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Infantile regurgitation is one of the most common discomforts in the first months of life. Infantile colic and, in older children, functional dyspepsia have been linked to migraine. To date, this is the first study to investigate a possible association between infantile regurgitation and primary headaches in children. This is a case–control study of 195 children aged 6–17 years, with primary headache (migraine, or tension type headache) in 5 European paediatric hospitals. The control group is composed of 240 same-aged children attending with minor injuries during the same period — February 1st 2020 to December 1st 2020. A structured questionnaire identified a history of infantile regurgitation and other functional gastrointestinal disorders for case and control participants. The outcome was the difference in the prevalence of infantile regurgitation among children with or without a diagnosis of primary headache. The analysis showed a significant association between infantile regurgitation and migraine (OR = 1.88, CI 95 = 1.01–3.4, p = 0.04). No association was found between infantile regurgitation and tension type headache (p = 0.33). Subgroup analysis confirmed that the association was only significant for migraine without aura (OR = 2.3, CI 95 = 1.2–4.4, p = 0.01). In a further subgroup analysis, the presence of functional dyspepsia, irritable bowel syndrome and abdominal migraine was associated with migraine without aura. Conclusion: The presence of migraine among children aged 6–17 was associated with a history of infantile regurgitation. Additional longitudinal studies are required to confirm whether infantile regurgitation could be considered as a precursor of migraine.What is Known:• Children suffering from functional gastrointestinal disorders are more likely to be suffering from migraine and tension-type headache as well.• Children suffering from primary headache are more likely to have had infantile colic in their first six month of life.What is New:• It is the first study to find an association between migraine and infantile regurgitation in children.• These findings could have an impact on the diagnosis and therapeutics of both migraine and infantile regurgitation. Supplementary information The online version contains supplementary material available at 10.1007/s00431-021-04368-6.

Background: Disparities in neuraxial analgesia use for childbirth by maternal origin have been reported in high-resource countries. We explored the association between maternal immigrant status (characterised separately by geographic continental origin and Human Development Index [HDI] of maternal country of birth) and neuraxial analgesia use. We hypothesised that immigrant women from low-resource countries may have more limited access to neuraxial analgesia than native French women. Methods: The study population, extracted from the 2016 National Perinatal Survey, a cross-sectional study of a representative sample of births in France, included only women who initially wished to deliver with neuraxial analgesia. We used multivariable multilevel logistic regression to explore the association between immigrant status and both use of neuraxial analgesia and its timely administration. Results: Among the 6070 women included, 88.1% gave birth with neuraxial analgesia and 15.8% were immigrants. There was no difference in neuraxial analgesia use between native French women and either immigrant women by geographic continental region of origin, or immigrants from countries with low HDI. However, immigrants from countries with very high HDI were more likely to give birth with neuraxial analgesia (adjusted odds ratio [aOR]=2.6; 95% confidence interval (CI), 1.2–5.8; P=0.018) and its timeliness

Les crises fébriles (CF) sont les crises convulsives les plus fréquentes prises en charge dans les services d’urgence dans la population des moins de cinq ans. Elles sont une crise accompagnée de fièvre, sans infection du système nerveux central, se produisant chez les enfants entre six mois et cinq ans. Les critères utilisés et enseignés pour classer les crises en simples ou complexes n’ont pas la même signification en pratique clinique pour prendre la décision d’effectuer une ponction lombaire et/ou une imagerie cérébrale, et pour l’indication de la prescription d’un antiépileptique de recours ou de fond. Certains facteurs sont prédictifs de la récurrence fébrile, tandis que d’autres sont prédictifs d’une épilepsie. À partir de deux cas cliniques de CF complexes, nous proposons une démarche de prise en charge et de faire une revue des syndromes épileptiques survenant au décours des CF chez le jeune nourrisson.

With the COVID-19 pandemic, documenting whether health care workers (HCWs) are at increased risk of SARS-CoV-2 contamination and identifying risk factors is of major concern. In this multicenter prospective cohort study, HCWs from frontline departments were included in March and April 2020 and followed for 3 months. SARS-CoV-2 serology was performed at month 0 (M0), M1, and M3 and RT-PCR in case of symptoms. The primary outcome was laboratory-confirmed SARS-CoV-2 infection at M3. Risk factors of laboratory-confirmed SARS-CoV-2 infection at M3 were identified by multivariate logistic regression. Among 1062 HCWs (median [interquartile range] age, 33 [28–42] years; 758 [71.4%] women; 321 [30.2%] physicians), the cumulative incidence of SARS-CoV-2 infection at M3 was 14.6% (95% confidence interval [CI] [12.5; 16.9]). Risk factors were the working department specialty, with increased risk for intensive care units (odds ratio 1.80, 95% CI [0.38; 8.58]), emergency departments (3.91 [0.83; 18.43]) and infectious diseases departments (4.22 [0.92; 18.28]); current smoking was associated with reduced risk (0.36 [0.21; 0.63]). Age, sex, professional category, number of years of experience in the job or department, and public transportation use were not significantly associated with laboratory-confirmed SARS-CoV-2 infection at M3. The rate of SARS-CoV-2 infection in frontline HCWs was 14.6% at the end of the first COVID-19 wave in Paris and occurred mainly early. The study argues for an origin of professional in addition to private life contamination and therefore including HCWs in the first-line vaccination target population. It also highlights that smokers were at lower risk.Trial registration The study has been registered on ClinicalTrials.gov: NCT04304690 first registered on 11/03/2020.

