Archives De Pediatrie最新文献

{"title":"Urinary leukotriene E4 in pediatric pulmonary arterial hypertension: a pilot case control study.","authors":"Hamdy El-Sayed, Hala Elmarsafawy, Basma Shouman, Mostafa Mansour, Amal Osman","doi":"10.1016/j.arcped.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.08.004","url":null,"abstract":"<p><strong>Background: </strong>Pediatric pulmonary arterial hypertension (PAH) is a potentially fatal disease. New targeted therapies based on the underlying pathogenesis are still needed.</p><p><strong>Objective: </strong>This study aims to evaluate the role of leukotriene E4, an inflammatory mediator, in developing pediatric pulmonary arterial hypertension (PAH).</p><p><strong>Methods and setting: </strong>The study included 21 patients with PAH who belonged to group 1 of the international pH classification. PAH was diagnosed via cardiac catheterization. Most patients had PAH associated with congenital heart disease (PAHCHD). The control group comprised 21 healthy participants of matched age and sex. Urinary leukotriene E4 (LTE4) levels were assessed using an enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Urinary LTE4 levels and urinary LTE4 to urinary creatinine ratio were significantly increased among patients compared to healthy controls (p < 0.05). Further, a high combination of sensitivity and specificity was observed for urinary LTE4 with a cut-off level of 35.4pg/ml for predicting PAH.</p><p><strong>Conclusion: </strong>The significantly elevated urinary LTE4 levels in pediatric patients with PAH can suggest the role of LTE4 as an inflammatory mediator in the disease pathogenesis.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence and prediction of clinical interventions during transfer of near-term and term infants with respiratory distress on CPAP. An observational study.","authors":"Alexia Morel, Julien Baleine, Christophe Milesi, Maliha Badr, Arthur Gaudaire, Alexandra Deveze, Sylvain Paulhac, Charline Andrieu, Marion Palpacuer, Gilles Cambonie, Arthur Gavotto","doi":"10.1016/j.arcped.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.07.001","url":null,"abstract":"<p><strong>Background: </strong>Neonatal respiratory distress (NRD) requiring continuous positive airway pressure (CPAP) is a common indication for inter-hospital transfer of late preterm and term neonates. The optimal composition of the inter-hospital team transfer - involving an advanced neonatal nurse and an ambulance driver or a complete team, which also includes a paediatrician - remains uncertain. Particularly when clinical interventions are required.</p><p><strong>Objectives: </strong>To assess the occurrence of clinical interventions necessitating a complete transport team during the inter-hospital transfer of neonates with NRD on CPAP. A secondary objective was to evaluate whether data provided to the transfer regulation centre predicted such interventions.</p><p><strong>Methods and setting: </strong>This retrospective observational study was conducted at the Paediatric Emergency Transport Service (PETS) of a level 3 maternity hospital between 2021 and 2023. A total of 110 infants ≥34 weeks' gestational age were included, all transported for NRD with CPAP (mean gestational age 37.6 ± 2.2 weeks, mean birth weight 3042±615 g). Clinical interventions recorded included intubation, surfactant administration, inhaled nitric oxide (iNO) administration, needle aspiration for pneumothorax, and prostaglandin E1 infusion. Complete team transport involved a paediatrician, an advanced neonatal nurse, and an ambulance driver.</p><p><strong>Results: </strong>Clinical interventions occurred in 11 cases (10%). Factors associated with the need for intervention included higher FiO₂ (71.4 ± 18.5% vs 28.3 ± 8.0%, p < 0.01), presence of pneumothorax (p < 0.01), and transfer from higher-level maternity hospitals (p < 0.01). The ROC curve for FiO₂ predicting intervention had an area of 0.99 (95% CI 0.97-1.01, p = 0.001), with a cut-off of >40% yielding 91% sensitivity, 98% specificity, 83% positive predictive value, and 99% negative predictive value.</p><p><strong>Conclusions: </strong>High oxygen dependency and the presence of pneumothorax are key indicators for mobilizing a complete transport team during the transfer of late preterm and term neonates with NRD on CPAP. Early identification of these factors could enhance team allocation and resource utilization.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scuba diving of children: A global review.","authors":"Chloé Andres, Lukas Widmann","doi":"10.1016/j.arcped.