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Multisystem inflammatory syndrome in children (MIS-C) is a novel post-infectious disease occurring in the context of SARS-CoV2 infection. COVID-19 vaccines have been authorized since December 2020, and adverse events including myocarditis have been reported following vaccination. We describe the cases of two pediatric patients presenting with clinical and laboratory features suggestive of MIS-C a few days after receiving their first dose of the Pfizer BNT162b2 vaccine. The outcome was favorable for both patients (after corticosteroid and immunoglobulin administration for one patient). These cases suggest an association between the COVID-19 vaccine and the occurrence of MIS-C.

Resume La bronchiolite est la premiere cause d’infection respiratoire chez le nourrisson. Des complications peuvent etre associees, notamment hydroelectrolytiques a type d’hyponatremie, definie par un seuil plasmatique

Metabolic phenotyping consists in the identification of subtle and coordinated metabolic variations associated with various pathophysiological stimuli. Different analytical methods, such as nuclear magnetic resonance, allow the simultaneous quantification of a large number of metabolites. Statistical analyses of these spectra thus lead to the discrimination between samples and the identification of a metabolic phenotype corresponding to the effect under study. This approach allows the extraction of candidate biomarkers and the recovery of perturbed metabolic networks, driving to the generation of biochemical hypotheses (pathophysiological mechanisms, diagnostic tests, therapeutic targets…). Metabolic phenotyping could be useful in anaesthesiology and intensive care medicine for the evaluation, monitoring or diagnosis of life-threatening situations, to optimise patient managements. This review introduces the physical and statistical fundamentals of NMR-based metabolic phenotyping, describes the work already achieved by this approach in anaesthesiology and intensive care medicine. Finally, potential areas of interest are discussed for the perioperative and intensive management of patients, from newborns to adults.

Les traumatismes crâniocerebraux (TCC) graves sont une cause frequente de deces et de sequelles neurologiques a long terme. L’epidemiologie des TCC graves est mal connue car les definitions different selon les etudes. Les etudes basees en population sont rares, la plupart sont issues de donnees hospitalieres prenant rarement en compte les deces prehospitaliers. L’incidence annuelle des TCC graves dans les pays riches varie de 2,3 a 17 pour 100 000 en utilisant l’echelle de Glasgow et peut atteindre 46 pour 100 000 avec d’autres classifications. Les TCC graves representent 3 a 10 % des TCC, a l’origine d’une mortalite annuelle de 2,5 a 9 pour 100 000. Les accidents de la circulation representent la majorite des TCC graves et des deces chez les enfants, largement devant les chutes. La part des chutes, de la maltraitance et des chocs directs est beaucoup plus importante chez les nourrissons. Les TCC infliges, probablement sous-estimes, sont des TCC graves et representent un quart des deces par TCC graves chez le nourrisson de moins d’un an. La letalite des TCC graves est de 15–20 %. Le taux de sequelles a long terme varie selon le type de sequelles evalue et les outils de mesure. Il est plus eleve apres un TCC inflige. Parmi les enfants avec TCC grave, un tiers developpe des troubles psychocomportementaux, 20 a 30 % des incapacites et des troubles cognitifs, 60–70 % se plaignent de fatigue, troubles de concentration et de comportement, et dans 50 % des cas des dysfonctions familiales surviennent.

