Transmission des gastro entérites et infections respiratoires aiguës des enfants à leurs parents à domicile : étude des enfants en centre de garde de la Grande Région de Québec

Les infections respiratoires aigues (IRA) et les gastro-entérites aigues (GEA) sont les infections les plus fréquentes chez les enfants, leur incidence augmentant lors de la fréquentation de centres de garde. L’objectif de notre étude était d’estimer le risque de transmission des IRA et des GEA des enfants fréquentant les centres de garde à leurs parents. Nous avons par ailleurs décrit les mesures de prévention utilisées par les familles afin de prévenir la transmission de ces infections à domicile. Notre étude est rétrospective, basée sur des enfants de 12 à 60 mois fréquentant les Centres de la Petite Enfance (CPE) de plus de 60 places de la Grande région de Québec, Canada, ainsi que leurs parents. 374 foyers et 608 participants ont été inclus. L’incidence des IRA et des GEA est respectivement 19 et 8,7 épisodes pour 100 enfants-mois. Les deux types d’infections sont fréquemment acquises par les parents soit environ une fois sur trois. Les GEA chez les parents entrainent plus fréquemment de l’absentéisme au travail que les IRA (60% vs 34%), cet absentéisme étant légèrement plus long (23% vs 15% absent ≥2 jours). Les habitudes rapportées concernant les mesures de prévention des infections au sein des familles sont pratiquement les mêmes pour les IRA et GEA. Le lavage des mains au savon reste la principale mesure évoquée dans les deux cas. Ainsi, le risque de transmission des infections respiratoires et digestives aux parents via leur enfant n’est pas négligeable de même que leur impact. Les IRA sont plus fréquentes chez les enfants mais l’absentéisme parental au travail est plus important suite à la transmission des GEA. Nos résultats suggèrent que les mesures de prévention à domicile méritent une grande attention, un renforcement de l’éducation aux familles et une évaluation par des études prospectives

Vascularites associées aux ANCA à début pédiatrique (présentation clinique et devenir à long terme. Etude multicentique française)

INTRODUCTION : les vascularites associées aux ANCA (anticorps anti-cytoplasme des PNN) sont bien décrites dans la population adulte alors qu'en pédiatrie, bien que rares, ces pathologies restent peu dans la littérature pédiatrique. OBJECTIFS : le but de cette étude était de décrire le tableau clinique initial, le traitement et le devenir à long terme des vascularites à ANCA à début pédiatrique. L'objectif secondaire était d'identifier les déterminants potentiels de l'évolution rénale qui conditionne le pronostic de la maladie. PATIENTS ET METHODES : il s'agit d'une étude rétrospective multicentrique conduite dans 9 centres hospitaliers français, principalement des services de néphrologie pédiatrique, au cours des 25 dernières années. Les granulomatoses avec polyangéite (GPA) selon les critères EULAR 2008 et les polyangéites microscopiques (PAM) ont été inclues; les syndromes de Churg-Strauss ont été exclus. RESULTATS : quarante-neuf enfants ont été inclus, 18 GPA et 31 PAM. Le profil du patient est celui d'un adolescent, de sexe féminin, en général caucasien. La présentation clinique initiale est marquée par une altération de l'état général et de la fièvre, les atteintes pulmonaire et rénale. Le tableau initial est similaire entre PAM et GPA, à l'exception de l'atteinte des VAS spécifique de la GPA. L'atteinte rénale est quasiment constante dans notrre étude et fait le pronostic de la maladie. L'atteinte pulmonaire principale est l'hémorragie pulmonaire. Les atteintes cutanéo-muqueuses et rhumatologiques ne sont pas rares mais sont peu spécifiques. Le traitement est très variable et a considérablement évolué au cours du temps. Les critères de réponse thérapeutique apparaissent favorables et les rechutes sont toutefois habituelles, plus fréquentes dans le groupe des GPA. Le risque de décès est faible dans notre population (6 %) et associé au risque d'insuffisance rénale terminale. Une IRT est présente chez plus d'un tiers de la population d'étude, le plus souvent dès le diagnostic ou dans les semaines suivantes. Les principaux facteurs associés au risque de survenue d'IRT sont le retard diagnostique et l'altération de la fonction rénale initiale. CONCLUSION : Les connaissances à propos de vascularites associées aux ANCA ont considérablement progressé au cours des dernières années, permettant une amélioration du pronostic global. Elles restent encore peu connues des pédiatres, en dehors de certains centres spécialisés et il apparaît important de ne pas les méconnaître au vu de l'impact du retard diagnostic.BACKGROUND : Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is mainly reported in adults. Data in children is scarce. The current study aimed to describe the clinical features of the disease at diagnosis and the long-term outcomes in pediatric patients with ANCA-associated vasculitis. METHODS : This retrospective study was conducted in 9 French Hospitals (mainly pediatric nephrology units) and includes patients diagnosed during the past 25 years. Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) were included, but not Churg-Strauss syndrome. RESULTS : Forty-nine children were included, 18 (37 %) with GPA and 31 (63 %) with MPA, 71 % children were PANCA+/MPO. Female predominated (84 %), the median age at diagnosis was 11 years [9-12], and average time to diagnosis was 1 month (20d-6m). 57 % children presented with fever, 76 % with deterioration of generall condition. 90 % had renal involvement. Among them 86 % had proteinuria, 41 % had hypertension, 84 % had renal failure of whom one third presented with end-stage renal disease (ESRD), 20 % had gross hematuria and 78 % microscopic hematuria. Almost half the patients showed pulmonary involvement (alveolar hemorrhage for 77 % and nodules for 22 %. 27 % presented with upper involvement, 45 % with cutaneous lesions (68 % purpura), and 41 % with arthritis. Few had digestive, ophtalmic or CNS involvement. After an average follow-up of 5 years (1g-8g), 3 patients (6 %) died. 94 % were considered in remission after induction treatment and 85 % at last follow-up. 68 % of children with initial renal involvement developed chronic kidney disease, half of them progressed to ESRD. Five-year kidney survival was 66 %. CONCLUSION : Clinical features and outcome in children with ANCA-vasculitis are close to the findings in adults but they are characterized by delayed diagnosis and female predominance. Although the cases may be selected, renal involvement appears as a major prognostic factor of the disease. Diagnosis delay and sclerosis on initial renal histology appear as factors predicting renal survival.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Childhood-onset autoimmune cytopenia as the presenting feature of biallelic ACP5 mutations