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.06.007","url":null,"abstract":"<p><strong>Introduction: </strong>Scuba diving is becoming increasingly popular worldwide, including among children and adolescents. This activity carries risks and potential accidents. Differences in anatomy, psychology, and human physiology between adults and children must be considered, leading to specific recommendations for scuba diving for young people.</p><p><strong>Methods and results: </strong>Contra-indications should be known by the dive physician and in this article we compare recommendations of different countries, leading diving organizations (PADI (Professional Association of Diving Instructors) and SSI (Scuba Schools International)) to the French recommendations. The lack of homogeneous international recommendations and limited evidence-based data result in significantly different recommendations.</p><p><strong>Conclusion: </strong>It seems necessary to inform general practitioners and pediatricians, mostly without experience in diving medicine, about the key physiological effects of scuba diving and the main differences in physiology between adults and children or teenagers. This is essential to ensure proper medical examinations and certification.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NT-proBNP plasma levels as early predictor of ventilatory support in bronchiolitis: A prospective analysis.","authors":"Zayani Seyfeddine, Thabet Farah, Daya Abir, Benabdallah Imen, Mkaouer Wejdenne, Chouchane Chokri, Neffati Fadoua, Chouchane Slaheddine","doi":"10.1016/j.arcped.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.06.006","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the role of serum NT-proBNP (N-Terminal Pro Brain Natriuretic Peptide) levels as an early predictor of ventilatory support in infants hospitalized with bronchiolitis.</p><p><strong>Design: </strong>A single-center, prospective, observational study.</p><p><strong>Setting: </strong>Pediatric department of a tertiary university-affiliated hospital in Tunisia.</p><p><strong>Patients: </strong>Eighty infants under one year of age, admitted with bronchiolitis between December 2023 and February 2024, were included. Infants with comorbidities such as congenital heart disease or immunosuppression were excluded.</p><p><strong>Interventions: </strong>NT-proBNP levels were measured within 2 h of admission. Patients were managed following standard protocols, and the need for ventilatory support was documented.</p><p><strong>Main outcome measures: </strong>The association of elevated NT-proBNP levels (>1585 pg/mL) with the requirement for ventilatory support, as well as the predictive accuracy of NT-proBNP compared to the Wang score.</p><p><strong>Results: </strong>Of the 80 infants, 33.8 % had elevated NT-proBNP levels, and 18.8 % required ventilatory support. Median NT-proBNP levels were significantly higher in the ventilatory support group (2185 pg/mL) compared to those managed with room air or simple oxygen therapy (634 pg/mL). NT-proBNP demonstrated superior predictive accuracy (AUC 0.869) compared to the Wang score (AUC 0.701). A threshold of 1585 pg/mL yielded 73.3 % sensitivity and 87.7 % specificity. NT-proBNP elevation was independently associated with the need for ventilatory support (OR 17.1; 95 % CI 4.46-65.6).</p><p><strong>Conclusions: </strong>NT-proBNP levels provide valuable prognostic insights into bronchiolitis severity and outperform clinical severity scores like the Wang score in predicting ventilatory support needs. Integration of NT-proBNP measurement into clinical practice may enhance risk stratification and improve management of high-risk infants.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to start prophylaxis in untreated children with severe and moderate haemophilia in 2025, opinion of paediatricians from the French Society of Thrombosis and Haemostasis.","authors":"Alexandre Theron, Olivia Pineau, Sophie Bayart, Caroline Oudot, Sandrine Meunier","doi":"10.1016/j.arcped.2025.08.002","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.08.002","url":null,"abstract":"<p><p>Hemophilia is the most prevalent constitutional bleeding disorder. Management of severe and moderate hemophilia has completely evolved in recent years due to major therapeutic innovations, such as antihemophilic factors with a prolonged half-life and non-substituted treatments, particularly emicizumab. Initial treatment takes place as early as possible in infancy to limit bleeding incidents and their consequences. In light of recent therapeutic changes, the pediatricians of the French Society of Thrombosis and Hemostasis have therefore carried out a national practice survey. Based on the survey results and a literature review, this article proposes suggestions for the initial management, prophylaxis, and monitoring of children with severe or moderate hemophilia. We recommend establishing early and long-term prophylaxis for all patients with severe or moderate hemophilia and a severe phenotype who have not been previously treated. The choice of treatment and prophylaxis regimen should be made through a shared decision-making process with the family. Close monitoring is recommended after prophylactic treatment initiation.