Resume Objectifs La loi Leonetti de 2005 est venue encadrer des procedures de limitation et d’arret de traitements de maintien des fonctions vitales (LAT) pratiquees depuis longtemps par les reanimateurs (Loi no 2005-370 du 22 avril 2005 relative aux droits des malades et a la fin de vie.) Les recommandations des societes savantes encouragent les equipes a evaluer leurs pratiques. C’est inspires du document de la commission ethique de la Societe de reanimation de langue francaise (SRLF) que nous avons realise une evaluation des pratiques de la transcription de nos decisions de LAT. Type d’etude Evaluation retrospective des pratiques sous une forme originale d’etude avant/apres une reunion d’information qui rappelait les textes de loi et les recommandations actuelles. L’etude a concerne l’ensemble des enfants ayant fait l’objet d’un questionnement de LAT (de mars 2008 a aout 2011), soit 95 enfants, dans le service de reanimation pediatrique de l’hopital Femme-Mere-Enfant de Lyon. L’analyse comprenait le recueil des donnees epidemiologiques ainsi qu’une evaluation de la transcription de nos procedures de LAT dans nos dossiers. Patients et methodes L’evaluation des pratiques a porte sur 40 dossiers. Une reunion d’information a ete realisee en janvier 2011 : 20 dossiers ont ete tires au sort avant cette date puis compares aux 20 dossiers survenus consecutivement apres la reunion. Le critere d’evaluation principal etait l’amelioration du taux de respect de chaque critere tire de la demarche d’evaluation publiee par la SRLF en janvier 2010 et adapte a la pratique pediatrique. Resultats principaux Nos donnees epidemiologiques sont comparables aux donnees de la litterature et l’evaluation de nos pratiques a servi a mettre une tendance a l’amelioration avec certains points a ameliorer : manque de details dans l’argumentation des decisions, evaluation de la douleur encore imparfaite. Il n’y pas cependant de significativite statistique. Conclusion L’evaluation des pratiques professionnelles est recommandee pour ameliorer les procedures de LAT, qui sont devenues un domaine d’expertise a part entiere en reanimation.

Les explorations neurophysiologiques completent l’evaluation clinique et radiologique d’un enfant cerebrolese. Leur interet est a la fois diagnostique, quand il s’agit de mettre en evidence des crises convulsives ou une mort encephalique pour l’electroencephalogramme (EEG) ou d’evaluer une dysfonction du tronc cerebral pour les potentiels evoques (PE) auditifs precoces, et pronostique pour predire un mauvais devenir neurologique dans les comas anoxiques. A la phase aigue d’un traumatisme crânien grave (TCG) et d’une meningite, il est utile de reconnaitre et de traiter des convulsions ; neanmoins, la frequence des etats epileptiques non convulsifs est importante et variable selon les etudes (de 7 a 48 %). Bien que lourdes et couteuses, les techniques d’EEG continues pourraient en ameliorer la detection. D’ou le developpement de techniques d’EEG d’amplitude, dont l’interet reste encore a preciser en pediatrie. Concernant le pronostic, certains traces EEG comme des burst-suppression, un trace nul ou un etat de mal convulsif sont consideres comme mauvais. La valeur predictive des EEG reste limitee et inferieure a celle des PE somesthesiques (PES). Les PES ont une excellente valeur predictive dans les comas anoxiques de l’adulte et de l’enfant (de 94 a 100 %, selon les etudes), surtout en combinaison avec l’evaluation des reflexes pupillaires et des reponses motrices apres 48 heures. En revanche, la prediction d’un devenir neurologique favorable est moins performante. Pour les TCG et les meningites, la performance des PES est moins bonne. L’etude des PE cognitifs ou negativite de discordance (MMN) pourrait ameliorer la prediction du reveil.

The case of 3-year-old girl severely injured, as restrained car passenger in a road crash, is reported. She presented with isolated circulatory failure, without specific clinical signs except skin contusions corresponding to seat belt. Because of mediastinum enlargement on systematic chest X-ray, a pericardial effusion was suspected, which was confirmed by echography, rapidly complicated by an acute tamponade without visible cause on CT-scan. The radiological assessment showed a moderate peritoneal haemorrhage related to a splenic injury. A persistent haemodynamic instability required a pericardial puncture, after rapid sequence tracheal intubation of the child, but without clinical improvement, despite fluid bolus, red-blood cell transfusion and epinephrine infusion. The child was rapidly transferred to the cardiac operating room for sternotomy, which showed a right atrial laceration. The injury was repaired, allowing the child to survive without disability. Tamponade due to traumatic cardiac injury is extremely rare in children. The clinical diagnosis is particularly difficult to establish in the context of polytrauma. The classical symptoms of cardiac tamponade are rarely complete. The association of chest injury, isolated circulatory failure and enlargement of mediastinum at chest X-ray should alert the physician. As the severity of these injuries is high, a rapid and multidisciplinary management is required, as well as specific anaesthetics precautions.

