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Background Idiopathic central precocious puberty (ICPP) is supposed to be non-existent in a context of testicular destruction that is typically present in Klinefelter syndrome (KS). Herein, we describe a rare case of ICPP in a Klinefelter patient (47,XXY) with 2 maternal X chromosomes. Moreover, we highlight the differences in gonadotropin levels in comparison to males with ICPP and a normal karyotype. Case presentation An 8 years old boy with a history of cryptorchidism was evaluated for precocious puberty (Tanner staging: P2/G3). Both testes measured 25x35mm. His hormonal profile confirmed a central origin of precocious puberty with high serum testosterone (4.3 ng/ml), luteinizing hormone [LH (3.5 UI/l)] and follicle stimulating hormone [FSH (7.7 UI/l)] levels. Luteinizing hormone-releasing hormone (LHRH) test amplified LH and FSH secretion to 24 and 14 UI/l respectively. Brain magnetic resonance imaging (MRI) was normal. No MKRN3 mutation was detected. He was treated for ICPP for two years. During puberty, he suffered from hypergonadotropic hypogonadism leading to the diagnosis of KS (47,XXY karyotype). Chromosomal analysis by fluorescent multiplex polymerase chain reaction (PCR) using X chromosome microsatellite markers identified 2 maternal X chromosomes. Analysing 8 cases of KS developing ICPP (our reported case and 7 other published cases) revealed that these KS patients with ICPP have higher LH and FSH levels during ICPP episode than in ICPP patients with a normal karyotype (ICPP with KS vs ICPP with a normal karyotype: LH levels 9.4 ± 12 vs 1.1 ± 0.6 UI/l; FSH levels 23.1 ± 38.5 vs 2.7 ± 1.5 UI/l). Furthermore, their response to gonadotropin-releasing hormone (GnRH) stimulation is characterized by excessive LH and FSH secretion (LH levels post-GnRH: 58 ± 48 vs 15.5 ± 0.8 UI/l; FSH levels post-GnRH: 49.1 ± 62.1 vs 5.7 ± 3.9 UI/l). Conclusions ICPP in boys is extremely rare. The pathophysiology of ICPP in KS is unknown. However, maternal X supplementary chromosome and early testicular destruction may play a significant role in the initiation of ICPP, in part explaining the relative “overrepresentation of ICPP in KS. Thus, karyotype analysis could be considered for boys suffering from ICPP, especially if testicular size is smaller or gonadotropins are significantly elevated.

Resume Le tabagisme pre- et post-natal a des consequences sur le developpement pulmonaire, modifie la reponse immunitaire et augmente la prevalence des bronchites sifflantes durant l’enfance. Les nouveau-nes exposes ont un risque d’alteration de leur fonction respiratoire et d’augmentation des symptomes d’asthme. Recemment, les progres de la genomique et de l’epigenetique ont mis en evidence des alterations de la methylation de l’ADN pouvant expliquer des consequences a long terme. Cette revue analyse l’influence du tabagisme passif sur l’augmentation des risques infectieux, la deviation de la reponse immunitaire vers un profil lymphocytaire de type TH2 et l’evolution vers un phenotype allergique des manifestations asthmatiques. Le tabagisme passif peut egalement contribuer au developpement d’allergie alimentaire via la progression de la marche atopique, l’IPFT etant un risque avere d’eczema et d’asthme. Fumer pendant la grossesse est la cause la plus commune de morbidite et mortalite infantile que l’on peut prevenir. Il existe un faisceau d’argument qui montre que l’enfant peut aussi beneficier pour sa sante de l’implantation d’une legislation restreignant le tabagisme dans les lieux publics.

International audience; Specific allergic immunotherapy requires repeated administration of allergens in order to induce clinical and immunological tolerance. This is the only therapy with an aetiological aim that modifies the course of the disease by ensuring remission after the interruption of the procedure. The prevention of new sensitizations by immunotherapy is still under discussion. In this review we will consider the main immunological mechanisms and indications for immunotherapy in children and adolescents.

Introduction Acute bronchiolitis is a major cause of acute respiratory distress in infants. The soluble receptor for advanced glycation end‐products (sRAGE) is a biomarker of pulmonary damage processes, with a diagnostic and a prognostic value in acute respiratory distress syndrome (ARDS). The RAGE pathway is also implicated in the pathogenesis of other respiratory diseases like asthma, but the value of sRAGE levels in acute bronchiolitis remains under‐investigated. Material and methods A prospective, observational, and analytical study was conducted at Clermont‐Ferrand University Hospital. The main objective was to evaluate the correlation between serum sRAGE and clinical severity of bronchiolitis in hospitalized infants aged

To assess risk factors of recurrent bronchial obstruction and allergic sensitization 3 years after an episode of acute bronchiolitis, whether after ambulatory care treatment or hospitalization. A monocentric prospective longitudinal study including infants aged under 1 year with acute bronchiolitis was performed, with clinical (severity score), biological (serum Krebs von den Lungen 6 antigen), and viral (14 virus by naso-pharyngeal suction detection) assessments. Follow-up included a quaterly telephone interview, and a final clinical examination at 3 years. Biological markers of atopy were also measured in peripheral blood, including specific IgEs towards aero- and food allergens. Complete data were available for 154 children. 46.8% of them had recurrent wheezing (RW). No difference was found according to initial severity, care at home or in the hospital, respiratory virus involved, or existence of co-infection. A familial history of atopy was identified as a risk factor for recurrent bronchial obstruction (60% for RW infants versus 39%, P = 0.02), as living in an apartment (35% versus 15%, P = 0.002). 18.6% of the infants were sensitized, with 48.1% of them sensitized to aeroallergens and 81.5% to food allergens. Multivariate analysis confirmed that a familial history of atopy (P = 0.02) and initial co-infection RSV-hRV (P = 0.02) were correlated with the risk of sensitization to aeroallergens at 3 years. Familial history of atopy and RSV-hRV co-infection are risk factors for recurrent bronchial obstruction and sensitization.

