULTS Three of 32 (9%) children had HBoV-DNA in the serum suggesting a recent infection. HBoV-DNA was detected in naso-pharyngeal aspiration of 7/32 (21.8%) children with Kawasaki Disease and six of them (18%) had an increased viral load. No common respiratory viruses were isolated from the 32 patients with the exception of one adenovirus. The seven bocaviruses were identified during the winter-spring season. In addition, 4 of 7 of Kawasaki disease patients shedding bocavirus had detectable interferon alpha in the blood, indicating a possible active or recent viral infection. CONCLUSIONS This study shows that a recent bocavirus infection is concomitant with the onset of some cases of Kawasaki disease. Bocavirus may be a cofactor in the pathogenesis of this disease as previously reported for other infectious agents.
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Comment définir une croissance staturo-pondérale anormale ? Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71459-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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AFPA P-06 - Déterminants de l’usage des AINS dans la fièvre : une étude nationale. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71605-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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AFPA CO-05 - Règles de décision clinique pour les angines de l’enfant. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71597-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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SFP P-101 - Infections communautaires invasives à Entérobactéries productrices de BLSE (EBLSE). Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Syndrome des abcès aseptiques : étude d’une cohorte française et internationale. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Test de diagnostic rapide du streptocoque du groupe A dans les angines de l’enfant : effet et biais de spectre. Arch Pediatr 2012. [DOI: 10.1016/s0929-693x(12)71184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Faux positifs du test de diagnostic rapide du streptocoque du groupe A dans les angines de l’enfant. Arch Pediatr 2012. [DOI: 10.1016/s0929-693x(12)71183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paediatric nephrology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Diagnostic des méningites bactériennes : apport des règles de décision clinique. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Analyse des délais diagnostiques en pédiatrie : pièges méthodologiques. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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[Pneumococci isolated from vaccinated children with pneumonia]. Arch Pediatr 2011; 18:518-21. [PMID: 21458975 DOI: 10.1016/j.arcped.2011.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 02/03/2011] [Accepted: 02/20/2011] [Indexed: 11/28/2022]
Abstract
Among 76 children fully vaccinated with 7-valent conjugate vaccine and subsequently hospitalized from 2006 to 2009 for community-acquired pneumonia, isolated or with empyema or pleuritis, 10 had confirmed pneumococcal infections. All pneumococci isolated with blood or pleural culture were non vaccine serotypes (1, 5, 7F, and 19A). The proportion of pneumococcal pneumonias was similar to that in two series from the same hospital before the vaccine era. These data show that the 13-valent conjugate vaccine could be useful in prevention of community-acquired pneumonia and that bacteriologic survey of community-acquired pneumonia remains necessary.
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Épidémies parisiennes de gastro-entérites à norovirus. Arch Pediatr 2010; 17:1522-6. [DOI: 10.1016/j.arcped.2010.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 07/05/2010] [Accepted: 08/06/2010] [Indexed: 12/21/2022]
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Characteristics of Vogt-Koyanagi-Harada Disease in a French Cohort: Ethnicity, Systemic Manifestations, and HLA Genotype Data. Ocul Immunol Inflamm 2009; 16:3-8. [DOI: 10.1080/09273940801923895] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Soins sub-optimaux dans la prise en charge initiale des infections bactériennes sévères. Arch Pediatr 2009; 16:649-51. [DOI: 10.1016/s0929-693x(09)74099-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dépistage familial systématique dans la coqueluche du nourrisson. Med Mal Infect 2008; 38:477-82. [DOI: 10.1016/j.medmal.2008.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Revised: 11/09/2007] [Accepted: 06/23/2008] [Indexed: 11/24/2022]
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Procalcitonine semi-quantitative aux urgences pédiatriques. Arch Pediatr 2007; 14:529-31. [PMID: 17418544 DOI: 10.1016/j.arcped.2007.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/25/2022]
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[Simultaneous outbreaks of rotavirus and respiratory syncytial virus in Paris: a 12-year survey]. Med Mal Infect 2007; 37:262-5. [PMID: 17459636 DOI: 10.1016/j.medmal.2007.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 02/27/2007] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The authors had for aim to study the coincidence of RSV and rotavirus epidemic peaks in pediatric patients hospitalized in the Paris area. METHODOLOGY A retrospective hospital-based monocentric cohort study was made over a 12-year period (1993-2004). Clinical and laboratory findings were prospectively collected on admission. RESULTS Three thousand and four hundred ninety-six stool samples were positive for rotavirus; 3,507 nasopharyngeal aspirates were positive for RSV. The coincidence of epidemic peaks for both viruses in November, December, and January was observed during the 12 years of the study. CONCLUSION The exact coincidence of winter outbreaks of RSV and rotavirus is a characteristic of the Paris area. It contributes to increase overcrowding in pediatric units and nosocomial infections.