Bacterial meningitis is still a serious disease with a high risk of mortality and sequels. The progress in antibiotic treatment has not improved the prognosis. Thus, optimizing the initial care and the treatment of the most severe cases should improve the outcome. No study has compared the outcome according to the level of care at the admission site. There is evidence that the most severe cases should be managed by critical care units. It seems reasonable to recommend initial admission of common cases to units able to provide intensive care. Most people now agree that fluid restriction has not demonstrated its efficiency, furthermore it might have deleterious effects. However, a fluid overload should be avoided. Maintaining cerebral perfusion is a key issue in the treatment of bacterial meningitis and requires monitoring both arterial blood pressure and intracranial pressure. Intracranial pressure monitoring is probably useful to optimize the treatment of the most severe cases. The aggressive treatments of cerebral edema have not been evaluated but seem, in some limited series, able to improve some life threatening situations. The benefit of systematic glycerol administration needs confirmation. Seizures should be treated with the usual medications. However, drugs with potentially deleterious effects on hemodynamics should be avoided. There is no sufficient evidence to support the administration of a systematic prophylactic treatment. Fever should be treated when above 39.5 degrees C/40 degrees C and in the case of intracranial hypertension. There is no clinical study to explore the modifications of fever on bacterial growth or on inflammation as observed in some experimental studies.

To compare management of injured children in an adult trauma center (TC) with competencies in pediatric trauma care (2005-2007) and in a pediatric-only trauma center (2010-2012).A before-after retrospective study.Fifty-nine children between 1 and 15 years of age admitted to the adult TC (2005-2007) were compared to 56 children admitted to the pediatric TC (2010-2012). Epidemiological data, severity scores, early outcome, and care duration in trauma resuscitation before whole-body CT were collected and compared between the two periods.This study found no significant differences between the two periods in terms of care duration before the whole-body CT scan (28 min [18-40] vs 26.5 min [21-36], P=0.89) and early mortality (eight children [13.5%] vs ten children [17.8%], P=0.35).With no differences in early management of injured children demonstrated, this study validates the organization within our pediatric trauma center. The effectiveness of management of children between 1 and 15 years of age with severe trauma seems to be similar in the two contexts.

Introduction La pneumopathie est une pathologie extremement frequente et represente la premiere cause mondiale de deces de pathologie infectieuse chez l’enfant de moins de 5 ans. La prise en charge respiratoire de la pneumopathie en cas d’hypoxemie repose sur une oxygenotherapie. L’oxygenotherapie a haut debit (OHD) est une methode de ventilation recente permettant d’administrer a haut debit de l’oxygene rechauffe et humidifie avec un effet PEP et une diminution du travail respiratoire. Materiel et methodes Notre etude retrospective, menee dans le service de reanimation de l’HFME a Lyon, portait sur 92 patients âges de 1 a 18 ans, atteints de pneumopathie hypoxemiante. Notre objectif etait d’evaluer l’OHD chez ces patients et de mettre en evidence des facteurs favorisant la reussite ou l’echec de ce mode de ventilation. Pour cela, nous avons compare des criteres clinico-biologiques et radiologiques a differents temps pendant les 48 premieres heures. Resultats La prise en charge respiratoire des pneumopathies hypoxemiantes par OHD a ete une reussite chez deux tiers des patients. Aucun effet indesirable n’a ete rapporte et la tolerance de l’OHD a ete bonne pour tous. Le risque d’echec d’OHD etait plus important chez les enfants presentant initialement une FiO 2 haute ( p = 0,001), un rapport SpO 2 /FiO 2 bas ( p = 0,001) ainsi qu’un score PELOD eleve ( p = 0,042). Ce risque persistait dans les 48 premieres heures. Une atteinte de plus de 2 quadrants sur la radiographie pulmonaire augmentait de maniere significative le risque d’echec d’OHD ( p = 0,006). Les patients immunodeprimes presentaient egalement un risque d’echec d’OHD plus important que les autres patients de notre cohorte ( p = 0,047). Conclusion L’OHD semble etre un support ventilatoire prometteur dans les pneumopathies hypoxemiantes, cependant le taux d’echec pourrait etre plus eleve chez des patients immunodeprimes ou plus graves sur le plan respiratoire.