In the French braille code, becoming an efficient contracted braille user requires a considerable investment in time and effort. Students must learn 1217 abbreviations to allow time- and space-saving, but practitioners are questioning whether this investment is worthwhile. The purpose of this study was to examine the frequency of contracted braille use by adults and their perceptions about the importance of this code. A total of 23 Quebec braille users (aged 18–40 years) completed a telephone interview with quantitative questions about the frequency of their braille use, and their use of technologies as well as qualitative items regarding their perceptions of braille now and in the future, 12 of whom completed a brief braille reading test.In all, 85% of participants used uncontracted braille for reading, 59% used contracted braille, and 95% used text-to-speech. Contracted braille was used mostly for tasks that require continuous reading (e.g. novels). All except one recognized the need to learn uncontracted braille and 78% considered contracted braille useful. In all, 11 participants indicated that they “can read faster” with contracted braille, a finding that was not replicated by our reading test, whereby reading speeds were not statistically significantly different between the two conditions . The portrait that emerges from the current use of contracted French braille in Quebec indicates that it is not often used in the life of blind individuals. However, the faith of our participants in the relevance of the contracted code is still very strong. This may be explained by the fact that braille is part of their identity. The potential increase in reading speed with contracted braille may not justify the time, effort, and cognitive resources required to learn/teach this code in French. The educational challenge remains to find the proper balance between the uses of French braille versus other technologies such as text-to-speech.

Resume Nous rapportons les resultats de l’exploration d’enfants consultant pour la premiere fois dans une unite specialisee pour leur asthme. Nous avons separe les enfants dont l’eosinophilie sanguine etait superieure a 500 giga/L des autres pour savoir si cette donnee avait une signification particuliere. Au total, 97 enfants ont ete etudies. Tous ont beneficie du meme type d’examens : hemogramme, dosage des IgE seriques totales et specifiques, exploration fonctionnelle respiratoire. Les enfants dont l’eosinophilie est superieure a 500 giga/L sont plus âges (7,94 +> 3,06 vs 6,7 ± 2,23 ans, p = 0,03) avec un Zscore d’indice de masse corporelle (IMC) identique. Les filles ont plus souvent une eosinophilie basse que les garcons (60,9 % vs 31,4 %, p = 0,04). Il existe une forte correlation entre la notion d’atopie et l’eosinophilie (34,8 % de patients allergiques avec un taux d’eosinophiles 500 giga/L, p

International audience; Rationale: Lumacaftor-ivacaftor is a CFTR (cystic fibrosis transmembrane conductance regulator) modulator combination recently approved for patients with cystic fibrosis (CF) homozygous for the Phe508del mutation.Objectives: To evaluate the safety and effectiveness of lumacaftor-ivacaftor in adolescents (≥12 yr) and adults (≥18 yr) in a real-life postapproval setting.Methods: The study was conducted in the 47 CF reference centers in France. All patients who initiated lumacaftor-ivacaftor from January 1 to December 31, 2016, were eligible. Patients were evaluated for lumacaftor-ivacaftor safety and effectiveness over the first year of treatment following the French CF Learning Society's recommendations.Measurements and Main Results: Among the 845 patients (292 adolescents and 553 adults) who initiated lumacaftor-ivacaftor, 18.2% (154 patients) discontinued treatment, often owing to respiratory (48.1%, 74 patients) or nonrespiratory (27.9%, 43 patients) adverse events. In multivariable logistic regression, factors associated with increased rates of discontinuation included adult age group, percent predicted FEV1 (ppFEV1) less than 40%, and numbers of intravenous antibiotic courses during the year before lumacaftor-ivacaftor initiation. Patients with continuous exposure to lumacaftor-ivacaftor showed an absolute increase in ppFEV1 (+3.67%), an increase in body mass index (+0.73 kg/m2), and a decrease in intravenous antibiotic courses by 35%. Patients who discontinued treatment had significant decrease in ppFEV1, without improvement in body mass index or decrease in intravenous antibiotic courses.Conclusions: Lumacaftor-ivacaftor was associated with improvement in lung disease and nutritional status in patients who tolerated treatment. Adults who discontinued lumacaftor-ivacaftor, often owing to adverse events, were found at high risk of clinical deterioration.

Introduction The purpose of this study was to assess differences in observed pain-related behaviors during cannulation between a device combining cold and vibration (Buzzy) and the standard care (EMLA patch). Methods Patients 18 months to 6 years old, requiring venous access in a pediatric emergency department, received either the Buzzy device or the EMLA patch. Predefined week randomization ensured equal allocation to the 2 intervention groups. Pain during cannulation was measured using the Children's Hospital of Eastern Ontario Pain Scale. Parent and nurse reports, cannulation success, and venous access times were also assessed. Results In total, 607 included patients were randomized into the Buzzy group (n = 302) or the EMLA group (n = 305). Observed pain-related behaviors scores, parent-assessed pain scores, and nurse-reported pain ratings were higher with Buzzy. Conclusions Pain relief by a combination of cold and vibration during cannulation is not as effective as the standard-care method in children 18 months to 6 years old.

Acute bronchiolitis is responsible for high morbidity in infants. Club cell protein 16 kDa (CC16) is a major pneumoprotein secreted by club cells of the bronchial epithelium and eliminated by the renal pathway. CC16 seems to be a biomarker of epithelial damage in asthma. However, its value as a marker of acute bronchiolitis severity and later recurrent wheezing are uncertain, especially the value of its urinary assay for this purpose. A prospective, observational, analytical study was conducted at Clermont‐Ferrand University Hospital to correlate serum CC16 level with clinical severity of bronchiolitis in hospitalized infants aged less than 1 year. We analyzed correlations between serum and urinary CC16, CC16 levels and Wainwright score, immediate morbidity due to bronchiolitis, causal viruses, and recurrent wheezing 1 year after inclusion. In 166 infants, serum CC16 did not correlate with acute bronchiolitis severity (P = .49), but urinary CC16 did (P

