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Background: The vast majority of prenatally diagnosed congenital pulmonary malformations (CPM) remain asymptomatic at birth. The maximal value of the CPM volume ratio (CVRmax) predicts the risk of neonatal respiratory distress (NRD), and should allow for better assessment of the level of expertise needed at the delivery site., Aim: This study evaluated the level of maternity units currently chosen for the delivery of CPMs, and determined the impact of the choice of delivery site based on the CVRmax, with a threshold of 0.4 cm 2 ., Methods: Data were extracted from the French prospective MALFPULM cohort, with inclusion between March 2015 and June 2018., Results: The final study population consisted of 383 women. Deliveries in level 1 or 2 maternity units (n = 98, 25%) involved CPMs with lower CVRmax (p<0.001), causing fewer signs of prenatal compression (p = 0.025). Among the 62 children (16%) who presented with NRD, only seven (11%) were born in level 1 or 2 units (p = 0.0078). Choosing the maternity level according to the CVRmax would have increased the number of births in level 1 or 2 maternity hospitals by 70%. In these maternity units, the percentage of children with NRD would have increased from 8% in the actual distribution to 10% in the new strategy., Conclusion: Our results showed an overuse of level 3 maternity hospitals for the delivery of newborns with a prenatal diagnosis of CPM. The use of CVRmax should enable a reduction in the use of expertise centers without an adverse impact on newborns., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Objective: The aim of this study was to characterize conventional pediatric care capacities in French public hospitals and identify the main difficulties in guiding upcoming health policies. The secondary objective was to assess the quality of care by the implementation of the European Charter of the Rights of Children in Hospital., Method: Multicenter cross-sectional study using a questionnaire survey sent by e-mail to the heads of conventional pediatric departments in four French regions identified on the French Hospital Federation's website. The survey was conducted between 25 September and 25 October 2018., Results: Fifty-six of 113 heads of departments participated in the survey. The mean annual number of admissions per unit in 2017 was 2066 (SD, 1433), with a median length of stay of 2.7 days (range, 1-10). Children were admitted up to age 18 years in 76% of the departments, and 83% of the departments had an individualized pediatric emergency department. The nurse care load was very high, specifically during the night shift (9.5 patients/nurse). Inpatient education and academic teaching were unavailable in 38% of the departments. Overall, 89% of department heads declared knowing the European Charter of the Rights of Children in Hospital, and a copy of it was posted in all units in 57% (95% confidence interval, 44-70) of the services/departments. At all times and in all departments, parents were allowed to be with their children, and for 34% (95% CI, 21-47) of the departments, an accommodation for parents was available close to the hospital., Conclusion: Public hospital pediatric departments lack sufficient medical and nonmedical caregivers. Department heads were well aware of the European Charter, and it was well disseminated but should be updated to address today's challenges in pediatrics. An area of improvement would be to include parents in their child's care more effectively., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate the respiratory outcome in children with congenital heart disease (CHD), considering recent management procedures and the CHD pathophysiology., Design and Setting: Clinical and functional respiratory outcome were evaluated in 8-year-old children with isolated CHD followed up from birth in the prospective population-based EPICARD cohort., Patients: Children were assigned to two groups, based on the pathophysiology of the CHD: CHDs with left-to-right shunt (n = 212) and CHDs with right outflow tract obstruction (n = 113)., Results: Current wheezing episodes were observed in 15% of the children with isolated CHD and left-to-right shunt, and 11% of the children with isolated CHD and right outflow tract obstruction (not significant). Total lung capacity (TLC) was the only respiratory function parameter that significantly differed between the two groups. It was lower in children with left-to-right shunt (88.72 ± 0.65% predicted) than in those with right outflow tract obstruction (91.84 ± 0.96, p = 0.006). In multivariate analysis, CHD with left-to-right shunt (coeff. [95% CI]: -3.17 [-5.45; -0.89]) and surgery before the age of 2 months (-6.52 [-10.90; -2.15]) were identified as independent factors associated with significantly lower TLC values., Conclusion: Lower TLC remains a long-term complication in CHD, particularly in cases with left-to-right shunt and in patients requiring early repair. These findings suggest that an increase in pulmonary blood flow may directly impair lung development., (Copyright © 2021 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: There is a crucial need to perform clinical trials in pediatrics due to an increased prescription rate of unapproved drugs. Since pediatricians are the gatekeepers of clinical trials, the primary objective of the current study was to evaluate, for the first time in France, pediatricians' views on performing clinical trials. The second objective was to identify the factors that influence their perceptions., Material and Methods: In 2017, pediatricians who were members of the French Pediatric Society completed an online survey comprising 27 questions. Fisher's exact test was performed to evaluate possible correlations between pediatrician characteristics (age, sex, parenthood, professional experience, status, type of practice, previous participation in clinical trials, ethics education) and personal views on clinical trials. A value of P≤0.001 was considered statistically significant., Results: Overall, 207 pediatricians completed the questionnaire. Almost all participants (96.6%) were in favor of performing clinical trials. Pediatricians with teaching experience at university hospitals were more reluctant to propose children's participation in clinical trials for fear of increasing parental stress (P<0.001), or the occurrence of serious adverse reactions (P<0.001). Pediatricians with coordinator or investigator experience considered that one of the ethical drifts in pediatric clinical trials is the risk of child exploitation (P<0.001)., Conclusion: Our findings suggest a favorable position of pediatricians concerning clinical trials, despite numerous concerns. Another outcome is the need to create an educational system of research in ethics in France dedicated to pediatricians in order to guarantee good clinical practice in research., (Copyright © 2021 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Background and Objectives: The role of schools in the spread of SARS-CoV-2 infections in the community is still controversial. The objective of our study was to describe the epidemiology of SARS-CoV-2 infections in different pediatric age groups during the first 2 months of the fall back-to-school period, in the context of increasing viral transmission in France., Methods: Weekly epidemiological data provided by Santé Publique France and the Ministry of National Education were analyzed according to the age groups defined by the different school levels. Weeks (W) 34-42 were considered for analysis., Results: The PCR positivity rate and incidence rate increased in all age groups during the study period, in an age-dependent manner. At W42, with adults being considered as reference, the risk ratio for a positive PCR test was 0.46 [95% CI: 0.44-0.49] and 0.69 [0.68-0.70] for children aged 0-5 years and 6-17 years, respectively. Similarly, the incidence rate ratio was 0.09 [0.08-0.09], 0.31 [0.30-0.32], 0.64 [0.63-0.66], and 1.07 [1.05-1.10] for children aged 0-5 years, 6-10 years, 11-14 years, and 15-17 years, respectively. Children and adolescents accounted for 1.9% of the newly hospitalized patients between W34 and W42, and for 1.3% of new intensive care admissions. No death was observed. Among infected children and adolescents, the percentage of asymptomatic individuals was 57% at W34 and 48% at W42. The number of schools closed remained low, less than 1% throughout the study period. The number of confirmed cases among school staff was consistent with the data measured in the general population., Conclusion: In the context of increasing viral transmission in the population, the spread among children and adolescents remained lower than that observed among adults, despite keeping schools open. However, the impact was age-dependent, with data in high schools close to those observed in adults., (Copyright © 2021 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