Local anesthetic intoxication is an uncommon complication of regional anesthesia. We report the case of a 4-month-old infant who presented with generalized tonic-clonic seizure complicated by cardiac arrest secondary to a severe intoxication to local anesthesia. These complications were observed after a bilateral dorsal penile nerve block with lidocaine for circumcision in a non-hospital setting. This report emphasizes the potential risk of local anesthetic systemic toxicity in such circumstances and describes its treatment.

La dialyse peritoneale (DP) est une des trois modes d’epuration extrarenale (EER) utilisee en pediatrie pour traiter une insuffisance renale aigue (IRA). Elle fait appel a deux mecanismes de dialyse : la diffusion et la convection. Les proprietes anatomiques du peritoine permettent des echanges d’eau et de solutes. Ces proprietes peuvent etre alterees dans certaines situations cliniques. Les indications de la DP ont beaucoup evolue ces 20 dernieres annees du fait du developpement de machines d’hemofiltration automatisees et securisees permettant de realiser de l’hemofiltration ou de l’hemodialyse continue chez des enfants de poids inferieur a 10 kg [1,2]. Il reste neanmoins une place pour la DP dans certaines indications que nous detaillerons, car meme si les techniques continues ont fait des progres, les complications sont frequentes, la mise en place n’est pas toujours facile chez des malades fragiles et la DP a de nombreux avantages et un moindre cout [2]. Actuellement, aucune technique d’EER n’a montre sa superiorite par rapport a une autre en termes de survie. Celle-ci est faible dans les situations d’IRA en reanimation puisque les etudes rapportent des taux de survie au mieux de 60–70 %. L’apprentissage de la technique est assez simple mais exige un protocole strict et une surveillance etroite. La DP est source d’une charge en soin non negligeable. Nous exposons ici les principes de cette technique d’EER, ses indications et ses modalites pratiques.

Deep vein thrombosis occurs in 30% of patients with essential thrombocythemia, but rarely at initial diagnosis. We report two pediatric patients with essential thrombocythemia revealed by atypical deep vein thrombosis. First, a 16-year-old girl presented Budd-Chiari syndrome revealed by a hemorrhagic shock. Clinical exam revealed isolated splenomegaly. A search for thrombophilia found a factor V Leiden homozygous mutation and a Jak2 mutation. Bone marrow biopsy confirmed the diagnosis of a myeloproliferative disorder. The second case, a 17-year-old girl, had a routine examination by her physician that revealed splenomegaly. Ultrasonography displayed thrombus in the splenic and portal vein. An isolated Jak2 mutation was found and a myeloproliferative disorder was confirmed by bone marrow biopsy. The diagnosis of myeloproliferative disorder was made in both patients presenting atypical venous thrombosis with a Jak2 mutation and confirmed by bone marrow biopsy. These initial presentations of myeloproliferative disorders are rare in childhood and possibly underdiagnosed.