Summary Background Enteroviruses are the most frequent cause of acute meningitis and are seen increasingly in sepsis-like disease and fever without source in the paediatric population. Detection of enterovirus in cerebrospinal fluid (CSF) specimens by PCR is the gold standard diagnostic test. Our aim was to assess a method of detecting enterovirus in blood specimens by PCR. Methods We did a prospective, multicentre, observational study at 35 French paediatric and emergency departments in 16 hospitals. We recruited newborn babies (aged ≤28 days) and infants (aged >28 days to ≤2 years) with fever without source, sepsis-like disease, or suspected meningitis, and children (aged >2 years to ≤16 years) with suspected meningitis, who were admitted to a participating hospital. We used a standardised form to obtain demographic, clinical, and laboratory data, which were anonymised. Enterovirus PCR testing was done in blood and CSF specimens. Findings Between June 1, 2015, and Oct 31, 2015, and between June 1, 2016, and Oct 31, 2016, we enrolled 822 patients, of whom 672 had enterovirus PCR testing done in blood and CSF specimens. Enterovirus was detected in 317 (47%) patients in either blood or CSF, or both (71 newborn babies, 83 infants, and 163 children). Detection of enterovirus was more frequent in blood samples than in CSF specimens of newborn babies (70 [99%] of 71 vs 62 [87%] of 71; p=0·011) and infants (76 [92%] of 83 vs 62 [75%] of 83; p=0·008), and was less frequent in blood samples than in CSF specimens of children (90 [55%] of 163 vs 148 [91%] of 163; p

International audience; Although symptom controls in asthmatic children can be achieved through compliant use of conventional medication, some children have uncontrolled severe persistent asthma, especially if they are allergic. For these children, omalizumab (approved by the EMA and FDA in children aged > 6 years) could be a therapeutic option. However, response to omalizumab varies from one child to another. Predictive biomarkers of omalizumab effectiveness could be useful to monitor response to treatment. Area covered: The authors searched in the PubMed database for publications related to the use of biomarkers in allergic asthma. Supported by their own experience in phenotyping asthma in children, they analyzed whether these biomarkers could be useful in assessing response to omalizumab. Expert commentary: Th2 inflammation in children with allergic asthma can be assessed by measuring several biomarkers (blood eosinophil, serum ECP or periostin, FeNO). While a single measurement may be insufficient, a combination of biomarkers assessments may improve the follow-up of children treated by omalizumab.

Mycoplasma pneumoniae infection is common in children. Extrapulmonary symptoms usually reveal as neurological symptoms, mainly as encephalitis with significant morbidity and mortality. Various other neurological presentations have also been reported. We describe a cohort of nine children with neurological manifestations due to M. pneumoniae infection, including five cases of encephalitis, one of polyradiculoneuritis, one of ophthalmoplegia, one of optic neuritis, and one of myositis. Progression was variable from ad integrum recovery to severe brain damage. Diagnosis is usually confirmed by PCR and/or serological follow-up, but the latter is still insufficiently used in practice to systematically affirm the diagnosis. Therapeutic management is not clearly defined and long-term progression can be uncertain despite early antibiotic and/or anti-inflammatory treatments.

Resume But de l’etude Les outils d’evaluation permettant d’objectiver le niveau de controle de l’asthme etant nombreux, il est important de valider pour chacun d’entre eux leur pertinence. Nous proposons dans cette etude prospective de comparer des methodes cliniques, fonctionnelles et biologiques pour le suivi d’enfants asthmatiques connus. Methode Cent trois enfants asthmatiques âges de 5 a 18 ans suivis en consultation ont ete inclus. Chaque patient a beneficie d’un examen clinique complet, d’un test de controle de l’asthme (TCA), d’une exploration fonctionnelle respiratoire (EFR), d’une mesure de la fraction expiree en monoxyde d’azote (FeNO) et d’une prise de sang avec hemogramme et dosage de la proteine cationique des eosinophiles (ECP). Resultats Le TCA est correle significativement avec le pourcentage de patients ayant une obstruction bronchique : 18,2 % si TCA Conclusion L’evaluation objective du controle de l’asthme reste difficile et plusieurs marqueurs semblent etre necessaires. L’EFR associe au TCA permet de reperer les patients insuffisamment stabilises et la determination de la FeNO peut etre utile surtout pour le suivi individuel de l’enfant. Par contre, l’interet de l’ECP semble limite.

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 Avancees en Pneumo-Pediatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP(2)A). The Haute Autorite de sante (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.

Summary Objectives Few studies have been made on the impact of therapeutic education (TE) on the quality of life (QOL) of asthmatic primary-school aged children. We attempted to assess the beneficial effects on the QOL of children and their parents of a short TE program initiated immediately after the first consultation with a pediatric pulmonologist. Methods The QOL of 31 families of asthmatic children (aged 5–11) was measured before and 3 months after a short and early programme of TE by the French version of the Pictured Child's Quality of Life Self Questionnaire (AUQUEI, AUtoquestionnaire QUalite de vie Enfant Image) for the children, and by the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) for the parents. The other criteria studied were asthma management, school and workplace absenteeism and functional respiratory parameters. Results TE did not significantly alter the AUQUEI score (P = 0.67). No change was observed in the different areas studied: autonomy (P = 0.97), leisure activities (P = 0.64), functions (P = 0.88), and social relations (P = 0.51). In contrast, the PACQLQ score considerably improved after TE (P

RésuméIntroductionL’asthme est une des pathologies les plus fréquemment rencontrées aux urgences pédiatriques. L’objectif est de caractériser les consultations aux urgences pour exacerbation d’asthme et la gestion de ces exacerbations avant le recours aux soins d’urgence.MéthodesÉtude prospective menée pendant trois mois aux urgences pédiatriques du CHU de Clermont-Ferrand incluant des enfants âgés d’un à 16ans.RésultatsCent quarante-trois patients ont été inclus. Il s’agissait d’exacerbations modérées à sévères dans 69,2 % des cas (n=99). La gestion pré-hospitalière était appropriée dans 17,5 % des cas (n=25). La plupart des patients asthmatiques connus n’avaient pas de suivi spécialisé (n=56). Un protocole d’action en cas d’exacerbation au domicile avait été mis en place dans 16,5 % des cas (n=20). Les exacerbations étaient plus sévères chez les enfants plus jeunes (p=0,002) et dans les milieux de niveau économique faible (p=0,025).ConclusionsLa sensibilisation sur la conduite à tenir en cas d’exacerbation, notamment la possession et l’application d’un plan d’action, paraît insuffisante. La diminution du recours aux soins d’urgences pourrait passer par une amélioration du diagnostic et de l’éducation thérapeutique des patients asthmatiques.SummaryIntroductionThe frequency of emergency department visits for asthma is a major public health problem in pediatrics. The aim of this study is to establish the characteristics of children visiting pediatric emergency departments for acute asthma and to assess their therapeutic management prior to admission.MethodsA prospective clinical study performed during 3months at the pediatric emergency department of the university teaching hospital of Clermont-Ferrand, of children aged 1 to 16years admitted to the department with a clinical diagnosis of asthma exacerbation.ResultsOne hundred and forty-three patients were included in the study. Asthma crises were moderate to severe in 69.2% of cases (n=99). Initial therapeutic management prior to the admission to the emergency department was appropriate in 17.5% of cases (n=25). Most of the known asthmatic patients had not been followed up by a pediatric pulmonologist (n=56). A crisis protocol had been set up in 16.5% of cases (n=20). Exacerbations were more severe among younger patients (P=0.002) and economically disadvantaged children (P=0.025).ConclusionsThis study uncovers poor knowledge of the disease among asthmatic children and their families, and an insufficient awareness among health practitioners of current recommendations for the treatment of asthmatic children. Admissions to the emergency department for asthma could be partly avoided by improving diagnosis and therapeutic education.