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Abstract
This study investigated 41 infants, aged <4 months, who were hospitalised with symptoms compatible with pertussis. Of these, 16 had Bordetella pertussis infection confirmed by real-time PCR. For four of these 16 patients, the initial sample was PCR-negative, but samples collected 5-7 days after the onset of infection were PCR-positive. PCR was also positive with samples from 15/16 families and 20/41 household contacts. Nine of the 20 positive household contacts were asymptomatic. Among the 16 infants with proven pertussis, apnoea was more frequent than in a control group for whom PCR was negative with both children and household contacts (69% vs. 28%). It was concluded that real-time PCR performed with samples from household contacts facilitates the diagnosis of infants suspected clinically of having pertussis, thereby enabling earlier treatment.
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[Distinction between bacterial and aseptic meningitis in children: refinement of a clinical decision rule]. Arch Pediatr 2007; 14:434-8. [PMID: 17258439 DOI: 10.1016/j.arcped.2006.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 12/08/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To refine and to re-validate the best current tool (the Nigrovic rule: ''outpatient management may be considered for children without seizure, blood neutrophil count>or=10,000/mm(3), positive cerebrospinal fluid -CSF- Gram-staining, CSF protein>or=80 mg/dl, or CSF neutrophil count>or=1,000/mm(3)'') proposed to distinguish between aseptic meningitis (AM) and bacterial meningitis (BM) in the emergency department. METHODS Children hospitalized for BM between 1995 and 2004, or AM between 2000 and 2004 were included, and randomly divided into derivation (111 children, 14 BM) and internal validation (57 children, 7 BM) sets. The Nigrovic rule was refined on the derivation set, introducing new variables (purpura, toxic appearance and high serum procalcitonin), changing variables thresholds (CSF protein) and withdrawing some variables (blood neutrophil count, CSF neutrophil count), according to previous results, with the aim to obtain 100% sensitivity user friendly tool. The refined rule was then applied on the internal validation set, stayed blinded during the derivation process. RESULTS The refined rule was: start antibiotics in case of seizure, purpura, toxic appearance, procalcitonin>or=0.5 ng/ml, positive CSF Gram-staining, or CSF protein>or=50 mg/dl. The refined rule had 100% sensitivity on the derivation and the internal validation sets (95% confidence interval 78-100, and 65-100, respectively) with 62 and 51% specificity, respectively. CONCLUSION The refined rule (called Meningitest) was a highly sensitive, specific and user friendly tool that could allow to safely avoid>50% a posteriori unuseful antibiotic treatments for patients with AM.
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Abstract
BACKGROUND Clinical decision rules have been derived to distinguish between bacterial and aseptic meningitis in the emergency room to avoid unnecessary antibiotic treatments and hospitalisations. AIMS To evaluate the reproducibility and to compare the diagnostic performance of five clinical decision rules. METHODS All children hospitalised for bacterial meningitis between 1995 and 2004 or aseptic meningitis between 2000 and 2004 have been included in a retrospective cohort study. Sensitivity and specificity were calculated by applying each rule to the patients. The best rule was a priori defined as the one yielding 100% sensitivity for bacterial meningitis, the highest specificity, and the greatest simplicity for a bedside application. RESULTS Among the 166 patients included, 20 had bacterial meningitis and 146 had aseptic meningitis. Although three rules achieved 100% sensitivity (95% CI 84-100), one had a significantly lower specificity (13%, 95% CI 8-19) than those of the other two rules (57%, 95% CI 48-65; and 66%, 95% CI 57-73), which were not statistically different. The ease of manual computation of the rule developed by Nigrovic et al (a simple list of five items: seizure, blood neutrophil count, cerebrospinal fluid (CSF) Gram stain, CSF protein, CSF neutrophil count) was higher than the one developed by Bonsu and Harper. CONCLUSION On our population, the rule derived by Nigrovic et al had the best balance between accuracy and simplicity of manual computation and could help to avoid two thirds of unnecessary antibiotic treatments and hospitalisations.