Metabolic phenotyping consists in the identification of subtle and coordinated metabolic variations associated with various pathophysiological stimuli. Different analytical methods, such as nuclear magnetic resonance, allow the simultaneous quantification of a large number of metabolites. Statistical analyses of these spectra thus lead to the discrimination between samples and the identification of a metabolic phenotype corresponding to the effect under study. This approach allows the extraction of candidate biomarkers and the recovery of perturbed metabolic networks, driving to the generation of biochemical hypotheses (pathophysiological mechanisms, diagnostic tests, therapeutic targets…). Metabolic phenotyping could be useful in anaesthesiology and intensive care medicine for the evaluation, monitoring or diagnosis of life-threatening situations, to optimise patient managements. This review introduces the physical and statistical fundamentals of NMR-based metabolic phenotyping, describes the work already achieved by this approach in anaesthesiology and intensive care medicine. Finally, potential areas of interest are discussed for the perioperative and intensive management of patients, from newborns to adults.

Le polytraumatisme se definit comme l’association d’au moins deux traumatismes impliquant deux zones corporelles distinctes dont une au moins une mettant en jeu le pronostic vital. Les polytraumatismes de l’enfant sont domines par les chutes et les accidents de la circulation.

Leonetti Law of 2005 concerns procedures for questioning about the appropriateness of initiating or maintaining life-sustaining treatments. Decision of withdrawing and withholding treatment has long been practiced by neonatologists, adult and pediatricians intensivists. In this regard, the recommendations of societies encourage medical teams to assess their practices to improve them. Our evaluation is based on the document of the Ethics Committee of SRLF edited in 2010.We achieved a retrospective evaluation of professional practices of the transcription of our decisions of withdrawing and withholding treatment.This study included all children (95 patients) who have had a questioning about life-sustaining treatment of ICU between March 2008 and August 2011 in the pediatric intensive care unit of Children's Hospital of Lyon. Our evaluation is based on the document of the Ethics Committee of French Society of intensive care (SRLF) edited in 2010. We collected epidemiological data on children concerned by questioning about the appropriateness of initiating or maintaining LST and an evaluation of the transcription of our procedures for LST in our folders. Evaluation included 40 cases: 20 folders randomly selected prior an information meeting (January 2011) which were compared with 20 cases occurred consecutively after this information. This meeting was intended to remind recommendations of good practice and principal points of the law. The main assessment measure was the improvement of the practices respecting criteria of the document of the Ethics Committee of SRLF modified for pediatric care.Epidemiological data on procedures are comparable to literature data. Concerning the evaluation of our practices before/after a briefing and highlighted a tendency to the improvement without statistically significance. The transcription of reflection and the arguments of decision of withdrawing and withholding treatment and evaluation of pain was the points who need improvement. Finally, despite the positive developments in the therapeutic use of analgesics and sedatives, pain continues to be undervalued.The evaluation of professional practices is recommended to improve the procedures of questioning about life-sustaining treatments have become an area of expertise in intensive care.

Introduction S’il est connu que le traumatisme crânien (TC) joue sur la qualite de vie (QdV) du blesse, son evolution dans le temps est peu etudiee. L’objectif de notre etude etait d’evaluer l’evolution de la QdV durant cinq annees suivant un TC. Methodologie Nous avons utilise le « WhoQol-bref » pour evaluer la QdV des sujets de la cohorte ESPARR (957 victimes d’accident de la route ; TC = 22,7 %) 1, 3 et 5 ans apres l’accident. Chacun des six scores derivant de cet outil variait de 4 a 20. Le TC a ete entre comme variable explicative dans les modeles. Des analyses par classes latentes ont ete realisees afin d’identifier les trajectoires concernant chaque score et etablir les associations entre chaque trajectoire et le TC. Resultats La qualite de vie des TC etait significativement alteree par rapport aux autres blesses. Deux trajectoires ont ete determinees pour le score global et pour les scores des domaines mental, social et environnemental ; trois trajectoires ont ete definies pour le score de sante globale et pour le score du domaine physique. Les traumatises crâniens ont plus de chances d’appartenir a la trajectoire basse pour la QdV globale (OR = 2,2 ; 1,3–3,9), le domaine physique (OR = 2,1 ; 1,3–3,5) et le domaine social (OR = 2,2 ; 1,3–3,5) et d’appartenir a la trajectoire moyenne pour la sante globale (OR = 2,0 ; 1,2–3,4). Discussion Nos resultats soulignent la necessite d’accroitre les efforts pour ameliorer la qualite de vie des traumatises crâniens, dans toutes ses dimensions.