The educational and social benefits provided by school far outweigh the risks of a possible COVID-19 contamination of children in school environments or in daycare centers. Following summer break, the back-to-school period in France is taking place in the context of an increasing viral spread and requires strict adherence to health measures to limit the risk of outbreaks in communities. Based on a critical update of the role of children in the transmission of the infection, and of children's susceptibility to infection, the French Pediatric Society published practical guidelines for school re-entry and the management of COVID-19 infections in schools., (Copyright © 2020 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Early screening is recommended in children exposed to a contagious case of tuberculosis (TB), to prevent rapid progression to active TB. The aim of this study was to evaluate the percentage of potentially preventable cases of pediatric TB stemming from inadequate screening. The data gathered on children aged 0 to 10 years, who were evaluated by the Paris Center for TB Control (CLAT75) between January 2009 and December 2013, were extracted and retrospectively analyzed. French National Guidelines for screening were used as reference. During the study period, 1232 children 0-10 years were screened, because of a known exposure to an index case, including 124 (10%) with criteria for latent tuberculosis infection (LTBI) and 26 (2%) with active TB. Twelve additional cases of TB were reported, diagnosed based on symptoms or systematic exams. As a whole, 68% of pediatric TB cases were diagnosed at screening around an adult index case, highlighting the quality of the screening network. Among the 38 TB cases, 19 (50%) had a missed opportunity for potential prevention, due to the absence of screening despite a known contaminant (n=2) or to screening not in compliance with current recommendations (n=17). Delayed first evaluation was the most frequent error of the screening procedures. In conclusion, despite the quality of the screening network set up in Paris, half of the pediatric TB cases in this study did not undergo the recommended screening procedures. A significant reduction in the number of pediatric TB cases can be expected through the optimization of screening networks., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Hot tub lung is a type of hypersensitivity pneumonitis caused by inhalational exposure to the Mycobacterium avium complex. We report the case of a 14-year-old boy presenting dyspnea with hypoxemia, whose medical history and clinical course helped make the diagnosis. Infectious causes were considered first, and antibiotics were initiated without success. Further questioning and explorations led to discussing a hypersensitivity pneumonitis diagnosis. Relapse after exposure to a hot tub enabled us to confirm hot tub lung. Hypersensitivity pneumonitis is a rare cause of pulmonary disorder, especially in children. It should be discussed with unusually severe and progressive cough or dyspnea. Further explorations should therefore be undertaken (CT, fibroscopy). Taking a precise medical history allows early diagnosis, leading to a quick withdrawal from the allergenic source and appropriate treatments., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Recommendations for the use of diagnostic testing in low respiratory infection in children older than 3 months were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP(2)A). The Haute Autorité de santé (HAS) methodology, based on formalized consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text is available on the SP(2)A website., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Some children with chronic lung disease associated with mucociliary clearance impairment and chronic bronchial congestion develop, during their evolution, bronchial bacterial colonization and recurrent infections. Therefore, antibioprophylaxis (ABP) is proposed by pediatric pulmonology specialists. Although some children seem improved by this strategy, it is worthy to note that no pediatric study supports its effectiveness, and no guidelines from society currently recommend its prescription. Demonstrated clinical benefits of ABP involve rare and highly targeted diseases. These children require a specialized assessment before any decision of ABP. Cystic fibrosis is definitely a situation where the interest of ABP is well established. By extension of the data obtained in adults, children with bronchiectasis (DDB) could potentially benefit from prolonged antibiotic therapy. In recurrent bacterial infections of the airways without DDB, ABP should be limited and restricted to most severe cases. In the absence of data on the benefit of alternate antibiotic treatment, we propose to focus on a single-molecule antibiotic prescribed for long periods. It may be amoxicillin, macrolides or cotrimoxazole. Furthermore, there is currently no data justifying the prescription of long-term macrolides in childhood asthma., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Recommendations for acute and long-term oxygen therapy (needs assessment, implementation criteria, prescription practices, and follow-up) in children were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP2A). The Haute Autorité de Santé (HAS) methodology, based on the Formalized Consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text (arguments+recommendations) is available at the website of the French Paediatric Society: www.sfpediatrie.com., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Fungal colonization in cystic fibrosis patient is frequent and dominated by Aspergillus fumigatus (A. fumigatus). Mycological analysis on specific media showed other filamentous species Scedosporium, Geosmithia argillacea. Prospective studies are necessary to appreciate prevalence and pathogenicity in this pathology. A. fumigatus causes the most frequently allergic bronchopulmonary aspergillosis (ABPA). Invasive infection is exceptional in this context. An early diagnosis is important to avoid bronchial deterioration but is very difficult despite international consensus. New more specific biological markers are evaluated. Oral corticotherapy is the cornerstone of therapy but adverse effects are more frequent in cystic fibrosis. Antifungal therapy has a corticosteroid-sparing effect. New therapeutic strategies have to be evaluated., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