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Abstract
The study reported here prospectively evaluated the time-to-diagnosis of imported Plasmodium falciparum malaria in children in seven French pediatric emergency departments during a 1-week period. For the 29 patients included, the mean patient, doctor and total delays were 3.1, 1.5 and 4.7 days, respectively. The late medical diagnosis for 11 patients was mainly due to the treating physician's failure to consider malaria, despite having been informed that the child had been in an endemic area, and erroneously making a diagnosis of viral infection. The five patients who were diagnosed correctly without delay had higher mean platelet counts than the others (206,000 vs 118,541/mm(3); p=0.008). The results indicate that greater awareness of the risk of malaria in returning travelers may help reduce delays in diagnosis and its consequences.
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Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule. Arch Dis Child 2006; 91:241-4. [PMID: 15890693 PMCID: PMC2065936 DOI: 10.1136/adc.2004.068205] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To test the reproducibility of a highly sensitive clinical decision rule proposed to predict vesicoureteral reflux (VUR) after a first febrile urinary tract infection in children. This rule combines clinical (family history of uropathology, male gender, young age), biological (raised C reactive protein), and radiological (urinary tract dilation on renal ultrasound) predictors in a score, and provides 100% sensitivity. METHODS A retrospective hospital based cohort study included all children, 1 month to 4 years old, with a first febrile urinary tract infection. The sensitivities and specificities of the rule at the two previously proposed score thresholds (< or =0 and < or =5) to predict respectively, all-grade or grade > or =3 VUR, were calculated. RESULTS A total of 149 children were included. VUR prevalence was 25%. The rule yielded 100% sensitivity and 3% specificity for all-grade VUR, and 93% sensitivity and 13% specificity for grade > or =3 VUR. Some methodological weaknesses explain this lack of reproducibility. CONCLUSIONS The reproducibility of the previously proposed decision rule was poor and its potential contribution to clinical management of children with febrile urinary tract infection seems to be modest.
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Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection. J Urol 2006. [DOI: 10.1016/s0022-5347(05)00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Comparaison des prescriptions des pédiatres et des médecins généralistes : une étude en population en Franche-Comté sur la base de données de la caisse régionale d'assurance maladie. Arch Pediatr 2005; 12:1688-96. [PMID: 16102954 DOI: 10.1016/j.arcped.2005.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 06/14/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the medical management of children by private pediatricians or by general practitioners. POPULATION AND METHODS A retrospective cohort study analyzed information from the automated database of the Regional Health Insurance Fund for salaried workers in Franche-Comté from January 2001 through December 2002 and compared the mean rates of prescriptions in the populations seen only by general practitioners or mainly by pediatricians. RESULTS Analysis concerned 1 535 208 visits (office and home). Management by pediatricians was associated with 25% fewer consultations and 6% fewer hospitalizations. Pediatricians also wrote 25% fewer prescriptions for drugs, 17% fewer for laboratory tests, and 42% fewer for speech and language therapy. Children seen by pediatricians took antibiotics much less often (penicillin: -24%; cephalosporins: -74%; macrolides: -53%) as well as half as many corticoids and NSAIDs. Their vaccination coverage was more complete (31% more hepatitis B vaccines, 7% more MMR), as was prevention against rickets and cavities (twice the rate of vitamin D and fluoride prescriptions). The population followed mainly by pediatricians included 25% more children with a chronic disease. CONCLUSION General practitioners and pediatricians appear to differ significantly in their management of children. Other studies that can take into account such confounding factors as health status are needed to confirm these results.