BACKGROUND AND OBJECTIVES: The actual frequency of respiratory symptoms related to congenital pulmonary malformations (CPMs) remains undetermined. The goal of this study was to prospectively evaluate the respiratory symptoms occurring in infants with prenatally diagnosed CPMs, identify factors associated with the occurrence of these symptoms, and evaluate their resolution after surgery. METHODS: Infectious and noninfectious respiratory symptoms were prospectively collected in a French multicenter cohort of children with CPMs. RESULTS: Eighty-five children were followed up to the mean age of 2.1 ± 0.4 years. Six children (7%) underwent surgery during the first 28 days of life. Of the 79 remaining children, 33 (42%) had respiratory symptoms during infancy before any surgery. Wheezing was the dominant symptom (24 of 79 [30%]), and only 1 infant had documented infection of the cystic lobe. Symptoms were more frequent in children with noncystic CPMs, prenatally (P = .01) or postnatally (P < .03), and with postnatally hyperlucent CPMs (P < .01). Sixty-six children underwent surgery during the follow-up period, and 40% of them displayed symptoms after the intervention. Six children had documented pneumonia during the postoperative period. At the end of the follow-up, pectus excavatum was observed in 10 children, significantly associated with thoracotomy (P < .02) or with surgery before the age of 6 months (P < .002). CONCLUSIONS: CPMs are frequently associated with wheezing episodes. Surgery had no significant impact on these symptoms but was associated with a paradoxical increase in pulmonary infections, as well as an increased risk of pectus excavatum after thoracotomy.

Krebs von den Lungen 6 antigen (KL-6) has been shown to be a useful biomarker of the severity of Respiratory syncytial virus bronchiolitis. To assess the correlation between the clinical severity of acute bronchiolitis, serum KL-6, and the causative viruses, 222 infants with acute bronchiolitis presenting at the Pediatric Emergency Department of Estaing University Hospital, Clermont-Ferrand, France, were prospectively enrolled from October 2011 to May 2012. Disease severity was assessed with a score calculated from oxygen saturation, respiratory rate, and respiratory effort. A nasopharyngeal aspirate was collected to screen for a panel of 20 respiratory viruses. Serum was assessed and compared with a control group of 38 bronchiolitis-free infants. No significant difference in KL-6 levels was found between the children with bronchiolitis (mean 231 IU/mL ± 106) and those without (230 IU/mL ± 102), or between children who were hospitalized or not, or between the types of virus. No correlation was found between serum KL-6 levels and the disease severity score. The absence of Human Rhinovirus was a predictive factor for hospitalization (OR 3.4 [1.4–7.9]; P = 0.006). Older age and a higher oxygen saturation were protective factors (OR 0.65[0.55–0.77]; P

Resume Objectif Etudier les apports d’une technique d’apprentissage par le recit (ou pedagogie narrative) baptisee « focus-groupe pedagogique » (FGP), reposant sur la rencontre entre etudiants en medecine et parents d’enfants hospitalises. Le FGP comprend 3 temps : etudiants seuls, parents en presence des etudiants, a nouveau etudiants seuls. Methodes Etude qualitative. Deux seances de FGP reunissant chacune 4 a 6 parents et autant d’etudiants ont ete realisees. Les parents ont ete interroges sur la hierarchie medicale, l’identification des soignants, la communication et la prise en charge globale. Analyse thematique des discours des etudiants et des parents. Resultats Les etudiants ont exprime leur vecu a l’hopital, en particulier l’ambiguite de leur fonction d’etudiants-soignants. De leur cote, les parents ont exprime leur sentiment et leur analyse de la vie hospitaliere, mais egalement leur conception de la relation medecin–malade a travers leur enfant et leur propre vecu de patient (parfois d’ancien enfant malade). La confrontation a revele des differences entre les a priori des etudiants et les attentes des parents, en termes de qualite relationnelle, de communication, d’attitude professionnelle, de connaissances et de competences. Cette approche a permis de mieux apprehender le point de vue « de l’autre cote », pour les etudiants, pour les parents et pour l’animateur, avec des implications directes pour la pratique quotidienne. Conclusion Le FGP est une technique de sensibilisation a la diversite des points de vue adaptee aux specificites de la pediatrie.

Internationally adopted children often present diseases contracted in the country of origin. Skin diseases are common in new arrivals, and diagnosis may prove challenging for GPs or even dermatologists if they are inexperienced in the extensive geographic and ethnic diversity of international adoptees. To analyse the frequency and characteristics of skin diseases in international adoptees. In total, 142 adoptees were evaluated for a cross-sectional cohort study. The most frequent diseases observed at arrival were dermatological conditions. Of the adoptees, 70% presented at least one skin disease, of which 57.5% were infectious; Tinea capitis being the most frequent (n = 42). The recovery rate of Tinea capitis was 89% (n = 32/36). Ten cases of scabies were diagnosed. Other diseases included viral skin infection (n = 22), with 16 cases of Molluscum contagiosum and bacterial infection. Skin diseases are very common in internationally adopted children. There is a need for close collaboration between dermatologists and paediatricians to diagnose such infections, as well as clear guidelines to treat them.

Cat scratch disease (CSD) is usually a benign, self-limited regional lymphadenopathy, caused by Bartonella henselae. However, systemic complications have been described. We report on 2 children who developed neurological symptoms of acute encephalitis or neuroretinitis. Cat scratch disease should be suspected when neurological symptoms of undetermined cause occur in children, whether or not anamnesis is significant.