In France, half of hospital admissions for asthma concern children and the rates of hospitalization, decreasing in adults, are stable in children. Most admissions for asthma exacerbation are avoidable with appropriate disease management. The objective of this study was to describe the characteristics of children admitted for asthma. The study was carried out in 14 pediatric units over 1 year. Children aged 3 years and over who were hospitalized for an asthma exacerbation were included. Data from 727 hospitalizations were collected. In 48% of the hospitalizations, children were 3-5 years old. Asthma was undiagnosed at the time of the admission in 27%. Among children with diagnosed asthma, 57% had already been admitted to the hospital for asthma exacerbation, 37% had been admitted to the hospital or emergency department during the last year, and the control of asthma in the previous month was unacceptable in 46%; 11% had received an oral and written self-management action plan. This study underlines the need to strengthen the efforts to encourage improvement of the therapeutic education of asthmatic children in order to decrease the risk of hospitalization for exacerbation of asthma., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Introduction: Seven cases of pneumococcal meningitis caused by serotypes covered by the available vaccine occurred in France in vaccinated children, 4 of which were caused by serotype 19F., Case Report: A 3-year-old child, who had received 3 doses of the 7-valent pneumococcal conjugate vaccine Prevenar but not the 4th injection, presented with bacterial meningitis after acute media otitis. The identified bacterium was a 19F serotype of Streptococcus pneumoniae., Comments: This vaccine failure was characterized by an immune memory installation defect and underscores the necessity of the booster dose of vaccine during the 2nd year of life to acquire rates of protective and lasting antibodies. Serotype 19F of S. pneumoniae is particular since, despite good immunogenecity, it induces antibodies with weak avidity. We describe a case of pneumococcal meningitis caused by 19F serotype S. pneumoniae, which is included in the vaccine, in an immunocompetent child. Such events should be inventoried. They can reveal rates of antibodies that are very weak defenders, in spite of the vaccination, reflecting the absence of implementation of immunizing memory. Furthermore, an underlying immune deficit must be ruled out.

