Comparaison de l'impression clinique du praticien avant et après obtention des résultats biologiques dans le dépistage d'une infection bactérienne chez le nourrisson de moins de 3 mois

Objectif: Evaluer et comparer l'impression clinique et l'impression clinico-biologique du praticien dans le dépistage d'une infection bactérienne sévère (IBS) chez le nourrisson fébrile âgé de moins de 3 mois. Méthodes: 2204 nourrissons âgés de 7 à 92 jours ont été inclus prospectivement dans 15 centres d'urgences pédiatriques français du 1er octobre 2008 au 1er mars 2011. le praticien complétait un cahier de recueil clinique anonymisé et évaluait sur une échelle visuelle analogique la probabilité d'IBS avant (proba1) et après (proba2) obtention des résultats biologiques aux urgences. Résultats: La prévalence d'IBS était de 18,2%. Le sex-ratio était de 1,45 et l'âge moyen de 51,8 +/- 22,1 jours. Les signes significativement plus fréquents dans le groupe des nourrissons ayant une IBS étaient une fièvre élevée et une modification du cri et de l'échange. Les symptômes ORL et respiratoires étaient en faveur de l'absence d'IBS. La performance diagnostique de la proba2 était meilleure que celle de la proba1 sans influence de l'âge ni de la saison. L'aire sous la courbe receiver operating characteristic de la proba2 était de 0,85 pour le diagnostic d'IBS. Pour 1,7% des enfants le praticien a été faussement rassuré par les examens biologiques. Conclusion: La performance diagnostique de l'impression clinico-biologique du praticien (proba2 de notre étude) n'est pas optimale mais elle est supérieure aux scores diagnostiques existants. Ce résultat demande à être confirmé par d'autres études en incluant le dosage de la procalcitonine.Aim: To evaluate and to compare the practitioner clinical and clinico-biological impression in the detection of a serious bacterial infection (SBI) in febrile infants less than 3 months old. Methods: 2204 infants aged from 7 to 92 days were prospectively included in 15 French pediatric emergency centers between October 1st, 2008 and March 1st, 2011. The practitioner completed a list of anonymous clinical data collection and assessed on a visual analogue scale the probability of SBI before (proba1) and after (proba2) obtaining the results of biological testing from the emergency unit. Results: SBI prevalence was 18.2%. The sex ratio was 1.45 and the average age of 51.8 +/- 22.1 days. The most significant and frequent signs in the group of infants with SBI were a high fever and a change in the crying and way in communicating. ENT and respiratory symptoms were in favor of the absence of SBI. The diagnostic performance of proba2 was better than the proa1 with no influence of age or season. The area under the receiver operating characteristic curve for the proba2 was 0.85 in the diagnosis of SBI. The practitioner has been wrongly reassured by laboratory tests for 1.7% of children. Conclusion: The diagnostic performance of the clinico-biological impression of the practitioner (proba2 of our study) is not optimal but is superior to existing diagnostic scores. This result needs to be confirmed by other studies including procalcitonin's dosage.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Formative evaluation to improve prevention of sudden infant death syndrome (SIDS): a prospective study.

International audienceAIM: To evaluate formative evaluation, a pedagogic method that sensitizes mothers to sudden infant death syndrome (SIDS), as a new way to improve prevention of SIDS. METHODS: Prospective and randomized study. Mothers in a test group (n = 148) received an educative questionnaire about SIDS during maternity stay. Three months later, we evaluated, by a telephonic interview, their scores of knowledge and observance of the recommendations in comparison with a control group (n = 144). RESULTS: Mothers' scores at the educative questionnaire was 5.12 (1.52) [mean(standard deviation)]. The scores performed 3 months later were better in test group for knowledge [7.64 (1.56) vs. 7.16 (1.61), p < 0.01] and for observance [8.28 (1.51) vs. 7.62 (1.72), p < 0.001]. Logistic regression analysis confirmed the benefits in test group regarding knowledge of SIDS risk factors [ORa = 1.69 (1.02-2.77), p < 0.05], of the advice to avoid overheating infants [ORa = 2.50 (1.43-4.38), p < 0.01] and of the risks of bed sharing [ORa = 2.7 (1.6-4.5), p < 0.001]. There was a significant association between non-compliance with the sleeping position recommendation and unemployment (p < 0.01) and absence of postsecondary school education (p < 0.01). CONCLUSION: Formative evaluation using an educative questionnaire could improve maternal awareness on SIDS risk factors and their compliance with recommendations about SIDS prevention

Diagnosis of fetal urinary tract malformations: prenatal management and postnatal outcome.

International audienceOBJECTIVE: To evaluate prenatal management and to define the criteria of gravity for accurate assessment of the renal and overall prognosis of fetuses presenting malformations of the urinary tract. METHODS: We carried out a retrospective study of 127 cases of urinary tract malformation. We carried out descriptive statistical and univariate analyses as a function of severity criteria and the outcome of pregnancy. RESULTS: One-third of fetuses presented associated extrarenal malformations and 10% of the karyotypes were abnormal. There were more abortions in case of decrease in amniotic fluid volume (p < 0.001), extent of renal damage (p < 0.05), presence of associated extrarenal malformations (p < 0.05), early diagnosis of the malformation (p < 0.001) and presence of chromosomal syndrome (p = 0.01). In our study, there was an excellent correlation between prenatal data and pathological findings for the fetus following abortions for medical reasons or obtained during the surveillance of live-born children. Fetal biochemistry made very little contribution. CONCLUSION: In cases of urinary tract malformation, this work confirms the need for regular and frequent ultrasound scans, checking for the echographic factors indicative of gravity and for adapted karyotyping. It also demonstrates that pluridisciplinary management is necessary for the prenatal evaluation of renal and overall fetal prognosis

Cardiac involvement in pediatric hemolytic uremic syndrome.