Resume Nous avons mene une etude sur le devenir d’enfants victimes de rhinoconjonctivite pollinique desensibilises au pollen de graminees reevalues au moins trois ans apres l’arret de leur traitement. Ce travail a concerne 46 enfants d’âge median en debut de traitement de 10,46 ans. Parmi eux, (32) 69,57 % ont recu une desensibilisation par voie sous-cutanee (SC), (11) 23,61 % par voie sublinguale (SL) et (3) 6,52 % par voie SC puis SL. La duree moyenne de la desensibilisation etait de 4,41 ans. Un asthme etait associe dans 84,78 % des cas et 50 % etaient polysensibilises. L’evolution des scores symptomatiques restait en dessous des scores cliniques moyens avant desensibilisation ( p p = 0,001). A l’inverse, la toux seche et/ou les crises d’asthme, ne recidivaient pas lors de la saison pollinique. Il n’a pas ete observe d’augmentation significative de la prise de medicaments de secours au cours de la saison pollinique a l’exception d’antihistaminiques lors du pic pollinique ( p = 0,001). En fin d’etude, 82 % de la population trouvaient la desensibilisation toujours efficace du point de vue de l’asthme, contre 71 % pour la rhinite et 76 % pour la conjonctivite. L’efficacite de la desensibilisation reste prononcee apres arret prolonge. La persistance de symptomes mineurs justifie un suivi clinique adapte.

Background About 100 serotypes of human rhinovirus (HRV), classified into two species, have been identified by 1990. Uncultivable HRV variants have recently been identified and designated a new species. Recent improved diagnosis has led to a re-appraisal of the clinical impact of HRV infections in lower respiratory diseases. Objectives To characterise clinical features in hospitalised patients with positive HRV RNA detection and to determine the distribution of HRV species in respiratory infections diagnosed during the winter of 2009–2010. Study design Prospective virus typing was conducted by sequencing the VP4/VP2 genomic regions, and clinical data were collected. Results Fifty-eight patients (for 63 respiratory specimens) were included. Phylogenetic analysis identified 52% of HRV species A, 6% of species B and 40% of species C, and revealed the co-circulation of 34 different HRV types during the study period. Three infants had successive infections with two or three different types. Five patients were admitted to an intensive care unit, four of them on arrival. Bronchiolitis, pneumonia and exacerbation of asthma were observed in 34/45 children. Pneumonia and severe exacerbation of chronic lung disease were observed in 8/13 adults, of whom 1, with immunocompromised status, died of multivisceral failure. Conclusions This study underlines the diversity of co-circulating strains and the potential severity of clinical presentations associated with HRV infections.

Recurrent wheezing in infants is a recognized risk factor for the development of childhood asthma. We sought to develop an easy-to-use persistent asthma predictive score (PAPS) in a population of young recurrent wheezers.We retrospectively studied clinical and biological data of infants under 2 years of age presenting recurrent wheezing and evaluated current asthma at 6 years of age using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Multivariate analysis was performed to select predictive variables to generate a PAPS. The score was then tested on another cohort for independent validation.Two hundred infants were included in the cohort used to create the PAPS, and 227 in the validation cohort. In the first population, 47% of the children had developed asthma at 6 years of age, including 33% with mild to severe persistent asthma. Three parameters independently predicted persistent asthma: family history of asthma, personal atopic dermatitis, and multiple allergen sensitizations. Based on these variables, the PAPS showed 42% sensitivity, 90% specificity, 67% positive predictive value, and 76% negative predictive value for the prediction of persistent asthma. It was able to discriminate future persistent asthmatic from nonfuture persistent asthmatic children, with an accuracy of 74% in the initial population and 67% in the validation population.The PAPS, based on three easy-to-obtain variables, could help the physician in clinical practice to identify infants at high risk for persistent childhood asthma, and thus better evaluate the need for secondary preventive measures.

Resume Objectif L’objectif de cette etude etait d’analyser les resultats de nos trois premieres annees de photocoagulation-laser (PL) et de comparer le devenir perinatal des grossesses gemellaires compliquees d’un syndrome transfuseur-transfuse (STT) avant et apres la mise en place du traitement par PL. Patients et methodes Cette etude retrospective de type avant/apres a ete menee dans un seul centre. Elle comparait le devenir perinatal d’enfants issus de 19 grossesses consecutives compliquees de STT au deuxieme trimestre et traitees par amniodrainages iteratifs (AI), sur une periode de dix ans, a celui d’enfants issus de 49 grossesses consecutives compliquees de STT et traitees par PL, sur une periode de trois ans. Resultats La PL ameliorait de facon significative la survie a la naissance ( p = 0,02) et apres 28 jours de vie ( p = 0,01), sans variation significative des taux de complications neurologiques ( p = 0,5) et cardiologique ( p = 0,3). Le taux de survie du donneur etait significativement augmente par la PL a la naissance ( p = 0,04). Discussion et conclusion Cette etude confirme la superiorite de la PL par rapport a l’AI. Elle montre sa faisabilite par une equipe emergente avec des resultats comparables a ceux d’equipes experimentees.

Resume L’evaluation du pronostic a long terme de l’asthme du nourrisson est une question essentielle compte tenu de sa frequence. La persistance de l’asthme a l’adolescence est d’origine multifactorielle. Objectif principal de l’etude Comparer la frequence de l’asthme a l’adolescence selon l’origine geographique des enfants. Objectif secondaire Determiner les principaux facteurs de risque de persistance. Type d’etude Retrospective, transversale, menee dans deux centres hospitalo-universitaires (centre de l’Asthme, hopital Trousseau, Paris ; unite de pneumologie et allergologie infantile, CHU-Estaing, Auvergne, Clermont-Ferrand). Criteres d’inclusion Enfants âges de moins de 36 mois presentant un asthme du nourrisson selon la definition de l’HAS et ayant beneficie d’une exploration standardisee. Les symptomes d’asthme ont ete reevalues apres l’âge de 12 ans. Deux cent vingt-sept patients ont ete inclus (148 a Clermont-Ferrand, 79 a Paris). Resultats Il n’existe pas de difference evolutive (persistance de l’asthme a l’adolescence) selon l’origine geographique des patients (32,26 % a Clermont-Ferrand vs 25 % a Paris, p = 0,27). Les enfants suivis en Auvergne sont plus sensibilises a l’adolescence que les Parisiens (26,16 % de sensibilisations a deux pneumallergenes vs 11,11 % a Paris, p = 0,03). Les risques de persistance de l’asthme dans les deux groupes sont: la sensibilisation multiple aux pneumallergenes (OR 4,6), l’antecedent de dermatite atopique (OR 3,4), la severite initiale (OR 2,3) et une eosinophilie superieure a 470/mm3 (OR 2,2). L’existence d’une rhinite allergique est associee de facon significative a la gravite de l’asthme actuel. Conclusions La dermatite atopique et la multisensibilisation allergenique constituent des facteurs de risque evolutif. Le fait de vivre dans une region fortement urbanisee ou non ne modifie pas de facon significative le devenir a long terme, a l’exception de la sensibilisation allergenique.