Non-pharmaceutical interventions (NPIs) were implemented to reduce the spread of coronavirus disease 2019 (COVID-19). A first national lockdown was decided in France on the 17 March 2020. These measures had an impact on other viral and non-viral infectious diseases. We aimed to assess this impact on community-acquired pneumonia (CAP) in children. We performed a quasi-experimental interrupted time series analysis. We used data from a French prospective surveillance system of six pediatric emergency departments (PEDs). All visits from 1 January 2017 to 31 December 2020 were included. Pre-intervention period was before 17 March 2020 and post-intervention period was after 18 March 2020. We estimated the impact on the weekly number of visits for CAP and CAP admission using quasi-Poisson regression modeling. A total of 981,782 PEDs visits were analyzed, among them, 8318 visits were associated with CAP, and 1774 of these were followed by a hospital admission. A major decrease was observed for CAP visits (−79.7% 95% CI [−84.3, −73.8], p &lt, 0.0001), and CAP admission (−71.3% 95 CI [−78.8, −61.1], 0.0001). We observed a dramatic decrease of CAP in children following NPIs implementation. Further studies are required to assess the long-term impact of these measures.

Acute bronchiolitis is one of the most common health burdens in infants worldwide and leads to frequent hospitalisation, morbidity and mortality (1). Children have been relatively spared by the COVID-19 pandemic, but reports of multisystem inflammatory syndrome (2) and probable long-term COVID (3) effects in children have started to emerge. One major concern was whether the overlap of the pandemic and seasonal bronchiolitis would put substantial pressure on healthcare systems. Bronchiolitis has a predictable seasonal pattern, primarily in autumn and winter, and in France this is between October and February. The second COVID-19 wave in France led to a two-week night curfew from 17 October 2020, followed by a full lockdown on 30 October. However, day care centres and primary and secondary schools remained open.

BackgroundBronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of severe acute respiratory syndrome coronavirus 2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries.MethodsWe conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling.ResultsIn total, 42 916 children were included. We observed an overall cumulative 78% (95% CI −100– −54%; pConclusionsSeveral NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis.

International audience; Objectives: To identify subgroups with a congenital heart defect (CHD) at risk of health-related quality of life (QoL) impairment at 8 years of age according to their medical and surgical management.Study design: From a prospective population-based cohort study, 598 patients with CHD were subdivided according to their medical and surgical management: (1) CHD followed-up in an outpatient clinic, (2) complete repair before age 3 years, (3) complete repair after age 3 years, (4) palliative repair, or (5) CHD with spontaneous resolution (reference subgroup). Self-reported QoL and parent-reported QoL were measured using the Pediatric Quality of Life Inventory version 4.0 (score range, 0-100) at age 8 years. Multivariable regression analysis and Cohen effect size were used to compare outcomes across the CHD groups.Results: Self-reported and parent-reported QoL scores for the palliative repair subgroup were lower (β = −2.1 [95% CI, −3.9 to −0.2] and β = −16.0 [95% CI, −22.4 to −9.5], respectively), with a large effect size (δ = −0.9 [95% CI, −1.4 to −0.4] and δ = −1.3 [95% CI, −1.8 to −0.7], respectively). Parent-reported QoL scores for the complete repair after age 3 years subgroup were lower (β = −9.2; 95% CI, −15.0 to −3.5), with a large effect size (δ = −0.9; 95% CI, −1.4 to −0.5). Self-reported QoL scores for the complete repair before age 3 years subgroup was lower (β = −1.3; 95% CI, −1.9 to −0.6), with a small effect size (δ = −0.4; 95% CI, −0.6 to −0.2).Conclusions: The QoL of children with CHD who experienced a hospital intervention is reduced at age 8 years. Patient age at the last cardiac intervention might influence QoL at 8 years.

Objective To assess whether children with symptomatic congenital heart defects (CHDs) at birth (cyanosis and/or heart failure) are at greater risk of adverse neurodevelopmental outcomes at 8 years of age. Study design From a prospective population-based cohort study of newborns with CHDs (EPICARD), we included 473 children with available neurodevelopmental assessments at 8 years of age. We grouped the CHD based on symptoms at birth and need for early neonatal intervention. Ventricular septal defects that closed spontaneously within the first year of life were considered the control group. Neurodevelopmental outcomes were assessed using the Kauffman Assessment Battery Test for Children, Second Edition, for IQ (mean 100 ± 15), and the Developmental NEuroPSYchological Assessment Battery, Second Edition, for detailed assessment of specific neurocognitive domains (mean 10 ± 3). Multivariable regression analysis was used to compare the outcomes across the CHD groups after considering potentially confounding variables. Results Compared with the control group, children with cyanotic CHD without heart failure had lower scores for IQ, −7.2 (95% CI –13.4 to −1.2). Children with noncyanotic CHD with heart failure had lower scores in the specific domains of language −1.5 (95% CI –2.2 to −0.7), and memory and learning −1.3 (95% CI –2.4; −0.3). Those with both cyanotic CHD and heart failure had lower scores for IQ, −7.6 (95% CI –13.5 to −1.8), as well as the specific domains of language and memory and learning, −2.0 (95% CI –2.9 to −1.0) and −1.1 (95% CI –2.3 to −0.1), respectively. Conclusions Children with symptomatic CHD at birth are at greater risk of adverse neurodevelopmental outcomes at 8 years of age, with the greatest risk for those who were born with both cyanosis and heart failure.