Langerhans cell histiocytosis (LCH) is a multisystemic disease, which may present with neurological involvement. We report the case of a 20-month-old girl with initial liver and skin involvement. Initial symptoms were recurrent episodes of trunk dystonia, lasting approximately 2 months prior to the diagnosis of LCH. No brain MRI abnormality was demonstrated at initial work-up and over 7 years of follow-up, except for a postpituitary involvement noted after 3 years of follow-up. These episodes of dystonia subsided during the first week of specific LCH chemotherapy (vinblastine and steroid), suggesting that they may have resulted from hepatalgia related to the histiocytic infiltration of the liver.

Unlabelled: It has been suggested that the incidence of childhood empyema have increased during the last years in France without clear explanation. Streptococcus pneumoniae is responsible for the vast majority of bacteriological documented cases. Potential prevention of pleural empyemas by the heptavalent pneumococcal conjugate vaccine is dependent on adequation between specific pneumococcal serogroups present in vaccine and those responsible for empyemas., Material and Methods: We retrospectively collected cases of pleural empyemas registered at the National Reference Center for pneumococci (December 2002 to February 2004). Thirty children, aged 4.1+/-3.3 (SD) years, were included., Results: Ten specific serogroups were identified: 1, 3, 5, 6B, 7F, 9V, 14, 18C, 19A, and 23F. Serogroups 19A and 1 were the 2 dominant serogroups and represented 50% of cases. All children infected with serotype 19A were younger than 5 years, whereas serotype 1 was identified in 80% of empyemas in children older than 5 years. Among the 30 patients enrolled, 20 (69%) were infected with serotypes not included in the conjugate vaccine., Conclusion: These results thus limit the potential impact of the heptavalent pneumococcal conjugate vaccine on the frequency of pleural empyemas in children.