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary reflections on the paradigm shift in the care of children with genital development variations.","authors":"Karinne Gueniche, Dinane Samara-Boustani, Michel Polak","doi":"10.1016/j.arcped.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.05.008","url":null,"abstract":"","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of prognostic factors for high-flow nasal cannula therapy failure in infants with bronchiolitis: a prospective study.","authors":"Seyfeddine Zayani, Farah Thabet, Amal Marzouki, Abir Daya, Manel Benfredj, Salma Mhalla, Chokri Chouchane, Slaheddine Chouchane","doi":"10.1016/j.arcped.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.06.002","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify factors associated with High-flow nasal cannula (HFNC) therapy failure in infants with moderate to severe bronchiolitis to personalize management and optimize outcomes.</p><p><strong>Methods: </strong>A prospective cohort study was conducted from September 2021 to March 2023 in a pediatric intensive care unit. Infants aged 0-12 months with bronchiolitis requiring HFNC were included, excluding those with prior ventilation, tracheostomy, uncorrected cyanotic congenital heart disease, or chronic respiratory/neuromuscular conditions. Clinical and biological characteristics were evaluated at HFNC initiation and after 2 hours. Logistic regression was used to identify predictors of failure.</p><p><strong>Results: </strong>Of 154 patients, 54 (35.1 %) experienced HFNC failure. Univariate analysis showed significant differences in age and weight at admission between responders and non-responders. Multivariate analysis identified weight below the 10th percentile, FiO2 ≥ 42.5 %, and Wang score ≥ 10 at initiation as predictors of failure. Persistence of tachycardia, tachypnea, hypercapnia, and FiO2 ≥ 48.5 % after 2 hours were also significant predictors. Common causes of failure were increased respiratory effort (64.8 %) and severe apnea (18.5 %).</p><p><strong>Conclusions: </strong>Predictors of HFNC failure include low weight, high initial FiO2, and severe clinical scores, as well as persistent clinical instability during early therapy, aiding clinical decision-making.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological disorders in pediatric emergency department: From consultation to follow-up of first epileptic seizures.","authors":"Gaëlle Quentin-Romand, Philippe Eckart, Nathalie Bach, Claire Dupont, Anne-Sophie Diependaële","doi":"10.1016/j.arcped.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.05.014","url":null,"abstract":"<p><strong>Background: </strong>Neurological disorders are a common reason for consultations in pediatric emergency rooms. The aims of this study were 1) to evaluate the role of neurological symptoms in consultations in pediatric emergency departments at a French hospital, and 2) to assess the management of patients presenting with a first seizure in line with the 2020 recommendations of the French National Authority for Health (Haute Autorité de Santé - HAS).</p><p><strong>Method: </strong>This single-center retrospective observational study was carried out over a period of 16 months, from January 2021 to April 2022. Children referred for neurological symptoms were identified through the ICD10 coding. Demographic data, past medical history for neurological disorder, circumstances of arrival at the emergency room, the occurrence of advice by a child neurologist at the emergency room, and the need for hospitalization were extracted from the files. Statistical analyses were performed in the subgroups of patients consulting for seizures and for headaches. The observance of the HAS guidelines after a first unprovoked seizure was analyzed in looking for EKG and appropriate blood work-up occurrences, and time delays for EEG, MRI, and pediatric neurology consultation.</p><p><strong>Results: </strong>734 patients presented for neurological symptoms (2.2 % of emergency consultations). Headaches (n = 282) and seizures (n = 368) represent the most frequent reasons for visits (88.5 %). Of all seizures, a first unprovoked seizure affected 45 patients (12.2 %). Considering HAS recommendations for first seizures, only 3 patients (6.7 %) had a consultation with a pediatric neurologist within 15 days, and 9 patients (20 %) underwent a brain MRI within the first month.