International audienceBackgroundCardiac involvement is a known but rare complication of pediatric hemolytic uremic syndrome (HUS). We conducted a nationwide observational, retrospective case–control study describing factors associated with the occurrence of myocarditis among HUS patients.MethodsCases were defined as hospitalized children affected by any form of HUS with co-existent myocarditis in 8 French Pediatric Intensive Care Units (PICU) between January 2007 and December 2018. Control subjects were children, consecutively admitted with any form of HUS without coexistent myocarditis, at a single PICU in Lyon, France, during the same time period.ResultsA total of 20 cases of myocarditis were reported among 8 PICUs, with a mean age of 34.3 ± 31.9 months; 66 controls were identified. There were no differences between the two groups concerning the season and the typical, Shiga toxin-producing Escherichia coli (STEC-HUS), or atypical HUS (aHUS). Maximal leukocyte count was higher in the myocarditis group (29.1 ± 16.3G/L versus 21.0 ± 9.9G/L, p = 0.04). The median time between admission and first cardiac symptoms was of 3 days (range 0–19 days), and 4 patients displayed myocarditis at admission. The fatality rate in the myocarditis group was higher than in the control group (40.0% versus 1.5%, p < 0.001). Thirteen (65%) children from the myocarditis group received platelet transfusion compared to 19 (29%) in the control group (p = 0.03).ConclusionOur study confirms that myocarditis is potentially lethal and identifies higher leukocyte count and platelet transfusion as possible risk factors of myocarditis

Prevalence of Novel MAGED2 Mutations in Antenatal Bartter Syndrome

International audienceBACKGROUND AND OBJECTIVES: Mutations in the MAGED2 gene, located on the X chromosome, have been recently detected in males with a transient form of antenatal Bartter syndrome or with idiopathic polyhydramnios. The aim of this study is to analyze the proportion of the population with mutations in this gene in a French cohort of patients with antenatal Bartter syndrome. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The French cohort of patients with antenatal Bartter syndrome encompasses 171 families. Mutations in genes responsible for types 1-4 have been detected in 75% of cases. In patients without identified genetic cause (n=42), transient antenatal Bartter syndrome was reported in 12 cases. We analyzed the MAGED2 gene in the entire cohort of negative cases by Sanger sequencing and retrospectively collected clinical data regarding pregnancy as well as the postnatal outcome for positive cases. RESULTS: We detected mutations in MAGED2 in 17 patients, including the 12 with transient antenatal Bartter syndrome, from 16 families. Fifteen different mutations were detected (one whole deletion, three frameshift, three splicing, three nonsense, two inframe deletions, and three missense); 13 of these mutations had not been previously described. Interestingly, two patients are females; in one of these patients our data are consistent with selective inactivation of chromosome X explaining the severity. The phenotypic presentation in our patients was variable and less severe than that of the originally described cases. CONCLUSIONS: MAGED2 mutations explained 9% of cases of antenatal Bartter syndrome in a French cohort, and accounted for 38% of patients without other characterized mutations and for 44% of male probands of negative cases. Our study confirmed previously published data and showed that females can be affected. As a result, this gene must be included in the screening of the most severe clinical form of Bartter syndrome

Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis

International audienc

Clinical course and cost assessment of infants with a first episode of acute bronchiolitis presenting to the emergency department: Data from the GUERANDE clinical trial

International audienc

Clinical course and cost assessment of infants with a first episode of acute bronchiolitis presenting to the emergency department: Data from the GUERANDE clinical trial

International audienceIntroduction: Bronchiolitis is the leading cause of hospitalization for infants but its economic burden is not well documented. Our objective was to describe the clinical evolution and to assess the 1-month cost of a first episode of acute bronchiolitis presenting to the emergency department (ED).Methods: Our study was an epidemiologic analysis and a cost study of the cohort drawn from the clinical trial GUERANDE, conducted in 24 French pediatric EDs. Infants of 6 weeks to 12 months of age presenting at pediatric EDs with a first episode of bronchiolitis were eligible. The costs considered were collected from a societal viewpoint, according to the recommendations of the French National Health Authority.Results: A total of 777 infants were included with a median age of 4 months. A total of 57% were hospitalized during the month following the first consultation in the ED, including 28 (3.6%) in an intensive care unit. The mean length of stay was 4.2 days (SD = 3.7). The average time to relief of all symptoms was 13 days (SD = 7). Average total cost per patient was €1919 (95% confidence interval: 1756-2138) from a societal perspective, mostly due to hospitalization cost. The estimated annual cost of bronchiolitis in infants was evaluated to be between €160 and €273 million in France.Discussion: Bronchiolitis represent a high cost for the health care system and broadly for society, with hospitalizations costs being the main cost driver. Thus significant investments should be made to develop innovative therapies, to reduce the number of hospitalizations and length of stay

Acute tubulointerstitial nephritis with or without uveitis: a novel form of post-acute COVID-19 syndrome in children

International audienceMultiorgan sequelae of coronavirus disease 2019 (COVID-19) beyond the acute phase of infection are increasingly described as clinical experience expands. In children, acute COVID-19 appears to be generally asymptomatic or mild. Yet, the multisystem inflammatory syndrome in children (MIS-C) may be a severe postinfectious complication following exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 During the first pandemic year, we observed a striking increase in the incidence of acute tubulointerstitial nephritis (aTIN) without or with uveitis (TINUs) among children. Causes of aTIN include drugs, infections, and systemic diseases, but often remain undetermined. The rare TINUs syndrome associating aTIN and uveitis is considered to result from a still ill-characterized immune-mediated process. The observed increased incidence of idiopathic aTIN/TINUs prompted us to examine whether SARS-CoV-2 might be the initial trigger