In order to better target children who should be screened for tuberculosis and to tailor treatment according to risk a good knowledge of the risk factors for latent tuberculosis infection and progression to disease is needed. Risk of infection is strongly related to number and duration of exposure and is particularly high when contact happens at home. Host factors like a young age or chronic underlying disease seem to favor progression to disease but do not increase infection rate. Some M. tuberculosis strains seem to be more easily transmissible. An adaptation of the criteria for a positive tuberculin skin test according to risk may help to increase the positive and negative predictive values of the test. When the risk of progression to disease is high a prophylactic treatment may be considered.

Persistent asthma is associated to airway remodeling, characterized by structural changes of the bronchi, poorly responsive to therapies. Remodeling may strongly contribute to the residual airway obstruction observed in asthmatic patients, both children and adults, and to the loss of reversibility of this obstruction. Remodeling has been demonstrated in paediatric asthma and is not limited to longstanding severe asthma. Numerous arguments indicate that this process begins early in the development of asthma. Some studies argue for a possible prevention - or limitation - of this process by an early treatment.

Lung inflammation plays a pivotal role in the pathogenesis of airway disease in cystic fibrosis (CF). Inflammation occurs very early and can be identified in very young infants. Inflammatory response is also more intense in CF than in non-CF airway inflammatory diseases. Among the different cell types involved in the airway inflammation, neutrophils are recognized to play a central role by releasing proinflammatory mediators, such as reactive oxygen species and proteolytic enzymes. Whether inflammation arises independently from infection remains debated. While infection was demonstrated to clearly amplify the inflammation, several studies argue for the possibility of an intrinsic inflammation. Finally, there is also evidence that the severity of pulmonary disease is linked to other genetic factors outside the CFTR gene locus, involved in host defence and inflammation.

Relationships between lower respiratory diseases with wheezing during infancy and asthma at school-age remain debatted. Indeed, although epidemiologic studies show that wheezy infants most often become asymptomatic before entry to school, they also demonstrate that severe bronchiolitis during infancy is a significant risk factor for persistence of wheezing episodes at school-age. One of the most important factors demonstrated to enhance the risk for persistence of asthma is an early allergic sensitization.

Unlabelled: Underdiagnosis of asthma is frequent in children and may be improved by the development of school-based health programs., Material and Methods: We developed an educational program in 11-year-old schoolchildren who participated in a screening test for exercise-induced asthma (EIA). All children were given an asthma questionnaire before and after two educational sessions., Results: Mean score for asthma knowledge quiz increased from 63 to 85% (p < 0.001). Thirty-six children (3.7%) were initially considered as asthmatic and showed better responses than non-asthmatic children. Peak expiratory flow (PEF) was measured before and after an outside running exercise. A fall in PEF of at least 15% was considered an abnormal result. Seventy-height children (8%) had a decrease in PEF, including 65 children initially not recognized as asthmatic. For these latter, a medical evaluation was recommended to parents. Only 28 of these children gave informations on follow-up: 19 had lung function tests, two received a treatment without preliminary function test, and seven had neither lung function test nor treatment. Among the children who realized lung function tests, five had criteria for airway obstruction at baseline, and ten had significant bronchial hyperreactivity., Conclusions: However, a new screening test revealed that only a small minority of children initially not recognized as asthmatic but having decreased their PEF, were consequently considered as asthmatic by their practitioner, even in case of positive lung function test.

Cough is initiated from organs innervated by the vagus nerve. The larynx and the lower airways are the main sites involved in cough initiation. Cough is mainly triggered by mechanical stimuli, especially at the laryngeal level, and also by inflammatory stimuli and chemical irritants. Two receptor types are involved in the cough reflex: the irritant receptors (IR) and the C fibers. IR are directly involved in cough initiation whereas stimulated C fibers act essentially through tachykinin release, which in turn activates IR. Cough in asthma was initially thought to be related to the bronchospasm reflex, but seems in fact mainly due to airway inflammation.