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Faut-il développer l'épidémiologie clinique en pédiatrie ? Arch Pediatr 2005; 12:820-2. [PMID: 15904816 DOI: 10.1016/j.arcped.2005.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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[An example of hospital-based pharmacoepidemiology in paediatrics: tolerance to fluoroquinolones]. Arch Pediatr 2004; 11:500-2. [PMID: 15158810 DOI: 10.1016/j.arcped.2004.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
UNLABELLED Children without chronic or serious medical conditions are at increased risk for hospitalization during influenza seasons, mainly with respiratory tract infections. But influenza virus infections frequently remain undiagnosed, even in hospitalized patients. We prospectively studied the rate of concomitant and preceding influenza infections in children hospitalized with a community acquired pneumonia (CAP). POPULATION AND METHODS All 1-15-year-old children with CAP requiring hospitalization between 1st April 2000 and 2002 had nasopharyngeal aspirate for viruses, immunofluorescence and serologies for respiratory pathogens. The peak of influenza IgG measured by complement fixation (CF) is transient, and a titer of 1/64 or more indicates an acute influenza infection in the preceding weeks. Children with chronic disease were excluded and a control group of patients from outpatient clinic was measured. RESULTS Among 33 previously healthy children (age 4.9 years, range 1.2-14 years), 8 had a pneumococcal pneumonia, 10 a pneumonia caused by Mycoplasma pneumoniae (MP), 1 by Chlamydia pneumonia, and 8 of unknown origin. In six patients immunofluorescence was positive: Respiratory Syncitial Virus, 2, Adenovirus, 1 and Influenza A, 3 (including a patient with concomitant MP infection). Thirteen of the 33 children (39.4%) had evidence of a recent influenza A infection with CF ab > or = 1/64: with pneumococcal pneumonia, 5/10 with MP pneumonia, 3/8 with unknown origin pneumonia, 9/13 of these previous influenza infections being clinically inapparent. Only 1/30 children of control group (3.3%) had CF ab > or = 1/64. CONCLUSION In this study, influenza infection is the direct cause of CAP of children in 12% of cases. In other children with CAP, 39.4% of patients had an influenza infection in the preceding weeks which leads to secondary infection caused by Streptococcus pneumoniae or by MP or other pathogens.
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Abstract
OBJECTIVES To study the frequency with which maternity ward staff complete the perinatal information section of infants' permanent pediatric health records. METHODS In 2000, 71 pediatricians in private practice and on staff in a general pediatric ward in a tertiary hospital in Paris carried out an observational study to assess which indicators were reported at what rates. Pediatricians were also asked which information about the perinatal admission they would find helpful in these records. RESULTS One thousand seven hundred and eighty-five pediatric health records were studied. The frequency of completed information varied from 5 to 100%, depending on the item. Of the items reported rarely, some, such as thoracic circumference, were obsolete, while others were very important (response to noise, light reflex). The new information desired by office-based pediatricians involved mainly risk factors for vertical infections (maternal fever during delivery, prolonged rupture of the membranes). CONCLUSION Although the rate of completion of information in the pediatric health record was globally good, some important data should be reported more often (sensorial screening), while other items could be deleted. New information about the pregnancy and delivery would be useful.
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CO38 SFRP Tolerance des fluorquinolones chez l'enfant: etude prospective controlle multicentrique. Arch Pediatr 2003. [DOI: 10.1016/s0929-693x(03)90504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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[Mucolytic agents for acute respiratory tract infections in infants: a pharmacoepidemiologic problem?]. Arch Pediatr 2002; 9:1128-36. [PMID: 12503503 DOI: 10.1016/s0929-693x(02)00091-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the use of mucolytics agents, i.e. acetylcystein and carbocystein, in infants. To evaluate their efficacy and safety for their main indications. METHODS A prospective one-day survey of prescriptions among 95 office-based pediatricians. A systematic review of the literature. RESULTS Among 1327 prescriptions regarding infants, 4.3% were mucolytics agents. Main indications were rhinopharyngitis, isolated cough, and acute bronchitis. Our review did not identify any study of rigorous methodological quality that supported the efficacy or safety of mucolytics agents in infants for their in-label (isolated cough, acute bronchitis) and off-label (rhinopharyngitis) indications. Six cases of infants, aged less than eight months, presenting paradoxical bronchial congestion during a treatment with mucolytics agents, have been reported to the French pharmacovigilance system. No causal relationship was established from these cases because of a possible protopathic bias. DISCUSSION Our results concerning mucolytics agents use are similar to those reported by the French Health Care Funds. In addition to the lack of studies on efficacy, no studies on the dose-response relationship were available, leading to suggested dose regimens in the French license of acetylcystein ranging from 44.4 to 16.4 mg kg-1 j-1 between one to 24 months. These dose regimens could predispose to overdosing in the youngest infants as it seems observed in the six reported cases. CONCLUSION In infants, mucolytics agents efficacy has never been demonstrated and some elements suggest poor safety (paradoxical bronchial congestion).