* Abbreviation: COVID-19 — : coronavirus disease Acute bronchiolitis, a viral seasonal infection of the lower respiratory tract, affects nearly 20% of all children and leads to the hospitalization of 2% to 3% of all children younger than 12 months every year.1,2 Approximately 2% to 6% of hospitalized children require admission to the PICU.1 Acute bronchiolitis may account for as much as 13% of PICU admissions,3 and it is responsible for the death of ∼3 of 100 000 children under 12 months each year4 (eg, nearly 20 and 100 infants annually in England4 and the United States,5 respectively). Bronchiolitis epidemic has a predictable seasonal pattern, and in France, it starts in September, peaks in November to December, and ends in February. Although children have been relatively spared by the coronavirus disease (COVID-19) pandemic, the impact that the overlap of the second wave of this pandemic and of the associated public measures have … Address correspondence to Ricardo Carbajal, MD, PhD, Pediatric Emergency Department, APHP Hopital Armand Trousseau, 26, av du Dr Netter, 75012 Paris, France. E-mail: ricardo.carbajal{at}aphp.fr

Background: With the COVID-19 pandemic, documenting whether health care workers (HCWs) are at increased risk of SARS-CoV-2 contamination and identifying risk factors is of major concern. Methods: In this multicenter prospective cohort study, HCWs from COVID-19 frontline departments were included in March and April 2020 and followed for 3 months. SARS-CoV-2 serology was performed at month 0 (M0), M1, and M3 and RT-PCR in case of symptoms. The primary outcome was laboratory-confirmed SARS-CoV-2 infection (positive serology and/or positive RT-PCR result) at M3. Secondary outcomes were positive serology for SARS-CoV-2 at M0, M1 and M3. Risk factors of laboratory-confirmed SARS-CoV-2 infection at M3 were identified by multivariate logistic regression. Findings: Among 1,062 HCWs (median [interquartile range] age, 33 [28-42] years; 758 [71.4%] women; 321 [30.2%] physicians), the cumulative incidence of SARS-CoV-2 infection at M3 was 14.6% (95% confidence interval [CI] [12.5; 16.9]). Seroprevalence at M0, M1, and M3 was 5.9% [4.7; 7.5], 12.9% [10.9; 15.1] and 13.0% [11.1; 15.2], respectively. Risk factors were the working department specialty, with increased risk for intensive care units (odds ratio 1.80, 95%CI [0.38; 8.58]), emergency departments (3.91 [0.83; 18.43]) and infectious diseases departments (4.22 [0.92; 18.28]); active smoking was associated with reduced risk (0.36 [0.21; 0.63]). Age, sex, professional category, number of years of experience in the job or department, and public transportation use were not significantly associated with laboratory-confirmed SARS-CoV-2 infection at M3. Interpretation: The rate of SARS-CoV-2 infection in frontline HCWs was 14.6% at the end of the first COVID-19 wave in Paris and occurred mainly early. Seroprevalence in May was higher than in the general population. The study argues for an origin of professional in addition to private life contamination and therefore including HCWs in the first-line vaccination target population. It also highlights that smokers were at lower risk. Trial Registration: The study is registered on ClinicalTrials.gov: NCT04304690 Funding Statement: The sponsor of the study was Assistance Publique-Hopitaux de Paris (AP-HP), with study management by URC Pitie-Salpetriere. This study was funded by the French Ministry of Health (Programme Hospitalier de Recherche Clinique) and the French Agency for Research (Fond d’amorcage de l’Agence National pour la Recherche). Declaration of Interests: None to declare. Ethics Approval Statement: The SEROCOV study was approved by the ethics committee (CPP Sud-Ouest et Outre-Mer I, approval no. 2-20-023 id7257) and all participants signed informed consent before inclusion.

International audience; Aim: This study determined the influence of the COVID-19 pandemic on the occurrence of multisystem inflammatory syndrome in children (MIS-C) and compared the main characteristics of MIS-C and Kawasaki disease (KD).Methods: We included patients aged up to 18 years of age who were diagnosed with MIS-C or KD in a paediatric university hospital in Paris from 1 January 2018 to 15 July 2020. Clinical, laboratory and imaging characteristics were compared, and new French COVID-19 cases were correlated with MIS-C cases in our hospital.Results: There were seven children with MIS-C, from 6 months to 12 years of age, who were all positive for the virus that causes COVID-19, and 40 virus-negative children with KD. Their respective characteristics were as follows: under 5 years of age (14.3% vs. 85.0%), paediatric intensive care unit admission (100% vs. 10.0%), abdominal pain (71.4% vs. 12.5%), myocardial dysfunction (85.7% vs. 5.0%), shock syndrome (85.7% vs. 2.5%) and mean and standard deviation C-reactive protein (339 ± 131 vs. 153 ± 87). There was a strong lagged correlation between the rise and fall in MIS-C patients and COVID-19 cases.Conclusion: The rise and fall of COVID-19 first wave mirrored the MIS-C cases. There were important differences between MIS-C and KD.