Purpura fulminans (PF) and deep vein thrombosis are rare complications secondary to chicken pox disease. The presence of antibodies reflects an ongoing immunological process and requires specialized management. The present study reports a 4-year-old boy with no medical history who presented with purpura on the legs 10 days after chicken pox eruption. Laboratory tests showed a disseminated intravascular coagulation associated with low plasma protein C and S activities, and the presence of anti-protein S antibodies. A replacement therapy with protein C infusions and fresh frozen plasma was prescribed. The patient also underwent regular sessions of hyperbaric oxygen followed by the surgery. Fourteen days after the beginning of the purpuric lesions, he presented deep vein thrombosis (DVT) of the lower limbs and was treated with unfractionated heparin. This case report illustrates the pathophysiology of DVT occurring in a patient with chicken pox disease (i.e., acquired protein C and S deficiencies and anti-protein S autoantibodies) and emphasizes the utility of thrombophilia testing in order to better adapt treatment.

The case of 3-year-old girl severely injured, as restrained car passenger in a road crash, is reported. She presented with isolated circulatory failure, without specific clinical signs except skin contusions corresponding to seat belt. Because of mediastinum enlargement on systematic chest X-ray, a pericardial effusion was suspected, which was confirmed by echography, rapidly complicated by an acute tamponade without visible cause on CT-scan. The radiological assessment showed a moderate peritoneal haemorrhage related to a splenic injury. A persistent haemodynamic instability required a pericardial puncture, after rapid sequence tracheal intubation of the child, but without clinical improvement, despite fluid bolus, red-blood cell transfusion and epinephrine infusion. The child was rapidly transferred to the cardiac operating room for sternotomy, which showed a right atrial laceration. The injury was repaired, allowing the child to survive without disability. Tamponade due to traumatic cardiac injury is extremely rare in children. The clinical diagnosis is particularly difficult to establish in the context of polytrauma. The classical symptoms of cardiac tamponade are rarely complete. The association of chest injury, isolated circulatory failure and enlargement of mediastinum at chest X-ray should alert the physician. As the severity of these injuries is high, a rapid and multidisciplinary management is required, as well as specific anaesthetics precautions.

190 Les convulsions sont des affections frequentes en pediatrie. Les plus courantes sont les convulsions hyperthermiques qui concernent de 2 a 7 % des enfants de moins de 5 ans.

86, 173 Les infections broncho-pulmonaires sont un motif tres frequent de consultation en pediatrie, surtout durant la periode hivernale. Trois entites peuvent etre distinguees: la bronchite, la bronchiolite et la pneumonie.

Episode aigu survenant de maniere brutale ou inopinee d’hypotonie, de detresse respiratoire, de cyanose, de pâleur ou de changement de teint; avec impression de mort imminente d’apres les temoins (A differencier de l’arret cardiorespiratoire ou mort subite).

Difficultes d’evaluation liees a l’âge. Signes cliniques variables et peu specifiques (pleurs, cri, tachycardie, tachypnee, HTA...).

203 La fievre est le premier motif de recours aux consultations d’urgence en pediatrie. La fievre fait peur et cette crainte est liee aux complications de l’hyperthermie et au souci de ne pas meconnaitre une infection bacterienne. La prise en charge d’un enfant febrile doit integrer trois principes: — la recherche systematique d’un foyer infectieux

Les diarrhees representent la deuxieme cause d’hospitalisation des enfants dans les pays developpes. La deshydratation represente la premiere cause de mortalite infantile dans les pays en voie de developpement et est responsable de vingt a trente deces de nourrissons par an en France.