Childhood-onset chronic and refractory cytopenias are rare and may be genetic in etiology. We report three pediatric cases of severe autoimmune thrombocytopenia or anemia associated with growth retardation and spastic diplegia with intracranial calcification. The identification of platyspondyly and metaphyseal lesions suggested a potential diagnosis of spondyloenchondrodysplasia (SPENCD), which was confirmed with the identification of biallelic ACP5 mutations. Two patients demonstrated elevated serum interferon alpha levels. Our report highlights ACP5-associated disease as a cause of childhood-onset autoimmune cytopenia, particularly combined with growth retardation and/or spasticity. Furthermore, a role for type I interferon in the pathogenesis of autoimmune cytopenias is supported

Iron‐fortified formula use in young children and association with socioeconomic factors in the French nationwide ELFE cohort: Iron--fortified formula use and socioeconomic factors

Marie Aline Charles, PhD and Martin Chalumeau, MD, PhD : are equally contribution.International audienceTo study the rate of iron-fortified infant formula (IFF) use in young children in France and its association with socioeconomic factors.The ELFE national birth cohort included, in 2011, 18 329 living births in 349 hospitals randomly selected. The present analyses were restricted to children with follow-up at age two years. Milk consumption was evaluated by parental telephone interview, and its association with socioeconomic factors was studied.The 12 341 analysed children had a mean age of 26 months; 50% were girls. Rate of IFF use before two years old and at two years old was 65% and 43%, respectively. At age two years, use of IFF was lower with young age of the mother (adjusted OR [aOR] = 0.4, 95% CI: 0.3-0.5), low educational level (aOR = 0.7, 95% CI: 0.6-0.9), high parity (aOR = 0.3, 95% CI 0.2-0.4), and mother smoking (aOR = 0.8, 95% CI: 0.7-0.9) as well as low household income (aOR = 0.5, 95% CI: 0.4-0.7), and parents' unemployment (aOR = 0.7, 95% CI: 0.5-0.9).In this national population-based study, the rate of implementation of the ID prevention strategy was much lower at two years old than before two years old, and significantly lower in disadvantaged populations

Iron-fortified formula consumption in toddlers and association with sociodemographic factors in France: results from the ELFE national birth cohort

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Stability of serum ferritin measured by immunoturbidimetric assay after storage at -80°C for several years

<div><p>Background</p><p>Iron deficiency (ID) may impair long-term neurological development when it occurs in young infants. In cohort studies, it is sometimes necessary to evaluate ID with sera kept frozen for several years. To assess ID, learned societies recommend measuring serum ferritin (SF) level combined with C-reactive protein level. The long-term stability of C-reactive protein in frozen samples is well established but not ferritin.</p><p>Methods</p><p>We measured SF level (immunoturbidimetric assay; in micrograms per liter) immediately after collection from 53 young adults recruited and followed-up in Porto, Portugal, from 2011 to 2013 (SF₁), and then, in 2016 in two aliquots kept frozen at– 80°C for 3 to 5 years: one without (SF_2A) and one with (SF_2B) intermediate thawing in 2014. We compared SF₁ to SF_2A then SF_2B; statistical agreement was evaluated by the Bland and Altman method and the effect of intermediate thawing by regression modelling.</p><p>Results</p><p>Mean SF_2A–SF₁ and SF_2B–SF₁ differences were -2.1 (SD 7.0) and 48.9 (SD 66.9). Values for Bland and Altman 95% limits of agreement were higher for the comparison of SF_2B and SF₁ than SF_2A and SF₁: -82.2 to 179.9 and -15.8 to 11.8, respectively; the effect of thawing was highly significant (p <0.001).</p><p>Conclusions</p><p>Agreement between SF values before and after 3 to 5 years of constant freezing at -80°C was in a generally accepted range, which supports the hypothesis of ferritin’s stability at this temperature for a long period. In long-term storage by freezing, intermediate thawing induced a major increase in values.</p></div