This case series examines cardiac MRI findings in four children and adolescents admitted to intensive care in April 2020 for multisystem inflammatory syndrome and Kawasaki disease-like features related to coronavirus disease 2019 (COVID-19). Acute myocarditis occurred less than 1 week after onset of fever and gastrointestinal symptoms. Physical examination showed rash and cheilitis or conjunctivitis. All patients recovered after intravenous immunoglobulin therapy. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was negative in nasopharyngeal, stool, and respiratory samples and was positive on serology. Cardiac MRI showed diffuse myocardial edema on T2 short tau inversion-recovery sequences and native T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis. These findings favor postinfectious myocarditis in children and adolescents with COVID-19.

A time series analysis of 871 543 pediatric emergency visits revealed that the coronavirus disease 2019 (COVID-19) lockdown and school closures were associated with a significant decrease in infectious diseases disseminated through airborne or fecal–oral transmission: common cold, gastroenteritis, bronchiolitis, and acute otitis. No change was found for urinary tract infections.

BackgroundPast epidemics, including influenza, have resulted in increased paediatric patient volume in EDs. During the early weeks of the COVID-19 pandemic, it was unclear how ED volume would be impacted in paediatric hospitals. The objective of this study was to examine differences in the international experience of paediatric ED utilisation and disposition at five different children’s hospitals.MethodsWe obtained data on ED volume, acuity level and disposition (hospitalisation and intensive care unit (ICU) admission) for the time period 1 December1–10 August for the years 2017–2020 from hospitals in five cities (Boston, Massachusetts, USA; Singapore; Melbourne, Australia; Seattle, Washington, USA; and Paris, France). Per cent change was analysed using paired t-tests or Wilcoxon signed rank test.ResultsOverall ED volume dramatically decreased in all five hospitals during the early months of COVID-19 compared with prior years. There was a more varied response of decreases in ED volume by acuity level, hospitalisation and ICU admission among the five hospitals. The one exception was a 2% increase in ICU admissions in Paris. As of August 2020, all hospitals have demonstrated increases in ED volume; however, they are still below baseline.ConclusionPaediatric EDs in these five cities demonstrated differential decreases of ED volume by acuity and disposition during the early months of the COVID-19 pandemic.

BACKGROUND: The first case of SARS-CoV-2 was detected in France in January 2020 and the government decided on national confinement from March 17 to May 11, 2020. Our aim was to analyze the incidence of pediatric emergency department (ED) visits and hospitalizations for traumatic injuries during this period. METHODS: Any visit with an ICD-10 discharge diagnosis code of burn, fracture, traumatic wound, or sprain/bruise contusion was recorded within the 2 weeks before (weeks 10 and 11) and during the confinement (weeks 12 and 19). The visits with the same ICD-10 discharge diagnosis code during similar weeks of the previous 2 years were also included. For each of those visits, the number of hospitalizations was counted. RESULTS: The number of recorded visits between week 10 and 19 in 2018, 2019, and 2020 was, respectively, 2657, 2625, and 1106 children. The average number of visits per day during the confinement (13±5) was significantly different from the average number of visits per day during the same weeks in 2018 and 2019 (38±8 vs. 39±9, P

OBJECTIVES In pediatric emergency departments (EDs), racial/ethnic minorities are less likely to receive needed and timely care; however, clinical protocols have the potential to mitigate disparities. Neonatal fever management is protocolized in many EDs, but the timeliness to antibiotic administration is likely variable. We investigated the timeliness of antibiotic administration for febrile neonates and whether timeliness was associated with patients' race/ethnicity. METHODS Retrospective cross-sectional study of febrile neonates evaluated in one pediatric ED that uses an evidence-based guideline for the management of neonatal fever between March 2010 and December 2015. Primary outcome was time from ED arrival to antibiotic administration. Analysis of variance tests compared mean time with antibiotic administration across race/ethnicity. Multivariable linear regression investigated racial/ethnic differences in time to antibiotic administration after adjusting for patient demographics, timing of visit, the number of physicians involved, and ED census. RESULTS We evaluated 317 febrile neonates. Of the 269 patients with racial/ethnic data (84.9%), 54% were white non-Hispanic, 13% were black non-Hispanic, and 23% were Hispanic. The mean time to antibiotic administration was 204 minutes (range = 51-601 minutes). There was no significant association between patient race/ethnicity and time to first antibiotic administration. Emergency department census was significantly associated with timeliness. CONCLUSIONS There was a 10-hour range in the time to antibiotic administration for febrile neonates; however, variability in timeliness did not differ by race or ethnicity. This study demonstrates the need to further examine the role of protocols in mitigating disparities as well as factors that influence timeliness in antibiotic administration to febrile neonates.