US11 protein, one of herpes simplex virus type 1 (HSV-1) true late gene products, plays a role in the virally induced post-transcriptional control of gene expression. In addition, US11 expression also interferes with the cellular response to HSV-1 infection that can lead to apoptosis. We have previously shown that US11 expression enhanced the recovery of cellular protein synthesis and increased cell survival in response to thermal stress. Since heat shock can activate apoptosis, we tested for a possible anti-apoptotic behavior of US11. Here, we show that, in HeLa cells, US11 expression strongly reduced heat induced apoptosis, a phenomenon independent of Hsp expression and characterized by a delayed cytochrome c efflux from mitochondria and reduced caspase 3 activation. Moreover, US11 expression also protected against staurosporine induced apoptosis. Hence, our results favor an anti-apoptotic activity of US11 polypeptide that appears to be located at the level of mitochondria or upstream signaling pathways.

The aim of this study was to systematically evaluate adverse drug reactions (ADRs) in children consulting at the pediatric emergency unit during a 6-month period.The regional pharmacovigilance center (CRPV) and the department of clinical pharmacology prospectively and systematically recorded all potential ADRs among patients younger than 18 years of age in the pediatric emergency unit reported at the daily staff meetings. All cases were then screened and validated by the CRPV. For validated cases, preventability, seriousness, and off-label use were evaluated.During the study period, from 1 March to 1 September 2005, 90 children presented potential adverse drug events. ADRs were confirmed in 43 patients, 19 females and 24 males. Thirty-four patients (79%) were under the age of 5. According to the European definition, 14 patients (33%) had serious ADRs. One anaphylactic shock after amoxicillin injection; antimalarial prophylaxis misuse leading to convulsive status epilepticus, convulsion, and coma after hepatitis B and MMR vaccines were deemed life-threatening. Three ADRs were considered avoidable. Antibiotics and vaccines were the most common possible cause of ADRs (76%). Skin reactions (n=27), fever (n=8), and gastric disorders (n=5) were the most common clinical manifestations.Because ADRs were reported by clinicians on a voluntary basis, serious ADRs were probably reported more systematically. Compared to a similar period without active monitoring, active drug monitoring of ADRs doubled the number of confirmed cases 43 vs 17, p0.001. Close collaboration between the pharmacovigilance center, pharmacologists, and clinicians is necessary and seems feasible for improving the monitoring of ADRs in children.

Background and aims Many sources of conflict exist in intensive care units between family’s members, team–family, or within the ICU team. These conflicts are frequents (48%) in adults ICU, and most are in relation to end-of-life decisions especially with decisions to forgo LST. In PICU, no study has previously reported the prevalence, characteristics and effects of these conflicts. Methods We conducted a retrospective observational study of children admitted to PICU of Lyon, France, for whom a meeting to forgo LST had been held between October 1st 2010 and February 28th 2014. We search in medical record if conflict or disagreement were noticed and we interviewed the referent physician about conflict. We distinguished simple disagreement (quickly resolved), continuing disagreement (parents refuse recommendations with communication still possible), and conflict (communication impossible). Results For 72 children (31 girls, 41 boys), 91 decision-making meetings were organised. We identified 27.7% (20/72) disagreements or conflicts: 4 simple disagreements, 12 continuing disagreements and 4 conflicts. Five children had acute disease and 15 children had chronic disease. Source of disagreements was continuing LST in 19 cases (families wanted to continue aggressive treatment). In 1 case, the family wanted to stop treatments despite medical opinion (refusal of tracheotomy). Consequences of theses disagreements were continuation of treatments despite LST decisions in 12 cases. For 3 cases a compromise solution was found. Conclusion Disagreements are frequent in decisions to forgo LST (27,7%) and most of the child undergo treatments that are medically futile.