Background. In recurrent wheezing infants, it is important to identify those likely to remain asthmatic in order to propose appropriate long-term management. Objective. To establish predictive factors for persistent asthma at adolescence in a population of recurrent wheezing infants. Methods. Retrospective study of 227 infants. Inclusion criteria were age under 36 months, a history of at least three wheezing episodes assessed via a doctor-led ISAAC questionnaire and a standardized allergy testing programme. At 13 years, active asthma was assessed by questionnaire. Results. Risk factors for asthma persisting into adolescence were allergic sensitization to multiple airborne allergens (OR 4.6, CI-95% (1.9–11.2) ), initial atopic dermatitis (OR 3.4, CI-95% (1.9–6.3) ), severe recurrent wheezing (OR 2.3, CI-95% (1.3–4.2) ), and hypereosinophilia ≥470/mm3 (OR 2.2, CI-95% (1.07–4.7) ). Conclusion. While it is still difficult to predict the long-term course of asthma, atopy remains the major risk factor for persistent asthma.

Congenital diaphragmatic hernia (CDH) is a common cause of severe neonatal respiratory distress. Mortality and morbidity are determined by the amount of pulmonary hypoplasia (PH) that occurs and by the development of therapy-resistant pulmonary hypertension. The pathogenesis and aetiology of CDH and its associated anomalies are still largely unknown despite all research efforts. The pathogenesis of CDH is based on an assumption linking herniation of abdominal viscera into the thorax with compression of the developing lung. PH, however, can also result from reduced distension of the developing lung secondary to impaired fetal breathing movements. Our understanding of CDH has also been aided by basic research with the use of dietary, teratogen-induced, and knockout models of CDH. These studies indicate that lung hypoplasia may involve disturbances of mitogenic signalling pathways fundamental to embryonic lung development. Recent data reveal the role of disruption of a retinoid-signalling pathway in the pathogenesis of CDH. Although multifactorial inheritance may best explain most cases of CDH in humans, much has been learned about the genetic factors that play a role in the development of CDH by studies of patients with CDH caused by specific genetic syndromes and chromosome anomalies. More research is warranted to improve our understanding of normal and abnormal lung development in relation to CDH. Such investigations will help in the design of new treatment strategies to improve the natural course or even to prevent this anomaly.

Resume L’anaphylaxie aigue (ANA) est rare chez l’enfant. Son diagnostic est difficile surtout quand il s’agit d’une manifestation inaugurale. Les urgences pediatriques recoivent des pathologies variees dont certaines sont allergiques. Objectif de l’etude Analyser l’interet du dosage de la tryptase serique dans une population d’enfants admis dans un service d’urgence pediatrique (SUP) pour une suspicion d’ANA. Type d’etude Analyse retrospective de 77 enfants recus dans un SUP avec un diagnostic de suspicion d’allergie aigue (AA). Resultats Sur les 77 dossiers analyses, 61 ont ete retenus car ils presentaient des manifestations cliniques compatibles avec une AA. Quarante avaient des symptomes evocateurs d’ANA et 21 une urticaire isolee (UI). L’âge moyen est identique dans les deux groupes (6,47 ans versus 6,07 ans). En cas d’ANA les taux de tryptase serique sont significativement plus elevees (12,41 ± 8,9 μg/l) que ceux obtenus dans les cas d’UI (5,55 ± 3,17 μg/l), p : 0,0005. Parmi les enfants ayant une ANA ceux qui ont les symptomes les plus graves (hypotension arterielle) ont les valeurs de tryptase les plus fortes (21,67 ± 13,77 μg/l) p

In asthmatic children, control of the disease is perfect when no symptoms occur and lung function is normal. The aim of this study is to analyse the role of plethysmography in the follow-up of asthmatic children. We present the results of a retrospective study of lung function (plethysmography and forced expiratory flow) in about 100 asthmatic children aged five to 16years. FEV1/FVC less than 80% predicted was considered as pathological (airflow obstruction). The ratio RV/TLC was considered pathological if greater than 30% and RV was considered pathological if greater than 120% (lung hyperinflation). Bronchodilator reversibility was performed in all patients. All patients were studied in a stable condition. None had developed any asthmatic exacerbations during the past month. We found a significant correlation between the residual volume/total lung capacity (RV/TLC) ratio and, on one hand: FEV1 (p

Objective To present longitudinal observations of hyperechoic lung lesions (HLL) in a non-selected population from the time of prenatal diagnosis by ultrasound (US) until postnatal surgery. Methods We conducted a retrospective study of all fetuses diagnosed with an HLL between 1990 and 2005 in our Fetal Medicine Unit. Results We observed 21 cases of HLL. Among the 17 fetuses with unilateral lesion, two cyst punctures were attempted on fetuses with signs of fetal compromise. Termination of pregnancy (TOP) was performed on seven fetuses. Fourteen fetuses were followed till birth. First Chest X-ray was abnormal in ten cases, while delayed CT scans revealed a lung lesion in 12 cases. Two neonates required emergency surgery and died post operatively. Surgery was successfully performed in all other cases (n = 10). Pathological examination revealed congenital high airway obstruction syndrome, CHAOS (n = 4), lower airway stenosis (n = 2), bronchogenic cyst (n = 1), congenital lobar emphysema (n = 1), and congenital cystic adenomatoid malformation, CCAM (n = 11) including two cases associated with a sequestration. Conclusion HLL cover a wide spectrum of lung abnormalities of various severities. Post natal management should always include an early chest X-ray and CT scan to allow appropriate selection for surgery. Copyright © 2009 John Wiley & Sons, Ltd.