Background No population-based prospective cohort study has assessed the neurodevelopmental outcomes of school-aged children with CHD. Objective To assess whether some groups of CHDs, more specifically cyanotic CHD (CCHD) with or without heart failure and non CCHD with heart failure, are at greater risk of adverse neurodevelopmental outcomes at 8 years of age. Methods We used data from the prospective population-based cohort study EPICARD, which included all children with a CHD diagnosed in the prenatal period and up to 1 year of age, between 2005 and 2008 in the greater Paris areas. We looked at the overall intellectual quotient (IQ), and the specific neurocognitive domains. We classified the CHDs based on pathophysiological and clinical management characteristics and compared the outcomes across six groups of CHDs as compared with the control group (minor ventricular septal defects). In order to do so, we used multivariable linear regression models with the Heckman method to account for selection bias due to differential loss to follow-up. Results From the 1196 eligible patients for the 8-year follow up, 473 (39.5%) completed the neurodevelopmental evaluations. Compared to the control group, children with CCHD with or without heart failure had lower IQ scores, −8.0 (P Conclusion Children with CHD associated with cyanosis and/or heart failure had significantly lower neurodevelopment scores at 8 years of age, both for overall IQ and specific neurocognitive domains.

Background Many antibiotics are prescribed inappropriately in pediatric emergency departments (PEDs), but little data are available in these settings about effective interventions based on guidelines that follow the antimicrobial stewardship principle. Our aim was to assess the impact of implementing the 2011 national guidelines on antibiotic prescriptions for acute respiratory tract infection (ARTI) in PEDs. Method We conducted a multicentric, quasiexperimental, interrupted time series analysis of prospectively collected electronic data from 7 French PEDs. We included all pediatric patients who visited a participating PED during the study period from November 2009 to October 2014 and were diagnosed with an ARTI. The intervention consisted of local protocol implementation, education sessions, and feedback. The main outcome was the antibiotic prescription rate of discharge prescriptions for ARTI per 1000 PED visits before and after implementation, analyzed using the segmented regression model. Results We included 242534 patients with an ARTI. The intervention was associated with a significant change in slope for the antibiotic prescription rate per 1000 PED visits (-0.4% per 15-day period, P = .04), and the cumulative effect at the end of the study was estimated to be -30.9%, (95% CI [-45.2 to -20.1]), representing 13136 avoided antibiotic prescriptions. The broad-spectrum antibiotic prescription relative percentage decreased dramatically (-62.7%, 95% CI [-92.8; -32.7]) and was replaced by amoxicillin. Conclusion Implementation of the 2011 national French guidelines led to a significant decrease in the antibiotic prescription rate for ARTI and a dramatic drop in broad-spectrum antibiotic prescriptions, in favor of amoxicillin.

OBJECTIVES To determine whether real-time video communication between the first responder and a remote intensivist via Google Glass improves the management of a simulated in-hospital pediatric cardiopulmonary arrest before the arrival of the ICU team. DESIGN Randomized controlled study. SETTING Children's hospital at a tertiary care academic medical center. SUBJECTS Forty-two first-year pediatric residents. INTERVENTIONS Pediatric residents were evaluated during two consecutive simulated pediatric cardiopulmonary arrests with a high-fidelity manikin. During the second evaluation, the residents in the Google Glass group were allowed to seek help from a remote intensivist at any time by activating real-time video communication. The residents in the control group were asked to provide usual care. MEASUREMENTS AND MAIN RESULTS The main outcome measures were the proportion of time for which the manikin received no ventilation (no-blow fraction) or no compression (no-flow fraction). In the first evaluation, overall no-blow and no-flow fractions were 74% and 95%, respectively. During the second evaluation, no-blow and no-flow fractions were similar between the two groups. Insufflations were more effective (p = 0.04), and the technique (p = 0.02) and rate (p < 0.001) of chest compression were more appropriate in the Google Glass group than in the control group. CONCLUSIONS Real-time video communication between the first responder and a remote intensivist through Google Glass did not decrease no-blow and no-flow fractions during the first 5 minutes of a simulated pediatric cardiopulmonary arrest but improved the quality of the insufflations and chest compressions provided.

How to cite this article: Rambaud J, Allioux C, Jean S, Guilbert J, Guellec I, Demoulin M, et al. Nosocomial Infections in Neonates Supported by Extracorporeal Membrane Oxygenation: First French Retrospective Study. Indian J Crit Care Med 2019;23(9):392–395.