Hepcidin, Soluble Transferrin Receptor, and Other Biomarkers of Iron Status Distributions in Healthy 2 Years Old Infants from a National Ambulatory Study in France

International audienceBackground: Adequate evaluation of iron status in young children is of paramount importance given the frequency of iron deficiency (ID) and its potential short- and long-term neurocognitive adverse effects when occurs early. Iron metabolism is complex and the correct evaluation of iron status may be difficult, notably when inflammation is present. Soluble transferrin receptor (sTfR) is not modified by inflammation but lacks specificity in ID, and its combination with serum ferritin (SF) by the TfR-F index (TfR/logSF) has been proposed to improve diagnosis performances [Punnonen Blood 1997]. Hepcidin has been identified in the two last decades has the key regulator of iron homeostasis mainly by controlling iron release from macrophages via ferroportin degradation, as well as enterocytes absorption [Ganz Blood 2011]. Scarce studies have been published on hepcidin in healthy children in industrialized countries [Uijterschout Pediatr Res 2014]. The distribution of sTfR and hepcidin in healthy young children is unknown, including according to gender. Aims: Our objective was to describe hepcidin, sTfR and other iron status biomarkers (serum ferritin [SF], hemoglobin (Hb), transferrin saturation, zinc protoporphyrin [ZnPP]) distributions in a population of healthy infants aged 2 years old. Methods: In a cross-sectional observational study conducted in primary care pediatricians' offices throughout France from 2016 to 2017, infants aged 2 years old were consecutively included to undergo a blood sampling in the morning fasting. They were excluded if they were affected by a chronical disease involving iron metabolism, had fever in the last 15 days or biological inflammation defined as a CRP≥10 mg/L, and had no measurement for hepcidin. Hepcidin and ZnPP in erythrocytes were measured after a 0.3). Distributions of other iron biomarkers were closed to those reported in the literature. Conclusion: We described for the first time in a nationwide ambulatory study hepcidin and TfR/logSF distributions in a population of 2 year-old healthy infants with a low ID prevalence. Hepcidin had a right-skewed distribution and its normalisation was not obtained by usual transformations. Low values, partly corresponding to the limit of detection, were over-represented despite the low proportion of ID defined by SF level. High values were also observed despite the exclusion of infants with CRP>10 mg/L. We did not find significant variations according to gender. Our results will help define normal values at this age to better interpret iron status

Clinical Prediction of Iron Deficiency at Age 2 Years: A National Cross-sectional Study in France

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Young children formula consumption and iron deficiency at 24 months in the general population: A national-level study

International audienceBackground & aims: Iron deficiency (ID) is considered the most frequent micronutrient deficiency in industrialized countries where strategies for its primary prevention vary widely and are insufficiently evaluated. We aimed to study the effectiveness for iron status of a national iron deficiency prevention strategy based on recommendations for young-child formula (YCF) use after age 12 months, taking into consideration other sources of iron and the family's socio-economic status.Methods: In a cross-sectional observational study conducted in primary care pediatrician offices throughout France from 2016 to 2017, infants aged 24 months were consecutively included for a food survey and blood sampling. Associations between YCF consumption and serum ferritin (SF) level were studied by multivariable regression after adjustment on sociodemographic, perinatal and dietary characteristics, notably other intakes of iron.Results: Among the 561 infants analyzed, the ID prevalence was 6.6% (37/561; 95% confidence interval [CI] 4.7-9.0). Daily iron intake excluding YCF and total daily iron intake including YCF were below the 5-mg/day recommended average requirements for 63% and 18% of children, respectively. ID frequency was significantly decreased (or SF level was independently higher) with any YCF consumption after age 10 months (odds ratio 0.15, 95% CI 0.07-0.31), current YCF consumption at age 24 months (median SF level 29 vs 21 μg/L if none), prolonged YCF consumption (28 μg/L if >12 months vs 17 μg/L if none), and increasing daily volume of YCF consumed at age 24 months from a small volume (e.g., 29 μg/L if <100 mL/day vs 21 μg/L if none).Conclusions: Current or past YCF use was independently associated with a better iron status at age 24 months than non-use. The strategy recommending YCF use at weaning after age 12 months seems effective in the general population. CLINICALTRIALS.Gov identifier: NCT02484274