Background Human adenovirus (HAdV) infections, while common in infancy and childhood, occur rarely in the neonatal period but may be fatal. Objectives To describe a transmission of HAdV from a patient with fatal pneumonia to heath-care workers that could be considered as a model of respiratory virus transmission in a care unit. Study design Case report with virologic studies. Results A 10-day-old neonate developed pneumonia with acute respiratory distress, external pulmonary bleeding and coagulopathy and died 36 h after admission of multivisceral failure. An adenovirus was isolated from pulmonary biopsy and detected by PCR in blood and respiratory secretions. Ten days later, three members of medical staff in charge of this infant, who used neither masks nor glasses for close patient contact, developed keratoconjunctivitis. Molecular analysis of the infant's and one of the pediatrician's isolates identified a species D HAdv and showed 100% identity, thereby demonstrating viral transmission. Conclusion In view of the serious outcome, HAdV infections should be considered in the differential diagnosis of pneumonia in neonates. This case illustrates the epidemic potential of viruses with respiratory transmission and underlines the importance of complying with standard precautions to prevent viral spread in routine practice.

Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n = 32) and those whose results were available > 24 hr after collection of CSF (n = 14). Duration of antibiotic treatment (difference: 2.3 days; P = 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis.

Resume En France, la vaccination saisonniere annuelle contre la grippe est recommandee depuis 2000 chez les patients souffrant d’affections bronchopulmonaires chroniques graves, dont l’asthme. Chaque annee, l’Assurance maladie adresse un bon de prise en charge a 100 % du vaccin contre la grippe aux patients souffrant d’insuffisance respiratoire chronique grave, parmi lesquels les patients atteints d’asthme severe. En novembre 2006, la prise en charge gratuite du vaccin grippe a ete etendue a toutes les personnes atteintes d’asthme, quelle que soit la severite de leur asthme. Cette etude evalue la couverture vaccinale contre la grippe pour la saison 2006–2007 chez 433 enfants asthmatiques âges de six a 17 ans (âge moyen : 9,5 ans ; garcons : 61 %) ayant consulte un pneumopediatre a l’hopital entre mars et septembre 2007. Le taux de couverture vaccinale contre la grippe pour la saison 2006–2007 etait de 15,7 % (13,9 % en 2005–2006 et 10,9 % en 2004–2005). Dans 72,1 % des cas, les enfants etaient vaccines par un medecin generaliste. Le motif de non-vaccination le plus souvent rapporte etait le manque d’information (42 %). La reception du bon de prise en charge (recu par 39,6 % des enfants) augmentait significativement le taux de couverture vaccinale (31 % versus 5,9 % ; p

International audience; Rabbit lung is often used to study the pathophysiology of some congenital anomalies affecting the lung because its development is very comparable with that of human. Retinoids and the molecular transducers of the retinoic signal play a crucial role in mammalian lung development. In the rabbit, the molecular retinoic pathway has so far been poorly studied. As a first step in elucidating this process, we aimed to identify the retinoic acid receptors (RARs) and retinoid X receptors (RXRs). We cloned a part of the nuclear receptors (RARs and RXRs), and we used reverse transcription - polymerase chain reaction (RT-PCR) and immunohistochemistry assays to demonstrate the presence of RAR (α,β) and RXR (α, β) at all stages of rabbit lung development. Our results initiate further analysis into the molecular and genetic functions of retinoids during normal and pathological rabbit lung development including the surgical model of congenital diaphragmatic hernia.

Airway smooth muscle cells (ASMC) play a major role in airway inflammation, hyperresponsiveness, and obstruction in asthma. However, very little is known regarding the relation between inflammatory mediators and cytokines and immature ASMC. The aim of this study was to evaluate 1) the secretion of leukemia inhibitory factor (LIF) (an IL-6 family neurotrophic cytokine) by ASMC; 2) intracellular calcium concentration ([Ca2+]i) signaling; and 3) the effect of LIF on mast cell chemotaxis and rat airway contractility. Immature and adult human ASMC were cultured. ELISA and real-time PCR were performed to assess LIF protein secretion and mRNA production, [ methyl-3H]thymidine incorporation to quantify ASMC DNA synthesis, a Boyden chamber to evaluate the effect of LIF on mast cell chemotaxis, microspectroflurimetry using indo-1 (at baseline and after stimulation bradykinin, U-46619, histamine, and acetylcholine, in the presence or absence of LIF or TNF-α) for [Ca2+]i signaling, and isolated rat pup tracheae to determine the effect of LIF on airway contractility to ACh. TNF-α-stimulated immature ASMC produce more LIF mRNA and protein than adult ASMC, although this cytokine induces a moderate increase in DNA synthesis (+20%) in adult ASMC only. Human recombinant LIF exerts no chemotactic effect on human mast cells. In immature ASMC, ACh-induced [Ca2+]i response was enhanced twofold after incubation with LIF, whereas TNF-α increased the [Ca2+]i to U-46619 threefold. In TNF-α-exposed adult ASMC, [Ca2+]i responses to ACh were of greater magnitude (sixfold increase) than in immature ASMC. Human recombinant LIF increased contractility to ACh by 50% in immature, isolated rat tracheae. Stimulated immature human ASMC greatly secrete LIF, thus potentially contributing to neuroimmune airway inflammation and subsequent remodeling. Increased LIF secretion enhances airway reactivity and [Ca2+]i signaling.

Human enterovirus D68 (EV-D68) is known to be associated with mild to severe respiratory infections. Recent reports in the United States and Canada of acute flaccid paralysis (AFP) in children with detection of EV-D68 in respiratory samples have raised concerns about the aetiological role of this EV type in severe neurological disease. This case study is the first report of AFP following EV-D68 infection in Europe.

INTRODUCTION Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.

Silicone stents were inserted into the trachea or left main-stem bronchus in 14 children aged 2-69 months (median, 7 months). Indications were as follows: tracheomalacia or airway kinking (7 cases), vascular compression (5 cases), and surgically corrected congenital tracheal stenoses (2 cases). The best results were obtained in tracheomalacia. Overall, 6 cases out of 14 (43%) were considered successful, with a stent placement duration of 3-15 months (median, 7 months). Two cases were considered a technical success, although they were clinical failures. Five cases were considered failures primarily due to stent migration. A retrospective analysis of failures suggests that most of these could have been avoided by the use of larger stents. One patient died of stent obstruction. No wall erosion was observed, and the development of granulation tissue was infrequent. Endoscopic removal of the prostheses was uneventful. The biocompatibility of silicone stents appears to be better than what is reported for metal ones, although the stability of the former is less satisfactory. The present study shows the feasibility of silicone stent placement in infants. These stents should be considered as a possible therapeutic option in certain types of childhood airway disorders, although further studies are required.