Acute gingivostomatitis is relatively frequent in children; of viral origin, its diagnosis is usually straightforward. Acute gingivostomatitis is very painful and for many years, codeine, whose use was restricted in 2013, was widely employed in this context. The aim of this study was to ascertain the prevalence of acute stomatitis in pediatric emergency care, to evaluate the pain caused by stomatitis, and to determine the analgesic resources deployed both in the emergency department and at discharge, over the 5-year period preceding restriction of the use of codeine. Methods This was a retrospective study conducted in a pediatric emergency department (PED) of a university hospital between August 2008 and June 2013. Results A total of 702 children (372 herpetic gingivostomatitis [HGS], 149 herpangina [H], 181 hand, foot, and mouth disease [HFMD]) were included. Over the 5 years, one case of gingivostomatitis was identified for 303 visits to the PED. A total of 548 (78.1%) children were aged less than 36 months and the median age was 22 months. For 501 of 702 (71.4%) children, parents reported pain and/or feeding difficulties; in the HGS group, 314 of 372 (84.4%) patients had these symptoms. Of the 702 children, 48 (6.8%) were admitted to hospital. Overall, 457 (65.1%) of 702 children were given codeine before the PED visit, during the PED visit, or as a medication to take after discharge. The corresponding figures were 314 of 372 (84.4%) for the HGS group, 67 of 149 (45.0%) for the H group, and 76 of 181 (42.0%) for the HFMD group, P Conclusions Acute gingivostomatitis is a relative frequent reason for PED visits, and the pain and feeding difficulties that it elicits are a real challenge. Before codeine restriction, this medication played a major role in the analgesic strategy for this disease. It is essential that analgesic regimens at least as effective as codeine replace it. Morphine combined with paracetamol or the association of ibuprofen with paracetamol are options that are recommended by the French National Health Authority (HAS).

Aim To assess the prevalence of clinically urgent intracranial pathology (CUIP) in children visiting the emergency department with a complex febrile seizure (CFS). Methods Retrospective cohort review. We analysed the visits of patients for a CFS from January 2007 to December 2011 in seven paediatric emergency departments. Our main outcomes were the proportions of CUIP diagnosed between day 0 and 1 and within 30 days after the index visit. Results From 1 183 487 visits, 839 were for a CFS and 130 (15.5%) of these had a neuroimaging performed within 30 days (CT scan for 75 visits [8.9%], MRI for 30 visits [3.6%] and both for 25 visits [3.0%]). Three CUIP were diagnosed between day 0 and 1 (0.4% [CI-95%: 0.1-1.3]), 5 within 30 days after the index visit (0.7% [CI-95%: 0.2-1.7]) but none among the 630 visits of children presenting with a normal neurological clinical examination (0% [95% CI: 0.0-0.7]), nor among the 468 presenting only with multiple seizure (0% [95% CI: 0.0-1.0]). Conclusion In children with a CFS, CUIP is rare event in the subgroup of children with a normal neurological clinical examination and in those with brief generalised multiple seizures.

Newborns in intensive care units (ICUs) undergo numerous painful procedures including venipunctures. Skin-breaking procedures have been associated with adverse neurodevelopment long-term effects in very preterm neonates. The venipuncture frequency and its real bedside pain management treatment are not well known in this setting.To describe venipuncture frequency, its pain intensity, and the analgesic approach in ICU newborns; to determine the factors associated with the lack of preprocedural analgesia and with a high pain score during venipuncture.Further analysis of EPIPPAIN 2 (Epidemiology of Procedural Pain In Neonates), which is a descriptive prospective epidemiologic study.All 16 neonatal and pediatric ICUs in the Paris region in France.All newborns in the ICU with a maximum corrected age under 45 weeks of gestation on admission who had at least one venipuncture during the study period.Data on all venipunctures, their pain score assessed with the DAN scale and their corresponding analgesic therapies were prospectively collected. The inclusion period lasted six weeks, from June 2, 2011, to July 12, 2011. Newborns were followed from their admission to the 14th day of their ICU stay or discharge, whichever occurred first.495 newborns who underwent venipunctures were included. The mean (SD) gestational age was 33.0 (4.4) weeks and duration of participation was 8.0 (4.5) days. A total of 257 (51.9%) neonates were very preterm (33 weeks). The mean (SD; range) number of venipunctures per neonate during the study period was 3.8 (2.8; 1-19) for all neonates and 4.1 (2.9; 1-17) for neonates33 weeks. Of the 1887 venipunctures, 1164 (61.7%) were performed successfully in one attempt, 437 (23.2%) with continuous analgesia, 1434 (76.0%) with specific preprocedural analgesia. In multivariate models, lack of preprocedural analgesia was associated with higher disease-severity score, intrauterine growth retardation, invasive or noninvasive ventilation, venipuncture performed on the first day of hospitalization or at nighttime, and the use of continuous sedation/analgesia. High pain scores were significantly associated with absence of parents during procedures, surgery during the study period, and higher number of attempts.Venipuncture is very frequent in preterm and term neonates in the ICUs. 76% were performed with preprocedural analgesia. Strategies to reduce the number of attempts and to promote parental presence seem necessary.