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[Procalcitonin and viral meningitis: reduction of unnecessary antibiotics by measurement during an outbreak]. Arch Pediatr 2002; 9:358-64. [PMID: 11998420 DOI: 10.1016/s0929-693x(01)00793-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Viral meningitis are often treated with antibiotics in emergency because routine analysis of CSF is not always efficient for distinguishing between viral and bacterial infection. The aim of the study was to evaluate the usefulness of procalcitonin (PCT) to reduce antibiotic treatments. METHODS AND RESULTS A blood PCT level < 0.5 ng/mL was prospectively used for the diagnosis of viral origin of meningitis in 58 patients (two months-14 years), in which enterovirus was isolated by culture or PCR during an outbreak (May-June 2000). CSF cells range was 10 to 2800/mL (m: 244), PMN 5 to 2464/mL and CSF proteins range was 0.19 to 0.92 mg/dL (m: 0.37). Seventeen patients received antibiotic therapy in admission. In nine patients, PCT (dosage was routinely measured 3/week) result < 0.5 ng/mL was obtained in 24 h and in 48 h in six: treatment was then stopped and children led hospital. In two patients, PCT was > 1 ng/mL because of bacterial coinfection. CSF and PCT values were similar to those of an already published control group. CONCLUSION PCT dosage allowed to shorten hospitalization of 4.47 (controls) to 2.06 (patients) days in patients receiving unnecessary antibiotic treatments. During this outbreak, PCT dosage allowed to reduce 40 days of hospitalization.
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[Can clinical risk factors for perinatal mortality in West Africa be detected during antenatal care or during labor?]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2002; 31:63-9. [PMID: 11976579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Perinatal mortality (PNM) is a public health problem in West Africa. Aims. To evaluate the rate of PNM in 6 countries of West Africa, to identify clinical risk factors for PNM, to quantify the relative contribution of antenatal care and labor survey in the detection of these risk factors. METHODS The MOMA study was a prospective population-based study that collected data about 20326 pregnant women in various, primarily urban, areas of Burkina-Faso, Ivory-Coast, Mali, Mauritania, Niger and Senegal. The present report analyses 19.870 singleton births and 31 simple clinical variables. RESULTS The mean PNM ratio was 42 per 1000 total births. In the crude analysis, after adjustment or taking prevalence into account, the principal risk factors were: immediately antenatal and intrapartum vaginal bleeding, labor hypertension, dystocia and infection. CONCLUSION The PNM are very high in West Africa. The principal risk factors for PNM can be detected only during labor.
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Acetylcysteine and carbocysteine for acute respiratory tract infections in paediatric patients without chronic bronchopulmonary disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2001. [DOI: 10.1002/14651858.cd003124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
SUMMARY. Spontaneous pneumomediastinum (SPM) is rare in children, mainly affecting male adolescents. It is usually secondary to alveolar rupture in the pulmonary interstitium, followed by dissection of gas towards the hilum and mediastinum. Many pathological and physiological events can lead to alveolar rupture, but the most common cause in children is asthma. The clinical diagnosis is based on the symptom triad of chest pain, dyspnea, and subcutaneous emphysema, and is also based on Hamman's sign. The diagnosis is confirmed by chest radiography. The main differential diagnosis is esophageal perforation, which requires an esophagogram with contrast when there is the slightest doubt in the diagnosis. Spontaneous pneumomediastinum generally resolves spontaneously within a few days, meaning that ambulatory treatment is usually appropriate. Management consists of treating the underlying cause (if identified), rest, analgesics, and simple clinical monitoring. Predisposing factors should be identified and controlled to prevent recurrence. Cases of idiopathic SPM necessitate diagnostic pulmonary function tests after the acute episode, to establish whether the child has asthma.
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