</p><p><strong>Discussion: </strong>Our results confirm the high frequency of consultations for neuropediatric symptoms in French emergency departments, with seizures and headaches being the most common. However, they highlight challenges in obtaining specialist neuropediatric consultations and implementing national recommendations for the management of patients with a first unprovoked seizure.</p><p><strong>Conclusion: </strong>Based on these results, establishing specialized neurological care networks would enhance patient management and ensure better implementation of HAS recommendations.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proteinuria and albuminuria prevalence in allergic children.","authors":"Marina Vincent, Laure Ponthier, Thierry Chianea, Céline Menetrey, Chahrazed El Hamel, Vincent Guigonis","doi":"10.1016/j.arcped.2025.05.011","DOIUrl":"10.1016/j.arcped.2025.05.011","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have reported an atopic background in patients with idiopathic nephrotic syndrome. Proteinuria has also been reported in allergic patients, but in a limited number of studies, and most of them with a low level of evidence. If confirmed, the presence of proteinuria in allergic children could be a clue to approach the pathophysiology of idiopathic nephrotic syndrome.</p><p><strong>Objective: </strong>We therefore performed a prospective study to compare the urine protein levels in allergic and non-allergic children.</p><p><strong>Methods and setting: </strong>Urine samples were collected from 190 children suspected of having allergies. Total urinary protein, albumin, and creatinine levels were measured. After completing the allergological analysis, patients were divided into allergic and non-allergic groups.</p><p><strong>Results: </strong>In the allergic group (n = 97), four children (4.1 %) were proteinuric compared to five (5.4 %) in the non-allergic patients (n = 93). Eleven children (11.3 %) were albuminuric versus eight (8.6 %), in the allergic and non-allergic groups respectively. Therefore, no significant differences were observed in proteinuria or albuminuria between allergic and non-allergic children.</p><p><strong>Conclusion: </strong>The lack of increased prevalence of proteinuria in allergic patients does not support a strong pathophysiological hypothesis linking allergy to idiopathic nephrotic syndrome through the presence of asymptomatic pathological proteinuria in allergic patients. Other hypotheses still need to be explored to analyze the possible association between idiopathic nephrotic syndrome and allergy.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinguishing atypical focal areas of signal intensity from probable low-grade gliomas in the posterior fossa of children with neurofibromatosis type 1.","authors":"Agnès Viguier, Bastien Estublier, Anne-Isabelle Bertozzi, Marion Gambart, Annick Sevely, Nicolas Leboucq, Pierre Antherieu, François Rivier, Pierre Meyer, Didier Bessis, Yves Chaix, Eloïse Baudou","doi":"10.1016/j.arcped.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.arcped.2025.05.010","url":null,"abstract":"<p><strong>Introduction: </strong>Focal areas of signal intensity (FASI) in the posterior fossa are common in children with neurofibromatosis type 1 (NF1). These can be difficult to distinguish from tumour processes when they are atypical. This study aimed to describe the initial radiological features of atypical posterior fossa FASI, depending on the clinical and radiological evolution of the lesion.</p><p><strong>Methods: </strong>We conducted a multicentre retrospective study of NF1 children with atypical FASI in the posterior fossa. The lesions were classified according to their evolution over time: 'non-neoplastic FASI' if they regressed, or 'possible neoplastic FASI' if they remained stable or progressed.</p><p><strong>Results: </strong>Forty-two lesions from 31 patients were analyzed. The mean follow-up period between the first and last MRI scans was 7.1 years. Twenty-one atypical FASI were classified as 'non-neoplastic FASI' and 21 as 'possible neoplastic FASI'. Younger age at diagnosis, pontine location, and blurred contours were more indicative of 'non-neoplastic FASI' on the initial MRI, whereas symptomatic, cystic or exophytic lesions, the presence of enhancement after gadolinium injection, sharp contours, and clear mass effect were more indicative of a 'possible neoplastic FASI'. Unexpectedly, abnormal initial spectroscopy and small mass effect could be found in 'non-neoplastic FASI', as could the presence of hypointensity on T1-weighted images.</p><p><strong>Conclusion: </strong>This study is important in specifying which posterior fossa hyperintensities on T2-weighted MRIs require specific clinical and radiological follow-up.</p>","PeriodicalId":55477,"journal":{"name":"Archives De Pediatrie","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}