Resume Objectifs L’objectif du deuxieme cycle des etudes medicales (DCEM) est « l’acquisition des competences generiques permettant aux etudiants d’exercer par la suite les fonctions du troisieme cycle ». Aucune etude, a notre connaissance, ne s’est interessee aux competences des internes de pediatrie a l’aube de leur prise de fonction. Materiels et methodes Les internes de pediatrie d’Ile-de-France nommes a l’issue des epreuves classantes nationales (ECN) 2014 ont ete evalues par simulateur sur un scenario d’arret cardiorespiratoire (ACR) de l’enfant. Le score de competence (respect de l’algorithme et technique de la reanimation) et les fractions de temps sans ventilation et sans compression ont ete recueillis. Resultats principaux Quarante-deux des 79 nouveaux internes ont ete evalues 15 jours avant leur prise de fonction. Le score de competence median a ete de 4 sur 13. Les fractions de temps sans ventilation et sans compression ont ete respectivement de 55 et 81 %. Il n’existait pas de correlation entre les resultats et le classement des internes aux ECN. Conclusions La prise en charge de l’ACR de l’enfant n’est pas maitrisee par les internes de pediatrie a quelques jours de leur prise de fonction. L’introduction de la simulation au cours du DCEM devrait favoriser l’acquisition des competences.

BACKGROUND Ventilator-associated pneumonia (VAP) is a severe intensive complication and remains under estimated in neonatal intensive care unit (NICU). Center for Disease Control defined criteria for adults and pediatrics without neonatal criteria. The objective of this article was to evaluate the rate, the risks factors and the outcome of neonates suffering from ventilator-associated pneumonia in a French NICU. METHODS We conducted a prospective observational study within a one-year period in our NICU. Three hundred and eighty-one neonates under 28 days of age were included. Data analyses were performed using Fischer exact-test, Kolgomorov analysis, Mann-Whitney test and logistic regression. RESULTS Seventeen patients were diagnosed with ventilator-associated pneumonia. Incidence rate of VAP was 8.8 per 1000 invasive mechanical ventilator days. The median age at diagnosis was 20 days (range: 4-45). Extremely low birth weight (under than 1000 grams) were significantly associated with VAP (OR=4.31 [95% CI: 1.38-13.39]). Newborns suffering from VAP had a significantly longer duration of invasive ventilation (median: 16 days [range 4-75] versus 3 days [range 1-28], P

ObjectiveAs the results from epidemiological studies about the impact of outdoor air pollution on asthma in children are heterogeneous, our objective was to investigate the association between asthma exacerbation in children and exposure to air pollutants.MethodsA database of 1 264 585 paediatric visits during the 2010–2015 period to the emergency rooms from 20 emergency departments (EDs) of ‘Assistance Publique Hôpitaux de Paris (APHP)’, the largest hospital group in Europe, was used. A total of 47 107 visits were classified as asthma exacerbations. Concentration of air pollutants (nitrogen dioxide, ozone, fine particulate matter (PM) with an aerodynamic diameter smaller than 10 µm (PM10) and 2.5 µm (PM2.5)), as well as meteorological data, evolution of respiratory syncytial virus infection and pollen exposition, were collected on an hourly or daily basis for the same period using institutional databases. To assess the association between air pollution and asthma, mixed-effects quasi-Poisson regression modelling was performed.ResultsThe only compound independently associated with ED visits for asthma was PM2.5 (P−4). The association between asthma exacerbation and PM2.5 was not linear, and a sigmoid function described the relationshipsatisfactorily. PM2.5 concentration, which gives half the maximum effect, was estimated at 13.5 µg/m3.ConclusionsWe found an association between daily asthma exacerbation in paediatric visits to the ED and fine particulate air pollutants.

Resume Introduction Les consultations non programmees (CNP) sont definies par l’absence de rendez-vous ou un rendez-vous pris dans un delai de moins de 24 heures. La diminution du nombre de pediatres liberaux depuis les annees 2000 pourrait etre responsable de leur moins grande disponibilite pour ce type de consultation, ce qui pourrait expliquer en partie le recours aux structures d’accueil des urgences. Nous avons evalue la proportion de CNP en pediatrie de ville et decrit la pratique quotidienne des pediatres liberaux. Methode Un questionnaire portant sur l’ensemble des consultations realisees au cours d’une journee a ete adresse a l’ensemble des pediatres de ville appartenant a l’Association francaise de pediatrie ambulatoire (AFPA). Resultats Le taux de reponse a ete de 42,5 % (434/1022). Sur les 10 263 consultations realisees, 4574 (44,6 % [IC–95 % : 43,6 – 45,5]) etaient des CNP. Parmi les pediatres, 59,5 % avaient refuse au moins un patient souhaitant une CNP par manque de place et le nombre de patients n’ayant pu etre vus a ete de 957, soit 2,2 enfants par pediatre et par jour. Une absence de permanence de soins pediatriques de ville a ete notifiee pour le week-end par 61 % des pediatres (n = 266) et pour la nuit par 90 % (n = 391). Conclusion Les CNP representent une part importante de l’activite des pediatres de ville. Cependant, un grand nombre de CNP ne peut avoir lieu par indisponibilite du praticien et il existe rarement une permanence de soins la nuit et le weekend en pratique de ville.