Unilateral primitive agenesia of pulmonary artery is a rare congenital disorder. Experience of three hospital-based pulmonology pediatric units including eight children (three boys and five girls) with such anomaly is reported (11 years median follow-up, range 6 months to 10 years). Median age at diagnosis was 4 years. Clinical features included recurrent respiratory tract infections (75%), effort dyspnea (50%) and, curiously, asthmatic symptoms (75%). Diagnosis was evoked on chest X rays and confirmed by angiography in all cases. Agenesis of the right pulmonary artery was more frequent (five cases). Abnormal vascular ring was associated in two cases of agenesis of the left pulmonary artery. Pulmonary function tests were performed in six children, with bronchial obstruction in two. Regular clinical follow-up, up to adult age in four cases, showed no complication, such as hemoptysis or pulmonary hypertension in our patients.

Study objective: The Vesta project aims to assess the role of traffic related air pollution in the occurrence of childhood asthma. Design and setting: Case-control study conducted in five French metropolitan areas between 1998 and 2000. A set of 217 pairs of matched 4 to 14 years old cases and controls were investigated. An index of lifelong exposure to traffic exhausts was constructed, using retrospective information on traffic density close to all home and school addresses since birth; this index was also calculated for the 0–3 years age period to investigate the effect of early exposures. Main results: Adjusted on environmental tobacco smoke, personal and parental allergy, and several confounders, lifelong exposure was not associated with asthma. In contrast, associations before age of 3 were significant: odds ratios for tertiles 2 and 3 of the exposure index, relative to tertile 1, exhibited a positive trend (1.48 (95%CI = 0.7 to 3.0) and 2.28 (1.1 to 4.6)), with greater odds ratios among subjects with positive skin prick tests. Conclusions: These results suggest that traffic related pollutants might have contributed to the asthma epidemic that has taken place during the past decades among children.

Acquired emphysema is a rare pathology in pediatrics. We report the case of a patient born at term with a neonatal respiratory distress, which had required mechanical ventilation. She developed gradually chronic obstructive pulmonary disease with severe emphysematous lesions, respiratory failure and functional impairments. Bilateral emphysema resection, performed at 16 years old, allowed major functional benefits at rest and during exercise. We present the results of respiratory functional evaluations, walk tests and maximal exercise tests (including measure of dynamic hyperinflation) before and after surgery, which highlights that surgery is a successful option in the treatment of compressive emphysema in childhood.

Resume Le but de cette etude etait de determiner la prevalence de l’asthme en region Auvergne. Patients et methodes. – Deux mille neuf eleves d’ecoles primaires (cinq–six ans) et secondaires (14–15 ans) ont ete etudies a l’aide d’un questionnaire remis a l’occasion de la visite medicale obligatoire. Resultats. – Le taux de reponse a ete de 82 %. La prevalence de l’asthme etait de 5,6 %. Il n’y avait pas de difference selon les deux tranches d’âge considerees ou le sexe. On observait, en revanche, une difference significative de la prevalence (p = 0,01) selon que l’enfant habitait une zone urbaine (7,3 %) ou rurale (4,6 %). Dans le Puy-de-Dome, cette difference etait encore plus marquee puisqu’elle atteignait 10,2 % en zone urbaine contre 4,0 % en zone rurale (p = 0,001). Douze pour cent des enfants interroges avaient presente des sifflements dans l’annee ecoulee. La prevalence des bronchites etait superieure en milieu rural (17,3 %) a celle du milieu urbain (11,8 %) sans que cette difference ait ete significative. Le tabagisme passif accroissait significativement ce risque (18,9 % contre 14 %, p = 0,003). Conclusion. – En region Auvergne, la prevalence de l’asthme dans les deux tranches d’âge considerees etait faible par rapport a celle des autres regions de France et d’Europe. La difference de prevalence observee entre habitat urbain et rural refletait l’impact possible de l’environnement.

Objective Clinical and diagnostic management of traumatic brain injuries is problematic in young children. To facilitate this management, we describe blood reference ranges for the well established biomarker S100B in children younger than 3 years. Design and methods Serum S100B concentrations were determined by electro-chemiluminescence immunoassay in a population of 186 healthy children aged 0–3 years. Results Four age groups emerged, i.e. 0–3, 4–9, 10–24 and 25–36 months. We also found an interesting inverse correlation with head circumference. Conclusion This study provides useful serum S100B values from the largest cohort of healthy children aged 0–3 years old.

BACKGROUND AND OBJECTIVE: Congenital pulmonary malformations (CPM) are mostly recognized on prenatal ultrasound scans. In a minority of cases, they may impair breathing at birth. The factors predictive of neonatal respiratory distress are not well defined, but an understanding of these factors is essential for decisions concerning the need for the delivery to take place in a tertiary care center. The aim of this study was to identify potential predictors of respiratory distress in neonates with CPM. METHODS: We selected cases of prenatal diagnosis of hyperechoic and/or cystic lung lesions from RespiRare, the French prospective multicenter registry for liveborn children with rare respiratory diseases (2008–2013). Prenatal parameters were correlated with neonatal respiratory outcome. RESULTS: Data were analyzed for 89 children, 22 (25%) of whom had abnormal breathing at birth. Severe respiratory distress, requiring oxygen supplementation or ventilatory support, was observed in 12 neonates (13%). Respiratory distress at birth was significantly associated with the following prenatal parameters: mediastinal shift (P = .0003), polyhydramnios (P = .05), ascites (P = .0005), maximum prenatal malformation area (P = .001), and maximum congenital pulmonary malformation volume ratio (CVR) (P = .001). Severe respiratory distress, requiring oxygen at birth, was best predicted by polyhydramnios, ascites, or a CVR >0.84. CONCLUSIONS: CVR >0.84, polyhydramnios, and ascites increased the risk of respiratory complications at birth in fetuses with CPM, and especially of severe respiratory distress, requiring oxygen supplementation or more intensive intervention. In such situations, the delivery should take place in a tertiary care center.