Background: Poor inhaler technique in asthmatics is well documented. The objective of this study was to evaluate the influence of reading the instruction leaflet and the consultant's explanations on the use of the new breath-actuated inhaler (Autohaler 3M)., Methods: In this study were participating 379 asthmatic children and adolescents, aged from four to 17 years (mean age: 10; 64% boys), recruited by 80 pediatricians. The use of the Autohaler device was considered to be correct if the shaking, lip position, deep inhalation and apnea were all properly performed., Results: The Autohaler was used correctly by 42% of the subjects simply after reading the instruction leaflet (phase I), and by 75% of the subjects who, having failed phase I, received the consultant's explanations (phase II). At the end of phases I and II, the device was correctly used by 84% of the subjects. In multivariate analysis, those under the age of nine years and those with no prior use of inhaler systems accounted for a significant amount of the incorrect use of the Autohaler during phase I. In phase II, only the fact of being less than nine years old was significantly related to incorrect use., Conclusion: More than four-fifths of the asthmatic children and adolescents properly used the Autohaler after merely reading the instructions and after receiving additional explanation from the consultant. The marked improvement obtained after medical explanations underlines the essential educative role of the physician when prescribing. Young children require specific training and particularly careful attention.

The Mantoux test is the only validated method for the diagnosis of acquired immunity against tuberculosis. Its interpretation may be difficult. A standard procedure must be strictly respected in performing and interpreting the test, and the factors that can increase or decrease the intensity of the response must be taken into account.

Inflammation is constantly observed in allergic reactions. Corticosteroids are most effective in preventing the late phase of allergic reaction. The action of glucocorticosteroids is mediated through glucocorticoid receptors present in the cellular cytoplasm. When activated, glucocorticoid receptors form a dimer and bind to DNA after migration into the nucleus. Interaction to DNA induces changes in the transcription rate, leading to either gene induction or gene repression. Glucocorticoid receptors are also able to interact with transcriptional factors such as AP-1 (activator protein-1) of NF-kappa B (nuclear factor-kappa B). Through these actions glucocorticosteroids are susceptible to modify functions of cells involved in the allergic inflammatory response. They are in particular able to inhibit most of the pro-inflammatory functions of the eosinophils.

Extrinsic allergic alveolitis (EEA) is a lung disease mediated by immunologic mechanisms and induced by repeated exposure to organic dusts. EAA in children are mostly observed around 10 years of age. Subacute clinical presentation is the most frequent. Diagnosis is based on simultaneous presence of most of the following arguments: exposure to a known risk factor, spontaneous improvement after cessation of the exposure, identification of specific precipitins, demonstrative aspects on X-ray and tomodensitometry, and CD8+ lymphocytosis in bronchoalveolar lavage. Lung biopsy and specific provocation test are rarely necessary for diagnosis. Treatment is based on total eviction from inhaled antigen and on oral corticosteroids in acute and subacute forms.

Have been selected for this review: 1) the recent and impressive development of high-resolution and spiral CT scan in pediatric thoracic imaging; 2) the emerging of new and promising therapies for asthma (long acting inhaled beta 2-agonists, leukotriene antagonists, anti-IgE monoclonal antibodies); 3) the multifactorial origin of asthma in childhood; 4) the development of thoracoscopic surgery, a minimal-invasive approach beneficial in numerous circumstances.

Ipratropium bromide is a synthetic derivative of atropine with little absorption when used in inhalation, and therefore little secondary effects. The authors review its pharmacological properties and therapeutic efficacy in the treatment of asthma in children. Combined nebulized inhalation of ipratropium bromide and beta 2 sympathomimetic results in a more efficient and more sustained bronchodilatation than beta 2 sympathicomimetic alone in the treatment of acute asthma in children. Ipratropium bromide should be usefully introduced in the therapeutic scheme of acute asthma in children. Further studies will be necessary in order to determine its efficacy and tolerance in infants.