The objective of this study was to investigate the accuracy of renal point of care ultrasound (POCUS) for the detection of hydronephrosis in children with a urinary tract infection (UTI). We prospectively included all patients with a final diagnosis of UTI who visited our pediatric emergency department between November 2009 and April 2011. Emergency physicians were encouraged to perform a renal POCUS during these visits, and a follow-up renal ultrasonography was performed by a radiologist who was blinded to the results of POCUS. We calculated the accuracy of POCUS to detect hydronephrosis (renal pelvis enlargement ≥10 mm). We included 433 UTI visits, and 382 (88.2%) POCUS were performed. The sensitivity and the specificity were 76.5% (95% confidence interval: 58.1-94.6%) and 97.2% (95.2-99.2%), respectively. The positive and the negative predictive values were 59.1% (36.4-79.3%) and 98.8% (97.7-99.9%), respectively. Renal POCUS might be used to rule out hydronephrosis in pediatric UTI.

Diagnostic and therapeutic skin-breaking procedures have become ubiquitous in current medical practice and neonatology does not constitute an exception. One of the main sources of neonatal pain is procedure-induced pain. It has recently become clear that pain prevention must be a health care priority. Non-pharmacological approaches constitute a first option for the analgesia of common procedures performed in neonatology. This article reviews the non-pharmacological treatments most frequently used in this context: swaddling, tucking, containment, sweet solutions, non-nutritive sucking (NNS), breastfeeding analgesia, breast milk and music. In practice, the dose of 1 to 2mL of 24% or 30% sucrose solution or 30% glucose solution immediately followed by NNS can be given for minor painful procedures in term neonates or those weighing more than 2500g. In the preterm, 0.3mL of a sweet solution (sucrose or glucose) can be given for infants weighing less than 1500g and 0.5mL for those weighing between 1500 and 2500g. The synergistic effect of sweet solutions and NNS has been clearly shown and thus their association is largely justified in practice. For breast-fed term neonates, breastfeeding can be given to sooth procedure-induced pain. All these non-pharmacological options can be effective to relieve pain from minor or moderate procedures. However, when more painful procedures are performed, stronger analgesics must be used.

Objectives Extracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions. Study design This was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support. Measurements The assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography. Results Thirty-four infants

Study objective We assess the prevalences of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children with a complex febrile seizure and determine these prevalences in the subgroup of children with a clinical examination result not suggestive of meningitis or encephalitis. Methods This multicenter retrospective study was conducted in 7 pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 months to 5 years for a complex febrile seizure from January 2007 to December 2011 were analyzed. We defined a subgroup of patients whose clinical examination result was not suggestive of meningitis or encephalitis. Bacterial meningitis and HSV-ME were sequentially sought for by analyzing bacteriologic and viral data at the visit, looking for data from a second visit to the hospital after the index visit, and telephoning the child's parents. Results From a total of 1,183,487 visits in the 7 pediatric EDs, 839 patients presented for a complex febrile seizure, of whom 260 (31.0%) had a lumbar puncture. The outcomes bacterial meningitis and HSV-ME were ascertainable for 715 (85%) and 657 (78.3%) visits, respectively, and we found 5 cases of bacterial meningitis (0.7% [95% confidence interval [CI] 0.2% to 1.6%]) and no HSV-ME (0% [95% CI 0% to 0.6%]). Among the 630 visits of children with a clinical examination result not suggesting meningitis or encephalitis, we found no bacterial meningitis (0% [95% CI 0% to 0.7%]) and no HSV-ME (0% [95% CI 0% to 0.8%]). Conclusion In children with a complex febrile seizure, bacterial meningitis and HSV-ME are unexpected events when the clinical examination after complex febrile seizure is not suggestive of meningitis or encephalitis.

Motivation In the era of big data and precision medicine, the number of databases containing clinical, environmental, self-reported and biochemical variables is increasing exponentially. Enabling the experts to focus on their research questions rather than on computational data management, access and analysis is one of the most significant challenges nowadays. Results We present Rcupcake, an R package that contains a variety of functions for leveraging different databases through the BD2K PIC-SURE RESTful API and facilitating its query, analysis and interpretation. The package offers a variety of analysis and visualization tools, including the study of the phenotype co-occurrence and prevalence, according to multiple layers of data, such as phenome, exposome or genome. Availability and implementation The package is implemented in R and is available under Mozilla v2 license from GitHub (https://github.com/hms-dbmi/Rcupcake). Two reproducible case studies are also available (https://github.com/hms-dbmi/Rcupcake-case-studies/blob/master/SSCcaseStudy_v01.ipynb, https://github.com/hms-dbmi/Rcupcake-case-studies/blob/master/NHANEScaseStudy_v01.ipynb). Supplementary information Supplementary data are available at Bioinformatics online.

L’echographie en medecine d’urgence est utilisee depuis plus de 20 ans et fait partie integrante de la formation des urgentistes en medecine d’adulte, notamment dans l’evaluation des traumatismes abdominaux ou la recherche d’un anevrisme aortique. Son utilisation en pediatrie est plus recente, et peu de pediatres, y compris aux Etats-Unis, travaillant aux urgences ont la possibilite d’utiliser ou de se former a l’echographie. Le champ des applications potentielles est neanmoins varie, et il y a une veritable necessite d’evaluer et de valider nos pratiques. Cet article propose de faire le point sur les differentes possibilites offertes aux pediatres (hors echocardiographie fonctionnelle) a travers notre experience aux urgences pediatriques de l’hopital Necker-Enfant-Malades.